National Cancer Institute monograph最新文献

Sera were collected in a high-risk area for stomach cancer in Colombia from 857 residents who had been gastroscoped. The levels of 6 micronutrients (retinol, beta-carotene, ascorbic acid, vitamin E, prealbumin, retinol-binding protein) were measured and the mean values correlated with the presence of gastric pathology thought to represent precursors of stomach cancer. Two micronutrients showed important variations in mean levels by gastric pathology: beta-carotene and vitamin E. Beta-carotene levels were low in patients with dysplasia, but no differences were detected for retinol levels.

The risk of developing a second primary cancer was evaluated in over 250,000 persons reported to the Connecticut Tumor Registry (CTR) during 1935-82. The CTR has collected data on cancer incidence longer than any other population-based tumor registry and thus provided researchers with a unique opportunity to investigate the occurrence of second cancers among persons followed for long periods, in some cases for more than 40 years. When compared with the general Connecticut population, cancer patients had a 31% increased risk of developing a subsequent cancer overall and a 23% elevated risk of second cancer at a different site from the first. Little variation in risk was seen for the first 20 years of follow-up, although the risk for females averaged twice that for males (41% vs. 18%). Persons who survived more than 20 years after the diagnosis of their first cancer were at highest risk: 51% for females and 45% for males. Over 1 million person-years of observation were recorded, and the excess risk of developing a new cancer was 3.5 per 1,000 persons per year. Common environmental exposures seemed responsible for the excess occurrence of many second cancers, particularly those related to cigarette smoking, alcohol consumption, or both. For example, persons with epithelial cancers of the lung, larynx, esophagus, buccal cavity, and pharynx were particularly prone to developing new cancers in the same or contiguous tissue throughout their lifetimes. A notable finding was the high risk of cancers of the lung, larynx, buccal cavity, and pharynx observed among cervical cancer patients, which suggested a common etiology involving cigarette smoking. The intriguing association previously reported among cancers of the colon, uterine corpus, breast, and ovary was confirmed in our data, which indicated the possible influence of hormonal or dietary factors. Incidental autopsy findings were largely responsible for the observed excesses of second cancers of the prostate and kidney, and heightened medical surveillance of cancer patients likely resulted in ascertainment bias and elevated risks for some tumors during the early period of follow-up, most notably cancers of the thyroid. Interestingly, patients with prostate cancer were the only ones found to be at significantly low risk for second cancer development. However, this might be an artifact of case-finding because advanced age at initial diagnosis of prostate cancer was associated with an underascertainment of second cancers.(ABSTRACT TRUNCATED AT 400 WORDS)

Using the data accumulated in the Osaka Cancer Registry, we conducted a study on the effect of radiotherapy for cervical cancer in causing second primary cancers. Two groups of patients with cervical cancer, 1,767 who were given radiotherapy and 1,377 who were not, were followed for 7-9 years on average. In the radiotherapy group, 79 women had second primaries, and in the nonradiotherapy group, 23 did. These figures were compared with the expected cancer incidence for all sites. In the radiotherapy group, a significantly high observed-to-expected ratio was noted in cancers of the rectum, lung, and bladder. The nonradiotherapy group showed no site with a significantly high observed-to-expected ratio. Factors causing the increased level of lung cancer were studied. Some evidence indicated the excess was probably not related to smoking but to radiation, although the mechanism is unknown.

We compared recent incidence rates for lung cancer in females among several regions in the Pacific Basin, Shanghai, Hong Kong, Miyagi, Hawaii, and Los Angeles, by ethnic group using data from the population-based registry in each area. The rates were high among whites and Hawaiians, intermediate in Chinese, and low in Japanese regardless of area. The risk of lung cancer among females who smoke relative to that in female nonsmokers varied from 1 ethnic group to another as did the proportion of smokers in the populations studied. Most of the interethnic differences in lung cancer incidence rates could be explained by differences in smoking patterns. The estimated annual incidence rate for lung cancer in females after subtraction of the proportion of the incidence due to smoking was 7.5/100,000 population in every ethnic group except the Chinese (15-20/100,000 population). Most of the residual incidences of lung cancer were adenocarcinoma of the lung.

To lay the groundwork for subsequent chapters in this monograph of multiple primary cancers in Connecticut and Denmark, we present a description of the historical significance of previous studies, focusing on key surveys that have enhanced our understanding of the origins of multiple cancers. Case reports, hospital series, and cancer registry studies have progressively sharpened our perspective on the patterns and causes of multiple cancers. These findings in turn have generated hypotheses about host and environmental determinants of various combinations of cancer and have provided clues to the actual mechanisms of carcinogenesis. The registries of Connecticut and Denmark which began in the 1930s and 1940s, respectively, afford investigators a unique opportunity to analyze the cancer experience of well-defined populations, followed for long periods. The major contribution of this monograph is the evaluation of second cancer risks among long-term survivors of cancer, including relatively rare tumors about which little information currently exists. For patients with a particular cancer, the number of observed second cancers are tabulated over time and compared with those expected if the patients experienced the same rates prevailing in the corresponding general population. We have discussed problems in distinguishing statistical artifacts from biologically plausible associations in light of the potential biases inherent in follow-up surveys of cancer patients; for example, heightened medical surveillance and mistaken metastases could result in false indications of elevated risk. Several differences in the reporting, follow-up, and coding practices between the Connecticut and Denmark registries are described and probably account for many differences in the reported findings.(ABSTRACT TRUNCATED AT 250 WORDS)

The Danish Cancer Registry began in 1942 as the world's first program to register all cases of cancer arising in an entire nation. The Registry covers a population with free access to good medical care. Voluntary notifications are received of patients with reportable malignant and certain related diseases from hospital departments, pathology institutes, and practicing physicians. The Registry is linked annually to death certificates made available by the Danish National Board of Health to ascertain additional cancers and to learn whether patients previously reported to the registry have died. During the period 1943-77, coding of the reported diseases was done by the Registry's medical and clerical staff according to an extended version of the Seventh Revision of the International Classification of Diseases (ICD). Since 1978, information has been coded according to the ICD for Oncology. Multiple primary cancers in the same patient are entered individually into the Registry; however, before 1978 only multiple primary cancers in different organs were registered. An evaluation of the completeness and the validity of diagnoses in the Danish Cancer Registry generally confirms the high quality of its data. However, it appears that the approach taken by the Registry in accepting multiple primary cancers has been a conservative one, and the risk of a person developing second cancers of some sites will thus be underestimated.

Rationale and plans are described for a collaborative case-control study of large bowel cancer among Chinese-Americans in Los Angeles and the San Francisco Bay Area and among Chinese in Zhejiang Province, People's Republic of China. A common protocol and questionnaire will be used during personal interviews of approximately 400 Chinese and 300 Chinese-American patients with histologically confirmed adenocarcinoma of the colon or rectum and 2,100 Chinese and Chinese-American controls. Controls will be matched to patients on age, sex, and community of residence. The information requested from subjects will permit testing of hypotheses relating colorectal cancer risk to: dietary factors, including intake of fat (saturated and unsaturated), animal protein, fiber, and vitamins A and E and ascorbic acid; physical activity levels and body mass index; reproductive factors among women; history of bowel disease; and family history of cancer. The information requested of Chinese-American subjects will also permit testing of hypotheses relating cancer risk to such migrant factors as United States versus Chinese nativity, duration of residence in the United States, and Chinese province of ancestry. These factors will be tested for associations with cancers of the colon and rectum separately and with cancers of the large intestine as a whole. We will examine sex and geographic differences in relative risks for etiologic factors, location of tumors within the large bowel, histologic subtype of adenocarcinoma, and frequency of accompanying polyps.

This case-control study included 183 Japanese and 161 Caucasian patients with breast cancer and equal numbers of matched hospital and neighborhood controls. The following factors were found to be associated with increased breast cancer risk in both groups of women: family history of breast cancer, history of benign breast disease, early age at menarche, late age at first childbirth, and late menopause. We noted a weak suggestion that the patients ate more saturated fats and oleic acid and took replacement estrogens for a longer period than did the neighborhood, but not hospital, controls. However, none of these differences was statistically significant.

This report presents preliminary findings from 3 case-control studies in Hawaii in which we are examining the relationship of dietary vitamin A and ascorbic acid intake to the risk for cancers of the lung, bladder, and prostate. All 3 studies involved home interviews of cancer patients and neighborhood controls and use of quantitative dietary history method. In the lung cancer study, we found an inverse dose-response effect for total vitamin A intake in males only, with an odds ratio of 1.8 (P less than .05) for the lowest intake quartile relative to the highest; we found no association for ascorbic acid. In the bladder cancer study, we found lower (but not statistically significant) mean intakes of both vitamins in patients compared with controls, with the effect stronger for ascorbic acid. In the prostate cancer study, no effect was detected for total vitamin A or ascorbic acid in men less than 70 years old, but a direct association of vitamin A only with a dose-response gradient was found for men 70 years or older (odds ratio = 1.87; P less than .05, for the highest relative to the lowest intake quartile). Our findings at present indicate that vitamin A has a protective effect against lung and bladder cancers but not against prostate cancer and that ascorbic acid has a protective effect against bladder cancer as well. In our later analyses, we will examine the possibility that the effects of vitamin A vary with histologic type and that this may account for the lack of an association with lung cancer in women.

The South Pacific Commission Cancer Registry has been operational since 1977, and reasonably complete cancer incidence rates are available for New Caledonia, Fiji, Micronesia, the Cook Islands, and Niue. In addition, less complete reporting is available from American Samoa, Papua New Guinea, and French Polynesia. Cancers of the lung, oral cavity, esophagus, liver, and cervix are potentially preventable but prevalent in many Pacific island countries. Unusually low rates of many cancers were observed in Fiji, the most notable being lung and colon-rectum. Thyroid cancer rates are elevated in some but not all female populations. These and other variations in cancer by site are important areas for further research.