epid of cancer

Epidemiology and Control of Cancer

K.A. Narayan

Please answer the following questions in your group. Read the epidemiology of cancer worldwide WHO Fact Sheet• What is Cancer? How can it be defined? • Why are cancers important? • Which are the leading types of cancers? • What causes cancer?• What are the risk factors for cancer?• How can the burden of cancer be reduced?• What is the strategy in India ? Read the document

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Cancer 201214.1 million new cancer cases, 8.2 million cancer deaths and 32.6 million people living with cancer (within 5 years of diagnosis) worldwide. 57% (8 million) of new cancer cases, 65% (5.3 million) of the cancer deaths and 48% (15.6 million) of the 5-year prevalent cancer cases occurred in the less developed regions.

The overall age standardized cancer incidence rate is almost 25% higher in men than in women, with rates of 205 and 165 per 100,000, respectively. Male incidence rates vary almost five-fold across the different regions of the world,

with rates ranging from 79 per 100,000 in Western Africa to 365 per 100,000 in Australia/New Zealand (with high rates of prostate cancer representing a significant driver of the latter).There is less variation in female incidence rates (almost three-fold) with rates ranging from 103 per 100,000 in South-Central Asia to 295 per 100,000 in Northern America.

Cancer Mortality 2012• less regional variability than for incidence, • the rates being 15% higher in more developed than in less developed

regions in men, and 8% higher in women.• In men, the rates is highest in Central and Eastern Europe (173 per

100,000) and lowest in Western Africa (69). • In contrast, the highest rates in women are in Melanesia (119) and

Eastern Africa (111), and the lowest in Central America (72) and South-Central (65) Asia.

Trends in incidence of cancer in selected countries: age-standardised rate (W) per 100,000, men

Trends in mortality from cancer in selected countries: age-standardised rate (W) per 100,000, men

Trends in incidence of cancer in selected countries: age-standardised rate (W) per 100,000, women

Trends in mortality from cancer in selected countries: age-standardised rate (W) per 100,000, women

International Comparisons of AAR with that of PBCRs in IndiaAll Sites (ICD-10:C00-C96) - Males

http://www.canceratlasindia.org/chapter3_3.aspx

International Comparisons of AAR with that of PBCRs in IndiaAll Sites (ICD-10:C00-C96) - Females

• The four most common cancer in India are• Male-oropharynx, esophagus, stomach and lower respiratory tract• Female-breast, cervix, oropharynx and esophagus• Tobacco is used widely used in India • 91% cases of oropharynx is due to Tobacco use• 60% cases in female are breast, cervix and ovary cancer

India…

Cancer Patterns

Ten Leading Sites of Cancer in Indian PBCRs (Males)Age Adjusted (ARR) in Brackets

• Chennai • Delhi


Ten Leading Sites of Cancer in Indian PBCRs (Males)Age Adjusted (ARR) in Brackets

• Mumbai • Bangalore


Ten Leading Sites of Cancer in Indian PBCRs (Females)Age Adjusted (ARR) in Brackets

• Chennai • Delhi

Ten Leading Sites of Cancer in Indian PBCRs (Females)Age Adjusted (ARR) in Brackets

• Bombay • Bangalore


• There are lot of international variations in the pattern of cancer which are attributed to a number of factors such as • environmental factors• food habit• lifestyle• genetic factor• inadequacy in detection and reporting of cases

Cancer patterns

• Tobacco • Tobacco in various forms of usage can cause cancer of lungs, larynx, mouth,

pharynx, esophagus, bladder, pancreas and probably kidney• Cigarette smoking is now responsible for more than 1 million death each year

• Alcohol• Excess intake of alcohol can cause esophageal and liver cancer• Beer consumption may be associated with rectal cancer• Alcohol contributes about 3 % of all cancer deaths

Environmental factors

• Dietary factor• Smoked fish is related to stomach cancer• Dietary fiber to intestinal cancer• Beef consumption to bowel cancer• High fat diet to breast cancer• Food additives and contaminants have fallen under suspicion as causative

agents

• Occupational exposures• These includes exposure to benzene, cadmium, arsenic, chromium, vinyl

chloride, asbestos, polycyclic hydrocarbons, etc.• The risk of occupational exposure is said to be increased if the individual also

smokes cigarette• Occupational exposure is usually reported 1-5% of human cancer

• Virus• Hepatitis B & C - hepatocarcinoma• HIV infection – kaposi’s carcinoma• AIDS – non Hodgkin’s lymphoma• Epstein – bar virus – Burkitts lymphoma and naso – pharyngial carcinoma• Cytomegalovirus – Kaposi’s Sa• Pappiloma virus – cervix cancer• Human T cell leukemia virus – T cell leukemia

• Parasite• May be a cause of cancer• Schistosomiasis can produce Ca of bladder

• Customs, habits and life style• May be associated with an increased risk of cancer• Smoking and lung cancer• Tobacco and beetle chewing and oral cancer

Tobacco and Alcohol Consumption (India)• beedis, cigarettes and

smokeless forms• 275 million tobacco users• main causes of premature, NCD-associated

death and disability• increasing among the

youth, women and the poor.• Account for one million deaths

most deaths occurring among the poor and in the economically productive age group of 30–69 years

• 2030, it is estimated that nearly 1.5million deaths

Figure 17.2 Mortality (%) Attributable to Leading Chronic Disease Risk Factors in India (2004)

Source 214 India Infrastructure Report 2013|14

• Others• Sunlight, radiation, water and air pollution, medication and pesticides• These are related to cancer as environmental factors

• Genetic influences have long been suspected• Retinoblastoma occurs in children of the same parent• Mongols are more likely to develop leukemia• There is probably a complex relationship between hereditary

susceptibility and environmental carcinogenic stimuli in the causation of cancer

Genetic factors

Breast Cancer• Every year, kills more than 500,000 women around the world. • In resource-poor settings, are diagnosed at an advanced stage; • 5 -year survival rates are low, ranging from 10-40%.• where early detection and basic treatment are available and accessible, 5 -

year survival rate for early localized breast cancer exceeds 80%.• can be detected early through two strategies: early diagnosis and screening.• Early diagnosis is based on improved public and professional awareness &

recognizing possible warning signs of cancer and taking prompt action.• Screening involves the systematic use of testing, such as mammography,

across an asymptomatic population to detect and treat cancer or pre-cancers.

Cervical Cancer• Worldwide, fourth most frequent cancer in women, estimated 530 000 new

cases in 2012 representing 7.5% of all female cancer deaths. • Of the estimated more than 270 000 deaths from cervical cancer every year,

more than 85% of these occur in less developed regions.• developed countries have programmes for early screening and early treatment

which prevents up to 80% of cervical cancers in these countries.• developing countries have limited access to effective screening. Disease is often

not identified till advanced stage and symptoms develop. • Prospects for treatment of such late-stage disease may be poor, resulting in a

higher rate of death• The high mortality rate from cervical cancer globally (52%) could be reduced by

effective screening and treatment programmes.

http://www.who.int/mediacentre/factsheets/fs380/en/

Lung cancer• most frequent cancer worldwide.• more than 1.8 million new cases (13% of total cancer incidence) and

almost 1.6 million deaths (20% of total cancer mortality), as estimated in 2012.• More than one third of all newly diagnosed cases occurred in China.• leading cause of cancer death in men in 87 countries and in women in 26

countries. Age-standardized rates vary 80-fold internationally,• are highest in North America, Europe, and East Asia, and tend• to still be relatively low in many African countries and some Asian

countries.

Lung Cancer• Due to a high and rather stable case fatality rate, patterns and• trends for mortality rates are similar to those for incidence rates,• irrespective of level of resource within a given country.• Recent trends in lung cancer reflect the evolution of the smoking epidemic.

In men, incidence rates have peaked in a number• of highly developed countries at a late stage of the tobacco epidemic, while

rates continue to rise among women.• Only in a few countries (Australia and the USA), where the tobacco epidemic

is most advanced and smoking prevalence has been declining for several decades, are there recent downward incidence trends among women

The National Cancer Control Programme• for India was formulated in 1984 with four major goals:

1. Primary prevention of tobacco related cancers.2. Early detection of cancers of easily accessible sites3. Augmentation of treatment facilities, and4. Establishment of equitable, pain control andpalliative care network throughout the country.

• Approaches to Cancer ControlThere are four principal approaches to cancer control:1. Prevention2. Early Detection3. Diagnosis and Treatment4. Palliative Care.

Source” 218 India Infrastructure Report 2013|14

By 2025

Strategies for Cancer Prevention in India

• highest priority to tobacco controlEducating people regarding the disease • The contents of cancer education should focus on, tobacco control,

physical activity and avoidance of obesity, healthy dietary practices, reducing occupational and environmental occupational exposures, reducing alcohol use, immunization against hepatitis B virus, safe sexual practices to avoid human papilloma virus infection

• The cancers of the oral cavity, uterine cervix and female breast are very amenable to early detection.• Periodic examination by Pap smear and Mammography are the

accepted standards for early detection of cervix and breast cancers in the developed countries. • Pap smear and mammography are however not practical and

affordable methods for cervix and breast cancer screening in India.

Distribution of 27 Regional Cancer Centres• National Cancer Registry Programme (NCRP)

initiated in 1982 by ICMR• Population-based registries take the sample

population in a geographically defined area• Hospital-based registries-data from patients

coming to a particular health institution• 21 Population-based registries and 6

Hospital-based registries

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GOALS & OBJECTIVES OF NCCP• Primary prevention by health education tobacco consumption and necessity

of genital hygiene for prevention of cervical cancer• Secondary prevention i.e. early detection and diagnosis of cancers,

cancer of cervix, breast and of the oro-pharyngeal cancer by screening methods and patients’ education on self examination methods.• Strengthening of existing cancer treatment facilities• Palliative care in terminal stage of the cancer

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Strategies• Recognition of New Regional Cancer Centres (RCCs) one-time grant of Rs. 5.00 crores• Strengthening of existing Regional Cancer Centres: A one-time grant of Rs.3.00

crores • Development of Oncology Wing: Government Hospitals & Government Medical

College – 3 crores• District Cancer Control Programme: cluster of 2-3 districts are taken up for

prevention, early detection, minimal treatment and provision of supportive cancer care at district levels• Decentralized NGO Scheme: grant of Rs. 8000/- per camp will be provided to the

NGOs for IEC activities

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epid of cancer

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