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Transcript of Epi Lung Cancer - Mohsen
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Epidemiology of Lung Cancer in
Middle East and in The Rest of World
By
Prof. Mohsen Gadallah
Chairman of Community Medicine Department
Faculty of Medicine- Ain Shams UniversityCairo ± Egypt
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Outline
Statistics for Lung Cancer: World,
North America, Europe, Asia, Africa,
Middle East, Arab Countries.
Epidemiology of Lung Cancer
Risk Factors of Lung Cancer
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Source of Data
National Population-based Cancer Registries:
Gulf Center for Cancer Registration, 2001
Syria National Cancer Registry 2007
Jordan, 2000
Lebanon, Cancer Program-Tumor Registry, 2000 Regional Population-based Cancer Registries:
Egypt: NCI 2005
Algeria: Algiers,
Tunisia: Tunis, EMRO - WHO
Globocan 2002, IARC
American Cancer Society, Global Cancer Statistics, 2002
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The four most common cancers in men are
lung, prostate, stomach and colorectal
cancers. Among Women the top four cancers
are breast, cervix utri , colorectal and lung
cancer .
Pattern of cancer distribution Worldwide
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Lung cancer: how did it start?
First described in 1420 in Schneeberg-
Austria after the opening of cobalt- and
nickel mines.
Incidence was very low in the 19th
century.
Is now worldwide the commonest form of
cancer in men, and the fourth most
frequent cancer in women.
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-Lung cancer has been the most common cancer
worldwide since 1985, and by 2002 accounted for (12.4
percent of world total New Cases) and (17.6 percent of
world total Deaths)
-Just over half (50.1 percent) of lung cancer cases occur in
developed countries, a significant change since 1980,
when 70 percent were in developed countries.
Lung Cancer Worldwide
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Lung Cancer Worldwide
Global incidence of lung cancer is increasing at 0.5%
per year. A major contribution to this trend comes from
the East European and developing countries.
Although it is the most frequent cancer in men
worldwide, lung cancer is second to prostate cancer in
incidence in developed countries
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World Estimated New Cancer Cases
and Age adjusted Incidence Rates,
Males Females
Number of New
Cancer
Cases
Ageadjusted
Incidenc
e Rates
Number of New
Cancer
Cases
Ageadjusted
Incidence
Rates
More
developed
481,950 54.9 194,731 17.1
Less
developed
481,029 25.9 191,192 9.4
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Average Years of Life
Lost from Cancer
P r o s t a t e
C o l o r e c t a l
L u n g
K i d n e y
B r e a s t
C e r v i x
T e s t i s
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Lung Cancer in USA
Estimated new cases and deaths from lungcancer (non-small cell and small cell combined)in the United States in 2008:
New cases: 215,020Males: 114,690Females: 100,330
Deaths: 161,840Males: 90,810Females: 71,030
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Lung Cancer in North America
It is the second most common cancer among both menand women after prostate cancer in men and breast cancer in women
It is the leading cause cancer-related deaths, accountingfor around 28% of all cancer deaths.
It kills more people than breast, prostate, colon, andpancreas cancers combined
Nearly 60% of people diagnosed with lung cancer diewithin 2 years. This had not improved in 10 years.
.
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EuropeThere is a wide variation in incidence and
death rates in Europe
Central and Eastern Europe have the highestincidence and death rates, 65.7/100,000 and
59.7/100,000.
For men, incidence rates range from a low of 21.1/100,000 in Sweden to a high of
94.6/100,000 in Hungary. Death rates range
from 22.6/100,000 to 83.9/100,000
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Estimates of the cancer incidence and mortality in
Europe in 2006.
Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P. Ann Oncol. 2007 Mar;18(3):581-92. Epub 2007 Feb 7.
RESULTS: In 2006 in Europe, there were an estimated3,191,600 cancer cases diagnosed (excludingnonmelanoma skin cancers) and 1,703,000 deaths fromcancer. The most common form of cancers was breastcancer (429,900 cases, 13.5% of all cancer cases),followed by colorectal cancers (412,900, 12.9%) andlung cancer (386,300, 12.1%). Lung cancer, with anestimated 334,800 deaths (19.7% of total), was the mostcommon cause of death from cancer, followed bycolorectal (207,400 deaths), breast (131,900) andstomach (118,200) cancers.
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Estimates of the cancer incidence and mortality in
Europe in 2006.
Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P. Ann Oncol. 2007 Mar;18(3):581-92. Epub 2007 Feb 7.
± CONCLUSIONS: The total number of new cases of
cancer in Europe appears to have increased by300,000 since 2004. With an estimated 3.2 million
new cases (53% occurring in men, 47% in women)
and 1.7 million deaths (56% in men, 44% in women)
each year, cancer remains an important public health
problem in Europe and the ageing of the European
population will cause these numbers to continue to
increase even if age-specific rates remain constant.
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Estimates of the cancer incidence and mortality in
Europe in 2006.
Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P.
Ann Oncol. 2007 Mar;18(3):581-92. Epub 2007 Feb 7.
± Evidence-based public health measures existto reduce the mortality of breast and
colorectal cancer (Treatment & Screening )
while the incidence of lung cancer, and
several other forms of cancer, could bediminished by improved tobacco control.
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SurvivalThe 1-year survival rate for lung cancer has increased
from 34% in 1975 to 42% in 1998.
Despite major advances in understanding and
treating
cancer, the 5-year relative survival rate is only 15%, a
rate that has improved only slightly over the last 30
Years
According to the World Health Organization, three
people die every minute worldwide from lung cancer
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5-Year Survival Rates by World Region
7
8
8
10
12
13
14
20
21
0 5 10 15 20 25
ort estern
uro e
iddle ast ort
ri a
ina
Sout ri a
ast uro e
ustralia eZealand
atin
eri a aribbean
ort eri a
a an
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EMRO LUNG CANCER
In 2004, around 300,000 from EMRO diagnosed with
lung cancer, and 200,000 will die from it
It is the second most common cancer among men
It is the leading cause cancer-related deaths, killing
more people than breast, liver, prostate, colon, and
pancreas cancers combined
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Age-adjusted Incidence Rates for Men,
North Africa and Middle East
16.7
17.1
23
24.4
25.6
28.6
28.9
37.7
0 10 20 30 40
Jordan
Kuwait
Iraq
Algeria
Morocco
Tunisia
Lebanon
Syrian
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Age Specific Incidence Rate (100,1000) in
Arab Countries and other African countries
Glubocan 2002
Country Crude ASR
Kenya 1.9 4.2
Rwanda 0.9 1.7
Mauritius 12.6 15.8
Chad 2.3 4.7Algeria 9.8 16.9Egypt 5.3 8.6
Libya 6.7 10.4Morocco 11.9 20.1Sudan 0.5 1.0Tunisia 21.5 27.8
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Age Specific Incidence Rate (100,1000) in
Arab Countries - Glubocan 2002
Country Crude ASR
Bahrain 15.9 30.5Saudi
Arabia6.0 10.3
Syria 14.4 32.9Iraq 10.5 22.7Yemen 1.4 4.1Jordan 7.9 16.5Kuwait 11.2 18.9Lebanon 22.5 31.3Oman 5.5 9.6Qatar 14.3 19.9United A
Emirates11.6 13.7
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Country 1st 2nd 3rd 4th 5th
Egypt Bladder Liver NHL Lung Colorectal
Algeria Lung Bladder Stomach Prostate Colorectal
Tunisia Lung Bladder Prostate Larynx Colorectal
Jordan Lung Bladder Prostate NHL Skin
Lebanon Bladder Lung Prostate Colorectal stomach
Yemen NHL HD Liver Leukemia Colorectal
Type of Cancers in Egypt and
some Arab Countries, Males
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Percent of cancer casesCountry Male % Female %
Egypt (Gharbiah & NCI) 14.3 3.7
Morocco 18.8 2.0Tunisia 23.3 2.3
Lebanon 14.1 4.3
Iraq 15.7 4.7
Algeria 16.8 2.0
Jordan 11.2 2.3
Yemen 2.8 2.6
Frequency of Lung Cancer in
Egypt and other Arab Countries
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Histological types of lung cancer
2 major types:
small-cell lung cancer, and
nonsmall-cell lung cancer, which is further subdivided into:
squamous cell carcinoma,
adenocarcinoma, and large-cell carcinoma.
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Origin and characteristics of
various types of lung cancer Squamous cell lung cancer: commonesttype in males, central origin, manifestsearly
Adenocarcinoma: commonest type infemales, peripheral origin, manifests late
Large cell lung cancer: least common
type, peripheral originSmall cell lung cancer: most aggressive
type, central origin, spreads quickly
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Lung cancer histology
There are two main types of lung cancers:around 20% are small cell lung cancers (SCLC)
and the remainder are non-small cell lungcancers (NSCLC).
The main types of NSCLC are squamous cellcarcinoma, adenocarcinoma and large cell
carcinoma, which account for approximately35%, 27% and 10% of all lung cancer casesrespectively in the UK.
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Egypt
Accurate epidemiological data on lung cancer in Egypt
is not available since a comprehensive national
population-based cancer registry is lacking.
However, official statistics as well as institution and
hospital-based studies show that it is the second most
common cancer in men and second leading cause of
cancer death, after bladder cancer
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Descriptive Epidemiology:
Age
Age-specific incidence rates increase
exponentially until the rates plateau and then declineafter the age of 80 in men and the age of 70 in
women
Only 5% to 10% of lung cancer cases arediagnosed under 50 years of age
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Lung cancer incidence by age
and sex
Lung cancer is rarely diagnosed in peopleyounger than 40, but incidence rises steeplythereafter peaking in people aged 75-80 years.Most cases (85%) occur in people over the ageof 60.
In the 1950s the male/female ratio for lungcancer cases was 6:1 but with decreasing male
rates and increasing female rates, the ratio isnow 7:5 (22,495 male cases and 15,818 femalecases in 2004). Overall, 13% of all new cases of cancer are lung cancers
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Descriptive Epidemiology:Gender
Worldwide, age-adjusted incidence rates of lung
cancer among men exceed, twofold or more, thanamong Women
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Descriptive Epidemiology:
Race
The risk of lung cancer in United States black
men has been about 50% higher than in white men
in the past 10-15 years. During 1975 to 1990, the
age-adjusted lung cancer incidence in the United
States black women was 10% to 20% higher than
in white women.
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Genetic factors
Smoking is the biggest risk factor, linked to ninein 10 lung cancers . So genetics play a minor role.
Some people have a genetic risk or predisposition for lung cancer. Anyone with afirst degree relative (parent, brother, sister) withlung cancer has a higher risk of developing lungcancer .
Research is ongoing to further define the geneticfactors associated with lung cancer.
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Risk Factors
Doctors cannot always explain why oneperson develops lung cancer and another does not. However, we do know that a
person with certainrisk factors
may bemore likely than others to develop lungcancer. A risk factor is something that mayincrease the chance of developing adisease.
Studies have found the following riskfactors for lung cancer:
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Risk factors
1. Tobacco (and passive) smoking
2. Air pollution in urban areas
3. Chronic lung conditions: COPD4. Occupational exposure (man-made
mineral fibre)
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Smoking
The overwhelming role of smoking in the causation of lungcancer has been repeatedly demonstrated over the past 50years:
± 87% of lung cancer cases are thought to result from smoking ± The longer you smoke and the more packs per day you
smoke, the greater your risk
± Secondhand or environmental tobacco smoke increase the risk
± A nonsmoker married to a smoker has a 30% greater risk
± Workers exposed to tobacco smoke at the workplace are at ahigher risk
±± No evidence that low tar cigarettes reduces risk
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Smoking
Tobacco use accounts for at least 30% of all
cancer deaths and 87% of lung cancer deaths.
(Source: Cancer Facts and Figures 2008 ).
Each year, about 3,000 non-smoking adults dieof lung cancer as a result of breathing
secondhand smoke. Each year secondhand
smoke also causes an estimated 35,000 deaths
from heart disease in people who are not currentsmokers. (Source: Cancer Facts and Figures
2008 )
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Cause and effect: cigarette
smoking lung cancer Men started smoking cigarettes in 1920s
20 years later, incidence of lung cancer in
men climbed sharply.
In 1940s, women became cigarette
smokers 20 years later, a similar
dramatic increase in lung cancer among
women.
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Smoking
Besides lung cancer, tobacco use also
causes increased risk for cancer of the
mouth, nasal cavities (nose), larynx (voice
box), pharynx (throat), esophagus
(swallowing tube), stomach, liver,
pancreas, kidney, bladder, uterine cervix,
and acute myeloid leukemia. (Source:Cancer Facts and Figures 2008 )
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Smoking
Smoking has been implicated in:
± 80% of lung cancer deaths in men ± 75% of lung cancer deaths in women
± 13% of lung cancer deaths in nonsmokers
± 28% of all cancer deaths
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Risk Factors
Radon: Radon is a radioactive gas that
you cannot see, smell, or taste. It forms in
soil and rocks. People who work in mines
may be exposed to radon. Radon is found
in houses. Radon damages lung cells, and
people exposed to radon are at increased
risk of lung cancer. The risk of lung cancer from radon is even higher for smokers.
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Risk Factors: Other ³occupational carcinogens´
(cancer-causing agents found in workplace) Radioactive ores such as uranium
Inhaled chemicals or minerals such as:
± Arsenic
± Vinyl chloride
± Nickel chromates
± Chloromethyl ethers
± Coal products
± Mustard gas
- Fuels such gasoline- Diesel exhaust
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Risk Factors
Asbestose and other substances: People who havecertain jobs (such as those who work in the constructionand chemical industries) have an increased risk of lung
cancer. Exposure to asbestos, arsenic, chromium,nickel, soot, tar, and other substances can cause lungcancer. The risk is highest for those with years of exposure. The risk of lung cancer from these substancesis even higher for smokers.
Asbestos: Asbestos worker are about 7 times morelikely to die of lung cancer
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Risk Factors: other than smoking
± People with silicosis and berylliosis (lung diseases
caused by breathing in certain minerals) also have ahigher risk
- Diet (vitamins A, C, E, -carotene deficiencies)
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Risk Factors:
Marijuana :
It has been hard to prove a connection because it is not
easy to gather information about the use of illegal drugs ±
Many marijuana also smoke cigarettes
Radiation therapy: ± Particularly if they smoke
Recurring inflammation
:
Tuberculosis and some types of pneumonia often leave
scars. This increases risk of adenocarcinoma type
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Prevention of lung cancer
80% of lung cancer
cases are
associated with
many years of
tobacco smoking,
and can therefore
be AVOIDED.
10% of lung cancer
cases are
associated with
exposure to
occupational
carcinogens, and
can therefore be AVOIDED.
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The estimated Proportion of
Preventable Cancer
N
r
%
r
%
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What are the Percent of such
Modifiable Risk Factors ?
Smoking = 20 %
Alcohol = 5 %
Low Fruit and Vegetable Intake = 5 % Unsafe Sex = 2 %
Lack of Exercise = 2%
Others = 6%
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Remember
Cancer kill around 8 Million people in2007, three quarters of whom were indeveloping Countries.
Smoking is the main etiological factor responsible for up to 90% of cases.
Lung Cancer is the most preventable formof cancer death.
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Many Thanks