癌症并非死亡判决。如果早发现、早 治疗，它是可治愈的。这是突尼斯 医生们给他们的患者的信息。
癌症并非死亡判决。如果早发现、早 治疗，它是可治愈的。这是突尼斯 医生们给他们的患者的信息。
提高普通公众对癌症预防和治疗的认 识，对于突尼斯公共卫生部的宣传工作至 关重要。这些包括有关辐射医学和技术作 用的教育（见方框“科学”）和向公众解释 核成像技术是安全、无痛和高性价比的。
“人们对核医学应用有一种恐惧症。” 突尼斯Salah Azaïz研究所生物物理和核医学 部主任兼国家辐射防护中心主任Mohamed Faouzi Ben Slimane说。“我们定期开展公 众宣传运动，以便在辐射技术用于癌症 治疗的好处和有效性方面消除愚昧和提 高认识。”
医生们确信，他们可以通过精心筹划的 有针对性活动提供有关医学成像和放射治 疗及其如何帮助改善对患者治疗的简单、 相关和实用的信息来克服心理障碍。“成 功的是我们将癌症的‘禁忌’非神秘化， 使更多的人前来接受检查。”Ben Slimane说道。
根据突尼斯公共卫生部的统计，从 2011年到2015年新增癌症病例大约8000例， 其中肺癌和乳腺癌最为常见。Salah Azaïz研 究所每年诊断超过2万例，对其中1.2万例进 行了治疗。“我们必须确保放射治疗和施 加的剂量是精确的，并进行仔细监测，因 为我们的重点是对癌症患者的治疗。”Ben Slimane 补充道。过去几年里，突尼斯的癌 症病例一直在增加。总数从1994年的2553 例增加到2009年的3926例，年平均增加 3.3%。然而，这个平均值只是一个相对值， 在2009年和2011年间的癌症病例为3715例， 并没有显著降低。
像大多数中低收入国家一样，愈来愈 大的癌症负担正对突尼斯的公共卫生体系 造成巨大的压力。在国际原子能机构的支 持下，这个国家的医生们正在致力于满足 日益增多的癌症治疗需求，包括说服人们 尽早去接受癌症治疗。
早发现、迅速治疗
对医务人员进行不间断的培训是必不 可少的。“不仅是这些技术能帮助像我这样 的肿瘤学家来观察身体和选择处理不同类 型癌症所需的最佳治疗方法，而且我们也 需要确保我们使用正确的放射药物。这些 药物对追踪所取得的进展和评估身体的反 应及功能至关重要。”Ben Slimane解释道。
这是一个国际原子能机构正在发挥重 要作用的领域。国际原子能机构在适当和 安全使用放射源进行癌症治疗方面向突尼 斯提供了培训、知识转让和援助。国际原 子能机构专家对放射药物学家和医学物理学家进行了培训，以改进质量控制，提高辐 射医学及设备的安全利用。
“我们同医学物理学家携手合作，确 保他们拥有正确的知识，得到适当的培训， 以保护自身和患者。”儿科放射医生、前 国家辐射防护中心主任Azza Hammou说。 “我们的安全方案符合国际原子能机构的 安全标准。”她说，进行核医学应用操作 的医生和技术人员必须执行正确的操作规 程，严格遵守安全准则。
辐射医学的质量保证是一个复杂的过 程。它涵盖影像诊断和放射治疗的临床、 物理和技术方面的评估，以及对避免差错、 事故和误诊必不可少的管理控制。国际原 子能机构的支持包括为在医院实施和审查 放射治疗、核医学和放射学诊断的质量保 证计划提供技术指导。
国际原子能机构几十年里一直支持突 尼斯经过自身努力来改善癌症防治。国际 原子能机构技术合作司突尼斯计划管理官 员Adnan Atwa说，这个国家现在一千万人 口中有17台放射治疗机，居大多数非洲国 家之前。自2013年以来，突尼斯政府在国 际原子能机构的支持下，在该国的突尼斯、 苏斯和斯法克斯三个城市建立了放射治疗中心，装备了新一代的直线加速器。这些治 疗患者最常用的直线加速器能够对肿瘤施 以精确定位的高能X射线照射。国际原子 能机构还通过在医学物理和放射治疗方面 提供专业培训（包括进修和科学访问）支 持该国。
为评估突尼斯的癌症防治能力和对其 国家综合癌症防治计划提供建议，国际原 子能机构及其伙伴于2013年后期对突尼斯 实施了一次国际原子能机构“治疗癌症行 动计划”综合工作组访问。这次访问为这 个国家在加强癌症防治规划、预防、早期 检测、诊断、治疗和姑息护理的能力方面 确定优先行动提供了帮助。它也有助于加 强突尼斯的癌症积极登记，保持对癌症病 例的跟踪。
2012年，全球报告新增 癌症病例1410万。预计 到2030年，全球报告新 增癌症病例将达 到2460万。
About 6600 new cases of cancer were recorded in Tunisia in 2014, according to the Ministry of Health, with lung and breast cancer being the most common. According to Ben Slimene, over 19 000 diagnoses are conducted annually at the Salah Azaïez Institute, with over 9000 patients undergoing treatment. “We have to ensure that the radiation treatment and dosages are accurate, carefully monitored, as our prime priority is the care given to cancer patients,” he added. Tunisia also has an active cancer registry that keeps track of cancer cases.
As in a majority of low and middle income countries, especially in Africa, the growing cancer burden is putting considerable strain on the public health system in Tunisia. Tunisian doctors are working hard, with the support of the IAEA, to meet the growing demands in cancer care, which includes convincing people to undertake cancer therapy at the earliest opportunity, Ben Slimene said.
Catch early, treat swiftly
Ongoing training of medical staff is also essential. “Not only do these technologies help oncologists like me to view the body and to select the best treatment required to deal with different types of cancer, but we need to use the correct radiopharmaceuticals, which are vital to track the progress achieved, and assess how the body is reacting and functioning,” Ben Slimene said.
This is where the IAEA is playing an important role. It has assisted Tunisia with training, knowledge transfer, and assistance in the proper and safe use of radioactive sources in cancer treatment. IAEA experts have conducted workshops for radiopharmacists and medical physicists to improve quality control and the safe use of radiation medicine and equipment for cancer control.
“We work hand-in-hand with medical physicists to ensure that they have the right knowledge and training to protect themselves and the patients,” said Azza Hammou, a paediatric radiologist and the former Head of the National Centre of Radiation Protection. “Our safety protocols are in line with the IAEA Safety Standards.” Doctors and technicians handling nuclear medical applications have to implement correct procedures while following safety guidelines strictly, he said.
Quality assurance in radiation medicine is a multi-step process. It covers the assessment of clinical, physical and technical aspects of diagnostic imaging and radiation treatment, and management controls that are essential to avoid errors, accidents and misdiagnoses. The IAEA’s support includes technical guidance for implementing and reviewing quality assurance programmes at hospitals for radiotherapy, nuclear medicine and diagnostic radiology.
IAEA support
The IAEA has supported Tunisia in its efforts towards cancer control for decades. The country now has 17 radiotherapy machines for its population of 10 million, placing Tunisia above the most countries in Africa with regard to access to radiotherapy, said Abdou Salam Ndiath, programme management officer at the IAEA. Since 2013, the Tunisian government, with IAEA support, has established three radiotherapy centres in Tunis, Sousse and Sfax, which are equipped with a new generation of linear accelerators (LINAC). These accelerators are most commonly used to treat patients by delivering very precisely localised, high-energy x-ray irradiation to tumours. The IAEA is also assisting the country with training in medical physics and radiotherapy.
To assess Tunisia’s cancer control capacities and provide recommendations on the comprehensive national cancer control programme, the IAEA and its partners conducted an imPACT review in Tunisia in late 2013. This has helped the country to identify priority actions for strengthening cancer control planning, prevention, early detection, diagnosis, treatment and palliative care capacities.
