1. Extent and Effects of Cancer: Cancer as a Clinical Problem Folder: Clinical(NoTP) See also Cancer2013_ACS_TPFEdit2015.ppt 1.Impact of cancer in human populations 2. What does understanding the clinical manifestations of cancer tell us about cancer biology and what we can do about cancers? Updated: January 26, 2015

3. Causes of Death 1900-1960 Causes of Death in the 20thCentury

4. Causes of Death 1960 - 1980

5. Causes of Death 1900-1976

6. Cx 1900-1975

7. % Cause of Death Increasing Effect of Neoplastic Diseases as Causes of Deaths in the United States: 1973 to 1990

8. Years of Life Lost

9. Costs of Diseases Comparative costs of diagnosing and managing malignant neoplastic diseases.

10. Cancer Incidence and Mortality in Ageing Populations Colorectal Cancer Presentation on Cancer Epidemiology will address the effects of ageing on incidence and mortality of cancers in general

11. Figure 16.45a The Biology of Cancer (© Garland Science 2007)

12. Figure 16.45c The Biology of Cancer (© Garland Science 2007)

13. Cancer Mortality and Spread to Distant Sites (Metastases)

14. Figure 16.1a The Biology of Cancer (© Garland Science 2007) Effects of prevention and early diagnosis on death rates from cancers

15. Figure 16.46a The Biology of Cancer (© Garland Science 2007) Melanoma Incidence and Mortality: Melanoma Mortality as a Function of Stage at Diagnosis. (Fig 16.46A, p. 789)

16. Survival and Progression

17. Figure 14.51b The Biology of Cancer (© Garland Science 2007)

18. Figure 14.50b The Biology of Cancer (© Garland Science 2007)

19. Figure 14.50a The Biology of Cancer (© Garland Science 2007)

20. The Boy Policeman from Raleigh, North Carolina http://abclocal.go.com/wtvd/story?section=news/local&id=7531763 http://www.msnbc.msn.com/id/26184891/vp/38084943#38084943

21. About Kuyler Van Nocker and Neuroblastoma Experimental FDA-Approved Cancer Therapy (FDA = Food and Drug Administration) Who will pay for approved but experimental therapy? (Played in Class: January 21, 2014) http://www.msnbc.msn.com/id/3036677/#39049661

22. A Lesson from Lung Cancer and the Cigarette Industry 1940 to 1970: The Human Devastation and Societal Costs of Commercially-Motivated Anti-Science Denials

23. Figure 16.1b The Biology of Cancer (© Garland Science 2007) Lung cancer in males after 1985

24. Some Chilling Calculations: Lung Cancer Death Rate in Men at Peak Year (1990): 90 per 100,000 or about 1 per 1,000 men Number of Men in the US in 1990: About 150 Million Deaths of Men from Lung Cancer in 1990: 150,000 Clear Demonstration of Tobacco-induced Lung Cancer: ~1940 Action to curb advertising and to control tobacco epidemic: ~1970 Time required to reverse the rising death-rate: ~ 30 Years Number of Men Killed by the 30-Year Delay: ~4,500,000 Number of Women killed by the Same Delay: ~2,000,000

25. The Messages from the History of Cigarettes and the Human Devastation They Caused: 1.Evidence-based Science and Medicine: Denial of evidence does not change the facts. Nature doesn’t care what we believe or how much we stand to gain economically. If we deny the evidence, the consequences can be horrendous. 2. The Response to Corrective Action The time-delay between accepting the evidence, orchestrating a response, and gaining control of the problem (if control is still possible) can be decades. The devastation during that time delay can be monumental.

26. In 1990 we saw the full impact of the failure to respond to the evidence of cigarettes and lung cancer. Lung cancer incidence and deaths in both men and women began to drop. In 2040 will we see the impact of failing to respond to greenhouse gases and global climate change in 2013? Will effective response still be possible in 2015 or 2030?

27. Slides 32 to 58 in this presentation were covered in different form under Cancer Statistics 2013 by the American Cancer Society as edited by TPF and are not presented again under Clinical.ppt

28. Clinical Manifestations of Different Neoplastic Diseases

31. Cancer Incidence 2002: 1,285,000. Cancer Deaths 555,000. 43% Death Rate Cancer Incidence 2009: 1,479,000. Cancer Deaths 562,000. 38% Death Rate

32. Introduction of PSA (prostate specific antigen) test to screen for prostate cancer

38. Cancer Incidence and Mortality in Children Ages 0 to 14

43. Cancer and Obesity 2015

44. To Here: January 22, 2015

45. Cancer Prevention Colorectal Cancer Screening

46. Figure 16.45b The Biology of Cancer (© Garland Science 2007)

47. Figure 11.8b The Biology of Cancer (© Garland Science 2007)

48. Cancer as the Leading Cause of Death in the US 2015

49. Science: March 25, 2011; Cancer Crusade at 40. Cancer Research and the $90 Billion Metaphor. Vol 331, p. 1540

53. Note the terrifying increase in deaths from lung cancer:1930 to 1986. Why was that happening? What could be done about it? Can we change the trajectory of that curve?

54. Cx Types 1930-1990 Note Stunning drop in deaths from stomach cancer: 1930 to 1985 What could possibly be the cause of this dramatic and very favorable event? Why did uterine cancer death rate go down in the 1950’s? Can we apply the lessons from stomach and uterine cancers to other cancers?

55. Figure 16.1b The Biology of Cancer (© Garland Science 2007) Lung cancer in males after 1985