Cancer prevention &

SCREENING

Dr. Abdul Aziz TAYOUN

• consultant in community medicine
• Jordanian Board in Community medicine
• DU méthode en recherche clinique/université Bordeaux 2, France
• DU méthode statistique en santé /université Bordeaux 2, France
 TOPICS DISCUSSED
• Global burden.
• Local burden.
• Risk factors for cancer
• Control and prevention.
• Epidemiology of common cancers

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 GLOBAL BURDEN OF
CANCER

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 Global burden of cancer 1
• Cancer is one of the leading causes of morbidity and mortality worldwide , with approximately 14
million cases in 2012.
• The number of new cases is expected to rise by about 70% over the next 2 decades.
• Cancer is the second leading cause of death globally and was responsible for 8.8 million deaths in 2015
globally , nearly 1 in 6 deaths is due to cancer.
• These estimates correspond to age –standardized incidence and mortality rates of 182 and 102 per
100,000, respectively.
• There were slightly more incident cases (53%)of the total and deaths (57%) among men than among
women.
• The worldwide estimate for the number of cancers diagnosed in childhood(ages 0 -14 years) in 2012 is
165,000 (95,000 in boys and 70,000 in girls)
• More than 60% of the world’s cancer cases occur in Africa ,Asia and central and south America , and
these regions account for about 70% of the cancer deaths.
• Around one third of deaths from cancer are due to the 5 leading behavioural and dietary risks : high
body mass index ,low fruit and vegetable intake ,lack of physical activity, tobacco use and alcohol use
• Between 30-50% of all cancer cases are preventable
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 Global burden of cancer 2
• Tobacco use is the most important risk factor for cancer and is responsible for approximately
22% of cancer deaths.
• Cancer causing infections, such as hepatitis and human papilloma virus(HPV), are responsible for
up to 25% of cancer cases in low and middle income countries.
• In 2015 the 5 most common types of cancer that kill women are : breast , lung ,colorectal ,cervical
and stomach cancers.
• Late –stage presentation and inaccessible diagnosis and treatment are common . In 2015 only
35% of low income countries reported having pathology services generally available in public
sector.
More than 90% of high income countries reported treatment services are available
compared to less than 30% of low income countries.
• The economic impact of cancer is significant and increasing . The total annual economic cost of
cancer in 2010 was estimated to approximately 1.16 trillion us dollars.
• Only 1 in 5 low and middle income countries have the necessary data to drive cancer policy.

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REGIONAL AND LOCAL BURDEN OF
CANCER

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Cancer in KSA according to SCR 2013
• In 2013 the total number of cancer incident cases was 15,653.
• Overall cancer was more among women(53.0% )than men (47%).
• 11,645 cases(77.6%) were reported among Saudis.
• Crude incidence rate among Saudis 57.5/100,000.
• The geographic regions with the highest ASR were : eastern region , Riyadh
region and Tabuk .
• The median age at diagnosis for men 58 years, range (0-122) and for women 51
years ,range (0-116).

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 RISK FACTORS FOR CANCER

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Risk Factors
Non Modifiable • • Modifiable
Age - - Tobacco
- Chronic infection
Sex -
- Alcohol drinking
Genetic factor - - Occupational exposure
- Dietary factors
- Obesity and physical exercise
- Physical inactivity
- Radiation
- Medical drugs and procedures
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 Cancer Epidemiology
Identified Associations

• Tobacco & Lung Cancer

• Asbestos & Lung Cancer
• Leather Industry & Nasal Cancer
• Dyes & Bladder Cancer
• Ionizing Radiation & Many Cancers
• EBV & Burkitt’s Lymphoma
• HPV & Cervical Cancer

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Tobacco Consumption
- Main single cause of human cancer worldwide
- Accounts for 30% approx of all human cancer in developed countries
- Responsible for 13 types of cancer: lung, oral cavity, nasal cavity and
nasal sinuses, pharynx, larynx, esophagus, stomach, pancreas, liver,
urinary bladder, kidney, uterine cervix and myeloid leukemia
- Any form of tobacco are risk( smoking, SHS, chewing)
- Benefit of quitting tobacco in adulthood for all kind of major cancer

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Chronic infection
Approx 15- 20% of cancer worldwide: 26% in developing countries, -
8% in developed countries
Common cancer associated with chronic infection: HCC- HBV -
HCV,Cervical cancer and other malignancy- HPV, Lymphoma- EBV,
Leukemia- HTLV, Kaposi sarcoma- HHV8, Gastric cancer- H. Pylori,
Bladder cancer- schistosomiasis

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Alcohol Drinking

- Global burden of cancer attributed to alcohol 3.6%

- A causal association has been established between alcohol drinking
and cancers of the oral cavity, pharynx, larynx, esophagus, liver, colon,
rectum and breast in women .
- For all cancer sites, risk depends on the amount of alcohol
consumption.

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Dietary Factors, Obesity and Physical
activities
Responsible for 25% of human cancers in high income countries but -
exact role of dietary factors for causing cancer remains largely
obscure
Increased weight gain is associated with cancer of colon, gall bladder, -
postmenopausal breast, endometrium, kidney and esophagus
Increasing physical activities decrease the risk of the breast and colon -
cancer

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Occupational exposures

- Global burden of cancer: 2-3%

- Approx 40 occupational agents, groups of agents and mixtures are
classified as carcinogens(IARC monographs)

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Genetic Factor
• Cancer genes may be oncogenes, tumor suppressor gene, risk
modifier genes
• oncogenes are genes where either over-expression or gain of function
mutations contribute to tumorigenesis eg:RAS and MYC families
• Tumour suppressor gene: genes where either under-expression or
loss of function mutations contribute to tumorigenesis. RB and the
melanoma predisposition gene CDKN2A (p16), BRCA1, TP53
• risk modifier genes: genes whose normal function can modify the risk
due to a carcinogenic exposure (either environmental or genetic).
ADHs and ALDHs-hnc, RAD51-BRAC2
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Others
• Ionizing and non ionizing radiation
• Medical procedures and drugs
• Sunlight

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 PREVENTION AND
CONTROL

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Cancer Prevention and control
• Four Strategies: WHO
- Primary Prevention
- Early Detection and Secondary Prevention
- Diagnosis and Treatment
- Palliative Care

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Primary Prevention
• Goal: to reduce or eliminate exposure to cancer-causing factors
• Approaches :
- Immunization against, or treatment of, infectious agents that cause
certain cancers- HBV and HPV vaccine, eradication treatment of H. pylori
- application of effective tobacco control measures
- reduction of excessive alcohol consumption
- maintenance of healthy body weight and physically active lifestyles
- reduction in occupational exposure to carcinogens
- pharmacological intervention

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Early Detection of Cases
• Objective: to detect pre-cancerous changes or early stage cancer
when they can be treated most effectively
• Two strategies of cancer screening
- Opportunistic Screening: Physician or individual
- Organized screening: Mass screening or selective screening
• Cancers that have proven early detection methods include cervix,
colon and rectum, and breast.

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Palliative care
• 70% of cases presented in hospital at advance stage.
Goal: To improve quality of life of the patients & relief of
sufferings
To decrease the problems faced by the families psychologically
To prolong the life

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EPIDEMIOLOGY OF COMMON
CANCERS

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Breast Cancer
• the most frequently diagnosed cancer and the leading cause of cancer
death among women worldwide
• Risk factors: gender, age, inheritance of genetic mutation(BRCA1
BRCA2), high breast tissue density, high dose radiation, obesity after
menopause, use postmenopausal HRT, physical inactivity, alcohol,
smoking etc

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• Prevention strategies.
- Reduce the risk factors by maintaining the body weight, rigorous
physical activity, decrease alcohol intake
• Early diagnosis include screening by mammography, clinical breast
examination (CBE), and breast self-examination (BSE).

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 Early detection of breast cancer
ACS

• Yearly mammograms are recommended starting at age 40 and continuing for as

long as the women is in good health.
• Clinical breast examination(CBE) every 3 years for women in their 20s and 30s
and every year for women 40 and over,
• Women should know how their breasts normally look and feel and report any
breast change promptly to their health care provider. Breast self-exam(BSE) is an
option for women starting in their 20s.
• Women with a family history or genetic tendency should be screened with MRI
in addition to mammograms.

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Colorectal Cancer
• Risk factors
• Age, family history, smoking , alcohol, obesity, exercise, high fat diet/red meat
• Early Detection/Prevention
• 4 modalities recommended for people age 50 and older
• Fecal occult blood test (FOBT) every year
• Flexible sigmoidoscopy every 5 years
• Colonoscopy every 10 years
• Double-contrast barium enema every 5 years

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Early detection of colorectal cancer
ACS
Starting at age 50 , both men and women should follow one of these testing
schedules:
• Yearly fecal occult blood test(GFOBT).
• Yearly fecal immunochemical test(FIT).
• Stool DNA test (sDNA)
The multiple stool take -home test should be used , a colonoscopy should be done
if the teat is positive.

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Lung cancer
• Estimated 1.5 million new cases of cancer in year, account 12% of all
cancer
• Leading cause of cancer mortality in men and second cause in
women
• Cigarette smoking most important risk factor- risk related to No of
cigarette, age of starting and habits, no of puff and nicotine & tar
content as well length of cigarette
• Others: SHS, occupational & environmental exposures, radiation, as
well genetic susceptibility among younger cancer pt

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Prevention strategies
• Tobacco control
- Policy based intervention : FCTC
- Non policy Intervention:
Pharmolocigal( NRT, bupripion,
vareniciline), Non
Pharmacological (counselling)
• Early diagnosis with screening

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Cervical cancer
• the second most commonly diagnosed cancer and the third leading
cause of cancer death in women worldwide
• Risk factors: HPV-16, 18 , early marriage, OCP, Low socio economic
status, single divorce with multiple sex partner
• Prevention and control strategies
- Primary: HPV Vaccination
- Secondary: early case detection with cervical screening

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 Early detection of cervical cancer
ACS

• All women should begin cervical cancer screening about 3 years after they begin
vaginal intercourse, but no later than 21 years old. Screening should be done
every year with a regular pap test or every 2 years the newer liquid-based pap
test.
• Beginning at age 30 , women who have had 3 normal pap tests in a raw may get
screened every 2-3 years. Women older than 30 years may also get screened
every 3 years with either the conventional or liquid-based pap test , plus the
human papilloma virus(HPV) test.
• Women 70 years and older who have had 3 or more normal pap tests in a raw and
no abnormal pap test result in the last 10 years may choose to stop having pap
test.
• Women who have had a total hysterectomy may also choose to stop having pap
tests.
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Prostate Cancer
• Risk factors
• Age, ethnicity, family history, dietary fat?, weight?
• Early detection/prevention >50yrs old
• PSA blood test/yr
• Digital rectal exam/yr

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 THANK YOU

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