CANCER, LINKING CANCER WITH ITS RISK FACTORS, A STUDY CONDUCTED IN NRS MEDICAL COLLEGE , KOLKATA

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` Risks Of Cancer A STUDY OF RISK FACTORS R PATIENTS

description

Cancer is a dreadful disease.But like any other disease it depends on certain risk factors which predisposes certain people to have it and certain people to not have it.This slide shows details of a project undertaken by 20 medical students of the reputed Nil Ratan Sircar Medical College of Kolkata, so as to understand cancer and associate it with its risk factors. This study has been conducted in NRS itself selecting various groups of cancer and non cancer patients with varying pathologies.This project attempts to establish the fact that simple lifestyle modifications may reduce your chances of actually acquring Cancer.Simple changes in diet like avoiding junk food can actually lower the risk of getting Colon Cancer. So please go through the slides so as to get a perspective of the disease and what simple measures can be taken, on your behalf to avoid it.

Transcript of CANCER, LINKING CANCER WITH ITS RISK FACTORS, A STUDY CONDUCTED IN NRS MEDICAL COLLEGE , KOLKATA

Page 1: CANCER, LINKING CANCER WITH ITS RISK FACTORS, A STUDY CONDUCTED IN NRS MEDICAL COLLEGE , KOLKATA

Risks Of Cancer

`

A STUDY OF

RISK FACTORS

OF CANCER

AMONG THE PATIENTS

ATTENDING

NRSMCH

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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.

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•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.

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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

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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%)

Risks Of Cancer

V/SN=400

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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

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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%)

Risks Of Cancer

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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

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ADDICTION HISTORY

Risks Of Cancer

ALCOHOLISM

SMOKING

TOBACCO

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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

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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

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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

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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

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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

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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.

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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

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•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

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…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

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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

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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