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Descriptive Epidemiology and Cancer Prevention and Control

Descriptive Epidemiology and Cancer Prevention and Control. Resa M. Jones, M.P.H., Ph.D. Special Topic: Cancer Control January 23, 2006 rmjones2@vcu.edu. Learning Objectives. Students should be able to: Explain the impact of cancer internationally and nationally

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Descriptive Epidemiology and Cancer Prevention and Control

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  1. Descriptive Epidemiology and Cancer Prevention and Control Resa M. Jones, M.P.H., Ph.D. Special Topic: Cancer Control January 23, 2006 rmjones2@vcu.edu

  2. Learning Objectives • Students should be able to: • Explain the impact of cancer internationally and nationally • Identify the most prevalent cancers internationally and nationally • Identify the leading causes of cancer death internationally and nationally • Explain the difference in cancer incidence and death rates by gender, age, and race/ethnicity • Identify the relationship between cancer control and disease frequency measures • Explain the historical perspective of cancer control • Understand the cancer control continuum and explain its implication to public health • Identify the differences between clinical and intervention studies • Explain important factors and trends affecting cancer control and directions for future research

  3. What is cancer? • Cancer is a group of diseases characterized by uncontrolled growth and spread of abnormal cells. • Cancer is caused by external factors and internal factors which may act together to initiate or promote carcinogenesis.

  4. Progression Initiation Promotion Biologic Basis for Cancer Control Normal cell Initiated cell Pre-cancerous cell CANCER

  5. Rates • Incidence • Prevalence • Specific • Crude • Adjusted/Standardized • SMR/SIR

  6. Cancer incidence for the regions of the world, 2002 estimates

  7. Age standardized incidence rates for all cancers* by region of the world, 2002 estimates

  8. The most commonly diagnosed cancers* worldwide, 2002 estimates

  9. Trends in the numbers of new cases being diagnosed worldwide, selected cancers, 1975-2000

  10. The proportion of all deaths caused by cancer in the different regions of the world, 2002

  11. The most common causes of death from cancer* worldwide, 2002 estimates

  12. Surveillance

  13. Mortality: Leading Causes of Death No. of deaths % of all deaths Rank Cause of Death 1. Heart Diseases 696,947 28.5 2. Cancer557,271 22.8 3. Cerebrovascular diseases 162,672 6.7 4. Chronic lower respiratory diseases 124,816 5.1 5. Accidents (Unintentional injuries) 106,742 4.4 6. Diabetes mellitus 73,249 3.0 7. Influenza and pneumonia 65,681 2.7 • Alzheimer disease 58,866 2.4 • Nephritis 40,974 1.7 10. Septicemia 33,865 1.4 Source: US Mortality Public Use Data Tape 2002, National Center for Health Statistics, Centers for Disease Control and Prevention, 2004.

  14. Change in the US Death Rates* by Cause, 1950 & 2001 1950 2001 Rate Per 100,000 HeartDiseases CerebrovascularDiseases Cancer Pneumonia/Influenza * Age-adjusted to 2000 US standard population. Sources: 1950 Mortality Data - CDC/NCHS, NVSS, Mortality Revised. 2001 Mortality Data–NVSR-Death Final Data 2001–Volume 52, No. 3. http://www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_03.pdf * Age-adjusted to 2000 US standard population. Sources: 1950 Mortality Data - CDC/NCHS, NVSS, Mortality Revised. 2001 Mortality Data–NVSR-Death Final Data 2001–Volume 52, No. 3. http://www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_03.pdf

  15. Estimated New Cancer Cases Men710,040 Women662,870 Prostate 33% Lung and bronchus 13% Colon and rectum 10% Urinary bladder 7% Melanoma of skin 5% Non-Hodgkin 4% lymphoma Kidney 3% Leukemia 3% Oral Cavity 3% Pancreas 2% All Other Sites 17% 32% Breast 12% Lung and bronchus 11% Colon and rectum 6% Uterine corpus 4% Non-Hodgkin lymphoma 4% Melanoma of skin 3% Ovary 3% Thyroid 2% Urinary bladder 2% Pancreas 21% All Other Sites *Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. Source: American Cancer Society, 2005.

  16. Estimated New Cancer Cases and Survival NOTE: n.a. = not applicable. 1. The 5-year relative survival rate indicates that a person will not die from causes directly related to their cancer within 5 years. 2. Includes other sites not shown separately. 3. Survival rates for females only. 4. All types combined. Source: U.S. National Institutes of Health, National Cancer Institute.

  17. Cancer Incidence Rates* for Women, US, 1975-2001 Rate Per 100,000 Breast Colon & rectum Lung & bronchus Uterine corpus Ovary *Age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, 1975-2001, Division of Cancer Control and Population Sciences, National Cancer Institute, 2004.

  18. Cancer Incidence Rates* for Men, US, 1975-2001 Rate Per 100,000 Prostate Lung & bronchus Colon & rectum Urinary bladder Non-Hodgkin lymphoma *Age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, 1975-2001, Division of Cancer Control and Population Sciences, National Cancer Institute, 2004.

  19. Estimated Cancer Deaths Men295,280 Women275,000 Lung and bronchus 31% Prostate 10% Colon and rectum 10% Pancreas 5% Leukemia 4% Esophagus 4% Liver and intrahepatic 3%bile duct Non-Hodgkin 3% Lymphoma Urinary bladder 3% Kidney 3% All other sites 24% 27% Lung and bronchus 15% Breast 10% Colon and rectum 6% Ovary 6% Pancreas 4% Leukemia 3% Non-Hodgkin lymphoma 3% Uterine corpus 2% Multiple myeloma 2% Brain/ONS 22% All other sites ONS=Other nervous system. Source: American Cancer Society, 2005.

  20. Cancer Death Rates*, for Women, US,1930-2001 Rate Per 100,000 Lung & bronchus Uterus Breast Colon & rectum Stomach Ovary Pancreas *Age-adjusted to the 2000 US standard population. Source: US Mortality Public Use Data Tapes 1960-2001, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2004.

  21. Cancer Death Rates*, for Men, US,1930-2001 Rate Per 100,000 Lung & bronchus Stomach Prostate Colon & rectum Pancreas Leukemia Liver *Age-adjusted to the 2000 US standard population. Source: US Mortality Public Use Data Tapes 1960-2001, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2004.

  22. Cancer Incidence Rates* by Sex and Race,All Sites, 1975-2001 Rate Per 100,000 African American men White men White women African American women *Age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, 1975-2001, Division of Cancer Control and Population Sciences, National Cancer Institute, 2004.

  23. SEER Age Adjusted Incidence Rates by RaceAll Cancer Sites, All AgesSEER 9 Registries for 1973-2002

  24. SEER Age Adjusted Incidence Rates by SexAll Cancer Sites, All AgesSEER 9 Registries for 1973-2002

  25. Cancer Incidence Rates* by Race and Ethnicity, 1997-2001 Rate Per 100,000 *Age-adjusted to the 2000 US standard population. †Hispanic is not mutually exclusive from whites, African Americans, Asian/Pacific Islanders, and American Indians. Source: Surveillance, Epidemiology, and End Results Program, 1975-2001, Division of Cancer Control and Population Sciences, National Cancer Institute, 2004.

  26. Cancer Death Rates* by Sex and Race, US, 1975-2001 Rate Per 100,000 African American men White men African American women White women *Age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, 1975-2001, Division of Cancer Control and Population Sciences, National Cancer Institute, 2004.

  27. Age-Adjusted Total US Mortality RatesAll Cancer Sites, All AgesFor 1992-2002 by 'Expanded' Race and Sex

  28. Cancer Sites in Which African-American Death Rates* Exceed White Death Rates* for Men, US, 1996-2000 Ratio of African American/White African American White Site • All sites 356.2 249.5 1.4 • Larynx 5.7 2.4 2.4 • Prostate 73.0 30.2 2.4 • Stomach 14.0 6.1 2.3 • Myeloma 9.2 4.5 2.0 • Oral cavity and pharynx 7.9 4.0 2.0 • Esophagus 12.2 7.3 1.7 • Liver 9.3 6.0 1.6 • Lung & bronchus 107.0 78.1 1.4 • Pancreas 16.4 12.0 1.4 • Small intestine 0.7 0.5 1.4 • Colon & rectum 34.6 25.3 1.4 *Per 100,000, age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control and Population Sciences, National Cancer Institute, 2003.

  29. Cancer Sites in Which African-American Death Rates* Exceed White Death Rates* for Women, US, 1996-2000 • All sites 198.6 166.9 1.2 • Myeloma 6.6 2.9 2.3 • Stomach 6.5 2.9 2.2 • Uterine cervix 5.9 2.7 2.2 • Esophagus 3.4 1.7 2.0 • Uterine corpus, NOS 7.0 3.8 1.8 • Larynx 0.9 0.5 1.8 • Liver & intrahepatic bile duct 3.0 1.9 1.6 • Pancreas 12.9 8.9 1.5 • Colon & rectum 24.6 17.5 1.4 • Breast 35.9 27.2 1.3 • Urinary bladder 3.0 2.3 1.3 • Soft tissue, including heart 1.7 1.3 1.3 Ratio of African American/White African American White *Per 100,000, age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control and Population Sciences, National Cancer Institute, 2003.

  30. Lifetime Probability of Developing Cancer, By Site, Men, US, 1999-2001 Site Risk All sites 1 in 2 Prostate 1 in 6 Lung and bronchus 1 in 13 Colon and rectum 1 in 17 Urinary bladder 1 in 28 Non-Hodgkin lymphoma 1 in 46 Melanoma 1 in 53 Kidney 1 in 67 Leukemia 1 in 68 Oral Cavity 1 in 73 Stomach 1 in 81 Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 5.2 Statistical Research and Applications Branch, NCI, 2004. http://srab.cancer.gov/devcan

  31. Lifetime Probability of Developing Cancer, By Site, Women, US, 1999-2001 Site Risk All sites 1 in 3 Breast 1 in 7 Lung & bronchus 1 in 18 Colon & rectum 1 in 18 Uterine corpus 1 in 38 Non-Hodgkin lymphoma 1 in 56 Ovary 1 in 68 Melanoma 1 in 78 Pancreas 1 in 81 Urinary bladder 1 in 88 Uterine cervix 1 in 130 Source:DevCan: Probability of Developing or Dying of Cancer Software, Version 5.2 Statistical Research and Applications Branch, NCI, 2004. http://srab.cancer.gov/devcan

  32. Cancer Survival*(%) by Site and Race,1995-2000 African White Difference Site American All Sites 66 55 11 Breast (female) 89 75 14 Colon 64 54 10 Esophagus 16 9 7 Leukemia 48 39 9 Non-Hodgkin lymphoma 60 51 9 Oral cavity 61 39 22 Prostate 100 96 4 Rectum 65 55 10 Urinary bladder 83 62 21 Uterine cervix 74 66 8 Uterine corpus 86 63 23 *5-year relative survival rates based on cancer patients diagnosed from 1995 to 2000 and followed through 2001. Source: Surveillance, Epidemiology, and End Results Program, 1975-2001, Division of Cancer Control and Population Sciences, National Cancer Institute, 2004.

  33. Cancer Incidence & Death Rates* in Children 0-14 Years, 1975-2000 Rate Per 100,000 Incidence Mortality 1975 1980 1985 1990 1995 2000 *Age-adjusted to the 2000 Standard population. Source: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control and Population Sciences, National Cancer Institute, 2003.

  34. Yearly Incidence of Common Childhood Cancers

  35. Cancer Incidence Rates* in Children 0-14 Years, by Site, US, 1996-2000 Site Male Female Total All sites 15.4 13.8 14.6 Leukemia 4.9 4.1 4.5 Acute Lymphocytic 3.9 3.3 3.6 Brain/ONS 3.3 2.9 3.1 Non-Hodgkin lymphoma 1.2 0.4 0.8 Kidney & Renal pelvis 0.9 1.0 0.9 Soft tissue 1.0 1.1 1.0 Bones & Joint 0.8 0.5 0.6 Hodgkin’s disease 0.6 0.6 0.6 * Per 100,000, age-adjusted to the 2000 US standard population. ONS = Other nervous system Source: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control and Population Sciences, National Cancer Institute, 2003

  36. Cancer Death Rates* in Children 0-14 Years, by Site, 1996-2000 Site Male Female Total All sites 2.8 2.3 2.5 Leukemia 0.9 0.7 0.8 Acute Lymphocytic 0.4 0.3 0.4 Brain/ONS 0.8 0.7 0.7 Non-Hodgkin lymphoma 0.1 0.1 0.1 Soft tissue 0.1 0.1 0.1 Bones & Joint 0.1 0.1 0.1 Kidney & Renal pelvis 0.1 0.1 0.1 * Per 100,000, age-adjusted to the 2000 US standard population. ONS = Other nervous system Source: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control and Population Sciences, National Cancer Institute, 2003.

  37. Trends in Survival, Children 0-14 Years, All Sites Combined, 1974-1999 Year ofDiagnosis Age 5 - Year Relative Survival Rates * 1974 - 76 1974 - 761992 - 99 1974 - 76 0 - 4 Years 5 - 9 Years 10 - 14 Years 1992 - 99 1992- 99 *5-year relative survival rates, based on follow up of patients through 2000.Source: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control and Population Sciences, National Cancer Institute, 2003.

  38. Lung Cancer • Risk factors • Cigarette smoking, environmental exposures, tuberculosis • Detection/Prevention • Reduce exposure to tobacco smoke

  39. Breast Cancer • Risk Factors • Age, family history, biopsy, breast density, early menstruation, obesity after menopause, recent use of oral contraceptives, hormone therapy, late or no children, alcohol, breast feeding, exercise • Early Detection • Mammography and clinical breast exam every year after age 40 (ACS)

  40. Prostate Cancer • Risk factors • Age, ethnicity, family history, dietary fat?, weight? • Early detection/prevention >50yrs old • PSA blood test/yr • Digital rectal exam/yr

  41. Colorectal Cancer • Risk factors • Age, family history, smoking , alcohol, obesity, exercise, high fat diet/red meat • Early Detection/Prevention • 4 modalities recommended for people age 50 and older • Fecal occult blood test (FOBT) every year • Flexible sigmoidoscopy every 5 years • Colonoscopy every 10 years • Double-contrast barium enema every 5 years

  42. Cancer control: Historical perspective • 1913 • American Society for the Control of Cancer (became American Cancer Society in 1945) • American College of Surgeons formed (Developed standards for cancer clinics in 1930) • 1937 • National Cancer Institute formed “[to] prompt use of most effective methods of prevention, diagnosis and treatment of cancer”

  43. Cancer control: Historical perspective • 1971 • National Cancer Act Cancer centers responsible for conducting cancer demonstration and outreach programs • 1974 • Division of cancer prevention and control (DCPC) formed at NCI • 1983 • Cancer control defined • Clinical Community Oncology Programs (CCOP) • Clinical Cooperative Group Trials

  44. Cancer control: Historical perspective • 1997 • DCPC at NCI splits into two divisions: • Cancer Prevention • Cancer Control and Population Science • 1998/1999 • New Strategy, new definition, new model

  45. Definition: Cancer control • …the reduction of cancer incidence, morbidity, and mortality through an orderly sequence from research on interventions and their impact in defined populations to the broad systematic application of the research results. (Old) • …the conduct of basic and applied research in the behavioral, social, health and population sciences to create or enhance interventions that, independently or in combination with biomedical approaches, reduce cancer risk, incidence, morbidity and mortality, and improve quality of life (Cancer Control Review Group, 1998 - modified).

  46. Fig. 1 Cancer control research activities. Adapted from the 1994 Advisory Committee on Cancer Control, National Cancer Institute of Canada (61). Intervention Research Knowledge synthesis Surveillance Research Fundamental Research Application and Program Delivery Reducing the cancer burden

  47. What is cancer control research? • Research that aims to reduce risk, incidence, and deaths from cancer as well as enhance the quality of life for cancer survivors. • The DCCPS conducts and supports an integrated program of the highest quality genetic, epidemiologic, behavioral, social, applied, and surveillance cancer research. Cancer control research aims to understand the causes and distribution of cancer in populations, support the development and implementation of effective interventions, and monitor and explain cancer trends in all segments of the population. Central to these activities is the process of synthesis and decision-making that aids in evaluating what has been learned, identifying new priorities and strategies, and effectively applying research discoveries to reduce the cancer burden.

  48. How much cancer incidence and mortality can we prevent by 2015? IncidenceMortality

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