epidemiology of cancer

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


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


Adapted from Greenlee RT, et al. CA Cancer J Clin. 2000:50;22.

Leading causes of deathLeading causes of death

0.7

0.9

1.3

2.7

3.7

4.1

4.7

6.9

23.3

31.4

Percentage of Total Deaths, USPercentage of Total Deaths, US

Heart Diseases

Cancer

Cerebrovascular Diseases

Chronic Obstructive Lung Diseases

Accidents

Pneumonia & Influenza

Diabetes Mellitus

Suicide

Homicide

HIV Infection

Rat

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Adapted from Greenlee RT, et al. CA Cancer J Clin. 2000;50:27.

Evolution of cancer death rates, malesEvolution of cancer death rates, males

PancreasLiverProstateStomachLung & bronchusColon & rectumLeukemia

10

20

30

40

50

60

70

1930 1940 1950 1960 1970 1980 1990

Rat

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100

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Fem

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YearYear



Evolution of cancer death rates, femalesEvolution of cancer death rates, females

0

10

20

30

40 Uterus†

BreastPancreasOvaryStomachLung & bronchusColon & rectum

1930 1940 1950 1960 1970 1980 1990


*Non-Hodgkin’s lymphoma.†Other nervous system.

Mortality for leading cancersMortality for leading cancers


Males by Age (years), USMales by Age (years), US

All AgesAll Ages

Lung & bronchus91,278

Prostate32,891

Colon & rectum28,075

Pancreas13,470

NHL12,286

20-3920-39

NHL*723

Leukemia662

Brain & ONS†

625

Lung & bronchus512

Colon & rectum412

60-7960-79


Prostate16,277


Pancreas7,898

NHL6,383

> 80> 80


Prostate15,511

Colon & rectum7,459

Bladder2,900

Pancreas2,843

40-5940-59


Colon & rectum4,347

NHL2,552

Pancreas2,584

Esophagus2,069


*Other nervous system.†Non-Hodgkin’s lymphoma.

Mortality for leading cancersMortality for leading cancers


All AgesAll Ages


Breast41,943


Pancreas14,205

Ovary13,507

20-3920-39

Breast1,629

Uterine cervix629

Leukemia462

Lung & bronchus462

Brain & ONS*385

60-7960-79


Breast18,385


Pancreas7,437

Ovary7,207

> 80> 80



Breast9,835

Pancreas5,045

NHL†

3,859

40-5940-59

Breast12,093


Colon & rectum3,426

Ovary2,801

Uterine cervix1,803

Females by Age (years), USFemales by Age (years), US

ONCOLOGYONCOLOGYEpidemiologyEpidemiologyMale cancer statisticsMale cancer statistics


Estimated incidenceEstimated incidence Estimated deathsEstimated deaths

Melanoma of skin

Oral cavity & pharynx

Lung & bronchus

Pancreas

Kidney & renal pelvis

Colon & rectum

Prostate

Urinary bladder

Leukemia

Non-Hodgkin’s lymphoma

All others

4%

3%

14%

2%

3%

10%

29%

6%

3%

5%

19%

Esophagus

Lung & bronchus

Pancreas

Liver & intrahepatic bile duct

Stomach

Colon & rectum

Prostate

Urinary bladder

Leukemia


All others

3%

31%

5%

3%

3%

10%

11%

3%

4%

5%

22%

ONCOLOGYONCOLOGYEpidemiologyEpidemiologyFemale cancer statisticsFemale cancer statistics


2%

15%

25%

5%

2%

11%

5%

2%

5%

4%

2%

21%

Melanoma of skin

Thyroid

Breast

Lung & bronchus

Pancreas

Colon & rectum

Ovary

Uterine corpus

Urinary bladder


All others

3%

2%

30%

12%

2%

11%

4%

6%

2%

4%

22%

Brain & other nervous system

Breast

Lung & bronchus

Pancreas

Stomach

Colon & rectum

Ovary

Uterine corpus


Leukemia

Multiple myeloma

All others

Estimated incidenceEstimated incidence Estimated deathsEstimated deaths


Occupational exposure

Lifestyle factors

Biologic agents

Iatrogenic factors

Known cancer causesKnown cancer causes

Trichopoulos D, et al. Cancer: Principles & Practice of Oncology. 5th ed. 1997;231-257.


Cancer of the esophagus

Head and neck cancer

Cancer of the large bowel

Liver cancer

Pancreatic cancer

Breast cancer

Alcohol-related cancersAlcohol-related cancers



Major causeMajor cause Lung Larynx Oral cavity Esophagus

Contributory factorContributory factor Pancreas Bladder Kidney Stomach Uterine cervix

Smoking-related cancersSmoking-related cancers

Blum A, et al. Cancer: Principles & Practice of Oncology. 5th ed. 1997;545-557.


AgentsAgents

Hepatitis B

Hepatitis C

HTLV-1

HPV

Epstein-Barr

Virus-related cancersVirus-related cancers

Adapted from Trichopoulos D, et al. Cancer: Principles & Practice of Oncology. 5th ed. 1997;249.

Site of CancerSite of Cancer

Liver

Liver

Adult T-cell leukemia or lymphoma

Uterine cervix

Burkitt’s lymphoma, nasopharynx,Hodgkin’s disease


AgentsAgents

Helicobacter pylori

Schistosoma haematobium

Opisthorchis viverrini

Bacterial-related cancersBacterial-related cancers


Site of CancerSite of Cancer

Stomach

Urinary bladder

Liver

ONCOLOGYONCOLOGYEpidemiologyEpidemiologyIatrogenic contributorsIatrogenic contributors


AgentAgent

Ionizing radiation

Type of CancerType of Cancer

Breast cancer

Leukemia


PharmaceuticalsPharmaceuticals

AgentsAgents Site of CancerSite of Cancer

Cancer chemotherapeutic drugs Bone marrow

Immunosuppressive drugs Reticuloendothelial system

Exogenous hormones

Menopausal estrogens Endometrium, breast

Diethylstilbestrol Vagina, cervix uteri

Anabolic steroids Liver

Oral contraceptives Liver

Tamoxifen Endometrium

Phenacetin analgesics Kidney, pelvis

Iatrogenic contributors (cont’d)Iatrogenic contributors (cont’d)



Industries Associated with Exposure to CarcinogensIndustries Associated with Exposure to Carcinogens

IndustryIndustry CarcinogenCarcinogen CancerCancer

Shipbuilding, demolition, insulation Asbestos Lung, pleura, peritoneum

Varnish, glue Benzene Leukemia

Pesticides, smelting Arsenic Lung, skin, liver

Mineral refining and manufacturing Nickel, chromium Lung

Furniture manufacturing Wood dusts Nasal passages

Petroleum products Polycyclic hydrocarbons Lung

Rubber manufacturing/dye workers Aromatic amines Bladder

Vinyl chloride Vinyl chloride Liver

Radium Radium Bone

Petroleum refining/coal hydrogenation Coal tar products, mineral oils Skin

Occupational-related cancersOccupational-related cancers

Bal DG, et al. American Cancer Society Textbook of Clinical Oncology. 2nd ed. 1995;48.


Germline tumor suppressor gene inactivation

Germline oncogene activation

DNA repair defects

Ecogenetic traits

Genetic risk factors: mechanisms of cancer predispositionGenetic risk factors: mechanisms of cancer predisposition

Bale AE, Li FP. Cancer: Principles & Practice of Oncology. 5th ed. 1997;285-293.


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, Li FP. Cancer: Principles & Practice of Oncology. 5th ed. 1997;285-293.


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.


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 mortalityReducing 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:


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.


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


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.



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)




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)



Test/ProcedureTest/Procedure SexSex AgeAge FrequencyFrequency

Sigmoidoscopy, preferably flexible M&F >50 Every 3-5 yrs, based on advice of physician

Fecal occult blood test M&F >50 Every year

Digital rectal exam M&F >40 Every year

Prostate exam M >50 Every year

Pap test F >18* Every year, if normal >3 times, Pap test may be performed less frequently at discretion of physician

Pelvic exam F 18-40 Every 1-3 years, with Pap test

>40 Every year

Endometrial tissue sample F † At menopause and thereafter at discretion of physician

Breast self-exam F >20 Every month

Breast clinical exam F 20-40 Every 3 years>40 Every year

Mammography F 40-49 Every 1-2 years (1st by age 40)>50 Every year

Health counseling and cancer M&F >20 Every 3 years checkups >40 Every year

Early detection guidelinesEarly detection guidelines

Adapted from Fink DJ, Mettlin CJ. American Cancer Society Textbook of Clinical Oncology. 2nd ed. 1995;181.

ACS Screening Recommendations for Asymptomatic People (Average Risk)ACS Screening Recommendations for 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.

epidemiology of cancer

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