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Lecture notes Oncology And Public Health (AB_1027)
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All lectures from the course Oncology and Public Health, based on the learning goals.
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Lectures Oncology and Public HealthLecture 2: Introduction in Public Health
- Explain the role of public health in cancer prevention and survivorship
o Definition of public health
The science and art of preventing disease, prolonging life and promoting health through the
organized efforts of and informed choices of society, organizations, public and private,
communities and individuals
Health WHO
o A state of complete physical, mental and social well-being and not merely
the absence of disease or infirmity
Refers to collective actions to improve population health
WHO all organized measures to prevent disease, promote health, and prolong life among
the population as a whole
o Application of public health
Epidemiology and community diagnosis
Occurrence of disease on community level
Collective prevention and health promotion
Health care organization and performance
Access
Cost-effectiveness
Populations form local areas to the world population
Causes of disease (causes of causes) from behaviors to broader environments
Prevention of disease from individual patients to national policies
General health outcomes from quality of life to healthy life expectancy
o Public health functions
Main public health functions WHO
Assessment and monitoring of the health of communities and populations at risk to
identify health problems and priorities
The formulation of public policies designed to solve identified local and national
health problems and priorities
Assure that all populations have access to appropriate and cost-effective care,
including health promotion and disease prevention services
o Current/future public health challenges
Infectious diseases Environmental quality
Chronic diseases Social issues
Overweight/obesity violence/drug
Mental health abuse/teenage pregnancy
- Global burden of cancer
o Leading cause of death 1/8 deaths worldwide
o Expected rise in incidence and mortality
Increasing global population
Increasing age
Increase in screening if you look for something, you’ll find it
Breast cancer/cervical cancer/colon cancer
Increases in risk factors smoking/obesity/physical inactivity/unhealthy diet
o Geographic variations
Stomach cancer 7x increased in Japan/Korea consumption of smoked fish
Breast & prostate cancer less frequent in Asian people diet
Melanoma Australia + sunny parts south US
Liver cancer South-East Asia & East Africa hepatitis B
Thyroid cancer Swiss Alps/Rocky Mountains etc deficiency of iodine in local food and
water supplies
o Why public health policy
Much of behavior passive reflection of “upstream” factors rather than active choice
Environmental/economic/social factors outside most people’s control
Thus, effectiveness of behavioral change relies on policies that influence upstream factors and
norms that determine people’s behaviors (causes of causes)
Public health policy therefore is an important and sometimes even critical determinant of
population health
- Explain the relation between lifestyle and cancer risk
o Primary prevention Prevent disease from occurring
Encourage healthy lifestyles Can reduce cancer risk by 30-35%
WCRF world cancer research fund international
1
, Increases risks
o Overweight/obesity
o Weight gain in adulthood
o Salt-preserved foods
o Arsenic in drinking water
o Alcohol
o Beta-carotene supplements
o Mate
o Cantonese style salted fish
o Processed meat
o Red meat
o Glycemic load
o Aflatoxins
o Height
o Greater birth weight
Decreases risks
o Non-starchy vegetables
o Fruit
o Physical activity
o Dietary fiber
o Breast feeding
o Coffee
o Garlic
o Greater body fatness (between 18-30)
o Diet high in calcium
o Alcohol
Recommendations
o Be a healthy weight maintain energy balance
Being physically active
Eating a diet rich in wholegrains, vegetables, fruit and pulses
Limiting fast food consumption and other processed foods
Limiting consumption of sugar sweetened drinks
o Be physically active
o Limit alcohol consumption
Smoking cessation reduces cancer risk most
Legislation increase tax on tobacco/alcohol
HPV vaccination for prevention of cervical cancer
o Secondary prevention
Detect and treat the disease in an early phase before symptoms occur
Example
Screening for breast/cervical/colon cancer
o Tertiary prevention
Prevent damage and pain from the disease, slow down the disease and prevent the disease
from causing other problems
Examples
Survivorship care improve health related quality of life
Prevention of cancer recurrence
Lecture 3: Introduction in Oncology
- Explain the critical role genomic alterations in oncogenes and tumor suppressor genes in cancer development
o Genomic alterations may affect genes and proteins that regulate normal cell growth and division (proto-
oncogenes) can turn into oncogene stimulation of division
Rapid growth and frequent division, cause an increased risk of additional genomic alterations
Single nucleotide mutation (point mutation)
Changes in amino acid sequence of proteins can cause continuous
activation/inactivation of enzymes
Copy number mutations deletions/duplications
Suppression of growth and induction of apoptosis is lost
- Describe factors that cause cancer, such as environmental toxins and diseases
o Lifestyle ±2/3 of cancer
Smoking
±20% of worldwide total cancer deaths
2
, One-half of all smokers die of a tobacco-related disease
Adult smokers lose an average of 13 years
Carcinogenesis
o Delivers carcinogens directly to tissues risk of new mutations
o Causes irritation and inflammation increased cell replication
o Interferes with the body’s natural protective barriers carcinogens more
toxic to cells
Unprotected exposure to sun (UV-rays)
Cumulative and repeated intense exposures increase risk of melanoma
Tanning booths before 35 75% increase in risk for melanoma
Carcinogenesis
o Ultraviolet radiation causes genetic mutations
o Interferes with cutaneous immune system (inhibitory way)
Lack of exercise
Sedentary lifestyle is associated with 5% of cancer deaths
Carcinogenesis
o Physical activity stimulates the immune system, angiogenesis and
hormonal function
Obesity
Estimated to cause up to 20% of all cancers
Carcinogenesis
o Higher hormone levels estrogen, insulin, oxidative stress
Diet high in fat and low in fruits and vegetables
Alcohol
3.6% of cancers are associated with chronic alcohol drinking
o Environmental risks
Secondhand smoke
Air pollution
Industrial pollution
Chemical exposures
o Lifestyle & environmental
Human papilloma virus
Sexually transmitted
Can cause cervical carcinoma, cancer of vagina/penis
Also involved in head and neck cancer (oropharyngeal cancer)
Epstein-barr virus
Nasopharyngeal carcinoma, Burkitt Lymphoma
Hepatitis B & C virus
Hepatocellular carcinoma
o Inherited
±5% inherited
Gene mutations are linked to some inherited cancers
For example:
Colon cancer (Lynch syndrome)
Breast cancer (BRCA)
Ovarian (BRCA)
Lecture 4: Oncogenesis; tumor biology and clinical behavior
- Appreciate the complexity of oncogenesis
no starting point & no end
3
, - Describe the basic pathways of oncogenesis
o 8 hallmarks
Activating invasion & metastasis interplay of processes that are intrinsic to tumor cells and
signals are initiated by the tissue environment
Inducing angiogenesis otherwise tumor can’t grow
Resisting cell death resistant to programmed cell death
Deregulating cellular energetics metabolic switch in tumors to aerobic glycolysis, which
enables the synthesis of macromolecules and organelles needed for rapid cell growth
Sustaining proliferative signaling tumors can proliferate without external stimuli, as a
consequence of oncogene activation
Avoiding immune destruction exhibit alterations that allow them to evade host immune
system
Altered proteins are in normal conditions recognized as foreign by immune cells
Tumor mutational burden
PD-L1 expression by tumor cells
Evading growth suppressors tumors may not respond to molecules that inhibit
proliferation of normal cells, due to inactivation of tumor suppressor genes
Enabling replicative immortality unrestricted proliferative capacity stem cell-like avoid
cellular senescence and mitotic catastrophe
o Enabling factors promote cellular transformation and subsequent tumor progression
Tumor promoting inflammation
Genomic instability
- Understand the clinical context of tumor biology
o Chance finding or detected in screening program asymptomatic patients
o Index complaint
o Physical examination symptomatic patients
o Radiologic investigations
o Diagnostic nuclear medicine
o Blood tests and other clinical chemical tests
o Diagnostic microscopy pathology
Cytopathology
Exfoliate cytology fluids/smears
Fine needle aspiration
o Palpation or ultrasound-guided
o No anesthesia required
o 20-40 seconds
Histopathology loss of differentiation/pleomorphism/disorderly architecture/abnormal
mitotic activity
Biopsies
o Endoscopic
o Punch
Resection specimens
Lecture 5: Prevention and screening
- Explain the meaning of the concepts NPV/PPV/sensitivity/specificity in relation to safety and screening harms
o Safety emphasized in curative cure treat/monitor in case of doubt
Sensitivity if you have the disease, what is the probability of a positive test?
NPV if you have a negative test, what is the probability of not having the disease?
o Screening harms should be as low as possible
PPV if you have a positive test, what is the probability of having the disease?
Specificity if you don’t have the disease, what is the probability of having a negative test?
o Potential problems when evaluating performance of screening test
Choice of gold standard
Misclassification
Inappropriate definition
Selection bias
Study population not representative of screening population
Partial verification
Screen-positives have higher probability of being verified by gold standard than
screening-negatives
o When gold standard is burdensome
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