Breast cancer is the second most common cancer worldwide however, it ranks fifth as a cause of death behind lung, stomach, liver, and colorectal cancer. Its incidence is highly variable, affecting only 2 per 100,000 African women but as many as 61 per 100,000 North American men. Lung cancer is the most common cancer and the most common cause of cancer death in the world. When broken down by region of the world, ~45% of cases were in Asia, 26% in Europe, 14.5% in North America, 7.1% in Central/South America, 6% in Africa, and 1% in Australia/New Zealand ( Fig. In 2008, 12.7 million new cancer cases and 7.6 million cancer deaths were estimated worldwide, according to estimates of GLOBOCAN 2008, developed by the International Agency for Research on Cancer (IARC). The basis for these differences is unclear. Incidence and mortality vary among racial and ethnic groups ( Table 99-3). Cancers are more often deadly in blacks the 5-year survival was 61% for the 2003вЂ“2009 interval however, the racial differences are narrowing over time. The five leading causes of cancer deaths are shown for various populations in Table 99-2. The magnitude of the decline is illustrated in Fig. Between 19, cancer deaths decreased by 21% among men and 12.3% among women. After a 70-year period of increase, cancer deaths began to decline in 1990вЂ“1991 ( Fig.

Incidence trends over time are shown in Fig. Cancer has overtaken heart disease as the number one cause of death in persons younger than age 85 years. Deaths from heart disease have declined 45% in the United States since 1950 and continue to decline. The cancer patient feels that he or she, and not just a body part, is diseased.Д¬ancer is the second leading cause of death behind heart disease.

One consequence of the traitorous behavior of cancer cells is that the patient feels betrayed by his or her body. Not only is there a failure of the cancer cell to maintain its specialized function, but it also strikes out on its own the cancer cell competes to survive using natural mutability and natural selection to seek advantage over normal cells in a recapitulation of evolution. Cancer takes this malfunction one step further. Many diseases occur because the specialized cells fail to perform their assigned task. In general, the cells of a multicellular organism are programmed for collaboration. Cancer is an exception to the coordinated interaction among cells and organs. Every ache or pain takes on desperate significance. He or she is being attacked and invaded by a disease that could be anywhere in the body. By contrast, the patient with pancreatic cancer has a completely altered self-image and is viewed differently by family and anyone who knows the diagnosis. However, the patient with heart disease may remain functional and maintain a self-image as a fully intact person with just a malfunctioning part, a diseased organ (вЂњa bum tickerвЂќ). The prognosis of a person who has just been found to have pancreatic cancer is the same as the prognosis of the person with aortic stenosis who develops the first symptoms of congestive heart failure (median survival, ~8 months). Independent of prognosis, the diagnosis brings with it a change in a personвЂ™s self-image and in his or her role in the home and workplace.

Nevertheless, patients experience the diagnosis of cancer as one of the most traumatic and revolutionary events that has ever happened to them. The application of current treatment techniques (surgery, radiation therapy, chemotherapy, and biologic therapy) results in the cure of nearly two of three patients diagnosed with cancer.

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