National Cancer Institute monograph最新文献

We based our systematic review of the cancer incidence rates of 48 anatomic sites of Japanese in Japan (Miyagi, Osaka, and Fukuoka Prefectures) and Japanese and Caucasians in the United States (Hawaii, San Francisco Bay Area, and Los Angeles County) on the cancer incidence data included in volume IV of "Cancer Incidence in Five Continents." Cancer sites were classified into 10 categories according to the trend of cancer incidence among the 3 groups. To evaluate the influences of environmental and racial factors, we used the ratio of cancer incidence in Japanese living in the United States to that of native Japanese, and the ratio of cancer incidence in Caucasians to that of Japanese living in the same areas of the United States. The present study revealed that the risks of cancers of the prostate, corpus uteri, colon, thyroid, breast, ovary, and testis were elevated, whereas those of the stomach, esophagus, and cervix uteri were decreased in the United States. Caucasians were more susceptible to melanoma, cancers of the mouth, lip and vermilion border, tongue, oropharynx, and larynx than were the Japanese, but the Japanese were more susceptible to cancers of the stomach, gallbladder, and liver. The difficulties we encountered in differentiating the influences of environmental factors from those of genetic racial factors are discussed. The necessity for further observations of the life-style (especially dietary habits) and the cancer incidence of Japanese living in the United States and comparisons with those of native Japanese and Caucasians are emphasized.

A 10% increased risk of developing a second cancer was observed among approximately 36,000 persons reported to the Danish Cancer Registry with a cancer of the respiratory system during 1943-80. This estimate is markedly influenced by a striking tendency by physicians not to report or the Cancer Registry not to accept a report of a second lung cancer following a primary lung cancer (14 observed vs. 99 expected). A significant 30% excess of all second cancer was seen after laryngeal cancer (368 vs. 282), whereas the 22% excess following cancer of the nasal cavities and paranasal sinuses did not quite reach the level of statistical significance (95% CI = 0.9-1.6). For cancers of the lung and larynx, second cancers arose mainly in the buccal cavity, bladder, kidney (after lung cancer only) and lung (after laryngeal cancer only). These second cancers may be due to common carcinogenic factors, most likely tobacco. Elevated risks of second cancers of the breast, cervix uteri, and other female genital organs were found consistently. Radiotherapy may have contributed to the increased risk of breast cancer, but the excess risk of cancer of the female genital organs other than the cervix was unexpected. Although not significant, the risk of esophageal cancer following cancer of the larynx was below expectation (1 vs. 4.1), which was surprising because alcohol consumption and smoking are thought to be common risk factors for these 2 sites. Significant excesses of pancreatic cancer were observed following cancers of the lung, larynx, and nasal cavities, which might be due to more careful medical surveillance of these patients or to common risk factors such as cigarette smoking. Finally, the risk of a patient developing liver cancer after lung cancer was significantly elevated (22 vs. 11.6). This increase is unlikely to be due to misdiagnosed metastases from the lung, inasmuch as the risk was generally elevated throughout the observation period.

The risk of second primary cancer was assessed in persons who developed cancer of the urinary tract in Connecticut during 1935-82. Among 12,384 patients with a first primary tumor of the bladder or urethra, a second cancer was reported in 1,151 (or 9%). A significantly elevated relative risk (RR) of 1.23 was due to excess cancers of the lung, larynx, prostate, and kidney, and acute nonlymphocytic leukemia. Among 5,115 persons with a first primary tumor of the kidney, renal pelvis or ureter, a second cancer was reported in 374 (or 7%) that yielded a significantly elevated RR of 1.54 due to excess tumors of the bladder and prostate and second primary kidney neoplasms. The role of common etiologic factors, such as cigarette smoking, the multifocal tendency of tumors of the urinary tract, and heightened medical surveillance are discussed in relation to these findings.

A 24-week pilot study of daily or weekly multiple vitamin supplementation among 852 adults in Linxian, where the rate of esophageal cancer is exceptionally high, demonstrated the feasibility of an intervention trial in this population. Compliance, when judged by pill count, was high for both frequencies of pill use. Only 2% of the subjects refused to take any pills, and, among pill takers, over 95% were reported to be taking most of their pills at the end of the study. Biochemical confirmation of high compliance was demonstrated in urine and blood tests, which showed markedly improved vitamin levels after supplementation. Results of the pilot study indicated that a system in which barefoot doctors were used in pill distribution was effective and that established field operating procedures for a full-scale intervention trial in this area were acceptable.

The risk of second primary cancer was evaluated in 29,128 patients who developed tumors of the urinary tract, including benign and malignant tumors of the renal pelvis and ureter and bladder papillomas in Denmark between 1943 and 1980. Among 9,162 persons with kidney cancer, 416 developed a second primary tumor [relative risk (RR) = 1.4]. Among 19,966 persons with bladder cancer, 1,423 developed a second primary tumor against 1,239 expected (RR = 1.1). The risk of bladder cancer was increased following kidney cancer in both men (RR = 6.3) and women (RR = 10.1), and kidney cancer was increased in both men (RR = 2.9) and women (RR = 4.5) following bladder cancer. These risks were particularly pronounced for cancers occurring in the ureter and renal pelvis. Etiologic similarities are likely explanations for these observations, which also emphasize the role of host factors and the multifocal nature of urothelial tumors. A decrease in relative risks since diagnosis of the first primary cancer was seen that may partly be attributed to a lessening of the intensity of medical surveillance with time. Among long-term survivors with kidney cancer, increased risks were observed for colon and pancreatic cancers, which may be related to treatment; approximately 25% received radiotherapy. Among bladder cancer patients, increased risks of cancers of the lung and larynx occurred, probably due to tobacco smoking. A slight elevation of prostate cancer (RR = 1.3) may be attributable to medical surveillance. Unexpected findings were the significant deficits of cancers of the stomach and rectum among patients with bladder cancer and stomach cancer among those with kidney cancer.

The risk of second primary cancer was evaluated in more than 25,000 women with cancer of the genital organs diagnosed between 1935 and 1982 in Connecticut. Significant excesses of subsequent cancers were observed following cancers of the cervix (35%, n = 656), uterine corpus (16%, n = 1,060), and ovary (58%, n = 366). When observed and expected second cancers of the female genital tract were excluded, these excesses became 40%, 30%, and 59% after cervix, uterine corpus, and ovary, respectively. Among women with either cancer of the cervix or uterine corpus, the risk of developing a second cancer rose with increasing duration of follow-up, reaching an excess of 61 and 34%, respectively, after 20 years. In contrast, among patients with ovarian cancer, the second cancer risk decreased over time to 41% after 10 years. Cancers related to smoking, i.e., oral cavity and pharynx, esophagus, and respiratory system, were notably increased among cervical cancer patients. The twofold to threefold risks observed for these second cancers are consistent with recent evidence linking cervical cancer to cigarette smoking and seem too large to be artifacts of confounding by low socioeconomic status. An increased incidence of second cancer of the abdominal organs (colon, rectum, kidney, bladder, ovaries) was generally observed for each gynecologic site. However, only rectal cancer was consistently linked with radiation treatment for the first primary cancer. Leukemia occurred in excess after cancers of the uterine corpus and ovary, but not after cervical cancer. The predominant cell type was acute nonlymphocytic leukemia, and the excess was associated with radiotherapy for uterine corpus cancer and with chemotherapy for ovarian cancer. Cancers of the breast and colon were increased following uterine corpus and ovarian cancer and vice versa, which supports the notion that these sites share a common etiology, perhaps related to dietary or hormonal factors. Cervical cancer patients experienced a deficit of subsequent breast cancer, possibly due to ovarian removal or ablation by radiation. Investigators need to explore further the association between the smoking-related cancer sites and cervical cancer, to clarify the role of radiotherapy and chemotherapy in relation to excess cancers, and to define more fully the etiologic factors that link cancers of the breast, colon, uterine corpus, and ovary.

We conducted a population-based case-control study of patients with bladder cancer and of controls drawn randomly from the general population of Metropolitan Nagoya and interviewed both groups. The incidence rates of bladder cancer were 2.42 and 7.05/100,000 for females and males, respectively. The analysis, based on 293 patients and 589 controls who were frequency matched for age, sex, and residence, provided the following major findings. Age-adjusted relative risks of 1.89 (1.15-3.10) and 3.53 (1.71-7.27) were found in male and female cigarette smokers, respectively. Significant relative risk was also found in males who drank cocoa. Elevated risk with a dose-response relationship was observed among women who used hair dye and who smoke, but this risk was insignificant, with the disappearance of a dose-response relationship, when it was adjusted for smoking. Age- and smoking-adjusted relative risk of coffee drinking was insignificant with no dose-response relationship. Relative risk of artificial sweetener use was below 1 with adjustment for age and smoking. Intake of alcoholic beverages and cola was insignificantly associated. Reduced risk of significance was suggested for the intake of black tea and matcha (powdered green tea) in females and of fruit juice in males.

Using 16 years of follow-up results of a prospective cohort study for 122,261 men, 95% of the census population, aged 40 years and older in 29 Health Center Districts in Japan as subjects, we compared the age-standardized mortality rates for cancer of each site and other causes of death in Japanese with life-styles similar to those of Seventh-Day Adventists (SDA), i.e., no smoking, no drinking, no meat consumption daily and eating green and yellow vegetables daily, with those of Japanese with opposite life-styles. Compared with the latter Japanese, the risks were one-fifth or less in Japanese with SDA-like life-styles for cancers of the mouth, pharynx, esophagus, and lung, and subarachnoid hemorrhage. Risks were less than one-half for cancers of all sites, stomach, and liver, and for peptic ulcer and heart disease. As a single factor, the addition of daily smoking was observed to elevate the risk most strikingly in Japanese who followed SDA life patterns. Influences of further addition of habits of daily drinking of alcohol and dietary changes were significant for cancers of the esophagus, liver, and bladder and other selected diseases. Strategies for cancer prevention by means of life-style modification, e.g., increased consumption of green and yellow vegetables, were discussed.

Chinese in the province of Guangdong have the highest risk of nasopharyngeal carcinoma (NPC) in China. Within Guangdong, variation in rates among the 3 major dialect groups is threefold. The Cantonese who reside in the central region of Guangdong display the highest risk of NPC. Among the Cantonese, those living on boats have twice the risk of those who live on land. These observations are consistent with earlier studies of southern Chinese residing in Hong Kong and Southeast Asia.

Using ethnicity of surname, nativity, residential social class, and inferred age at migration to characterize and subdivide Hispanics in Los Angeles, we compared risk ratios and proportional incidence ratios to examine the patterns of occurrence of selected neoplasms within the Hispanic community. Common neoplasms for which Hispanics have high, low, and intermediary risk were examined in detail. Although the patterns expected on the basis of current concepts of etiology were generally found and served to reinforce presumptions about the biologic significance of the risk factors, a number of observations cannot be explained easily with current knowledge. The risks for stomach and bowel cancers do not conform to the mirror-image patterns to be expected on the basis of inverse patterns of dietary acculturation. Incidence of cancer of the breast, in contrast to that of cervix, does not appear to reflect early cultural practice. Consistent details in the patterns of cancers of the bladder, rectum, ovary, prostate, and possibly pancreas imply unrecognized determinants of disease. Gallbladder cancer in Hispanic women is the disease most closely tied to Hispanic origin or culture, or both, but the ethnic pattern in women differs greatly from that in men.