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CANCER EPIDEMIOLOGY
Bidasari Lubis Dept.I.Kesehatan Anak FK-USU Medan

Epidemiology
The study of distribution and determinants of disease in human population ; why different population or group different risks , diferrent disease Patterns of incidence and death rates of malignant disease : sex,age,race,geography

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Concept epidemiology

1.Disease is not randomly distributed 2.Disease causation is multifactorial

General approach
What Who Where When

Descriptive epidemiology

Analytic epidemiology
Why How

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Types of epidemilogical
Occupational epidemiology : effects of workplace exposures on workers Clinical epidemiology : outcome the patients Genetic epidemiology: focus on familes or high risk individual, concerned with determinants of disease in families and on inherited causes of cancer in population Nutritional or environmental epidemiology Molecular epidemiology

Application epidemiology Planning Evaluation of cancer control Primary prevention Early detection Scope of cancer epidemiology: broad concern causes of cancer identification of population where risk reduced prevention

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Leading cancer types in Indonesia 1.Cervix cancer 2.Breast cancer 3.Colorectal cancer 4.Lung cancer 5.Nasopharyng cancer
( POI=Perhimpunan Onkologi Indonesia)

Leading cancer types among African American

Male
Prostate Lung and bronchus Colon and rectum NHL Oral cavity Kidney Urinary bladder Pancreas Stomach liver

Female
Breast Lung and bronchus Colon and rectum Uterine corpus Pancreas Ovary NHL Kidney Multiple Myeloma

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Etiology
Chemical carcinogens Environmental and industrial carcinogens Drug induced cancers Radiation carcinogenesis Viral and immunologic mechanisms

Etiology
A.Chemical carcinogens 1.Industrial exposure 2-Naphthylamine Benzidine Bis(chloromethyl)ether Bis(2-chloroethyl)sulfide (mustard gas) Vinyl chloride Certain tars,soots,oils Chromium compounds Nickel compounds Asbestos Benzene

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2.Medical exposure N,N-bis(2-chloroethyl)2-naphthylamine (Chlornaphazin) Diethylstilbestrol Inorganic arsenic comp. Mephalan,cyclophosph amide Azathioprine,Phenytoin

3.Societal exposure Cigarette smoke Betel nut and tobacco quid

2.Radiation carcinogenesis:medical x-rays,atomic weapon,radon in house 3.Viral and immunologic mechanisms -Epstein-Barr virus -Hepatitis-B -HIV 4.Environmental: ultraviolet

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Cancers 7 warning signals

1.Change in bowel or bladder habits 2.A sore that does not heal 3.Unusual bleeding or discharge 4.Thickening or lump in breast or elsewhere 5.Indigestionor difficulty in swallowing 6.Obvious change in wart or mole 7.Nagging cough or hoarseness If you have a warning signal ,see your doctor

Role of infection
Epstein-Barr virus (EBV) Underdeveloped country rate infection in infancy , high the age of onset HD -EBV is present in 40 60% of cases -chronic viral infection activation of cellular oncogenes, loss of tumour suppressor genes and deregulation of several cytin

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