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Cancer Epidemiology

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Cancer

(2)

Cancer is not a single disease but rather a name applied to a great variety of malignant tumor that are formed by the same basic process of uncontrolled growth.

Cancer is one of the most common and severe problem of clinical medicine.

Cancer has emerged as a major public health problem in developing countries for the first time, matching its effect in industrialized nations. This is a global problem.

Cancer

(3)

Tumor

(4)

Carcinoma

Sarcoma

Lymphoma

(5)

Error in DNA replication (randomly acquired).

Effects of carcinogens, such as tobacco smoke, radiation, chemicals, or infectious agents.

Inheritance, and thus present in all cells from birth.

Abnormalities in the genetic material due to:

(6)

Cancer is predicted to be an increasingly important cause of

morbidity and mortality in the next few decades, in all regions of the world.

The forecasted changes in population demographics in the next two decades mean that even if current global cancer rates remain

unchanged, the estimated incidence of 12.7 million new cancer cases in 2008 will rise to 21.4 million by 2030, with nearly two

thirds of all cancer diagnoses occurring in low- and middle-income countries

Cancer as a Global Health Problem

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Proportion of NCD deaths (<70 yrs)

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(10)
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Source: http://p53.free.fr/p53_info/p53_cancer.hl

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 Cancer may affect people at all ages, even fetuses but risk for the more common varieties tends to increase with age.

 Early diagnosis and early treatment are vital, and

identification of persons at increased risk of cancer before its development is an important objective of cancer

research.

Cancer Epidemiology

(14)

 The etiology of cancer is multifactorial, with genetic, environmental, medical, and lifestyle factors interacting to produce a given malignancy.

 Most cancer is caused by genetic mutations often, by a series of mutations.

Etiology

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World Scenario

Males Females Both Sexes

Lung Breast Lung

Prostate Colorectum Breast

Colorectum Cervix Uteri Colorectum

Stomach Lung Stomach

Liver Stomach Prostate

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Indian Scenario

Males Females Both Sexes

Lung Cervix Uteri Cervix Uteri

Lip, Oral Cavity Breast Breast

Other Pharynx Ovary Lip, Oral Cavity

Oesophagus Lip, Oral Cavity Lung

Stomach Oesophagus Oesophagus

(17)

Cancer Statistics (India)

Number of New cancer Cases/ 1000 948.9

Risk of getting cancer before age 75 (%) 10.4

Number of Cancer Deaths/ 1000 633.5

Risk of dying from cancer before age 75 (%) 7.5

(18)

RISK FACTORS FOR CANCER

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 A risk factor is anything that increases a person's chance of getting a disease.

 Some risk factors can be changed, and others cannot.

 Different cancers have different risk factors

Risk Factor

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Old age

Unhealthy lifestyle (Western lifestyle), Poor diet, lack of physical activity, or being overweight.

Environmental factors, defined broadly to include tobacco use, diet, sunlight and infectious diseases.

Occupational carcinogens

Radiation

Family history of cancer (Genetic susceptibility)

Alcohol

Chemicals and other substance

Risk Factors

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Cancer Type

Risk Factor

Lung Cancer Tobacco smoke

Radiation

Asbestos and other substances Air pollution

Breast Radiation

Genetic changes (Inherited mutation) Estrogen & Progesterone

Colorectal Cancer polyp

Genetic alteration Diet

Cigarette smoking

Ulcerative colitis or crohn's disease

Prostate Diet

Certain prostate changes Race Africans Americans

Risk Factor/ Cancer Type

(22)

Cancer Type Risk Factor

Liver Hepatitis viruses (HCV.HBV)

Pancreas Smoking

Diabetes Being male

Chronic pancreatitis

Kidney Tobacco smoking

High blood pressure Diabetes

Von-Hippel-Lindau syndrome (VHL)

Leukemia Radiation

Chemotherapy

Certain disease (Down syndrome) Human T cell leukemia virus

Myelodysplatic syndrome

Risk Factor/ Cancer Type

(23)

Cancer Type

Risk Factor Bladder

Occupation Certain infection Tobacco smoking

Uterine Endometrial hyperplasia

Race Africans Americans Hormonal replacement therapy

Obesity

Melanoma Dysplastic nevi

Weakened immune system Sever blistering/Sunburn

UV irradiation

Risk Factor/ Cancer Type

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Microorganism Cancer

Human papilloma virus Cervical cancer Helicobacter pylori Stomach cancer Hepatitis B and hepatitis C viruses Liver cancer Human T-cell leukemia/lymphoma

virus

Lymphoma and leukemia

Human immunodeficiency virus Lymphoma and a rare cancer called Kaposi's sarcoma

Epstein-Barr virus Lymphoma

Human herpes virus 8 Kaposi's sarcoma

Certain viruses or bacteria may increase the risk of developing cancer

(25)

Risk Factors for Breast Cancer

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Risk Factors for Prostate Cancer

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(28)

Cancer Screening

Search for unrecognized malignancy by means of rapidly applying tests

.

Cancer Screening is possible because:

Premalignant lesions

Most cancers begin as localized lesion

As much as 75% of all cancers in body sites that are accessible.

(29)

Treatment of Precancerous lesions

• Cervical tears

• Intestinal polyps

• Warts

• Chronic Gastritis

• Chronic Cervicitis

• Adenomata

(30)

Methods of Cancer Screening

• Mass Screening by comprehensive cancer detection examination

• Mass Screening at single sites

• Selective screening

(31)

Screening of Cervical Cancer

Pap smear

VIA

VIAM

VILI

(32)

Screening of Breast Cancer

BSE by patient

Palpation by physician

Thermography

Mammography

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Screening of Lung Cancer

X-Ray

Sputum Cytology

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Cancer Education

Lump or hard area in the breast

A change in wart or mole

Persistent Change in digestive or bowel habits

Persistent Cough/ hoarseness

Excessive loss of blood at monthly period or loss of blood outside usual dates

Blood loss from natural orifice

A swelling or sore that doesn’t get better

Unexplained weight loss

(35)

Cancer Registries

• Hospital Based Registries

• Population Based strategies

(36)

Primary prevention: avoidance of exposure to cancer-

causing agents (e.g. tobacco, industrial carcinogens, etc

….).

Early detection of cancer: education to promote early

diagnosis and screening (Imaging diagnosis and

laboratory tests,…)

Genetic testing: these tests can check for certain

inherited gene changes that increase the chance of developing cancer.

Prevention

References

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