A study observing whether the consumption of different diets from around the world can lea, High school final essays of Biology

Download A study observing whether the consumption of different diets from around the world can lea and more High school final essays Biology in PDF only on Docsity! To what extent do various diets from around the world affect the incidence of gastrointestinal cancers in the 45-64 years age group (middle age)? Research Question Subject Word Count Student Code 3965 hnx782 Title A study observing whether the consumption of different diets from around the world can lead to a higher incidence of gastrointestinal cancers. IBDP Biology CONTENTS 1. Introduction……………………………………………………………………[3 - 4] 2. Background………………………………………………………………….…[4 - 8] A. What is cancer ………………………………………………………………..……………[4] B. Characteristics of cancer…………………………………………………..………………[5] C. What causes cancer……………………………………………………..….………………[5] D. How is cancer treated……………………………………………….. ………………….…[6] E. Cell cycle of cancerous cells…………………………………….………………………….[6] F. Gastrointestinal cancers….…………………………………….…………………………..[7] G. Types of diets and brief summary of why they were chosen……………………….…….[7] 3. Hypothesis..………………………………………………….…….. ……….…….[8] 4. Methodology……………………………………………………………….…..[8 - 9] H. Sources…..………………………………………………………………………….……….[8] I. Brief summary of similar studies…..….. ………………………………….…………..….[9] 5. Raw Data……….……………….. …………………………….……………[10 - 12] J. Qualitative data: types and characteristics of chosen diets…………………………….[10] K. Figures for the incidence of GI cancers in the 45-64 age group for each diet…………[11] 6. Data Processing and Analysis………………….……………………….…..[13 - 17] L. Incidence of GI cancers for each diet………………………………………………….…[13] M. Ranking of diets based on their HIV’s and relative incidences of GI cancers….. ……[15] 7. Evaluation…………………………………………………………….. ……[17 - 19] 8. Conclusion……….……………………………………………………….………[19] 9. Bibliography………….……………………………………………..………[20 - 23] 10. Appendix…………….…………………………….…………………………[23 -26] N. Deriving HIV’s……..…………………………………………………………………[23 - 25] O. Tables…..………………………………………………………………..…………….[25 - 26] P. Acknowledgements…………………………………………………………………….. …[26] Page of 262 Characteristics of cancer Cancer occurs in 4 stages, depending on the development of the tumour (based on the Tumour, Node, Metastasis (TNM) system) (Cancer Research UK 12). A primary tumour is a tumour in the organ of origin whereas a secondary tumour has metastasised and spread to other parts of the body. The 4 stages of cancer are classified depending on how far the tumour has metastasised from the organ/ tissue of origin, and how aggressive it is (MayoClinic 10). What causes cancer? Mutagens are factors that have the ability to cause cancer. They are broken up into 3 main and one minor group: - Radiation: UV rays/ X-rays that can cause mutations when cells are exposed to them over long periods of time. - Carcinogens: these are cancer-causing chemicals such as asbestos and arsenic. - Environmental factors: this includes substances that people are involuntarily exposed to, such as second-hand cigarette smoke, pollutants etc. It can also include lifestyle choices such as reduced physical activity and an unhealthy diet. - Some viruses such as HIV/ HPV (MayoClinic 15). Cancer can be caused in two ways: 1. Mutation of the tumour suppressor gene: these are genes that are responsible for the controlling, monitoring and repair of cells. Tumour suppressor genes are recessive mutations, i.e. only one copy of the gene needs to be mutated in order to encourage cancerous growth (ASCO 16). Tumour suppressor genes include DNA repair genes that correct mistakes occurring during DNA replication. Page of 265 2. Mutation of an oncogene: these are genes that help a cell grow, divide or stay alive. Most oncogenes are dominant mutations where both copies of the gene in a cell need to be mutated in order to make the cell cancerous (ASCO 19). There are different types of genetic mutations that can lead to the development of cancer. - Acquired mutations: These are mutations that are caused during a person’s life based on environment factors, lifestyle choices, radiation, carcinogens etc. Cancers that arise from such mutations are called sporadic cancers (ASCO 9). Cancers triggered by these kind of mutations are the main focus of this essay. - Germ-line mutations: these are “mutations that occur in the sperm / egg cells” (ASCO 11) and can be passed down generations. Cancers that arise from such mutations are called inherited cancers (ASCO 11). How is cancer treated? Common treatment methods include Chemotherapy and Radiation therapy. The doses and cycles are dependent on the type and stage of the cancer but also the details of the cancer patient to whom the drugs are being administered (such as gender, age etc.) (Cancer Research UK 12). Cell cycles of cancerous cells A normal cell cycle goes through 5 stages; Interphase, Prophase, Metaphase, Anaphase and Telophase. However, in cancerous cells, due to mutations, the distortion of the cells cycle means that the normal cell cycle is disrupted. Cells begin to multiply without any control whatsoever, and this trait is called “replicative immortality” i.e they divide many more times than normal cells (divide 40-60 times) before they die (Khan Academy 9). Page of 266 As figure 1 shows, normal cells with a mutation will immediately carry out apoptosis, however, cancer cells are unable to do so. (Figure 1; Khan Academy) Gastrointestinal cancers GI cancers are cancers whose primary tumours originate from organs in the digestive system. They include cancers of the oesophagus, liver, pancreas, stomach, colon, rectum, anus etc. (“GI Cancers explained” 2). GI cancers are the most common forms of cancer. “In 2018, it was estimated that 13,809 people would die from gastro-intestinal cancers — more than twice the estimated combined total for breast and prostate cancers” (“GI Cancers explained” 3). Types of diets and brief summary of why they were chosen Type of diet/ origin On what basis this diet was chosen Japanese The Japanese diet is considered by many to be a very healthy and balanced diet. Japan is also famous for having the most number of living centenarians, and this phenomenon has often been attributed to their healthful diet. German The German diet is known for its high processed meat consumption, along with high intake of alcohol, carbohydrates and cheeses. It is assumed that this country might provide some truly insightful data regarding the link between red meat consumption and colorectal cancer, specifically. Germany is also the world’s biggest consumer of processed meat products (Severin & Hogan 2). Greek Due to the balance of nutrients, the simplicity of the food and health benefits of commonly used ingredients, the Greek/ Mediterranean diet has a reputation for being the healthiest diet to consume. Nigerian Nigerians are known to eat spicy, oily, and very complex foods. Nigeria is also the most populated country in Africa so it would provide a good spread of data in order to uncover a discernible link between the two variables. Page of 267 Raw Data Qualitative data: types and characteristics of chosen diets According to Drescher, Thiele and Mensink, the right composition of food groups in a balanced diet is as illustrated in figure 2. This ratio will be used as a reference point to compare the other diets, and then rate them based on how much they deviate from the established “golden ratio”. Figure 2 (Drescher et al.) Thus, the ratio of food groups in a balanced diet is 30:43:18:7:2 = grains & carbs : fruits & vegetables : dairy : meat & poultry : fats & oils Based on this ratio as a point of reference, the “health index values” (HIV) will be established below. The HIV is derived by comparing the ratios of each of the components of the studied diets, with the “golden ratio”. The % error for each food group is then calculated in order to represent the relative deviation from the optimal value. Finally, these errors are averaged across the 5 food groups to obtain the HIV for each diet . The smaller the value, the more balanced the diet is. 1 Similarly, a higher HIV indicates that the diet is disproportionate, and thus, not very healthy. Diet Characteristics of this diet Japanese (“What is the Japanese” 8) HIV = 21.1 • “[…] whole-foods-based diet rich in fish, seafood, and plant-based foods” • “ […] minimal amounts of animal protein, added sugars, and fat” • diet helps with digestion and weight control. High fibre content also promotes good gut health • ample amounts of seaweed/green tea are consumed - contain powerful antioxidants and are believed to protect against cellular damage and disease - The numerical workings can be found under the “Deriving HIV’s” section in the Appendix. 1 Page of 2610 Figures for the incidence of GI cancers in the 45-64 age group for each diet 1.The Greek diet Population of people aged 45-64 (“World Population Prospects”): (“Cancer Today”) Of the total population, 0.220% have GI cancers, in the 45-65 age group, across both sexes . 2 Greece (Shwingshackl 7) HIV = 22.8 • “A high consumption of plant-based foods, especially whole grain products, vegetables, fruits, nuts, and legumes” • “[…] regular intake of fish and seafood” • “Eggs, red and processed meat as well as high-fat dairy products are consumed in low amounts” German (Heuer et al. 1606) HIV = 26.1 • low intake of plant-based foods, especially vegetables • high consumption of red meat and other meat products • abundant consumption of white bread, cheese, fish and pickled meats According to the National Nutritional Survey, men consumed higher quantities of high-carbonated foods. They also consumed twice as much meat than women. Women, on the other hand, consumed more raw vegetables, especially in the 35-64 age group. Nigerian (Onimawo 9) HIV = 108.9 • high consumption of starchy roots, tubers and locally grown vegetables native to the country • vegetables are commonly consumed but fruits/dairy products are consumed in moderation • “Condiments and spices are also quite abundantly used in Nigerian cooking […]” • “In terms of meat, game meat (such as rabbit and antelope), poultry, fish and insects are also consumed” American (McCoy 4) HIV = 131.1 • commonly known as the ‘Standard American Diet’- represents the excessive consumption of fast foods and other ultra-processed foods • fruits and vegetables are consumed in meagre amounts • sugar, and hydrogenated oils are major components in fast/junk foods thus consumed way beyond dietary guidelines • processed foods make up 63% of calories in the Standard American Diet Total (approx..) 1,564,567 Incidence of GI cancers Male 777,825 2,150 (≈ 19.2% are GI) Female 786,743 1,292 (≈ 13.8% are GI) - a breakdown of the figures for each of the GI cancers for every diet can be found in Tables i - v.2 Page of 2611 2. The Japanese diet Population of people aged 45-64 (“Monthly Report”): (“Cancer Today”) Of the total population, 0.198% have GI cancers in the 45-65 age group, across both sexes. 3. The Nigerian diet Population of people aged 45-64 (“World Population Prospects”): (“Cancer Today”) Of the total population, 0.035% have GI cancers, in the 45-65 age group, across both sexes. 4. The German diet Population of people aged 45-64 (“World Population Prospects”): (“Cancer Today”) Of the total population, 0.119% have GI cancers, in the 45-65 age group, across both sexes. 5. The American Diet Population of people aged 45-64 (“World Population Prospects”): (“Cancer Today”) Of the total population, 0.125% have GI cancers, in the 45-65 age group, across both sexes. Total (approx.) 33,550,000 Incidence of GI cancers Male 16,810,000 44,296 (≈ 47.6% are GI) Female 16,750,000 22,087(≈ 25.6% are GI) Total (approx.) 20,344,500 Incidence of GI cancers Male 10,041,500 3,969 (≈ 24.1% are GI) Female 10,303,000 3,061 (≈ 9.36% are GI) Total (approx.) 24,616,000 Incidence of GI cancers Male 12,297,000 18,537 (≈ 20.7% are GI) Female 12,319,000 10,647 (≈ 12.3% are GI) Total (approx.) 83,169,000 Incidence of GI cancers Male 41,177,500 65,424 (≈ 18.7% are GI) Female 41,991,500 38,414 (≈ 11.8% are GI) Page of 2612 Ranking of diets based on their HIV’s and relative incidences of GI cancers Based on each of the diets and how they scored according to their HIV’s, the diets can be ranked in the order shown below: It is mildly surprising that the German diet is healthier than the Nigerian diet. However, when looking at figures, this makes sense as Nigerians have a disproportionately high consumption of fats and carbohydrates, while their daily average intake of fruits and vegetables is very low. Germany on the other hand, had quite a low consumption of carbohydrates and red meats, but their intake of dairy, and fruits/vegetables is quite high. Japan coming first also makes sense, especially when taking into account the significant number of centenarians this country produces. The diets that have an occurrence of the lowest incidences of GI cancers are the Greek and Nigerian diets, as demonstrated by the scale above. The Japanese diet surprisingly has a high incidence of GI cancers, which could be attributed to high sodium, HCA and tobacco intake (Nagao & Tsugane 8). 3 Germany’s ranking is also unexpected, but this could be explained by the fact that the more elderly population of Germans tend to consume larger amounts of fruits and vegetables, compared to the rest of the population (Heuer et al. 1606). The American ranking is expected, as established in the explanations above. - other non-diet related explanations are elaborated upon in the Evaluation.3 Page of 2615 Looking at both the rankings together, a strong correlation is not visible, however, there is definitely a weak positive correlation between the healthiness of a diet and the incidence of GI cancers, as seen on the graph below. Graph 3: The total incidences of GI cancers vs. HIV’s of the diets The coloured points refer to the diets that correspond with those colours. Greece, Japan and Germany are all situated below the trend-line, and closer to the “golden ratio”, whereas Nigeria and America are higher up, and further away from the trend. Therefore, in terms of the hypotheses, the credibility of the alternate and the null hypothesis can be evaluated as follows: Null hypothesis: Diet does not have any effect on the carcinogenesis of GI cancers, and their causes can be attributed to other non-diet related determinants. Alternate hypothesis: The incidence of cancers will follow the rankings of the diets based on their individual healthfulness quotient. As shown on Graph 3, there is a very weak positive correlation between the HIV and the incidence of GI cancers. This means that both the hypotheses cannot be fully discarded or accepted. Page of 2616 Therefore, it is safe to say that diet does influence the incidence of GI cancers, albeit only to a very small extent. Evaluation There are many shortcomings with this research that affect the credibility of the established links between diet and GI cancers: • Not all the people within the age group consume these typical diets. Diets may vary according to region, socioeconomic status, religion, personal preferences etc. The amount of food consumed varies from person to person, which might mean that people who tend to consume more food, are exposed to these certain carcinogenic substances for a prolonged period of time, compared to a person of the same age who eats less (“Comparing more and” 4). • The quality of the diet may depend on where the produce/ingredients are sourced. Commercially produced food, carried out on a larger scale may also employ the use of pesticides and insecticides, thus contaminating the crops with potentially carcinogenic chemicals; as opposed to organic products. • Most of these cancers have already been linked to excessive consumption of alcohol and tobacco and other prominent lifestyle factors such as poor health, amount and level of exercise etc. Genetic determinants such as mutations in the BRCA1/2 genes (for breast cancer) or the CHD1 (for stomach cancer) are significant etiological factors (“What is stomach” 8). Therefore, their effect cannot be measured, making it challenging to establish a link solely based on diet. • Over the years, there have been an increasing number of mutagenic substances that people are exposed to on a daily basis, which can also contribute to their carcinogenesis. This includes factors such as arsenic/ mercury in water supplies, Page of 2617 Bibliography ASCO. American Society of Clinical Oncology. Accessed 24 September 2019 <https://www.cancer.net/navigating-cancer-care/cancer-basics/genetics/genetics-cancer>. Bach-Faig, Anna, et al. “Mediterranean Diet Pyramid Today. Science and Cultural Updates: Public Health Nutrition.” Cambridge Core, Public Health Nutrition; Cambridge University Press, 13 Dec. 2011, Accessed 1 October 2019 <www.cambridge.org/core/ journals/public-health-nutrition/article/mediterranean-diet-pyramid-today-science-and-cultural- updates/70359644D12A038AC003B935AA04E120>. Dangoor Education. Cancer Research UK. Cancer Research UK. Accessed 22 August 2019 <https://www.cancerresearchuk.org/about-cancer/what-is-cancer/stages-of-cancer>. Drescher, Larissa S, et al. “New Index to Measure Healthy Food Diversity Better Reflects a Healthy Diet Than Traditional Measures.” OUP Academic, The Journal of Nutrition; Oxford University Press, 1 Mar. 2007, Accessed 25 October 2019 <academic.oup.com/jn/article/ 137/3/647/4664681>. GBD 2017 Diet Collaborators. “Health Effects of Dietary Risks in 195 Countries, 1990–2017: a Systematic Analysis for the Global Burden of Disease Study 2017.” The Lancet, 3 Apr. 2019, Accessed 24 October 2019 <http://dx.doi.org/10.1016/S0140-6736(19)30041-8>. GI Cancer. GI Cancers Explained. Accessed 18 September 2019 <https://gicancer.org.au/gi-cancer-explained/>. Heuer, Thorsten, et al. “Food Consumption of Adults in Germany: Results of the German National Nutrition Survey II Based on Diet History Interviews.” British Journal of Nutrition , vol. 113, 13 Apr. 2015, pp. 103–1614., Accessed 25 October 2019 <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462161/>. Khan Academy. Cancer and the Cell Cycle . Accessed 29 March 2019 <https://www.khanacademy.org/science/biology/cellular-molecular-biology/stem-cells-and- cancer/a/cancer>. Kim, Hae-In, et al. “Sex Differences in Cancer: Epidemiology, Genetics and Therapy.” Biomolecules & Therapeutics, The Korean Society of Applied Pharmacology, 1 July 2018, Accessed 23 October 2019 <www.ncbi.nlm.nih.gov/pmc/articles/PMC6029678/>. Matsumura , Yasuhiro. “Nutrition Trends in Japan.” Asia Pacific Journal of Clinical Nutrition , Asia Pacific Journal of Clinical Nutrition , 2001, Accessed 19 October 2019 <http://apjcn.nhri.org.tw/server./APJCN/10 Suppl/S40.pdf>. MayoClinic. MayoClinic. Mayo Foundation for Medical Education and Research. Accessed 20 August 2019 <https://www.mayoclinic.org/diseases-conditions/cancer/symptoms-causes/ syc-20370588>. Page of 2620 McCoy, Kathleen. “9 Charts That Show the Standard American Diet.” Dr. Axe, Dr. Axe , 13 June 2017, Accessed 15 October 2019 <https://draxe.com/health/weight-loss/charts-american- diet/>. Nagao, Minako, and Shoichiro Tsugane. “Cancer in Japan: Prevalence, Prevention and the Role of Heterocyclic Amines in Human Carcinogenesis.” Genes and Environment : the Official Journal of the Japanese Environmental Mutagen Society, BioMed Central, 1 July 2016, Accessed 23 October 2019 <www.ncbi.nlm.nih.gov/pmc/articles/PMC4929724/>. Olson , Richard, et al. “Chapter 2 Shifts Needed To Align With Healthy Eating Patterns.” A Closer Look at Current Intakes and Recommended Shifts - 2015-2020 Dietary Guidelines, U.S. Department of Health and Human Services, U.S. Department of Agriculture, 2014, Accessed 20 October 2019 <health.gov/dietaryguidelines/2015/guidelines/chapter-2/a-closer-look-at- current-intakes-and-recommended-shifts/#callout-nutrient-dense>. Onimawo , Ignatius. NIGERIAN TRADITIONAL FOOD NIGERIAN TRADITIONAL FOOD SYSTEM AND NUTRITION SYSTEM AND NUTRITION SECURITY SECURITY. International Scientific Symposium, 4 Nov. 2010, Accessed 13 October 2019 <http://www.fao.org/ag/humannutrition/25375-02fe454548959127d5a0ea3af260d945e.pdf>. Ritchie, Hannah, and Max Roser. “Gender Ratio.” Our World in Data, University of Oxford, Global Change Data Lab, 13 June 2019, Accessed 24 September 2019 <https://ourworldindata.org/ gender-ratio>. Robbins, Carolyn. A typical Japanese Diet. Accessed 29 March 2019 <https://www.livestrong.com/article/264082-a-typical-japanese-diet/>. Schwingshackl, Lukas, et al. “Adherence to Mediterranean Diet and Risk of Cancer: An Updated Systematic Review and Meta-Analysis.” Nutrients, MDPI, 26 Sept. 2017, Accessed 12 October 2019 <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5691680/#B7- nutrients-09-01063>. Severin, Thorsten, and Michael Hogan . “Germany's Answer to WHO Study: Don't Be Scared of Sausages.” Reuters, Thomson Reuters, 27 Oct. 2015, Accessed 12 October 2019 <https://www.reuters.com/article/us-health-meat-germany/germanys-answer-to-who-study- dont-be-scared-of-sausages-idUSKCN0SL28D20151027>. The Cell Cycle. Accessed 24 September 2019 <https://courses.lumenlearning.com/suny-biology1/ chapter/the-cell-cycle/>. Trafton, Anne. “Study Explains Why Men Are at Higher Risk for Stomach Cancer.” MIT News, Massachusetts Institute of Technology, 13 July 2011, Accessed 17 October 2019 <news.mit.edu/2011/gastric-cancer-0713>. “Cancer Today.” Global Cancer Observatory, GLOBOCAN 2018, IARC WHO, 2018, Accessed 27 September 2019 <http://gco.iarc.fr/today/online-analysis- tablev=2018&mode=cancer&mode_population=continents&population=900&populations=935_39 2&key=asr&sex=2&cancer=39&type=0&statistic=5&prevalence=0&population_group=0&ages_gr Page of 2621 oup[]=12&nb_items=5&group_cancer=1&include_nmsc=0&include_nmsc_other=1#collapse- group-0-3>. “Chapter 7 - Food, Nutrients and Diets.” Agriculture Food and Nutrition for Africa - A Resource Book for Teachers of Agriculture, Accessed 20 October 2019 <www.fao.org/3/w0078e/ w0078e08.htm>. “Comparing More and Less Developed Countries.” World Cancer Research Fund, World Cancer Research Fund/ American Institute for Cancer Research, 12 Sept. 2018, Accessed 11 October 2019 <www.wcrf.org/dietandcancer/cancer-trends/comparing-more-and-less- developed-countries>. “Human Development Index and It's Components.” Human Development Reports, United Nations Development Programme, Accessed 12 October 2019 <http://hdr.undp.org/en/composite/ HDI>. “Monthly Report.” Statistics Bureau of Japan , Statistics Bureau, Ministry of Internal Affairs and Communications, Accessed 24 September 2019 <https://www.stat.go.jp/english/data/jinsui/ tsuki/index.html>. “What Is the Japanese Diet Plan? All You Need to Know.” Healthline , Healthline Media, Accessed 12 October 2019 <https://www.healthline.com/nutrition/japanese- diet#bottom-line/>. “What Is Stomach Cancer?” No Stomach For Cancer, No Stomach For Cancer, Accessed 20 October 2019 <www.nostomachforcancer.org/about/stomach-cancer>. “World Population Prospects - Population Division.” United Nations, United Nations, Accessed 27 September 2019 <https://population.un.org/wpp/DataQuery/>. Yagi, Takashi. “A Perspective of Genes and Environment for the Development of Environmental Mutagen Research in Asia.” Genes and Environment : the Official Journal of the Japanese Environmental Mutagen Society, BioMed Central, 1 Oct. 2017, Accessed 31 October 2019 <www.ncbi.nlm.nih.gov/pmc/articles/PMC5623060/>. Page of 2622 GI cancer breakdown Table i - Incidence of GI cancers in Greece (2018) Table ii - Incidence of GI cancers in Greece (2018) Table iii - Incidence of GI cancers in Greece (2018) GI Cancers (Greece) Incidence in females (total cancers: 9,396) Incidence in males (total cancers: 11,198) Esophagus 10 78 Stomach 143 292 Colon + Rectum + Anus 824 1,096 Liver 105 283 Gallbladder etc. 39 58 Pancreas 171 343 Total 1,292 (≈ 13.8% are GI) 2,150 (≈ 19.2% are GI) GI Cancers (Japan) Incidence in females (total cancers: 86,369) Incidence in males (total cancers: 93,071) Esophagus 817 3,243 Stomach 5,617 12,572 Colon + Rectum + Anus 11,759 19,228 Liver 677 3,845 Gallbladder etc. 854 1,356 Pancreas 2,363 4,053 Total 22,087(≈ 25.6% are GI) 44,296 (≈ 47.6% are GI) GI Cancers (Nigeria) Incidence in females (total cancers: 32,710) Incidence in males (total cancers: 16,449) Esophagus 51 160 Stomach 395 641 Colon + Rectum + Anus 1,500 1,760 Liver 701 943 Gallbladder etc. 49 91 Pancreas 365 374 Total 3,061 (≈ 9.36% are GI) 3,969 (≈ 24.1% are GI) Page of 2625 Table iv - Incidence of GI cancers in Greece (2018) Table v - Incidence of GI cancers in Greece (2018) Acknowledgements I would like to thank both my biology teachers over the two years, Ms. Smit and Ms. Rose for their continued support and feedback. I would also like to thank my ToK teacher, Ms. Rimmington for providing valuable insights into what I could do with the statistics and how to analyse them, and lending me “Bad Science” by Ben Goldacre for inspiration. Finally, I would like to thank my mother for her everlasting support and care, and for her helpful editing skills. GI Cancers (Germany) Incidence in females (total cancers: 86,640) Incidence in males (total cancers: 89,585) Esophagus 532 2,274 Stomach 1,315 2,915 Colon + Rectum + Anus 6,000 8,641 Liver 590 1,803 Gallbladder etc. 344 492 Pancreas 1,866 2,412 Total 10,647 (≈ 12.3% are GI) 18,537 (≈ 20.7% are GI) GI Cancers (America) Incidence in females (total cancers: 324,396) Incidence in males (total cancers: 349,696) Esophagus 1,160 6,110 Stomach 2,528 5,242 Colon + Rectum + Anus 23,166 29,590 Liver 4,053 14,171 Gallbladder etc. 1,494 1,566 Pancreas 6,013 8,745 Total 38,414 (≈ 11.8% are GI) 65,424 (≈ 18.7% are GI) Page of 2626