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  • 1. Epidemiology: Leading Cancers Worldwide Worldwide, 8.1 million new cancer cases were estimated for 1990, the most recent year for which complete global data are available. The ranking of the 10 most common sites for new cancers among men and women are shown in this slide. The four most common sites in both sexes combined were lung, stomach, breast, and colon and rectum, each representing more than 750,000 cases.
  • 2. Epidemiology: Cancer Incidence by World Region The incidence of cancers is known to vary substantially from one world region to another. North America and Australia/New Zealand, for example, have incidences of cancers among both males and females that are considerably higher than in other developed regions. In contrast, Northern and Western Africa and many parts of Asia have the lowest cancer incidences.
  • 3. Epidemiology: Leading Causes of Death In one developed country, the United States, for which complete epidemiologic data are available for 2001, cancer is second only to heart disease as the leading cause of death. Cancer deaths account for slightly less than one-quarter of all deaths in the United States, substantially ahead of other common causes of death.
  • 4. Epidemiology: Evolution of Cancer Death Rates, Males Cancer death rates in one developed country, the United States, have shown dramatic changes over the past several decades. Age-adjusted death rates due to cancers of the lung and bronchus, for example, nearly doubled from 1960 through 1996, before declining thereafter. In contrast, death rates due to stomach cancer declined markedly over this time.
  • 5. Epidemiology: Evolution of Cancer Death Rates, Females The most marked changes in cancer death rates among women in one developed country, the United States, over the past several decades were observed in cancers of the lung and bronchus, stomach, uterus, and colon and rectum. Whereas age-adjusted death rates due to lung cancer more than tripled among women from 1960 through 1996, deaths due to cancers of the stomach, uterus, and colon and rectum have declined steadily.
  • 6. Epidemiology: Mortality for Leading Cancers (Males) Mortality due to different cancer types among males is known to vary by age. Cancers of the lung and bronchus, which are the most common cause of cancer death among males in the United States, are relatively uncommon among men 20 to 39 years of age, but are the most common cause of cancer death among men 40 to 59 and 60 to 79 years of age. Similarly, prostate cancer is uncommon in younger men, but emerges as the second most common cause of cancer death among men 60 to 79 years of age and men over the age of 80.
  • 7. Epidemiology: Mortality for Leading Cancers (Females) Cancer mortality among women is known to vary by age for different cancer types. Breast cancer is the most common cause of cancer mortality among women 20 to 39 and 40 to 59 years of age. However, cancers of the lung and bronchus are the most common causes of cancer deaths in women 60 to 79 years of age and in women over the age of 80.
  • 8. Epidemiology: Male Cancer Statistics The estimated incidence of various cancer types and number of cancer deaths due to these cancers among men in the United States are shown in this table. Whereas, prostate cancer is the most common cancer type among males, representing 31% of all cancers, cancers of the lung and bronchus are the most common causes of cancer deaths among men, accounting for 31% of all cancer deaths.
  • 9. Epidemiology: Female Cancer Statistics The estimated incidence of various cancer types and the estimated number of cancer deaths due to these cancers among women in the United States are shown in this slide. Breast cancer, which accounts for 31% of all cancers in these women, is implicated in 15% of cancer deaths. In contrast, cancers of the lung and bronchus account for 13% of cancers but are implicated in 25% of cancer deaths.
  • 10. Epidemiology: Known Cancer Causes A number of exogenous factors are well known to cause cancer in exposed persons. Much has been written about occupational exposure to a broad array of carcinogens, such as benzene, asbestos, and polychlorinated biphenyls though such exposure has been considerably reduced in developed regions of the world. Lifestyle choices such as diet, consumption of tobacco and/or alcohol, and exposure to biologic agents, such as the hepatitis B or C viruses or the Epstein-Barr virus, have also been demonstrated to lead to the development of cancer. Iatrogenic factors, such as the use of some pharmaceutical agents or ionizing radiation, may also contribute to the development of some cancers.
  • 11. Epidemiology: Alcohol-Related Cancers Alcoholic beverages have been judged by IARC (WHO) as a lifestyle factor linked to cancer in the esophagus, oral cavity, pharynx, larynx, and liver. Alcohol is also considered a risk factor for breast cancer, but studies have not yet conclusively demonstrated a plausible mechanistic process between alcohol consumption and breast cancer.
  • 12. Epidemiology: Smoking-Related Cancers Overall, cigarette smoking has been identified as the chief preventable cause of deaths due to cancer in the United States. It is a major cause of cancers of lung, larynx, oral cavity, and esophagus, and is considered a contributory factor in pancreatic, bladder, kidney, stomach, and uterine cervix cancers.
  • 13. Epidemiology: Virus-Related Cancers Overwhelming evidence shows that chronic infection with hepatitis B is an important cause of hepatocellular carcinoma (HCC)—the most common primary liver cancer. Epidemiologic studies have shown hepatitis C to also be conclusively linked to HCC. HTLV-1 has been implicated in adult T-cell leukemia, whereas HIV type 1 causes Kaposi’s sarcoma. HPV is likely to be an important determinant of cervical cancer, and strong evidence also indicates that Epstein-Barr virus is a causal factor of Burkitts’ lymphoma, cancer of the nasopharynx, and Hodgkin’s disease.
  • 14. Epidemiology: Bacterial-Related Cancers In Asia, a more rare histologic type of liver cancer, cholangiocarcinoma, has been linked to infestation by Opisthorchis viverrini. Other studies have suggested that gastric infection with the bacterium Helicobacter pylori is an important risk factor for gastric cancer. In parts of Africa and the Middle East, infection with the bladder parasite Schistosoma haematobium plays a major role in the causation of bladder cancer.
  • 15. Epidemiology: Pharmacologic/Iatrogenic Contributors The relation between ionizing radiation and breast cancer is well established, with preadolescent exposure greatly increasing the risk of radiation-induced breast cancer. Low doses of ionizing radiation may cause childhood leukemia, and high doses have consistently been found to be leukemogenic. Radiation also has been implicated in the subsequent development of skin cancer, thyroid cancer, and lung cancer.
  • 16. Epidemiology: Pharmacologic/Iatrogenic Contributors (cont’d) A number of pharmaceutical agents have been determined to be human carcinogens. Cancer chemotherapeutic drugs have been linked to bone marrow cancer, while immunosuppressive drugs have been shown to have a carcinogenic effect on the reticuloendothelial system. Nonsteroidal estrogens have been implicated in cancer of the vagina, breast, and testes, whereas steroidal estrogens and tamoxifen increase the risk of endometrial cancer. Increased risks of both endometrial and liver cancer have been documented among oral contraceptive users. Finally, phenacetin analgesics are implicated in the cause of kidney and pelvis cancer.
  • 17. Epidemiology: Occupational-Related Cancers The American Cancer Society estimates that approximately 20,000 deaths in the United States can be attributed to occupational exposure to carcinogens. This slide lists occupational cancers by industry and carcinogen.
  • 18. Epidemiology: Genetic Risk Factors: Mechanisms of Cancer Predisposition Several mechanisms have been proposed to explain the genetic basis of cancer. An individual’s predisposition can be attributed to germline mutations that inactivate tumor-suppressor genes that would normally serve to inhibit inappropriate and unregulated cell growth and proliferation. Conversely, mutations that produce inappropriate activation of germline oncogenes can stimulate DNA synthesis, cell growth and division. Defects in DNA repair mechanisms can increase the risk that mutations in cancer-related genes will lead to cancerous disease. Ecogenetic traits are believed to reflect individuals’ increased susceptibility to common carcinogens due to polymorphisms in systems affected by or involved in the clearance of exogenous carcinogens from the body. Disorders associated with abnormal tissue architecture (eg, juvenile polyposis) or abnormalities in humoral tumor promoters and regressors (eg, polycystic ovarian syndrome) also may play a role in predisposing patients to cancer.
  • 19. Epidemiology: Genetic Risk Factors: Characteristics of Cancer Families Expression of hereditary cancers may be observed in at least some members of families that have a history of cancer. Cancers in individuals within these families often manifest relatively early in life, possibly in the form of birth defects, and may appear as multiple and bilateral tumors. Hereditary cancers may include rare tumor types, such as retinoblastoma or breast cancer in males, may affect multiple body systems, and may be revealed with variable expressivity among members of the family.
  • 20. Epidemiology: Genetic Risk Factors: Familial Cancer Syndromes A number of familial cancer syndromes have been identified. These typically rare syndromes include neurofibromatosis Types 1 and 2, von Hippel-Lindau disease, hereditary Wilms’ tumor and related syndromes, Li-Fraumeni syndrome, and nevoid basal cell carcinoma syndrome.
  • 21. Epidemiology: Genetic Risk Factors: Familial Cancer Syndromes (cont’d) Other familial cancer syndromes include familial adenomatous polyposis, hereditary nonpolyposis colorectal cancer, Cowden’s syndrome, and cancers associated with the presence of the BRCA-1 and BRCA-2 genes.
  • 22. Epidemiology: Reducing Mortality An estimated one in three Americans will have cancer over the course of his or her lifetime. However, the National Cancer Institute suggests that a substantial reduction in cancer mortality could be achieved through the following measures: control of tobacco use, widespread adoption of a low-fat diet with greatly increased fiber consumption, early detection and screening, and the wider application of state-of-the art treatments.
  • 23. Epidemiology: Risk Reduction The elimination of exposure to risk factors is the focus of cancer primary prevention efforts. The relative risk for a particular type of cancer describes the greater risk of the population exposed to the risk factor compared to those not exposed. For example, the relative risk of developing lung cancer is 11 for smokers, meaning that the relative risk is 11 times greater for smokers than nonsmokers. The population attributable risk describes the percentage of cancer cases that could be eliminated by eliminating exposure to the risk factor. For example, it is estimated that 87% of the lung cancer cases could be eliminated by eliminating exposure to smoking.
  • 24. Epidemiology: Modifiable Risk Factors This slide lists the modifiable risk factors for lung and colorectal cancers, along with the magnitude of the relative risk and the best available estimate of attributable risk for these cancers.
  • 25. Epidemiology: Modifiable Risk Factors (cont’d) This slide lists the modifiable risk factors for breast cancer, along with the magnitude of the relative risk and the best available estimate of attributable risk for this cancer.
  • 26. Epidemiology: Modifiable Risk Factors (cont’d) This slide lists the modifiable risk factors for cancer of the cervix, along with the magnitude of the relative risk and the best available estimate of attributable risk for this cancer.
  • 27. Epidemiology: Early Detection Guidelines This slide lists the American Cancer Society’s guidelines for early detection of selected cancers in both men and women.

Transcript

  • 1. ONCOLOGY Epidemiology
  • 2. ONCOLOGY Epidemiology 1 Lung Breast Lung 1,037,000 2 Stomach Colon/rectum Stomach 798,000 3 Colon/rectum Cervix uteri Breast 796,000 4 Prostate Stomach Colon/rectum 783,000 5 Liver Lung Liver 437,000 6 Mouth/pharynx Ovary Prostate 396,000 7 Esophagus Corpus uteri Cervix uteri 371,000 8 Bladder Liver Mouth/pharynx 363,000 9 Leukemia Mouth/pharynx Esophagus 316,000 10 NHL* Esophagus Bladder 261,000 Total New Rank Males Females Both Sexes Cases *Non-Hodgkin’s lymphoma. Adapted from Parkin DM, et al. CA Cancer J Clin. 1999;49:39. Leading cancers worldwide
  • 3. ONCOLOGY Epidemiology 1 N. America 369.9 N. America 277.5 2 Australia/N.Z. 312.7 Australia/N.Z. 254.0 3 W. Europe 294.8 N. Europe 234.5 4 Japan 270.9 S. America* 230.1 5 N. Europe 270.0 W. Europe 210.4 6 E. Europe 269.4 Micronesia/ 205.2 Polynesia 7 S. Europe 256.0 Southern Africa 187.8 8 S. America* 255.1 Melanesia 185.6 9 Southern Africa 247.4 S. America † 185.0 10 Eastern Asia ‡ 235.7 Central America 180.1 Incidence/ Incidence/ Rank Region 100,000 Region 100,000 *Temperate South America. † Tropical South America. ‡ Other than Japan or China. Adapted from Parkin DM, et al. CA Cancer J Clin. 1999;49:43. Cancer incidence by world region Males Females
  • 4. ONCOLOGY Epidemiology Adapted from Greenlee RT, et al. CA Cancer J Clin. 2001:51;15-36. Leading causes of death in 2001 Percentage of Total Deaths, US Heart Diseases Cancer Cerebrovascular Diseases Chronic Obstructive Lung Diseases Accidents Pneumonia & Influenza Diabetes Mellitus Suicide Nephritis Cirrhosis of the Liver
  • 5. ONCOLOGY Epidemiology Evolution of cancer death rates, males 80 70 60 50 40 30 20 10 0 Year Pancreas Lung & Bronchus Prostate Stomach Colon & Rectum Leukemia Liver 1930 1940 1950 1960 1970 1980 1990 1997 Rate per 100,000 Male Population Greenlee RT, et al. CA Cancer J Clin. 2001;51:15-36.
  • 6. ONCOLOGY Epidemiology Evolution of cancer death rates, females Year 80 70 60 50 40 30 20 10 0 Uterus Stomach Pancreas Ovary Lung & Bronchus Colon & Rectum Breast 1930 1940 1950 1960 1970 1980 1990 1997 Rate per 100,000 Female Population Greenlee RT, et al. CA Cancer J Clin. 2001;51:15-36.
  • 7. ONCOLOGY Epidemiology *Other nervous system. † Non-Hodgkin’s lymphoma. Mortality for leading cancers in 2001 Adapted from Greenlee RT, et al. CA Cancer J Clin. 2001;51:15-36. Males by Age (years), US All Ages Lung & bronchus 91,399 Prostate 32,203 Colon & rectum 28,024 Pancreas 13,806 NHL 12,205 20-39 Leukemia 663 Brain & ONS* 627 NHL † 612 Lung & bronchus 484 Colon & rectum 404 60-79 Lung & bronchus 59,377 Prostate 15,742 Colon & rectum 15,615 Pancreas 8,070 NHL 6,341 > 80 Lung & bronchus 16,011 Prostate 15,373 Colon & rectum 7,455 Bladder 3,034 Pancreas 2,945 40-59 Lung & bronchus 15,521 Colon & rectum 4,539 Pancreas 2,671 NHL 2,399 Esophagus 2,141
  • 8. ONCOLOGY Epidemiology *Other nervous system. † Non-Hodgkin’s lymphoma. Mortality for leading cancers in 2001 Greenlee RT, et al. CA Cancer J Clin. 2000;50:15-36. All Ages Lung & bronchus 63,075 Breast 41,737 Colon & rectum 28,950 Pancreas 14,529 Ovary 13,391 20-39 Breast 1,604 Uterine cervix 634 Leukemia 456 Lung & bronchus 442 Brain & ONS* 401 60-79 Lung & bronchus 39,077 Breast 18,292 Colon & rectum 12,950 Pancreas 7,454 Ovary 7,038 > 80 Lung & bronchus 13,392 Colon & rectum 12,174 Breast 9,949 Pancreas 5,193 NHL † 3,881 40-59 Breast 11,889 Lung & bronchus 10,155 Colon & rectum 3,472 Ovary 2,841 Pancreas 1,775 Females by Age (years), US
  • 9. ONCOLOGY Epidemiology Male cancer statistics Adapted from Greenlee RT, et al. CA Cancer J Clin. 2000;51:18, 15-36. Estimated incidence Estimated deaths Melanoma of skin Oral cavity & pharynx Lung & bronchus Pancreas Kidney Colon & rectum Prostate Urinary bladder Leukemia Non-Hodgkin’s lymphoma All others 5% 3% 14% 2% 3% 10% 31% 6% 3% 5% 18% Esophagus Lung & bronchus Pancreas Liver Kidney Colon & rectum Prostate Urinary bladder Leukemia Non-Hodgkin’s lymphoma All others 3% 31% 5% 3% 3% 10% 11% 3% 4% 5% 22%
  • 10. ONCOLOGY Epidemiology Female cancer statistics Adapted from Greenlee RT, et al. CA Cancer J Clin. 2001;51:18, 15-36. 2% 15% 25% 6% 2% 11% 5% 2% 5% 4% 23% Melanoma of skin Thyroid Breast Lung & bronchus Pancreas Colon & rectum Ovary Uterine corpus Urinary bladder Non-Hodgkin’s lymphoma All others 4% 2% 31% 13% 2% 11% 4% 6% 2% 4% 21% Brain Breast Lung & bronchus Pancreas Stomach Colon & rectum Ovary Uterine corpus Non-Hodgkin’s lymphoma Leukemia All others Estimated incidence Estimated deaths
  • 11. ONCOLOGY Epidemiology
    • Environmental factors
    • Occupational exposure
    • Lifestyle factors
    • Biologic agents
    • Pharmacologic/Iatrogenic factors
    Known cancer causes Cole P, Rodu B. Cancer: Principles & Practice of Oncology. 6th ed. 2001;241-252.
  • 12. ONCOLOGY Epidemiology
    • Cancer of the esophagus
    • Head and neck cancer
    • Liver cancer
    • Breast cancer
    Alcohol-related cancers Cole P, Rodu B. Cancer: Principles & Practice of Oncology. 6th ed. 2001;241-252. Winer E, et al. Cancer: Principles & Practice of Oncology. 6th ed. 2001;1651-1717.
  • 13. ONCOLOGY Epidemiology
    • Major cause
    • Lung
    • Larynx
    • Oral cavity
    • Esophagus
    • Contributory factor
    • Pancreas
    • Bladder
    • Kidney
    • Stomach
    • Uterine cervix
    Smoking-related cancers Cole P, Rodu B. Cancer: Principles & Practice of Oncology. 6th ed. 2001; 241-252 .
  • 14. ONCOLOGY Epidemiology
    • Agents
    • Hepatitis B
    • Hepatitis C
    • HIV-1
    • HTLV-1
    • HPV
    • Epstein-Barr
    Virus-related cancers Site of Cancer Liver Liver Kaposi’s sarcoma Adult T-cell lymphoma Uterine cervix Burkitt’s lymphoma, nasopharynx, Hodgkin’s disease Cole P, Rodu B. Cancer: Principles & Practice of Oncology. 6th ed. 2001;241-252.
  • 15. ONCOLOGY Epidemiology
    • Agents
    • Helicobacter pylori
    • Schistosoma haematobium
    • Opisthorchis viverrini
    Bacterial-related cancers Site of Cancer Stomach Urinary bladder Liver Cole P, Rodu B. Cancer: Principles & Practice of Oncology. 6th ed. 2001;241-252.
  • 16. ONCOLOGY Epidemiology
    • Agent
    • Ionizing radiation
    Pharmacologic/iatrogenic contributors Ullrich RL, et al. Cancer: Principles & Practice of Oncology. 6th ed. 2001;195-206. Type of Cancer Breast cancer Leukemia Skin cancer Thyroid cancer Lung cancer
  • 17. ONCOLOGY Epidemiology
    • Pharmaceuticals
    • Agents Site of Cancer
    • Cancer chemotherapeutic drugs Bone marrow
    • Immunosuppressive drugs Reticuloendothelial system
    • Exogenous hormones Nonsteroidal estrogens Vagina, breast, testis Steroidal estrogens Endometrium Oral contraceptives Liver, endometrium Tamoxifen Endometrium
    • Phenacetin analgesics Kidney, pelvis, bladder
    Pharmacologic/iatrogenic contributors (cont’d) Adapted from Cole P, Rodu B. Cancer: Principles & Practice of Oncology. 6th ed. 2001;241-252.
  • 18. ONCOLOGY Epidemiology
    • Selected Industries Associated with Exposure to Carcinogens
    • Industry Carcinogen Cancer
    • Shipbuilding, demolition, insulation Asbestos Lung, pleura, skin
    • Varnish, glue Benzene Leukemia
    • Pesticides, smelting Arsenic Lung, skin, liver
    • Mineral refining and manufacturing Nickel, chromium Lung, nasal passages
    • Furniture manufacturing Wood dusts Nasal passages
    • Petroleum products Polycyclic hydrocarbons Lung
    • Rubber manufacturing Aromatic amines Bladder
    • Vinyl chloride Vinyl chloride Liver
    • Radium Radium Lung, bone
    • Outdoor occupations Ultraviolet light Skin
    Occupational-related cancers Costanza ME, et al. American Cancer Society Textbook of Clinical Oncology. 3rd ed. 2001;55-74.
  • 19. ONCOLOGY Epidemiology
    • Germline tumor suppressor gene inactivation
    • Germline oncogene activation
    • DNA repair defects
    • Ecogenetic traits
    • Abnormal tissue architecture
    • Humoral tumor promoters and regressors
    Genetic risk factors: mechanisms of cancer predisposition Bale AE, Brown SJ. Cancer: Principles & Practice of Oncology. 6th ed. 2001;207-217.
  • 20. ONCOLOGY Epidemiology
    • Family history of cancer
    • Cancer appears earlier in life
    • Multiple and bilateral tumors
    • May include rare tumor types (eg, retinoblastoma)
    • Multisystem involvement
    Genetic risk factors: characteristics of cancer families Bale AE, Brown SJ. Cancer: Principles & Practice of Oncology. 6th ed. 2001; 207-217 .
  • 21. ONCOLOGY Epidemiology
    • Familial Cancer Syndrome Site of Cancer
    • Neurofibromatosis type 1 CNS, neurofibrosarcomas, pheochromocytomas, leukemia
    • Neurofibromatosis type 2 CNS, spine von Hippel-Lindau disease CNS, renal cell, spine, pancreas, adrenal glands
    • Li-Fraumeni syndrome CNS, breast, head and neck, soft tissue, osteosarcoma, adrenal cortical carcinomas, leukemia
    • Wilms’ tumor gene Wilms’ tumor
    • Basal cell carcinoma syndrome Skin, CNS, ovary
    Genetic risk factors: Familial cancer syndromes Bale AE, Li FP. Cancer: Principles & Practice of Oncology . 5th ed. 1997;285-293. Linehan WM, et al. Cancer: Principles & Practice of Oncology . 5th ed. 1997;1253-1271.
  • 22. ONCOLOGY Epidemiology
    • Familial Cancer Syndrome Site of Cancer
    • Familial adenomatous polyposis coli Colorectal, jaw, skull, skin, stomach, CNS
    • Hereditary nonpolyposis colorectal Colorectal cancer
    • Cowden’s syndrome Thyroid, stomach, breast, ovary
    • BRCA-1 Breast, ovary
    • BRCA-2 Breast (female and male)
    Genetic risk factors: Familial cancer syndromes (cont’d) Bale AE, Li FP. Cancer: Principles & Practice of Oncology . 5th ed. 1997;285-293. Safai B. Cancer: Principles & Practice of Oncology . 5th ed. 1997;1883-1933. Cohen AM, et al. Cancer: Principles & Practice of Oncology . 5th ed. 1997;1144-1197. Dickson RB, Lippman ME. Cancer: Principles & Practice of Oncology . 5th ed. 1997;1541-1557.
  • 23. ONCOLOGY Epidemiology
    • 8% to 16% by a 15% decrease in tobacco use among adults
    • 8% by dietary measures (ie, reduction of dietary fat to <25% and double dietary fiber)
    • 3% by early screening and early detection
    • 10% to 26% by the wider application of state-of-the art treatments
    Reducing mortality Bal DG, et al. American Cancer Society Textbook of Clinical Oncology . 2nd ed. 1995;40-63. The National Cancer Institute estimates that cancer mortality rates could be significantly reduced, as follows:
  • 24. ONCOLOGY Epidemiology
    • Relative risk = risk of developing a disease in the population exposed to a risk factor, divided by the risk of developing that same disease among those not exposed to that same risk factor
    • Population attributable risk = the percentage by which the disease could be eliminated if exposure to the risk factor was eliminated
    Risk reduction Bal DG, et al. American Cancer Society Textbook of Clinical Oncology . 2nd ed. 1995;40-63.
  • 25. ONCOLOGY Epidemiology
    • Site of Relative Attributable Cancer Risk Factor Risk Risk
    • Lung Cigarette smoking Strong 87%
    • Occupation Strong 13%
    • Residential radon exposure Moderate 10%
    • Second-hand smoke Weak 2%
    • Diet low in beta carotene Weak -
    • Dietary fat/low-vegetable diet Possible 5%
    • Urban air pollution Possible -
    • Colorectal High-fat/low-vegetable diet Weak 50%
    • Physical inactivity Weak 20%
    • Occupation Weak -
    • Obesity Weak -
    Modifiable risk factors Adapted from Bal DG, et al. American Cancer Society Textbook of Clinical Oncology . 2nd ed. 1995;44.
  • 26. ONCOLOGY Epidemiology
    • Site of Relative Attributable Cancer Risk Factor Risk Risk
    • Breast First full-term pregnancy after age 30 Moderate 7%
    • Large doses of chest radiation Moderate 2%
    • Never married Weak -
    • Never having children Weak 5%
    • Post-menopausal obesity Weak 12%
    • Alcohol consumption Weak -
    • High fat Possible -
    • Low physical activity Possible -
    • Use of diethylstilbestrol Possible -
    • Use of oral contraceptives or ERT Possible -
    Modifiable risk factors (cont’d) Adapted from Bal DG, et al. American Cancer Society Textbook of Clinical Oncology . 2nd ed. 1995;45.
  • 27. ONCOLOGY Epidemiology
    • Site of Relative Attributable Cancer Risk Factor Risk Risk
    • Cervix Multiple sex partners Moderate 38%
    • Early age at first intercourse Moderate 25%
    • History of STD Moderate 5%
    • Cigarette smoking Weak 32%
    • Use of barrier contraceptives Weak -
    • Low dietary intake of vitamin A, Weak - beta-carotene, and folate
    Modifiable risk factors (cont’d) Adapted from Bal DG, et al. American Cancer Society Textbook of Clinical Oncology . 2nd ed. 1995;45.
  • 28. ONCOLOGY Epidemiology
    • Test/Procedure Sex Age Frequency
    • Colorectal cancer screening M&F > 50 Annual FOBT, flexible sigmoidoscopy every 5 years, or both; colonoscopy every 10 years; or
    • double-contrast barium enema every 5 years
    • PSA test + digital rectal exam M > 50 Every year if life expectancy > 10 years
    • Pap test F > 18* Every year, if normal >3 times, Pap test may be performed less frequently at discretion of physician
    • Pelvic exam F > 18* Every year
    • Breast self-exam F > 20 Every month
    • Breast clinical exam F 20-39 Every 3 years > 40 Every year
    • Mammography F > 40 Every year
    • Health counseling and cancer M&F 20-39 Every 3 years checkups > 40 Every year
    ACS Screening Recommendations for Colorectal, Prostate, Cervical, and Breast Cancer Adapted from Smith RA, et al. CA Cancer J Clin 2001;51:38-75. Asymptomatic People (Average Risk) * Or before if sexually active. † At menopause, for women at high risk for endometrial cancer due to history of infertility, obesity, failure to ovulate, abnormal uterine bleeding, unopposed ERT or tamoxifen use.