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Dr. basem aldeek some%final epidemiological aspects about cancer in king saudi[1]1 [autosaved] Dr. basem aldeek some%final epidemiological aspects about cancer in king saudi[1]1 [autosaved] Presentation Transcript

  • By Basem Salama Eldeek MSc,MD,MHPE Associate prof of community medicine Faculty of medicine king Abdulaziz university,KSA And mansoura university ,Egypt.    
  • Acknowledgement
  • •  The study of the factors affecting cancer, as a way to infer possible trends and causes. •  The study of cancer epidemiology uses epidemiological methods to find the cause of cancer and to identify and develop improved treatments.
  • •  This area of study must contend with problems of •  lead time bias •  length time bias.
  •   •  Lead time bias is the concept that early diagnosis may artificially inflate the survival statistics of a cancer, without really improving the natural history of the disease.
  • •  Length bias is the concept that slower growing, more indolent tumors are more likely to be diagnosed by screening tests, but improvements in diagnosing more cases of indolent cancer may not translate into better patient outcomes after the implementation of screening programs.
  • •  A similar epidemiological concern is overdiagnosis, the tendency of screening tests to diagnose diseases that may not actually impact the patient's longevity. This problem especially applies to prostate cancer and PSA screening. •  Some cancer researchers have argued that negative cancer clinical trials lack sufficient statistical power to discover a benefit to treatment.
  •   •  Observational epidemiological studies that show associations between risk factors and specific cancers mostly serve to generate hypotheses •  Randomized controlled trials then test whether hypotheses generated by epidemiological studies and laboratory research actually result in reduced cancer incidence and mortality. •  Programmatic trials.
  • Robert A. Weinberg, "If we lived long enough, sooner or later we all would get cancer."[10] •  Over a third of cancer deaths worldwide are due to potentially modifiable risk factors §  Tobacco smoking, lung cancer, mouth, and throat cancer; §  Drinking alcohol, oral, esophageal, breast, and other cancers; §  A diet low in fruit and vegetables, §  Physical inactivity, colon, breast, §  Obesity, is associated with colon, breast, endometrial §  Sexual transmission of human papillomavirus, which causes cervical cancer &anal cancer.
  •   •  Men with cancer are twice as likely as women to have a modifiable risk factor .[11] •  lifestyle and environmental factors known to affect cancer risk . •  use of exogenous hormones (e.g., hormone replacement therapy causes breast cancer) •  exposure to ionizing radiation and ultraviolet radiation, and certain occupational and chemical exposures.
  •     •  Every year, at least 200,000 people die worldwide from cancer related to their workplace.[12] •  Millions of workers run the risk of developing cancers such as pleural and peritoneal mesothelioma from inhaling asbestos fibers, or leukemia from exposure to benzene .[12] •  It is estimated that approximately 20,000 cancer deaths and 40,000 new cases of cancer each year in the U.S. are attributable to occupation.[13]
  • •  The Saudi Cancer Registry (SCR) of Saudi Arabia is a population-based registry established in 1992 under the the Ministry of Health (MOH) by the order of His Excellency the Minister of Health. •  The SCR commenced reporting cancer cases from 01 January 1994.
  • Objec'ves:   •  The primary goal of the SCR is to define the population-based incidence of cancer in Saudi Arabia. Additional objectives include programs for early detection and cancer screening, as well as cancer research projects.
  • Saudi Cancer Registry has eleven reports . §  1994 Summary Report, §  1994-1996 Incidence Report, §  1997-1998 Incidence Report, §  1999-2000 Incidence Report, §  2001 Incidence Report, §  2002, 2003, 2004, 2005, 2006, §  2007and Incidence Reports.  
  • Cancer report Total reporting cancer cases Estimated population at K S A Absolute incidence 1994-­‐1996   23092   14089156   54.36      per  1000000   1997-­‐1998   14529   15121791   48.03      per  1000000   1999-­‐2000   14856   15588805   47.06    per  1000000   2001   5616   16056470   34.72    per  1000000   2002   5876   15612781   37.63    per  1000000   2003   8840   16109198   54.78    per  1000000   2004   9381   16527340   56.76  per  1000000   2005   10513   16945484   62.47  per  1000000   2006   11040   17270181   63.92  per  1000000   2007   12,309   17493364   70.63  per  1000000  
  • 20   25   30   35   40   45   50   55   60   65   70   75  
  • 20   25   30   35   40   45   50   55   60   65   70   75   Absolute  incidence     absolute  incidence    
  • 94   95   96   97   98   99   20   01   02   03   04   05   06   07   Thyroid   C  73   5.5   5.3   4.6   5   5.7   5.4   4.8   4.6   4.7   6.1   5.7   6.4   6.5   6.6   Colon     C18   2.2   2.7   2.6   2.2   2.2   2.9   2.6   3.4   3.1   4.2   4.3   4.3   5.3   4.8   NHL   C82,85, 96   4.3   4.2   4.1   4   5   4.3   4.1   4.4   4.4   5   5   5.3   4.8   5.1  
  • 94   95   96   97   98   99   20   01   02   03   04   05   06   07   Leukemi a   C92,94   1.8   1.8   1.7   1.6   1.7   1.6   1.7   1.8   1.8   1.6   1.9   1.6   2   1.5     Hodgkin   C81   1.4   1.3   1   1.1   1.3   1.2   1.2   1.1   1   1.5   1.4   1.3   1.6   1.6     stomach   C16   2.4   2.4   2.1   1.8   2   1.9   1.6   1.7   1.8   1.8   1.7   1.7   2.7   2.5    liver   C22   3.9   3.1   3.3   2.9   3.8   2.7   3.2   2.7   2.8   3.3   2.9   3.1   3.1   2.6  
  • 94   95   96   97   98   99   20   01   02   03   04   05   06   07   Breast  C50   13.4   13   13.4   13.3   14.3   12.6   13.7   12.1   13.9   14.6   16.5   18.7   18.1   21.6   Corpus  uteri  C54   2.1   1.4   1.4   1.6   2   1.6   2.5   2.1   2.2   2.8   2.9   3.6   3.6   4   Corpus  cervix  C53   2.4   2.2   2.5   2.3   2.9   2   1.9   2   1.8   1.9   2   2.1   1.6   1.9   Ovary  C56   2.9   3   2.7   3.1   3.1   2.2   2.2   2.4   2.3   2.5   2.4   2.9   3   2.6  
  • §  The total number of cancer incident cases reported to the SCR was 12,309. §  Overall cancer was slightly more among women than men. §  Cancers affected 5,982 (48.6%) males and 6,321 (51.4%) females with a male to female ratio of 95:100. §  9,347 cases were reported among Saudis, §  2,590 among Non-Saudis.
  • •  11,651 cases were analyzed, of which 9,124 (78.3%) were Saudis and 2,527 (21.7%) were Non-Saudis. Among the Saudis •  4,351 (47.7%) were male •  4,773 (52.3%) were female. •  The male to female ratio •  was 91:100. 47%   53%   proportion Males   Female  
  • Confirmation of Diagnosis of malignancy •  Histologically in 86.2% of the cases. •  Haematological & cytologically in 8% of cases. •  Clinically confirmed cases were 0.3%. •  Radiologically confirmed cases were 2%. •  Cases confirmed by Death Certificate Only were 2.7% . •  The method of diagnosis was unknown for 0.8% of the cases.
  • Age adjusted rate (ASR) of all cancers among Saudi Population
  • 47   48   49   50   51   52   53   total   Men   Women   CIR   CIR per 100,000   Total 52.3% Men 49.4 % women 51.5%
  • Age adjusted rate (ASR) of all cancers among Saudi Population 77   78   79   80   81   82   83   84   85   Total   Men   Women   ASR   ASR per 100,000   Total 82.1 Men 80 women 84.2
  • The age-specific incidence rate (AIR) increased with age for gender. After the age of 64 years, the increase was nearly one and one half fold for males compared to females. The median age at diagnosis is was 59 years for men and 50 years for women
  • §  Riyadh Region 108.5/100,000 §  Tabuk Region 105.0/100,000 §  Eastern Region 104.4/100,000 §  Makkah Region 89.3/100,000 §  Madinah Region 73.8/100,000.   0   20   40   60   80   100   120   ASR   ASR  
  • Percentage  distribu'on  of  most  frequent  type  of   cancer  by  gender  2007  age  (0-­‐14  year)Saudi  children    
  • Percentage  distribu'on  of  most  frequent  type  of   cancer  by  gender(  above  14  years)  2007  Saudi  Adult      
  • Percentage  distribu'on  of  most  frequent  type   of  cancer  by  age  and    gender  2007    
  • Percentage  distribu'on  of  most  frequent  type   of  cancer  by  gender  2007    
  • Percentage  distribu'on  of  most  frequent  type  of   cancer  by  gender  2007  age  (15-­‐29  year)  
  • Percentage  distribu'on  of  most  frequent  type  of   cancer  by  gender  2007  age  (30-­‐44  year)  
  • Percentage  distribu'on  of  most  frequent  type  of   cancer  by  gender  2007  age  (45-­‐59  year)  
  • Percentage  distribu'on  of  most  frequent  type  of   cancer  by  gender  2007  age  (60-­‐74  year)  
  • Percentage  distribu'on  of  most  frequent  type  of   cancer  by  gender  2007  age  (75+year)  
  • Males    
  • Females    
  • Specific cancer common in female
  • Males and 6.6 / 100,000 females
  • Preventive oncology
  • Summary Of Primary Preventive Actions Prospects seem bright for ultimately preventing many cancers. There is already much that can be done: 1. Quit smoking and use of tobacco in any from, and encourage all nonusers not to start (especially the young). 2. Stop alcohol. 3. Control exposures to known carcinogens in the workplace. 4. Reduce exposures outside the workplace to known carcinogens such as arsenic, chromium, nickel, vinyl chloride, and asbestos.
  • 5.  Restrict use of drugs that are known/suspected to be carcinogenic. 6. Prudent use of diagnostic x-rays. 7. Avoid excess exposure to sunlight, especially for fair skinned persons, and encourage use of protective creams and sunscreen. 8. Avoid giving estrogens to pregnant women. Use the lowest dose necessary and include a progestin in the regimen. Summary Of Primary Preventive Actions
  • 5.  Restrict use of drugs that are known/suspected to be carcinogenic. 6. Prudent use of diagnostic x-rays. 7. Avoid excess exposure to sunlight, especially for fair skinned persons, and encourage use of protective creams and sunscreen. 8. Avoid giving estrogens to pregnant women. Use the lowest dose necessary and include a progestin in the regimen. Summary Of Primary Preventive Actions
  • Screening for cancer
  • SCREENING AND 2 RY PREVENTION •  By means of early detection followed by definitive treatment. •  Screening is one component of early detection Secondary prevention can be achieved only if there is a stage of that cancer that is amenable to cure, and if there are means of detecting the cancer at that stage.
  • Natural history of a disease over time, including the pre- clinical stage in which a screening test can detect the presence of disease. A screening test can identify diseased individuals before Detection by routine diagnosis (Occurance of symptoms). Treatment at the time of detection by screening, as opposed to the time of routine diagnosis, results in an improved chance of survival. Biologic onset of disease Disease detectable by screening Detection by Screening test Detectable by routine methods Death treatment
  • The clinical decision-making is based on probability. Probability of breast cancer (percent) 0 20 40 60 80 100 Before mammogram After positive mammogram After positive FNA results 0.3 13 64 Diagnostic test (screening test) is to move the estimated probability of the presence of a disease toward either end of probability scale, thereby providing information that will alter subsequent diagnostic or treatment plans.
  • Bias in Screening lead-time bias    DNAdamage Cancerbegins Cancer firstscreendetectable Lead time Death Patient diagnosed from clinical symptoms Apparent survival Apparent survivalPatient diagnosed by screening Lead time Lead time bias is an increase in survival as measured From detection of disease to death, without lengthening of life.
  • Advanced Uses of Screening Tests -To Determine the probability that a disease is present’ -To assess the severity of an illness’ -To predict the disease outcome’ -To monitor response to therapy’ -To estimate the probability of an outcome.
  • Evaluation of a screening Test.
  • Evaluation of a Diagnostic Test. Truth (gold standard) Test results (Screening test) No diseaseDisease b False-positive Non diseased+ positive test a True positive Disease present +test positive Positive d True negative Non diseased with negative test c False- negative Have the disease with negative test results Negative
  • Evaluation of a Diagnostic Test. Sensitivity and Specificity Sensitivity and specificity are descriptors of the accuracy of a test. The sensitivity of a test is defined as the percentage of persons with the disease of interest who have positive test results: few false positive Sensitivity = X 100 = a/a + c X100 = 14/14+1 X100 = 93 % True positives True positive+ false negatives
  • Evaluation of a Diagnostic Test. Sensitivity and Specificity Specificity of a test is defined as the percentage of persons without the disease of interest who have negative test results It is the ability of the test to rule out the non- diseased few false negative Specificity = X 100 = d /d + b X 100 = 91/91+8 X100 = 92 % True negatives True negatives + false-positives
  • Evaluation of a Diagnostic Test. Total Surgical biopsy FNA results No cancerCancer 228 False- positive 14 True positive Positive 9291 True negative 1 False- negative Negative 1149915Total Sensitivity = 14/14+1 X100 = 93 % Specificity = 91/91+8 X100 = 92 %
  • Positive and Negative Predictive Value Two measures concerning the estimation of the probability of the presence or absence of disease are the positive predictive value (PV+) and the negative predictive value (PV-). The PV+ is defined as the percentage of who actually have the disease of interest to persons with positive test results (allow us to estimate how likely it is the disease of interest is present if the test is positive). PV+= X 100 = a/a + b X100 = 14/ 14+8 X100 = 64 % True positives True positives +false positives
  • Positive and Negative Predictive Value The PV- is defined as the percentage of who do not have the disease of interest to persons with negative test results : PV- = X 100 = d/ d + c X100 = 91 /91+1 X100 = 99 % True negatives True negatives + false negatives
  • Likelihood Ratios (LR) Likelihood Ratios LR + Likelihood Ratios LR -
  • Likelihood Ratios An LR+ of 1, indicates a test of no value in sorting out persons with and without disease. The larger the LR+more than 1 , the stronger the association between having a positive test result and having the disease. LR+ of more than 10 is an indication of a test of high diagnostic value. The smaller the LR- value, the better the diagnostic value of the test. An LR- of 0.1 or less is an indication of a good diagnostic test.
  • 1.   WHO  Disease  and  injury  country  esHmates".  World  Health  OrganizaHon.  2009.   hMp://www.who.int/healthinfo/global_burden_disease/esHmates_country/en/ index.html.  Retrieved  Nov.  11,  2009.     2.  Brawley  OW  (2004).  "Prostate  cancer  screening:  clinical  applicaHons  and   challenges".  Urol.  Oncol.  22  (4):  353–7.  doi:10.1016/j.urolonc.2004.04.014.   PMID  15283896.     3.  Bedard  PL,  Krzyzanowska  MK,  PinHlie  M,  Tannock  IF  (2007).  "StaHsHcal  power  of   negaHve  randomized  controlled  trials  presented  at  American  Society  for  Clinical   Oncology  annual  meeHngs".  J.  Clin.  Oncol.  25  (23):  3482–7.  doi: 10.1200/JCO.2007.11.3670.  PMID  17687153.     4.  SEER  Surveillance  Epidemiology  and  End  Results".  hMp://seer.cancer.gov/.   Retrieved  2007-­‐11-­‐02.     5.  Furlow,  B,  Accuracy  of  US  cancer  surveillance  under  threat  Lancet  Oncology  2007;   8:762-­‐763.  Retrieved  2007-­‐11-­‐01.   6.  Saudi  cancer  register  incidence  repor,t1994-­‐1996.   7.  Saudi  cancer  register  incidence  report,1997-­‐1998.   8.  Saudi  cancer  register  incidence  report,1999-­‐2000.   References  
  • References   9-­‐Saudi  cancer  register  incidence  report  ,2003.   10-­‐Saudi  cancer  register  incidence  report,2004.   11-­‐Saudi  cancer  register  incidence  report,2005.   12-­‐Saudi  cancer  register  incidence  report,2006.   13-­‐Saudi  cancer  register  incidence  report,2007.   14-­‐States  and  V.A.  at  Odds  on  Cancer  Data  (10  October  2007).  New  York   Times.  Retrieved  2007-­‐11-­‐01.   15-­‐NegaHve  Impact  of  HIPAA  on  PopulaHon-­‐Based  Cancer  Registry   Research:  Update  of  a  Brief  Survey  (14  June  2007).  IOM  Presenta=on.   Retrieved  2007-­‐11-­‐01.   16-­‐Cancer  Facts  and  Figures  2012".  Journalist's  Resource.org.   hMp://journalistsresource.org/studies/society/health/cancer-­‐facts-­‐ figures-­‐2012/.