Prevention of stomach cancer

In Japan the mortality rate from stomach cancer is higher than in any other countries of the world. But this rate has recently been decreasing in almost all countries including Japan. We can accelerate the speed of this decreasing tendency by promoting systematically such preventive measures like avoidance of salty foods intake, high consumption of vegetables and fruits, smoking cessation and stomach cancer screening programs.     

A comparative case-control study of stomach and large intestinal cancers

The incidence of stomach cancer, the most common cancer in Japan, has been decreasing, but that of colon cancer has been increasing in recent years. It is assumed that the change of Japanese life style, in particular dietary habits, has influenced the time trends of these gastro-intestinal cancers. In order to identify common, inverse and independent risk factors for the two contrasting cancers, a simultaneous comparative case-control study of both sites of cancers was done using a common questionnaire at the Aichi Cancer Center Hospital in 1981-1984. Its main results suggested that typical Japanese foods were positively associated with stomach cancer whereas western style foods increased the risk of colon cancer but decreased the risk of stomach cancer. It was suggested that a simultaneous comparative case-control study could be useful in identifying common, inverse or independent risk factors for the two contrasting cancers, such as stomach and colon cancers.     

Trends in cancer incidence and mortality in Osaka, Japan: Evaluation of cancer control activities

It is essential to analyze trends in cancer incidence and mortality in the evaluation of cancer control activities. Previous studies from Japan, however, described trends in cancer incidence and mortality only qualitatively. There have been few studies that evaluated the trends quantitatively. We calculated age-standardized mortality rates (1968–2006) and incidence rates (1968–2002) for overall cancer sites and for each major site (stomach, colorectal, liver, lung, prostate, breast, and uterus) in Osaka. We applied a joinpoint regression model to the trends in incidence and mortality, in order to identify the joinpoint and estimate annual percentage change. Then, we quantified the contribution of individual cancer sites to the change in overall cancer mortality rate. For the sites that made a major contribution, we estimated the contribution of the incidence reduction to the mortality reduction. In Osaka, the overall cancer mortality started to decrease from 1998. The decrease was largely attributable to the reduction of stomach and liver cancer mortality (73% for men, 53% for women). The reduction of mortality from the two cancer sites could be explained by the decrease in their incidences (more than 80% for stomach, approximately 100% for liver). Female breast cancer incidence and mortality were both increased probably due to lifestyle changes and delayed introduction of an effective screening program among Japanese. In conclusion, the decreased overall cancer mortality in Osaka during the study period was mainly due to natural decreases in the incidence of stomach and liver cancer, which were attributable to the decrease in risk factors. ( Cancer Sci 2009: 100: 2390–2395)     

Cancer patterns among Koreans in Japan, Koreans in Korea and Japanese in Japan in relation to life style factors

Cancer incidences for major sites were compared among Koreans in Osaka, Japan, Koreans in Korea and Japanese in Osaka by calculating standardized proportional incidence ratios (SPIR's), in addition to updating the findings on cancer mortality experiences of Koreans and Japanese in Osaka reported before. Compared with Japanese, Koreans in Osaka had significantly higher mortality rates from cancers of the esophagus, liver and lung in males, and liver in females. Mortality rates among Koreans in Osaka were significantly lower for stomach cancer in both sexes and for breast cancer in females. Compared with Korean counterparts in the homeland, Koreans in Osaka had a reduced risk for cancers of the stomach in males and the uterus in females. On the other hand, an elevated risk was observed for cancers of the esophagus, colon, liver and lung among Korean males in Osaka and for cancers of the colon and liver among Korean females in Osaka. The risk for cancer of the breast in females was similar among Koreans in the host and home countries. These different cancer patterns among Koreans in the host and home countries and Japanese are discussed in relation to their life styles, such as smoking, drinking and dietary habits, which have been investigated by means of questionnaire surveys.     

Incidence and mortality from stomach cancer in Japan, Slovenia and the USA

The mortality and incidence from stomach cancer were compared in Japan (a country with a high incidence where there was full application of mass screening during this period) and 2 countries with no screening policy: the USA (with a very low incidence) and Slovenia (with an intermediate rate). The registered cases of stomach cancer were from the Osaka Cancer Registry, the Slovenian National Cancer Registry and the Surveillance, Epidemiology, and End Results (SEER) registries in the USA. In the period 1975-95, the age-adjusted incidence rate (/100,000) of stomach cancer declined in the 3 countries, as follows: Japan, from 76.0 to 53.0 in men and 38.4 to 21.3 in women; Slovenia, from 40.2 to 24.1 in men and 16.6 to 10.8 in women; and the USA, from 9.5 to 6.9 in men and 4.3 to 2.9 in women. During the same period, the age-adjusted mortality rate declined, as follows: Japan, from 60.2 to 34.2 in men and 30.5 to 14.1 in women; Slovenia, from 37.7 to 21.2 in men and 13.8 to 9.0 in women; the USA, from 5.6 to 4.7 in men and 2.5 to 2.3 in women. In the period studied, specific trends on incidence and mortality with a cohort effect occurred only in Japan: analysis by the age period-cohort model confirmed that the decline has occurred since the generations born in 1910. The trend therefore corresponds to unplanned prevention through changes in environmental factors occurring since the early 20th century. The study of stage-specific incidence rates confirmed the declining trend for regional cancer, whereas there was an increase in the incidence of localized cancer, associated with a period effect in 1975-95. This is attributed to the policy of early detection of stomach cancer, with the inclusion of intramucosal lesions of favorable prognosis and explains why mortality decreased faster than incidence during the period.     

High Mortality Rate of Stomach Cancer Caused Not by High Incidence but Delays in Diagnosis in Aomori Prefecture,Japan

Background: There are substantial differences in the mortality rates of stomach cancer among the 47 prefectures in Japan, and Aomori prefecture is one of the most severely impacted. The aims of this study were to determine the incidence and mortality rates of stomach cancer in Aomori prefecture in comparison with Japan as a whole and cast light on reasons underlying variation. Methods: Data on stomach cancer cases were extracted from the Aomori Cancer Registry Database. Incidence rates for specific stages at the time of diagnosis were cited from Monitoring of Cancer Incidence in Japan, and mortality rates for stomach cancer in Aomori prefecture and the whole of Japan were obtained from Vital Statistics. Age-standardised incidence and mortality rates were calculated using the direct method. Results: The age-standardised incidence rate of stomach cancer in Aomori prefecture was higher than in the whole of Japan for males but lower for females. However, the age-standardised mortality rates were higher in Aomori prefecture in both sexes. The proportion of localised cancers was lower in Aomori prefecture than in the whole of Japan for most age groups. Conclusions: The lower rate for localised cancer suggests that higher age-standardised mortality rates are due to delays in diagnosis, despite an attendance rate for stomach cancer screening was higher in Aomori prefecture than in the whole of Japan. One plausible explanation for the failure of successful early detection might be poor quality control during screening implementation that impedes early detection.     

Estimation and projections of stomach cancer trends in Italy

Mortality data from official sources, and survival data from population-based cancer registries, are used for the estimation of incidence and prevalence of stomach cancer. Time trends of morbidity, survival, and mortality during the period 1970–90 are presented and analyzed. Incidence rates were decreasing during the considered period, but the rate of decrease was slowing down during the last decade. Almost stable rates, and even slightly increasing for women, were estimated for the youngest cohorts. Relative survival for stomach cancer was higher for women and for young ages; it was associated positively with period of diagnosis, and presented a significant South-North geographic gradient. Prevalence was estimated as decreasing during the period 1970–80, but increasing during the successive decade, due to both better survival and population aging. Projection of stomach cancer morbidity and mortality to the year 2000 showed that the disease should still be considered in Italy as a major public health problem.This work was partially supported by the National Research Council (CNR), Progetto Finalizzato Oncologia (CNR.94.01254.PF39).     

Epidemiology of breast cancer in Japan

The mortality and incidence of breast cancer are high in Western industrialized countries and relatively low in developing countries in Asia and other parts of the world. In Japan the mortality of breast cancer has gradually been increasing, but is still much lower compared with those of Western countries. Within Japan the mortality of breast caner is higher in urban areas than in non-urban areas. The future estimation of cancer incidence in Japan predicts that breast cancer will become a leading cancer in the near future. From the present review of epidemiology of breast cancer it is recommended that excess intake of fat and calories, especially of animal fat, be avoided.     

Descriptive epidemiology of cancers in children

According to the Vital Statistics of Japan, the age-adjusted mortality rate for cancers in children has decreased almost 0.7 times between 1969 and 1986. The decrease was pronounced in cancers of the ovary, testis, stomach, nose & ear and leukemia, and in the age group under 5. Rises in the mean age at death were also observed. From international comparison, Japanese children had a relatively low mortality rate for cancers except leukemia. The international comparison of cancer of incidence suggested that some of risk factors for adult cancers were also involved in the etiology of cancers in children.     

Comparison of laryngeal cancer mortality in five countries: France, Italy, Japan, UK and USA from the WHO mortality database (1960-2000)

Laryngeal cancer mortality age-standardized rates (ASRs), using1985 Japanese standard population, are shown for Japan, USA,UK, France and Italy (Fig. 1). In all of the countries, maleshave higher ASRs compared with females. For males, ASRs havebeen decreasing since 1970s in Japan and France. ASRs in theother countries have     

Trends of stomach cancer mortality in Eastern Asia in 1950-2004: comparative study of Japan, Hong Kong and Singapore using age, period and cohort analysis

To characterize the temporal trends of stomach cancer mortality in Eastern Asia and to better interpret the causes of the trends, we performed age, period and cohort analysis (APC analysis) on the mortality rates in Japan, Hong Kong and Singapore during 1950-2004, as well as the rates in the US as a control population. For the APC analysis, Holford's approach was used to avoid the identification problem. Age-standardized mortality rates (ASMR) decreased consistently in all four areas during the observation period in both males and females. Japan had the highest ASMR in both sexes, followed by Singapore, Hong Kong and the US, but the differences in ASMR among the four areas diminished with time. The results of APC analysis suggested that the decreasing mortality rates in Eastern Asia were caused by the combination of decreasing cohort effect since the end of the 1800s and decreasing period effect from the 1950s. The US showed similar results, but its decreases in the period and cohort effect preceded those of Eastern Asia. Possible causes for the decrease in the cohort effect include improvement in the socioeconomic conditions during childhood and a decrease in the prevalence of H. pylori infection, while possible causes for the decrease in the period effect include a decrease in dietary salt intake and improvements in cancer detection and treatment. These findings may help us to predict future changes in the mortality rates of stomach cancer.     

Trends in mortality from cancers of the breast, colon, prostate, esophagus, and stomach in East Asia: role of nutrition transition

Although substantial nutrition transition, characterized by an increased intake of energy, animal fat, and red meats, has occurred during the last several decades in East Asia, few studies have systematically evaluated temporal trends in cancer incidence or mortality among populations in this area. Therefore, we sought to investigate this question with tremendous public health implications. Data on mortality rates of cancers of the breast, colon, prostate, esophagus, and stomach for China (1988-2000), Hong Kong (1960-2006), Japan (1950-2006), Korea (1985-2006), and Singapore (1963-2006) were obtained from WHO. Joinpoint regression was used to investigate trends in mortality of these cancers. A remarkable increase in mortality rates of breast, colon, and prostate cancers and a precipitous decrease in those of esophageal and stomach cancers have been observed in selected countries (except breast cancer in Hong Kong) during the study periods. For example, the annual percentage increase in breast cancer mortality was 5.5% (95% confidence interval: 3.8, 7.3%) for the period 1985-1993 in Korea, and mortality rates for prostate cancer significantly increased by 3.2% (95% confidence interval: 3.0, 3.3%) per year from 1958 to 1993 in Japan. These changes in cancer mortality lagged ～ 10 years behind the inception of the nutrition transition toward a westernized diet in selected countries or regions. There have been striking changes in mortality rates of breast, colon, prostate, esophageal, and stomach cancers in East Asia during the last several decades, which may be at least in part attributable to the concurrent nutrition transition.     

Pathology of breast cancer: Present and prospect in Japan

Breast cancer among Japanese females is characterized by its relatively low incidence and better prognosis than among Caucasian females. The annual mortality due to breast cancer among Japanese is about one-fifth that among Caucasians. Comparison of case distribution by histological type indicates that the ratio of well-differentiated carcinoma is slightly higher among Japanese, while the ratio of poorly differentiated carcinoma is slightly higher among Caucasian females. It is noteworthy that the incidence ofin situ and invasive lobular carcinoma among Japanese is much lower than among Caucasian females. The age distribution shows that breast cancer is more frequent among middle-aged females in Japan, but more common among aged females in the West. Breast cancer among Japanese females shows a better prognosis than among Caucasian females as a whole, even with equal tumor size and lymph node metastasis. As mentioned above, the morbidity and mortality rates of breast cancer among Japanese females are very low, but recently, both morbidity and mortality rates in Japan have been steeply increasing. For example, the mortality rate of breast cancer in Japan almost doubled during the past 20 years. Moreover, biological behavior of breast cancer among Japanese females has been recently changing. Time-trend data clearly indicate that breast cancer in Japan in the future will be much more like that in the West, and nowadays it is already westernizing.     

Breast cancer risk assessment for possible tailored screening for Japanese women

Accurate risk assessment for individual women is essential for effective screening of breast cancer (BC) in Japan, because the incidence of BC is still lower than in Western countries. We investigated various new risk factors of BC by means of case control studies and found that serum estrone and adiponectine levels as well as mammographic breast density were significantly correlated to BC risk. Combining these new factors and conventional risk factors of BC may result in a new and useful risk assessment tool, may improve the cost-effectiveness of screening, and may enable us to reduce the BC mortality of Japanese women.     

Relationship between westernization of dietary habits and mortality from breast and ovarian cancers in Japan

To clarify the relationship between the westernization of dietary habits and the changes of mortality from breast and ovarian cancers in Japan, correlation analyses were performed using data from the Vital Statistics and National Nutritional Survey Reports. With increasing population size of the areas, the age-adjusted death rates (AADRs) for both types of cancer increased together with the per capita intakes of fat, animal protein and western-style foods such as butter & margarine, cheese, ham & sausage and dairy products. The association of the AADRs with the population size was strong after the age group of 45-54 years in breast cancer, and became stronger as the age increased in ovarian cancer. The association of the AADRs with western-style foods was also observed in the correlation analyses among the 12 geographical districts in Japan. From chronological correlation analyses, the correlation coefficients for some nutrients and foods in breast cancer were highest when the "time-lag" between the foods/nutrients intake and the cancer mortality was assumed to be around 10 years. The results of the present study suggest that an increase of western-style fat-rich foods such as butter & margarine, cheese, bread and ham & sausage among Japanese might be associated with the recent increase of AADRs for breast cancer and ovarian cancers in Japan.     

Cancer mortality among japanese residents of the city of säo paulo,Brazil

Death certificates of Japanese residents of the city of S?o Paulo, Brazil from 1979 to 1981 were analyzed for cancer deaths by means of the standardized mortality ratio (SMR) and the standardized proportional mortality ratio (SPMR). Compared with residents of Japan, a significantly higher SMR value was obtained from Japan-born residents of S?o Paulo for prostate cancer, whereas lower values were obtained for cancer of the liver and gall-bladder in both sexes, of the esophagus and rectum in males, and of the lung in females. SMR values were higher for cancer of the stomach in both sexes but lower for those of the esophagus and prostate in males and of the gall-bladder and breast in females, when compared with the general population of S?o Paulo. Among Japan- and Brazil-born residents, stomach cancer in women revealed a significant stepwise decrease by generation when SPMR was used as an indicator. The high proportion of stomach cancer in males, however, was as high among the Brazil-born generation as in Japan. The SPMR of liver cancer decreased to the low level of the general population of S?o Paulo, even among the first generation. These changes in cancer patterns are discussed in relation to those among Japanese residents in the United States.     

The beginning of the end of the lung cancer epidemic in Dutch women?

In some European countries, female lung cancer mortality and incidence have started to decrease or flatten out, whereas they are still rising in The Netherlands. We present recent mortality and incidence trends of lung cancer and smoking trends in The Netherlands to show the end of the lung cancer epidemic in Dutch women. Lung cancer mortality and incidence rates by gender were analyzed for 4 age groups (20-44, 45-49, 50-54 and 55-59), and smoking prevalence rates were examined for women using joinpoint regression and birth cohort analysis. Data on mortality were collected for the period 1960-2006, incidence for the period 1989-2003 and smoking prevalence for the period 1988-2007. Because of decreasing lung cancer mortality and incidence rates among males and dramatically increasing rates among females, rates of young males were surpassed by those of females after the mid-1990s. However, although in young women (20-49) mortality increased with 4-5% per year, it flattened out (no significant in- or decreases) since 1999. Among older women, mortality rates were still increasing markedly. Mortality rates and smoking prevalence tended to decrease in women born after the 1950s. This is the first report suggesting that the lung cancer epidemic in Dutch women is coming to an end. Although the increase in lung cancer incidence and mortality among Dutch women has been one of the most dramatic in Europe, the recent decrease in young women is expected to be followed by a future leveling off or a slight decrease in overall female lung cancer rates.     

Eating habits and colorectal cancer

In order to investigate the relation between the occurrence of colorectal cancer and food consumption in Hokkaido, Japan, etiological factors of colorectal cancer were investigated through an ecologic study using official food consumption and mortality statistics concerning colorectal cancer, and through a community-based case-control study. The ratio of 'animal foods' to 'plant foods' and that of 'animal protein' to 'plant protein' had a significant correlation with the mortality rate in colorectal cancer. The percentage of fat energy was much more contributory than the absolute amount of fat. Traditional Japanese foods tended to prevent while Western foods tended to promote colorectal cancer. Odds ratios for Japanese foods were low for colon cancer, and those for Western foods were high for rectum cancer. Relative amounts of foods are more contributory than their absolute amounts. An increase of colorectal cancer in Japanese people may be attributable to the increase in the relative amounts of Western foods. Reduction of the ratio of animal foods to plant foods (i.e., a reduction in relative amounts of Western foods or an increase in relative amounts of Japanese foods) may lend to the prevention of colorectal cancer.     

发达与发展中国家癌症发病率与死亡率的比较与分析

  目的  分析发达国家与发展中国家的常见癌症发病情况与死亡率, 并将中国的癌症现状与之比较, 明确我国面临的主要癌症负担类型。  方法  各国家常见肿瘤的发病人数、发病率、死亡率及世界标化发病率等数据均来源于GLOBOCAN 2008。  结果  发达国家和发展中国家的恶性肿瘤发病第1位均是肺癌, 其次发达国家为结直肠癌、乳腺癌、前列腺癌, 发展中国家的胃癌、乳腺癌和肝癌; 发达国家死亡率最高的分别依次为肺癌、结直肠癌、乳腺癌、前列腺癌, 发展中国家为肺癌、肝癌、胃癌、食管癌。中国的肺癌发病率和死亡率均居第1位, 胃癌、肝癌发病及死亡率均高于发展中国家和发达国家, 乳腺癌的死亡率远低于发达国家亦低于其他发展中国家。预计到2020年, 中国新增发病和死亡人数最多的癌症是肺癌、胃癌和肝癌。  结论  不同国家的癌谱不同, 中国癌谱具有发达国家和发展中国家的双重特征。肺癌、胃癌及肝癌是威胁我国居民健康的主要恶性肿瘤, 并且未来十几年其增长速度较快, 是我国恶性肿瘤防控的重点。