Japan collaborative cohort study for evaluation of cancer risk sponsored by monbusho (JACC study)

This paper primarily aimed to overview the rationale for initiating the Japan Collaborative Cohort Study for Evaluation of Cancer Risk Sponsored by Monbusho (Ministry of Education, Science, Sports and Culture of Japan) (JACC Study), by comparing socio-demographic and nutritional changes that were witnessed between 1965 and 1990 in Japan, and also to describe the study design, the follow-up conditions as of the end of 1997, and the frameworks for analyzing the data of the lung, stomach, pancreas and gallbladder/bile duct, based on the approximately 8-year follow-up data. For other major sites such as cancers of the large intestine and liver, an analysis will be started in the fiscal year of 2002. This paper secondarily aimed to be cited as the basic information on the JACC Study when several publications are to be based on.     

Alcohol consumption and all-cause and cancer mortality among middle-aged Japanese men: seven-year follow-up of the JPHC study Cohort I. Japan Public Health Center

To examine the association between alcohol consumption and mortality in Japan, where mortality and lifestyle differ substantially from Western countries, a population-based prospective study was conducted in four public health center areas as part of the Japan Public Health Center-based prospective study on cancer and cardiovascular disease (JPHC). After excluding subjects with self-reported serious diseases at baseline, 19,231 men aged 40-59 years who reported their alcohol intake were followed from 1990 through 1996, and 548 deaths were documented. The association between all-cause mortality and alcohol consumption was J-shaped. The lowest risk was observed for men who consumed 1-149 g/week (relative risk (RR) = 0.64, 95% confidence interval (CI) 0.46, 0.88), while the highest risk was seen for men who consumed > or =450 g/week (RR = 1.32, 95% CI 1.00, 1.74), after adjustment for possible confounders. The association did not change after excluding deaths that occurred in the first 2 years of follow-up. However, the association was modified by smoking, and beneficial effects of moderate drinking were largely limited to nonsmokers. The risk of cancer death showed a similar trend, but increased more in heavy drinkers. The background characteristics of moderate drinkers were healthier than either nondrinkers or heavy drinkers. The authors conclude that moderate alcohol consumption was associated with the lowest risks of all-cause and cancer mortality, especially among nonsmokers.     

Alcohol consumption and increased mortality in Russian men and women: a cohort study based on the mortality of relatives

OBJECTIVE: To examine the relations between frequency of alcohol consumption and of binge drinking and adult mortality in Russian men and women. METHODS: Using modified indirect demographic techniques, a convenience cohort was constructed based on survey respondents' information about their close relatives. A random sample general population of the Russian Federation of 7172 respondents (response rate 61%) provided information on 10 475 male and 3129 female relatives, including age, vital status, and frequency of alcohol consumption and binge drinking. These relatives formed the cohort analysed in this report. The outcome measure was all-cause mortality after the age of 30 years. FINDINGS: There was a strong linear relation between frequency of drinking and of binge drinking and all-cause mortality in men; after controlling for smoking and calendar period of birth, the relative risk of death in daily drinkers compared to occasional drinkers was 1.52 (95% confidence interval (CI) 1.33-1.75). Male binge drinkers had higher mortality than drinkers who did not binge, which persisted after adjustment for drinking frequency (adjusted relative risk 1.09, 95% CI 1.00-1.19). In women, the increased mortality was confined to a small group of those who binged at least once a month (adjusted relative risk 2.68, 95% CI 1.54-4.66). CONCLUSION: The results suggest a positive association between alcohol and mortality in the Russian Federation. There was no evidence for the protective effect of drinking seen in western populations. Alcohol appears to have contributed to the high long-term mortality rates in Russian men, but it is unlikely to be a major cause of female mortality.     

Smoking cessation and COPD mortality among Japanese men and women: The JACC study

ObjectiveTo investigate an effect of smoking cessation on chronic obstructive pulmonary disease (COPD) mortality in Asians.MethodsThe data was obtained from the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study). A total of 41465 Japanese men and 52662 Japanese women aged 40–79 years who had no history of COPD, asthma, other chronic lung diseases, cardiovascular disease or cancer were followed between 1988 and 2008.ResultsDuring median 18-year of follow-up, there were 285 (251 men and 34 women) documented deaths from COPD. Multivariable-adjusted hazard ratios with 95% confidence intervals of COPD death were 4.46 (2.72–7.29) and 9.26 (4.19–20.5), respectively for current male and female smokers when compared to never smokers. Compared with current smokers, the multivariable HRs for 5–9 years and 10 years or more smoking cessation prior to baseline were 0.44 (0.22–0.87) and 0.36 (0.22–0.58) in men, respectively while the HR for never smokers was 0.30 (0.16–0.57). There were an insufficient number of COPD deaths in women to clarify this association.ConclusionSmoking cessation for ten years or more prior to enrollment reverses the excess risk of COPD mortality to a level similar to that observed among never smokers in men.     

Alcohol consumption and suicide mortality among Japanese men: the Ohsaki Study.

The risk of suicide is well known to be increased among heavy alcohol drinkers. However, whether the risk is increased or decreased among light drinkers is still under debate. We investigated this association in a population-based sample of men in Japan. The Ohsaki Study was a population-based, prospective cohort study among Japanese adults aged from 40 to 79 years. Between October and December, 1994, 22,804 men in Miyagi Prefecture, Japan, completed a questionnaire on various health-related lifestyles, including alcohol drinking. During the subsequent 7 years follow-up, 73 participants committed suicide. We used the Cox proportional hazards regression model to estimate the hazard ratio (HR) for suicide mortality according to the quantity of alcohol consumed daily, with adjustment for potential confounders. There was a statistically significant positive and linear association between the amount of alcohol consumed and the risk of suicide: the multivariate HRs in reference to nondrinkers (95% confidence interval) were 1.2 (0.5-2.7), 1.5 (0.7-3.4), and 2.4 (1.2-4.6) in current drinkers who consumed /=45.6g of alcohol per day, respectively (P-trend=.016). Even after the early death cases were excluded, a significant linear association was observed between alcohol consumption and the risk of suicide, with the risk of suicide also being nonsignificantly higher among the light drinkers than among nondrinkers (multivariate HR=1.7). This prospective cohort study indicated a positive linear association between alcohol consumption and the risk of suicide, and the suicide risk among the light drinkers was not decreased as compared with that in nondrinkers.     

Smoking cessation and COPD mortality among Japanese men and women: The JACC study

ObjectiveTo investigate an effect of smoking cessation on chronic obstructive pulmonary disease (COPD) mortality in Asians.MethodsThe data was obtained from the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study). A total of 41465 Japanese men and 52662 Japanese women aged 40–79 years who had no history of COPD, asthma, other chronic lung diseases, cardiovascular disease or cancer were followed between 1988 and 2008.ResultsDuring median 18-year of follow-up, there were 285 (251 men and 34 women) documented deaths from COPD. Multivariable-adjusted hazard ratios with 95% confidence intervals of COPD death were 4.46 (2.72–7.29) and 9.26 (4.19–20.5), respectively for current male and female smokers when compared to never smokers. Compared with current smokers, the multivariable HRs for 5–9 years and 10 years or more smoking cessation prior to baseline were 0.44 (0.22–0.87) and 0.36 (0.22–0.58) in men, respectively while the HR for never smokers was 0.30 (0.16–0.57). There were an insufficient number of COPD deaths in women to clarify this association.ConclusionSmoking cessation for ten years or more prior to enrollment reverses the excess risk of COPD mortality to a level similar to that observed among never smokers in men.     

饮酒与男性肺癌发病关系的前瞻性队列研究

目的 研究我国男性饮酒与肺癌发病风险之间的关联。方法 对开滦集团队列（2006－2015年）男性人群每两年随访一次,收集饮酒相关信息及肺癌发病资料;此外,检索开滦附属医院医疗信息系统、开滦集团社保系统、唐山市医疗保险系统,补充收集随访过程中可能遗漏的肺癌新发病例。以不饮酒人群为参比组,利用Cox风险比例回归模型分别分析饮酒频率、饮酒类型与男性肺癌发病风险的关联,计算发病风险比（HR）及其95% CI。按照吸烟状况对研究人群分层,分别分析从不吸烟与既往吸烟/现在吸烟人群中饮酒与肺癌发病的关联。结果 共纳入101 751名男性,总随访808 146.56人年,中位随访时间8.88年,共收集肺癌新发病例913名。调整年龄、吸烟状态、吸烟量、文化程度、粉尘暴露、BMI等潜在的混杂因素后,既往饮酒、现在饮酒频率<1次/d、现在饮酒频率≥1次/d人群肺癌发病风险HR值（95% CI）分别为1.30（0.90～1.88）、0.80（0.64～1.01）和1.04（0.85～1.27）。饮用啤酒/红酒（HR=0.91,95% CI：0.69～1.20）和饮用白酒（HR=0.99,95% CI：0.83～1.19）与肺癌发病无统计学关联。依据吸烟状况分层分析,所得结果类似。结论 本研究结果尚不支持饮酒与男性肺癌发病风险存在关联。     

Alcohol and mortality: a cohort study of male Japanese physicians

The relationship between drinking habit surveyed in 1965 and cause-specific mortality over 19 years was investigated in 5135 male Japanese physicians taking into account smoking habit and separating ex-drinker from non-drinker. As compared with non-drinkers, daily drinkers with high consumption had a significantly increased mortality from all causes. Drinking was significantly related to the so-called alcohol-related causes of death; upper aerodigestive cancer, liver cancer and liver cirrhosis. Mortality from acute myocardial infarction was inversely related to drinking, whereas other coronary heart disease showed a somewhat higher mortality among men consuming a large amount of alcohol than among non-drinkers. There was a weak, but significant, association between stroke and drinking, and the relation did not differ between haemorrhagic stroke and other stroke. No obvious relationship with drinking was observed for cancers of the stomach, large bowel, pancreas and lung.     

Dietary habits and risk of ovarian cancer death in a large-scale cohort study (JACC study) in Japan

The Japan Collaborative Cohort (JACC) Study was established in 1988-1990 and consisted of 46,465 men and 64,327 women observed until the end of 2003. A self-administered food frequency questionnaire was used as a baseline survey, and associations of dietary habits with the risk of ovarian cancer death were evaluated, taking into consideration age, menstrual and reproductive, anthropometric, and lifestyle factors. During the observation period, 77 women died of ovarian cancer. Hazard ratios for dietary factors were calculated by Cox's proportional hazards model. Being adjusted only for age, high intakes of dried or salted fish and Chinese cabbage were positively associated with the risk of ovarian cancer death, and the risk increased dose-dependently. In contrast, intake of soybean curd (tofu) was inversely associated with the risk. After being adjusted for age and potential confounding factors, the results regarding the intakes of dried or salted fish and Chinese cabbage did not change. However, the significance relating to the intake of soybean curd (tofu) was attenuated. From the results of this cohort study, it was suggested that high intakes of dried or salted fish and Chinese cabbage were potential risk factors of ovarian cancer death. In contrast, however, a high intake of soy bean curd (tofu) might have preventive effects against the risk.     

Effect of coffee consumption on all-cause and total cancer mortality: findings from the JACC study

Coffee consumption is known to be related to various health conditions. Recently, its antioxidant effects have been suggested to be associated with all-cause or cancer mortality by various cohort studies. However, there has been only one small Asian cohort study that has assessed this association. Thus, we tried to assess the association of coffee with all-cause and total cancer mortality by conducting a large-scale cohort study in Japan. A total of 97,753 Japanese men and women aged 40–79 years were followed for 16 years. Hazard ratios and 95% confidence intervals of all-cause and total cancer mortality in relation to coffee consumption were calculated from proportional-hazards regression models. A total of 19,532 deaths occurred during the follow-up period; 34.8% of these deaths were caused by cancer. The all-cause mortality risk decreased with increasing coffee consumption in both men and women, with a risk elevation at the highest coffee consumption level (≥4 cups/day) compared with the 2nd highest consumption level in women, although the number of subjects evaluated at this level was small. No association was found between coffee consumption and total cancer mortality among men, whereas a weak inverse association was found among women. The present cohort study among the Japanese population suggested that there are beneficial effects of coffee on all-cause mortality among both men and women. Furthermore, the results showed that coffee consumption might not be associated with an increased risk of total cancer mortality.     

Dietary habits and risk of urothelial cancer death in a large-scale cohort study (JACC Study) in Japan

In the present study, the associations of dietary habits with the risk of urothelial cancer death were evaluated taking into consideration sex, age, and smoking habits. The Japan Collaborative Cohort Study was established in 1988-1990 and consisted of 47,997 men and 66,520 women observed until the end of 1999. A self-administered food-frequency questionnaire was used as a baseline survey. Hazard ratios for dietary factors were calculated by Cox's proportional hazards model. During the observation period, 63 men and 25 women died of urothelial cancer. Increasing age, male gender, and history of smoking were all significantly associated with increased risk of urothelial cancer death. A high intake of milk and fruits other than oranges reduced the risk significantly and dose dependently, in particular among subjects with smoking history. However, consumption of butter and yogurt had no associations with the risk. Intakes of cabbage, lettuce, green leafy vegetables, carrots, squash, tomatoes, and oranges were not significantly associated with the risk. It was suggested that urothelial cancer death could be potentially preventable by smoking cessation and regular intake of milk and fruit.     

Smoking cessation and mortality from cardiovascular disease among Japanese men and women: the JACC Study

To examine the effect of smoking cessation on cardiovascular disease mortality in Asians, the authors conducted a 10-year prospective cohort study of 94,683 Japanese (41,782 men and 52,901 women) aged 40-79 years who were part of the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study). During 941,043 person-years of follow-up between 1989-1990 and 1999, 698 deaths from stroke, 348 from coronary heart disease, and 1,555 from total cardiovascular disease occurred in men and 550, 199, and 1,155, respectively, in women. For men, the multivariate relative risks for current smokers compared with never smokers were 1.39 (95% confidence interval (CI): 1.13, 1.70) for stroke, 2.51 (95% CI: 1.79, 3.51) for coronary heart disease, and 1.60 (95% CI: 1.39, 1.84) for total cardiovascular disease. The respective relative risks for women were 1.65 (95% CI: 1.21, 2.25), 3.35 (95% CI: 2.23, 5.02), and 2.06 (95% CI: 1.69, 2.51), with larger excess risks for persons aged 40-64 years than for older persons. The risk decline after smoking cessation occurred for coronary heart disease and total cardiovascular disease within 2 years and for total stroke after 2-4 years. For each endpoint and in both age subgroups of 40-64 and 65-79 years, most of the benefit of cessation occurred after 10-14 years following cessation. Findings imply the importance of smoking cessation at any age to prevent cardiovascular disease in Japanese.     

Alcohol consumption as a major risk factor for the rise in liver cancer mortality rates in Japanese men

BACKGROUND: Age-adjusted liver cancer mortality rates have been increasing for both men and women in Japan since 1970; however, increases in mortality rates in men are much greater than those in women. Hepatitis C virus infections and heavy alcohol consumption are considered to be the major risk factors of liver cancer deaths in Japanese. The purpose of this study is (1) to examine the pattern of liver cancer mortality by gender and birth year to compare those with the pattern of other alcohol-related mortality and (2) to estimate the attributable risk per cent of heavy alcohol consumption for liver cancer deaths in Japanese men. METHODS: Age-specific liver cancer mortality rates by gender were compared with those of cirrhosis mortality rates. Then male-to-female mortality rate ratios were calculated by birth cohort and compared with cirrhosis mortality rate ratios and oesophageal cancer mortality rate ratios. The attributable risk per cent of alcohol consumption for liver cancer death was calculated, using female liver cancer mortality rates as standard rates. RESULTS: Examination of both gender and birth cohort mortality rates revealed that male-to-female liver cancer mortality rate ratios by birth cohort correspond well with those rate ratios for liver cirrhosis and oesophageal cancer mortality. The attributable risk per cent of alcohol consumption for liver cancer deaths in Japanese men was 70%. CONCLUSION: Alcohol consumption is more important than hepatitis C virus infections as a major cause of liver cancer deaths in Japanese men.     

Alcohol consumption and blood pressure in Japanese men.

In a study of Japanese men, a nonlinear association of alcohol consumption and blood pressure was not observed. This cross-sectional study was conducted to clarify the effect of infrequent or light alcohol consumption on blood pressure in normotensive Japanese men. The subjects were 2,179 male workers ranging in age from 40 to 54 years. Drinking habits were represented by three indices: episodic alcohol consumption, frequency of drinking, and monthly alcohol consumption. Seven items were analyzed as covariates: age, body mass index, salt intake, physical activity, and levels of gamma-glutamyl transpeptidase, uric acid, and plasma glucose. The association between drinking habits and blood pressure was evaluated by using analysis of covariance. Both episodic alcohol consumption and frequency of drinking were significantly associated with blood pressure in subjects aged 45 to 54 years. In those aged 40 to 44 years, there was a significant association between frequency of drinking and diastolic blood pressure. Significant associations of monthly alcohol consumption with blood pressure in every age group also were found. In subjects aged 45 to 54 years, linear associations between episodic alcohol consumption, frequency of drinking, monthly alcohol consumption, and adjusted blood pressure were observed. In those aged 40 to 44 years, nonlinear associations of monthly alcohol consumption and frequency of drinking with adjusted blood pressure were observed, and threshold effects of 540 ml of alcohol per month and a frequency of 1 to 12 days per month were found. In conclusion, habitual alcohol consumption increases blood pressure linearly in normotensive workers aged 45 to 54 years, although light consumption does not affect blood pressure in those aged 40 to 44 years.     

Alcohol drinking and colorectal cancer in Japanese: a pooled analysis of results from five cohort studies

Colorectal cancer is an alcohol-related malignancy; however, the association appears to be stronger among Asian populations with a relatively high prevalence of the slow-metabolizing aldehyde dehydrogenase variant. To examine the association between alcohol consumption and colorectal cancer in Japanese, the authors analyzed original data from five cohort studies that measured alcohol intake using validated questionnaires at baseline. Hazard ratios were calculated in the individual studies, with adjustment for a common set of variables, and then combined using a random-effects model. During 2,231,010 person-years of follow-up (ranging variously from 1988 to 2004), 2,802 colorectal cancer cases were identified. In men, multivariate-adjusted pooled hazard ratios for alcohol intakes of 23-45.9 g/day, 46-68.9 g/day, 69-91.9 g/day, and > or =92 g/day, compared with nondrinking, were 1.42 (95% confidence interval (CI): 1.21, 1.66), 1.95 (95% CI: 1.53, 2.49), 2.15 (95% CI: 1.74, 2.64), and 2.96 (95% CI: 2.27, 3.86), respectively (p for trend < 0.001). The association was evident for both the colon and the rectum. A significant positive association was also observed in women. One fourth of colorectal cancer cases in men were attributable to an alcohol intake of > or =23 g/day. An alcohol-colorectal cancer association seems to be more apparent in Japanese than in Western populations. Whether this difference can be ascribed to genetic or environmental factors needs to be clarified.