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Epidemiology is the study of the distribution and determinants of
health-related states or events in specified populations and the
application of this study to control health problems
The oldest known description of human cancer is found in 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.
Introduction
2
Cancer EpidemiologyHistorical Perspective
1713 Bernardino Ramazzini, an Italian doctor - the virtual
absence of cervical cancer and relatively high incidence of breast
cancer in nuns
1775 - British surgeon, Percival Pott - probably the first description of
occupational carcinogenesis in the form of scrotum cancer among
chimney sweeps.
1950 - Lung cancer study conducted by Doll and Hill -
linked tobacco smoking to an increased mortality of lung cancer in
over 40,000 medical professionals in the United Kingdom3
Cancer EpidemiologyHistorical Perspective
Tobacco and Lung Cancer
Asbestos and Lung Cancer
Leather Industry and Nasal Cancer
Dyes and Bladder Cancer
Ionizing Radiation and Many Cancers
DES and Vaginal Adenocarcinoma
EBV and Burkitt’s Lymphoma
HPV and Cervical Cancer
4
Aims of Cancer Epidemiology
Uncover new etiologic leads
study of the distribution of cancer
quantify the risk associated with different exposures and
host factors
Promote insights into the mechanisms of carcinogenesis
Assess efficacy of preventive measures
Investigate predictors of survival
5
The Surveillance, Epidemiology, and End Results (SEER)
Program of the National Cancer Institute (NCI) - an
authoritative source of information on new cancer cases and
cancer survival in the United States.
Case ascertainment for SEER began in 1973
The World Health Organization's International Agency for
Research on Cancer and the International Association of Cancer
Registries publishes Cancer Incidence in Five Continents6
Cancer EpidemiologySources
US SEER Registry System
IARC International Registries
State/Hospital Registries
Etiologic Clues
“Alert” Clinician
Experimental Studies
7
Methods of Cancer Epidemiology
Descriptive Studies
Incidence, mortality, survival
Time Trends
Geographic Patterns
Patterns by Age, Gender, SES,
Ethnicity
9
a global perspective on cancer is critical
The huge international variation in the occurrence of many types of cancer
worldwide burden of cancer is no longer confined predominantly to the industrialized, wealthy countries
The impact of migration on cancer rates
Global Cancer Incidence (Surveillance, Epidemiology, and End Results Database)
10
Incidence and Mortality Rates
quantify the number of newly diagnosed cancer cases or
deaths, respectively, in a specified population over a defined time
period
Prevalence
the rate at which new cancer cases are diagnosed in a
specified population and time interval, measures the number or
percentage of people in the population who are living after a
diagnosis of cancer.
Data Sources and Measurements
11
In addition to the effects of age, the overall risk of developing
or dying from cancers is affected by gender, socioeconomic
status, race/ethnicity and geographic location
Sex
The incidence rates of most cancers that affect both men
and women are higher in men than women
few exceptions breast, thyroid, and gallbladder
Overall Cancer Risk
12
Cancers that are strongly related to infectious etiologies, for
example, stomach, liver, and uterine cervix are, in general,
decreasing globally
Rapid increase in the occurrence of malignancies that were
historically common only in wealthy countries, but that now
are increasing in middle- and low-resource countries - include
cancers of the lung, breast, prostate, and colon/rectum.
Temporal Trends
14
A comparison of inter registry rates showed that among males, lung
cancer was the leading site in Bhopal, Delhi and Mumbai while it was the
second leading site in Chennai and Bangalore.
Cancer of the stomach was the leading site in Chennai and Bangalore,
whereas, it occupied different positions in other registries.
In Barshi, cancer of oesophagus occupied the leading site.
Tongue and mouth - the leading site of cancer in Ahmedabad registry.
Comparison
19
In females, breast cancer was the leading site of cancer in all
registries except Barshi
This was followed by cancer cervix as the second leading site of
cancer.
Ovarian cancer occupies the third leading site in Delhi, Mumbai,
Chennai, Bhopal and Ahmedabad registry while it was placed
fourth and fifth in Bangalore and Barshi respectively.
Comparison
20
Worldwide, lung cancer - the most common cancer in terms of both
newly diagnosed cases and deaths
The highest rates are among men in eastern Europe, North America,
and the rest of Europe, whereas the lowest rates are observed in Africa,
excluding South Africa
Lung Cancer
29
Lung cancer - more strongly associated with cigarette smoking
than any other cancer site. Globally, an estimated 85% of lung
cancers in men and 47% in women
Cigarette smoking is estimated to have killed 100 million
people in the 20th century, and is projected to kill one billion
people in the 21st century, unless smoking patterns change
30
The joinpoint trend in SEER cancer incidence with associated APC(%) for cancer of the lung and bronchus
between 1975-2010, All Races
Male and Female Male Female
Trend Period Trend Period Trend Period
2.5* 1975-1982 1.4* 1975-1982 5.6* 1975-1982
1.0* 1982-1991 -0.4 1982-1991 3.4* 1982-1991
-0.7* 1991-2007 -1.8* 1991-2010 0.5* 1991-2007
-2.6* 2007-2010
32
Based on rates from 2008-2010, as 1 in 15 men and women will
be diagnosed with cancer of the lung and bronchus during their lifetime.
Lifetime Risk
Stage Distribution and 5-year Relative Survival by Stage at Diagnosis for
2003-2009, All Races, Both Sexes
Stage at DiagnosisStage
Distribution (%)
5-year
Relative Survival (%)
Localized (confined to primary
site)15 53.5
Regional (spread to regional
lymphnodes)22 26.1
Distant (cancer has metastasized) 57 3.9
Unknown (unstaged) 6 7.833
Among women, breast cancer is the most frequently diagnosed
cancer and the leading cause of cancer death worldwide
Female Breast Cancer
34
Factors that contribute to the striking international variation -
historical differences in reproductive factors (age at menarche,
menopause, and first live birth and number of children), use of
hormone-replacement therapy, obesity after menopause,
alcohol intake, and screening practices.
Based on rates from 2008-2010, 1 in 8 women will be diagnosed
with cancer of the breast during their lifetime
35
The joinpoint trend in SEER cancer incidence with
associated APC(%) for cancer of the breast between
1975-2010, All Races
Female
Trend Period
-0.5 1975-1980
4.0* 1980-1987
-0.2 1987-1994
1.8* 1994-1999
-2.3* 1999-2004
0.1 2004-2010
The joinpoint trend in US cancer mortality with
associated APC(%) for cancer of the breast
between 1975-2010, All Races
Female
Trend Period
0.4* 1975-1990
-1.8* 1990-1995
-3.2* 1995-1998
-1.9* 1998-2010
36
Cancers of the colon and rectum (colorectal cancer) are the
fourth most common cancer diagnosed in men and the third most common in women
Colon and Rectum Cancer
37
The joinpoint trend in SEER cancer incidence with associated APC(%) for cancer of the colon and rectum
between 1975-2010, All Races
Male and Female Male Female
Trend Period Trend Period Trend Period
0.8* 1975-1985 1.1* 1975-1985 0.3 1975-1985
-1.8* 1985-1995 -1.2* 1985-1991 -1.9* 1985-1995
1.5 1995-1998 -3.2* 1991-1995 1.8 1995-1998
-2.3* 1998-2008 2.0 1995-1998 -2.0* 1998-2008
-5.1* 2008-2010 -2.8* 1998-2008 -5.1* 2008-2010
-4.8* 2008-2010
Based on rates from 2008-2010, 1 in 21 men and women will be diagnosed with cancer of the colon and rectum
during their lifetime.
38
Stage Distribution and 5-year Relative Survival by Stage at Diagnosis for
2003-2009, All Races, Both Sexes
Stage at DiagnosisStage
Distribution (%)
5-year
Relative Survival (%)
Localized (confined to primary
site)40 90.3
Regional (spread to regional
lymphnodes)36 70.4
Distant (cancer has metastasized) 20 12.5
Unknown (unstaged) 5 33.6
1 in 21 men and women will be diagnosed with cancer of the colon and rectum during their lifetime.
39
The joinpoint trend in SEER cancer incidence with associated APC(%) for cancer of the oral cavity and
pharynx between 1975-2010, All Races
Male and Female Male Female
Trend Period Trend Period Trend Period
0.7 1975-1981 -0.1 1975-1983 3.4 1975-1979
-1.1* 1981-2003 -1.5* 1983-2001 -0.8* 1979-2010
0.4 2003-2010 0.2 2001-2010
Oral cavity
40
Stage Distribution and 5-year Relative Survival by Stage at Diagnosis for
2003-2009, All Races, Both Sexes
Stage at DiagnosisStage
Distribution (%)
5-year
Relative Survival (%)
Localized (confined to primary
site)31 82.7
Regional (spread to regional
lymphnodes)47 59.2
Distant (cancer has metastasized) 17 36.3
Unknown (unstaged) 6 49.3
1 in 92 men and women will be diagnosed with cancer of the oral cavity and pharynx during their lifetime
41
Prostate - second most frequently diagnosed cancer and the sixth most common fatal cancer among men worldwide
The joinpoint trend in SEER cancer incidence with
associated APC(%) for cancer of the prostate
between 1975-2010, All Races
Male
Trend Period
2.6* 1975-1988
16.5* 1988-1992
-11.6* 1992-1995
2.4 1995-2000
-2.0* 2000-2010
The joinpoint trend in US cancer mortality with
associated APC(%) for cancer of the prostate
between 1975-2010, All Races
Male
Trend Period
0.9* 1975-1987
3.1* 1987-1991
-0.8 1991-1994
-3.8* 1994-2004
-3.1* 2004-2010
42
Stage Distribution and 5-year Relative Survival by Stage at Diagnosis
for
2003-2009, All Races, Males
Stage at DiagnosisStage
Distribution (%)
5-year
Relative Survival (%)
Localized (confined to
primary site)81 100.0
Regional (spread to
regional lymphnodes)12 100.0
Distant (cancer has
metastasized)4 27.9
Unknown (unstaged) 3 72.9
1 in 7 men will be diagnosed with cancer of the prostate during their lifetime
43
The joinpoint trend in SEER cancer incidence with associated APC(%) for cancer of the kidney and renal
pelvis between 1975-2010, All Races
Male and Female Male Female
Trend Period Trend Period Trend Period
2.3* 1975-1994 1.8* 1975-2004 2.7* 1975-1994
-0.6 1994-1997 4.2* 2004-2008 -0.9 1994-1997
3.2* 1997-2008 -3.0 2008-2010 3.4* 1997-2008
-3.4 2008-2010 -6.1 2008-2010
Kidney
The joinpoint trend in US cancer mortality with associated APC(%) for cancer of the kidney and renal pelvis
between 1975-2010, All Races
Male and Female Male Female
Trend Period Trend Period Trend Period
1.0* 1975-1994 1.1* 1975-1991 1.1* 1975-1994
-0.6* 1994-2010 -0.1 1991-2001 -0.9* 1994-2010
-0.9* 2001-201045
Stage Distribution and 5-year Relative Survival by Stage at Diagnosis for
2003-2009, All Races, Both Sexes
Stage at DiagnosisStage
Distribution (%)
5-year
Relative Survival (%)
Localized (confined to primary
site)63 91.7
Regional (spread to regional
lymphnodes)17 64.2
Distant (cancer has metastasized) 17 12.3
Unknown (unstaged) 3 33.5
1 in 62 men and women will be diagnosed with cancer of the kidney and renal pelvis during their lifetime
46
cervix
The joinpoint trend in SEER cancer
incidence with associated APC(%) for
cancer of the cervix uteri between 1975-
2010, All Races
Female
Trend Period
-4.6* 1975-1982
-0.2 1982-1990
-2.5* 1990-2010
The joinpoint trend in US cancer
mortality with associated APC(%) for
cancer of the cervix uteri between 1975-
2010, All Races
Female
Trend Period
-4.3* 1975-1982
-1.6* 1982-1996
-3.7* 1996-2003
-1.1* 2003-2010
47
Stage Distribution and 5-year Relative Survival by Stage at Diagnosis for
2003-2009, All Races, Females
Stage at DiagnosisStage
Distribution (%)
5-year
Relative Survival (%)
Localized (confined to primary
site)47 90.9
Regional (spread to regional
lymphnodes)36 57.1
Distant (cancer has metastasized) 12 16.1
Unknown (unstaged) 4 54.3
1 in 151 women will be diagnosed with cancer of the cervix uteri during their lifetime
48
The burden of cancer worldwide varies across countries according
to differences in risk factors, detection practices, treatment
availability, age structure, and completeness of reporting.
Cancers related to infections account for about 28% of the cases in
developing countries and less than 8% of the cases in developed
countries.
Conclusion
50
Cancers in developing countries more often result in death - generally
diagnosed at late stage and the resources for early detection and
treatment limited.
21% of the world population (most of whom are in the more affluent
world) is covered by population-based cancer registries with high-
quality incidence data for only 9% of the world population
expansions of registries in geographic coverage, quality, and scope
will be a necessary step in promoting cancer control programs
worldwide.
Conclusion
51