Master Catania (4 Modulo

7/27/2019 Master Catania (4 Modulo

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EPIDEMIOLOGIA

ANALITICA O

INVESTIGATIVA


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AMBIENTEUOMO

MALATTIA

Diade di Ippocrate

INFETTIVA

AGENTE

EZIOLOGICO

Causa necessariama non sufficiente


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FATTORI DI

RISCHIO

MALATTIE

FR 1 M 1

M 2

M 3

M 4

FR 1

FR 2FR 2

FR 3FR 3

FR 4FR 4

M 1

M 2

M 3

M 4

FATTORI DI

RISCHIO

MALATTIE

INTERAZIONI

Effetti additiviSinergismi

Antagonismi


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FATTORI

PROTETTIVI

MALATTIE

FP 1 M 1

M 2

M 3

M 4

FP 1

FP 2FP 2

FP 3FP 3

FP 4FP 4

M 1

M 2

M 3

M 4

MALATTIEFATTORI

PROTETTIVI


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FATTORI DI RISCHIOCANCEROGENO DI NATURA

BIOLOGICA, MECCANICA,FISICA E CHIMICA


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THE PREVENTION OF INFECTIONASSOCIATED CANCERS

Pathogen Main asociated cancerIARC

Group

Hepatocellular carcinoma

Hepatitis viruses

HBV

HCV

HDV

1

1

3


None

(S. De Flora and P. Bonanni, Carcinogenesis 32, 787-795,

2011)

Pathogen Main asociated cancerIARC

Group

4.9% of all cancers

85.5% of all HCCs

4.9% of all cancers4.9% of all cancers

85.5% of all HCCs85.5% of all HCCs

Infectious agents cause 17% of all cancers

worldwide, 26% in developing world,

8% in developed world

D.M. Parkin, Int.J.Cancer 15, 3030D.M. Parkin, Int.J.Cancer 15, 3030--44, 200544, 2005


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HBV INFECTION AND PRIMARY

HEPATOCELLULAR CARCINOMA

Insertional mutagenesis, i.e., integration of HBV DNA into thecellular genome, in proximity of genes involved in cellproliferation and/or differentiation

Transcriptional transactivation, i.e., induction of cellularoncogenes (e.g., c-mic, c-fos) by HBV gene products (e.g.,HBxAg)

Deletion or mutation of tumor suppressor genes (e.g.,p53)

Liver cirrhosis, with inflammation, necrosis and regeneration

Enhanced metabolic activation of chemicalhepatocarcinogens (e.g., aflatoxin B1, food pyrolysisproducts)


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Rischio relativo

HBV 7,3

AFB1 3,4

HBV + AFB1 60,0DANNO AL DNAE INIZIAZIONEDEL CANCRO

AUMENTATO METABOLISMODI EPATOCANCEROGENICHIMICI

O O

O

O O

OCH3

CH3

N

N

NH2

AFB1

Trp-P-2

In collaborazione con:1Catt. Gastroenterologia, ISMI, Universit di Genova2Ist. Fisiologia Generale, Universit di Genova3Institute for Cancer Research, Philadelphia, PA, USA4International Agency for Research on Cancer (IARC), Lyon, France5National Cancer Institute (NCI), Bethesda, MD, USA6Environmental Protection Agency (EPA), Research Triangle Park, NC, USA7Integrated Laboratory Systems, Research Triangle Park, NC, USA

Nellepatite B umana (HBV) e animale (WHV)

vi un esaltato metabolismo di epatocancerogeni chimici


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Pathogen Main asociated cancer

Hepatitis viruses

HBV

IARCGroup

HCV

HDV

1

1

3



None


2011)

Pathogen Main asociated cancerIARCGroup

Papillomaviruses HPV

HPV type 16

HPV types 18, 31, 33, 35,39, 45, 51, 52, 56, 58, 59

HPV type 68

1

1

2A

Cancers at several sites

Cervical cancer

Cervical cancer

HPV types 26, 30, 34, 53,66, 67, 69, 70, 73, 82, 85, 97 2B Cervical cancer

HPV type 5 and 8 2B Skin cancer HPV type 6 and 11 3 None

Other and HPV types 3 None

4.9% of all cancers

85.5% of all HCCs



5.2% of all cancers

100% of cervix cancers


100% of cervix cancers100% of cervix cancers






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Hepatitis viruses

HBV

IARCGroup

HCV

HDV

1

1

3



None

HPV type 16

HPV types 18, 31, 33, 35,39, 45, 51, 52, 56, 58, 59

HPV type 68

1

1

2A


Cervical cancer

Cervical cancer





Polyomaviruses

JCV NA CNS tumors and colorectalcancer?

MCV NA Skin cancer (Merkel cell

carcinoma)SV40 NA Malignant mesothelioma ?

Herpesviruses

EBV or HHV4 1 Burkitts lymphoma, sinonasalangiocentric T-cell lymphoma,immunosuppressor-related non-Hodgkins lymphoma, Hodgkinslymphoma, nasopharyngeal

carcinomaKSHV or HHV8 1 Kaposis sarcoma, primary

effusion lymphoma

Retroviruses

HTLV-I

HTLV-II

HIV-I

1

3

1

Adult T-cell leukemia/lymphoma

None

Kaposis sarcoma, non-Hdgkins

lymphoma, Hodgkins lymphoma,cervical cancer, anus cancer,conjunctive cancer

HIV-II 2B Kaposis sarcoma, non-Hodgkinslymphoma

HERV-K NA Human breast cancer

THE PREVENTION OF INFECTIONASSOCIATED CANCERS(S. De Flora and P. Bonanni, Carcinogenesis 32, 787-795,

2011)





4.9% of all cancers

85.5% of all HCCs



5.2% of all cancers






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Hepatitis viruses

HBV

IARCGroup

HCV

HDV

1

1

3



None


HPV type 16

HPV types 18, 31, 33, 35,39, 45, 51, 52, 56, 58, 59

HPV type 68

1

1

2A


Cervical cancer

Cervical cancer



2011)




Polyomaviruses




Herpesviruses



effusion lymphoma

Retroviruses

HTLV-I

HTLV-II

HIV-I

1

3

1


None





4.9% of all cancers

85.5% of all HCCs



5.2% of all cancers









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Hepatitis viruses

HBV

IARCGroup

HCV

HDV

1

1

3



None


HPV type 16

HPV types 18, 31, 33, 35,39, 45, 51, 52, 56, 58, 59

HPV type 68

1

1

2A


Cervical cancer

Cervical cancer



2011)




Polyomaviruses




Herpesviruses



effusion lymphoma

Retroviruses

HTLV-I

HTLV-II

HIV-I

1

3

1


None



Helicobacter pylori 1 Gastric cancer, MALT



4.9% of all cancers

85.5% of all HCCs



5.2% of all cancers



100% of cervix cancers100% of cervix cancers 5.5% of all cancers

63.4% of stomach cancers

5.5%5.5% ofof allall cancerscancers

63.4%63.4% ofof stomachstomach cancerscancers






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Helicobacter pylori

Gastric mucosa(119 subjects)

Antibiotic resistance assay

rRNA

genotypes

vacA

GSTM1

OGG1

genotypes

DNAextraction

Gender - AgeStage of gastritisGastric dysplasia

Enteroid metaplasia

8-oxo-dG

cagA

Culture

PCR

It is an extremelyvaluable studywhich could affect,

positively, millionsof human beings


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Hepatitis viruses

HBV

IARCGroup

HCV

HDV

1

1

3



None

HPV type 16

HPV types 18, 31, 33, 35,39, 45, 51, 52, 56, 58, 59

HPV type 68

1

1

2A


Cervical cancer

Cervical cancer





Polyomaviruses




Herpesviruses



effusion lymphoma

Retroviruses

HTLV-I

HTLV-II

HIV-I

1

3

1


None



Helicobacter pylori 1 Gastric cancer, MALT



Schistosomes

S. haematubium 1 Urinary bladder cancer

S. japonicum 2B Colorectal and liver cancers

S. mansoni 3 None

Liver flukes

Opistorchis viverrini 1 Cholangiocarcinoma

Opistorchis felineus 3 NoneChlonorchis sinensis 1 Cholangiocarcinoma

THE PREVENTION OF INFECTIONASSOCIATED CANCERS(S. De Flora and P. Bonanni, Carcinogenesis 32, 787-795,

2011)





4.9% of all cancers

85.5% of all HCCs



5.2% of all cancers



100% of cervix cancers100% of cervix cancers 5.5% of all cancers

63.4% of stomach cancers

5.5%5.5% ofof allall cancerscancers

63.4%63.4% ofof stomachstomach cancerscancers



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PREVENZIONE DEI TUMORIASSOCIATI CON INFEZIONI O

INFESTAZIONI CRONICHE

Eradicazione di infezioni (es. H. pylori, HART) oinfestazioni

Vaccini contro virus (es. HBV, HPV, FLV, ecc.)


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S. De Flora et al, Cancer Res. 47, 40528, 1987; Carcinogenesis 10, 10991106, 1989

A.Izzotti et al, Chem.-Biol. Int. 97, 273285, 1995

AFB1

Trp-P-2

HBV

Prevention of

HBV infection

Prevention of

HBV infection

A. Camoirano et al, Cancer Epid. Biol. Biom. 10, 775783, 2001

ChemopreventionChemoprevention

DrugsDrugsDietDiet

Avoidanceof exposure

Avoidanceof exposure

RegulationsRegulations

Healtheducation

Healtheducation

PRIMARY PREVENTIONOF HEPATOCELLULAR

CARCINOMA

PRIMARY PREVENTIONOF HEPATOCELLULAR

CARCINOMA


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AMBIENTE E TUMORI


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AMBIENTEAMBIENTE

"insieme degli elementi che, nella complessit delle loro relazionicostituiscono le condizioni di vita dell'uomo" (EU, 1973)

Luomo, come tutti gli esseri viventi, interagiscecontinuamente con lambiente che pu divenire causa di

effetti negativi sul suo stato di salute.Lequilibrio del rapporto uomo-ambiente

(come risultato dinamico!) stato fortemente influenzatodai progressi socio-economici e

tecnico-scientifici avvenuti nellutlimo secolo.

Sostenibilit ambientale


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AMBIENTE E TUMORI

distribuzione geografica(a)


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STOMACO

POLMONE

MAMMELLA

COLON - RETTO

CERVICE UTERINA

BOCCA - FARINGE

ESOFAGO

FEGATO

LINFOMI

PROSTATA

VESCICA

LEUCEMIE

CORPO UTERO

OVAIO

PANCREAS

LARINGE 67,152,9

90 47,4

70,4 67,2

103,5 45,3

82,7 105,5

148,2 71,2

177,2 58,6

116,1 121,8

59,6 191,6

56,8 253,6

106,2 272,3

96,1 369,5

389,2 182,9

347,9 224,2

454,6 205,9

333 336,4

500 400 300 200 100 0 500400300200100

PAESI SVILUPPATI PAESI IN VIA DI SVILUPPO

NUMERO DI CASI (X 1000)

NUMERO DEI CASI DI CANCRO RELATIVI A 16 SITI ANATOMICI


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CANCRO DELPOLMONE


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CANCRO DELLOSTOMACO


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CANCRO DELLAMAMMELLA


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AMBIENTE E TUMORI


gruppi di popolazione(b)

popolazioni migranti(c)


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TUMORI IN DIVERSE GENERAZIONI DI EMIGRATI

GIAPPONESI CONFRONTATI CON LA POPOLAZIONESTATUNITENSE

Giappone Bianchi U.S.1a 2a 3a

Stomaco + + + + + + + + + + +

Colon e retto + + + + + + + + + + + + + + + +

Mammella + + + + + + + + + + + + +

Prostata + + + + + + + + + + +


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0 - 5 6 - 16 17 +

Anni di residenza

1,6

1,4

1,2

1,0

0,8

0,6

0,4

0,2

0

Mortalit(d

atistandardizzati)

MORTALITA PER CANCRO DELLA MAMMELLA IN DONNE ITALIANEMIGRANTI IN AUSTRALIA (19621971)

donne australiane

MORTALITA PER CANCRO DELLA MAMMELLA IN DONNE ITALIANEMIGRANTI IN AUSTRALIA (19621971)


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AMBIENTE E TUMORI


gruppi di popolazione(b)

popolazioni migranti(c)

variazioni nel tempo(d)

rimozione fattori di rischio(e)


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INCREASING CONSUMPTION OF CIGARETTES IS FOLLOWED BYA STEEP RISE IN DEATHS FROM LUNG CANCER

Lung cancer deaths in England and Wales show a close correlation with thenumber of cigarettes smoked in earlier years. Source: J. Cairns.

MenWomen

Smoking Lung cancer

Smoking

Lung cancer

5000

4000

3000

2000

1000

0

200

150

100

50

0Ann

ualpercapitac

onsumptionofcigarettes

Annua

llungcancerde

athsper100,00

0population

1900 1920 1940 1960 1980

MORTALITA PER TUMORI POLMONARI


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Maschi

MORTALITA PER TUMORI POLMONARI

(DATI STANDARDIZZATI PER 100.000)

90

80

70

60

50

40

30

20

10

0

1965-69 70-74 75-79 80-84 85-89 92

UK

USA

UNGHERIA

ITALIA

GIAPPONE

Femmine

30

20

10

0

1965-69 70-74 75-79 80-84 85-89 92

USA

UK

UNGHERIAGIAPPONE

ITALIA


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INTERAZIONIGENE-AMBIENTE

Documents

Master Catania (4 Modulo