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Epidemiology, Prevention and control

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  • Currently, the lung cancer death rate in women is about two-and-a-half times what it was 25 years ago, and lung cancer is the most common cause of cancer death. In comparison, breast cancer death rates were virtually unchanged between 1930 and 1990, and have since decreased. The death rates for stomach and uterine cancers have decreased steadily since 1930; colorectal cancer death rates have been decreasing for over 50 years.
  • The next four slides look at the lifetime probability of developing cancer and relative survival rates of cancer.   Presently, the risk of an American man developing cancer over his lifetime is one in two. The leading cancer sites are prostate, lung, and colon & rectum.
  • Cancer

    1. 1. Cancer Dr. G.S. Jogdand, M.D. Ph.D. Professor & Head Community Medicine Department
    2. 2. Definition <ul><li>A group of diseases having following characteristic:- </li></ul><ul><li>Abnormal growth of cells. </li></ul><ul><li>Ability to invade adjacent and distant organs. </li></ul><ul><li>Death of patient if the tumor has become inoperable. </li></ul>
    3. 3. Theories of genesis of cancers <ul><li>Standard dogma: protooncogenes (Melanoma). </li></ul><ul><li>Tumor suppressor genes (Various Cancers) </li></ul><ul><li>Modified dogma: Mutations in DNA repair leads to the accumulation unrepaired mutations (Xeroderma pigmentosum) Loeb 1974. </li></ul><ul><li>Early instability theory: Master genes required for adequate cell reproduction are disabled resulting in aneuploidy (Philadelphia chromosome). </li></ul>
    4. 4. <ul><li>What is the molecular basis of cancer? </li></ul><ul><ul><li>Cancer is a gene tic disease. </li></ul></ul><ul><ul><ul><li>Mutations in genes result in altered proteins </li></ul></ul></ul><ul><ul><ul><ul><li>During cell division </li></ul></ul></ul></ul><ul><ul><ul><ul><li>External agents </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Random event </li></ul></ul></ul></ul><ul><ul><ul><li>Most cancers result from mutations in somatic cells </li></ul></ul></ul><ul><ul><ul><li>Some cancers are caused by mutations in germline cells </li></ul></ul></ul>
    5. 5. Origin of cancers <ul><li>Carcinomas- originate from epithelial cell lining of internal surfaces of various organs. </li></ul><ul><li>Sarcomas- originate from mesodermal cells of various connective tissues eg. Bones, fat and fibrous tissues. </li></ul><ul><li>Lymphomas and leukaemias- originate from cells of bone marrow and immune system </li></ul>
    6. 6. Cancers showing Genetic/familial Tendencies <ul><li>Stomach cancer </li></ul><ul><li>Breast cancer </li></ul><ul><li>Retinoblastoma </li></ul><ul><li>Osteosarcoma </li></ul><ul><li>Ovarian cancer </li></ul><ul><li>Hereditary non-polyposis colorectal Cancer </li></ul>
    7. 7. Time trends for cancer <ul><li>At the beginning of the century cancer was sixth cause of death in developed countries. </li></ul><ul><li>At the present time it is the second cause. </li></ul><ul><li>Stomach cancer is showing decline in the developed countries. </li></ul>
    8. 8. Diagnosis of cancer <ul><li>Clinical assessment </li></ul><ul><li>Histopathology </li></ul><ul><li>Biochemistry </li></ul><ul><li>Tumor markers </li></ul>
    9. 9. Tumor Markers Name Foetal Ag Normally detected Tumor Carcion Embryonic Antigen yes yes GIT, Lung, Breast Cancer Ag. 125 yes yes Ovary Alpha fetoprotein yes yes Hepato-cellular Ca, germ cell tumors Lactate dehydrogenase No yes Most reflecting tumor burden Prostate specific Antigen No Yes Prostate cancer Human Chorionic Gonadotrophin No Pregnancy Teratoma, chorio-carcinoma
    10. 10. Problem statement: Incidence and mortality of cancer (Global) <ul><li>Site Incidence Mortality </li></ul><ul><li>Male Female Male Female </li></ul><ul><li>Lung 901 337 810 292 </li></ul><ul><li>Breast - 1050 - 372 </li></ul><ul><li>Colo 498 445 254 237 </li></ul><ul><li>rectal </li></ul><ul><li>Stomach 558 317 405 241 </li></ul><ul><li>Liver 398 165 383 164 </li></ul><ul><li>Five leading cancers their gender wise incidence & mortality, per lakh population. </li></ul>
    11. 11. Five leading cancers in India <ul><li>Oral cancer </li></ul><ul><li>Ca cervix </li></ul><ul><li>Breast cancer </li></ul><ul><li>Stomach </li></ul><ul><li>Liver </li></ul>
    12. 12. Causes of cancer <ul><li>Tobacco use in any form. </li></ul><ul><li>Excessive alcohol intake. </li></ul><ul><li>Dietary factors:- Intake of smoked fish can cause stomach cancer, increased beef consumption to colorectal cancer, intake of high fatty diet to breast cancer. </li></ul><ul><li>Occupational exposure. </li></ul><ul><li>Viral and parasitic infections. </li></ul><ul><li>Customs, habits and life styles. </li></ul>
    13. 13. <ul><li>Male Cancer Death Rates </li></ul>
    14. 14. Cancer Death Rates, for Women *Age-adjusted to the 2000 US standard population. Source: US Mortality Public Use Data Tapes 1960-2000, US Mortality Volumes 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2003. Lung Colon & rectum Uterus Stomach Breast Ovary Pancreas Rate Per 100,000
    15. 15. Lifetime Probability of Developing Cancer, Men, US, 1998-2000 Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 5.1 Statistical Research and Applications Branch, NCI, 2003. All sites 1 in 2 Cancer
    16. 16. Prevention of cancers <ul><li>Primary prevention </li></ul><ul><li>Control of tobacco and alcohol consumption. </li></ul><ul><li>Improved personal hygiene. </li></ul><ul><li>Radiation exposure control. </li></ul><ul><li>Prevention of occupational exposure. </li></ul><ul><li>Testing of food, cosmetics and drugs. </li></ul><ul><li>Legislation. </li></ul><ul><li>Cancer education. </li></ul>
    17. 17. Secondary prevention <ul><li>Early diagnosis of cases:- Through screening for cancer. </li></ul><ul><li>Treatment of cases:- Treatment will vary according to the stage of the disease. </li></ul><ul><li>Hospital based cancer registration. </li></ul><ul><li>Population based cancer registration. </li></ul>
    18. 18. Cancer education <ul><li>C- Change in the bladder or bowel habits. </li></ul><ul><li>A- Any chronic non healing sore. </li></ul><ul><li>U- Unusual bleeding from natural orifices. </li></ul><ul><li>T- thickening or lump in any part of the body. </li></ul><ul><li>I- Indigestion or difficulty in swallowing. </li></ul><ul><li>O- Obvious change in a wart or a mole. </li></ul><ul><li>N- Nagging cough or persistent hoarseness of voice. </li></ul>
    19. 19. Thank you