Cancers in the Urban Environment: How Malignant Diseases Are Caused and Distributed among the Diverse People and Neighborhoods of a Major Global Metropolis

By Thomas M. Mack

Cancers in the Urban Environment: How Malignant Diseases Are Caused and Distributed among the Diverse People and Neighborhoods of a Major Global Metropolis, Second Edition, provides a detailed description of the occurrence of common forms of cancer in the ethnically, socially and environmentally complex milieu of a modern urban complex. The location is Los Angeles County, and the patterns of 72 different malignancies are described according to race, age, sex, social class calendar time (since 1972) and most notably, individual neighborhood, using detailed maps of high risk. This second edition uses twice as many cases and more demographic diversity.

Physicians and scientific investigators in California and elsewhere can use the material provided to counsel patients and evaluate the consistency of any specific pattern of occurrence with each specific causal hypothesis. A detailed appendix describes the source of data, provides the basis for the choices made in the production of the volume, and gives a perspective on the search for "clusters" of malignancy.

• Compares different types of cancers with respect to the degree of non-random occurrence
• Contains numerous maps detailing the demographic and geographic pattern of cancer occurrence in Los Angeles County
• Provides an empirical perspective on the search for disease "clusters"

• Language: English
• Publisher: Academic Press
• Release date: Dec 3, 2020
• ISBN: 9780128117460

Thomas M. Mack

Thomas M. Mack is an internationally renowned researcher specialized in the lifestyle factors related to the development of cancer. He is founder of International Twin Registry, a continent-wide series of comparisons between patients with chronic diseases and their unaffected twins; and California Twin Program, an analogous program of studies among twins who differ in lifestyle or personal exposures and experiences.

Book preview

Cancers in the Urban Environment

How Malignant Diseases Are Caused and Distributed Among the Diverse People and Neighborhoods of a Major Global Metropolis

Second Edition

Thomas M. Mack, MD MPH

Departments of Preventive Medicine and Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California, United States

Table of Contents

Cover image

Title page

Copyright

Dedication

Foreword

Preface

Chapter 1. Introduction for laypersons

Abstract

Chapter 2. Introduction for professionals

Abstract

Chapter 3. What a cancer is

Abstract

Overview

Initial Insult

Cellular Interaction

In The Nucleus

Fail-Safe Protections

Ganging UP

Moving On

Chapter 4. How and why cancers differ?

Abstract

Chapter 5. How a cancer can be caused by a carcinogenic toxin

Abstract

Chapter 6. Recognizing carcinogens

Abstract

Chapter 7. When carcinogens are not (very) hazardous

Abstract

Chapter 8. How a cancer can be caused by an inherited gene

Abstract

Chapter 9. Recognizing risky genes

Abstract

Chapter 10. Describing an urban population

Abstract

Chapter 11. Counting urban cases

Abstract

Chapter 12. Cancer cases have personal characteristics

Abstract

Chapter 13. Mapping methods and conventions

Abstract

Chapter 14. Cancers spread: Delays matter

Abstract

Chapter 15. Finding unexpected risk discrepancies

Abstract

Chapter 16. Bias and errors in measurement

Abstract

Chapter 17. Alternative predictable explanations: Confounding

Abstract

Chapter 18. Trying to account for chance

Abstract

Chapter 19. Addressing cancer clusters

Abstract

Chapter 20. Interpretation of cancer-specific figures and maps

Abstract

Chapter 21. Summarizing the information, cancer by cancer

Abstract

Definition and frequency

Background

Local pattern

Thumbnail interpretation

Chapter 22. Beyond these data

Abstract

The Cancers

Lip carcinoma

Background

Local pattern

Thumbnail interpretation

Lip carcinoma: Both

Lip carcinoma: Male

Lip carcinoma: Female

Lip carcinoma: Both

Base of tongue, tonsil

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Base of tongue, tonsil: Both

Base of tongue, tonsil: Male

Base of tongue, tonsil: Female

Base of tongue, tonsil: Both

Base of tongue, tonsil: Maps (cases were too few for Maps 1, 4, and 5)

Anterior tongue carcinoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Anterior tongue carcinoma: Both

Anterior tongue carcinoma: Male

Anterior tongue carcinoma: Female

Anterior tongue carcinoma: Both

Anterior tongue carcinoma: Map (cases were too few for Maps 1, 4, and 5)

Salivary gland carcinoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Salivary gland carcinoma: Both

Salivary gland carcinoma: Male

Salivary gland carcinoma: Female

Salivary gland carcinoma: Both

Salivary gland carcinoma: Maps (cases were too few for Maps 1, 2, and 5)

Oropharyngeal carcinoma total

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Oropharynx carcinoma total: Both

Oropharynx carcinoma total: Male

Oropharynx carcinoma, total, male: Map

Oropharynx carcinoma total: Female

Oropharynx carcinoma, total, female: Map

Oropharynx carcinoma total: Both

Oropharynx carcinoma total: Maps

Nasopharyngeal carcinoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Nasopharyngeal carcinoma: Both

Nasopharyngeal carcinoma: Male

Nasopharyngeal carcinoma: Female

Nasopharyngeal carcinoma: Both

Nasopharyngeal carcinoma: Maps (cases were too few for Maps 1, 4, and 5)

Squamous carcinoma of the esophagus and gastric cardia

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Squamous carcinoma of the esophagus and gastric cardia: Both

Squamous carcinoma of the esophagus and gastric cardia: Male

Squamous carcinoma of the esophagus and gastric cardia: Female

Squamous carcinoma of the esophagus and gastric cardia: Both

Squamous carcinoma of the esophagus and gastric cardia: Maps (cases were too few for Maps 1, 2, and 5)

Adenocarcinoma of the esophagus and gastric cardia

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Adenocarcinoma of the esophagus and gastric cardia: Both

Adenocarcinoma of the esophagus and gastric cardia: Male

Adenocarcinoma of the esophagus and gastric cardia: Female

Adenocarcinoma of the esophagus and gastric cardia: Both

Adenocarcinoma of the esophagus and gastric cardia: Maps (cases were too few for Maps 1, and 5)

Adenocarcinoma of the lower stomach

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Adenocarcinoma of the lower stomach: Both

Adenocarcinoma of the lower stomach: Male

Adenocarcinoma of the lower stomach, total, male: Map

Adenocarcinoma of the lower stomach: Female

Adenocarcinoma of the lower stomach, total, female: Map

Adenocarcinoma of the lower stomach: Both

Adenocarcinoma of the lower stomach: Maps (cases were too few for Map 5)

Carcinoma of the small bowel

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Carcinoma of the small bowel: Both

Carcinoma of the small bowel: Male

Carcinoma of the small bowel: Female

Carcinoma of the small bowel: Both

Carcinoma of the small bowel: Maps (cases were too few for Maps 1, 2, and 5)

Colorectal carcinoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Colorectal carcinoma: Both

Colorectal carcinoma: Male

Colorectal carcinoma: Female

Colorectal carcinoma: Both

Colorectal carcinoma: Maps (Cases were too few for Maps 1 and 5. This combination was not included in the first edition. Hence Map 4 is not included.)

Colon carcinoma total

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Colon carcinoma total: Both

Colon carcinoma total: Male

Colon carcinoma, total, male: Map

Colon carcinoma total: Female

Colon carcinoma, total, female: Map

Colon carcinoma total: Both

Colon carcinoma total: Maps

Carcinoma of the upper colon

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Carcinoma of the upper colon: Both

Carcinoma of the upper colon: Male

Carcinoma of the upper colon, total, male: Map

Carcinoma of the upper colon: Female

Carcinoma of the upper colon, total, female: Map

Carcinoma of the upper colon: Both

Carcinoma of the upper colon: Maps

Carcinoma of the sigmoid colon

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Carcinoma of the sigmoid colon: Both

Carcinoma of the sigmoid colon: Male

Carcinoma of the sigmoid colon, total, male: Map

Carcinoma of the sigmoid colon: Female

Carcinoma of the sigmoid colon, total, female: Map

Carcinoma of the sigmoid colon: Both

Carcinoma of the sigmoid colon: Maps

Carcinoma of the rectum

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Carcinoma of the rectum: Both

Carcinoma of the rectum: Male

Carcinoma of the rectum, total, male: Map

Carcinoma of the rectum: Female

Carcinoma of the rectum, total, female: Map

Carcinoma of the rectum: Both

Carcinoma of the rectum: Maps

Carcinoma of the anus

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Carcinoma of the anus: Both

Carcinoma of the anus: Male

Carcinoma of the anus: Female

Carcinoma of the anus: Both

Carcinoma of the anus: Maps (cases were too few for Maps 1 and 5. This cancer was not included in the first edition. Hence Map 4 is not included.)

Hepatocellular carcinoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Hepatocellular carcinoma: Both

Hepatocellular carcinoma: Male

Hepatocellular carcinoma, total, male: Map

Hepatocellular carcinoma: Female

Hepatocellular carcinoma, total, female: Map

Hepatocellular carcinoma: Both

Hepatocellular carcinoma: Maps

Cholangiocarcinoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Cholangiocarcinoma: Both

Cholangiocarcinoma: Male

Cholangiocarcinoma: Female

Cholangiocarcinoma: Both

Cholangiocarcinoma: Maps (cases were too few for Maps 1, 2, and 5)

Gallbladder carcinoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Gallbladder carcinoma: Both

Gallbladder carcinoma: Male

Gallbladder carcinoma: Female

Gallbladder carcinoma: Both

Gallbladder carcinoma: Maps (cases were too few for Maps 1 and 5)

Biliary tract carcinoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Biliary tract carcinoma: Both

Biliary tract carcinoma: Male

Biliary tract carcinoma: Female

Biliary tract carcinoma: Both

Biliary tract carcinoma: Maps (cases were too few for Maps 1 and 5)

Adenocarcinoma of the pancreas

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Adenocarcinoma of the pancreas: Both

Adenocarcinoma of the pancreas: Male

Adenocarcinoma of the pancreas, total, male: Map

Adenocarcinoma of the pancreas: Female

Adenocarcinoma of the pancreas, total, female: Map

Adenocarcinoma of the pancreas: Both

Adenocarcinoma of the pancreas: Maps

Pancreas islet cell carcinoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Pancreas islet cell carcinoma: Both

Pancreas islet cell carcinoma: Male

Pancreas islet cell carcinoma: Female

Pancreas islet cell carcinoma: Both

Carcinoma of the nose and sinuses

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Carcinoma of the nose and sinuses: Both

Carcinoma of the nose and sinuses: Male

Carcinoma of the nose and sinuses: Female

Carcinoma of the nose and sinuses: Both

Carcinoma of the nose and sinuses: Maps (cases were too few for Maps 1, 2, and 5)

Carcinoma of the larynx

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Carcinoma of the larynx: Both

Carcinoma of the larynx: Male

Carcinoma of the larynx: Female

Carcinoma of the larynx: Both

Carcinoma of the larynx: Maps (cases were too few for Maps 1 and 5)

Carcinoma of the lung and bronchus total

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Carcinoma of the lung and bronchus total: Both

Carcinoma of the lung and bronchus total: Male

Carcinoma of the lung and bronchus total: Female

Carcinoma of the lung and bronchus total: Both

Carcinoma of the lung and bronchus total: Maps (Maps 1 and 5 are omitted for this combination)

Squamous carcinoma of the lung and bronchus

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Squamous carcinoma of the lung and bronchus: Both

Squamous carcinoma of the lung and bronchus: Male

Squamous carcinoma of the lung and bronchus, total, male: Map

Squamous carcinoma of the lung and bronchus: Female

Squamous carcinoma of the lung and bronchus, total, female: Map

Squamous carcinoma of the lung and bronchus: Both

Squamous carcinoma of the lung and bronchus: Maps

Small cell carcinoma of the lung and bronchus

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Small cell carcinoma of the lung and bronchus: Both

Small cell carcinoma of the lung and bronchus: Male

Small cell carcinoma of the lung and bronchus, total, male: Map

Small cell carcinoma of the lung and bronchus: Female

Small cell carcinoma of the lung and bronchus, total, female: Map

Small cell carcinoma of the lung and bronchus: Both

Small cell carcinoma of the lung and bronchus: Maps

Adenocarcinoma of the lung and bronchus

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Adenocarcinoma of the lung and bronchus: Both

Adenocarcinoma of the lung and bronchus: Male

Adenocarcinoma of the lung and bronchus, total, male: Map

Adenocarcinoma of the lung and bronchus: Female

Adenocarcinoma of the lung and bronchus, total, female: Map

Adenocarcinoma of the lung and bronchus: Both

Adenocarcinoma of the lung and bronchus: Maps

Undifferentiated carcinoma of the lung and bronchus

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Undifferentiated carcinoma of the lung and bronchus: Both

Undifferentiated carcinoma of the lung and bronchus: Male

Undifferentiated carcinoma of the lung and bronchus: Female

Undifferentiated carcinoma of the lung and bronchus: Both

Undifferentiated carcinoma of the lung and bronchus: Maps (cases were too few for Maps 1, 2, and 5)

Carcinoma of the lung and bronchus, not otherwise specified

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Carcinoma of the lung and bronchus, not otherwise specified: Both

Carcinoma of the lung and bronchus, not otherwise specified: Male

Carcinoma of the lung and bronchus, not otherwise specified, total, male: Map

Carcinoma of the lung and bronchus, not otherwise specified: Female

Carcinoma of the lung and bronchus, not otherwise specified, total, female: Map

Carcinoma of the lung and bronchus, not otherwise specified: Both

Carcinoma of the lung and bronchus, not otherwise specified: Maps

Mesothelioma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Mesothelioma: Both

Mesothelioma: Male

Mesothelioma: Female

Mesothelioma: Both

Mesothelioma: Maps (cases were too few for Maps 1, 2, and 5)

Leiomyosarcoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Leiomyosarcoma: Both

Leiomyosarcoma: Male

Leiomyosarcoma: Female

Leiomyosarcoma: Both

Leiomyosarcoma: Maps (cases were too few for Maps 1–5)

Rhabdomyosarcoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Rhabdomyosarcoma: Both

Rhabdomyosarcoma: Male

Rhabdomyosarcoma: Female

Rhabdomyosarcoma: Both

Rhabdomyosarcoma: Maps (cases were too few for Maps 1–5)

Angiosarcoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Angiosarcoma: Both

Angiosarcoma: Male

Angiosarcoma: Female

Angiosarcoma: Both

Angiosarcoma: Maps (cases were too few for Maps 1, 2, and 5)

Kaposi sarcoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Kaposi sarcoma: Both

Kaposi sarcoma: Male

Kaposi sarcoma: Female

Kaposi sarcoma: Both

Kaposi sarcoma: Maps (cases were too few for Maps 1 and 5)

Other soft tissue sarcoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Other soft tissue sarcoma: Both

Other soft tissue sarcoma: Male

Other soft tissue sarcoma, total, male: Map

Other soft tissue sarcoma: Female

Other soft tissue sarcoma, total, female: Map

Other soft tissue sarcoma: Both

Other soft tissue sarcoma: Maps

Osteosarcoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Osteosarcoma: Both

Osteosarcoma: Male

Osteosarcoma: Female

Osteosarcoma: Both

Osteosarcoma: Maps (cases were too few for Maps 1, 2, and 5)

Ewing’s sarcomas

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Ewing’s sarcomas: Both

Ewing’s sarcomas: Male

Ewing’s sarcomas: Female

Ewing’s sarcomas: Both

Malignant chordoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Malignant chordoma: Both

Malignant chordoma: Male

Malignant chordoma: Female

Malignant chordoma: Both

Malignant chordoma: Maps (cases were too few for Maps 1, 2, and 5)

Malignant melanoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Malignant melanoma: Both

Malignant melanoma: Male

Malignant melanoma, total, male: Map

Malignant melanoma: Female

Malignant melanoma, total, female: Map

Malignant melanoma: Both

Malignant melanoma: Maps

Breast cancer

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Breast cancer: Both

Breast cancer: Male

Breast cancer, total, male: Map

Breast cancer: Female

Breast cancer, total, female: Map

Breast cancer: Both

Breast cancer: Maps

Squamous carcinoma of the cervix

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Squamous carcinoma of the cervix: Both

Squamous carcinoma of the cervix: Male (Excludes Figures 5M-11M)

Squamous carcinoma of the cervix, total, male: Map

Squamous carcinoma of the cervix: Female

Squamous carcinoma of the cervix, total, female: Map

Squamous carcinoma of the cervix: Both

Squamous carcinoma of the cervix: Maps (Excludes Map 1M)

Carcinoma of the endometrium

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Carcinoma of the endometrium: Both

Carcinoma of the endometrium: Male (Excludes Figures 5M-11M)

Carcinoma of the endometrium, total, male: Map

Carcinoma of the endometrium: Female

Carcinoma of the endometrium, total, female: Map

Carcinoma of the endometrium: Both

Carcinoma of the endometrium: Maps (Excludes Map 1M)

Epithelial carcinoma of the ovary

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Epithelial carcinoma of the ovary: Both

Epithelial carcinoma of the ovary: Male

Epithelial carcinoma of the ovary, total, male: Map

Epithelial carcinoma of the ovary: Female

Epithelial carcinoma of the ovary, total, female: Map

Epithelial carcinoma of the ovary: Both

Epithelial carcinoma of the ovary: Maps

Germ cell carcinoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Germ cell carcinoma: Both

Germ cell carcinoma: Male

Germ cell carcinoma, total, male: Map

Germ cell carcinoma: Female

Germ cell carcinoma, total, female: Map

Germ cell carcinoma: Both

Germ cell carcinoma: Maps

Choriocarcinoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Choriocarcinoma: Both

Choriocarcinoma: Male

Choriocarcinoma: Female

Choriocarcinoma: Both

Prostate carcinoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Prostate carcinoma: Both

Prostate carcinoma: Male

Prostate carcinoma, total, male: Map

Prostate carcinoma: Female (Excludes Figures 5F-11F)

Prostate carcinoma, total, female: Map

Prostate carcinoma: Both

Prostate carcinoma: Maps (Excludes Map 1F)

Other genital adenocarcinoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Other genital adenocarcinoma: Both

Other genital adenocarcinoma: Male

Other genital adenocarcinoma: Female

Other genital adenocarcinoma: Both

Other genital adenocarcinoma: Maps (cases were too few for Maps 1, 2, and 5)

Other genital squamous carcinoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Other genital squamous carcinoma: Both

Other genital squamous carcinoma: Male

Other genital squamous carcinoma: Female

Other genital squamous carcinoma: Both

Other genital squamous carcinoma: Maps (cases were too few for Maps 1 and 5)

Mixed cell genital neoplasms

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Mixed cell genital neoplasms: Both

Mixed cell genital neoplasms: Male

Mixed cell genital neoplasms: Female

Mixed cell genital neoplasms: Both

Mixed cell genital neoplasms: Maps (cases were too few for Maps 1, and 5)

Urothelial carcinoma of the bladder

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Urothelial carcinoma of the bladder: Both

Urothelial carcinoma of the bladder: Male

Urothelial carcinoma of the bladder, total, male: Map

Urothelial carcinoma of the bladder: Female

Urothelial carcinoma of the bladder, total, female: Map

Urothelial carcinoma of the bladder: Both

Urothelial carcinoma of the bladder: Maps

Squamous carcinoma of the bladder

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Squamous carcinoma of the bladder: Both

Squamous carcinoma of the bladder: Male

Squamous carcinoma of the bladder: Female

Squamous carcinoma of the bladder: Both

Squamous carcinoma of the bladder: Maps (cases were too few for Maps 1, 2, and 5)

Renal cell carcinoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Renal cell carcinoma: Both

Renal cell carcinoma: Male

Renal cell carcinoma, total, male: Map

Renal cell carcinoma: Female

Renal cell carcinoma, total, female: Map

Renal cell carcinoma: Both

Renal cell carcinoma: Maps

Wilms tumor/nephroblastoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Wilms tumor/nephroblastoma: Both

Wilms tumor/nephroblastoma: Male

Wilms tumor/nephroblastoma: Female

Wilms tumor/nephroblastoma: Both

Wilms tumor/nephroblastoma: Maps (cases were too few for Maps 1, 2, and 5)

Retinoblastoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Retinoblastoma: Both

Retinoblastoma: Male

Retinoblastoma: Female

Retinoblastoma: Both

Retinoblastoma: Maps (cases were too few for Maps 1, 2, and 5)

Central nervous system glioma, childhood

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Central nervous system glioma, childhood: Both

Central nervous system glioma, childhood: Male

Central nervous system glioma, childhood: Female

Central nervous system glioma, childhood: Both

Central nervous system glioma, total

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Central nervous system glioma, total: Both

Central nervous system glioma, total: Male

Central nervous system glioma, total, male: Map

Central nervous system glioma, total: Female

Central nervous system glioma, total, female: Map

Central nervous system glioma, total: Both

Central nervous system glioma, total: Maps

Neurolemmoma–neurofibroma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Neurolemmoma–neurofibroma: Both

Neurolemmoma–neurofibroma: Male

Neurolemmoma–neurofibroma: Female

Neurolemmoma–neurofibroma: Both

Neurolemmoma–neurofibroma: Maps (cases were too few for Maps 1, 2, and 5)

Neuroblastoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Neuroblastoma: Both

Neuroblastoma: Male

Neuroblastoma: Female

Neuroblastoma: Both

Neuroblastoma: Maps (cases were too few for Maps 1, 2, and 5)

Malignant meningioma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Malignant meningioma: Both

Malignant meningioma: Male

Malignant meningioma: Female

Malignant meningioma: Both

Papillary carcinoma of the thyroid

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Papillary carcinoma of the thyroid: Both

Papillary carcinoma of the thyroid: Male

Papillary carcinoma of the thyroid, total, male: Map

Papillary carcinoma of the thyroid: Female

Papillary carcinoma of the thyroid, total, female: Map

Papillary carcinoma of the thyroid: Both

Papillary carcinoma of the thyroid: Maps

Follicular carcinoma of the thyroid

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Follicular carcinoma of the thyroid: Both

Follicular carcinoma of the thyroid: Male

Follicular carcinoma of the thyroid: Female

Follicular carcinoma of the thyroid: Both

Follicular carcinoma of the thyroid: Maps (cases were too few for Maps 1, 2, and 5)

Medullary carcinoma of the thyroid

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Medullary carcinoma of the thyroid: Both

Medullary carcinoma of the thyroid: Male

Medullary carcinoma of the thyroid: Female

Medullary carcinoma of the thyroid: Both

Anaplastic carcinoma of the thyroid

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Anaplastic carcinoma of the thyroid: Both

Anaplastic carcinoma of the thyroid: Male

Anaplastic carcinoma of the thyroid: Female

Anaplastic carcinoma of the thyroid: Both

Carcinoma of the thyroid, total

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Carcinoma of the thyroid, total: Both

Carcinoma of the thyroid, total: Male

Carcinoma of the thyroid, total: Female

Carcinoma of the thyroid, total: Both

Carcinoma of the thyroid, total: Maps (cases were too few for Maps 1, 4, and 5)

Carcinoma of the pituitary

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Carcinoma of the pituitary: Both

Carcinoma of the pituitary: Male

Carcinoma of the pituitary: Female

Carcinoma of the pituitary: Both

Carcinoid malignancies

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Carcinoid cancers: Both

Carcinoid cancers: Male

Carcinoid cancers, total, male: Map

Carcinoid cancers: Female

Carcinoid cancers, total, female: Map

Carcinoid cancers: Both

Carcinoid cancers: Maps (This cancer was not included in the first edition. Hence Map 4 is not included.)

Miscellaneous endocrine malignancies

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Miscellaneous endocrine malignancies: Both

Miscellaneous endocrine malignancies: Male

Miscellaneous endocrine malignancies: Female

Miscellaneous endocrine malignancies: Both

Miscellaneous endocrine malignancies: Maps (cases were too few for Maps 1, 2, and 5)

Carcinoma of the thymus

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Carcinoma of the thymus: Both

Carcinoma of the thymus: Male

Carcinoma of the thymus: Female

Carcinoma of the thymus: Both

Carcinoma of the thymus: Maps (cases were too few for Maps 1, 2, and 5)

Childhood Hodgkin lymphoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Childhood Hodgkin lymphoma: Both

Childhood Hodgkin lymphoma: Male

Childhood Hodgkin lymphoma: Female

Childhood Hodgkin lymphoma: Both

Mixed cellularity Hodgkin lymphoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Mixed cellularity Hodgkin lymphoma: Both

Mixed cellularity Hodgkin lymphoma: Male

Mixed cellularity Hodgkin lymphoma: Female

Mixed cellularity Hodgkin lymphoma: Both

Mixed cellularity Hodgkin lymphoma: Maps (cases were too few for Maps 1, 2, and 5)

Nodular sclerosis Hodgkin lymphoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Nodular sclerosis Hodgkin lymphoma: Both

Nodular sclerosis Hodgkin lymphoma: Male

Nodular sclerosis Hodgkin lymphoma: Female

Nodular sclerosis Hodgkin lymphoma: Both

Nodular sclerosis Hodgkin lymphoma: Maps (cases were too few for Maps 1 and 5)

Nodular lymphocyte predominant Hodgkin lymphoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Nodular lymphocyte predominant Hodgkin lymphoma: Both

Nodular lymphocyte predominant Hodgkin lymphoma: Male

Nodular lymphocyte predominant Hodgkin lymphoma: Female

Nodular lymphocyte predominant Hodgkin lymphoma: Both

Hodgkin lymphoma, total

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Hodgkin lymphoma, total: Both

Hodgkin lymphoma, total: Male

Hodgkin lymphoma, total: Female

Hodgkin lymphoma, total: Both

Hodgkin lymphoma, total: Maps (cases were too few for Maps 1 and 5. This combination was not included in first edition. Hence Map 4 is not included.)

Follicular non-Hodgkin lymphoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Follicular non-Hodgkin lymphoma: Both

Follicular non-Hodgkin lymphoma: Male

Follicular non-Hodgkin lymphoma, total, male: Map

Follicular non-Hodgkin lymphoma: Female

Follicular non-Hodgkin lymphoma, total, female: Map

Follicular non-Hodgkin lymphoma: Both

Follicular non-Hodgkin lymphoma: Maps

Diffuse large B-cell non-Hodgkin lymphoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Diffuse large B-cell non-Hodgkin lymphoma: Both

Diffuse large B-cell non-Hodgkin lymphoma: Male

Diffuse large B-cell non-Hodgkin lymphoma, total, male: Map

Diffuse large B-cell non-Hodgkin lymphoma: Female

Diffuse large B-cell non-Hodgkin lymphoma, total, female: Map

Diffuse large B-cell non-Hodgkin lymphoma: Both

Diffuse large B-cell non-Hodgkin lymphoma: Maps

Mediastinal large B-cell non-Hodgkin lymphoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Mediastinal large B-cell non-Hodgkin lymphoma: Both

Mediastinal large B-cell non-Hodgkin lymphoma: Male

Mediastinal large B-cell non-Hodgkin lymphoma: Female

Mediastinal large B-cell non-Hodgkin lymphoma: Both

Mantle cell non-Hodgkin lymphoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Mantle cell non-Hodgkin lymphoma: Both

Mantle cell non-Hodgkin lymphoma: Male

Mantle cell non-Hodgkin lymphoma: Female

Mantle cell non-Hodgkin lymphoma: Both

Mantle cell non-Hodgkin lymphoma: Maps (cases were too few for Maps 1, 2, 3, and 5)

Small cell non-Hodgkin lymphoma/chronic lymphocytic leukemia

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Small cell non-Hodgkin lymphoma/chronic lymphocytic leukemia: Both

Small cell non-Hodgkin lymphoma/chronic lymphocytic leukemia: Male

Small cell non-Hodgkin lymphoma/chronic lymphocytic leukemia: Female

Small cell non-Hodgkin lymphoma/chronic lymphocytic leukemia: Both

Small cell non-Hodgkin lymphoma/chronic lymphocytic leukemia: Maps (cases were too few for Maps 1 and 5)

Burkitt non-Hodgkin lymphoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Burkitt non-Hodgkin lymphoma: Both

Burkitt non-Hodgkin lymphoma: Male

Burkitt non-Hodgkin lymphoma: Female

Burkitt non-Hodgkin lymphoma: Both

Burkitt non-Hodgkin lymphoma: Maps (cases were too few for Maps 1, 2, and 5)

Marginal zone extra-nodal non-Hodgkin lymphoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Marginal zone extra-nodal non-Hodgkin lymphoma: Both

Marginal zone extra-nodal non-Hodgkin lymphoma: Male

Marginal zone extra-nodal non-Hodgkin lymphoma: Female

Marginal zone extra-nodal non-Hodgkin lymphoma: Both

Marginal zone extra-nodal non-Hodgkin lymphoma: Maps (cases were too few for Maps 1 and 5. This cancer was not included in the first edition. Hence Map 4 is not included.)

NK-cell non-Hodgkin lymphoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

NK-cell non-Hodgkin lymphoma: Both

NK-cell non-Hodgkin lymphoma: Male

NK-cell non-Hodgkin lymphoma: Female

NK-cell non-Hodgkin lymphoma: Both

T-cell non-Hodgkin lymphoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

T-cell non-Hodgkin lymphoma: Both

T-cell non-Hodgkin lymphoma: Male

T-cell non-Hodgkin lymphoma: Female

T-cell non-Hodgkin lymphoma: Both

T-cell non-Hodgkin lymphoma: Maps (cases were too few for Maps 1 and 5)

Cutaneous T-cell malignancies

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Cutaneous T-cell malignancies: Both

Cutaneous T-cell malignancies: Male

Cutaneous T-cell malignancies: Female

Cutaneous T-cell malignancies: Both

Cutaneous T-cell malignancies: Maps (cases were too few for Maps 1, 2, 3, and 5)

Central nervous system non-Hodgkin lymphoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Central nervous system non-Hodgkin lymphoma: Both

Central nervous system non-Hodgkin lymphoma: Male

Central nervous system non-Hodgkin lymphoma: Female

Central nervous system non-Hodgkin lymphoma: Both

Central nervous system non-Hodgkin lymphoma: Maps (cases were too few for Maps 1, 2, and 5)

Stomach non-Hodgkin lymphoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Stomach non-Hodgkin lymphoma: Both

Stomach non-Hodgkin lymphoma: Male

Stomach non-Hodgkin lymphoma: Female

Stomach non-Hodgkin lymphoma: Both

Stomach non-Hodgkin lymphoma: Maps (cases were too few for Maps 1, 2, and 5)

Other gastrointestinal non-Hodgkin lymphoma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Other gastrointestinal non-Hodgkin lymphoma: Both

Other gastrointestinal non-Hodgkin lymphoma: Male

Other gastrointestinal non-Hodgkin lymphoma: Female

Other gastrointestinal non-Hodgkin lymphoma: Both

Other gastrointestinal non-Hodgkin lymphoma: Maps (cases were too few for Maps 1, 2, and 5)

Childhood non-Hodgkin lymphoma, total

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Childhood non-Hodgkin lymphoma, total: Both

Childhood non-Hodgkin lymphoma, total: Male

Childhood non-Hodgkin lymphoma, total: Female

Childhood non-Hodgkin lymphoma, total: Both

Childhood non-Hodgkin lymphoma, total: Maps (cases were too few for Maps 1, 2, 4, and 5)

Non-Hodgkin lymphoma, total

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Non-Hodgkin lymphoma, total: Both

Non-Hodgkin lymphoma, total: Male

Non-Hodgkin lymphoma, total, male: Map

Non-Hodgkin lymphoma, total: Female

Non-Hodgkin lymphoma, total, female: Map

Non-Hodgkin lymphoma, total: Both

Non-Hodgkin lymphoma, total: Maps

Myeloproliferative and myelodysplastic malignancies

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Myeloproliferative and myelodysplastic malignancies: Both

Myeloproliferative and myelodysplastic malignancies: Male

Myeloproliferative and myelodysplastic malignancies: Female

Myeloproliferative and myelodysplastic malignancies: Both

Waldenstrom’s macroglobulinemia

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Waldenstrom’s macroglobulinemia: Both

Waldenstrom’s macroglobulinemia: Male

Waldenstrom’s macroglobulinemia: Female

Waldenstrom’s macroglobulinemia: Both

Multiple myeloma

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Multiple myeloma: Both

Multiple myeloma: Male

Multiple myeloma, total, male: Map

Multiple myeloma: Female

Multiple myeloma, total, female: Map

Multiple myeloma: Both

Multiple myeloma: Maps

Acute lymphoblastic leukemia, childhood

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Acute lymphoblastic leukemia, childhood: Both

Acute lymphoblastic leukemia, childhood: Male

Acute lymphoblastic leukemia, childhood: Female

Acute lymphoblastic leukemia, childhood: Both

Acute lymphoblastic leukemia, total

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Acute lymphoblastic leukemia, total: Both

Acute lymphoblastic leukemia, total, male: Map

Acute lymphoblastic leukemia, total, female: Map

Acute lymphoblastic leukemia, total: Female

Acute lymphoblastic leukemia, total: Female total Map

Acute lymphoblastic leukemia, total: Both

Acute lymphoblastic leukemia, total: Maps (cases were too few for Map 2. Leukemia does not spread like solid cancers. Hence Map 5 is not included.)

Hairy cell leukemia

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Hairy cell leukemia: Both

Hairy cell leukemia: Male

Hairy cell leukemia: Female

Hairy cell leukemia: Both

Hairy cell leukemia: Maps (cases were too few for Maps 1 and 2. Leukemia does not spread like solid cancers. Hence Map 5 is not included.)

Acute myeloid leukemia

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Acute myeloid leukemia: Both

Acute myeloid leukemia: Male

Acute myeloid leukemia, total, male: Map

Acute myeloid leukemia: Female

Acute myeloid leukemia, total, female: Map

Acute myeloid leukemia: Both

Acute myeloid leukemia: Maps (Leukemia does not spread like solid cancers. Hence Map 5 is not included.)

Chronic myelocytic leukemia

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

Chronic myelocytic leukemia: Both

Chronic myelocytic leukemia: Male

Chronic myelocytic leukemia: Female

Chronic myelocytic leukemia: Both

Chronic myelocytic leukemia: Maps (cases were too few for Maps 1 and 2. Leukemia does not spread like solid cancers. Hence Map 5 is not included.)

T-cell leukemia

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

T-cell leukemia: Both

T-cell leukemia: Male

T-cell leukemia: Female

T-cell leukemia: Both

All malignancies of infants and toddlers

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

All malignancies of infants and toddlers: Both

All malignancies of infants and toddlers: Male

All malignancies of infants and toddlers, total, male: Map

All malignancies of infants and toddlers: Female

All malignancies of infants and toddlers, total, female: Map

All malignancies of infants and toddlers: Both

All malignancies of infants and toddlers: Maps (cases were too few for Maps 2 and 3; however that was not so previously, as seen in Map 4)

All malignancies of older children

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

All malignancies of older children: Both

All malignancies of older children: Male

All malignancies of older children, total, male: Map

All malignancies of older children: Female

All malignancies of older children, total, female: Map

All malignancies of older children: Both

All malignancies of older children: Maps

All malignancies of adolescents and young adults

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

All malignancies of adolescents and young adults: Both

All malignancies of adolescents and young adults: Male

All malignancies of adolescents and young adults, total, male: Map

All malignancies of adolescents and young adults: Female

All malignancies of adolescents and young adults, total, female: Map

All malignancies of adolescents and young adults: Both

All malignancies of adolescents and young adults: Maps

All malignancies of middle age

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

All malignancies of middle age: Both

All malignancies of middle age: Male

All malignancies of middle age, total, male: Map

All malignancies of middle age: Female

All malignancies of middle age, total, female: Map

All malignancies of middle age: Both

All malignancies of middle age: Maps (Middle-age was not separately described in the first edition. Hence Map 4 is not included.)

All malignancies of the aged

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

All malignancies of the aged: Both

All malignancies of the aged: Male

All malignancies of the aged, total, male: Map

All malignancies of the aged: Female

All malignancies of the aged, total, female: Map

All malignancies of the aged: Both

All malignancies of the aged: Maps

All malignancies

Background

Local pattern

Stage at diagnosis

Thumbnail interpretation

All malignancies: Both

All malignancies: Male

All malignancies, total, male: Map

All malignancies: Female

All malignancies, total, female: Map

All malignancies: Both

All malignancies: Maps

References

Index

Copyright

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Dedication

To Brian MacMahon, who taught us how to seek new truths, and

To Alex Langmuir, who taught us how to use the old ones.

Foreword

The comparison of disease rates or risk of individuals living in different areas—geographical pathology as it was originally referred to—remains a highly insightful tool in descriptive epidemiology; by visually mapping cancer incidence rates by place of residence we can assess not only the risk of developing cancer in a particular area, but also gauge whether there are geographical differences by comparing the patterns across different maps. This is of particular value when used to generate possible causative hypotheses and may serve to alert health planners of the need for action where specific geographic incongruences are identified.

In Cancers in the Urban Environment, Prof. Tom Mack manages to bridge the science and the art of mapping cancer risk in resident populations, delivering a contemporary investigation of variations in the age-adjusted incidence rates of over 100 different malignancies occurring in Los Angeles County, one of the largest in the United States. The book is a rich demonstration of the power of descriptive epidemiology as the essential tool of the community-orientated health specialist. It provides a detailed assessment of the cancer profiles among the 10 million inhabitants of the county today, shedding light on where higher rates and disparities are likely present by race, social class, time at diagnosis, sex, and age. From this viewpoint, the book provides not only insights into observed disparities—for example, in risk of developing cancer, in stage at diagnosis—but also serves as a call for tangible actions aimed to narrow the inequity gap such as through targeted prevention measures, through better access to care.

The first edition, published in 2004, portrayed the geographic and temporal differences in the incidence across 84 cancer types in Los Angeles County over the period 1972–98, based on the high-quality cancer data collected on residents by the cancer registry, the Cancer Surveillance Program (CSP). As well as describing the demographic and lifestyle-environmental risk factors associated with each malignancy, local geographic patterns of occurrence of each malignancy by residential areas were explored based on the census tract. Maps were carefully designed to identify those neighborhoods with rates that exceed both a standard level of relative risk and a standard threshold of significant risk. If neither chance, nor bias, nor an obvious confounder was plausible explanations for an observed local excess of cancer, an account outlining possible contributing factors, set against alternatives, was provided. As an explanatory guide to local cancer patterns, the book was rightly lauded for a presentation and writing style that was not only clear and concise, but also accessible to nonspecialists, including dedicated chapters on the interpretation of small area statistics.

This second edition continues where the first left off, providing a meticulous pictorial assessment of cancer risk over the subsequent two decades, from 1999 to 2014. The geographic variations observed across exhaustive 104 cancers are presented together with an account of the probable explanations, based on present knowledge. As with the previous edition, patterns are investigated by ethnicity, neighborhood, and social class as a means to explore and draw attention to the diverse risks and disparities apparent within the boundaries of one of the largest states in the United States. Among the many novel additions to this edition is the quantification of the proportion of cases in a given neighborhood diagnosed at stages too advanced to allow curative treatment, drawing attention to the inadequacies of the present system of medical care. Perhaps what makes this book truly exceptional, however, are the initial chapters that provide an informative context for the interpretation of the visual mapping that follows. These are highly accessible to laypersons and professionals, outlining the rationale for this book, as well as providing succinct summaries of the biology of cancer, and the genetic and environmental causes of the disease.

As Prof. Mack notes in the introductory sections, small area statistics have indeed been somewhat neglected in recent times. Cancers in the Urban Environment may then be considered a major accomplishment in the rejuvenation of a form of descriptive study that has been in existence for well over a century. The discoveries within this second edition should ensure it will appeal to a broad range of readers, regardless of speciality or expertise. It is a state-of-the-art reference work on cancer and the consequences of the urban environment in the 21st century.

Freddie Bray

Section Head, Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France

Preface

This book is designed to meet three separate needs. One is the need to demystify cancer for laypersons. Cancer occurrence is not a mystery, it is just one of the predictable setbacks in human (and nonhuman) existence. Accidents are predictable because we are clumsy and the physical environment is unyielding. Organ failure is predictable because tissue imperfections accumulate over time. Infections are predictable because other species successfully compete with us in the evolutionary struggle. Cancers are predictable because millions of cells cannot replicate through decades without error, especially in the face of environmental challenge. We know cancers regularly will occur. We have counted them and recognize that most of us will get at least one.

The second need is for a field guide to the diversity of cancers. Even scientists have never had a source that describes the disparate patterns of occurrence of the many different forms of cancer based on extensive experience. We provide more information about more kinds, causes, and patterns of cancer, of interest to scientists as well as laypersons, than has ever been available in any single place. We provide the record of each of 104 categories of cancer as found in a complex urban environment, together with any currently understood universal or local reason for the pattern. Each record is comprised of information about age, gender, race/ethnicity, calendar trend, neighborhood, social class, and stage at diagnosis. Because these patterns derive from basic biology, including human behavior, these descriptive patterns are likely to be universal, varying only in magnitude as they appear in other locations.

But the third need pertains only to citizens of the United States. Because our information comes from every case in a defined American population, and because the clinical stage of every cancer at the time of diagnosis is available, we can quantify the timeliness with which each case, according to social class or race–ethnicity, first made contact with a medical provider. The proportion of cases only seen at a stage too late for effective treatment allows us to quantify the overall failures and the specific disparities inherent in the American system of medical care.

Los Angeles County is an ideal setting to describe the occurrence and impact of any medical condition. The population is large, roughly that of Sweden. Medical care and medical records are of high quality. The county is complex both ethnically and economically. European-Americans are outnumbered by the combined African-American, Hispanic, and Asian-American subpopulations, and the GDP, where the county to be an independent country, would exceed that of 90% of the world’s nations, just ahead of Saudi Arabia, Switzerland, and Sweden. Although much of the geographic detail found here may be of special interest to Los Angeles residents, the real subjects of this book are the cancers, and how they impact a complex human population.

It should be said up front that we can be far more certain about these profiles than about the actual determinants. Even based on accumulated research, we can satisfactorily explain only a small proportion of the vast number of systematic and nonrandom variations in occurrence. However, it will become clear to the reader that while the affluent bears slightly more of the burden of cancer occurrence, often for reasons as yet unclear, under our current system of medical care, those in the lowest socioeconomic stratum, with the least education and the fewest resources, more often pay the ultimate price of a cancer.

Before providing these details, we have included a series of optional initial chapters in order to give a context for interpretation. Chapter 1, Introduction for Laypersons, and Chapter 2, Introduction for Professionals, introduce the book in more detail for the purposes of laypersons and professionals respectively. Chapter 3, What a Cancer Is?, and Chapter 4, How and Why Cancers Differ?, summarize the biology of cancers and their diversity. Chapter 5, How a Cancer Can Be Caused by a Carcinogenic Toxin?, and Chapter 7, When Carcinogens Are Not (Very) Hazardous?, discuss the nongenetic environmental determinants and Chapter 8, How a Cancer Can Be Caused by an Inherited Gene?, and Chapter 9, Recognizing Risky Genes, the genetic underpinnings of cancer occurrence. Chapters 10–13 explain the technical infrastructure needed to gather, construct, and describe the patterns of occurrence. Chapter 14, Cancers Spread: Delays Matter, describes how cancers progress, and Chapters 15–18 summarize the methods used to investigate causal explanations. Chapter 19, Addressing Cancer Clusters, and Chapter 20, Beyond These Data, address the specific concerns that laypersons often have and Chapter 21, Interpretation of Cancer-Specific Figures and Maps, and Chapter 22, Summarizing the Information, Cancer by Cancer, prepare the reader for the interpretation of the figures and maps that describe the occurrence of each kind of cancer.

The first-person plural is routine in these chapters because every part of the book is the result of a team effort, although the principal author takes the sole responsibility for the final accuracy, the interpretations, and the clarity of presentation.

Chapter 1

Introduction for laypersons

Abstract

Why me? Why here? These questions follow every cancer diagnosis. We would like to think that a cancer is something that happens to someone else, to someone with a past habit or experience that should have led them to expect it. Other diseases—infections, heart attacks, strokes—are understandable intrusions in our lives that make sense. But there is no rational way to explain why in an otherwise healthy body, a single cell should suddenly grow out of control.

Keywords

Cancer; clinicians; laboratory scientist; Los Angeles; expert; epidemiologist

Why me? Why here? These questions follow every cancer diagnosis. We would like to think that a cancer is something that happens to someone else, to someone with a past habit or experience that should have led them to expect it. Other diseases—infections, heart attacks, strokes—are understandable intrusions in our lives that make sense. But there is no rational way to explain why in an otherwise healthy body, a single cell should suddenly grow out of control.

Rather than explain, we have tried to describe the biology of cancer in its different forms, give the basic facts about environmental causes and heritable susceptibility, show how we track cancer occurrence, describe scientific research into causality, and discuss concerns about local variations in cancer incidence. We also have provided an unprecedented level of detail about the patterns of 104 categories of cancer in the urban environment of Los Angeles County, representative of populations worldwide.

In reality, cancers are commonplace. Most of us will get at least one at some time in our lives. Even so, every diagnosis suggests an insidious, even mysterious, thing that is in our body, but not a part of it. Our sense of self and thus our self-confidence disappears. We wonder what in the world could have gone wrong. Have others been affected, or have I been singled out? We are concerned when cases occur among friends and family members. If, after a diagnosis, when we learn of other cases concern transforms into mystery, and sometimes suspicion. Neighbors and coworkers become fearful and seek explanations. While few pretend to know much about cancer, many do understand and are concerned about the dangers on chemicals and environmental pollutants, and most assume that while medical and environmental scientists can recognize and anticipate problems, concerns are rarely shared. When explanations and predictions are unavailable, fear is converted to frustration and anger.

Why are explanations usually unavailable? Doctors do know some of the causes of the common cancers, and sometimes even of the uncommon ones. There is often enough information to predict the general pattern of occurrence, but understanding is incomplete and questions about specific cases are rarely fully answerable. This partly is a people problem. Cancer experts come in three major flavors. Oncologists and other clinicians are experts in diagnosis and treatment. Laboratory scientists work to disentangle the basic mechanisms underlying the effects of carcinogens and genes. Epidemiologists and those primarily concerned with prevention look to identify dangers and protect those persons at risk on a population basis. Each of these three broad areas of expertise can be divided into many subspecialties, and the work of each specialist and subspecialist requires expertise that only partially overlaps that of other specialists. Accordingly, clinicians can rarely afford the time to become experts in the mechanics of causation or the subtleties of risk; laboratory scientists rarely can concern themselves with patterns of risk or the detailed pros and cons of therapy; preventive medicine specialists and epidemiologists usually must leave the details of mechanism and therapeutics to others. Whatever the specialty, however, sometimes every cancer expert is placed in a hot seat and forced to answer questions about both familiar and unfamiliar specifics.

Fortunately, human beings are more or less biologically identical from place to place, and while both genetic risks and environmental dangers vary, the variation is mostly in degree rather than in kind. In this book we try to make cancer less mysterious. We provide less complicated and generally more agreed-upon answers to questions about causation and especially about personal and community levels of risk. We will describe and explain the known causes and patterns of each kind of cancer as of the time of writing, how that information accumulates, and how we analyze and interpret the patterns of occurrence, using the neighborhoods of Los Angeles County as the blackboard. In the process, we will show how we use the available information to search for surprises (unexplained discrepancies) that might lead to new knowledge.

When concerns are raised by a diagnosis, they are then followed by concerns about the outcome. In general, when a cancer occurs, the earlier it is identified, the less it has already spread, and the more successful the treatment. In addition to the patterns of cancer occurrence, we will describe the magnitude and geographical patterns of late diagnosis, which mostly reflect the local ease of access to timely care. We hope that the identification