Basic science of Oncology 2011

CANCER EPIDEMIOLOGY
Hematology Oncology Division Child Health Departement Universty of Sumatera Utara

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

Basic science of Oncology 2011

Childhood cancer
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is rare less than 1 % of all cancer in industrialized countries Several types of cancer are virtually unique to childhood, whereas the carcinomas most frequently seen in adults Some of the most striking progress in cancer treatment has been made in paediatric oncology Investigation of childhood tumours has led to major advances in the understanding of the genetic
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Concept epidemiology
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1.Disease is not randomly distributed 2.Disease causation is multifactorial

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The scope of Epidemiology

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Concerned with population health Concern to clinicians Clinical researchers Laboratory scientiest

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General approach
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What Who Where When

Descriptive epidemiology

Analytic epidemiology

Why How
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Types of epidemilogical
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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
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Application epidemiology
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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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Cancer statistic
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When a patient is diagnosed with cancer one of the first questions an oncologist will be asked: how long do I have Survival based statistics : observational studies : 1.relative 5-year survival rates 2.Overall survival 3.Median survival

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Cancer trends
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Relatifve 5-year survival rate for all cancer: 1975 - 1977 : 51%

1996 - 2002 : 66% The reason: Multifactorial: Increasing:1. diagnostic test:mammogram,Pap smears,prostate specific antigen 2.immunosupression 3.the aging of population
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Leading cancer types in Indonesia

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1.Cervix cancer 2.Breast cancer 3.Colorectal cancer 4.Lung cancer 5.Nasopharyng cancer

( POI=Perhimpunan Onkologi Indonesia)

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Leading cancer types among African American

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Male

Female

Prostate Lung and bronchus Colon and rectum

Breast Lung and bronchus Colon and rectum

NHL
Oral cavity Kidney Urinary bladder Pancreas Stomach liver

Uterine corpus
Pancreas Ovary NHL Kidney Multiple Myeloma

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Leading cancer in children

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Leukemia
Lymphoma

and Reticuloendothelial neoplasms CNS tumours Retinoblastoma Renal Tumours Hepatic Tumours

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.cancer in children
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Malignant

Bone tumours Soft Tissue sarcomas Germ Cell, trophoblastic and other gonadal neoplasms Carcinomas and other malignant epithelial neoplasms Other and unspecified malignant neoplasms

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

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Etiology
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A.Chemical Chromium carcinogens compounds 1.Industrial exposure Nickel compounds 2-Naphthylamine Asbestos Benzidine Benzene Bis(chloromethyl)ethe r Bis(2chloroethyl)sulfide (mustard gas) Vinyl chloride Basic science of Oncology 2011

Chemicals
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pesticides (CNS tumors) solvents (eg, CNS tumors, leukemia, neuroblastoma, hepatoblastoma) metals (hepatoblastoma) petroleum products (eg, Wilms tumor, leukemia, hepatoblastoma) lead (Wilms tumor) boron (Wilms tumor) furnaces (lymphoma) chemotherapy (leukemia)
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2.Medical exposure 3.Societal exposure N,N-bis(2Cigarette smoke chloroethyl)-2Betel nut and naphthylamine tobacco quid (Chlornaphazin) Diethylstilbestrol Inorganic arsenic comp. Mephalan,cyclophos phamide Basic science of Oncology 2011

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

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Environmental Factors
Ionizing

radiation

Data

derived from the atomic bomb exposures at Hiroshima and Nagasaki Leukemia
fields

Electromagnetic

Published

reports have suggested that electromagnetic fields have some potential effect on the promotion of leukemia

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Cancers 7 warning signals

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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
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Role of infection
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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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Epstein-Barr

virus (EBV)

African

Burkitt lymphoma Hodgkin lymphoma Nasopharyngeal carcinoma

HIV-induced

immunosuppression

CNS

lymphoma Leiomyosarcoma

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Thank You
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Basic science of Oncology 2011