Age-specific incidence of cancer: Phases, transitions, and biological implications

Proc Natl Acad Sci U S A. 2008 Oct 21;105(42):16284-9. doi: 10.1073/pnas.0801151105. Epub 2008 Oct 20.

Abstract

The observation that the age-specific incidence curve of many carcinomas is approximately linear on a double logarithmic plot has led to much speculation regarding the number and nature of the critical events involved in carcinogenesis. By a consideration of colorectal and pancreatic cancers in the Surveillance Epidemiology and End Results (SEER) registry we show that the log-log model provides a poor description of the data, and that a much better description is provided by a multistage model that predicts two basic phases in the age-specific incidence curves, a first exponential phase until the age of approximately 60 followed by a linear phase after that age. These two phases in the incidence curve reflect two phases in the process of carcinogenesis. Paradoxically, the early-exponential phase reflects events between the formation (initiation) of premalignant clones in a tissue and the clinical detection of a malignant tumor, whereas the linear phase reflects events leading to initiated cells that give rise to premalignant lesions because of abrogated growth/differentiation control. This model is consistent with Knudson's idea that renewal tissue, such as the colon, is converted into growing tissue before malignant transformation. The linear phase of the age-specific incidence curve represents this conversion, which is the result of recessive inactivation of a gatekeeper gene, such as the APC gene in the colon and the CDKN2A gene in the pancreas.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Age Distribution
  • Biology
  • Female
  • Humans
  • Male
  • Neoplasms / epidemiology*
  • Neoplasms / pathology*
  • Sex Characteristics
  • Time Factors