Epi Lung Cancer - Mohsen

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8/8/2019 Epi Lung Cancer - Mohsen http://slidepdf.com/reader/full/epi-lung-cancer-mohsen 1/61 Epidemiology of Lung Cancer in Middle East and in The Rest of World By Prof. Mohsen Gadallah Chairman of Community Medicine Department Faculty of Medicine- Ain Shams University Cairo ± Egypt

Transcript of Epi Lung Cancer - Mohsen

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Epidemiology of Lung Cancer in

Middle East and in The Rest of World

By

Prof. Mohsen Gadallah

Chairman of Community Medicine Department

Faculty of Medicine- Ain Shams UniversityCairo ± Egypt

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Outline

Statistics for Lung Cancer: World,

North America, Europe, Asia, Africa,

Middle East, Arab Countries.

Epidemiology of Lung Cancer 

Risk Factors of Lung Cancer 

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Source of Data

National Population-based Cancer Registries:

Gulf Center for Cancer Registration, 2001

Syria National Cancer Registry 2007

Jordan, 2000

Lebanon, Cancer Program-Tumor Registry, 2000 Regional Population-based Cancer Registries:

Egypt: NCI 2005

Algeria: Algiers,

Tunisia: Tunis, EMRO - WHO

Globocan 2002, IARC

American Cancer Society, Global Cancer Statistics, 2002

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The four most common cancers in men are

lung, prostate, stomach and colorectal

cancers. Among Women the top four cancers

are breast, cervix utri , colorectal and lung

cancer .

Pattern of cancer distribution Worldwide

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Lung cancer: how did it start?

First described in 1420 in Schneeberg-

 Austria after the opening of cobalt- and

nickel mines.

Incidence was very low in the 19th

century.

Is now worldwide the commonest form of 

cancer in men, and the fourth most

frequent cancer in women.

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-Lung cancer has been the most common cancer 

worldwide since 1985, and by 2002 accounted for (12.4

percent of world total New Cases) and (17.6 percent of 

world total Deaths)

-Just over half (50.1 percent) of lung cancer cases occur in

developed countries, a significant change since 1980,

when 70 percent were in developed countries.

Lung Cancer Worldwide

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Lung Cancer Worldwide

Global incidence of lung cancer is increasing at 0.5%

per year. A major contribution to this trend comes from

the East European and developing countries.

Although it is the most frequent cancer in men

worldwide, lung cancer is second to prostate cancer in

incidence in developed countries

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World Estimated New Cancer Cases

and Age adjusted Incidence Rates,

Males Females

Number of New

Cancer 

Cases

Ageadjusted

Incidenc

e Rates

Number of New

Cancer 

Cases

Ageadjusted

Incidence

Rates

More

developed

481,950 54.9 194,731 17.1

Less

developed

481,029 25.9 191,192 9.4

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Average Years of Life

Lost from Cancer 

P  r  o  s  t  a  t  e  

C   o  l   o  r  e  c  t  a  l   

L  u  n   g  

K   i   d   n  e   y  

B  r  e  a  s  t  

C   e  r  v  i   x  

T   e  s  t  i   s  

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Lung Cancer in USA

Estimated new cases and deaths from lungcancer (non-small cell and small cell combined)in the United States in 2008:

New cases: 215,020Males: 114,690Females: 100,330

Deaths: 161,840Males: 90,810Females: 71,030

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Lung Cancer in North America

It is the second most common cancer among both menand women after prostate cancer in men and breast cancer in women

It is the leading cause cancer-related deaths, accountingfor around 28% of all cancer deaths.

It kills more people than breast, prostate, colon, andpancreas cancers combined

Nearly 60% of people diagnosed with lung cancer diewithin 2 years. This had not improved in 10 years.

.

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EuropeThere is a wide variation in incidence and

death rates in Europe

Central and Eastern Europe have the highestincidence and death rates, 65.7/100,000 and

59.7/100,000.

For men, incidence rates range from a low of 21.1/100,000 in Sweden to a high of 

94.6/100,000 in Hungary. Death rates range

from 22.6/100,000 to 83.9/100,000

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Estimates of the cancer incidence and mortality in

Europe in 2006.

Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P. Ann Oncol. 2007 Mar;18(3):581-92. Epub 2007 Feb 7.

RESULTS: In 2006 in Europe, there were an estimated3,191,600 cancer cases diagnosed (excludingnonmelanoma skin cancers) and 1,703,000 deaths fromcancer. The most common form of cancers was breastcancer (429,900 cases, 13.5% of all cancer cases),followed by colorectal cancers (412,900, 12.9%) andlung cancer (386,300, 12.1%). Lung cancer, with anestimated 334,800 deaths (19.7% of total), was the mostcommon cause of death from cancer, followed bycolorectal (207,400 deaths), breast (131,900) andstomach (118,200) cancers.

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Estimates of the cancer incidence and mortality in

Europe in 2006.

Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P. Ann Oncol. 2007 Mar;18(3):581-92. Epub 2007 Feb 7.

 ± CONCLUSIONS: The total number of new cases of 

cancer in Europe appears to have increased by300,000 since 2004. With an estimated 3.2 million

new cases (53% occurring in men, 47% in women)

and 1.7 million deaths (56% in men, 44% in women)

each year, cancer remains an important public health

problem in Europe and the ageing of the European

population will cause these numbers to continue to

increase even if age-specific rates remain constant.

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Estimates of the cancer incidence and mortality in

Europe in 2006.

Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P.

 Ann Oncol. 2007 Mar;18(3):581-92. Epub 2007 Feb 7.

 ± Evidence-based public health measures existto reduce the mortality of breast and

colorectal cancer (Treatment & Screening )

while the incidence of lung cancer, and

several other forms of cancer, could bediminished by improved tobacco control.

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SurvivalThe 1-year survival rate for lung cancer has increased

from 34% in 1975 to 42% in 1998.

Despite major advances in understanding and

treating

cancer, the 5-year relative survival rate is only 15%, a

rate that has improved only slightly over the last 30

Years

According to the World Health Organization, three

people die every minute worldwide from lung cancer 

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5-Year Survival Rates by World Region

7

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10

12

13

14

20

21

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EMRO LUNG CANCER

In 2004, around 300,000 from EMRO diagnosed with

lung cancer, and 200,000 will die from it

It is the second most common cancer among men

It is the leading cause cancer-related deaths, killing

more people than breast, liver, prostate, colon, and

pancreas cancers combined

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Age-adjusted Incidence Rates for Men,

North Africa and Middle East

16.7

17.1

23

24.4

25.6

28.6

28.9

37.7

0 10 20 30 40

Jordan

Kuwait

Iraq

 Algeria

Morocco

Tunisia

Lebanon

Syrian

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 Age Specific Incidence Rate (100,1000) in

 Arab Countries and other African countries

Glubocan 2002

Country Crude ASR 

Kenya 1.9 4.2

Rwanda 0.9 1.7

Mauritius 12.6 15.8

Chad   2.3 4.7Algeria 9.8 16.9Egypt 5.3 8.6

Libya  6.7 10.4Morocco 11.9 20.1Sudan 0.5 1.0Tunisia 21.5 27.8

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 Age Specific Incidence Rate (100,1000) in

 Arab Countries - Glubocan 2002

Country Crude ASR 

Bahrain 15.9 30.5Saudi

Arabia6.0 10.3

Syria  14.4 32.9Iraq 10.5 22.7Yemen 1.4 4.1Jordan 7.9 16.5Kuwait 11.2 18.9Lebanon 22.5 31.3Oman 5.5 9.6Qatar 14.3 19.9United A

Emirates11.6 13.7

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Country 1st 2nd 3rd 4th 5th

Egypt Bladder Liver NHL Lung Colorectal

Algeria Lung Bladder Stomach Prostate Colorectal

Tunisia Lung Bladder Prostate Larynx Colorectal

Jordan Lung Bladder Prostate NHL Skin

Lebanon Bladder  Lung Prostate Colorectal stomach

  Yemen NHL HD Liver Leukemia Colorectal

Type of Cancers in Egypt and

some Arab Countries, Males

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Percent of cancer casesCountry Male % Female %

Egypt (Gharbiah & NCI) 14.3 3.7

Morocco 18.8 2.0Tunisia 23.3 2.3

Lebanon 14.1 4.3

Iraq 15.7 4.7

 Algeria 16.8 2.0

Jordan 11.2 2.3

Yemen 2.8 2.6

Frequency of Lung Cancer in

Egypt and other Arab Countries

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Histological types of lung cancer 

2 major types:

small-cell lung cancer, and

nonsmall-cell lung cancer, which is further subdivided into:

squamous cell carcinoma,

adenocarcinoma, and large-cell carcinoma.

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Origin and characteristics of 

various types of lung cancer Squamous cell lung cancer: commonesttype in males, central origin, manifestsearly

 Adenocarcinoma: commonest type infemales, peripheral origin, manifests late

Large cell lung cancer: least common

type, peripheral originSmall cell lung cancer: most aggressive

type, central origin, spreads quickly

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Lung cancer histology

There are two main types of lung cancers:around 20% are small cell lung cancers (SCLC)

and the remainder are non-small cell lungcancers (NSCLC).

The main types of NSCLC are squamous cellcarcinoma, adenocarcinoma and large cell

carcinoma, which account for approximately35%, 27% and 10% of all lung cancer casesrespectively in the UK.

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Egypt

Accurate epidemiological data on lung cancer in Egypt

is not available since a comprehensive national

population-based cancer registry is lacking.

However, official statistics as well as institution and

hospital-based studies show that it is the second most

common cancer in men and second leading cause of 

cancer death, after bladder cancer 

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Descriptive Epidemiology:

Age

 Age-specific incidence rates increase

exponentially until the rates plateau and then declineafter the age of 80 in men and the age of 70 in

women

Only 5% to 10% of lung cancer cases arediagnosed under 50 years of age

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Lung cancer incidence by age

and sex

Lung cancer is rarely diagnosed in peopleyounger than 40, but incidence rises steeplythereafter peaking in people aged 75-80 years.Most cases (85%) occur in people over the ageof 60.

In the 1950s the male/female ratio for lungcancer cases was 6:1 but with decreasing male

rates and increasing female rates, the ratio isnow 7:5 (22,495 male cases and 15,818 femalecases in 2004). Overall, 13% of all new cases of cancer are lung cancers

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Descriptive Epidemiology:Gender 

Worldwide, age-adjusted incidence rates of lung

cancer among men exceed, twofold or more, thanamong Women

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Descriptive Epidemiology:

Race

The risk of lung cancer in United States black

men has been about 50% higher than in white men

in the past 10-15 years. During 1975 to 1990, the

age-adjusted lung cancer incidence in the United

States black women was 10% to 20% higher than

in white women.

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Genetic factors

Smoking is the biggest risk factor, linked to ninein 10 lung cancers . So genetics play a minor role.

Some people have a genetic risk or predisposition for lung cancer. Anyone with afirst degree relative (parent, brother, sister) withlung cancer has a higher risk of developing lungcancer .

Research is ongoing to further define the geneticfactors associated with lung cancer.

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Risk Factors

Doctors cannot always explain why oneperson develops lung cancer and another does not. However, we do know that a

person with certainrisk factors

may bemore likely than others to develop lungcancer. A risk factor is something that mayincrease the chance of developing adisease.

Studies have found the following riskfactors for lung cancer:

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Risk factors

1. Tobacco (and passive) smoking

2. Air pollution in urban areas

3. Chronic lung conditions: COPD4. Occupational exposure (man-made

mineral fibre)

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Smoking

The overwhelming role of smoking in the causation of lungcancer has been repeatedly demonstrated over the past 50years:

 ± 87% of lung cancer cases are thought to result from smoking ± The longer you smoke and the more packs per day you

smoke, the greater your risk

 ± Secondhand or environmental tobacco smoke increase the risk

 ± A nonsmoker married to a smoker has a 30% greater risk

 ± Workers exposed to tobacco smoke at the workplace are at ahigher risk

 ±± No evidence that low tar cigarettes reduces risk

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Smoking

Tobacco use accounts for at least 30% of all

cancer deaths and 87% of lung cancer deaths.

(Source: Cancer Facts and Figures 2008 ).

Each year, about 3,000 non-smoking adults dieof lung cancer as a result of breathing

secondhand smoke. Each year secondhand

smoke also causes an estimated 35,000 deaths

from heart disease in people who are not currentsmokers. (Source: Cancer Facts and Figures

2008 )

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Cause and effect: cigarette

smoking lung cancer Men started smoking cigarettes in 1920s

20 years later, incidence of lung cancer in

men climbed sharply.

In 1940s, women became cigarette

smokers 20 years later, a similar 

dramatic increase in lung cancer among

women.

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Smoking

Besides lung cancer, tobacco use also

causes increased risk for cancer of the

mouth, nasal cavities (nose), larynx (voice

box), pharynx (throat), esophagus

(swallowing tube), stomach, liver,

pancreas, kidney, bladder, uterine cervix,

and acute myeloid leukemia. (Source:Cancer Facts and Figures 2008 )

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Smoking

Smoking has been implicated in:

 ± 80% of lung cancer deaths in men ± 75% of lung cancer deaths in women

 ± 13% of lung cancer deaths in nonsmokers

 ± 28% of all cancer deaths

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Risk Factors

Radon: Radon is a radioactive gas that

you cannot see, smell, or taste. It forms in

soil and rocks. People who work in mines

may be exposed to radon. Radon is found

in houses. Radon damages lung cells, and

people exposed to radon are at increased

risk of lung cancer. The risk of lung cancer from radon is even higher for smokers.

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Risk Factors: Other ³occupational carcinogens´

(cancer-causing agents found in workplace) Radioactive ores such as uranium

Inhaled chemicals or minerals such as:

 ± Arsenic

 ± Vinyl chloride

 ± Nickel chromates

 ± Chloromethyl ethers

 ± Coal products

 ± Mustard gas

- Fuels such gasoline- Diesel exhaust

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Risk Factors

Asbestose and other substances: People who havecertain jobs (such as those who work in the constructionand chemical industries) have an increased risk of lung

cancer. Exposure to asbestos, arsenic, chromium,nickel, soot, tar, and other substances can cause lungcancer. The risk is highest for those with years of exposure. The risk of lung cancer from these substancesis even higher for smokers.

 Asbestos: Asbestos worker are about 7 times morelikely to die of lung cancer 

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Risk Factors: other than smoking

 ± People with silicosis and berylliosis (lung diseases

caused by breathing in certain minerals) also have ahigher risk

- Diet (vitamins A, C, E, -carotene deficiencies)

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Risk Factors:

Marijuana :

It has been hard to prove a connection because it is not

easy to gather information about the use of illegal drugs ±

Many marijuana also smoke cigarettes

Radiation therapy: ± Particularly if they smoke

Recurring inflammation

:

Tuberculosis and some types of pneumonia often leave

scars. This increases risk of adenocarcinoma type

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Prevention of lung cancer 

80% of lung cancer 

cases are

associated with

many years of 

tobacco smoking,

and can therefore

be AVOIDED.

10% of lung cancer 

cases are

associated with

exposure to

occupational

carcinogens, and

can therefore be AVOIDED.

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The estimated Proportion of 

Preventable Cancer 

N

%

%

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What are the Percent of such

Modifiable Risk Factors ?

Smoking = 20 %

Alcohol = 5 %

Low Fruit and Vegetable Intake = 5 % Unsafe Sex = 2 %

Lack of Exercise = 2%

Others = 6%

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Remember 

Cancer kill around 8 Million people in2007, three quarters of whom were indeveloping Countries.

Smoking is the main etiological factor responsible for up to 90% of cases.

Lung Cancer is the most preventable formof cancer death.

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Many Thanks