Basic science of Oncology 2011

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

Epidemiology
2

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
3

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
4

1.Disease is not randomly distributed

2.Disease causation is multifactorial

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The scope of Epidemiology

5

Concerned with population health

Concern to clinicians
Clinical researchers
Laboratory scientiest

Basic science of Oncology 2011

General approach
6

What
Who
Where
When

Descriptive epidemiology

Analytic epidemiology

Why
How
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Types of epidemilogical
7

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
8

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
9

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
10

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)

Basic science of Oncology 2011

Leading cancer types among African

American
12

Male

Female

Prostate

Breast

Lung and bronchus

Lung and bronchus

Colon and rectum

Colon and rectum

NHL

Uterine corpus

Oral cavity

Pancreas

Kidney

Ovary

Urinary bladder

NHL

Pancreas

Kidney

Stomach

Multiple Myeloma

liver
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Leading cancer in children

13

Leukemia
Lymphoma and Reticuloendothelial neoplasms
CNS tumours
Retinoblastoma
Renal Tumours
Hepatic Tumours

Basic science of Oncology 2011

.cancer in
children
14

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
15

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
carcinogens
1.Industrial exposure
2-Naphthylamine
Benzidine
Bis(chloromethyl)ether
Bis(2chloroethyl)sulfide
(mustard gas)
Vinyl chloride
Certain tars,soots,oils

Chromium
compounds
Nickel compounds
Asbestos
Benzene

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Chemicals
17

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
N,N-bis(2-chloroethyl)2-naphthylamine
(Chlornaphazin)
Diethylstilbestrol
Inorganic arsenic
comp.
Mephalan,cyclophosph
amide
Azathioprine,Phenytoi
n

3.Societal
exposure
Cigarette smoke
Betel nut and
tobacco quid

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3.Viral and immunologic mechanisms

2.Radiation carcinogenesis:medical x-Epstein-Barr
virus
rays,atomic weapon,radon
in house
-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

Electromagnetic fields
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
22

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
Basic science of Oncology 2011