Transcript Lifetime Probability of Developing Cancer, by Site, Men, US, 1997

Retrospective studies: Dietary carotenoids and lung cancer risk
Ziegler et al 1984, 1986
Carotenoids
Decreased (significant)
Samet et al, 1985
Carotenoids
Decreased (significant)
Byers et al, 1987
Carotenoids
Decreased (significant)
Pastorino et al, 1987
Carotenoids
Decreased (significant)
Marchand et al, 1989
β-carotin
Decreased (significant)
Prospective studies: Serum or plasma carotenoids and lung cancer risk
Stahelin et al, 1984, 1990
β-carotene
Lower (significant)
Nomura et al, 1985
β-carotene
Lower (significant)
Menkes et al, 1986
β-carotene
Lower (significant)
Wald et al, 1988
β-carotene
Lower (significant)
Connett et al, 1989
β-carotene
Lower (significant)
Effect of -Carotene Supplementation
on the Risk of Lung Cancer
• ATBC (Finnland, 1994 >29 000 smokers)
β-carotene (20 mg/day/5-8 years)
Lung cancer 18%
• CARET (USA, 1996, 18 000 participants)
30 mg ß-carotene and 25,000 IU retinil- palmitate
Lung cancer 28%
Tea Consumption and Esophageal Cancer
I.
• Green tea consumption statistically significantly decreased
the risk of esophageal cancer
(OR: 0.50; 95% CI = 0.30-0.830)
(Gao YT, McLaughlin JK, Blot WJ, et al.
Reduced risk of esophageal cancer associated
with green tea consumption.
J Natl Cancer Inst 1994;86:855-888.)
Tea Consumption and Esophageal Cancer
II.
Daily tea consumption (g tea leaves) in Northern Iranian regions:
Winter
Spring-summer
High-risk region
5.2
7.8
Low-risk region
3.0
5.1
Summer-autumn
4.7
3.9
(Hormozdiari, 1975)
Regular Intake and Supplementation
Level of -Carotene
mg/day
Calcium: Dietary Intake and Supplements
mg/day
Factors Affecting the
Antioxidant/Prooxidant Properties of
-carotene
•
•
•
•
Concentration
Presence of certain prooxidant compounds
Oxigene-concentration
Presence of other antioxidants
Temperature of Tea at Consumption in
Different Regions of Iran
High-risk region
(esophageal
cancer)
Low-risk region
(esophageal
cancer)
Percent of people
drinking tea at less
than 55 °C
Percent of people
drinking tea at
more than 65 °
3%
62%
72%
19%
(Ghadirian, 1987)
Factors Concerning Tea Consumption
• Sort and quality of tea (green, oolong, black)
• Preparation method (water temperature, soaking time)
• Water quality (hardness, contaminants)
• Quality of dishes, contaminants
• Sweetening (sugar)
• Temperature at consumption
Lifetime Probability of Developing
Cancer, by Site, Men, US, 1997-1999
All sites
1 in 2
Prostate
1 in 6
Lung & bronchus
1 in 13
Colon & rectum
1 in 17
Urinary bladder
1 in 29
Non-Hodgkin lymphoma
1 in 47
Melanoma
1 in 57
Leukemia
1 in 69
Oral cavity
1 in 71
Kidney
1 in 72
Stomach
1 in 79
Source: Surveillance, Epidemiology, and End Results Program, 1973-1999, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2002.
Lifetime Probability of Developing Cancer,
by Site, Women, US, 1997-1999
Risk
All sites
1 in 3
Breast
1 in 8
Lung & bronchus
1 in 17
Colon & rectum
1 in 18
Uterine corpus
1 in 37
Non-Hodgkin lymphoma
1 in 56
Ovary
1 in 58
Pancreas
1 in 80
Melanoma
1 in 81
Urinary bladder
1 in 88
Uterine cervix
1 in 123
Source: Surveillance, Epidemiology, and End Results Program, 1973-1999, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2002.
Cancer Survival*(%) by Site and Race,1992-1998
White
African
American
% Difference
All Sites
64
53
11
Breast (female)
88
73
15
Colon & rectum
63
53
10
Esophagus
15
8
7
Leukemia
47
38
9
Non-Hodgkin lymphoma
56
46
10
Oral cavity
59
35
24
Prostate
98
93
5
Urinary bladder
82
65
17
Uterine cervix
72
60
12
Uterine corpus
86
61
25
*5-year relative survival rates based on follow up of patients through 1999.
Source: Surveillance, Epidemiology, and End Results Program, 1973-1999, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2002.
Relative Survival* (%) during Three Time
Periods by Cancer Site
1974-1976
1983-1985
1992-1998
•
All sites
50
52
62
•
Breast (female)
75
78
86
•
Colon & rectum
50
57
62
•
Leukemia
34
41
46
•
Lung & bronchus
12
14
15
•
Melanoma
80
85
89
•
Non-Hodgkin lymphoma
47
54
55
•
Ovary
37
41
53
•
Pancreas
3
3
4
•
Prostate
67
75
97
•
Urinary bladder
73
78
82
*5-year relative survival rates based on follow up of patients through 1999.
Source: Surveillance, Epidemiology, and End Results Program, 1973-1999, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2002.
Cancer Death Rates*, by Race and Ethnicity,
1992-1999
400
369,0
350
300
Male
Female
258,1
250
200
204,5
171,2
160,6
150
163,7
154,5
104,4
110,4
105,7
100
50
0
White
African
American
Asian/Pacific
Islander
American
Indian/ Alaskan
Native
Hispanic†
*Per 100,000, age-adjusted to the 2000 US standard population.
†Hispanic is not mutually exclusive from whites, African Americans, Asian/Pacific Islanders, and American Indians.
Source: Surveillance, Epidemiology, and End Results Program, 1973-1999, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2002.
Change in the US Death Rates* by Cause,
1950 & 2000
Rate Per 100,000
600
586,8
1950
2000
500
400
300
258,2
193,7 200,9
180,5
200
100
60,9
48,1
23,7
0
Heart
Diseases
Cerebrovascular
Diseases
Pneumonia/
Influenza
Cancer
* Age-adjusted to the 2000 US standard population.
Source: US Mortality Volume 1950, National Vital Statistics Report, 2002, Vol. 50, No. 15.
Cardiovascular and cancer mortality in Hungary
(1993-2003).
Cardiovascular
Cancer
(% of total mortality)
1993
Male
46,28
Female
57,52
2003
Male
45,47
Female
56,54
1993
Male
22,63
Female
20,53
2003
Male
27,22
Female
22,79
Cancer deaths in Hungary (per 100.000)
Men
Type of cancer
Women
1993
2003
1993
2003
Lung
115,60
121,6
32,32
44,2
Colorectal
45,38
57,8
40,70
43,5
Mouth, lip
24,32
42,5
Not among the 6
most
significant
causes
Not among the 6
most
significant
causes
Prostate
25,13
27,2
---
---
Stomach
32,35
24,6
20,87
16,0
Liver,
gallbladder
17.07
18,1
21,75
17,4
x
x
12,92
16,4
---
---
43,09
43,4
Pancreas
Breast (female)
Cancer is a worldwide health issue
MALES
Site
High
Low
Population
Rate
Population
Tongue
Bermuda: Black
16.3
China, Qidong
U.S., Los Angeles: Filipino
The Gambia
Stomach
Japan, Yamagata
93.3
Colon
U.S., Hawaii:
Japanese
Rectum
Ratio
Rate
H/L
0.2
81.5
India, Ahmedabad
2.1
44.4
37.2
The Gambia
0.7
53.1
Czech., Boh.& Morav.
22.9
The Gambia
0.7
32.7
Liver
Thailand, Khon Kaen
China, Qidong
90.0
Netherlands, Maastricht
0.8
112.5
Pancreas
U.S., CaliforniaAlameda: Black
13.7
The Gambia
0.4
34.3
Larynx
Spain, Basque
Country
20.4
China, Qidong
0.1
204.0
Bronchus, Lung
New Zealand: Maori
The Gambia
1.0
119.1
Melanoma of
Skin
Australian Capital
Territory
Kuwait: Kuwaitis
Thailand, Khon Kaen
0.1
289.0
Prostate
U.S., Atlanta: Black
102.0
China, Qidong
0.8
127.5
Testis
Switzerland, Zurich
8.8
The Gambia
0.2
44.0
Bladder
Italy, Trieste
34.0
U.S., Los Angeles: Filipino
The Gambia
India, Madras
1.8
18.9
Kidney, etc.
Italy, Trieste
15.5
Algeria, Sétif
0.2
77.5
119.1
28.9
FEMALES
Site
High
Population
Low
Rate
Population
Ratio
Rate
H/L
Mouth
India, Bangalore
9.6
Japan, Yamagata
Spain, Tarragona
Poland, Warsaw
Rural
Algeria, Sétif
0.1
96.0
Esophagus
India, Bangalore
8.8
U.S., Los Angeles:
Japanese
0.1
88.0
Stomach
Japan, Yamagata
42.9
India, Ahmedabad
The Gambia
1.5
28.6
Colon
Bermuda: Black
34.4
Algeria, Sétif
0.9
38.2
Rectum
Israel: Born in
Europe, America
16.1
The Gambia
0.6
26.8
Liver
Thailand, Khon
Kaen
38.3
Canada, Prince
Edward Island
0.1
383.0
Bronchus, Lung
New Zealand: Maori
62.2
India, Madras
1.4
44.4
Melanoma of
Skin
Australian Capital
Territory
25.3
China, Qidong
Kuwait: NonKuwaitis
Algeria, Sétif
0.1
253.0
Breast
U.S., California-Bay
Area: White
104.2
The Gambia
3.4
30.6
All Sites
Canada, British
Columbia
345.4
The Gambia
39.6
8.7
Cancer Sites in Which African-American Death Rates*
Exceed White Death Rates* for Men, US, 1995-1999
African American
•All sites
359.2
•Larynx
White
Ratio of African
American/White
253.0
1.4
5.8
2.4
2.4
•Prostate
72.8
31.2
2.3
•Stomach
14.2
6.3
2.3
9.2
4.5
2.0
8.3
4.2
2.0
12.9
7.2
1.8
9.2
5.9
1.6
109.1
79.7
1.4
•Myeloma
•
•Oral cavity and pharynx
•
•Esophagus
•
•Liver
•Lung & bronchus
•Pancreas
12.0
1.4
16.2
•Small intestine
0.7
0.5
1.4
•Colon & rectum
34.4
25.8
1.3
*Per 100,000, age-adjusted to the 2000 US standard population.
Source: Surveillance, Epidemiology, and End Results Program, 1973-1999, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2002.
Cancer Sites in Which African-American Death Rates*
Exceed White Death Rates for Women, US, 1995-1999
African-American
•All sites
White
Ratio of African
American/White
203.5
169.8
1.2
•Stomach
6.8
3.0
2.3
•Myeloma
6.8
3.0
2.3
•Uterine cervix
6.2
2.8
2.2
•Esophagus
3.5
1.7
2.1
•Larynx
0.9
0.5
1.8
•Uterine corpus, NOS
6.9
3.9
1.8
•Soft tissue, including heart
1.9
1.3
1.5
•Colon & rectum
25.4
18.0
1.4
•Pancreas
13.0
9.0
1.4
3.9
2.8
1.4
37.1
28.2
1.3
3.1
2.3
1.3
•Liver & intrahepatic bile duct
•Breast
•Urinary bladder
*Per 100,000, age-adjusted to the 2000 US standard population.
Source: Surveillance, Epidemiology, and End Results Program, 1973-1999, Division of Cancer Control and
Population Sciences, National Cancer Institute, 2002.
• Different locations have different rates of cancer.
Why does China have a 50x higher rate of liver cancer than
Canada?
Why does US have a 20x higher colon cancer rate than India?
• Epidemiological studies of human cancer
Can't do highly controlled studies as for animals.
Immigrant studies--track cancer incidence among individuals
that have immigrated to country.
• Japanese women in Japan
Rates of cancer:
Stomach cancer high,
breast cancer low
Japanese immigrants to US
Rates of cancer: After one or
two generations, develop
cancer patterns like other US
women
Daganatincidenciák afrikai és amerikai fekete népesség körében
Daganat
m
Nem
Vastagbél
férfiak
Nigéria
1960-69
34
USA
Végbél
Máj
Hasnyálmirigy
férfiak
férfiak
férfiak
34
272
55
159
67
200
217
39
126
Gége
Tüdő
Prosztata
Emlő
Méhnyak
Méhtest
Limfoszarkoma
férfiak
férfiak
férfiak
nők
nők
nők
férfiak
37
27
134
337
559
42
133
236
1,546
724
1,268
507
235
10
141
983
318
1,828
249
695
4
Feketék
349
Fehérek
294
Daganatincidenciák japán őslakosság és hawaii
bevándorlók körében
m
Daganat
Nem
Nyelőcső
Gyomor
Vastagbél
Végbél
Tüdő
Prosztata
Emlő
Méhnyak
Méhtest
Petefészek
férfiak
férfiak
férfiak
férfiak
férfiak
férfiak
nõk
nők
nők
nők
Japán
150
1,331
78
95
237
14
335
329
32
51
Hawaii, 1968-72
Japán
Kaukázusi
46
397
371
297
379
154
1,221
149
407
160
75
217
368
204
962
343
1,869
243
714
274
Factors Contributing to the
Incidence of Human Cancer
Diet (35%)
Tobacco (30%)
Reproductive & Sexual behavior (7%)
Infection (10%)
Occupation (4%)
Geophysical Factors (3%)
Alcohol (3%)
Pollution (2%)
Food Additives (<1%)
Medicines (1%)
Industrial Products (1%)
Unknown (?)
Adapted from Doll, R. and Peto, R.(1981) The Causes of Cancer. Oxford Medical Publication
Causes of cancer
•
•
•
•
•
•
•
•
Nutrition 35%
Smoking 30%
Infections 10%
Sexual behaviour 7%
Occupation 4%
Alcohol 3%
Geophysical factors 3%
Pollution, others 2%
0%
10%
20%
30%
40%
Trends in Overweight* Prevalence (%),
Adults 18 and Older, US, 1992-2001
Geography and occupation influence cancer
risk
Urban
Rural
industrial pollution
dietary fat intake
sedentary lifestyle
occupational hazards
sun exposure
accessibility of medical care
meat consumption
**toxic chemicals from
fertilizers
Standardized mortality ratios for breast (F) and stomach (M) cancer among American
residents of Japanese Ancestry and White Americans (SMR relative to rate in Japan)
300
Breast (F)
Stomach (M)
Preventable
200
Convergence towards host
cancer rates
100
70-90% of Cancer
is Preventable
US white males
2nd generation migrants
1st generation migrants
Japanese
US white females
2nd generation migrants
1st generation migrants
Japanese
0
Large influence of lifestyle
and environment
Population Impact
Population Attributable Risk %
Percent of cancer cases attributable to a risk factor
= Function of exposure prevalence and increase in risk
High exposure to benzene in certain occupations increases bladder
cancer risk 8 fold
Smoking associated with a 4-fold increase bladder cancer risk
Which exposure has a larger impact on the number of bladder
cancers?
Major Causes of Cancer - Tobacco *
Cancer site
Relative Risk
PAR%
Lung
Oral
Esophogus
Bladder
Pancreas
10-12
8-10
7-9
4-6
3-5
80-90%
60-90%
70-80%
40-50%
29-34%
Most important cause of cancer
Smoking usually multiplies the background rates
* Source - Cancer Epid and Prevention, Shottenfield and Fraumeni
Major Causes of Cancer - Diet
Cancer site
Diet factors
PAR%*
Colorectal
Breast
Prostate
Stomach
Pancreas
Fat and vegetable
Fat and vegetable
Fat consumption
Nitrite, fruit and vegetable
Sugar, vegetable
60%
27%
20%
70%
30%
Complex to study
Risks not well understood - nutrients vs individual foods vs patterns
No single factor shows a strong and consistent relationship
* Miller - Chronic Diseases in Canada 1992
Major Causes of Cancer - Viruses
Factor
Cancer sites
Human Papillomaviruses (HPV)
Helicobacter pylori
Hepatisus B (HBV)
Ebstien-Barr (EBV)
HIV
Cervix
Stomach
Liver
Lymphoma
N-H Lymphoma, Kaposi’s sarcoma
Strong evidence for an infective etiology of childhood leukemia
- pattern of occurrence tends to cluster like infectious disease
Major Causes - Reproductive and hormonal factors
Protective Factors
late age at menarche
early age at menopause
early first childbirth
high parity
Risk factors
Oral contraceptive use
Estrogen replacement therapy
Chemicals (PCB) which mimic estrogens
Breast cancer risk influenced by endogenous and exogenous hormones
Major Causes of Cancer - Occupation
Occupation
Cancer Sites
Agricultural
Leukemia, Testes, Lung
Cement
Lung
Mining
Lung, Stomach, Leukemia
Dry Cleaning
Bladder, Kidney, Cervix, Lung
Firefighters
Brain, Lung
Oil Refinery
Leukemia, Bone, Brain, Kidney,
Pancreas, Skin, Lymphatitc
Several occupations, and exposures within these occupations are linked
to high risk for cancer
An important starting point for epidemiologic studies of specific
exposures - e.g. study highly exposed populations
Major Causes of Cancer - Genetics
Factor
Prevalence
RR
PAR
Mutations
Polymorphisms
Low
High (> 1%)
High
Low
Low
High
Causes of Breast Cancer
Prevalence
RR
PAR
BRCA1/BRCA2
Very low
Very High
2%
Specific genetic mutations which are associated with a very high
probability for developing cancer, may account for relatively few cases
because they are present in a small proportion of the underlying
population
Major Causes of Cancer - Gene-Environment Interactions
Polymorphism (NAT2)
Slow acetylation
Fast acetylation
Bladder cancer relative risk
associated with smoking = 8
Bladder cancer relative risk
associated with smoking = 1.5
Interaction -
effect of smoking is different in subjects with a specific
polymorphic gene
- better understanding of the effects of established carcinogens
- uncover low levels of risk previously masked by genetic susceptibility
Summary
Epidemiologic evidence suggests that a substantial proportion of cancer
mortality and morbidity can be prevented
Lifestyle and Environmental factors play an important role
- smoking
- diet
- hormonal
- UV radiation
- occupation
- air and water
Risk factors for many cancer sites still poorly understood
Investigation of gene-environment interactions has enormous potential
to contribute to the understanding of cancer risk
Major role for epidemiology in identifying preventable risk factors
Epidemiologic Study Designs
Experimental
Intervention / Randomized Controlled Trial
Observation
Cohort study
Case-Control study
Methodological considerations in observation studies
CONFOUNDING
Exposure (Exhaust)
Outcome (bladder cancer)
Confounder (Smoking)
Potential confounders
Smoking
Physical activity
Diet
Egyes daganatok kezelésének relatív költségei
Daganat
Fejlett országok (%)
Tüdő
Máj
Nyelőcső
Leukémia
Gyomor
Kolorektális
Ajak-szájüreg
Emlő
Méhnyak
Átlag
122
113
111
109
107
105
76
65
54
100
Fejlődő országok (%)
782
727
709
700
687
336
243
206
174
641