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Frank SA. Dynamics of Cancer: Incidence, Inheritance, and Evolution. Princeton (NJ): Princeton University Press; 2007.

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Dynamics of Cancer: Incidence, Inheritance, and Evolution.

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Appendix: Incidence

The first section shows plots of cancer incidence for different tissues (Figures A.1A.12). The second section shows plots of the male:female ratio in incidence for different tissues (Figures A.13A.18).

Plots of Cancer Incidence at Different Times and Places

The following plots show cancer incidence and acceleration patterns at different time periods and in different countries. In some cases, the acceleration plots fluctuate between countries because of the nature of the data, which may have small numbers of cases at early or late ages. Thus, it is best to focus only on the broad trends in the acceleration plots, particularly those patterns that recur in different years and in different locations. For example, prostate cancer shows a remarkably strong and linear decline in acceleration beginning in midlife (Figure A.2). Some cancers show midlife peaks in acceleration, for example, colon and bladder cancer (Figure A.4).

Cervical cancer has an acceleration close to zero throughout life, with higher fluctuations outside the USA probably caused by smaller samples for those other countries (Figure A.12). However, cervical cancer in the USA follows different patterns of acceleration in different ethnic groups (not shown), emphasizing that external factors such as environment and lifestyle can strongly affect incidence and acceleration. Given the variability in potential causal factors, the data in the following plots can be used only to suggest possible hypotheses for further study.

Figure A.1. Age-specific incidence for different time periods and geographic locations.

Figure A.1Age-specific incidence for different time periods and geographic locations.

Male cases shown by solid lines; female cases shown by dashed lines. The different databases are: SEER 93–97 and SEER 73–77 from the SEER database (http://seer.cancer.gov/) in the USA for 1993–1997 and 1973–1977 using white individuals in the standard nine registries that have been in use since 1973; England, Sweden, and Japan from the CI5 database (Parkin et al. 2002) for 1993–1997 (for Japan, I excluded the Hiroshima registry, which had data for a different range of dates).

Figure A.2. Age-specific acceleration for different time periods and geographic locations.

Figure A.2Age-specific acceleration for different time periods and geographic locations.

Male cases shown by solid lines; female cases shown by dashed lines. Data description as in Figure A.1. The prostate acceleration is shown on a different scale, to accomodate the very high acceleration that occurs in midlife.

Figure A.3. Age-specific incidence for different time periods and geographic locations.

Figure A.3Age-specific incidence for different time periods and geographic locations.

Male cases shown by solid lines; female cases shown by dashed lines. Data description as in Figure A.1. SEER plots show combined data for colon and rectal cancer, other countries show colon cancer only. Colon cancer is more common than rectal cancer, so these plots are roughly comparable.

Figure A.4. Age-specific acceleration for different time periods and geographic locations.

Figure A.4Age-specific acceleration for different time periods and geographic locations.

Male cases shown by solid lines; female cases shown by dashed lines. Data description as in Figure A.1. SEER plots show combined data for colon and rectal cancer, other countries show colon cancer only. Colon cancer is more common than rectal cancer, so these plots are roughly comparable.

Figure A.5. Age-specific incidence for different time periods and geographic locations.

Figure A.5Age-specific incidence for different time periods and geographic locations.

Male cases shown by solid lines; female cases shown by dashed lines. Data description as in Figure A.1.

Figure A.6. Age-specific acceleration for different time periods and geographic locations.

Figure A.6Age-specific acceleration for different time periods and geographic locations.

Male cases shown by solid lines; female cases shown by dashed lines. Data description as in Figure A.1.

Figure A.7. Age-specific incidence for different time periods and geographic locations.

Figure A.7Age-specific incidence for different time periods and geographic locations.

Male cases shown by solid lines; female cases shown by dashed lines. Data description as in Figure A.1.

Figure A.8. Age-specific acceleration for different time periods and geographic locations.

Figure A.8Age-specific acceleration for different time periods and geographic locations.

Male cases shown by solid lines; female cases shown by dashed lines. Data description as in Figure A.1.

Figure A.9. Age-specific incidence for different time periods and geographic locations.

Figure A.9Age-specific incidence for different time periods and geographic locations.

Male cases shown by solid lines; female cases shown by dashed lines. Data description as in Figure A.1.

Figure A.10. Age-specific acceleration for different time periods and geographic locations.

Figure A.10Age-specific acceleration for different time periods and geographic locations.

Male cases shown by solid lines; female cases shown by dashed lines. Data description as in Figure A.1.

Figure A.11. Age-specific incidence for different time periods and geographic locations.

Figure A.11Age-specific incidence for different time periods and geographic locations.

Male cases shown by solid lines; female cases shown by dashed lines. Data description as in Figure A.1.

Figure A.12. Age-specific acceleration for different time periods and geographic locations.

Figure A.12Age-specific acceleration for different time periods and geographic locations.

Male cases shown by solid lines; female cases shown by dashed lines. Data description as in Figure A.1.

Sex Differences in Incidence

Figures A.13A.18 show the male:female ratios for the major adult cancers. The plots highlight two kinds of information. First, the values on the y axis measure the male:female ratio, with positive values for male excess and negative values for female excess. The scaling is explained in the legend of Figure A.13. Second, the trend in each plot shows the relative acceleration of male and female incidence with age. For example, in Figure A.13, the positive trend for lung cancer shows that male incidence accelerates with age more rapidly than does female incidence, probably because males have smoked more than females, at least in the past. Positive trends also occur consistently for the colon, bladder, melanoma, leukemia, and thyroid. Negative trends may occur for the pancreas, esophagus, and liver, but the results for those tissues are mixed among locations. Simple nonlinear curves seem to explain the patterns for the stomach and Hodgkin's, and maybe also for oral-pharyngeal cancers.

The patterns of relative male:female incidence probably arise from differences between males and females in exposure to carcinogens, to expression of different hormone profiles, or from different patterns of tissue growth, damage, or repair. At present, the observed patterns serve mainly to guide the development of hypotheses along these lines.

Figure A.13. Ratio of male to female age-specific incidence.

Figure A.13Ratio of male to female age-specific incidence.

The y axis shows male incidence rate divided by female incidence rate for each age, given on a log2 scale. This scaling maps an equal male:female incidence ratio to a value of zero; each unit on the scale means a two-fold change in relative incidence, with negative values occurring when female incidence exceeds male incidence. Each plot shows the Spearman's rho correlation coefficient and p-value; a p-value of zero means p < 0.0005. Positive correlations occur when there is an increasing trend in the ratio of male to female incidence with increasing age. Note that the scales differ between plots, using the maximum range of the data to emphasize the shapes of the curves. The data are the same as used in Figures A.1A.11.

Figure A.14. Sex differences in incidence, as in Figure A.13.

Figure A.14Sex differences in incidence, as in Figure A.13.

Figure A.15. Sex differences in incidence, as in Figure A.13.

Figure A.15Sex differences in incidence, as in Figure A.13.

Figure A.16. Sex differences in incidence, as in Figure A.13.

Figure A.16Sex differences in incidence, as in Figure A.13.

Figure A.17. Sex differences in incidence, as in Figure A.13.

Figure A.17Sex differences in incidence, as in Figure A.13.

Figure A.18. Sex differences in incidence, as in Figure A.13.

Figure A.18Sex differences in incidence, as in Figure A.13.

Copyright © 2007, Steven A Frank.

This book, except where otherwise noted, is licensed under a Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Bookshelf ID: NBK1565

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