asian pacific organization for cancer prevention (apocp) cancer epidemiology and prevention...
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Asian Pacific Organization for Cancer Prevention (APOCP)
Cancer Epidemiology and
PreventionEducationScreeningToxicological Pathology
25th IACR Annual Meeting,Hawai’i
‘Cancer Registration andSurveillance…Around the
Globe’
APOCP ASIATOX Satellite Symposium, Bangkok‘In Vivo Models for Assessment of Carcinogenicity and
Chemopreventive Potential of Food Components’ASIATOX III,
Bangkok/Chiang Mai‘International Toxicology
Harmonization : The Challengeof Asia’
1st Regional APOCP Conference -Western Asia, Izmir
‘New Strategies for Cancer Control’
2nd Regional APOCP Con-ference -
South East Asia, Khon Kaen‘Customs, Environment and
Cancer’
ISSN 1513-7368
APOCP Groups
Australasia
Central Asia
China
Japan
Korea
South Asia
South-East Asia
Western Asia
http://www.apocp.org
Education Epidemiology
Screening and Intervention Toxicological Pathology
Vol 5 2004
ASIAN PACIFIC JOURNAL of CANCER PREVENTION The Official Publication of the Asian Pacific Organization for Cancer Prevention
An Official Journal of the International Association of Cancer Registries
Aims and Scope Asian Pacific Journal of Cancer Prevention Contents - Volume 1 - Volume 2 - Volume 3 - Volume 4 - Volume 5 ConstitutionInformation for APJCPInformation for AuthorsInformation for SubscribersEventsMembers
Aims and Scope
The aim of the APOCP and its official journal the APJCP is to promote an increased awareness in all areas of cancer prevention and to stimulate practical intervention approaches. The scope is wide-ranging, including descriptive, analytical and molecular epidemiology, experimental and clinical histopathology/biology of preneoplasias and early neoplasias, assessment of risk and beneficial factors, experimental and clinical trials of primary preventive measures/agents, screening and secondary prevention, and all aspects of cancer prevention education.
APJCP Chief Editor - APOCP Chairman Kazuo Tajima
Division of Epidemiology and Prevention, Aichi Cancer Center, Research Institute1-1 Kanokoden, Chikusa-ku, Nagoya 467-8681, Japan Tel +81-52-764-2986, Fax +81-52-763-5233 Email: [email protected]
APJCP Managing Editor - APOCP Coordination Director Malcolm A Moore
Email: [email protected]
ASIAN PACIFIC ORGANIZATIONfor
CANCER PREVENTION
Subject Editor - Education/Cancer Registration Timothy J Threlfall (IARC Rep)Supannee Sriamporn
Subject Editor - Epidemiology Shinkan Tokudome, Keun-Young YooSubject Editor - Screening and Intervention You-Lin Qiao, IinumaSubject Editor - Toxicological Pathology Hiroyuki Tsuda,
Yogeshwer Shukla
Genetic Polymorphisms
Genetic Anomalies
Familial Cancer
Molecular
Descriptive
Analytical
Pathophysiological
Pathological Diagnosis
Environmental Factors
Cancer Registration
Tissue/organ Physiology
Biochemical Parameters
Epidemiology
Areas of Interest
Cancer Registration
Male Burden of Cancers in Major Organs - Incidences/100,000
Registry China India Indonesia Iran Japan Korea Pakistan Philippines# Thailand Vietnam Ranking
Oral 1.3 (9)R 16.3 (1) ? 6.6 (4) 6.0 (9) 4.4 (8) 25.8 (1) 8.6 (6) 8.5 (4) 8.2 (5) 45 (6)
Oesophagus 14.8 (3) 7.4 (2) ? 39.4 (1) 10.0 (5) 10.1 (5) 6.2 (5) 3.1 (9) 3.7 (8) 3.7 (6) 46 (5)
Stomach 14.7 (4) 6.8 (3) ? 17.3 (2) 67.0 (1) 70.0 (1) 4.6 (8) 11.1 (5) 4.9 (6) 23.7 (2) 58 (4)
Colorectal 11.5 (5) 5.4 (4) 6.8 (2) 3.8 (7) 48.0 (2) 40.9 (4) 5.9 (6) 18.7 (3) 10.4 (3) 11.4 (4) 60 (3)
Liver 21.0 (2) ? 5.7 (3) 3.9 (6) 26.0 (4) 48.8 (2) 5.0 (7) 23.9 (2) 37.4 (1) 22.6 (3) 70 (2)
Pancreas 3.9 (6) 1.7 (8) ? 1.2 (9) 9.2 (7) 7.7 (7) ? 4.7 (8) ? 1.6 (9) 16 (9)
Lung 26.6 (1) 4.0 (6) 14.8 (1) 14.2 (3) 39.9 (3) 48.4 (3) 20.0 (2) 64.3 (1) 26.5 (2) 29.3 (1) 77 (1)
Prostate 2.1 (8) 5.2 (5) 5.6 (4) 2.0 (8) 10.0 (5) 4.2 (9) 7.6 (4) 17.6 (4) 4.4 (7) 2.2 (8) 28 (8)
Bladder 3.4 (7) 3.5 (7) ? 4.4 (5) 8.2 (8) 9.5 (6) 9.4 (3) 4.9 (7) 5.2 (5) 2.4 (7) 35 (7)
*Data from Selected Cancer Registries (see text for references) # Data from Parkin et al., 1997 R, rank
Descriptive Epidemiology: Males
Female Burden of Cancers in Major Organs - Incidences/100,000
Registry China India Indonesia Iran Japan Korea Pakistan Philippines*Thailand Vietnam Ranking
Oral 0.8 (9)R 7.8 (3) ? 6.6 (4) 2.0 (8) 1.2 (8) 18.7 (2) 6.0 (8) 4.5 (7) 2.7 (8) 33 (6)
Oesophagus 6.0 (6) 5.8 (5) ? 24.9 (1) 1.3 (9) 1.0 (9) 6.9 (5) 1.6 (9) 1.3 (9) 0.5 (9) 28 (9)
Stomach 14.7 (1) 3.5 (7) ? 5.9 (5) 27.0 (2) 25.7 (1) 3.2 (8) 6.4 (7) 1.5 (8) 8.5 (3) 58 (3)
Colorectal 9.0 (4) 3.8 (6) 6.3 (3) 2.9 (6) 25.5 (3) 10.3 (6) 5.0 (6) 15.8 (3) 7.5 (5) 6.4 (5) 53 (4)
Liver 8.0 (5) ? ? 1.8 (9) 7.7 (6) 11.6 (5) 3.4 (7) 8.0 (6) 15.5 (3) 4.6 (6) 33 (6)
Lung 10.2 (3) 3.1 (8) 4.8 (5) 2.5 (7) 11.2 (4) 12.7 (3) 2.8 (9) 17.7 (4) 11.1 (4) 7.9 (4) 49 (5)
Breast 12.7 (2) 22.6 (2) 14.8 (2) 12.3 (2) 31.0 (1) 12.5 (4) 56.6 (1) 47.7 (1) 16.3 (2) 13.8 (1) 80 (1)
Ovary 5.3 (7) 5.9 (4) 5.2 (4) 2.5 (7) 6.4 (7) 4.0 (7) 9.5 (3) 9.4 (5) 4.7 (6) 4.4 (7) 43 (8)
Cervix 1.2 (8) 25.3 (1) 21.7 (1) 7.0 (3) 8.5 (5) 15.3 (3) 7.3 (4) 21.6 (2) 20.9 (1) 13.1 (2) 70 (2)
*Data from Selected Cancer Registries (see text for references) # Data from Parkin et al., 1997 R , rank
Descriptive Epidemiology: Females
Prevalent Cancers
Australia India (Ahmedebad)
10
20
30
40
50
0
Incidence Data (/100,000 Population)
Larynx M Buccal Cavity M Oesophagus M Cervix Colon M Prostate Breast Ovary and Endometrium
Adjusted Mortality Data (/100,000)
Squamous cell carcinoma and adenocarcinoma links
Data from World Health Statistics, WHO (1996)
Consumption of Major Food Groups Worldwide as Percentages of Total Energy
Dietary Variation
Histogenesis of Cancers and Prevention Timing
Field
Clonal
Preneoplastic/precancerous Neoplastic
Initiation Modulation Progression
Carcinogen Dependent Proliferation Sensitive
Carcinogen Independent? Proliferation Sensitive
Carcinogen Dependent? Proliferation Independent?
Single
Subclonal
Primary PreventionClinical Treatment
Secondary Prevention
Individual Body Sites
Cancer TypePrevalence over TimeRisk FactorsBeneficial FactorsPrimary PreventionSecondary Prevention
Screening Modalities
Oral Cavity Cancer
0
5
10
15
20
25
30
Singapore Chinese
SC
SCSC SC
SM SMSingapore Malay SM
SM
SISingapore Indian
SI
SISI
IB
IB
Indian BombayIB
IB
CS CSCS
Chinese Shanghai CS
CHKChinese Hong Kong
CHKCHK
CHK
JM JM
JM JM Japanese MiyagiJO
JOJO JO
Japanese Osaka
1982 1987 1992 1997 2003
Year of Publication
HHHH
HH
HH
Hawaiin Hawaii
Incidence (/100,000)
Site Distribution and Factors
Risk FactorsTobaccoBetel Nut TraumaHPV/EBVDiet
Protective FactorsAntioxidantsOral Hygiene
India Singapore Hawaii Ahmedabad Chinese Whites
20
40
0
Nasopharynx Tongue Mouth Oropharynx Hypopharynx
Incidence (/100,000)
Distribution of Betel Chewing
From Chiba, 2001 APJCP
Histogenesis of Buccal Cancer
Oesophageal Cancer
0
5
10
15
20
25
SC
SC
SC
SC
Singapore Chinese
SM SMSingapore Malay
SM SM
SI
SI
SI
Singapore Indian
SI
IBIndian Bombay
IBIB
IB
CS
Chinese Shanghai
CS
CS
CS
CHKCHK
Chinese Hong Kong
CHK
CHK
JM
JM
JMJapanese Miyagi
JM
JOJapanese Osaka
JOJO
JO
HH
Hawaiin Hawaii
HH HH
HH
1982 1987 1992 1997 2003
Year of Publication
Incidence (/100,000)
Country Location SCC AC Ratio
China, Tianjin 33.1 3.3 10:1China, Hong Kong 84.5 9.3 9:1India, Bombay 91.9 1.0 92:1India, Madras 86.0 11.8 7:1Israel, All Jews 69.9 23.5 3:1Japan, Miyagi 92.2 3.2 29:1Japan, Osaka 90.3 3.8 24:1Philippines, Manila 67.1 18.3 4:1Australia, NSW 54.3 38.5 1:1Australia, Victoria 53.6 39.1 1:1
SCC:Adenocarcinoma Ratios for Oesophageal Cancer
20
30
40
50
60
70
80
90
Brunei
IranIraq
Israel
Jordan
Kuwait
Lebanon
Saudi ArabiaSyria
Turkey
United Arab Emirates
Afghanistan
BangladeshCambodia
Indonesia
Laos
MyanmarNepal
Pakistan
Sri Lanka
Vietnam
South Korea
Malaysia
Hong Kong
JapanSingapore
China
India
Fiji
Philippines
Thailand
Papua New GuineaSamoa
Solomon Islands
Vanuatu
AustraliaNew Zealand
0 5 10 15 20Oesophageal Cancer Incidence/100,000
Correlation Coefficient r=0.31 p<0.059
ケ
Cereals (% Diet)
Correlation between Cereal Intake and Oesophageal Cancer
Risk Factors
SCC Tobacco Opium Nutrient Deficiency Cereal Intake
Adenocarcinoma Obesity
Prevention
SQUAMOUS EPITHELIUM
PLAKIA PAPILLOMA
Primary Prevention Secondary Prevention
Vegetables and fruits
Smoking and Dietary Carcinogens Retinoids Antioxidants
Avoidance
TraumaReverse smoking Betel and lime
Alcohol VirusesScreening and resection
Sputum tests Physical examination CT/X-rays
Avoidance
Vaccination
Intervention Strategies: Buccal and Oesophageal SCCs
ProgressionInitiation Growth SCC
Gastric Cancer
0
10
20
30
40
50
60
70
80
90
SC
SC Singapore Chinese
SCSC
SMSingapore Malay
SM
SMSM
SI SI Singapore India
SI SIIBIB
IB
Indian Bombay
IB
CSCS
Chinese Shanghai
CS
CS
CHK
CHKCHK
Chinese Hong Kong
CHK
JM
JM
JMJapanese Miyagi
JM
JO JOJapanese Osaka
JOJO
HH
HH
Hawaiin Hawaii
HH HH
1982 1987 1992 1997 2003
Year of Publication
Incidence (/100,000)
Disease Linkage: Correlation between mortality from cerebrovascular disease and gastric cancer in malesC
ereb
rova
scul
ar D
isea
se
50
100
150
200
250
300
UK
Scotland
N. IrelandHolland
Denmark
NorwaySweden
Finland
Germany
Switzerland
Austria
BelgiumFrance
Spain
Portugal
Italy
GreeceCroatia
Slovenia
Bulgaria
Czech
Hungary
Poland
Lithuania
Estonia
Latvia
Belarus
Ukraine
Moldova
Russia
Australia
New Zealand
CanadaUSA
5 10 15 20 25 30 35 40 45
Gastric Cancer
All r=0.7933 P<0.001
Group E r=0.7055 P=0.007
Group W r=0.7056 P<0.001
Factor Cardia Antrum
RiskHelicobacter +/- +++Epstein-Barr + +/-Gastric Ulcers +/- ++High Salt Diet ++ +++High fat Diet ++ +/-Obesity ++ +/-Smoking ++ +Alcohol + ++
ProtectiveVegetable Intake -- --
Data from the literature
Risk and Protective Factors for Cancer of the Gastric Cardia and Antrum
NORMAL
PAPILLOMA ADENO- CARCINOMA
Primary Prevention Secondary Prevention
Dietary supplementation
Smoking and Dietary Carcinogens
Avoidance
High Salt Diet/Alcohol Screening and resection
Serum Pepsinogen Endoscopy Fluorography
Avoidance
Chemoprevention?
Intervention Strategies: Gastric Adenocarcinoma
ProgressionInitiation Growth
Atrophic Gastritis H. Pyloris
Eradication Medication
?
Duodenogastric Reflux
NSAID'S?
Prevention
Colorectal Cancer
5
10
15
20
25
30
35
SC
Singapore Chinese
SC
SCSC
SMSM
SM
SM
Singapore Malay
SI
SISI
Singapore Indian
SIIB
IB IB Indian BombayIB
CS
CS CS
Chinese ShanghaiCS
CHKCHK
Chinese Hong Kong
CHK CHK
JMJM
JM
JM
Japanese Miyagi
JO
JO
Japanese Osaka
JO
JO
Hawaiin Hawaii
HH
HH
HHHH
1982 1987 1992 1997 2003
Year of Publication
Incidence (/100,000)
20
30
40
50
60
70
80
90
Brunei
IranIraq
Israel
Jordan
Kuwait
Lebanon
Saudi Arabia
Syria
Turkey
United Arab Emirates
Afghanistan
BangladeshCambodia
Indonesia
LaosMyanmar
Nepal
Pakistan
Sri Lanka
Vietnam
South Korea
Malaysia
Hong Kong
JapanSingapore
China
India
Fiji
PhilippinesThailand
Papua New Guinea
SamoaSolomon Islands
Vanuatu
Australia
New Zealand
0 10 20 30 40 50 60
Colon Cancer Incidence /100,000
Correlation Coefficient r=-0.61 p<0.001
Cereals (% Diet)
Correlation between Cereal Intake and Colon Cancer
Dietary Factors
Major risk and beneficial factors on preneoplastic and neoplastic cells, with reference to dietary influence. IGF-IR, insulin like growth factor I receptor; IR, insulin receptor; SHR, steroid hormone receptor; SCFA's, short chain fatty acids; , enhancing stimulus; , inhibitory effect.
High Fat Diet
High fat diet
High calorie diet
PRENEOPLASTIC/NEOPLASTIC COLONIC CELL
GROWTH
Estrogen
IGF-IR IR SHR
GENE ACTIVATION
Insoluble Fiber
Insoluble>Soluble FiberSoluble Fiber
Soluble FiberInsulin
Cholesterol
Phytoestrogens
Lipid
Carbohydrate
Enterohepatic circulation
SCFAs
Mitoinhibition/ApoptosisToxicity
Bile Acids
Binding/Excretion
Carcinogen Initiation
Binding/Excretion
Antioxidant
Factors for Colon and Rectal Cancer
Factor Colon Rectum
RiskHigh fat Diet ++ ++Obesity ++ +/-Alcohol +/- +
ProtectivePhysical Activity +++ +/-Fibre Intake ++ ++
(Data from Food, Nutrition and the Prevention of Cancer: a global perspective, World Cancer Research Fund/American
Association for Cancer Research)
Colon or Rectal CancerR
ectu
m
0
1
2
3
4
5
6
7
8
UKEngland
Scotland
N. IrelandIreland Holland
Denmark
Iceland
Norway
SwedenFinland
Germany
Switzerland
Austria
Belgium
Luxembourg
FranceSpain
Portugal
Italy
Greece
Macedonia
Albania
Croatia
Slovenia
Bulgaria
Roumania
Czech
Hungary
Poland Lithuania
EstoniaLatvia
BelarusUkraine
Moldova
Russia
0 2 4 6 8 10 12 14Colon
All NS
Group East p<0.001
Group West p<0.05
Prevention
GLANDULAR EPITHELIUM
ADENOMA
Primary Prevention Secondary Prevention
Dietary supplementation
Smoking and Dietary CarcinogensNSAID'S Insulin Sensitizers Lactoferrin
Avoidance
Trauma Alcohol Familial polyposisScreening and resection
Fecal Blood Mucin Markers Endoscopy
Avoidance
Surgery/Chemoprevention
Intervention Strategies: Colorectal Adenocarcinoma
ProgressionInitiation Growth
Colitis Hemorrhoids
Medication
ADENO- CARCINOMA
Hepatocellular Cancer
0
10
20
30
40
50
SC SC
SC
Singapore Chinese
SC
SMSingapore Malay
SMSM
SM
SI SI
SI
Singapore Indian
SI
IB
Indian Bombay
IB IB IB
CS
CS
Chinese Shanghai
CS
CS
CHK
CHK
CHKChinese Hong Kong
CHK
JM
JM
JM
Japanese Miyagi JM
JO
JO
Japanese Osaka
JO
JO
HH
HH Hawaiin Hawaii
HH
HH
1982 1987 1992 1997 2003Year of Publication
Incidence (/100,000)
Lung Cancer
0
10
20
30
40
50
60
70
80
90
100
SC
SC
Singapore Chinese
SC
SC
SM SM
SMSM
Singapore Malay
SI
SI Singapore IndianSI
SIIB
IB
Indian Bombay IBIB
CSCS
CSChinese Shanghai
CS
CHKChinese Hong Kong
CHKCHK
CHK
JM
JM
JM
JM Japanese Miyagi
JO
JO
JO
Japanese Osaka JO
HH
Hawaii Hawaii
HH
HH
HH
1982 1987 1992 1997 2003
Year of Publication
Incidence (/100,000)
Lun
g S
quam
ous
Cel
l Car
cino
ma
0
10
20
30
40
50
UK
Eire
Holland
Denmark
Norway
Sweden
Finland
E Germany
France
Spain
Italy
Yugoslavia
Slovenia
Czech Republic
Slovakia
Estonia
Poland
Israel
India BombayIndia Madras
Singapore Chinese
Singapore Malay
Singapore Indian
Hong Kong
Thai Chiang Mai
Thai Khon Kaen
Vietnam
Korea
Japan
Philippines
Australia Hawaiian White
Hawaiian Japanese
Hawaiian Hawaiian
Hawaiian Filipino
Hawaiian Chinese
Canada
USA White
USA Black
SwitzerlandAustria
0 5 10 15Larynx Cancer
All: r=0.657 p<0.001
Group East: r=0.998 NS
Group West: r=0.582 p<0.005
Cancer Site Linkage: Lung Squamous Cell Carcinoma by Larynx Cancer Incidence/100,000
Col
on
0
5
10
15
20
25
30
UK
Eire
Holland
DenmarkNorway
Sweden
Finland
E Germany
France
Spain
Italy
YugoslaviaSlovenia
Czech
Slovakia
EstoniaPoland
Israel
India BombayIndia Madras
Singapore Chinese
Singapore Malay
Singapore Indian
Hong Kong
Thailand Chiang MaiThailand Khon KaenVietnam
Korea
Japan
Philippines
Australia NSWHawaii WhiteHawaii Japanese
Hawaii Hawaiian
Hawaii Filippino
Hawaii Chinese
CanadaUSA White
USA Black
Switzerland
Austria
0 5 10 15 20Lung AC
All p<0.001
Group Asia p<0.005
Group West p<0.001
Cancer Site Linkage: Colon By Lung Adenocarcinoma Incidence/100,000
Lung Carcinoma TypesAdenocar
cinoma Hobnail Columnar/Cuboidal Mixed Polygonal Goblet
Squamous Cell Carcinoma
Tumour Behaviour
Background Disease
Pathology EpidemiologyMolecular Biology
Parameters
Mutations Transversions Transitions
Kinetics Apoptosis Proliferation
Cell cycle/Signalling
Polymorphisms
Cancer Registration
Hospital-based Population-based
Risk/Beneficial Factors
Tobacco Dietary Factors Cooking Environment Climate Lifestyle Anthropomorphic factors
Genetic Background
Prevention
NORMAL
ADENOMA /PAPILLOMA
CARCINOMA
Primary Prevention Secondary Prevention
Dietary supplementation
Smoking and Dietary Carcinogens Chemopreventor Application?
Avoidance
Irritants Bacterial InfectionScreening and resection
Sputum tests CT/X-rays
Medication
Intervention Strategies: Lung SCC, AC, Small Cell Carcinoma
ProgressionInitiation Growth
Avoidance
Bronchitis Fibrosis
Smoking
Urinary Bladder Cancer
2
4
6
8
10
12
14
16
18
SC
SC
Singapore ChineseSC SC
SM SM
Singapore Malay
SM
SM
SI
SI
SISingapore Indian
SI
IB
IB
Indian Bombay
IB
IB
Chinese Shanghai
CS CSCS CS
CHK
CHKChinese Hong Kong
CHK
CHK
JM
JM
JM
JMJapanese Miyagi
JO
JO
Japanese Osaka
JO
JO
HH
Hawaiin Hawaii
HH
HH
HH
1982 1987 1992 1997 2003
Year of Publication
Incidence (/100,000)
Prostate Cancer
0
1
2
3
4
5
6
7
8
9
10
12
13
14
15
SC
SC
SC
Singapore Chinese
SC
SM
SM
Singapore Malay SM
SM
SI
Singapore Indian
SI
SI
SI
IB
IB
IBIndian Bombay IB
CS
CS CSChinese Shanghai
CS
CHK
CHK
CHK CHK Chinese Hong Kong
JM
JM
JMJM
Japanese Miyagi
JO
Japanese Osaka
JOJO
JO
1982 1987 1992 1997 2003
Year of Publication
Incidence (/100,000)
Prevention
NORMAL
PIN ADENO CARCINOMA
Dietary supplementation
Avoidance
Obesity
Intervention Strategies: Prostate Adenocarcinoma
Progression GrowthInitiation Growth
Testosterone GF/IGF
Smoking, Dietary Carcinogens
IGF
IGFBP3Test/DT
Serum Insulin
BMI (Obesity?)
1,25(OH)2D
Calcium FructoseHyperplasia
?SHBG
NIDDM
?
Physical Exercise
Screening and resectionDigital Examination Prostate Specific Antigen
Primary Prevention
Secondary Prevention
Nutrition
Breast Cancer
15
20
25
30
35
40
45
SC
SC
SC
Singapore Chinese
SC
SM
SM
SM
SM
Singapore Malay
SISI
Singapore Indian
SI
SI
IB
IB IB
Indian Bombay IB
CSCS
Chinese Shanghai
CS CS
Chinese Hong Hong
CHK
CHK
CHKCHK
JM
JM
JM
JMJapanese Miyagi
JO
JO
JO
Japanese Osaka
JO
1982 1987 1992 1997 2003Year of Publication
Incidence (/100,000)
Registry Age class 25-34 35-44 45-54 55-64 65-74
China, Tianjin 4.5 15.5 15.8 13.5 6.9
India, Madras 1.8 8.2 9.7 7.6 4.4
Japan, Osaka 1.9 13.3 21.6 14.7 10.5
Phillipines, Manila 5.0 15.8 16.8 12.9 7.0
Thailand, Khon Kaen 1.3 4.5 4.5 2.8 1.1
Viet Nam, Hanoi 2.7 9.1 11.0 5.1 1.1
Australia, Victoria 5.2 25.3 38.3 37.5 41.8
*Incidence/100,000 x percentage of the female population # Data from Parkin et al., 1997
Age Dependence: Mammary cancer
0 10 20 30 40 50 60 70 80 90 Age (years)
Menarche Breast Density Menopause
Post-Menopausal Risk:Hormone Replacement/ Obesity Nulliparity or late first pregnancy
Pre-Menopausal Risk: Early menarche and late menopause Nulliparity or late first pregnancy Pre-Menopausal Protection: Obesity Anovulation and low progesterone Early first pregnancy and multiparity
Oestrogen/Progesterone Exposure
BREAST CANCER
Diet/ Phytoestrogens
Physical Exercise
Reproductive History Early Menarche/
Late Menopause
High Density
Low Density
Late Menarche/ Early Menopause
Low Density
High Density
Risk and Protective Factors
Risk Factors
NORMAL
ADENOMA ADENO CARCINOMA
Primary Prevention Secondary Prevention
Dietary supplementation
Smoking, Dietary carcinogens
Avoidance
Screening and resectionPhysical Examination Mammography Ultrasound
Lifestyle Improvement of the Hormone Milieu
Intervention Strategies: Breast Adenocarcinoma
ProgressionInitiation Growth
Oestrogen + Progesterone
Mastitis
Oestrogen
Insulin
Medication
Lifestyle Improvement
Physical Exercise Fiber Intake
Pharmaceutical Manipulation
Prevention
Cervical Cancer
0
5
10
15
20
25
30
SC
SC
SCSingapore Chinese
SC
SM
SM
Singapore Malay
SM
SM
SI
Singapore Indian
SI
SI SI
IB
IB Indian BombayIB
IB
CS
CS
Chinese Shanghai
CS CS
Chinese Hong Kong
CHK
CHK
CHK
CHKJM
JM
JMJapanese Miyagi
JM
JOJapanese Osaka
JO
JO
JO
HH
HH
HH
HH
Hawaiin Hawaii
1982 1987 1992 1997 2003Year of Publication
0
5
10
15
20
25
30
Incidence (/100,000)
Dietary Factors Physical Exercise Hormonal Environment
Persistent HPV High Risk Group Infection
Other STDsSmoking
Environmental Carcinogens
Normal Epithelium CINI CINII CINIII CERVICAL CANCER
Dietary Factors Physical Exercise Hormonal Environment
Comprehensive Cervical Cancer Research Program Questionnaire: Lifestyle Factors (Smoking, Diet, Exercise, Cooking/Work Environment, Sexual Behaviour Disease and Reproductive History Screening: HPV Testing, Pap Smear (Self/Non-self Sampling), Direct Visual Acetic Acid Blood Samples: Nutrients, HPV Antibodies, Serum Markers, Hormones
Risk Factors
Prevention
NORMAL
CIN I-III
Primary Prevention Secondary Prevention
Dietary supplementation
Smoking and Dietary Carcinogens
Avoidance
Trauma VirusesScreening and resection
Papanicolau Smear Direct Visual Acetic Acid HPV Testing
Careful Sexual Behaviour
Vaccination
Intervention Strategies: Cervical Squamous Cell Carcinoma
ProgressionInitiation Growth
Infections
Medication
SCC
Data from Inoue and Tominaga, 2003 (APJCP)
Lifetime Cumulative Risk: Japan
SitesCancer control Methods/assumptions Direct All
Primary prevention Smoking 17.5% 8.8% Chemoprevention? Dietary 25.6% 10.3%
Infection 13.9% 7.0%Subtotal 26.1%
Cancer screening Participation rates for gastric, colo-rectal, cervical, lung andbreast cancer 30 to 50% 29.4% 8.8-14.7%
Improved diagnosis/treatment 5-year survival rate elevated by
0.6 - 1.0% per year for 10 years 6.0-10.0%
Total 40.9-50.8%
Potential for Prevention of Cancer Incidence/Deaths in Japan
Data after Tominaga, 2001 (APJCP)
Level 2 Screening
Level 3 Screening and Surgery
Hospitals
Secondary Prevention
Primary Prevention Information
Access
Exercise Arobics Dance /Yoga Bicycle Transport
Vegetables Health Foods
Pharmaceuticals
Intervention Method Efficacy
Metabolic/ Infectious Agent Parameters
Psychological/ Socioeconomic Factors
W H Y
W H A T
Level 1 Screening
PPPAccess
Research Access
General Populace, Local Groups, Firms, Hospitals, Education Establishments
Access
Infectious Agents Metabolic Lifestyle - Diet and Exercise
Lifestyle Improvement Screening Efficacy Tobacco Cessation
Practical Prevention Program
Schools Colleges Universities
Students
Teachers
Public Offices / Libraries
General/Hospital Practitioners
Pre-schools
Parents
Children
Medical Schools
Oncology Curriculum
Oncology Information
Cancer Prevention Coordination
General Population
ScreeningProgress Courses
Workplace Workers
Retirees
Integrated Cancer Prevention: Communication Routes
Civil Servants/ Volunteers/
Ethics Committees
Government
Who and Where?
Thank you!