CANCER IN THE AMERICAS

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CANCER IN THE AMERICAS

COUNTRY PROFILES 2013

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©Pan American Health Organization, 2013

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Suggested citation: Pan American Health Organization. Cancer in the Americas: Country Profiles 2013. Washington, D.C.:

2013

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CANCER IN THE AMERICAS

COUNTRY PROFILES 2013

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INDEX

INTRODUCTION. ...1

Rationale for the report...1

Purpose and objectives...1

How the report is structured...1

METHODS AND DATA SOURCES ...3

Socio-demographic indicators...3

Cancer risk factor data...3

Cancer mortality analysis...4

Ministry of Health capacity for cancer prevention and control...4

CANCER DEATHS IN THE AMERICAS ...7

CANCER PROFILES ...9

NORTHERN AMERICA

...11

Canada...11

United States of America...15

MEXICO, CENTRAL AMERICA AND LATIN CARIBBEAN

...19

Costa Rica...19

Cuba...23

Dominican Republic...27

El Salvador...31

Guatemala...35

Honduras...39

Mexico...43

Nicaragua...47

Panama...51

Puerto Rico...55

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SOUTH AMERICA

...59

Argentina...59

Bolivia...63

Brazil...67

Chile...71

Colombia...75

Ecuador...79

Paraguay...83

Peru...87

Uruguay...91

Venezuela...95

NON-LATIN CARIBBEAN

...99

Anguilla...99

Antigua and Barbuda...103

Bahamas...107

Barbados...111

Belize...115

Dominica...119

Grenada...123

Guyana...127

Jamaica...131

Saint Kitts and Nevis...135

Saint Lucia...139

Suriname...143

Trinidad and Tobago...147

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1

Rationale for the report

Cancer is the second leading cause of death in the countries of the Americas

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, yet there is limited information available on how each country in this Region is responding to this public health problem. The recent global and regional commitments on non-communicable diseases (NCD), including cancer, have called attention to the need for more available and accurate information on the country situation with respect to epidemiological status of NCDs and the capacity for public health programs for prevention and control. Furthermore, the World Health Organization (WHO) global monitoring framework

²

includes specific indicators related to cancer, and which require on- going monitoring and reporting on global progress towards NCD. Meanwhile, the Member States of the Pan American Health Organization/ World Health Organization (PAHO/WHO) provide annual mortality statistics, as well as information about their NCD programs and services through the national capacity survey of NCD programs.

Purpose and objectives

The purpose of Cancer in the Americas: Country profiles, 2013 is to disseminate data made available to the Pan American Health Organization by its Member States on the current state of cancer risk factors, cancer mortality, and cancer plans, policies and services. The objective is to synthesize, in one reference document, the state of cancer control in countries in the Americas. Cancer incidence data is, unfortunately, not provided in this report, as this information is not available to the Pan American Health Organization in a systematic manner.

How the report is organized

The country profiles are arranged according to the main sub-regions of the Americas: Northern America; Mexico, Central America and Latin America Caribbean; South America; and non-Latin Caribbean. By grouping the countries by sub-region, it enables the reader to review each country profile in relation to other countries which share geographic, historic and socio-economic

situations.

INTRODUCTION

1Pan American Health Organization. Health in the Americas: 2012 edition. Regional Outlook and Country Profiles. Washington, DC. 2012

2World Health Organization. NCD Global Monitoring Framework 2013, available at: http://www.who.int/nmh/global_monitoring_framework/en/index.html

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Each country profile has the same structure, and summarizes the following country specific information:

t socio-demographic indicators;

t main cancer risk factors (tobacco, alcohol, diet, physical inactivity, obesity);

t ranking of the 10 most frequent cancer types in terms of mortality, by sex, for the latest year with available mortality data;

t trends in cancer mortality during the period 2000-2010, for all cancer types (excluding skin non-melanoma) and 7 most common cancer types (breast, cervix, colorectal, liver, lung, prostate and stomach), by sex ; and t capacity of Ministry of Health for cancer plans, policies and services.

The information sources used in this report, as well as the methods used to calculate cancer

mortality trends are described in the Methods section. In addition, each country profile includes a

reference on the data sources.

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The principle data sources used in preparing this report include the PAHO/WHO Survey on National Capacity for the Prevention and Control of Non-communicable Diseases,2013; the PAHO/WHO Mortality Database, 2012; and the PAHO/WHO Basic Health Indicators on Non-Communicable Diseases, 2011. Additional information was obtained through various sources, using publically accessible databases and documents, as described below and as indicated in the data sources section of each country profile.

Socio-demographic indicators

PAHO/WHO prepares an annual report on the basic indicators for health, using data supplied by its Member States. These data include socio-demographic information such as population size and age structure, total deaths, life expectancy, literacy, and gross national income. These data are included in this report, from the 2012 PAHO/WHO Basic Indicators, as general background about the country’s situation.

Cancer risk factor data

The main cancer risk factors included in this report include tobacco use, alcohol, diet, physical inactivity and obesity. Data on tobacco use includes prevalence (%) of current smokers of tobacco aged 18 years of age and older; as well as among adolescents 13-15 years of age. The percentage of the population who eat 5 or more servings of fruits and vegetables are reported as the indicator for diet. For alcohol, the prevalence (%) of adult alcohol consumers is reported. Low physical activity is reported as the prevalence of adults who are physically active for <600 met minutes; and obesity is reported as the prevalence (%) of adults with a body mass index > 30. Data on these risk factors are taken from the PAHO/WHO Non-communicable Diseases in the Americas, Basic Indicators, 2011, as well as the PAHO/WHO Tobacco Control Report for the Region of the Americas, 2013; and the WHO Global Information System on Alcohol and Health.

In addition, the prevalence of human papilloma virus (HPV), as the risk factor for cervical cancer, is included in this report and is defined as the prevalence of HPV among the general population of women with normal cytology. Data was extracted from the database of the ICO (Institut Català d’Oncologia) Information Centre on HPV and Cancer.

METHODS AND DATA SOURCES

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Cancer mortality

Data on cancer mortality were extracted from the 2012 PAHO/WHO Regional Mortality Database, which includes deaths registered in national vital registration systems and reported annually to PAHO by the Member States. All deaths whose underlying cause was classified in the ICD-10 as C00-97, except C44 were extracted (Annex 1), from the year 2000 to the latest available year for 33 countries with complete data. This time period was used since it is when all countries of the Americas applied the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) to code mortality.

Cancer deaths from approximately 10 cancer types, which represent the vast majority of cancers that occur in the countries of the Americas are included in this report. Age-standardized mortality rates for both sexes were estimated using the direct method and changes in mortality rates over the study period were calculated using Poisson Regression models, excluding those countries with small populations and large fluctuations in yearly data. Data were analyzed separately for each country, and are presented for all cancer types (excluding skin non-melanoma) and for 7 common cancer types: breast, cervix, colorectal, liver, lung, prostate and stomach.

In the case of the non-Latin Caribbean, due to small population size, mortality data from the following countries were combined to present changes in cancer mortality for this sub-region:

Anguilla, Antigua and Barbuda, Aruba, Bahamas, Barbados, Dominica, Grenada, Cayman Islands, Turks & Caicos Islands, Virgin Islands (UK), Virgin Islands (USA), Montserrat, Saint Kitts and Nevis, Saint Vincent & the Grenadines, Saint Lucia, Bermuda, French Guyana, Martinique and Guadalupe.

Ministry of Health capacity for cancer prevention and control

Information on the public health program capacity for cancer was extracted from the PAHO/

WHO Survey on National Capacity for the Prevention and Control of Non-communicable Diseases,

conducted in April – June 2013 and consisting of a structured questionnaire completed by the

person(s) responsible for the NCD program in the country’s national Ministry of Health. A total of

35 countries from the Americas provided written responses to the questionnaire, which included

information on their cancer policy and plans, cancer registration, prevention policies, cancer

screening services, treatment and palliative care services. All responses to the survey were checked

and cleared by senior health officials at the Ministry of Health before submission to PAHO. Upon

receipt of the questionnaires, PAHO/WHO carried out additional validation on a number of survey

item responses. Where discrepancies were noted, clarifications were sought from the country and

responses were updated. An additional round of consultation and updating with Member States

was undertaken in September 2013.

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To supplement information on the country’s capacity for cancer control, we used several additional data sources and these specific data sources are all referenced in the country profiles. Overall sources include the following. For cervical, breast and prostate cancer screening guidelines, and program coverage, we reviewed documents available from the Ministry of Health websites, or where available in the scientific literature, as well as responses to the PAHO/WHO cervical cancer program assessment questionnaire (2013 for the Caribbean countries; 2010 for the Latin America countries). For HPV vaccination and for HBV vaccination, information was provided by the PAHO/

WHO Comprehensive Family Community Immunization program and from WHO 2013 country immunization profiles. For cancer treatment, we extracted data on radiotherapy capacity (total energy teletherapy units, radiotherapy centres, radiation oncologists, medical physicists) from the Directory of Radiotherapy Centres (DIRAC) database of the International Atomic Energy Agency.

For palliative care, opioid consumption data were extracted from the opioid consumption database

from the WHO Collaborating Centre for Pain Policy and Palliative Care at the University of Wisconsin.

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Table 1 provides an overview of the cancer mortality data, for both sexes, made available to PAHO/

WHO by the Member States for the period of 2000-2010. Empty cells signify no data provided for that year. This data was analyzed and the results are presented in the following country profiles.

CANCER DEATHS IN THE AMERICAS

Table 1. PAHO/WHO Mortality Database, 2012 – number of cancer deaths, both sexes, by country and year

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CANCER PROFILES

NORTHERN AMERICA

...11

Canada...11

United States of America...15

MEXICO, CENTRAL AMERICA AND LATIN CARIBBEAN

...19

Costa Rica...19

Cuba...23

Dominican Republic...27

El Salvador...31

Guatemala...35

Honduras...39

Mexico...43

Nicaragua...47

Panama...51

Puerto Rico...55

SOUTH AMERICA

...59

Argentina...59

Bolivia...63

Brazil...67

Chile...71

Colombia...75

Ecuador...79

Paraguay...83

Peru...87

Uruguay...91

Venezuela...95

NON-LATIN CARIBBEAN

...99

Anguilla...99

Antigua and Barbuda...103

Bahamas...107

Barbados...111

Belize...115

Dominica...119

Grenada...123

Guyana...127

Jamaica...131

Saint Kitts and Nevis...135

Saint Lucia...139

Suriname...143

Trinidad and Tobago...147

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11 CANADA|CANCER PROFILE

CANADA

SOCIODEMOGRAPHIC INDICATORS

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x Total population: 34,349,600

x Average annual deaths: 262,800

x Life expectancy at birth (years):

Total: 81 Male: 79 Female: 83

x Adult literacy rate: ...

x Gross National Income US$ per capita: 41,980

RISK FACTORS

Prevalence of: Total (%) Male (%) Female (%)

Current adult tobacco smokers^2,a 18.0 20.0 15.0

Adolescent tobacco smokers² 2.8 2.8 2.7

Fruit and vegetable intake in adults^1,b ... ... ...

Alcohol consumers, past 12 months³ 77.6 81.2 74.2

Low physical activity in adults^1,b 33.9 32.3 35.4

Obesity among adults (BMI ≥30)¹ 24.0 26.0 23.0

HPV prevalence (women with normal cytology)⁴ ... ... 9.9

Notes: a: age-standardized prevalence of tobacco smoking in adults (15 years+), 2011; b: % who eat ≤5 servings of fruit and vegetables per day; c: % who are physically active for <600 met minutes; BMI: Body Mass Index; HPV: Human Papillomavirus.

CANCER MORTALITY PROFILE (2009)

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37,204

DEATHS

MEN WOMEN

33,551

DEATHS

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AGE-STANDARDIZED CANCER MORTALITY TRENDS (2000-2009)

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All cancer types except skin non-melanoma Breast cancer

Cervical cancer Colorectal cancer

Liver cancer Lung cancer

Prostate cancer Stomach cancer

Average annual percent change (AAPC) of age-standardized mortality rates, by cancer type (2000-2009)⁵

Cancer type Sex Number of deaths (2009) ASMR (2009) AAPC

All cancer types Male 37,204 145.56 -1.87*

Female 33,551 108.02 -1.12*

Breast cancer 4,944 16,68 -2.46*

Cervical cancer 370 1,45 -2.61*

Colorectal cancer Male 4,203 16.33 -1.01*

Female 3,607 10.61 -0.92*

Liver cancer Male 1,256 5.01 1.90*

Female 694 2.16 1.59*

Lung cancer Male 10,572 51.54 -2.1*

Female 8,540 28.52 0.2

Prostate cancer 3,745 13,50 -3.6*

Stomach cancer Male 1,177 4.64 2.88*

Female 734 2.24 2.58*

Notes: ASMR: Age-standardized mortality rate; AAPC: Average annual percent change; *: The AAPC is significantly different from zero at p=0.05.

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CANCER PLANS AND CANCER REGISTRATION

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National integrated NCD policy, strategy or action plan

Is there a national integrated NCD policy, strategy or action plan? ^Yes Is cancer included in the overall NCD plan? Yes

First year of implementation ²⁰¹⁰

Cancer policy, strategy or action plan

Is there a Cancer policy, strategy or action plan? Yes

First year of implementation ²⁰⁰⁶

Cancer registry

Is there a Cancer registry? Yes

Scope (National vs. Subnational)? Both

Type of registry (Population vs. hospital based)? Population based

Last year with available data 2010

CANCER PRIMARY PREVENTION POLICIES

Tobacco control²

Smoke free environments? All public spaces are completely smoke free

Raised taxes on tobacco? 51-75% of retail price is tax

Health warning labels about the dangers of tobacco? Large graphic labels on packs with all appropriate characteristics

Bans on tobacco advertising, promotion and sponsorship? Ban on television, radio and print media and some but not all forms of direct and/or indirect advertising

Overweight and obesity prevention and control⁶ Is there a policy, strategy or action plan for reducing

overweight/obesity? (First year of implementation) Yes (2010) Harmful use of alcohol prevention and control⁶

Is there a policy, strategy or action plan for reducing harmful use of

alcohol? (First year of implementation) ^No

HPV vaccination in national immunization program?⁷ ^Yes

Year of introduction/Target age group/Delivery strategy 2007-2009/Varies by province/Schools Estimated 3-dose coverage (calendar year) 85%-58% (Varies by province) HBV vaccination in national immunization program?⁸ ^Yes

Year of introduction/Target age group 1998/Early infancy (3 doses) or pre-teen (2-3 doses)

Estimated 3-dose coverage (calendar year) 70%

CANCER SCREENING Cervical Cancer

Guidelines⁹

Are there cervical cancer screening guidelines available? ^Yes

Guideline recommendations (Tests/Age groups/Frequency) Pap test/25-69 years of age/every 3 years Availability and coverage of screening services

Cervical cytology⁶ Generally available in the public and the private sectors Visual Inspection with Acetic Acid⁶ Generally not available in the public and the private sectors

Screening coverage¹⁰ 79.6% of target population

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CANCER SCREENING Breast Cancer

Guidelines¹¹

Are there breast cancer screening guidelines available? Yes

Guideline recommendations (Tests/Age groups/Frequency) Mammography/women aged 50-69 years/every 2 years (province specific) Availability and coverage of screening services

Clinical Breast Examination⁶ Generally not available in the public and the private sectors Mammogram⁶ Generally available in the public and the private sectors

Screening coverage¹⁰ 72.4% of target population

Colorectal Cancer

Guidelines¹²

Are there colorectal cancer screening guidelines available? Yes

Guideline recommendations (Tests/Age groups/Frequency) FT or FTi/50-74 years of age/every 2 years (province specific) Availability and coverage of screening services

Faecal occult blood test or fecal immunological test⁶ Generally available in the public and the private sectors Exam or colonoscopy⁶ Generally available in the public and the private sectors

Screening coverage¹⁰ 42.8% of target population

CANCER TREATMENT AND PALLIATIVE CARE

Radiotherapy¹³ Oral Morphine⁶

Availability of services?⁶ Generally

available Availability in the public health sector? Generally available Total energy teletherapy units/million

inhabitants 8.2 Covered by health insurance or publically funded? Yes

Total radiotherapy centers 53 Appears in the national list of essential medicines? N/A

Radiation oncologists 358 Opioid consumption¹⁴

Medical physicists 346 Total morphine equivalence, per capita 753.4

Chemotherapy⁶ Community/home care available?⁶

Availability of services? Generally

available

Are community/home care services available for people with advanced stages of NCDs?

Generally available Notes: ...: Information not available; N/A: Not applicable; FT: Fecal test; FTi; Immunochemical fecal-occult blood test.

Sources:

(1) PAHO. Non communicable Diseases in the Americas: Basic Health Indicators 2011. Washington D.C, USA, 2011.

(2) PAHO. Tobacco Control Report for the Region of the Americas, 2013. Washington D.C, USA, 2013.

(3) WHO. Global Information System on Alcohol and Health, retrieved August 28,2013, from http://bit.ly/17zhuqZ.

(4) ICO. Information Centre on HPV and Cancer, retrieved August 28, 2013, from http://www.hpvcentre.net/ . (5) PAHO/WHO Mortality Database, 2012.

(6) PAHO/WHO Survey on National Capacity for the Prevention and Control of Non-communicable Diseases, 2013.

(7) Markowitz LE et al. Vaccine. 2012 Nov 20; 30 Suppl 5:F139-48.

(8) PAHO/WHO Comprehensive Family Immunization Unit. Immunization Country Profiles, retrieved August 28, 2013, from http://bit.ly/1dn4Td3; Immunization Reported Coverage in the Americas, by vaccine, retrieved August 28, 2013 from http://bit.ly/1dn59ZK .

(9) Canadian Task Force on Preventive Health Care. Screening for Cervical Cancer, 2013. Available from: http://bit.ly/13M7ziM.

(10) Canadian Partnership Against Cancer. The 2012 Cancer System Performance Report. December 2012. Available from: http://bit.ly/Uwpxwb.

(11) Canadian Task Force on Preventive Health Care. Screening for Breast Cancer, 2011. Available from: http://bit.ly/16DMJAa.

(12) Canadian Task Force on Preventive Health Care. Screening for Colorectal Cancer, 2001 (Currently under review).

(13) WHO/IAEA Directory of Radiotherapy Centers (DIRAC) Database, retrieved August 28, 2013 from http://www-naweb.iaea.org/nahu/dirac/.

(14) University of Wisconsin. WHO Collaborating Centre for Pain Policy and Palliative Care, Opioid Consumption Database 2010, retrieved August 28, 2013, from http://www.painpolicy.wisc.edu/countryprofiles/amro.

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15 UNITED STATES OF AMERICA|CANCER PROFILE

UNITED STATES OF AMERICA

SOCIODEMOGRAPHIC INDICATORS

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x Average annual deaths: 2,621,700

x Adult literacy rate: ...

RISK FACTORS

Adolescent tobacco smokers³ 8.0 8.2 7.8

Fruit and vegetable intake in adults^1,b 23.4 19.2 27.7

Alcohol consumers, past 12 months⁴ 65.4 71.7 59.5

Low physical activity in adults^1,c 40.5 43.5 47.4

HPV prevalence (women with normal cytology)⁵ ... ... 13.3

Notes: a: current cigarette smoking in adults (18 years+); b: % who eat ≤5 servings of fruit and vegetables per day; c: % who are physically active for <600 met minutes; BMI: Body Mass Index; HPV: Human Papillomavirus.

CANCER MORTALITY PROFILE (2009)

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294,731

DEATHS

MEN WOMEN

270,034

DEATHS

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AGE-STANDARDIZED CANCER MORTALITY TRENDS (2000-2009)

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Average annual percent change (AAPC) of age-standardized mortality rates, by cancer type (2000-2009)⁶

All cancer types Male 294,731 141.05 -1.85*

Female 270,034 102.03 -1.53*

Breast cancer 40,684 16,31 -2.10*

Cervical cancer 3,913 1,88 -1.8*

Colorectal cancer Male 26,976 12.89 -2.81*

Female 25,424 8.93 -2.76*

Liver cancer Male 13,038 6.40 2.94*

Female 6,319 2.36 1.51*

Lung cancer Male 87,744 42.31 -2.6*

Female 70,417 26.82 -1.0*

Prostate cancer 28,091 12,28 -3.4*

Stomach cancer Male 6,666 3.22 -3.1*

Female 4,522 1.65 -2.83*

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CANCER PLANS AND CANCER REGISTRATION

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Is there a national integrated NCD policy, strategy or action plan? ^Yes Is cancer included in the overall NCD plan? Yes

Cancer registry

Scope (National vs. Subnational)? National

CANCER PRIMARY PREVENTION POLICIES

Tobacco control³

Smoke free environments? Up to two types of public places completely smoke-free

Raised taxes on tobacco? 43% of retail price is tax

Health warning labels about the dangers of tobacco? Medium size warnings with all appropriate characteristics or large warning missing some appropriate characteristics Bans on tobacco advertising, promotion and sponsorship? Complete absence of ban, or ban does not cover national

television, radio and print media Overweight and obesity prevention and control⁷

Is there a policy, strategy or action plan for reducing

overweight/obesity? (First year of implementation) Yes (2010) Harmful use of alcohol prevention and control⁷

alcohol? (First year of implementation) Yes (2010) HPV vaccination in national immunization program?⁸ ^Yes

Year of introduction/Target age group/Delivery strategy 2006/boys and girls aged 11-12 years/primary care providers and health centers

Estimated 3-dose coverage (calendar year) 32% of target population (2010) HBV vaccination in national immunization program?⁹ Yes

Year of introduction/Target age group 1991/Newborn, 1-2m, 6-18m

Estimated 3-dose coverage (calendar year) 91%

CANCER SCREENING Cervical Cancer

Guidelines¹⁰

Are there cervical cancer screening guidelines available? Yes

Guideline recommendations (Tests/Age groups/Frequency) Pap test/21-65 years of age/every 3 years HPV and cytology/30-65 years of age/every 5 years Availability and coverage of screening services

Cervical cytology⁷ Generally available in the public and the private sectors Visual Inspection with Acetic Acid⁷ Generally not available in the public and the private sectors Screening coverage¹¹ 83% of women with a Pap test within the past 3 years (2010)

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CANCER SCREENING Breast Cancer

Guidelines¹²

Guideline recommendations (Tests/Age groups/Frequency) Mammography/50-74 years of age/every 2 years Availability and coverage of screening services

Clinical Breast Examination⁷ Generally available in the public and the private sectors Mammography⁷ Generally available in the public and the private sectors

Screening coverage¹¹ 70.4% women 50-74 with a mammogram in the past 2 years (2010)

Colorectal Cancer

Guidelines¹³

Are there colorectal cancer screening guidelines available? Yes

Guideline recommendations (Tests/Age groups/Frequency) Faecal occult blood test, sigmoidoscopy or colonoscopy/50-75 years of age

Availability and coverage of screening services

Faecal occult blood test or fecal immunological test⁶ Generally available in the public and the private sectors Exam or colonoscopy⁷ Generally available in the public and the private sectors Screening coverage¹¹ 58.6% adults up-to-date with colorectal cancer screening (2010)

CANCER TREATMENT AND PALLIATIVE CARE

Radiotherapy¹⁴ Oral Morphine⁷

Availability of services?⁷ Generally

Total radiotherapy centers 2,734 Appears in the national list of essential medicines? Yes

Radiation oncologists 2,683 Opioid consumption¹⁵

Medical physicists 1,739 Total morphine equivalence, per capita 693.45

Chemotherapy⁷ Community/home care available?⁷

available

Generally available Notes: ...: Information not available; N/A: Not applicable; m: months.

Sources:

(1) PAHO/WHO. Non communicable Diseases in the Americas: Basic Health Indicators 2011. Washington D.C, USA, 2011.

(2) WHO Report on the Global Tobacco Epidemic, 2013, retrieved August 28, 2013 from http://www.who.int/tobacco (3) PAHO/WHO. Tobacco Control Report for the Region of the Americas, 2013. Washington D.C, USA, 2013.

(8) Markowitz LE et al. Vaccine. 2012 Nov 20; 30 Suppl 5:F139-48.

(10) U.S: Preventive Services Task Force. Screening for cervical cancer. Current recommendation, 2012, retrieved August 28, 2013, from: http://bit.ly/cyDcWj.

(11) Cancer Screening-United States, 2010. MMWR, January 27, 2012/61(03);41-45, retrieved August 28, 2013, from:http://1.usa.gov/14n4i81.

(12) U.S: Preventive Services Task Force. Screening for breast cancer. 2009, retrieved August 28, 2013, from:http://bit.ly/aJJ6O7.

(13) U.S: Preventive Services Task Force. Screening for colorectal cancer. 2008, retrieved August 28, 2013, from: http://bit.ly/f2eT5q (14) WHO/IAEA Directory of Radiotherapy Centers (DIRAC) Database, retrieved August 28, 2013 from http://www-naweb.iaea.org/nahu/dirac/.

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19 COSTA RICA|CANCER PROFILE

COSTA RICA

SOCIODEMOGRAPHIC INDICATORS

¹

x Adult literacy rate: 96.1%

RISK FACTORS

HPV prevalence (women with normal cytology)⁴ ... ... 30.2

CANCER MORTALITY PROFILE (2011)

⁵

2,559

DEATHS

MEN WOMEN

2,035

DEATHS

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AGE-STANDARDIZED CANCER MORTALITY TRENDS (2000-2011)

⁵

All cancer types Male 2,559 130.83 0.17

Female 2,035 90.46 0.6

Breast cancer 296 13.10 1.03*

Cervical cancer 117 5.12 -3.45*

Colorectal cancer Male 205 10.37 2.26*

Female 247 10.75 1.43

Liver cancer Male 173 8.92 0.29

Female 85 3.82 -2.04

Lung cancer Male 230 12.11 0.8

Female 97 4.41 -2.47

Prostate cancer 485 25.45 2.2

Stomach cancer Male 414 21.38 -3.35*

Female 239 10.49 -3.09*

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CANCER PLANS AND CANCER REGISTRATION

⁶

Is there a national integrated NCD policy, strategy or action plan? Under development Is cancer included in the overall NCD plan? N/A

First year of implementation ^N/A

First year of implementation ²⁰¹¹

Cancer registry

CANCER PRIMARY PREVENTION POLICIES

Smoke free environments? All public spaces are completely smoke free

Health warning labels about the dangers of tobacco? Medium size warnings with all appropriate characteristics or large warning missing some appropriate characteristics Bans on tobacco advertising, promotion and sponsorship? Ban on television, radio and print media and some but not

all forms of direct and/or indirect advertising Overweight and obesity prevention and control⁶

overweight/obesity? (First year of implementation) Under development Harmful use of alcohol prevention and control⁶

alcohol? (First year of implementation) Under development HPV vaccination in national immunization program?⁷ ^No

Year of introduction/Target age group/Delivery strategy N/A

Estimated 3-dose coverage (calendar year) ^N/A

HBV vaccination in national immunization program?⁷ ^Yes

Year of introduction/Target age group 2000/Newborn-2m-6m; risk groups, health care professionals

Estimated 3-dose coverage (2012) 91%

CANCER SCREENING Cervical Cancer

Guidelines⁸

Are there cervical cancer screening guidelines available? ...

Guideline recommendations (Tests/Age groups/Frequency) Pap test/women aged 20 years and older/annual Availability and coverage of screening services

Cervical cytology⁶ Generally available in the public and the private sectors Visual Inspection with Acetic Acid⁶ Generally available in the public and the private sectors Screening coverage⁹ 35% women aged 35 years and older with a Pap test in the

past 2 years (2010)

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CANCER SCREENING Breast Cancer

Guidelines¹⁰

Guideline recommendations (Tests/Age groups/Frequency) Mammography/women aged 40 years and older/annual Availability and coverage of screening services

Clinical Breast Examination⁶ Generally available in the public and the private sectors Mammography⁶ Generally available in the public and the private sectors

Screening coverage ^...

Colorectal Cancer

Guidelines

Are there colorectal cancer screening guidelines available? ...

Guideline recommendations (Tests/Age groups/Frequency) ...

Faecal occult blood test or fecal immunological test⁶ Generally available in the public and the private sectors Exam or colonoscopy⁶ Generally available in the public and the private sectors

Screening coverage ...

CANCER TREATMENT AND PALLIATIVE CARE

Radiotherapy¹¹ Oral Morphine⁶

Total radiotherapy centers 3 Appears in the national list of essential medicines? Yes

Radiation oncologists 18 Opioid consumption¹²

not available

Generally not available Notes: ...: Information not available; N/A: Not applicable; m: months.

Sources:

(2) PAHO/WHO. Tobacco Control Report for the Region of the Americas, 2013. Washington D.C, USA, 2013.

(8) PAHO/WHO. Cervical cancer prevention and control programs: A rapid assessment in 12 countries of Latin America. Washington D.C.: PAHO, 2010.

(9) Ministry of Health of Costa Rica. Plan Nacional para la prevención y el control del cáncer, 2011-2017, retrieved August 28, 2013 from http://bit.ly/14YT5gx.

(10) González-Robledo LM. Acciones gubernamentales para la detección temprana del cáncer de mama en América Latina. Retos a futuro. Salud Publica Mex 2010;52:533-543.

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23 CUBA|CANCER PROFILE

CUBA

SOCIODEMOGRAPHIC INDICATORS

¹

RISK FACTORS

Adolescent tobacco smokers³ 17.1 19.8 15.0

Alcohol consumers, past 12 months⁴ 45.6 67.2 24.5

Low physical activity in adults^1,c ... ... ...

HPV prevalence (women with normal cytology)⁵ ... ... ...

Notes: a: current tobacco smoking in adults (15 years+); b: % who eat ≤5 servings of fruit and vegetables per day; c: % who are physically active for <600 met minutes; BMI: Body Mass Index; HPV: Human Papillomavirus.

CANCER MORTALITY PROFILE (2010)

⁶

12,599

DEATHS

MEN WOMEN

9,368

DEATHS

(30)

AGE-STANDARDIZED CANCER MORTALITY TRENDS (2001-2010)

⁶

Average annual percent change (AAPC) of age-standardized mortality rates, by cancer type (2001-2010)⁶

All cancer types Male 12,599 164.31 0.8*

Female 9,368 112.01 0.43*

Breast cancer 1,470 17.58 0.55*

Cervical cancer 439 5.64 0.1

Colorectal cancer Male 938 11.95 0.73

Female 1,295 14.14 0.13

Liver cancer Male 357 4.71 -0.59

Female 387 4.50 -0.14

Lung cancer Male 3,286 43.20 0.5

Female 1,842 22.19 2.42*

Prostate cancer 2,779 34.06 1.67*

Stomach cancer Male 552 7.21 -0.26

Female 311 3.56 -0.78

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CANCER PLANS AND CANCER REGISTRATION

⁷

Is there a national integrated NCD policy, strategy or action plan? Under development Is cancer included in the overall NCD plan? N/A

First year of implementation ^N/A

First year of implementation ²⁰⁰⁹

Cancer registry

CANCER PRIMARY PREVENTION POLICIES

Smoke free environments? Three to five types of public spaces completely smoke-free

Health warning labels about the dangers of tobacco? Medium size warnings with all appropriate characteristics or large warning missing some appropriate characteristics Bans on tobacco advertising, promotion and sponsorship? Complete absence of ban, or ban does not cover national

television, radio and print media Overweight and obesity prevention and control⁷

overweight/obesity? (First year of implementation) Yes (2008) Harmful use of alcohol prevention and control⁷

alcohol? (First year of implementation) Yes (2002) HPV vaccination in national immunization program?⁸ ^No Year of introduction/Target age group/Delivery strategy N/A

Estimated 3-dose coverage (calendar year) ^N/A

HBV vaccination in national immunization program?⁸ ^Yes

Year of introduction/Target age group 1990/Newborn-2m-4m-6m

Estimated 3-dose coverage (2012) 100%*

Note: *Reported coverage >100%.

CANCER SCREENING Cervical Cancer

Guidelines⁹

Are there cervical cancer screening guidelines available? ^Yes

Guideline recommendations (Tests/Age groups/Frequency) Pap test/25-64 years of age/every 3 years Availability and coverage of screening services

Cervical cytology⁷ Generally available in the public sector

Visual Inspection with Acetic Acid⁷ Generally not available in the public sector

Screening coverage⁹ 70% of target population (2010)

(32)

CANCER SCREENING Breast Cancer

Guidelines¹⁰

Guideline recommendations (Tests/Age groups/Frequency) CBE/women aged 30 years and older

Mammography/50-64 years of age/every 3 years Availability and coverage of screening services

Clinical Breast Examination⁷ Generally available in the public sector

Mammography⁷ Generally available in the public sector

Colorectal Cancer

Guidelines

Faecal occult blood test or fecal immunological test⁷ Generally available in the public sector Exam or colonoscopy⁷ Generally available in the public sector

CANCER TREATMENT AND PALLIATIVE CARE

Radiotherapy¹¹ Oral Morphine⁷

available Availability in the public health sector? Generally not available Total energy teletherapy units/million

inhabitants 1.2 Covered by health insurance or publically funded? No

Total radiotherapy centers 9 Appears in the national list of essential medicines? No

Chemotherapy⁷ Community/home care available?⁷

available

Generally available Notes: ...: Information not available; N/A: Not applicable; NB: Newborn; m: months; CBE: Clinical Breast Examination.

Sources:

(2) WHO Report on the Global Tobacco Epidemic, 2013, retrieved August 28, 2013 from http://www.who.int/tobacco (3) PAHO/WHO. Tobacco Control Report for the Region of the Americas, 2013. Washington D.C, USA, 2013.

(9) Network of National Cancer Institutes of the South American Union (RINC/UNASUR). Informe preliminar reducido sobre la situación del control del cáncer de cuello uterino en 8 países de Latinoamérica. 2012

(10) Goss et al. Planning cancer control in Latin America and the Caribbean. Lancet Oncol 2013; 14:391-436.

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27 DOMINICAN REPUBLIC|CANCER PROFILE

DOMINICAN REPUBLIC

SOCIODEMOGRAPHIC INDICATORS

¹

RISK FACTORS

HPV prevalence (women with normal cytology)⁴ ... ... ...

CANCER MORTALITY PROFILE (2010)

⁵

*Note: Cancer mortality data for Dominican Republic is only available to PAHO for 2000-2004 and 2010, thus a mortality trend analysis was not possible.

4,578

DEATHS

MEN WOMEN

3,855

DEATHS

(34)

CANCER PLANS AND CANCER REGISTRATION

⁶

Is there a national integrated NCD policy, strategy or action plan? Yes

Is cancer included in the overall NCD plan? No

First year of implementation 1996

Cancer registry

Is there a Cancer registry? ^Yes

CANCER PRIMARY PREVENTION POLICIES

Smoke free environments? Up to two types of public places completely smoke-free

Health warning labels about the dangers of tobacco? No warnings or small warnings

Bans on tobacco advertising, promotion and sponsorship? Complete absence of ban, or ban does not cover national television, radio and print media

Overweight and obesity prevention and control⁶ Is there a policy, strategy or action plan for reducing

overweight/obesity? (First year of implementation) ^No Harmful use of alcohol prevention and control⁶

alcohol? (First year of implementation) ^No

HPV vaccination in national immunization program?⁷ No Year of introduction/Target age group/Delivery strategy ^N/A

Estimated 3-dose coverage (calendar year) N/A

HBV vaccination in national immunization program?⁷ ^Yes

Year of introduction/Target age group 1994/Newborn-2m-4m-6m

Estimated 3-dose coverage (2011) 80%

CANCER SCREENING Cervical Cancer

Guidelines^8,9

Are there cervical cancer screening guidelines available? Yes

Guideline recommendations (Tests/Age groups/Frequency) Pap test/35-64 years of age/annual Availability and coverage of screening services

Cervical cytology⁶ Generally available in the public and the private sectors Visual Inspection with Acetic Acid⁶ Generally not available in the public and the private sectors

Screening coverage ...

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CANCER SCREENING Breast Cancer

Guidelines¹⁰

Guideline recommendations (Tests/Age groups/Frequency)

BSE/women aged 18 and older/monthly

CBE/women aged 35 and older/any contact with a healthcare provider Mammography/35-40 years of age, every 2 years/women over 40 years of age, annual

Clinical Breast Examination⁶ Generally available in the public and the private sectors

Mammography⁶ Generally not available in the public sector and generally available in the private sector

Colorectal Cancer

Guidelines

Faecal occult blood test or fecal immunological test⁶ Generally available in the public and the private sectors

Exam or colonoscopy⁶ Generally not available in the public sector and generally available in the private sector

CANCER TREATMENT AND PALLIATIVE CARE

Radiotherapy¹¹ Oral Morphine⁶

available Availability in the public health sector? Generally not available Total energy teletherapy units/million

inhabitants 1.1 Covered by health insurance or publically funded? No

Total radiotherapy centers 7 Appears in the national list of essential medicines? Yes

not available

Generally not available Notes: ...: Information not available; N/A: Not applicable; m: months; SBE: Self-breast examination; CBE: Clinical breast examination.

Sources:

(2) PAHO/WHO. Tobacco Control Report for the Region of the Americas, 2013. Washington D.C, USA, 2013.

(8) Ministry of Health and Social Assistance of Dominican Republic. Normas nacionales de Salud Reproductiva. 2004, retrieved August 28,2013 from http://bit.ly/1bTglLP.

(9) PAHO/WHO. Cervical cancer prevention and control programs: A rapid assessment in 12 countries of Latin America. Washington D.C.: PAHO, 2010.

(10) Ministry of Health and Social Assistance of Dominican Republic. Normas nacionales para la prevención y manejo de patologías de mama. Series de Normas Nacionales No.37. República Dominica, retrieved August 28,2013 from http://bit.ly/14CZYhq.

(36)

(37)

31 EL SALVADOR|CANCER PROFILE

EL SALVADOR

SOCIODEMOGRAPHIC INDICATORS

¹

x Adult literacy rate: 84.1

RISK FACTORS

Alcohol consumers, past 12 months³ ... ... ...

Low physical activity in adults^1,c ... ... ...

HPV prevalence (women with normal cytology)⁴ ... ... ...

CANCER MORTALITY PROFILE (2009)

⁵

2,022

DEATHS

MEN WOMEN

2,900

DEATHS

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32 EL SALVADOR|CANCER PROFILE

AGE-STANDARDIZED CANCER MORTALITY TRENDS (2000-2009)

⁵

All cancer types Male 2,022 91.15 -0.7

Female 2,900 101.79 -1.2*

Breast cancer 191 7.07 1.45

Cervical cancer 304 11.26 -4.09*

Colorectal cancer Male 84 3.93 -0.84

Female 147 5.04 0.84

Liver cancer Male 115 5.50 -0.86

Female 214 7.49 -1.07

Lung cancer Male 126 5.73 -3.08

Female 145 5.00 -1.9

Prostate cancer 294 12.76 0.24

Stomach cancer Male 374 17.22 -2.93*

Female 358 12.31 -2.41*