Proposal of National Cancer Control Plan, Yemen NCCP 2023-2027

Volume 7, Issue 12, December – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Proposal of National Cancer Control Plan,

Yemen "NCCP" 2023-2027
Dr. Gamal Abdul Hamid and Dr. Saeed Noman
Gamal Abdul Hamid 1,2 , Saeed Noman2
1
Faculty of Medicine, Aden University, Yemen
2
National Oncology Center, Aden, Yemen
Corresponding-Author: Dr. Gamal Abdul Hamid
Abstract:- National planning for cancer control is the The development of treatment guidelines enhances the
most effective way to address the cancer problem in focus on preventing cancers or detecting cases early so that
Yemen. Each country has its own characteristics in they can be treated, and providing the greatest possible
terms of cancer burden, cancer and risk factors, culture, comfort for patients with advanced diseases.”
health system, and available financial and human
resources as well. As infrastructure it must be carefully A. WHO Study “National Cancer Control Programmes:
evaluated in order to establish realistic and achievable Policy and Management Guidelines, Second Edition,
business priorities. The Ministry of Public Health and World Health Organization, 2002” (1) , Provides A
Population in Yemen has started the process of Framework for Developing these Programs. the
preparing the document “National Cancer Control plan Planning Process to be Undertaken Should Follow Four
in Yemen” (NCCP-Y) “in January 2006, and it was Basic Steps:
amended in 2007. But this document did not see the  Estimate the extent of the cancer problem
light, then events and local and Arab popular  Setting measurable targets for cancer control
interactions followed, and at a time when there were no  Evaluation of potential cancer prevention and control
oncology centers other than the National oncology strategies
Center in Sana’a, no specific strategy or plan was  Giving priority to primary cancer control activities
implemented. The National Program of Cancer Control
preparing the proposal of national plan for cancer II. BURDEN OF CANCER IN YEMEN
control in Yemen in line with the framework of the
World Health Organization and the Regional Office for A. Current Situation
the Eastern Mediterranean, with specific goals and The situation of cancer patients in Yemen is the most
objectives. The goals are to control cancer, reduce suffering, as their suffering extends even before the conflict,
incidence, control mortality, and improve outcomes and as they suffer from a great inability to bear the cost of
quality of life for cancer patients. treatment. Available and scarce statistics indicate that the
size of the cancer problem and the high incidence of cancer
Keywords:- Cancer Control Plan, Yemen, Burden of is the second largest disease causing death by 16.6% after
Cancer, Treatment Guidelines cardiovascular diseases. The health system suffers from
weakness and many problems that have been exacerbated by
I. INTRODUCTION the ongoing conflict as well as epidemics and pandemics
(Covid 19), which has increased a burden on the weak
The World Health Organization (WHO) recommends health system and led to a severe weakness in meeting the
that all countries with a large proportion of the cancer minimum needs, care and treatment of cancer patients.
problem, national cancer control planning organize work
within the framework of the national cancer control program The World Health Organization estimated that in 2016,
(NCCP). 13.4 percent of deaths related to non-communicable diseases
were caused by cancer in Yemen. In 2020, there were an
(NCCP) “is a public health program designed to reduce estimated 16,476 new cancer cases and 12,103 deaths.
the number of cancer cases and deaths and improve the
quality of life for cancer patients through the systematic and The most common ten cancers in Yemen according to
equitable implementation of evidence-based strategies for oncology cancer report 2021 are: Breast cancer, Leukemia,
prevention, early detection, diagnosis, treatment and Colorectal, Lymphoma, Head and Neck, Gastric, Thyroid,
palliative care, and optimization of available resources. The Brain and CNS, Ovary and Prostate cancers.
National Cancer Control Plan evaluates methods of various
disease control and program implementation is most cost-
effective and beneficial to the majority of the population.
IJISRT22DEC648 www.ijisrt.com 1616

ISSN No:-2456-2165
B. Cancer Mortality Rate: important role in the pathogenesis of head and neck cancer.
Cancer deaths in Yemen for the year 2020 were The risks may increase in Yemen in proportion to the
estimated at 12,103 deaths, 76.5 ASR (global) per 100,000. intensity and duration of exposure to each carcinogenic
The results showed a convergence between males and substance (qat, snuff, shammah).[8-10]
females (77.9 vs 76.1 ASR (world) per 100,000, and total
deaths 6436 vs 5667, respectively) (IARC 2021). Among The majority of head and neck cancer cases were
the sites of cancer incidence, breast cancer ranked first in recorded in the 50-59 age group (27.9%), followed by the
mortality rates (12.1%), followed by colorectal (10.0%), 60-69 age group (20.8%) and less common in the 0-9 and
stomach (9.7%), leukemia (8.6%), and esophageal ( 8.3%), 10-19 age group. For two years (1.1% and 3.3%),
and the liver (6.5%). %), lung (6.2%), brain and central respectively, the most common site was the oral cavity
nervous system (6.0%) and non-Hodgkin's lymphoma (31.7%), followed by pharyngeal cancers (22.9%) and
(3.2%) (ICCP 2020) This high death rate is especially laryngeal cancers (19.1%). [ 11 ]
among cancers considered curable such as breast cancer and
colorectal cancer. Due to some culture and poor access to The National Program of Cancer Control considers a
health care services for the diagnosis and management of necessary and regular free oral care examination for all
cancer, it presents in the late stage of the tumor and consumers of qat, snuff and zardh with the support of the
therefore has a poor prognosis in general.( 2-4) World Health Organization and the Yemeni Ministry of
Public Health and Population.
C. The Most Cancer Diseases Suffering For The Patient
And The Country  Gynecological cancers
In developing countries such as Yemen, routine
 Breast cancer cervical cancer screening is rudimentary; Hence, there is a
Data on breast cancer from the main cancer registries high incidence of cervical cancer due to the lack of
in Yemen NOC, ACR and Hadramout Cancer Registry awareness of cervical cancer in the population and the
(HCR), Hadhramaut Valley and the Desert Oncology absence or poor quality of the screening programme. The
Center (HVDOC) showed varied in the number of cases mortality rate from cervical cancer is high in Yemen, and
reported by each registry and ranged from 17.5% to 31.6% most cases are diagnosed at a late stage of the disease. In
with most local researchers suggesting that this type of fact, due to the lack of sufficient national records. Although
cancer affects Yemeni women younger than women in other the prevalence of HPV is unknown in Yemen, data from
countries. Western Region at least one decade in which neighboring countries have shown an increasing burden.
about 70% of women were aged 50 years or younger at the HR-HPV31, HR-HPV33, HR-HPV35, HR-HPV39, and HR-
time of diagnosis and the most common age group affected HPV45 are prevalent among Yemeni women with cervical
was 41–50 years. IDC was the most common disease with cancer. Moreover, there is an urgent need to take strategic
76% and 79% of patients having lymph node involvement at measures and plans to reduce the burden of cervical cancer
the time of diagnosis.[ 5,6 ] in Yemen. [12]
We can estimate the decrease in breast cancer Ovarian cancer is the most common type of cancer of
incidence in our country compared to high-income countries the female reproductive organs and a leading cause of death
due to a number of factors such as different reproductive from malignant tumors of the female reproductive system.
factors, as well as fertility rates, preterm births and lactation Most patients with ovarian cancer have advanced stages due
in Yemeni women compared to women in western countries. to non-specific symptoms of the disease. Ovarian cancer has
The improvement that oncology centers in Yemen observed the highest mortality rate in Yemen because two-thirds of
in the diagnosis and treatment of breast cancer in 2019-2020 cases are in advanced stages.[13]
played an important role in the early detection of breast
cancer as ultrasound machines and mammograms were In May 2018, the Director-General of the World
introduced in some centers, which helped in the early Health Organization, Dr. Tedros Ghebreyesus, issued a
detection of breast cancer. As well as the development of global call to eliminate cervical cancer at the World Health
diagnostic and operating techniques for examining ER, PR Assembly. Ending cervical cancer is a priority within the
and Her 2, and this necessitates the need to add other framework of the Thirteenth General Program of Work of
devices in the newly developed centers for mammography, the World Health Organization ( GPW) and will contribute
as well as equipping pathology laboratories for some to achieving the 2030 Sustainable Development Goals and
oncology centers. The program also works in coordination the United Nations Global Strategy for Women, Children
with the World Health Organization to provide targeted and Adolescents (2016-2030). We are confident that the
treatment to oncology centers, which has a positive role in continuous support of the World Health Organization will
improving patients' survival.[7] result in improving and developing cancer control programs
in the Republic of Yemen and saving thousands of patients
 Head and Neck Cancers from cancerous diseases. [14]
Head and neck cancers mainly appear in the lower
socioeconomic classes, which makes them more common
among Yemenis. Smokeless tobacco (sniffing and citrus), as
well as qat treated with chemicals and pesticides, play an

ISSN No:-2456-2165
III. CANCER REGISTRY IN YEMEN centers and developing the electronic network to connect
and rehabilitate all the center during the period 2021-2025.
Cancer registration centers affiliated with oncology
centers play an important role in health policy development, Future expectations Planning must take into account
monitoring and implementation if they fulfill their role. not only the current situation, but how it is likely to develop
Because rational planning is not possible without the in the future.
possibility of recognizing essential health problems,
prioritizing preventive and curative programs, evaluating the The United Nations projections for the population of
achievement of goals in the target groups and comparing Yemen in 2020 are 53 million. Population growth,
them with what has been achieved in relation to the increasing aging of the population inevitably leads to more
resources expended.The primary function of Can Reg in cases of cancer. Also allowing for a very modest increase in
relation to cancer control is to assess the current size of the infection rates (0.5% per year), so the total number of new
cancer burden and its potential future development. cases expected in 2030 will double. Unfortunately, in the
Although the stated policy in Yemen was to develop a absence of any information on incidence trends for any
network of PBCRs serving five cancer registration centers particular type of cancer, we can only speculate about the
for the time being, five cancer registries were doing little to growth in numbers of different cancers within this estimated
collect data on cancer patients and analyze outcomes : Aden total.
Cancer Registry (leading in the country since 1997),
Hadhramout Cancer Registry in Mukalla and Wadi Table 1: Distribution of all Cancers According to 5
Hadramawt, Desert Cancer Center (HVDOC), National Oncology Cancer Centers During 2016-2020
Cancer Center in Sana’a, the most recent of which is the Oncology Center Male Female Total %
Cancer Registry in Taiz and Shabwah, however, all These
registries often suffer from inadequate health services, National oncology
1 1840 2510 4350 33.9
transient populations, lack of financial resources, shortage of center, Aden
qualified workforce, insufficient or inaccurate data due to Al-Amal Oncology
2 1389 1781 3170 24.75
incomplete coverage, difficulty in establishing a reliable and center, Taiz
reasonable cancer registry in the country, and difficulty in National oncology
obtaining data on cancer mortality. , and it is clear that the 3 1517 1701 3218 25.1
center, Mukala
situation is not satisfactory until the next steps are achieved
National oncology
in the registration stage at diagnosis and estimation of 4 669 733 1402 10.94
center, Sayoun
survival rates for specific types of cancer, which requires
expanded and dedicated cadres, and a change in working National oncology
5 321 349 670 5.3
methods to lag behind the comprehensive national center, Shabwah
registration. We believe that supporting training and Total 5736 7074 12810 100
rehabilitation programs for the staff of cancer registration
Fig 1 Cancer patients registered for chemotherapy in 5 oncology centers 2016-2020

ISSN No:-2456-2165
Fig 2 Most common cancers in male. Aden,Taiz,Hadramout and Shabwah oncology centers 2021
Fig 3 Most common cancer in female in Aden,Taiz,Hadramout and Shabwah oncology centers 2021
IV. CANCER SERVICES IN YEMEN In 2007, a Tobacco Control Department was

established in the Ministry of Public Health and Population.
A. Preventive: It has 3 employees, but it is planned to expand to 12.
Tobacco control advertising material has been prepared for
 Tobacco Control: various media (including TV footage), And anti-tobacco
Yemen signed (2003) and ratified (2006) the messages are included in one very popular TV series. The
Framework Convention on Tobacco Control (FCTC). A World No Tobacco Day is celebrated annually in various
general law was passed In 2005 (Law No. 26) “Concerning governorates with the aim of increasing public awareness of
tobacco control and treating its complications. The law the dangers of tobacco.
provides for the implementation of several provisions of the
FCTC, including the ban on smoking in public places, on  Vaccination:
advertising, warnings on products, import restrictions, Chronic infection with hepatitis B virus (HBV) and
implementation of education and awareness programs and hepatitis C virus (HCV) is an important cause of
the allotment of 1% customs and tax duties for tobacco hepatocellular carcinoma (HCC). The incidence of hepatitis
control (including treatment) provisions . Nowadays, the B surface antigen (HBsAg) was 18.5% in healthy subjects
regulations necessary for its implementation are drafting and 24.1% in patients with chronic liver disease (p=0.03).
many of these provisions. Studies found evidence of no signs of hepatitis B virus
(HBV) infection in 59.8% of healthy individuals and 75.9%
Abdul Hamid et al reported that the majority (83.8%) of patients with chronic liver disease (p=0.0016). Studies
of lung cancer cases were smokers. [15] also showed the presence of HBeAg in 32.1% of HBsAg-
positive pregnant women, confirming that vertical
transmission may play a role in the formation of the HBV

ISSN No:-2456-2165
carrier group [16]. Hepatitis B vaccine has been part of the number of other associations) contribute to awareness
routine infant immunization program since 2000 and programs.
coverage is 85%.
D. Nuclear Medicine Centers in Yemen
The HPV vaccine, also known as the cervical cancer
vaccination, is given with the goal of avoiding infection  Nuclear Medicine Center at Al-Thawra Hospital, Sana'a
with certain types of HPV. This vaccine provides protection It was providing the services to all cancer patients in
against two, four or nine types of HPV. The program is the Republic of Yemen in the diagnosis and treatment of
working to address the World Health Organization to radioactive materials, It contains a gamma camera.
provide this vaccine.
Currently, it has stopped providing the service to not
 Early detection / screening allow the provision and transfer of radioactive materials to
A very limited screening for cervical cancer is done by Yemen, and secondly, due to the migration of all nuclear
individual request of women's departments for the work of medicine specialists out of Yemen due to the war.
PAP SMEAR)) and tumor centers have witnessed the
introduction of ultrasound , mammogram and MRI-Coil ,  Nuclear Medicine Center in Aden, located in Al-Sadaqa
which helped in the early detection of breast cancers. hospital,
No service was provided to patients due to the failure
B. Radiotherapy to install the gamma camera device by the relevant
The standard requirement of radiotherapy machine is authorities in the International Atomic Energy Agency and
one machine for 3 million of population. There are the Hungarian company from which the device was
significant restrictions on access to care. Access to purchased, in addition to the Hot laboratory device, which is
radiotherapy is limited in Yemen and restricted to Sana'a. still present at the headquarters of the National Atomic
There is low professional training for health care providers. Energy Commission, in addition to the fact that the
Only one center in Yemen is responsible for implementing operational budget of the center has not been approved until
palliative radiotherapy, however, it does not meet the long today.
waiting list for patients who wait for a long time (up to 4
months). Many patients from governorates prefer to travel to The urgent requirement of PET-CT scan for diagnosis ,
Egypt, Jordan or India as patients suffer a lot. made up evaluation and follow up is mandatory reduce the traveling
to Egypt, Jordan and India and rreducing the suffering of
The equipment available at the National Cancer Center traveling in search of PET CT scan device or a dose of
in Sana’a is a cobalt machine, a simulator (the old traditional radioactive iodine.
Toshiba 1) and CTS-sim (Philips) [17]
E. Diagnostic Services
During the year 2020, the Cancer Patients Support Diagnostic pathology services are provided in all
Fund provided support to the National Center in Sana’a, centers free of charge and include laboratory tests, x-rays,
with an accelerated line that covers patients in Sana’a and ultrasound, mammogram and blood bank services.
the neighboring governorates. Histology and cytology laboratories have been introduced to
some centers, and preparations are underway for other
C. Chemotherapy centers. CT and MRI machines Most major hospitals are
During the years 2017-2020, it was agreed with the located within the framework of subsidized centers for
King Salman Center and the World Health Organization to oncology patients.
provide 40% of the basic list of chemotherapy and wave
therapy for breast cancer and lymph nodes, provided that the F. Rehabilitation, Pain Control, Palliative Care.
state commits to providing 60% and actually 80% of the Physical rehabilitation centers exist, but there are no
agreed list was provided, and treatment is provided to all specialized services for pain control or palliative care in
centers in accordance with the treatment systems and Yemen. Opoids (eg oral morphine) are provided by the Drug
programs according to international protocols, all treatments Supply Program.
are given free of charge to all patients. The remaining 20%
constitutes modern, targeted, biological, high-cost treatment G. Societies and Foundations Working in the Fight Against
that requires support from the Ministry of Finance so that Cancer
the oncology centers can provide integrated services. [7] There are Four Ngos Dedicated to Providing Services
Related to Cancer Control in Yemen
Oncology centers also offer all examinations, which  Aden Cancer Society (1988).
include tumor markers, free of charge. In the field of breast  The National Cancer Control Foundation (established in
cancer care, the centers began establishing breast cancer 2002 as a charitable foundation to support cancer
care units and providing mammograms and ultrasounds to patients)
provide free services to all patients. A number of  Hadhramout Cancer Control Society (2006).
associations (Aden Cancer Society, the National Cancer  Pediatric Oncology society Aden
Control Foundation, Hadhramout Cancer Foundation and a  Al-Resalah Seiyun Hadramout Foundation (2021)
 Shabwah Cancer Foundation (2022)

ISSN No:-2456-2165
The Areas in which Ngos can Make a Significant VI. COMPONENTS OF THE NATIONAL CANCER
Contribution, in Cooperation with the Government, are: CONTROL PLAN IN YEMEN
 Public awareness campaigns
 Production of health educational materials. A. The Following are the Main Components of the Yemen
 Supporting scientific work including establishing and National Cancer Control Plan (NCCP-Y):
funding support for cancer registries  Prevention
 Hospice care / palliative treatment  Early detection
 Patient and family support  Diagnosis and treatment.
 Palliative care and rehabilitation
V. OBJECTIVES OF THE NATIONAL CANCER  Surveillance and monitoring
CONTROL STRATEGY  Cancer Control Research
A. General Objectives: B. Prevention:

 To reduce cancer incidence and mortality and improve Prevention programs, which involve reducing or
quality of life eliminating population exposure to causes of cancer and
 To ensure that priority cancer prevention and control promoting lifestyles known to prevent cancer. Prevention is
services are provided in an equitable (i.e. accessible to the most cost-effective and long-term method of fighting
all) and sustainable manner cancer that offers the best possible approach and the greatest
public health impact.
B. Specific Goals
 Work to reduce the incidence of tobacco-related cancer C. Tobacco Control:
 Work on enacting regulations limiting the spread of  As previously explained, Yemen has ratified the
smoked and oral tobacco (shamma) use Framework Convention on Tobacco Control (FCTC),
 Work to reduce exposure to secondhand smoke and issued a law to implement many of its provisions.
 Developing regulations that will help reduce the opposite
incidence of cancer resulting from exposure to  How was the tobacco control unit established in the
professionals and environmental carcinogens. ministry? Despite these activities, much is still being
 Work on developing prevention to reduce the incidence done within the Ministry of Health and Population as
of cancers due to infections well as by other government departments and NGOs.
 Develop areas of early detection to reduce breast cancer  Information about the prevalence of smoking in Yemen
deaths. is relatively scarce, with very little correct information.
 Work to raise awareness of the early signs and Population surveys, unrest and internal wars have
symptoms of breast cancer among patients and negatively affected the implementation of procedures.
healthcare providers, and develop early referral  The WHO and EMRO Country Profiles for Yemen give
programs to oncology centers and specialized clinics to the following:
ensure prompt diagnosis, treatment, follow-up and  The prevalence of use among adults in 2004 was 27% in
rehabilitation when needed for cancer cases that are men and 10% among women. According to data from
developing result from the early detection strategy. the World Health Organization and UICC Globalink, the
 Develop a mechanism to provide on-demand diagnostic, prevalence of smoking among men is 77% and women,
treatment and rehabilitation resources for all types of 29%. [18,19]
cancer  This sounds implausible, and the best local survey data,
 To ensure high healing potential or significant life from the Household Health Survey in 2003, the
extension following the protocols outlined prevalence of smoking among adults (over the age of 15)
 Relieves moderate/severe pain and physical problems in was found to be 34.5% among men, and 12.8% among
advanced cancer patients women, with very little difference between urban and
 and psychological rural populations. In addition to smoking, oral tobacco
use as 'Shama' is said to be relatively common in Hajjah,
 To improve access to pain management and supportive
care for advanced cancer patients, especially at home Al Mahwit and Hodeidah governorates (although there
and at the primary health care level. are no accurate statistics on the prevalence of use). Oral
leukoplakia is found to be much more common. [20]
 Develop a cancer surveillance and monitoring system
that can provide the information needed for NCCP
 Tobacco control within NCCP-Y will include actions in
planning and evaluation.
several areas:
 Promote the expansion of the existing cancer registry
 Education
network to provide 8-10 population-based cancer
 Taxes
registries
 Increasing research capacity in priority areas for cancer  Legislation: Health warnings and restrictions on
advertising
control in Yemen
 No smoking in public places and transportation.
 Establishment of smoking cessation clinics in various
health services.

ISSN No:-2456-2165
D. Strategies to Combat Smoking:  It was established to manage and refer cases between
 School/Education Level Information: smoking cessation clinics, internal medicine clinics and
 The curriculum should include improving knowledge of oncology clinics.
the risks of tobacco, through the media from:  Clinics must be able to provide appropriate support for
 Short stories, people wishing to quit, including pharmacological agents
 Science and religion courses. known to be helpful (nicotine patches, chewing gum,
 Create student anti-tobacco groups with teacher support. tablets, etc.).
 Develop a topic on tobacco control in the form of short
talks, brochures and posters.  Responsibility: Ministry of Public Health, Interior and
 Responsibility: The Ministry of Education must related NGOs.
coordinate with the school administration to implement
these activities. NGOs can make a significant  Hepatitis infection
contribution, by forming groups of volunteers  Good infant vaccination coverage is important to
maintain protection against hepatitis B - while correct,
 Information at the community/education level: sterile methods of injection, blood transfusion, and blood
Information on tobacco control should be widely testing for HBV and HCV are routine preventive
disseminated through the media (especially including measures.
television), the press, mosques and universities.  Responsibility: Ministry of Public Health, central
laboratories and blood banks.
 Responsibility: Ministry of Information, Ministry of
Public Health (tobacco control unit with health offices  HPV Vaccine
and oncology centers), anti-cancer and tobacco  The HPV vaccine, also known as the cervical cancer
associations and local universities. vaccination, is given with the goal of avoiding infection
with certain types of HPV. This vaccine provides
 Tax collection: protection against two, four or nine types of HPV.
Steady increase in taxes imposed on tobacco products,  Responsibility: Ministry of Public Health, Oncology
whether locally produced or imported. As stipulated by the Centers and the World Health Organization (WHO)
2005 law, 1% of customs revenues, tax duties, and fines
imposed on organizations that violate legal provisions,  Diet, physical activity and obesity.
should be allocated Tobacco control activities (including  Dietary intake patterns influence the risk of many types
treatment of tobacco-related diseases). Implementation of of cancer, particularly gastrointestinal and, to a lesser
these provisions of the law would make a significant extent, breast cancer. Overweight and obesity risk of
contribution to reducing morbidity and mortality from developing cancers of the large intestine, breast
tobacco-related diseases Liability: Ministry of Finance, (postmenopausal), and endometrial (uterine) cancer.
House of Representatives, Office of the President. Despite the lack of studies in Yemen on the role it plays.
Additionally, subjects pay meticulous attention to
 Legislation and Oversight: nutrient intake, levels of physical activity, or even
To ensure that the necessary regulations target population height/weight. The World Health
restrictions on advertising and sponsorship, smoking in Organization estimates the prevalence of being
public places, health warnings, sales to minors, as defined in overweight (BMI >25 kg/m2), with a prevalence of
the 2005 law, and work to ensure increased compliance and 24.6% in men and 27.8% in women, and obesity (BMI
enforcement of legal provisions. 30 kg/m²).
 or more) 2.0% of men and 4.4% of women. However,
 Responsibility: The Yemeni Parliament, the Ministries of daily observation indicates a gradual deviation from the
Justice and Interior, and the local councils of directorates dietary pattern from normal eating based on whole grains
and municipalities and simple cooking methods towards more adoption of
the Western dietary pattern.
 Establishing smoking cessation clinics in various health
services.  The following activities are recommended in this field:
 At the national level, a number of clinics should be  Awareness of the public about healthy diet and ideal
established in the main public hospitals in the following body standards through the development of health
cities: 2 in Sana’a (Al-Thawra Hospital and Al-Jumhouri education materials.
Hospital), and 2 in each of
 Aden (Al-Jumhuriya Teaching Hospital), Al-Sadaqa,
 Encouraging physical exercise in schools and sports
activities facilities for adults.
Taiz (Al-Jumhuri Hospital), Hadhramaut (Ibn Sina)
hospital and the bodies of Ibb, Al-Hodeidah, Lahj,
Abyan and Shabwah.
 Short training courses are of paramount importance for
ten doctors. Formatting should be

ISSN No:-2456-2165
 Action steps and action plan:  Action steps and operational plan:
 Develop brochures, posters, informational programs and  The World Bank has prepared a set of proposals for
school curricula to promote healthy eating and a more actions to reduce qat consumption.
active lifestyle to prevent cancer.  They include increasing the tax burden, building public
 Provide patients and their families with detailed awareness, teaching in schools, changing public policy
information and printed materials that explain the (eg in working hours), filling knowledge gaps and
nutritional adjustments needed before and during diversifying the crop
chemotherapy to demonstrate its effect.
 Activating exercise sessions in schools and establishing  The responsibility: Ministry of Information, Ministry of
them appropriately in clubs for regular practice. Public Health (Health Education Department) and local
 Establishment of free public places suitable for councils.
practicing sports (such as walking paths, swimming
areas, etc.) in addition to the establishment of more  Early detection and examination:
organized centers for physical exercise at a cost  By diagnosing cancer at an early stage, the chance of
affordable to the majority of people. dying from that cancer can be reduced. This can be
achieved through early diagnosis of symptoms of the
 The responsibility: disease in patients with cancer already. Screening, on the
Ministry of Public Health (Family Health Department, other hand, aims by applying special tests to
Health Education Department), Ministry of Information, asymptomatic individuals to detect cancer without
Ministry of Education, Ministry of Youth and Sports. symptoms.
 In the case of cervical cancer, the test (pap smear) aims
 Chewing Qat and the effects of pesticides to detect Pap smear.
 A notable feature of Yemeni culture is the chewing of  Properly organized screening programs for cervical and
qat, a large, slow-growing qat evergreen shrub, Catha large intestine cancer
edulis. Qat leaves contain amphetamine-related  (Colon and rectum) are effective in reducing the
structural alkaloids, which are currently chewed daily by mortality rate of
a high proportion of the adult population in all Yemeni  These cancers (and in the case of cervical cancer)
governorates and have a mild stimulant effect. Qat however, the incidence of these diseases is very low in
central pleasurable stimulant properties are widely Yemen. [12, 23]
believed to improve working capacity, and it is used on
expeditions and by students preparing for exams and E. Early Detection
confronted with fatigue. Khat leaves also contain  Breast cancer:
significant amounts of tannins (7-14% in dried material),  Breast cancer is the most common type of malignancy in
vitamins, minerals and flavonoids. [21] Yemen and the leading cause of death from cancer.
 The cost of qat is important to the Yemeni economy  Breast cancer data from the main cancer registries at
because it takes a large amount of water to grow and is oncology centers in Aden, Mukalla,Taiz, Seiyun and
seen by many as reducing people's productivity. Shabwa showed differences in the number of cases
 The direct cost per person is also significant. It should be reported by each registry, ranging from 13.8% to 22%
noted that qat is routinely sprayed with harmful according to the tumor center reports.
pesticides by farmers; Besides posing a strong health risk  According to previous studies, the incidence of breast
in themselves, pesticides are believed to pose a strong cancer in Yemen is lower than in developed countries,
health risk in their own right, and pesticides are believed and through statistics on the number of new cases, we
to exacerbate the ill effects of chewing qat. have seen an increase in the number of breast cancer
 Evidence linking qat use to cancer is scant and cases at a younger age and more advanced disease than
circumstantial, although it does exist. women in western countries at least a decade ago . At the
 Some suggestions are that oral leukoplakia (possibly time of diagnosis the most common age range was 41 to
precancerous) is more common in qat users. Since qat 50 years and about 73% of women were aged 50 or
users are often tobacco users, a distinction can be made younger. The most common type of breast cancer was
between the rarely addressed and their separate effects. IDC disease, with 76% and 79% of patients having
qat leaves appear to contain nothing specific for lymph node involvement at time of diagnosis.
carcinogens (no evidence of carcinogenic tannin, for  The lower incidence of breast cancer compared to high-
example), nor has it been formally evaluated (for income countries is likely related to a number of
example, by the IARC), as a human carcinogen. different reproductive factors such as fertility rates,
Miscellaneous indirect mechanisms (eg mucosal preterm birth and length of breastfeeding in Yemeni
thickening, gastric reflux) have been suggested as women, in contrast to women in Western countries.
potentially increasing the risk of upper gastrointestinal Techniques of breast cancer diagnosis and treatment in
cancers. [22] tumor centers in Yemen have relatively improved in
2019-2020 as ultrasound and mammography equipment
has been introduced in some centers and the role of
associations and institutions involved in cancer control
has been strengthened at the opening of screening clinics

ISSN No:-2456-2165
that aided in the early detection of breast cancer; and the cancer reports lack vital information about the patient,
development of diagnostic and treatment especially place of residence. Pathologists should
technologies.Working on the development of tissue consider submitting a standard application form for
laboratory techniques and examination plays an nationwide use, requiring basic demographic data (name,
important role in treatment. The addition of 6 age, gender, residency (province)) and clinical data and
mammography devices and the development of tissue encouragement to complete them correctly.
laboratories with modern technologies will play a
positive role in improving the response rate to treatment.  Action steps and operational plan:
With regard to oncology centers, the National Cancer  Establishment of an immunochemistry unit in the
Control Program worked in coordination with the World Department of Pathology (immunohistochemistry) and
Health Organization to provide targeted treatment to Cytogenetics at least in oncology centers in Sana'a,
oncology centers, which has a positive role in improving Aden, Hadramout and Taiz to improve diagnosis
patients' condition, but the introduction of targeted and  Appropriate flow of samples and pathological tissues for
biological treatment according to international rules is the aforementioned
the responsibility of the national program and the
Ministry of Health.  Responsibilities: Ministry of Public Health, National
Oncology Centers and Central Laboratories.
 Action steps and operational plan  Developing annual training courses to qualify doctors
 Public awareness of the nature and importance of breast and technicians
cancer and how to detect it early (training in breast self-  Responsibilities: Ministry of Public Health, central
examination), and information on medical services for laboratories and universities
diagnosis and treatment  National pathology application form that includes
 Raising awareness of breast cancer nurses and doctors in important demographic data
primary health centers. The natural history of the  Responsibilities: Pathologist, Oncology Centers,
disease, early signs and symptoms, how to detect early, Ministry of Public Health, Central Laboratories
clinical breast examination, and clinical stage of breast
cancer and appropriate referral practices and treatment  Medical Oncology:
outcomes.  Adult and pediatric oncology chemotherapy is limited to
 Establishing ultrasound-equipped diagnostic centers in some specialties. Cancer care services.
selected cancer units/hospitals  Intensive chemotherapy for some curable cancers is of
 (and mammography), and staffed by trained personnel. great importance and requires
 Provide education about other types of cancer where  highly trained doctors. Chemotherapy drugs are
they are likely to be detected early and enhance the expensive and whose use requires the monitoring of
prospects for treatment, especially colorectal cancer, oral laboratory tests and skilled nursing supervision.
cancer and cervical cancer .  There is a shortage of oncologists and nurses trained in
clinical medicine, and coordination with universities is
 The responsibility: Ministry of Public Health, Oncology required to open the doors for postgraduate studies in
Centers (Primary Health Services and Maternal and these fields.
Child Health Units), NGOs.  There is a government provision of the basic list of
chemotherapy drugs for oncology patients, but some of
F. Diagnosis and Treatment: the more expensive treatments must be purchased, which
 Oncology centers still need to introduce modern are targeted and biological drugs, which are required to
technologies to diagnose and treat cancer patients. be provided in accordance with international treatment
 Diagnosis: rules and protocols.
 Cancer diagnostic facilities (endoscopy, biochemical  There are currently 11 centers and units that provide
investigations, hematology, tumor markers, imaging, oncology services for cancer patients, especially those
diagnostic cytology, and histology) are extensively coming from remote areas of the country. The plan to
developed in some of the major cities in Yemen. open new oncology units in governorates that do not
 However, many governorates still lack some of these have oncology care units.
services. Even in existing pathology laboratories, some
facilities lack some of the major diagnostic methods such  Action steps and operational plan:
as histopathology methods not found in some centers and  Short-term training courses in oncology (1-4 weeks) for
hospitals. 20 doctors from different governorates for the year 9-
 Histopathology services need strengthening, in 2021.
particular, facilities and staff training for centers required  Long-term training in oncology (1-4 years) 10 doctors
to provide immunohistochemistry (IHC), specifically for (external) per year
the type of breast cancer with respect to hormone  2023-2022
receptor status, ER, PR, HER 2 , which is important in  Short-term training courses for nurses locally (1-4
defining treatment and prognosis protocols. weeks) for 20 nurses from different specialties
 Histopathology services are an important source of
information for cancer registries, but usually, their

ISSN No:-2456-2165
 Long-term training in nursing oncology (1-2 years) for  Specialization
20 nurses (external) for the year 2022-2023  Radiotherapy and chemotherapy are provided by medical
staff with experience and training in oncology, although
 Radiation therapy: more advanced specialized training for staff remains a
 The National Oncology Center in Sana'a (NOC) is the  requirements, as is. Surgery for cancer cases, however, is
only comprehensive cancer center in the country with provided by general surgeons, without special training in
radiotherapy facilities. Nowadays, with somewhat surgical oncology.
limited equipment, it treats patients referred from the  Experience elsewhere has shown treatment outcomes (in
entire country. terms of recurrence and survival) when patients are
 In addition to the Azal Center. This work is clearly treated in specialized units, by surgeons experienced in
insufficient for a country of 28 million people. dealing with the cancer in question, and who treat a large
 The facilities in the National Center will be expanded number of similar cases annually. Therefore, the
when modern treatment equipment is operational and the oncology centers must move towards appointing a
expedited line is introduced at the expense of the Cancer specialist in oncology surgical units for the most
Patient Support Fund, after all attempts by the program important cancer diseases in Yemen with high quality.
and the World Health Organization to introduce two  Treatment is known to improve outcomes in some types
lines to Sanaa and Aden failed. of cancers like breast cancer (several nationwide), head
 There is coordination between the Ministry and the King and neck tumors and gynecological malignancies.
Salman Center to work on building a radiotherapy center
in Aden to reduce the burden of traveling abroad for  Treatment protocols:
radiotherapy.  The treatment offered for different types of cancer
 A new center is planned in Hadhramaut, with depends not only on the nature and stage of the cancer,
construction by Saudi Arabia and equipment and staff the known effectiveness of different treatments (a
training from the Ministry of Energy (NATIC), in 2008- combination of surgery, chemotherapy and
2010. And wait until 2022-2023 AD radiotherapy), but also on the availability of human,
 A fourth center is to be established in Taiz, by donating a material and financial resources. Treatment protocols for
special hospital center, equipment and personnel training largely different types of cancer in high-income
from the Ministry of Energy (NATIC) and the countries, where the focus is on maximizing efficacy and
construction period has not been specified. safety, with little regard for cost. As an approach, it is
 The fifth center is Al-Amal Hospital for Oncology in not feasible in countries such as Yemen, where cost,
Aden is a charitable hospital. The first phase was built efficacy, and absolute value availability have become
and there are possibilities to complete it due to the important considerations.
availability of liquidity and the failure of construction  Decisions regarding treatment protocols, including
under the pretext of war. decisions regarding the type of patient who should be
 Seiyun and Shabwa centers are linked to providing referred to oncology centers, should be made by working
suitable lands and supporting the local authority through groups, responsible for preparing a set of treatment
the support of oil institutions. guidelines for oncology centers in Yemen. National
guidelines/protocols for the diagnosis and treatment of
 Action steps and operational plan: major cancers can ensure standardized care. Work
 Providing a linear accelerator and brachytherapy for the groups can be set within the administration
Sana’a Center
 Development of radiotherapy accessories (planning  Action steps and operational plan:
system and molding room)  Promote the development of unified national oncology
 Establishing a new treatment center in Aden, which was protocols for each cancer to be applied in various
moved from 2008/ oncology care services according to available facilities
 Equipping (accelerated line device) and training (2021-2022).
radiotherapy cadres (radiation therapists, physicists and
radiotherapy technicians) during the period 2022-2025  Responsibilities: The Ministry of Public Health and
for each of: Population, the National Program for Cancer Control and
 The National Center Oncology , Aden Oncology Centers
 The National Center Oncology in Hadhramaut, Al
G. Palliative Care and Pain Treatment Unit:
Sahel. and Al Amal Center in Taiz.
 Palliative care addresses the needs of all patients who
 Responsibilities: Ministry of Public Health, National require relief from their symptoms, as well as the needs
Atomic Energy Commission, National program of of patients and their families for psychosocial care and
cancer control.. support. When patients are in particularly advanced
stages and the patients' chances of recovery are very low,
or when they are near the end stage of the disease.
Because of the social, spiritual, emotional, and economic
implications of cancer and its treatment, palliative care
service programs that address the needs of patients and

ISSN No:-2456-2165
their families from the earliest stages of diagnosis can  Responsibilities: Ministry of Public Health, NGOs such
effectively improve quality of life and resilience. as NCCF, Regional Program for Drug Supply and
Oncology Centers.
 The majority of cancer patients (more than 80%)
experience severe pain and other serious symptoms that H. Monitoring And Surveillance:
require urgent relief. Reducing the suffering of patients  Monitoring methods are based on:
from pain.And other painful symptoms that cannot be  Systematic measurement of health and environmental
achieved unless palliative care is received due to the parameters, recording, data transmission, etc
attention of cancer health services. A successful  Comparison and interpretation of data to identify
palliative care program relies on a drug policy and a possible changes in the health and environmental status
rational logistical plan for distribution even within the of the population.
country.[24]  “Surveillance” can encompass the concept of
 Education in pain relief and palliative care should be an “observing” a disease, change or intervention and
essential component of the training of health care assessing its impact. Monitoring also includes
personnel who may be expected to care for cancer continuously adjusting performance based on results.
patients. The essential elements of a monitoring program are data
 In Yemen, there is currently a limited service in collection, analysis and continuous or disseminated
oncology centers to provide palliative care. The general feedback.
objectives are to improve the quality of life for cancer  Disease surveillance plays an important role in the
patients and their families, and to provide palliative care development and implementation of public health policy
services in an integrated, equitable and sustainable - indeed, rational planning is not possible without the
manner in Yemen, and the immediate objectives are means to identify key health issues, prioritize preventive
 Ensure that standards of palliative care, including pain and curative programs, and evaluate and analyze
relief, are progressively adopted in the target area by all outcomes and know targets were achieved in the target
levels of care groups and what was achieved. In terms of resources
 Providing care mainly through home services expended. Therefore, according to World Health
Organization (WHO) guidelines, the role of the cancer
 Action steps and operational plan surveillance program is to continuously provide data:
 The following specific actions are suggested:  Assessing the current level of the cancer burden and its
 Establish a unit within each cancer treatment center that potential evolution in the future
will be responsible for analgesics and care, to include  Work to develop areas of scientific research and provide
pain management and supportive care after hospital a basis for understanding the causes and prevention of
discharge. cancer
 Provide appropriate training for doctors and nursing staff  •Development of the area of information monitoring on
(abroad) for the management of these centers. the prevalence and development of risk factors,
 Providing specialized training for a number of  Monitor the impact of screening/examination, treatment,
anesthesiologists in the field of pain control, to be analgesics and care.
located in the main oncology centers.  Death statistics from the vital record accompanied by a
 Working with the voluntary sector to establish an medical certificate of cause of death, when available.
association in Yemen that provides home care for  The other major component of the cancer surveillance
terminal patients, and acts as a national training center system is the population-based cancer registry (PBCR).
for home palliative care  The situation is clearly unsatisfactory in that it is still not
 Ensure that medicines used for pain relief, according to possible to produce correct data on cancer incidence in
the WHO “step” protocol, are available to everyone who Yemen, even from a single center (although the
needs them. This includes developing regulations that  data for Aden Governorate are not very far from reality).
allow easy access for patients with opioids, and a Until this is achieved, the next steps - the scoring phase
logistical plan for equitable distribution within the at diagnosis, estimating survival and rates of selected
country. cancers (particularly breast cancer) - are unimaginable.
 Inclusion of information on palliative care in
professional curricula (medical and nursing.)  Action steps and operational plans:
 Create self-help and cancer support groups. These allow  Adequate and dedicated staffing of cancer registration
patients to share their fears, pain, and concerns with centers should be ensured in the oncology centers and
others who have the same problems, and to be made the main center. This should include, for each of them, a
aware of the services, facilities and support that should medical director, who is prepared to supervise the work
be provided to them. of the registration staff as part of their duties.
 Establishment of Hot line and family psychological  Review the current methods of data collection taking
support units in cooperation with cancer societies and into consideration all the possibilities and sources in the
foundations . population (hospitals, public and private laboratories) is
required, by a consultant with appropriate experience in
low income environments, and prepare a manual of

ISSN No:-2456-2165
registration procedures for each of them Provide  Responsibilities: The Ministry of Public Health and
sufficient funding to allow travel to identified data Population, oncology centers and universities in
sources and payments to hospital/laboratory staff cooperation with the World Health Organization /
identified as data collectors. Yemen. The role of NGOs
 More appropriate training for registry staff (data
collection, coding, data entry and for medical VII. CANCER CONTROL SUPPORT FUND
supervisors (in principles of epidemiology).
 When opening new oncology centers in the governorate A. The Fund Aims to Find Financial Resources that are
based on the population, records must be created (for the Stable and Sustainable to Achieve the Following
governorates concerned) as one of its functions. Purposes:
 Cancer prevention and control.
 Responsibilities: NOC, MOPHP, NGOs, with assistance  Contribute to the establishment and support of centers,
from WHO (providing consultants). Searching for projects and programs related to cancer control in
potential partners in Europe or Arab countries. accordance with the national cancer control strategy .
 Supporting and providing medicines, supplies, devices
I. Scientific Research: and medical equipment necessary for diagnosing and
 The World Health Organization has proposed the treating cancer in government centers, health facilities,
following criteria for setting priorities in cancer and institutions that provide all their services free of
research: charge in accordance with the general policy of the fund,
 Scale of the cancer problem financing conditions and legal exchange rules.
 The expected cost-effectiveness of the intervention in  Funding programs, research and scientific studies related
question. to the cancer control programs, according to the
 Impact on equity possibilities available to the Fund.
 possibility of finding a solution.  Contribute to supporting training and rehabilitation
 The scientific quality of the proposed research programs for health personnel in the programs of cancer
 The feasibility of the proposed research. control.
 Contribute to the establishment of the National oncology
 Ethical Acceptance Centers to provide an integrated service for cancer
 Miscellaneous scholarly work has been published in patients through..
regional and international peer-reviewed journals related  Providing all necessary diagnostic and therapeutic
to cancer in Yemen. Research in the National Library means.
(US) presents the Medicines Database (PubMed) and an  Providing nutrition, housing and medicines during the
article under the key terms “Yemen +” “cancer”. Most of treatment period in a way that enables the health staff to
the research of interest is based on clinical continuums complete treatment plans without interruption and
from a variety of hospitals, departments and laboratories. ensures that the cancer patient obtains the best results
There is a number of population-level research on the according to the available capabilities of the fund.
most common types of cancer and causative risk factors.
 There are several areas in which research is clearly VIII. HUMAN RESOURCES (HR):
indicated to aid in planning and evaluating cancer
control in Yemen: Human resources are a key factor for the proper
 As mentioned above, it is important to determine the true implementation of the program in different stages. There is
picture of cancer in Yemen, as well as important still a gap between what could be and what is actually in
indicators such as operation.
 Diagnosis and survival stage of common cancers
 An investigation into the nature of the pesticides used in Capacity building including training programs in
the cultivation of qat, the level of contamination of the various technical disciplines. Management should be
leaves for sale, the potential harmful effects of this and established through short-term and long-term programs
any common contaminations. Studies have been properly primarily for surgeons, oncologists, radiation oncologists,
conducted about the potential carcinogenicity of qat, pediatric oncologists, histopathologists, hematologists,
with an initial focus on oral or esophageal cancers. Case- epidemiologists, cancer registry, nurses and other
control design, with the appropriate control group, and specialties.
attention to adjusting for important confounding factors
(tobacco smoking is known to be associated with qat use,
for example).
 Action steps and operational plan:

 Identifying research topics that are locally relevant, in
cooperation with medical schools.
 Develop research protocols with the help of reputable
researchers from medical institutions around the world.

ISSN No:-2456-2165
Table 2: Available Human Resources at Oncology Centers
Specialty NOC Sanaa NOC Aden Alamal Taiz Shabwah Mukalla Sayoun
Radiation Oncologist 12 3 2 0 1 0
Medical hemato-Oncologis 3 7 2 2 4 2
Pediatric Oncology 3 3 3 0 1 0
Diagnostic Radiologist 1 2 2 1 2 2
Histopathology 1 2 1 0 1 1
G physician 10 10 5 3 5 2
Medical physics 5 1 2 0 1 0
Diagnostic radiology 2 3 1 1 1 2
Chemotherapy nurses 43 35 25 9 15 9
Laboratory technicians 20 15 8 3 8 3
Table 3: Available Equipments at Oncology Centers

Specialty NOC Sanaa NOC Aden Alamal Taiz Shabwa Mukalla Sayoun
Cobalt machine 1 0 0 0 0 0
Simulator 1 0 0 0 0 0
CT scan 1 1 0 0 0 1
Ultrasound 2 2 1 1 2 1
X-ray 1 0 1 1 1 1
Mamogram 1 1 1 1 0 1
Chemotherapy Cabinet 2 4 2 1 2 1
Endoscopy 0 2 0 0 0 0
Pathology Lab 1 1 1 0 0 1
Bed inpatient 90 120 60 25 40 30
Laboratory 1 1 1 1 1 1
Blood bank 0 1 0 0 0 0
IX. PROGRAM MANAGEMENT AND and research according to the available capabilities of the
COORDINATION National Cancer Control Program at the Ministry of Health
and in consultation with the societies and institutions
Implementation of the NCCP - ie ensuring its progress involved in the fight against cancer.
beyond the paper document, as well as reviewing the results
of the work, updating the plan, requires the establishment of REFERENCES
an executive body charged with these responsibilities. These
roles shall be the responsibility of the National Cancer [1]. World Health Organization. National Cancer Control
Control Committee (NCCC), which is supervised by the Programs: Policies and Managerial Guidelines, 2nd
Minister of Public Health and Population or his designee. ed.; World Health Organization:Geneva, Switzerland,
The Committee shall have a permanent secretariat which 2002. Available online:
shall be responsible to the Chairman of the Board of http://www.who.int/cancer/media/en/408.pdf .
Directors for the agenda and supporting documents of its https://apps.who.int/iris/handle/10665/42494
meetings, preparing minutes and other memos and following [2]. IARC. In: Cancer today: estimated age-standardized
up on decision making with appropriate persons or incidence rates (world) in 2020, all cancers, all ages
organizations. The NCCC will form sub-committees and (Yemen). Lyon: World Health
working groups , to engage all key stakeholders in the Organization/International Agency for Research on
cancer control program across the country, to discuss the Cancer; 2021. https://gco.iarc.fr/today/online-
NCCP project, and to seek contributions from as many analysis-
people as possible at its end of review and evaluation. map?v=2020&mode=population&mode_population=
continents&population=900&populations=900&key=
X. CONCLUSIONS: asr&sex=2&cancer=39&type=0&statistic=5&prevale
nce=0&population_group=0&ages_g r o u p % 5 B
The National Cancer Control Plan is a pioneering %5D=0&ages_group%5B%5D=17&
effort of the National Cancer Control Program to develop n b _ i t e m s = 1 0 & g r o u p
and implement a comprehensive and coordinated program in _cancer=1&include_nmsc=1&include_nmsc_other=1
2023-2027 AD to fight cancer in Yemen and develop &projection=globe&color_palette=default&map_scal
infrastructure. The proposed plan sets out principles for e=quantile&map_nb_colors=5&continent=0&rotate=
current and future cancer control actions in line with WHO %255B10%252C0%255D
regulations. It also includes goals and priority areas for work

ISSN No:-2456-2165
[3]. ICCP. In: Cancer country profiles Yemen 2020: [14]. Global strategy to accelerate the elimination of
WHO-international cancer control partnership. The cervical cancer as a public health problem . Geneva:
International Cancer Control Partnership; 2020. World Health Organization; 2020. Licence: CC BY-
https://www.iccp-portal.org/who-cancer-country- NC-SA 3.0 IGO
profiles-yemen-2020 [15]. Abdul Hamid G. Al-Nabhi A. ,Baom N. , Algalabi A.
[4]. WHO/EMRO. In: Cancer patients in Yemen face the Lung cancer in Aden, Yemen.World J Pharm Res.
compounded pain of disease and conflict. Cairo: The 2015; 4: 324-332
World health Organization/Eastern Meditterranean [16]. El Guneid AM, Gunaid AA, O'Neill AM, Zureikat
Region; 2020. NI, Coleman JC, Murray-Lyon IM. Prevalence of
http://www.emro.who.int/yemen/news/cancer- hepatitis B, C, and D virus markers in Yemeni
patients-in-yemen-face-the-compounded-pain-of- patients with chronic liver disease. J Med Virol. 1993
disease-and-conflict.html Aug;40(4):330-3. doi: 10.1002/jmv.1890400413.
[5]. Al-Kahiry W, Omer HH, Saeed NM, Hamid GA. PMID: 8228926.
Late presentation of breast cancer in Aden, Yemen. [17]. Bawazir, A., Basaleem, H., Badheeb, A., Abdul
The Gulf Journal of Oncology. 2011 Jan(9):7-11. Hamid, G. (2022). General Oncology Care in the
PMID: 21177203. Republic of Yemen. In: Al-Shamsi, H.O., Abu-
[6]. Abdul Hamid, G., Tayeb, M.S. & Bawazir, A.A. Gheida, I.H., Iqbal, F., Al-Awadhi, A. (eds) Cancer
(2001). Breast cancer in south-east Republic of in the Arab World. Springer, Singapore.
Yemen. EMHJ - Eastern Mediterranean Health https://doi.org/10.1007/978-981-16-7945-2_20
Journal, 7 (6), 1012-1016, 2001 [18]. Jafari A, Rajabi A, Gholian-Aval M, Peyman N,
https://apps.who.int/iris/handle/10665/119120 Mahdizadeh M, Tehrani H. National, regional, and
[7]. Gamal Abdul Hamid, Breast cancer care in Yemen. global prevalence of cigarette smoking among
EUROPEAN JOURNAL of PHARMACEUTICAL women/females in the general population: a
AND MEDICAL RESEARCH. Ejpmr, 2022,9(3), systematic review and meta-analysis. Environ Health
24-29 Prev Med. 2021 Jan 8;26(1):5. doi: 10.1186/s12199-
[8]. Hamid, G. A. . Epidemiology and Outcomes of 020-00924-y. PMID: 33419408; PMCID:
Nasopharyngeal Carcinoma. In: Zhou, X. , Zhang, Z. PMC7796590.
, editors. Pharynx - Diagnosis and Treatment [19]. WHO global report on trends in prevalence of
[Internet]. London: IntechOpen; 2021 [cited 2022 Jun tobacco smoking 2000-2025, second edition ,
16]. Available from: GENEVA; World Health Organization; 2018
https://www.intechopen.com/chapters/75804 doi: [20]. Bakdash A. Shammah (Smokeless Tobacco) and
10.5772/intechopen.96802 Public Health. Asian Pac J Cancer Prev. 2017 May
[9]. Baom MN. Hamid AG. epidemiology of oral and 1;18(5):1183-1190. doi:
pharyngeal cancer . ejpmr 2017; 9;155-169 10.22034/APJCP.2017.18.5.1183. PMID: 28610400;
[10]. Hamid GABN. Tobacco and betel quid in PMCID: PMC5555521.
development of oral cancer. JCancer Prev Curr Res. [21]. Nasir Tajure Wabe, Mohammed Adem Mohammed.
2017;7(1):00223. What science says about khat (Catha edulis Forsk)?
[11]. Abdul-Hamid G, Saeed NM, Al-Kahiry W, et Overview of chemistry, toxicology and
al.Pattern of head and neck cancer in Yemen. GulfJ pharmacology. J Exp Integr Med. 2012; 2(1): 29-37
Oncol. 7: 21–24 (2010) doi: 10.5455/jeim.221211.rw.005
[12]. Abdul Hamid G, Hadi A, Al-Ahdel F, Yassin S. [22]. El-Zaemey, S et al. “Qat Chewing and Risk of
Gynecological malignancies in Aden, Yemen: Potentially Malignant and Malignant Oral Disorders:
Anoverview of 4 years. European JPharmaceutical A Systematic Review.” The international journal of
Medical Research.2018; 5(10): 117-20. [Citied occupational and environmental medicine vol. 6,3
2018July 20]. Available from: (2015): 129-43. doi:10.15171/ijoem.2015.537
https://www.ejpmr.com/home/abstract_id/4278 [23]. Abdul Hamid G, Saeed NM, Kahiry W, Ba-
https://www.researchgate.net/publication/358712474 KhubiraS, Batarfi A. Pattern of gasterointestinal
_Female_Breast_and_Gynecological_Cancers_in_Ad cancers in south Eastern Region of Yemen. Uni.Aden
en_Yemen_An_Epidemiological_Study J.Nat. andAppl Sc vol 12 No 2 2008, 461467
[13]. Gamal Abdul Hamid , Amani Saleh Hadi and Nadia [24]. Hamid, G.A. (2021). Prevalence and Management of
Ali Yeslam. Ovarian cancer in southeastern of Cancer Pain in Developing Countries. In:
Yemen. GSC Advanced Research and Reviews, Silbermann, M. (eds) Palliative Care for Chronic
2022, 10(03), 047–051; DOI: Cancer Patients in the Community. Springer, Cham.
https://doi.org/10.30574/gscarr.2022.10.3.0026 https://doi.org/10.1007/978-3-030-54526-0_38

Proposal of National Cancer Control Plan, Yemen NCCP 2023-2027

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Proposal of National Cancer Control Plan, Yemen NCCP 2023-2027

Uploaded by

Copyright:

Available Formats

Volume 7, Issue 12, December – 2022 International Journal of Innovative Science and Research Technology

Proposal of National Cancer Control Plan,

IJISRT22DEC648 www.ijisrt.com 1616

IJISRT22DEC648 www.ijisrt.com 1617

Fig 1 Cancer patients registered for chemotherapy in 5 oncology centers 2016-2020

IJISRT22DEC648 www.ijisrt.com 1618

IV. CANCER SERVICES IN YEMEN In 2007, a Tobacco Control Department was

IJISRT22DEC648 www.ijisrt.com 1619

IJISRT22DEC648 www.ijisrt.com 1620

A. General Objectives: B. Prevention:

IJISRT22DEC648 www.ijisrt.com 1621

IJISRT22DEC648 www.ijisrt.com 1622

IJISRT22DEC648 www.ijisrt.com 1623

IJISRT22DEC648 www.ijisrt.com 1624

IJISRT22DEC648 www.ijisrt.com 1625

IJISRT22DEC648 www.ijisrt.com 1626

 Action steps and operational plan:

IJISRT22DEC648 www.ijisrt.com 1627

Table 3: Available Equipments at Oncology Centers

IJISRT22DEC648 www.ijisrt.com 1628

IJISRT22DEC648 www.ijisrt.com 1629

You might also like