world cancer report - iarc

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CONTENTS Foreword 9 1 The global burden of cancer 11 2 The causes of cancer 21 Tobacco 22 Alcohol drinking 29 Occupational exposures 33 Environmental pollution 39 Food contaminants 43 Medicinal drugs 48 Radiation 51 Chronic infections 56 Diet and nutrition 62 Immunosuppression 68 Genetic susceptibility 71 Reproductive factors and hormones 76 3 Mechanisms of tumour development 83 Multistage carcinogenesis 84 Carcinogen activation and DNA repair 89 Oncogenes and tumour suppressor genes 96 The cell cycle 104 Cell-cell communication 109 Apoptosis 113 Invasion and metastasis 119 4 Prevention and screening Primary prevention 127 Tobacco control Reduction of occupational and environmental 128 exposures 135 Reduction of exposure to ultraviolet radiation 141 Hepatitis B vaccination 144 Human papillomavirus vaccination 148 Chemoprevention Secondary prevention/screening 151 Breast cancer 156 Prostate cancer 160 Colorectal cancer 163 Cervical cancer 167 Oral cancer 172 Stomach cancer 175 5 Human cancers by organ site 181 Lung cancer 182 Breast cancer 188 Stomach cancer 194 Colorectal cancer 198 Liver cancer 203 Cancers of the male reproductive tract 208 Cancers of the female reproductive tract 215 Oesophageal cancer 223 Bladder cancer 228 Head and neck cancer 232 Lymphoma 237 Leukaemia 242 Pancreatic cancer 248 Melanoma 253 Thyroid cancer 257 Kidney cancer 261 Tumours of the nervous system 265 6 Cancer management 271 Surgical oncology 272 Radiotherapy 277 Medical oncology 281 Rehabilitation 292 Palliative care 297 7 Cancer control 303 Cancer control: a global outlook 304 Cancer control in developing countries 312 Perspectives and priorities 320 Contributors and Reviewers 329 Sources of figures and tables 335 Subject index 343
FOREWORD The global burden of cancer continues to increase. In the year 2000, 5.3 million men and 4.7 million women developed a malignant tumour and 6.2 million died from the disease. Given the current trends in smoking prevalence and the adoption of unhealthy lifestyles, the number of new cases is expected to grow by 50% over the next 20 years to reach 15 million by 2020. Worldwide, twelve per cent of people die from cancer and in industrialised countries more than one in four will die from the disease. Each of us will experience grief and pain as a result of cancer, as a patient, a family member or a friend. In developed countries, the overall cancer mortality is more than twice as high as in developing countries. The main reasons for the greater cancer burden of affluent societies are the earlier onset of the tobacco epidemic, the earlier exposure to occupational carcinogens and the Western diet and lifestyle. In developing countries, up to one quarter of malignancies are caused by infectious agents, including the hepatitis (HBV and HCV), and human papillomaviruses (HPV). HBV vaccination has already been shown to prevent liver cancer in high-incidence countries and it is likely that HPV vaccination will become a reality within the next 3-5 years. Today, more than 80% of women dying from cervical cancer live in developing countries. Successful prevention of HPV infection would make an immense contribution to women’s health. Tobacco consumption remains the most important avoidable cancer risk. During the twentieth century, approximately 100 million people died worldwide from tobacco-associated diseases. Half of all regular smokers are killed by the habit and one quarter will die prematurely before the age of 70. The World Health Organization and its member states will soon adopt the Framework Convention on Tobacco Control, a major step towards reducing the enormous morbidity and mortality associated with tobacco consumption. During the past decade, research into the causes of human cancer, the molecular basis of malignant transformation and gene-environment interactions that contribute to individual cancer risks has made significant progress. Insight into cellular signalling pathways has led to the development of new anticancer drugs that are more specific and carry a lesser burden for the patient. It is possible to prevent at least one-third of the cases that occur every year throughout the world through better use of existing knowledge. Where sufficient resources are available, current knowledge also allows the early detection and effective treatment of a further one-third of cases. Pain relief and palliative care can improve the quality of life of cancer patients and their families, even in very low resource settings. My colleagues at the International Agency for Research on Cancer in Lyon and more than 50 contributors from all over the world have compiled a summary of the current understanding of cancer causes, cancer development, prevention and treatment. Together with the recently published WHO guidelines for national cancer control programmes, it will provide a scientific basis for public health action and assist us in our goal to reduce the morbidity and mortality from cancer and to improve the quality of life of cancer patients and their families, everywhere in the world. Gro Harlem Brundtland, M.D. Director-General, World Health Organization
Page 2 and 3: WORLD HEALTH ORGANIZATION WHO OMS I
Page 4 and 5: WORLD CANCER REPORT Editors Bernard
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 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
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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
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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
Page 317 and 318:
Fig. 7.17 Main causes of death in d
Page 319 and 320:
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
Page 327 and 328:
2.53 T. Norat and E. Riboli, IARC 2
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Gastroenterology, 118(2 Suppl 1): S
Page 331 and 332:
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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