National Cancer Institute monograph最新文献

Stomach cancer is the leading cause of death from cancer in China. Although the causes of this cancer are unknown, special opportunities exist for the evaluation of etiologic factors in Linqu County in Shandong Province where rates are exceptionally high. We have described here a newly initiated case-control study, which focuses on certain dietary items as risk factors for stomach cancer in Linqu.

Cancer incidence rates were compared for Filipinos in Hawaii (1978-81) and Manila (1977). Data for Hawaii were from the statewide Hawaii Tumor Registry; those for Manila were from the Central Tumor Registry of the Philippines. In addition, time trends (4-yr intervals) for cancer among Filipinos in Hawaii were examined for the period 1962-81 and compared with corresponding patterns among Caucasians. For most cancer sites, the rates among Filipinos in Hawaii showed expected increases or decreases from the Manila rates. Notable findings included a dramatic increase in thyroid cancer rates among Filipino women in Hawaii (highest of all ethnic groups), a surprising lack of increase in female breast cancer rates in Hawaii, and a lower than expected increase in colon cancer rates in Hawaii. The time trend analyses showed remarkably similar patterns in Filipinos and Caucasians in Hawaii and no suggestion that differences between the 2 populations are decreasing over time. These observations indicate that useful clues to cancer etiology can be found by further study of the Filipino experience in Hawaii.

Comparisons of Hawaiian Japanese with Japanese living in Japan identify several differences between the 2 populations. The Hawaiian Japanese are heavier and taller; they consume more fat and protein; they have higher levels of serum cholesterol, more frequent fecal mutagens, and more frequent adenomatous polyps and diverticulae. These differences offer indirect support to the concept that the consumption of a Western diet favors the development of coronary heart disease and colon cancer which occur more frequently among the Japanese in Hawaii than in Japan. When assessed directly and prospectively, obesity, the serum cholesterol level, and dietary fat intake are positively associated with coronary heart disease. The serum cholesterol level and dietary fat intake are negatively associated with colon cancer, whereas the body mass index (height/weight) is positively related to this tumor in older men. The 2 diseases have shown dissimilar trends in the past 20 years, with coronary heart disease being stable at levels intermediate between the United States and Japan experience, whereas colon cancer has shown a steady increase with rates higher than those of whites in the United States. The differences in risk factors and trends displayed by the 2 diseases indicate that they affect different subsets of the westernized Japanese population. Additional studies are necessary if we are to establish the basis for these differences.

The results of a survey of a population with a high risk of oral and esophageal cancer and the outline of a chemoprevention scheme for persons found to have a precancerous condition of the mouth and esophagus are presented. Of a total of 1,569 men examined, 11% had preleukoplakia and leukoplakia of the mouth, and 60% of the 1,344 men in whom esophagogastroscopy was performed had chronic esophagitis. The relative risk of oral leukoplakia was highest (11.5) among men who smoke and use nass quid. The relative risk was also elevated for persons who only use nass quid (5.6) or who only smoke cigarettes (7.8). Nass use had no effect on the risk of esophagitis. A slight elevation of risk (1.9) of esophagitis was observed for current smokers and drinkers. Of the men from whom blood was drawn for analysis, 4%, 66%, and 86% had low levels of retinol, carotene, and riboflavin, respectively. The high prevalence of oral and esophageal precancerous conditions and low blood levels of riboflavin, carotene, and vitamin A observed in the surveyed population, as well as the existing evidence on the possible protective effect of these nutrients in carcinogenesis, provide an opportunity and a justification for the chemopreventive trial, with the regression of observed precancerous lesions as the end point of the study.

The Connecticut Tumor Registry (CTR) was established in 1941 and is the oldest population-based cancer registry in the world. Since 1935, all malignant tumors have been registered, and cancer patients are followed annually for vital status. Reporting by hospitals of all cancers diagnosed in Connecticut residents became mandatory in 1971. The reporting physician or hospital makes the initial determination as to whether a tumor is an independent primary cancer, recurrent tumor, or metastatic lesion. In addition, the Registry maintains stringent quality control procedures to avoid duplication of cancer reports. The Registry reviews reports of new cancers developing in patients with a previous primary cancer to rule out the possibility of misdiagnosed metastases. Microscopic confirmation of the diagnosis has improved from 49% in 1935-39 to 94% in 1980-82. Cancers reported only from death certificates currently account for only 1% of all registrations. Between 1935 and 1979, cancer rates in Connecticut almost doubled among males and increased by more than one-third among females; notable increases were seen for cancers of the lung and prostate in males and cancers of the lung and breast in females. In recent years, rates for malignant melanoma of the skin have increased dramatically among both sexes. Stomach cancer has decreased over time in both sexes, as has cervical cancer in females. Although the CTR has used several revisions of the International Classification of Diseases to code the primary site of cancers, rules for the coding of multiple primary cancers have remained essentially the same. Among 253,536 individuals diagnosed between 1935 and 1982 with an invasive cancer, 16,727 (6.6%) nonsimultaneous second cancers were evaluated and are discussed in subsequent chapters of this monograph. Simultaneous cancers were diagnosed in 4,107 individuals and accounted for approximately 20% of all multiple cancers reported in Connecticut. The most frequent simultaneous tumors were cancers of the colon, rectum, prostate, lung, breast, and bladder. Some simultaneous cancers (chronic lymphocytic leukemia, testis, prostate, rectum, uterine corpus, and liver and biliary tract) occurred almost as frequently as the number of subsequent nonsimultaneous tumors, which suggests that the patterns of risk over time for certain sites may be distorted when diagnoses are advanced in time and removed from analysis.(ABSTRACT TRUNCATED AT 400 WORDS)

In Denmark, approximately 5% of all malignant neoplasms occur within the lymphatic and hematopoietic tissues. Between 1943 and 1980, 23,367 persons with these diseases fulfilled the criteria for entering the study. The risk of developing a second primary cancer was significantly increased only after Hodgkin's disease [relative risk (RR) = 1.6], whereas no increase was found after non-Hodgkin's lymphoma [(NHL); RR = 1.0] or leukemia (RR = 1.1), and a significant deficit occurred after multiple myeloma (RR = 0.8). All initial cancer sites showed a higher incidence of second primary cancers among males than females. Significant elevated risks for acute non-lymphocytic leukemia occurred after Hodgkin's disease (RR = 17), NHL (3.8), and multiple myeloma (9.1). Among persons initially diagnosed with leukemia, NHL was significantly elevated (RR = 2.6). However, these RR should be regarded as minimum figures due to the likelihood of serious underreporting of second primary hematologic cancers in Denmark. The secondary leukemias were likely induced by the treatment of the first primary cancer (chemotherapy, radiotherapy), but common etiologies, misclassification, or progression of the initial cancer cannot be ruled out entirely. Other second primary cancers found to be above expectation following Hodgkin's disease were cancers of the pancreas, lung, and urinary bladder. The risk for bladder cancer increased with time, which suggested a causal relation to radiation or chemotherapy, or both. Cancers of the colon and rectum following NHL and female breast cancer following leukemia occurred below expectation and remain unexplained.

The risk of developing a second primary cancer was evaluated in approximately 64,000 persons diagnosed with cancer of the digestive system in Connecticut during 1935-82. Significant excesses of all second cancers combined were observed following cancer of the esophagus (58 observed vs. 33 expected), small intestine (41 vs. 24), and colon (2,268 vs. 1,714). A slight excess of multiple primaries was observed following cancer of the liver and biliary tract (47 vs. 40). The observed number of second cancers was nearly equal to the expected number for persons initially diagnosed with cancers of the stomach (251 vs. 258), rectum (952 vs. 941), and pancreas (40 vs. 40). Persons with initial cancers of the small intestine, colon, and rectum also had excess second cancers arising primarily in the colon, which suggested the influence of common etiologic factors or possibly misclassified metastases in some. Shared dietary, socioeconomic, or hormonal factors may explain the excess of uterine and ovarian cancers among patients with colon cancer and the excess of breast cancer among patients with colon and rectal cancers. Oral and respiratory cancers occurred more frequently than expected in persons with an initial esophageal cancer, which is likely due to common risk factors of cigarette smoking or alcohol intake, or both. The elevations in cancer of the prostate among males with cancers of the esophagus, small intestine, colon, rectum, liver/biliary, and pancreas are probably artifacts associated with increased medical surveillance of cancer patients. The prostate cancer excesses were limited to the first year after diagnosis of the initial cancer or decreased over time for all but cancer of the colon and small intestines. Increased medical surveillance may also contribute to the excess renal and bladder cancers seen within 5 years of diagnosis of stomach cancer. Excesses were also seen for second pancreatic cancer among small intestine and liver/biliary cancer patients and second kidney and brain cancers among those with colon cancer. The deficits of stomach and rectal cancer among persons initially diagnosed with the same tumors, respectively, were anticipated because surgical removal of the organ is the primary form of treatment. Patients with rectal cancer also had deficits of stomach and pancreatic cancers. Future research should clarify the role of diet, alcohol, metabolic and endocrine factors, and host susceptibility on the risk of second neoplasms following cancer of the digestive system.

Plasma levels of nutrients in 196 individuals were assayed as part of a study of the feasibility of a nutrition intervention trial in Linxian, a county in North Central China with exceptionally high rates of esophageal cancer. High-performance liquid chromatography analyses of samples collected in April 1983 showed low (relative to United States standards) base-line levels for retinol, alpha-tocopherol, and beta- and alpha-carotene. Repeat sampling in August 1983 revealed significantly increased plasma levels of retinol and alpha-tocopherol among those who had in the interim received daily supplementation with multivitamin pills containing the Recommended Dietary Allowance levels of those nutrients but not among those without supplementation. Levels of carotenes, which were not included in the pills, tended to increase regardless of supplementation, consistent with seasonal variations in availability of carotenoid-containing foods. Atomic absorption spectrophotometry analyses showed essentially normal levels of copper and zinc in plasma. Neither was affected by vitamin supplementation (the pills did not contain minerals) nor seasonal variation. The data are generally consistent with prior biochemical surveys in indicating marginal or low status of several nutrients in Linxian and in showing that supplementation with vitamins can effectively raise blood nutrient levels.

An epidemiologic study on breast cancer in relation to diet and reproductive history was conducted with 3 populations at different levels of risk for the disease: Japanese in Fukuoka, Japan (low risk), Japanese in Hawaii (intermediate risk), and Caucasians in Hawaii (high risk). This report describes the Fukuoka portion of the study. We interviewed 212 patients with histologically confirmed breast cancer and an equal number each of hospital and neighborhood controls to determine risk factors for the disease. The results indicated that "overnutrition" (a high-fat and high-animal protein diet) was not statistically associated with the disease. As noted in previous studies, age at the first birth was positively related to the disease; those women who gave birth to their first child when they were 35 or more years of age showed a relative risk of 5.0 compared with those giving birth at less than 20 years of age. A past history of both natural abortion and of benign breast disease were significantly associated with the disease. On the whole, the results obtained from this Fukuoka portion of study were in good agreement with those from the Hawaii study during which Japanese and Caucasians in Hawaii were investigated.

Lung cancer mortality rates are higher in Shanghai than all other large cities in China, with rates for females among the highest in the world. In this paper, we describe a case-control study now under way in Shanghai to evaluate reasons for this pattern, reviewing what is known about the risk factors under study. The objectives and methods used in the investigation are outlined.