(20) epidemiology of cancers 2012

8/13/2019 (20) Epidemiology of Cancers 2012

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EPIDEMIOLOGY OF CANCERS

Sudarsa

Division of Surgical Oncology, Department of Surgery.

School of Medicine University of UdayanaSanglah Hospital Denpasar



Epidemiology is a science, which studying

a disease, its distribution and changes of a

particular disease in a (risk) population.

Cancer Epidemiology is a science, which

studying Cancers, their distribution, changes.

differences in a population, and comparingdifferences among populations, races, etc.



Cancer Epidemiology : GOALS

• CAUSATION OF CANCERS

(Risk factors, etiology)

• EFFECTIVE – PREVENTION

reduce incidence/ morbidity

reduce mortality



STUDIES IN CANCER EPIDEMIOLOGY

- MORBIDITY

- Prevalence- Incidence

- Differences

- Data ( pathology/ Autopsy, Hospital, population

based registry, Ad-hoc survey/ safari survey)

- MORTALITY

- Time Trends, interpretations

- Differences

- Cancer mortality and occupation

- Cancer death and other characteristics

- etc



WHO PRIORITIES IN

CANCER MANAGEMENT

• Primary Prevention (“Public Education”, “Political

will”, vaccination).

• Secondary Prevention : “Early Detection” Screening Program (mass or individual)

• Tertiary Prevention : Prompt Diagnosis &

Appropriate Treatment

• Palliative Management pain management.



STUDY – CANCER EPIDEMIOLOGY

- Descriptive Epidemiology.

Data obtained from Hospital, pathology.

autopsy, safari survey, ad-hoc survey.

population based tumor registry.

- Analytical Epidemiology

Cross Sectional Study

Case Control Retrospective Study

Prospective Cohort Study



Global Cancer Statistics

• GLOBOCAN 2008 (available at http://www.

globocan.iarc.fr)

• 12.7 million cancer cases and 7.6 million cancer

deaths.• Breast cancer is the most frequently diagnosed

cancer and the leading cause of cancer deathamong females,

•

Lung cancer is the leading cancer site in males,comprising 17% of the total new cancer cases and23% of the total cancer deaths.



Number Of New Cancer Cases And Deaths In 2008 For The Ten Leading

Cancer Sites By Sex, Worldwide, And By Level Of Economic

Development.



CANCERS : World Trends

Dikutip dari Clinical Oncology. Abeloff, 2004.



CANCERS : World Trends

Dikutip dari Clinical Oncology, Abeloff, et al, 2004



Looking at Specific Site

Cancer……World Trends



Lung cancer



Colo-Rectal Cancer



Colo-Rectal Cancer : Differences in Migrant

Populations



BREAST CANCER



PRECANCER LESIONS BREAST CANCER



RISK FACTORS

OF BREAST

CANCER.



Breast Cancer in Bali

Hospital & Pathology Based



20 - 25

Th

66 - 70

Th

> 70

Th

26 - 30

Th

31 - 35

Th

36 - 40

Th

41 - 45

Th

46 - 50

Th

51 - 55

Th

56 - 60

Th

61 - 65

Th

umur

0

10

20

30

40

F r e q u e

n c y

umur

BALI BREAST CANCER ACCORDING TO AGE



I IIA IIB IIIA IIIB IIIC IV

std

0

10

20

30

40

50

60

70

F r e q u e n

c y

std

Bali Breast Cancer Population according to Stage.



BREAST CANCER IN BALI

70 – 80% were at stage III & IV

• No mass screening program

• No effective individual program.

• No effective public education

• No effective professional education

• Avoidance of surgery.

• Avoidance of chemotherapy

• Avoidance of radiation therapy

• Less risk of choosing alternative medicines.

• Huge advertisement of traditional medicines/complimentary medicines.



The Success Role of Epidemiological

Study in Cancer :

Cervical Cancer.

Etiology (HPV, H.S.V)

Prevention/ PrimaryLowering the Incidence/ morbidity/

pre-cancer lesions

Effective method of early detection/

mass screening method

better outcome of treatment.

Lowering mortality



CARCINOGENESIS



CANCER CELL.

1. Activation of Oncogenes.

2. Deactivation of Tumor Supressor Genes

3. Defect of DNA Repair Genes.

4. Defect of Apoptosis.



Carcinogen

• 90 – 95% cancers sporadic cancers

• 5 – 10% familial cancers.

• Sporadic cancers environment factors

• 30 – 40% cancers probably preventable.• Material (chemical, radiation, virus, diet) causing

cancers carcinogen.

• Carcinogen could directly causing cancers, or

indirectly.

• Indirect carcinogens (co-carcinogen) have to bemetabolized into more active carcinogen.



CARCINOGEN DAMAGE TO DNA chain

Gene alteration/ mutation

CO-CARCINOGEN ACTIVATED

CARCINOGEN DAMAGE TO DNA

Gene alterations/ mutation

Damage the DNA or structures surround DNA,

That ..if changed would Influence theDNA function transformed cell.

Carcinogens cause mutation mutagens



DAMAGE TO DNA (direct or indirect)

• COULD BE REPAIRED BY DNA REPAIR GENES.

•

OR CELLS COULD BE GEARED INTO CELL CYCLE ARREST.

• OR APOPTOSIS.

• If not corrected, cell will replicate, and will change

its function.



Etiology of Cancer

• Tobacco

• Cancer Susceptibility syndromes (5-10%)

• DNA Viruses

•

RNA Viruses• Inflammation

• Chemical Factors

• Physical Factors

• Dietary Factors

• Obesity and Physical Activity



TOBACCO

• Cigarette smoking, Kreteks, Bidis, Chewingtobacco, Pan and betel quid.

• Cigarette smoking causes well over 1 million

cancer deaths annually worldwide.• Lung cancer is the dominant malignancy

caused by smoking.

•

Carcinogens in tobacco products• Cigarette, Cigar, Pipe, Secondhand/Forced

smoking..



World Smoking Prevalence by Gender

L C D th R t A d P C it Ci tt C ti I Th



Lung Cancer Death Rates And Per Capita Cigarette Consumption In The

United States, 20th Century



Cancer Type Likely Carcinogen Involvementa

Lung PAH, NNK (major) 1,3-butadiene, isoprene,

ethylene oxide, ethyl carbamate,

aldehydes, benzene, metals

Larynx PAH

Nasal NNK, NNN, other N-nitrosamines,

aldehydes

Oral cavity PAH, NNK, NNN

Esophagus NNN, other N-nitrosamines

Liver NNK, other N-nitrosamines, furan

Pancreas NNK, NNAL

Cervix PAH, NNKBladder 4-aminobiphenyl, other aromatic amines

Leukemia Benzene

Colorectal Heterocyclic aromatic amines

Carcinogens and Tobacco-Induced Cancers



ETIOLOGY OF CANCER.

Tobacco and ALCOHOL …

MULTIPLICATIVE EFFECT OF ALCOHOL AND TOBACCO

RR of Oral and pharyngeal cancers relative to tobacco and alcohol intake



NICOTINIC PLAQUE



Conceptual Model For Understanding Mechanisms Of Tobacco Carcinogenesis



Cancer Susceptibility Syndromes

• Familial Adenomatous Polyposis (FAP)

• Hereditary Non Polyposis Colon Cancer (HNPCC)

• Hereditary Breast and Ovarian Cancer (HBOC)

• Neurofibromatosis (NF type 1)

• Xerrodermal Pigmentosum (XP)

• MEN syndromes, Cowden syndromes, ect

• (5-10% of Cancers)



VIRUSES

DNA VIRUSES RNA VIRUSES



Virus Family Type Associated Human Tumors Cofactors

Adenovirus Types 2, 5, 12 Not associated with human

cancer

Flaviviruses Hepatitis C (HCV) Hepatocellular carcinoma —

Hepadnavirus Hepatitis B (HBV) Hepatocellular carcinoma Aflatoxin, alcohol, smoking

Herpesviruses EBV Burkitt’s lymphoma Malaria

Immunoblastic lymphoma Immunodeficiency

Nasopharyngeal carcinoma Nitrosamines

Hodgkin’s lymphoma —

Leiomyosarcomas —

Gastric cancers —

KSHV (HSV8) Kaposi’s sarcoma HIV infectionPulmonary effusion

lymphoma

HIV infection

Castleman’s disease HIV infection

Papillomaviruses HPV-16, -18, -33, -39, others Anogenital cancers and

some upper airway cancers

Smoking, other factors

HPV-5, -8, -17, others ? nonmelanoma skin cancer EV, sunlight,

immunesuppression

Polyomavirus Merkel cell virus Merkel cell carcinomas ImmunosuppressionSV40 (monkey virus) ? Brain tumors —

? Non-Hodgkin’s

lymphomas

—

? Mesotheliomas —

JC virus ? Brain tumors —

BK virus ? Prostate cancer —

Retroviruses HTLV-1 Adult T-cell

leukemia/lymphoma

Uncertain

Human Viruses with Oncogenic Properties



INFLAMMATION



The Contrasting Effects Of Inflammation And Immunity

Associated Factors On Cancer

Ch i I fl t C diti A i t d ith T F ti



Pathologic Condition Associated Tumor(s) Etiologic Agent

Sunburned skin, burn scar Basal cell carcinoma, squamous cell

carcinoma (SCC), melanoma

Ultraviolet light

Severe thermal injury Marjolin’s ulcer (SCC) —

Epidermolysis bullosa SCC Genetic, mechanical

Gingivitis, lichen planus Oral SCC —

Lichen sclerosus Vulvar SCC —

Sialadenitis Salivary gland carcinoma —

Sjögren syndrome, Hashimoto’s

thyroiditis

Mucosa-associated lymphoid tissue

lymphomas

—

Asbestosis, silicosis Mesothelioma, lung carcinoma Asbestos fibers, silica particles

Bronchitis (nitrosamines, peroxides) Lung carcinoma Silica, asbestos, smoking

Reflux esophagitis, Barrett’s esophagus Esophageal carcinoma Gastric acid, alcoholism, smoking

Hematochromatosis Liver Genetic

Liver cirrhosis Hepatocellular carcinoma Alcoholism

Chronic pancreatitis Pancreatic carcinoma Genetic (mutation in trypsinogen gene

on chromosome 7), alcoholism,smoking

Inflammatory bowel disease, Crohn’s

disease, chronic ulcerative colitis

Colorectal carcinoma, small intestine

carcinoma

—

Cystitis, bladder Bladder carcinoma Chronic indwelling, urinary

inflammation catheters

Chronic Inflammatory Conditions Associated with Tumor Formation



Pathologic Condition Associated Tumor(s) Pathogen(s)

Hepatitis Hepatocellular carcinoma Hepatitis B and C virus

Mononucleosis B-cell non-Hodgkin’s and

Burkitts lymphoma

Epstein-Barr virus

AIDS Non-Hodgkin’s lymphoma,

squamous cell carcinoma,

Kaposi’s sarcoma

Human immunodeficiency

virus, human erpes virus type 8

Warts Nonmelanoma skin cancer Papillomaviruses

Pelvic inflammatory disease,

chronic cervicitis

Ovarian carcinoma,

cervical/anal carcinoma

Neisseria gonorrhoeae,

Chlamydia spp., human

papillomaviruses

Osteomyelitis Skin carcinoma in draining

sinuses

Bacteria

Chronic prostatitis Prostate cancer Gram( –) bacteria, others

Conjunctivitis Ocular adnexal lymphoma Chlamydia psittaci

Gastritis/ulcers Gastric adenocarcinoma Helicobacter pylori

Chronic cholecystitis Gall bladder cancer Bacteria, gall bladder stonesOpisthorchiasis, Cholangitis Cholangiosarcoma, colon

carcinoma

Opisthorchis viverrini, O.

sinensis (liver flukes), bile acids

Chronic cystitis Bladder, liver, rectal carcinoma,

follicular lymphoma of the

spleen

Schistosoma hematobium, S.

japonicum, irradiation,

carcinogens

CANCER ASSOCIATED WITH INFLAMMATION CAUSED BY INFECTIOUS AGENTS



CHEMICAL FACTORS



Target Organ Agents Industries Tumor Type

Lung Tobacco smoke, arsenic, asbestos, crystalline

silica, benzo(a)pyrene, beryllium,

bis(chloro)methyl ether, 1,3-butadiene,

chromium VI compounds, coal tar and pitch,nickel compounds, soots, mustard gas, cobalt-

tungsten carbide powders

Aluminum production, coal

gasification, coke production,

hematite mining, painters,

grinding in oil and gas

Squamous, large cell, and small

cell cancer and adenocarcinoma

Pleura Asbestos, erionite Insulation, mining Mesothelioma

Oral cavity Tobacco smoke, alcoholic beverages, nickel

compounds

Boot and shoe production,

furniture manufacturer,

isopropyl alcohol production

Squamous cell cancer

Esophagus Tobacco smoke, alcoholic beverages — Squamous cell cancer

Gastric Smoked, salted and pickled foods Rubber industry Adenocarcinoma

Colon Heterocyclic amines, asbestos Pattern makers Adenocarcinoma

Liver Aflatoxin, vinyl chloride, tobacco smoke,

alcoholic beverages, thorium dioxide

— Hepatocellular carcinoma,

hemangiosarcoma

Kidney Tobacco smoke, phenacetin — Renal cell cancer

Bladder Tobacco smoke, 4-aminobiphenyl, benzidine, 2-

napthylamine, phenacetin

Magenta manufacture, auramine

manufacture

Transitional cell cancer

Prostate Cadmium — Adenocarcinoma

Skin Arsenic, benzo(a)pyrene, coal tar and pitch,

mineral oils, soots, cyclosporin A, PUVA

Coal gasification, coke

production

Squamous cell cancer basal cell

cancer

Bone marrow Benzene, tobacco smoke, ethylene oxide,

antineoplastic agents, cyclosporin A

Rubber workers Leukemia, lymphoma

Known or Suspected Chemical Carcinogens in Humans



HEAD AND NECK CANCER



PHYSICAL FACTORS

• Ionizing Radiation

• Ultraviolet light

• Radiofrequency and Microwave Radiation

• Electromagnetic Fields

• Asbestosis

•Nanoparticles



XP Skin cancer



DIETARY FACTORS

• Energy

• Alcohol

• Dietary Fat

• Red Meat

• Fruits and Vagetable

• Fiber

• Folate

• Calsium• Vitamin D

• Soy Products

• Carotinoids

Doll & Peto 35% of all cancer deaths may be preventable by alteration in diet



YOU ARE WHAT YOU EAT!



OBESITY AND PHYSICAL ACTIVITY

• BMI > 30

• Steroid Hormones

• Insulin/Insulinlike Growth Factors (IGF)

Pathway



Physical Activity Overweight/Obesity

Breast,

postmenopausal

+++ +++

Breast,

premenopausal

++ ++ (protection)

Colon +++ +++

Endometrium + +++Esophagus,

adenocarcinoma

? +++

Kidney/renal cell ? +++

Gallbladder ? ++

Pancreas ? ++

Non-Hodgkinlymphoma

? +

Prostate, aggressive + +

Lung + ?

Ovary ? ?

Summary of the Strength of the Observational Epidemiologic Evidence for

Physical Activity as a Protective Factor and Obesity as a Risk Factor for

Cancer, by Type of Cancer



Thank you

(20) epidemiology of cancers 2012

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