ONCOLOGY Epidemiology. 1LungBreastLung1,037,000 2StomachColon/rectumStomach798,000...
-
Upload
randell-atkinson -
Category
Documents
-
view
214 -
download
0
Transcript of ONCOLOGY Epidemiology. 1LungBreastLung1,037,000 2StomachColon/rectumStomach798,000...
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
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
Total NewTotal NewRankRank MalesMales FemalesFemales Both SexesBoth Sexes CasesCases
*Non-Hodgkin’s lymphoma.
Adapted from Parkin DM, et al. CA Cancer J Clin. 1999;49:39.
Leading cancers worldwideLeading cancers worldwide
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
1 N. America 369.9 N. America 277.52 Australia/N.Z. 312.7 Australia/N.Z. 254.03 W. Europe 294.8 N. Europe 234.54 Japan 270.9 S. America* 230.15 N. Europe 270.0 W. Europe 210.46 E. Europe 269.4 Micronesia/ 205.2
Polynesia7 S. Europe 256.0 Southern Africa 187.88 S. America* 255.1 Melanesia 185.69 Southern Africa 247.4 S. America† 185.0
10 Eastern Asia‡ 235.7 Central America 180.1
Incidence/Incidence/ Incidence/Incidence/RankRank RegionRegion 100,000100,000 RegionRegion 100,000100,000
*Temperate South America.†Tropical South America.‡Other than Japan or China.
Adapted from Parkin DM, et al. CA Cancer J Clin. 1999;49:43.
Cancer incidence by world regionCancer incidence by world region
MalesMales FemalesFemales
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
Adapted from Greenlee RT, et al. CA Cancer J Clin. 2001:51;15-36.
Leading causes of death in 2001Leading causes of death in 2001
1.1
1.1
1.3
2.8
3.9
4.2
4.8
6.8
23.2
31.0
Percentage of Total Deaths, USPercentage of Total Deaths, US
Heart Diseases
Cancer
Cerebrovascular Diseases
Chronic Obstructive Lung Diseases
Accidents
Pneumonia & Influenza
Diabetes Mellitus
Suicide
Nephritis
Cirrhosis of the Liver
ONCOLOGYONCOLOGYEpidemiologyEpidemiologyEvolution of cancer death rates, malesEvolution of cancer death rates, males
80
70
60
50
40
30
20
10
0
YearYear
Pancreas
Lung & Bronchus
ProstateStomach
Colon & RectumLeukemia
Liver
1930 1940 1950 1960 1970 1980 1990 1997
Rat
e p
er 1
00,0
00 M
ale
Po
pu
lati
on
Rat
e p
er 1
00,0
00 M
ale
Po
pu
lati
on
Greenlee RT, et al. CA Cancer J Clin. 2001;51:15-36.
ONCOLOGYONCOLOGYEpidemiologyEpidemiologyEvolution of cancer death rates, femalesEvolution of cancer death rates, females
YearYear
80
70
60
50
40
30
20
10
0
Uterus
Stomach
PancreasOvary
Lung & BronchusColon & Rectum
Breast
1930 1940 1950 1960 1970 1980 1990 1997
Rat
e p
er 1
00,0
00 F
emal
e P
op
ula
tio
nR
ate
per
100
,000
Fem
ale
Po
pu
lati
on
Greenlee RT, et al. CA Cancer J Clin. 2001;51:15-36.
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
*Other nervous system.† Non-Hodgkin’s lymphoma.
Mortality for leading cancers in 2001Mortality for leading cancers in 2001
Adapted from Greenlee RT, et al. CA Cancer J Clin. 2001;51:15-36.
Males by Age (years), USMales by Age (years), US
All AgesAll Ages
Lung & bronchus91,399
Prostate32,203
Colon & rectum28,024
Pancreas13,806
NHL12,205
20-3920-39
Leukemia663
Brain & ONS*627
NHL†
612
Lung & bronchus484
Colon & rectum404
60-7960-79
Lung & bronchus59,377
Prostate15,742
Colon & rectum15,615
Pancreas8,070
NHL6,341
>> 80 80
Lung & bronchus16,011
Prostate15,373
Colon & rectum7,455
Bladder3,034
Pancreas2,945
40-5940-59
Lung & bronchus15,521
Colon & rectum4,539
Pancreas2,671
NHL2,399
Esophagus2,141
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
*Other nervous system.†Non-Hodgkin’s lymphoma.
Mortality for leading cancers in 2001Mortality for leading cancers in 2001
Greenlee RT, et al. CA Cancer J Clin. 2000;50:15-36.
All AgesAll Ages
Lung & bronchus63,075
Breast41,737
Colon & rectum28,950
Pancreas14,529
Ovary13,391
20-3920-39
Breast1,604
Uterine cervix634
Leukemia456
Lung & bronchus442
Brain & ONS*401
60-7960-79
Lung & bronchus39,077
Breast18,292
Colon & rectum12,950
Pancreas7,454
Ovary7,038
>> 80 80
Lung & bronchus13,392
Colon & rectum12,174
Breast9,949
Pancreas5,193
NHL†
3,881
40-5940-59
Breast11,889
Lung & bronchus10,155
Colon & rectum3,472
Ovary2,841
Pancreas1,775
Females by Age (years), USFemales by Age (years), US
ONCOLOGYONCOLOGYEpidemiologyEpidemiologyMale cancer statisticsMale cancer statistics
Adapted from Greenlee RT, et al. CA Cancer J Clin. 2000;51:18, 15-36.
Estimated incidenceEstimated incidence Estimated deathsEstimated deaths
Melanoma of skin
Oral cavity & pharynx
Lung & bronchus
Pancreas
Kidney
Colon & rectum
Prostate
Urinary bladder
Leukemia
Non-Hodgkin’s lymphoma
All others
5%
3%
14%
2%
3%
10%
31%
6%
3%
5%
18%
Esophagus
Lung & bronchus
Pancreas
Liver
Kidney
Colon & rectum
Prostate
Urinary bladder
Leukemia
Non-Hodgkin’s lymphoma
All others
3%
31%
5%
3%
3%
10%
11%
3%
4%
5%
22%
ONCOLOGYONCOLOGYEpidemiologyEpidemiologyFemale cancer statisticsFemale cancer statistics
Adapted from Greenlee RT, et al. CA Cancer J Clin. 2001;51:18, 15-36.
2%
15%
25%
6%
2%
11%
5%
2%
5%
4%
23%
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%
Brain
Breast
Lung & bronchus
Pancreas
Stomach
Colon & rectum
Ovary
Uterine corpus
Non-Hodgkin’s lymphoma
Leukemia
All others
Estimated incidenceEstimated incidence Estimated deathsEstimated deaths
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
Environmental factors
Occupational exposure
Lifestyle factors
Biologic agents
Pharmacologic/Iatrogenic factors
Known cancer causesKnown cancer causes
Cole P, Rodu B. Cancer: Principles & Practice of Oncology. 6th ed. 2001;241-252.
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
Cancer of the esophagus
Head and neck cancer
Liver cancer
Breast cancer
Alcohol-related cancersAlcohol-related cancers
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.
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
Major causeMajor cause Lung Larynx Oral cavity Esophagus
Contributory factorContributory factor Pancreas Bladder Kidney Stomach Uterine cervix
Smoking-related cancersSmoking-related cancers
Cole P, Rodu B. Cancer: Principles & Practice of Oncology. 6th ed. 2001;241-252.
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
AgentsAgents
Hepatitis B
Hepatitis C
HIV-1
HTLV-1
HPV
Epstein-Barr
Virus-related cancersVirus-related cancers
Site of CancerSite 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.
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
AgentsAgents
Helicobacter pylori
Schistosoma haematobium
Opisthorchis viverrini
Bacterial-related cancersBacterial-related cancers
Site of CancerSite of Cancer
Stomach
Urinary bladder
Liver
Cole P, Rodu B. Cancer: Principles & Practice of Oncology. 6th ed. 2001;241-252.
ONCOLOGYONCOLOGYEpidemiologyEpidemiologyPharmacologic/iatrogenic contributorsPharmacologic/iatrogenic contributors
Ullrich RL, et al. Cancer: Principles & Practice of Oncology. 6th ed. 2001;195-206.
AgentAgent
Ionizing radiation
Type of CancerType of Cancer
Breast cancer
Leukemia
Skin cancer
Thyroid cancer
Lung cancer
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
PharmaceuticalsPharmaceuticals
AgentsAgents Site of CancerSite of Cancer
Cancer chemotherapeutic drugs Bone marrow
Immunosuppressive drugs Reticuloendothelial system
Exogenous hormones
Nonsteroidal estrogens Vagina, breast, testis
Steroidal estrogens Endometrium
Oral contraceptives Liver, endometrium
Tamoxifen Endometrium
Phenacetin analgesics Kidney, pelvis, bladder
Pharmacologic/iatrogenic contributors (cont’d)Pharmacologic/iatrogenic contributors (cont’d)
Adapted from Cole P, Rodu B. Cancer: Principles & Practice of Oncology. 6th ed. 2001;241-252.
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
Selected Industries Associated with Exposure to CarcinogensSelected Industries Associated with Exposure to Carcinogens
IndustryIndustry CarcinogenCarcinogen CancerCancer
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
Occupational-related cancersOccupational-related cancers
Costanza ME, et al. American Cancer Society Textbook of Clinical Oncology. 3rd ed. 2001;55-74.
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
Germline tumor suppressor gene inactivation
Germline oncogene activation
DNA repair defects
Ecogenetic traits
Abnormal tissue architecture
Humoral tumor promoters and regressors
Genetic risk factors: mechanisms of cancer predispositionGenetic risk factors: mechanisms of cancer predisposition
Bale AE, Brown SJ. Cancer: Principles & Practice of Oncology. 6th ed. 2001;207-217.
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
Family history of cancer
Cancer appears earlier in life
Multiple and bilateral tumors
May include rare tumor types (eg, retinoblastoma)
Multisystem involvement
Genetic risk factors: characteristics of cancer familiesGenetic risk factors: characteristics of cancer families
Bale AE, Brown SJ. Cancer: Principles & Practice of Oncology. 6th ed. 2001;207-217.
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
Familial Cancer SyndromeFamilial Cancer Syndrome Site of CancerSite 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
Genetic risk factors: Familial cancer syndromesGenetic risk factors: Familial cancer syndromes
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.
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
Familial Cancer SyndromeFamilial Cancer Syndrome Site of CancerSite 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)
Genetic risk factors: Familial cancer syndromes (cont’d)Genetic risk factors: Familial cancer syndromes (cont’d)
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.
Reducing mortality Reducing mortality
Bal DG, et al. American Cancer Society Textbook of Clinical Oncology. 2nd ed. 1995;40-63.
The National Cancer Institute estimates that cancer mortality rates could be significantly reduced, as follows:
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
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
Risk reductionRisk reduction
Bal DG, et al. American Cancer Society Textbook of Clinical Oncology. 2nd ed. 1995;40-63.
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
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
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
Site of Site of Relative Relative Attributable Attributable CancerCancer Risk FactorRisk Factor RiskRisk RiskRisk
LungLung Cigarette 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 -
ColorectalColorectal High-fat/low-vegetable diet Weak 50%
Physical inactivity Weak 20%
Occupation Weak -
Obesity Weak -
Modifiable risk factorsModifiable risk factors
Adapted from Bal DG, et al. American Cancer Society Textbook of Clinical Oncology. 2nd ed. 1995;44.
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
Site of Site of Relative Relative Attributable Attributable CancerCancer Risk FactorRisk Factor RiskRisk RiskRisk
BreastBreast First 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 -
Modifiable risk factors (cont’d)Modifiable risk factors (cont’d)
Adapted from Bal DG, et al. American Cancer Society Textbook of Clinical Oncology. 2nd ed. 1995;45.
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
Site of Site of Relative Relative Attributable Attributable CancerCancer Risk FactorRisk Factor RiskRisk RiskRisk
CervixCervix Multiple 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
Modifiable risk factors (cont’d)Modifiable risk factors (cont’d)
Adapted from Bal DG, et al. American Cancer Society Textbook of Clinical Oncology. 2nd ed. 1995;45.
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
Test/ProcedureTest/Procedure SexSex AgeAge FrequencyFrequency
Colorectal cancer screening M&F >50 Annual FOBT, flexible sigmoidoscopy every 5 years, or both; colonoscopy every 10 years; ordouble-contrast barium enema every 5 years
PSA test + digital rectal exam M >50 Every year if life expectancy > 10 yearsPap 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 yearBreast self-exam F >20 Every monthBreast clinical exam F 20-39 Every 3 years
>40 Every yearMammography F >40 Every yearHealth counseling and cancer M&F 20-39 Every 3 years checkups >40 Every year
ACS Screening Recommendations for Colorectal, Prostate, Cervical, and ACS Screening Recommendations for Colorectal, Prostate, Cervical, and Breast CancerBreast Cancer
Adapted from Smith RA, et al. CA Cancer J Clin 2001;51:38-75.
Asymptomatic People (Average Risk)Asymptomatic People (Average Risk)
* 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.