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Asian Pacific Organization for Cancer Prevention (APOCP)

Cancer Epidemiology and

PreventionEducationScreeningToxicological Pathology

25th IACR Annual Meeting,Hawai’i

‘Cancer Registration andSurveillance…Around the

Globe’

APOCP ASIATOX Satellite Symposium, Bangkok‘In Vivo Models for Assessment of Carcinogenicity and

Chemopreventive Potential of Food Components’ASIATOX III,

Bangkok/Chiang Mai‘International Toxicology

Harmonization : The Challengeof Asia’

1st Regional APOCP Conference -Western Asia, Izmir

‘New Strategies for Cancer Control’

2nd Regional APOCP Con-ference -

South East Asia, Khon Kaen‘Customs, Environment and

Cancer’

ISSN 1513-7368

APOCP Groups

Australasia

Central Asia

China

Japan

Korea

South Asia

South-East Asia

Western Asia

http://www.apocp.org

Education Epidemiology

Screening and Intervention Toxicological Pathology

Vol 5 2004

ASIAN PACIFIC JOURNAL of CANCER PREVENTION The Official Publication of the Asian Pacific Organization for Cancer Prevention

An Official Journal of the International Association of Cancer Registries

Aims and Scope Asian Pacific Journal of Cancer Prevention Contents - Volume 1 - Volume 2 - Volume 3 - Volume 4 - Volume 5 ConstitutionInformation for APJCPInformation for AuthorsInformation for SubscribersEventsMembers

Aims and Scope

The aim of the APOCP and its official journal the APJCP is to promote an increased awareness in all areas of cancer prevention and to stimulate practical intervention approaches. The scope is wide-ranging, including descriptive, analytical and molecular epidemiology, experimental and clinical histopathology/biology of preneoplasias and early neoplasias, assessment of risk and beneficial factors, experimental and clinical trials of primary preventive measures/agents, screening and secondary prevention, and all aspects of cancer prevention education.

APJCP Chief Editor - APOCP Chairman Kazuo Tajima

Division of Epidemiology and Prevention, Aichi Cancer Center, Research Institute1-1 Kanokoden, Chikusa-ku, Nagoya 467-8681, Japan Tel +81-52-764-2986, Fax +81-52-763-5233 Email: [email protected]

APJCP Managing Editor - APOCP Coordination Director Malcolm A Moore

Email: [email protected]

ASIAN PACIFIC ORGANIZATIONfor

CANCER PREVENTION

Subject Editor - Education/Cancer Registration Timothy J Threlfall (IARC Rep)Supannee Sriamporn

Subject Editor - Epidemiology Shinkan Tokudome, Keun-Young YooSubject Editor - Screening and Intervention You-Lin Qiao, IinumaSubject Editor - Toxicological Pathology Hiroyuki Tsuda,

Yogeshwer Shukla

Genetic Polymorphisms

Genetic Anomalies

Familial Cancer

Molecular

Descriptive

Analytical

Pathophysiological

Pathological Diagnosis

Environmental Factors

Cancer Registration

Tissue/organ Physiology

Biochemical Parameters

Epidemiology

Areas of Interest

Cancer Registration

Male Burden of Cancers in Major Organs - Incidences/100,000

Registry China India Indonesia Iran Japan Korea Pakistan Philippines# Thailand Vietnam Ranking

Oral 1.3 (9)R 16.3 (1) ? 6.6 (4) 6.0 (9) 4.4 (8) 25.8 (1) 8.6 (6) 8.5 (4) 8.2 (5) 45 (6)

Oesophagus 14.8 (3) 7.4 (2) ? 39.4 (1) 10.0 (5) 10.1 (5) 6.2 (5) 3.1 (9) 3.7 (8) 3.7 (6) 46 (5)

Stomach 14.7 (4) 6.8 (3) ? 17.3 (2) 67.0 (1) 70.0 (1) 4.6 (8) 11.1 (5) 4.9 (6) 23.7 (2) 58 (4)

Colorectal 11.5 (5) 5.4 (4) 6.8 (2) 3.8 (7) 48.0 (2) 40.9 (4) 5.9 (6) 18.7 (3) 10.4 (3) 11.4 (4) 60 (3)

Liver 21.0 (2) ? 5.7 (3) 3.9 (6) 26.0 (4) 48.8 (2) 5.0 (7) 23.9 (2) 37.4 (1) 22.6 (3) 70 (2)

Pancreas 3.9 (6) 1.7 (8) ? 1.2 (9) 9.2 (7) 7.7 (7) ? 4.7 (8) ? 1.6 (9) 16 (9)

Lung 26.6 (1) 4.0 (6) 14.8 (1) 14.2 (3) 39.9 (3) 48.4 (3) 20.0 (2) 64.3 (1) 26.5 (2) 29.3 (1) 77 (1)

Prostate 2.1 (8) 5.2 (5) 5.6 (4) 2.0 (8) 10.0 (5) 4.2 (9) 7.6 (4) 17.6 (4) 4.4 (7) 2.2 (8) 28 (8)

Bladder 3.4 (7) 3.5 (7) ? 4.4 (5) 8.2 (8) 9.5 (6) 9.4 (3) 4.9 (7) 5.2 (5) 2.4 (7) 35 (7)

*Data from Selected Cancer Registries (see text for references) # Data from Parkin et al., 1997 R, rank

Descriptive Epidemiology: Males

Female Burden of Cancers in Major Organs - Incidences/100,000

Registry China India Indonesia Iran Japan Korea Pakistan Philippines*Thailand Vietnam Ranking

Oral 0.8 (9)R 7.8 (3) ? 6.6 (4) 2.0 (8) 1.2 (8) 18.7 (2) 6.0 (8) 4.5 (7) 2.7 (8) 33 (6)

Oesophagus 6.0 (6) 5.8 (5) ? 24.9 (1) 1.3 (9) 1.0 (9) 6.9 (5) 1.6 (9) 1.3 (9) 0.5 (9) 28 (9)

Stomach 14.7 (1) 3.5 (7) ? 5.9 (5) 27.0 (2) 25.7 (1) 3.2 (8) 6.4 (7) 1.5 (8) 8.5 (3) 58 (3)

Colorectal 9.0 (4) 3.8 (6) 6.3 (3) 2.9 (6) 25.5 (3) 10.3 (6) 5.0 (6) 15.8 (3) 7.5 (5) 6.4 (5) 53 (4)

Liver 8.0 (5) ? ? 1.8 (9) 7.7 (6) 11.6 (5) 3.4 (7) 8.0 (6) 15.5 (3) 4.6 (6) 33 (6)

Lung 10.2 (3) 3.1 (8) 4.8 (5) 2.5 (7) 11.2 (4) 12.7 (3) 2.8 (9) 17.7 (4) 11.1 (4) 7.9 (4) 49 (5)

Breast 12.7 (2) 22.6 (2) 14.8 (2) 12.3 (2) 31.0 (1) 12.5 (4) 56.6 (1) 47.7 (1) 16.3 (2) 13.8 (1) 80 (1)

Ovary 5.3 (7) 5.9 (4) 5.2 (4) 2.5 (7) 6.4 (7) 4.0 (7) 9.5 (3) 9.4 (5) 4.7 (6) 4.4 (7) 43 (8)

Cervix 1.2 (8) 25.3 (1) 21.7 (1) 7.0 (3) 8.5 (5) 15.3 (3) 7.3 (4) 21.6 (2) 20.9 (1) 13.1 (2) 70 (2)

*Data from Selected Cancer Registries (see text for references) # Data from Parkin et al., 1997 R , rank

Descriptive Epidemiology: Females

Prevalent Cancers

Australia India (Ahmedebad)

10

20

30

40

50

0

Incidence Data (/100,000 Population)

Larynx M Buccal Cavity M Oesophagus M Cervix Colon M Prostate Breast Ovary and Endometrium

Adjusted Mortality Data (/100,000)

Squamous cell carcinoma and adenocarcinoma links

Data from World Health Statistics, WHO (1996)

Consumption of Major Food Groups Worldwide as Percentages of Total Energy

Dietary Variation

Histogenesis of Cancers and Prevention Timing

Field

Clonal

Preneoplastic/precancerous Neoplastic

Initiation Modulation Progression

Carcinogen Dependent Proliferation Sensitive

Carcinogen Independent? Proliferation Sensitive

Carcinogen Dependent? Proliferation Independent?

Single

Subclonal

Primary PreventionClinical Treatment

Secondary Prevention

Individual Body Sites

Cancer TypePrevalence over TimeRisk FactorsBeneficial FactorsPrimary PreventionSecondary Prevention

Screening Modalities

Oral Cavity Cancer

0

5

10

15

20

25

30

Singapore Chinese

SC

SCSC SC

SM SMSingapore Malay SM

SM

SISingapore Indian

SI

SISI

IB

IB

Indian BombayIB

IB

CS CSCS

Chinese Shanghai CS

CHKChinese Hong Kong

CHKCHK

CHK

JM JM

JM JM Japanese MiyagiJO

JOJO JO

Japanese Osaka

1982 1987 1992 1997 2003

Year of Publication

HHHH

HH

HH

Hawaiin Hawaii

Incidence (/100,000)

Site Distribution and Factors

Risk FactorsTobaccoBetel Nut TraumaHPV/EBVDiet

Protective FactorsAntioxidantsOral Hygiene

India Singapore Hawaii Ahmedabad Chinese Whites

20

40

0

Nasopharynx Tongue Mouth Oropharynx Hypopharynx


Distribution of Betel Chewing

From Chiba, 2001 APJCP

Histogenesis of Buccal Cancer

Oesophageal Cancer

0

5

10

15

20

25

SC

SC

SC

SC

Singapore Chinese

SM SMSingapore Malay

SM SM

SI

SI

SI

Singapore Indian

SI

IBIndian Bombay

IBIB

IB

CS

Chinese Shanghai

CS

CS

CS

CHKCHK

Chinese Hong Kong

CHK

CHK

JM

JM

JMJapanese Miyagi

JM

JOJapanese Osaka

JOJO

JO

HH

Hawaiin Hawaii

HH HH

HH

1982 1987 1992 1997 2003

Year of Publication


Country Location SCC AC Ratio

China, Tianjin 33.1 3.3 10:1China, Hong Kong 84.5 9.3 9:1India, Bombay 91.9 1.0 92:1India, Madras 86.0 11.8 7:1Israel, All Jews 69.9 23.5 3:1Japan, Miyagi 92.2 3.2 29:1Japan, Osaka 90.3 3.8 24:1Philippines, Manila 67.1 18.3 4:1Australia, NSW 54.3 38.5 1:1Australia, Victoria 53.6 39.1 1:1

SCC:Adenocarcinoma Ratios for Oesophageal Cancer

20

30

40

50

60

70

80

90

Brunei

IranIraq

Israel

Jordan

Kuwait

Lebanon

Saudi ArabiaSyria

Turkey

United Arab Emirates

Afghanistan

BangladeshCambodia

Indonesia

Laos

MyanmarNepal

Pakistan

Sri Lanka

Vietnam

South Korea

Malaysia

Hong Kong

JapanSingapore

China

India

Fiji

Philippines

Thailand

Papua New GuineaSamoa

Solomon Islands

Vanuatu

AustraliaNew Zealand

0 5 10 15 20Oesophageal Cancer Incidence/100,000

Correlation Coefficient r=0.31 p<0.059

ｹ

Cereals (% Diet)

Correlation between Cereal Intake and Oesophageal Cancer

Risk Factors

SCC Tobacco Opium Nutrient Deficiency Cereal Intake

Adenocarcinoma Obesity

Prevention

SQUAMOUS EPITHELIUM

PLAKIA PAPILLOMA

Primary Prevention Secondary Prevention

Vegetables and fruits

Smoking and Dietary Carcinogens Retinoids Antioxidants

Avoidance

TraumaReverse smoking Betel and lime

Alcohol VirusesScreening and resection

Sputum tests Physical examination CT/X-rays

Avoidance

Vaccination

Intervention Strategies: Buccal and Oesophageal SCCs

ProgressionInitiation Growth SCC

Gastric Cancer

0

10

20

30

40

50

60

70

80

90

SC

SC Singapore Chinese

SCSC

SMSingapore Malay

SM

SMSM

SI SI Singapore India

SI SIIBIB

IB

Indian Bombay

IB

CSCS

Chinese Shanghai

CS

CS

CHK

CHKCHK

Chinese Hong Kong

CHK

JM

JM

JMJapanese Miyagi

JM

JO JOJapanese Osaka

JOJO

HH

HH

Hawaiin Hawaii

HH HH

1982 1987 1992 1997 2003

Year of Publication


Disease Linkage: Correlation between mortality from cerebrovascular disease and gastric cancer in malesC

ereb

rova

scul

ar D

isea

se

50

100

150

200

250

300

UK

Scotland

N. IrelandHolland

Denmark

NorwaySweden

Finland

Germany

Switzerland

Austria

BelgiumFrance

Spain

Portugal

Italy

GreeceCroatia

Slovenia

Bulgaria

Czech

Hungary

Poland

Lithuania

Estonia

Latvia

Belarus

Ukraine

Moldova

Russia

Australia

New Zealand

CanadaUSA

5 10 15 20 25 30 35 40 45

Gastric Cancer

All r=0.7933 P<0.001

Group E r=0.7055 P=0.007

Group W r=0.7056 P<0.001

Factor Cardia Antrum

RiskHelicobacter +/- +++Epstein-Barr + +/-Gastric Ulcers +/- ++High Salt Diet ++ +++High fat Diet ++ +/-Obesity ++ +/-Smoking ++ +Alcohol + ++

ProtectiveVegetable Intake -- --

Data from the literature

Risk and Protective Factors for Cancer of the Gastric Cardia and Antrum

NORMAL

PAPILLOMA ADENO- CARCINOMA


Dietary supplementation

Smoking and Dietary Carcinogens

Avoidance

High Salt Diet/Alcohol Screening and resection

Serum Pepsinogen Endoscopy Fluorography

Avoidance

Chemoprevention?

Intervention Strategies: Gastric Adenocarcinoma

ProgressionInitiation Growth

Atrophic Gastritis H. Pyloris

Eradication Medication

?

Duodenogastric Reflux

NSAID'S?

Prevention

Colorectal Cancer

5

10

15

20

25

30

35

SC

Singapore Chinese

SC

SCSC

SMSM

SM

SM

Singapore Malay

SI

SISI

Singapore Indian

SIIB

IB IB Indian BombayIB

CS

CS CS

Chinese ShanghaiCS

CHKCHK

Chinese Hong Kong

CHK CHK

JMJM

JM

JM

Japanese Miyagi

JO

JO

Japanese Osaka

JO

JO

Hawaiin Hawaii

HH

HH

HHHH

1982 1987 1992 1997 2003

Year of Publication


20

30

40

50

60

70

80

90

Brunei

IranIraq

Israel

Jordan

Kuwait

Lebanon

Saudi Arabia

Syria

Turkey

United Arab Emirates

Afghanistan

BangladeshCambodia

Indonesia

LaosMyanmar

Nepal

Pakistan

Sri Lanka

Vietnam

South Korea

Malaysia

Hong Kong

JapanSingapore

China

India

Fiji

PhilippinesThailand

Papua New Guinea

SamoaSolomon Islands

Vanuatu

Australia

New Zealand

0 10 20 30 40 50 60

Colon Cancer Incidence /100,000

Correlation Coefficient r=-0.61 p<0.001

Cereals (% Diet)

Correlation between Cereal Intake and Colon Cancer

Dietary Factors

Major risk and beneficial factors on preneoplastic and neoplastic cells, with reference to dietary influence. IGF-IR, insulin like growth factor I receptor; IR, insulin receptor; SHR, steroid hormone receptor; SCFA's, short chain fatty acids; , enhancing stimulus; , inhibitory effect.

High Fat Diet

High fat diet

High calorie diet

PRENEOPLASTIC/NEOPLASTIC COLONIC CELL

GROWTH

Estrogen

IGF-IR IR SHR

GENE ACTIVATION

Insoluble Fiber

Insoluble>Soluble FiberSoluble Fiber

Soluble FiberInsulin

Cholesterol

Phytoestrogens

Lipid

Carbohydrate

Enterohepatic circulation

SCFAs

Mitoinhibition/ApoptosisToxicity

Bile Acids

Binding/Excretion

Carcinogen Initiation

Binding/Excretion

Antioxidant

Factors for Colon and Rectal Cancer

Factor Colon Rectum

RiskHigh fat Diet ++ ++Obesity ++ +/-Alcohol +/- +

ProtectivePhysical Activity +++ +/-Fibre Intake ++ ++

(Data from Food, Nutrition and the Prevention of Cancer: a global perspective, World Cancer Research Fund/American

Association for Cancer Research)

Colon or Rectal CancerR

ectu

m

0

1

2

3

4

5

6

7

8

UKEngland

Scotland

N. IrelandIreland Holland

Denmark

Iceland

Norway

SwedenFinland

Germany

Switzerland

Austria

Belgium

Luxembourg

FranceSpain

Portugal

Italy

Greece

Macedonia

Albania

Croatia

Slovenia

Bulgaria

Roumania

Czech

Hungary

Poland Lithuania

EstoniaLatvia

BelarusUkraine

Moldova

Russia

0 2 4 6 8 10 12 14Colon

All NS

Group East p<0.001

Group West p<0.05

Prevention

GLANDULAR EPITHELIUM

ADENOMA



Smoking and Dietary CarcinogensNSAID'S Insulin Sensitizers Lactoferrin

Avoidance

Trauma Alcohol Familial polyposisScreening and resection

Fecal Blood Mucin Markers Endoscopy

Avoidance

Surgery/Chemoprevention

Intervention Strategies: Colorectal Adenocarcinoma


Colitis Hemorrhoids

Medication

ADENO- CARCINOMA

Hepatocellular Cancer

0

10

20

30

40

50

SC SC

SC

Singapore Chinese

SC

SMSingapore Malay

SMSM

SM

SI SI

SI

Singapore Indian

SI

IB

Indian Bombay

IB IB IB

CS

CS

Chinese Shanghai

CS

CS

CHK

CHK


CHK

JM

JM

JM

Japanese Miyagi JM

JO

JO

Japanese Osaka

JO

JO

HH

HH Hawaiin Hawaii

HH

HH

1982 1987 1992 1997 2003Year of Publication


Lung Cancer

0

10

20

30

40

50

60

70

80

90

100

SC

SC

Singapore Chinese

SC

SC

SM SM

SMSM

Singapore Malay

SI

SI Singapore IndianSI

SIIB

IB

Indian Bombay IBIB

CSCS

CSChinese Shanghai

CS


CHKCHK

CHK

JM

JM

JM

JM Japanese Miyagi

JO

JO

JO

Japanese Osaka JO

HH

Hawaii Hawaii

HH

HH

HH

1982 1987 1992 1997 2003

Year of Publication


Lun

g S

quam

ous

Cel

l Car

cino

ma

0

10

20

30

40

50

UK

Eire

Holland

Denmark

Norway

Sweden

Finland

E Germany

France

Spain

Italy

Yugoslavia

Slovenia

Czech Republic

Slovakia

Estonia

Poland

Israel

India BombayIndia Madras

Singapore Chinese

Singapore Malay

Singapore Indian

Hong Kong

Thai Chiang Mai

Thai Khon Kaen

Vietnam

Korea

Japan

Philippines

Australia Hawaiian White

Hawaiian Japanese

Hawaiian Hawaiian

Hawaiian Filipino

Hawaiian Chinese

Canada

USA White

USA Black

SwitzerlandAustria

0 5 10 15Larynx Cancer

All: r=0.657 p<0.001

Group East: r=0.998 NS

Group West: r=0.582 p<0.005

Cancer Site Linkage: Lung Squamous Cell Carcinoma by Larynx Cancer Incidence/100,000

Col

on

0

5

10

15

20

25

30

UK

Eire

Holland

DenmarkNorway

Sweden

Finland

E Germany

France

Spain

Italy

YugoslaviaSlovenia

Czech

Slovakia

EstoniaPoland

Israel

India BombayIndia Madras

Singapore Chinese

Singapore Malay

Singapore Indian

Hong Kong

Thailand Chiang MaiThailand Khon KaenVietnam

Korea

Japan

Philippines

Australia NSWHawaii WhiteHawaii Japanese

Hawaii Hawaiian

Hawaii Filippino

Hawaii Chinese

CanadaUSA White

USA Black

Switzerland

Austria

0 5 10 15 20Lung AC

All p<0.001

Group Asia p<0.005

Group West p<0.001

Cancer Site Linkage: Colon By Lung Adenocarcinoma Incidence/100,000

Lung Carcinoma TypesAdenocar

cinoma Hobnail Columnar/Cuboidal Mixed Polygonal Goblet

Squamous Cell Carcinoma

Tumour Behaviour

Background Disease

Pathology EpidemiologyMolecular Biology

Parameters

Mutations Transversions Transitions

Kinetics Apoptosis Proliferation

Cell cycle/Signalling

Polymorphisms

Cancer Registration

Hospital-based Population-based

Risk/Beneficial Factors

Tobacco Dietary Factors Cooking Environment Climate Lifestyle Anthropomorphic factors

Genetic Background

Prevention

NORMAL

ADENOMA /PAPILLOMA

CARCINOMA



Smoking and Dietary Carcinogens Chemopreventor Application?

Avoidance

Irritants Bacterial InfectionScreening and resection

Sputum tests CT/X-rays

Medication

Intervention Strategies: Lung SCC, AC, Small Cell Carcinoma


Avoidance

Bronchitis Fibrosis

Smoking

Urinary Bladder Cancer

2

4

6

8

10

12

14

16

18

SC

SC

Singapore ChineseSC SC

SM SM

Singapore Malay

SM

SM

SI

SI

SISingapore Indian

SI

IB

IB

Indian Bombay

IB

IB

Chinese Shanghai

CS CSCS CS

CHK


CHK

CHK

JM

JM

JM

JMJapanese Miyagi

JO

JO

Japanese Osaka

JO

JO

HH

Hawaiin Hawaii

HH

HH

HH

1982 1987 1992 1997 2003

Year of Publication


Prostate Cancer

0

1

2

3

4

5

6

7

8

9

10

12

13

14

15

SC

SC

SC

Singapore Chinese

SC

SM

SM

Singapore Malay SM

SM

SI

Singapore Indian

SI

SI

SI

IB

IB

IBIndian Bombay IB

CS

CS CSChinese Shanghai

CS

CHK

CHK

CHK CHK Chinese Hong Kong

JM

JM

JMJM

Japanese Miyagi

JO

Japanese Osaka

JOJO

JO

1982 1987 1992 1997 2003

Year of Publication


Prevention

NORMAL

PIN ADENO CARCINOMA


Avoidance

Obesity

Intervention Strategies: Prostate Adenocarcinoma

Progression GrowthInitiation Growth

Testosterone GF/IGF

Smoking, Dietary Carcinogens

IGF

IGFBP3Test/DT

Serum Insulin

BMI (Obesity?)

1,25(OH)2D

Calcium FructoseHyperplasia

?SHBG

NIDDM

?

Physical Exercise

Screening and resectionDigital Examination Prostate Specific Antigen

Primary Prevention


Nutrition

Breast Cancer

15

20

25

30

35

40

45

SC

SC

SC

Singapore Chinese

SC

SM

SM

SM

SM

Singapore Malay

SISI

Singapore Indian

SI

SI

IB

IB IB

Indian Bombay IB

CSCS

Chinese Shanghai

CS CS

Chinese Hong Hong

CHK

CHK

CHKCHK

JM

JM

JM

JMJapanese Miyagi

JO

JO

JO

Japanese Osaka

JO



Registry Age class 25-34 35-44 45-54 55-64 65-74

China, Tianjin 4.5 15.5 15.8 13.5 6.9

India, Madras 1.8 8.2 9.7 7.6 4.4

Japan, Osaka 1.9 13.3 21.6 14.7 10.5

Phillipines, Manila 5.0 15.8 16.8 12.9 7.0

Thailand, Khon Kaen 1.3 4.5 4.5 2.8 1.1

Viet Nam, Hanoi 2.7 9.1 11.0 5.1 1.1

Australia, Victoria 5.2 25.3 38.3 37.5 41.8

*Incidence/100,000 x percentage of the female population # Data from Parkin et al., 1997

Age Dependence: Mammary cancer

0 10 20 30 40 50 60 70 80 90 Age (years)

Menarche Breast Density Menopause

Post-Menopausal Risk:Hormone Replacement/ Obesity Nulliparity or late first pregnancy

Pre-Menopausal Risk: Early menarche and late menopause Nulliparity or late first pregnancy Pre-Menopausal Protection: Obesity Anovulation and low progesterone Early first pregnancy and multiparity

Oestrogen/Progesterone Exposure

BREAST CANCER

Diet/ Phytoestrogens

Physical Exercise

Reproductive History Early Menarche/

Late Menopause

High Density

Low Density

Late Menarche/ Early Menopause

Low Density

High Density

Risk and Protective Factors

Risk Factors

NORMAL

ADENOMA ADENO CARCINOMA



Smoking, Dietary carcinogens

Avoidance

Screening and resectionPhysical Examination Mammography Ultrasound

Lifestyle Improvement of the Hormone Milieu

Intervention Strategies: Breast Adenocarcinoma


Oestrogen + Progesterone

Mastitis

Oestrogen

Insulin

Medication

Lifestyle Improvement

Physical Exercise Fiber Intake

Pharmaceutical Manipulation

Prevention

Cervical Cancer

0

5

10

15

20

25

30

SC

SC

SCSingapore Chinese

SC

SM

SM

Singapore Malay

SM

SM

SI

Singapore Indian

SI

SI SI

IB

IB Indian BombayIB

IB

CS

CS

Chinese Shanghai

CS CS

Chinese Hong Kong

CHK

CHK

CHK

CHKJM

JM

JMJapanese Miyagi

JM

JOJapanese Osaka

JO

JO

JO

HH

HH

HH

HH

Hawaiin Hawaii


0

5

10

15

20

25

30


Dietary Factors Physical Exercise Hormonal Environment

Persistent HPV High Risk Group Infection

Other STDsSmoking

Environmental Carcinogens

Normal Epithelium CINI CINII CINIII CERVICAL CANCER

Dietary Factors Physical Exercise Hormonal Environment

Comprehensive Cervical Cancer Research Program Questionnaire: Lifestyle Factors (Smoking, Diet, Exercise, Cooking/Work Environment, Sexual Behaviour Disease and Reproductive History Screening: HPV Testing, Pap Smear (Self/Non-self Sampling), Direct Visual Acetic Acid Blood Samples: Nutrients, HPV Antibodies, Serum Markers, Hormones

Risk Factors

Prevention

NORMAL

CIN I-III



Smoking and Dietary Carcinogens

Avoidance

Trauma VirusesScreening and resection

Papanicolau Smear Direct Visual Acetic Acid HPV Testing

Careful Sexual Behaviour

Vaccination

Intervention Strategies: Cervical Squamous Cell Carcinoma


Infections

Medication

SCC

Data from Inoue and Tominaga, 2003 (APJCP)

Lifetime Cumulative Risk: Japan

SitesCancer control Methods/assumptions Direct All

Primary prevention Smoking 17.5% 8.8% Chemoprevention? Dietary 25.6% 10.3%

Infection 13.9% 7.0%Subtotal 26.1%

Cancer screening Participation rates for gastric, colo-rectal, cervical, lung andbreast cancer 30 to 50% 29.4% 8.8-14.7%

Improved diagnosis/treatment 5-year survival rate elevated by

0.6 - 1.0% per year for 10 years 6.0-10.0%

Total 40.9-50.8%

Potential for Prevention of Cancer Incidence/Deaths in Japan

Data after Tominaga, 2001 (APJCP)

Level 2 Screening

Level 3 Screening and Surgery

Hospitals


Primary Prevention Information

Access

Exercise Arobics Dance /Yoga Bicycle Transport

Vegetables Health Foods

Pharmaceuticals

Intervention Method Efficacy

Metabolic/ Infectious Agent Parameters

Psychological/ Socioeconomic Factors

W H Y

W H A T

Level 1 Screening

PPPAccess

Research Access

General Populace, Local Groups, Firms, Hospitals, Education Establishments

Access

Infectious Agents Metabolic Lifestyle - Diet and Exercise

Lifestyle Improvement Screening Efficacy Tobacco Cessation

Practical Prevention Program

Schools Colleges Universities

Students

Teachers

Public Offices / Libraries

General/Hospital Practitioners

Pre-schools

Parents

Children

Medical Schools

Oncology Curriculum

Oncology Information

Cancer Prevention Coordination

General Population

ScreeningProgress Courses

Workplace Workers

Retirees

Integrated Cancer Prevention: Communication Routes

Civil Servants/ Volunteers/

Ethics Committees

Government

Who and Where?

Thank you!