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Course title : Non-Communicable Diseases

Code and number: PHS 434

‫رﻣﺮ اﻟﻤ ﮴ ﺮر‬

‫ر﮴ﻢ و ﮲‬ 434 ‫ﺻﺤﺔ‬

Credit hours: 4 (4 +0)

Prerequisite : CMD 225

Level 7

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 Distribution of course degrees:
 1 - (10) degrees for first midterm examination.
2 - (10) degrees for second midterm examination.
3 - (20) the degree of a sudden and short tests and
research assignments, and workshops to discuss
and share.
4 - (60) degrees for the final test.

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 References:
 1- S.L. Goel. Education of Communicable and Non-Communicable
Diseases (2009) Publisher: Deep & Deep Publications
 2- Judith Carrier. Managing Long-term Conditions and Chronic
Illness in Primary Care: A Guide to Good Practice (2009) Publisher:
Routledge; 1 edition
 3- Patrick L., M.D. Remington, Ross C., Ph.D. Brownson, and Mark
V., M.D. Wegner Chronic Disease Epidemiology and Control (2010)
Publisher: American Public Health Association; 3 edition
 4- State-based chronic disease control: the Rocky Mountain
Tobacco-Free Challenge.: An article from: Morbidity and Mortality
Weekly Report (2005) Publication: Morbidity and Mortality Weekly
Report


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Welcome to the
contents

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Diseases classification
diseases

communicable non
communicable

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 Is a disease which is not infectious. Such diseases may result from
genetic or lifestyle factors.
 A non-communicable disease is an illness that is caused by
something other than a pathogen.
 It might result from hereditary factors, improper diet, smoking, or
other factors. Those resulting from lifestyle factors are sometimes
called diseases of affluence.
 Examples include hypertension, diabetes, cardiovascular disease,
cancer, and mental health problems, asthma, atherosclerosis, allergy
etc.
 The non-communicable diseases are spread by: heredity,
surroundings and behavior.

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 Noncommunicable diseases are not
spread by pathogens
 May be present at birth
 In other cases, noncommunicable disease
may develop as a result of a person’s
lifestyle behavior
 May develop from the effects of
substances in the environment
 or the cause may be unknown.

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 Many noncommunicable diseases are
chronic- diseases that are present either
continuously or off and on over a long
time.
 Examples: asthma

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 Some noncommunicable diseases cause
the body cells and tissue to break down,
or degenerate.
 Degenerative diseases are diseases that
cause further breakdown in body cells,
tissues, and organs as they progress.
 Example: multiple sclerosis, Alzheimer
disease, Pick's disease (frontotemporal
dementia)
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 Some babies are born with physical or
mental disabilities that are a result of
genetics or birth defects
 The causes of many birth defects are
unknown
 Some may result from harmful substances
in environment (x-rays), lifestyle behaviors
of the mother (alcohol), or a defect in
genes ( down syndrome).

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 Some diseases there are certain risk
factors.
 Risk factors are characteristics that
increase a person’s chances of
developing a disease
 Risk factors over which people have no
control are heredity, age, gender, and
ethnic group.

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 Lifestyle behaviors are risk factors we
have control of:
 Eating habits
 Physical activity
 Sleep habits
 Healthful lifestyles can prevent, control, or
reduce the risk of certain diseases.

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 These substances can cause serious
health problems or make existing health
problems worse
 Chemical waste buried in landfills creates
fumes; illness can occur years after initial
exposure.
 Construction materials (asbestos) can cause
lung disease long after exposure

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 Household chemicals (paints, solvents) can
pollute the indoor air and cause health
problems
 Secondhand smoke can be harmful to
nonsmokers
 Improper waste disposal by manufacturers
of household items like plastics/paint creates
water and air pollution. Oil from cars old
aerosol cans can pose health risks too.

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 Radon a colorless, odorless gas released from soil
and rocks that contain tiny amounts of radium. Radon
can seep into the air through foundations, basements,
and pipes. Exposure over a long period of time
increases the risk of lung cancer.
 Carbon monoxide is a colorless, odorless gas
produced when fuel is burned. It is present in fumes
from car exhaust and some furnaces and fireplaces. If
fuel burning appliances do not work properly they can
produce dangerous levels of carbon monoxide which
can cause illness or death.

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 Allergies
 Alzheimer’s disease
 Arthritis
 Asthma
 Cancer
 Cardiovascular disease
 Cerebral palsy
 Cystic Fibrosis
 Multiple Sclerosis
 Muscular Dystrophy
 Sickle-Cell disease

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 Approximately, 17 million people die prematurely each
year as a result of the global epidemic of chronic
diseases
 The risks of high blood pressure and high blood
cholesterol, tobacco and excessive alcohol
consumption, obesity and physical inactivity were more
commonly associated with affluent societies.
 becoming dominant in all middle and low income
countries and not limited to the effluent countries
 NCDs, is responsible for almost 60% of world deaths
(31.7 million deaths) and 43% of the global burden of
diseases.
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 This increase is clearly related to changes in global dietary
patterns and increased consumption of industrially processed
fatty, salty and sugary foods

 In its 2003 annual report, MOH stated that it considers

(NCDs), caused by unhealthy diets and habits, to be just as
serious as those caused by under-nutrition

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Some Continuing Challenges
• Lack of national policies for NCD prevention and control
• Low resources - only 1/3 of countries have a budget line for NCD
prevention & control.
• Lack of NCD surveillance systems
• Fragmented and uncoordinated care
• PHC capacity to deal with NCDs is poor
…

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 NCD CHALLENGES CHANGES NEEDED
Cost Pressures • Comprehensiveness
Disease burden,  With policy/legislation
interventions, drugs support
Quality of Care
• Coordination
Care teams, medical
records, financial  Information flows
incentives • Continuity
Prevention  Organized Care
Fragmentation, lack of • Communication
protocols, lack of  Orient. on self
financial management
incentives/support
Poverty • Community linkages
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 ‫نعزز‬

How to strengthen health

systems for NCDs?
‫التمويل‬
 Financing (increased, better and sustained
 Regulation (assured quality and affordability)
 Service Delivery (ensured access and
availability)
 Governance (improved performance)

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25
 Epidemiology of Non-
Communicable Diseases

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NON- COMMUNICABLE DISEASES INCLUDE

 Cardiovascular ( hypertension, coronary artery disease,

stroke )
 Renal (nephritis, nephrotic syndrome)
 Nervous and mental ( mania, depression)
 Musculoskeletal ( arthritis)
 Respiratory (asthma, emphysema, bronchitis)
 Cancer
 Diabetes
 Obesity
 Blindness
 Degenerative disorders
 Accidents

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Gaps in the natural history of NCD
 Absence of known agent: in most of NCD the cause is
not known.
 Multifactorial causation: in absence of causative
agents, risk factors are studied
 An attribute or exposure that is significantly associated
with development of disease.
 If determinant is modified by intervention, it reduces
possibility of occurrence of disease.
 Risk factors can be causative, contributory or predictive.
 They can be modifiable or non-modifiable
 They can be individual or community risk factors
 Epidemiological studies are needed to identify risk
factors
 At-risk approach, at-risk groups, risk factors with
diseases 28
 Gaps in the natural history of NCD
Web of causation
Changes in life stylestress

Abundance of food lack of physical activitysmoking emotional disturbance

aging

Obesity hypertension

Hyperlipidemiathrombotic tendency
changes artery walls
Coronary arthrosclerosiscoronary occlusion

Myocardial
infarction
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Gaps in the natural history of NCD
 Long latent period: it is the period between the
first exposure to suspected cause and the
eventual development of disease. This makes
it difficult to link suspected causes with
outcomes.
 Indefinite onset : Most (NCD) are slow in onset
and development. Distinction between
diseased and non diseased may be difficult to
establish.

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Prevention of NCD
 To lessen the impact of NCDs on individuals and
society, a comprehensive approach is needed that
requires all sectors, including health, finance, foreign
affairs, education, agriculture, planning and others, to
work together to reduce the risks associated with
NCDs, as well as promote the interventions to
prevent and control them.

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 Other way is via a primary health-care approach to
strengthen early detection and timely treatment.
Evidence shows that such interventions are excellent
economic investments because, if applied to patients
early, can reduce the need for more expensive
treatment.

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Prevention of NCD
Levels of prevention
 Primordial For healthy people
 Primary

 Secondary
For unhealthy people
 Tertiary

 Primordial prevention- Prevention of the emergence or

development of risk factors in countries or population groups in
which they have not yet appeared. Efforts are directed towards
discouraging children from adopting harmful life styles.

 Primary prevention- Action taken prior to the onset of disease

which removes the possibility that the disease will ever occur. Can
be divided into population & high risk strategy.

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Causation in epidemiology
Cause :is an event, circumstance, condition, risk
factor, exposure, characteristic or a combination of
these factors, which results in producing the
disease.
Necessary cause: Vibrio cholerae is necessary for
Cholera.
Sufficient cause : are factors and conditions ,which
are other than the etiological cause of disease.
In sanitary conditions, water conditions, adequate
dose of vibrio cholerae,host immunity.

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Association and causation :
 Association may be defined as ASSOCIATION

the concurrence of two ‫توافق متغيزين‬

variables more often than
would be expected by chance.
 It does not necessarily imply a
causal relationship. ‫وجود‬
DIRECT
SPURIOUS INDIRECT
(CAUSAL)

 Correlation indicates the

degree of association between
two characteristics.
 The correlation coefficients
range from -1.0 to +1.0 ONE TO ONE MULTI
CAUSAL FACTORIAL

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1. Spurious association: 3.Indirect association :
When an observed It is statistical association
association between a between a variable and a
disease and suspected disease due to presence
factor is not real. of another factor known or
unknown, that is common
 Direct (causal): to both the variable and
disease. This common
 One to one relationship factor is confounding
Germ theory of disease factor.
 Necessary cause
altitude
 Sufficient cause
 Multifactorial causation
Iodine deficiency

endemic
goiter

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Criteria for causality

temporal

coherence strength

association

biological specificity

consistency

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 Temporal association: the cause must precede
the effect.
 Strength of association:
 Larger the relative risk greater the likely hood of
causal relation
 Dose response and duration response relationship
 Specificity of association: one to one
relationship between cause and effect.
 It is difficult in chronic diseases.
lung cancer
ca cervix
Cigarette smoking
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 Consistency of association:
When results are replicated when studied in different
settings and by different methods.
 Biological plausibility :
Association agrees with current understanding of the
response of cells, tissues, organs and system to
stimuli.
Food intake and cancer are correlated. The positive
association of intestine and rectal carcinoma is
logical whereas positive association of food and
Ca. skin makes no biological sense.
 Coherence of association:
Rising consumption of tobacco in form of cigarettes
and rising incidence of lung Ca.
Fall in RR of lung Ca when smoking is stopped.
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Obesity

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 Obesity is a condition in which people have an excess of
body fat.
 According to (CDC), the prevalence of obesity in the
U.S more than doubled between the years 1960 and
2000, with the greatest increase from 1980 forward.

 According to the National Institutes of Health, almost one

-third of Americans are obese.

 Obesity is growing problem across the globe.

 Worldwide, more than 300 million adults are obese,
according to (WHO).
 obesity is the second-leading cause of preventable
death in the U.S, surpassed only by smoking. At least
300,000 Americans die each year as a result of factors
attributed to obesity, American Obesity Association
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2- Obesity

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Facts

 Overweight and obesity are the Fifth leading risk for

global deaths.
 At least 2.8 million adults die each year as a result of being
overweight or obese.

 In addition, 44% of the diabetes burden,

 23% of the heart disease burden, and

 7% of certain cancer are attributable to overweight and

obesity.

 Source: ( WHO global estimates from 2011) 44

 Researches and scientific studies
Area Year %
Overweight Obese Severe
obesity
Saudi reference data
for (BMI) for children
aged 5 to 18 years - 2007 23.1% , 9.3% 2%
Using the 2007 WHO
reference

Al-EHassa
Governorate 2008 14.2% 9.7%
schoolchildren -

ministry of education- 2012 One out of five One out of -

school health student ten
administration
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 THE RESULTS SHOWS:

 Overweight and obese children were more in :

 Urban schools, among older age group belonged to less
educated parents,

 Working mothers and

 Small family size

 Eating away from home showed a higher trends

among overweight-obese children

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Short report

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 ‫تساهم‬
Factors Contributing to Obesity
Lifestyle Psychosocial Biomedical
 Poor diet • Depression • Genetics
 Skipping meals • Anxiety • Metabolism
 Sugary soft • Binge eating • Intrauterine growth
drinks • Social events • Medications
 Poor sleep • Low income • Injury
 Snacking • Stress • Mobility issues
• Etc. • Etc.
 Alcohol
 Etc.

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Risk factors
EATING HABITS
Fast food

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 Obesity
Life style

Eating habits Exercise

Genetics others

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Obesity is a major risk factor for a number
of serious health conditions, including:
 Coronary heart disease.
 Cancer.
 Diabetes.
 Fatty liver disease.
 Gallbladder disease.
 High blood pressure..
 Osteoarthritis.
 Stroke.
 Sleep apnea and other breathing problems.
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Classification
Obesity, in absolute terms, is an increase
of body adipose tissue (fat tissue) mass.
BMI
Body mass index or BMI is a simple and
widely used method for estimating body
fat mass. BMI was developed in the
19th century by the Belgian statistician

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 BMI is an accurate reflection of body fat
percentage in the majority of the adult
population. It is less accurate in people such as
body builders and pregnant women in whom
body composition is affected.

 BMI is calculated by dividing the subject's weight

by the square of his or her height:

BMI = kg / m2
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 BMI Classification

Less than 18.5 underweight

18.5–24.9 normal weight

25.0–29.9 is overweight

30.0–34.9 is class I obesity

35.0–39.9 class II obesity

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Questions ??

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 The surgical literature breaks down "class III" obesity into further
categories.

 Any BMI > 40 is severe obesity

 A BMI of 40.0–49.9 is morbid obesity
 A BMI of >50 is super obese
Gabriel I Uwaifo (June 19, 2006). "Obesity". Retrieved on 2008-09-29.

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59
 Definition of DM
Diabetes is a chronic disease that occurs when the
pancreas does not produce enough insulin, or
alternatively, when the body cannot effectively use the
insulin it produces. Insulin is a hormone that regulates
blood sugar

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 FPG 2-hr PG on OGTT
mg/dL mg/dL
126 Diabetes Mellitus 200 Diabetes Mellitus

100 and <126 140 and <200 Prediabetes

Prediabetes
Glucose Tolerance

<100 Normal <140 Normal

The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care.61
2002;25(suppl):S5
Type1 -cell destruction with lack of
insulin
Type2 Insulin resistance with insulin
deficiency

Other specific types Genetic defects in -cell exocrine

pancreas diseases drug- or
chemicalinduced, and other rare
forms
Gestational Insulin resistance with -cell
dysfunction

Adapted from The Expert Committee on the Diagnosis and Classification of

Diabetes Mellitus. Diabetes Care. 1997;20:1183-1197. 62
 Macrovascular Microvascular
Brain
Cerebrovascular disease Eye
• Transient ischemic Retinopathy
attack Cataracts
• Cerebrovascular Glaucoma
accident
• Cognitive impairment

Heart Kidney
Coronary artery disease Nephropathy
• Coronary syndrome • Microalbuminuria
• Myocardial infarction • Gross albuminuria
• Congestive heart • Kidney failure
failure

Extremities
Peripheral vascular Nerves
disease Neuropathy
• Ulceration • Peripheral
• Gangrene • Autonomic
• Amputation
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 "Diabetes is a major threat to global public health
that is rapidly getting worse, and the biggest impact
is on adults of working age in developing countries.
At least 171 million people worldwide have diabetes.
This figure is likely to more than double by 2030 to
reach 366 million."

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 GLOBAL PROJECTIONS FOR THE
DIABETES EPIDEMIC: 2003-2030 (millions)

World
2003 = 194 million
2030 = 366 million
Increase 75%

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 Epidemiology
 In 2000, according to the World Health Organization, at least
171 million people worldwide suffer from diabetes. Its incidence
is increasing rapidly, and it is estimated that by the year 2030,
this number will double.

 Prevalence of Diabetes mellitus among population above 20

years in 2005 was 11%.(WHO,2006)

 Diabetes is in the top 10, and perhaps the top 5, of the most
significant diseases in the developed world. (Wikipedia)

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 According to the American Diabetes Association,
approximately 18.3% (8.6 million) of Americans age 60
and older have diabetes. Diabetes mellitus prevalence
increases with age. (ADA, 2004).

 The National Diabetes Information Clearinghouse

estimates that diabetes costs $132 billion in the United
States alone every year (Eberhart, MS et al, 2004).

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 Diabetes frequency is dramatically
rising all over the world

 The World Health Organization (WHO) estimates

that more than 180 million people worldwide have
diabetes. This number is likely to more than double
by 2030.
 In 2005, an estimated 1.1 million people died from
diabetes.
 Almost 80% of diabetes deaths occur in low and
middle-income countries.

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 The global increase in diabetes will occur because
of population ageing and growth, and because of
increasing trends towards obesity, unhealthy diets
and sedentary lifestyles.
 Worldwide, 3.2 million deaths are attributable to
diabetes every year.
 One in 20 deaths is attributable to diabetes; 8,700
deaths every day; six deaths every minute.

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 At least one in ten deaths among adults between 35 and 64
years old is attributable to diabetes.
 Three-quarters of the deaths among people with diabetes
aged under 35 years are due to their condition.
 Almost half of diabetes deaths occur in people under
the age of 70 years; 55% of In developing countries
the number of people with diabetes will increase by
150% in the next 25 years.

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 In developed countries most people with diabetes are
above the age of retirement, whereas in developing
countries those most frequently affected are aged
between 35 and 64.
 WHO projects that diabetes deaths will increase by
more than 50% in the next 10 years without urgent
action. Most notably, diabetes deaths are projected to
increase by over 80% in upper-middle income
countries between 2006 and 2015.

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 In the developed world, diabetes is the most
significant cause of adult blindness in the non-
elderly, the leading cause of non-traumatic
amputation in adults, and diabetic nephropathy
is the main illness requiring renal dialysis in the
United States
.

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73
Estimated number of adults with diabetes by age-
group in the world

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Estimated number of adults with diabetes by age-
group in developed courtiers

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Estimated number of adults with diabetes
by age-group in developing courtiers

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Prevalence rates of diabetes and hypertension among registered
Population 40 years and above by Field, 2005

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New cases of Diabetes mellitus in West Bank clinics

In 2005, out of total 2,741 new reported cases of

diabetes in the West Bank diabetic clinics, out of them
28.2% was among age group of (55-64), 41.0% among
age group of 35-54 years, 6.3% among age less than
35 years, 24.4% among age 65 years and over.

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New reported cases of D.M. in WB clinics by age2005

0.5 41.00%

0.4 28.20%
24.40%
0.3

0.2
6.30%
0.1

0
less than 34 35-54 55-64 65 and more

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Distribution of diabetic (type II) cases by
management in the West Bank health
clinic:

 1. About 28.6% of diabetics’ cases were managed

by insulin treatment.
 2. About 5.0% were treated with a combined therapy
(insulin and OHA).
 3. About 64.7% of diabetics' cases were managed
by tablets.
 4. Diet control (exclusively managed by lifestyle
modification) was 1.7%
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Major risk factors
 Family history
 Obesity
 Age (older than 45)
 History of gestational diabetes
 High cholesterol
 Hypertension

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Prevention of effects combination
approach
 Increased exercise
Decreases need for insulin

 Reduce calorie intake

Improves insulin sensitivity

 Weight reduction
Improves insulin action

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Triad of Treatment
 Diet

 Medication
 Oral hypoglycemics
 Insulins

 Exercise

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 Diet

 Lower calorie

 Fewer foods of “high glycemic index”

 Spread meals evenly

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Diabetic Meal Plan Using the Food
Guide Pyramid

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Anti-Diabetic medications
 Oral hypoglycemic agents

 Sulfonylureas
 Thiazolidinediones
 Biguanides
 Alpha-glucosidase inhibitors
 D-phenylalinine derivatives

 Insulins

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Cancer

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Cancer
 medical term: (malignant neoplasm) is
a class of diseases in which a group of
cells display uncontrolled growth,
invasion and sometimes metastasis
(spread to other locations in the body
via lymph or blood).

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 Cancer may affect people at all ages, even fetuses,
but the risk for most varieties increases with age.
 Cancer causes about 13% of all deaths.
 According to the American Cancer Society, 7.6
million people died from cancer in the world during
2007.

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Cancer: Reducing Your Risk
An Overview Of Cancer
 2006, approximately 564,830 Americans died of
cancer
 1.4 million new cases diagnosed
 1/3 of cancers are related to poor nutrition, physical
inactivity, and obesity – preventable causes
What Is Cancer?
 Cancer – a large group of diseases characterized by
the uncontrolled growth and spread of abnormal cells
 Neoplasm – new growth of tissue that serves no
physiological function
 Tumor – clumping of neoplasmic cells
 Malignant - cancerous
 Benign - noncancerous
 Biopsy – microscopic examination of cell
development
Disparities In Cancer Rates
 African Americans have the highest death rates from
cancer
 The gap in cancer mortality rates is greater now than
in 1975
 African Americans with certain cancers are more
likely to go unstaged and less likely to receive
treatment
 Men from poorer census counties have a 22% higher
death rate from prostate cancer than their affluent
county comparison groups
What Causes Cancer?
 External Factors – chemicals, radiation, viruses, and
lifestyle
 Internal Factors – hormones, immune conditions,
and inherited mutations
 Theories
 Cellular change/mutation theories
 Carcinogens
 Oncogenes/ protooncogenes
Factors Believed to Contribute to Global Causes of
Cancer
Risks For Cancer
 Lifetime risk – the probability that an individual, over
the course of a lifetime, will develop cancer or die
from it
 Relative risk – measure of the strength of the
relationship between risk factors and a particular
cancer
 Smoking – 30% of all cancer deaths, 87% of lung
cancer deaths
 Obesity – 50% higher risk for breast cancer in
postmenopausal women, 40% higher risk in colon
cancer for men
Preventing Cancer through Diet
and Lifestyle
Biological Factors
 Some cancers such as breast, stomach, colon,
prostate, uterus, ovaries and lung appear to run in
families
 certain leukemia's show similar patterns
 A rare form of eye cancer appears to be transmitted
genetically from mother to child
Reproductive And Hormonal Risks For Cancer

 Pregnancy and oral contraceptives increase a

woman’s chances of breast cancer
 Early first childbirth, having many children have been
shown to reduce risk of breast cancer
Occupational And Environmental Factors

 Asbestos
 Nickel
 Chromate
 Benzene
 Arsenic
 Radioactive substances
 Cool tars
 Herbicides/pesticides
Social And Psychological Factors
 Stress has been implicated in increased
susceptibility to several types of cancers
 Sleep disturbances, diet, or a combination of factors
may weaken the body’s immune system
Chemicals In Foods
 Sodium nitrate when ingested forms a potential
carcinogen, nitrosamine
 Sodium nitrate is still used because it is effective in
preventing botulism
 Pesticide and herbicide residues
Viral Factors
 Herpes-related viruses may be involved in the
development of leukemia,
 Hodgkin’s(a malignant but often curable disease of
lymphatic tissues typically causing painless
enlargement of the lymph nodes, liver, and spleen.)
disease, cervical cancer, .
 Epstein-Barr virus, associated with mononucleosis,
may contribute to cancer
 Helicobacter pylori causes ulcers which are a major
factor in the development of stomach cancer
 Medical Factors
 Some medical treatments actually increase a
person’s risk for cancer
 Diethylstilbestrol (DES) used 1940 to 1960 to control
bleeding during pregnancy, the daughters of mothers
that used DES were found to have an increased risk
for cancers of the reproductive organs.
 Estrogen supplementation.
 Chemotherapy used to treat one form of cancer may
increase risk for another type of cancer
Types Of Cancers
Lung Cancer
 In 2006, 174,470 people died from lung cancer
 Since 1987, more women have died from lung
cancer that breast cancer
 Symptoms: persistent cough, blood-streaked
sputum, chest pain
 Treatment: surgery, radiation therapy, and
chemotherapy
 Prevention: avoid smoking and environmental
tobacco smoke
Breast Cancer
 1 out of 8 women will develop breast cancer (lifetime
risk)
 1 in 227: birth to age 39
 1 in 25: ages 40-59
 1 in 15: ages 60-79
 Detection: mammograms, regular breast self-exams
 Symptoms: lump in the breast, thickening, dimpling,
skin irritation, distortion or tenderness
 Risk factors: family history, hyperplasia, long menstrual
history, obesity after menopause, oral contraceptives

 Prevention: exercise
Breast Self-Examination
Colon And Rectal Cancers
 Third most common cancer in men and women with
over 148,610 new cases diagnosed in 2006
 Risk factors: over 50 years old, obese, family
history of colon or rectum cancer or polyps, diets
high in fats, low in fiber, smoking, high alcohol
consumption, lack of exercise
 90% of colorectal cancers are preventable
 Treatment: radiation, surgery, and possible
chemotherapy
 Prevention: regular exercise, a diet heavy in fruits
and plant-origin foods, a health weight, and
moderation in alcohol consumption
Prostate Cancer
 Most common cancer in men, excluding skin cancer
 In 2006, 234,460 new cases diagnosed
 1 in 3 men will be diagnosed in their lifetime
 Prostate is a muscular, walnut-sized gland the
surrounds part of the urethra. Its primary function is to
produce seminal fluid.
 Symptoms: nonspecific, weak or interrupted urine
flow, difficulty starting or stopping urination
 Risk factors: age, race, nationality, family history, diet,
lifestyle, and vasectomy
 Prevention: diet high in lycopenes, vitamin E
Skin Cancer
 Long term effects of sun exposure can result in skin
cancer
 Malignant melanoma, deadliest form of skin cancer
 Sun give off 3 types of harmful rays:
 UVA
 UVB
 UVC
 Prevention: limit exposure to harmful UV rays, drink
more fluids than usual, apply cool compresses to
skin, moisturize skin
Types of Ultraviolet Rays

Figure 16.7
Testicular Cancer
 Affects nearly 8,250 young men world wide.
 Men between the ages 15-35 are at the greatest risk
 Important to practice regular testicular self exams
 Lance Armstrong Foundation “LiveStrong” campaign
to raise awareness
Testicular Self-Examination
Cervical and Endometrial (Uterine) Cancer

 9,710 new cases of cervical cancer, 41,200 cases of

endometrial cancer in U.S. in 2012.
 Pap test – cells are taken from the cervical region
 Risk factors:
 Cervical cancer: early age at first intercourse, multiple
sex partners, cigarette smoking, and certain STIs
 Endometrial cancer: age, endometrial hyperplasia,
overweight, diabetes, and high blood pressure
Other Cancers
 Pancreatic cancer –
 Leukemia – cancer of blood forming tissues
Detecting Cancer
 The earlier the diagnosis the better the prospect for
survival
 Magnetic resonance imaging (MRI)
 Computerized axial tomography scan (CAT scan)
 Prostatic ultrasound
 Regular self-exams, and check ups
2006 Estimated US Cancer Deaths*
Lung & bronchus31% Men Women 26%Lung & bronchus
291,270 273,560
Colon & rectum10% 15%Breast

Prostate9% 10%Colon & rectum

Pancreas6% 6% Pancreas

Leukemia4% 6%Ovary
4%Leukemia
Liver & intrahepatic4%
bile duct 3%Non-Hodgkin
lymphoma
Esophagus4%
3%Uterine corpus
Non-Hodgkin 3%
lymphoma 2%Multiple myeloma

Urinary bladder3% 2%Brain/ONS

Kidney3% All other sites 23%

All other sites 23%

ONS=Other nervous system.

119
Source: American Cancer Society, 2006.
 Hypertension

The Silent killer

120
Definition
Hypertension is high blood pressure.
Blood pressure is the force of blood
pushing against the walls of arteries as
it flows through them.

121
Classification of hypertension :
Essential ( primary ) Hypertension :
It indicates that no specific medical cause can be found to
explain a patient's condition, from the patients diagnosed
with hypertension, 95% fall in the category of essential (or
idiopathic) hypertension.

Secondary Hypertension :
Indicates that the high blood pressure is a result of (i.e.
secondary to) another condition, such as kidney disease or
tumors, 5% will fall in the category of secondary
hypertension.

122
Risk factors for hypertension include:
 Non-modifiable
 Modifiable  Age
 Body weight  Sex/gender
 Sodium chloride intake  Heredity
 Alcohol intake  Ethnicity/race
 Physical activity
 Psychosocial factors
 Socio-economic status
 Hormonal contraceptives

123
Global burden of hypertension


 The biggest increase in prevalence was expected to be in developing

(increase of 24%) and third world countries (increase of 80%) as the
rapidly take on the more western lifestyle.
Scientists are now claiming that 1 in 3 adults in the world will have high
blood pressure in 2025. By 2025, the number will increase by about
60% to a total of 1.56 billion as the proportion of elderly people will
increase significantly.

Kearney PM et al. Lancet 2005; 365:217-223. 125

Prevalence of hypertension can differ
according to gender and age.

 Men are at increased risk for high blood

pressure as compared to women until the age
of 55. After 55, there is a higher percentage of
women at risk for high blood pressure.
 High blood pressure is 2 to 3 times more
common in women taking oral contraceptives,
especially in obese and older women, than in
women not taking them.
 64% of men over 75 years old have
hypertension.
126
 77% of women over 75 years old have
hypertension.
 Older females have a significant risk of
developing high blood pressure. More than 50%
of women over age 60 have high blood
pressure.
 African-Americans who live in the United States
have the highest prevalence of hypertension in
the world. ( WHO )

127
Hypertension disease Mortality in 2005 :

•Hypertension disease is the fifth-leading cause of

cardiovascular diseases deaths; 12.9% of the total
cardiovascular mortality, with a rate of 13.0 per 100,000.

•Hypertension disease is the eight-leading cause of

deaths in total population (4.8%), while it was the ninth
leading deaths in males and females (2.7% and 3.8%) of
males and females deaths respectively.

128
Cardiovascular Disease

129
Introduction
Non communicable disease account for a
large and increasing burden of disease
worldwide. It is currently estimated that
non communicable disease accounts for
approximately 59% of global deaths and
43% of global disease burden. This is
projected to increase to 73% of deaths
and 60% of disease burden by 2020.

130
Introduction, cont.
The worldwide burden of cardiovascular disease is
substantial. In most industrialized countries,
cardiovascular disease are the leading cause of
disability and death. Developing countries, with
previous low rate are now seeing increased rates
as economic develop, infectious disease are
conquered and life expectancy improves.

131
 Definition

Cardiovascular disease refers to the class of

diseases that involve the heart or blood
vessels (arteries and veins). While the term
technically refers to any disease that affects
the cardiovascular system, it is usually used
to refer to those related to atherosclerosis
(arterial disease).

132
 CVD are
CVD are present
presentininmany
manyforms
formsand
andhave
have different
different categories
categories and include:-
and include:-
 Hypertension (high blood pressure)
 Coronary heart disease (heart attack)
 Cerebrovascular disease (stroke)
 Peripheral vascular disease
 Heart failure
 Rheumatic heart disease
 Congenital heart disease
 Cardiomyopathies

133
Risk factors for cardiovascular
disease
 Non-modifiable Risk Factors

 Age
 Gender, men under the age 64 are much more likely to die of
coronary heart disease than women, although anyone can die
from it.
 Genetic factors/Family history of cardiovascular disease.
 Race (or ethnicity), Studies show that blacks are twice as likely
to develop high blood pressure as Caucasians.

134
Risk factors, cont.
 Environment, your chances can increase because of areas with a lot
of smog or other form of air pollution, including passive smoking.

 Modifiable Risk Factors

cigarette smoking, high cholesterol and high blood
Pressure, lack of exercise, diabetes, obesity, alcohol,
certain infections and inflammation, estrogens,
androgens, and certain psychosocial factors.

135
 Global Burden of Cardiovascular
Disease
Cardiovascular disease is the number one cause of death globally and is
projected to remain the leading cause of death.

Anestimated
An estimated 17.5
17.5 million
million people
people died cardiovascular
died from from cardiovascular disease in
disease in 2005, representing
2005, representing 30 global
30 % of all % of alldeaths.
global deaths.

Of these deaths, 7.6 million were due to heart attacks and 5.7 million
were due to stroke.

136
 Statistics, cont
Around 80% of these deaths occurred in low and
middle income countries (LMIC).

If appropriate action is not taken, by 2015, an

estimated 20 million people will die from
cardiovascular disease every year, mainly from heart
attacks and strokes . (WHO, 2005)

137
Percentage breakdown of deaths
from cardiovascular diseases

138
 Statistics, cont
American Heart Association, 2006.

Estimates for the

Estimates year
for the year2005
2005 are that
are that 80,700,000
80,700,000 people
people in the in the
United
UnitedStates
Stateshave oneone
have or more forms forms
or more of cardiovascular disease (CVD).
of cardiovascular disease
(CVD).

• High blood pressure — 73,000,000.

• Coronary heart disease — 16,000,000.
 Myocardial infarction (acute heart attack) — 8,100,000.

139
 Statistics, cont
 Angina pectoris (chest pain or discomfort caused
by reduced blood supply to the heart muscle) —
9,100,000.
• Stroke — 5,800,000.
• Heart Failure — 5,300,000
Over 142,000 Americans killed by CVD in 2004 are
under age 65

140
 Statistics, cont
2004 death rates from CVD were 335.1 for white males and 454.0
for black males; for white females 238.0 and for black females
333.6 (Death rates are per 100,000 population.

From 1993 to 2003 death rates from CVD declined 24.7 percent.

Despite this decline in the death rate, in the same 10-year period the
actual number of deaths declined only 8 percent.

141
Cardiovascular Disease Mortality Indicator
Mortality rate per 100,000 of cardiovascular
diseases was:

• All heart diseases 56.8

• Rheumatic HD 0.7
• Ischemic HD 36.4
• Pulmonary HD 1.6
• Other heart diseases 18.1
• CVA 29.8
• Essential hypertension 13

142
 Statistics
In 2005, 3,799 persons died from cardiovascular
diseases (1,956 males and 1,843 females), with a
proportion of 36.7% of total deaths, with a rate of
101/100,000 population.

Mortality among males was higher than females

(51.5% in males and 48.5% in females).

143
 Statistics, cont
Cardiovascular mortalities are ranking as following:

• All heart diseases (Ischaemic, Rheumatic,

Pulmonary and Other Heart diseases), constitute
56.8% of cardiovascular diseases with a rate of 54.4
per 100,000 population

• Ischaemic heart disease constitutes 37.5% of

cardiovascular diseases with a rate of 35.9 per
100,000 population;

144
 Statistics, cont
 Cerebrovascular disease constitutes 24.4% of CVDs
with a rate of 23.4 per 100,000 population.
 Hypertensive disease constitutes 17.4% of
cardiovascular diseases with a rate of 16.6 per
100,000 population.
 Other heart diseases constitutes 17.4% of
cardiovascular diseases with a rate of 16.7 per
100,000 population.

145
Thanks …

146