Summary Deck

Question 1

How would you approach Cancer Cluster investigation

Answer 1

Cancer cluster investigation
* Cancer cluster: greater than expected number of
cancer cases that occurs within a group of people
in geographic area over a defined time period
* Investigation steps
- Initial contact and response (e.g. cancer type,
number of cases, hazard of concern)
- Assessment: is cluster in statistically significant
excess? calculate standardized incidence ratio
- Determine feasibility of epi study (e.g. study
population, comparison group, study design)
- Conduct etiological investigation: determine
if contaminant might be associated with cluster

Question 2

IARC Group 1 carcinogens by element

Answer 2

• Aluminium: lung, bladder
• Arsenic: lung, skin
• Beryllium: lung
• Cadmium: lung
• Chromium VI: lung
• Iodine-131: thyroid
• Nickel: nasal cavity/paranasal sinus, lung
• Radon: lung
• Plutonium: lung, bone

Question 3

IARC Group 1 carcinogen by microorganism

Answer 3

• HPV types 16 and 18: cervical cancer
• Human T-cell lymphotropic virus 1 (HTLV-1):
  leukemia, lymphoma
• Hepatis B virus: liver cancer
• Hepatitis C virus: liver cancer
• Helicobacter pylori: stomach cancer
• Human herpes virus 8: Kaposi sarcoma
• HIV: lymphoma, eye cancer, Kaposi’s
• EBV: lymphoma, stomach cancer
• Schistosoma: bladder cancer

Question 4

Top Cancer causes, incidence, mortality and prevention

Answer 4

Tobacco (22%)
* Micro-organisms (22%)
* Occupational exposures (10%)
* Environmental (1-4%)
Incidence
* 40% of Canadians will develop cancer
* Overall: lung, breast, colorectal
* Men: prostate, lung, colorectal
* Women: breast, lung, colorectal
Mortality
* 25% of Canadian will die from cancer
* Overall: lung, colorectal, pancreas
* Men: lung, colorectal, prostate
* Women: lung, breast, colorectal
Prevention
* Avoid smoking
* Reduce alcohol consumption
* Healthy eating and active lifestyle
* Healthy body weight
* Receive the HPV and Hepatitis B vaccines
* Reduce environmental exposures
* Wear PPE for occupational carcinogen exposure

Question 5

IRAC Carcinogens

Answer 5

• UV radiation: melanoma, SCC, BCC
• Particulate matter: lung cancer
• Benzene: leukemia
• Asbestos: lung cancer, mesothelioma

Question 6

Breast Cancer risk factors

Answer 6

Risk factors
Biological
* Female sex
* Family history
* Genetic mutations
* Early menarche
* Late menopause
Medical
* First pregnancy
after age 30
* HRT > 5 years,
* Obesity
* Not breastfeeding
* Dense breast
tissue
Behavioral
* Smoking
* Heavy alcohol use
* Physical inactivity
Environmental
* Ionizing radiation from
occupation (radiation
worker) or iatrogenic
(repeated CXR for TB,
childhood leukemia
treatment)
* 2nd hand smoke exposure

Question 7

Colorectal Cancer Risk factors

Answer 7

Biological: Age over 50
* Male sex
* Family history
* Ashkenazi ethnicity
Medical: Polyps
* Obesity
* IBD (Chron’s)
Lifestyle: Smoking
* Heavy alcohol use
* Physical inactivity
* Red & processed meat
-Environmntal * Ionizing radiation (x-ray,
gamma ray)

Question 8

What is active and passive prevention?

Answer 8

• Active prevention: require action on part of
  individuals (seatbelt use, falls prevention)
• Passive prevention: require no action on part of
  individual (air bags, smoke alarm)

Question 9

What is the Risk homeostasis theory?

Answer 9

People adapt behaviour to changes in
environmental conditions (safer the situation, the
riskier the behaviour, overall risk level is the same)
* More an individual values their future, the less
overall risk they will be willing to take

Question 10

What are the types of injury ?

Answer 10

• Intentional: inter-personal violence (homicide,
  sexual assault, neglect), suicide, collective violence
• Unintentional: road traffic collisions, poisoning,
  falls, fire and burn injuries

Epidemiology
* Injury leading cause of death amongst ages 1 - 34
* < 12 months: fall, threat to breathing, poisoning
* 1 to 4: falls, poisoning, fire/hot object
* 5 – 9: falls, stuck by/against an obstacle, MVC
* 10 – 14: falls, stuck by/against an obstacle, MVC
* 15 – 19: falls, MVC, stuck by/against an obstacle
* 20 – 64: suicide
* 65+: falls

Question 11

What is Haddon’s Matrix

Answer 11

• Framework to identify underlying causes of injury
  in order to design interventions
• Conceptualizes injuries as resulting from
  interactions between host, agent/vector, and
  environment
• Preinjury phase: eliminate source, reduce
  exposure, or increase magnitude of resistance to it
• Event: reduce magnitude and duration of
  exposure, decrease host’s susceptibility to injury
• Post-injury phase: environment can be altered to
  reduce the source of the injury in the future and
  facilitate the rescue and resuscitation of victims

Question 12

Risk factors for injuries and injury pyramid by type

Answer 12

Risk factors for injury
* Adolescents aged 12 – 19 and elderly
* Males
* Participating in sports activities

Injury pyramid by type
* Fatal injury
* Serious injury
* Minor injury
* Near miss event
* Unsafe act

Question 13

injury Pyramid by type and source of data

Answer 13

1.Deaths = Vital Statistics

2.Injuries requiring hospitalization = Discharge Abstract Databases (DADs)

3. Injuries requiring ED visit = National Ambulatory Care Reporting System (NACRS), Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP)
4. Injuries resulting in Primary Care visit = administrative data/billing codes, primary care EMRs contributing to Canadian Primary Care Sentinel Surveillance Network (CPCSSN)

5.Injuries treated outside health system = Canadian Community Health Survey (CCHS)