dr brenda wilson department of epidemiology community medicine l.
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Dr Brenda Wilson Department of Epidemiology & Community Medicine. Cancer Prevention. Global burden of cancer. IARC estimates of new cancer patients in 2000: All countries ≈ 5,300,000 Developed ≈ 2,500,000 Less developed ≈ 2,800,000. Cancer is a disease of rich countries.

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dr brenda wilson department of epidemiology community medicine
Dr Brenda Wilson

Department of

Epidemiology & Community Medicine

Cancer Prevention

global burden of cancer
Global burden of cancer
  • IARC estimates of new cancer patients in 2000:
    • All countries ≈ 5,300,000
    • Developed ≈2,500,000
    • Less developed ≈2,800,000
burden of cancer canada
Burden of cancer: Canada
  • 134,000 new cases per year
  • 65,000 deaths per year
  • Lifetime risk of developing cancer
    • males 40%
    • females 35%
time trends all cancers in canada
Time trends – all cancers in Canada

Standardized incidence rate per 100,000

500

400

300

200

100

0

1975

1980

1985

1990

1995

2000

Year

Females

Males

canada commonest male cancers
Canada: commonest male cancers

Standardized rate per 100,000 (1998)

time trends male cancers
Time trends: male cancers

Standardized incidence rate per 100,000

canada commonest female cancers
Canada: commonest female cancers

Standardized rate per 100,000 (1998)

time trends female cancers
Time trends: female cancers

Standardized rate per 100,000

time trends lung cancer

100

80

60

40

20

0

1975

1980

1985

1990

1995

2000

Year

Males

Females

Time trends: lung cancer

Standardized incidence rate per 100,000

lung cancer risk factors
Lung cancer risk factors
  • Tobacco
  • Occupational exposures – asbestos, arsenic, polycyclic aromatic hydrocarbons, chromium, silica, nickel
  • Radon, radon daughters (occupational, domestic)
  • Protective effect of fruit & vegetables?
  • Genetic predisposition
time trends colorectal cancer

70

60

50

40

30

20

10

0

1975

1980

1985

1990

1995

2000

Year

Males

Females

Time trends: colorectal cancer

Standardized incidence rate per 100,000

colorectal cancer risk factors
Colorectal cancer risk factors
  • Family history
  • Diet
  • Ulcerative colitis & Crohn’s disease
  • Obesity
  • Lack of exercise (colon)
time trends melanoma

15

10

5

0

1975

1980

1985

1990

1995

2000

Year

Males

Females

Time trends: melanoma

Standardized rate per 100,000

melanoma risk factors
Melanoma risk factors
  • Gender
  • Fair skin
  • UV exposure patterns
  • Tanning predisposition
  • Number of naevi
  • Dysplastic naevi
  • Family history
time trends breast cancer
Time trends: breast cancer

Standardized rate per 100,000

breast risk factors
Breast risk factors
  • Age
  • Family history
  • Obesity
  • Hormonal effects
    • nulliparity
    • age of first pregnancy
    • early menarche
    • late menopause
  • Socioeconomic status
  • Benign breast disease (some)
  • Radiation to chest
time trends cervix cancer
Time trends: cervix cancer

Standardized rate per 100,000

cervical cancer risk factors
Cervical cancer risk factors
  • Age at first intercourse
  • Number of sexual partners
  • Age
  • Smoking habit
  • Socioeconomic status
  • Oral contraceptive use
  • Nutritional deficiencies?
time trends prostate cancer

140

120

100

80

60

40

20

0

1975

1980

1985

1990

1995

2000

Year

Time trends: prostate cancer

Standardized rate per 100,000

prostate risk factors
Prostate risk factors
  • Fat consumption
  • Androgens
  • Ethnic group
  • Family history
  • ?role of vitamins
estimated preventable cancer deaths
Estimated preventable cancer deaths
  • Smoking 30%
  • Diet 20-50%
  • Infections 10-20%
  • Reproductive hormones 10-20%
  • Alcohol 5%
  • EM radiation 6%
  • Occupational exposures 3%
  • Pollution up to 5%
risk factors
Risk factors
  • Tobacco
  • Diet & exercise
  • UV exposure
  • Viral infection
  • Genetic susceptibility
tobacco in canada
Tobacco in Canada
  • 29% of adults smoke (>6m)
  • 1.4 million children exposed to tobacco smoke at home
  • Complete elimination of smoking could prevent >38,000 cancer cases, 18,000 cancer-associated deaths annually
available interventions
Available interventions
  • Individual
    • smoking prevention
    • smoking cessation
    • healthier diet
  • Societal level
    • Restrict availability
    • Restrict advertising
    • increase cost
    • smoking bans
diet exercise in canada
Diet & exercise in Canada
  • Most Canadians not meeting even minimum recommendations for fruit & vegetable consumption, most unaware of recommendations
  • 57% inactive during leisure time
  • Daily diets high in vegetables and fruit decrease cancer incidence by 20%
  • Healthy diet, physical activity, body mass reduces cancer incidence by 30-40%
  • Improve nutrition, reduce obesity – could prevent >161,000 cancer cases, 12,000 deaths
available interventions36
Available interventions
  • Individual
    • Healthy eating campaigns, initiatives
    • Food preparation tips
    • Shopping skills
    • Physical activity in school curricula
  • Societal
    • Food fortification
    • Increase access to healthier foods
    • Increase nutritional information
    • Increase accessibility of places for physical activity
uv radiation in canada
UV radiation in Canada
  • Repeated exposure to the sun related to risk of melanoma – 66 000 new cases in 1999 in Canada
  • Half of adults do not adequately protect themselves against the sun. About 45% parents report that at least one of their children was sunburned at least once in the past summer
  • Reduction of over-exposure to sun – prevents ?13,800 melanoma cases
available interventions38
Available interventions
  • Individual
    • Education
  • Societal
    • School policies
    • Occupational protection
    • Availability of protection
viral infections available interventions
Viral infections – available interventions
  • Cervical cancer
    • Education
    • Barrier methods of contraception
    • Vaccines?
environmental carcinogens
Environmental carcinogens
  • Tobacco smoke, pesticides, radon, chlorinated disinfection by-products in drinking water
  • Overall exposure 3-9%
  • Few studies
  • Exposure to carcinogens – we don’t know