ONCOLOGY Epidemiology. 1LungBreastLung1,037,000 2StomachColon/rectumStomach798,000 3Colon/rectumCervix uteriBreast796,000 4ProstateStomachColon/rectum783,000

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. 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



*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


Prostate15,742


Pancreas8,070

NHL6,341

>> 80 80


Prostate15,373

Colon & rectum7,455

Bladder3,034

Pancreas2,945

40-5940-59


Colon & rectum4,539

Pancreas2,671

NHL2,399

Esophagus2,141


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

Mortality for leading cancers in 2001Mortality for leading cancers in 2001


All AgesAll Ages


Breast41,737


Pancreas14,529

Ovary13,391

20-3920-39

Breast1,604

Uterine cervix634

Leukemia456

Lung & bronchus442

Brain & ONS*401

60-7960-79


Breast18,292


Pancreas7,454

Ovary7,038

>> 80 80



Breast9,949

Pancreas5,193

NHL†

3,881

40-5940-59

Breast11,889


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


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


All others

4%

2%

31%

13%

2%

11%

4%

6%

2%

4%

21%

Brain

Breast

Lung & bronchus

Pancreas

Stomach

Colon & rectum

Ovary

Uterine corpus


Leukemia

All others

Estimated incidenceEstimated incidence Estimated deathsEstimated deaths


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.


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.


Major causeMajor cause Lung Larynx Oral cavity Esophagus

Contributory factorContributory factor Pancreas Bladder Kidney Stomach Uterine cervix

Smoking-related cancersSmoking-related cancers



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



AgentsAgents

Helicobacter pylori

Schistosoma haematobium

Opisthorchis viverrini

Bacterial-related cancersBacterial-related cancers

Site of CancerSite of Cancer

Stomach

Urinary bladder

Liver


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


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.


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.


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.


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.


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 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:


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

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.

Documents

ONCOLOGY Epidemiology. 1LungBreastLung1,037,000 2StomachColon/rectumStomach798,000 3Colon/rectumCervix uteriBreast796,000 4ProstateStomachColon/rectum783,000