Basic science of Oncology 2014 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 2014

 Concept epidemiology
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 1.Disease is not randomly

distributed
 2.Disease causation is multifactorial

Basic science of Oncology 2014

 The scope of Epidemiology
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 Concerned with population health

 Concern to clinicians
 Clinical researchers
 Laboratory scientiest

Basic science of Oncology 2014

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

Analytic epidemiology
 Why
 How

Basic science of Oncology 2014

 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 2014
 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 2014
 Non Communicable Diseases ( NCDs)
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 Cancer
 Cardiovascular disease
 Diabetes
 Chronic Respiratory Disease

greatest killer of both adults and children

70% cancer deaths in low and middle income
countries (LMICs)

Basic science of Oncology 2014

 What is cancer?
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 Cancer is a group of diseases characterized

by uncontrolled growth and spread of
abnormal cells.

 Cancer is caused by external factors and

internal factors which may act together to
initiate or promote carcinogenesis.

Basic science of Oncology 2014

 Key components of National Childhood Cancer
Strategies in Low and Middle-Income Countries
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1. Financial coverage of childhood cancer treatment

2. Accreditation of childhood cancer centers
3. Mandatory childhood csncer reporting and registration
4. Development of national standard of care :  National
treatment protocols
5. Creation of a national childhood cancer governing body
: multidisciplinary , monitoring , evaluation

Basic science of Oncology 2014

 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

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 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 2014

 The most commonly diagnosed cancers* worldwide,
2002 estimates
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Basic science of Oncology 2014

 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 2014

 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 2014
 Pediatric cancer as a Global Child Health
Priority in LMICs
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 6.0 – 18.6% of deaths among children ages 5 –

14 years  due to cancer
 175.000 children diagnosed with cancer
annually  150.000 live in LMICs
 Problem : - underestimate
- under-diagnosis
- under-treated
- under-registration
Gupta S et al,2014.PLOS Med 11(6):e1001656.

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 Incidence rate for childhood cancer has

increased  mortality rate has declined
dramatically
 Improved survival  dramatic for childhood
cancer ( ALL, Lymphoma ,Kidney cancer ) 
increasing need for longterm follow-up of late
effects
Can Pharm J 2010:143:176-183

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 5 year EFS children with cancer 75-79 % HIC (High

Income Country )
 80% of the world’s children live in middle and low
income country ( MIC and LIC)  high mortality and low
childhood cancer cure rate : genetic predisposition, early and
delayed exposure to infectious disease and environment

Howard SC ,et al: Cancer 2008;112:461-72. 2007 American Cancer Society

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Childhood cancer

 Rare
 Several types of cancer are virtually unique to
childhood, generally embryonal or sarcoma
 Epithelial carcinoma : most common in adults
 Investigation of childhood tumours has led to
major advances in the understanding of the
genetic

Basic science of Oncology 2014

 ……………Childhood cancer
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 Developed countries : “modern day miracle”

 90% survival rates

 Developing countries : often survival rates

range from 20 – 30 %
Many more lives of children with cancer will be lost
because : poverty, unaffordable medical costs , delayed
detection and treatment, advanced cancer die
because of absence of effective palliative care ,
catastrophic treatment costs.
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 Leading cancer in children
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 Leukemia  Retinoblastoma
 Lymphoma and  Wilms Tumour
Reticuloendothelial
 Liver Tumours
neoplasms
 Brain and spinal
 Sarcomas
tumours  Others cancers
 Neuroblastoma
PA Voute: Cancer in children :Clinical
management , 5th ed,2005

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 Causes of childhood cancers
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 Aetiology of childhood cancer
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 Environmental factors : radiation, ionizing and non

ionizing ( ultraviolet radiation) , the role of infection in the
child, the mother and the community
 Parental occupation and socio-economic status
 Drug induced : diethylstilboestrol (DES)
 Viral : Burkitt lymphoma , Hodgkin disease ,
Nasopharyngeal carcinoma (Epstein-Barr virus) ; Liver
carcinoma (Hepatitis B) ; Kaposi sarcoma ( HIV and
HHV8)
PA Voute: Cancer in children :Clinical management , 5th ed,2005

Basic science of Oncology 2014

 Role of infection
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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 2014