Cancer

Epidemiology: an
overview
 A Global Concern
• 1990 2000 2010

60 million deaths 80 million deaths

2/3 in developing countries

With 5% of the resources to deal with the
problem

40 million of these deaths are preventable

 A Global Concern
• 9 Million new diagnoses each year

• 5 million deaths each year

• 10% of all deaths in the world each year

• Usually regarded as a problem of developed

countries

• More than half of of all cancers are seen in ¾

of the world’s population who live in
developing countries
 Epidemiology of Cancer
• Studies on the epidemiology of cancer
break down into two basic areas.

• The biology/molecular genetics of cancer.

• The sociology of cancer.

• Understanding both of these areas in

critical for cancer control.
 Basic biology of cancer
• Many diseases – One disease process.

• A disorder of cellular growth and differentiation.

• 100 different cancers

• Affects any cell in the body that can undergo

mitosis/cell division.

• Cancer has links to other disease processes

 Biology of Cancer
• Some infections cause cancer
– Schistosomiasis: bladder cancer
– Liver fluke (Clonorchis sinensis): gall bladder cancer

• Toxic causes and cancer

– Lung cancer (mesothelioma) exposure to asbestos

• Despite all this cancer is fundamentally a

genetic disorder.

• Cancers are only a problem because they

spread or metastasise
 Biology of Cancer

HOST RESISTANCE TUMOUR GROWTH

OUTCOME
 Biology of Cancer
• Tumours do not grow freely in the human host.

• There is a defence or “host resistance”.

• Resembles a defence against an infection.

• Transformation, invasiveness, metastasis

malignancy, will all depend upon interaction with
the host defences.

• This balance will change during the life history of

the tumour.
 Biology of Cancer
Implications
• Regard cancer as a “Rule” of thirds.

• 1/3 are preventable

• 1/3 are curable (1/2 in developed countries)

• These numbers depend on

– Effective and comprehensive screening
– Early diagnosis
• Leads to greater curability
 The “Rule” of Thirds
• This is the case because most cancers are
acquired (somatic).

• Only about 5% of all cancers are inherited.

• If cancers are acquired (from external

influences) they are potentially avoidable.
 The Sociology of Cancer
• Cancer is a lifestyle disease

• Carcinogens arise as a consequence of

lifestyle.
– Conditions of living
– Conditions of work

• Carcinogen exposures arise from two

situations
– Where people live
– Changes people make in the world
 Sociology of Cancer
• Where people live.

• Geographic and temporal variability

– Habits
• Smoking ----- Lung cancer.
• Diet ------------ Stomach and colon cancer.
• Food preservatives --------- Stomach and liver cancer.

• Environmental hazards
– Viruses and liver cancer.
 Sociology of Cancer
• Changes people make in the world
– (Industrialisation)
• Ionising radiation
• Chemicals from manufacturing processes.

• For example (Ionising Radiation):

• Latter part of 19th century half of certain
groups of mine workers in central Europe died
of lung cancer

• Also occurred in early 20th century USA

• Radioactivity in the bedrock of these mines

caused the cancer
 Sociology of Cancer
• Example (manufacturing)

• Dyestuffs (betanaphthylamine) caused bladder

cancer in Europe and USA until occupational
health initiatives stooped its use.

• Reoccurring in Southern Asia where

industrialisation has exported this technology
to new areas.

• New cases of mesothelioma in turkey due to

use of asbestos like products
 Sociology – Implications for
Cancer Control
• Importance of lifestyle changes.

• Importance of prevention and screening.

• The need for a public health strategy fro

cancer control
– At a national level
– Balanced programme of Prevention, Screening,
Early diagnosis, treatment, palliation
 Implications for cancer
control
• These factors mainly depend on changes
in the behaviour patterns of humans.
– Addictions to drugs, smoking, alcohol, food.
– Sexual behaviour

• Examples:
– Oral cancer and tobacco chewing
– Lung cancer and smoking
– Cervical cancer and sexual promiscuity

• Major area of research is how to change

behavioural patterns to promote health
and prevent disease and cancer.
Biological Factors and cancer
aetiology
• Four classes of external agents in
carcinogenesis.
– Physical
– Chemical
– Biological
– Diet

• Physical Agents
– Ionising radiation: Cosmic and earth sources
(energy production).
– Cumulative exposure from medical medical and
diagnostic procedures.
 Biological Factors and cancer
aetiology
• Ionising radiation
– Breast, leukaemia, lung, thyroid, stomach, colon,
bladder are common radiation induced tumours.

• Non-Ionising radiation: Solar UV light and

tanning industry
– All forms of skin cancer.

• Particles:
– Air Pollution and other factors
• Asbestos dust and mesothelioma
 Biological Factors and cancer
aetiology
• Chemical Agents are very important in
carcinogenesis.

• Concepts of Promotion and Initiation have

been developed in chemical exposure.

• Industrial exposure.

• Chemical exposure due to habits.

 Biological Factors and cancer
aetiology
• Chemical exposure is perhaps one of the
areas that provides a mechanism of control.

• Many chemical exposures are as a result of;

– Habits (smoking): lung cancer
– Industrial processes: Many cancers
– Medicinal practices (diethylstilbestrol to prevent
abortion (can cause vaginal cancer)
– Alcohol: head and neck cancer
 Chemical Agents

Exposure Chemical Site of Cancer

Insecticide spraying Arsenic Skin

Nickel refining Nickel Paranasal Sinuses

Chromium plating Chromium Lung

Polynuclear Aromatic
Shale oil production Scrotum
Hydrocarbons

Vinyl chloride production Vinyl Chloride Liver

Gas retort work naphthylamine Bladder

Tyre manufacturing Benzene Leukaemia
 Biological Factors and cancer
aetiology
• Biological Agents are central to the
development of many cancer:

– Hepatitis B virus: Liver cancer

– Epstein Barr virus: Lymphomas and some
nasal/pharyngeal cancer
– Human Papilloma virus 16: Cervical cancer
– Schistosomiasis: Bladder cancer
– Liver fluke: Gall bladder cancer
 Biological Factors and cancer
aetiology
• Dietary factors
– Dietary fat
– Food preservatives
– Protective substances in food and diet.

• These factors mainly relate to lifestyle and habits.

– High fat /low fibre diet associated with colorectal cancer
– Food preservative (nitrites) associated stomach cancer
• Many food are associated with health and
protection against cancer
– Cruciferous vegetables, whole grain (fibre), citrus fruits
Social Factors and Cancer
Causation
• Social class
– Socioeconomic gradient

• Occupation
– Industrial hazards

• Medical Services and care

– Radiation and medications

• Lifestyle
– Habits and food handling

• Air and water pollution

 Summary - Risk factors
• Smoking • Reproductive
factors
• Dietary factors
• Socioeconomic
factors
• Obesity
• Environmental
• Exercise pollution
• Ultraviolet light
• Occupation • Ionising radiation
• Genetic susceptibility
• Prescription drugs
• Electromagnetic
• Infectious agents fields