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Cancer control has been in effect in Indonesia since the early 1920s. It was the Dutch Colonial
Government who started with the Institution for Cancer Control, which was closed by the
Japanese Occupation Administration between 1942 and 1945. After the independence of the
Republic of Indonesia, a Cancer Control Foundation was established in 1962. At present,
clinical and non-clinical departments in government teaching hospitals (there are 13 teaching
hospitals) usually handle all cancer problems. In 1993, Dharmais Cancer Center in Jakarta
was established and has become the top referral cancer hospital for Indonesia. Until now, there
have been no nationwide accurate data on cancer registration, owing to a lack of funds and
manpower. Cancer data collection is usually provided as a relative frequency study from
several departments of the teaching hospitals. It is currently estimated that there will be at least
170190 new cancer cases annually for each 100 000 people. The most frequent and
primary cancers are cervix, breast, lymph node, skin and nasopharynx. Since Indonesia is now
in a transition phase and has many problems concerning the economy and health care, we
suggested a well-planned cancer control program. It includes the primary, secondary and
tertiary prevention of cancer in cities, where inhabitants can afford to subsidize a certain
proportion of the budgets for the implementation of this program.
Key words: Indonesia cancer control
INTRODUCTION
Historically, the first major effort aimed at cancer control in
Indonesia was initiated by the Dutch Colonial Government in
the early 1920s (1). The first organization for cancer control
which coordinated the activities for research and prevention
was established in Bandung in 1933, called the Nederlands
Indische Kanker Institute, which was closed during the
Japanese occupation between 1942 and 1945 (1). After independence of the Republic of Indonesia, the first Indonesian
Foundation for Cancer Control was established in 1962 in
Jakarta. This was followed by several Cancer Foundations in
several cities such as Surabaya, Solo, Yogyakarta and Bandung. The Coordinating Foundation of all these cancer societies
was then established in Jakarta on April 17, 1977, named the
Indonesian Cancer Society. Research Institutions have also
been established such as the National Cancer Research Institute in Jakarta in 1965, under the supervision of the Department of National Research, which was closed in 1966. In 1974,
a Research Center for Cancer and Radiology was established
under the National Health Research Institute of the Ministry of
Health.
In 1993, a new comprehensive Cancer Center Hospital was
established in Jakarta which is also affiliated to the Medical
Faculty University of Indonesia for the purpose of teaching
and training for medical postgraduates and also for research on
basic oncology.
Since the incidence of cancer goes up with increasing of life
expectancy and better control of communicable diseases, the
cancer load in developing countries such as Indonesia can soon
be expected to be formidable (24). It is currently estimated
that there will be at least 170190 new cancer cases annually
for each 100 000 people (5,6) and therefore cancer has risen to
become sixth in rank among deaths after infectious diseases,
cardiovascular diseases, traffic accidents, nutritional deficiency and congenital diseases (1,57). However, most cancer
patients (6070%) seek medical treatment when it is already
too late (1,6).
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1988
1989
1990
1991
Site
Site
Site
Site
Cervix
18.41
Cervix
18.61
Cervix
19.18
Cervix
19.18
Breast
11.59
Breast
12.60
Breast
11.52
Breast
12.10
Lymph node
4.91
Lymph node
4.48
Lymph node
4.74
Lymph node
5.62
Skin
8.24
Skin
8.37
Skin
8.64
Skin
7.69
Nasopharynx
8.15
Nasopharynx
5.95
Nasopharynx
6.23
Ovary
5.31
Ovary
4.94
Ovary
4.68
Ovary
4.95
Nasopharynx
5.64
Rectum
4.42
Rectum
4.68
Rectum
4.95
Rectum
4.42
Soft tissue
3.50
Thyroid
3.42
Soft tissue
2.75
Thyroid
3.88
Thyroid
3.34
Unknown P
6.24
Unknown P
4.41
Soft tissue
2.58
Colon
2.81
Colon
2.88
Thyroid
3.26
Colon
2.82
10
Source: CME. Prevention and Early Detection of Cancer. Jakarta: Medical Faculty, University of Indonesia 1998.
Table 2. The 10 most frequent primary cancer in females: pathology based 198891
No.
1988
1989
1990
1991
Site
Site
Site
Site
Cervix
28.66
Cervix
29.21
Cervix
29.63
Cervix
28.66
Breast
18.03
Breast
19.52
Breast
18.02
Breast
17.77
Ovary
7.68
Ovary
7.25
Ovary
7.65
Ovary
7.77
Skin
6.23
Skin
6.32
Skin
6.73
Skin
5.89
Thyroid
4.07
Thyroid
3.87
Thyroid
3.72
Thyroid
4.61
Unknown P
3.22
Unknown P
4.32
Unknown P
3.10
Unknown P
3.73
Lymph node
3.24
Lymph node
2.84
Lymph node
2.79
Lymph node
3.40
Rectum
3.37
Rectum
3.13
Rectum
3.46
Rectum
3.20
Nasopharynx
3.01
Nasopharynx
2.92
Nasopharynx
3.17
Nasopharynx
3.03
Uterus
3.09
Uterus
3.15
Uterus
3.48
Uterus
3.00
10
Source: CME. Prevention and Early Detection of Cancer. Jakarta: Medical Faculty, University of Indonesia 1998.
Table 3. The 10 most frequent primary cancer in males: pathology based 198891
No.
1988
1989
1990
1991
Site
Site
Site
Site
Skin
11.79
Skin
10.02
Skin
11.99
Skin
11.59
Nasopharynx
11.76
Nasopharynx
11.52
Nasopharynx
11.87
Nasopharynx
11.27
Unknown P
8.63
Unknown P
9.75
Unknown P
6.80
Unknown P
7.50
Lymph node
7.94
Lymph node
7.49
Lymph node
8.34
Lymph node
10.40
Rectum
6.34
Rectum
6.54
Rectum
6.79
Rectum
7.07
Soft tissue
5.21
Soft tissue
4.22
Soft tissue
4.30
Soft tissue
4.19
Prostate
4.09
Prostate
3.81
Prostate
4.45
Prostate
4.85
Bladder
3.98
Bladder
4.73
Bladder
3.58
Bladder
3.97
Colon
3.98
Colon
4.09
Colon
4.19
Colon
4.17
10
Lung
3.95
Lung
3.64
Lung
4.68
Lung
3.99
Source: CME. Prevention and Early Detection of Cancer. Jakarta: Medical Faculty, University of Indonesia 1998.
Table 6. Relative frequency of the three most frequent primary cancers: site
by geographic distribution
Gender
1988
1989
1990
1991
Total
Male
6.258
6.449
7.054
5.944
25.705
34.5
Female
11.312
11.807
12.833
12.826
48.778
65.4
No information
36
34
11
81
0.1
Total
17.606
18.290
19.898
18.770
74.564
100.0
<15
1988
1989
1990
1991
2.76
2.83
2.53
2.43
1524
5.13
4.75
4.65
4.59
2534
11.38
11.46
10.63
10.99
3544
19.44
19.81
19.21
19.60
4554
25.80
26.79
26.14
25.96
5564
19.93
21.25
20.75
20.03
6574
10.09
10.05
10.27
10.76
>75
3.02
3.05
3.35
3.10
Lost
2.45
2.46
2.65
Total
100%
100%
100%
100%
Island
First
Second
Third
Cervical uterus
Skin
Breast
Cervical uterus
Breast
Skin
Cervical uterus
Breast
Skin
Cervical uterus
Nasopharynx
Breast
Cervical uterus
Breast
Rectum
S19
PRESENT SITUATION
The Indonesian archipelago consists of over 17 000 islands,
occupying almost 2 106 km2 of land. Administratively, Indonesia is divided into 27 provinces, 241 districts, 55 municipalities, 3501 subdistricts and 66 979 villages. Indonesia has a
population of more than 200 million people (1974) (7) and is
the fifth most populated country in the world after China,
India, the Russian Federation and the USA. As there are no
population based registries in Indonesia, the exact incidence
and prevalence of cancer are not known. However, data collected from hospitals in several regions shows that cancer incidence increased by 28% per year during the last decade (1,6).
Data which have been collected from 13 pathological laboratories throughout Indonesia during the period of 198891 show
that in the combined picture, cervical, breast, lymph node, skin
and nasopharynx are the five major anatomical sites for cancer
disease (8) (Table 1). Among females, the most common
cancers are cervical, breast and ovarian cancer (Table 2), and
among males skin, nasopharynx and lymph node cancer (Table
3). The relative proportions between male and female patients
can be seen in Table 4, where most cancer patients are female,
with a proportion of 65.4% in comparison with 34.5% for
males for an observation period of 4 years (198891). The incidence rate of various cancer sites in males and females showed
S20
S21
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