Overview

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Overview Global Burden of CancerChallenges
and OpportunitiesJohn L. Ziegler, M.D.,
M.Sc.UCSF Comprehensive Cancer Center
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Projected Deaths by Major Cause and World Bank
Income Group - All Ages, 2005
Source Lancet, 2005
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Major Causes/Influences of the Rise in Global
Cancer Rates

• Tobacco Use
• Infections
• Diet/Nutrition/Physical Activity
• Sun Exposure
• Age
• Poverty

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Infectious agents account for 18 of all cancers
and 25 of cancers in the developing world
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Global Burden of Cancers Linked to Infections
(Parkin, 2006)

• H. pylori (5.5)
• HPV (5.2)
• HBV and HCV (4.9)
• EBV (1)
• HIV and KSHV (0.9)
• Parasites, HTLV-1 (0.1)

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Cancer and Infection
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Cancer and Infection

• Inflammation (cytokines, TAMs)
• Cell proliferation (injury response)
• Viral oncogenes
• Role of cofactors
• Genetic susceptibility

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Cancer in Africa
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Burkitts Lymphoma
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What Did Burkitts lymphoma Teach Us?

•   Development of a staging system and curative
  regimen for a common childhood lymphoma role of
  tumor cell kinetics
•   Recognition of tumor debulking as an
  important adjunct to therapy
•   Creation of Burkitt lymphoma cell lines for
  laboratory study
•   Discovery of a viral etiology (Epstein Barr
  virus)
•   Discovery of the MYC oncogene translocation as
  a molecular driver of cell proliferation

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Kaposis Sarcoma
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Case Control Studies of KS in Uganda

• HIV-positive
• Urban address, wealth markers, better education,
  travel, monogamous, STDs
• Exposure to water
• HIV negative
• Wealth markers, travel
• Barefoot

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Ano-Genital Cancer
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Cofactors HPV and Ano-genital Cancer

• STDs
• Tobacco
• Genetic susceptibility

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Liver Cancer
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Cofactors HBV, HCV and Hepatocellular Carcinoma

• Aflatoxin (p53 signature)
• Cirrhosis
• Alcohol consumption
• Iron overload

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Malignant Melanoma
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Carcinoma of the Bilharzial Bladder
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Dietary Fibre and Disease
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Diseases you seldom see in AfricansWhy?

• Colon cancer
• Diverticulosis
• Varicose veins
• Hemorrhoids
• Hiatus hernia
• Appendicitis
• Gallstones
• Coronary artery disease

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Transit time
Stool weight
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Intraperitoneal pressure from straining
at stool Firm stool high pressure soft stool
low pressure
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Diseases you seldom see in AfricansWhy?

• Colon cancer
• Diverticulosis
• Varicose veins
• Hemorrhoids
• Hiatus hernia
• Appendicitis
• Gallstones
• Coronary artery disease

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Diseases you seldom see in AfricansWhy?

• Colon cancer
• Diverticulosis
• Varicose veins
• Hemorrhoids
• Hiatus hernia
• Appendicitis
• Gallstones
• Coronary artery disease

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The removal of fibre from food, and also its
physical disruption, can result in faster and
easier ingestion, decreased satiety, and
disturbed glucose homeostasis which is probably
due to inappropriate insulin release. These
effects favour overnutrition and, if often
repeated, might lead to diabetes mellitus
Haber et al, Lancet 1977ii679
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Grateful patients are few in preventive
medicine, where a successful outcome is a
non-event-Goeffrey Rose, 1992
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Sustainable Research in Africa

• Create an equal research partnership
• Studies relevant to local medical priorities
• Teach and train students and physicians
• Engage in local and regional medical meetings
• Tansparency and cultural sensitivity
• Innovate low tech diagnostic and treatment
  methods that can be translated to upcountry
  hospital settings