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

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

Fight Against Cancer in Countries with Limited Resources: The Post-genomic Era Scenario

The enormous advances in science and technology in the 20th century have facilitated the process of globalization ‍with the aim of a better quality of life for all. Paradoxically, the gap between the rich and the poor, for both nations ‍and people, is constantly widening. The actual trends in human genome research are leading towards promising ‍genomic medicine, but it will be expensive and inaccessible for many. Also, it may not offer a quick fix ‘cure’ for ‍various types of cancers. The biggest challenge before the clinicians now is the management of the rising incidence of ‍cancer in developing countries, with little prospect of more resources becoming available to fight the disease. The ‍death rate from cancer in the developing countries is set to rise at least 3-fold by the year 2025 largely due to the ‍increased life expectancy, containment of infectious diseases and changing lifestyles. It is estimated that about 50% ‍of cancers are curable if they are detected early and treated appropriately. Screening has a major role in early ‍diagnosis. However, in the developing world around 80% of cancer patients have late stage incurable disease when ‍they are diagnosed. Moreover, in a developing country like India, about 70% of the population obtain medical help ‍from private practitioners. Nearly half of those who seek medical help utilize alternative and traditional systems of ‍medicine. Appalling poverty, poor hygiene and complex social dynamics, pose major hurdles in this regard. Many in ‍the private sector who call themselves doctors have no medical degree. By 2030 tobacco is expected to kill 10 million ‍people worldwide, out of which 70% of the deaths will occur in the developing countries. Control of usage of tobacco ‍has still not achieved a conducive atmosphere. It is now realized that the research information and knowledge ‍generated in the west may neither be relevant nor applicable to developing countries, due to differences in social and ‍cultural attitudes, lifestyles and lack of sophisticated technologies. Though the sequencing of the human genome will ‍have a major impact on the prevention, diagnosis, treatment, monitoring, and outcome of cancer, the cancer scenario ‍in the developing countries for the next 20 years is likely to be more or less the same, rather than presenting a ‍radically different picture. Cancer awareness and screening programs for early detection thus should be continue to ‍be given utmost attention .     

Time Trends in the Occurrence of Major GI Cancers in Iran

Objective: The aim of this study was to study the changes in occurrence of esophageal, stomach and colon ‍cancers (cancers of interest) over the last 30 years in Iran. ‍Material and Methods: Cancer cases referred to two main cancer centers in the country (the Shiraz cancer ‍center and the Tehran cancer center) during last 30 years and published by the two centers were utilized. Morbidity ‍odds ratios (MOR) were used to study trend in the occurrence of each cancer site in each center. For this purpose ‍the cancers of interest were considered as cases; childhood cancers as controls; and calendar year as exposure. A ‍regression line was fitted to morbidity odds ratios over years and the slope of the regression line was considered to ‍indicate the overall trend. MORs and 95% CIs comparing the last five and first five years were computed to ‍measure the magnitude of the change over time. ‍Result: The overall trend for esophageal cancer was decrease (slopes = -0.02 for Shiraz and -0.03 for Tehran); for ‍stomach was increase (slopes = 0.04 for Shiraz and 0.08 for Tehran), and for colon cancer was sharp increase (slopes ‍= 0.02 for Shiraz and 0.10 for Tehran). The magnitude of changes showed stomach cancer to increase by 35% in ‍Shiraz (MOR = 1.35 with 95% CI 1.1, 1.65) and 13% in Tehran (MOR = 1.13 with 95% CI 0.96, 1.38), esophageal ‍cancer to decrease by 20% in Shiraz (MOR = 0.82 with 95% CI 0.62, 1.11) and 50% in Tehran (MOR = 0.52 with ‍95% CI 0.45, 0.60), and colon cancer to increase by 65% in Shiraz (MOR = 1.65 with 95% CI 1.26, 2.16) and 82% in ‍Tehran (MOR = 1.82 with 95% CI 1.52, 2.25). ‍Conclusion: During the last thirty years the occurrence of major GI cancers has changed in Iran with sharp ‍increase in colon cancer, slight to moderate increase in stomach cancer and sharp decrease in esophageal cancer. ‍     

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. ‍     

Changes in Incidence of in situ and Invasive Breast Cancer by Histology Type following Mammography Screening

Objective: To investigate secular trends and correlates of incidence of breast cancer by histology type following ‍the introduction of population-based mammography screening. Methods: Analysis of age-standardised incidence ‍rates for 1,423 in situ and 16,157 invasive carcinomas recorded on the South Australian population-based cancer ‍registry for the 1985-2004 diagnostic period. Multiple logistic regression was undertaken to compare sociodemographic ‍characteristics by histology. Progression from in situ disease was investigated using the Kaplan-Meier ‍method. Results: The incidence of in situ lesions increased approximately seven-fold over the 20-year period, compared ‍with an increase of about 40% for invasive cancers. The increase for in situ lesions was due to increases for ductal ‍carcinomas, with little change for lobular lesions. By comparison, the percentage increase in incidence for invasive ‍cancer was greater for lobular than ductal cancers. Both for in situ and invasive cancers, percentage increases were ‍greatest for the screening target age range of 50-69 years. One in 14 in situ cases was found to progress to invasive ‍cancer within seven years of diagnosis, but insufficient detail was available to determine whether the invasive cancers ‍were a progression of the in situ lesions or whether they originated separately. These invasive cancers were smaller ‍than generally applying for other invasive cancers of the female breast. Conclusions: The larger secular increases in ‍incidence for in situ than invasive cancers would reflect the dominant role of mammography in the detection of ‍ductal carcinoma in situ. The lack of an increase for lobular in situ lesions may have resulted from their poorer ‍radiological visibility. The greater percentage increase for lobular than ductal invasive lesions may have been due to ‍an increase in imaging sensitivity for these lesions, plus real increases in incidence. The smaller sizes of invasive ‍cancers found in women with a prior in situ diagnosis may have resulted from more intensive medical surveillance, ‍although the possibility of biological differences cannot be discounted.     

Cancer Mortality in a Hanoi Population,Viet Nam, 1996-2005

Background: Hitherto, cancer mortality data have not been available in Viet Nam, so that the real public health ‍problem with this disease has yet to be addressed and recognized in the country with a population of over 80 million ‍in South East Asia. The aim of the present pilot study was to examine cancer mortality in a commune population of ‍Hanoi city, 1996-2005. Methods: Cancer data was accessed from the database of the population-routine-based death ‍registration performed by medical workers at commune health stations based on the guidelines of the Ministry of ‍Health at Hanoi city. All deaths occurring in the community were registered. This registration process was monthly ‍reviewed for each fatal case regarding the name, age, sex, address, occupation, date - place - cause of death, and ‍information concerning to pre - death medical care during the study period from Jan. 1996 to Dec. 2005. The list of ‍death and residents of the study population was carefully cross-checked with other information sources to avoid ‍under- or over-registration. The world population structure was used to estimate Age-standardized cancer mortality ‍rates per 100,000, (ASR). Results: During 60,770 person-years estimated from Jan. 1996 to Dec. 2005, 320 deaths ‍and their causes were registered. Among them, 100 cancer cases of all sites (66 males and 34 females) were included. ‍Cancer mortality rates were 222 and 109 (Crude), 353 and 115 (ASR), for males and females, respectively. For both ‍genders combined, lung cancer was the most common, 27 cases, followed by liver, 26 cases and stomach, with 19. ‍Proportion of death from cancer was about 31% of all causes. Conclusions: The present findings suggest that in Viet ‍Nam, a developing country, cancer is indeed an important public health problem.     

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. ‍     

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

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

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

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

Trends of Head and Neck Cancers in Urban and Rural India

Background:The sub-site predilection of head and neck squamous cell carcinoma (HNSCC) reflects the risk ‍profile of a community and there are suggestions that these are changing over time. Objective: To determine the ‍change in head and neck cancer in rural and urban populations in India. Methods: Cancer registry data of an urban ‍and a rural population were reviewed over a period of 13 and 11 years, respectively. Age adjusted rates (AAR) and ‍age specific incidence rates were used for data analysis. Results: Oral cancers formed the majority of the head and ‍neck cancers with a predilection for tongue, except in rural males, in whom the pharynx was the predominant subsite. ‍Overall there was a reduction in the incidence of HNSCC, which was more pronounced in urban females and ‍rural males (p< .001). Among the sub-sites, oral cavity cancers showed a decreasing trend in urban females (p< .01) ‍and rural males (p< .01). However, the trend was towards increase of incidence of tongue cancers. Pharyngeal ‍cancer showed reduction in urban females (p< .01), whereas it increased in rural females. The recent increase in ‍incidence of young adults with HNSCC reported in developed countries was not observed. Conclusions: Overall, ‍incidence of HNSCC is reducing. This may be attributed to the decreased prevalence of tobacco use.The increase in ‍incidence of tongue cancer may suggest factors other than tobacco and alcohol in its genesis.     

Cancer Burden and Trends in the Asian Pacific Rim Region

This paper describes the current cancer burden and time trends, discusses dominant risk factors and prevention ‍and control strategies, and makes future projections for the top eight cancers (stomach, lung, liver, colon/rectum, ‍esophagus, breast, cervix, and leukemia) in the Asian Pacific Rim region. The future cancer trends through to the ‍year 2050 are projected based on population dynamics, including population growth and ageing. In 2000, the Asian ‍Pacific Rim had over 3 million new cancer cases, over 2 million cancer deaths, and 5.4 million people living with ‍cancer. In 2050, 7.8 million new cancer cases and 5.7 million deaths from cancer are projected. The current cancer ‍burden and the future projection provide facts that cancer is and will be a very serious public health problem in the ‍Asian Pacific Rim region and will assist public health officers and cancer researchers in the design and establishment ‍of public health policies, prioritization of future research, and application of current knowledge in the prevention ‍and control of cancer. ‍     

Cancer Occurrence in Iran in 2002, an International Perspective

For almost 30 years no population-based cancer statistics have been available with which to estimate the cancer ‍burden in Iran. In 2002 and 2003 two separate reports of population based cancer registries were published from ‍Iran and the cancer incidence rates from these sources have permitted informed estimates of cancer incidence and ‍mortality to be prepared. They suggest that more than 51,000 cases of cancer are diagnosed and 35,000 deaths due to ‍cancer occur each year. The 5 most common cancers in males (by ASR) are stomach (26.1 per 105), esophagus (17.6 ‍), colon-rectum (8.3), bladder (8.0) and leukemia (4.8), and in females are breast (17.1), esophagus (14.4), stomach ‍(11.1), colon-rectum (6.5) and cervix uteri (4.5). The incidence rates of esophageal and stomach cancer in Iran are ‍high, well above the world average, while the incidence of lung cancer is very low. Breast cancer, although the most ‍common cancer of females in Iran, has rates that are low by world standards, especially those observed in Europe ‍and USA. Similarly, the incidence of cervix cancer in Iran is very low, even lower than such low risk countries as ‍China, Kuwait and Spain. Comparing these rates with the data of 30 years ago, the incidence of esophageal cancer ‍has decreased dramatically, but gastric cancer has increased about two fold.     

Smoking-related Cancers in Maori and non-Maori in New Zealand, 1974-1993: Fewer Bladder Cancers among Maori

Smoking is, and long has been, more prevalent among Maori than non-Maori in New Zealand. Lung cancer, but ‍not other smoking-related cancers, is known to be markedly more common among Maori than non-Maori. Incidence ‍and mortality data from the New Zealand Cancer Registry for cancers of the mouth/pharynx, oesophagus, pancreas, ‍larynx, kidney and bladder, as well as lung/pleura, during the period 1974 to 1993 were analysed by sex to determine ‍whether the rates of each of these smoking-related cancers were higher in Maori than in non-Maori. Truncated (35- ‍64 yr) age-standardized incidence rates for 1974-93 were significantly higher in Maori than non-Maori for cancers ‍of the pancreas, lung/pleura and kidney (both sexes), mouth/pharynx and oesophagus (males only). There was no ‍difference between the Maori and non-Maori rates for cancer of the larynx, and bladder cancer incidence was ‍significantly lower in Maori than non-Maori. Mortality rates followed a similar pattern as those for incidence for ‍cancers of the pancreas, larynx, lung/pleura and kidney (both sexes) and bladder (males only). The pattern predicted ‍by the higher prevalence of smoking in Maori than non-Maori was borne out for all smoking-related cancers except ‍bladder and laryngeal cancer. Under-enumeration through lower access to health services may have contributed to ‍the lower than expected rates of bladder cancer in Maori, but a role for a genetically or lifestyle related protective ‍effect is suggested.     

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

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

Knowledge of the Effects of Sun Exposure of Turkish High School Students and Their Sun Bathing Habits

Cancer, long a serious problem in developed countries, is now becoming a serious health concern throughout the ‍world. There has been an alarming increase in the number of new cases of melanoma each year, this cancer increasing ‍at a faster rate than any other neoplasm in some regions. This may be a result of depletion of the ozone layer. An ‍association between non-melanocytic skin cancer and exposure to the sun appears to have first been suggested in ‍1894; it was not until about 1952 that it was argued that exposure to the sun also causes melanoma. It is commonly ‍believed that skin cancers develop only after long-term exposure to UVR. At the individual level, people who live in ‍sunnier climates comparatively have a higher risk for skin cancer than do people who live in colder climates. This is ‍particularly the case for migrant populations with a fair skin. The present study was conducted to evaluate the ‍knowledge of the young generation in Turkey related to the side effects of sun exposure, and their sun bathing ‍habits. Sun sensitivity, use of sunscreens, sunbathing habits and protective behaviours were determined for a total ‍of 1244 high school students from the answers to a questionnaire completed by them. Data from 627 (50.4 %) ‍females and 617 (49.6 %) males were evaluated. All were aged between 15 and 18 years. Sunscreen use was found to ‍be higher in female students (59 %) than in their male counterparts (45.8 %). The wearing of sunglasses was reported ‍by 36.7 %, whereas the incidence of hat wear was found to be 55.1% overall. The results of this study indicate that, ‍although most high school students are aware of the side effects of sun exposure, they do not pay sufficient attention ‍to protective behaviour. A further study should now be conducted to evaluate the use of sunscreens in a large group. ‍     

Trends in Incidence of Childhood Leukemia,Khon Kaen,Thailand, 1985-2002

Background: The Khon Kaen Cancer Registry (KKCR), providing both hospital and population-based ‍registration, was established in 1984 in the Faculty of Medicine, Khon Kaen University. Leukemia is the most ‍common cancer among Thai children in Thailand, including both curable and preventable types, but no assessment ‍of trends has hitherto been performed. Objective: To perform a statistical assessment of the incidence trend of ‍childhood leukemia in Khon Kaen, Thailand, between 1985 and 2002. Methods: Population-based cases of childhood ‍leukemia registered between 1985 and 2002 were retrieved from the KKCR and cases with an ICD-O diagnosis ‍(coding C42) in children under 15 were selected. Incidence trends were calculated using the Generalized Linear ‍Model method (GLM), which generates incidence-rate-based logarithms. Results: Of the 277 cases of leukemia, ‍boys were affected two times more frequently than girls and half of the cases were 0-4 years of age. Most diagnoses ‍were histologically- or cytologically-proven and the most common type (affecting two-thirds, 65.7%) was acute ‍lymphoblastic leukemia (ALL). The overall, age-standardized rate (ASR) for leukemia was 31.9 per million (95%CI: ‍28.1 to 35.7); 40.3 per million (95%CI: 34.2 to 46.4) in boys and 27.0 (95%CI: 21.8 to 32.2) in girls. Incidence has ‍been increasing by 2.4% per year in boys (95% CI: -0.5 to 5.3) and 4.1% per year in girls (95% CI: 1.1 to 7.2). ‍Conclusions: This incidence-rate-based logarithm indicates that childhood leukemia has been increasing, suggesting ‍further epidemiological research on causes and possible prevention is needed.     

Report: 15th Asian Pacific Cancer Conference

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

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

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

Cancer of the Oral Cavity and Pharynx in Karachi - Identification of Potential Risk Factors

The objective of the study was to provide an overview of the demographics of cancer of the oral cavity and ‍pharynx in Karachi South (1995-2001), and identify potential risk factors. Cases recorded for Karachi South, at ‍Karachi Cancer Registry during 1st January 1995 to 31st December 2002 were analysed. For maximum completion ‍of data cancer cases, recorded from 1st January 1995 to 31st December 2001 were included for final analysis. The age ‍standardized incidence rates per 100,000 population (ASIRs) for cancer of the oral cavity (excluding salivary gland) ‍in Karachi South were 17.1 and 16.5 in males and females whereas the ASIRs for cancer of the pharynx (excluding ‍nasopharynx) were 7.1 and 2.4 in males and females, respectively. The oral pharyngeal ratios were 2.4 and 6.9 for ‍males and females and gender ratios (M F) were 1.04 for the oral cavity and 3.0 for the pharynx. The mean ages were ‍51 years (95% CI 49.6; 52.2) and 56.1 years (95% CI 54.4; 57.8) respectively. Cancer of the oral cavity ranked 2nd in ‍Karachi in both genders. Cancer of the pharynx ranked 7th in males and 14th in females. Approximately 97% of the ‍oral cavity and pharyngeal cancers were histologically confirmed. The majority of the oral (47.1%) and pharyngeal ‍(51.9%) cancer cases presented as grade II lesions, and were discovered at advanced stages. Of the cancers reported ‍during 1995-2001, 60.4% of the oral and 78.1% of the pharyngeal lesions had spread to a distant site at the time of ‍diagnosis. Squamous cell carcinoma comprised 96.5% and 91.8% of the totals. The incidences of these cancers are ‍comparable to the highest risk regions of the world. As distinct from other geographical areas oral cancer is as ‍common in females as in males, which may reflect the pattern of exposure to known risk factors such as betal quid, ‍arecanut and tobacco and the absence of alcohol as a risk factor in both genders. Apergillus contamination of ‍arecanut could also be a risk factor but no confirmation studies or quantification is available. Despite the common ‍risk factors, incidence of pharyngeal cancer is three times higher in men as compared with women. The keys to ‍reducing the incidence and mortality due to oral and pharyngeal cancers are prevention and control, emphasizing ‍cessation of tobacco use and cancer screening. However a targeted cancer and tobacco control program does not ‍presently exist in Pakistan. ‍