Oncology & Public Health
Lecture 1: Introduction Oncology & Public Health
- Prevalence of cancer:
o In Europe, the incidence was >4 million in 2020 with a mortality rate of 1.9 million.
o In the Netherlands, the incidence was 224.000 in 2020 with a mortality rate of 45.863.
The five-year survival rate (1990-1994) was 56% in women and 42% in men.
The five-year survival rate (2015-2019) was 70% in women and 66% in men.
The twenty-year prevalence was 856.914 in 2021 and is expected to increase to 1.4
million in 2032 (1 in 13).
o During COVID-19 (2020), the population-based screening stopped, and patients were hesitant
to go to their general practitioner or to the hospital.
o There are around 260 cancer types in total that someone can be diagnosed with, and 86% of
all cancer types are rare. The most common cancer types are breast cancer (women),
squamous cell carcinoma (skin), lung cancer, prostate cancer (men), and colon cancer.
o In the Netherlands, cancer is still the leading cause of death. Around one third of deaths from
cancer are due to the five leading behavioural and dietary risks: high body mass index (BMI),
low fruit and vegetable intake, lack of physical activity, tobacco use, and alcohol use.
- Public health:
o Public health is the science and art of preventing disease, prolonging life, and promoting
health through the organised efforts of society.
o Health is a state of complete physical, mental, and social wellbeing and not merely the
absence of disease or infirmity.
- Integraal ZorgAkkoord:
o Focus on prevention limit risk factors for cancer obesity, smoking, alcohol use and
UV-radiation.
o Increase health care capacity working in health care should be made more attractive.
o Efficient organisation of health care use of technology at the right location.
o Digitalisation connecting data.
o Support the needs of patients and survivors.
o Increase quality of life and quality of end-of-life.
Lecture 2: Public Health Issues in Oncology
- Definitions of public health:
o Public health is the science and art of preventing disease, prolonging life, and promoting
health through the organised efforts and informed choices of society, organisations (public and
private), communities and individuals (Acheson, 1988).
It refers to collective actions to improve population health (Bonita et al., 2006).
All organised measures (whether public or private) to prevent disease, promote health,
and prolong life among the population as a whole (WHO).
o Health is a state of complete physical, mental, and social well-being and not merely the
absence of disease or infirmity (WHO, 1948).
- Application of public health:
Population: from local areas to world
population.
Causes of disease (“cause of causes”):
from behaviours to broader
environments for example, focusing
on surrounding of a person.
Prevention of disease: from individual
patients to national policies.
General health outcomes: from quality of
life to healthy life expectancy.
o Three fields of public health research:
, Epidemiology and community diagnosis.
Collective prevention and health promotion.
Health care organisations and performance (e.g., finances).
- Main public health functions (WHO):
o Assessment and monitoring of the health of communities and populations at risk to identify
health problems and priorities.
o The formulation of public policies designed to solve identified local and national health
problems and priorities.
o Assure that all populations have access to appropriate and cost-effective care, including health
promotion and disease prevention services.
- Public health achievements and challenges:
o Achievements
Since 1900: vaccination, safer workplace, and control of infectious diseases.
Since 1920: safer and healthier foods, healthier mothers/babies, and family planning.
Since 1965: fluoridation of drinking water, motor-vehicle safety, recognition of tobacco
uses as health hazard, and decline in deaths from coronary heart diseases and stroke.
Biggest milestone was improved sewage disposal and clean water supply system.
o Current/future challenges: infectious diseases (Ebola, COVID-19), chronic diseases,
overweight/obesity, mental health, environmental quality, planetary health, and social issues
(violence, drug abuse, and teenage pregnancy).
- Global burden of cancer:
o Cancer is still the leading cause of death (1:8 worldwide) and is expected to rise enormously.
2012: 14.1 million cases and 8.2 million deaths | 2030: 21.7 million cases and 13
million deaths.
o Increase of cases and deaths because of:
Increasing global population and increase in age.
Better screening rise in new cases (breast, cervix, and colon cancer).
Increase in risk factors smoking, obesity, physical inactivity, and unhealthy diet.
o Geographic variations:
Stomach cancer: 7x increased risk in Japan and Korea (consumption smoked fish).
Breast & prostate cancer: less frequent in Asians than Caucasian people (diet).
Melanoma: increased risk in Australia and sunny southern USA (sun exposure).
Liver cancer: South-east Asia and east Africa (Hepatitis B).
Thyroid cancer: deficiency of iodine in local food and water supplies (e.g., Swiss Alps,
Rocky Mountains, Andes, Himalayas).
- Cancer prevention:
o Primary prevention prevent the disease from occurring.
Encourage healthy lifestyles | legislation (tax on tobacco/alcohol) | HPV vaccination for
prevention of cervical cancer.
o Secondary prevention detect and treat disease in an early phase before symptoms occur.
Screening for breast, cervical, or colon cancer.
o Tertiary prevention prevent damage and pain from disease, slow down the disease, and
prevent the disease from causing other problems.
Survivorship care (improve HRQoL) | prevention of cancer recurrence.
o Approximately 30% of cancer risk could be prevented by changes in lifestyle.
Recommended to maintain a healthy weight by being physically active, eating a rich
diet, limiting fast food consumption and other processed foods high in fat, starches, or
sugar, and limiting consumption of sugar sweetened drink.
- Why public health policy?:
o Much of behaviour is passive reflection of ‘upstream’ factors rather than active choice.
Environmental, economic, and social factors (outside most people’s control).
o Effectiveness of behavioural change relies on policies that influence upstream factors and
social norms that determine people’s behaviours (“causes of causes”).
o Public health policy (i.e., laws, regulations, guidelines) therefore is an important and sometimes
even critical determinant of population health.
,
, Lecture 3: Introduction in Oncology
- What is cancer?:
o Our bodies consist of about 30 trillion cells that group together to form tissues and organs, of
which the organs work together.
o Cancer can arise in any of the cells our body contains.
o Cancer comprises a large group of diseases
characterised by abnormal cells, which continuously
proliferate, invade local tissues, and can spread to
other organs (metastasis).
Cancer cells can spread to tissues and organs
via lymph nodes and blood vessels.
o The additional cells may form a mass of tissue called a
tumour. There are 1.000.000.000 cells needed to form
a tumour the size of a grape.
o A patient usually has had cancer for several years
before the tumour is detected or causes symptoms.
o A benign tumour has distinct, smooth, regular borders that can become quite large, but will not
invade nearby tissues or spread to other parts of the body. Malignant tumours have irregular
borders, grow faster than a benign tumour, and are able to spread to other parts of the body.
- Types of cancer:
o The main type of cancer is carcinoma (85%) that forms in epithelial tissue (lines most organs).
Most cancers that affect skin, breasts, kidneys, liver, lungs, pancreas, prostate gland,
head, and neck are carcinomas.
Example: oesophageal cancer can be divided into adenocarcinoma and squamous cell
carcinoma. Adenocarcinoma comes from the glandular epithelium of the oesophagus
and squamous cell carcinoma comes from the lining of the oesophagus.
o Other, less common types of cancer:
Sarcoma originates in the bone and soft tissues.
Glioma originates in glial cells of the central nervous system.
Melanoma originates in melanocytes in the skin.
Leukaemia originates in the blood-forming tissues of the bone marrow.
Lymphoma and myeloma originate in cells of the immune system.
- How does cancer arise?:
o Normally, human cells grow and multiply to regenerate tissues.
DNA is exposed DNA is replicated two exact copies in DNA cells divide
each cell contains the same DNA.
o The process of DNA replication is complex and vulnerable to:
Damage by toxins (e.g., cigarette smoke), either direct/ indirect (increased cell replication).
“Random” errors: the more replications, the more random errors as well.
o Mistakes in DNA can normally be repaired, or cells undergo apoptosis. Some cells survive with
an abnormal change in their DNA (genomic alteration).
o New genomic alterations give cells growth advantage.
o The normal suppression of growth and induction of apoptosis is lost.
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller manonvoskuil. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $7.60. You're not tied to anything after your purchase.
