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Lecture to 1st year students, Kulliyah of Medicine, International Islamic University, Kuantan on 14th November 1997 by Prof Dr Omar Hasan Kasule, Sr. Deputy Dean for Research and Post-graduate Affairs
OUTLINE
INTRODUCTION
HISTORY OF CANCER EPIDEMIOLOGY
DESCRIPTIVE EPIDEMIOLOGY OF CANCER
PURPOSES OF DESCRIPTIVE EPIDEMIOLOGY
MEASUREMENT OF CANCER
TRENDS OF CANCER
TYPES OF CANCER DATA
SOURCES OF DATA ON CANCER
METHODS OF CANCER EPIDEMIOLOGY
ENVIRONMENTAL RISK FACTORS
INTRODUCTION
Cancer Epidemiology deals with the distribution, determinants (causes) and prevention of cancer. It also extends to deal with aspects of cancer treatment. Epidemiology being a quantitative medical science deals with numbers and figures.
Cancer is not one disease. It is many diseases each with its risk factors and different methods of treatment and prevention.
Cancer is a global problem affecting all countries of the world and all humans irrespective of ethnicity, age, and socio-economic status
HISTORY OF CANCER EPIDEMIOLOGY
1713: Ramazzini recorded high cancer in nuns (nulliparous)
18th century Hill observed cancer of the nose in snuff users
18th century Soemmering observed cancer of the lower lip in pipe
smokers
? Percival Pott recorded high cancer of the scrotum in
chimney sweeps
1895: Bladder cancer associated with work in the dye stuff
industry
1956 Smoking and lung cancer among British doctors
DESCRIPTIVE EPIDEMIOLOGY OF CANCER
Geographical variation
Ethnic/racial variation
Socio-economic variation
Socio-cultural variation
Age distribution
Sex distribution
Time trends
Migratory patterns
Site distribution
PURPOSES OF DESCRIPTIVE EPIDEMIOLOGY
Understand the public health impact of cancer
Study how cancer burden varies from place to place
Understand temporal changes and trends
Get clues about causation and avoidability
MEASUREMENT OF CANCER
Incidence
Prevalence (cancer burden)
Mortality
Survival
TRENDS OF CANCER
There are approximately 8 million new cases of cancer a year. With the decrease of infectious diseases, increasing life-spans in all countries of the world in addition to increasing exposure to environmental and industrial cancer risk factors, incidence and mortality due to cancer are increasing as a proportion of total morbidity and mortality.
TYPES OF CANCER DATA
Epidemiological
Laboratory (biological, pathological, chemical, molecular)
Clinical
Environmental
SOURCES OF DATA ON CANCER
National or Regional Cancer Registries
Death Certificate Data
Hospital Records
Special Surveys and Studies
METHODS OF CANCER EPIDEMIOLOGY
DESCRIPTIVE
Incidence
Prevalence
ANALYTIC
Causal association
Prospective and retrospective
Correlation
Migratory studies
INTERVENTION
Primary prevention
Diet
Environment
Education
Control infections
Secondary prevention
Tertiary prevention
PREVENTION
Epidemiological data used to prevent cancer even without knowing the exact cause(s)
Epidemiology helps cancer prevention by manipulation of exposure to environmental exposures and life-style
Education
Intervention
Screening for early detection
Prevention strategies for given cancers
Lung stop smoking, new cigarettes, diet
Mouth stop quid smoking, stop tobacco chewing
Liver HBV immunisation, aflatoxin
Cervix genital hygiene, sexual behaviour
ENVIRONMENTAL RISK FACTORS
Time of exposure
Duration of exposure
Age at exposure
Identified risk factors
Tobacco
Occupation
Radiation
Alcohol
Diet
Drugs
Reproductive Factors
Air Pollution
Microbial agents
TREATMENT OF CANCER
Strategies
Curative eg BL, leukemia
Supportive
Treatment modalities
Surgery
Chemotherapy
Irradiation
Immunotherapy