2. ONCOLOGY
Epidemiology
Adapted from Greenlee RT, et al. CA Cancer J Clin. 2000:50;22.
Leading causes of death
0.7
0.9
1.3
2.7
3.7
4.1
4.7
6.9
23.3
31.4
Percentage of Total Deaths, US
Heart Diseases
Cancer
Cerebrovascular Diseases
Chronic Obstructive Lung Diseases
Accidents
Pneumonia & Influenza
Diabetes Mellitus
Suicide
Homicide
HIV Infection
3.
4. PRINCIPALES CAUSAS DE MUERTE EN CHILE
AÑO 1994
A. Circulatorio 27.8 %
Tumores Malignos 20.7 %
Traumatismos y Envenenamientos
A. Respiratorio
A.Digestivo Resto Patologías
Síntomas M. Def.
Inf. Parasitarias
A. Perinatales
A. Genitourinario
Enf. Gl. End.
5.
6.
7.
8.
9.
10.
11. 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.
Adaptado de Parkin DM, et al. CA Cancer J Clin. 1999;49:39.
Leading cancers worldwide
14. ONCOLOGY
Epidemiology
*Non-Hodgkin’s lymphoma.
†Other nervous system.
Mortality for leading cancers
Adapted from Greenlee RT, et al. CA Cancer J Clin. 2000;50:23.
Males by Age (years), US
All Ages
Lung & bronchus
91,278
Prostate
32,891
Colon & rectum
28,075
Pancreas
13,470
NHL
12,286
20-39
NHL*
723
Leukemia
662
Brain & ONS†
625
Lung & bronchus
512
Colon & rectum
412
60-79
Lung & bronchus
59,558
Prostate
16,277
Colon & rectum
15,842
Pancreas
7,898
NHL
6,383
> 80
Lung & bronchus
15,823
Prostate
15,511
Colon & rectum
7,459
Bladder
2,900
Pancreas
2,843
40-59
Lung & bronchus
15,379
Colon & rectum
4,347
NHL
2,552
Pancreas
2,584
Esophagus
2,069
15. ONCOLOGY
Epidemiology
*Other nervous system.
†Non-Hodgkin’s lymphoma.
Mortality for leading cancers
Adapted from Greenlee RT, et al. CA Cancer J Clin. 2000;50:23.
All Ages
Lung & bronchus
61,922
Breast
41,943
Colon & rectum
28,621
Pancreas
14,205
Ovary
13,507
20-39
Breast
1,629
Uterine cervix
629
Leukemia
462
Lung & bronchus
462
Brain & ONS*
385
60-79
Lung & bronchus
38,488
Breast
18,385
Colon & rectum
12,799
Pancreas
7,437
Ovary
7,207
> 80
Lung & bronchus
12,879
Colon & rectum
12,046
Breast
9,835
Pancreas
5,045
NHL†
3,859
40-59
Breast
12,093
Lung & bronchus
10,088
Colon & rectum
3,426
Ovary
2,801
Uterine cervix
1,803
Females by Age (years), US
16. ONCOLOGY
Epidemiology
Male cancer statistics
Adapted from Greenlee RT, et al. CA Cancer J Clin. 2000;50:16.
Estimated incidence Estimated deaths
Melanoma of skin
Oral cavity & pharynx
Lung & bronchus
Pancreas
Kidney & renal pelvis
Colon & rectum
Prostate
Urinary bladder
Leukemia
Non-Hodgkin’s lymphoma
All others
4%
3%
14%
2%
3%
10%
29%
6%
3%
5%
19%
Esophagus
Lung & bronchus
Pancreas
Liver & intrahepatic bile duct
Stomach
Colon & rectum
Prostate
Urinary bladder
Leukemia
Non-Hodgkin’s lymphoma
All others
3%
31%
5%
3%
3%
10%
11%
3%
4%
5%
22%
17. ONCOLOGY
Epidemiology
Female cancer statistics
Adapted from Greenlee RT, et al. CA Cancer J Clin. 2000;50:16.
2%
15%
25%
5%
2%
11%
5%
2%
5%
4%
2%
21%
Melanoma of skin
Thyroid
Breast
Lung & bronchus
Pancreas
Colon & rectum
Ovary
Uterine corpus
Urinary bladder
Non-Hodgkin’s lymphoma
All others
3%
2%
30%
12%
2%
11%
4%
6%
2%
4%
22%
Brain & other nervous system
Breast
Lung & bronchus
Pancreas
Stomach
Colon & rectum
Ovary
Uterine corpus
Non-Hodgkin’s lymphoma
Leukemia
Multiple myeloma
All others
Estimated incidence Estimated deaths
18. TASA POR 100.000
TASA DE MORTALIDAD POR PRINCIPALES LOCALIZACIONES
DE CANCER EN EL HOMBRE CHILE 1998
6ª PANCREAS
19. TASA DE MORTALIDAD POR PRINCIPALES LOCALIZACIONES
DE CANCER EN LA MUJER CHILE 1998
6ª PANCREAS
TASA POR 100.000
N= 8.648
20. PRINCIPALES LOCALIZACIONES DEL CÁNCER
SEGUN MORTALIDAD
ESTOMAGO 28,9%
PULMON 16,1 %
VESICULA 15,1 %
MAMA 9,27%
C.UTERINO 8,9 %
PROSTATA 7,8 %
HIGADO Y V. BILIARES 7,03 %
ESOFAGO 6,71 %
21. ONCOLOGY
Epidemiology
Occupational exposure
Lifestyle factors
Biologic agents
Iatrogenic factors
Known cancer causes
Trichopoulos D, et al. Cancer: Principles & Practice of Oncology. 5th ed. 1997;231-257.
22. ONCOLOGY
Epidemiology
Cancer of the esophagus
Head and neck cancer
Cancer of the large bowel
Liver cancer
Pancreatic cancer
Breast cancer
Alcohol-related cancers
Trichopoulos D, et al. Cancer: Principles & Practice of Oncology. 5th ed. 1997;231-257.
23. ONCOLOGY
Epidemiology
Major cause
Lung
Larynx
Oral cavity
Esophagus
Contributory factor
Pancreas
Bladder
Kidney
Stomach
Uterine cervix
Smoking-related cancers
Blum A, et al. Cancer: Principles & Practice of Oncology. 5th ed. 1997;545-557.
24. ONCOLOGY
Epidemiology
Agents
Hepatitis B
Hepatitis C
HTLV-1
HPV
Epstein-Barr
Virus-related cancers
Adapted from Trichopoulos D, et al. Cancer: Principles & Practice of Oncology. 5th ed. 1997;249.
Site of Cancer
Liver
Liver
Adult T-cell leukemia or lymphoma
Uterine cervix
Burkitt’s lymphoma, nasopharynx,
Hodgkin’s disease
27. ONCOLOGY
Epidemiology
Pharmaceuticals
Agents Site of Cancer
Cancer chemotherapeutic drugs Bone marrow
Immunosuppressive drugs Reticuloendothelial system
Exogenous hormones
Menopausal estrogens Endometrium, breast
Diethylstilbestrol Vagina, cervix uteri
Anabolic steroids Liver
Oral contraceptives Liver
Tamoxifen Endometrium
Phenacetin analgesics Kidney, pelvis
Iatrogenic contributors (cont’d)
Adapted from Trichopoulos D, et al. Cancer: Principles & Practice of Oncology. 5th ed. 1997;249.
28. ONCOLOGY
Epidemiology
Industries Associated with Exposure to Carcinogens
Industry Carcinogen Cancer
Shipbuilding, demolition, insulation Asbestos Lung, pleura, peritoneum
Varnish, glue Benzene Leukemia
Pesticides, smelting Arsenic Lung, skin, liver
Mineral refining and manufacturing Nickel, chromium Lung
Furniture manufacturing Wood dusts Nasal passages
Petroleum products Polycyclic hydrocarbons Lung
Rubber manufacturing/dye workers Aromatic amines Bladder
Vinyl chloride Vinyl chloride Liver
Radium Radium Bone
Petroleum refining/coal hydrogenation Coal tar products, mineral oils Skin
Occupational-related cancers
Bal DG, et al. American Cancer Society Textbook of Clinical Oncology. 2nd ed. 1995;48.
29. ONCOLOGY
Epidemiology
Germline tumor suppressor
gene inactivation
Germline oncogene activation
DNA repair defects
Ecogenetic traits
Genetic risk factors: mechanisms of cancer predisposition
Bale AE, Li FP. Cancer: Principles & Practice of Oncology. 5th ed. 1997;285-293.
30. 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, Li FP. Cancer: Principles & Practice of Oncology. 5th ed. 1997;285-293.
31. 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.
32. 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.
33. 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:
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
34. 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.
35. 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.
36. 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.
37. ONCOLOGY
Epidemiology
Test/Procedure Sex Age Frequency
Sigmoidoscopy, preferably flexible M&F >50 Every 3-5 yrs, based on advice of physician
Fecal occult blood test M&F >50 Every year
Digital rectal exam M&F >40 Every year
Prostate exam M >50 Every year
Pap test F >18* Every year, if normal >3 times, Pap test may be
performed less frequently at discretion of physician
Pelvic exam F 18-40 Every 1-3 years, with Pap test
>40 Every year
Endometrial tissue sample F † At menopause and thereafter at discretion of physician
Breast self-exam F >20 Every month
Breast clinical exam F 20-40 Every 3 years
>40 Every year
Mammography F 40-49 Every 1-2 years (1st by age 40)
>50 Every year
Health counseling and cancer M&F >20 Every 3 years
checkups >40 Every year
Early detection guidelines
Adapted from Fink DJ, Mettlin CJ. American Cancer Society Textbook of Clinical Oncology. 2nd ed. 1995;181.
ACS Screening Recommendations for 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.
38. 3. Cáncer : ¿Cómo deberíamos prevenirlo?
Gallardo Jorge.
Rev Hosp Clínico U. De Chile, 10: 109-112, 1999
1. Carta al editor. ¿ Cáncer: Una condena a
pagar o una enfermedad prevenible?. ¿ Que
podemos hacer en Chile?
Jorge Gallardo.
Rev Chil Cancerología y Hematología. Vol 9: 51-54,
(1999), 2000
