international & national patterns of cancer rates 1-2 zhang.pdfstomach cancer 934,000 new cases...

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Cancer Incidence and Cancer Incidence and Mortality and Risk Mortality and Risk

Factors in the WorldFactors in the World

ZuoZuo--FengFeng Zhang, M.D., Ph.D.Zhang, M.D., Ph.D.Fogarty International Training Fogarty International Training

Workshop on Cancer Epidemiology Workshop on Cancer Epidemiology Prevention and ControlPrevention and Control

Shanghai, March, 11Shanghai, March, 11--13, 200813, 2008

Age Standardized Incidence Rates (/100,000)Age Standardized Incidence Rates (/100,000)

US China World

Site Males Females Males Females Males Females

Stomach 7.2 3.3 41.4 19.2 22.0 10.3

Liver 5.5 2.0 37.9 14.2 15.7 5.8

Esophagus 4.9 1.3 27.4 12.0 11.5 4.7

Colon/Rectum 44.6 33.1 13.6 9.2 20.1 14.6

Leukemia 11.2 7.4 5.7 4.1 5.9 4.1

Pancreas 8.3 6.3 3.9 2.6 4.6 3.3

Brain 6.5 4.5 3.9 2.8 3.7 2.6

Cervix 0 7.7 0 6.8 0 16.2

Lung 61.9 36.1 42.4 19.0 35.5 12.1

Breast ─ 101.1 ─ 18.7 ─ 37.5

Prostate 124.8 0 1.6 0 25.3 0

Source: GLOBOCAN 2002

The Major CancersThe Major Cancers

Lung (ICDLung (ICD--10 C33 and C34)10 C33 and C34)Breast (female, C50)Breast (female, C50)Colon/rectum (C18Colon/rectum (C18--C20)C20)Stomach (C16)Stomach (C16)Prostate (C61)Prostate (C61)Liver (C22)Liver (C22)Cervix uteri (C53)Cervix uteri (C53)Esophagus (C15)Esophagus (C15)

Lung cancerLung cancer

1.35 million new cases and 1.18 million 1.35 million new cases and 1.18 million deaths worldwide estimated in 2002deaths worldwide estimated in 200250% new cases occurred in more 50% new cases occurred in more developed countries (previously 69%)developed countries (previously 69%)more common in males (2.9 male:female more common in males (2.9 male:female ratio)ratio)patterns of lung cancer occurrence patterns of lung cancer occurrence determined largely by past exposure to determined largely by past exposure to tobacco smoking tobacco smoking

AgeAge--standardized incidence rates for standardized incidence rates for lung cancer lung cancer

Source: Figure 5: Parkin DM, et al. CA Cancer J Clin [2005]; 55: 74-108

Lung cancer Lung cancer incidence trendsincidence trends

in countries where in countries where smoking was first smoking was first established (UK, US, established (UK, US, Australia, etc.), Australia, etc.), rates declining rates declining among menamong menin most other in most other countries, rates countries, rates risingrisingrates in women rates in women generally increasing generally increasing since tobacco habit since tobacco habit is fairly recent, is fairly recent, except in countries except in countries where their smoking where their smoking prevalence is prevalence is decliningdeclining

Lung cancer Lung cancer mortality trendsmortality trends

similar to incidence similar to incidence trendstrends

Risk FactorsRisk Factors for Lung Cancerfor Lung Cancer

•• Tobacco smokingTobacco smoking•• ETSETS•• AsbestosAsbestos•• Radon exposureRadon exposure•• Occupational exposuresOccupational exposures•• Air pollutionAir pollution•• Other rOther radiationadiation•• Recurring inflammationRecurring inflammation•• Family history of cancerFamily history of cancer•• Insufficient diet and poor Insufficient diet and poor

nutritional factorsnutritional factors

Lung Cancer Primary PreventionLung Cancer Primary Prevention

Reducing smoking initiation among Reducing smoking initiation among adolescentsadolescents

Increasing smoking cessation among Increasing smoking cessation among adults: increasing price of tobacco, adults: increasing price of tobacco, restricting tobacco advertising and restricting tobacco advertising and promotion, banning smoking in public promotion, banning smoking in public places, counter advertising, provide places, counter advertising, provide treatment and counseling for tobacco treatment and counseling for tobacco dependencedependence

Lung Cancer Secondary Lung Cancer Secondary Prevention: Early DetectionPrevention: Early Detection

Screening has not yet been proven Screening has not yet been proven to reduce mortalityto reduce mortality

Spiral CT scan and molecular Spiral CT scan and molecular markers in sputum may be effective. markers in sputum may be effective.

Stomach cancerStomach cancer

934,000 new cases and 700,000 deaths 934,000 new cases and 700,000 deaths worldwide estimated in 2002worldwide estimated in 2002ranked 4ranked 4thth in number of new cancers but 2in number of new cancers but 2ndnd in in most common cause of deaths from cancermost common cause of deaths from canceralmost twoalmost two--thirds of cases occur in developing thirds of cases occur in developing countriescountriesmore common in males (1.75 male:female ratio)more common in males (1.75 male:female ratio)however, in younger age groups (<40 years) however, in younger age groups (<40 years) rates in women are greater than men rates in women are greater than men Five year survival rate is around 18%Five year survival rate is around 18%--53%53%

In the USIn the US•• Estimate 22,280 incident cases and 11,430 death in Estimate 22,280 incident cases and 11,430 death in

both sexes in 2006 both sexes in 2006 •• The fiveThe five--year survival rate is 23%.year survival rate is 23%.

In ChinaIn China•• The 2The 2ndnd most frequent cancer in both sexes, which most frequent cancer in both sexes, which

accounts for accounts for 42 %42 % of cases worldwideof cases worldwide•• The 3rd cancer killer in China, accounts for 19% of The 3rd cancer killer in China, accounts for 19% of

total deathstotal deaths

Epidemiology of Stomach CancerEpidemiology of Stomach Cancer

Risk and Protective Factors of Stomach CancerRisk and Protective Factors of Stomach Cancer

Risk factorsRisk factors•• Helicobacter pylori Helicobacter pylori •• Chronic atrophic gastritis Chronic atrophic gastritis •• Cigarette smokingCigarette smoking•• Alcohol drinkingAlcohol drinking•• Consumption of salted meat, cured meat, smoked Consumption of salted meat, cured meat, smoked

food, fried food, fish sauce, and fermented beans food, fried food, fish sauce, and fermented beans •• Diets high in salt Diets high in salt

Protective factorsProtective factors•• Refrigeration of food Refrigeration of food •• Consumption of fruit and vegetables Consumption of fruit and vegetables •• Consumption of milk Consumption of milk •• Green tea drinkingGreen tea drinking•• Garlic consumptionGarlic consumption

AgeAge--standardized incidence rates for standardized incidence rates for stomach cancer stomach cancer


Stomach cancer Stomach cancer incidence trendsincidence trends

general decline in general decline in rates among both rates among both developed and developed and developing countries developing countries because of improved because of improved food preservation food preservation practices practices (refrigerators) and (refrigerators) and better nutrition better nutrition (higher vegetable (higher vegetable and fruit intake)and fruit intake)

Stomach cancer Stomach cancer mortality trendsmortality trends

generally declining in generally declining in both less and more both less and more developed regionsdeveloped regions

Esophageal cancerEsophageal cancer

462,000 new cases and 386,000 deaths 462,000 new cases and 386,000 deaths worldwide estimated in 2002worldwide estimated in 200284% of cases occur in developing countries84% of cases occur in developing countriesgenerally, more common in males generally, more common in males (male:female ratio over 2), but female (male:female ratio over 2), but female predominance in some areas of predominance in some areas of ““esophageal cancer beltesophageal cancer belt””

Epidemiology of Esophageal CancerEpidemiology of Esophageal CancerWorldwideWorldwide•• The 8th incidence cancer and 6th most common The 8th incidence cancer and 6th most common

cancer death worldwidecancer death worldwide

•• Five year survival rate is 16%Five year survival rate is 16%

•• 80% of the total cases occurred80% of the total cases occurred in developing in developing countriescountries

In the USIn the US•• The number 7th ranked cancer death in male in 2006The number 7th ranked cancer death in male in 2006•• Five year survival rate is 15% estimated from 1995Five year survival rate is 15% estimated from 1995--

20012001

In ChinaIn China•• The 4th common both cancer morbidity and The 4th common both cancer morbidity and

mortality.mortality.•• A total of 253,752 new cases would occur each year, A total of 253,752 new cases would occur each year,

which accounts for which accounts for 54.9%54.9% of worldof world

Major Risk and Protective Factors of Esophageal Major Risk and Protective Factors of Esophageal CancerCancer

Risk factorsRisk factors•• AlcoholAlcohol•• SmokeSmoke•• HPV (?)HPV (?)•• GastricGastric--esophageal reflux (Adenocarcinoma)esophageal reflux (Adenocarcinoma)•• Age and race Age and race •• Infrequent consumption of raw fruits and Infrequent consumption of raw fruits and

vegetablevegetable•• High consumption of hot soup for northern High consumption of hot soup for northern

ItalianItalian•• ““MajowehMajoweh”” or "or "majummajum”” in in pregnant women in pregnant women in

IranIranProtective factorsProtective factors•• Diets high in fruits and vegetablesDiets high in fruits and vegetables•• Olive oilOlive oil•• Black raspberryBlack raspberry

AgeAge--standardized incidence rates for standardized incidence rates for esophageal cancer esophageal cancer


Esophageal cancer Esophageal cancer incidence trendsincidence trends

trends vary from trends vary from increasing (Eastern increasing (Eastern Europe and US), Europe and US), stabilized (Southern stabilized (Southern Europe), to decreasing Europe), to decreasing (Finland and China)(Finland and China)

Esophageal cancer Esophageal cancer mortality trendsmortality trends

inconsistent trends inconsistent trends like incidencelike incidence

Liver cancer worldwideLiver cancer worldwideThe 6th most common cancer (626,000 new The 6th most common cancer (626,000 new cases) and the 3rd most common cause of death cases) and the 3rd most common cause of death from cancer (598,000 deaths) worldwide.from cancer (598,000 deaths) worldwide.Sex ratio (male/female) is around 2~3Sex ratio (male/female) is around 2~3age standardized incidence (per 100,000 age standardized incidence (per 100,000 population): males:15.7; females 5.8population): males:15.7; females 5.8Occurred in younger population in high risk areas Occurred in younger population in high risk areas with the peak at the age of 50with the peak at the age of 50Poor survival rate: 5Poor survival rate: 5--year survival below 10%year survival below 10%Over 80% occurred in developing countriesOver 80% occurred in developing countries

Liver cancer in ChinaLiver cancer in China

345,844 new cases and 321,800 deaths 345,844 new cases and 321,800 deaths in 2002 (in 2002 (55%55% of worldwide)of worldwide)The 3rd most common cancer and 1st The 3rd most common cancer and 1st most common death from cancer in most common death from cancer in menmenThe 2nd most common cancer and the The 2nd most common cancer and the 4th most common death from cancer in 4th most common death from cancer in womenwomen55--year survival rate: 2% in year survival rate: 2% in QidongQidong, 5% , 5% in Shanghaiin Shanghai

Risk/Protective FactorsRisk/Protective Factors

Risk FactorsRisk Factors•• Hepatitis B Virus (HBV)Hepatitis B Virus (HBV)•• Hepatitis C Virus (HCV)Hepatitis C Virus (HCV)•• AflatoxinAflatoxin B1 (AFB1)B1 (AFB1)•• AlcoholAlcohol•• TobaccoTobacco•• Oral contraceptivesOral contraceptives

Protective FactorsProtective Factors•• Dietary antioxidants (selenium and Dietary antioxidants (selenium and retinoidsretinoids))•• HBV vaccinationHBV vaccination

Possibility for PreventionPossibility for PreventionDietary antioxidantsDietary antioxidants

Among Among HBsAgHBsAg carriers, low retinol is associated with carriers, low retinol is associated with higher risk of higher risk of hepatocellularhepatocellular carcinoma (HCC) carcinoma (HCC) (OR,14.1)(OR,14.1)Among HBV/HCV carriers, high selenium is associated Among HBV/HCV carriers, high selenium is associated with lower risk of HCC in low retinol group (OR, 0.2)with lower risk of HCC in low retinol group (OR, 0.2)

VaccinationVaccinationHBV immunization provides protection against HBV immunization provides protection against infection in more than 90% of healthy peopleinfection in more than 90% of healthy peopleHCC incidence in 6HCC incidence in 6--14 years of age children has 14 years of age children has declined after 10 years of implementing HBV vaccine declined after 10 years of implementing HBV vaccine program in Taiwanprogram in Taiwan

AgeAge--standardized incidence rates for standardized incidence rates for liver cancer liver cancer


Liver cancer incidence Liver cancer incidence trendstrends

difficult to interpret difficult to interpret because of ICD because of ICD revisionsrevisions•• 77thth revision includes gall revision includes gall

bladder cancerbladder cancer•• 99thth revision includes revision includes

category of category of ““unspecified unspecified 110 0 or 2or 200””

↓↓ among Chinese among Chinese because of because of ↓↓ in in prevalence of HBVprevalence of HBV↑↑ in Japan because of in Japan because of ↑↑ alcohol alcohol consumption and HCV consumption and HCV prevalanceprevalance↑↑ in developed in developed countries possibly countries possibly from from ↑↑ HCV infection HCV infection (from transfusions (from transfusions and drug use)and drug use)

Liver cancer Liver cancer mortality trendsmortality trends

similar to incidence similar to incidence trendstrendsincrease in mortality increase in mortality among developed among developed countries not countries not necessarily from necessarily from alcohol (since alcohol (since mortality from liver mortality from liver cirrhosis is decreasing)cirrhosis is decreasing)

Breast cancerBreast cancer1.15 million new cases and 410,000 1.15 million new cases and 410,000 deaths worldwide estimated in 2002deaths worldwide estimated in 2002most common cancer in womenmost common cancer in womenOver half of new cases occurred in more Over half of new cases occurred in more developed countriesdeveloped countriesstage of disease at diagnosis is most stage of disease at diagnosis is most important prognostic factor important prognostic factor most prevalent cancer in world because of most prevalent cancer in world because of its good prognosesits good prognosesrisk increases with age but slows at about risk increases with age but slows at about 50 years because of menopause and lower 50 years because of menopause and lower estrogen levelsestrogen levels

AgeAge--standardized incidence and standardized incidence and mortality rates for breast cancermortality rates for breast cancer


Breast cancer Breast cancer incidence trendsincidence trends

generally increasing generally increasing at all agesat all ages

Breast cancer Breast cancer mortality trendsmortality trends

may be declining may be declining in recent years in recent years (like in US, (like in US, Canada, and some Canada, and some European European countries) due to countries) due to screening and screening and detection of early detection of early stage cancers and stage cancers and more effective more effective treatmenttreatment

BRCA1-2 Mutations Increase the Risk of Cancer More Than Other Factors

BRCA1BRCA1--2 Mutations Increase the Risk of 2 Mutations Increase the Risk of Cancer More Than Other FactorsCancer More Than Other Factors

Relative Relative risk of risk of breast breast cancercancer

123456789

101112

Family Family historyhistory

BRCA1BRCA1--2 2 mutationmutation

Early Early menarchemenarche

Late age Late age at birth of at birth of 1st child1st child

Benign Benign breast breast

diseasedisease

Hormone Hormone replacement replacement

therapytherapy

Alcohol Alcohol useuse

Colorectal cancerColorectal cancer

About 1 million new cases and 529,000 About 1 million new cases and 529,000 deaths worldwide estimated in 2002deaths worldwide estimated in 200233rdrd most common cause of cancer in world most common cause of cancer in world but 2but 2ndnd most common in developed most common in developed countries.countries.good prognoses (40good prognoses (40--50% 550% 5--year survival) year survival) makes it the 2makes it the 2ndnd most prevalent cancermost prevalent cancermales and females have similar ratesmales and females have similar rates

AgeAge--standardized incidence rates for standardized incidence rates for colorectal cancer colorectal cancer


Colorectal cancer Colorectal cancer incidence trendsincidence trends

increasing trend in increasing trend in lowlow--risk areasrisk areasstabilized or stabilized or decreasing trends in decreasing trends in highhigh--risk areasrisk areasgreatest increases greatest increases observed in Asia observed in Asia (especially Japan) (especially Japan) and Eastern Europe and Eastern Europe (possibly from (possibly from ““westernizationwesternization”” of of lifestyle/diet)lifestyle/diet)

Colorectal cancer Colorectal cancer mortality trendsmortality trends

decreasing trend in decreasing trend in developed countries developed countries may be due to may be due to decreasing in decreasing in incidence, improved incidence, improved treatment, and treatment, and improvements in improvements in early detection (from early detection (from screening)screening)

Prostate cancerProstate cancer

679,000 new cases and 221,000 deaths 679,000 new cases and 221,000 deaths worldwide estimated in 2002worldwide estimated in 200222ndnd most common new cancer and most most common new cancer and most prevalent form of cancer among malesprevalent form of cancer among males75% of cases occur in men aged 65+75% of cases occur in men aged 65+prostateprostate--specific antigen assay introduced specific antigen assay introduced in mid to late in mid to late ‘‘80s80s

AgeAge--standardized incidence rates for standardized incidence rates for prostate cancer prostate cancer


Prostate cancer Prostate cancer incidence trendsincidence trendsin many developed in many developed countries incidence countries incidence increased greatly, increased greatly, especially among especially among younger men (<65 younger men (<65 yrs)yrs)most dramatic most dramatic increases are in increases are in highhigh--risk areas risk areas partly due to partly due to detection of detection of prevalent latent prevalent latent cancers using PSAcancers using PSAless developed less developed countries also countries also increasingincreasing

Prostate cancer Prostate cancer mortality trendsmortality trends

generally increasing generally increasing but not as but not as dramatically as dramatically as incidenceincidencesince 1990s, decline since 1990s, decline in several developed in several developed countries attributed countries attributed to earlier detection to earlier detection and improved and improved treatmenttreatment

Cervical cancerCervical cancer493,000 new cases and 274,000 deaths 493,000 new cases and 274,000 deaths worldwide estimated in 2002worldwide estimated in 200222ndnd most common new cancer among most common new cancer among womenwomen83% of cases occur in developing 83% of cases occur in developing countriescountriesrates are very low in developed countriesrates are very low in developed countriesgenerally, incidence rises at age 20generally, incidence rises at age 20--29 29 and peaks around 45and peaks around 45--49 in developed 49 in developed countries, but usually later in developing countries, but usually later in developing countries countries

AgeAge--standardized incidence and standardized incidence and mortality rates for cervical cancer mortality rates for cervical cancer


Cervical cancer Cervical cancer incidence trendsincidence trends

decreases in many decreases in many developed countries developed countries because of because of screening programsscreening programsin developing in developing countries, trends countries, trends vary, but generally, vary, but generally, rates (including rates (including mortality) are mortality) are stabilized or stabilized or decreasingdecreasing

Cervical cancer Cervical cancer mortality trendsmortality trends

decreases in many decreases in many developed countries developed countries also because of also because of diagnoses at earlier diagnoses at earlier stages and improved stages and improved treatmenttreatment

ResourcesResourcesFerlay J, et al. GLOBOCAN 2002 Database. Ferlay J, et al. GLOBOCAN 2002 Database. Descriptive Epidemiology Group, Descriptive Epidemiology Group, International Agency for Research on International Agency for Research on Cancer, 2002.Cancer, 2002.Parkin DM, et al. Global Cancer Statistics, Parkin DM, et al. Global Cancer Statistics, 2002. 2002. CA Cancer J CA Cancer J ClinClin, , 2005; 55: 742005; 55: 74--108.108.Parkin DM, et al. Cancer burden in the Parkin DM, et al. Cancer burden in the year 2000. The global picture. year 2000. The global picture. Eur J Eur J Cancer, Cancer, 2001; 37 Suppl 8: S42001; 37 Suppl 8: S4--66. 66.

international & national patterns of cancer rates 1-2 zhang.pdfstomach cancer 934,000 new cases...

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