Cancer Screening,Reproductive History,Socioeconomic Status,and Anticipated Cancer-related Behavior among Hmong Adults

In the United States, breast, cervical, colorectal and prostate cancer screening rates are low or non-existent in the ‍Hmong population compared to non-Hispanic Whites. No Hmong adults report ever participating in prostate (male ‍only) and colorectal cancer screening. US-born Hmong women, those living in the US ≥20 years, and those ≤39 years ‍old are more likely to be screened for breast and cervical cancer than other women. The Hmong, in general, are a ‍young population (median age = 34 years) with low socioeconomic status. As a function of these characteristics, 52% ‍of Hmong women reported having their first child at 15-19 years old and continued to bear children until 40-54 ‍years old. The combination of young age at first pregnancy and multiparity probably protects Hmong women from ‍breast cancer but elevates cervical cancer risk.     

A Review of Cohort Studies on the Association Between History of Diabetes Mellitus and Occurrence of Cancer

We conducted a review of previous cohort studies on the association between a history of diabetes mellitus ‍(DM) and the occurrence of cancer. We limited the papers to those concerning cohort studies on 9 cancer sites, ‍i.e. the kidney, liver, biliary tract, pancreas, colon or rectum, prostate, breast, endometrium, and ovary, in ‍addition to all cancers. With regard to kidney, liver, biliary tract, pancreatic, colorectal, breast, and endometrial ‍cancers, the risk of cancer development has been consistently reported to be positively associated with DM by ‍two or more cohort studies. In contrast, DM was shown to relate negatively to the risk of prostate cancer by ‍two cohort studies. However, there were no cohort studies which showed an either significantly positive or ‍negative association of DM with ovarian cancer. Elevated levels of insulin or IGFs among DM patients have ‍been proposed as a causal mechanism of increased risk for most of the reviewed cancers. In addition, increased ‍estrogen levels in DM patients have been suggested to explain the casual mechanism of increased risk for ‍kidney, breast and endometrial cancers, and decreased risk for prostate cancer. On the other hand, the ‍possibility of detection bias has been suggested in the association of DM with the risk of most of these cancers. ‍Obesity and heavy consumption of alcohol have been indicated as confounding factors in the relationship of ‍DM to the risk for some of them. Thus, further studies are necessary for firm conclusions regarding the ‍association of DM with cancer risk.     

Grand Challenges in Global Health and the Practical Prevention Program? Asian Focus on Cancer Prevention in Females of the Developing World

In response to the request for ‘Breakthrough Questions’ for ‘Grand Challenges in Global Health’ recently ‍published in Nature, the Asian Pacific Organization for Cancer Prevention should focus its attention on what projects ‍are of the highest priority for integration with its Practical Prevention Program (PPP). The most common female ‍cancers in most of the countries of Asia are carcinoma of the breast, followed by the uterine cervix. While the ‍incidences of breast adenocarcinomas are still generally lower than in the Western world they are rapidly increasing, ‍and squamous cell carcinomas of the cervix are a major problem. Clearly there are many areas which would reward ‍research. One factor which appears of major relevance in the mammary gland case is the diet, and particularly the ‍phytoestrogens included in ‘tofu’, along with physical exercise. The age at which these could be operating needs to ‍be elucidated, with reference to timing of menarche and menopause, and also breast mammographic density, another ‍predictor of likelihood of neoplasia. In the cervix, the predominant influence is well established to be persistent ‍infection with a high risk ‘oncogenic’ type of human papilloma virus (HPV). Vaccines therefore hold much promise, ‍but a better understanding of the mechanisms underlying spontaneous clearance of both infection and cervical ‍intraepithelial neoplasia (CIN) of different grades is also essential for optimal intervention. The roles of smoking ‍and antioxidant intake in particular deserve emphasis. In Asia, with the considerable variation evident in both ‍breast and cervical cancer incidence rates, as well as in cultural and other environmental factors, we are in a very ‍favourable position to meet two specific challenges: 1) elucidation of how diet in adolescence determines susceptibility ‍to neoplasia of the mammary glands; and 2) determination of what governs persistence of HPV infection. Realisation ‍of these pivotal research aims, with especial emphasis on the context of the PPP, is our shared goal.     

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. ‍     

Population-based Survival from Cancers of Breast,Cervix and Ovary in Women in Mumbai,India

Background: Breast, cervix and ovarian cancers contribute more than 45% of the total in women in Mumbai ‍and survival proportions for these neoplasms are very high in most developed populations in the World. The authors ‍here report and discuss the population-based survival for these cancers in Mumbai, India. ‍Methods: Follow-up information on 4865 cancers of breast, cervix and ovary, registered in the Mumbai Population ‍Based Cancer Registry for the period 1992-1994 was obtained by a variety of methods, including matching with ‍death certificates from the Mumbai vital statistics registration system, postal/telephone enquiries, home visits and ‍scrutiny of medical records. The survival for each case was determined as the duration between the date of diagnosis ‍and date of death, date of loss to follow-up or the closing date of the study (December 31st, 1999). Cumulative ‍observed and relative survival was calculated by the Hakulinen Method. For comparison of results with other ‍populations, age-standardized relative survival (ASRS) was calculated by directly standardizing age specific relative ‍survival to the specific age distributions of the estimated global incidence of major cancers in 1985. The log rank test ‍was used in univariate analysis to identify the potentially important prognostic variables. The variables showing ‍statistical significance in univariate analysis were introduced stepwise into a Cox Regression model to identify the ‍independent predictors of survival. ‍Results: The 5-year relative survival rates were 46.2% for breast, 47.7% for the cervix and 25.4% for the ovary. ‍Higher survival was observed for those younger than 35 years for all these three sites. For each, survival declined ‍with advancing age. Single patients who remained unmarried had better survival. For all sites Muslims had a better ‍and Christians a lower survival as compared to Hindus. Education did not appear to be of significance. Survival ‍decreased rapidly with advancing clinical extent of disease for all sites. With localized cancer, 5-year rates ranged ‍from 54.7% to 69.3%, for regional spread 20.4% to 41.6% and distant metastasis not a single site recorded more ‍than 5%. On multivariate analysis, age and extent of disease emerged as independent predictors of survival for all ‍the sites. ‍Conclusion: All the sites included in the study demonstrated moderate survival rates with significant variation. ‍Comparison with other populations revealed lower survival rates as compared to developed countries, particularly ‍for breast and ovary. In Indian populations survival proportions did not show much variation for these cancers. ‍Early detection and treatment are clearly important factors to reduce the mortality from these cancers. ‍     

Screening and Management of PreCancerous Lesions To Prevent Cervical Cancer in Low-Resource Settings

Cervical cancer is a leading cause of cancer death among women in low-resource settings, but it is completely ‍preventable by screening for and treating precancerous lesions. In this article, the current approaches to screening, ‍confirmation, and treatment of precancerous lesions of the cervix are reviewed from the perspective of low-resource ‍settings. Cervical cytology is compared to visual inspection with acetic acid (VIA) for screening women to detect ‍precancerous lesions. The use of colposcopy to confirm findings in women with positive screening test results and ‍various treatment methods are discussed. With one examination, cytology appears to detect fewer precancerous ‍lesions than VIA, but VIA has a lower specificity and labels proportionately more women falsely positive. When ‍available, colposcopy may be used to obtain directed biopsies from abnormal areas of the cervix to pathologically ‍confirm the findings in women with positive screening tests. Treatment with cryotherapy appears to be a safe, ‍acceptable, and effective procedure for the majority of precancerous lesions. Lesions that are not suitable for ‍cryotherapy because of endocervical canal involvement or large size are amenable to outpatient treatment by loop ‍electrical excision procedure (LEEP). HIV/AIDS and immune system suppression are associated with more rapid ‍CIN progression and HIV-positive women generally have high recurrence rates of CIN after treatment. Women ‍tempora may more readily transmit the virus after cryotherapy and, therefore, they require counseling regarding ‍abstinence and condom use. Highly active antiretroviral therapy (HAART) may cause CIN to regress and may ‍decrease the risk of cervical cancer in HIV-infected women. Cost-effectiveness modeling using South African data ‍shows that use of a single lifetime VIA test and immediate cryotherapy saves costs compared to cytology or to no ‍screening. VIA and cryotherapy are appropriate services for low-resource settings. Colposcopy and LEEP services ‍should be available on a referral basis. ‍     

Cancer Occurrence in Semnan Province,Iran: Results of a Population-Based Cancer Registry

Introduction: suitable information of different cancers in special geographic areas can help define medical ‍programs for treatment and screening of high-risk groups. ‍Aims and Methods: The provincial health authority reported a high mortality rate from upper GI cancer in the ‍center of Iran. A comprehensive search was undertaken to survey and register all cases of cancer during a 5-year ‍(1998-2002) period among the indigenous population of Semnan Province. Diagnosis of cancer was based on ‍histopathology, clinical or radiological findings, and death certificates. ‍Results: A total of 1732 patients with cancers (mean age 59.41%+19.08% years) were found during the study. Of ‍these, 936(54.86%) were in males. Crude rates were 124.8/100’000 and 112.1/100,000 for males and females, ‍respectively. Age-standardized ratios (ASRs) for all cancers in males and females were 156/100’000 and 136/100,000 ‍person-year, respectively. Gastric cancer was the most common tumor with an incidence rate of 19.7 per 100,000 ‍people (ASR=27.5). In upper gastrointestinal cancers, gastric cancer was the most common (47.17%), followed by ‍colon malignancies (8.1%, 9.5 per 100,000 populations), esophagus (6.8%, 7.9 per 100,000 populations), liver (2.4%, ‍and 2.8 per 100,000 populations). In women, breast, uterine and ovary, stomach and skin were the most common ‍cancers. In the child population the most common tumors were of the brain, acute lymphocytic leukemia, and bone. ‍Conclusion: Gastric cancer alone constitutes one-sixth of all cancers in Semnan, with the highest ASR incidence ‍rate reported from Iran up to now.     

Screening for Gastric Cancer in Miyagi,Japan: Evaluation with a Population-Based Cancer Registry

Mass screening for gastric cancer originated in Miyagi Prefecture, Japan, in 1960. This review summarizes ‍studies assessing the efficacy of screening using data from a population-based cancer registry in the prefecture ‍that was started in 1959. Sensitivity and specificity of screening photofluorography (indirect radiography) is ‍81.1% and 88.8%, respectively. Ten-year survival rates are 30-40% better in screen-detected cases than in ‍symptom-diagnosed cases. No randomized controlled trials have reported the efficacy of the screening in the ‍country. In a 18-year follow-up study of 7,008 residents in the prefecture, incidence from gastric cancer did not ‍differ between screened and unscreened subjects, but mortality decreased significantly in screened subjects ‍compared with unscreened subjects for men (61.9 vs. 137.2 per 100,000 person-years, P<0.005) and women (28.1 ‍vs. 53.8 per 100,00 person-years, P<0.01). In a population-based case-control study with 198 cases and 577 ‍controls, odds ratio (95% confidence interval) of gastric cancer mortality was 0.41 (0.28-0.61) for ever vs. never ‍screened within 5 years. Studies conducted in other regions have provided similar findings. Substantial evidence ‍indicates that the Japanese screening program is effective in reducing the mortality from gastric cancer. ‍Population-based cancer registries play a crucial role in assessing the efficacy of cancer screening programs.     

Prostate Specific Antigen for Screening for Prostate Cancer: An Appraisal of Thai Report

Prostate cancer is the most common cancer in male populations in many parts of the world. It is a slowing ‍growing deadly cancer with very few signs and symptoms in the early stage. For screening, prostate specific antigen ‍(PSA) has been proposed as a marker in the serum. It is widely employed in western countries, but use of PSA for ‍prostate cancer screening in developing Asian countries is not generalized. Here, the author performed an appraisal ‍on the diagnostic properties of serum PSA in screening prostate cancer among the Thais. Four reports from the ‍literature were recruited for further metanalysis of a total of 1,321 cases. The overall diagnostic activity with regard ‍to sensitivity, specificity, false positive and false negative rates, values being 95.8 %, 66.2 %, 33.8 % and 4.2 %, ‍respectively. Therefore the test has good sensitivity, and sufficiently good diagnostic properties for screening when ‍compared to digital rectal examination (DRE). However, serum PSA cannot be used for a definitive diagnosis, for ‍which pathological confirmation is also necessary. ‍     

Cervical Cancer in the Asian Pacific - Epidemiology,Screening and Treatment

Squamous cell carcinoma (SCC) of the cervix continues to be a major problem in many areas of the Asian- ‍Pacific, particularly in the Indian subcontinent and Papua New Guinea, and to a lesser extent in South-East Asia, ‍Korea and Mongolia. In contrast, levels in the developed countries of the region are low, as is also the case for the ‍Muslim countries of Western Asia, and mainland China. Incidence generally mirrora associated mortality, although ‍with some exceptions reflecting facilities and infrastructure for early detection. Over the last 25 years there has been ‍a marked decrease in incidence rates across most of the Asian Pacific, although less pronounced in India than ‍elsewhere, and there are exceptions where the incidence is on the increase. The predominant risk factor is well ‍established to be persistent infection with a high risk ‘oncogenic’ type of human papilloma virus (HPV), along with ‍multiple partners, other sexually tansmitted diseases and smoking. Consumption of vegetables, in contrast, appears ‍to be protective. Hormonal factors may also play some role. Modifying factors may either impact on neoplasia by ‍directly influencing the processes underlying carcinogenesis, or indirectly by affecting persistence of viral infections. ‍For primary prevention, avoidance of repeated infections and smoking, as well as a high antioxidant intake may be ‍beneficial. Vaccines against HPV also have promise for the future, but a better understanding of the mechanisms ‍underlying spontaneous clearance of both infection and cervical intraepithelial neoplasia (CIN) of different grades ‍is also essential for optimal intervention. For screening, the choice of whether the PAP smear, HPV testing or some ‍form of visual inspection are utilized depends on the resources which are available, all approaches having their own ‍advantages and disadvantages, but with similar sensitivity and specificity. One complication is the increase in ‍adenocarcinoma of the cervix which has been reported in some countries, for which risk factors and most effectice ‍screening may differ from the SCC case. A focus on high risk groups like sex workers might be warranted where ‍financial and technical support are limited. If cervical intraepithelial neoplasias are detected then cryotherapy or ‍the loop electrosurgical excision procedure (LEEP) are effective for their removal. Control of cancer of the cervix, ‍however, demands that a comprehensive approach to screening and management is adopted, necessitating major ‍training of personnel and provision of appropriate resources. ‍     

Mortality Report of Malignant Tumors in SheXian,Hebei Province,China, from the 1970’s to the Present

Background: Investigations into mortality from malignant tumors were initiated in the 1970’s in Hebei Province, ‍China, and especially for esophageal cancer the rates were high, Shexian county ranking in first place of the towns ‍that were surveyed. ‍Methods: Since the 1970’s, a register system for all causes of death has been in place. Data for the decades of the ‍1970’s, 1980’s, 1990’s and 2000’s century were here checked and analyzed by SPSS software. ‍Result: From the decades of the 1970’s onward, the mortality rates of malignant tumors/100,000 were 272.0, ‍260.1, 211.7 and 180.1, respectively, with significant differences over time (x2 =240.5, P<0.001). The main malignant ‍tumors were esophageal, gastric, liver, lung and cervix cancers. The sum of their percentages of all cancer deaths ‍were 92.1% in the 1970’s, 91.6% in the 1980’s, 92.1% in the 1990’s and 93.9% in the 21st century. The sex ratios ‍(male vs female) were 1.5, 1.5, 1.7 and 2.0 respectively, with an ascending trend. Mortality rates of malignant tumors ‍increased with age, with an obvious geographic distribution. The highest mortality of malignant tumors was evident ‍in the area where the Qingzhang and Zhuozhang rivers join. ‍Conclusion: From 1970’s to the beginning of the 21st century, the mortality rate of malignant tumors has shown ‍a declining trend. The main responsible cancers are in the esophagus, stomach, liver, and lung. Through great ‍efforts for prevention, obvious decrease for esophageal cancer and cervix cancer has been achieved, but the mortality ‍rate for gastric cancer remains high.     

A Prospective Study of Diet,Lifestyle, and Genetic Factors and the Risk of Cancer in Khon Kaen Province,Northeast Thailand: Description of the Cohort

Cohort studies are the preferred design in observational epidemiology, but few involving the general population ‍have been performed in Asia, and most concern affluent urban populations.The Khon Kaen study has recruited ‍about 25,000 subjects, aged mainly 35-64, from villages in the relatively underdeveloped north-east of Thailand. All ‍subjects underwent simple physical examination, completed an interviewer-administered questionnaire (including ‍sections on lifestyle, habits, and diet) and donated specimens of blood, which were processed and stored in a biological ‍bank at -20oC. Female subjects (about 16,500) were offered screening by Pap smear, and specimens of cells from the ‍cervix were stored at -20oC. This paper describes the methodology of the study, and the characteristics of the ‍participants. Almost all subjects are peasant farmers, with low annual income and body mass, although 14.6% of ‍women had a BMI in the obese range (>30 kg/m2). Smoking was common among men (78% regular smokers, most ‍of whom used home-produced cigarettes), but rare among women. Fertility levels were relatively high, with a more ‍than half the women having four or more live births. 23.4% of subjects were infected with the liver fluke Opisthorchis ‍viverrini, known to be highly endemic in this region. Follow-up of the cohort is by record-linkage to the provincial ‍cancer registry. By 2003, 762 cancer cases had occurred, the most common being cancers of the liver (363 cases) and ‍cervix uteri (44 cases). The antecedents of these cancers are being investigated using a nested case-control approach. ‍The cohort will yield increasing numbers of cancers for study in the next decade, giving important information on ‍the relative importance of dietary and lifestyle factors in a rural population, undergoing gradual transition to a ‍more westernised lifestyle.     

Fecal Blood versus Sigmoidoscopy for Colorectal Screening in the Asian-Pacific Area

While the guaiac-based fecal occult blood test (FOBT) has been found to be effective for population screening ‍for colorectal cancer, immunochemical FOBT (IFOBT) deserves attention as offering superior sensitivity, usually ‍with no major loss of specificity. A great deal of interest has been concentrated on sigmoidoscopy or colonoscopy ‍as alternatives but medical capacity is a major problem with these approaches, which have yet to be validated ‍for general employment. Other major problems which have still to be overcome with regard to colorectal screening ‍are physician and target population compliance with recommendations as well as ensuring that positives undergo ‍appropriate diagnostic investigations. The APJCP/APOCP has an important role to play in their future solution.     

Cumulative Risk and Trends in Prostate Cancer Incidence in Mumbai,India

Background: Information relating to cancer incidence trends in a community forms the scientific basis for the ‍planning and organization of prevention, diagnosis and treatment of cancer. We here estimated the cumulative risk ‍and trends in incidence of prostate cancer in Mumbai, India, using data collected by the Bombay Population-based ‍Cancer Registry from the year 1986 to 2000. ‍Methods: During the 15 year period, a total of 2864 prostate cancer cases (4.7% of all male cancers and 2.4% of ‍all cancers) were registered by the Bombay Population-based Cancer Registry. For evaluation of the trend, we ‍applied a linear regression model based on the logarithm of the observed incidence rates. The annual percentage ‍changes were also computed for the evaluation. Cumulative incidence rates percentages were calculated by adding ‍up the age specific incidence rates at single ages and then expressed as a percentage. ‍Results: Analysis of the trends in age-adjusted incidence rates of prostate cancer during the period 1986 to 2000 ‍showed no statistically significant increase or decrease and the rates proved stable across the various age groups (00- ‍49, 50-69 and 70+) also. The probability estimates indicated that one out of every 59 men will contract a prostate ‍cancer at some time in his whole life and 99% of the chance is after he reaches the age of 50. ‍Conclusion: The stability in age adjusted-incidence rates indicates that there are no changes in the etiological ‍factors for prostate cancer in Mumbai, India. These findings may be of general interest because changes in diagnostic ‍practices are confounded in the time trends of prostate cancer change in many western countries preventing inferences ‍on the changes in risk. ‍     

What is Important for the Introduction of Cancer Screening in the Workplace?

Although cancer screening has been introduced into physical checkup programs in the workplace, it has not ‍been regulated by the Occupational Health and Safety Law in Japan. In addition, the target age groups and strategy ‍for cancer screening have not been defined. To aid in development of better screening programs, we investigated ‍primary factors considered for introducing cancer screening in workplaces. A mail survey targeted 441 facilities of ‍the Kanto Occupational Health Management Association in June 2002. We received ninety-one responses (20.6%), ‍including 59 facilities of manufacturing companies. The implementations of gastric and colorectal cancer screening ‍were higher than other cancer screenings, exceeding 90% in the responding facilities. Thirty years old or over was ‍the target age in most facilities. The facilities were divided into two groups, A and B, except for two examples whose ‍strategies for cancer screening were not well-documented in their response. There were 35 facilities in group A and ‍54 in group B. In group A, cancer screening was conducted using strategies for all of which effectiveness has been ‍established. On the other hand, in group B, cancer screening was conducted using strategies whose effectiveness ‍were at least partially unestablished. We chose five items to evaluate important factors for introducing a cancer ‍screening program into the workplace: prevalence, screening strategy, effectiveness, efficacy and needs of workers. ‍The most important was the same in both groups, effectiveness. However, there was a tendency for neglect of this ‍aspect in actual conducted plans. Appropriate cancer screening should be carefully coordinated in accordance with ‍the guidelines of the Task Force for Cancer Screening in Japan in the workplace. ‍     

A Low Fat Diet Rich in Fruits and Vegetables May Reduce the Risk of Developing Prostate Cancer

Background: Diet has been implicated in prostate cancer risk and there is evidence of risk reduction with a ‍healthy diet. The objective of this population-based case control study was to examine whether a low fat diet rich in ‍fruits and vegetables can reduce the risk of developing prostate cancer in Mumbai, India. Methods: Included in this ‍study were microscopically proved cases of prostate cancer diagnosed during 1998 to 2000 and registered by Bombay ‍Population Based Cancer Registry (n=594). The controls were healthy men belonging to the resident general population ‍of Mumbai, India. Two controls for each case matched by age and place of residence were selected as the comparison ‍group. Data on oil/fat consumption, fruits and vegetable consumption and other probable confounding factors were ‍obtained by structured face-to-face interview. After exclusions, 390 cases and 780 controls were available for final ‍analysis and confounding was controlled by multiple logistic regression. Results: 58.7% of the control group consumed ‍more than 3 kg of fruits and vegetables per week compared to 52.1% of the case group. Controlling for age and ‍probable confounding factors, a statistically significant protective effect for prostate cancer was observed for those ‍who consumed fruits and vegetables 2 to 3 kg (OR 0.5, 95%CI 0.3-0.8) and more than 3 kg (OR 0.4, 95% CI 0.3-0.6) ‍per week compared to those who consumed less than 2 kg per week. The linear trend for the protective effect was ‍highly significant with increase in the consumption of fruits and vegetables (p = 0.001). Even though not statistically ‍significant, oil/fat consumption showed an elevated risk (OR 1.7, 95%CI 0.9-3.3) for those who consumed more than ‍2kg of oil/fat per month compared to those who consumed less than 1kg. Conclusion: The findings from this study ‍support the hypothesis that a low fat diet rich in fruits and vegetables may reduce the risk of prostate cancer.     

Cancer Profile of Hyderabad,Pakistan 1998-2002

Hyderabad is the third largest city of Pakistan, the second largest city of Sindh Province and one of the oldest ‍cities of the sub-continent. This administrative headquarter is located just east of the River Indus and is an important ‍commercial and industrial center. Once a provincial capital, it is at a distance of approximately 200-km from Karachi. ‍This present study was conducted with the objective of providing the cancer profile of Hyderabad, which has an ‍urban population of 2,840,653 (52.2% M, 47.8% F) annual growth rate 1.13. The city is inhabited by all ethnicities ‍of the country, however the predominant ethnicity is Sindhi, followed by Mohajirs (post-partition immigrants from ‍India), and a lesser extent other ethnicities of Pakistan viz. Baluchs, Punjabis and Pathans. ‍The study includes two sets of patients. First the incident cancer cases, residents of Hyderabad, who reached ‍Karachi for diagnosis or treatment. Second the incident cancer cases registered at the Aga Khan University Pathologybased ‍Cancer Registry (APCR) Pathology collection points at Hyderabad and subsequently registered at APCR, ‍during 1st January 1998 to 31st December 2002. The pathology department of the AKU has 3 centers in Hyderabad, ‍which provide diagnostic pathology especially oncopathology services to the city. The age-standardized rates (ASR) ‍for cancer (all sites) 1998 to 2002 in Hyderabad were 91.6/100,000 in males and 96.0/100,000 in females. The most ‍common malignancies (ASR per 100,000) in males were oral cavity (11.8), lymphoma (10.6), lung (8.0), urinary ‍bladder (6.8), prostate (4.8), liver (4.4), pharynx (4.2), colo-rectum (3.6), larynx (3.2), and skin (3.2). The cancers in ‍females (ASR per 100,000) were breast (22.4), oral cavity (11.5), gall bladder (4.8), esophagus (4.2), cervix (3.6), ‍ovary (3.4), colo-rectum (3.4), lymphoma (3.4), uterus (3.4), and thyroid (2.4). Tobacco-associated cancers were ‍responsible for approximately 40.0% of the tumors in males and 20.0% in females. Histological confirmation remained ‍96.3%, with 44.5% presenting in grade II or I, 55.5% presenting as stage III and IV. Information on grade and stage ‍of malignancy was available in 70% and 50% of the cases respectively. Males comprised 53.1%, and females 46.9% ‍of the cases. The mean age of cancer all sites, both genders was 45.2 years (95% CI 44.4; 45.9), males 45.4 years (95% ‍CI 44.3; 46.5); females 44.9 years (95% CI 43.9; 45.9). ‍Conclusions drawn from this database must be interpreted with care, as it may be identified as data from selected ‍medical institutions. Chances of selective collection bias are minimized as the data of the AKU pathology is collected ‍from multiple centers in the city of Hyderabad, dispersed at distances, which allows adequate sampling from the ‍entire city. There is a slight preponderance of lymphomas in males which we feel is a true higher risk, yet it may ‍indicate an over representation of easily accessible sites in pathology based-data. Nonetheless, this is the first attempt ‍to determine the cancer incidence pattern of Hyderabad, and should serve as a guideline for estimation of the cancer ‍burden and risk assessment statistics of Pakistan and the cancer control program of the country.     

Is it Reporting Bias Doubled the Risk of Prostate Cancer in Vasectomised Men in Mumbai,India?

Background: Vasectomy is a common method of family planning in India and worldwide. The objective of the ‍present study was to assess the association of vasectomy with prostate cancer in a low risk population of a developing ‍country. A population based case control study was conducted in Mumbai, India, for this purpose. Methods: Included ‍in this study were microscopically proved cases of prostate cancer diagnosed during 1998 to 2000 and registered by ‍Bombay Population Based Cancer Registry (n=594). The controls were healthy men belonging to the resident general ‍population of Mumbai, India. Two controls for each case matched by age and place of residence were selected as the ‍comparison group. Data on vasectomy and potential confounding factors were obtained by structured face to face ‍interviews. After exclusions, 390 cases and 780 controls were available for final analysis and confounding was controlled ‍by multiple logistic regression. Results: Overall 14.9% of cases and 10.0% of controls had undergone vasectomy. ‍Compared with no vasectomy the OR with ever having undergone vasectomy was 1.9 (95% CI: 1.3-2.9), after ‍controlling for age and other possible confounding factors. The risk for those who had had a vasectomy before the ‍age of 45 years was 2.1 fold (95% CI: 1.2-3.9) and for those who underwent the procedure at a later age was 1.8 fold ‍(95% CI: 1.1-2.9). The linear trend for an increase in risk with a decrease in age at vasectomy was statistically ‍significant (p for trend= 0.01). The risk for those who completed 25 years or more time since undergoing vasectomy ‍was 3.8 fold (95% CI: 1.9-7.6) and for those who completed less than 25 years it was 1.2 fold (95% CI: 0.7-2.1). The ‍linear trend for an increase in risk with an increase in time since vasectomy was highly significant (p for trend = ‍0.001). Conclusion: There are major public health and birth control implications on vasectomy increases the risk for ‍prostate cancer. It is likely, however, that biases identified in this study result in high estimates of risk and the true ‍risk due to vasectomy is substantially less than the estimated one. Due to the several limitations and possibilities for ‍reporting biases in this study, the evidence for the estimates of the higher odds ratio for prostate cancer in vasectomised ‍men may not be a strong one. In view of the importance of vasectomy for fertility control, further studies with good ‍design and conduct (the information on vasectomy need to be collected with better reliability) are required to clarify ‍the issue of vasectomy associations with prostate cancer.     

Lack of Association of VDR Polymorphisms with Thai Prostate Cancer as Compared with Benign Prostate Hyperplasia and Controls

While still relatively low as compared to rates in the Western world, prostate cancer is on the increase in Asia, ‍presumably due to change in dietary and other lifestyle factors. One risk factor is reported to be vitamin D (VD) and ‍therefore the function of its receptor (VDR) could be of importance. In the present study polymorphims with functional ‍significance in the Bsm, Apa 1 and Taq 1 genes were therefore compared in 28 prostate cancer (CaP), 44 benign ‍prostate hyperplasia (BPH) and 30 control cases in Thailand. None demonstrated any significant variation in ‍distribution within these three groups and therefore we conclude that vitamin D may not be major risk factor for ‍prostate cancer in this population. However, there is considerable variation in the distribution frequencies from ‍country to country and this, combined with differences in sun exposure, means that the results may not be extrapolated ‍to the general case.