1. CancerCancer
EpidemiologyEpidemiology
Nayyar Raza KazmiNayyar Raza Kazmi

2.  A group of diseases characterized by anA group of diseases characterized by an
 Abnormal growth of cellsAbnormal growth of cells
 Ability to invade adjacent tissues and evenAbility to invade adjacent tissues and even
distant organsdistant organs

3. 1990 2000 2010
7 Million 8 Million 16 Million
2/3rd
of Cancer Deaths Occur in
Developing Countries with 5%
of the Resources

4. Global Cancer IncidenceGlobal Cancer Incidence
and Mortalityand Mortality
 12.1 million new cases estimated in 2007 (5.412.1 million new cases estimated in 2007 (5.4
million in developed countries, 6.7 million inmillion in developed countries, 6.7 million in
developing countries)developing countries)
 Lung cancer is the leading site (excluding non-Lung cancer is the leading site (excluding non-
melanoma skin cancer), followed by breast cancermelanoma skin cancer), followed by breast cancer
 7.6 million cancer deaths estimated in 2007 (2.97.6 million cancer deaths estimated in 2007 (2.9
million in developed countries, 4.7 million inmillion in developed countries, 4.7 million in
developing countries)developing countries)
 Lung, followed by stomach and colo-rectal cancerLung, followed by stomach and colo-rectal cancer
 Source: American Cancer Society. “Global Cancer Facts & Figures - 2007”Source: American Cancer Society. “Global Cancer Facts & Figures - 2007”
available at www.cancer.orgavailable at www.cancer.org

5. Cancer in PakistanCancer in Pakistan
 Blood Cancers ( Leukemias and LymphomasBlood Cancers ( Leukemias and Lymphomas
top the list, highest in NWFP)top the list, highest in NWFP)
 Esophageal Cancer (Western Baluchistan andEsophageal Cancer (Western Baluchistan and
Tribal Belt)Tribal Belt)
 Colon Cancer ( NWFP)Colon Cancer ( NWFP)
 Oral Cancer ( throughout Indus Basin)Oral Cancer ( throughout Indus Basin)
 Breast Cancer ( in Women throughoutBreast Cancer ( in Women throughout
Pakistan)Pakistan)
 Lung Cancer ( in Men throughout PakistanLung Cancer ( in Men throughout Pakistan

6. Biology of CancerBiology of Cancer
 Many Diseases: One Disease ProcessMany Diseases: One Disease Process
 A Disorder of Cellular Growth andA Disorder of Cellular Growth and
Differentiation.Differentiation.

7. Biology of Cancer-2Biology of Cancer-2
 The Role of Host resistanceThe Role of Host resistance
HOST CANCER
Resistance Balance
Outcome

8. Biology of Cancer-3Biology of Cancer-3
 Phases in Cancer DevelopmentPhases in Cancer Development
 Healthy CellsHealthy Cells
 DysplasiaDysplasia
 Carcinoma in SituCarcinoma in Situ
 Localized CancerLocalized Cancer Stage1Stage1
 Regional SpreadRegional Spread Stage II and IIIStage II and III
 Generalized DiseaseGeneralized Disease Stage IVStage IV

9. Biology of Cancer-4Biology of Cancer-4
 Cancer is a Histopathological DiagnosisCancer is a Histopathological Diagnosis
 The importance of Biological MarkersThe importance of Biological Markers

10. Biology of Cancer-5Biology of Cancer-5
 The Rule of ThirdsThe Rule of Thirds
 1/31/3rdrd
Preventable 1/3Preventable 1/3rdrd
CurableCurable
 ( One half in Developed Countries)( One half in Developed Countries)
 The importance of ScreeningThe importance of Screening
 Early Diagnosis means greater curabilityEarly Diagnosis means greater curability

11. Sociology of Cancer-1Sociology of Cancer-1
 Cancer is a lifestyle DiseaseCancer is a lifestyle Disease
 Carcinogens arise as a consequence ofCarcinogens arise as a consequence of
LifestyleLifestyle
 Conditions of LivingConditions of Living
 Conditions of WorkConditions of Work

12. Sociology of Cancer-2Sociology of Cancer-2
 Where people LiveWhere people Live
 Geographic and Temporal VariabilityGeographic and Temporal Variability
 Habits: Tobacco- Lung CancerHabits: Tobacco- Lung Cancer
 DietDiet Stomach CancerStomach Cancer
 Food PreservationFood Preservation Stomach and LiverStomach and Liver
cancerscancers
 Environmental HazardsEnvironmental Hazards
 Viruses- Liver CancerViruses- Liver Cancer

13. Sociology of Cancer-3Sociology of Cancer-3
 Changes people make in the worldChanges people make in the world
 IndustrializationIndustrialization
 Ionizing RadiationIonizing Radiation
 Manufacturing : Dyestuffs, AsbestosManufacturing : Dyestuffs, Asbestos

14. Sociology of Cancer-4Sociology of Cancer-4
Implications for cancerImplications for cancer
ControlControl
 The importance for Lifestyle changesThe importance for Lifestyle changes
 The importance of Prevention andThe importance of Prevention and
ScreeningScreening
 The need for a Public Health Strategy forThe need for a Public Health Strategy for
integrated cancer control at the nationalintegrated cancer control at the national
level to include balanced programminglevel to include balanced programming
forfor
 Prevention, Screening and Early Diagnosis,Prevention, Screening and Early Diagnosis,
Treatment and Palliation.Treatment and Palliation.

15. The Causation of CancerThe Causation of Cancer
External agentsExternal agents
important for diseaseimportant for disease
controlcontrol
 1. Carcinogenesis by Physical Agents1. Carcinogenesis by Physical Agents
 Ionizing Radiation: Xrays and RadioactivityIonizing Radiation: Xrays and Radioactivity
 Non-Ionizing Radiation- SunlightNon-Ionizing Radiation- Sunlight
 Physical Substances: Asbestos andPhysical Substances: Asbestos and
PollutionPollution

16. The Causation of cancerThe Causation of cancer
External agents imptt forExternal agents imptt for
disease controldisease control
 2. Carcinogenesis by chemical agents2. Carcinogenesis by chemical agents
 Promotion and InitiationPromotion and Initiation
 Industrial ExposureIndustrial Exposure
 HabitsHabits

17. The Causation of cancerThe Causation of cancer
External agents imptt forExternal agents imptt for
disease controldisease control
 3. Carcinogenesis by Biological Agents3. Carcinogenesis by Biological Agents
 VirusesViruses
 ParasitesParasites

18. The Causation of cancerThe Causation of cancer
External agents imptt forExternal agents imptt for
disease controldisease control
 4. The Role of Diet4. The Role of Diet
 Dietary fatDietary fat
 Food PreservationFood Preservation
 Protective Substances in DietProtective Substances in Diet

19. Oncogenes- The FinalOncogenes- The Final
Common PathwayCommon Pathway
Viruses Chemicals
and
Radiation
Initiation with Oncogene Activation
Activation of additional Oncogenes
Malignant Transformation
Escape from Growth Control
Invasiveness
metastasis

20. The Causation of CancerThe Causation of Cancer
Social Factors in CancerSocial Factors in Cancer
EtiologyEtiology
 Social ClassSocial Class
 Socioeconomic GradientSocioeconomic Gradient
 OccupationOccupation
 Industrial HazardsIndustrial Hazards
 Medical Services and CareMedical Services and Care
 Radiation and MedicationsRadiation and Medications
 LifestyleLifestyle
 Habits and Food HandlingHabits and Food Handling
 Air and Water pollutionAir and Water pollution

23. Cancer ControlCancer Control
 Primary PreventionPrimary Prevention
 Public Information and EducationPublic Information and Education
 LegislationLegislation
 National and International CoordinationNational and International Coordination
 Secondary preventionSecondary prevention
 Early DiagnosisEarly Diagnosis
 Pap SmearsPap Smears
 6 monthly Chest radiographs in smokers6 monthly Chest radiographs in smokers
 Breast Self ExaminationBreast Self Examination
 6 monthly rectal examination in men aged 50 plus6 monthly rectal examination in men aged 50 plus
 Cancer symptoms alert checklistCancer symptoms alert checklist