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to occupational exposures in developed countries are in the range of 4-5% [9,10]. Lung cancer is probably the most frequent of these cancers. However, the REFERENCES 1. Pott P, ed. (1775) Chirurgical Observations, London, Hawes, Clarke and Collins. 2. Rhen L (1895) Blasengeschwülste bei Fuchsin- Arbeitern. Arch Klin Chir, 50: 588-600. 3. Monson R (1996) Occupation. In: Schottenfeld D, Fraumeni, JF eds, Cancer Epidemiology and Prevention, New York, Oxford University Press, 373-405. 4. IARC (1972-2001) IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vols 1-78, Lyon, IARCPress. 5. Alderson M (1986) Occupational Cancer, Butterworths. 6. Hayes RB, Songnian Y, Dosemeci M, Linet M (2001) Benzene and lymphohematopoietic malignancies in humans. Am J Ind Med, 40: 117-126. 38 The causes of cancer estimates do not apply uniformly to both sexes or to the different social classes. Among those actually exposed to occupational carcinogens (those doing manu- 7. IARC (2002) Man-made Vitreous Fibres, IARC Monographs on the Evaluation of Carcinogenic Risks to Humans Vol. 81, Lyon, IARCPress. 8. Pearce N, Matos E, Vainio H, Boffetta P, Kogevinas M, eds (1994) Occupational Cancer in Developing Countries (IARC Scientific Publications, No. 129), Lyon, IARCPress. 9. Harvard Center for Cancer Prevention (1996) Harvard report on cancer prevention. Causes of human cancer. Occupation. Cancer Causes Control, 7 Suppl 1: S19-S22. 10. Doll R, Peto R (1981) The causes of cancer: quantitative estimates of avoidable risks of cancer in the United States today. J Natl Cancer Inst, 66: 1191-1308. al work in mining, agriculture and industry, for example), the proportion of cancer attributable to such exposure is estimated to be about 20%. WEBSITES NCI Occupational Epidemiology Branch: http://dceg.cancer.gov/ebp/oeb/ The American Conference of Governmental Industrial Hygienists: http://www.acgih.org/home.htm International Programme on Chemical Safety (IPCS): http://www.who.int/pcs/index.htm IARC Monographs programme: http://monographs.iarc.fr
ENVIRONMENTAL POLLUTION SUMMARY > Pollution of air, water and soil is estimated to account for 1-4% of all cancers. > A small proportion of lung cancer ( Carcinogenic indoor air pollutants include tobacco smoke, and cooking fumes in particular regions, including parts of Asia. > Chlorofluorocarbons cause destruction of the ozone layer and enhance the risk of skin cancer through increased ultraviolet radiation. > Contamination of drinking water is not a general carcinogenic hazard, but high levels of arsenic and chlorination byproducts in some communities carry a risk. In a broad sense, “environmental factors” are implicated in the causation of the majority of human cancers [1]. In respect of many such environmental factors, such as active smoking, alcohol intake, sun exposure and dietary make-up, individuals exercise a degree of control over their level of exposure. However in the present context, “environmental pollution” refers to a specific subset of cancer-causing environmental factors; namely, contaminants of air, water and soil. One characteristic of environmental pollutants is that individuals lack control over their level of exposure. The carcinogenic pollutants for which most information is available include asbestos (referring here to nonoccupational exposure), toxic agents in urban air, indoor air pollutants and chlorination by-products and other contaminants of drinking water. Relevant risk factors include place of residence: whether rural or urban, and the relationship to major industrial emission sources. Various determinations suggest that environmental pollution accounts for 1-4% of the total burden of cancer in developed countries [2,3]. Asbestos Asbestos is one of the best characterized causes of human cancer in an occupational context (Occupational exposures, p33); the carcinogenic hazard associated with inhalation of asbestos dust has been recognized since the 1950s [1]. Non-occupational exposure to asbestos may occur domestically and as a consequence of localized pollution. Cohabitants of asbestos workers may be exposed to dust brought home on clothes. The installation, degradation, removal and repair of asbestos-containing products in the context of household maintenance represents another mode of domestic exposure. Further afield, whole neighbourhoods may be subject to outdoor pollution as a result of local asbestos mining or manufacture. The erosion of asbestos or asbestiform rocks may constitute a natural source of asbestos exposure in some parts of the world. In common with occupational exposure, exposure to asbestos under domestic circumstances results in an increased risk of mesothelioma, a rare tumour derived from the cells lining the peritoneum, pericardium or pleura. Likewise, non-occupational exposure to asbestos may cause lung cancer, particularly among smokers [4]. A consequence of neighbourhood exposure, namely a very high incidence of mesothelioma, is evident among inhabitants of villages in Turkey where houses are built from erionite (a zeolite mineral). Outdoor air pollution Ambient air pollution has been implicated as a cause of various health problems, including cancer, and in particular as a cause of lung cancer. Air may be polluted by a complex mixture of different gaseous and particulate components. The concentrations of specific components vary greatly with locality and time. A critical exposure scenario is therefore hard to define, particularly as relevant biological mechanisms are largely unknown. It is, however, possible to attribute at least some carcinogenic risk to particular atmospheric pollutants, including benzo[a]pyrene, benzene, some metals, particulate matter (especially fine particles) in general, and possibly ozone. Over recent decades, emission levels have been tending to decrease in developed countries, so that concentrations of traditional industrial air pollutants such as sulfur dioxide and particulate matter have fallen. However, vehicular exhaust remains a continuing or even increasing Fig. 2.22 Fuel used for heating and cooking, and high levels of cooking oil vapours are responsible for the high incidence of lung cancer among women in some parts of Asia. Fig. 2.23 Air pollution is common to many large cities throughout the world. Environmental pollution 39
Page 2 and 3: WORLD HEALTH ORGANIZATION WHO OMS I
Page 4 and 5: WORLD CANCER REPORT Editors Bernard
Page 6 and 7: CONTENTS Foreword 9 1 The global bu
Page 8 and 9: The global burden of cancer Cancer
Page 10 and 11: Fig. 1.2 Incidence and mortality of
Page 12 and 13: Central and Southern Europe differ
Page 14 and 15: Incidence of cancer in South Centra
Page 16 and 17: from documentation of disease to a
Page 18 and 19: TOBACCO SUMMARY >In addition to lun
Page 20 and 21: Fig. 2.3 Smoking by children is inc
Page 22 and 23: Cancers positively Sex Standardized
Page 24 and 25: PHARMACOLOGICAL APPROACHES TO SMOKI
Page 26 and 27: level the dose—response relations
Page 28 and 29: lipoprotein-associated cholesterol,
Page 30 and 31: Agent Cancer site/cancer Main indus
Page 32 and 33: Industry, occupation Cancer site/ca
Page 36 and 37: Air pollutant WHO Air Quality Guide
Page 38 and 39: der cancer of the order of 50% is p
Page 40 and 41: AFLATOXIN B 1 HEPATITIS VIRUS (chro
Page 42 and 43: Fig. 2.30 Correlation between regio
Page 44 and 45: MEDICINAL DRUGS SUMMARY > Certain d
Page 46 and 47: Drug or drug combination Cancer IAR
Page 48 and 49: Agent or substance Cancer site/canc
Page 50 and 51: sources of electromagnetic fields [
Page 52 and 53: CHRONIC INFECTIONS SUMMARY > Infect
Page 54 and 55: Infection Subclinical Mutagenic fac
Page 56 and 57: TUMOURS ASSOCIATED WITH HIV/AIDS Ap
Page 58 and 59: DIET AND NUTRITION SUMMARY > Up to
Page 60 and 61: Fig. 2.54 The age-adjusted mortalit
Page 62 and 63: OVERWEIGHT, OBESITY AND PHYSICAL AC
Page 64 and 65: IMMUNOSUPPRESSION SUMMARY >Persiste
Page 66 and 67: Fig. 2.64 Cancer following immunosu
Page 68 and 69: Syndrome Gene Location Cancer site/
Page 70 and 71: viduals, confirmation of a gene def
Page 72 and 73: REPRODUCTIVE FACTORS AND HORMONES S
Page 74 and 75: PHYTO-ESTROGENS AND CANCER PEVENTIO
Page 76 and 77: 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
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CARCINOGEN ACTIVATION AND DNA REPAI
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adducts, a few weeks or months for
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I Reactive oxygen species Methylati
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which remove the mismatched bases,
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Common human oncogenes Many common
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product of the RB1 gene (pRb) and a
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ates a molecular bridge between p53
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potential cancer genes altered thro
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One of the earliest genes to be ide
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Regulation of the cell cycle and co
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CELL-CELL COMMUNICATION SUMMARY > C
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Connexin genes and tumour suppressi
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APOPTOSIS SUMMARY > The term apopto
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Caspase-8 Caspase-3 c-FLIP Procaspa
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ways. Several options are under inv
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INVASION AND METASTASIS SUMMARY > T
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laminin, entactin and also heparan
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Target Example of agent Comments Ad
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organs, and to respond to local gro
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TOBACCO CONTROL SUMMARY > Tobacco-i
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Region Deaths due to % of total dea
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ipated, is primarily attributable t
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smoke. This may be achieved in part
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there is no evidence for the effica
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industries, processes and occupatio
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stoves arises in rural areas of dev
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Climbing plants on trellis at end r
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HEPATITIS B VACCINATION SUMMARY > P
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Fig. 4.17 Chronic active HBV-associ
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HUMAN PAPILLOMAVIRUS VACCINATION SU
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Vaccine Site of trial Number of pat
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prolonged use. Similar drugs, that
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aspirin and other non-steroidal ant
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SCREENING FOR BREAST CANCER SUMMARY
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Fig. 4.35 Cumulative mortality from
Page 155 and 156:
SCREENING FOR PROSTATE CANCER SUMMA
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Fig. 4.39 Poster designed for an an
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is around 10% for cancer (out of ev
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45 with one positive rehydrated FOB
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eing based on (i) time trends in th
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Fig. 4.48 Women at a clinic in Indi
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SCREENING FOR ORAL CANCER SUMMARY >
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India will provide useful informati
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cer incidence following cure of inf
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100 50 25 10 5 2.5 1 Japan Males Fe
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Human cancers by organ site Maligna
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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
Page 219 and 220:
Fig. 5.76 A radiographic view of an
Page 221 and 222:
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
Page 231 and 232:
LYMPHOMA SUMMARY > Malignant lympho
Page 233 and 234:
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
Page 267 and 268:
Year Radical mastectomy (%) Modifie
Page 269 and 270:
TELEMEDICINE The prospects for tele
Page 271 and 272:
Equipment Energy 50% depth dose App
Page 273 and 274:
CANCER EDUCATION IN MEDICAL COURSES
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Fig. 6.10 Crystals of cisplatin: mo
Page 277 and 278:
Responsiveness Cancer (in decreasin
Page 279 and 280:
Most of the world’s most common c
Page 281 and 282:
treatment of cancer. The problems l
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duction. It is clear that tumour ce
Page 285 and 286:
REHABILITATION SUMMARY > Rehabilita
Page 287 and 288:
cer and its associated disability.
Page 289 and 290:
REFERENCES 1. Garden FH, Gillis TA
Page 291 and 292:
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
Page 297 and 298:
priority to cancer control activiti
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Prevention of cancer Every country
Page 301 and 302:
- Assessing the magnitude of the ca
Page 303 and 304:
high-risk women. Further details on
Page 305 and 306:
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
Page 317 and 318:
Fig. 7.17 Main causes of death in d
Page 319 and 320:
Contributors and Reviewers Sources
Page 321 and 322:
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
Page 337 and 338:
Fibroblast growth factor (FGF), 117
Page 339 and 340:
Microarray, 240 Micronutrients, 65,
Page 341 and 342:
S Saccharin, 64, 85 Salicin, 153 Sa
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