[MUSIC] Hello everybody. I'm going to talk to you about cancer epidemiology and how epidemiology can inform prevention and treatment services. In my presentation I will cover a little definition about epidemiology and cancer epidemiology. And I will give you some data about the burden of this disease in terms of incidents and mortality. And we need to know both to have a complete picture of the burden of the disease. And about some differences. And being an epidemiologist, I'm very interested in the geology of cancer, meaning about the causes of cancer. So that we can later Use this knowledge to prevent the disease. So Epidemiology, in general, describes the pattern of the disease and the determinants of the disease of a health in the general population. And cancer epidemiology of course provides an overview of cancer burden in the nation and the world and its likely future evolution. Cancer epidemiology describes national and international differences and possible reasons for these differences. Possible explanations for these differences. And assess efficacy of preventative measures. And also what we do in epidemiology, cancer epidemiology is to evaluate survival after diagnosis and assess the evolution of survival. And also see if there are differences among different from populations. So let's start with the, some data abouf the burden of the disease. Let's start with mortalities. So cancer mortality compared to other diseases, we have here a big blue circle with over 30 million that's due to non-communicable disease which includes cancer, cardiovascular, respiratory disease, and diabetes. And we can see that over 7 million of these deaths are due to cancer, meaning that 25% of the deaths for non-communicable disease are due to cancer. As a comparison, you have a little circle under the big one to represent the number of deaths for some communicable disease, some very important communicable disease, such as AIDS, malaria, and so on. I'm showing you now some geographical map and then the burden of disease, the burden of cancer in the world. And these maps are easily downloaded from the International Agency for Research on Cancer's website, free of charge and they are part of the global camera database. So here you have the world and you have the incident rates of cancer in the world. The red represents the area with the most cancer and you can see that most cancer cases are actually in developed regions such as North America, Europe and Australia. On the other hand, green represents the areas with less cases, lower rates, and we have most of the green in Africa and India, and, and some of these, regions. But, on the other hand, you can see also that there are some regions, like Russian and China. Let's call them, and South America, let's call them emerging countries in terms of economy, that have some rates that are in between, the green and the red, such as orange, and we can say overall that over 13 million cancer cases of 56% were in developing countries. And in 2008, over 7 million cancer deaths, over 64% were in developing countries. Now I'll show you two slides with the map with the leading cancer types by region of the world. And here we have the males so you can see that the blue regions, they are the regions where they Mmain cancer type is prostate cancer, in terms of incidents. The incidents that's in the top map. And then we have a lot of blue Prostate also in Africa and Australia and again in Europe and South America. And then we have a lot of pink too which is due to lung cancer. That's a lot in China, Russia again and in India. We have areas with the stomach cancer which is red in areas with liver cancer in Africa in particular. In terms of mortality, the situation is different. Basically, lung cancer in males is the most important cause of that. And that's almost everywhere except in Africa where we still have a lot of liver cancer deaths and some stomach cancer deaths. In fact 80% of the liver cancer deaths were in developing countries in 2008. For women we he have in terms of incidents we have breast cancer which is, marked in blue, light blue. Basically everywhere in the world except few areas where the leading cause, leading cancer type in terms of incidence is cervical cancer. In, if we look at mortality, we have that breast cancer is still the leading cause in many African, South American, and Asian countries. But lung cancer is the main cause of death for North America in particular. In these slides I can give you some figures of what I just said. in terms of mortality we just saw that for developing regions for males we have lung, liver, stomach cancer. They are the main cause of that in cancer. And in developed regions, we have lung, colorectum and prostate among males. For women instead, we have breast cancer which is the leading cause of death in both regions, developed and developing. And then we have cervical cancer in developing countries, with lung and colorectum in the relevant countries. We know also that there are some trends in the mortality, which are not going the same direction in developing and developed world. In developed world, we know that actually mortality for many cancers is reducing, and this improvement in mortality is due to better treatment, new treatments that are being discovered, the early detection of cancer and screening. And also though probably lower incidents for some cancer. There is prevention that is working. And so for example for lung cancer there are less cases that developed in developed world. This is not the same for the developing regions where in fact we have not always the treatment available. And we have less limited early detection and screening for cancer. And we also have, at the same time, an increase in incidents because of more exposure to risk factors. And that causes, of course, an increased mortality. So we're talking about risk factors. Risk factors of course we know a lot of risk factors but we don't know all the risk factors for all cancers unfortunately. Some of these factors are related to the individual, some other risk factors are called for example environmentalist factors because they in fact affect more in general population. We have some risk factors which are related to lifestyle, to behavior of an individual such as diet, smoking, alcohol, diet, overweight and physical activity. We have those that we call environmentalist factors that include the infectious diseases, the pollutions and like. But also other environmentalist factor include the carcinogens that which a person is exposed during work, radiation. And of course we have those risk factors which is age for example of a person, or some family history, genetic predisposition that are really related to the individual. In this light we have the known risk factor for some of the most important cancers. And like I said we know many of the risk factors but we do not know all the risk factor for cancer. And actually for some cancer types we only know a part of them. And we know for example for breast cancer the risk factors we know explain only 50% of the cases of cancer. So we still have to research a lot to be able to know what are the causes of cancer. And even for some risk factors like this one, like smoking we know very well that is associated to lung cancer. And we know actually that over 70% of cases of lung cancers are due to smoking. We still have part of them due to other risk factors like air pollution. And part of them is due to a other that we don't even know what they are. And here for example, we know that for breast cancer some of the known risk factors are related to the reproductive history of the women. And we know that, for example, if women in the developed world would have the same reproductive history like women in the developing world. Their incidence rate of breast cancer decrease from 63 of 100,000 like it is now to less than 3, per 30 then per 100,000 like we have in the developing world. So we know that we can do something to prevent cancer. In fact we know that one out of three cancer cases can be prevented. And that's a good news. We can do a lot. We can do a lot at an individual level. And at a social level. At an individual level we can start to avoid a number of risk factors such as we should quit smoking, reduce alcohol intake, start to eat a better diet, start to lose weight, do physical exercise, and so on. And at a social and political level of course there is the need from countries to plan regulations like banning smoking in public places, banning smoking and alcohol advertisements. Assure, education of programs for children and for population for a good diet, for they to do exercise and to lose weight. And of course, providing scanning programs for those cancer for which of the screening is known to be effective. And for example, vaccination programs for those scans of like cervical cancer, hepatitis for which we know that a vaccine is effective tool. So cancer is costly, and the economic cost of cancer in terms of economic losses for disability and deaths,that exceeds any other disease. So we have a cost that is almost $1 trillion. But we know that by spending less than two billion, we can actually have some effective solution to prevent some of these disease that we said we can prevent one case out of three. So in conclusion, what we need to do is ask an epidemiologist., We need to first of all understand is the more risk factors and the causes of cancer. Of course, we still have to do a lot of research on it. We need to have better data from low income countries about cancer because that will help the countries themselves to implement cancer control programs and evaluate their programs. We need to implement, assess the impact of interventions, including for example vaccination ntervention for cancer like cervical cancer and hepatitis. And we need to extend the proven cancer screening programs. Such as the programs for cervical cancer, for breast cancer, for colon cancer. And we need to assure an equitable access to essential cancer care including preventive care to all the countries. And thank you. [MUSIC]
