CANCER EPIDEMIOLOGY

Bidasari Lubis Dept.I.Kesehatan Anak FK-USU Medan

Epidemiology
The study of distribution and determinants of disease in human population ; why different population or group different risks , diferrent disease Patterns of incidence and death rates of malignant disease : sex,age,race,geography

Concept epidemiology

1.Disease is not randomly distributed 2.Disease causation is multifactorial

General approach

What Who Where When

Descriptive epidemiology

Analytic epidemiology

Why How

Types of epidemilogical

Occupational epidemiology : effects of workplace exposures on workers Clinical epidemiology : outcome the patients Genetic epidemiology: focus on familes or high risk individual, concerned with determinants of disease in families and on inherited causes of cancer in population Nutritional or environmental epidemiology Molecular epidemiology

Application epidemiology
Planning Evaluation of cancer control Primary prevention Early detection Scope of cancer epidemiology: broad concern causes of cancer identification of population where risk reduced prevention

Leading cancer types in Indonesia

1.Cervix cancer 2.Breast cancer 3.Colorectal cancer 4.Lung cancer 5.Nasopharyng cancer

( POI=Perhimpunan Onkologi Indonesia)

Leading cancer types among African American

Male

Female

Prostate Lung and bronchus Colon and rectum NHL Oral cavity

Breast Lung and bronchus Colon and rectum Uterine corpus Pancreas

Kidney
Urinary bladder Pancreas Stomach

Ovary
NHL Kidney Multiple Myeloma

liver

Etiology

Chemical carcinogens Environmental and industrial carcinogens Drug induced cancers Radiation carcinogenesis Viral and immunologic mechanisms

Etiology
A.Chemical carcinogens 1.Industrial exposure 2-Naphthylamine Benzidine Bis(chloromethyl)ethe r Bis(2chloroethyl)sulfide (mustard gas) Vinyl chloride Chromium compounds Nickel compounds Asbestos Benzene

2.Medical exposure N,N-bis(2chloroethyl)-2naphthylamine (Chlornaphazin) Diethylstilbestrol Inorganic arsenic comp. Mephalan,cyclophos phamide

3.Societal exposure Cigarette smoke Betel nut and tobacco quid

2.Radiation carcinogenesis:medical xrays,atomic weapon,radon in house 3.Viral and immunologic mechanisms -Epstein-Barr virus -Hepatitis-B -HIV 4.Environmental: ultraviolet

Cancers 7 warning signals

1.Change in bowel or bladder habits 2.A sore that does not heal 3.Unusual bleeding or discharge 4.Thickening or lump in breast or elsewhere 5.Indigestionor difficulty in swallowing 6.Obvious change in wart or mole 7.Nagging cough or hoarseness If you have a warning signal ,see your doctor

Role of infection
Epstein-Barr virus (EBV) Underdeveloped country rate infection in infancy , high the age of onset HD -EBV is present in 40 60% of cases -chronic viral infection activation of cellular oncogenes, loss of tumour suppressor genes and deregulation of several cytin