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EXMD 504 Biology of Cancer > Epidemiology of Neoplasia > Flashcards

Epidemiology of Neoplasia Flashcards

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1
Q

Bert Vogelstein’s paper “Variation in cancer risk […] explained by the number of stem cell divisions” showed that only a ________ of the variation in cancer risk among tissues is attributable to ______________ factors or ___________ dispositions

A

Third; environmental; inherited

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2
Q

What was the conclusion of Vogelstein’s paper?

A

The majority of cancers is due to “bad luck”, which is random mutations during DNA replication in normal, noncancerous stem cells

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3
Q

How did epidemiologists react to this conclusion?

A

They disagreed, stating that the majority of cancers are preventable and not due to “bad luck”

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4
Q

Which cancer has the largest age-adjusted death rate amongst males?

A

Lung and bronchus cancer

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5
Q

True or false: Men in the US during the 1940s were less likely to develop cancer compared to the men in the 1990s

A

True

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6
Q

How did the conclusion from the paper come to be? Complete the following sentence:
“A linear correlation equal to 0.804 suggests that 65% of the differences in cancer risk between different _________ can be explained by the total number of ______ cell divisions in those tissues.”

A

Tissues; stem

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7
Q

Epidemiologists conclude that one cannot explain differences in cancer risk between different _______ and between different _____________

A

People; populations

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8
Q

Most cancers are not due to “bad luck”; cancer incidence and cancer risk are ____________-level quantities where the denominator is ___________ size, not ___________ sites

A

Population; population; tissue

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9
Q

Epidemiology is the study of the patterns and causes of ___________ in a ______________

A

Diseases; population

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10
Q

Cancer surveillance is the burden of ___________, incidence and ____________ trends

A

Disease; mortality

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11
Q

Cancer risk is assessing _____________ ___________ factors

A

Candidate etiologic

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12
Q

Cancer prevention is assessing the efficacy and the impact of __________, chemoprevention and other preventive ______________

A

Screening; approaches

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13
Q

Cancer survival is assessing ______________ factors, determinants of quality of life

A

Prognostic

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14
Q

What kinds of questions determine the cancer surveillance?

A

Who gets cancer? How many people have cancer? How many people will die of cancer?

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15
Q

What are the two factors of measuring occurrence of cancer?

A

Number of cases and incidence/mortality rates

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16
Q

The incidence rate is the new cancer ________ in a population per ______________-______

A

Cases; person-years

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17
Q

The mortality rate is the new cancer _________ in a population per _____________-_______

A

Deaths; person-years

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18
Q

True or false: The number of cases is useful for measuring risk and casuality

A

True

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19
Q

The incidence rate adjusts for what?

A

The population size

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20
Q

In which part of the world are the incidence rates higher?

A

The Western world and Europe

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21
Q

What does age-standardized mean?

A

Adjusted for differences in ages

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22
Q

Age structure varies over which factors?

A

Space and time

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23
Q

In which countries is the majority of the population older?

A

High income countries

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24
Q

In which countries is the majority of the population younger?

A

Low and lower-middle income countries

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25
Q

True or false: There were less cases in 2022 than in 2002 because the population was getting smaller

A

False, there were more cases in 2022 than in 2002 because the population was getting larger

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26
Q

What is a standard population age distribution?

A

2011 census population in Canada (cross-time) and 1960 World population (cross-country)

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27
Q

How do we calculate what the cancer incidence rate would have been if it had the same age distribution as the standard?

A
  1. Calculate the % of population in each age group in 2011
  2. Calculate age-specific incidence rates of given year X
  3. Multiply age-specific incidence rates of given year X by proportion in that age group in 2011 and sum over all age groups
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28
Q

What does standardization allow?

A

Comparing populations with different age structures to assess change in cancer risk

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29
Q

All the populations have the same standard ____ _______________ after standardization

A

Age distribution

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30
Q

What is the crude incidence rate?

A

Dividing by population size adjusts for changes in population size

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31
Q

What is age-standardized incidence rate?

A

Standardization adjusts for changes in population age

32
Q

What does the net cancer survival adjusts for?

A

Competing causes of cancer

33
Q

Why would the net cancer survival be adjusted in that way?

A

To better assess the efficacy of cancer treatments as well as adjust the rate based off of other factors

34
Q

What explains the different rates of cervical cancer between all countries?

A

HPV and HIV infection

35
Q

What prevention technique is used to detect cervical pre-cancer?

A

PAP smear

36
Q

True or false: Countries with less screening programs will have a lesser chance of being able to prevent cancer

A

True

37
Q

True or false: Cervical cancer is not potentially preventable

A

False, it is potentially preventable

38
Q

What are the risk factors of liver cancer?

A

Hepatitis infection, alcohol

39
Q

What increases the risk of liver cancer in Mongolia?

A

The usage of same needles to treat many individuals

40
Q

True or false: Liver cancer is potentially preventable

A

True

41
Q

Vascularization is part of which phase of tumor growth?

A

Dormant phase of tumor growth

42
Q

Clinical detection and lethal tumor burden are part of which phase of tumor growth?

A

Rapid tumor progression phase

43
Q

What are the questions associated with assessing cancer risk factors?

A

What are the causes of cancer? What increases/decreases your risk of cancer?

44
Q

True or false: In the 1910s, dying from lung cancer was a rare phenomenon

A

True

45
Q

What led to the increase of cigarette usage in the 1910s?

A

World War I

46
Q

Around what time did the consumption of tobacco increase then decrease?

A

The 1930s (the Great Depression)

47
Q

What did Dr. Ochsner conclude about the link between tobacco consumption and lung cancer mortality?

A

He concluded that the increase of lung cancer doesn’t have to be correlated with the increase of smoking

48
Q

Analytical studies measure the association between an ___________ and a health __________

A

Exposure; outcome

49
Q

Analytical studies include which group used to compare outcomes?

A

Control groups

50
Q

What model is used to justify causal inference?

A

Counterfactuals

51
Q

What is the counterfactual model?

A

A causal factor is needed to make a certain outcome occur

52
Q

True or false: Individual causal effect can be observed

A

False, it can never be observed

53
Q

When inferring causal effects, what can be done to estimate the average causal effect?

A

Comparing outcomes in similar individuals (control group)

54
Q

Why would a randomized control trial not be efficient for determining causal factors of lung cancer?

A

You cannot randomize an exposure that is potentially harmful

55
Q

What is the ratio measure of clinical trials?

A

Risk ratio (RR)

56
Q

What type of clinical trial would be used to assess the causes of cancer?

A

Case-control study

57
Q

What is the ratio measure of case-control studies?

A

Odds ratio (OR)

58
Q

If RR=1, exposed individuals have the _________ risk of experiencing the outcome as unexposed individuals

A

Same

59
Q

If RR > 1, exposed individuals have a _________ risk of experiencing the outcome as unexposed individuals

A

Higher

60
Q

If RR < 1, exposed individuals have a _________ risk of experiencing the outcome as unexposed individuals

A

Lower

61
Q

True or false: RR is a measure of causal effect

A

False, RR is a measure of association

62
Q

What is the ratio measure of cohort studies?

A

Incidence rate ratio (IRR)

63
Q

What does a cohort study entail?

A

Following a group of participants over time to evaluate the effect of certain exposures on their health

64
Q

What are the issues with observational data?

A

Confounding bias and information bias

65
Q

What is the basis of confounding bias?

A

Exposure is confounded with other extraneous factors causing disease

66
Q

What is the basis of information bias?

A

Error due to incorrect measurement of exposure and/or health outcome

67
Q

What type of studies were conducted to find out that HPV was the cause of cervical cancer?

A

Case-control studies

68
Q

What type of studies were conducted to find out that regular users of NSAIDs had 10-15% lower incidence rates of colorectal cancer?

A

Cohort studies

68
Q

Which drug reduces inflammation and prevents blood clots?

A

NSAIDs

69
Q

What question does the population attributable fraction (PAF) pose?

A

What proportion of cancer cases are attributable to a specific exposure?

70
Q

What proportion of cancer cases are attributable to a specific exposure?

A

Depends on the increased risk of cancer associated with the exposure (RR, OR, IRR) and the prevalence of the exposure

71
Q

What is the PAF of melanoma?

A

45% of the 80% of people with sunburns will most likely have a higher risk of getting melanoma

72
Q

True or false: Not all the risk factors have the same impact on cancer risk

A

True

73
Q

Screening is the examination of asymptomatic people in order to identify disease or disease precursor ________ it would have become symptomatic

A

Before

74
Q

What are the conditions of screening?

A

Must be preclinical phase during which disease is undiagnosed, asymptomatic, but detectable
Must be some benefit of early treatment over later treatment

75
Q

What type of study was done to observe sigmoidoscopy screening and ovarian cancer screening?

A

Randomized control trial

76
Q

According to the Canadian Task Force on Preventative Health Care, which screenings are recommended and not recommended?

A

R: Colorectal, cervical, lung and breast cancer
NR: Pelvic exams for other gynecological cancers and prostate cancer

EXMD 504 Biology of Cancer (5 decks)

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