world cancer report - iarc

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8% = High prevalence 2% - 8% = Intermediate prevalence < 2% = Low prevalence Fig. 4.15 Global prevalence of chronic hepatitis B virus (HBV) infection 1997, based on HB surface antigen serology. blood products, sharing contaminated needles during intravenous drug use and through sexual transmission. Currently, there are around 350 million chronic carriers of HBV worldwide and, based on conservative assumptions, an estimated 70 million of these individuals are likely to die from HBV-related liver disease. Because of the relatively low cost of the hepatitis B vaccine and the uniformly fatal outcome of hepatocellular carcinoma, childhood hepatitis B vaccination in highly HBV endemic areas is one of the most cost-effective measures available for prevention of early mortality in adults [2]. Nature of the intervention Vaccination efforts have historically concentrated on preventing acute infectious diseases, particularly those of childhood. Hepatitis B vaccine is the first vaccine designed to prevent a major human cancer and currently the only one in widespread use. The vaccine was initially developed by purifying the viral envelope component of the surface antigen particle (HBsAg) of the virus from the blood of individuals with chronic HBV infection. This plasma-derived vaccine undergoes intensive treatment to destroy any live virus, as well as to remove any other potential contaminants, and is then combined with an alum adjuvant to stimulate the immune system. Second-generation vaccines involved production of HBsAg particles through yeast or mammalian cells using recombinant DNA technology. Both plasma-derived and DNA recombinant vaccines are equally safe and effective. Since the early 1980s, hundreds of millions of doses of hepatitis B vaccine have been administered worldwide. Adverse reactions are uncommon and generally mild in nature, with this vaccine considered among the safest of vaccines. Hepatitis B vaccine is generally administered in sequential doses with at least four weeks between doses. An appropriate response to the vaccine is the development of antibodies to the surface antigen and is termed seroconversion. Three doses of vaccine will generally produce seroconversion rates in excess of 90%. Vaccination campaigns aimed at reducing HBV-related hepatocellular carcinoma must take into consideration the patterns of HBV transmission. Because the highest risk for development of chronic HBV carriage occurs at the youngest ages, hepatitis B vaccine is most efficacious when given as close to birth as possible. This early vaccination benefit will be most pronounced in those highendemicity countries with significant mother-to-child and early horizontal transmission. Hepatitis B vaccine does not interfere with other vaccines and can be administered simultaneously with many of the other routine childhood immunizations, including diphtheria, tetanus and whole-cell pertussis vaccine, oral attenuated poliomyelitis vac- No routine immunization Routine immunization Fig. 4.16 Global distribution of countries using HBV vaccine in their national immunization programme, 2000. cine and BCG (bacille Calmette-Guérin). Integration of hepatitis B vaccine into the routine “Expanded Programme on Immunization” (EPI) efforts of individual countries provides the most appropriate strategy for global hepatitis B vaccination. In addition to the focus on hepatitis B vaccination to prevent primary infection with HBV, new therapeutic vaccines have been designed to treat chronic HBV carriers and hopefully prevent progression to cirrhosis or cancer. Several novel vaccines, including DNA-based vaccines which incorporate the hepatitis B surface antigen gene, have been designed to stimulate the immune system of HBV-infected individuals, through induction of either a T-cell response or production of neutralizing antibodies [3]. Although therapeutic vaccines demonstrate potential, these trials are in the earliest stages and it remains to be seen what level of efficacy in reducing or stopping HBV replication and preventing progression can be achieved. The frequency and degree of serious adverse effects from these vaccines must also be demonstrated to be acceptably low. Implementation of preventive measures In the early 1990s, WHO/EPI recommended integration of hepatitis B vaccination into the routine EPI and this was subsequently endorsed by the World Health Assembly. Earlier, hepatitis B vaccine was utilized sporadically, with fewer than 20 countries routinely administering the vac- Hepatitis B vaccination 145
Fig. 4.17 Chronic active HBV-associated hepatitis is associated with risk of hepatocellular cancer. Inflammatory infiltrates are present in the parenchyma (arrowhead) and in the periportal space (arrow). cine. Initial implementation strategies varied based on the local epidemiology. Routine childhood immunization was the recommendation for high-endemicity countries, having over 8% of the population with chronic HBsAg carriage. Lowendemicity regions (
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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
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Mechanisms of tumour development Th
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The stages in tumorigenesis have be
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PRECURSOR LESIONS IN CHEMOPREVENTIO
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CARCINOGEN ACTIVATION AND DNA REPAI
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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 and 128: ipated, is primarily attributable t
Page 129 and 130: smoke. This may be achieved in part
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: HEPATITIS B VACCINATION SUMMARY > P
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
Page 179 and 180: diagnosis is usually confirmed by h
Page 181 and 182: is frequent and survival rates are
Page 183 and 184: Fig. 5.14 Physician reading digital
Page 185 and 186: Markers of prognosis in breast canc
Page 187 and 188: cer in the contralateral breast (Ch
Page 189 and 190: 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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