Diet and stomach cancer risk in Warsaw, Poland

Some of the world's highest rates of stomach cancer are found in Poland. Reasons for the increased incidence are not known, but high intake of sausages and other preserved foods and low intake of fresh fruits and vegetables may be involved. A case-control study comprising residents newly diagnosed with stomach cancer during 1994-96 and controls randomly selected from the general population was conducted in Warsaw, Poland. Standardized interviews were conducted to ascertain usual consumption of 118 common foods and beverages and other exposures. Using data from direct interviews with 274 cases and 463 controls, odds ratios of stomach cancer were calculated as estimates of risks associated with dietary factors, adjusting for age, sex, education, smoking, and caloric intake. Risk of stomach cancer was inversely related to intake of total fruits and dark green-yellow vegetables and to indices of vitamins C and E and alpha- and beta-carotenes. However, risk was not significantly increased among those with high intake of pickled/salted vegetables and sausages. Risks were positively associated with increased intake of breads/cereals/rice/pasta and other refined grains, as well as a high carbohydrate index. Our findings add to the evidence of a protective effect of fruits and certain vegetables on stomach cancer risk, but do not indicate that high intake of sausage and other preserved foods typical in the Polish diet has contributed to the country's elevated stomach cancer incidence. Our data also suggest that high carbohydrate consumption may influence risk, but further confirmation is needed.     

High prevalence of antibodies to Legionella spp. in Danish blood donors. A study in areas with high and average incidence of Legionnaires' disease

The incidence of Legionnaires' disease has an uneven geographical distribution in Denmark, ranging from 3 to 70 notified cases per million inhabitants per year in different towns. We investigated the prevalence of antibodies to Legionella in the one town with a consistently high incidence (Randers, Aarhus County) and compared it with that of an area of average incidence (Vejle, Vejle County). Blood samples were collected from healthy blood donors in Randers (n=308) and in Vejle (n=400), and analysed for antibodies to Legionella by indirect immunofluorescence antibody test with L. pneumophila, L. micdadei, and L. bozemanii as antigens. Overall 22.9% of the donors had antibody titres of > or = 1:128; indicating that antibodies to Legionella are common in healthy individuals, and reflecting that the bacteria may be widely distributed in the environment. Surprisingly, the study did not reveal a higher prevalence in the hyperendemic area. Thus, the high incidence of notified cases in this particular town may not be attributed to an overall increased exposure of the general population.     

Thyroid cancer: incidence, mortality and histological pattern in Denmark

In Denmark, as in many other countries, the incidence of thyroid cancer is increasing, while mortality from this disease is decreasing. The proportionate distribution of cell types is similar to that seen elsewhere. The increase in incidence in other countries has been attributed to the increased use of radiation for benign conditions of the head and neck. This cannot explain the increase in incidence in Denmark, and other factors may contribute importantly to the changing picture of thyroid cancer.     

Cancer risk among Danish and Italian farmers.

Cancer risk for farmers in Denmark and Italy was studied by linking occupational census data with incidence of cancer in Denmark and with cancer mortality in Italy. Farmers in the two countries had a consistent risk reduction for cancer of the lung, bladder, small intestine, colon, rectum, and prostate. No excess of stomach cancer was found among farmers in the two countries, which is in agreement with the most recent data from other surveys. The risk of oesophageal cancer was reduced among the Danish and increased among the Italian male farmers. This can probably be explained by differences in alcohol consumption between the Danish and Italian farmers compared with the general population. The risk of brain cancer was significantly reduced among Italian farmers. There was a significant risk reduction for Hodgkin's disease and no excess for non-Hodgkin's lymphoma in Denmark, whereas in Italy a statistically significant excess risk was found for the first and a slight excess risk for the second of these diseases. The per capita consumption of phenoxy-herbicides between 1950 and 1970 was lower in Italy than in Denmark but treatments were performed mainly by professional applicators in Denmark and by the farmers themselves in Italy. Risk of leukaemia among Italian female farmers was increased. In Denmark, this increase was limited to women who were themselves owners of a farm. Specific occupations in agriculture showing a high risk for cancers of the lymphopoietic system in Denmark mostly entailed contact with animals.     

Cancer risk among Danish and Italian farmers.

Cancer risk for farmers in Denmark and Italy was studied by linking occupational census data with incidence of cancer in Denmark and with cancer mortality in Italy. Farmers in the two countries had a consistent risk reduction for cancer of the lung, bladder, small intestine, colon, rectum, and prostate. No excess of stomach cancer was found among farmers in the two countries, which is in agreement with the most recent data from other surveys. The risk of oesophageal cancer was reduced among the Danish and increased among the Italian male farmers. This can probably be explained by differences in alcohol consumption between the Danish and Italian farmers compared with the general population. The risk of brain cancer was significantly reduced among Italian farmers. There was a significant risk reduction for Hodgkin's disease and no excess for non-Hodgkin's lymphoma in Denmark, whereas in Italy a statistically significant excess risk was found for the first and a slight excess risk for the second of these diseases. The per capita consumption of phenoxy-herbicides between 1950 and 1970 was lower in Italy than in Denmark but treatments were performed mainly by professional applicators in Denmark and by the farmers themselves in Italy. Risk of leukaemia among Italian female farmers was increased. In Denmark, this increase was limited to women who were themselves owners of a farm. Specific occupations in agriculture showing a high risk for cancers of the lymphopoietic system in Denmark mostly entailed contact with animals.     

Stomach cancer incidence in Brazil: an ecologic study with selected risk factors

Contrary to many industrialized countries in which a sharp decline in stomach cancer incidence has been observed, Brazil still shows intermediate to high incidence rates. An ecologic analysis was performed to explore variables possibly associated with the development of stomach cancer. Cluster analysis, principal component analysis, and factor analysis were carried out with population data, including the following: stomach cancer incidence rates in the early 1990s obtained from population-based cancer registries in Porto Alegre, Campinas, Fortaleza, Belém, and Goiania; and data from a Brazilian national survey on family expenditures (several diet consumption items and availability of home refrigerators) carried out in 1974-75. The results suggested that past availability of a home refrigerator, i.e. food preservation, may have played an important role in currently observed differences in stomach cancer incidence among the various populations studied in Brazil. Differences in living standards among populations in these cities also appear to have played an important role in the observed incidence differences.     

Cervical cancer rates by population size of towns: Implications for cancer control programs

Incidence rates and standardized incidence ratios (SIRs) for invasive and in situ cervical cancers diagnosed in 1982–87 were analyzed according to total population size of 148 towns, using data from the population-based Connecticut Tumor Registry. Previous studies have not considered socioeconomic or sociodemographic variables in analyzing cervical cancer rates in urban-rural or population density groups. In multiple regression analyses, increases in SIRs for invasive and in situ cancers from medium-sized to large towns were explained by differences in poverty prevalence or other sociodemographic variables. Nevertheless, cancer screening programs (aimed at preventing invasive cancer through early detection) could be targeted to some extent on the basis of town size category, because larger towns include large numbers of poorer and minority women with higher rates of invasive cervical cancer. SIRs for in situ cancer were significantly elevated in the largest towns (100,000+ total population), and primary prevention programs could target these larger towns with a higher prevalence of poverty.Anthony P. Polednak is Senior Research Scientist; Dwight T. Janerich is Professor; both in the Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, CT 06510.John T. Flannery is Director, Connecticut Tumor Registry, Connecticut Department of Health Services, 150 Washington Street, Hartford, CT 06106This work was supported in part by a grant from the National Cancer Institute (CA-42101), as part of the Cancer Prevention Research Unit at the Yale School of Medicine.     

The relationship of cancer incidence to terrestrial radiation and population density in Connecticut, 1935-1974

The relationship of cancer incidence to terrestrial radiation and population density was investigated. Cancer incidence was obtained using 40 years of age-standardized data from the Connecticut Tumor Registry, and environmental radiation was estimated using data from an airborne gamma radiation survey of the entire state. These variables were examined ecologically, using the 169 towns of the state as the analytic units in a weighted regression analysis. The study design involves a large population base in a state having relatively high terrestrial radiation exposure levels overall and reasonable variation in exposure between towns. For all cancer combined, only one of the eight sex-specific analyses by decade yielded a significant radiation regression coefficient, and this was negative. In the sex- and site-specific analyses, almost all the coefficients for radiation were not significantly different from zero. In contrast, significant positive relationships of cancer incidence with population density were found for all cancer, for cancer of the lung for both sexes, for stomach, colonic, and prostatic cancer for males, and for lymphomas, thyroid, breast, and ovarian cancer for females. Both the radiation and population density relationships were adjusted for socioeconomic status. Socioeconomic status was significantly negatively associated with stomach and lung cancer in males and with cervical cancer in females; it was also positively associated with lymphomas and breast cancer in females. A power calculation revealed that, despite the relatively large size of this study, there was only a small probability of detecting a radiation effect of the strength anticipated from previous estimates.     

Environmental asbestos exposure and cancer mortality

From 1970 to 1980, mortality from cancer of the lung and stomach was analyzed in a town with asbestos deposits and in a town with asbestos processing. The populations of the entire country, the province, the district, and of all communities of the same size and agricultural index were used as references. In the town with asbestos contamination of air and water from natural tremolite deposits and an endemic occurrence of pleural plaques, no increased risk for lung or stomach cancer was found. In the town with asbestos cement production lung cancer rates were lower in males and higher in females, and stomach cancer rates were lower than expected. No significant differences could be attributed to environmental asbestos exposure.     

Associations between stomach cancer incidence and drinking water contamination with atrazine and nitrate in Ontario (Canada) agroecosystems, 1987-1991

BACKGROUND: Nitrate and atrazine are two chemicals that are heavily used in certain sectors of agriculture. They are suspected to be associated with the development of certain types of tumours. METHODS: Existing data were obtained on the incidence of specific types of cancers, contamination of drinking water with atrazine and nitrate, and related agricultural practices for the 40 ecodistricts in the province of Ontario. The data were merged into a georelational database for geographical and statistical analyses. Weighted (by population size) least squares regression analyses were conducted while controlling for confounding socioeconomic and lifestyle factors. Maximum likelihood spatial error models were estimated when least square regression error terms were found to be spatially autocorrelated using the Moran's I statistic. RESULTS: Atrazine contamination levels (range 50-649 ng/l, maximum acceptable concentration [MAC] = 60000 ng/l) were positively associated (P < 0.05) with stomach cancer incidence and negatively associated with colon cancer incidence. Nitrate levels, (range 0-91 mg/l, MAC = 10 mg/l) were negatively associated with stomach cancer incidence. CONCLUSION: The associations found at the ecodistrict level, both positive and negative, if confirmed by other studies, raise serious questions about maximum allowable limits for atrazine, as well as possibilities of complex trade-offs among disease outcomes, and interactions of biophysical and social mechanisms which might explain them. Although the negative associations appear to have no direct biological explanations, such counter-intuitive outcomes may occur in complex systems where social and biological variables interact.     

Diet and nutrition in cancer causation

Some 30 randomly selected men, aged 50–59 years, were in vestigated in each of 4 areas — Copenhagen, Them (rural Denmark), Helsinki, and Parikkala (rural Finland) — to determine the relationship of diet, gut transit time, fecal bulk, fecal bacteriology, bile acid concentration, and urinary volatile phenol production to large bowel cancer risk.

Average daily fat intake was found to be high in all 4 areas, and no differences emerged between areas. Saturated fatty acid consumption was higher in low‐incidence areas than in high‐incidence areas. Intakes of nonstarch polysaccharides (the main component of dietary fiber), carbohydrate, and protein (mainly milk) were higher in the low‐incidence area of Parikkala than in the high‐incidence area of Copenhagen. The fecal bile acid concentration was higher in the high‐incidence area than in the low‐incidence area, with the other 2 areas having intermediate values. Fecal bulk showed an inverse association with colorectal cancer incidence. No differences were observed with regard to fecal bacteriology or mutagenic activity of the foods.

These results indicate that a population can have a low risk of colorectal cancer despite a high intake of dietary fat, protein, and meat. Dietary carbohydrate and fiber may be considered protective. One mechanism limiting colorectal cancer risk could be the increase in fecal bulk resulting from such intakes, since increased fecal bulk dilutes the increased colonic bile acid concentrations of subjects on high‐fat diets.     

Socioeconomic group, occupation and incidence of breast cancer and genital cancer among women in Denmark

Most studies of occupational cancer have included only maleemployees. In Denmark more than 40% of the labour force havebeen women since the 1970s and a large proportion of Danishwomen may have had occupational exposures, including exposuresto carcinogens. In a register linkage study we investigatedcancer incidence in a cohort of 1.4 million women, categorizedby occupation in the 1970 census. Professionals, salaried employeesand unskilled workers all had a slightly increased overall cancerrisk. The risk of breast cancer was significantly increasedin several groups of professionals such as lawyers, medicaldoctors, dentists and physiotherapists, nurses and clerks, butin only 2 groups of blue-collar workers: skilled tobacco workersand bookbinders. Ovarian cancer incidence was significantlyelevated among clerks, while travelling saleswomen, furriers,hairdressers, nurses, and clerks had a significant excess ofuterine corpus cancer. Uterine cervix cancer was almost exclusivelyelevated in a variety of unskilled occupations. Women shouldbe included in studies of occupation and cancer. Although occupationalhazards cannot be excluded for some associations found in thisstudy, reproductive and lifestyle factors may also influencecancer risk and need to be considered in studies of occupationand cancer in women.     

Geographic Distribution of Liver and Stomach Cancers in Thailand in Relation to Estimated Dietary Intake of Nitrate,Nitrite, and Nitrosodimethylamine

It is our working hypothesis that the high rate of the liver and gastric cancers in North and Northeast Thailand is associated with increased daily dietary intake of nitrate, nitrite, and nitrosodimethylamine (NDMA). Samples of fresh and preserved Thai foods were systematically collected and analyzed from 1988 to 1996 and from 1998 to 2005. Consumption frequencies of various food items were determined on the basis of a dietary questionnaire given to 467 adults (212 males and 255 females) from 1998 to 2005. Food consumption data for the preceding and current year were collected and intakes (day, week, and month) of nitrate, nitrite, and NDMA were calculated. The trends in liver and stomach cancer age-standardized incidence rates (ASR) in four regions of Thailand were compared with the dietary intake of nitrate, nitrite, and NDMA in those same geographic regions. Mean daily intakes of nitrate of 155.7 mg/kg, of nitrite of 7.1 mg/kg, and of NDMA of 1.08 μ g/kg per day were found. Significant differences in dietary nitrate, nitrite, and NDMA intakes were seen between various Thai regions (P < 0.0001), and these corresponded to the variations in liver and stomach cancer ASR values between the regions. Dietary factors are likely to play key roles in different stages of liver and stomach carcinogenesis in Thailand.     

Geographic distribution of liver and stomach cancers in Thailand in relation to estimated dietary intake of nitrate, nitrite, and nitrosodimethylamine

It is our working hypothesis that the high rate of the liver and gastric cancers in North and Northeast Thailand is associated with increased daily dietary intake of nitrate, nitrite, and nitrosodimethylamine (NDMA). Samples of fresh and preserved Thai foods were systematically collected and analyzed from 1988 to 1996 and from 1998 to 2005. Consumption frequencies of various food items were determined on the basis of a dietary questionnaire given to 467 adults (212 males and 255 females) from 1998 to 2005. Food consumption data for the preceding and current year were collected and intakes (day, week, and month) of nitrate, nitrite, and NDMA were calculated. The trends in liver and stomach cancer age-standardized incidence rates (ASR) in four regions of Thailand were compared with the dietary intake of nitrate, nitrite, and NDMA in those same geographic regions. Mean daily intakes of nitrate of 155.7 mg/kg, of nitrite of 7.1 mg/kg, and of NDMA of 1.08 microg/kg per day were found. Significant differences in dietary nitrate, nitrite, and NDMA intakes were seen between various Thai regions (P < 0.0001), and these corresponded to the variations in liver and stomach cancer ASR values between the regions. Dietary factors are likely to play key roles in different stages of liver and stomach carcinogenesis in Thailand.     

Air pollution and cardiovascular health in Mandi-Gobindgarh, Punjab, India - a pilot study

Large number of epidemiological studies to know the effect of air pollution on the general mortality and morbidity, and the cardiopulmonary morbidity and mortality are concentrated in USA and Europe. Regional differences in air pollution necessitate regional level health effects studies. Present study is a cross sectional pilot study from India, an Asian country. A sample of population from an industrial town 'Mandi Gobindgarh' and a nonindustrial town 'Morinda' were selected. A cross-sectional household survey was done in both the towns. One hundred subjects were selected from each of the towns. Ambient air quality data was collected for both towns over a period of 10-months to assess seasonal variations. In the present study the average PM10 (particulate matter with < or = 10 microm aerodynamic diameter) levels in Morinda were 99.54 microg/m3 and in Mandi Gobindgarh 161.20 microg/m3. As per NAAQS the permitted levels of PM10 is 50 microg/m3 taken as annual average (arithmetic mean). Elemental analysis of the aerosol samples found the concentration levels to be higher in Mandi- Gobindgarh than Morinda. The population in Gobindgarh shows a higher prevalence of symptoms of angina and cardiovascular disease considered in the study as compared to Morinda. When the same data is viewed in terms of male and female population, the female population is found to show these symptoms marginally higher than their counterparts. Considering the results of present study it can be stated that the increased levels of different pollutants and the higher prevalence of cardiovascular symptoms in Mandi-Gobindgarh (Industrial town) than the Morinda (Non-Industrial town) is because of the association of PM pollution with cardiovascular diseases. Keeping in view the current status of literature, further studies in this direction are needed in a country like India. Such data will also be globally relevant.     

Iodine intake before and after mandatory iodization in Denmark: results from the Danish Investigation of Iodine Intake and Thyroid Diseases (DanThyr) study

Iodine deficiency is still common in some European countries. In Denmark an iodine fortification programme was introduced in 1998 and a monitoring programme was established prior to iodization. This study reports the change in urinary iodine excretion caused by fortification and investigates determinants of iodine intake after fortification. Iodine excretion in casual urine samples was assessed in 4649 subjects in 1997-8 and in 3570 comparable subjects in 2004-5 in women 18-22, 25-30, 40-45 and 60-65 years of age and in men 60-65 years of age living in Aalborg (western part of Denmark) or Copenhagen (eastern part of Denmark). These areas had moderate and mild iodine deficiency, respectively, before iodine fortification. All subjects filled in a FFQ and a questionnaire regarding lifestyle factors. Iodine excretion, expressed as the estimated 24 h urinary iodine excretion and as urinary iodine concentration, increased significantly in all age and sex groups. However, the iodine intake was still below the recommended in the youngest age groups in both cities and in women 40-45 years of age living in Aalborg. Intake of milk and salt had strong significant direct associations with iodine excretion (P < 0.001). It is concluded that although the median iodine intake in the whole study population is at the recommended level, some groups still have an intake below the recommended. It is important to have a moderate milk intake to obtain a sufficient iodine intake in Denmark.     

Trends in reported incidences of gastric cancer by tumour location, from 1975 to 1989 in Japan

BACKGROUND: This study was performed to estimate the incidence of gastric cancer by tumour location and to clarify whether the relative and absolute rates of gastric cancer in Japan changed between 1975 and 1989. METHODS: The stomach was anatomically divided into the upper, middle, and lower thirds. Age- and sex-specific incidences by tumour location were estimated by multiplying the age- and sex-specific national incidences of gastric cancer by the corresponding proportions of tumour location. We studied 171 721 cases of gastric cancer from the Gastric Cancer Registry of Japan. RESULTS: Over 15 years, the proportion of tumours in the upper third of the stomach increased in men but did not change much in women. The proportion of tumours in the middle third of the stomach increased among both men and women while the proportion of tumours in the lower third of the stomach decreased among both men and women. The incidence of tumours in the upper third of the stomach showed an increasing trend among elderly men and women but not among young ones. The incidence of tumours in the lower third of the stomach decreased significantly among men and women of most age groups. CONCLUSIONS: The present study added evidence of disparate trends in the incidence of gastric cancer by tumour location. The separate epidemiological features may indicate different aetiologies as well as changes in the degree of influence of these aetiologies.     

Patterns in cancer incidence among American Indians/Alaska Natives, United States, 1992-1999

OBJECTIVE: Cancer is a major public health concern in American Indian and Alaska Native (AI/AN) communities. However, information on the incidence of cancer is lacking for this group. The purpose of this study is to report cancer incidence patterns for the U.S. AI/AN population. METHODS: Age-adjusted annual cancer incidence rates for 1992 through 1999 were calculated for 12 Surveillance, Epidemiology and End Results (SEER) areas, representing a sample (42%) of the U.S. AI/AN population. Trends in cancer incidence rates for the AI/AN sample were determined using standard linear regression of log-transformed rates and were compared to those of the U.S. white population. RESULTS: The top five incident cancers (from highest to lowest) among AI/AN males were prostate, lung and bronchus, colon and rectum, kidney and renal pelvis, and stomach cancers. Among AI/AN women, cancers of the breast, colon and rectum, lung and bronchus, endometrium, and ovary ranked highest. Four sites where cancer incidence rates are greater for AI/ANs than for whites include gallbladder (the AI/AN rate was 4.1 times the rate for white males and 2.6 times the rate for white females), liver and intrahepatic bile duct cancers (1.3 times for males and 2.3 times for females), stomach (1.2 times for males and 1.5 times for females), and kidney and renal pelvis (1.03 times for males and 1.07 times for females). The data show increasing trends for AI/AN males and females and declining trends for white males and females for colorectal, stomach, and pancreatic cancers and leukemia. Similar differences between AI/AN rates and white rates were found for urinary bladder cancers in males and gallbladder cancer in females. CONCLUSIONS: Analysis of SEER data allowed for the determination of disparities in cancer incidence between a sample of the U.S. AI/AN population and the white population. The findings of this study provide baseline information necessary for developing cancer prevention and intervention strategies specific to the AI/AN population to address these cancer disparities.     

Occupation and stomach cancer in a cohort of Swedish men

Using the Cancer-Environment Registry of Sweden, which links the 1960 census information on employment with cancer incidence data from 1961–1979, we conducted a systematic, population-based assessment of stomach cancer incidence by industry and occupation for men in Sweden. Nearly 17,000 stomach cancer cases were diagnosed during the 19 years of follow-up. Stomach cancer incidence was elevated among miners and quarrymen, farmers and fishermen, and craftsmen and production workers. Men who held white collar jobs, including professional and technical, administrative and management, clerical, and sales jobs, had a reduction in stomach cancer incidence. Examination of specific jobs revealed generally elevated rates of stomach cancer among men who may be exposed to dusty work environments, such as quarry workers, stone cutters, circular and plane operators, construction workers, crane operators, heavy laborers, and shop and construction metal workers. These occupational associations mostly were observed for stomach cancers of noncardia origin, and no significant associations were found with cardia cancers. We had no information on dietary or other potential confounding factors and cannot make inferences about the role of occupation per se, but the current findings support those of earlier investigations and add to the evidence of a small but significant occupational role in stomach carcinogenesis.     

Incidence of cancer in Bradford Asians.

STUDY OBJECTIVE--The aim of the study was to investigate the incidence of cancer in Asians living in Bradford. DESIGN--Cancer registrations were obtained from the Yorkshire Regional Cancer Registry for the six year period 1979-1984. Registrations relating to persons of Asian background were extracted using forenames and surnames. Data were analysed by disease category and age and sex specific incidence rates were calculated. These were compared with expected incidence rates for the non-Asian population and with rates for the Indian subcontinent derived from the Bombay Cancer Registry. SETTING--Data collection was confined to the Bradford Metropolitan District, population 449,897 (1981). SUBJECTS--The Asians studied originated from Pakistan (65%), India (28%), Bangladesh (4%), and East Africa (3%). The total Asian population of the Bradford Metropolitan District was approximately 45,000. MAIN RESULTS--Over the study period there were 178 Asian cancer registrations. The overall standardised registration ratio was 53.7 for males (100 cases, 95% confidence interval 43-64), and 43.5 for females (78 cases, 95% CI 34-53). The standardised registration ratios for cancer of the hypopharynx in males and gall bladder in females were significantly raised. There was a particularly low incidence of cancer of the stomach, large bowel, lung, skin, and bladder in males, and of skin, breast, cervix (in situ), and ovary in females. The analyses suggested that lung and breast cancer incidence may be increasing towards the non-Asian level. In situ cancer of cervix in Asians shows no evidence of the high rates found in younger non-Asian age groups. CONCLUSIONS--Lower incidence of many cancers in Asians may be due to lower exposure to major risk factors. Demographic change resulting in increased exposure to these risk factors can be expected to result in an increase in cancer incidence in Asians.