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Risk factors and determinants of the most malignant cancer
types globally and future challenges for public health
speciali...
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INTRODUCTION
Cancer: Cancer is defined as the unreasonable and uncontrollable proliferation of
cells, which occurs by nu...
2
malignant cancer types and what are the future challenges for global health specialists
in order to reduce cancer rates?...
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  1. 1. Risk factors and determinants of the most malignant cancer types globally and future challenges for public health specialists in order to reduce cancer rates. Literature Review Author: Athanasios Andriopoulos Supervisor: Carina Källestål Global Health course/ IMCH November 2016, Uppsala/ Sweden
  2. 2. 1 INTRODUCTION Cancer: Cancer is defined as the unreasonable and uncontrollable proliferation of cells, which occurs by numerous alterations in gene expression of cell division (1) . Due to those changes in human genome, which are called DNA mutations and due to the failure of the vital programmed cell death, which is called apoptosis, tumors are created in human tissues (2) . Cancer is a non communicable disease with high fatality and morbidity rates on a global basis. According to World Health Organisation (WHO), in 2012, 14 million people were diagnosed with cancer, while at the same time 8.2 million cancer patients died. Future cancer rates do not seem to be that auspicious as well. By 2030, scientists claim that approximately 22 million people will suffer from cancer, which is an augmentation of 70% (3) . Malignancy and Cancer rates: Tumors can be classified into two categories, which are the benign and malignant ones. The main reason why malignant tumors tend to be more fatal is because they are much more metastatic than benign tumors. In fact, benign tumors do not have metastatic properties, which means that cancer cells are not able to expand to nearby organs. Moreover, another crucial characteristic about malignant tumors is that they tend to grow in a very short period of time, whilst benign ones grow at a slower pace (1) . Apart from the malignancy, we also have to focus on the number of deaths that have been caused by each type of cancer. But, the most efficient way to discover how life- threatening each cancer type is, we must look both at the number of cases and the number of deaths. The most trustworthy indicator is the ‘’Case Fatality Ratio’’ (CFR) during a certain period of time. The bigger the quotient, the more life-threatening the disease is. WHO official data can be seen in the table 2 in the annex (4) . Aim of Study: The aim of this literature review is to give an overview of cancer on a global basis. The research question is : ‘’What are the risk factors and determinants of
  3. 3. 2 malignant cancer types and what are the future challenges for global health specialists in order to reduce cancer rates?” Starting by the risk factors, my main goal is to prioritize them and highlight their significance by collecting official data that can prove to what extent they are responsible for cancer mortality. By analyzing determinants such as gender and age, I expect to obtain a clear view about which gender and which age group has lower or higher chances of cancer development. More emphasis will be put on ethnicity, and therefore to poverty, in order to examine the prevalence of a variety of cancer types and their chances to occur in citizens of low, middle and high income countries. Finally, the analysis of the global burden of cancer (DALYs measurement), and the review of current and mainly future challenges that global health specialists have to face, will give us the opportunity to regard this research question as a global health issue, which demands universal attention. METHODS The main source of my articles was derived from the internet. More specifically, the majority of articles were chosen from the online ‘’Bibliotek’’ from ‘’Uppsala Universitet’’ and from online databases such as PubMed. The keywords that I used were: ‘’cancer’’, ‘’cancer risk factors’’, ‘’cancer malignancy’’, ‘’tumors’’, ‘’cancer and gender’’, ‘’cancer and ethnicity’’, ‘’cancer and age’’, ‘’cancer prevalence’’, ‘’burden of cancer’’, ‘’infections and cancer’’, ‘’cancer rates’’, ‘’cancer future rates’’. I mainly focused on peer reviewed articles, and my exclusion criteria were related to non-English articles and any articles before the year 2005. Furthermore, I avoided snowballing. Since my topic was broad, I excluded many articles because they were too specific, and my initial plan was to give an overview of cancer. I mostly focused on articles and studies which included the whole population of Earth and more specifically all cancer patients, which I found it very challenging. At first, I found 60 publications, but the majority of them were rejected since despite the fact that the topics where exactly what I was asking for, I preferred taking into account the most recent ones. Lastly, I tried to find articles/ journals/ publications which had a ‘’global/ public health’’ point of view, by checking if authors/ scientists are named as ‘’MPH’’.
  4. 4. 3 RESULTS Smoking. The grand majority of risk factors are preventable. Smoking in general and tobacco consumption is one of them and is considered as the leading cause of most cancer types. For instance, in 2010, 18.75% of cancer patients died due to excessive tobacco use on a global basis (5) . Smokers are more likely to develop the most malignant types of cancer such as lung, pancreatic and esophageal cancer. In fact, individuals who have never smoked in their life are 30 times less likely to suffer from lung cancer (6) . Moreover, tobacco can be consumed in various ways, such as snus or chewing tobacco. These new trends are more familiar in high-income countries, and despite the fact there is room for improvement in research fields, some researchers mention that these tobacco types are responsible for esophageal and pancreatic cancer (7) . Unhealthy eating habits. People who adopt an unhealthy lifestyle, without any kind of physical exercise are more likely to develop various cancer types. Sedentary lifestyle combined with excessive red meat and trans fat consumption can cause breast cancer in women, prostate cancer in men and colorectal, esophageal and stomach cancer in both genders. Even after the diagnosis of cancer, cancer patients who have a Body Mass Index (BMI) higher than 25 are more likely to die rather than those who are not overweight. For instance, chances of dying increase by 25% for overweight men who suffer from colorectal cancer, rather than for those who are not obese. In addition, pancreatic cancer patients have approximately double chances to survive than the patients whose BMI is over 35. Consequently, the decrease of BMI is a key factor for prevention before and after cancer appears. Finally, the distribution of fat in our body might be an indicator of the likelihood of development of certain types of cancer in the future (8) . Alcohol. Alcohol consumption is a less menacing, but still important risk factor in terms of cancer. People who exaggerate alcohol consumption are more likely to develop tumors in 7 human tissue types. Nevertheless, the most common cancer type for heavy alcohol consumers is liver cancer, which has high fatality rates. In 2012, it was reported that alcohol consumption was the factor that caused approximately 6% of deaths related to cancer. Lastly, the average amount of consumed alcohol plays a
  5. 5. 4 profound role in which type of cancer is more likely to be developed. For instance, moderate drinkers are more likely to develop esophageal or pharyngeal cancer, whilst heavy drinkers are more likely to develop liver or colorectal cancer (9) . STDs and Infections. Women who are unaware of safe sexual practices can be infected by numerous viruses. Nevertheless, only one specific virus named Human Papillomavirus (HPV) seems to be the one which can cause cervical cancer. The grand majority of infected women mostly come from low-income countries. On a global basis, more than half a million women who are infected by HPV, end up having cervical cancer per year. 50% of those women die on an annual basis due to this reason (10) . Furthermore, numerous studies have shown that 8 out of 10 liver cancer cases have been caused by chronic hepatitis B and C viruses globally. In 2002, 483,000 people died from liver cancer due to HBV and HCV. 68% of those were HBV patients and 32% of them were HCV patients (11) . Environmental Pollution. Lung cancer is not only associated with tobacco use. Exposure to NO2, O3, PM2.5 and PM10 can be harmful for the human pulmonary system. Even in high income countries people are exposed to these gases daily. For instance, European cohort studies have proved that excessive exposure to PM10 increases the odds of lung cancer development by 22%, and excessive exposure to PM2.5 increases those odds by 18% (12) Genders. Gender inequality can be observed in many aspects of life. Apparently, this phenomenon exists also in cancer rates. A research conducted in 2012 showed that male cancer cases are approximately 1 million more than female ones, whilst, male victims are more than 1 million than female ones. By examining the total amount of all cancer type incidents globally, we will see that the CFR for men is 0.62, whilst for women it is 0.53, which also means that men are less likely to survive cancer than women. To begin with, recent studies have shown that female related cancer types such as breast, cervical, corpus uteri and ovary cancer are 4 of the 10 most common cancers in women. Whilst, male related cancer types are only 2 out 10 of those for men (prostate and urinary bladder). In 2012, 1 out 4 male cancer patients died due to lung cancer, while at the same time less than 14% of women cancer patients died due to the same reason. Liver cancer death rates for men are also much higher than those
  6. 6. 5 rates for women (11.2% vs 6.3%) (13) . Comparing the rates for both occasions, we can deduce that this is reasonable if we take into account the social trends in many countries, where men exaggerate alcohol consumption and tobacco use, whilst women are not so keen on smoking or drinking due to numerous factors (14) . The only case where both numbers and percentages come into accordance in terms of death rates for both sexes can be observed in colorectal cancer (13) . Age. Undoubtedly, age plays a major role on disease development. The grand majority of the most fatal diseases start to appear to individuals aged around 60 years old, when the human body becomes less and less functional. As a consequence, cancer is referred as an age-related disease. Cancer is one of the leading reasons why life expectancy numbers remain relatively stable as years go by. A recent study in 2009, which took place in USA proved that the most threatening age in terms of cancer development is around 65 years old, with more than 200,000 cases observed. The second and the third most common age groups in terms of new cancer incidents are 60-64 years old, and 70-74 years old respectively, with slightly less than 200,000 new patients. Another interesting finding is that individuals aged less than 60 years old are much more likely to be diagnosed with cancer during their lifetime rather than those aged more than 60 years old. What we can deduce from that, is that individuals are at a lower risk developing cancer and eventually die if they are aged more than 70 years old (15) . But despite this, in most cases, younger patients who are diagnosed with the majority of cancer types are more likely to have a higher 5-year relative survival rate than the elderly ones especially in high and upper middle-income countries (16) . Population based studies have proved that even in Europe, approximately 25% of young cancer patients (0-14 years old) die from cancer in a short period of time (17) . Sub Saharan Africa. Cancer is considered to be a serious issue for Sub Saharan Africans, since most of the countries in this area are low-income ones and consequently not enough money can be spent on health care. In Sub Saharan Africa infectious diseases are very common, which means that viruses such as HPV result in the majority of cases of cervical cancer. Moreover, gender related cancers such as breast and cervical cancer for women and prostate cancer for men are the ones who cause the biggest number of deaths among cancer patients. Lastly, chances of developing cancer and finally dying remained stable for many years (18) .
  7. 7. 6 Latin America and the Caribbean. This region contains low and middle income countries. In 2012, equal percentages (13.9%) were observed for both sexes for prostate and breast cancer. The rates of those two cancer types are increasing year by year but luckily they do not appear to be the most common causes of death in terms of cancer. On the other hand, despite that few new cases appeared for lung and stomach cancer, death numbers are relatively high. In many large Latin American nations such as Brazil and Colombia, the incidence of breast cancer has almost doubled since 1980. Impressive is the fact that Chilean women have the highest gallbladder cancer rates on a global basis. To conclude with, CFR in this region is 0.59, which is surprisingly high (19) . Northern America. This region includes USA and Canada, which are both high income countries. Once more, prostate and breast cancers are the two most prevalent ones. Good news is that the overall CFR in this region is quite low (0.38), mainly due to the superior health care system, and that is why year by year cervical and lung cancer rates are decreasing. Nevertheless, approximately 30% of cancer patients died from lung cancer in 2012. Colorectal cancer rates have been decreasing through years, especially in white skinned individuals. In USA, where public health insurance policy does not exist, uninsured people are less likely to survive cancer than those who have private insurance (18) . Eastern and Southern Asia. This region has more than half of Earth’s population, since China and India belong there. This is one of the few regions, where breast and prostate cancers are not the most common ones. On the contrary, lung and stomach cancers are the top two cancer types observed due to air pollution and the high prevalence of Helicobacter pylori infection, which can potentially cause stomach cancer. Moreover, according to WHO in 2012 the CFR was 0.9 for lung cancer, which is an indicator of poor survival rate. But the highest ratio can be seen in stomach cancer (0.95) despite the fact that stomach cancer victims are 50% less than the lung cancer ones. To conclude with, bad news is that in less than 10 years estimated cancer deaths according to multiple studies are about to increase by more than 40% (18) . Europe. Europe is a continent that mostly has high income countries and very few middle income ones. One out of five European cancer patients die from lung cancer every year. Quite impressive is the fact that in each and every European country, the
  8. 8. 7 most common type of cancer among women is breast cancer. Whilst among men, those who come from higher income countries are mostly suffering from prostate cancer, while at the same time those who come from relatively lower income European countries mostly suffer from lung cancer. Moreover, colorectal cancer is the number two reason for both categories of total estimated cases and deaths in this region. To sum up, despite the fact that breast cancer incidents are increasing in Europe, good news is that fatality rates keep on decreasing because of early screening and because of the advanced level of health care systems (18) . Northern Africa and Central and Western Asia. This region contains numerous countries, most of them being low and middle income ones. As usual, lung cancer is the number one cause of death in terms of cancer, since tobacco use is rising among individuals of this region. Breast cancer death rates are relatively high comparing to other regions, since 1 out of 10 patients die from this type of cancer. Moreover, in 2012 the CFR of liver cancer was 0.95. Furthermore, it has been observed that despite the fact that all cancer rates due to almost every cancer type are increasing, and that bladder cancer rates are 3 times higher in some countries such as Lebanon and Turkey, bladder cancer is the only cancer type whose death numbers keep on decreasing year by year in both sexes (18) . Oceania. Oceania’s main population is derived mainly from high-income countries like Australia and New Zealand. Prostate and colorectal cancers are the most usual types among Oceanian people. In 2012, almost 1 out of 5 cancer patients died from colorectal cancer. Moreover, Oceania is the only region where 1 out of 10 new cancer incidents have to do with melanoma, mainly due to Southern Europeans who were previously overexposed to sun and choose to migrate there. To conclude with, due to effective anti-smoking campaigns and due to the overpriced tobacco products in Australia, lung cancer incident rates have decreased by almost 50% in males (18) . Global Burden of Cancer: Cancer is considered to be an important global health issue. Technology booming and the increase of cancer research have not contributed a lot, since currently cancer is the number two cause of death globally, while in 1990 it was the number three. New incident and estimated death rates are trustworthy enough tools on public health workers’ hands, but they do not depict ideally the global burden
  9. 9. 8 of this disease. DALYS (Disability Adjusted Life Years) provide us with a clearer view of health loss measurement, since they are able to define mortality and morbidity in a more effective way. DALYs display the perdition of the equivalent of a healthy year. In 2013, the total amount of DALYs was 196.3 million. The highest number of DALYs in men is observed in the case of lung cancer with approximately 25 million. Among female cancer patients, the main reason of DALYs was breast cancer, with more than 13 million. Moreover, 7 out of 10 DALYs happened in lower income countries. Comparing 1990 to 2013, the number of DALYs has increased by 29%. Lastly, the cancer types that mainly contributed to the augmentation of this high percentage (29%) of DALYs between 1990 and 2013 are the most malignant ones, whose DALYs increased unexpectedly high, such as: pancreatic cancer (73.87%), colorectal cancer (45.57%), liver cancer (42.50%), and lung cancer (34.53%) (20) . Future Challenges: The ultimate challenge for public health workers is to act effectively, so that projected cancer rates will be proved wrong. Unfortunately, anti- cancer campaigns are not enough. Public health scientists have to collaborate, and analyse global cancer data and consequently put all their interest in regions where we can observe the poorest survival rates. Long- term ameliorations in the management of cancer on a global basis will provide the appropriate knowledge to medical staff (doctors, nurses, pharmacists). Apart from that, pharmaceutical companies with public health specialists have to unite their efforts in order to provide individuals with free vaccinations mainly in low-income countries, so that the rates of cancer types which are related to viruses will be drastically decreased. All in all, collaboration between scientists, investigators, medical companies, and both governmental and nongovernmental organizations is more than important in order to at least eliminate cancer incidents related to poverty, lack of resources, lack of knowledge and awareness, malnutrition, and infectious diseases (21) . DISCUSSION Cancer is the second most common disease nowadays. This fact highlights the importance of research in this field. The purpose of the literature review was to
  10. 10. 9 highlight which cancer types are the most life threatening ones, how can we potentially avoid them, in which parts of the world are more common and examine cancer rates’ likelihood of increase based on old and current DALYs. The vast majority of studies include global and official cancer data. Focusing on such a broad research question, challenges and limitations were expected to be numerous. For instance, despite the fact that the majority of data is trustworthy, and consequently challenges and limitations did not have to do with transparency and originality, the main obstacles for this review were associated with the number of available studies that covers such a broad topic. Nevertheless, those kinds of global based studies in such life-threatening diseases are the most essential ones for global health scientists, because despite the previously mentioned obstacles, only such kind of challenging projects will potentially lead to solution for global health issues. Case and Medical Records were mostly used so that the provided information cannot be doubted and to demonstrate the relevance and magnitude of cancer. So, despite the difficulties of finding such official records, the interpretation of those can be processed in a more efficient way. From the data given, we can deduce that lung cancer is estimated to be the most common type of cancer on a global basis, and one which has a very poor survival rate. To be more specific, according to the ratios, liver cancer seems to be the most difficult to handle, while at the same time esophageal, lung and stomach cancers have poor prognoses. Lastly, despite the fact that there is a large number of breast and prostate cancer patients, very few of them end up dying from those reasons (4) . Moreover, in terms of risk factors, we can deduce that smoking is the most harmful of the five mentioned ones, since 18.75% of cancer patients die due to excessive tobacco use (5) . Quite impressive is the fact that in 2002, 80% of liver cancer patients were previously infected by HBV or HCV. So, we can claim that deaths from the most malignant cancer type can be drastically reduced if the target of elimination of those two viruses will be achieved (11) . In terms of gender, we can imply that men have higher chances of developing the most malignant cancer types, (and consequently dying), than women (13) . In terms of region (ethnicity), Cancer Atlas (by ACS and WHO) was chosen due to the credibility of its sources. As expected, poorer regions had lower survival rates, whilst in relatively higher income continents (Europe, Oceania), more auspicious CFRs and future predictions were
  11. 11. 10 observed (18,19) . Furthermore, the global burden of cancer article proved that as years go by cancer mortality will increase, whilst the main contributors of this augmentation will be the most malignant cancer types (20) . Lastly, although no bias can be observed in included articles about age, American and British age-related studies were utilized due to poor record-keeping in lower-income settings. Both of those conclude that cancer is an age-related disease and despite the fact that elderly people have lower chances of cancer development than younger ones, younger people have higher chances of survivorship (15, 16) . Cohort studies were used in either topics where official data was missing, or in topics whose official data were not enough to prove a certain point or were relatively old. Additionally, cohort studies were used mostly to justify in a more efficient way the findings of case records, and consequently add relevant information when needed. For that purpose, a cohort study was included in order to add some extra information regarding alcohol consumption. More specifically, it has been reported that even moderate alcohol consumers have high chances of developing malignant cancer types (9) . Furthermore, despite the fact that the cohort study about snus products can be controversial because it is recent and lacks clinical trials, we can infer that new tobacco trends are responsible for cancer development (7) . Moreover, the main reason why European cohort studies were chosen for environmental pollution was to prove that even in high-income countries environmental pollution contributes to lung cancer development (12) . To conclude with, this research contains enough evidence which proves that cancer is an age and gender-related disease, and that behavioral changes can potentially reduce cancer rates. Cancer makes no discriminations on individuals, but poorer nations have poorer survival rates. The most menacing factor that contributes to DALYs increase is population growth. All things considered, such kind of reviews in conjunction with the mutual cooperation of both governmental and non-governmental organisations can be considered as a key solution for global health scientists in order to reduce the global burden of cancer.
  12. 12. 11 REFERENCES 1. Ruddon, R. (2007). Cancer biology. 4th ed. Oxford: Oxford University Press.. Available from: http://ksrbiotech.com/uploads/Cancer%20Biology%204th%20ed%20- %20R.%20Ruddon%20(Oxford,%202007)%20WW.pdf 2. Hejmadi, M. (2010). Introduction to Cancer Biology. 1st ed. Ventus Publishing ApS.. Available from: http://csbl.bmb.uga.edu/mirrors/JLU/DragonStar2016/download/introduction-to- cancer-biology.pdf 3. WHO. Cancer. Fact sheet No 297. February 2015. Available from: http://www.who.int/mediacentre/factsheets/fs297/en/ 4. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015 Mar 1;65(2):87–108. 5. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet. 2012 Dec 15;380(9859):2095–128. 6. Danaei G, Vander Hoorn S, Lopez AD, Murray CJ, Ezzati M. Causes of cancer in the world: comparative risk assessment of nine behavioural and environmental risk factors. The Lancet. 2005 Nov 25;366(9499):1784–93. 7. Luo J, Ye W, Zendehdel K, Adami J, Adami H-O, Boffetta P, et al. Oral use of Swedish moist snuff (snus) and risk for cancer of the mouth, lung, and pancreas in male construction workers: a retrospective cohort study. The Lancet. 2007 Jun 22;369(9578):2015–20. 8. Arnold M, Leitzmann M, Freisling H, Bray F, Romieu I, Renehan A, et al. Obesity and cancer: An update of the global impact. Cancer Epidemiol. 2016 Apr;41:8–15. 9. Connor J. Alcohol consumption as a cause of cancer. Addiction. 2016 Jan 1;n/a-n/a. 10. Burroni E, Bonanni P, Sani C, Lastrucci V, Carozzi F, The HPV ScreeVacc Working Group: Anna Iossa KLA Livia Brandigi, Carmelina Di Pierro, Massimo Confortini, Miriam Levi, Sara Boccalini, Laura Indiani, Antonino Sala, Tommaso Tanini, Angela Bechini, Chiara Azzari. Human papillomavirus prevalence in paired urine and cervical samples in women invited for cervical cancer screening. J Med Virol. 2015 Mar 1;87(3):508–15.
  13. 13. 12 11. Perz JF, Armstrong GL, Farrington LA, Hutin YJF, Bell BP. The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol. 2006 Oct;45(4):529–38. 12. Raaschou-Nielsen O, Andersen ZJ, Beelen R, Samoli E, Stafoggia M, Weinmayr G, et al. Air pollution and lung cancer incidence in 17 European cohorts: prospective analyses from the European Study of Cohorts for Air Pollution Effects (ESCAPE). Lancet Oncol. 2013 Aug;14(9):813–22. 13. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015 Mar 1;136(5):E359–86. 14. Cancer Epidemiology and Prevention - Oxford Scholarship [Internet]. 2006 [cited 2016 Nov 19]. Available from: http://www.oxfordscholarship.com/view/10.1093/acprof:oso/9780195149616.001.000 1/acprof-9780195149616 15. White MC, Holman DM, Boehm JE, Peipins LA, Grossman M, Jane Henley S. Age and Cancer Risk: A Potentially Modifiable Relationship. Am J Prev Med. 2014 Mar;46(3, Supplement 1):S7–15. 16. de Magalhães JP. How ageing processes influence cancer. Nat Rev Cancer. 2013 May;13(5):357–65. 17. Gatta G, Botta L, Rossi S, Aareleid T, Bielska-Lasota M, Clavel J, et al. Childhood cancer survival in Europe 1999–2007: results of EUROCARE-5—a population-based study. Lancet Oncol. 2014 Jan;15(1):35–47. 18. The Cancer Atlas [Internet]. The Cancer Atlas. [cited 2016 Nov 27]. Available from: http://canceratlas.cancer.org/ 19. Curado MP, de Souza DLB. Cancer Burden in Latin America and the Caribbean. Ann Glob Health. 2014 Sep;80(5):370–7. 20. Fitzmaurice C, Dicker D, Pain A, Hamavid H, Moradi-Lakeh M, MacIntyre MF, et al. The Global Burden of Cancer 2013. JAMA Oncol. 2015 Jul 1;1(4):505. 21. Varmus H, Trimble EL. Integrating Cancer Control into Global Health. Sci Transl Med. 2011 Sep 21;3(101):101cm28-101cm28.
  14. 14. 13 ANNEX Table 1 REFERENCES STUDY DESIGN/ DATA SOURCES RESULTS COMMENTS Global cancer statistics, 2012 (2015) Torre LA et al. Case Records Medical Records Measurement of case fatality ratio in cancer types. Liver: 0.95, Esophageal: 0.88, Breast: 0.31, Prostate: 0.28 Malignant cancer types: Liver, Lung, Esophagus, Stomach, Colorectal Non malignant: Breast, Prostate Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 (2013) Lozano R. et al. Case Records Medical Records 18.75% of cancer patients died due to excessive tobacco use Tobacco use is one of the leading causes of cancer development. Causes of cancer in the world: comparative risk assessment of nine behavioral and environmental risk factors (2005) Goodarz Danaei et al. Case Records Medical Records Non smokers are 30 times less likely to develop lung cancer Smoking is the top risk factor of lung cancer development Oral use of Swedish moist snuff (snus) and risk for cancer of the mouth, lung, and pancreas in male construction workers: a retrospective cohort study (2007) Luo Juhua et a Retrospective cohort study Relative risk of snus users of: oral (0.8), lung (0.8), and pancreatic (2.0) cancer. (Numbers>1 give a positive effect) Snus use can potentially cause pancreatic cancer but not oral and lung cancer. Obesity and cancer: An update of the global impact (2015) Melina Arnolda et al. Case Records Medical Records Overweight men with colorectal cancer are 25% more likely to die than thinner ones. Pancreatic cancer patients with BMI>35 have 50% less chances to live. BMI plays a profound role on cancer development and on the outcome after diagnosis of colorectal and pancreatic cancer. Alcohol consumption as a cause of cancer (2016) Connor et al. Case Records Medical Records Cohort studies Alcohol consumption causes 6% of cancer deaths. Non heavy drinkers are more likely to have esophageal or pharyngeal cancer. Heavy drinkers suffer mostly from liver and colorectal cancer. Alcohol is responsible for malignant cancer types and is considered as a risk factor for various cancer types, considering the amount of alcohol that is consumed. Human papillomavirus prevalence in paired urine and cervical samples in women invited for cervical cancer screening. (2014) Elena Burroni et al. Case Records Medical Records <500 million HPV infected women end up having cervix uteri cancer <50% of those die annually. HPV is the number one cause of cervix uteri cancer.
  15. 15. 14 The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide (2006) Joseph F. Perzl et al. Case Records Medical Records In 2002: 8/10 liver cancer patients had been previously infected by either HBV or HCV Viruses such as HBV and HCV can be considered as risk factors for liver cancer. Air pollution and lung cancer incidence in 17 European cohorts: prospective analyses from the European Study of Cohorts for Air Pollution Effects (ESCAPE) (2014) Cohort Studies Lung cancer incidents increased by 22% due to PM10 and by 18% due to PM2.5 Environmental pollution contributes to lung cancer development even in higher income countries. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012 (2015) J Ferlay et al. Case Records Medical Records Population based cancer registries Male cancer patients in 2012 were 500 thousands more than the female ones. Case cancer fatality men VS women : 0.62 VS 0.53 Men are more likely to suffer and die from cancer. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012 (2015) J Ferlay et al. Case Records Medical Records Population based cancer registries 25% of male cancer patients died from lung cancer (Women: 14%) Males Liver Cancer : 11.2%, Females Liver: 6.5% Malignant cancer types are more common in men in terms of mortality. Age and Cancer Risk (2014) Schotterfield David et al. Case Records Medical Records USA Most common US age groups in terms of new cancer incidents : 1) +-65 years old 2)60-64 y.o , 3) 70-74 y.o Cancer is an age-related disease. People aged more than 70 years old are less likely to develop cancer. How ageing processes influence cancer (2013) De Magalhaes et al. Case Records Medical Records UK Young cancer patients are more likely to achieve 5-year relative survival than older ones. Cancer mortality depends on the age of cancer patients. Childhood cancer survival in Europe 1999-2007: results of EUROCARE -5 a population based study (2014) Gemma Gatta Population Based Studies Cancer deaths in Europe among patients aged 0-14 years old: ’99-’01: 23.9% ‘02’-04’: 22.7% ’05-’07: 20.9% Child cancer mortality increases through the years even in high income countries. Cancer Burden in Latin America and the Caribbean (2014) Maria Paula Curado et al. Case Records Medical Records Population based study Overall regional case fatality ratio: 0.59 This number ranks this region in the second place of the regions with the poorest cancer survivorship The Global Buren of Cancer (2013) Mohsen Naghavi et al. Case Records Medical Records Cancer DALYS 1990: 152 million Cancer DALYS 2013: 196 million This is a proof that cancer incidents and cancer mortality rates will increase as years go by The Global Buren of Cancer (2013) Mohsen Naghavi et al. Case Records Medical Records Cancer DALY odds increase comparing 1990 with 2013: Liver:+42.50%, Lung:+34.53% Colorectal:+45.57%, Pancreatic:73.87% The most malignant cancer types contribute to the increase of DALYS and therefore to cancer mortality.
  16. 16. 15 Table 2 (4) CANCER TYPE CASES (THOUSANDS) DEATHS (THOUSANDS) RATIO Colorectal 1361 694 0.51 Liver 782 746 0.95 Lung 1825 1590 0.87 Esophageal 456 400 0.88 Stomach 952 723 0.76 Breast (females) 1671 522 0.31 Prostate (males) 1095 307 0.28

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