CANCER, LINKING CANCER WITH ITS RISK FACTORS, A STUDY CONDUCTED IN NRS MEDICAL COLLEGE , KOLKATA
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Transcript of CANCER, LINKING CANCER WITH ITS RISK FACTORS, A STUDY CONDUCTED IN NRS MEDICAL COLLEGE , KOLKATA
Risks Of Cancer
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A STUDY OF
RISK FACTORS
OF CANCER
AMONG THE PATIENTS
ATTENDING
NRSMCH
Risks Of Cancer
INTRODUCTION
•Cancer, a malignant neoplasm, is a broad group of diseases, all involving uncoordinated and unregulated cell growth, often leading to fatality.
•Carcinogens are a class of substances that are directly responsible for damaging DNA, promoting or aiding cancer. Tobacco, asbestos, arsenic, radiation, sun, exhaust fumes- all these attribute to the formation of cancer.
• As we age, there is an increase in the number of possible cancer causing mutations in our DNA, making it an important risk factor.
Risks Of Cancer
•The importance of studying the risk factors lies in the fact that many cancers are closely linked to certain behaviours that are easiest to prevent. •While few diagnosed cancers can be traced to heredity, most have their origins in an individual’s lifestyle choices and environmental factors leading to cancer maybe dietary factors, use of tobacco products and alcohol, obesity, lack of sufficient physical activity, pollutants, physical agents, infections, stress, radiation and sunlight.
Risks Of Cancer
OBJECTIVES OF THE STUDY
• TO FIND OUT THE VARIOUS RISK FACTORS OF CANCER• TO FIND OUT THE MOST PREVALENT CANCERS AMONG THE
PATIENTS ATTENDING NRSMCH• TO ASSESS THE VARIOUS SOCIO-DEMOGRAPHIC FACTORS IN
RELATION TO THE CANCERS• A COMPARISON OF THE CANCER V/S NON CANCER PATIENTS
TO UNDERSTAND THE PRECIPITATING FACTORS
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MATERIALS AND METHODS• TYPE OF STUDY-OBSERVATIONAL,DESCRIPTIVE
• STUDY DESIGN-CROSS SECTIONAL, DESCRIPTIVE• STUDY AREA- NRSMCH HOSPITAL WARDS• TIME OF STUDY-1 MONTH• STUDY POPULATION-PATIENTS ATTENDING NRSMCH• SAMPLE SIZE-400• SAMPLING-PURPOSIVE SAMPLING• TOOL USED-PREDESIGNED AND PRETESTED SCHEDULE• TECHNIQUES-INTERVIEW AND RECORD ANALYSIS
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DEPENDING ON THE RISK FACTORS USUALLY ASSOCIATED WITH THE MAJORITY OF CANCERS, WE
BASED OUR STUDY ON THE FOLLOWING PARAMETERS
• Demographic Details• Diet History• Lifestyle• Addiction History• Obstetric & Gynaecological History• Occupation And Environment History• Provisional Diagnosis of the Cases• Past History• Family History
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TABLE NO 1- DISTRIBUTION OF STUDY POPULATION ACCORDING TO AGE
AGE(yrs) NON-CANCER CANCER
<12 38(19%) 38(19%)
12-18 11(5.5%) 10(5%)
19-40 91(45.5%) 52(26%)
41-60 49(24.5%) 80(40%)
>60 11(5.5%) 20(10%)
TOTAL 200(100%) 200(%)
N=400
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TABLE NO 2- DISTRIBUTION OF STUDY POPULATION ACCORDING TO GENDER
PATIENTS MALE FEMALE TOTAL
NON-CANCER 95(46.8%) 105(53.3%) 200
CANCER 108(53.2%) 92(46.7%) 200
TOTAL 203 197 400
N=400
TABLE NO 3- DISTRIBUTION OF STUDY POPULATION ACCORDING TO RESIDENCE/LOCALITY
LOCALITY NON CANCER CANCER
URBAN 72 (36%) 50(25%)RURAL 128(64%) 150(75%)TOTAL 200(100%) 200(100%)
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V/SN=400
TABLE NO 4 – DISTRIBUTION OF STUDY POPULATION ACCORDING TO OCCUPATION
OCCUPATION NON-CANCER CANCER
SERVICE 20(10%) 19(9.5%)
BUSINESS 21(10.5%) 10(5%)
MANUAL LABOUR 32(16%) 81(40.5%)
RETIRED 5(2.5%) 18(9%)
NA(PAED) 38(19%) 25(12.5%)
HOME-MAKER 72(36%) 41(20.5%)
STUDENT 12(6%) 6(3%)
TOTAL 200(100%) 200(100%)
N=400
TABLE NO 5 – DISTRIBUTION OF STUDY POPULATION ACCORDING TO PER CAPITA
INCOME
PER CAPITA INCOME NON-CANCER CANCER
<MEAN(Rs 3532) 187(93.5%) 180(90%)
>MEAN(Rs 3532) 13(6.5%) 20(10%)
TOTAL 200(100%) 200(100%)
N=400
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TABLE NO 6– DISTRIBUTION OF STUDY POPULATION ACCORDING TO DIET
N=400
DIET NON CANCER CANCER
VEG 17(8.5%) 9(4.5%)
NON VEG 183 (91.5%) 191(95.5%)
TOTAL 200(100%) 200(100%)
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TABLE NO 7- DISTRIBUTION OF STUDY POPULATION ACCORDING TO CONSUMPTION OF JUNK FOOD
CONSUMPTION OF JUNK FOOD NON CANCER CANCER
<2 TIMES/WEEK 147(73.5%) 123(61.5%)
>2 TIMES/WEEK 53 (26.5%) 77(38.5%)
TOTAL 200(100%) 200(100%)
N=400
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TABLE NO 8 – DISTRIBUTION OF STUDY POPULATION ACCORDING TO CONSUMPTION OF ARTIFICIALLY
COLOURED SUBSTANCES
N=400
CONSUMPTION OF COLOURED FOOD
NON CANCER CANCER
YES 51(25.5%) 57(28.5%)NO 149(74.5%) 143(71.5%)
TOTAL 200(100%) 200(100%)
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TABLE NO 9 – DISTRIBUTION OF STUDY POPULATION ACCORDING TO LIFESTYLE
LIFESTYLE NON CANCER CANCER
SEDENTARY 149(74.5%) 117(58.5%)
ACTIVE 51(25.5%) 83(41.5%)
TOTAL 200(100%) 200(100%)
V/S
N=400
ADDICTION HISTORY
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ALCOHOLISM
SMOKING
TOBACCO
SMOKING NON CANCER CANCER YES
•present•past
43(21.5%)2914
54(27%)4311
NO 157(78.5%) 146(73%)
TOTAL 200(100%) 200(100%)
TABLE NO 10- DISTRIBUTION OF STUDY POPULATION ACCORDING TO INCIDENCE OF
SMOKING N=400
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MATERIAL NON-CANCER CANCER
BIDI 21(72.4%) 32(74.4%)
CIGARETTE 8(27.6%) 11(25.6%)
TOTAL 29 43
TABLE NO 11 – DISTRIBUTION OF CURRENT SMOKERS ACCORDING SMOKING MATERIALS
N=72
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TABLE NO 12 – DISTRIBUTION OF PAST SMOKERS ACCORDING SMOKING MATERIALS
MATERIAL NON-CANCER CANCER
BIDI 12(85.7%) 8(72.7%)
CIGARETTE 2(14.3%) 3(27.3%)
TOTAL 14 11
N=25
TABLE NO 13 – DISTRIBUTION OF STUDY POPULATION ACCORDING TO TOBACCO
CONSUMPTION
TOBACCO USE NON-CANCER CANCER YES
•present•past
19(9.5%)163
27(13.5%)207
NO 181(90.5%) 173(86.5%)
TOTAL 200(100%) 200(100%)
N=400
TABLE NO 14- DISTRIBUTION OF STUDY POPULATION ACCORDING TO ALCOHOL CONSUMPTION
ALCOHOL NON-CANCER CANCER YES
•present•past
19(9.5%)145
32(16%)239
NO 181(90.5%) 168(84%)
TOTAL 1(6.25%) 2(11.76%)
N=400
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OBSTETRIC AND GYNAECOLOGICAL
HISTORY
TABLE NO 15-DISTRIBUTION OF FEMALE PATIENTS ACCORDING
TO OBSTETRIC HISTORY - PARITY
N=197PARITY NON CANCER CANCER
≤2 47(44.8%) 45(48.9%)
>2 24(22.9%) 27(29.3%)
Not Applicable 34(32.4%) 20(21.7%)
TOTAL 105 92
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AGE AT 1ST PREGNANCY NON CANCER CANCER
≤20 43(40.9%) 41(44.6%)
21-30 21(20%) 20(21.7%)
>30 7(6.6%) 11(11.9%)
Not Applicable 34(32.4%) 20(21.7%)
TOTAL 105 92
TABLE NO 16-DISTRIBUTION OF FEMALE
PATIENTSACCORDING TO OBSTETRIC HISTORY – AGE
AT 1ST PREGNANCY
N=197
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TABLE NO 17-DISTRIBUTION OF FEMALE PATIENTS
ACCORDING TO MENSTRUAL HISTORY
MENSTRUAL HISTORY NON CANCER CANCER
PRE MENSTRUAL 19(18%) 14(15.2%)
MENSTRUATING 66(62.8%) 37(40.2%)
POST MENOPAUSAL 20(19%) 41(44.6%)
TOTAL 105 92
N=197
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TABLE NO 18-DISTRIBUTION OF FEMALE PATIENTS
ACCORDING TO CONTRACEPTIVE HISTORY
CONTRACEPTIVE HISTORY
NON CANCER CANCER
YES• OCP• IUCD
22184
10100
NO 83 82
TOTAL 105 92
N=197
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TABLE NO 19 - DISTRIBUTION OF FEMALE PATIENTS
ACCORDING TO GYNAECOLOGICAL HISTORY
GYN. DISORDER NON CANCER CANCER
WHITE DISCHARGE 24(22.9%) 13(14.1%)
OTHER ILLNESS 6(5.7%) 1(1%)
ABSENT 75 78
TOTAL 105 92
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<28.87yrs >28.87yrs0%
10%
20%
30%
40%
50%
60%
70%55%
45%
23%
66%
NON CANCER CANCER
FIGURE NO 1 – STUDY OF PREPONDERANCE OF CANCERS IN POST MENOPAUSAL WOMEN ON THE BASIS OF NUMBER OF MENSTRUATING YEARS
N=61
Systems Affected Cancer(%)
Haematopoietic System 22.5
Respiratory System 7
Gastro Intestinal System
21.5
Excretory System 1
Reproductive 33Central Nervous System
4.5
Musculo Skeletal System
2
Endocrine System 0Vascular System 2Oropharyngeal System 6.5TOTAL 100
TABLE NO 21- DISTRIBUTION OF THE CANCER PATIENTS ACCORDING TO SYSTEMS AFFECTED
N=200
TABLE NO 22- DISTRIBUTION OF THE CANCER PATIENTS ACCORDING TO TYPES OF CANCER
CANCER NUMBER OF PATIENTS PERCENTAGEALL 22 11%AML 9 4.5%CA BREAST 32 16%CA CERVIX 8 4%CA OVARY 10 5%CA ENDOMETRIUM 8 4%CA LUNG 13 6.5%CA BRONCHUS 3 1.5%CA STOMACH 18 9%CA COLON 7 3.5%CA RECTUM 10 5%ORAL CANCER 12 6%BRAIN TUMOUR 8 4%CA GALL BLADDER 5 2.5%
Other cancers include CA Bladder , CA prostrate, CA parotid, melanomas and lymphomas.
TABLE NO-23 HISTORY OF SIGNIFICANT DISEASES OR PRE CANCEROUS LESIONS IN CANCER PATIENTS
*multiple response present
HISTORY CANCER PATIENTS
1. HISTORY OF CANCER 7(3.5%)
2.ORAL LESIONS 9(4.5%)
3.BENIGN BREAST DISEASE 20(10%)
4.HISTORY OF PREVIOUS SURGERY 42(21%)
5.TUBERCULOSIS 0
6.DIABETES MELLITUS 7(3.5%)
7.JAUNDICE 25(12.5%)
8.HYPERTENSION 13(6.5%)
9.HEART DISEASE 4(2%)
10.HYPERCHOLESTEROLEMIA 3(1.5%)
11.OTHER CHRONIC DISORDERS 16(8%)
12.NO HISTORY 59(29.5%)
NN=200
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SYSTEM AFFECTED NO OF PATIENTS 1ST DEGREE RELATIVE
REPRODUCTIVE SYSTEM
66 12(18.2%)
GASTROINTESTINAL SYSTEM
43 4(9.3%)
RESPIRATORY SYSTEM 15 1(6.7%)
HAEMATOPOETIC SYSTEM
45 2(4.4%)
OTHERS 31 1(3.2%)
TOTAL 200 20
TABLE NO 24 – DISTRIBUTION OF CANCER PATIENTS ACCORDING TO FAMILIAL
PREDISPOSITION OF CANCERS
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SUMMARY
The following observations have come up in our study:
• Cancer predominance maximum(40%) in the 41-60 age group• In our study population, rural people affected 3 times more with
cancer than urban people• Cancer incidences maximum in the labourer class, followed by
housewives and children• More than 90% of both cancer and non cancer patients came
from lower socio economic backgrounds
Risks Of Cancer
•95.5% of the cancer patients were non vegetarians
•Greater percentage of cancer patients consumed junk and coloured foods than non cancer patients
•More than 50% of cancer patients lead sedentary lives.•About 1/4th cancer patients either smoke or have a history of smoking, mostly bidis•Tobacco- a common addiction in about 13% cancer cases•16% of cancer patients consume alcohol compared to 9.5% non cancer cases
…continued
…continued
• Cancer incidence found to increase by about 4% in parity<2• Percentage of cancer patients is almost double than that of non
cancer patients, when age of 1st pregnancy is >30 yrs.• 30% more cancer cases observed than non cancer in post
menopausal women, with such chances being almost thrice with prolonged reproductive life, i.e. late menopause.
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…continued
• 16% of cancer patients with CA breast, majority had history of benign breast disease
• ALL next common; notable 9% with CA stomach , 6% with lung and oral cancers
• 20% of cancer cases with history of previous surgery• Family history of cancers maximum in reproductive system
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PROBLEMS IDENTIFIED
• Lack of awareness about the risks of cancer among the patients and how to avoid them
• Negligence for treatment , on the part of the patients , observed in many cases
RECOMMENDATIONS AND CONCLUSION
• Decrease consumption of junk food and artificially coloured food
• Regular walking , exercise or other forms of physical activity• Abstain from smoking, taking tobacco , drinking alcohol and
using other addictives• Limit number of children to two• Avoid long hours under sun, use protective measures• Avoid contact with harmful chemicals or such, as much as
possible, or take proper precautions
Finally, we can conclude that with the proper knowledge and necessary precautions, chances of cancers can be reduced, if not abolished.
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LIMITATIONS
• Study conducted only amongst patients attending NRSMCH
• Hospital based and not community based study• No follow up on the cases• Most patients belonged to middle and lower
income groups• Calculations may have had analyzing mistakes• Some of the patients were non cooperative
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REFERENCES
• www.google.com
• Wikipedia
• PARK’S Textbook of Preventive And Social Medicine
Risks Of Cancer
ACKNOWLEDGEMENTSWe would like to thank• Dr. Anima Halder, Head, Department of Community
Medicine• Our guide and teacher, Dr. Sonali Sain, Department of
Community Medicine• Departments of Radiology , Haematology , Surgery ,
Gynaecology , Paediatrics , Medicine , Orthopaedics• The patients and their families• All the students who did this project