Descriptive Epidemiology and Cancer Prevention and Control - PowerPoint PPT Presentation

Loading...

PPT – Descriptive Epidemiology and Cancer Prevention and Control PowerPoint presentation | free to download - id: ecd04-ODM1Z



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Descriptive Epidemiology and Cancer Prevention and Control

Description:

Descriptive Epidemiology and Cancer Prevention and Control. Resa M. Jones, M.P.H., Ph.D. ... January 23, 2006. rmjones2_at_vcu.edu. Learning Objectives. Students ... – PowerPoint PPT presentation

Number of Views:149
Avg rating:3.0/5.0
Slides: 66
Provided by: resam
Learn more at: http://www.vipbg.vcu.edu
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Descriptive Epidemiology and Cancer Prevention and Control


1
Descriptive Epidemiology and Cancer Prevention
and Control
  • Resa M. Jones, M.P.H., Ph.D.
  • Special Topic Cancer Control
  • January 23, 2006
  • rmjones2_at_vcu.edu

2
Learning Objectives
  • Students should be able to
  • Explain the impact of cancer internationally and
    nationally
  • Identify the most prevalent cancers
    internationally and nationally
  • Identify the leading causes of cancer death
    internationally and nationally
  • Explain the difference in cancer incidence and
    death rates by gender, age, and race/ethnicity
  • Identify the relationship between cancer control
    and disease frequency measures
  • Explain the historical perspective of cancer
    control
  • Understand the cancer control continuum and
    explain its implication to public health
  • Identify the differences between clinical and
    intervention studies
  • Explain important factors and trends affecting
    cancer control and directions for future research

3
What is cancer?
  • 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.

4
Biologic Basis for Cancer Control
Normal cell
Initiated cell
Pre-cancerous cell
CANCER
5
Rates
  • Incidence
  • Prevalence
  • Specific
  • Crude
  • Adjusted/Standardized
  • SMR/SIR

6
Cancer incidence for the regions of the world,
2002 estimates
7
Age standardized incidence rates for all cancers
by region of the world, 2002 estimates
8
The most commonly diagnosed cancers worldwide,
2002 estimates
9
Trends in the numbers of new cases being
diagnosed worldwide, selected cancers, 1975-2000
10
The proportion of all deaths caused by cancer in
the different regions of the world, 2002
11
The most common causes of death from cancer
worldwide, 2002 estimates
12
Surveillance
13
Mortality Leading Causes of Death
No. of deaths
of all deaths
Rank
Cause of Death
  • 1. Heart Diseases 696,947 28.5
  • 2. Cancer 557,271 22.8
  • 3. Cerebrovascular diseases 162,672 6.7
  • 4. Chronic lower respiratory diseases 124,816
    5.1
  • 5. Accidents (Unintentional injuries) 106,742
    4.4
  • 6. Diabetes mellitus 73,249 3.0
  • 7. Influenza and pneumonia 65,681 2.7
  • Alzheimer disease 58,866 2.4
  • Nephritis 40,974 1.7

Source US Mortality Public Use Data Tape 2002,
National Center for Health Statistics, Centers
for Disease Control and Prevention, 2004.
14
Change in the US Death Rates by Cause, 1950
2001
1950 2001
Rate Per 100,000
HeartDiseases
CerebrovascularDiseases
Cancer
Pneumonia/Influenza
Age-adjusted to 2000 US standard
population. Sources 1950 Mortality Data -
CDC/NCHS, NVSS, Mortality Revised. 2001 Mortality
DataNVSR-Death Final Data 2001Volume 52, No. 3.
http//www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_03
.pdf
Age-adjusted to 2000 US standard
population. Sources 1950 Mortality Data -
CDC/NCHS, NVSS, Mortality Revised. 2001 Mortality
DataNVSR-Death Final Data 2001Volume 52, No. 3.
http//www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_03
.pdf
15
Estimated New Cancer Cases
Men710,040
Women662,870
32 Breast 12 Lung and bronchus 11 Colon and
rectum 6 Uterine corpus 4 Non-Hodgkin
lymphoma 4 Melanoma of skin 3
Ovary 3 Thyroid 2 Urinary
bladder 2 Pancreas 21 All Other Sites
Prostate 33 Lung and bronchus 13 Colon and
rectum 10 Urinary bladder 7 Melanoma of
skin 5 Non-Hodgkin 4
lymphoma Kidney 3 Leukemia 3 Oral
Cavity 3 Pancreas 2 All Other Sites 17
Excludes basal and squamous cell skin cancers
and in situ carcinomas except urinary
bladder. Source American Cancer Society, 2005.
16
Estimated New Cancer Cases and Survival
NOTE n.a. not applicable. 1. The 5-year
relative survival rate indicates that a person
will not die from causes directly related to
their cancer within 5 years. 2. Includes other
sites not shown separately. 3. Survival rates for
females only. 4. All types combined. Source U.S.
National Institutes of Health, National Cancer
Institute.
17
Cancer Incidence Rates for Women, US, 1975-2001
Rate Per 100,000
Breast
Colon rectum
Lung bronchus
Uterine corpus
Ovary
Age-adjusted to the 2000 US standard
population. Source Surveillance, Epidemiology,
and End Results Program, 1975-2001, Division of
Cancer Control and Population Sciences, National
Cancer Institute, 2004.
18
Cancer Incidence Rates for Men, US, 1975-2001
Rate Per 100,000
Prostate
Lung bronchus
Colon rectum
Urinary bladder
Non-Hodgkin lymphoma
Age-adjusted to the 2000 US standard
population. Source Surveillance, Epidemiology,
and End Results Program, 1975-2001, Division of
Cancer Control and Population Sciences, National
Cancer Institute, 2004.
19
Estimated Cancer Deaths
Men295,280
Women275,000
27 Lung and bronchus 15 Breast 10 Colon and
rectum 6 Ovary 6 Pancreas 4 Leukemia
3 Non-Hodgkin lymphoma 3 Uterine
corpus 2 Multiple myeloma 2 Brain/ONS 22
All other sites
Lung and bronchus 31 Prostate 10 Colon and
rectum 10 Pancreas 5 Leukemia 4 Esophagus 4 Li
ver and intrahepatic 3bile duct Non-Hodgkin
3 Lymphoma Urinary
bladder 3 Kidney 3 All other sites
24
ONSOther nervous system. Source American Cancer
Society, 2005.
20
Cancer Death Rates, for Women, US,1930-2001
Rate Per 100,000
Lung bronchus
Uterus
Breast
Colon rectum
Stomach
Ovary
Pancreas
Age-adjusted to the 2000 US standard
population. Source US Mortality Public Use Data
Tapes 1960-2001, US Mortality Volumes
1930-1959, National Center for Health Statistics,
Centers for Disease Control and Prevention, 2004.
21
Cancer Death Rates, for Men, US,1930-2001
Rate Per 100,000
Lung bronchus
Stomach
Prostate
Colon rectum
Pancreas
Liver
Leukemia
Age-adjusted to the 2000 US standard
population. Source US Mortality Public Use Data
Tapes 1960-2001, US Mortality Volumes 1930-1959,
National Center for Health Statistics, Centers
for Disease Control and Prevention, 2004.
22
Cancer Incidence Rates by Sex and Race,All
Sites, 1975-2001
Rate Per 100,000
African American men
White men
White women
African American women
Age-adjusted to the 2000 US standard
population. Source Surveillance, Epidemiology,
and End Results Program, 1975-2001, Division of
Cancer Control and Population Sciences, National
Cancer Institute, 2004.
23
SEER Age Adjusted Incidence Rates by RaceAll
Cancer Sites, All AgesSEER 9 Registries for
1973-2002
24
SEER Age Adjusted Incidence Rates by SexAll
Cancer Sites, All AgesSEER 9 Registries for
1973-2002
25
Cancer Incidence Rates by Race and Ethnicity,
1997-2001
Rate Per 100,000
Age-adjusted to the 2000 US standard
population. Hispanic is not mutually exclusive
from whites, African Americans, Asian/Pacific
Islanders, and American Indians. Source
Surveillance, Epidemiology, and End Results
Program, 1975-2001, Division of Cancer Control
and Population Sciences, National Cancer
Institute, 2004.
26
Cancer Death Rates by Sex and Race, US, 1975-2001
Rate Per 100,000
African American men
White men
African American women
White women
Age-adjusted to the 2000 US standard
population. Source Surveillance, Epidemiology,
and End Results Program, 1975-2001, Division of
Cancer Control and Population Sciences, National
Cancer Institute, 2004.
27
Age-Adjusted Total US Mortality RatesAll Cancer
Sites, All AgesFor 1992-2002 by 'Expanded' Race
and Sex
28
Cancer Sites in Which African-American Death
Rates Exceed White Death Rates for Men, US,
1996-2000

Ratio of African American/White
African American
White
Site
  • All sites 356.2 249.5
    1.4
  • Larynx 5.7 2.4 2.4
  • Prostate 73.0 30.2 2.4
  • Stomach 14.0 6.1 2.3
  • Myeloma 9.2 4.5 2.0
  • Oral cavity and pharynx 7.9 4.0
    2.0
  • Esophagus 12.2 7.3 1.7
  • Liver 9.3 6.0 1.6
  • Lung bronchus 107.0
    78.1 1.4
  • Pancreas 16.4 12.0 1.4
  • Small intestine 0.7 0.5 1.4
  • Colon rectum 34.6 25.3 1.4

Per 100,000, age-adjusted to the 2000 US
standard population. Source Surveillance,
Epidemiology, and End Results Program, 1975-2000,
Division of Cancer Control and Population
Sciences, National Cancer Institute, 2003.
29
Cancer Sites in Which African-American Death
Rates Exceed White Death Rates for Women, US,
1996-2000
Ratio of African American/White
African American
White
  • All sites 198.6 166.9 1.2
  • Myeloma 6.6 2.9 2.3
  • Stomach 6.5 2.9 2.2
  • Uterine cervix 5.9 2.7 2.2
  • Esophagus 3.4 1.7 2.0
  • Uterine corpus, NOS 7.0 3.8 1.8
  • Larynx 0.9 0.5 1.8
  • Liver intrahepatic bile duct 3.0 1.9 1.6
  • Pancreas 12.9 8.9 1.5
  • Colon rectum 24.6 17.5 1.4
  • Breast 35.9 27.2 1.3
  • Urinary bladder 3.0 2.3 1.3
  • Soft tissue, including heart 1.7 1.3 1.3

Per 100,000, age-adjusted to the 2000 US
standard population. Source Surveillance,
Epidemiology, and End Results Program, 1975-2000,
Division of Cancer Control and Population
Sciences, National Cancer Institute, 2003.
30
Lifetime Probability of Developing Cancer, By
Site, Men, US, 1999-2001
Site
Risk
All sites 1 in 2 Prostate 1 in 6 Lung
and bronchus 1 in 13 Colon and rectum 1 in
17 Urinary bladder 1 in 28 Non-Hodgkin
lymphoma 1 in 46 Melanoma 1 in 53 Kidney 1
in 67 Leukemia 1 in 68 Oral Cavity 1 in
73 Stomach 1 in 81
Source DevCan Probability of Developing or
Dying of Cancer Software, Version 5.2 Statistical
Research and Applications Branch, NCI, 2004.
http//srab.cancer.gov/devcan
31
Lifetime Probability of Developing Cancer, By
Site, Women, US, 1999-2001
Site
Risk
All sites 1 in 3 Breast 1 in 7 Lung
bronchus 1 in 18 Colon rectum 1 in
18 Uterine corpus 1 in 38 Non-Hodgkin
lymphoma 1 in 56 Ovary 1 in 68 Melanoma
1 in 78 Pancreas 1 in 81 Urinary
bladder 1 in 88 Uterine cervix 1 in 130
SourceDevCan Probability of Developing or Dying
of Cancer Software, Version 5.2 Statistical
Research and Applications Branch, NCI, 2004.
http//srab.cancer.gov/devcan
32
Cancer Survival() by Site and Race,1995-2000
African
White
Difference
Site
American
All Sites 66 55 11 Breast (female) 89 75 14 C
olon 64 54 10 Esophagus 16 9
7 Leukemia 48 39
9 Non-Hodgkin lymphoma 60 51 9 Oral
cavity 61 39 22 Prostate
100 96 4 Rectum 65 55 10 Urinary
bladder 83 62 21 Uterine cervix 74 66
8 Uterine corpus 86 63 23
5-year relative survival rates based on cancer
patients diagnosed from 1995 to 2000 and followed
through 2001. Source Surveillance,
Epidemiology, and End Results Program, 1975-2001,
Division of Cancer Control and Population
Sciences, National Cancer Institute, 2004.
33
Cancer Incidence Death Rates in Children 0-14
Years, 1975-2000
Rate Per 100,000
Incidence
Mortality
1975
1980
1985
1990
1995
2000
Age-adjusted to the 2000 Standard
population. Source Surveillance, Epidemiology,
and End Results Program, 1975-2000, Division of
Cancer Control and Population Sciences, National
Cancer Institute, 2003.
34
Yearly Incidence of Common Childhood Cancers
35
Cancer Incidence Rates in Children 0-14 Years,
by Site, US, 1996-2000
Site Male Female Total All sites 15.4
13.8 14.6 Leukemia 4.9 4.1 4.5
Acute Lymphocytic 3.9 3.3
3.6 Brain/ONS 3.3 2.9 3.1 Non-Hodgkin
lymphoma 1.2 0.4 0.8 Kidney Renal
pelvis 0.9 1.0 0.9 Soft tissue 1.0
1.1 1.0 Bones Joint 0.8 0.5
0.6 Hodgkins disease 0.6 0.6 0.6
Per 100,000, age-adjusted to the 2000 US
standard population. ONS Other nervous
system Source Surveillance, Epidemiology, and
End Results Program, 1975-2000, Division of
Cancer Control and Population Sciences, National
Cancer Institute, 2003
36
(No Transcript)
37
Cancer Death Rates in Children 0-14 Years, by
Site, 1996-2000
Site Male Female Total All sites 2.8
2.3 2.5 Leukemia 0.9 0.7 0.8 Acute
Lymphocytic 0.4 0.3 0.4 Brain/ONS 0.8
0.7 0.7 Non-Hodgkin lymphoma 0.1
0.1 0.1 Soft tissue 0.1 0.1 0.1 Bones
Joint 0.1 0.1 0.1 Kidney Renal pelvis
0.1 0.1 0.1
Per 100,000, age-adjusted to the 2000 US
standard population. ONS Other nervous
system Source Surveillance, Epidemiology, and
End Results Program, 1975-2000, Division of
Cancer Control and Population Sciences, National
Cancer Institute, 2003.
38
Trends in Survival, Children 0-14 Years, All
Sites Combined, 1974-1999
Year ofDiagnosis
Age
5 - Year Relative Survival Rates
1974 - 76 1974 - 76 1992 - 99 1974 -
76
  • 0 - 4 Years
  • 5 - 9 Years
  • 10 - 14 Years

1992 - 99
1992- 99
5-year relative survival rates, based on follow
up of patients through 2000.Source
Surveillance, Epidemiology, and End Results
Program, 1975-2000, Division of Cancer Control
and Population Sciences, National Cancer
Institute, 2003.
39
Lung Cancer
  • Risk factors
  • Cigarette smoking, environmental exposures,
    tuberculosis
  • Detection/Prevention
  • Reduce exposure to tobacco smoke

40
Breast Cancer
  • Risk Factors
  • Age, family history, biopsy, breast density,
    early menstruation, obesity after menopause,
    recent use of oral contraceptives, hormone
    therapy, late or no children, alcohol, breast
    feeding, exercise
  • Early Detection
  • Mammography and clinical breast exam every year
    after age 40 (ACS)

41
Prostate Cancer
  • Risk factors
  • Age, ethnicity, family history, dietary fat?,
    weight?
  • Early detection/prevention gt50yrs old
  • PSA blood test/yr
  • Digital rectal exam/yr

42
Colorectal Cancer
  • Risk factors
  • Age, family history, smoking , alcohol, obesity,
    exercise, high fat diet/red meat
  • Early Detection/Prevention
  • 4 modalities recommended for people age 50 and
    older
  • Fecal occult blood test (FOBT) every year
  • Flexible sigmoidoscopy every 5 years
  • Colonoscopy every 10 years
  • Double-contrast barium enema every 5 years

43
Cancer control Historical perspective
  • 1913
  • American Society for the Control of Cancer
    (became American Cancer Society in 1945)
  • American College of Surgeons formed (Developed
    standards for cancer clinics in 1930)
  • 1937
  • National Cancer Institute formed to prompt use
    of most effective methods of prevention,
    diagnosis and treatment of cancer

44
Cancer control Historical perspective
  • 1971
  • National Cancer Act Cancer centers responsible
    for conducting cancer demonstration and outreach
    programs
  • 1974
  • Division of cancer prevention and control (DCPC)
    formed at NCI
  • 1983
  • Cancer control defined
  • Clinical Community Oncology Programs (CCOP)
  • Clinical Cooperative Group Trials

45
Cancer control Historical perspective
  • 1997
  • DCPC at NCI splits into two divisions
  • Cancer Prevention
  • Cancer Control and Population Science
  • 1998/1999
  • New Strategy, new definition, new model

46
Definition Cancer control
  • the reduction of cancer incidence, morbidity,
    and mortality through an orderly sequence from
    research on interventions and their impact in
    defined populations to the broad systematic
    application of the research results. (Old)
  • the conduct of basic and applied research in the
    behavioral, social, health and population
    sciences to create or enhance interventions that,
    independently or in combination with biomedical
    approaches, reduce cancer risk, incidence,
    morbidity and mortality, and improve quality of
    life (Cancer Control Review Group, 1998 -
    modified).

47
Fig. 1 Cancer control research activities.
Adapted from the 1994 Advisory Committee on
Cancer Control, National Cancer Institute of
Canada (61).
Intervention Research
Knowledge synthesis
Surveillance Research
Fundamental Research
Application and Program Delivery
Reducing the cancer burden
48
(No Transcript)
49
What is cancer control research?
  • Research that aims to reduce risk, incidence, and
    deaths from cancer as well as enhance the quality
    of life for cancer survivors.
  • The DCCPS conducts and supports an integrated
    program of the highest quality genetic,
    epidemiologic, behavioral, social, applied, and
    surveillance cancer research. Cancer control
    research aims to understand the causes and
    distribution of cancer in populations, support
    the development and implementation of effective
    interventions, and monitor and explain cancer
    trends in all segments of the population. Central
    to these activities is the process of synthesis
    and decision-making that aids in evaluating what
    has been learned, identifying new priorities and
    strategies, and effectively applying research
    discoveries to reduce the cancer burden.

50
How much cancer incidence and mortality can we
prevent by 2015?
Incidence Mortality
51
Comprehensive Cancer Control Plans
  • Basic Implementation
  • 28 States/Territories/Republics
  • Capacity Building
  • 33 States/Territories/Republics
  • Not Yet Funded
  • 3 States/Territories

52
Prevention
  • Primary
  • Secondary
  • Tertiary
  • Terms
  • Mortality
  • Morbidity
  • Incidence
  • Prevalence

53
Percent of cancer that could be prevented if risk
factor were removed
54
Strategies for cancer prevention
55
Tobacco Use in the US, 1900-2000
Per capita cigarette consumption
Male lung cancer death rate
Female lung cancer death rate
Age-adjusted to 2000 US standard population.


Source Death rates US Mortality Public Use
Tapes, 1960-2000, US Mortality Volumes,
1930-1959, National Center for Health Statistics,
Centers for Disease Control and Prevention, 2002.
Cigarette consumption US Department of
Agriculture, 1900-2000.
56
Trends in Cigarette Smoking Prevalence (), by
Gender, Adults 18 and Older, US, 1965-2001
Men
Women
Redesign of survey in 1997 may affect
trends. Source National Health Interview Survey,
1965-2001, National Center for Health Statistics,
Centers for Disease Control and Prevention, 2003.
57
Trends in per capita cigarette consumption for
selected states and the average consumption
across all states, 1980-2001
United States
Massachusetts
California
Data from Orzechowski W, Walker RC. The tax
burden on tobacco historical compilation 2001
impact and opportunity, Volume 36. Arlington
(VA) Orzechowski and Walker 2001. Reprinted
with permission. Source Weir et al. Annual
report to the nation on the status of cancer,
1975-2000, featuring the uses of surveillance
data for cancer prevention and control. J Natl
Cancer Inst 2003 951276-1299
58
Current Cigarette Smoking Prevalence (), by
Gender and Race/Ethnicity, High School Students,
US, 1991-2001
Smoked cigarettes on one or more of the 30 days
preceding the survey.Source Youth Risk Behavior
Surveillance System, 1991, 1995, 1997, 1999,
2001, National Center for Chronic Disease
Prevention and Health Promotion, Centers for
Disease Control and Prevention, 2002.
59
Trends in Consumption of Five or More Recommended
Vegetable and Fruit Servings for Cancer
Prevention, Adults 18 and Older, US, 1994-2002
Note Data from participating states and the
District of Columbia were aggregated to represent
the United States. Source Behavioral Risk Factor
Surveillance System CD-ROM (1984-1995, 1996,
1998) and Public Use Data Tape (2000), National
Center for Chronic Disease Prevention and Health
Promotion, Centers for Disease Control and
Prevention, 1997, 1999, 2000, 2001.
60
Trends in Leisure-Time Physical Activity
Prevalence (), by Educational Attainment, Adults
18 and Older, US, 1992-2002
Adults with less than a high school education
All adults
Note Data from participating states and the
District of Columbia were aggregated to represent
the United States. Educational attainment is for
adults 25 and older. Source Behavioral Risk
Factor Surveillance System CD-ROM (1984-1995,
1996, 1998) and Public Use Data Tape (2000),
National Center for Chronic Disease Prevention
and Health Promotion, Centers for Disease Control
and Prevention, 1997, 1999, 2000, 2001.
61
Trends in Overweight Prevalence, Children and
Adolescents, by Age Group (), US, 1971-2000
Overweight is defined as at or above the 95th
percentile for body mass index by age and sex
based on reference data. Source National Health
Examination Survey 1960-1962, National Health and
Nutrition Examination Survey, 1971-1974,
1976-1980, 1988-1994, 1999-2000, National Center
for Health Statistics, Centers for Disease
Control and Prevention, 2002.
62
Trends in Obesity Prevalence (), By Gender,
Adults Aged 20 to 74, US, 1960-2000
Obesity is defined as a body mass index of 30
kg/m2 or greater. Source National Health
Examination Survey 1960-1962, National Health and
Nutrition Examination Survey, 1971-1974,
1976-1980, 1988-1994, 1999-2000, National Center
for Health Statistics, Centers for Disease
Control and Prevention, 2002.
63
Important trends affecting cancer control
64
Cancer control research directions for the 21st
century
  • Basic research of behavioral, social biological
    mechanisms
  • Informatics and communication
  • Prevention across the lifespan (modifiable risk
    factors)
  • Cancer screening
  • Health care delivery systems
  • Survivorship
  • Underserved populations
  • Methods research
  • Genetic predisposition and gene-environment
    interaction
  • Chemoprevention

65
Conferences
  • American Society of Preventive Oncology
  • American Society of Clinical Oncology
  • American Association for Cancer Research
About PowerShow.com