Cancer Prevention

Cancer control is the reduction of cancer incidence, morbidity,

.and mortality in defined population

Primary prevention refers to health promotion and risk

reduction in the general population so that invasive cancer does
not develop. Examples of primary prevention include smoking
cessation, diet and lifestyle modification, and micronutrient
.supplementation

Secondary prevention is the identification and treatment of

asymptomatic persons who already have developed
premalignant or early malignant disease in whom the condition
has not become clinically apparent. Examples include screening
.like mammography, pap smears, and flexible sigmoidoscopy

Attributable risk factors for cancer

agent
Tobacco
Diet
Radiation
Chemical, occupation

Major type of cancer

Estimated contribution to
% excess cancer mortality
Lung, oropharynx, bladder, 30
.pancrease, esophagus
Breast, colon, prostate,
.aero digestive
35
Lung, leukemia
3
Bladder, mesothelioma
4

.The single most avoidable cause of cancer is cigarette smoking

Current smoker of about one pack of cigarettes a day has about a
20 fold increased risk of lung cancer. Nearly 90% of lumg
.cancer is attributable to cigarette smoking
Lung cancer
1

:Incidence
Male 14%. Prostate cancer is the most common cancer type in men .
29%
Female 12%. Breast cancer is the common cancer type in women.
30%

Death
Male 31% the most common cause of death
Female 25% the most common cause of death

Etiology
Smoking. Cigarette smoking is the cause of 85% to 90% of lung -1
.cancer
.Asbestose -2
.Radiation exposure -3
.Other substances: Arsenic, nickel, chromium compound .4
.COPD, lung scar .5

Pathology
Small cell carcinoma 15%
NSCLC85%

Prevention and early detection

.Prevention is the best way to reduce the death rate from lung cancer
Screening with chest radiograph and sputum cytology has not been
.clearly demonstrated to improve survival rate
Recent review phase II prevention trial JCO 2002 concluded that
Alpha tocopherol, beta carotene, retinol, retinyl palmitate, Nacetylcystine and isotritenion can not prevent lung cancer in
smokers

Breast cancer
Etiology
Genetics: BRCA1, BRCA2, and P53 -1
Hormone -2
Diet -3
Risk factor for Breast cancer > 3 fold
High risk factors
A- Age
B- Previous cancer in one Breast
2

C- Previous cancer in the family

D- Hyperplasia with atypia
E- Parity
F- Lobular carcinoma in situ
G- Risk factors in men. Klinefelter syndrome, gynecomastia and family
.history of male breast cancer

Intermediate risk factors

A- Menstruation history
Early menarche
Late menopause
B- Oral pills
.C- History of cancer of the ovary, uterine fundus or colon
D- DM
E- Alcohol
Factors known to decrease risk
A- Asian
B- Term pregnancy before 18
C- Early menopause
D- Surgical castration before the age of 37 years

Prevention of high risk women

Tamoxifen reduce risk in ER positive by 49%
Side effect -endometrial carcinoma and thrombo-embolic disease
Raloxifene has effect similar to tamoxifen but did not cause
endometrial carcinoma

.No woman should ignore a lump in her breast without knowing what it is

Lymphoma
Symptoms
Painless lymphadenopathy
Fever, weight loss, night sweating

B symptoms

Pruritus
Pel ebstein fever

Hodgkin lymphoma

Frequency of lymphoma in adult

B cell lymphoma 85%
T cell lymphoma 15%
Follicular 35%
PTL 5
DLCL 30%
ALCL5%
MCL 5%
ALL 2%
SLL/CLL 5%
MALT 2%
LPL 1-2%
Differential diagnosis
Lymphoma
Tuberculosis,
Brucellosis,
Fungal infection,
Viral infection
HIV
Connective tissue disease like Systemic lupus erthymatosus

TREATMENT
Lymphoma

> first line treatment > fail >

High dose chemotherapy > fail
None/palliative or
Stem cell transplantation

Life style factors and risk of cancer risk

Obesity
Body mass index 30 kg/m2
Increased risk of breast, endometrial, colorectal, renal and
gallbladder cancers
Functionally enhanced food
Epidemiologic data suggest that consumption of soy products is
associated with reduced risk for breast cancer, endometrial
cancer and prostate cancer

Review
In North America, tobacco use if avoided would prevent 30%
of cancer death. Which of the following smoking can cause:
1- Lung cancer
2- Head and neck cancer
3- Esophageal cancer
4- Pancreatic cancer
5- All of the above
All of the following will help to differentiate Mastitis from
inflammatory breast cancer except:
1- Fever
2- Pain
3- Peodo orange
4- Duration of symptoms and relation to menstrual cycle
5- Bilaterality
:All

of the following are aggressive type of lymphoma except

1- Diffuse large B-cell lymphoma (40% of NHL)
2- Follicular lymphoma (35% of NHL)
3- Mantle cell lymphoma (6% of NHL)
4- Peripheral T-cell lymphoma (5% of NHL)
5- Ana plastic large cell lymphoma (5% of NHL)
Which of the following is not correct about bronchogenic
carcinoma?
1- Screening program has level one evidence not to reduce
mortality
2- Adjuvant treatment of completely resected pulmonary
tumor prolong overall survival
3- The cell origin of lung carcinoma is more likely from
plueripotent stem cell as proposed by Aeurbach
4- Non tobacco carcinogen include radon, asbestos and
COPD
5- Treatment of advanced lung cancer is mainly palliative

All of the following are true about prevention of breast

cancer except
1- Prophylactic mastectomy can be considered only for very
high risk groups
2- Annual mammogram have been demonstrated to reduce
breast cancer mortality in women older than 50 years
3- Raloxifene is as effective as tamoxifen to prevent breast
cancer but less toxic
4- Raloxifene and tamoxifen are only effective for ER
positive breast cancer
5- Age is not a risk factor for breast cancer
Dr. Ali Al-Amri, M.D
23/9/2006