Cancer Epidemiology

Clinical Division of OncologyDepartment of Medicine I

Medical University ofVienna, Austria

Cancer Epidemiology



Epidemiology Leading causes of death in 2001Leading causes of death in 2001

Greenlee RT, et al. CA Cancer J Clin. 2001:51;15-36.1,1

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



Epidemiology Leading cancers worldwideLeading cancers worldwide

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. Parkin DM, et al. CA Cancer J Clin. 1999;49:39.



Epidemiology Cancer incidence Cancer incidence

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

MalesMales FemalesFemales

*Temperate South America.†Tropical South America.‡Other than Japan or China.

Parkin DM, et al. CA Cancer J Clin. 1999;49:43.



Epidemiology Evolution of cancer death rates, Evolution of cancer death rates,

malesmales

Greenlee RT, et al. CA Cancer J Clin. 2001;51:15-36.

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



Epidemiology Evolution of cancer death rates, Evolution of cancer death rates,

femalesfemales


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



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

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


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



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

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


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



Epidemiology Male cancer statisticsMale cancer statistics

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%



Epidemiology Female cancer statisticsFemale cancer statistics

Estimated incidenceEstimated incidence Estimated deathsEstimated deaths

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



Epidemiology Known causes of cancerKnown causes of cancer

• Environmental factors

• Occupational exposure to carcinogens

• Lifestyle factors

• Biologic agents

• Pharmacologic/Iatrogenic factors



Epidemiology Alcohol-related cancersAlcohol-related cancers

• Cancer of the esophagus

• Head and neck cancer

• Liver cancer

• Breast cancer



Epidemiology Alcohol-related cancersAlcohol-related cancers

Major causeMajor cause• Lung• Larynx• Oral cavity• Esophagus

Contributory factorContributory factor• Pancreas• Bladder• Kidney• Stomach• Uterine cervix



Epidemiology Virus-related cancersVirus-related cancers

Cole P, Rodu B. Cancer: Principles & Practice ofOncology. 6th ed. 2001;241-252.

AgentsAgents

• Hepatitis B

• Hepatitis C

• HIV-1

• HTLV-1

• HPV

• Epstein-Barr

Site of CancerSite of Cancer

Liver

Liver

Kaposi’s sarcoma

Adult T-cell lymphoma

Uterine cervix

Burkitt’s lymphoma, nasopharynx,Hodgkin lymphoma



Epidemiology

Bacterial-related cancersBacterial-related cancers

AgentsAgents

Helicobacter pylori

Schistosoma haematobium

Opisthorchis viverrini

Site of CancerSite of Cancer

Stomach, Pancreas (?)

Urinary bladder

Liver

Ullrich RL, et al. Cancer: Principles & Practice of Oncology. 6th ed. 2001;195-206.



Epidemiology Pharmacologic/iatrogenic Pharmacologic/iatrogenic

causes of cancer Icauses of cancer I

AgentsAgentsIonizing radiation

Site of CancerSite of CancerBreast cancerLeukemiaSkin cancerThyroid cancerLung cancer

Cole P, Rodu B. Cancer: Principles & Practice of Oncology. 6th ed. 2001;241-252.



Epidemiology Pharmacologic/iatrogenic Pharmacologic/iatrogenic

causes of cancer IIcauses of cancer II

PharmaceuticalsPharmaceuticalsAgentsAgents Site of CancerSite of CancerChemotherapeutic 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

Costanza ME, et al. American Cancer Society Textbook of Clinical Oncology. 3rd ed. 2001;55-74.



Epidemiology Occupational-related cancersOccupational-related cancers

Selected Industries Associated with Exposure to CarcinogensSelected Industries Associated with Exposure to CarcinogensIndustryIndustry CarcinogenCarcinogen CancerCancerShipbuilding, demolition, insulation Asbestos Lung, pleura, skinVarnish, glue Benzene LeukemiaPesticides, smelting Arsenic Lung, skin, liverMineral refining and manufacturing Nickel, chromium Lung, nasal passageFurniture manufacturing Wood dusts Nasal passagesPetroleum products Polycyclic hydrocarbons LungRubber manufacturing Aromatic amines BladderVinyl chloride Vinyl chloride LiverRadium Radium Lung, boneOutdoor occupations Ultraviolet light Skin

Bale AE, Brown SJ. Cancer: Principles & Practice of Oncology. 6th ed. 2001;207-217.



Epidemiology Genetic risk factors: mechanisms of Genetic risk factors: mechanisms of

cancer predispositioncancer predisposition

• Germline tumor suppressor gene inactivation• Germline oncogene activation• DNA repair defects• Ecogenetic traits• Abnormal tissue architecture• Humoral tumor promoters and regressors




Epidemiology Genetic risk factors: characteristics Genetic risk factors: characteristics

of cancer familiesof cancer families

Family history of cancer

Cancer appears relatively early

Multiple and bilateral tumors

May include rare tumor types (eg, retinoblastoma)

Multifocal involvement




Epidemiology Genetic risk factors: Genetic risk factors:

Familial cancer syndromesFamilial cancer syndromes

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•

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.



Epidemiology Genetic risk factors: Genetic risk factors:

Familial cancer syndromesFamilial cancer syndromes

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.

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)



Epidemiology

Reducing mortalityReducing mortality

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 • 3% by early screening and early detection • 10 - 26% by wider application of state-of-the art

treatment

Bal DG, et al. American Cancer Society Textbook of Clinical Oncology. 2nd ed. 1995;40-63.



Epidemiology Risk reductionRisk reduction

• 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 reduced if exposure to the risk factor was eliminated




Epidemiology Modifiable risk factors IModifiable risk factors I

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 -




Epidemiology Modifiable risk factors IIModifiable risk factors II


BreastBreast First full-term pregnancy after age 30 Moderate 7%

Large doses of chest irradiation 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 -




Epidemiology Modifiable risk factors IIIModifiable risk factors III


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




Epidemiology ACS Screening Recommendations for Colorectal, ACS Screening Recommendations for Colorectal,

Prostate, Cervical, and Breast CancerProstate, Cervical, and Breast Cancer

Test/ProcedureTest/Procedure SexSex AgeAge FrequencyFrequencyColorectal 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 + 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 yearCounseling and cancer M&F 20-39 Every 3 years checkups >40 Every year

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.

Cancer Epidemiology

Documents

Transcript of Cancer Epidemiology