Summary Deck Flashcards
How would you approach Cancer Cluster investigation
Cancer cluster investigation
* Cancer cluster: greater than expected number of
cancer cases that occurs within a group of people
in geographic area over a defined time period
* Investigation steps
- Initial contact and response (e.g. cancer type,
number of cases, hazard of concern)
- Assessment: is cluster in statistically significant
excess? calculate standardized incidence ratio
- Determine feasibility of epi study (e.g. study
population, comparison group, study design)
- Conduct etiological investigation: determine
if contaminant might be associated with cluster
IARC Group 1 carcinogens by element
- Aluminium: lung, bladder
- Arsenic: lung, skin
- Beryllium: lung
- Cadmium: lung
- Chromium VI: lung
- Iodine-131: thyroid
- Nickel: nasal cavity/paranasal sinus, lung
- Radon: lung
- Plutonium: lung, bone
IARC Group 1 carcinogen by microorganism
- HPV types 16 and 18: cervical cancer
- Human T-cell lymphotropic virus 1 (HTLV-1):
leukemia, lymphoma - Hepatis B virus: liver cancer
- Hepatitis C virus: liver cancer
- Helicobacter pylori: stomach cancer
- Human herpes virus 8: Kaposi sarcoma
- HIV: lymphoma, eye cancer, Kaposi’s
- EBV: lymphoma, stomach cancer
- Schistosoma: bladder cancer
Top Cancer causes, incidence, mortality and prevention
Tobacco (22%)
* Micro-organisms (22%)
* Occupational exposures (10%)
* Environmental (1-4%)
Incidence
* 40% of Canadians will develop cancer
* Overall: lung, breast, colorectal
* Men: prostate, lung, colorectal
* Women: breast, lung, colorectal
Mortality
* 25% of Canadian will die from cancer
* Overall: lung, colorectal, pancreas
* Men: lung, colorectal, prostate
* Women: lung, breast, colorectal
Prevention
* Avoid smoking
* Reduce alcohol consumption
* Healthy eating and active lifestyle
* Healthy body weight
* Receive the HPV and Hepatitis B vaccines
* Reduce environmental exposures
* Wear PPE for occupational carcinogen exposure
IRAC Carcinogens
- UV radiation: melanoma, SCC, BCC
- Particulate matter: lung cancer
- Benzene: leukemia
- Asbestos: lung cancer, mesothelioma
Breast Cancer risk factors
Risk factors
Biological
* Female sex
* Family history
* Genetic mutations
* Early menarche
* Late menopause
Medical
* First pregnancy
after age 30
* HRT > 5 years,
* Obesity
* Not breastfeeding
* Dense breast
tissue
Behavioral
* Smoking
* Heavy alcohol use
* Physical inactivity
Environmental
* Ionizing radiation from
occupation (radiation
worker) or iatrogenic
(repeated CXR for TB,
childhood leukemia
treatment)
* 2nd hand smoke exposure
Colorectal Cancer Risk factors
Biological: Age over 50
* Male sex
* Family history
* Ashkenazi ethnicity
Medical: Polyps
* Obesity
* IBD (Chron’s)
Lifestyle: Smoking
* Heavy alcohol use
* Physical inactivity
* Red & processed meat
-Environmntal * Ionizing radiation (x-ray,
gamma ray)
What is active and passive prevention?
- Active prevention: require action on part of
individuals (seatbelt use, falls prevention) - Passive prevention: require no action on part of
individual (air bags, smoke alarm)
What is the Risk homeostasis theory?
People adapt behaviour to changes in
environmental conditions (safer the situation, the
riskier the behaviour, overall risk level is the same)
* More an individual values their future, the less
overall risk they will be willing to take
What are the types of injury ?
- Intentional: inter-personal violence (homicide,
sexual assault, neglect), suicide, collective violence - Unintentional: road traffic collisions, poisoning,
falls, fire and burn injuries
Epidemiology
* Injury leading cause of death amongst ages 1 - 34
* < 12 months: fall, threat to breathing, poisoning
* 1 to 4: falls, poisoning, fire/hot object
* 5 – 9: falls, stuck by/against an obstacle, MVC
* 10 – 14: falls, stuck by/against an obstacle, MVC
* 15 – 19: falls, MVC, stuck by/against an obstacle
* 20 – 64: suicide
* 65+: falls
What is Haddon’s Matrix
- Framework to identify underlying causes of injury
in order to design interventions - Conceptualizes injuries as resulting from
interactions between host, agent/vector, and
environment - Preinjury phase: eliminate source, reduce
exposure, or increase magnitude of resistance to it - Event: reduce magnitude and duration of
exposure, decrease host’s susceptibility to injury - Post-injury phase: environment can be altered to
reduce the source of the injury in the future and
facilitate the rescue and resuscitation of victims
Risk factors for injuries and injury pyramid by type
Risk factors for injury
* Adolescents aged 12 – 19 and elderly
* Males
* Participating in sports activities
Injury pyramid by type
* Fatal injury
* Serious injury
* Minor injury
* Near miss event
* Unsafe act
injury Pyramid by type and source of data
1.Deaths = Vital Statistics
2.Injuries requiring hospitalization = Discharge Abstract Databases (DADs)
- Injuries requiring ED visit = National Ambulatory Care Reporting System (NACRS), Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP)
- Injuries resulting in Primary Care visit = administrative data/billing codes, primary care EMRs contributing to Canadian Primary Care Sentinel Surveillance Network (CPCSSN)
5.Injuries treated outside health system = Canadian Community Health Survey (CCHS)
COunter measures
Prevent the creation of the
hazard eg- Banning body checking in hockey for children
Reduce the amount of the
hazard created eg-Catalytic converters
Prevent the release of the
hazard that already exists eg-Milk pasteurization
Modify the rate of release of
the hazard from its source eg- Nuclear reactor control rods
Separate, in time or space,
the hazard and the individual
eg- Isolation of COVID19 case
Separate hazard and
individual using a barrier
eg-Childproofing
Modify the hazard to make it
less hazardous
eg-Reducing the space
between crib slats
Make individual at risk more
resistant to the hazard eg- Immunization
Counter the damage already
done by a hazard
eg-Rescue operations
Stabilize, rehabilitate, or
repair damaged objects
Rebuilding
Seniors Fall
Biological * Acute illness
* Chronic conditions (e.g., stroke,
CVD, disability)
* Cognitive impairment
* Balance and gait deficits
* Vision impairment
* Muscle weakness
Behavioural * Alcohol use
* Meds (sedatives, anti-HTN)
* Loose or thick footwear/clothing
* Inadequate diet
* Fear of falling
* Misuse of assistive devices
Socioeconomic
* Low income and education
* Limited social network
Environment * Community hazards (no
handrails, curbs)
* Home hazards (rugs, lighting)
* Poor weather conditions (icy
sidewalk)
- Health outcomes: fractures, isolation,
depression, immobilization - Interventions: falls risk assessment, exercise
program targeting balance/gait, assistive device,
home modification, vision correction, medication
review, vitamin D supplementation
