Bioengineering and World HealthLecture TwelveFour Questions What are the major health problems worldwide? Who pays to solve problems in health care? How can technology solve health care problems? How are health care technologies managed?Three Case Studies Prevention of infectious disease HIV/AIDS Early detection of cancer Cervical Cancer Ovarian Cancer Prostate Cancer Treatment of heart disease Atherosclerosis and heart attack Heart failureOutline The burden of cancer How does cancer develop? Why is early detection so important? Strategies for early detection Example cancers/technologies Cervical cancer Ovarian cancer Prostate cancerThe Burden of Cancer: U.S. Cancer: 2nd leading cause of death in US 1 of every 4 deaths is from cancer 5-year survival rate for all cancers: 62% Annual costs for cancer: $172 billion $61 billion - direct medical costs $16 billion - lost productivity to illness $95 billion - lost productivity to premature deathU.S. Cancer Incidence & Mortality 2004 New cases of cancer: United States: 1,368,030 Texas: 84,530 Deaths due to cancer: United States: 563,700www.cancer.org, Cancer Facts & FiguresUS Mortality, 2001Source: US Mortality Public Use Data Tape 2001, National Center for Health Statistics, Centers for Disease Control and Prevention, 2003.1. Heart Diseases 700,142 29.02. Cancer 553,768 22.93. Cerebrovascular diseases 163,538 6.84. Chronic lower respiratory diseases 123,013 5.15. Accidents (Unintentional injuries) 101,537 4.26. Diabetes mellitus 71,372 3.07. Influenza and Pneumonia 62,034 2.68. Alzheimer’s disease 53,852 2.29. Nephritis 39,480 1.610. Septicemia 32,238 1.3 Rank Cause of DeathNo. of deaths% of all deaths2004 Estimated US Cancer Cases**Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder.Source: American Cancer Society, 2004.Men699,560Women668,47032% Breast12% Lung & bronchus11% Colon & rectum6% Uterine corpus4% Ovary 4% Non-Hodgkinlymphoma 4% Melanomaof skin3% Thyroid2% Pancreas2% Urinary bladder20% All Other SitesProstate 33%Lung & bronchus 13%Colon & rectum 11%Urinary bladder 6%Melanoma of skin 4%Non-Hodgkinlymphoma 4%Kidney 3%Oral Cavity 3%Leukemia 3%Pancreas 2%All Other Sites 18%2004 Estimated US Cancer Deaths*ONS=Other nervous system.Source: American Cancer Society, 2004.Men290,890Women272,81025% Lung & bronchus15% Breast10% Colon & rectum6% Ovary6% Pancreas4% Leukemia3% Non-Hodgkinlymphoma3% Uterine corpus2% Multiple myeloma2% Brain/ONS24% All other sitesLung & bronchus 32%Prostate 10%Colon & rectum 10%Pancreas 5%Leukemia 5%Non-Hodgkin 4%lymphomaEsophagus 4%Liver & intrahepatic 3%bile ductUrinary bladder 3%Kidney 3%All other sites 21%Worldwide Burden of Cancer Today: 11 million new cases every year 6.2 million deaths every year (12% of deaths) Can prevent 1/3 of these cases: Reduce tobacco use Implement existing screening techniques Healthy lifestyle and diet In 2020: 15 million new cases predicted in 2020 10 million deaths predicted in 2020 Increase due to ageing population Increase in smokingLingwood, et al;The challenge of cancer control in Africa; Nat Rev CA, 8:398, 2008.Global Cancer TrendsWorldwide Burden of Cancer 23% of cancers in developing countries caused by infectious agents Hepatitis (liver) HPV (cervix) H. pylori (stomach) Vaccination could be key to preventing these cancers1996 Estimated Worldwide Cancer Cases*Men Women910 Breast524 Cervix431 Colon & rectum379 Stomach333 Lung & bronchus192 Mouth191 Ovary 172 Uterine corpusLung & bronchus 988Stomach 634Colon & rectum 445 Prostate 400Mouth 384Liver 374Esophagus 320Urinary bladder 236What is Cancer? Characterized by uncontrolled growth & spread of abnormal cells Can be caused by: External factors: Tobacco, chemicals, radiation, infectious organisms Internal factors: Mutations, hormones, immune conditions Squamous Epithelial TissuePrecancer Æ Cancer SequenceHistologic ImagesNormalNormalCervical PreCervical Pre--CancerCancerhttp://www.gcarlson.com/images/metastasis.jpgFig 7.33 – The Metastatic cascade Neoplasiahttp://www.mdanderson.org/images/metastasesmodeljosh1.gifClinical Liver Metastaseshttp://www.pathology.vcu.edu/education/pathogenesis/images/6d.b.jpgWhat is Your Lifetime Cancer Risk?Lifetime Probability of Developing Cancer, by Site, Men, US, 1998-2000Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 5.1 Statistical Research and Applications Branch, NCI, 2003. http://srab.cancer.gov/devcanSite RiskAll sites 1 in 2Prostate 1 in 6Lung & bronchus 1 in 13Colon & rectum 1 in 17Urinary bladder 1 in 29Non-Hodgkin lymphoma 1 in 48Melanoma 1 in 55Leukemia 1 in 70Oral cavity 1 in 72Kidney 1 in 69Stomach 1 in 81 Lifetime Probability of Developing Cancer, by Site, Women, US, 1998-2000Source:DevCan: Probability of Developing or Dying of Cancer Software, Version 5.1 Statistical Research and Applications Branch, NCI, 2003. http://srab.cancer.gov/devcanSite RiskAll sites 1 in 3Breast 1 in 7Lung & bronchus 1 in 17Colon & rectum 1 in 18Uterine corpus 1 in 38Non-Hodgkin lymphoma 1 in 57Ovary 1 in 59Pancreas 1 in 83Melanoma 1 in 82Urinary bladder 1 in 91Uterine cervix 1 in 128The War on Cancer 1971 State of Union address: President Nixon requested $100 million for cancer research December 23, 1971 Nixon signed National Cancer Act into law "I hope in years ahead we will look back on this action today as the most significant action taken during my Administration."Change in the US Death Rates* by Cause, 1950 & 2001* Age-adjusted to 2000 US standard population.Sources: 1950 Mortality Data - CDC/NCHS, NVSS, Mortality Revised.2001 Mortality Data–NVSR-Death Final Data 2001–Volume 52, No. 3. http://www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_03.pdf21.8180.748.1586.8193.957.5194.4245.80100200300400500600HeartDiseasesCerebrovascularDiseasesPneumonia/InfluenzaCancer19502001Rate Per 100,000Change in the US Death Rates* by Cause, 1950 & 2001* Age-adjusted to 2000 US standard population.Sources: 1950 Mortality Data - CDC/NCHS, NVSS, Mortality Revised.2001 Mortality Data–NVSR-Death Final Data 2001–Volume 52, No. 3.
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