Comparison of Bladder Cancer Survival Among Japanese,Chinese, Filipino,Hawaiian and Caucasian Populations in the United States

Background: Racial differences for bladder cancer survival have been reported for Caucasians and African- ‍Americans. However, the survival experience of bladder cancer patients in Asian and Pacific Islander ethnic groups ‍in the United States have not been fully explored. The purpose of this study was to compare the bladder cancer ‍survival rates of Japanese, Chinese, Filipinos, Hawaiians and Caucasians in the U.S. population. ‍Materials and Methods: The data was from the Surveillance, Epidemiology, and End Results (SEER) Program of ‍the National Cancer Institute between 1973 and 1998. Cox proportional hazard models and Kaplan-Meier’s estimates ‍were used to study differences in survival between the ethnic groups, adjusting for factors including age at diagnosis, ‍gender, year of diagnosis, histological grade, stage, surgery type, and radiation therapy. ‍Results: The overall bladder cancer survival was 66% for Japanese patients, 64% for Chinese patients, 61% for ‍Caucasians, 59% for Filipino patients and 52% for Hawaiian patients. Differences in bladder cancer survival rates ‍between Japanese and Chinese populations in the United States were not observed. In the Asian population, higher ‍relative risks and lower 5-year survival were observed with increasing age at diagnosis (p for trend<0.0001), grade ‍(p for trend<0.0001), and stage (p for trend<0.0001). Asian women had lower survival and a higher risk of death due ‍to bladder cancer than Asian men. ‍Conclusions: Japanese and Chinese bladder cancer patients had higher overall survival rates than Caucasians, ‍while Filipino and Hawaiian patients had lower survival than Caucasians.     

Survival Rates of Invasive Breast Cancer among Ethnic Chinese Women Born in East Asia and the United States

Background: Few studies have compared the breast cancer survival rates of US born ethnic Chinese women and ‍the survival rates of Chinese immigrants. The main purpose of this study is to explore the difference of breast cancer ‍survival rates between the two populations and compare the survival rates to those of Caucasians born in the US. ‍Methods: Between 1973 and 2002, 365,215 women who had been diagnosed with primary invasive breast cancer ‍(ICD-O-2 C500:C509) were recorded in the Surveillance, Epidemiology, and End Results (SEER) registries. Of the ‍316,881 breast cancer patients who were white, 180,835 (57%) were born in the United States, 20,983 (7%) were ‍born elsewhere, and 115,063 (36%) had unknown birthplaces. Among the 3,634 breast cancer patients who were ‍ethnically Chinese, 952 (26%) patients were born in the US, 1,356 (37%) were born in East Asia, 146 (4%) were born ‍elsewhere, and 1,180 (33%) had unknown birthplaces. We compared the survival rates and estimated the risk ratios ‍(RRs) by the Kaplan-Meier estimates and the Cox proportional hazards models. Results: A lower 5-year overall ‍survival rate of breast cancer was observed among Chinese women born in East Asia (0.74, 95% CI=0.72-0.77) than ‍those born in the U.S. (0.79, 95% CI=0.76-0.81), with an adjusted hazards ratio of 1.22 (95% CI=1.06-1.40). The 5- ‍year survival rates for SEER stage were higher among Chinese women born in the U.S. (localized: 0.90, 95% CI=0.87- ‍0.93; regional: 0.71, 95% CI=66-0.77; distant: 0.16, 95% CI=0.06-0.25) than that among Chinese women born in ‍East Asia (localized: 0.86, 95% CI=0.83-0.89; regional: 0.68, 95% CI=0.63-0.73; distant: 0.16, 95% CI=0.07-0.25). ‍Higher 5-year survival rates among Chinese women born in the U.S. in comparison to Chinese women born in East ‍Asia were also observed in different calendar years (1973-1980, 1981-1990, 1991-2002), in surgery and radiation ‍therapy. Conclusions: Our analysis showed that among the Chinese breast cancer patients, women born in East Asia ‍had lower 5-year survival rates than women born in the United States. SEER stage, grade, and tumor size appear to ‍be important prognostic factors. The poor 5-year survival rates among Chinese women born in East Asia indicate ‍potential problems of accessing medical facilities for early detection, diagnosis and treatment because of potential ‍language and culture barriers, lower education level, as well as stress of the first generation of migrant Chinese ‍women in the United States.     

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

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

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.     

Helicobacter Pylori Eradication as a Preventive Tool Against Gastric Cancer

Helicobacter pylori (H. pylori), which increases the risk of gastric diseases, including digestive ulcers and gastric ‍cancer, is highly prevalent in Asian countries. There is no doubt that eradication of the bacterium is effective as a ‍treatment of digestive ulcer, but eradication aiming to reduce the gastric cancer risk is still controversial. Observational ‍studies in Japan demonstrated that the eradication decreased the gastric cancer risk among 132 stomach cancer ‍patients undergoing endoscopical resection (65 treated with omeprazol and antibiotics and 67 untreated). In Columbia, ‍976 participants were randomized into eight groups in a three-treatment factorial design including H. pylori ‍eradication, resulting in significant regression in the H. pylori eradication group. A recent randomized study in ‍China also showed a significant reduction of gastric cancer risk among those without any gastric atrophy, intestinal ‍metaplasia, and dysplasia. Efficacy of eradication may vary in extent among countries with different incidence rates ‍of gastric cancer. Since the lifetime cumulative risk (0 to 84 years old) of gastric cancer in Japan is reported to be ‍12.7% for males and 4.8% for females (Inoue and Tominaga, 2003), the corresponding values for H. pylori infected ‍Japanese can be estimated at 21.2% in males and 8.0% in females under the assumptions that the relative risk for ‍infected relative to uninfected is 5 and the proportion of those infected is 0.5. Both the fact that not all individuals are ‍infected among those exposed and the knowledge that only a small percentage of individuals infected with the ‍bacterium develop gastric cancer, indicate the importance of gene-environment interactions. Studies on such ‍interactions should provide useful information for anti-H. pylori preventive strategies.     

Respiratory Cancer Population-Based Survival in Mumbai,India

Survival experience of patients with cancer of the larynx (ICD-32) or lung (ICD-34) registered by the Mumbai ‍(Bombay) population based cancer registry, India, during the years 1992-94 was determined. The vital statistics of ‍the patients were established by matching with death certificates from the Mumbai Municipal death register and by ‍active methods such as telephone enquiry, reply-paid postal enquiry, house visits and scrutiny of case records. Of ‍the 1905 (675 larynx and 1230 lung) eligible cases for analysis, 1480 were dead (450 larynx and 1030 lung) and 425 ‍were alive (225 larynx and 200 lung). The overall 5-year observed and relative survival rates for laryngeal cancers ‍were 29.1% and 36.4%, and for lung cancers were 12.5% and 15.9% respectively. On multivariate analysis, age, ‍treatment and clinical extent of disease emerged as independent predictors of survival with both cancers. People ‍aged 55 years and above had a relative risk of four or more for laryngeal cancer and 2.3 times and more for lung ‍cancer death as compared to those aged less than 35 years. Early detection and prompt treatment should improve ‍overall survival from lung as well as laryngeal cancer.     

Breast Cancer in Iran: a Survival Analysis

A prospective study was undertaken to examine survival in Iranian breast cancer patients. One hundred and ‍sixty-seven breast cancer patients diagnosed in 1997 were entered into the study and followed up for five years. The ‍mean age of thr patients at diagnosis was 47.2 (SD = 13.5), ranging from 24 to 81 years. A total of 39 patients were lost ‍in the follow-up period, leaving 128 for analysis of data. Of these, 79 were alive and 49 were dead after five years. ‍Most patients (61%) presented with advanced disease. Using life table analysis, the overall relative 5-year survival ‍rate was found to be 62% (SE = 0.04). In addition, after adjustment for age at diagnosis, initial treatment (mastectomy, ‍breast conserving surgery, and neo-adjuvant therapy), and disease stage, using Cox’s regression model, it was found ‍that receiving neo-adjuvant therapy as the initial treatment was an independent predictor of poorer survival (Hazard ‍ratio = 4.56, 95% CI 2.20-9.44, P<0.0001). The other variables (older age and late stage disease), although associated ‍with high hazards rates, were not significant. The study findings suggest that overall relative survival rate in Iranian ‍breast cancer patients stands between western and eastern European countries and needs to be improved. It seems ‍that early detection and better management using standard guidelines might contribute considerably to improvement ‍of survival in women experiencing breast cancer. ‍     

The transition of breast cancer treatment and Japan Clinical Oncology Group research over two decades

The Japanese Breast Cancer Study Group (JABCSG) was established before the Japan Clinical Oncology Group (JCOG). The JABCSG became the JCOG Breast Cancer Group 20 years ago. The first chairman of the Breast Cancer Group was Dr Kaoru Abe (National Cancer Center Hospital). Since 1978, five doctors have chaired the Breast Cancer Group. Sixteen clinical trials (eight phase III and eight phase I/II) have been conducted by the Breast Cancer Group since 1985. The Breast Cancer Group was restructured in 2010, and in June 2011 a new clinical trial (JCOG 1017) was initiated. Standard treatment for breast cancer (surgery, radiotherapy and systemic therapy) has changed dramatically over the last two decades. This review describes the transition of breast cancer treatment along with the history of JCOG research in this setting.     

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

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

Population-based Survival from Cancers Having a Poor Prognosis in Mumbai (Bombay), India

Background: Oesophagus, stomach, pancreas and lung cancers contribute more than 35% of the total cancer ‍incidence in Mumbai and survival rates for these cancers are very poor in most populations in the world. The ‍authors here report and discuss the population-based survival from these cancers in Mumbai, India. ‍Methods: Follow-up information on 5717 cancers patients having a low prognosis, registered in the Mumbai ‍Population-Based Cancer Registry for the period 1987-1991, was obtained by a variety of methods, including matching ‍with death certificates from the Mumbai vital statistics registration system, postal/telephone enquiries, home visits ‍and scrutiny of medical records. The survival for each case was determined as the duration between the date of ‍diagnosis and date of death, loss to follow-up or the closing date of the study at the end of 1996. Cumulative observed ‍and relative survival rates were calculated by the Hakulinen Method. For comparison of results with other populations, ‍age-standardized relative survival (ASRS) was calculated by directly standardizing age specific relative survival to ‍the specific age distributions of the estimated global incidence of major cancers in 1985. The log rank test was used ‍with univariate analysis to identify the potentially important prognostic variables. The variables showing statistical ‍significance in univariate analysis were introduced stepwise into a Cox Regression model to identify the independent ‍predictors of survival. ‍Results: The 5-year relative survival rates were 11.8% for oesophagus, 10.1% for the stomach, 4.1% for the ‍pancreas, and 7.0% for lung. Females had higher survival rates than males, except with lung cancer. Lower survival ‍was observed for those younger than 35 years for all 4 sites. For each site, survival declined with advancing age. ‍Single patients who remained unmarried had better survival, except with pancreatic cancer. For all sites Muslims ‍had a better survival and Christians had a lower survival as compared to Hindus. Education did not show any ‍pattern for any site. Survival decreased rapidly with advancing clinical extent of disease for all sites. Survival for ‍localized cancer ranged from12.5% to 31.3%, for regional spread 1.3% to 3.4% and with distant metastasis not a ‍single site recorded more than 1%. On multivariate analysis, extent of disease emerged as an independent predictor ‍of survival with all the sites. Also, age for oesophagus, stomach and lung, religion for oesophagus and stomach, and ‍education for stomach and lung, emerged as independent predictors of survival. ‍Conclusion: All the sites included in the study demonstrated very low survival rates with significant variation. ‍Comparison with other populations revealed lower survival rates than for Shanghai-China. In remaining populations, ‍survival proportions did not show much variation for pancreas and lung cancers. For stomach cancer, European ‍countries showed better survival rates. Early detection with treatment is clearly important to reduce the mortality ‍from these cancers. ‍     

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. ‍     

Population Based Survival of Female Breast Cancer Cases in Riyadh Region,Saudi Arabia

Breast cancer is the most frequent tumor among Saudi women, accounting to 19.8% of female cancers. The ‍present study was conducted to determine 5-year survival for all cases of invasive breast cancer that occurred during ‍1994-96 in the province of Riyadh (n=316). The overall observed survival probability of the study population at 1, 3 ‍and 5 years was 93.9%, 79.2% and 59.6%, respectively. The 5 year survivals for the younger (< 40 years), older (50 ‍+ years) and 40-49 years patients were 60.6%, 51.6% and 69.2% respectively, the differences not reaching statistical ‍significance. While there was not a great deal of variation in the 5-year survival between cases with regional (55.6%), ‍distant metastasis (57.6%) and extent of disease unknown (56.7%) cases, localized (67.5%) cases had a clearly better ‍prognosis. An increased but not significant hazard was seen for the cases with regional and distant metastasis disease, ‍1.40 and 1.11 respectively, compared to localized cases. The 5-year survival for duct carcinomas (62.8%) was greater ‍than for adenocarcinomas (55.6%) and lobular carcinomas (50.0%).     

Decreasing Trend in the Incidence of Stomach Cancer in Mumbai,India, during 1988 to 1999

The time trend in incidence of stomach cancer in males and females in Mumbai, India during 1988 to 1999 was ‍estimated using data collected by the Bombay Population-based Cancer Registry. During the 12-year period, a total ‍of 3657 stomach cancer cases (3.9% of all cancers) were registered by the Bombay Population-based Cancer Registry ‍of which 2467 (5.1% of all male cancers) were in males and 1184 (2.6% of all female cancers) in females. 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 incidence rates for evaluating the time trend. A statistically significant ‍decreasing trend in the overall age-adjusted incidence rates of stomach cancer was observed during the period 1988 ‍to 1999, with an yearly decrease of 4.44% in males and 2.56% in females. This decrease was most striking in males ‍in the age groups 40-59 and 60+, and in females only in the age group 40-59. The probability estimates indicated that ‍one out of every 92 men and one out of every 187 women will contract a stomach cancer at some time in their whole ‍life and 95% of the chance is after his or her 40th birthday. The decreasing trend in the age-adjusted incidence rates ‍of stomach cancer in both the sexes indicates that there is a critical change in the etiology of this cancer. The findings ‍may provide clues relating to various life-style and environmental changes impacting on stomach cancer incidence.     

What Do Cancer Registry and Household Expenditure Data in Japan Tell Us About Variation in Tumour Burden ?

Data from the total of six Japanese Cancer Registries presently reporting to Cancer Incidence in Five Continents ‍demonstrate marked variation in relative prevalence of cancers at particular sites, despite the genetic homogeneity ‍of the Japanese population. Thus either major differences in registry procedures or local environment must be ‍playing an important role and since the variation is clearly changing with time, the former must be considered likely. ‍Over the last 25 year period, incidence rates for the esophagus have been generally increasing in Japan, except in ‍Miyagi where they have been persistently high. Stomach cancer rates are on the decrease, although the trend is not ‍so clear in Yamagata and Hiroshima, while colon and rectal cancers have both demonstrated consistent increment ‍throughout the period surveyed, with a remarkable correlation between the two sites evident on cross-registry ‍comparisons. Continued increases have also been apparent in lung, kidney, urinary bladder and prostate cancers in ‍males and in breast, endometrium and thyroid neoplasms in females. Cervical cancer, in contrast, is decreasing, ‍although a plateau may now have been reached in Miyagi. In the hepatopancreatic axis, patterns have generally ‍showed elevation followed by a recent reduction, although without correlations among liver, gallbladder and pancreas ‍rates at the cross-registry level. Common lifestyle factors may to some extent underly the increases seen in colon, ‍breast, urinary bladder and thyroid incidence rates, given the significant relations apparent for these in the latest ‍data across registries. Whether analysis of variation in dietary intake and exposure to other risk factors, for example ‍using data for household expenditure, may provide clues to explaining the variation apparent across Japan is a ‍question warranting further consideration. If so an expanded role for the cancer registry could well be envisaged. ‍     

Association between Type II Diabetes and Colon Cancer among Japanese with Reference to Changes in Food Intake

Many epidemiological studies have provided support for the hypothesis that type II diabetes can increase the risk ‍of colorectal cancer, but time trends, geographical distributions and host factors for the two diseases remain largely ‍to be clarified. To address these issues, we investigated the epidemic pattern of colon cancer and type II diabetes ‍among Japanese in Japan (J-Japanese), with consideration of the westernization of dietary habits. Over the last ‍three decades, the increase in crude mortality rates of colon cancer from the Vital Statistics has closely paralleled the ‍increment in prevalence rates (PRs) from hospital based surveys of diabetes. Age-standardized incidence rates (ASIRs) ‍for colon cancer among Japanese in the United States (US-Japanese) were higher than those among J-Japanese and ‍almost the same as those among US-Whites, while PRs for type II diabetes among US-Japanese were the highest in ‍the three populations. Correlation analysis showed that PRs for type II diabetes had a positive association with ‍ASIRs for colon cancer among the combination of Japanese and US-Japanese (r=0.79, p<0.01). Since 1950, intake of ‍milk, meat, eggs and fat/oil has increased, while that of rice and potatoes has gradually decreased. Our findings ‍indicate that the increment of ASIRs for colon cancer among J-Japanese might be closely associated with the increment ‍of PRs for type II diabetes, reflecting the westernization of food intake. ‍     

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. ‍     

A New Model Population-Based Cancer Registration System in Aichi Prefecture,Japan

A dramatic overhaul of the population-based cancer registration system in Aichi Prefecture, Japan - Aichi ‍Cancer Registry (ACR) - was undertaken in 1998, with a view to rationalization and strengthening of its ‍effectiveness, supported by a grant from the Ministry of Health and Welfare. A more comprehensive organization ‍encompassing the prefectural cancer center and prefectural public health centers (PPHCs), promoting PPHCbased ‍primary and secondary cancer prevention has now been in operation since January 1999. Application of ‍its basic components is also feasible for other population-based cancer registries in Japan, which share similar ‍operation characteristics. This paper introduces the new cancer registration system in Aichi Prefecture, Japan.     

Cancer incidence rates among Japanese immigrants in the city of São Paulo,Brazil, 1969–78

Cancer incidence rates among first-generation Japanese immigrants in the city of São Paulo, Brazil, were estimated from the data of the São Paulo Cancer Registry during the years 1969 to 1978. From all registered cases, 2,179 cancer cases of Japan-born residents (1,288 males, 891 females) were selected and age-specific and summary age-adjusted incidence rates (AAIR) were calculated for the selected sites of cancer. The AAIR for all sites except non-melanoma skin cancer was 195.2 per 100,000 population (95 percent confidence interval: 176.4–214.1) in males and 147.3 (134.6–160.0) in females. Stomach cancer had the highest incidence rate of all cancers in both sexes (males, 69.3; females, 32.0). This was followed by cancer of the lung (22.5), esophagus (10.2), colon (8.3), and prostate (7.1) in males; and by breast (24.0), cervix (18.0), colon (8.4), and lung (7.2) in females. When these rates were compared with those among Japanese in Japan, cancer of the stomach and rectum revealed significantly lower rates, while non-melanoma skin cancer, and prostate and breast cancer showed higher rates. No significant increase of colorectal cancer was recognized among Japanese immigrants in São Paulo, contrary to the remarkably high rates of colorectal cancer being observed among Japanese immigrants in the U5.Drs Tsugane and Watanabe are in the Epidemiology Division, National Cancer Center Research Institute, Tokyo, Japan. All other authors are in the Department of Epidemiology, School of Public Health, University of São Paulo, Brazil. Address reprint requests to Dr Shoichiro Tsugane at 5-1-1, Tsukiji, chuo-ku, Tokyo 104, Japan. This study was supported by a grant-in-aid for the International Science Research Program from the Ministry of Education, Science and Culture, Japan, and by a grant-in-aid for Cancer Research from the Ministry of Health and Welfare, Japan.