CANCER AND AGING

JOSE RONILO G. JUANGCO, MD. MPH

Institute of Community and Family Health, Inc.
Public Health 200
EPIDEMIOLOGY
CANCER AND AGING
60 % of New Cancer
Cases
71 % of Cancer Deaths
7 X more frequent
among Elderly Men
4 X more frequent
among Elderly Women
Elderly Men 2x more
common incidence than
Elderly Women
International Agency for Research on Cancer (Cancer J 2005)

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 AGE IS THE SINGLE
GREATEST RISK FACTOR
FOR CANCER

Institute for the Advanced Study in Aging and Geriatric Medicine

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THEORIES ON INCREASE
CANCER WITH AGE

Time required for Cancer Development

Lifetime Carcinogen Exposure
Decrease ability to repair DNA
Oncogene amplification or activation
Decreased Tumor Suppressor Gene
Activity
Immune Senescence
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AGING SENESCENCE AND
CANCER

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CANCER LESS AGGRESSIVE?

“AGE DIFFERENCE IN TUMOR

GROWTH”
 Seed Hypothesis
 Soil Hypothesis

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COMMON CANCER

PROSTATE
LUNG BREAST
COLON COLON
LUNG
STOMACH

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RISK FACTORS

PROSTATE CANCER
 Age
 Family history
 Black race
 High fat diet (minor RF)
 RR>3x if father had prostate ca and >8x if 2 or
>1st relatives have prostate ca
 9% of prostate ca has a genetic basis
 BPH does not increase risk
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RISK FACTORS

BREAST CANCER
 Age
 H/o previous breast ca
 Family h/o breast ca in
mother or sister
 Menarche before age 12
 First birth after age 35
 Menopause after 53
 Exogenous estrogens
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RISK FACTOR

LUNG CANCER
 SMOKING

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 PASSIVE SMOKING

5%
Filter

70 %
25 % ETS
direct Passive
smoker Smoking
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ENVIROMENTAL TOBACCO
SMOKE

5 X more Carbon Monoxide

3 x more Nicotine and Tar
46 x more Carcinogens

1992 Study of Lung Cancer at Lung Center of the

Philippines
Office workers 19 %
Farmers 18 %
Housewives 10 %
Drivers 6%
Policemen 6%
Vendors 6%
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 THE BENEFITS OF QUITTING
20 min Blood Pressure and Pulse Rate return to normal
Circulation improves in hands and feet
8 hrs Oxygen levels return to normal
24 hrs Carbon Monoxide is eliminated. The lungs start to
clear out mucus and debris.
48 hrs Nicotine is no longer detectable. Improve smell and
taste
72 hrs Breathing becomes easier. Relaxed bronchial tubes
2 – 12 weeks Circulation improves making walking easier
3 -9 months Breathing problems such as couging shortness of
breath and wheezing improves.
Lung function increase by 10 %
5 years Risk of Heart attack falls to about half of that of
non smoker
10 years Risk of Lung Cancer falls tohalf of non smoker. Risk of
heart attack the same as that who does not smoke
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SCREENING
FOR
COMMON
CANCERS

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 TREATMENT ISSUES

Elderly Patients
present with more
advanced disease
Bias against
Aggressive Treatment
Patient present with
co-morbidities
Age relevant Clinical
Trials are inadequate
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TREATMENT SELECTION
HETEROGENEITY

comorbid conditions,
functional status,
social situation
willingness of the
patient to tolerate
side effects of
treatment.

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AGGRESSIVE VS
CONSERVATIVE

Response to
treatment,
Extent of spread,
Comorbid
conditions that
could limit therapy,
and
Patient's wishes.

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TREATMENT ISSUES

Treatment Outcomes
are comparable in
young vs. old
Chemo alone can cure
certain ca
Adjuvant chemo and
radiation produces
substantially increased
survival
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 END OF LIFE ISSUES

Elderly have decreased

life expectancy
The extent of potential
remaining life is often
underestimated
Average woman age 70
has a remaining life
expectancy of 15yrs
and a man 11yrs
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END OF LIFE ISSUES

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 TREATMENT
Co - Morbidity

The Tumor
Cancer Prevention
Biology & Impact
& Control
Of Disease

Integrate all to
Achieve Optimal Functional Outcome
Care Quality of Life
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JOVITO SALONGA

"I do not pretend to be 'very active

and healthy,' considering what I
had gone through. Undoubtedly, a
simple lifestyle and a dependence
on a higher power bigger than
myself have made all the
difference in my life."

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