Introduction to Cancer

Epidemiology
 What this course is about
• Learning more about cancer epidemiology
• Investigating risk factors implicated in
cancer development
• Learning to write grants and critique articles
• Learning to be passionate about chronic
disease epidemiology
 True or False?

Smoking causes lung cancer

 True or False?

Large percentage of cancers are

preventable
 True or False?

In the past 20 years tremendous

improvements in the treatment
of all cancers have been
achieved
 True or False?

Preventing cancer is easier than

treating cancer
 True or False?

Screening tests are available for

most cancers
 Epidemiology

“Distribution and
determinants of
disease frequency
in human
populations”
 Cancer Epidemiology
Historical Perspective
1775
British surgeon, Percival
Pott reported probably
the first description of
occupational
carcinogenesis in the
form of scrotum
cancer （ men’s
Reproductive
system ） among
chimney sweeps.
 Cancer Epidemiology
Historical Perspective
Tight corsets and cancer
1842
Rigoni-Stern, Italian physician, observed
that married women in the city were
getting cervical cancer, but nuns in
nearby convents weren’t. He also
observed that nuns had higher rates of
breast cancer, and suggested that the
nuns’ corsets were too tight.
 Five Criteria for a Cause  Effect Relationship

Criteria Risk Factor for Disease

1) Timing ♦ Exposure occurs before development

of disease or during its progression
2) Strength ♦ Is dose-dependent
♦ Cessation of exposure can modify disease
3) Prevalence ♦ Occurs in multiple populations
4) Relationship to ♦ Is independent
other risk factors ♦ Can also act synergistically
5) Plausibility ♦ Produces structural‡ or functional changes
which are events in mechanism of disease

‡
anatomic or molecular
 Cancer Epidemiology
Historical Perspective
1700s: tobacco and cancer
Reports of cancer risks associated with
tobacco in the 18th century included
snuff taking and nasal cancer, reported
by Hill in 1761, and pipe smoking and lip
cancer by von Soemmering in 1795.
 Cancer Epidemiology
Historical Perspective
• Tobacco and Lung Cancer
• Asbestos and Lung Cancer
• Leather Industry and Nasal Cancer
• Dyes and Bladder Cancer
• Ionizing Radiation and Many Cancers
• DES and Vaginal Adenocarcinoma
• EBV and Burkitt’s Lymphoma
• HPV and Cervical Cancer
 Cancer Epidemiology
An Introduction
• The Epidemiologic Perspective
• Aims of Cancer Epidemiology
• Methods of Epidemiology
• Historical Perspective and Examples
• Contemporary Studies
• The Future
 Aims of Cancer Epidemiology

• Uncover new etiologic leads

– study of the distribution of cancer
– quantify the risk associated with different
exposures and host factors
• Promote insights into the mechanisms of
carcinogenesis
• Assess efficacy of preventive measures
• Investigate predictors of survival
Types of Epidemiologic Studies

• Cohort
• Case-Control
• Cross-Sectional (Prevalence)
• Other
 Methods of Cancer Epidemiology

• Descriptive Studies
– Incidence, mortality, survival
– Time Trends
– Geographic Patterns
– Patterns by Age, Gender, Ethnicity
• Analytic Studies
– Case-control
– Cohort
 Challenges to Interpretation

– Observational vs. Experimental Design

– Cancer “clusters”
– Study Design and Conduct
• Study Size
• Biases: Misclassification, confounding, selection

– Exposure assessment important

– Epidemiology and “strong” and “weak” effects
– Impact on a population level
– Replication critical
 Cancer Epidemiology
Sources
• US SEER Registry System
• IARC International Registries
• State/Hospital Registries

• Etiologic Clues
– “Alert” Clinician
– Experimental Studies
 Cancer Epidemiology
Current/Future Topics
• Infectious Agents
• Cancer and inflammation
• Obesity
• Physical Activity
• Diet
• Hormones
• Immunologic Factors
• Cancer disparities
• Inherited Susceptibility (Polymorphisms)
 Cancer Epidemiology
Current/Future Topics
• Tumor (somatic) Alterations
• Cancer Classification
• Biomarkers of Exposure/Effect
• Vaccines
• Survivorship
• Cancer and disability
• Alternative therapy