Download - Epidemiology of Cancer
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. 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
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ONCOLOGYONCOLOGYEpidemiologyEpidemiology
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
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ONCOLOGYONCOLOGYEpidemiologyEpidemiology
Adapted from Greenlee RT, et al. CA Cancer J Clin. 2000;50:26.
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
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
*Non-Hodgkin’s lymphoma.†Other nervous system.
Mortality for leading cancersMortality for leading cancers
Adapted from Greenlee RT, et al. CA Cancer J Clin. 2000;50:23.
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
Lung & bronchus59,558
Prostate16,277
Colon & rectum15,842
Pancreas7,898
NHL6,383
> 80> 80
Lung & bronchus15,823
Prostate15,511
Colon & rectum7,459
Bladder2,900
Pancreas2,843
40-5940-59
Lung & bronchus15,379
Colon & rectum4,347
NHL2,552
Pancreas2,584
Esophagus2,069
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
*Other nervous system.†Non-Hodgkin’s lymphoma.
Mortality for leading cancersMortality for leading cancers
Adapted from Greenlee RT, et al. CA Cancer J Clin. 2000;50:23.
All AgesAll Ages
Lung & bronchus61,922
Breast41,943
Colon & rectum28,621
Pancreas14,205
Ovary13,507
20-3920-39
Breast1,629
Uterine cervix629
Leukemia462
Lung & bronchus462
Brain & ONS*385
60-7960-79
Lung & bronchus38,488
Breast18,385
Colon & rectum12,799
Pancreas7,437
Ovary7,207
> 80> 80
Lung & bronchus12,879
Colon & rectum12,046
Breast9,835
Pancreas5,045
NHL†
3,859
40-5940-59
Breast12,093
Lung & bronchus10,088
Colon & rectum3,426
Ovary2,801
Uterine cervix1,803
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;50:16.
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
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. 2000;50:16.
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
Non-Hodgkin’s lymphoma
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
Non-Hodgkin’s lymphoma
Leukemia
Multiple myeloma
All others
Estimated incidenceEstimated incidence Estimated deathsEstimated deaths
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
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.
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
Cancer of the esophagus
Head and neck cancer
Cancer of the large bowel
Liver cancer
Pancreatic cancer
Breast cancer
Alcohol-related cancersAlcohol-related cancers
Trichopoulos D, et al. Cancer: Principles & Practice of Oncology. 5th ed. 1997;231-257.
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
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.
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
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
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
AgentsAgents
Helicobacter pylori
Schistosoma haematobium
Opisthorchis viverrini
Bacterial-related cancersBacterial-related cancers
Adapted from Trichopoulos D, et al. Cancer: Principles & Practice of Oncology. 5th ed. 1997;249.
Site of CancerSite of Cancer
Stomach
Urinary bladder
Liver
ONCOLOGYONCOLOGYEpidemiologyEpidemiologyIatrogenic contributorsIatrogenic contributors
Trichopoulos D, et al. Cancer: Principles & Practice of Oncology. 5th ed. 1997;231-257.
AgentAgent
Ionizing radiation
Type of CancerType of Cancer
Breast cancer
Leukemia
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
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)
Adapted from Trichopoulos D, et al. Cancer: Principles & Practice of Oncology. 5th ed. 1997;249.
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
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.
ONCOLOGYONCOLOGYEpidemiologyEpidemiology
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.
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, Li FP. Cancer: Principles & Practice of Oncology. 5th ed. 1997;285-293.
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 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:
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
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.