Cancer epidemiologyan introduction

Yi Ning, ScD, MD, MPHDept of Epidemiology and Community Health

yning2@vcu.edu

Overview Data review Risk factors and prevention Secondary prevention

Data review

Cancer 1st described by Hippocrates to

describe radiating appendage-like projections observed in breast tumors› In Greek, cancer = crab

Def.: malignant tumor of potentially unlimited growth that expands locally by invasion and systemically by metastasis

Global NCD Death under 70

global status report on noncommunicable diseases 2010

Age-Adjusted Death Rates* for the 10 Leading Causes of Death

WWMR, December 9, 2011 / 60(48);1656-1656

global status report on noncommunicable diseases 2010

New cases and deaths

Death rates by site: Male

Death rates by site: Female

5 YEAR RELATIVE SURVIVAL

RATE

12 MILLION CANCER

SIVORVORS

Risk factors and prevention

CANCER, NON-COMMUNICABLE DISEASES AND LIFESTYLE

global status report on noncommunicable diseases 2010

Causes of Death

WWMR, December 9, 2011 / 60(48);1656-1656

Colon cancer paradigm

From AACR Cancer Progress Report 2011Colon cancer

9/7/2004

Actual Causes of Death in the United States

McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA 1993; 270(18):2207-12.

Major recommendation from World Cancer Research Fund and American Institute for Cancer Research

(All?)

Obesity Trends* Among U.S. Adults BRFSS, 1985

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

CDC Obesity Trends http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/

RESULTS:

RR for 5 kg/m2 BMI RR=1.18 (1.14, 1.21)

Ning Y. et al. Obesity Review, 200920

Obesity Trends* Among U.S. Adults BRFSS, 1987

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

CDC Obesity Trends http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/

Obesity Trends* Among U.S. Adults BRFSS, 1989

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

CDC Obesity Trends http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/

Obesity Trends* Among U.S. Adults BRFSS, 1991

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

CDC Obesity Trends http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/

Obesity Trends* Among U.S. Adults BRFSS, 1993

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

CDC Obesity Trends http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/

Obesity Trends* Among U.S. Adults BRFSS, 1995

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.CDC Obesity Trends http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/

Obesity Trends* Among U.S. Adults BRFSS, 1997

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

CDC Obesity Trends http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/

Obesity Trends* Among U.S. Adults BRFSS, 1999

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

CDC Obesity Trends http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/

Obesity Trends* Among U.S. Adults BRFSS, 2001

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

CDC Obesity Trends http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/

Source: Behavioral Risk Factor Surveillance System, CDC

(*BMI 30, or ~ 30 lbs overweight for 5’4” person)

No Data <10% 10% –14% 15%–19% 20%–24% ? 25%

Obesity Trends* Among U.S. Adults BRFSS, 2002

Secondary Prevention

Natural History of CRC

Normal Epithelium

Hyperproliferating Epithelium Early

Adenoma Intermediate Adenoma

Late Adenoma Carcinoma Metastasis

Screening

30-40 years

Secondary Prevention Natural history of the disease Treatment is effective Reduce mortality

Cancer prevention 1981 Doll and Peto compared incidence in

countries or regions with the highest and lowest rates› Estimated majority of cancer due to

preventable causes ACS challenge goals (1996) to reduce

mortality by 50% through 2015

9/7/2004

9/7/2004