Epidemiology, Prevention
and Control of Cancers
Dr.Maryam Chaudhry
Community Medicine
What is cancer?
• Cancer is a group of diseases characterized by abnormal cell growth
and the ability to invade adjacent tissues and spread to distant organs.
• It can occur in any tissue or site in the body, involving any type of cell.
• The study of cancer, including its diagnosis, treatment and
prevention is called oncology.
• If left unmanaged, cancer can lead to the death of the affected
patient
Key Concepts:
Global Burden
• Cancer is the second leading cause of death globally, and the global cancer
burden is expected to increase over the next two decades.
• In 2022, there were an estimated 20 million new cancer cases and 9.7 million
deaths globally.
• Approximately 1 in 5 people develop cancer in their lifetime
• About 1 in 9 men and 1 in 12 women die from the disease
• https://www.who.int/news/item/01-02-2024-global-cancer-burden-growing--amidst-mounting-need-for-services
Varying Patterns of Cancers
• The global burden of cancer is unequally distributed, with different
types of cancer exhibiting varying patterns across the world.
• For example, stomach cancer is common in Japan but not in the
United States,
• While cervical cancer is common in Columbia.
Frequently diagnosed cancers
• https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21834
Cancer Burden in Pakistan
According to the Global Cancer Observatory's 2022 data for Pakistan:
• New cancer cases: 185,748.
• Cancer deaths: 118,631.
The top most frequent cancers in Pakistan were:
• Lip, oral cavity: A significant concern in Pakistan.
• Lung cancer: A leading cause of cancer-related deaths.
• Colorectal cancer: Increasing in incidence.
• https://gco.iarc.who.int/media/globocan/factsheets/populations/586-pakistan-fact-sheet.pdf
Distribution
• Gender Distribution: 46.7% of cases were in males and 53.61% in
females.
• Provincial Distribution: 45.13% of cases were from Punjab, 26.83%
from Sindh, 16.46% from Khyber Pakhtunkhwa (KP), and 3.52% from
Baluchistan
• https://www.jcpsp.pk/article-detail/pnational-cancer-registry-of-pakistan-first-comprehensive-report-of-cancer-statistics-20152019orp
Cont..
• In males, the top cancers were oral (11.6%), liver (6.73%), colorectal
(6.43%), lung (6.05%), and prostate (5.87%).
• In females, the top cancers were breast (38.8%), ovary (6.09%), oral
(4.97%), cervix (4.17%) and colorectal (3.36%).
• In children, leukemia (14.5%) was the leading malignancy
• https://www.jcpsp.pk/article-detail/pnational-cancer-registry-of-pakistan-first-comprehensive-report-of-cancer-statistics-20152019orp
Modifiable Risk Factors
• Tobacco Use : Smoking and smokeless tobacco significantly increase
the risk of lung & oral cancers
• Alcohol Consumption :Heavy alcohol use raises the risk of liver,
colorectal and breast cancer.
• Unhealthy Diet :Diets high in processed foods and low in
fruits/vegetables are linked to cancer.
• Physical Inactivity :Sedentary lifestyles increase cancer risk, especially
for colorectal.
Modifiable Risk Factors
• Obesity :Excess body weight contributes to cancers like breast and
colorectal cancer.
• Radiation Exposure :UV rays increase skin cancer risk.
• Environmental Pollutants :
1) Industrial Chemicals: e.g
• Asbestos → Causes mesothelioma
• Benzene → leukemia and other blood cancers.
Modifiable Risk Factors
2)Pesticides and Herbicides:
Glyphosate-Based Herbicides → Non-Hodgkin Lymphoma
High levels of pesticides → prostate and pancreatic cancer.
3)Air Pollution
Fine particulate → Increases risk of lung cancer.
Polycyclic aromatic hydrocarbons → lung, bladder and skin cancers.
Modifiable Risk Factors
4)Water Contaminants:
Arsenic → skin, lung, and bladder cancers.
Industrial run off containing heavy metals → kidney and liver cancer.
5)Workplace Exposures:
Construction workers exposed to silica dust → lung cancer.
Painters and metalworkers exposed to solvents and heavy metals →
bladder and lung cancer.
Modifiable Risk Factors
• Infectious Agents – Certain infections (HPV, Hepatitis B/C, H. pylori)
increase cancer susceptibility.
• Hormone Use – Hormonal therapies (like HRT or oral contraceptives)
can elevate cancer risk.
Non-Modifiable Risk Factors
Non-Modifiable Risk Factors
• Age :Cancer risk increases significantly with age.(exposed to sunlight,
cigarette smoke, chemicals and other cancer-causing agents for longer)
• Genetic Predisposition :Family history and inherited genetic mutations
e.g., BRCA1/BRCA2 for breast cancer
• Gender – Some cancers are gender-specific
e.g., prostate cancer in men, ovarian cancer in women
Non-Modifiable Risk Factors
• Ethnicity/Race – Certain ethnic groups have higher susceptibility to
specific cancers
• e.g.,Non-Hispanic White suffer more from skin cancers
• Personal Medical History:
Radiation therapy for one cancer (e.g., Hodgkin’s lymphoma) has an
increased risk of developing secondary cancers
Systemic lupus erythematosus (SLE) has been associated with an
increased risk of lymphoma
Prevention and Control
Prevention and Control of Cancers
• Primary Prevention:
• Aims to prevent disease onset and remove risk factors.
Strategies include:
• Reducing exposure to radiation.
• Avoid smoking and tobacco products (e.g., cigarettes, smokeless
tobacco).
• Limit alcohol consumption to reduce the risk of liver, breast, and
esophageal cancers.
• Healthy Diet and Physical Activity
Primary Prevention:
• Consume a diet rich in fruits, vegetables and whole grains.
• Reduce red and processed meat intake.
• Maintain a healthy weight and engage in regular physical activity.
• Hepatitis B vaccine → Prevents liver cancer.
• Human Papillomavirus (HPV) vaccine → Prevents cervical cancer.
Primary Prevention:
• Reducing Environmental Exposure
• Avoid exposure to asbestos, benzene and other carcinogens.
• Reduce air pollution and avoid secondhand smoke.
• Sun Protection
• Use sunscreen and protective clothing to prevent skin cancers.
Primary Prevention:
• Monitoring of foods, drugs and cosmetics.
• Legislation.
• Cancer education
Secondary Prevention
Focuses on early detection and treatment to prevent progression.
This includes:
• Early diagnosis.
• Mammograms → Early detection of breast cancer.
• Pap smear & HPV testing → Cervical cancer detection.
• Colonoscopy → Screening for colorectal cancer.
cont..
• Self-Examinations & Awareness
• Breast self-examinations
• Regular skin checks for abnormal moles or skin changes.
• Genetic Testing for High-Risk Individuals
• BRCA1/BRCA2 genetic testing for individuals with a family history of
breast or ovarian cancer.
• Treatment, including surgery, chemotherapy, and radiotherapy
Tertiary Prevention
• Improve quality of life and reduce complications in cancer patients.
• Strategies:
• Effective Cancer Treatment
• Surgery, chemotherapy, radiation therapy and immunotherapy to
treat diagnosed cancers.
• Hormone therapy for hormone-sensitive cancers (e.g., breast,
prostate cancer).
• Palliative and Supportive Care
cont..
• Pain management using medications and supportive therapies.
• Nutritional support to maintain strength and immunity.
• Psychosocial support through counseling and support groups.
• Rehabilitation
• Physiotherapy to recover mobility after cancer surgeries.
• Occupational therapy to help patients resume daily activities.
• Follow-up care to monitor for recurrence or secondary cancers.
Cancer Screening
• Specific screening methods include:
• Cervical Cancer: Pap smear
• Breast Cancer: Breast self-examination, examination by a physician,
mammography.
• Lung Cancer: Chest X-ray, sputum cytology
Thank You
