Biliary tract cancer and occupation in Sweden.

Using the Cancer-Environment Registry, which links the incidence of cancer (1961-79) and the 1960 census data on industry and occupation for all employed individuals in Sweden, the occurrence of biliary tract cancer (ICD 7th rev 155.1-.9) was systematically assessed according to occupational and industrial classifications. Data are presented separately for cancer of the gall bladder (ICD 155.1) and other cancers of the biliary tract (ICD 155.2-.9) including cancers of the extrahepatic bile ducts, ampulla of Vater, and unspecified bile passages. Statistically significant increased risks for cancer of the gall bladder were observed for men employed in petroleum refining, papermills, chemical processing, shoemaking, and repairing, and for both men and women employed in textile work. A significant increase in the incidence of other cancers of the biliary tract (mostly cancers of the bile duct) was found for such asbestos related employment as shipbuilding and in the wholesale construction materials industry and among insulation workers. These findings should be considered only as clues to aetiological factors, although several are consistent with earlier observations from other countries.     

Biliary tract cancer and occupation in Sweden

Using the Cancer-Environment Registry, which links the incidence of cancer (1961-79) and the 1960 census data on industry and occupation for all employed individuals in Sweden, the occurrence of biliary tract cancer (ICD 7th rev 155.1-.9) was systematically assessed according to occupational and industrial classifications. Data are presented separately for cancer of the gall bladder (ICD 155.1) and other cancers of the biliary tract (ICD 155.2-.9) including cancers of the extrahepatic bile ducts, ampulla of Vater, and unspecified bile passages. Statistically significant increased risks for cancer of the gall bladder were observed for men employed in petroleum refining, papermills, chemical processing, shoemaking, and repairing, and for both men and women employed in textile work. A significant increase in the incidence of other cancers of the biliary tract (mostly cancers of the bile duct) was found for such asbestos related employment as shipbuilding and in the wholesale construction materials industry and among insulation workers. These findings should be considered only as clues to aetiological factors, although several are consistent with earlier observations from other countries.     

Body mass index and biliary tract disease: A systematic review and meta-analysis of prospective studies

ObjectiveTo evaluate the association between body mass index (BMI, kg/m²) and incidence of biliary tract disease.MethodsWe performed a systematic review and a meta-analysis of prospective studies by searching the database of PubMed and EMBASE published up to December 31, 2013. Outcome of interest was disease of biliary tract system (gallbladder, extrahepatic bile duct and Ampullar of Vater). We used a random-effects model to combine the study-specific relative risks (RRs) and 95% confidence intervals (95% CIs) from 22 prospective studies. We examined whether BMI was associated with a higher risk of biliary tract disease in a combined analysis.ResultsThe positive association was stronger for non-cancer biliary tract disease than biliary tract cancer; combined RRs (95% CIs) comparing the top with bottom categories were 1.40 (1.15–1.65) for biliary tract cancer and 2.75 (2.35–3.15) for non-cancer biliary tract disease (P for difference < 0.001). For non-cancer biliary tract disease, combined RRs (95% CIs) comparing the top with bottom categories were 3.21 (2.48–3.93) for women and 2.01 (1.66–2.37) for men (P for difference = 0.04).ConclusionObesity is associated with higher risks of biliary tract cancer and, to a greater extent, non-cancer biliary tract disease.     

Combined radiotherapy and local external hyperthermia in advanced cancer--animal experiment and clinical study

The response of a mouse's foot to heat was studied. Transplanted syngeneic tumor, C3H mouse mammary carcinoma, was treated with irradiation and hyperthermia in a waterbath. The tumor did not disappear in any of the mice treated with radiotherapy with a dose of 20 Gy alone, but disappearance of the tumor was observed in 11 of 15 and 6 of 8 of the mice treated with combined therapy of irradiation and hyperthermia. There was a significant difference between these two groups. Synergistic effect was confirmed (P less than 0.001, P less than 0.005). Hyperthermia using Thermotron RF-8 was performed on 19 patients (5 bladder cancers, 3 uterine cancers, 3 rectal cancers, 4 soft tissue tumors, 2 oral cancers, 1 biliary tract cancer, 1 renal cancer) between April, 1986 and December, 1986. They were irradiated with a daily dose of 1.5-2.0 Gy, 5 times a week and hyperthermia was performed within 30 minutes after each irradiation once or twice a week. Intratumoral temperature was kept at 43 degrees C-45 degrees C. Temperature over 41 degrees C was maintained in most patients. Clinical response was assessed by tumor regression rates. Partial response a (PRa), defined as 80% or more regression in tumor volume, was obtained in 1 bladder cancer patient and PRb, defined as 50% to less than 80% regression, was obtained in another 5 patients. Side effects were observed in all patients including mild skin burn, nausea and diarrhea. Rectovaginal fistula developed in 1 patient. Combined radiotherapy and hyperthermia seems to be useful in advanced cancer patients.     

Pesticide sales and adult male cancer mortality in Brazil

In Brazil, where the use of pesticide grows rapidly, studies that evaluate the impact of pesticide exposure on cancer incidence and mortality are very scarce. In this study, we evaluated the degree of correlation between pesticide sales in 1985 in eleven Brazilian states and cancer mortality rates during 1996-1998. Information of all cancer deaths occurred in men 30-69 years old from 1996 to 1998 were collected from National Mortality System. Single and multiple linear regression coefficients were obtained to assess the relationship between per capita sales of pesticides in 1985, specific-site cancer mortality rates (prostate, soft tissue, larynx, leukemia, lip, esophagus, lung, pancreas, bladder, liver, testis, stomach, brain, non-Hodgkin's lymphoma, and multiple myeloma) during 1996-1998, and several covariates. In addition, states were stratified into three groups according to tertiles of pesticides sales and cancer mortality rate ratios (MRR) were then calculated using first tertile as reference. Finally, a factor analysis was performed to reveal unapparent relationships between pesticide use and cancer mortality. Pesticide sales showed statistically significant correlation with the mortality rates for the cancers of prostate (r=0.69; p=0.019), soft tissue (r=0.71; p=0.015), leukemia (r=0.68; p=0.021), lip (r=0.73; p=0.010), esophagus (r=0.61; p=0.046), and pancreas (r=0.63; p=0.040). Moderate to weak correlations were observed for the cancers of larynx, lung, testis, bladder, liver, stomach, brain, and NHL and multiple myeloma. In addition, correlation between pesticide sales and specific-site cancer mortality rates was reinforced by multiple regression analysis. For all specific-sites, cancer mortality rates were significantly higher in the states of moderate (2nd tertile) and high (3rd tertile) pesticide sales, with MRR ranging from 1.11 to 5.61. Exploring hidden relationships between pesticide sales and cancer mortality in Brazil, through a factor analysis, revealed that affluence; public policies and lifestyle behaviors may explain almost 70% of the variance of the studied association. The results suggest that population exposure to pesticides in the 1980s in some Brazilian States may have been associated with selected cancer sites observed a decade later.     

Mortality of cellulose fiber production workers

Mortality was studied among 1271 employees of a cellulose fiber production plant in Rock Hill, South Carolina, in the United States. Each subject was employed for at least three months between 1 January 1954 and 1 January 1977 in jobs that entailed exposure to the highest concentrations of methylene chloride. In the cohort 122 deaths were identified through 1 September 1986, and mortality rates for the cohort were compared with mortality rates for York County, South Carolina. Deficit mortality was observed for cancers of the respiratory system, breast, and pancreas and from ischemic heart disease. Excess mortality was observed for cancers of the buccal cavity and pharynx and the liver and biliary tract, and for melanoma as well. The largest relative excess was for liver and biliary tract cancers. There were only four deaths in this category; however, three of the four deaths were cancer of the biliary tract (3 observed, 0.15 expected, standardized mortality ratio 20).     

胆道系统肿瘤患者生存预测模型的构建及验证研究

目的 调查胆道系统肿瘤患者的生存率及其影响因素，并构建预后风险预测模型对生存概率进行预测。方法 选取美国监测、流行病学和结果项目（SEER）收集的2010-2015年诊断的14 005例胆道系统肿瘤（包括胆囊癌、肝外胆管癌和壶腹癌）患者作为观察人群。运用多因素Cox回归模型调查胆道系统肿瘤预后因素，并构建预测列线图对其1、3和5年总生存率进行预测并进行模型预测区分能力和标定能力评价。同时，选取SEER 2004-2009年诊断的11 953例患者作为验证队列对模型的外部预测准确性进行验证。结果 胆道系统肿瘤患者1、3和5年总生存率分别为41.9%、20.4%和15.3%。年龄>50周岁、黑人/印第安/阿拉斯加人种、较高的TNM分期及较差组织学分化程度是患者死亡的危险因素，而已婚状态、亚裔和太平洋岛人种、有医疗保险和原发部位手术是保护因素，性别与预后无关。预测模型C统计量为0.73（95%CI：0.72~0.74），标准曲线显示胆道系统肿瘤患者1、3和5年预测生存概率和实际生存概率交互曲线均与45°对角线接近。验证队列的结果与建模队列相似，预测模型C统计量0.70（95%CI：0.69~0.72），提示该预测模型具有较高的外部适用性。胆囊癌、肝外胆管癌和壶腹癌与总体胆道系统肿瘤结果一致。结论 胆道系统肿瘤患者生存率相对较差，基于预后因素构建的生存预测模型具有较高的预测准确性。未来可将该预测模型应用于临床，指导患者的个体化治疗。     

The association between frequency of vigorous physical activity and hepatobiliary cancers in the NIH-AARP Diet and Health Study

Despite a potential preventive effect of physical activity on hepatobiliary cancer, little information is available on the relation between the two. We studied the association between frequency of vigorous physical activity and hepatobiliary cancer among 507,897 participants of the NIH-AARP Diet and Health Study, aged 50–71 years at baseline in 1995/1996. During 10 years of follow-up, 628 incident cases of liver cancer and 317 cases of extrahepatic biliary tract cancer were registered. Physical activity levels were assigned according to the frequency of engagement in 20 min or more of vigorous physical activity per week: never/rarely (lowest level), less than once per week, 1–2 times per week, 3–4 times per week, 5 or more times per week (highest level). Using Cox regression, multivariate-adjusted relative risks (RR) comparing the highest with the lowest level of physical activity revealed a statistically significant decreased risk for liver cancer (RR = 0.64, 95 % confidence interval (CI) = 0.49–0.84, p-trend <0.001), particularly hepatocellular carcinoma (RR = 0.56, 95 % CI = 0.41–0.78, p-trend <0.001), independent of body mass index. By comparison, multivariate analyses indicated that physical activity was not statistically significantly associated with extrahepatic bile duct cancer (RR = 0.86, 95 % CI = 0.45–1.65), ampulla of Vater cancer (RR = 0.66, 95 % CI = 0.29–1.48), or gallbladder cancer (RR = 0.63, 95 % CI = 0.33–1.21). These results suggest a potential preventive effect of physical activity on liver cancer but not extrahepatic biliary tract cancer, independent of body mass index.     

Demographic factors and cancer mortality. A mathematical model for cancer mortality in Denmark 1943-78

Deaths from cancer in Denmark from 1943-1978 were extracted from the Danish National Death Register at the Danish Institute for Clinical Epidemiology. This paper illustrates the relationship between demographic factors and mortality from a large group of cancers, which increases progressively from young adult life into old age. One-year age-specific mortality rates between 30 and 79 years of age were computed for 14 different cancer sites among both males and females, in five ten-year birth cohorts and for the capital and provinces. The number of deaths at a particular age were found to follow a Poisson distribution and the mortality rate could be expressed by the function lx = bxk, where lx is the mortality rate at age x, and b and k are parameters to be estimated. With this model a straight line is obtained, when mortality and age are plotted on a double logarithmic scale. The maximum likelihood estimates of b and k were found iteratively for each of the 280 combinations of sex--cancer site--residence--cohort. For fixed sex and cancer site the relationship between age, residence and cohort was examined. It appeared that k was independent of residence. For 10 of the male cancers and 12 of the female cancers, k was found to be independent of cohort and in the last 6 cases k was found to be a linear function of cohort. For 12 out of 14 cancer sites among males the ratio of mortality in the capital to mortality in the provinces was significantly greater than one.(ABSTRACT TRUNCATED AT 250 WORDS)     

高龄肝外胆道疾病手术治疗临床分析

目的：分析高龄肝外胆道疾病患者的内科合并病，术后并发症和手术时机的关系，提高老年胆道疾病的治疗水平。方法：对82例65岁以上高龄肝外胆道疾病手术患者进行回顾性总结。结果：82例中行急诊手术31例（38％），择期手术51例（63％）。术后并发症发生率为20％（17／82）；在并发症中肺部感染发生率占35％（6／17）；泌尿道感染占28％（5／17）；切口感染占19％（3／17）；全组术后近期死亡3例（4％），其中，死于肝肾衰竭1例，呼吸衰竭1例，心力衰竭1例。结论：无内科合并病的高龄肝外胆道疾病患者应早手术，有合并病患者宜对合并病作及时处理后于48h内手术。     

Regional Assessment of Atrazine Exposure and Incidence of Breast and Ovarian Cancers in Kentucky

The association between breast and ovarian cancers with endogenous estrogen or hormonally related events has led to the hypothesis that exposures to exogenous estrogenic compounds in the environment may increase the risk of these cancers. Atrazine, the most commonly used herbicide in the United States, belongs to this group of compounds and is widely used in corn production. This study is an expansion of a previous investigation conducted in Kentucky. Using secondary data, we derived several indices of environmental exposure to atrazine and examined the association between these measures and the incidence of breast and ovarian cancer in Kentucky over a 5-year period (1993–97). Exposure indices to atrazine were derived based on public water measurements, acres of corn planted, and pounds of atrazine sold. Data on breast and ovarian cancer incidence were obtained from the Kentucky Cancer Registry by county and by the 15 Area Development Districts (ADDs) in which the 120 counties are grouped. Poisson regression analyses adjusted for education and race were conducted separately for each index of exposure and for a combined total exposure score. All exposure measures were divided in quartiles for analysis. A null association was found for breast cancer across all exposure indices, both by county and by ADD. For ovarian cancer, the data suggest an inverse association, with increasing exposure linked to decreasing incidence rates, both at the county and ADD level. The following are the rate ratios (RR) and corresponding 95% confidence intervals, for the summary exposure scores in the three upper quartiles, using the lowest quartile as baseline (RR = 1.0), and the county as the unit of analysis: 1.01 (0.83–1.21), 0.77 (0.66–0.90), and 0.76 (0.65–0.88). Due to the ecologic nature of this study and inherent limitations, it is possible that other factors may be contributing to these findings. Studies using individual-level data are recommended to elucidate the relationships between estrogenic environmental exposures and female reproductive cancers. Received: 3 April 2001/Accepted: 12 June 2001     

First analysis of cancer incidence and occupational radiation exposure based on the National Dose Registry of Canada

A cohort study was conducted to investigate the relation between cancer incidence and occupational exposure to ionizing radiation. Records containing dose information from 1951 to 1988 for 191,333 persons were extracted from the National Dose Registry of Canada. The records were linked to the Canadian Cancer Data Base, with incidence data from 1969 to 1988. Standardized incidence ratios were calculated using Canadian cancer incidence rates stratified by age, sex, and calendar year. Excess relative risks were obtained from internally based dose-response analyses. The following significant results were found for males and females combined: a deficit in the standardized incidence ratio for all cancers combined; elevated standardized incidence ratios for thyroid cancer and melanoma; and elevated excess relative risks for rectum, leukemia, lung, all cancers combined, all except lung, and all except leukemia. For males, cancers of the colon, pancreas, and testis also showed significantly elevated excess relative risks. The specific cancer types listed above have been implicated in previous studies on occupational exposure to ionizing radiation, except for testis, colon, and melanoma, while the findings on thyroid cancer from previous studies are inconclusive. The thyroid standardized incidence ratios in this study are highly significant, but further investigation is needed to assess the possibility of association with occupational radiation exposure.     

A meta-analysis of occupational trichloroethylene exposure and liver cancer

Objective  Findings from epidemiologic studies of trichloroethylene (TCE) exposure and liver cancer have been inconsistent. To quantitatively evaluate this association and to examine sources of heterogeneity, we conducted a meta-analysis of occupational studies of TCE exposure and liver/biliary tract cancer. Methods  We identified 14 occupational cohort studies of TCE exposed workers and one case-control study that met our inclusion criteria. Nine studies specifically identified TCE as a workplace exposure, and were classified as Group I cohort studies. Subcohorts of workers, identified within eight of these studies as more likely exposed to TCE than the total cohort, were analyzed separately. Results  The combined liver/biliary cancer summary relative risk estimate (SRRE) for all studies was 1.08 (95% CI 0.91–1.29; heterogeneity (H)-P-value = 0.12). For the total study populations in the Group I cohorts, the SRRE was 1.14 (95% CI 0.93–1.39; H-P-value = 0.05) and for the subcohorts, the SRRE was 1.30 (95% CI 1.09–1.55). Within this subcohort analysis, the association for the European studies of workers from various industries (SRRE = 1.38; based on four studies) was higher than the association for the US studies of aerospace and aircraft workers (SRRE = 0.97, based on four studies). Conclusion  Although positive associations were observed for some analyses, results were inconsistent across occupational groups (aerospace/aircraft vs. other industries combined), study location, and incidence versus mortality endpoints. In addition, exposure-response trends were not observed consistently across studies. Interpretation is also limited by the potential impact of uncontrolled confounding by other occupational or lifestyle exposures such as smoking or alcohol consumption. Given these limitations, the currently available epidemiologic data are not sufficient to support a causal relation between occupational TCE exposure and liver/biliary cancer.     

Historical cohort study of 10 109 men in the North American vinyl chloride industry, 1942-72: update of cancer mortality to 31 December 1995

OBJECTIVES—To update and assess mortality from neoplasms to 31 December 1995 among 10 109 men employed in a job exposed to vinyl chloride for at least 1 year between 1942 and 1972 at any of 37 North American factories. Previous analyses indicated associations between employment in vinyl production and increased mortality risk from cancers of the liver and biliary tract, due to increased mortality from angiosarcoma of the liver, and brain cancer.
METHODS—Standardised mortality ratio (SMR) analyses, overall and stratified by several work related variables, were conducted with United States and state reference rates. Cox's proportional hazards models and stratified log rank tests were used to further assess occupational factors.
RESULTS—895 of 3191 deaths (28%) were from malignant neoplasms, 505 since the previous update to the end of 1982. Mortality from all causes showed a deficit (SMR 83, 95% confidence interval (95% CI) 80 to 86), whereas mortality from all cancers combined was similar to state referent rates. Mortality from cancers of the liver and biliary tract was clearly increased (SMR 359, 95% CI 284 to 446). Modest excesses of brain cancer (SMR 142, 95% CI 100 to 197) and cancer of connective and soft tissue (SMR 270, 95% CI 139 to 472) were found. Stratified SMR and Cox's proportional hazard analyses supported associations with age at first exposure, duration of exposure, and year of first exposure for cancers of the liver and soft tissues, but not the brain.
CONCLUSIONS—Excess mortality risk from cancer of the liver and biliary tract, largely due to angiosarcoma, continues. Risk of mortality from brain cancer has attenuated, but its relation with exposure to vinyl chloride remains unclear. A potentially work related excess of deaths from cancer of connective and soft tissue was found for the first time, but was based on few cancers of assorted histology.


Keywords: vinyl chloride; angiosarcoma; liver; brain; connective tissue; soft tissue; neoplasms     

Air pollution and respiratory drug sales in the City of Le Havre, France, 1993-1996

The aim of this study is to evaluate ambulatory respiratory drug sales data as health indicators for the short-term effects of ambient air pollution in the city of Le Havre. Daily respiratory drug sales data were crossed with daily ambient air concentrations of sulfur dioxide (SO2), nitrogen dioxide (NO2), and black smoke (BS) using an autoregressive Poisson regression model adjusting for time trends, seasonal variations, influenza epidemics, and weather. Relative risks (RR) were expressed for an increase of two standard deviations above the mean of each pollutant. Respiratory drug sales were associated with most pollutants studied with lags varying from 1 to 9 days. For daily mean concentrations of BS, RR = 1.037 (95% confidence interval (CI) 1.009-1.066) for lag 1 and RR = 1.052 (95% CI 1.023-1.081) for lag 8. For daily mean concentrations of N02, RR = 1.033 (95% CI 1.001-1.066) for lag 1 and RR = 1.046 (95% CI 1.014-1.079) for lag 8. RR observed with a daily 1 h maximum of SO2 were RR= 1.027 (95% CI 1.004-1.051) for lag 3 and RR= 1.032 (95% CI 1.009-1.056) for lag 9. Our study concludes that ambulatory respiratory drug sales data could be useful for epidemiological surveillance of air pollutant health effects.     

Mortality patterns among petroleum refinery and chemical plant workers

A historical cohort study was conducted to evaluate the mortality experience of 6,831 employees of the Shell Oil Company, Deer Park, Texas, petroleum refinery and chemical plant with emphasis on cancer mortality. Subjects were all workers with potential plant exposure who were employed for at least 3 months during 1948-72. Vital status was determined as of 12/31/83 for 98% of the cohort and death certificates were obtained for 95.4% of 1,180 observed deaths. The statistical analyses excluded 159 female study members. For all causes of death combined, all cancers combined, and for most of the nonmalignant disease categories examined, there were deficits in mortality among refinery workers, chemical plant workers, and workers with experience in both areas. These deficits were generally most pronounced for chemical plant workers. An analysis of specific cancer sites revealed patterns of increased risk suggestive of a possible relationship between occupational exposures in the refinery and lympho-reticulosarcoma. Patterns of increased risk were also observed among chemical plant workers for a category of lymphopoietic tissue cancers, including multiple myeloma, myelofibrosis, polycythemia vera, and certain non-Hodgkin's lymphomas. Some very limited evidence of a possible workplace association was also found among refinery workers for leukemia and cancers of the central nervous system and biliary passages/liver. No evidence was found of an increased risk for cancer of the respiratory system or stomach or for malignant melanoma. A work history review of all suspect cancer excesses failed to identify any common work areas, job assignments, or exposure potentials, although the lack of detailed data on specific chemical exposures precluded accurate assessments of exposure-response.     

Cancer rates by county: how well does mortality relate to incidence?

The extent to which excess cancer mortality in a county is indicative of excess cancer incidence in the same county in the same time period was studied in white Iowa residents using routinely available 1973-1977 data. Evaluation consisted of population-weighted correlation analysis. The best correlations were obtained for cancers of the lung, pancreas, liver, stomach, brain (males), and kidney (males). These are the cancers for which excess mortality best indicates excess incidence. Correlations were low for prostate, female breast, and corpus uteri. The best indications of excess incidence are made for cancers with five year relative survival rates of 37.0 percent or less for males and 33.4 percent or less for females. Studies relating cancer mortality rates to occupational, environmental, or other demographic variables may be very misleading as to risk factors if the cancers selected have low correlations of incidence with mortality. Further development of the correlation model is recommended using data from all Surveillance, Epidemiology, and End Results Program counties for a ten-year period.