10 FACTS ON BLOOD

Fact 1

Blood transfusion saves lives and improves health, but millions of patients requiring transfusion do not have timely access to safe blood. Every country needs to ensure that blood supplies are sufficient and free from HIV, hepatitis viruses and other chronic infections that can be transmitted through unsafe transfusion.

Fact 2

In high-income countries, transfusion is most commonly used to support invasive medical procedures and surgeries like open-heart surgery and organ transplant. In low- and middle-income countries it is used more often in pregnancy-related complications and severe childhood anaemia. As the demand for blood is increasing, blood shortages are common. More blood donors are needed to replace those that are lost every year due to ill health, retirement and relocation.

Fact 3

It is estimated that around 93 million blood donations are given every year. About 50% of these are donated in low- and middle-income countries where nearly 85% of the world’s population lives. The average blood donation rate is more than 13 times greater in high-income countries than in low- and middle-income.

Fact 4

Blood is collected in about 8000 blood centres spread all over the world. The average annual blood donation per centre varies from 30 000 in high-income countries to 7500 in middle-income countries and around 3700 in low-income countries.

Fact 5

Voluntary unpaid donors account for 100% of blood supplies in 58 countries. Since the inception of World Blood Donor Day in 2004, 111 countries have reported an increase in the number of voluntary donations. But in 45 countries, less than 25% of blood supplies come from voluntary unpaid donors.

Fact 6

The average donation rate in high-income countries is 45.4 donations per 1000 people. This compares with 10.1 donations per 1000 people in middle-income countries and 3.6 donations in low-income countries. If 1% to 3% of a country’s population donated blood, it would be sufficient to meet the country’s needs. But in 77 countries, donation rates are still less than 1%.

Fact 7

Adequate stocks of safe blood can only be assured through regular donation by voluntary unpaid blood donors, because the prevalence of bloodborne infections is lowest among these donors. It is higher among donors who give blood only as a replacement when it is required for a family and among those who give blood for money or other forms of payment.

Fact 8

Donated blood should always be screened for HIV, hepatitis B, hepatitis C and syphilis prior to transfusion, but in 42 countries (out of 173 countries reporting in 2008) not all donated blood is tested for one or more of these infections. Testing is not reliable in many countries because of staff shortages, poor quality test kits, irregular supplies, or lack of basic laboratory services.

Fact 9

Separating blood into its various components allows a single unit of blood to benefit several patients and provides a patient only the portion of blood which is needed. About 97% of the blood collected in high-income countries, 63% in middle-income countries and 28% in low-income countries is separated into blood components.

Fact 10

Often transfusions are prescribed when simpler, less expensive treatments might be equally effective. This exposes some patients to the needless risk of infections or severe transfusion reactions due to incompatibility of blood groups. Safe clinical transfusion practices are fundamental for transfusion to be truly life-saving with minimal risk.

Cancer prevention (sumber:WHO)

At least one-third of all cancer cases are preventable. Prevention offers the most cost-effective long-term strategy for the control of cancer.

Tobacco is the single largest preventable cause of cancer in the world today. It causes 80-90% of all lung cancer deaths, and about 30% of all cancer deaths in developing countries, including deaths from cancer of the oral cavity, larynx, oesophagus and stomach. A comprehensive strategy including bans on tobacco advertising and sponsorship, tax increases on tobacco products, and cessation programmes can reduce tobacco consumption in many countries. The WHO Framework Convention on Tobacco Control, adopted in May 2003, aims to curb tobacco-related deaths and disease.

– Tobacco Free Initiative

Dietary modification is another important approach to cancer control. There is a link between overweight and obesity to many types of cancer such as oesophagus, colorectum, breast, endometrium and kidney. Diets high in fruits and vegetables may have a protective effect against many cancers. Conversely, excess consumption of red and preserved meat may be associated with an increased risk of colorectal cancer. In addition, healthy eating habits that prevent the development of diet-associated cancers will also lower the risk of cardiovascular disease.

Regular physical activity and the maintenance of a healthy body weight, along with a healthy diet, will considerably reduce cancer risk. National policies and programmes should be implemented to raise awareness and reduce exposure to cancer risk factors, and to ensure that people are provided with the information and support they need to adopt healthy lifestyles.

– WHO global strategy on diet, physical activity and health

Infectious agents are responsible for almost 22% of cancer deaths in the developing world and 6% in industrialized countries. Viral hepatitis B and C cause cancer of the liver; human papilloma virus infection causes cervical cancer; the bacterium Helicobacter pylori increases the risk of stomach cancer. In some countries the parasitic infection schistosomiasis increases the risk of bladder cancer and in other countries the liver fluke increases the risk of cholangiocarcinoma of the bile ducts. Preventive measures include vaccination and prevention of infection and infestation.

– Infectious diseases health topics

Exposure to ionizing radiation is also known to cause to certain cancers. Excessive solar ultraviolet radiation increases the risk of all types of cancer of the skin. Avoiding excessive exposure, use of sunscreen and protective clothing are effective preventive measures.

– Ultraviolet radiation

Asbestos can cause lung cancer; aniline dyes have been linked to bladder cancer; and benzene can lead to leukaemia. The prevention of certain occupational and environmental exposure to these and other chemicals is another important element in preventing cancer.

– Occupational health

CANCER (sumber:WHO)

KEY FACTS

• Cancer is a leading cause of death worldwide: it accounted for 7.4 million deaths (around 13% of all deaths) in 2004.
• Lung, stomach, liver, colon and breast cancer cause the most cancer deaths each year.
• The most frequent types of cancer differ between men and women.
• More than 30% of cancer deaths can be prevented.¹
• Tobacco use is the single most important risk factor for cancer.
• Cancer arises from a change in one single cell. The change may be started by external agents and inherited genetic factors.
• Deaths from cancer worldwide are projected to continue rising, with an estimated 12 million deaths in 2030.

Cancer is a generic term for a large group of diseases that can affect any part of the body. Other terms used are malignant tumours and neoplasms. One defining feature of cancer is the rapid creation of abnormal cells that grow beyond their usual boundaries, and which can then invade adjoining parts of the body and spread to other organs. This process is referred to as metastasis. Metastases are the major cause of death from cancer.

Global burden of cancer

Cancer is a leading cause of death worldwide. The disease accounted for 7.4 million deaths (or around 13% of all deaths worldwide) in 2004. The main types of cancer leading to overall cancer mortality each year are:

• lung (1.3 million deaths/year)
• stomach (803 000 deaths)
• colorectal (639 000 deaths)
• liver (610 000 deaths)
• breast (519 000 deaths).

More than 70% of all cancer deaths occurred in low- and middle-income countries. Deaths from cancer worldwide are projected to continue rising, with an estimated 12 million deaths in 2030.

The most frequent types of cancer worldwide (in order of the number of global deaths) are:

• Among men – lung, stomach, liver, colorectal, oesophagus and prostate
• Among women – breast, lung, stomach, colorectal and cervical.

What causes cancer?

Cancer arises from one single cell. The transformation from a normal cell into a tumour cell is a multistage process, typically a progression from a pre-cancerous lesion to malignant tumours. These changes are the result of the interaction between a person’s genetic factors and three categories of external agents, including:

• physical carcinogens, such as ultraviolet and ionizing radiation
• chemical carcinogens, such as asbestos, components of tobacco smoke, aflatoxin (a food contaminant) and arsenic (a drinking water contaminant)
• biological carcinogens, such as infections from certain viruses, bacteria or parasites.

Some examples of infections associated with certain cancers:

• Viruses: hepatitis B and liver cancer, Human Papilloma Virus (HPV) and cervical cancer, and human immunodeficiency virus (HIV) and Kaposi sarcoma.
• Bacteria: Helicobacter pylori and stomach cancer.
• Parasites: schistosomiasis and bladder cancer.

Ageing is another fundamental factor for the development of cancer. The incidence of cancer rises dramatically with age, most likely due to a buildup of risks for specific cancers that increase with age. The overall risk accumulation is combined with the tendency for cellular repair mechanisms to be less effective as a person grows older.

Tobacco use, alcohol use, low fruit and vegetable intake, and chronic infections from hepatitis B (HBV), hepatitis C virus (HCV) and some types of Human Papilloma Virus (HPV) are leading risk factors for cancer in low- and middle-income countries. Cervical cancer, which is caused by HPV, is a leading cause of cancer death among women in low-income countries.

In high-income countries, tobacco use, alcohol use, and being overweight or obese are major risk factors for cancer.

How can the burden of cancer be reduced?

Knowledge about the causes of cancer, and interventions to prevent and manage the disease is extensive. Cancer can be reduced and controlled by implementing evidence-based strategies for cancer prevention, early detection of cancer and management of patients with cancer.

More than 30% of cancer could be prevented by modifying or avoiding key risk factors, according to a 2005 study by international cancer collaborators¹. Risk factors include:

• tobacco use
• being overweight or obese
• low fruit and vegetable intake
• physical inactivity
• alcohol use
• sexually transmitted HPV-infection
• urban air pollution
• indoor smoke from household use of solid fuels.

Prevention strategies:

• increase avoidance of the risk factors listed above
• vaccinate against human papilloma virus (HPV) and hepatitis B virus (HBV)
• control occupational hazards
• reduce exposure to sunlight

Early detection

About one-third of the cancer burden could be decreased if cases were detected and treated early. Early detection of cancer is based on the observation that treatment is more effective when cancer is detected earlier. The aim is to detect the cancer when it is localized (before metastasis). There are two components of early detection efforts:

• Education to help people recognize early signs of cancer and seek prompt medical attention for symptoms, which might include: lumps, sores, persistent indigestion, persistent coughing, and bleeding from the body’s orifices.
• Screening programmes to identify early cancer or pre-cancer before signs are recognizable, including mammography for breast cancer, and cytology (a “pap smear”) for cervical cancer.

Treatment and care

• Treatment aims to cure, prolong life and improve quality of life for patients. Some of the most common cancer types, such as breast cancer, cervical cancer and colorectal cancer, have high cure rates when detected early and treated according to best practice. Principal treatment methods are surgery, radiotherapy and chemotherapy. Fundamental for adequate treatment is an accurate diagnosis through imaging technology (ultrasound, endoscopy or radiography) and laboratory (pathology) investigations.
• Relief from pain and other problems can be achieved in over 90% of cancer patients through palliative care. Effective ways exist to provide palliative care for patients and their families in low resource settings.

WHO response

In 2008, WHO launched its Noncommunicable Diseases Action Plan. The Cancer Action Plan is currently under development.

WHO, other United Nations organizations and partners collaborate on international cancer prevention and control to:

• Increase political commitment for cancer prevention and control;
• Generate new knowledge, and disseminate existing knowledge to facilitate the delivery of evidence-based approaches to cancer control;
• Develop standards and tools to guide the planning and implementation of interventions for prevention, early detection, treatment and care;
• Facilitate broad networks of cancer control partners at global, regional and national levels;
• Strengthen health systems at national and local levels; and
• Provide technical assistance for rapid, effective transfer of best practice interventions to developing countries.