Cancer epidemiology

DR. RAJEEV KASHYAP B.SC.,B.D.S. M.SC (DENTAL PUBLIC HEALTH) U.K. C.C.R.A,. C.R.A.A (CANADA) Cancer Epidemiology Dr Rajeev Kashyap

International Agency for Research on Cancer The International Agency for Research on Cancer (IARC) was established in 1965 by the World Health Assembly, as an independently financed organization within the framework of the World Health Organization. The headquarters of the Agency are at Lyon, France. Concentrating particularly on the epidemiology of cancer and the study of potential carcinogens in the human environment. Its field studies are supplemented by biological and chemical research carried out in the Agency's laboratories in Lyon, Dr Rajeev Kashyap

Dr Rajeev Kashyap IARC, which is part of the World Health Organization, coordinates and conducts research on the causes of human cancer and the mechanisms of carcinogenesis, and develops scientific strategies or cancer control

Cancer Epidemiology Particularly in countries of the developing world. Population-based epidemiological studies are the only reliable source on the occurrence and outcome of cancer and form the basis of any national or regional cancer control programme. Medical and public health students, clinicians, health professionals and all those seeking to understand the principles and methods used in cancer epidemiology Dr Rajeev Kashyap

Epidemiology Aims Epidemiology aims to answer not only ' Who has what , when , and where ?', but also to find out why . Why are some at higher risk than others? Are associations between certain factors and increased risk of disease causal or spurious? Epidemiologists seek to address such basic issues, viewing their work as the search for a relationship between two factors. Dr Rajeev Kashyap

Introduction to Cancer Epidemiology Cancer is not a new disease Hippocrates introduced the term carcinoma from the Greek word karkinos , for crab: he saw cancer as crablike in its spread through the body and in its persistence. (Long, 1928) Symptoms of what can be assumed to be malignant diseases were also described in Chinese and Arabic medical writings. By the time of Hippocrates in the 4th century BC. Sorne 600 years later, Galen distinguished three types of tumour: 'tumours according to nature Dr Rajeev Kashyap

Epidemiology Concerns Epidemiology is concerned with events that occur in populations: The primary units of concern are groups of people, not separate individuals. Epidemiological studies are concerned not only with people who get a disease, but also with those who do not, and in particular how these two groups may differ Dr Rajeev Kashyap

History It was not untill the end of the 18th century that cancer began to be studied systematically and intensively. Bichat (1771-1802) described the pathology of many neoplasms in humans and suggested that cancer was an 'accidental formation' of tissue built up in the same manner as any other part of the organism. Sorne decades later, Müller (1801-58) and Virchow (1821-1902) extended Bichats findings, using the microscope to show that cancerous tissue was made up of cells (Long, 1928). Dr Rajeev Kashyap

What is cancer epidemiology? "Epidemiology is the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to control of health problems." Cancer epidemiology is the branch of epidemiology concerned with the disease cancer. Dr Rajeev Kashyap

Clinical V/S Epidemiology A doctor in clinical practice, who is usually concerned only with patients. Whereas clinicians direct their questions towards a particular patient-'What is wrong with this patient? What treatment is appropriate?‘ The epidemiologist is concerned equally with the population from which the patients came. The epidemiologist asks similar questions about whole communities-'What are the leading causes of death or disability in this population? What can be done to reduce them?' Dr Rajeev Kashyap

Cancer Epidemiological Studies ln fact , cancer epidemiological studies may focus on precursors of cancer; for example, on cervical intraepithelial neoplasia (CIN) as a precursor of invasive cervical cancer, or on chronic atrophic gastritis as a precursor of stomach cancer. Alternatively, the object of the study may be a characteristic that is related to cancer, such as growth or fertility. Thus, epidemiologists are concerned not only with illness, disability and death, but also with health and with preventing disease. Dr Rajeev Kashyap

Poverty and cancer Occupational risks are becoming a serious problem in developing countries, largely as a consequence of the transfer of hazardous industries from industrialized countries where certain industries are judged to be unacceptable. A similar double standard is applied to tobacco advertising and sales in the industrialized and developing countries Dr Rajeev Kashyap

epidemiologist must examine an association The epidemiologist must examine whether there is an association between an exposure and a disease, and decide whether the observed relationship is likely to be causaL. Questions to be addressed might be Ils lung cancer associated with cigarette smoking?‘ or 'Does cigarette smoking cause the disease?'. Dr Rajeev Kashyap

Epidemiology can ? Epidemiology can identify a cause and a means of prevention. Epidemiology is the only source of direct scientific evidence about exposure effects and the preventabilty of disease within human populations. Laboratory scientists have identified carcinogenic compounds in tobacco smoke and have been Dr Rajeev Kashyap

important roles of epidemiology Epidemiology is to learn about the causes of disease, or its natural history, knowledge that can lead to the introduction of preventive measures. Even when the biology of a disease is not fully understood, epidemiology can identify a cause and a means of prevention. Complete knowledge of causal mechanisms is not essential for effective preventive strategies, although in the spirit of scientific enquiry accepted in western culture, knowledge of the mechanisms involved is desirable in itself. Dr Rajeev Kashyap

The epidemiologist is to society what the doctor is to the patient, and epidemiology is thus part of the foundations of public health . Epidemiology describes and measures the occurrence of disease in the community, so that questions can be addressed such as 'is the disease (or condition) a priority for health intervention?' and 'Why do cases occur and why does the condition persist in the community?'. Epidemiology also helps in choosing the health programmes that are most likely to control a particular health problem and in evaluating their impact in the community. Dr Rajeev Kashyap

A brief history of cancer epidemiology Epidemiology has its origins in the idea present in many ancient civilizations that environmental factors can influence the occurrence of disease. This idea was clearly expressed about 2400 years ago by Hippocrates: First he ought to consider what effects each season of the year can produce. The next point is the hot winds and the cold. Each particular region. The mode of life also of the inhabitants that is pleasing to them, whether they are heavy drinkers, taking lunch, and inactive, or athletic, industrious, eating much and drinking little. Using this evidence. (Translated into English by Jones, 1923) Dr Rajeev Kashyap

an occupational cause Despite his emphasis on the role of environmental factors in causing human disease, Hippocrates believed that cancer was a disease caused by an excess of 'black bile', which was manufactured by both the spleen and stomach, but not the liver. ln 1775, Percival Pott described the relationship between scrotal cancer in chimney sweeps and soot in his Chirurgical Observations now considered a milestone in epidemiology. Pott was the first to attribute an occupational cause to this disease, raising the possibility of prevention. Dr Rajeev Kashyap

Cohort studies Cohort studies, the epidemiologist assembles a group of people and collects information to identify those who are exposed to a particular agent (e.g., smokers) and those who are not (e.g., non-smokers). The group is then followed over time, and the disease occurrence (e.g., lung cancer) in exposed individuals is compared with the disease occurrence in the non-exposed group. Dr Rajeev Kashyap

case-control study The logistic problems and costs encountered with cohort studies have led to the development and increase in popularity of another type of study: the case-control study. ln these studies, the epidemiologist compares a group of individuals who have the disease under investigation (termed 'cases'-e.g., persons with lung cancer) with a group without that disease (termed 'controls'), to see whether the groups differ in their past history of exposures (e.g., smoking habits) Dr Rajeev Kashyap

examples of cancer epidemiology Although several studies that would now be considered examples of cancer epidemiology were conducted before the 20th century, The growth of this discipline (and of epidemiology in general) did not begin until the end of the Second World War. ln 1954, results from two important cohort studies, now considered as classical, were published. One was the British Doctors' Study designed to investigate the relationship between tobacco smoking and lung cancer. (Doll & Hill, 1954), The other had been set up to determine the risk of bladder cancer in the British chemical industry (Case et al., 1954; Case & Pearson, 1954). Dr Rajeev Kashyap

links between exposure to specific agents Cohort studies of human populations, particularly of industrial workers, patients treated with radiation and cytotoxic chemotherapy, and victims of nuclear and other disasters, have provided the most convincing evidence of links between exposure to specific agents and cancer. Dr Rajeev Kashyap

the case-control study ln these studies, the epidemiologist compares a group of individuals who have the disease under investigation (termed 'cases'-e.g., persons with lung cancer) with a group without that disease (termed 'controls'), to see whether the groups differ in their past history of exposures (e.g., smoking habits). This type of study is uniquely well suited to studying cancer and other diseases with a long induction period, allowing the epidemiologist to look through time, retrospectively tracing the path back from effect to cause. This is the reverse of the time-sequence adopted in cohort studies. Dr Rajeev Kashyap

This technique of looking retrospectively is used daily by clinicians when they take case histories. However, case-control studies differ from case series in that they use a control group for drawing comparisons with the group of cases. One of the earliest studies to make use of the case-control approach was that reported by Broders (1920) on squamous cell epithelioma of the lip in relation to pipe smoking. Unfortunately, Broders failed to describe the method by which he selected the controls. Dr Rajeev Kashyap

Thereafter until the late 1940s, no further case-control studies of comparable quality were published. There were, however, studies in which the characteristics of cancer patients were compared with those of a group of non-cancer patients; an example, on betel chewing and oral cancers in lndia, was published by Orr (1933). ln 1947, Schrek & Lenowitz reported a case-control study of the relationship between carcinoma of the penis and poor sexual hygiene. ln the early 19S0s, results from four case-control studies linking cigarette smoking to lung cancer were reported (Schrek et al., 1950; Levin et aL., 1950; Wynder & Graham, 1950; Doll & Hill, 1950, 1952), and the following years saw numerous similar studies of many cancers. The 1950s also brought the first methodological developments of the case-control approach (e.g., Cornfield, 1951; Mantel & Hanszel, 1959). Dr Rajeev Kashyap

contribution of epidemiology The contribution of epidemiology to strategies for preventing certain types of cancer was until recently well in advance of our biological knowledge of the disease. However, advances in biology are now providing new tools and directions for epidemiological investigations into the occurrence and distribution of cancer in populations. Incorporation of biological markers into epidemiological research and development of genetic epidemiology are just some examples of this multidisciplinary approach. Dr Rajeev Kashyap

Key ISSUES Cancer epidemiology is concerned with the study of the distribution of the disease cancer in populations. Its ultimate Goal. is to identify Risk factors that may lead to early introduction of effective preventive measures. Cancer epidemiology and epidemiology in general, is based on the comparison of groups of people.. For ethical reasons, however, epidemiological methods are predominantly observational. Cancer epidemiology is a relatively new science, which has matured only in the last half of the 20 th century Dr Rajeev Kashyap

CANCER EPIDEMIOLOGY: PRINCIPLES AND METHODS BY :ISABEL DOS SANTOS SILVA References Dr Rajeev Kashyap

Cancer epidemiology

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Cancer epidemiology