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Background This is a systematic assessment of the burden of cancers in Malaysia in 2018 using epidemiologic approach. The purpose of this study was to identify the proportion of cancers in Malaysia that were attributable to the modifiable risk factors of excess weight, alcohol intake, physical inactivity, tobacco smoking and to estimate the number of cancer cases that could be prevented if the exposure to the modifiable risk factor was reduced. Methods We estimated the Population Attributable Fraction (PAF) of the modifiable risk factors to cancers incidences in Malaysia. The two parameters used for the estimation were exposure prevalence from national representative surveys and the relative risk of getting the cancers from worldwide literature review. Results Among 38,426 cancer incidences in 2018 from Globocan data, we estimated that 22.2% (95% confidence interval (CI):14.9 to 29.6%) of the cancer incidences included in this study were attributable to the investigated modifiable risk factors. 39.1% (95% CI:27.2 to 49.7%) and 10.5% (95% CI:5.8 to 15.7%) of cancers in male and female respectively, were attributable to the studied modifiable risk factors. The top main cancers attributed by the risk factors were lung cancer (65.1%; 95% CI:56.4 to 72.9%), laryngeal cancer (63.6%; 95% CI:39.9 to 80.5%), and oesophageal cancer (51.5%; 95% CI:39.9 to 62.0%). For each risk factor studied across genders, tobacco smoking contributed the most (14.3%; 95% CI:9.9 to 17.3%), followed by excess weight (7.0%; 95% CI:4.1 to 10.2%), physical inactivity (1.0%; 95% CI:0.4 to 1.7%) and alcohol intake (0.6%; 95% CI:0.2 to 1.0%). Conclusion Findings from this study suggests that tobacco smoking and excess weight are the two predominant factors out of the four studied risk factors for cancer cases in Malaysia. Nationwide public health prevention campaigns tailored to these risk factors are recommended. However, the other risk factors such as physical inactivity and alcohol intake shall not be neglected. PAFs are estimated based on the best available data that we have currently. Regular collection of other risk factor exposure prevalence data is vital for future analyses.

IntroductionBurden of cancer worldwide and in Malaysia. Cancer is the second leading cause of death globally.About 1 in 6 deaths is due to cancer.Cancer contributed to 9.6 million deaths worldwide and 16,000 deaths in Malaysia in year 2018.Prevention strategies.Around one third of deaths from cancer are due to the 5 leading behavioral and dietary risks: high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco use, and alcohol use. 30–50% of cancers can currently be prevented by avoiding risk factors and implementing existing evidence-based prevention strategies.Objective of this study .To identify the proportion of cancers in Malaysia that were attributable to the modifiable risk factors of overweight, alcohol intake, physical inactivity, tobacco smoking. To estimate the number of cancer cases that could be prevented if the exposure to the modifiable risk factor was reduced. MethodologyThe quantification of the burden of cancer due to risk factors can be estimated by the Population Attributable Fraction (PAF) approach. PAF estimate is interpreted as the proportion of cases that could have been prevented if the exposure to risk factors is reduced to the ideal reference level. The two parameters used for the estimation of PAF were exposure prevalence to selected risk factors(overweight, alcohol intake, physical inactivity and tobacco smoking) and the relative risk of getting the cancers given the exposure. Exposure prevalence (P) was taken from National Health and Morbidity Survey 2006 (NHMS 2006). Relative risks (RR) to cancers were obtained from high quality meta-analysis in the revised Continuous Update Project (CUP) report published in 2018.We estimated the number of cancer cases attributable to the modifiable risk factor(s) by applying the calculated combined PAFs to the cancer incidences obtained from Global Cancer Observatory (Globocan) 2018. Results[Refer to Poster]. DiscussionAccording to Malaysia National Cancer Registry report 2012-2016, the ten most common cancers among Malaysian were breast, colorectal, lung, lymphoma, nasopharynx, leukaemia, prostate, liver, cervix uteri and ovary6 . Although breast cancers and colorectal cancers were the top cancers affecting Malaysian population, the estimated PAFs were lower (less than 10%) due to limited evidence of attribution by the studied risk factors in these two cancers. Notably, PAFs estimates would be higher if the risk factors were strongly related to these two cancers, such as red and processed meat or long term use of hormone replacement therapy. These risk factors can be considered in the future studies. Gender-specific social behaviours such as tobacco smoking explained the vast difference in overall PAF by sexes (PAF male = 47.1% ;PAF female = 2.9%) The main factors affecting Malaysian were obesity, alcohol intake and smoking. On the contrary, physical inactivity has a lesser effect on cancers as the evidence from WCRF suggested it only increased the risk of three types of cancers in this study (colorectal, breast and endometrial). This study showed that laryngeal cancer, lung cancer and oesophageal adenocarcinoma had the highest proportion of potentially avoidable cases. The risk factor associated with these top three estimates was largely by tobacco smoking. This finding was consistent with the fractions of cancer reported by a global review done in 2016, in which more than half of the lung and laryngeal cancer were attributed by smoking7 . As a conclusion, approximately one-fifth (18.3%) of the overall cancers in Malaysia can be prevented by adjusting the modifiable risk factors. From this study, it has re-emphasized that tobacco smoking and excess weight are the two predominant factors for cancer cases in Malaysia. &nbsp

IntroductionVaccination for Covid-19 pandemic is highly anticipated. Initial vast demand for vaccines may cause limited supply, therefore prioritization of population groups could be needed to optimize public health impact. In order to develop effective evidence-based framework for vaccines allocation, exploration on general public’s preferences are equally important. Hence, this study aims to collate Malaysian’s perception on vaccines allocation. MethodologyLiterature review was done to identify priority groups to receive vaccine during pandemic. A web-based selfadministered survey was developed utilizing the Research Electronic Data Capture (REDCap) and disseminated to Malaysian adults. Cross sectional data was collected throughout July 2020. Besides sociodemographic information, respondents were asked to rate the importance of COVID-19 vaccine for different priority groups, using a 5-points Likert scale. For the assessment of willingness-to-pay, respondents were asked to give the maximum price that they were willing to pay in the scenarios of sufficient and limited vaccine supplies. An interim analysis was done to explore associations between sociodemographic factors and importance level for the priority groups by logistic regression. Results[Refer to Poster]. Discussion / ConclusionThe perception of importance level for each group did not differ by sociodemographic determinants, except for priority group with low household income. The top three prioritized groups were health care worker, essential workers, elderly or anyone with comorbidity. These main groups were in line with the priority population stated in the WHO global allocation framework for COVID-19 products. Also, the same groups have been highlighted in National Preparedness Plans during pandemic influenza across worldwide. The rationale for prioritisation of healthcare workers would be twofold: (1) they are at increased risk of acquiring infection and/or passing it to vulnerable patients, (2) they are required for quality medical care and good patient outcomes by treating those affected by the disease. During this Covid-19 pandemic, it was apparent that elderly and those with comorbidity were infected severely. Hence, this vulnerable group was expected to be prioritized, similar to previous pandemic plans. From this study, the mean maximum price the respondents were willing to pay for COVID-19 vaccine was relatively low (below USD 60) compared to USD184.72 from a study in Chile4 . This individual valuation assessment can be used as benchmark for vaccine introduction at our local setting. As a conclusion, Malaysian public’s perceptions on vaccines allocation were fairly consistent across groups. The findings from this study will be the basis to conduct patient-preference analysis using Discrete Choice Experiment to determine the main attributes for vaccines uptake in the future. Also, this will help our country in the development of vaccine management plan to ensure successful uptake by the majority.