world cancer report - iarc

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However the challenge posed is daunting. Cigarette smoking is an addiction, as powerful in many respects as cocaine or opiate dependence. The rates of dependence for nicotine in the general population are higher than for alcohol, cocaine or marijuana. Among those who have ever tried even a single cigarette, almost one-third develop nicotine dependence. Although most smokers want to quit, they experience well-characterized barriers and withdrawal symptoms during their attempts and they are largely unsuccessful in quitting. In fact, spontaneous quit rates without any cessation intervention range from 2% to 5% [19]. The efficacy of a range of interventions calculated to increase the spontaneous quit rates have been evaluated, and for many options the results of ten or more trials have been published. Simple advice from doctors in the course of routine care in the context of primary care, hospital wards, outpatient consultations and industrial clinics increases the quit rate by a factor of 1.69. Nurses providing individual counselling, as distinct from general health promotion, are also effective. Likewise, counselling provided through quit clinics is effective whether provided on an individual or group basis. The relative efficacy of different psychological approaches that might be used in such a situation is poorly understood. In the absence of face-to-face contact, the efficacy of self-help material is not as great but is discernable. Increasingly, such self-help materials may be delivered through the Internet, though whether this will be more effective than publications, audiotapes or videotapes remains to be seen. Nicotine replacement therapy is intended to provide the nicotine otherwise obtained from cigarettes, thereby reducing withdrawal symptoms associated with quitting. On the basis of more than 90 trials, this increases the chances of quitting up to two-fold (Fig. 4.4). The therapy is most effective if accompanied by at least some counselling. Nicotine may be delivered by various means (patch, inhaler, nasal spray, gum) and none has been identified as most effective; many protocols involve a combination of such prod- Fig. 4.6 Posters from smoking cessation campaigns in France, Italy, Tunisia, Japan and China. ucts. Apart from nicotine, a range of pharmacological agents have been proposed as expediting smoking cessation. Anxiolytics are not effective, but some antidepressants, specifically including bupropion, are. The drug may be used alone, or in combination with nicotine, and quit rates are increased by a factor of approximately 2.75. In more limited investigations, similar results have been claimed for the tricyclic antidepressant nortriptyline. Relevant mechanisms have not been demonstrated. A range of other pharmacological interventions are under evaluation and, not surprisingly, the field is one of intense activity. Reduced exposure to environmental tobacco smoke A tangential benefit of smoking cessation is decreased exposure of individuals apart from the smoker to tobacco Fig. 4.7 Declining lung cancer rates in California by comparison with rates in other parts of the USA. Centers for Disease Control and Prevention (2000) Mortality and Morbidity Weekly Report, 49:1066-1069. Tobacco control 133
smoke. This may be achieved in part by health protection legislation which limits smoking indoors and the requirement to provide a safe workplace. In common with some other areas of tobacco control, it is possible that progress in this area may be influenced by the outcome of litigation and the associated financial risk incurred by those permitting or tolerating such exposure. Outcome The health benefits of smoking cessation are indisputable, and specifically include reduced risk of malignant disease. A classic example involves the REFERENCES 1. Wald NJ, Hackshaw AK (1996) Cigarette smoking: an epidemiological overview. Br Med Bull, 52: 3-11. 2. Doll R, Peto R, Wheatley K, Gray R, Sutherland I (1994) Mortality in relation to smoking: 40 years' observations on male British doctors. BMJ, 309: 901-911. 3. Doll R (1998) Uncovering the effects of smoking: historical perspective. Stat Methods Med Res, 7: 87-117. 4. Thun MJ, Heath CW, Jr. (1997) Changes in mortality from smoking in two American Cancer Society prospective studies since 1959. Prev Med, 26: 422-4 26 5. Murray CJL, Lopez AD (1996) Quantifying the burden of disease and injury attributable to ten major risk factors. In: Murray CJL, Lopez AD, eds, The Global Burden of Disease, Geneva, World Health Organization, 295-324. 6. Peto R, Lopez AD, Boreham J, Thun M, Health CJ, eds (1994) Mortality from Smoking in Developed Countries 1950-2000: Indirect Estimates from National Vital Statistics, Oxford, Oxford University Press. 7. Niu SR, Yang GH, Chen ZM, Wang JL, Wang GH, He XZ, Schoepff H, Boreham J, Pan HC, Peto R (1998) Emerging tobacco hazards in China: 2. Early mortality results from a prospective study. BMJ, 317: 1423-1424. 8. Chen ZM, Xu Z, Collins R, Li WX, Peto R (1997) Early health effects of the emerging tobacco epidemic in China. A 16-year prospective study. JAMA, 278: 1500-1504. 9. Sasco AJ (1992) Tobacco and cancer: how to react to the evidence. Eur J Cancer Prev, 1: 367-373. 10. WHO (1992) Framework Convention on Tobacco Control. Technical Briefing Series Paper 2. Improving 134 Prevention and screening impact of anti-smoking publicity and health education in California, where smoking rates declined more than twice as rapidly as in the rest of the USA. It is now evident that during the period 1988-1997, age-adjusted lung cancer incidence rates in California declined significantly compared with stable incidence rates in other parts of the USA (Fig. 4.7). Thus, California is one of the few regions in the developed world where lung cancer mortality among women is declining. The efficacy of smoking cessation, as a means of decreasing the risk of malignant disease, is not an issue requiring Public Health through an International Framework Convention on Tobacco Control (Tobacco-Free Initiative), Geneva, World Health Organization. 11. Roemer R, ed. (1987) Legislative Strategies for a Smoke-Free Europe, Copenhagen, World Health Organization, Regional Office for Europe. 12. Saffer H, Chaloupka F (2000) The effect of tobacco advertising bans on tobacco consumption. J Health Econ, 19: 1117-1137. 13. Aftab M, Kolben D, Lurie P (1999) International cigarette labelling practices. Tob Control, 8: 368-372. 14. Sasco AJ, Kleihues P (1999) Why can't we convince the young not to smoke? Eur J Cancer, 35: 1933-1940. 15. Reid D (1996) Tobacco control: overview. Br Med Bull, 52: 108-120. 16. Greaves L ed. (1996) Smoke Screen. Women's Smoking and Social Control, Halifax, Fernwood Publishing. 17. The World Bank (1999) Development in Practice. Curbing the Epidemic. Governments and the Economics of Tobacco Control, Washington DC, The World Bank. 18. Curry SJ (2001) Bridging the clinical and public health perspectives in tobacco treatment research: scenes from a tobacco treatment research career. Cancer Epidemiol Biomarkers Prev, 10: 281-285. 19. Law M, Tang JL (1995) An analysis of the effectiveness of interventions intended to help people stop smoking. Arch Intern Med, 155: 1933-1941. further investigation. Hence, the immediate issue confronting governmental and other authorities is the amount and type of resources that should be allocated to this established means of cancer prevention. An important consideration is the limitation of those factors which tend to promote adoption of the smoking habit by the community in question. WEBSITES GLOBALink, the International Tobacco Control Network, UICC: http://www.globalink.org Florida Tobacco Control Clearinghouse: http://www.ftcc.fsu.edu CDC's Tobacco Information and Prevention Source: http://www.cdc.gov/tobacco/ List of smoking and tobacco control monographs from the National Cancer Institute: http://rex.nci.nih.gov/NCI_MONOGRAPHS/LIST.HTM Tobacco Control Research Branch (NCI), information on spit tobacco: http://dccps.nci.nih.gov/TCRB/less_default.html Tobacco Free Initiative, WHO: http://tobacco.who.int/ 11th World Conference on Tobacco or Health (August 2000): http://www.wctoh.org/ Smoking Cessation, “Live Smoke Free”, Health Canada: http://www.hc-sc.gc.ca/hppb/cessation/ Framework Convention on Tobacco Control : http://www.who.int/gb/fctc/ Quit: the National Tobacco Initiative (Australia): http://www.quitnow.info.au
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WORLD HEALTH ORGANIZATION WHO OMS I
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WORLD CANCER REPORT Editors Bernard
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CONTENTS Foreword 9 1 The global bu
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The global burden of cancer Cancer
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Fig. 1.2 Incidence and mortality of
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Central and Southern Europe differ
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Incidence of cancer in South Centra
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from documentation of disease to a
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TOBACCO SUMMARY >In addition to lun
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Fig. 2.3 Smoking by children is inc
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Cancers positively Sex Standardized
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PHARMACOLOGICAL APPROACHES TO SMOKI
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level the dose—response relations
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lipoprotein-associated cholesterol,
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Agent Cancer site/cancer Main indus
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Industry, occupation Cancer site/ca
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to occupational exposures in develo
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Air pollutant WHO Air Quality Guide
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der cancer of the order of 50% is p
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AFLATOXIN B 1 HEPATITIS VIRUS (chro
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Fig. 2.30 Correlation between regio
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MEDICINAL DRUGS SUMMARY > Certain d
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Drug or drug combination Cancer IAR
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Agent or substance Cancer site/canc
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sources of electromagnetic fields [
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CHRONIC INFECTIONS SUMMARY > Infect
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Infection Subclinical Mutagenic fac
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TUMOURS ASSOCIATED WITH HIV/AIDS Ap
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DIET AND NUTRITION SUMMARY > Up to
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Fig. 2.54 The age-adjusted mortalit
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OVERWEIGHT, OBESITY AND PHYSICAL AC
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IMMUNOSUPPRESSION SUMMARY >Persiste
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Fig. 2.64 Cancer following immunosu
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Syndrome Gene Location Cancer site/
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viduals, confirmation of a gene def
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REPRODUCTIVE FACTORS AND HORMONES S
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PHYTO-ESTROGENS AND CANCER PEVENTIO
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Indicator Number of oral contracept
Page 79 and 80: Mechanisms of tumour development Th
Page 81 and 82: The stages in tumorigenesis have be
Page 83 and 84: PRECURSOR LESIONS IN CHEMOPREVENTIO
Page 85 and 86: CARCINOGEN ACTIVATION AND DNA REPAI
Page 87 and 88: adducts, a few weeks or months for
Page 89 and 90: I Reactive oxygen species Methylati
Page 91 and 92: which remove the mismatched bases,
Page 93 and 94: Common human oncogenes Many common
Page 95 and 96: product of the RB1 gene (pRb) and a
Page 97 and 98: ates a molecular bridge between p53
Page 99 and 100: potential cancer genes altered thro
Page 101 and 102: One of the earliest genes to be ide
Page 103 and 104: Regulation of the cell cycle and co
Page 105 and 106: CELL-CELL COMMUNICATION SUMMARY > C
Page 107 and 108: Connexin genes and tumour suppressi
Page 109 and 110: APOPTOSIS SUMMARY > The term apopto
Page 111 and 112: Caspase-8 Caspase-3 c-FLIP Procaspa
Page 113 and 114: ways. Several options are under inv
Page 115 and 116: INVASION AND METASTASIS SUMMARY > T
Page 117 and 118: laminin, entactin and also heparan
Page 119 and 120: Target Example of agent Comments Ad
Page 121 and 122: organs, and to respond to local gro
Page 123 and 124: TOBACCO CONTROL SUMMARY > Tobacco-i
Page 125 and 126: Region Deaths due to % of total dea
Page 127: ipated, is primarily attributable t
Page 131 and 132: there is no evidence for the effica
Page 133 and 134: industries, processes and occupatio
Page 135 and 136: stoves arises in rural areas of dev
Page 137 and 138: Climbing plants on trellis at end r
Page 139 and 140: HEPATITIS B VACCINATION SUMMARY > P
Page 141 and 142: Fig. 4.17 Chronic active HBV-associ
Page 143 and 144: HUMAN PAPILLOMAVIRUS VACCINATION SU
Page 145 and 146: Vaccine Site of trial Number of pat
Page 147 and 148: prolonged use. Similar drugs, that
Page 149 and 150: aspirin and other non-steroidal ant
Page 151 and 152: SCREENING FOR BREAST CANCER SUMMARY
Page 153 and 154: Fig. 4.35 Cumulative mortality from
Page 155 and 156: SCREENING FOR PROSTATE CANCER SUMMA
Page 157 and 158: Fig. 4.39 Poster designed for an an
Page 159 and 160: is around 10% for cancer (out of ev
Page 161 and 162: 45 with one positive rehydrated FOB
Page 163 and 164: eing based on (i) time trends in th
Page 165 and 166: Fig. 4.48 Women at a clinic in Indi
Page 167 and 168: SCREENING FOR ORAL CANCER SUMMARY >
Page 169 and 170: India will provide useful informati
Page 171 and 172: cer incidence following cure of inf
Page 173 and 174: 100 50 25 10 5 2.5 1 Japan Males Fe
Page 175 and 176: Human cancers by organ site Maligna
Page 177 and 178: tobacco smoking: age at start, aver
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diagnosis is usually confirmed by h
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is frequent and survival rates are
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Fig. 5.14 Physician reading digital
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Markers of prognosis in breast canc
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cer in the contralateral breast (Ch
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100 50 25 10 5 2.5 1 Japan Chile Po
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depends on staging. Small intramuco
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Fig. 5.30 A diet rich in fresh frui
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ane protein involved in cell adhesi
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LIVER CANCER SUMMARY > About 560,00
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Fig. 5.39 A woman in the Gambia pre
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REFERENCES 1. Ferlay J, Bray F, Par
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Certain Possible Uncertain Age Andr
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Management The dramatic division be
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TUMOUR NORMAL Gastrula PGC 2n Impri
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CANCERS OF THE FEMALE REPRODUCTIVE
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Fig. 5.62 Five-year relative surviv
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Inheritance of high-penetrance gene
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invasive malignant. Malignant germ
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OESOPHAGEAL CANCER SUMMARY >Cancer
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Fig. 5.76 A radiographic view of an
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with a stent; laser recannulation,
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Fig. 5.82 Risk of bladder cancer am
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Partial cystectomy is appropriate f
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poorly known since hypopharyngeal c
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Fig. 5.92 Oral leukoplakia with mil
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LYMPHOMA SUMMARY > Malignant lympho
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T Fig. 5.101 Nuclear magnetic reson
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Fig. 5.106 Five-year relative survi
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Fig. 5.109 The immediate aftermath
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A B Fig. 5.113 Acute myeloid leukae
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Fig. 5.118 Five-year relative survi
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Fig. 5.120 Age-specific incidence a
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Hereditary condition Mode of inheri
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MELANOMA SUMMARY > Approximately 13
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Fig. 5.131 Primary melanoma with a
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THYROID CANCER SUMMARY > Cancer of
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Papillary carcinoma RET/PTC TRK BRA
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KIDNEY CANCER SUMMARY > Cancer of t
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Stage Clear cell carcinoma Papillar
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TUMOURS OF THE NERVOUS SYSTEM SUMMA
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ing the optic tract, brain stem and
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mut = mutant p53 wt = wildtype p53
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SURGICAL ONCOLOGY SUMMARY > Surgica
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Year Radical mastectomy (%) Modifie
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TELEMEDICINE The prospects for tele
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Equipment Energy 50% depth dose App
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CANCER EDUCATION IN MEDICAL COURSES
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Fig. 6.10 Crystals of cisplatin: mo
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Responsiveness Cancer (in decreasin
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Most of the world’s most common c
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treatment of cancer. The problems l
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duction. It is clear that tumour ce
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REHABILITATION SUMMARY > Rehabilita
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cer and its associated disability.
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REFERENCES 1. Garden FH, Gillis TA
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Cancer pain relief varies and in so
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EMERGING ISSUES IN PALLIATIVE CARE
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Cancer control The negative impact
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priority to cancer control activiti
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Prevention of cancer Every country
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- Assessing the magnitude of the ca
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high-risk women. Further details on
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ecords departments are either rudim
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THE INTERNATIONAL AGENCY FOR RESEAR
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in the capitals/urban areas of four
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in the overall cancer strategy. WHO
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68% 1955 1975 1995 2025 32% 40% by
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Fig. 7.15 A grandfather at work in
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Fig. 7.17 Main causes of death in d
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Contributors and Reviewers Sources
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Dr Vera Luiz da Costa e Silva Tobac
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Georgia Moore Centers for Disease C
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REVIEWERS Dr Sandra E. Brooks 405 W
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2.53 T. Norat and E. Riboli, IARC 2
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Gastroenterology, 118(2 Suppl 1): S
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5.106 & 5.107 IARC/SEER/Osaka Cance
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4.17 R. Lambert, IARC/Adapted from
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Brain cancer, see nervous system tu
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Fibroblast growth factor (FGF), 117
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Microarray, 240 Micronutrients, 65,
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S Saccharin, 64, 85 Salicin, 153 Sa
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