National Cancer Institute monograph最新文献

The risk of developing a second primary cancer was studied among 171,749 men and 208,192 women who were reported to the Danish Cancer Registry between 1943 and 1980. Only those who survived at least 2 months were included in the analysis, and more than 1.7 million person-years of observation were accrued. Altogether, 15,084 second primary cancers developed in organs other than the initial cancer site [relative risk (RR) = 0.99]. Adjustment for possible underreporting of multiple primary cancers increased the RR to 1.06. The overall RR of a second cancer developing for all sites was 0.91, but interpretation of this risk is difficult because new tumors arising within the same organ are generally not recorded in Denmark. The RR for all sites increased with time from 0.94 during the first decade of follow-up (excluding the first year) to 1.13 among 30-year survivors. Patients below the age of 20 years when first diagnosed with cancer experienced significantly increased risk of developing a second cancer. Elevated risks were also observed for sites thought to have a common etiology. For example, cancers of smoking-related sites were increased in both directions for cancers of the oral cavity, respiratory tract, and urinary organs. For cancers suspected to have a hormone- or dietary fat-related association, significant reciprocal relationships were seen among cancers of the endometrium, ovary, and colon. Cancer treatment probably is an important factor in second cancer development, even when judged indirectly in the present study. For example, radiotherapy may have been responsible for an elevated risk of subsequent cancers of the thyroid, breast, colon, rectum, bladder, connective tissue, and hematopoietic system in long-term survivors. Chemotherapy may have increased the risk of subsequent leukemias. Our data further indicate that cancer patients have no general susceptibility to develop new malignant tumors, although high rates may be found for particular sites sharing common risk factors. Conversely, the occurrence of one cancer does not appear to protect against developing a new cancer.

Of a total of 3,366 cases of malignant lymphoma in China reviewed histopathologically, T-cell lymphomas accounted for an average of 26.1% among all non-Hodgkin's lymphomas. However, the proportion of lymphomas of T-cell lineage varied in different parts of China, with the highest proportion (30-40%) along the east coast. Immunologic typing of 41 non-Hodgkin's lymphomas by the avidin-biotin-peroxidase complex technique revealed similar patterns. When serum antibodies to human T-cell leukemia virus were assayed in 462 normal men and 103 monkeys, 2-5% of the men and 8.4-15% of the monkeys were positive for antibodies to this virus.

Case-control studies of diet and colon cancer have produced inconsistent findings. Data from descriptive and metabolic epidemiologic studies suggest that colon carcinogenesis varies by sex-age status, particularly when considered in relation to anatomic subsite. Thus stratification of data analysis by these criteria may elucidate dietary etiology. Consideration should also be given to the limited and nonlinear variation in colon cancer risk likely to exist in relation to the range of dietary "exposure" within Western study populations. In our community-based case-control study of colon cancer, comprising 220 patients and 440 individually matched controls, the dietary data have been analyzed by both tertile and quintile of individual consumption level. For total dietary energy intake, the tertile approach indicates a weak (men) to moderate (women) dose-response relationship; however, the quintile approach revealed in women a fourfold step-up in risk between the lowest and next-to-lowest quintile. For dietary protein, the quintile approach doubled the step-up in risk between the 2 lowest consuming categories for men compared with the tertile approach. Applying this quintile approach to data analyses stratified by sex, age, and colon subsite, we found: 1) In women, the risk of colon cancer for the upper four quintiles of consumption of calories and other major nutrients was greatest at young ages, whereas for men it was greatest at older ages. 2) The diet-associated risks tend to be maximal in the left (distal) colon for men and in the right (proximal) colon for women.(ABSTRACT TRUNCATED AT 250 WORDS)

The patterns of cancer risk by religion in the large multidenominational population of Los Angeles County were examined with the method of proportional incidence. Risk estimates for individual cancers by religion were screened and those extreme but stable estimates found were reexamined in light of relative socioeconomic class, nativity, and ethnicity. Within Protestant denominations, gradients which can still best be attributed to religious preference were observed for leukemia, stomach, and cervix cancer. Roman Catholics tend to have high risks of stomach and gallbladder and a low risk of prostate cancer, whereas Eastern Orthodox women trade high risk of stomach cancer for low risk of endometrial and lung cancer. The most extreme pattern of risk, that for Jews, is comprised of lowered risk for cervical cancer and for most sites usually associated with smoking, plus consistently higher risk for lymphomas, thyroid cancer, and bladder cancer among males. Like Jews, Seventh-Day Adventists experience high risk for lymphoma and low risk for cervical and respiratory cancers. Risk to Mormons in Los Angeles differs from that of the standard Protestant population in only minor and inconsistent ways. Neither Mormons nor Adventists showed the previously reported deficits of colorectal or breast cancer. Although the method of proportional incidence may be partly responsible for our failure to confirm previous findings, nonreligious cultural or methodologic factors in the original investigations also provide plausible explanations. More generally, associations of the modest magnitude observed between cancer risk and religion in American populations should probably not be attributed to religious life-style, unless extraordinary circumstances permit the exclusion of other determinants.

The use of vitamin A supplements and the risk of cancer was examined in a cohort of 11,888 residents of a retirement community near Los Angeles, California. After 2 1/2 years of follow-up, 445 incident cancers occurred in 435 of the study participants. Overall, the relative risk of cancer for supplement users versus nonusers was 1.0. In a subset of 32 randomly selected individuals, the 14 supplement users had a significantly higher mean serum retinol level (86 micrograms/dl) than did the 18 nonusers (74 micrograms/dl).

The risk of a person developing a second primary cancer was evaluated in approximately 55,000 women diagnosed with breast cancer in Denmark between 1943 and 1980. Excluding second cancers of the contralateral breast, 2,480 new cancers were observed compared with 2,398 expected (relative risk = 1.03; 95% CI = 0.99-1.08). Breast cancer patients followed for 10 years or more showed a significant 13% excess of all second primary tumors. Significant excesses of cancers of the lung, bone, and connective tissue were observed. Although some misclassification of metastases may have occurred, the risk of second cancers at these sites (as well as the salivary gland and esophagus) increased significantly with time and was especially high among women followed for 10 years or more. These observations suggest that radiation, as a part of the initial treatment, may have been involved. Radiation or chemotherapy, or both, may also have influenced the risk of acute nonlymphocytic leukemia (51 cases observed vs. 20.7 expected), which remained significantly elevated after the first year of follow-up. Common risk factors, related to reproductive experience and nutrition, may have contributed to the excess risk of cancers of the ovary and colon. On the other hand, an anticipated excess of cancer of the corpus uteri was not found, although cancer of the uterus not otherwise specified was significantly increased. Significant deficits were observed for second cancers of the liver and biliary tract, due perhaps to underreporting or conservative coding practices, or both. A significant excess of malignant melanoma was not easily explained but might indicate a common hormonal etiology with breast cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Second primary cancers were studied in persons with rare tumors between 1943 and 1980. The risk of developing a new cancer was evaluated in 7,211 persons with cutaneous melanoma, 1,784 persons with eye cancer, 10,273 persons with tumors of the brain and nervous system, 1,935 persons with thyroid cancer, 1,542 persons with bone tumors, and 2,318 persons with malignant neoplasms of the connective tissue. All cancer patients were diagnosed in Denmark between 1943 and 1980 and survived for 2 or more months. Nonmelanoma skin cancers were excluded from the analysis, whereas tumors of the brain and nervous system included both benign and malignant neoplasms. Overall, patients with these cancers showed no greater incidence of new tumors than expected from comparisons with the general population. An excess of chronic lymphocytic leukemia was observed subsequent to all cancers derived from the neural tube, i.e., melanoma and tumors of the eye, brain, and nervous system. Bone cancer occurred excessively, although the possibility of misclassified metastases could not be eliminated. Patients with tumors of the brain and nervous system who survived for 10 or more years developed significantly more cancers of the kidney and connective tissue and melanoma than anticipated. A deficit of second cancers of the digestive system was noted after primary bone and connective tissue cancers, in contrast to an excess of second cancers of the lung and kidney. Although based on few cases, patients with bone cancer showed a large excess of eye cancer as a second primary. The association between cancers of the breast and connective tissue was found to be bidirectional. Persons with connective tissue cancer were at increased risk of developing non-Hodgkin's lymphoma. Thyroid cancer patients were at high risk of subsequent tumors of the brain and nervous tissue and non-Hodgkin's lymphoma. However, contrary to previous reports, the risk of breast cancer was not elevated following thyroid cancer.

Data on potential risk factors for primary liver cancer (PLC), including hepatitis B virus (HBV) infection, contaminated drinking water, maize consumption, and use of tobacco and alcohol were collected from 12,222 males over 40 years of age living on Chongming Island, a high-risk area for PLC. During the first 3 years of follow-up (1980-82), 70 deaths from this disease occurred among study subjects. Preliminary results indicate that HBV carriers were 6.7 times more likely to die of PLC than were noncarriers (P less than .05). No association was found between PLC and alcohol consumption. More data are needed for evaluation of the relationships between cigarette smoking, maize consumption, contaminated drinking water, and PLC on Chongming Island.

The risk of second primary cancers developing was evaluated in individuals with 6 rare tumors in Connecticut between 1935 and 1982. Small but significant excesses of all second cancers occurred in patients with cutaneous melanoma (42%), and cancers of the brain (59%), thyroid (49%), connective tissue (23%), bone (66%), and eye (40%). In individuals with cutaneous melanoma, the highest risks were for subsequent cutaneous melanomas [relative risk (RR) = 8.5] that persisted throughout all intervals of observation. The risk for second melanomas was higher in persons under age 40, consistent with a heritable component. Connective tissue tumors and breast cancers also occurred in excess. Among patients with brain cancer, an increase of melanoma was observed that may represent an underlying neural crest abnormality, although no excess of brain cancer was seen after melanoma. Reciprocal increases of bone cancer after connective tissue cancer and connective tissue cancer after bone cancer point to shared risk factors, such as high dose radiotherapy or genetic susceptibility states. An anticipated high risk of osteogenic sarcoma following Ewing's sarcoma was not seen. An excess of breast cancer (RR = 1.9) after thyroid cancer indicates common etiologic factors. Expected excesses of bilateral retinoblastoma and bone cancer after retinoblastoma were seen. Tumors commonly treated with alkylating agents or nitrosoureas (melanoma, brain, connective tissue) showed slightly elevated risks of acute nonlymphocytic leukemia. Prostate cancer was frequently found to be in excess, but this is likely an artifact due to ascertainment bias.