Magnitude of Arsenic Toxicity in Tube-well Drinking Water in Bangladesh and Its Adverse Effects on Human Health Including Cancer: Evidence from a Review of the Literature

Only after a decade from 1993, arsenic contamination of groundwater in Bangladesh has been reported as the ‍biggest arsenic catastrophe in the world. It is a burning public health issue in this country. More than 50 percent of ‍the total population is estimated at risk of contamination. Already thousands of people have been affected by the ‍disease arsenicosis. Many more may be on the way to manifest lesions in future. We conducted a review of previous ‍studies and published articles including MEDLINE database on this issue. We found that 59 districts out of 64 have ‍been already affected by arsenic in underground drinking water, where this particular source of drinking water is ‍the main source for 97 percent of the rural people. The water is unfortunately now a great threat for the human ‍being due to high level of arsenic. Continuous arsenic exposure can lead people to develop arsenicosis, which in turn ‍elevates the risk of cancer. Skin lesions are the most common manifestations in arsenicosis patients. Relatively poor ‍rural people and other socio-economically disadvantaged groups are more affected by this exposure. Until now ‍cancer patients have been relatively limited in Bangladesh. One of the reasons may be that several years are needed ‍to show cancer manifestations from the beginning of arsenic exposure. But it is suspected that after some years a ‍large number of patients will appear with cancer in different sites for arsenic exposure in drinking water. Various ‍studies have been conducted in arsenic affected countries - notably in Argentina, Chile, China, Japan, and Taiwan - ‍to find the potential of arsenic exposure to cause development of cancer. Among the arsenic related cancers, liver, ‍lung, skin, bladder and kidney cancers are reported to be prevalent in these countries. Unfortunately no scientific ‍study has been yet conducted in Bangladesh to find the relationship between arsenic exposure and cancers in different ‍sites of the body. So our aim is to conduct an ecological as well as a case-control study in the country in the future. ‍     

Cervical Cancer Prevention and Early Detection; The Role of Nurse and Midwives

Worldwide 31% of cancers in women are in the breast or uterine cervix. Cancer of the uterine cervix is one of the ‍leading causes of cancer death among women. The estimated new cancer cervix cases per year is 500.000 of which ‍79% occur in the developing countries, where it is consistently the leading cancer and there are in excess of 233.000 ‍deaths from the disease. The major risk factors for cervical cancer include early age at first intercourse, multiple ‍sexual partners, low socioeconomic status, HSV, HPV infection, cigarette smoking and extended use of oral ‍contraceptives. Well organized and applied public education and mass screening programmes can substantially ‍reduce the mortality from cervical cancer and the incidence of invasive disease in the population. Women who are ‍health conscious are more likely to have used screening services (mammogram, pap-smear test) and performed ‍breast-self examination and genital hygiene. There are both opportunities and burdens for nurses and midwives ‍working in primary health care settings. This is a prime example of a role of public education in cancer prevention ‍with reference to population-based cancer screening programs. ‍     

Cancer in Women in Kerala - a Transition from a Less-developed State

An epidemiologic assessment of the problem of cancer in women in Kerala based on 3 Population Cancer Registry ‍data and a Hospital Based data is presented. Kerala’s Socio-economic and demography presents an intermediate ‍development from a less developed to a better-developed state. As yet, the women follow a tradition-based life style. ‍Cancer incidence rate in Kerala was only 80% of urban rates than seen in Urban Metropolis in India. The pattern of ‍site distribution has shown that GI, Breast & Cervix cancers are the predominant cancers. Oral cavity cancers also ‍show a high frequency. Thyroid cancer has a higher incidence rate in Kerala compared to other areas. Lung cancer ‍among women has higher incidence rate in Karunagappally women. A high prevalence of tobacco use is reported ‍among the men in the above area. Breast cancer incidence rate in the rural areas was only 60% of the rate seen in ‍Urban Trivandrum. Unlike in other rural and urban areas of India Cervix cancer has a low incidence rate in Kerala ‍women. This may be due to better education and also due to the changes in marital and other life style practices. ‍Only 15% of cancer patients attend for medical assistance in localized stage of disease. The need for public education ‍is highlighted and focusing on tobacco use control, self-examination and screening.     

The Metabolic Syndrome is Associated with Increased Risk of Colorectal Adenoma Development: The Self-Defense Forces Health Study

The metabolic syndrome, a cluster of metabolic abnormalities linked to insulin resistance, has attracted much ‍interest as a risk factor for cardiovascular disease and type 2 diabetes. Hyperinsulinemia is also a postulated biological ‍risk factor for colorectal carcinogenesis. We therefore here examined the relation between the metabolic syndrome ‍and colorectal adenoma development. The study subjects were 756 cases of colorectal adenoma and 1751 controls ‍with no polyps who underwent total colonoscopy during the period January 1995 to March 2002 at two Self Defense ‍Forces (SDF) hospitals in Japan. The metabolic syndrome was defined with reference to abdominal obesity in ‍combination with any two of the following conditions: elevated triglycerides (≥150 mg/dL); lowered HDL cholesterol ‍(<40 mg/dL); elevated blood pressure (systolic blood pressure ≥130 mmHg and/or diastolic blood pressure ≥ 85 ‍mmHg); and raised fasting glucose (≥110 mg/dL). Abdominal obesity was defined as a waist circumference of 85cm ‍or more(Japanese criterion) or ≥ 90cm (Asian criterion). Statistical adjustment was made for age, hospital, and rank ‍in the SDF. The metabolic syndrome was found to be associated with a moderately increased risk of colorectal ‍adenomas whether either of the Japanese and Asian criteria was used; adjusted odds ratios with the Japanese and ‍Asian criteria were 1.38 (95% confidence interval [CI] 1.13-1.69) and 1.48 (95% CI 1.13-1.93), respectively. Increased ‍risk was more evident for proximal than distal colon or rectal adenomas, and was almost exclusively observed for ‍large lesions (≥ 5mm in diameter). Thus the metabolic syndrome appears to be an important entity with regard to ‍the prevention of colorectal cancer, as well as cardiovascular disease and type 2 diabetes.     

An Estimate of the Potential for Cancer Prevention in Japan

Cancer prevention is an important strategy in cancer control and it consists of primary prevention and secondaryprevention. Major avoidable or manageable risk factors for cancer identified from previous studies are tobacco,diet and infection. Some cancer could be prevented by controlling those risk factors. In Japan screenings for gastriccancer, cervical cancer, lung cancer, breast cancer and colo-rectal cancer have been widely conducted under the Lawof Health Maintenance for the Aged. In planning and evaluating cancer control activities in Japan, it was considereduseful to estimate the potential of primary and secondary prevention of cancer. The author estimated the potentialof cancer prevention in Japan twice previously in 1990 and 1999. In this paper the potential of cancer prevention inJapan was re-estimated by using a different method and more recent data. From the present study it was estimatedthat about 25% of cancer occurrence could be prevented by control of smoking, diet and infection, about 9-15% ofcancer deaths could be prevented by cancer screening, and about 6- 10 % of cancer deaths could be prevented byapplication of the state-of-the art diagnosis and treatment of cancer, altogether about 40-50% of cancer occurrences/deaths could be prevented if all possible measures for cancer prevention are applied to the general public and cancerpatients in Japan.     

Attitudes of Patients to Alternative Medicine For Cancer Treatment

Awareness of attitudes to different types of medicine is very important for estabishment of cancer prevention ‍programs. Alternative medicine has become an important feature of oncology regardless of geographic region, and ‍in India, the majority of cancer patients present at late advance stage of disease when curative treatment cannot be ‍initiated. Given the lack of facilities it is no surprise that many Indian cancer patients try various complementary ‍and alternative medicines, depsite the fact that little is known about their therapeutic efficacy and toxicity. A study ‍was conducted in 300 biopsy proven cancer patients undergoing alternative cancer therapy with Psorinum in Kolkata. ‍The main aim of the study was to analyze the patients’/ caregivers narratives regarding the therapy they have been ‍trying. One hundred and ninety five patients (65%) have consulted their oncologists before trying this therapy. ‍About 18.5 % of the patients expressed satisfaction with the therapy due to the holistic nature and team approach ‍employed for patient management. The cost of the therapy was within the reach of many cancer patients belonging ‍to the underprivileged segment of the society, contributing to its immense popularity in Kolkata. Whether this can ‍be translated into a willingness to use similar natural compounds for cancer prevention and treatment purposes now ‍needs to be analysed.     

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.     

Social and Geographic Predictors of Cancer Survival: Role of the Population-based Cancer Registry in Cancer Control

One of the objectives of a cancer registry is to provide survival information on subsections of the population that ‍have unfavorable outcomes. A cancer control strategy can be planned on the basis of such information. In the present ‍study, the data of the Songkhla Cancer Registry were analyzed to determine if social and geographic parameters ‍can be used to predict cancer survival. A total of 3423 cases identified in the population-based cancer registry of ‍Songkhla Province registered during 1990-1994, were the subjects of this study. The rest were excluded because of ‍unknown primary cancer sites. Eight leading primary cancer sites were focused on: oral cavity, pharynx, esophagus, ‍colorectum, lung, liver, breast, and cervix uteri. Predictors of survival were derived from items recorded in the ‍registry. Age, gender, extent of disease, cultural belief, life-style, and access to medical care were the predictors of ‍interest. Religion, urban environment, and distance to tertiary care centers were proxies for the last three parameters. ‍Kaplan-Meier plots, Cox regression, and log-rank tests were used for analysis of the hazard ratios. The results ‍revealed a significance of disease extent for survival from oral, colorectal, breast, and cervical cancers. Muslim ‍people had poorer survival rates than those of Buddhists for oral, breast, and cervical cancers. Women with breast ‍cancer living in distant from tertiary medical care centers had a poorer prognosis. For the non-aggressive cancers, ‍early detection and pretreatment counseling for the prevention of unnecessary incomplete treatment is recommended ‍for prolonged survival. With aggressive cancers such as lung, liver, and pharyngeal cancers, there were no significant ‍differences with these parameters investigated. Good quality of life provided by palliative care, not prolongation of ‍survival, is the ultimate goal of medical care services to such patients.     

Programs for Asian Pacific Cancer Prevention in Response to the Four Strategic Directions of UICC for the New Millennium

The final goal of epidemiology is the establishment of prevention measures and the promotion of better human ‍health. The information we obtain through research needs to be substantially supplemented by comprehensive ‍knowledge of the standardized “global strategy”. To establish regional cancer control programs, we need basic data ‍on cancer incidence and mortality in the general populace gained from well-organized cancer registration and collection ‍of vital statistics. Cancer is a typical lifestyle related disease and we should define the risk and protective factors for ‍cancer in particular peoples. In general, lifestyle is established by long-term acquired culture in each ethnic group ‍and area, and we cannot easily transfer established cancer control programs from developed countries to other ‍states with a very different cultural background. We need to establish our own cancer control strategy that would be ‍accommodating our own physical and social environments. This was the reason why the Asia Pacific Organization ‍for Cancer Prevention ( APOCP) was set up to promote all aspects of cancer prevention across our own area of the ‍globe. The idea of a Practical Prevention Program (PPP) pilot center in Asia was a well-timed proposal and to now ‍promote the PPP, continuous grass route activity by core persons and institutions, accompanied by positive ‍participation of the general populace, is indispensable. The APOCP and the UICC should play central roles in providing ‍rear-area logistic support to promote local activities on cancer control. What we learn here in the Asian Pacific will ‍also be of great assistance to efforts in other areas of the world. ‍     

Minimal Sizes of Cases with a Susceptible Genotype and Minimal Odds Ratios among Susceptible Individuals in Case-control Studies

Objective: Disease risk elevation due to an environmental factor only for individuals with a susceptible genotype ‍is a typical example of gene-environment interaction. In order to identify risk factors interacting with susceptible ‍genotypes in case-control studies, presumptions on minimal size of cases with the susceptible genotype (Smin) and ‍odds ratio (OR) among the susceptible individuals (ORsusceptible) are useful. ‍Model: Proportion of exposed cases (P1) and OR for whole cases (ORwhole) statistically detectable in a case-control ‍study can be calculated in a conventional method. P1 was assumed to be a weighted sum of the exposed among cases ‍with the genotype (Px) and cases without the genotype (equal to proportion of the exposed among controls, P0), i.e., ‍S Px + (1 - S) P0, where S is the size (proportion) of cases with the genotype. For each calculated P1, S became the ‍minimum (Smin) in case of Px = 1. ORsusceptible was calculated by {Px (1 - P0)} / {(1 - Px) P0}. ‍Results: Smin and ORsusceptible were listed for the combinations of the above components. For example, a detectable ‍P1 was 0.638 for P0=0.5 in a case-control study with 200 cases (N1) and 200 controls (N0), when á error of a two-sided ‍test was 0.05 with an 80% of power. In case of P1=0.638, ORwhole was 1.77, producing Smin=0.277 for infinite ORsusceptible. ‍It indicates that an environmental factor cannot be detected in case that a high-risk genotype frequency is less than ‍0.277. ‍Interpretation: If the size of cases with a susceptible genotype is expected to be less than Smin, case-control studies ‍are unlikely to detect a significant OR of the environmental factor.     

A Pilot Study on Inducement of Smoking Cessation by a Simple 5A (Asking,Advice, Assess,Assist, and Arrange) Approach at Outpatient Clinics

Asking smokers about their smoking status, followed by advice to quit smoking, assessing the intention to quit , ‍assistance with cessation, and arrange of follow-up (5A) is recommended for induction of smoking cessation. To ‍obtain preliminary data on effects of “5A” , we investigated the smoking cessation rate with two modes in the phase ‍I: 1) self-administered questionnaire and 2) doctor’s interview at respiratory disease clinics of three general hospitals ‍in Japan, and another mode in phase II: 3) doctor’s interview with an additional pamphlet at one of the three ‍hospitals. The interviews for smokers were conducted by doctors in charge of treatment. Subject smoking habits ‍were followed up by postal surveys three months after the enrollment. In phase I, 359 outpatients were recruited and ‍189 smokers responded, among whom 27 patients (7.5% of 359 outpatients) had quit smoking at the three months ‍after the enrollment. The cessation rate of the self-administered questionnaire group (8.4% of 238 smokers) did not ‍differ significantly from that of doctors’ interview group (5.8% of 121 smokers). Age and intention to quit at enrollment ‍were found to be independent predictors of smoking cessation. Patients aged 50 years or older (odds ratio=5.05, 95% ‍confidence interval 1.89-13.54), and participants with an intention to quit (odds ratio=6.78, 95% confidence interval ‍2.66-17.30) were more likely to be successful in quitting. In phase II, another 212 smokers of one hospital were ‍interviewed by doctors in charge and provided with an additional pamphlet describing how to practice to dislike ‍smoking. No significant difference in the cessation rate was observed between phase I and phase II (5.8% vs. 8.0%). ‍In conclusion, there were no differences among the three modes of “5A”, but 7.7% of the 571 outpatients visiting ‍respiratory divisions quit smoking with this simple “5A”. The findings may indicate that this simple practice at ‍clinics is useful for smoking cessation strategy, although randomized trials are now required.     

Allele Frequencies of 25 Polymorphisms Pertaining to Cancer Risk for Japanese,Koreans, and Chinese

Allele frequencies are rather constant among different ethnic groups in many genetic polymorphisms, but some ‍polymorphisms vary in the allele frequency depending on the time when the germ-line base exchanges occurred in ‍the history of humans and on the adaptability of the phenotypes to given environment. This review documented the ‍allele frequencies of polymorphisms pertaining to cancer risk for Japanese, Koreans, and Chinese. Twenty-five ‍polymorphisms of 21 genes whose allele frequencies were available for at least two out of the three ethnic groups ‍were selected. They were ALDH2 Glu487Lys, COMT Val158Met, CYP1A1 MspI and Val/Ile, CYP1B1 Leu432Val, ‍CYP2E1 RsaI, CYP17 T-34C, ER C975G, GSTM1, GSTT1, GSTP1 Ile105Val, IL-1B C-511T, IL-1RN 86-bp VNTR ‍(variable number of tandem repeats), MTHFR C677T and A1298C, NAT1, NAT2, NQO1 Pro187Ser, OGG1 Ser326Cys, ‍p21 Ser31Arg, p53 Arg72Pro, TNF-A G-308A and G-238A, and XRCC1 Arg194Trp and Arg399Gln. The allele ‍frequencies were found for 24 in Japanese, 16 in Koreans, and 24 in Chinese. All of the polymorphisms had similar ‍allele frequencies for these ethnic groups, except the following polymorphisms; ALDH2 Glu487Lys whose Lys allele ‍was more common for Japanese and Taiwanese, COMT Val158Met whose Met allele was more common for Japanese, ‍and NAT2 rapid/slow whose slow alleles were more common for Chinese. When compared with the allele frequencies ‍among Caucasians, the following minor alleles were more frequent among Japanese/Koreans/Chinese; ALDH2 478Lys, ‍CYP1A1 m1 and m2, CYP2E1 c2, ER 975G, GSTT1 null, NAT1 *10, NQO1 187Ser, OGG1 326Cys, p21 31Arg, and ‍XRCC1 194Trp, and less frequent in COMT 158Met, GST-P1 105Val, IL-1RN non-4R, MTHFR 1298C, and TNF-A - ‍308A. The differences in genetic background may affect the impact on the lifestyle factors and/or genotypes examined ‍in epidemiological studies. However, the influences of the variations in the allele frequency seemed to be limited ‍among Japanese, Koreans, and Chinese. The substantial differences in the allele frequency from Caucasians could ‍modify the influences of lifestyle factors and polymorphism genotypes, resulting in the inconsistent results of ‍epidemiologic studies. ‍     

The 4th JICA Training Course,Community-based Cancer Prevention (Epidemiological Approach)

The present training course was programmed by the Division of Epidemiology and Prevention, Aichi Cancer Center ‍Research Institute, Japan, and has been annually conducted since 1999, supported by the Japan International Cooperation ‍Agency (JICA) (Takezaki 2001). This course targets doctors and public health workers who are responsible for communitybased ‍cancer prevention in developing countries to promote comprehensive procedures focusing mainly on primary but also ‍including secondary prevention of cancer. ‍ Cancer is the leading cause of deaths in developed countries, while communicable diseases are still major causes of ‍mortality in developing countries (WHO 2000). However, the relative burdenn of cancer deaths is also increasing in developing ‍countries, with economic development and elongation of the life span (Walgate 1984; Chackiel 1999). Boffetta and Parkin ‍have estimated cancer to account for 13 percent of the annual deaths in adults of developing countries (Boffetta and Parkin ‍1994). Limitations of medical facilities and equipment in developing countries underly the necessity to stress prevention as ‍an indispensable measure for cancer control (Mikheev et al. 1994). However, human resources concerning cancer prevention ‍are limited, and encouragement should be given as the first priority as regards to cancer prevention. ‍The Japanese Government extends official development assistance (ODA) to developing countries to support self-help ‍efforts that will lead to economic progress and a better life for their citizens. Since its foundation in 1974, JICA has implemented ‍Japan's technical cooperation under the ODA programme. Currently, JICA conducts such activities as training, dispatch of ‍experts, provision of equipment, project-type technical cooperation, development studies, dispatch of cooperation volunteers ‍(JOCV), and survey and administration of capital grant aid programs. The present training program for overseas participants ‍is one of JICA's fundamental technical cooperation activities for developing countries. Participants come from overseas in ‍order to obtain knowledge and technology in a wide variety of fields. The objectives of the JICA training programs are: 1) ‍to contribute to the development of human resources who will promote the advancement of developing countries, and 2) to ‍contribute to the promotion of mutual understanding and friendship. ‍ The present report concentrates on revised contents with this 4th course and includes a commentary on its advantages ‍and disadvantages. ‍     

The JICA Training Course,Community-based Cancer Prevention for the Asian Pacific Countries,Fiscal Years 2004 and 2005 (Epidemiological Approach)

Communicable diseases are still major causes of deaths in developing countries. Cancer incidence, however, ‍increased 19% between 1990 and 2000, mainly in this same developing world (Stewart and Kleihaus, 2003), and ‍malignant neoplasms are now the second leading cause of mortality in these countries (WHO, 2003). Limitations of ‍medical facilities and equipment mean that prevention is indispensable for cancer control (Mikheev et al., 1994). ‍However, human resources concerning cancer prevention are limited, and encouragement of their development ‍should be taken as a first priority. To assist in this aim, the present training course was designed by the Division of ‍Epidemiology and Prevention, Aichi Cancer Center Research Institute, Japan, and has been annually conducted ‍since 1999, supported by the Japan International Cooperation Agency (JICA) (Takezaki, 2001; 2002; 2003; Wakai, ‍2004). The course targets doctors and public health workers who are responsible for community-based cancer ‍prevention in developing countries to promote the introduction of comprehensive procedures, focusing mainly on ‍primary prevention but also including screening for secondary prevention of cancer.     

Precise Definition of Anonymization in Genetic Polymorphism Studies

Anonymization is an essential tool to protect privacy of participants in epidemiologiocal studies. This paper ‍classifies types of anonymization in genetic polymorphism studies, providing precise definitions. They are: 1) unlinkable ‍anonymization at enrollment without a participant list; 2) unlinkable anonymization before genotyping with a ‍participant list; 3) linkable anonymization; 4) unlinkable anonymization for outsiders; and 5) linkable anonymization ‍for outsiders. The classification in view of accessibility to a table including genotype data with directly identifiable ‍data such as names is important; if such tables exist, staff may obtain genotype information about participants. The ‍first three modes are defined here as anonymization unaccessible to genotype data with directly identifiable information ‍for research staff. Anonymization with a key code held by participants is possible with any of the above anonymization ‍modes, by which participants can access to their own genotypes through telephone or internet. A guideline issued on ‍March 29, 2001 with collaboration of three Ministries in Japan defines “anonymization in a linkable fashion” and ‍“anonymization in an unlinkable fastion”, “for the purpose of preventing the personal information from being ‍divulged externally in violation of law, the present guidelines or a research protocol”, but the contents are not clear ‍in practice. The proposed definitions will be useful when we describe and discuss the preferable mode of anonymization ‍for a given polymorphism study.     

The 5th JICA Training Course,Community-based Cancer Prevention (Epidemiological Approach)

Cancer is the leading cause of deaths in developed countries, while communicable diseases are still more important in ‍in developing countries (WHO 2000). Boffetta and Parkin have estimated cancer to account for 13 percent of the annual ‍deaths in adults of developing countries (Boffetta and Parkin 1994). However, relative distribution of cancer deaths increases ‍in developing countries, with economic development and longer life span (Walgate 1984; Chackiel 1999). Actually, the ‍magnitude of the differences in age-adjusted mortality rates of all sites but skin cancers between the more and less developed ‍countries (173.9 vs. 112.9 in males and 103.1 vs. 77.5 in females) is not so large, compared with the crude rates (257.6 vs. ‍82.3 in males and 189.7 vs. 63.8 in females) (Ferlay, 2001). Limitations of medical facilities and equipment in developing ‍countries lead means that prevention as an indispensable measure for cancer control (Mikheev et al. 1994). However, ‍human resources concerning cancer prevention are limited, and encouragement of their development should be taken as a ‍first priority . To assist in development of human resources concerning cancer prevention, the present training course was designed by ‍the Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Japan, and has been annually conducted ‍since 1999, supported by the Japan International Cooperation Agency (JICA) (Takezaki, 2001; 2002). This course targets ‍doctors and public health workers who are responsible for community-based cancer prevention in developing countries to ‍promote the introduction of comprehensive procedures, focusing mainly on primary prevention but also including secondary ‍prevention of cancer. ‍ The Japanese Government extends official development assistance (ODA) to developing countries to support self-help ‍efforts that will lead to economic progress and a better life for their citizens. Since its foundation in 1974, JICA has ‍implemented Japan's technical cooperation under the ODA programme. Currently, JICA conducts such activities as training, ‍dispatch of experts, provision of equipment, project-type technical cooperation, development studies, dispatch of cooperation ‍volunteers (JOCV), and surveys and administration of capital grant aid programs. Hosting training programs for overseas ‍participants is one of JICA's fundamental technical cooperation activities for developing countries. Participants come from ‍target countries to obtain knowledge and technology training in a wide variety of fields. The objectives of the JICA training ‍program are: 1) to contribute to the development of the human resources necessary to promote progress in developing ‍countries, and 2) to contribute to the promotion of mutual understanding and friendship. ‍The present report concerns revision of contents in this 5th course, with a commentary regarding improvements for the ‍next, second-phase course. ‍     

A Model of Practical Cancer Prevention for Out-patients Visiting a Hospital: the Hospital-based Epidemiologic Research Program at Aichi Cancer Center (HERPACC)

To promote a cancer prevention program at hospital, we started the hospital-based epidemiologic research program at ‍Aichi Cancer Center (HERPACC) in 1988. Because patients visiting hospitals are very concerned not only about their ‍own health condition but also practical way of disease prevention, we consider outpatients, especially those free of ‍cancer, as ideal targets to make a model program and a practical cancer prevention strategy for general people. To ‍confirm risk and protective effects of lifestyle factors like dietary habits, smoking and drinking, and exercise on cancer ‍in Japanese, we have been undertaking large-scale case-referent comparative studies of main cancer sites (stomach, ‍colorectal, lung, breast and uterine cancers) using the data generated by HERPACC. The risk of respiratory tract cancer ‍was definitely elevated by habitual smoking and that of upper digestive tract cancer by combined habitual smoking and ‍drinking. Frequent intake of raw vegetables and/or fruit in contrast reduced the risk of lung cancer among smokers. ‍Current obesity was positively associated with risk of post-menopausal breast cancer, recently on the increase in Japan. ‍However, all sites of cancer were linearly decreased with frequency of exercise in both males and females. Based on ‍these pieces of evidence and other main results obtained from the HERPACC studies, prevention trials with provision ‍of information about protective and risk factors for main sites of cancers to outpatients have been planned in parallel to ‍continuation of HERPACC.     

A unique seroepidemiological pattern of HBV,HCV and HTLV-I in Nenets and Komi in Northwestern Russia

An epidemiological study of hepatitis viruses type B (HBV) and type C (HCV) and human T-cell leukemia virus ‍type I (HTLV-I) was carried out among 105 residents (male:female=19:86) regarded as Nenets partly mixed with ‍Komi, in the region of Krasnoe, the Nenets Autonomous District of the Arkhangelsk Region, in northwestern Russia ‍in 2004. Blood was drawn from apparently healthy volunteers at ages of 41.6+16.5 (range 14-85) years. HBsAg, ‍HBsAb, HBcAb, HBeAb and HCV Ab were measured by microparticle enzyme-immunoassay, and HTLV-I Ab was ‍measured by particle agglutination. Prevalences of HBsAg(+), HBsAb(+), HBcAb(+) and HBeAb(+) were 0.0%, ‍29.5.%, 20.0% and 7.6%, respectively. The overall HBV infection rate (positive HBsAb or HBcAb) was 34.3%, ‍while no positive HCV or HTLV-I Abs could be detected. A serological subgroup with positive HBsAb and negative ‍HBcAb, consisting of 15(14.3%) females, contrasted sharply to other serological subgroups in sex, age, parent’s ‍ethnicity, positive HBeAb rate, and HBcAb inhibition%. We conclude that HBV is prevalent with unique serological ‍patterns among the Nenets, while HCV and HTLV-I infections are negligible.