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1. EPIDEMIOLOGY OF
CANCER

2. Outline
 Introduction
 Differentiate categories of cancer
 Describe the magnitude of cancer
 Outline the cancer morbidity & Mortality-
worldwide
 Highlight the cancer morbidity- Somalia
 Incidence of cancer
 Understand the risk factors for Cancer
 Prevention and control of cancer

3. MYTH
 Cancer is a disease of developed
countries
FACT
 Low and middle-income countries
now bear a majority share of the
burden of cancer

4. Introduction
 Cancer (malignant tumours or neoplasms) may be
regarded as a group of diseases characterized by an
 Abnormal growth of cells
 Ability to invade adjacent tissues and even distant
organs, and
 The eventual death of the affected patient if the
tumour has progressed beyond that stage when it
can be successfully removed.
 Can occur at any site or tissue of the body and may
involve any type of cells.
 The invasion of cancer is referred to as metastasis.
 Metastases are the primary cause of death from cancer.

5. Categories of cancer
 The major categories of cancer are :
a) Carcinomas
 which arise from epithelial cells lining the internal
surfaces of the various organs (e.g. mouth, oesophagus,
intestines, uterus) and from the skin epithelium;
b) Sarcomas
 Which arise from mesodermal cells constituting the
various connective tissues (e.g. fibrous tissue, fat and
bone); and
c) Lymphomas
 Myeloma and leukaemias arising from the cells of
bone marrow and immune systems.

6.  Cancer is the second leading cause of death globally, and was responsible
for 9.3 million deaths in 2015. Globally, nearly 1 in 6 deaths is due to
cancer.
 Approximately 70% of deaths from cancer occur in low- and middle-
income countries.
 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
 Around one third of deaths from cancer are due to the 5 leading
behavioral and dietary risks: high body mass index, low fruit and vegetable
intake, lack of physical activity, tobacco use, and alcohol use.
 Tobacco use is the most important risk factor for cancer and is responsible
for approximately 22% of cancer deaths.
Magnitude of cancer

7.  Cancer-causing infections, such as hepatitis and human
papillomavirus (HPV), are responsible for approximately 30% of
cancer cases in low- and lower-middle-income countries.
 Late-stage presentation and lack of access to diagnosis and
treatment are common, particularly in low- and middle-income
countries.
 Comprehensive treatment is reportedly available in more than
90% of high-income countries but less than 15% of low-income
countries.
 The economic impact of cancer is significant and increasing.
 The total annual economic cost of cancer in 2010 was estimated
at US$ 1.16 trillion.
Magnitude of cancer

8. Magnitude of cancer
 Globally, one in five men and one in six women develop
cancer in their lifetime, while one in eight men and one in 11
women die of this disease.
 In Africa, it is estimated that there were 1,055,172 new
cancer cases (5.8% of the global total) and 693,487 cancer
deaths (7.3% of the global total) in 2018.
 Somalia is included in the East African region.

9.  The most common in 2020 (in terms of new cases of cancer) were:
 breast (2.26 million cases);
 lung (2.21 million cases);
 colon and rectum (1.93 million cases);
 prostate (1.41 million cases);
 skin (non-melanoma) (1.20 million cases); and
 stomach (1.09 million cases).
 The most common causes of cancer death in 2020 were:
 lung (1.80 million deaths);
 colon and rectum (935 000 deaths);
 liver (830 000 deaths);
 stomach (769 000 deaths); and
 breast (685 000 deaths).
Cancer morbidity & Mortality-
worldwide

10. Cancer morbidity- Somalia
 The ongoing global demographic and epidemiologic transitions mean an
increasing cancer burden, especially in low and middle-income countries
for the following decades.
 A definitive conclusion has not yet been made regarding the incidence of
all cancers in the region.
 The population-based cancer incidence is not known
 There is no national cancer registry system in Somalia
 It is evaluated that approximately one-third of cancer cases in Africa
occurs in the East Africa region.
 The data will be displayed is based on study of cancer incidence in
Somalia, especially in the capital Mogadishu and its surroundings
(Somalia Turkey Recep Tayyip Erdogan Education and Research Hospital)

11. Distribution of Cancer Cases in Somalia According to Gender and
Affected Organ from January 01, 2017 to December 31, 2019

13. The Most Common 10 Cancers Seen Among Men in East Africa Countries
and Somalia

14. The Most Common 10 Cancers Seen Among Women in East Africa
Countries and Somalia

15. Type and Frequency of Cancers in Pediatric Cases

16. What causes cancer?
 Cancer arises from the transformation of normal cells into
tumour cells in a multi-stage process that generally
progresses from a pre-cancerous lesion to a malignant
tumour.
 Result of the interaction between a person's genetic factors
and three categories of external agents, including:
 Physical carcinogens, such as ultraviolet and ionizing radiation;
 Chemical carcinogens, such as asbestos, components of tobacco
smoke, aflatoxin (a food contaminant), and arsenic (a drinking
water contaminant); and
 Biological carcinogens, such as infections from certain viruses,
bacteria, or parasites.

17. Incidence of cancer
 The incidence of cancer rises dramatically with age, most likely due to a
build-up of risks for specific cancers that increase with age.
 The overall risk accumulation is combined with the tendency for cellular
repair mechanisms to be less effective as a person grows older.
 Approximately 13% of cancers diagnosed in 2018 globally were attributed
to carcinogenic infections, including Helicobacter pylori, human
papillomavirus (HPV), hepatitis B virus, hepatitis C virus, and Epstein-Barr
virus.
 Hepatitis B and C viruses and some types of HPV increase the risk for liver
and cervical cancer, respectively.
 Infection with HIV substantially increases the risk of cancers such as
cervical cancer.

18.  Modifying or avoiding key risk factors can significantly reduce
the burden of cancer. These risk factors include:
 Tobacco use including cigarettes and smokeless tobacco
 Being overweight or obese
 Unhealthy diet with low fruit and vegetable intake
 Lack of physical activity
 Alcohol use
 Sexually transmitted HPV-infection
 Infection by hepatitis or other carcinogenic infections
 Ionizing and ultraviolet radiation
 Urban air pollution
 Indoor smoke from household use of solid fuels.
 Tobacco use is the single most important risk factor for cancer and is
responsible for approximately 22% of cancer-related deaths globally
 Some chronic infections are risk factors for cancer; this is a
particular issue in low- and middle-income countries.
Risk factors for Cancer

19. Prevention of cancer
 Cancer risk can be reduced by:
 Primary prevention
 Not using tobacco;
 Maintaining a healthy body weight;
 Eating a healthy diet, including fruit and vegetables;
 Doing physical activity on a regular basis;
 Avoiding harmful use of alcohol;
 Getting vaccinated against HPV and hepatitis B if you
belong to a group for which vaccination is
recommended;

20. Prevention of cancer
 Cancer risk can be reduced by:
 Primary prevention
 Avoiding ultraviolet radiation (which primarily results
from exposure to the sun and artificial tanning devices);
 Ensuring safe and appropriate use of radiation in health
care (for diagnostic and therapeutic purposes);
 Minimizing occupational exposure to ionizing radiation;
and
 Reducing exposure to outdoor air pollution and indoor
air pollution, including radon (a radioactive gas
produced from the natural decay of uranium, which can
accumulate in buildings (homes, schools and
workplaces).

21. Prevention of cancer
 Secondary prevention
 Cancer mortality can be reduced if cases are detected and
treated early. There are two components of early detection:
 Early diagnosis
 If identified early, cancer is more likely to respond to
treatment
 Result a greater probability of survival and less morbidity
 as well as less expensive treatment.
 Consists of three components:
 Being aware of the symptoms of different forms of cancer
and of the importance of seeking medical advice if you are
concerned;
 Access to clinical evaluation and diagnostic services; and
 Timely referral to treatment services.

22. Prevention of cancer
 Secondary prevention
 Screening
 Screening aims to identify individuals with findings suggestive of a
specific cancer or pre-cancer before they have developed symptoms.
 When abnormalities are identified during screening, further tests to
establish (or not) a diagnosis should follow, as should referral for
treatment if needed.
 Screening programmes are effective for some but not all cancer types
and in general are far more complex and resource-intensive than early
diagnosis as they require special equipment and dedicated personnel.

23. Prevention of cancer
 Secondary prevention
 Screening
 Patient selection for screening programmes is based
on age and risk factors to avoid excessive false
positive studies.
 Examples of screening methods are:
 HPV testing for cervical cancer;
 The PAP cytology test for cervical cancer;
 Visual inspection with acetic acid (VIA) for cervical cancer; and
 Mammography screening for breast cancer in settings with strong
or relatively strong health systems.
 Quality assurance is required for both screening and
early diagnosis programmes.

24. Prevention of cancer
 Secondary prevention
 Treatment
 A correct cancer diagnosis is essential for appropriate and effective
treatment
 Treatment usually includes radiotherapy, chemotherapy and/or
surgery.
 The primary goal is generally to cure cancer or to considerably
prolong life.
 Improving the patient's quality of life is also an important goal.
 Some of the most common cancer types, such as breast cancer,
cervical cancer, oral cancer, and colorectal cancer, have high cure
rates when detected early and treated according to best practices.
 Some cancer types, such as testicular seminoma and different types
of leukaemia and lymphoma in children, also have high cure rates if
appropriate treatment is provided, even when cancerous cells are
present in other areas of the body.

25. Prevention of cancer
 Tertiary prevention
 Palliative care
 Treatment to relieve, rather than cure, symptoms caused by cancer
 Improve the quality of life of patients and their families.
 Palliative care can help people live more comfortably.
 Relief from physical, psychosocial, and spiritual problems through
palliative care is possible for more than 90% of patients with advanced
stages of cancer.
 Improved access to oral morphine is strongly recommended for the
treatment of moderate to severe cancer pain, suffered by over 80% of
people with cancer in the terminal phase.