Cancer Epidemiology

Question 1

Describe the differences in death rate from cancer and heart disease in <85 and 85>

Answer 1

Higher rates in <85

Question 2

Describe the temporal trend in death rate from cancer

Answer 2

Little change from 1975

Question 3

Which countries have the highest cancer incidence rates (top 5)

Answer 3

Ireland
Belgium 
France
USA
UK

Question 4

What does a rapid change in risk following migration suggest

Answer 4

Lifestyle/environment factors act late in carcinogenesis

Question 5

What does a slow change in risk following migration suggest

Answer 5

Suggests that exposures early in life are the most relevant

Question 6

What does persistence of rates between generations suggest

Answer 6

Genetic susceptibility is important in determining risk

Question 7

Describe the trend in mortality of cancer

Answer 7

Decreasing in most high-income countries

Not decreasing in low income countries

Question 8

Describe the trend in incidence for common cancer sites

Answer 8

Incidence is increasing for common cancer sites in both high-income (now with plateauing and even decreases) and low-income countries (e.g. breast, colorectum, prostate)

Question 9

What is thought to be the cause of the increase in incidence of common cancer sites

Answer 9

effects of earlier diagnosis, screening, changes in risk factors

Question 10

Why is total burden of cancer increasing

Answer 10

Demographic changes (ageing populations, increasing size)
Westernization of lifestyles

Question 11

What proportion of cancer has its risks increased by inherited conditions

Answer 11

5-10%

Question 12

Give examples of inherited conditions that can increase risk of cancer

Answer 12

Paget’s - bone
Fanconi’s - leukaemia, liver, skin
Familial adenomatous polyposis - colon, rectum
Hereditary retimoblastoma - retinoblastoma

Question 13

What are the main risk factors for cancer

Answer 13

Smoking 
Diet 
Alcohol 
Infection 
Occupation 
Reproductive

Question 14

What percentage of cancers in men and women could be prevented if risk factors had been reduced to the optimal levels or eliminated

Answer 14

men - 45%

women - 40%

Question 15

Other than reducing cancer risk, what are the advantages of reduction/elimination of risk factors

Answer 15

Substantial reduction also of cases of: 
Cardiovascular disease
Renal disease
Hepatic disease
Diabetes 
Possibly some neurological diseases.

Question 16

What proportion of cancer deaths does smoking account for + lung cancer deaths in mean and women

Answer 16

30%

men - 90%
women - 80%

Question 17

What types of cancers are promoted by alcohol

Answer 17

Oral cavity
Pharynx 
Larynx
Oesophagus 
Liver

Question 18

Describe the effect of alcohol on cancer

Answer 18

all types of alcohol
mechanisms poorly understood
synergism with tobacco
balance with preventive effect for CHD

Question 19

What are the guidelines for dietary prevention of cancer

Answer 19

1. Be as lean as possible without becoming underweight
2. Be physically active for at least 30 minutes every day
3. Avoid sugary drinks. Limit consumption of energy-dense foods (particularly processed foods high in added sugar, or low in fibre, or high in fat)
4. Eat more of a variety of vegetables, fruits, wholegrains, and pulses such as beans.
5. Limit red and processed meats
6. Drinks limited to 2(M) or 1(F)
7. Limit salty foods
8. Supplements do not work

Question 20

Describe the western lifestyle

Answer 20

Energy dense diet, rich in 
	- fat, 
     	- refined carbohydrates 
	- animal protein
Low physical activity
Smoking and drinking

Question 21

What are the consequences of the western diet

Answer 21

Greater adult body height 
Early menarche
Obesity
Diabetes
Cardiovascular disease
Hypertension

Question 22

What proportion of cases of cancer are caused by infectious agents

Answer 22

16%

Question 23

Wha is cancer incidence related to

Answer 23

Age
Common environmental causes
Geographical variation and secular trends

There are several well defined risk factors for cancer