CANCER EPIDEMIOLOGY

BY:
DR (MRS) B.J.THANENTHIRAN(MBBS)
23.11.2012
 WHAT IS EPIDEMIOLOGY?
3 Greek roots:

Epi: Upon.
Demos: Human population.
Logia: Science.

“Epidemiology is a science that deals with the

distribution and determinants of diseases in
human populations”.
 Cancer is a major public health problem.

 Overall cancer incidence rates declined slightly in

men (by 0.6% per year) and were stable in women.

 Cancer death rates decreased by 1.8% per year in

men and by 1.6% per year in women.

 Death rates continue to decline for all 4 major

cancer sites (lung, colorectum, breast, and
prostate), with lung cancer accounting for almost
40% of the total decline in men and breast cancer
accounting for 34% of the total decline in women.
 Ten Leading Cancer Types for the Estimated
New Cancer Cases by Sex, United States, 2012.

Prostate 29% Breast 29%

Lung & bronchus 9% Lung & bronchus 14%
Colon & rectum 9% Colon & rectum 9%
Urinary bladder 7% Uterine corpus 6%
Melanoma of the skin 5% Thyroid 5%
Kidney & renal pelvis 5% Melanoma of the skin 4%
Non-Hodgkin 4% Non-Hodgkin 4%
lymphoma lymphoma
Oral cavity & pharynx 3% Kidney & renal pelvis 3%
Leukemia 3% Ovary 3%
Pancreas 3% Pancreas 3%
 Ten Leading Cancer Types for the Estimated
Cancer Deaths by Sex, United States, 2012.
Lung & bronchus 26%
Lung & bronchus 29% Breast 14%
Prostate 9% Colon & rectum 9%
Colon & rectum 9% Pancreas 7%
Pancreas 6% Ovary 6%
Liver & intra hepatic Leukemia 4%
bile duct 5% Non-Hodgkin 3%
Leukemia 4% lymphoma
Oesophagus 4% Uterine corpus 3%
Urinary bladder 3% Liver & intra hepatic
Non-Hodgkin 3% bile duct 2%
lymphoma Brain & other
Kidney & renal pelvis 3% nervous tissue 2%
 The death rates of many forms of malignant
neoplasia have changed.

 Overall death rates in women has fallen

slightly. Mostly due to decline in death rates
from cancers of uterus, stomach & large
bowel. But this trend has counterbalanced the
increasing lung cancer rate.

 Overall cancer rate in men has begun to drop.

 Determinants of cancer
1. Geographic & environmental factors.

2. Age.

3. Heredity.

4. Acquired preneoplastic disorders

 1. Geographic & environmental factors.

 Environmental factors are the predominant

determinant of the most common sporadic
cancers.
 Eg – Death rate from breast cancers are higher in US &
Europe compared to Japan. Conversely death rate for
stomach carcinoma is higher in Japan than in US

 Environmental carcinogens are seen in food,

work place and in personal practices.
 2. Age.

 Generally frequency of cancer is increases

with age.

 May be due to the,

1. Accumulation of somatic mutation.
2. Decline in immune competence.

 Major lethal cancers in children are leukemia,

tumors of CNS, lymphomas, soft tissue
sarcomas and bone sarcomas.
 3. Heridity

 Hereditary forms of cancer can be divided

into 3 categories.

1. Inherited cancer syndromes

2. Familial cancers

3. Autosomal recessive syndromes of defective DNA

repair.
1. Inherited cancer syndromes

 Autosomal dominant pattern of inheritance.

 Strong family history of uncommon cancer &
associated marker phenotype.
 Eg – familial retinoblastoma
familial adenomatous polyposis of the colon
multiple endocrine neoplasia (MEN)
neurofibromatosis types 1 & 2
von Hipple – Lindau syndrome
2. Familial cancers

◦ Virtually all the common forms of cancers that occur

sporadically have been reported to occur in familial forms.

◦ They are not associated with marker phenotype.

◦ Characteristic features are,

 Early age onset
 Occur in two or more close relatives
 Sometime multiple or bilateral tumors

◦ Eg – breast cancer
ovarian cancer
colonic cancers other than familial adenomatous
polyposis.
.
4. Autosomal recessive syndromes of defective DNA
repair.
 Chromosomal or DNA instability

 Eg – Xeroderma pigmentosum
Ataxia telangiectasia
Fanconi anaemia
Bloom syndrome
 4. Acquired preneoplastic disorders

Certain conditions are well recognized predisposition to the

development of malignant neoplasia.

Because cell replication is involved in cancerous transformation

regenerative, hyperplastic, and dysplastic proliferations are
fertile soil for the origin of a malignant neoplasm

1. Persistent regenerative cell replication

Eg – squamous cell carcinoma in long unhealed skin wound.

2. Hyperplastic & dysplastic proliferations

Eg –bronchogenic carcinoma in the dysplastic bronchial mucosa of cigarette
smokers

3. Chronic atrophic gastritis

Eg – gastric carcinoma in pernicious anaemia
4. Chronic ulcerative colitis
increased incidence of colorectal carcinoma in long
standing disease

5. Leucoplakia of the oral cavity , vulva or penis.

Increased risk of squamous cell carcinoma

6. Villous adenomas of the colon.

THANK YOU
 http://onlinelibrary.wiley.com/doi/10.3322/c
aac.20138/pdf

 http://www.merriam-webster.com/dictionary

http://v5.books.elsevier.com/
bookscat/samples/
9781416029731/2~Chapter_6_-
_Neoplasia.pdf