Cancer Epidemiology Prevention Control Hafsa Raheel Ibrahim Gosadi
Cancer Epidemiology, Prevention & Control Hafsa Raheel, Ibrahim Gosadi Dept of Family & Community Medicine KSU College of Medicine Acknowledgement: Dr Ahmed Mandil
Learning Objectives Students should be able to: n n n Appreciate the Global impact of cancer Identify the most prevalent cancers world wide Identify the leading causes of cancer deaths Understand the cancer control continuum and explain its implication to public health Explain important factors and trends affecting cancer control and directions for future research 9/10/2020 Cancer Epi 2
True or False? Smoking causes lung cancer 9/10/2020 Cancer Epi 3
True or False? Large percentage of cancers are preventable 9/10/2020 Cancer Epi 4
True or False? In the past 20 years tremendous improvements in the treatment of all cancers have been achieved 9/10/2020 Cancer Epi 5
True or False? Preventing cancer is easier than treating cancer 9/10/2020 Cancer Epi 6
True or False? Screening tests are available for most cancers 9/10/2020 Cancer Epi 7
CANCER HISTORY Human cancer is probably as old as the human race. It is obvious that cancer did not suddenly start appearing after modernization or industrial revolution. The oldest known description of human cancer is found in 7 Egyptian papyri written between 3000 -1500 BC. 9/10/2020 Cancer Epi 8
ANCIENT EGYPT (3000 BC-1500 BC) 1 § § The oldest known description of human cancer is found in 7 Egyptian papyri written between 3000 -1500 BC. Two of them, known as the "Edwin Smith" and "George Ebers" papyri, contain details of conditions that are consistent with modern descriptions of cancer. 9/10/2020 Cancer Epi 9
MAGNITUDE OF THE PROBLEM 9/10/2020 Cancer Epi 10
Estimated Cancer Deaths Lung and bronchus 31% Prostate 10% Colon and rectum Men 295, 280 Women 275, 000 27% Lung and bronchus 15% Breast 10% Colon and rectum Pancreas 5% 6% Ovary Leukemia 4% 6% Pancreas Esophagus 4% 4% Leukemia Liver and intrahepatic bile duct 3% 3% Non-Hodgkin lymphoma Non-Hodgkin Lymphoma 3% 3% Uterine corpus Urinary bladder 3% 2% Multiple myeloma Kidney 3% 2% Brain/ONS All other sites 24% 22% All other sites Source: American Cancer Society 9/10/2020 11
Estimated New Cancer Cases Women 32% 662, 870 12% Breast Prostate 33% Lung and bronchus 13% Colon and rectum 10% 11% Urinary bladder 7% 6% Uterine corpus Melanoma of skin 5% 4% Non-Hodgkin lymphoma 4% Kidney 3% Melanoma of skin Leukemia 3% Oral Cavity 3% Pancreas 2% All Other Sites Source: American Cancer Society 9/10/2020 17% Men 710, 040 Lung and bronchus Colon and rectum 3% Ovary 3% Thyroid 2% Urinary bladder 2% Pancreas 21% All Other Sites Cancer Epi 12
Regional and Local data 9/10/2020 Cancer Epi 13
9/10/2020 Cancer Epi 14
9/10/2020 Cancer Epi 15
9/10/2020 Cancer Epi 16
9/10/2020 Cancer Epi 17
9/10/2020 Cancer Epi 18
9/10/2020 Cancer Epi 19
Cancer Epidemiology Concepts
Methods of Cancer Epidemiology n n Descriptive Studies n Incidence, mortality, survival n Time Trends n Geographic Patterns n Patterns by Age, Gender, SES, Ethnicity Analytic Studies n Cross-sectional n Case-control n Cohort 9/10/2020 Cancer Epi 21
Challenges to Interpretation n n n Observational vs. Experimental Design Cancer “clusters” Study Design and Conduct n Study Size n Biases: misclassification, confounding, selection Exposure assessment important “Strong” and “weak” effects Impact on a population level 9/10/2020 Cancer Epi 22
Rates n n n Incidence Prevalence Specific Crude Adjusted/Standardized SMR/SIR 9/10/2020 Cancer Epi 23
Cancer Epidemiology Sources n n US SEER Registry System (SEER): Surveillance, Epidemiology, and End Results: http: //seer. cancer. gov/ IARC International Registries State/Hospital Registries Etiologic Clues n “Alert” Clinician n Experimental Studies 9/10/2020 Cancer Epi 24
Known Risk Factors for Cancer n Smoking n Reproductive factors n Dietary factors n Socioeconomic status n Obesity n Environmental pollution n Exercise n Ultraviolet light n Occupation n Radiation n Genetic susceptibility n Prescription Drugs n Infectious agents n Electromagnetic fields 9/10/2020 Cancer Epi 25
Cancer Epidemiology IIdentified Associations n n n n Tobacco & Lung Cancer Asbestos & Lung Cancer Leather Industry & Nasal Cancer Dyes & Bladder Cancer Ionizing Radiation & Many Cancers DES & Vaginal Adenocarcinoma EBV & Burkitt’s Lymphoma HPV & Cervical Cancer 9/10/2020 Cancer Epi 26
Prevention & Control
Comprehensive Approach n n Integrated coordinated approach is needed to reduce cancer incidence, morbidity, disability and mortality through promotion, prevention, early detection, management, rehabilitation, palliative care This involved combined work of public, private as well as civil society agencies 9/10/2020 Cancer Epi 28
Primary Prevention (Risk Factor Control) n n n n Cancer education & legislation Tobacco / alcohol prevention and cessation Diet: high fiber, low fat, fruits & vegetables Weight control STI prevention and control Monitoring exposure to sunlight / radiation RF control (within/outside workplace) Lowest estrogen dose, upon prescription 9/10/2020 Cancer Epi 29
Secondary Prevention n Cancer registration (hospital-based, population-based) Early detection / screening: best during preinvasive (in-situ) or pre-malignant stages. Examples: cervical, breast, prostate, colon, oral, skin, testis, etc Management: multi-modal: surgical, chemotherapy, radiotherapy, pain therapy 9/10/2020 Cancer Epi 30
9/10/2020 Cancer Epi 31
Lung Cancer n Risk factors n n Cigarette smoking, environmental exposures, tuberculosis Detection/Prevention n Reduce exposure to tobacco smoke 9/10/2020 Cancer Epi 32
Breast Cancer n Risk Factors n n Age, family history, biopsy, breast density, early menstruation, obesity after menopause, recent use of oral contraceptives, hormone therapy, late or no children, alcohol, breast feeding, exercise Early Detection n Mammography and clinical breast exam every year after age 40 (ACS) 9/10/2020 Cancer Epi 33
Prostate Cancer n Risk factors n n Age, ethnicity, family history, dietary fat? , weight? Early detection/prevention >50 yrs old n n PSA blood test/yr Digital rectal exam/yr 9/10/2020 Cancer Epi 34
Colorectal Cancer n Risk factors n n Age, family history, smoking , alcohol, obesity, exercise, high fat diet/red meat Early Detection/Prevention n 4 modalities recommended for people age 50 and older n n 9/10/2020 Fecal occult blood test (FOBT) every year Flexible sigmoidoscopy every 5 years Colonoscopy every 10 years Double-contrast barium enema every 5 years Cancer Epi 35
References -1 n n n Adami HO, Hunter D, Trichopoulos D. Textbook of cancer epidemiology. 2 nd edition. Oxford: Oxford University Press, 2008. Dennis LK, Lynch CF, Smith EM. Cancer. In: Wallace/Maxcy-Rosenau-Last Public Health & Preventive Medicine. 15 th edition. New York: Mc. Graw, 2009. Brownson RC, Joshu C. Cancer. In: Chronic disease epidemiology and control. 3 rd edition. Washington DC: American public health association, 2010. 9/10/2020 Cancer Epi 36
References -2 n n n Boffetta P, La Vecchia C. Neoplasms. In: Detels R, Beaglehole R, Lansang MA, Gulligord M. Oxford textbook of public health. 5 th edition. Oxford: Oxford University Press. International agency for research on cancer. http: //www. iarc. fr/ Centers for disease control and prevention. www. cdc. gov GCC and KSA national cancer registry. http: //bportal. kfshrc. edu. sa/wps/portal/bportal/KFCC American cancer society. http: //www. cancer. org/ 9/10/2020 Cancer Epi 37
Thank you for your kind attention 9/10/2020 Cancer Epi 38
- Slides: 38