V SEM THEORY Dr. KAN

1. Epidemiology and Control of
Cancer
K.A. Narayan

2. Please answer the following questions in your group.
Read the epidemiology of cancer worldwide WHO Fact Sheet
• What is Cancer? How can it be defined?
• Why are cancers important?
• Which are the leading types of cancers?
• What causes cancer?
• What are the risk factors for cancer?
• How can the burden of cancer be reduced?
• What is the strategy in India ? Read the document
1493693747note.pdf

3. Cancer 2012
14.1 million new cancer cases, 8.2 million
cancer deaths and 32.6 million people living
with cancer (within 5 years of diagnosis)
worldwide.
57% (8 million) of new cancer cases, 65% (5.3
million) of the cancer deaths and 48% (15.6
million) of the 5-year prevalent cancer cases
occurred in the less developed regions.
The overall age standardized cancer incidence
rate is almost 25% higher in men than in
women, with rates of 205 and 165 per
100,000, respectively.
Male incidence rates vary almost five-fold
across the different regions of the world,

4. with rates ranging from 79 per 100,000 in Western
Africa to 365 per 100,000 in Australia/New Zealand
(with high rates of prostate cancer representing a
significant driver of the latter).
There is less variation in female incidence rates
(almost three-fold) with rates ranging from 103 per
100,000 in South-Central Asia to 295 per 100,000 in
Northern America.

5. Cancer Mortality 2012
• less regional variability than for incidence,
• the rates being 15% higher in more developed than in less developed
regions in men, and 8% higher in women.
• In men, the rates is highest in Central and Eastern Europe (173 per
100,000) and lowest in Western Africa (69).
• In contrast, the highest rates in women are in Melanesia (119) and
Eastern Africa (111), and the lowest in Central America (72) and
South-Central (65) Asia.

7. Trends in incidence of cancer in selected countries: age-
standardised rate (W) per 100,000, men

8. Trends in incidence of cancer in selected countries: age-
standardised rate (W) per 100,000, men

9. Trends in mortality from cancer in selected countries: age-
standardised rate (W) per 100,000, men

12. Trends in incidence of cancer in selected countries: age-
standardised rate (W) per 100,000, women

14. Trends in mortality from cancer in selected countries: age-
standardised rate (W) per 100,000, women

15. International Comparisons of AAR
with that of PBCRs in India
All Sites (ICD-10:C00-C96) - Males
http://www.canceratlasindia.org/chapter3_3.aspx

16. International Comparisons of AAR
with that of PBCRs in India
All Sites (ICD-10:C00-C96) - Females

17. • The four most common cancer in India are
• Male-oropharynx, esophagus, stomach and lower respiratory tract
• Female-breast, cervix, oropharynx and esophagus
• Tobacco is used widely used in India
• 91% cases of oropharynx is due to Tobacco use
• 60% cases in female are breast, cervix and ovary cancer
India…

18. Cancer Patterns

19. Ten Leading Sites of Cancer in Indian PBCRs (Males)
Age Adjusted (ARR) in Brackets
• Chennai • Delhi
http://www.canceratlasindia.org/chapter3_6.aspx

20. Ten Leading Sites of Cancer in Indian PBCRs (Males)
Age Adjusted (ARR) in Brackets
• Mumbai • Bangalore
http://www.canceratlasindia.org/chapter3_6.aspx

21. Ten Leading Sites of Cancer in Indian PBCRs (Females)
Age Adjusted (ARR) in Brackets
• Chennai • Delhi

22. Ten Leading Sites of Cancer in Indian PBCRs (Females)
Age Adjusted (ARR) in Brackets
• Bombay • Bangalore
http://www.canceratlasindia.org/chapter3_6.aspx

23. • There are lot of international variations in the pattern of cancer which
are attributed to a number of factors such as
• environmental factors
• food habit
• lifestyle
• genetic factor
• inadequacy in detection and reporting of cases
Cancer patterns

24. • Tobacco
• Tobacco in various forms of usage can cause cancer of lungs, larynx, mouth,
pharynx, esophagus, bladder, pancreas and probably kidney
• Cigarette smoking is now responsible for more than 1 million death each year
• Alcohol
• Excess intake of alcohol can cause esophageal and liver cancer
• Beer consumption may be associated with rectal cancer
• Alcohol contributes about 3 % of all cancer deaths
Environmental factors

25. • Dietary factor
• Smoked fish is related to stomach cancer
• Dietary fiber to intestinal cancer
• Beef consumption to bowel cancer
• High fat diet to breast cancer
• Food additives and contaminants have fallen under suspicion as causative
agents

26. • Occupational exposures
• These includes exposure to benzene, cadmium, arsenic, chromium, vinyl
chloride, asbestos, polycyclic hydrocarbons, etc.
• The risk of occupational exposure is said to be increased if the individual also
smokes cigarette
• Occupational exposure is usually reported 1-5% of human cancer

27. • Virus
• Hepatitis B & C - hepatocarcinoma
• HIV infection – kaposi’s carcinoma
• AIDS – non Hodgkin’s lymphoma
• Epstein – bar virus – Burkitts lymphoma and naso – pharyngial carcinoma
• Cytomegalovirus – Kaposi’s Sa
• Pappiloma virus – cervix cancer
• Human T cell leukemia virus – T cell leukemia

28. • Parasite
• May be a cause of cancer
• Schistosomiasis can produce Ca of bladder
• Customs, habits and life style
• May be associated with an increased risk of cancer
• Smoking and lung cancer
• Tobacco and beetle chewing and oral cancer

29. Tobacco and Alcohol Consumption (India)
• beedis, cigarettes and
smokeless forms
• 275 million tobacco users
• main causes of premature, NCD-
associated death and disability
• increasing among the
youth, women and the poor.
• Account for one million deaths
most deaths occurring among the
poor and in the economically
productive age group of 30–69 years
• 2030, it is estimated that nearly 1.5
million deaths

30. Figure 17.2 Mortality (%) Attributable to Leading Chronic
Disease Risk Factors in India (2004)
Source 214 India Infrastructure Report 2013|14

31. • Others
• Sunlight, radiation, water and air pollution, medication and pesticides
• These are related to cancer as environmental factors

32. • Genetic influences have long been suspected
• Retinoblastoma occurs in children of the same parent
• Mongols are more likely to develop leukemia
• There is probably a complex relationship between hereditary
susceptibility and environmental carcinogenic stimuli in the causation
of cancer
Genetic factors

33. Breast Cancer
• Every year, kills more than 500,000 women around the world.
• In resource-poor settings, are diagnosed at an advanced stage;
• 5 -year survival rates are low, ranging from 10-40%.
• where early detection and basic treatment are available and accessible, 5 -
year survival rate for early localized breast cancer exceeds 80%.
• can be detected early through two strategies: early diagnosis and
screening.
• Early diagnosis is based on improved public and professional awareness &
recognizing possible warning signs of cancer and taking prompt action.
• Screening involves the systematic use of testing, such as mammography,
across an asymptomatic population to detect and treat cancer or pre-
cancers.

34. Cervical Cancer
• Worldwide, fourth most frequent cancer in women, estimated 530 000
new cases in 2012 representing 7.5% of all female cancer deaths.
• Of the estimated more than 270 000 deaths from cervical cancer every
year, more than 85% of these occur in less developed regions.
• developed countries have programmes for early screening and early
treatment which prevents up to 80% of cervical cancers in these countries.
• developing countries have limited access to effective screening. Disease is
often not identified till advanced stage and symptoms develop.
• Prospects for treatment of such late-stage disease may be poor, resulting in
a higher rate of death
• The high mortality rate from cervical cancer globally (52%) could be
reduced by effective screening and treatment programmes.
http://www.who.int/mediacentre/factsheets/fs380/en/

35. Lung cancer
• most frequent cancer worldwide.
• more than 1.8 million new cases (13% of total cancer incidence) and
almost 1.6 million deaths (20% of total cancer mortality), as
estimated in 2012.
• More than one third of all newly diagnosed cases occurred in China.
• leading cause of cancer death in men in 87 countries and in women in
26 countries. Age-standardized rates vary 80-fold internationally,
• are highest in North America, Europe, and East Asia, and tend
• to still be relatively low in many African countries and some Asian
countries.

36. Lung Cancer
• Due to a high and rather stable case fatality rate, patterns and
• trends for mortality rates are similar to those for incidence rates,
• irrespective of level of resource within a given country.
• Recent trends in lung cancer reflect the evolution of the smoking epidemic.
In men, incidence rates have peaked in a number
• of highly developed countries at a late stage of the tobacco epidemic, while
rates continue to rise among women.
• Only in a few countries (Australia and the USA), where the tobacco
epidemic is most advanced and smoking prevalence has been declining for
several decades, are there recent downward incidence trends among
women

37. The National Cancer Control Programme
• for India was formulated in 1984 with four major goals:
1. Primary prevention of tobacco related cancers.
2. Early detection of cancers of easily accessible sites
3. Augmentation of treatment facilities, and
4. Establishment of equitable, pain control and
palliative care network throughout the country.

38. • Approaches to Cancer Control
There are four principal approaches to cancer control:
1. Prevention
2. Early Detection
3. Diagnosis and Treatment
4. Palliative Care.

39. Source” 218 India Infrastructure Report 2013|14
By 2025

40. Strategies for Cancer Prevention in India
• highest priority to tobacco control
Educating people regarding the disease
• The contents of cancer education should focus on, tobacco control,
physical activity and avoidance of obesity, healthy dietary practices,
reducing occupational and environmental occupational exposures,
reducing alcohol use, immunization against hepatitis B virus, safe
sexual practices to avoid human papilloma virus infection

41. • The cancers of the oral cavity, uterine cervix and female breast are
very amenable to early detection.
• Periodic examination by Pap smear and Mammography are the
accepted standards for early detection of cervix and breast cancers in
the developed countries.
• Pap smear and mammography are however not practical and
affordable methods for cervix and breast cancer screening in India.

45. Distribution of 27 Regional
Cancer Centres
• National Cancer Registry Programme
(NCRP) initiated in 1982 by ICMR
• Population-based registries take the
sample population in a geographically
defined area
• Hospital-based registries-data from
patients coming to a particular health
institution
• 21 Population-based registries and 6
Hospital-based registries
48679626nccp4.pdf

46. GOALS & OBJECTIVES OF NCCP
• Primary prevention by health education tobacco consumption and
necessity of genital hygiene for prevention of cervical cancer
• Secondary prevention i.e. early detection and diagnosis of cancers,
cancer of cervix, breast and of the oro-pharyngeal cancer by screening
methods and patients’ education on self examination methods.
• Strengthening of existing cancer treatment facilities
• Palliative care in terminal stage of the cancer
1493693747note.pdf

47. Strategies
• Recognition of New Regional Cancer Centres (RCCs) one-time grant of Rs.
5.00 crores
• Strengthening of existing Regional Cancer Centres: A one-time grant of
Rs.3.00 crores
• Development of Oncology Wing: Government Hospitals & Government
Medical College – 3 crores
• District Cancer Control Programme: cluster of 2-3 districts are taken up for
prevention, early detection, minimal treatment and provision of supportive
cancer care at district levels
• Decentralized NGO Scheme: grant of Rs. 8000/- per camp will be provided
to the NGOs for IEC activities
1493693747note.pdf