Ecologic Study of Lung Cancer Risk Factors in the U.S. and Japan, with Special Reference to Smoking and Diet

Lung cancer mortality rates among United States and Japanese males were compared and related to smoking and dietary data. Mortality rates increased from 1950 to 1985 in both countries, but the absolute values are consistently lower in Japan (38.2 deaths/100,000 in 1985) than in the U.S. (72.2/100,000). The proportion of smokers is higher in Japan than in the U.S. since 1955. Japanese males start smoking considerably later than U.S. males, but smoke a higher quantity of cigarettes per day. Available information on inhalation practices and yield and type of cigarettes smoked showed no differences among the two countries large enough to account for the differences in mortality rates. Further data in this regard should he obtained. Dietary data show that fat consumption (as percentage of calories) is consistently higher in the U.S. than in Japan from 1950 (40% vs. 7.9%) through 1985 (43.5% vs. 24.5%). A linear relationship is observed between lung cancer mortality and fat intake. Our data support the hypothesis that dietary habits may modulate the carcinogenic effects of tobacco smoking.     

Trends in pancreatic cancer mortality in Europe, 1955–1989

Trends in death certification rates from pancreatic cancer over the period 1955–1989 were analyzed for 25 European countries (excluding the former Soviet Union and a few smaller countries). In 1985–1989, rates for males ranged between 5.3/100,000 (age-standardized world population) in Spain and 10.3/100,000 in Hungary and Czechoslovakia. Other high-mortality areas were located in Northern Europe (Finland, Iceland, Ireland, Denmark) and Central Europe (Austria, Poland, Germany), whilst mortality was lower in Southern Europe (Portugal, Greece). Between 1955 and 1989, mortality rates increased in all the countries considered, the change ranging between 6% in Scotland and 279% in Spain; the rises were higher in the Mediterranean and Eastern European countries than in Northern Europe. Among females, Nordic countries such as Iceland, Sweden and Denmark had the highest mortality rates in 1985–1989 (over 6/100,000) and, as for males, Southern Europe (Spain, Portugal, Greece) appeared as a low-mortality area (around 3/100,000). During the 1955–1989 period, upward trends were observed in all the countries studied, with the highest increase in Greece, Italy, Bulgaria, Poland and Spain. A negative correlation was observed between the percent change in mortality rates between 1955–1959 and 1985–1989 and the rate in 1955–1959 among both males (r = ?0.95, p <0.001) and females (r = ?0.81, p <0.001). Thus, a systematic levelling of rates was observed in most countries, with the exception of the UK and some Nordic countries, whose rates were already high in the late 1950s. Tobacco smoking and dietary factors could account for some of the generalized upward trends. Improved diagnostic and death certification of the disease might also partially explain the observed figures. © 1994 Wiley-Liss, Inc.     

Smoking and lung cancer mortality in Japanese men: estimates for dose and duration of cigarette smoking based on the Japan vital statistics data

For the purpose of understanding human carcinogenesis and making a quantitative prediction of lung cancer mortality in a general population of Japanese males, we evaluated a statistical model which assumes lung cancer mortality to be proportional to the 4.5th power of the effective duration of cigarette smoking among smokers and to the 4th power of age among nonsmokers, using Japan Vital Statistics data. For the male birth cohorts aged 30-69 in 1965 in the age range of 40-79, studied by quinquennial calendar time intervals from 1955 to 1985, it was found that, (i) for nonsmokers, the estimated lung cancer mortality rate was comparable to the rates reported in the US or Britain, assigning 20 to 25% proportions of nonsmokers, (ii) for smokers, the estimated duration of smoking was shorter than would be expected from the age when smoking was started according to various epidemiological surveys, and (iii) the estimated average numbers of cigarettes smoked per day by smokers were similar to those obtained by epidemiological studies, when these were estimated by incorporating a part of Doll and Peto's dose-response relationship. Also discussed is the possibility of assessing lung cancer mortality risk for Japanese male smokers by means of the statistical model, alpha x (cigarettes smoked per day + beta) x (age - (age started smoking) - gamma)4.5.     

Smoking and Lung Cancer Mortality in Japanese Men: Estimates for Dose and Duration of Cigarette Smoking Based on the Japan Vital Statistics Data

For the purpose of understanding human carcinogenesis and making a quantitative prediction of lung cancer mortality in a general population of Japanese males, we evaluated a statistical model which assumes lung cancer mortality to be proportional to the 4.5th power of the effective duration of cigarette smoking among smokers and to the 4th power of age among nonsmokers, using Japan Vital Statistics data. For the male birth cohorts aged 30–69 in 1965 in the age range of 40–79, studied by quinquennial calendar time intervals from 1955 to 1985, it was found that, (i) for nonsmokers, the estimated lung cancer mortality rate was comparable to the rates reported in the US or Britain, assigning 20 to 25% proportions of nonsmokers, (ii) for smokers, the estimated duration of smoking was shorter than would be expected from the age when smoking was started according to various epidemiological surveys, and (iii) the estimated average numbers of cigarettes smoked per day by smokers were similar to those obtained by epidemiological studies, when these were estimated by incorporating a part of Doll and Peto's dose-response relationship. Also discussed is the possibility of assessing lung cancer mortality risk for Japanese male smokers by means of the statistical model, a × (cigarettes smoked per day +β) × (age— (age started smoking) —γ)^4,s.     

Comparison of leukemia mortality in five countries: France, Italy, Japan, UK and USA from the WHO Mortality Database (1960-2000)

Leukemia mortality age-standardized rates (ASRs; using 1985Japanese standard population) are shown for France, Italy, Japan,UK and USA (Fig. 1). While males show much higher ASRs, trendsare quite similar for both males and females in last four decadesin these countries. Japan shows the     

Dark tobacco and lung cancer in Cuba

A retrospective epidemiologic study of 826 cytologically and/or histologically confirmed lung cancer cases (219 females and 607 males), 979 hospital controls, and 539 neighborhood controls was undertaken in Havana, Cuba, to investigate whether the high lung cancer mortality rates in this country could be explained by the cigarette and cigar consumption habits, including the smoking of dark-tobacco cigarettes. Relative risk(s)(RR) of lung cancer among cigarette smokers were 7.3 in women and 14.1 in men and increased consistently with various measures of exposure to smoke. The findings suggested that duration of smoking, daily number of cigarettes consumed, and inhalation practices have independent effects. Most Cubans smoked dark tobacco. RR were higher for dark-tobacco users than for light-tobacco users (RR = 8.6 vs. 4.6 for women and 14.3 vs. 11.3 for men), but the differences were reduced after adjustment for amount smoked. Cigarette smoking was associated with all histologic types of lung cancer, although the risk for adenocarcinoma was lower than that for the other types. Men who smoked exclusively cigars had a fourfold risk of lung cancer. Mixed smokers (i.e., cigar and cigarette smoker) had a greater RR than cigarette-only smokers (15.0 vs. 14.1), which was perhaps related to the unusually deep and frequent inhalation of cigar smoke. The data support the hypothesis that smoking patterns account for the higher lung cancer mortality in Cuba than in other Latin American countries.     

Comparison of laryngeal cancer mortality in five countries: France, Italy, Japan, UK and USA from the WHO mortality database (1960-2000)

Laryngeal cancer mortality age-standardized rates (ASRs), using1985 Japanese standard population, are shown for Japan, USA,UK, France and Italy (Fig. 1). In all of the countries, maleshave higher ASRs compared with females. For males, ASRs havebeen decreasing since 1970s in Japan and France. ASRs in theother countries have     

Lung cancer rates convergence in young men and women in the United States: analysis by birth cohort and histologic type

Age-specific rates of lung cancer have been consistently higher for men than for women in the United States, due primarily to different patterns of cigarette smoking. Gender differences in cigarette smoking have diminished in recent birth cohorts, however, especially among whites. We used U.S. population-based incidence and mortality data and examined trends in age-specific rates of lung cancer by birth cohort according to gender, ethnic group, and histology to evaluate the generational changes in U.S. lung cancer risk for men vs. women. All tests of statistical significance are 2-sided (95% confidence interval [CI]). Lung cancer mortality rates have converged between men and women born after 1960, especially in whites. The male-to-female (M:F) mortality rate ratio for ages 35-39 years decreased from 3.0 (95% CI = 2.7-3.4) around the 1915 birth cohort to 1.1 (95% CI = 1.0-1.1) around the 1960 birth cohort among whites and from 4.0 (95% CI = 3.2-5.0) around the 1925 birth cohort to 1.5 (95% CI = 1.3-1.7) around the 1960 birth cohort among blacks. Similarly, incidence rates for white men and women converged rapidly for adenocarcinoma, small cell carcinoma, and large cell carcinoma, but less so for squamous cell carcinoma. These findings reflect the smoking patterns among white and black men and women: cigarette smoking prevalence at age 24 was essentially equal among white men and women born after 1960 but continued to be higher in black men than women. The convergence of lung cancer death rates among men and women born after 1960s supports the idea that males and females maybe equally susceptible to develop lung cancer from a given amount of cigarette smoking, rather than the hypothesis that women are more susceptible.     

Epidemiology of cancer of the connective tissue in Canada during the period 1950-1985

Canadian patterns of morbidity and mortality from malignancies of the connective tissue were examined for the periods 1970-1982 and 1950-1985, respectively. Age-standardized morbidity rates have risen significantly during 1970-1982 in males (P = 0.005), whereas the increase noted in females was of borderline significance (P = 0.055). Examination of age-specific morbidity rates during this period revealed that rates for the eight age groups studied in males have increased, with rates of increase for males aged 65-74 attaining statistical significance (P = 0.0006), whereas increases for males aged 0-24 and 75-84 years were of borderline significance (P less than 0.08). Age-standardized mortality rates during 1950-1985 have risen significantly for both males (0.013 additional new deaths per 100,000 population per year; P less than 0.0001) and females (0.008 additional new deaths per 100,000 population per year; P less than 0.0001). Significant rates of increase were noted in age-specific mortality rates for seven of the eight age groups studied in males (P less than 0.03) and for five of the eight age groups studied in females (P less than 0.04). The rate of increase for women aged 35-44 years was of borderline significance (P = 0.06). Rates of increase in age-specific mortality rates were greatest in males and females aged 75-84 years at 0.113 and 0.059 additional new deaths per 100,000 population per year, respectively.     

Smoking and lung cancer risk in American and Japanese men: an international case-control study.

Rates of lung cancer in American men have greatly exceeded those in Japanese men for several decades despite the higher smoking prevalence in Japanese men. It is not known whether the relative risk of lung cancer associated with cigarette smoking is lower in Japanese men than American men and whether these risks vary by the amount and duration of smoking. To estimate smoking-specific relative risks for lung cancer in men, a multicentric case-control study was carried out in New York City, Washington, DC, and Nagoya, Japan from 1992 to 1998. A total of 371 cases and 373 age-matched controls were interviewed in United States hospitals and 410 cases and 252 hospital controls in Japanese hospitals; 411 Japanese age-matched healthy controls were also randomly selected from electoral rolls. The odds ratio (OR) for lung cancer in current United States smokers relative to nonsmokers was 40.4 [95% confidence interval (CI) = 21.8-79.6], which was >10 times higher than the OR of 3.5 for current smokers in Japanese relative to hospital controls (95% CI = 1.6-7.5) and six times higher than in Japanese relative to community controls (OR = 6.3; 95% CI = 3.7-10.9). There were no substantial differences in the mean number of years of smoking or average daily number of cigarettes smoked between United States and Japanese cases or between United States and Japanese controls, but American cases began smoking on average 2.5 years earlier than Japanese cases. The risk of lung cancer associated with cigarette smoking was substantially higher in United States than in Japanese males, consistent with population-based statistics on smoking prevalence and lung cancer incidence. Possible explanations for this difference in risk include a more toxic cigarette formulation of American manufactured cigarettes as evidenced by higher concentrations of tobacco-specific nitrosamines in both tobacco and mainstream smoke, the much wider use of activated charcoal in the filters of Japanese than in American cigarettes, as well as documented differences in genetic susceptibility and lifestyle factors other than smoking.     

Lung cancer death rates by smoking status: comparison of the Three-Prefecture Cohort study in Japan to the Cancer Prevention Study II in the USA

Cigarette smoking is an established risk factor for lung cancer. However, the magnitude of the relative risk (RR) on lung cancer mortality in relation to cigarette smoking is reported to be lower in Japan than in Western countries. We investigated whether this discrepancy could be explained by differences in the exposure to cigarettes smoked, by differences in sensitivity to smoking, or by differences in lung cancer mortality among non-smokers. We examined the 10-year follow-up data on 88,153 participants in a Japanese population-based prospective study conducted in three prefectures. Data used as a Western counterpart was retrieved from a published report of the US Cancer Prevention Study (CPS)-II. Although there was a significant increased risk of lung cancer death among current smokers compared with non-smokers, the observed RR in the Three-Prefecture Study were much lower than RR reported in the CPS-II. Lung cancer mortality of our Japanese sample was lower among current smokers and higher among non-smokers regardless of age and sex. Current smokers in our sample had initiated smoking at an older age and smoked fewer cigarettes per day for shorter durations than those in the CPS-II sample. The Poisson regression model (controlling for age, number of cigarettes smoked per day and duration of smoking) showed that male current smokers in our sample had a lower risk of lung cancer compared with those in the CPS-II sample (rate ratio 0.34 [95%CI 0.27-0.43]). These findings might explain why Japanese risks of lung cancer are lower than those observed in Western countries.     

Trends in mortality from leukemia in Europe: An update to 2009 and a projection to 2012

We considered trends in mortality from leukemia in Europe over the period 1970–2009 using data from the World Health Organization. We computed age‐standardized (world population) mortality rates, at all ages and in selected age groups, in 11 selected European countries, the European Union (EU) and, for comparative purposes, in the USA and Japan. For the EU, we also provided projections of the mortality to 2012. Over the period considered, mortality from leukemia steadily declined in most European countries in children and young adults, as well as in western and southern Europe at middle‐age (45–69 years); in central/eastern Europe, reductions at ages 45–69 started since the mid‐late 1990s. In the EU, annual percent changes were ?3.7% in males and ?3.8% in females at age 0–14, ?2% in both sexes at age 15–44, and ?0.6% in males and ?1% in females at middle‐age and overall. No decline was observed at age 70 or more. Between 1997 and 2007, overall EU rates decreased from 5.4 to 4.8/100,000 males and from 3.4 to 2.9/100,000 females. Declines were from 6.2 to 5.5/100,000 males and from 3.7 to 3.2/100,000 females in the USA and from 3.9 to 3.5/100,000 males and from 2.5 to 2.0/100,000 females in Japan. Projected overall rates in the EU at 2012 are 4.3/100,000 males (?11% compared to 2007) and 2.6/100,000 females (?12%).     

Cancer patterns among Koreans in Japan, Koreans in Korea and Japanese in Japan in relation to life style factors

Cancer incidences for major sites were compared among Koreans in Osaka, Japan, Koreans in Korea and Japanese in Osaka by calculating standardized proportional incidence ratios (SPIR's), in addition to updating the findings on cancer mortality experiences of Koreans and Japanese in Osaka reported before. Compared with Japanese, Koreans in Osaka had significantly higher mortality rates from cancers of the esophagus, liver and lung in males, and liver in females. Mortality rates among Koreans in Osaka were significantly lower for stomach cancer in both sexes and for breast cancer in females. Compared with Korean counterparts in the homeland, Koreans in Osaka had a reduced risk for cancers of the stomach in males and the uterus in females. On the other hand, an elevated risk was observed for cancers of the esophagus, colon, liver and lung among Korean males in Osaka and for cancers of the colon and liver among Korean females in Osaka. The risk for cancer of the breast in females was similar among Koreans in the host and home countries. These different cancer patterns among Koreans in the host and home countries and Japanese are discussed in relation to their life styles, such as smoking, drinking and dietary habits, which have been investigated by means of questionnaire surveys.     

Comparative epidemiology of cancer between the United States and Japan. A second look

Vital statistics were examined for the years 1955 through 1985 for Japanese natives and United States whites to elucidate changes in cancer mortality and related antecedent patterns of life-style in these two populations. Results show that lung cancer rates are rapidly accelerating among Japanese males as a consequence of their prior history of heavy cigarette smoking. Oropharyngeal cancer rates are also rising in Japan paralleling increases in alcohol and tobacco utilization. As the Japanese life-style and diet continue to become more "westernized," the rates of malignancies of the breast, ovary, corpus uteri, prostate, pancreas, and colon also continue to rise. Nevertheless, the mortality patterns of certain malignancies, viz., laryngeal, esophageal, and urinary bladder cancer, are discrepant with their established risk factor associations, suggesting the existence of other differences in risk factor exposure between the two countries. Epidemiologists and health educators need to develop innovative international programs of investigation and health promotion with preventive impact on common malignancies associated with risk factors of life-style.     

Comparison of pancreatic cancer mortality in five countries: France, Italy, Japan, UK and USA from WHO mortality database (1960-2000)

Pancreatic cancer mortality age-standardized rates (ASRs; using1985 Japanese standard population) are shown for Japan, USA,UK, France, and Italy (Fig. 1). ASRs of pancreatic cancer forboth males and females are quite similar for four decades inthese countries. After     

Indoor tobacco smoke pollution. A major risk factor for both breast and lung cancer?

Among 51 countries, those having high mortality rates for male lung cancer generally have high rates for female breast cancer (highest in England, Scotland, and the Netherlands). Conversely, those having low rates for one disease have low rates for both (P less than 0.001). Mortality rates available for 23 of the countries for 1954, 1964, and 1974 show a constant relationship of the female breast cancer rate, y = 13.3 + 0.17x (where x is the male lung cancer rate). Where data on 1950 tobacco consumption are available (20 countries), an even closer relationship with female breast cancer mortality in 1974 is observed. Because women in many of these countries account for only a small fraction of the tobacco consumption, the conclusion is that the risk of the female disease is closely related to the extent of male smoking. Thus, breast cancer is apparently initiated by the involuntary inhalation of indoor tobacco smoke for more than two decades on the average before diagnosis. The same relationship between female breast and male lung cancer is found in incidence rates for 80 populations of five continents, including northern and western populations of the US. Trends in age-adjusted breast cancer incidence rates rose almost 50% in many of these populations from 1950 to 1975. This increase corresponds to a tripling of cigarette consumption in the US from 1927 to 1952. There is a strong need to analyze passive smoking more than two decades before diagnosis as a confounding variable in all studies of other risk factors for breast cancer such as alcohol, dietary fat, and endogenous or exogenous estrogen. Comparison of incidence rates for lung cancer and lifetime cigarette consumption in various cultures of Hawaii indicates that even for male smokers, additional exposure to high levels of indoor tobacco smoke greatly increases their risk of lung cancer. This brings the safety of designated smoking areas into serious question.     

Comparison of esophageal cancer mortality in five countries: France, Italy, Japan, UK and USA from the WHO mortality database (1960-2000)

Esophageal cancer mortality age-standardized rates (ASRs; using1985 Japanese standard population) are shown for France, Italy,Japan, UK and the USA between 1996 and 2000 (Fig. 1). Althoughmales tend to have higher ASRs compared with females in allfive countries, the trends in ASRs show different patterns overthe four decades. For males, ASRs in France, which had the highestmortality rate until the 1990s, have continuously decreasedsince the     

Toward a comparison of survival in American and European cancer patients

BACKGROUND: Only recently have extensive population-based cancer survival data become available in Europe, providing an opportunity to compare survival in Europe and the United States. METHODS: The authors considered 12 cancers: lung, breast, stomach, colon, rectum, melanoma, cervix uteri, corpus uteri, ovary, prostate, Hodgkin disease, and non-Hodgkin lymphoma. The authors analyzed 738,076 European and 282,398 U.S. patients, whose disease was diagnosed in 1985-1989, obtained from 41 EUROCARE cancer registries in 17 countries and 9 U.S. SEER registries. Relative survival was estimated to correct for competing causes of mortality. RESULTS: Europeans had significantly lower survival rates than U.S. patients for most cancers. Differences in 5-year relative survival rates were higher for prostate (56% vs. 81%), skin melanoma (76% vs. 86%), colon (47% vs. 60%), rectum (43% vs. 57%), breast (73% vs. 82%), and corpus uteri (73% vs. 83%). Survival declined with increasing age at diagnosis for most cancers in both the U.S. and Europe but was more marked in Europe. CONCLUSIONS: Survival for most major cancers was worse in Europe than the U.S. especially for older patients. Differences in data collection, analysis, and quality apparently had only marginal influences on survival rate differences. Further research is required to clarify the reasons for the survival rate differences.     

Changing area socioeconomic patterns in U.S. cancer mortality, 1950-1998: Part II--Lung and colorectal cancers

BACKGROUND: Lung cancer and colorectal cancer are leading causes of U.S. cancer mortality. Because mortality rates for many cancers vary by socioeconomic characteristics, we used area socioeconomic indices to examine patterns in U.S. lung and colorectal cancer mortality between 1950 and 1998. METHODS: A factor-based area socioeconomic index was linked to 1950-1998 county mortality data to generate annual lung and colorectal cancer mortality rates for each area socioeconomic group. Joinpoint regression analysis was used to model and identify statistically significant changes in the mortality trends. RESULTS: Area socioeconomic patterns in U.S. lung cancer mortality changed dramatically between 1950 and 1998. Men aged 25-64 years and those aged 65 years or older in higher socioeconomic areas generally had higher lung cancer mortality than did those in lower socioeconomic areas during 1950-1964 and 1950-1980, respectively. Area socioeconomic differences in lung cancer mortality began to reverse and widen by the early 1970s for younger men and by the mid-1980s for older men. In 1998, lung cancer mortality was 56% (95% confidence interval [CI] = 49% to 64%) higher for younger men and 38% higher (95% CI = 34% to 43%) for older men in the lowest area socioeconomic group than for the same age groups in the highest area socioeconomic group. Lung cancer mortality among older women in all socioeconomic groups increased sevenfold to eightfold between 1950 and 1998, with higher mortality in higher area socioeconomic groups. The positive socioeconomic gradient in colorectal cancer mortality diminished substantially over time. Although colorectal cancer mortality among women in all area socioeconomic groups showed a consistent downward trend, colorectal cancer mortality among men in low area socioeconomic groups, but not in high area socioeconomic groups, showed an upward trend. CONCLUSIONS: Socioeconomic gradients in male lung cancer mortality reversed between 1950 and 1998, and those in colorectal cancer mortality narrowed over that time. Area measures may be useful for monitoring socioeconomic disparities in cancer mortality and for identifying areas for potential cancer control interventions.