Cancer mortality in Indian and British ethnic immigrants from the Indian subcontinent to England and Wales.

Risk of cancer mortality from 1973 to 1985 in persons born in the Indian subcontinent who migrated to England and Wales was analysed by ethnicity, and compared with cancer mortality in the England and Wales native population, using data from England and Wales death certificates. There were substantial highly significant raised risks in Indian ethnic migrants for cancers of the mouth and pharynx, gall bladder, and liver in each sex, larynx and thyroid in males, and oesophagus in females. There were also substantial raised risks in these migrants of each sex for non-Hodgkin''s lymphoma and myeloma. For the mouth and pharynx, and liver in each sex, and gall bladder in females, there were also raised risks of lesser magnitude in British ethnic migrants. For colon and rectal cancer and cutaneous melanoma in each sex, ovarian cancer in women and bladder cancer in men, there were appreciable significantly reduced risks in the Indian ethnic migrants not shared by those of British ethnicity. Appreciable raised risks in British ethnic migrants not shared by those of Indian ethnicity occurred for nasopharyngeal cancer in males, soft tissue malignancy in both sexes and non-melanoma skin cancer in males. In migrants of both ethnicities there were appreciable significantly raised risks in each sex for leukaemia and decreased risks in each sex for gastric cancer, for lung cancer except in females of British ethnicity and in males for testicular cancer. The results suggest the need for public health measures to combat the high risks of oral and pharyngeal cancers and liver cancer in the Indian ethnic immigrant population of England and Wales, by prevention of betel quid chewing and hepatitis transmission respectively. The data also imply that early exposures or early acquired behaviours in India, or exposures during migration, may increase the risk of leukaemia and reduce the risks of gastric and testicular cancers in the migrants irrespective of their ethnicity. Aetiological studies would be worthwhile to investigate the reasons for the sizeable decreased risk of colon and rectal cancer and increased risk of gall bladder cancer in each sex and the increased risk of thyroid and laryngeal cancer in males and oesophageal cancer in females of Indian ethnicity but not of British ethnicity who have migrated from the Indian subcontinent.     

Cancer in Indian Moslems

Moslems are the followers of Islam who, during the time of the Ghaznavid dynasty of Afghanistan, invaded India for the first time. Islam attaches equal importance to material and spiritual aspects of human life. Men and women have equal cultural rights. Marriage is positively enjoined and vigorously encouraged. Circumcision is compulsory before boys attain the age of 7. More than one wife (up to four) is permitted in Islamic Society. Differences in the habits, customs, and ethnic characteristics have all provided important leads for the study of cancer in this community. It is a sign of the times that some of the religious and social customs that were rigidly upheld by the older generations are rapidly giving way to "Modernism." Hence an attempt has been made to examine the differences found in the site-specific cancer risks in the Moslem community in Bombay. Analysis of the data was undertaken by sex- and age-adjusted and age-specific incidence rates. The common sites of cancer were found to vary greatly between the Moslem and non-Moslem populations of Greater Bombay. In Moslem men, the lung appears to be at highest risk, followed by the larynx, esophagus, tongue, and hypopharynx, whereas in non-Moslem men, the esophagus is the commonest site, followed by the lung, larynx, and tongue. In women, breast and cervix cancers, which rank first and second, respectively, in frequency in Moslems, reverse their positions in non-Moslem women.     

Indian studies on genetic polymorphisms and cancer risk

Genetic influences on cancer development have been extensively investigated during the last decade following publication of human genome sequence. The present review summarizes case-control studies on genetic polymorphisms and cancer risk in Indians. It is observed that the most commonly studied genes in the Indian population included members of phase I and phase II metabolic enzymes. Other than these genes, genetic polymorphisms for cell cycle and apoptosis-related factors, DNA repair enzymes, immune response elements, growth factors, folate metabolizing enzymes, vitamin/hormone receptors, etc., were investigated. Several studies also evidenced a stronger risk for combined genotypes rather than a single polymorphism. Gene-environment interaction was also found to be a determining factor for cancer development in some experiments. Data for single polymorphism and single cancer type, however, was insufficient to validate an association. It appears that much more experiments involving larger sample size, cross-tabulating genetic polymorphisms and environmental factors are required in order to identify genetic markers for different cancers in Indian populations.     

Cancer incidence in Indian Christians

Differences in habits, customs and ethnic characteristics have provided important leads for the study of cancer in Indian Christians. It is a sign of the times that some of the social customs rigidly upheld by the older generations are rapidly giving way to "Modernism". An attempt has been made to examine the differences found in the site-specific cancer risks in this community in Bombay. An analysis of the data has been made by sex and age-adjusted and age-specific incidence rates. The common sites of cancer were found to vary greatly between the Christian and non-Christian populations of Greater Bombay. In Christian males, the lung appears to be at highest risk, followed by the stomach, oesophagus and larynx, whilst in non-Christian males the oesophagus is the commonest site followed by the lung, larynx and tongue. In females, breast and cervical cancers, which occupy the first and second ranks in Christians reverse their position in non-Christian women.     

Pulmonary Aspergillosis in Indian buffaloes

Five cases of pulmonary aspergillosis were recorded in buffaloes on histopathological basis. Aspergillus flavus from an aged buffalo and A. fumigatus from a 4 week old buffalo calf could be isolated. Only six out of 789 sera samples gave positive precipitin reaction with filtrate antigen of Aspergillus species. The sera samples from 3, 2 and 1 case reacted with antigen of A. flavus, A. fumigatus and A. niger respectively. Sixty four sera gave false positive lines due to C-reacting proteins. A. flavus isolated from one case was found to be highly pathogenic to the rabbits. The histopathological lesions in natural cases as well as experimentally inoculated rabbits consisted of mixed granulomatous foci in affected organs.

Zusammenfassung

Fünf Fälle einer pulmonalen Aspergillose wurden bei Büffeln aufgrund histopathologischer Untersuchungen diagnostiziert. Aspergillus flavus wurde bei einem alten Büffel und A. fumigatus bei einem 4 Wochen alten Büffelkalb aus den Lungen isoliert. Nur 6 von 789 Serumproben zeigten eine positive Präzipitationsreaktion auf filtriertes Aspergillus - Antigen. Sechs Serumproben reagierten positiv auf die Antigene wie folgt: A. flavus 3ma1, A. fumigatus 2mal und A. niger 1mal. 64 Seren zeigten falsch-positive Präzipitations- linien auf C-reaktive Proteine. Der in einem Fall isolierte A. flavus -Stamm erwies sich für Kaninchen als hoch pathogen. Die histopathologischen Läsionen sowohl bei natürlichen Erkrankungen als auch bei experimentell infizierten Kaninchen bestanden aus verschie- denen granulomatösen Herden in den befallenen Organen.     

Human Papillomavirus Infection Among Indian Mothers and Their Infants

Objective: Several studies have demonstrated that infants can acquire human papillomavirus (HPV) infection at ‍birth from their mothers. The aim of the present investigation was to determine prevalence of HPV infection among ‍pregnant women and evaluate the extent of perinatal transmission of HPVs to infants. ‍Methods: The study included 135 pregnant women and their infants. The polymerase chain reaction (PCR) was ‍performed to detect HPV DNA in cervical cells of the women and buccal cells of the infants. ‍Results: HPVs detected were genotyped by PCR using type specific primers. HPV DNA was identified in 38 ‍mothers (28.14%, 38/135) and 14 babies (10.37%, 14/135). The prevalence rate of HPV type 16 was highest both in ‍HPV positive maternal (63.15%, 24/38) and baby samples (85.71%, 12/14). At birth, the frequency of HPV ‍transmission from infected mothers to their infants was 18.42% (7/38). The proportion of infants with HPV infection ‍delivered by cesarean section was 78.57% (11/14). ‍Conclusion: Cesarean section was not found protective for infants against perinatal HPV transmission. Infection ‍in the infants was cleared within one year. This is the first report of its kind from India. ‍     

Head and neck extranodal non-Hodgkin's lymphomas in Indian patients

Though radiotherapy has traditionally been the treatment of the choice for the patients with localised extranodal lymphomas of the head and neck areas, its adequacy as the sole modality of treatment has come to be questioned. The disease is shown to relapse in other distant extranodal sites especially the gastrointestinal tract. The addition of systemic chemotherapy has been suggested. Fifty-five patients with localised head and neck extranodal lymphomas were treated at the Tata Memorial Hospital during the period 1976-1982, 35 with radiation therapy alone and 20 with combination therapy. The total survival at 5 years was 65% for patients treated with radiation alone and 85% for those treated with combination therapy. The 5 year disease-free survival dropped to 45% for the former group but was 74% for the latter group. This difference was statistically significant (p less than 0.01). We infer that localised extranodal lymphomas be regarded as a systemic disease and be treated by a multimodal approach.     

Germ cell tumors in Indian children

The present paper is a retrospective study of one hundred and thirty five germ cell tumors seen in children at the University Hospital, Varanasi during a period of 21 years. These tumors constituted 7.5% of all solid tumors in the pediatric age group. Histologically 89 tumors (65.9%) were benign and 46 (34.1%) were malignant. Eighty percent of ovarian and all the testicular germ cell tumors were malignant. Thirty per cent of the tumors were located in the sacrococcyx. The ovaries were the next common site. There were 80 girls, 53 boys, and 2 cases in which the sex was not recorded. The predominance amongst girls was mainly due to the more frequent involvement of ovaries as compared to the testes. Twenty nine of the children were in the first year of life. The factors probably responsible for the higher incidence of malignancy, the differences in anatomic location, and the sex distribution in comparison to other reports have been examined and discussed.     

Tracheoesophageal Puncture - an Indian perspective

Neoplasms of the Larynx constitute a large group of malignancies in our country. The advanced stages of laryngeal carcinoma require a total laryngectomy, which is functionally and psychologically very debilitating for the patient, as he loses his speech. Although many methods have been devised to overcome this handicap, none has been proved to be entirely satisfactory. Singer and Blom (1980) introduced an endoscopic technique for voice restoration using a tracheoesophageal puncture. A one way silicone valve was used by them and they claimed a very high success rate. Similar good results were reported by other Western and Indian surgeons. However, in our series of ten patients, the results were not very encouraging. Sixty percent (6/10) patients could acquire speech but there were significant difficulties. We do not think that this technique should be used indiscriminately in a laryngectomee.     

Modified Indian pouch following radical cystectomy

Objective To investigate the indications, operation techniques and clinical effects of a modified technique of Indiana pouch. Methods A modified technique of Indiana pouch was performed on 5 patients following radical cystectomy. Results 5 cases showed satisfactory therapeutic effects with of follow-up range of 6 to 30 months. All patients were continent day and night with easy catherization. The number of micturations was 5 to 6 times in the daytime and 1 to 3 times in the nighttime. Cystography of 4 cases showed that pouches were spheroidic and volumes were between 400 to 500 ml. Conclusion The advantages of the modified Indiana pouch are as follows: easy manipulation; low tension and high volume in pouches; no reflux; satisfactory urinary continence and few complications. Therefore, it is worthy of clinical popularization.     

Findings from American Indian Needs Assessments

Because of decreased access and dismal survival rates, strategies need to be developed to increase cancer awareness and facilitate cancer prevention, early detection, and screening activities within American Indian (AI) populations. The purpose of this study was to develop a locally tailored needs assessment to collect cancer prevention, control, and risk factor information and knowledge, attitude, and perceived behavior (hereafter referred to as “needs assessment”) data from 500 community members living in 3 geographically diverse settings: the Southeastern USA, the Rocky Mountain region, and the Northern Plains. Needs assessment data helped identify local health priorities and create a pilot cancer prevention and early detection education intervention. There were two versions of common items of the instrument: short (~35 items) and long (55 items), and each partner added items that were recommended by their local AI Advisory Committee. Each partner collaborated with local AI organizations to identify and recruit participants at community venues. During the sessions, facilitators used Power Point® slides and ARS equipment and software to anonymously collect participants’ responses. The partners collected needs assessment data from 677 community members over a 4-year period. Cancer education knowledge was low, barriers to accessing timely cancer screening and care services were excessive, tobacco use was excessive, and daily physical activity was insufficient for most participants. ARS was an effective way to collect needs assessment information. During discussions following the data collection, community members requested more cancer education opportunities, access to patient navigation services, and cultural competency training for healthcare providers.     

Breast Cancer and Screening in American Indian and Alaska Native Women

Data relative to breast cancer among American Indian and Alaska native (AI/AN) women are limited and vary by regions. Despite national decreases in breast cancer incidence and mortality rates, declines in these measures have not yet appeared among AI/AN women. Health disparities in breast cancer persist, manifest by higher stage at diagnosis, and lower screening rates compared to other racial and ethnic groups. Disproportionately more AI/AN are younger at diagnosis. Screening beginning at age 40, improving access, annual rescreening, community education and outreach, and mobile mammography for rural areas are ways to improve these disparities in breast cancer.     

Breast cancer and screening in American Indian and Alaska Native women

Data relative to breast cancer among American Indian and Alaska native (AI/AN) women are limited and vary by regions. Despite national decreases in breast cancer incidence and mortality rates, declines in these measures have not yet appeared among AI/AN women. Health disparities in breast cancer persist, manifest by higher stage at diagnosis, and lower screening rates compared to other racial and ethnic groups. Disproportionately more AI/AN are younger at diagnosis. Screening beginning at age 40, improving access, annual rescreening, community education and outreach, and mobile mammography for rural areas are ways to improve these disparities in breast cancer.