world cancer report - iarc

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PHARMACOLOGICAL APPROACHES TO SMOKING ADDICTION Quitting smoking is very difficult. Surveys show that 74% of smokers report a desire to quit and 70% of smokers have made previous attempts to quit smoking, yet success rates remain low (US Department of Health and Human Services, Healthy People 2000 Review, 1994). The difficulty that most smokers encounter reflects both a habit and a physiological addiction. In addition, cessation involves discontinuing a dependency that smokers acquired at a vulnerable period in their lives (Tobacco control, p128). The low success rates associated with unaided attempts to quit suggest that REFERENCES 1. Wald NJ, Hackshaw AK (1996) Cigarette smoking: an epidemiological overview. Br Med Bull, 52: 3-11. 2. IARC (1986) Tobacco Smoking (IARC Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans, Vol. 38), Lyon, IARCPress. 3. IARC (1985) Tobacco Habits Other Than Smoking; Betel-quid and Areca-nut Chewing; and Some Related Nitrosamines (IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol. 37), Lyon, IARCPress. 4. Corrao MA, Guindon GE, Sharma N, Shokoohi DF, eds (2000) Tobacco Control Country Profiles, Atlanta, Georgia, American Cancer Society. 5. Law MR, Hackshaw AK (1996) Environmental tobacco smoke. Br Med Bull, 52: 22-34. 6. Boyle P, Maisonneuve P (1995) Lung cancer and tobacco smoking. Lung Cancer, 12: 167-181. 7. Stellman SD, Resnicow K (1997) Tobacco smoking, cancer and social class. In: Kogevinas M, Pearce N, Susser M & Boffetta P, eds, Social Inequalities and Cancer, (IARC Scientific Publications, No. 138), Lyon, IARCPress, 229- 250. 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. Doll R (1996) Cancers weakly related to smoking. Br Med Bull, 52: 35-49. 10. Winn DM (1997) Epidemiology of cancer and other systemic effects associated with the use of smokeless tobacco. Adv Dent Res, 11: 313-321. 28 The causes of cancer pharmacological treatment be offered unless there is a medical contraindication. Treatments for smoking addiction include nicotine replacement therapies and nonnicotine therapy (Okuyemi KS et al., Arch Family Med, 9: 270-281, 2000; The Tobacco Use and Dependence Clinical Practice Guideline Panel, JAMA, 283: 3244-3254, 2000). Nicotine replacement therapies include nicotine polacrilex gum, transdermal nicotine patch, nicotine nasal spray, nicotine sublingual tablet, and nicotine inhaler but only about 25% of attempts involve the use of any nicotine replacement therapy. The only approved non-nicotine therapy is the antidepressant bupropion hydrochloride. Other antidepressants such as nortriptyline and moclobemide have shown 11. Parkin DM, Pisani P, Lopez AD, Masuyer E (1994) At least one in seven cases of cancer is caused by smoking. Global estimates for 1985. Int J Cancer, 59: 494-504. 12. Doll R, Peto R (1981) The causes of cancer: quantitative estimates of avoidable risk of cancer in the USA today. J Natl Cancer Inst, 66: 1191-1308. 13. Levi F (1999) Cancer prevention: epidemiology and perspectives. Eur J Cancer, 35: 1912-1924. 14. Rodgman A, Smith CJ, Perfetti TA (2000) The composition of cigarette smoke: a retrospective, with emphasis on polycyclic components. Hum Exp Toxicol, 19: 573-595. 15. Brunnemann KD, Prokopczyk B, Djordjevic MV, Hoffmann D (1996) Formation and analysis of tobacco-specific N-nitrosamines. Crit Rev Toxicol, 26: 121-137. 16. Shields PG (2000) Epidemiology of tobacco carcinogenesis. Curr Oncol Rep, 2: 257-262. 17. Hecht SS (1999) Tobacco smoke carcinogens and lung cancer. J Natl Cancer Inst, 91: 1194-1210. 18. Shields PG, Harris CC (2000) Cancer risk and lowpenetrance susceptibility genes in gene-environment interactions. J Clin Oncol, 18: 2309-2315. 19. Hainaut P, Hollstein M (2000) p53 and human cancer: the first ten thousand mutations. Adv Cancer Res, 77: 81- 137. 20. IARC (2003) Tobacco Smoke and Involuntary Smoking (IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol. 83), Lyon, IARCPress. In preparation. some promise but are not generally approved for use. Combination of two nicotine replacement therapies (patch plus gum, spray, or inhaler) or a nicotine replacement therapy plus a non-nicotine drug (bupropion) may work better than single agents. In summary, treatments help fewer than one in five smokers and are not being used by the majority of smokers trying to quit. Recent progress in the understanding of the neuropharmacological basis of nicotine addiction holds promise for the development of new treatments. WEBSITES Tobacco & Cancer, The American Cancer Society: http://www.cancer.org/docroot/PED/ ped_10.asp?sitearea=PED Tobaccopedia, an online tobacco encyclopaedia: http://tobaccopedia.org/
ALCOHOL DRINKING SUMMARY > Heavy alcohol drinking causes cancer of the oral cavity, pharynx, larynx, oesophagus, and liver, and may increase the risk of breast and colorectal cancer. > Risk is linearly related to the mean daily consumption. > Low levels of consumption appear to exert a protective effect against cardiovascular disease. > In the oral cavity, pharynx, larynx and oesophagus, the risk is greatly increased by concurrent smoking. Beverages containing alcohol (the common name for ethanol) as the product of the fermentation of carbohydrates have been produced in most human societies since ancient times. Despite great variety, most alcoholic beverages can be grouped as either beers (brewed by fermenting malted barley and typically containing 5% volume of alcohol), wines (made by fermenting grape juice or crushed grapes, containing 12% alcohol) or spirits (made by distilling fermented products of a variety of cereals, vegetables and fruits, containing 40% alcohol). Beverages that are less common and which are often limited to particular regions include cider, fortified wines and flavoured wines. On a global scale, the consumption of alcoholic beverages by adults as calculated from official figures is equivalent to 4 L of alcohol per year (or 9 g/day), corresponding to approximately 3% of the average total intake of calories [1]. Unofficial consumption, however, is estimated to account for an additional amount corresponding to 20-100% of the official figures, depending on the country. Most “unofficial” alcohol is either sold illegally on the black market (usually to avoid taxation) or produced for private consumption. There is strong regional variability in consumption levels, with a minimum (12 L/year) in Central and Southern Europe. The distribution between each major type of beverage is also countryspecific (Fig. 2.10). Official figures show a decrease in alcohol consumption in more developed countries and, over recent years, an increase in consumption in less developed countries. Cancers caused Through analytical epidemiological studies of cohort and case-control type conducted in many populations with different levels of consumption, the causal association of drinking alcohol has been definitely established in respect of oral, oesophageal, liver and other cancers [2]. In particular, studies of cancer risk in brewery workers and in alcoholic patients have provided important evidence on the carcinogenic role of alcohol. A causal association is also established in the case of breast cancer and is probable for colon and rectal cancer [2,3]. There have been suggestions of a possible carcinogenic effect of alcohol drinking on other organs, such as the lung, but the evidence is still inconclusive [4]. An association between alcohol intake and risk of head and neck cancer is indicated by the geographical pattern of these neoplasms; countries (and regions within countries) with heavy alcohol consumption are among those with the highest incidence of these neoplasms. For all cancers caused by drinking alcohol, the risk of cancer is a linear function of the level of consumption, up to an intake of about 80 g/day (one litre of wine, a quarter of a litre of spirits), above which Mean alcohol Relative risk consumption (95% confidence) No alcohol 1 > 0 to 30 g/day 1.2 (0.4–3.4) > 30 to 60 g/day 3.2 (1.0–10.1) > 60 g/day 9.2 (2.8–31.0) *Adjusted for follow-up time, sex, education, body mass index (BMI), vegetable and fruit consumption, tobacco smoking and energy intake Table 2.4 Consumption of alcohol increases the risk of cancer of the upper gastrointestinal tract. Fig. 2.10 Patterns of alcohol drinking, expressed as mean equivalent volumes of pure ethanol, in selected countries, 1996. Alcohol drinking 29
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 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 34 and 35: to occupational exposures in develo
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
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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
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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
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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
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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,
Page 341 and 342:
S Saccharin, 64, 85 Salicin, 153 Sa
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