1. Epidemiology 242: Cancer Epidemiology Zuo-Feng Zhang, MD, PhD Fall Quarter, 2009

2. Overall Objectives of the Course The overall objectives are to introduce basic concept in cancer epidemiology, including concepts of carcinogenesis, multistage models, pre-malignant lesion, international patterns of cancer.

3. Overall Objectives of the Course To discuss major etiologic issues for a variety of cancers including smoking, alcohol drinking, virus, radiation, nutrition, occupational and environmental exposures. To review epidemiological data on major cancers including prostate, breast, lung, and other cancers. To lecture on the basic concepts of molecular and genetic epidemiology.

4. Introduction to Cancer Epidemiology (1) To overview the cancer magnitude (2) To familiarize students with basic concepts of tumor and its classification (3) To introduce basic concept of carcinogenesis and cancer epidemiology

5. Why Cancer is a Major Public Health Problem? Improved medical care and public health have lead to: Decrease and control of common diseases of childhood and infectious disease, the major causes of death in the past the increase of life expectation the increase of the proportion of aging population, since cancer is generally considered as an aging disease, cancer becomes a major public health problem.

7. Number of deaths for leading causes of death Heart disease: 631,636 Cancer: 559,888 Stroke (cerebrovascular diseases): 137,119 Chronic lower respiratory diseases: 124,583 Accidents (unintentional injuries): 121,599 Diabetes: 72,449 Alzheimer's disease: 72,432 Influenza and Pneumonia: 56,326 Nephritis, nephrotic syndrome, and nephrosis: 45,344 Septicemia: 34,234

13. Source: Table 1: Parkin DM, et al. CA Cancer J Clin [2005]; 55: 74-108 Incidence by sex and cancer site, World 2002

14. Mortality by sex and cancer site, World Source: Table 1: Parkin DM, et al. CA Cancer J Clin [2005]; 55: 74-108

15. The Major Cancers Lung (ICD-10 C33 and C34) Lung (ICD-10 C33 and C34) Breast (female, C50) Breast (female, C50) Colon/rectum (C18-C20) Colon/rectum (C18-C20) Stomach (C16) Stomach (C16) Prostate (C61) Prostate (C61) Liver (C22) Liver (C22) Cervix uteri (C53) Cervix uteri (C53) Esophagus (C15) Esophagus (C15)

16. What is Cancer Epidemiology?

17. Definition Cancer epidemiology is the study of the pattern of cancer in populations. Its essential aim is to identify causes of cancer, including preventable (avoidable) causes and inherited tumor susceptibility. It is also play an critical role in many other areas of cancer research including evaluation of screening effects, cancer prevention and control Current studies directions includes molecular and genetic epidemiology of cancer.

18. Types of Epidemiologic Studies Descriptive Epidemiologic study: To describe the difference in occurrence of a particular cancer between different groups (age, gender, race, country, a period of time for time trend) and to generate the hypothesis for increased/decreased for the specific tumor type.

19. Types of Epidemiological Studies Analytic Epidemiology: To study risk factors or potential causes of cancer by a particular study design, e.g., case-control study or cohort study.

20. Types of Epidemiological Studies Intervention studies: Applying the knowledge (risk/protective factors) obtained from analytic epidemiological studies to specific population in order to reduce the risk of cancer.

21. Risk factors for Cancer

22. Percentage of Cancer Deaths Attributed to Various Factors (Doll R and Peto R, JNCI, 1981) Tobacco Use: 30% (25%-40%) Diet:35% (10%-70%) Infection: 10%? (1%-?) Reproductive & Sexual Behavior: 7% (1%-13%) Occupation: 4% (<2%-8%) Alcohol: 3% (2%-4%) Geophysical factors (natural radiation): 3% (2-4%) Pollution: 2% (<1% – 5%) Food additive: <1% (-5% – 2%) Medicines and Medical Procedures: 1% (0.5%-3%) Industrial consumer products <1% (<1%-2%) Unknown: ?, ?

23. Harvard Center for Cancer Prevention (www.hsph.harvard.edu/cancer) Tobacco: 30% Diet in adult life, including obesity: 30% Sedentary lifestyle: 5% Infectious agents: 5% Defects in single genes that run in family: 5- 10%

24. Lichtenstein P, Holm NV, Verkasalo PK, Iliadou A, Kaprio J, Koskenvuo M, Pukkala E, Skytthe A, Hemminki K. NEJM, 2000

25. Chemical/environmental carcinogens Smoking and lung cancer Sun exposure and squamous cell carcinoma of skin Asbestos exposure and lung cancer Smoke food risk with nitrosamines and adenocarcinoma of the stomach Alcohol drinking and squamous cell carcinoma of esophagus Aflatoxin B1 and liver cancer

28. Radiation Exposure to ultraviolet radiation (in the form of sunlight) and squamous cell carcinoma of skin Ionizing radiation is related to skin cancer and leukemia in radiologist

29. Viral factors HPV (human papilloma virus) and Cervix cancer EBV(Epstein-Barr virus) and Nasopharyngeal cancer, Burkitt’s lymphoma HBV (hepatitis B virus) and hepatocellular carcinoma HIV (human immunodeficiency virus) and Kaposi’s sarcoma

32. http://www.yourdiseaserisk.wustl.edu/hccpquiz.pl?lang=english&func=home&page=cancer_index