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itself, with a higher incidence of worse prognosis disease found in blacks compared to whites In addition, differences in treatment and comorbid conditions play a significant role Overall, cancer rates are higher for whites and blacks than for Asians/Pacific Islanders Among the leading cancers, the incidence of prostate cancer among black men is about 15 times higher than among white men, and 27 times higher than among Asian/Pacific Islanders In contrast, breast cancer among white women is about 12 times higher than among black women, and 17 times higher than among Asian/Pacific Islander women Other racial differences include a higher rate of multiple myeloma in black men and women and a higher rate of liver, intrahepatic bile duct, and stomach cancers in Asian/Pacific Islander men and women Data from the 2000 census confirm the existence of geographic variability in cancer incidence, although this is not as marked as previously thought; for example, breast cancer rates in Marin County in California and in Washington state appear to be among the highest in the United States Interestingly, the increased incidence is similar to that seen in higher socioeconomic groups with higher attained education, delayed childbearing, a lower rate of breast-feeding, and higher relative alcohol intake and appears to primarily affect the white population The contribution of environmental factors, exposure to toxins, and other dietary factors is not fully understood but clearly plays a role Current research is focusing on exposures and risks that occur in childhood and adolescence to better understand the factors that increase risk of cancer in adulthood The cause of most cancers remains unknown, although workers in the field of molecular biology have begun to unravel the complex pathways leading to cancer cell growth and metastases Mutations in DNA sequences leading to abnormal or unregulated expression of protooncogenes or deletion of tumor suppressor genes or both have been linked to abnormal cellular proliferation Oncogenes encode.

for cellular growth factor receptors, growth factors, or elements of the proliferative machinery of the cancer cell Tumor suppressor genes either code for or control regulatory proteins that normally suppress cellular proliferation; loss of these genes leads to cell growth Cancer results from these and other mutations, which may be due to environmental exposure, genetic susceptibility, infectious agents, and other factors

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Table 39 2 Lifetime risks for the most common cancers, 2000 2002

Cancer Prostate Breast (women) Lung (men) (women) Colorectal (men) (women) Bladder (men) Uterus1 Any cancer (men) (women)

Risk of Diagnosis (%) 179 (1 in 6) 132 (1 in 8) 76 57 58 55 36 34 458 (1 in 2) 381 (1 in 3)

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Risk of Death (%) 30 30 743 48 24 23 07 08 236 200

Uterus includes the cervix and corpus uteri Data obtained from the NCI Seer Program Ries LAG et al (editors): SEER Cancer Statistics Review, 1975 2002, National Cancer Institute, 2005 http://seercancergov/csr/1975_2002

Most tumors exhibit chromosomal abnormalities such as deletions, inversions, translocations, or duplications Although usually nonspecific, certain genetic alterations are strongly associated with specific malignancies and in some cases can be used to assess prognosis

.

FIGURE 11-1

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