Cancer Prevention in MalaysiaFredie Robinson, MBBS, PhDUniversiti Malaysia Sabah

Malaysia National Cancer Registry• In 2002, the National Cancer Registry (NCR) was operating

under the Clinical Research Centre (CRC).• In 2007, the NCR and the Regional Cancer Registries were

merged and managed by the Non-Communicable DiseaseSector, Disease Control Division of the Ministry of Health.

• The National Cancer Institute took over as the secretariat on1st January 2015.

• The 2015 National Cancer Registry will be reporting on CancerIncidence of Malaysia. Much work has already been carriedout by the Disease Control Division of the Ministry of Health,together with the State Epidemiology officers and staff of theState Health Departments.

• The latest report produced in 2015 will be the data collectedfrom 2007 – 2011.

Six Zones of Regional Cancer Registry, Malaysia

Data Collection• Cancer cases registration in Malaysia is based on primarily

voluntary notification by using standardized form throughhealthcare workers help.

• However to ensure the completeness of data, active casefindings and routine checks are done for both government andprivate hospitals through discharge records.

• Pathology records from public and private labs were obtainedas well. Case detection through National RegistrationDepartment were done as well.

Cancer in Malaysia 2007 - 2011• Malaysia reported a total number of 103,507 new cancer cases

were diagnosed in Malaysia during the period of 2007 to 2011which accounts for 46,794 (45.2%) males and 56,713 (54.8%)females.

• A total of 64,275 medically certified and non-medically certifiedcancer deaths were reported by the National RegistrationDepartment of the period 2007 to 2011.

• Over the years, the numbers of medically certified cancer deathshave gradually increased.

Annual Age-Standardized rate (ASR) Cancer Incidence by sex, Malaysia (2007 – 2011)

Common Cancers in Malaysia• The three most common cancers among Malaysian

residents were breast, followed by colorectal and lung.

Sites Number Percentage (%)Breast 18,343 17.7Colorectal 13,693 13.2Trachea, Bronchus, Lung 10,608 10.2Lymphoma 5,374 5.2Nasopharynx 5,090 4.9Leukaemia 4,573 4.4Cervix Uteri 4,352 4.2Liver 4,128 4.0Ovary 3,472 3.4Stomach 3,461 3.3Others 30,413 29.4

Cancer % for MalesSites %

Colorectal 16.3

Trachea, Bronchus, Lung 15.8

Nasopharynx 8.1

Lymphoma 6.8

Prostate 6.7

Liver 6.5

Leukaemia 5.4

Stomach 4.3

Bladder 3.2

Other Skin 3.0

Cancer % for FemalesSites %

Breast 32.1

Colorectal 10.7

Cervix Uteri 7.7

Ovary 6.1

Trachea, Bronchus, Lung 5.6

Lymphoma 3.9

Corpus Uteri 3.8

Leukaemia 3.6

Thyroid 3.0

Stomach 2.6

Stage of Cancer Reporting• A total of 103,507 new cancer cases were

reported, of whom 52,794 (51.0%) had reportson staging.

• Of the patients whose stages were reported,9,029 (17.1%) were in stage I, 12,445 (23.6%) instage II, 12,135 (23.0%) in stage III and 18,885(35.8%) in stage IV.

• Thus at the time of diagnosis, 31,020 (58.8%)had advanced cancers (classified as either stageIII or IV).

Cancer as Principal Cause of Deathin Malaysia2016 figures reported that Cancer orNeoplasm as a cause of death was:• No.3 in Government hospitals after

Circulatory and Respiratory system• No.2 in Private hospitals after

Circulatory system

Cancer Control Programme inMalaysia

• Recognizing the findings in 2015 when the National CancerReport was produced, the government of Malaysiaintroduced The National Strategic Plan for Cancer ControlProgramme (NSPCCP) 2016 – 2020.

• NSPCCP which would aim to:• reduce the negative impact of cancer by decreasing the

resulting effects of cancer to the people on its morbidity,mortality and

• improve the quality of life of the cancer patients orsurvival as well as their families.

Cancer Control Programme inMalaysia• NSPCCP 2016-2020 addressed the cancer care and

management in a holistic view from primary preventionto the rehabilitative care.

• NSPCCP also calls for supports and commitment fromboth public and private cancer care agencies,professional bodies and NGOs to address cancer burdenan management issues.

• NSPCCP is part of the strategies in the Malaysia NationalStrategic Plan for Non-Communicable Disease 2016 –2025.

Cancer awareness and prevention works implementedin the University of Malaysia Sabah

In the University of Malaysia Sabah (UMS), several newly designedcourses of CPD (Continuous Professional development) which run overone to two days were introduced in year 2013 for all the universitystaff including academic, technical and clerical level.

These courses include ‘Cancer Awareness and Prevention’ and ‘Weight Management Challenge’

These courses convey the knowledge on NCD including cancers, its’nature, causes and risk factors of developing them.

Simple health parameters screening and risk factors identificationwere carried out on those who attended the symposium/courses.

Follow up was also done with health parameters measurement post 6months and 9 months. We are still following up the first and secondcohort groups.

Nutritional counselling was also done

Cancer awareness and prevention works implementedin the University of Malaysia Sabah

Symposium of Sabah Tobacco Control in collaboration with UniversityMalaya Centre of Addiction Sciences (UMCAS), University of MalayaSocial Preventive Medicine Department, QE Hospital and Sabah StateHealth Department

Participants are mainly the medical and health professionals andadvocates for Tobacco control works

Participants get the knowledge on latest global and local smokingprevalence and morbidity/mortality caused by smoking, the manymethods of quit smoking, the new approach through inter-professional groups

Get to test the level of carbon monoxide (CO) in their breaths, as goodportable device to decide smoking status in quit smoking clinics

The symposium hoped the new knowledge will help all practitionersto carry out awareness of tobacco smoking effects on NCD includinglung cancer in their own area of workplace or NGO’s.

Cancer awareness & prevention works implemented inthe rural community of Kudat by UMS and PERDESA

The UMS School of Medicine works inpartnership with PERDESA (Sabah RuralMedicine Association) a non-governmentalorganization, in carrying works of healthpromotion in the rural community especially inKudat, a northern district of Sabah.

We have carried out two major projects namely:‘Exercise for Health’ (2009-2010) and‘Men’s Health’ (2011-2013).

Both of these projects were funded by HealthPromotion Board, of Malaysia Ministry ofHealth.

Cancer awareness & prevention works implemented inthe community by UMS and PERDESA

• These projects involved altogether 1000 ruralfolks/communities with planned activities such as:• educating them on non-communicable diseases e.g. cancer• promoting healthy lifestyle e.g. no smoking and reduction intake of

alcohol• supervising weekly aerobic exercises in selected villages through

training of trainers• held simple health-checks with pre and post questionnaires and• individual counselling on health and diet.

Exercise for Health

Men’s Health Programme

Cancer screening and early detection by UMSSchool of Medicine

The UMS School of Medicine which has its own polyclinic inthe urban town and community clinic in the rural.

These clinics also plays a role in cancer prevention workthrough health education e.g. quit smoking advices and referals, regular

exerciseNutritional counselling pap-smear screening for cervical cancer started end 2012

Cancer Screening in Malaysia• The top three cancers screening/diagnosing done in Malaysia

namely for the cancers of breast, cervix and colorectal.• Ministry of Health provides screening for these cancers

however the approach is more of opportunistic rather thancommunity based or organized screening.

• The National Blue Ocean Strategy (NBOS) which was officiallylaunched the current Malaysia Prime Minister, Datuk SeriNajib Tun Razak has in recent years been applied in allactivities combining efforts of the different ministries andgovernment agencies towrads achieving the same goal whenit comes to activities towards the public or communities.

Current and Future Plans on Cancer Screening

• Malaysia is gradually on the move from implementingopportunistic form of screening for cancers at populationbased towards a more organized type of screening.

• Cancer screening is still opportunistic and not organized atpopulation based.

• Organized cancer screening programme will be one of theideal ways to detect early the cancers at an early stage oridentification of risk factors which may be preventable iflifestyle or behavioural changes occurred leading towards thereduction in the progress and risk.