Chapter

13
Cancer
 Cancer and Global
Health
13.1
 Cancer and Global Health
• Cancer is a major cause of disease, disability, and death in every country.
• Adults living in high-income countries are more likely to develop cancer
than are adults living in low-income countries.
• The life expectancy is higher in high-income countries, so more people live
long enough to develop cancer, but this trend is present even after adjusting
for differences in the age structures of populations.
• People who live in high-income countries are significantly more likely to
receive a cancer diagnosis than are people of the same age who live in low-
income countries.
• People in low-income countries who have cancer are more likely to die
from the disease than are people the same age who live in high-income
countries.
• Cancers in low-income countries tend to be diagnosed at an advanced stage.
• In many places there is limited access to cancer treatment.
 Cancer and Global Health
(cont’d)
• There is significant diversity in which types of
cancer cause the greatest burden by region and
country income level.
• All countries would benefit from discoveries
that enable primary prevention of various types
of cancer and from improvements in cancer
diagnosis and treatment.
• Global collaborations are the most efficient way to
accelerate the process of making scientific
breakthroughs.
 Cancer Biology
13.2
 Cancer Biology
• Cancers = abnormal cells begin to reproduce
uncontrollably, often invading nearby tissues and
then spreading to other parts of the body.
• Also called neoplasms, a term derived from words
meaning “new formation.”
• Normal cells are genetically stable, and if mutations
or other types of damage cannot be repaired, the cell
will undergo a process of programmed cell death
called apoptosis.
• Cancer cells are genetically unstable and undergo
unlimited reproductive cycles.
 Cancer Biology (cont’d)
• Cells from a primary cancerous tumor that invade the
walls of blood vessels or lymph vessels can travel to
other parts of the body, proliferate (multiply) there, and
form new tumors at that distant site.
• Metastasis = a secondary cancerous tumor at a new site.
• The cells in that secondary tumor will be the same as the
cells as the primary cancer site.
• Cancer cells can stimulate angiogenesis, the formation of
new blood vessels, to nourish a new cancerous tumor.
• Not all tumors are malignant (cancerous); some tumors
are benign (noncancerous), and they do not metastasize.
 Cancer Types
• It is a bit misleading to refer to cancer as one disease
because there are several hundred different types of cancer.
• Cancers are named for the part of the body where they
originate and for the specific type of cell that has become
cancerous.
• Carcinoma = a cancer that forms in epithelial tissues, which
usually line the inside or outside of the body.
• Sarcoma = a cancer that arises from connective tissues like
bones or muscles.
• Leukemias, lymphomas, and myelomas are cancers that form
from blood or in the bone marrow where blood is produced by
the body.
 Cancer Staging
• Cancers are classified based on whether the cancer cells remain
noninvasive and local, if they have spread to regional lymph nodes, or
if they have spread to distant parts of the body.
• TNM classification system
• Size of the original Tumor
• Number of lymph Nodes near the primary tumor that have cancer cells in
them
• Whether Metastasis has occurred
• 4-stage scale
• Stage 0: precancerous lesions like carcinoma in situ
• Stage I: cancer is localized
• Stages II and III: cancers have spread regionally
• Stage IV: cancer has spread to distant sites
• The treatment approach is based on the stage of the cancer at diagnosis.
 Cancer Epidemiology
13.3
 Cancer Epidemiology
• About 1 in 8 deaths worldwide each year is
caused by cancer.
• Each year nearly 15 million people are diagnosed
with cancer and more than 8 million people die of
cancer.
• About 30% of men and 20% of women who live
to age 80 will have developed some type of
cancer, even after excluding the non-melanoma
skin cancers that are typically not included in
reports of cancer statistics.
 Cancer Epidemiology (cont’d)
• The cancer diagnosis rate is much higher in high-
income countries than in low-income countries,
even after adjusting for differences in the age
structure of populations in those countries.
• A person living in a high-income country is more
than twice as likely to receive a cancer diagnosis as
a person of the same age who lives in a low-income
country.
• This is partly due to richer people having more
access to cancer screening and diagnosis.
 Cancer Epidemiology (cont’d)
• Cancer mortality rates are fairly similar
across income groups.
• A person in a high-income country has a
high likelihood of receiving a cancer
diagnosis but is likely to survive the disease.
• A person with cancer in a low-income
country has a low likelihood of being
diagnosed with cancer but is unlikely to
survive.
 Data from Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN
(diagnosis) rate is higher in high-income
countries than in low-income countries.
The age-standardized cancer incidence

2012: Estimated cancer incidence, mortality and prevalence

worldwide in 2012 v1.0. IARC CancerBase No. 11. Lyon: IARC; 2013.
Figure 13-1
 The age-standardized cancer mortality (death)

Data from Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN

rate is similar across most income levels.
2012: Estimated cancer incidence, mortality and prevalence
worldwide in 2012 v1.0. IARC CancerBase No. 11. Lyon: IARC; 2013.
Figure 13-2
 Cancer Epidemiology (cont’d)
• Cancer mortality rates have been decreasing in
high-income countries as diagnosis and
treatment options improve.
• Cancer incidence rates and mortality rates are
increasing in low- and middle-income countries
as life expectancies in those areas increase.
• The majority of cancer diagnoses and cancer
deaths now occur in the middle-income countries
where the majority of the world’s people live.
 High income countries have the highest burden
Data from Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN
2012: Estimated cancer incidence, mortality and prevalence
worldwide in 2012 v1.0. IARC CancerBase No. 11. Lyon: IARC; 2013.
Figure 13-3

from cancer.
 Common Cancers Worldwide
• Diagnosis
• Lung and prostate cancers are the most commonly
occurring cancers in men.
• Breast cancer is the most commonly occurring cancer in
women.
• Other commonly diagnosed cancers include colorectal,
stomach, liver, and cervical cancers.
• Mortality
• Lung cancer is the most common cause of cancer death.
• Other common causes of cancer death include liver,
stomach, colorectal, and breast cancers.
 Data from Ferlay J, Soerjomataram I, Dikshit R,
Eser S, Mathers C, Rebelo M, Parkin DM, Forman
D, Bray F. Cancer incidence and mortality
worldwide: sources, methods and major
patterns in GLOBOCAN 2012. Int J Cancer 2014;
136:E359-86.
Distribution of worldwide cancer diagnoses by
Figure 13-4

type and sex.

 Data from Ferlay J, Soerjomataram I, Dikshit R,
Eser S, Mathers C, Rebelo M, Parkin DM, Forman
D, Bray F. Cancer incidence and mortality
worldwide: sources, methods and major
patterns in GLOBOCAN 2012. Int J Cancer 2014;
136:E359-86.
Distribution of worldwide cancer deaths by
Figure 13-5

type and sex.

 Common Cancers by Country
• There are significant differences in the types of cancers that
are common in different world regions, and even by country
within world regions.
• For example, prostate cancer is the most commonly diagnosed
cancer in men in the United States, but the most common cancer
diagnosis is lung cancer in China, stomach cancer in Iran, lip and
oral cavity cancer in India, and colorectal cancer in Ethiopia.
• There are similarly diverse variations in the most common
causes of cancer mortality.
• While lung cancer is the most common cause of cancer death in
men in the United States, the most common cause of cancer death
among men is prostate cancer in Brazil and Nigeria, stomach
cancer in Iran, and leukemia in Ethiopia.
 Data from Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012:
Estimated cancer incidence, mortality and prevalence worldwide in
2012 v1.0. IARC CancerBase No. 11. Lyon: IARC; 2013.
Most common cancer diagnoses and causes of
cancer mortality in featured countries.
Figure 13-6
 Cancer Risk Factors
and Prevention
13.4
 Cancer Risk Factors
• Cancer is a genetic disease, but it usually results from
mutations rather than inheritance.
• Those mutations can occur via numerous pathways.
• Tobacco use increases risk of cancers.
• Occupational exposures to carcinogens damages cells.
• Environmental hazards such as air pollution, residential radon,
and arsenic induce cellular damage.
• An unhealthy diet, obesity, and physical inactivity may impair
cellular function.
• Chronic infections are thought to cause more than 2 million
cancers worldwide each year, contributing to more than 1 in 4
cancers in lower-income areas and about 1 in 14 cancers in in
higher-income areas.
 Data from Plummer M, de Martel C, Vignat J, Ferlay J, Bray F, Franceschi S.
Global burden of cancers attributable to infections in 2012: A synthetic
analysis.
Lancet Glob Health 2016;4:e609–16. Data from Examples of cancers
associated with chronic infections.
Examples of cancers associated with chronic
Figure 13-7

infections.
 Cancer Risk Factors (cont’d)
• Risk factor = an exposure or characteristic that increases
the likelihood of developing a particular disease.
• Risk factors may be biological, environmental, behavioral, or
other types of exposures or characteristics.
• For most kinds of cancer, age is the strongest risk factor.
• Nearly 60% of cancer diagnoses and 70% of cancer deaths
worldwide occur in people who are at least 60 years old.
• Aging is a nonmodifiable risk factor that cannot be
changed through health interventions.
• The burden from cancers associated with aging will increase
as life expectancies increase.
 Data from Global health risks: mortality and
burden of disease attributable to selected major
risks. Geneva: WHO; 2009.
Common risk factors for adverse health outcomes.
Figure 13-8
 Data from Ferlay J, Soerjomataram I, Ervik M, et al.
GLOBOCAN 2012: Estimated cancer incidence, mortality
and prevalence worldwide in 2012 v1.0. IARC CancerBase
No. 11. Lyon: IARC; 2013.
worldwide increase with age. (Non-melanoma
skin cancers are not included in these rates.)
The cancer incidence and mortality rates
Figure 13-9
 Data from Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012:
Most cancer deaths occur in older

Estimated cancer incidence, mortality and prevalence worldwide in 2012

v1.0. IARC CancerBase No. 11. Lyon: IARC; 2013.
Figure 13-10

adults.
 Cancer Risk Factors (cont’d)
• Modifiable risk factors = risk factors that can be altered.
• Behavioral risk factors = tobacco smoking, exercise habits, and
other lifestyle practices.
• Causal factor = an exposure that has been scientifically tested and
shown to occur before the disease outcome and to contribute
directly to its occurrence.
• Once risk factors are recognized, prevention campaigns that
reduce exposure to risk factors or promote a protective factor
can be tailored to particular populations.
• Many diseases are multicausal, which means that many
different risk factors contribute to the disease occurring and
many possible pathways for the primary prevention of cancer.
 Figure 13-11

Criteria for evaluating whether an exposure

causes a disease or other health outcome.
 The Risk Transition
• A global risk transition is occurring in which the
risk factors accounting for the largest proportion
of preventable morbidity and mortality globally
are shifting.
• Pre-transition key exposures: undernutrition, unsafe
water, indoor air pollution, and other factors that
increase the risk of childhood infectious diseases.
• Post-transition key exposures: obesity, physical
inactivity, tobacco use, and other exposures that
increase the risk of chronic diseases, including many
types of cancer.
 Cancer Prevention
• Today, about one-third of cancer deaths are attributed
to nine modifiable lifestyle and environmental factors:
• Overweight and obesity
• Low fruit and vegetable intake
• Physical inactivity
• Smoking
• Alcohol use
• Unsafe sex
• Urban air pollution
• Indoor smoke from household use of solid fuels
• Contaminated injections in healthcare settings
 Cancer Prevention (cont’d)
• Only about half of cancers occurring globally
today are ones that could be prevented with
current scientific knowledge and
technologies.
• Many types of cancer have no currently known
modifiable risk factors.
• About 5% of the genetic mutations that lead to
cancer are inherited, about 30% are due to
environmental exposures, and about two-thirds
are random mutations.
 Cancer Prevention (cont’d)
• It is rarely possible to know with certainty which
particular factors led to a particular case of cancer
developing.
• The existence of prevention methods for some types of
cancer does not mean that all cancers are preventable.
• It is inappropriate to assign blame for the disease to
people with cancer.
• Even people who follow all the scientific guidance
about cancer prevention must remain vigilant about
screening and seeking medical care for symptoms that
might indicate the presence of cancer.
 Cancer Screening and
Diagnosis
13.5
 Screening
• When cancer cannot be prevented, the next best option is to detect
cancer at an early stage through screening.
• Screening = a type of secondary prevention in which all members
of a well-defined group of people are encouraged to be tested for
a disease based on evidence that members of the population are at
risk for the disease and that early intervention improves health
outcomes.
• The goal of cancer screening programs is to identify precancerous
lesions or early-stage, localized cancers in people who have no
symptoms of a particular cancer.
• It is not screening when diagnostic tests are conducted in people
who already have signs and symptoms of cancer in order to
confirm the presence of cancerous cells.
 Figure 13-12

Timeline for the natural history of disease.

 Screening Tests
• A good screening test will have a high diagnostic accuracy,
with nearly 100% of test results being true positives or true
negatives.
• A good screening test will also have nearly 100% sensitivity,
specificity, PPV, and NPV.
• Sensitivity = the proportion of people who truly have the disease
who test positive for the disease.
• Specificity = the proportion of people who are truly free of the
disease who test negative for it.
• Positive predictive value (PPV) = the proportion of people who
test positive for the disease who truly have disease.
• Negative predictive value (NPV) is the proportion of people who
test negative for the disease who truly do not have disease.
 Cancer Screening
• The recommended cancer screenings vary by
country, by age group, by sex, and by other
population characteristics.
• Population-based screening targets large
groups of people, like all women ages 40 to 79
years.
• High-risk screening targets people who are
known to have an elevated risk of cancer due to
family history (genetics), occupational
exposures, tobacco use, or other risk factors.
 Cancer Screening (cont’d)
• Diseases that are targeted by screening
programs are usually severe, treatable, and
relatively common.
• In lower-income countries, the most cost-
effective cancer screening tests include clinical
breast exams and cervical cancer visualization.
• A more extensive set of screening tests are cost-
effective in higher-income countries that have
higher incidence rates and spend more money
on cancer treatment.
 Data from Sankaranarayanan R. Screening for cancer in low- and
middle-income countries. Ann Global Health 2014; 80:412-7; and
Recommendations for primary care practice. Rockville, MD: U.S.
Preventive Services Task Force (USPSTF); 2017.
Examples of cancer screening tests.
Figure 13-13
 Figure 13-14

Characteristics of good screening programs.

 Cancer Treatment
13.6
 Cancer Treatment
• A comprehensive cancer care plan
includes access to prevention, screening,
diagnosis, various types of treatment,
and psychosocial support for people
with cancer and their caregivers.
• Comprehensive cancer care also requires
access to palliative care, which focuses
on pain management and quality of life.
 Cancer Treatment (cont’d)
• Surgery = an operation to confirm whether a disease is
present or to remove a tumor or other part of the body.
• Biopsy = a small sample of cells or tissues may be collected
through an incision or with a needle so that the specimen can be
examined for the presence or absence of cancer.
• After a diagnosis is confirmed, the areas around the primary
tumor, including nearby lymph nodes, may be removed.
• Chemotherapy drugs = medicines that kill cancerous cells,
slow the growth of cancerous masses, and keep cancer from
spreading.
• More than 100 drugs are available.
• Chemotherapies can be delivered orally, intravenously, by
injection, or via other mechanisms.
 Cancer Treatment (cont’d)
• Radiation therapy = the use of high-energy ionizing
radiation to damage the DNA of actively dividing cells,
which causes the cells to stop dividing or die.
• External beam radiation therapy uses photon beams (or other
types of radiation, such as proton therapy) from a machine outside
the body to deliver targeted radiation to particular sites.
• Internal radiation therapy, also called brachytherapy, implants a
radioactive isotope in or near the tumor.
• Systemic radiation therapy injects radioisotopes into the body so
they can circulate throughout the body.
• Other advanced treatment options such as immunotherapies
(like the use of monoclonal antibodies) and stem cell
transplants are not as widely available.
 Access to Cancer Treatment
• There are significant disparities in access to
cancer care by country income level as well as by
rural and urban location.
• Surgery is widely available in high-income countries,
but may be inaccessible in rural areas of middle-
income countries and almost completely unavailable
in low-income countries.
• Chemotherapy may be cost prohibitive in low- and
middle-income countries.
• Radiation therapy is nonexistent in most low-income
countries.
 Data from Horton S, Gauvreau CL. Cancer in low- and middle-
income countries: an economic overview (Chapter 16). Disease
control priorities. Cancer (Vol. 3). 3rd ed. Washington: IBRD /
World Bank; 2015.
Typical resources for cancer care by country
Figure 13-15

income level and location.

 Access to Cancer Treatment
(cont’d)
• Because accessible and affordable options
for cancer care are limited in lower-income
areas, survival rates for those diagnosed
with cancer are significantly lower in low-
income countries than in high-income
countries.
• If access to screening and diagnostic tests and
advanced therapies was increased, many more
people worldwide would survive cancer.
 Figure 13-16

Data from Cancer country profiles 2014. Geneva: WHO; 2015.

Access to radiation therapy is very limited in
low- and middle-income countries.
 Data from Gelband H, Jha P, Sankaranarayanan R, Gauvreau CL,
Horton S. Summary (Chapter 1). Disease control priorities.
Cancer (Vol. 3). 3rd ed. Table 1.1. Washington: IBRD / World
Bank; 2015.
Cancer survival rates are higher in high-income
than low-income countries, but for some
cancers the survival rate remains low.
Figure 13-17
 Lung Cancer
13.7
 Lung Cancer
• Lung cancer is the most common cause of cancer death globally.
• More than 1 million men and about 500,000 women die from lung cancers
each year.
• There is wide variation in the lung cancer mortality rate, but the pattern
closely mirrors the prevalence of tobacco smoking.
• About 70% of lung cancer deaths are attributable to tobacco smoking.
• Other risky exposures include indoor air and outdoor pollution and
occupational hazards.
• The 5-year survival rate after a diagnosis of cancer of the lung,
bronchus, or trachea remains below 20% in countries across the
economic spectrum.
• The most cost-effective interventions for reducing lung cancer
incidence and mortality are tobacco control initiatives like warning
labels and taxation.
 Breast Cancer and
Cervical Cancer
13.8
 Breast Cancer
• Breast cancer is the most commonly diagnosed cancer in
women worldwide, with about 1.7 million new cases
detected each year.
• Breast cancer is responsible for about 25% of cancer diagnoses
and 15% of cancer deaths in women worldwide.
• The diagnosis rate is higher in higher-income countries, and the
mortality is higher in lower-income countries.
• Lower-income countries have a much higher case fatality rate
and a much lower survival rate.
• Women diagnosed with breast cancer in higher-income areas
usually have early stage breast cancers (Stages 0, I, or II), while
women diagnosed with breast cancer in lower-income areas
have advanced stage breast cancers (Stages III or IV).
 Data from Ferlay J, Soerjomataram I, Ervik M, et al.
GLOBOCAN 2012: Estimated cancer incidence, mortality and
prevalence worldwide in 2012 v1.0. IARC CancerBase No. 11.
Lyon: IARC; 2013.
Incidence (diagnosis) rates of female reproductive
Figure 13-18

cancers.
 Data from Ferlay J, Soerjomataram I, Ervik M, et al.
GLOBOCAN 2012: Estimated cancer incidence, mortality and
prevalence worldwide in 2012 v1.0. IARC CancerBase No. 11.
Lyon: IARC; 2013.
Mortality rates from female reproductive cancers.
Figure 13-19
 Stage of breast cancer at the time of diagnosis.

Data from Global cancer facts & figures .3rd ed. Table 6.
Atlanta: American Cancer Society; 2015.
Figure 13-20
 Breast Cancer Diagnosis and
Treatment
• Early detection of breast cancer is associated with more
favorable outcomes.
• In low-income countries, the options for early detection are typically
limited to clinical breast exams.
• In most middle-income and high-income areas, routine
mammography is available.
• Treatment options:
• For women with breast cancer who live in low-income countries, a
mastectomy followed by use of the drug tamoxifen is likely to be the
best available option.
• In high-income countries, breast-conserving surgery followed by
reconstruction is often offered along with a diversity of
chemotherapy, radiation, endocrine therapies, and biological
therapies that provide additional pathways to long-term survival.
 Cervical Cancer
• The uterine cervix is the lowest part of the uterine.
• The development of abnormal cervical cells, a condition called
cervical dysplasia, is not uncommon among women of
reproductive age.
• The majority of cervical dysplasia cases are associated with human
papillomavirus (HPV).
• In most women, the viral infection will clear on its own, but in some
women the infection becomes chronic and causes additional damage
to the cervical cells, eventually leading to cervical cancer.
• More than 500,000 women are diagnosed with cervical cancer
each year.
• HPV vaccination is a primary prevention against cervical cancer,
but it is not available in most lower-income countries.
 Cervical Cancer Screening
• Early detection of cervical dysplasia so that precancerous lesions can
be treated is another way to prevent cervical cancer from developing.
• Two screening options:
• Pap smear = cervical cells are collected and histologically examined in a
cytology laboratory.
• VIA = visual inspection with acetic acid, is a lower-cost option in which a
diluted vinegar solution applied to the cervix with a cotton swab causes
and areas that are inflamed or have cellular damage turn white.
• Lesions that are observed during VIA screening can be treated with
cryotherapy, a procedure that does not require surgery or anesthesia.
• Since women who have been vaccinated against the common strains
of HPV are still at risk of cervical cancer, screening for cervical
dysplasia is recommended for most women.
 Cervical Cancer Epidemiology
• In the high- and middle-income countries where
screening for cervical cancer is routinely
available, the incidence of cervical cancer has
decreased significantly.
• In the low-income countries where cervical
cancer screening is not available, this cancer
continues to cause a significant burden to women.
• Most of these global cancers could have been
prevented with increased access to screening.
Ovarian and Endometrial Cancer
• Ovarian cancer is difficult to diagnose at
an early stage, and survival rates for
ovarian cancer remain low.
• Uterine cancer, also called endometrial
cancer, usually occurs in post-menopausal
women, and the outcomes are generally
favorable in women who are able to access
surgery while the cancer is at an early
stage.
 Prostate Cancer
13.9
 Prostate Cancer
• Most older men develop benign prostatic hyperplasia
(BPH), a non-cancerous enlargement of the prostate gland
that may make urination difficult.
• A large proportion of men with BPH later develop
prostate cancer, which may metastasize from the male
reproductive gland to lymph nodes, bones, and other parts
of the body.
• Increased age is the dominant risk factor for prostate
cancer.
• About one-third of 70-year-old men, half of 80-year-old men,
and nearly 100% of 100-year-old men have cancerous cells in
their prostates.
 Prostate Cancer (cont’d)
• Prostate cancer is the most commonly diagnosed cancer
(other than non-melanoma skin cancers) among men in the
Americas, Western Europe, and Australia and New Zealand,
and the incidence rate is increasing in most world regions.
• Although men in high-income countries have the highest
likelihood of being diagnosed with prostate cancer, the
mortality rate is highest in low-income countries.
• Surgery and radiation therapy can both be effective
treatments for prostate cancer, but both are associated with
adverse side effects related to urinary, bowel, and sexual
function.
 Liver Cancer
13.10
 Liver Cancer
• Most cases of liver cancer currently occur in the places within
East Asia, South Asia, and sub-Saharan Africa that have had
historically high rates of hepatitis B virus (HBV) infection.
• Besides HBV, other major risk factors for liver cancer include
hepatitis C virus (HCV), alcohol use, tobacco smoking,
obesity, and exposure to aflatoxins (food molds).
• The best currently available option for preventing future cases
of liver cancer is hepatitis B vaccination.
• The vaccination will not stop cancer from developing in people
whose livers have already been scarred by the virus.
• The 5-year survival rate for liver cancer is less than 20% in
countries across the economic spectrum.
 Data from Ferlay J, Soerjomataram I, Ervik M, et al.
GLOBOCAN 2012: Estimated cancer incidence, mortality and
prevalence worldwide in 2012 v1.0. IARC CancerBase No. 11.
Lyon: IARC; 2013.
Liver cancer incidence (diagnosis) and mortality rates
Figure 13-21

by sex.
 Esophageal, Stomach,
and Colorectal Cancers
13.11
 Esophageal Cancer
• The incidence of cancers of the digestive tract—esophageal
cancers, stomach cancers, and colon and rectal cancers—vary
significantly by country.
• The highest incidence rates of esophageal cancer occur in
central and eastern Asia and in eastern and southern Africa.
• The risk factors for squamous cell carcinomas are not well defined.
• The major risk factors for esophageal adenocarcinomas are obesity
and gastroesophageal reflux disease (GERD), which increases the
risk of a treatable precancerous condition called Barrett’s
esophagus that results from chronic acid reflux.
• The survival rates for esophageal cancer are low in all
countries.
 Data from Ferlay J, Soerjomataram I, Ervik M, et al.
GLOBOCAN 2012: Estimated cancer incidence, mortality and
prevalence worldwide in 2012 v1.0. IARC CancerBase No. 11.
Lyon: IARC; 2013.
Esophageal, stomach, and colorectal cancer diagnosis
Figure 13-22

rates.
 Stomach Cancer
• Stomach cancer rates are highest in Central and
Eastern Asia, Eastern Europe, and South America.
• For stomach cancers located near the esophagus (that is,
for cardia gastric cancers), age, tobacco smoking, and
obesity are risk factors.
• For other stomach cancers (that is, for noncardia gastric
cancers), age and Helicobacter pylori infection are risk
factors.
• Because early-stage stomach cancer causes few
symptoms, most stomach cancers are diagnosed at
an advanced stage when survival rates are low.
 Colorectal Cancer
• Colorectal cancer incidence rates are highest in high-
income countries.
• Dietary factors like high intake of dietary fat, red meat,
and processed meats may account for 30% to 50% of all
colorectal cancers worldwide.
• Colon and rectal cancers can be prevented through
screening for polyps and removal of any observed
precancerous lesions, but these procedures are expensive.
• Colorectal cancer rates are decreasing in high-income
countries where colonoscopies are widely available, but
rates are increasing in some middle-income areas.
 Other Cancers
13.12
 Other Cancers
• Cancer can occur in any part of the body.
• Kidney cancer diagnosis rates are rising in most
countries, especially in Latin America.
• The major known risk factors for kidney cancer are tobacco
use, obesity, and hypertension.
• Pancreatic cancer has a relatively low incidence, but a
very low survival rate.
• Most cases of bladder cancer occur in men and are
linked to tobacco use, but some urinary bladder cancer
in Africa and Asia are linked to chronic infection with
schistosomiasis.
 Other Cancers (cont’d)
• Most skin cancers have a very low mortality rate,
but melanoma, a cancer that originates in
pigmented melanocytes in the skin, can be deadly.
• Thyroid cancer diagnosis rates are increasing but
the mortality rate is decreasing.
• Non-Hodgkin lymphoma (NHL) is an immune
system cancer that starts in the lymph nodes and is
associated with some types of chronic infections.
• Leukemia is a blood cancer that begins in the bone
marrow where blood is produced by the body.
 Children and Cancer
• Although children less than 15 years old probably account for
less than 1% of all cancer patients, the proportion of child
deaths that are attributable to cancer is increasing as deaths
from infectious diseases increase.
• Reducing the burden of cancer on today’s children as they age
into adulthood requires implementation of primary prevention
interventions now.
• Limit the uptake of tobacco use and excessive alcohol
consumption.
• Prevent and treat chronic infections.
• Promote healthy and active lifestyles.
• Minimize the risks associated with occupational and environmental
carcinogens.