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ONCOLOGY Epidemiology

ONCOLOGY Epidemiology. ONCOLOGY Epidemiology. Leading cancers worldwide. Total New Rank Males Females Both Sexes Cases. 1 Lung Breast Lung 1,037,000 2 Stomach Colon/rectum Stomach 798,000 3 Colon/rectum Cervix uteri Breast 796,000 4 Prostate Stomach Colon/rectum 783,000

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ONCOLOGY Epidemiology

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  1. ONCOLOGYEpidemiology

  2. ONCOLOGYEpidemiology Leading cancers worldwide Total NewRank Males Females Both Sexes Cases 1 Lung Breast Lung 1,037,000 2 Stomach Colon/rectum Stomach 798,000 3 Colon/rectum Cervix uteri Breast 796,000 4 Prostate Stomach Colon/rectum 783,000 5 Liver Lung Liver 437,000 6 Mouth/pharynx Ovary Prostate 396,000 7 Esophagus Corpus uteri Cervix uteri 371,000 8 Bladder Liver Mouth/pharynx 363,000 9 Leukemia Mouth/pharynx Esophagus 316,000 10 NHL* Esophagus Bladder 261,000 *Non-Hodgkin’s lymphoma. Adapted from Parkin DM, et al. CA Cancer J Clin. 1999;49:39.

  3. ONCOLOGYEpidemiology Cancer incidence by world region Males Females Incidence/ Incidence/Rank Region 100,000 Region 100,000 1 N. America 369.9 N. America 277.5 2 Australia/N.Z. 312.7 Australia/N.Z. 254.0 3 W. Europe 294.8 N. Europe 234.5 4 Japan 270.9 S. America* 230.1 5 N. Europe 270.0 W. Europe 210.4 6 E. Europe 269.4 Micronesia/ 205.2 Polynesia 7 S. Europe 256.0 Southern Africa 187.8 8 S. America* 255.1 Melanesia 185.6 9 Southern Africa 247.4 S. America† 185.0 10 Eastern Asia‡ 235.7 Central America 180.1 *Temperate South America. †Tropical South America. ‡Other than Japan or China. Adapted from Parkin DM, et al. CA Cancer J Clin. 1999;49:43.

  4. ONCOLOGYEpidemiology Leading causes of death in 2001 Percentage of Total Deaths, US Heart Diseases Cancer Cerebrovascular Diseases Chronic Obstructive Lung Diseases Accidents Pneumonia & Influenza Diabetes Mellitus Suicide Nephritis Cirrhosis of the Liver Adapted from Greenlee RT, et al. CA Cancer J Clin. 2001:51;15-36.

  5. ONCOLOGYEpidemiology Evolution of cancer death rates, males 80 Pancreas Liver Prostate 70 Stomach Lung & Bronchus 60 Colon & Rectum Leukemia 50 Rate per 100,000 Male Population 40 30 20 10 0 1930 1940 1950 1960 1970 1980 1990 1997 Year Greenlee RT, et al. CA Cancer J Clin. 2001;51:15-36.

  6. ONCOLOGYEpidemiology Evolution of cancer death rates, females 80 Uterus Breast Pancreas 70 Ovary Stomach 60 Lung & Bronchus Colon & Rectum 50 Rate per 100,000 Female Population 40 30 20 10 0 1930 1940 1950 1960 1970 1980 1990 1997 Year Greenlee RT, et al. CA Cancer J Clin. 2001;51:15-36.

  7. Males by Age (years), US All Ages Lung & bronchus 91,399 Prostate 32,203 Colon & rectum 28,024 Pancreas 13,806 NHL 12,205 20-39 Leukemia 663 Brain & ONS* 627 NHL† 612 Lung & bronchus 484 Colon & rectum 404 40-59 Lung & bronchus 15,521 Colon & rectum 4,539 Pancreas 2,671 NHL 2,399 Esophagus 2,141 60-79 Lung & bronchus 59,377 Prostate 15,742 Colon & rectum 15,615 Pancreas 8,070 NHL 6,341 > 80 Lung & bronchus 16,011 Prostate 15,373 Colon & rectum 7,455 Bladder 3,034 Pancreas 2,945 ONCOLOGYEpidemiology Mortality for leading cancers in 2001 *Other nervous system. † Non-Hodgkin’s lymphoma. Adapted from Greenlee RT, et al. CA Cancer J Clin. 2001;51:15-36.

  8. Females by Age (years), US All Ages Lung & bronchus 63,075 Breast 41,737 Colon & rectum 28,950 Pancreas 14,529 Ovary 13,391 20-39 Breast 1,604 Uterine cervix 634 Leukemia 456 Lung & bronchus 442 Brain & ONS* 401 40-59 Breast 11,889 Lung & bronchus 10,155 Colon & rectum 3,472 Ovary 2,841 Pancreas 1,775 60-79 Lung & bronchus 39,077 Breast 18,292 Colon & rectum 12,950 Pancreas 7,454 Ovary 7,038 > 80 Lung & bronchus 13,392 Colon & rectum 12,174 Breast 9,949 Pancreas 5,193 NHL† 3,881 ONCOLOGYEpidemiology Mortality for leading cancers in 2001 *Other nervous system. †Non-Hodgkin’s lymphoma. Greenlee RT, et al. CA Cancer J Clin. 2000;50:15-36.

  9. ONCOLOGYEpidemiology Male cancer statistics Estimated incidence Estimated deaths 3% 31% 5% 3% 3% 10% 11% 3% 4% 5% 22% Melanoma of skin Oral cavity & pharynx Lung & bronchus Pancreas Kidney Colon & rectum Prostate Urinary bladder Leukemia Non-Hodgkin’s lymphoma All others Esophagus Lung & bronchus Pancreas Liver Kidney Colon & rectum Prostate Urinary bladder Leukemia Non-Hodgkin’s lymphoma All others 5% 3% 14% 2% 3% 10% 31% 6% 3% 5% 18% Adapted from Greenlee RT, et al. CA Cancer J Clin. 2000;51:18, 15-36.

  10. ONCOLOGYEpidemiology Female cancer statistics Estimated incidence Estimated deaths Brain Breast Lung & bronchus Pancreas Stomach Colon & rectum Ovary Uterine corpus Non-Hodgkin’s lymphoma Leukemia All others Melanoma of skin Thyroid Breast Lung & bronchus Pancreas Colon & rectum Ovary Uterine corpus Urinary bladder Non-Hodgkin’s lymphoma All others 4% 2% 31% 13% 2% 11% 4% 6% 2% 4% 21% 2% 15% 25% 6% 2% 11% 5% 2% 5% 4% 23% Adapted from Greenlee RT, et al. CA Cancer J Clin. 2001;51:18, 15-36.

  11. ONCOLOGYEpidemiology Known cancer causes • Environmental factors • Occupational exposure • Lifestyle factors • Biologic agents • Pharmacologic/Iatrogenic factors Cole P, Rodu B. Cancer: Principles & Practice of Oncology. 6th ed. 2001;241-252.

  12. ONCOLOGYEpidemiology Alcohol-related cancers • Cancer of the esophagus • Head and neck cancer • Liver cancer • Breast cancer Cole P, Rodu B. Cancer: Principles & Practice of Oncology. 6th ed. 2001;241-252.Winer E, et al. Cancer: Principles & Practice of Oncology. 6th ed. 2001;1651-1717.

  13. ONCOLOGYEpidemiology Smoking-related cancers Major cause • Lung • Larynx • Oral cavity • Esophagus Contributory factor • Pancreas • Bladder • Kidney • Stomach • Uterine cervix Cole P, Rodu B. Cancer: Principles & Practice of Oncology. 6th ed. 2001;241-252.

  14. ONCOLOGYEpidemiology Virus-related cancers Agents • Hepatitis B • Hepatitis C • HIV-1 • HTLV-1 • HPV • Epstein-Barr Site of Cancer Liver Liver Kaposi’s sarcoma Adult T-cell lymphoma Uterine cervix Burkitt’s lymphoma, nasopharynx,Hodgkin’s disease Cole P, Rodu B. Cancer: Principles & Practice of Oncology. 6th ed. 2001;241-252.

  15. ONCOLOGYEpidemiology Bacterial-related cancers Agents Helicobacter pylori Schistosoma haematobium Opisthorchis viverrini Site of Cancer Stomach Urinary bladder Liver Cole P, Rodu B. Cancer: Principles & Practice of Oncology. 6th ed. 2001;241-252.

  16. ONCOLOGYEpidemiology Pharmacologic/iatrogenic contributors Agent Ionizing radiation Type of Cancer Breast cancer Leukemia Skin cancer Thyroid cancer Lung cancer Ullrich RL, et al. Cancer: Principles & Practice of Oncology. 6th ed. 2001;195-206.

  17. ONCOLOGYEpidemiology Pharmacologic/iatrogenic contributors (cont’d) Pharmaceuticals Agents Site of Cancer Cancer chemotherapeutic drugs Bone marrow Immunosuppressive drugs Reticuloendothelial system Exogenous hormonesNonsteroidal estrogens Vagina, breast, testisSteroidal estrogens EndometriumOral contraceptives Liver, endometriumTamoxifen Endometrium Phenacetin analgesics Kidney, pelvis, bladder Adapted from Cole P, Rodu B. Cancer: Principles & Practice of Oncology. 6th ed. 2001;241-252.

  18. ONCOLOGYEpidemiology Occupational-related cancers Selected Industries Associated with Exposure to Carcinogens Industry Carcinogen Cancer Shipbuilding, demolition, insulation Asbestos Lung, pleura, skin Varnish, glue Benzene Leukemia Pesticides, smelting Arsenic Lung, skin, liver Mineral refining and manufacturing Nickel, chromium Lung, nasal passages Furniture manufacturing Wood dusts Nasal passages Petroleum products Polycyclic hydrocarbons Lung Rubber manufacturing Aromatic amines Bladder Vinyl chloride Vinyl chloride Liver Radium Radium Lung, bone Outdoor occupations Ultraviolet light Skin Costanza ME, et al. American Cancer Society Textbook of Clinical Oncology. 3rd ed. 2001;55-74.

  19. ONCOLOGYEpidemiology Genetic risk factors: mechanisms of cancer predisposition • Germline tumor suppressor gene inactivation • Germline oncogene activation • DNA repair defects • Ecogenetic traits • Abnormal tissue architecture • Humoral tumor promoters and regressors Bale AE, Brown SJ. Cancer: Principles & Practice of Oncology. 6th ed. 2001;207-217.

  20. ONCOLOGYEpidemiology Genetic risk factors: characteristics of cancer families • Family history of cancer • Cancer appears earlier in life • Multiple and bilateral tumors • May include rare tumor types (eg, retinoblastoma) • Multisystem involvement Bale AE, Brown SJ. Cancer: Principles & Practice of Oncology. 6th ed. 2001;207-217.

  21. ONCOLOGYEpidemiology Genetic risk factors: Familial cancer syndromes Familial Cancer Syndrome Site of Cancer Neurofibromatosis type 1 CNS, neurofibrosarcomas, pheochromocytomas, leukemia Neurofibromatosis type 2 CNS, spinevon Hippel-Lindau disease CNS, renal cell, spine, pancreas, adrenal glands Li-Fraumeni syndrome CNS, breast, head and neck, soft tissue, osteosarcoma, adrenal cortical carcinomas, leukemia Wilms’ tumor gene Wilms’ tumor Basal cell carcinoma syndrome Skin, CNS, ovary Bale AE, Li FP. Cancer: Principles & Practice of Oncology. 5th ed. 1997;285-293. Linehan WM, et al. Cancer: Principles & Practice of Oncology. 5th ed. 1997;1253-1271.

  22. ONCOLOGYEpidemiology Genetic risk factors: Familial cancer syndromes (cont’d) Familial Cancer Syndrome Site of Cancer Familial adenomatous polyposis coli Colorectal, jaw, skull, skin, stomach, CNS Hereditary nonpolyposis colorectal Colorectalcancer Cowden’s syndrome Thyroid, stomach, breast, ovary BRCA-1 Breast, ovary BRCA-2 Breast (female and male) Bale AE, Li FP. Cancer: Principles & Practice of Oncology. 5th ed. 1997;285-293. Safai B. Cancer: Principles & Practice of Oncology. 5th ed. 1997;1883-1933. Cohen AM, et al. Cancer: Principles & Practice of Oncology. 5th ed. 1997;1144-1197. Dickson RB, Lippman ME. Cancer: Principles & Practice of Oncology. 5th ed. 1997;1541-1557.

  23. ONCOLOGYEpidemiology Reducing mortality The National Cancer Institute estimates that cancer mortality rates could be significantly reduced, as follows: • 8% to 16% by a 15% decrease in tobacco use among adults • 8% by dietary measures (ie, reduction of dietary fat to <25% and double dietary fiber) • 3% by early screening and early detection • 10% to 26% by the wider application of state-of-the art treatments Bal DG, et al. American Cancer Society Textbook of ClinicalOncology. 2nd ed. 1995;40-63.

  24. ONCOLOGYEpidemiology Risk reduction • Relative risk = risk of developing a disease in the population exposed to a risk factor, divided by the risk of developing that same disease among those not exposed to that same risk factor • Population attributable risk = the percentage by which the disease could be eliminated if exposure to the risk factor was eliminated Bal DG, et al. American Cancer Society Textbook of ClinicalOncology. 2nd ed. 1995;40-63.

  25. ONCOLOGYEpidemiology Modifiable risk factors Site of Relative Attributable Cancer Risk Factor Risk Risk LungCigarette smoking Strong 87% Occupation Strong 13% Residential radon exposure Moderate 10% Second-hand smoke Weak 2% Diet low in beta carotene Weak - Dietary fat/low-vegetable diet Possible 5% Urban air pollution Possible - ColorectalHigh-fat/low-vegetable diet Weak 50% Physical inactivity Weak 20% Occupation Weak - Obesity Weak - Adapted from Bal DG, et al. American Cancer Society Textbook of ClinicalOncology. 2nd ed. 1995;44.

  26. ONCOLOGYEpidemiology Modifiable risk factors (cont’d) Site of Relative Attributable Cancer Risk Factor Risk Risk BreastFirst full-term pregnancy after age 30 Moderate 7% Large doses of chest radiation Moderate 2% Never married Weak - Never having children Weak 5% Post-menopausal obesity Weak 12% Alcohol consumption Weak - High fat Possible - Low physical activity Possible - Use of diethylstilbestrol Possible - Use of oral contraceptives or ERT Possible - Adapted from Bal DG, et al. American Cancer Society Textbook of ClinicalOncology. 2nd ed. 1995;45.

  27. ONCOLOGYEpidemiology Modifiable risk factors (cont’d) Site of Relative Attributable Cancer Risk Factor Risk Risk CervixMultiple sex partners Moderate 38% Early age at first intercourse Moderate 25% History of STD Moderate 5% Cigarette smoking Weak 32% Use of barrier contraceptives Weak - Low dietary intake of vitamin A, Weak - beta-carotene, and folate Adapted from Bal DG, et al. American Cancer Society Textbook of ClinicalOncology. 2nd ed. 1995;45.

  28. ONCOLOGYEpidemiology ACS Screening Recommendations for Colorectal, Prostate, Cervical, and Breast Cancer Asymptomatic People (Average Risk) Test/Procedure Sex Age Frequency Colorectal cancer screening M&F >50 Annual FOBT, flexible sigmoidoscopy every 5 years, or both; colonoscopy every 10 years; or double-contrast barium enema every 5 years PSA test + digital rectal exam M >50 Every year if life expectancy > 10 years Pap test F >18* Every year, if normal >3 times, Pap test may be performed less frequently at discretion of physician Pelvic exam F >18* Every year Breast self-exam F >20 Every month Breast clinical exam F 20-39 Every 3 years>40 Every year Mammography F >40 Every year Health counseling and cancer M&F 20-39 Every 3 years checkups >40 Every year * Or before if sexually active. † At menopause, for women at high risk for endometrial cancer due to history of infertility, obesity, failure to ovulate, abnormal uterine bleeding, unopposed ERT or tamoxifen use. Adapted from Smith RA, et al. CA Cancer J Clin 2001;51:38-75.

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