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Supporting Strategies and Frameworks
The National Cancer Framework 2017-2022
Early detection of cancer is recognized to increase the chance of successful treatment. For example, in bowel cancer cases diagnosed at the earliest stage, more than 9 out of 10 people survive for at least 10 years. However, if diagnosed at a late stage, survival is below 5%
Breast and bowel cancers are among the most common in Qatar and the incidence is projected to grow significantly, as illustrated in the graphs below.
Increase awareness of screening
When healthcare professionals in Qatar were asked, What is the single most important factor in delivering comprehensive and effective national cancer screening services?’, 55% responded with community education.8 Awareness activities to promote the availability and im portance of screening should therefore continue. Utilizing public figures as role models in seeking screening should also be considered. Early cancer screening registry data suggest a positive uptake of screening services considering the relatively recent rollout of this service. A wareness activities must continue to be promoted across
The entire health system including public and private providers of primary, secondary and tertiary care. Further utiliz ation of the cancer-screening registry and population d ata is therefore recommended to ensure screening ta rgets are met.
Enhance Cancer Screening Services
Qatar begins screening women at an earlier age than many other developed geographies, to account for the earlier presentation of breast cancer in the Qatari population as well as the relatively younger population demographic seen in Qatar (see table below). There will be a continued roll-out of comprehensive national screening programs for:
Breast (45-69 years), with three-yearly recall
Bowel Men and Women (50-74 years), with yearly recall
A careful review of baselined data will determine the relative merit of further reducing the age of first screening to 40 years, as well as screening the young adult population (25-40 years). Once concluded, further investigation into the frequency of screening should also be considered.
Cervical screening currently operates within Qatar on an opportunistic basis due to the relatively low prevalence of the disease. A situational analysis to understand the evidence base for the adoption of a national population-based cervical cancer screening service in Qatar is currently under evaluation between screening service providers and the MOPH.
Lung cancer is one of the more common cancers within Qatar and significant improvements in the outcomes of detecting lung cancer are now possible with the emergence of evidence regarding the clinical and cost-effectiveness of offering Low-Dose Computed Tomography (LDCT) scanning to people with a significant risk of lung cancer,due to age and smoking history.19 This has relevance for Qatar where smoking in older Qatari men is prevalent and about double the amount of Western populations.
The suggested target population would be males, over 45 years of age with a targeted history of smoking. It is estimated that 7,000 males would be offered LDCT screening without contrast and conservative estimates suggest that this could result in 200 diagnoses per year, at an earlier stage when potentially curative surgery is still a treatment option. It is important to account for the fact that for every one cancer detected there are approximately 40 patients who are found to have non-cancerous incidental findings that may lead to unnecessary interventions.
In addition to the above, the concept of population-based thyroid screening is also under consideration. Thyroid cancer is listed as the sixth most prevalent cancer across all nationalities and genders in Qatar and is listed as the third most prevalent cancer amongst Qatari females.
Under the NCS three screening guidelines for breast,bowel and cervical cancers were developed and published to ensure consistency in the management of screening services. It is essential that the guidelines are adopted fully across all providers, PHCC, HMC, Sidra and private providers of care. Along with the clinical management guidelines for cancer, the screening guidelines will need to be peer-reviewed and updated on a bi-annual basis to reflect changes in practices and the projected technological advances in personalized diagnostics. The guidelines should be formally adopted and published as national policy and used as the basis for National Health Insurance reimbursement.
The breast and bowel screening service is now operational and therefore more focus must be placed on monitoring the i mplementation of the service to ensure targets are met and patient safety is maintained. To provide leadership in the ongoing development of the screening service for Qatar, MOPH in collaboration with PHCC and HMC will introduce a quality and risk management system, continuous im provement initiatives, performance monitoring, and
surveillance. Operational KPIs for breast and bowel cancer screening programs have been developed and are currently within the shadow-monitoring period, with actual monitoring starting in the second quarter of 2017. The NCF supports the breast and bowel-screening services’ aim of consistently achieving 70% coverage and uptake of breast and bowel screening, ongoing adequate resourcing and developing the expertise required to support this.
Deliver awareness campaigns to promote screening
Embed cancer screeening registry and population health data in screaning systems
Assess merit for implementation of population based cervical screening and high risk lung cancer screening programs
Implement and maintain screening guidelines
Review breast cancer screening access eligibility criteria
Develop screening performance monitoring, management and quality assurance program