Basic science of Oncology 2011 1

CANCER
EPIDEMIOLOGY
Hematology Oncology Division
Child Health Departement – Universty of Sumatera Utara
 Epidemiology
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The study of distribution and determinants of

disease in human population ; why different
population or group are at different risks for
diferrent disease
Patterns of incidence and death rates of
malignant disease : sex,age,race,geography

Basic science of Oncology 2011

 Childhood cancer
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 is rare  less than 1 % of all cancer in

industrialized countries
 Several types of cancer are virtually unique to
childhood, whereas the carcinomas most
frequently seen in adults
 Some of the most striking progress in cancer
treatment has been made in paediatric oncology
 Investigation of childhood tumours has led to
major advances in the understanding of the
genetic

Basic science of Oncology 2011

 Concept epidemiology
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 1.Disease is not randomly

distributed
 2.Disease causation is multifactorial

Basic science of Oncology 2011

 The scope of Epidemiology
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 Concerned with population health

 Concern to clinicians
 Clinical researchers
 Laboratory scientiest

Basic science of Oncology 2011

 General approach
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 What
 Who
 Where
 When
Descriptive epidemiology

Analytic epidemiology
 Why
 How

Basic science of Oncology 2011

 Types of epidemilogical
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 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
Basic science of Oncology 2011
 Application epidemiology
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 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”
Basic science of Oncology 2011
 Cancer statistic
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When a patient is diagnosed with cancer  one

of the first questions an oncologist will be
asked: “how long do I have “
Survival based  statistics : observational
studies : 1.relative 5-year survival rates
2.Overall survival
3.Median survival

Basic science of Oncology 2011

 Cancer trends
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- Relatifve 5-year survival rate for all

cancer: 1975 - 1977 : 51%
- 1996 - 2002 : 66%
The reason: Multifactorial:
Increasing:1. diagnostic test:mammogram,Pap
smears,prostate specific antigen
2.immunosupression
3.the aging of population

Basic science of Oncology 2011

 Leading cancer types in Indonesia
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 1.Cervix cancer
 2.Breast cancer

 3.Colorectal cancer

 4.Lung cancer

 5.Nasopharyng cancer

( POI=Perhimpunan Onkologi Indonesia)

Basic science of Oncology 2011

 Leading cancer types among African
American
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Male Female
 Prostate  Breast
 Lung and bronchus  Lung and bronchus
 Colon and rectum  Colon and rectum
 NHL  Uterine corpus
 Oral cavity  Pancreas
 Kidney  Ovary
 Urinary bladder  NHL
 Pancreas  Kidney
 Stomach  Multiple Myeloma
 liver
Basic science of Oncology 2011
 Leading cancer in children
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 Leukemia

 Lymphoma and Reticuloendothelial neoplasms

 CNS tumours

 Retinoblastoma

 Renal Tumours

 Hepatic Tumours

Basic science of Oncology 2011

 ……….cancer in children
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 Malignant Bone tumours

 Soft Tissue sarcomas

 Germ Cell, trophoblastic and other gonadal

neoplasms
 Carcinomas and other malignant epithelial
neoplasms
 Other and unspecified malignant neoplasms

Basic science of Oncology 2011

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

Basic science of Oncology 2011

 Etiology
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A.Chemical carcinogens Chromium compounds

1.Industrial exposure Nickel compounds
2-Naphthylamine Asbestos
Benzidine Benzene
Bis(chloromethyl)ether
Bis(2-chloroethyl)sulfide
(mustard gas)
Vinyl chloride
Certain tars,soots,oils
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 Chemicals
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• pesticides (CNS tumors)

• solvents (eg, CNS tumors, leukemia,
neuroblastoma, hepatoblastoma)
• metals (hepatoblastoma)
• petroleum products (eg, Wilms tumor, leukemia,
hepatoblastoma)
• lead (Wilms tumor)
• boron (Wilms tumor)
• furnaces (lymphoma)
• chemotherapy (leukemia)

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2.Medical exposure 3.Societal exposure

N,N-bis(2-chloroethyl)- Cigarette smoke
2-naphthylamine Betel nut and tobacco
(Chlornaphazin) quid
Diethylstilbestrol
Inorganic arsenic comp.
Mephalan,cyclophosph
amide
Azathioprine,Phenytoin
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2.Radiation carcinogenesis:medical x-rays,atomic

weapon,radon in house
3.Viral and immunologic mechanisms
-Epstein-Barr virus
-Hepatitis-B
-HIV
4.Environmental: ultraviolet

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 Environmental Factors
 Ionizing radiation
 Data
derived from the atomic bomb
exposures at Hiroshima and Nagasaki 
Leukemia

 Electromagnetic fields
 Published reports have suggested that
electromagnetic fields have some potential
effect on the promotion of leukemia

Basic science of Oncology 2011

 Cancer’s 7 warning signals
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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

Basic science of Oncology 2011

 Role of infection
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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
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 Epstein-Barr virus (EBV)

 African
Burkitt lymphoma
 Hodgkin lymphoma
 Nasopharyngeal carcinoma
 HIV-induced immunosuppression
 CNS lymphoma
 Leiomyosarcoma

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Thank You
Basic science of Oncology 2011