Religion and reduced cancer risk – What is the explanation? A review

Several studies of members of Christian religious communities have shown significantly lower risks for certain cancers amongst members than in the general population. We identified 17 epidemiological studies of the risk for cancer amongst members of Christian communities published during the past 40 years. In the studies in which adjustment was made only for age and sex, reductions were observed in the risks for lifestyle-associated cancers, i.e. those associated with tobacco smoking, alcohol consumption, diet, physical activity and reproductive factors. In the studies in which adjustment was also made for healthy habits, no reduction in risk for cancer was observed. We conclude that the most important factor in the correlation between membership in a religious Christian community and risk for cancer is the healthy lifestyle inherent in religious practice in these communities. The epidemiological studies reviewed did not, however, differentiate the effect on cancer risk of the meaning that a certain lifestyle can give to an individual.     

Increased incidence of tongue cancer after primary radiotherapy for nasopharyngeal carcinoma—the possibility of radiation carcinogenesis

The aim of this study was to define the risk of tongue and other aerodigestive tract cancers developing after primary radiation therapy for nasopharyngeal carcinoma (NPC). A cohort of 903 patients with non-disseminated NPC given radical radiotherapy between 1984 and 1989 was studied for the incidence of tongue cancer and other malignancies during follow-up. A contemporary cohort of 87 patients with tongue cancer, without a history of NPC, was studied for demographic data, cigarette smoking and alcohol consumption habits. These were then compared with all the NPC patients and with the NPC patients who later developed tongue cancers. There was a significantly increased number of tongue cancers following radiotherapy for NPC. The risk of developing tongue cancer after radiotherapy for NPC was 0.13% per patient per year. There was no increase in the number of other malignancies. The association between NPC and tongue cancer was that of a non-random temporal sequence with tongue cancers following NPC but not in the reverse order. The demographic data and smoking and alcohol consumption history of the 7 NPC patients who subsequently developed tongue cancer were significantly different from the de novo tongue cancer patient population. The absence of common aetiological factors between NPC and tongue cancer and the non-random sequence of tongue cancers occurring after NPC suggests that these seven tongue cancers could be radiation induced. The estimated radiation dose received by the part of the tongue developing cancer was substantial and significantly higher than the dose to the cancer-free tongue. An increase of tongue cancers after radiotherapy for NPC is reported and arguments are made in support of the hypothesis that these were radiation-induced malignancies. We suggest a decrease in the volume of tongue included within the planning target volume of NPC in the absence of oropharyngeal and/or parapharyngeal infiltration. Awareness of the association should make early diagnosis of this likely radiation-induced cancer possible.     

Celebremos La Salud! A Community Randomized Trial of Cancer Prevention (United States)

Background Compared to non-Hispanic whites, Hispanics in the United States are at higher risk for certain types of cancer. Methods In a randomized controlled trial of 20 communities, we examined whether a comprehensive intervention influenced cancer screening behaviors and lifestyle practices in rural communities in Eastern Washington State. Cross-sectional surveys at baseline and post-intervention included interviews with a random sample of approximately 100 households per community. The interview included questions on ever use and recent use of Pap test, mammogram, and fecal occult blood test (FOBT) and sigmoidoscopy/colonoscopy, fruit and vegetable consumption and smoking practices. Results We found few significant changes in use of screening services for cervical (Pap test), breast (mammogram) or colorectal cancer (fecal occult blood test (FOBT) or sigmoidoscopy/colonoscopy) between intervention and control communities. We found no significant differences in fruit and vegetable consumption nor in smoking prevalence between the two groups. We found more awareness of and participation in intervention activities in the treatment communities than the control communities. Conclusions Our null findings might be attributable to the low dose of the intervention, a cohort effect, or contamination of the effect in non-intervention communities. Further research to identify effective strategies to improve cancer prevention lifestyle behaviors and screening practices are needed.     

Some observations on the epidemiology of cancer of the breast in women of Western india

The incidence rate for cancer of the breast is comparatively low in India. Cancer of the cervix is more common than cancer of the breast amongst Indian women. Wide variations in the frequency of cancer of the breast have been observed amongst the religious communities of Western India. Compared to other communities, Sindhis (Hindus from Sind) and Parsis (Zoroastrians) have a higher frequency rate for cancer of the breast. It was felt that the prevalence of certain suspected factors may be partly responsible for such variations. Case control studies demonstrated that the role of certain “high risk factors”, especially those related to marriage and pregnancy, could be different in different age groups, and an intensive search for more factors and their significance in different populations and age groups is necessary. The factor or factors which can be used effectively for a public health programme for the prevention of this disease are yet to be demonstrated.     

Reducing Cancer Risk in Rural Communities Through Supermarket Interventions

Cancer risk is high, and prevention efforts are often minimal in rural communities. Feasible means of encouraging lifestyles that will reduce cancer risk for residents of rural communities are needed. This project developed and tested a model that could be feasibly adopted by rural communities to reduce cancer risk. This model focuses on incorporating multi-faceted cancer risk education in the local supermarket. As the supermarket functions both as the primary food source and an information source in small rural communities, the supermarket focus encourages the development of a community environment supportive of lifestyles that should reduce residents’ risk for cancer. The actions taken to implement the model and the challenges that communities would have in implementing the model are identified.     

Suspension of the tongue to the digastric tendon following resection of the anterior mandibular arch for oral cancer prevents postoperative tongue fall and avoids the need for tracheostomy

Background: Resection of the anterior arch of the mandible leads to tongue fall and postoperative stridor because of the detachment of tongue musculature from the mandible. In this article, a simple method of tongue suspension is described which would prevent such complications and the need for tracheostomy. Settings and Design: This study was carried out on patients with oral cancer requiring resection of the anterior arch of the mandible as a part of the surgical resection at a tertiary centre. Materials and Methods: This study was performed on 32 patients with oral cancer requiring resection of the anterior arch of the mandible as a part of the surgical resection. Following an appropriate resection of the oral cancer (including the anterior mandibular arch) and neck dissection, a silk suture is used to loop the tongue musculature on either side to the intermediate tendon of the digastric muscle. Result: This technique of tongue suspension was used in 32 patients who required resection of the anterior mandibular arch for oral cancer. Prophylactic tracheostomy was not performed. One patient developed stridor at extubation and required temporary tracheostomy. All other patients could be successfully extubated within 12 h of surgery and none experienced postoperative stridor or sleep apnea. One other patient required temporary tracheostomy for pulmonary toilet as he developed aspiration pneumonitis related to nasogastric feed. Conclusion: This simple method of tongue suspension to the digastric tendon prevents postoperative tongue fall and obviates the need for tracheostomy in most instances.     

Profile and Survival of Tongue Cancer Patients in “Dharmais” Cancer Hospital,Jakarta

Background: Tongue cancer is still a major health problem in most developing countries around the world.Statistics shown the number of tongue cancers, especially in early age, to be increasing, with poor survival.Objective: To analyze the characteristic profile of tongue cancer patients in Indonesia as well as the survivalrate. Materials and Methods: A cross sectional study was conducted in Dharmais National Cancer Hospitalby collecting general, clinical, and survival data of tongue cancer patients from medical records for January2009 to April 2012. Results: Tongue cancer incidence increased year by year. The average age of tongue cancerpatients was 47.5 years, and males predominated, accounting for 64.5% of cases. Most patients presented at anadvanced stage (69.6%). The histopathology type was squamous cell carcinoma in the vast majoriy (96.8%).The therapies applied were surgery (45.6%), radiation (63.6%) and chemotherapy (57.6%). The survival rateafter one year is 60.6% and after two years was 12.1%. In addition, median survival of tongue cancer patientswas 20 months (95% confidence interval 9.07-30.9). The significant factor affecting survival was size of tumorwith a hazard ratio of 3.18 (95% CI, 1.02-9.93; p 0.046) for largest versus smallest categories. Conclusions: Ineach year, the number of tongue cancer incidents in Indonesia is increasing. The age of tongue cancer patientsin Indonesia is younger compared to other countries. Moreover, the survival rates are not high.     

Community- Based Approaches to Cancer Prevention in Rural Thailand Based on Experiences of Accredited Health Professionals

This qualitative research aimed to describe important components of community based approaches of cancer prevention from working experiences of accredited health professionals in Thai rural communities. Methods: Data were collected from 23 communities with 23 accredited health professionals as key participants using in-depth interview and focus group discussions (FGDs) in each community. Other informants were community leaders, community health volunteers and community people. Content analysis was applied for data analysis. Results: Community based approaches for cancer prevention from the experiences of accredited health professionals were composed of 2 themes: approaches for community-based cancer prevention and methods for cancer-based prevention in the community. The approaches for community-based cancer prevention was composed of 4 components: 1) primary prevention focusing on health education; 2) secondary prevention include: life style modification, vaccination, advocacy of cancer screening, early detection, and prompt refer; 3) tertiary prevention focusing on primary care, and 4) research collaboration focusing on net working.  Methods for cancer-based prevention in the community were different based on types of cancer.  The 3 factors determined to be associated with community based approaches for cancer prevention were: 1) primary care policy; 2) hometown workplace; and 3) health practice skill. Conclusion: Community based approaches for cancer prevention should concentrate on building a literate community involvement to empower both health care providers and residents. From our evidence, dedicated community associates health professionals have a major role to play.     

Differential survival trends for patients with tonsillar, base of tongue and tongue cancer in Sweden

Tonsillar, base of tongue and tongue cancer have similar anatomical and histopathological appearances but present differences in prognosis. Human papillomavirus (HPV) is a known risk factor for tonsillar and base of tongue cancer, and a survival benefit has been shown for these tumors; however, HPV prevalence in tongue cancer is low. Tonsillar, base of tongue and tongue cancer patients registered in the Swedish Cancer Registry between 1960 and 2004 were followed from the date of cancer diagnosis until death, emigration out of Sweden, or the end of a follow-up (5 years since cancer diagnosis), whichever occurred first. The relative survival rate was computed as the ratio of the observed to the expected survival rate, in which the latter was inferred from the survival of the entire Swedish population in the same age, sex and calendar year stratum. The relative survival rate has improved significantly over time for patients with tonsillar and base of tongue cancer although delineated by different patterns. However, the relative survival rate in tongue cancer patients exhibited only a very modest improvement during the same time period. Contrary to the overall improved survival for patients with tonsillar and base of tongue cancer, the patients with tongue cancer show a very modest improvement in Sweden since 1960. Further studies are warranted to elucidate more effective treatment options for tongue cancer patients.     

Associations between cancer incidence and alcohol/cigarette consumption among five ethnic groups in Hawaii.

The average annual age-adjusted incidence rates of cancer for 15 sites were determined for 10 ethnic-sex groups in Hawaii. Consumption rates for cigarettes, beer, wine and hard liquor were also determined for the same 10 groups based on personal interview of a sample of 9920 individuals. Covariance analysis was used to adjust each exposure variable for the other three, and the cancer incidence rates were then linearly regressed on these covariance-adjusted consumption rates. Statistically significant regression coefficients were found for cancer of the tongue/mouth, pharynx, larynx, pancreas, lung, kidney and bladder regressed on cigarette consumption. Eight cancer sites, including tongue/mouth, pharynx, larynx, oesophagus, stomach, pancreas, lung and kidney, had significant positive regression coefficients for beer consumption which could not be explained by outlying values on the scattergram. Significant associations were also suggested between wine consumption and pharyngeal cancer and between hard-liquor consumption and pharyngeal, laryngeal and possibly brain cancer. No association was found between beer consumption and colorectal cancer. Multiple regression analysis with sex, cigarettes and alcoholic beverage as independent variables consistently found sex to be least important in determining cancer risk. This study supports the hypothesis that beer consumption may play a role in cancer risk for several sites. It is suggested that future studies of alcoholic beverages and cancer should examine not only types of alcoholic beverages, but individual brands of each type in an attempt to identify cancer risk due to carcinogens in only certain brands.     

Trends of Head and Neck Cancers in Urban and Rural India

Background:The sub-site predilection of head and neck squamous cell carcinoma (HNSCC) reflects the risk ‍profile of a community and there are suggestions that these are changing over time. Objective: To determine the ‍change in head and neck cancer in rural and urban populations in India. Methods: Cancer registry data of an urban ‍and a rural population were reviewed over a period of 13 and 11 years, respectively. Age adjusted rates (AAR) and ‍age specific incidence rates were used for data analysis. Results: Oral cancers formed the majority of the head and ‍neck cancers with a predilection for tongue, except in rural males, in whom the pharynx was the predominant subsite. ‍Overall there was a reduction in the incidence of HNSCC, which was more pronounced in urban females and ‍rural males (p< .001). Among the sub-sites, oral cavity cancers showed a decreasing trend in urban females (p< .01) ‍and rural males (p< .01). However, the trend was towards increase of incidence of tongue cancers. Pharyngeal ‍cancer showed reduction in urban females (p< .01), whereas it increased in rural females. The recent increase in ‍incidence of young adults with HNSCC reported in developed countries was not observed. Conclusions: Overall, ‍incidence of HNSCC is reducing. This may be attributed to the decreased prevalence of tobacco use.The increase in ‍incidence of tongue cancer may suggest factors other than tobacco and alcohol in its genesis.     

Prostate Cancer Ambassadors: Enhancing a Theory-Informed Training Program for Informed Decision-Making

Despite the high burden of prostate cancer in African American communities, there is a paucity of knowledge about prostate health. This paper describes the enhancement of a curriculum for training lay health advisors, called prostate cancer ambassadors, on informed decision-making for prostate cancer screening. Adult learning theory informed the structuring of the training sessions to be interactive, self-directed, and engaging. Trainings were developed in a manner that made the material relevant to the learners and encouraged co-learning. The research team developed strategies, such as using discussions and interactive activities, to help community members weigh the pros and cons of prostate-specific antigen (PSA) screening and to make an informed decision about screening. Furthermore, activities were developed to bolster four social cognitive theory constructs: observational learning, self-efficacy for presenting information to the community and for making an informed decision themselves, collective efficacy for presenting information to the community, and outcome expectations from those presentations. Games, discussions, and debates were included to make learning fun and encourage discovery. Practice sessions and team-building activities were designed to build self-efficacy for sharing information about informed decision-making. Topics added to the original curriculum included updates on prostate cancer screening, informed decision-making for screening, skills for being a lay health advisor, and ethics. This dynamic model and approach to lay health advisor (ambassador) training is flexible: while it was tailored for use with prostate cancer education, it can be adjusted for use with other types of cancer and even other diseases.     

Enhancing life after cancer in diverse communities

BACKGROUND:

Although large numbers of cancer survivors exist in every community, including minority communities, there is a significant gap in knowledge about best practices for these patients.

METHODS:

The Community Networks Program, funded by the National Cancer Institute Center to Reduce Cancer Health Disparities, has developed and tested unique services for these communities. These programs have used community‐based participatory research techniques under a framework of diffusion of innovation and communications theory.

RESULTS:

This article describes some specifically tailored interventions that may be useful to a wide range of providers working with the underserved.

CONCLUSIONS:

Enhancing life after cancer can be achieved in underserved communities by supplementing local resources. Cancer 2012. © 2012 American Cancer Society.     

Results of surgical treatment of tongue cancer

Fourty-four patients with squamous cell carcinoma of the tongue have been treated by surgery. Twenty-two out of 44 patients were treated by a glossectomy alone and the remaining 22 by en bloc dissection with a glossectomy and neck dissection. The 5-year cumulative survival rate of these 44 cases was 86.1%, broken down as follows: stage I (20 cases), 100%; stage II (9 cases), 88.9%; stage III (11 cases), 72.7%; and, stage IV (4 cases), 50%. Four cases had a recurrence in the primary site, and 6 in the cervical region. Five out of 44 cases died (4 from tongue cancer, and one from other causes). Further, 3 out of 5 cases died of a recurrent cancer in the primary focus or in the neck. Thus, it has been concluded that control of the primary focus and neck metastasis is important for the treatment of tongue cancer, and that surgery also is an excellent therapy for tongue cancer.     

肿瘤社区综合防治示范点建设模式运行及效果研究

＂三位一体＂工作模式是上海市试点推行的一个新型慢性病综合防治项目。该项目拟通过联合疾病预防控制中心、社区卫生服务中心和二/三级医院三方面的力量,整合优势,为社区肿瘤患者提供优质的社区卫生服务,以期满足他们的需求,同时,对社区目标人群开展健康教育,提高社区居民对于恶性肿瘤＂三早＂的认识。文章对此项目的试点运行情况进行了系统介绍,并对运行成效及特点进行了总结。     

Cancer information and support needs of statutory and voluntary sector staff working with people from ethnically diverse communities

Cancer is difficult for people from ethnically diverse communities to cope with, because there is inequality in getting information and services to meet their needs for prevention, prompt diagnosis, treatment, care and support. Research with black minority ethnic (BME) communities indicates a lack of knowledge about cancer, and a desire for more information, yet research is highly equivocal with regard to health and social care workers' ability to provide this. The study described in this article aimed to identify the educational and support needs of health and social care workers from statutory and voluntary sectors, working with people affected by cancer in one London borough. Qualitative research methods of one-to-one interview and focus group discussion were used among 33 staff working in various community, organizational and professional settings. Two focus groups were held with cancer patients and carers to gain complementary understanding of their needs for support and information. Health and social care workers are challenged when providing cancer information and support to people from BME communities, even when the worker is of the same cultural background as the person affected by cancer. Interviewees considered that in most respects, the challenges for improving cancer care for people from BME communities are those common for all, and that the difficulty in providing and sustaining improved cancer information and support services to BME communities in their borough lies in poverty, low literacy and social exclusion as much as cultural difference.     

Human papillomavirus is more common in base of tongue than in mobile tongue cancer and is a favorable prognostic factor in base of tongue cancer patients

The frequency of human papilloma virus (HPV) and its influence on clinical outcome was analyzed retrospectively in pre-treatment paraffin embedded biopsies from 110 patients with tongue cancer. The presence of HPV DNA was examined in 85 mobile tongue tumors and 25 base of tongue tumors by a polymerase chain reaction (PCR) with 2 general primer pairs, GP5+/6+ and CPI/IIG. When HPV-DNA was found, HPV-type specific primers and direct sequencing were used for HPV sub-type verification. Twelve of 110 (10.9%) samples were HPV-positive; 9 for HPV-16, 1 for HPV-33, 1 for HPV-35 and 1 could not be analyzed because of shortage of DNA. HPV was significantly more common in base of tongue tumors (10/25, 40.0%) compared to tumors of the mobile tongue (2/85, 2.3%). The influence of HPV on clinical outcome in mobile tongue cancer could not be studied, due to that HPV was present in too few cases. Of the 19 patients with base of tongue cancer that were included in the survival analysis, however, 7 patients with HPV-positive base of tongue cancer had a significantly favorable 5-year survival rate compared to the 12 HPV-negative patients. In conclusion, HPV is significantly more common in base of tongue cancer than in mobile tongue cancer, and has a positive impact on disease-specific survival in patients with base of tongue cancer.     

Cancer in Indian Moslems

Moslems are the followers of Islam who, during the time of the Ghaznavid dynasty of Afghanistan, invaded India for the first time. Islam attaches equal importance to material and spiritual aspects of human life. Men and women have equal cultural rights. Marriage is positively enjoined and vigorously encouraged. Circumcision is compulsory before boys attain the age of 7. More than one wife (up to four) is permitted in Islamic Society. Differences in the habits, customs, and ethnic characteristics have all provided important leads for the study of cancer in this community. It is a sign of the times that some of the religious and social customs that were rigidly upheld by the older generations are rapidly giving way to "Modernism." Hence an attempt has been made to examine the differences found in the site-specific cancer risks in the Moslem community in Bombay. Analysis of the data was undertaken by sex- and age-adjusted and age-specific incidence rates. The common sites of cancer were found to vary greatly between the Moslem and non-Moslem populations of Greater Bombay. In Moslem men, the lung appears to be at highest risk, followed by the larynx, esophagus, tongue, and hypopharynx, whereas in non-Moslem men, the esophagus is the commonest site, followed by the lung, larynx, and tongue. In women, breast and cervix cancers, which rank first and second, respectively, in frequency in Moslems, reverse their positions in non-Moslem women.     

Views on clinical trial recruitment,biospecimen collection,and cancer research: population science from landscapes of the Haudenosaunee (People of the Longhouse)

Biomedical research in culturally distinct communities is often a challenge. Potential barriers to participation occur because science is presented in a format that lacks cultural acknowledgement. Investigations may also fail to showcase beneficial relevance to the communities or include them in true partnership. The history of biomedical research within Native American societies has been complicated by these issues. Historical trauma among many Native groups sometimes transcends into contemporary challenges in both recruitment to and participation particularly in biobanking research. The participants for this study included members of the Haudenosaunee, the People of the Longhouse. Native Americans, including the Haudenosaunee, endure some of the worst health disparities in the country. These include high rates of cancer, obesity, and diabetes which may be linked at least partially to genetic predisposition. Results from a Haudenosaunee urban population shared response on ways to improve recruitment strategies for biospecimen, cancer, and other health-related clinical trials. Mixed methods approaches were used, and community responses indicated the importance of creating trust through respectful partnership; promoting culturally appropriate recruitment materials; the need for a greater understanding of consenting and signature processes; the necessity for concise summary sheets; and a desire to have information that community member understand. Discussion items also include international Indigenous perspectives to biobanking and genetic-related health disparity research.