Showing papers in "National Cancer Institute monograph in 1985"

Second cancer following cancer of the breast in Connecticut, 1935-82.

Abstract: Among 41,109 women diagnosed with breast cancer between 1935 and 1982 in Connecticut, 3,984 developed a second cancer, whereas 2,426 were expected [relative risk (RR) = 1.64; 95% CI = 1.6-1.7]. This increased risk persisted for 30 years and was highest in women under 55 years of age at the time of breast cancer diagnosis. Second primary breast cancers (RR = 3.0) accounted for almost one-half of all new neoplasms. However, if subsequent breast cancers were excluded, the risk for all other second cancers was only 1.15 (95% CI = 1.10-1.20), and no excess risk was seen among women over age 55 at initial breast cancer. Significant risks were found for cancers of the ovary (RR = 1.7) and uterine corpus (RR = 1.4), possibly linked with shared reproductive factors such as nulliparity or late age at menopause. Malignant melanoma (RR = 1.5), thyroid cancer (RR = 1.6), and colon cancer (RR = 1.2) were also significantly elevated; possible shared risk factors remain to be elucidated. Significant deficits of multiple myeloma and chronic lymphocytic leukemia were noted. Women who received initial radiotherapy compared with those who did not were at slightly higher risk of developing a second cancer, most notably acute nonlymphocytic leukemia, non-Hodgkin's lymphoma, and cancers of the esophagus, kidney, and connective tissue, although the nature of the associations was not always clear. Some of the soft tissue sarcomas were lymphangiosarcomas of the arm, a consequence of the lymphedema that may complicate radical mastectomy (Stewart-Treves syndrome). Women treated with radiation were at higher risk of developing a second breast neoplasm (RR = 3.9) than nonirradiated women (RR = 2.8). Further investigation should focus on the mechanisms underlying the relationships between breast, genital tract, and colon cancers, and on the effects of treatment modalities on the risk of subsequent neoplasms.

Selection, follow-up, and analysis in the Health Insurance Plan Study: a randomized trial with breast cancer screening.

Abstract: Critical decisions made 20 years ago by those who planned the randomized trial at the Health Insurance Plan (HIP) of Greater New York to determine the efficacy of periodic screening for breast cancer are detailed. These decisions affected the age group to be screened, screening modalities, frequency of screening, sample size, primary measures for testing efficacy, and period of follow-up (long term). Results of follow-up, 16 years after entry, indicate that mortality due to breast cancer continues to be lower among study women than controls. Numerically, the differential has been stable; relatively, it has decreased. It is estimated that the study group would have experienced about a 30% reduction in breast cancer mortality if screening had been maintained. Relative case survival rates over a 14-year period after diagnosis show changes in contours of trend lines that result from screening. The study group's trend is slightly concave in contrast to the usual convex curve for the controls. The contour of the curve is more decidedly concave among subjects detected through mammography alone than for other subgroups detected through screening, although the relative survival rate remains highest in the mammography only group. Uncertainty persists about effects of screening in the HIP study on breast cancer mortality among women aged 40-49 years at entry.

Selection, follow-up, and analysis in the American Cancer Society prospective studies.

Abstract: The organization and selection characteristics of the American Cancer Society's prospective studies are reviewed, and problems connected with the follow-up procedures are discussed. Also included are descriptions of some of the features of analysis in cohort studies.

Second cancer following cancer of the female genital system in Connecticut, 1935-82.

Abstract: The risk of second primary cancer was evaluated in more than 25,000 women with cancer of the genital organs diagnosed between 1935 and 1982 in Connecticut. Significant excesses of subsequent cancers were observed following cancers of the cervix (35%, n = 656), uterine corpus (16%, n = 1,060), and ovary (58%, n = 366). When observed and expected second cancers of the female genital tract were excluded, these excesses became 40%, 30%, and 59% after cervix, uterine corpus, and ovary, respectively. Among women with either cancer of the cervix or uterine corpus, the risk of developing a second cancer rose with increasing duration of follow-up, reaching an excess of 61 and 34%, respectively, after 20 years. In contrast, among patients with ovarian cancer, the second cancer risk decreased over time to 41% after 10 years. Cancers related to smoking, i.e., oral cavity and pharynx, esophagus, and respiratory system, were notably increased among cervical cancer patients. The twofold to threefold risks observed for these second cancers are consistent with recent evidence linking cervical cancer to cigarette smoking and seem too large to be artifacts of confounding by low socioeconomic status. An increased incidence of second cancer of the abdominal organs (colon, rectum, kidney, bladder, ovaries) was generally observed for each gynecologic site. However, only rectal cancer was consistently linked with radiation treatment for the first primary cancer. Leukemia occurred in excess after cancers of the uterine corpus and ovary, but not after cervical cancer. The predominant cell type was acute nonlymphocytic leukemia, and the excess was associated with radiotherapy for uterine corpus cancer and with chemotherapy for ovarian cancer. Cancers of the breast and colon were increased following uterine corpus and ovarian cancer and vice versa, which supports the notion that these sites share a common etiology, perhaps related to dietary or hormonal factors. Cervical cancer patients experienced a deficit of subsequent breast cancer, possibly due to ovarian removal or ablation by radiation. Investigators need to explore further the association between the smoking-related cancer sites and cervical cancer, to clarify the role of radiotherapy and chemotherapy in relation to excess cancers, and to define more fully the etiologic factors that link cancers of the breast, colon, uterine corpus, and ovary.

Occurrence of breast cancer in relation to diet and reproductive history: a case-control study in Fukuoka, Japan.

Abstract: An epidemiologic study on breast cancer in relation to diet and reproductive history was conducted with 3 populations at different levels of risk for the disease: Japanese in Fukuoka, Japan (low risk), Japanese in Hawaii (intermediate risk), and Caucasians in Hawaii (high risk). This report describes the Fukuoka portion of the study. We interviewed 212 patients with histologically confirmed breast cancer and an equal number each of hospital and neighborhood controls to determine risk factors for the disease. The results indicated that "overnutrition" (a high-fat and high-animal protein diet) was not statistically associated with the disease. As noted in previous studies, age at the first birth was positively related to the disease; those women who gave birth to their first child when they were 35 or more years of age showed a relative risk of 5.0 compared with those giving birth at less than 20 years of age. A past history of both natural abortion and of benign breast disease were significantly associated with the disease. On the whole, the results obtained from this Fukuoka portion of study were in good agreement with those from the Hawaii study during which Japanese and Caucasians in Hawaii were investigated.

Cancer incidence in Japanese in Japan, Hawaii, and western United States.

Abstract: We based our systematic review of the cancer incidence rates of 48 anatomic sites of Japanese in Japan (Miyagi, Osaka, and Fukuoka Prefectures) and Japanese and Caucasians in the United States (Hawaii, San Francisco Bay Area, and Los Angeles County) on the cancer incidence data included in volume IV of "Cancer Incidence in Five Continents." Cancer sites were classified into 10 categories according to the trend of cancer incidence among the 3 groups. To evaluate the influences of environmental and racial factors, we used the ratio of cancer incidence in Japanese living in the United States to that of native Japanese, and the ratio of cancer incidence in Caucasians to that of Japanese living in the same areas of the United States. The present study revealed that the risks of cancers of the prostate, corpus uteri, colon, thyroid, breast, ovary, and testis were elevated, whereas those of the stomach, esophagus, and cervix uteri were decreased in the United States. Caucasians were more susceptible to melanoma, cancers of the mouth, lip and vermilion border, tongue, oropharynx, and larynx than were the Japanese, but the Japanese were more susceptible to cancers of the stomach, gallbladder, and liver. The difficulties we encountered in differentiating the influences of environmental factors from those of genetic racial factors are discussed. The necessity for further observations of the life-style (especially dietary habits) and the cancer incidence of Japanese living in the United States and comparisons with those of native Japanese and Caucasians are emphasized.

Second cancer following cutaneous melanoma and cancers of the brain, thyroid, connective tissue, bone, and eye in Connecticut, 1935-82

Abstract: The risk of second primary cancers developing was evaluated in individuals with 6 rare tumors in Connecticut between 1935 and 1982. Small but significant excesses of all second cancers occurred in patients with cutaneous melanoma (42%), and cancers of the brain (59%), thyroid (49%), connective tissue (23%), bone (66%), and eye (40%). In individuals with cutaneous melanoma, the highest risks were for subsequent cutaneous melanomas [relative risk (RR) = 8.5] that persisted throughout all intervals of observation. The risk for second melanomas was higher in persons under age 40, consistent with a heritable component. Connective tissue tumors and breast cancers also occurred in excess. Among patients with brain cancer, an increase of melanoma was observed that may represent an underlying neural crest abnormality, although no excess of brain cancer was seen after melanoma. Reciprocal increases of bone cancer after connective tissue cancer and connective tissue cancer after bone cancer point to shared risk factors, such as high dose radiotherapy or genetic susceptibility states. An anticipated high risk of osteogenic sarcoma following Ewing's sarcoma was not seen. An excess of breast cancer (RR = 1.9) after thyroid cancer indicates common etiologic factors. Expected excesses of bilateral retinoblastoma and bone cancer after retinoblastoma were seen. Tumors commonly treated with alkylating agents or nitrosoureas (melanoma, brain, connective tissue) showed slightly elevated risks of acute nonlymphocytic leukemia. Prostate cancer was frequently found to be in excess, but this is likely an artifact due to ascertainment bias.

Second cancer following cancer of the female breast in Denmark, 1943-80.

Abstract: The risk of a person developing a second primary cancer was evaluated in approximately 55,000 women diagnosed with breast cancer in Denmark between 1943 and 1980. Excluding second cancers of the contralateral breast, 2,480 new cancers were observed compared with 2,398 expected (relative risk = 1.03; 95% CI = 0.99-1.08). Breast cancer patients followed for 10 years or more showed a significant 13% excess of all second primary tumors. Significant excesses of cancers of the lung, bone, and connective tissue were observed. Although some misclassification of metastases may have occurred, the risk of second cancers at these sites (as well as the salivary gland and esophagus) increased significantly with time and was especially high among women followed for 10 years or more. These observations suggest that radiation, as a part of the initial treatment, may have been involved. Radiation or chemotherapy, or both, may also have influenced the risk of acute nonlymphocytic leukemia (51 cases observed vs. 20.7 expected), which remained significantly elevated after the first year of follow-up. Common risk factors, related to reproductive experience and nutrition, may have contributed to the excess risk of cancers of the ovary and colon. On the other hand, an anticipated excess of cancer of the corpus uteri was not found, although cancer of the uterus not otherwise specified was significantly increased. Significant deficits were observed for second cancers of the liver and biliary tract, due perhaps to underreporting or conservative coding practices, or both. A significant excess of malignant melanoma was not easily explained but might indicate a common hormonal etiology with breast cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Summary: multiple primary cancers in Connecticut, 1935-82.

Abstract: The risk of developing a second primary cancer was evaluated in over 250,000 persons reported to the Connecticut Tumor Registry (CTR) during 1935-82 The CTR has collected data on cancer incidence longer than any other population-based tumor registry and thus provided researchers with a unique opportunity to investigate the occurrence of second cancers among persons followed for long periods, in some cases for more than 40 years When compared with the general Connecticut population, cancer patients had a 31% increased risk of developing a subsequent cancer overall and a 23% elevated risk of second cancer at a different site from the first Little variation in risk was seen for the first 20 years of follow-up, although the risk for females averaged twice that for males (41% vs 18%) Persons who survived more than 20 years after the diagnosis of their first cancer were at highest risk: 51% for females and 45% for males Over 1 million person-years of observation were recorded, and the excess risk of developing a new cancer was 35 per 1,000 persons per year Common environmental exposures seemed responsible for the excess occurrence of many second cancers, particularly those related to cigarette smoking, alcohol consumption, or both For example, persons with epithelial cancers of the lung, larynx, esophagus, buccal cavity, and pharynx were particularly prone to developing new cancers in the same or contiguous tissue throughout their lifetimes A notable finding was the high risk of cancers of the lung, larynx, buccal cavity, and pharynx observed among cervical cancer patients, which suggested a common etiology involving cigarette smoking The intriguing association previously reported among cancers of the colon, uterine corpus, breast, and ovary was confirmed in our data, which indicated the possible influence of hormonal or dietary factors Incidental autopsy findings were largely responsible for the observed excesses of second cancers of the prostate and kidney, and heightened medical surveillance of cancer patients likely resulted in ascertainment bias and elevated risks for some tumors during the early period of follow-up, most notably cancers of the thyroid Interestingly, patients with prostate cancer were the only ones found to be at significantly low risk for second cancer development However, this might be an artifact of case-finding because advanced age at initial diagnosis of prostate cancer was associated with an underascertainment of second cancers(ABSTRACT TRUNCATED AT 400 WORDS)

Introduction to the study of multiple primary cancers.

Abstract: To lay the groundwork for subsequent chapters in this monograph of multiple primary cancers in Connecticut and Denmark, we present a description of the historical significance of previous studies, focusing on key surveys that have enhanced our understanding of the origins of multiple cancers. Case reports, hospital series, and cancer registry studies have progressively sharpened our perspective on the patterns and causes of multiple cancers. These findings in turn have generated hypotheses about host and environmental determinants of various combinations of cancer and have provided clues to the actual mechanisms of carcinogenesis. The registries of Connecticut and Denmark which began in the 1930s and 1940s, respectively, afford investigators a unique opportunity to analyze the cancer experience of well-defined populations, followed for long periods. The major contribution of this monograph is the evaluation of second cancer risks among long-term survivors of cancer, including relatively rare tumors about which little information currently exists. For patients with a particular cancer, the number of observed second cancers are tabulated over time and compared with those expected if the patients experienced the same rates prevailing in the corresponding general population. We have discussed problems in distinguishing statistical artifacts from biologically plausible associations in light of the potential biases inherent in follow-up surveys of cancer patients; for example, heightened medical surveillance and mistaken metastases could result in false indications of elevated risk. Several differences in the reporting, follow-up, and coding practices between the Connecticut and Denmark registries are described and probably account for many differences in the reported findings.(ABSTRACT TRUNCATED AT 250 WORDS)

Second cancer following cancer of the digestive system in Connecticut, 1935-82.

Abstract: The risk of developing a second primary cancer was evaluated in approximately 64,000 persons diagnosed with cancer of the digestive system in Connecticut during 1935-82. Significant excesses of all second cancers combined were observed following cancer of the esophagus (58 observed vs. 33 expected), small intestine (41 vs. 24), and colon (2,268 vs. 1,714). A slight excess of multiple primaries was observed following cancer of the liver and biliary tract (47 vs. 40). The observed number of second cancers was nearly equal to the expected number for persons initially diagnosed with cancers of the stomach (251 vs. 258), rectum (952 vs. 941), and pancreas (40 vs. 40). Persons with initial cancers of the small intestine, colon, and rectum also had excess second cancers arising primarily in the colon, which suggested the influence of common etiologic factors or possibly misclassified metastases in some. Shared dietary, socioeconomic, or hormonal factors may explain the excess of uterine and ovarian cancers among patients with colon cancer and the excess of breast cancer among patients with colon and rectal cancers. Oral and respiratory cancers occurred more frequently than expected in persons with an initial esophageal cancer, which is likely due to common risk factors of cigarette smoking or alcohol intake, or both. The elevations in cancer of the prostate among males with cancers of the esophagus, small intestine, colon, rectum, liver/biliary, and pancreas are probably artifacts associated with increased medical surveillance of cancer patients. The prostate cancer excesses were limited to the first year after diagnosis of the initial cancer or decreased over time for all but cancer of the colon and small intestines. Increased medical surveillance may also contribute to the excess renal and bladder cancers seen within 5 years of diagnosis of stomach cancer. Excesses were also seen for second pancreatic cancer among small intestine and liver/biliary cancer patients and second kidney and brain cancers among those with colon cancer. The deficits of stomach and rectal cancer among persons initially diagnosed with the same tumors, respectively, were anticipated because surgical removal of the organ is the primary form of treatment. Patients with rectal cancer also had deficits of stomach and pancreatic cancers. Future research should clarify the role of diet, alcohol, metabolic and endocrine factors, and host susceptibility on the risk of second neoplasms following cancer of the digestive system.

Case-control study of urinary bladder cancer in metropolitan Nagoya.

Abstract: We conducted a population-based case-control study of patients with bladder cancer and of controls drawn randomly from the general population of Metropolitan Nagoya and interviewed both groups. The incidence rates of bladder cancer were 2.42 and 7.05/100,000 for females and males, respectively. The analysis, based on 293 patients and 589 controls who were frequency matched for age, sex, and residence, provided the following major findings. Age-adjusted relative risks of 1.89 (1.15-3.10) and 3.53 (1.71-7.27) were found in male and female cigarette smokers, respectively. Significant relative risk was also found in males who drank cocoa. Elevated risk with a dose-response relationship was observed among women who used hair dye and who smoke, but this risk was insignificant, with the disappearance of a dose-response relationship, when it was adjusted for smoking. Age- and smoking-adjusted relative risk of coffee drinking was insignificant with no dose-response relationship. Relative risk of artificial sweetener use was below 1 with adjustment for age and smoking. Intake of alcoholic beverages and cola was insignificantly associated. Reduced risk of significance was suggested for the intake of black tea and matcha (powdered green tea) in females and of fruit juice in males.

Second cancer following lymphatic and hematopoietic cancers in Connecticut, 1935-82.

Abstract: The risk of developing a second primary cancer was evaluated in approximately 19,000 persons with initial cancers of the lymphatic and hematopoietic system in Connecticut between 1935 and 1982. Significant excesses for all second cancers were observed among patients with leukemia (34%), Hodgkin's disease (70%), non-Hodgkin's lymphoma (25%), and multiple myeloma (24%). In general, the risk of second cancers was greater in males than in females, even for cohorts not showing an excess of surveillance-related prostate cancer. Among patients with leukemia, significant excesses of cancers of the lung, kidney/ureter, and prostate were noted; cutaneous melanoma was elevated only in males. These excesses did not persist in the small number of long-term survivors. Possible etiologic factors included tobacco smoking for lung and kidney cancers, medical surveillance artifact for prostate cancer, and immunosuppression for malignant melanoma and lung cancer. The large number and good prognoses of patients with chronic lymphocytic leukemia strongly influenced the pattern of second cancers when all leukemias were analyzed together; no evidence was found for an increased risk of second cancer in patients with acute lymphocytic leukemia. A disproportionate number of subsequent cancers, particularly those of the kidney and ureter, were diagnosed incidentally at autopsy. Patients with Hodgkin's disease displayed significant excesses of cancers of the buccal cavity and pharynx, lung, female breast, and thyroid. The latter 3 sites remained significantly elevated in long-term survivors (10 yr or more postdiagnosis), so that radiation therapy may have contributed to their development. Among persons with non-Hodgkin's lymphoma, cancers of the stomach, lung, brain, and connective tissue occurred excessively. The first 3 sites, plus cancers of the urinary bladder, remained elevated among long-term survivors. The brain cancer excess, not previously reported, may represent misclassification of central nervous system lymphoma. The risk of gastric cancer is reminiscent of similar findings in patients with both acquired and genetically determined immunodeficiency disorders. The alkylating agent, cyclophosphamide, used extensively in the treatment of non-Hodgkin's lymphoma, is known to cause bladder cancer in man.(ABSTRACT TRUNCATED AT 400 WORDS)

Cancer registration in Denmark and the study of multiple primary cancers, 1943-80.

Abstract: The Danish Cancer Registry began in 1942 as the world's first program to register all cases of cancer arising in an entire nation. The Registry covers a population with free access to good medical care. Voluntary notifications are received of patients with reportable malignant and certain related diseases from hospital departments, pathology institutes, and practicing physicians. The Registry is linked annually to death certificates made available by the Danish National Board of Health to ascertain additional cancers and to learn whether patients previously reported to the registry have died. During the period 1943-77, coding of the reported diseases was done by the Registry's medical and clerical staff according to an extended version of the Seventh Revision of the International Classification of Diseases (ICD). Since 1978, information has been coded according to the ICD for Oncology. Multiple primary cancers in the same patient are entered individually into the Registry; however, before 1978 only multiple primary cancers in different organs were registered. An evaluation of the completeness and the validity of diagnoses in the Danish Cancer Registry generally confirms the high quality of its data. However, it appears that the approach taken by the Registry in accepting multiple primary cancers has been a conservative one, and the risk of a person developing second cancers of some sites will thus be underestimated.

Second cancer following cancer of the male genital system in Denmark, 1943-80.

Abstract: The incidence of second primary cancers was investigated among 19,886 patients with prostate cancer. The analysis disclosed 594 new cancers, which was significantly less than the expected 1,176 cases (relative risk = 0.51). Deficits were observed for most sites but were only significant for cancers of the lip, lung, and gastrointestinal organs. The average age at diagnosis of prostate cancer was 72 years. It is likely that the apparent deficit in the incidence of second neoplasms resulted from less diagnostic aggressiveness in elderly patients with cancer compared with younger patients. The risk of developing a second primary cancer was also investigated in 4,290 men with testis cancer reported to the Danish Cancer Registry between 1943 and 1980. A significant 29% excess of second cancers was found (174 observed vs. 135 expected). A bimodal distribution of risk over time was found with a 67% excess seen among patients followed for 1-4 years that was mainly due to increased incidence of acute nonlymphocytic leukemia and malignant lymphomas. Among patients surviving 10 or more years, the overall excess of 32% observed was mainly due to cancers of the gastrointestinal tract and the urinary bladder. As part of the initial treatment for testis cancer, 82% of the patients received radiotherapy. Chemotherapy was rarely given before 1975 and then mostly to patients with a poor prognosis. Late effects of radiotherapy conceivably could account for some of the excess of second hematologic as well as solid neoplasms.

Cancer incidence in the islands of the Pacific.

Abstract: The South Pacific Commission Cancer Registry has been operational since 1977, and reasonably complete cancer incidence rates are available for New Caledonia, Fiji, Micronesia, the Cook Islands, and Niue. In addition, less complete reporting is available from American Samoa, Papua New Guinea, and French Polynesia. Cancers of the lung, oral cavity, esophagus, liver, and cervix are potentially preventable but prevalent in many Pacific island countries. Unusually low rates of many cancers were observed in Fiji, the most notable being lung and colon-rectum. Thyroid cancer rates are elevated in some but not all female populations. These and other variations in cancer by site are important areas for further research.

Some considerations in the design of a nutrition intervention trial in Linxian, People's Republic of China.

Abstract: Various issues pertaining to the design of a nutrition intervention trial in Linxian, a county in North Central China where esophageal cancer rates are extraordinarily high among a population with chronic deficiencies of multiple nutrients, are addressed. Two target populations are identified: One is a group of patients diagnosed with severe esophageal dysplasia, the other is the general population of the high-risk area. Interventions involving the supplementation of each group with vitamins and minerals are described, and a rationale is provided for the selection of nutrients and choice of dose levels. Several potential statistical designs are evaluated, with particular emphasis on the balancing of gains in specificity afforded by full and fractional factorial designs against their potential loss in sensitivity compared with the simplest design involving a placebo versus a multiple vitamin and mineral supplement.

Cancer registration in Connecticut and the study of multiple primary cancers, 1935-82.

Abstract: The Connecticut Tumor Registry (CTR) was established in 1941 and is the oldest population-based cancer registry in the world. Since 1935, all malignant tumors have been registered, and cancer patients are followed annually for vital status. Reporting by hospitals of all cancers diagnosed in Connecticut residents became mandatory in 1971. The reporting physician or hospital makes the initial determination as to whether a tumor is an independent primary cancer, recurrent tumor, or metastatic lesion. In addition, the Registry maintains stringent quality control procedures to avoid duplication of cancer reports. The Registry reviews reports of new cancers developing in patients with a previous primary cancer to rule out the possibility of misdiagnosed metastases. Microscopic confirmation of the diagnosis has improved from 49% in 1935-39 to 94% in 1980-82. Cancers reported only from death certificates currently account for only 1% of all registrations. Between 1935 and 1979, cancer rates in Connecticut almost doubled among males and increased by more than one-third among females; notable increases were seen for cancers of the lung and prostate in males and cancers of the lung and breast in females. In recent years, rates for malignant melanoma of the skin have increased dramatically among both sexes. Stomach cancer has decreased over time in both sexes, as has cervical cancer in females. Although the CTR has used several revisions of the International Classification of Diseases to code the primary site of cancers, rules for the coding of multiple primary cancers have remained essentially the same. Among 253,536 individuals diagnosed between 1935 and 1982 with an invasive cancer, 16,727 (6.6%) nonsimultaneous second cancers were evaluated and are discussed in subsequent chapters of this monograph. Simultaneous cancers were diagnosed in 4,107 individuals and accounted for approximately 20% of all multiple cancers reported in Connecticut. The most frequent simultaneous tumors were cancers of the colon, rectum, prostate, lung, breast, and bladder. Some simultaneous cancers (chronic lymphocytic leukemia, testis, prostate, rectum, uterine corpus, and liver and biliary tract) occurred almost as frequently as the number of subsequent nonsimultaneous tumors, which suggests that the patterns of risk over time for certain sites may be distorted when diagnoses are advanced in time and removed from analysis.(ABSTRACT TRUNCATED AT 400 WORDS)

Second cancer following cutaneous melanoma and cancers of the brain, thyroid, connective tissue, bone, and eye in Denmark, 1943-80.

Abstract: Second primary cancers were studied in persons with rare tumors between 1943 and 1980. The risk of developing a new cancer was evaluated in 7,211 persons with cutaneous melanoma, 1,784 persons with eye cancer, 10,273 persons with tumors of the brain and nervous system, 1,935 persons with thyroid cancer, 1,542 persons with bone tumors, and 2,318 persons with malignant neoplasms of the connective tissue. All cancer patients were diagnosed in Denmark between 1943 and 1980 and survived for 2 or more months. Nonmelanoma skin cancers were excluded from the analysis, whereas tumors of the brain and nervous system included both benign and malignant neoplasms. Overall, patients with these cancers showed no greater incidence of new tumors than expected from comparisons with the general population. An excess of chronic lymphocytic leukemia was observed subsequent to all cancers derived from the neural tube, i.e., melanoma and tumors of the eye, brain, and nervous system. Bone cancer occurred excessively, although the possibility of misclassified metastases could not be eliminated. Patients with tumors of the brain and nervous system who survived for 10 or more years developed significantly more cancers of the kidney and connective tissue and melanoma than anticipated. A deficit of second cancers of the digestive system was noted after primary bone and connective tissue cancers, in contrast to an excess of second cancers of the lung and kidney. Although based on few cases, patients with bone cancer showed a large excess of eye cancer as a second primary. The association between cancers of the breast and connective tissue was found to be bidirectional. Persons with connective tissue cancer were at increased risk of developing non-Hodgkin's lymphoma. Thyroid cancer patients were at high risk of subsequent tumors of the brain and nervous tissue and non-Hodgkin's lymphoma. However, contrary to previous reports, the risk of breast cancer was not elevated following thyroid cancer.

Diet and colon cancer: integration of the descriptive, analytic, and metabolic epidemiology.

Abstract: Case-control studies of diet and colon cancer have produced inconsistent findings. Data from descriptive and metabolic epidemiologic studies suggest that colon carcinogenesis varies by sex-age status, particularly when considered in relation to anatomic subsite. Thus stratification of data analysis by these criteria may elucidate dietary etiology. Consideration should also be given to the limited and nonlinear variation in colon cancer risk likely to exist in relation to the range of dietary "exposure" within Western study populations. In our community-based case-control study of colon cancer, comprising 220 patients and 440 individually matched controls, the dietary data have been analyzed by both tertile and quintile of individual consumption level. For total dietary energy intake, the tertile approach indicates a weak (men) to moderate (women) dose-response relationship; however, the quintile approach revealed in women a fourfold step-up in risk between the lowest and next-to-lowest quintile. For dietary protein, the quintile approach doubled the step-up in risk between the 2 lowest consuming categories for men compared with the tertile approach. Applying this quintile approach to data analyses stratified by sex, age, and colon subsite, we found: 1) In women, the risk of colon cancer for the upper four quintiles of consumption of calories and other major nutrients was greatest at young ages, whereas for men it was greatest at older ages. 2) The diet-associated risks tend to be maximal in the left (distal) colon for men and in the right (proximal) colon for women.(ABSTRACT TRUNCATED AT 250 WORDS)

Summary: multiple primary cancers in Denmark, 1943-80.

Abstract: The risk of developing a second primary cancer was studied among 171,749 men and 208,192 women who were reported to the Danish Cancer Registry between 1943 and 1980. Only those who survived at least 2 months were included in the analysis, and more than 1.7 million person-years of observation were accrued. Altogether, 15,084 second primary cancers developed in organs other than the initial cancer site [relative risk (RR) = 0.99]. Adjustment for possible underreporting of multiple primary cancers increased the RR to 1.06. The overall RR of a second cancer developing for all sites was 0.91, but interpretation of this risk is difficult because new tumors arising within the same organ are generally not recorded in Denmark. The RR for all sites increased with time from 0.94 during the first decade of follow-up (excluding the first year) to 1.13 among 30-year survivors. Patients below the age of 20 years when first diagnosed with cancer experienced significantly increased risk of developing a second cancer. Elevated risks were also observed for sites thought to have a common etiology. For example, cancers of smoking-related sites were increased in both directions for cancers of the oral cavity, respiratory tract, and urinary organs. For cancers suspected to have a hormone- or dietary fat-related association, significant reciprocal relationships were seen among cancers of the endometrium, ovary, and colon. Cancer treatment probably is an important factor in second cancer development, even when judged indirectly in the present study. For example, radiotherapy may have been responsible for an elevated risk of subsequent cancers of the thyroid, breast, colon, rectum, bladder, connective tissue, and hematopoietic system in long-term survivors. Chemotherapy may have increased the risk of subsequent leukemias. Our data further indicate that cancer patients have no general susceptibility to develop new malignant tumors, although high rates may be found for particular sites sharing common risk factors. Conversely, the occurrence of one cancer does not appear to protect against developing a new cancer.

Second cancer following cancer of the respiratory system in Connecticut, 1935-1982.

Abstract: The risk of a person developing a second primary cancer was evaluated in approximately 30,000 persons who developed cancer of the respiratory system in Connecticut between 1935 and 1982. A significant 44% excess of all second cancers was observed following cancer of the lung (614 observed vs. 426 expected). The excess of second tumors was 72% following cancer of the larynx (541 vs. 314) and 34% following cancer of the nasal cavities and sinuses (43 vs. 32). For cancers of the lung and larynx, second cancers arose mainly along the respiratory tract or other sites associated with cigarette smoking (oral cavity, bladder, kidney). A threefold excess of esophageal cancer followed cancer of the larynx, which was indicative of risk factors in common (alcohol and tobacco) and possibly an effect of radiotherapy. Radiotherapy may have contributed also to the increased risk of second lung and breast cancers. A slight excess risk of leukemia after lung cancer points to a possible effect of chemotherapy given for certain histologic types. An unexpected finding was a significant 50% increased risk of colon cancer following cancer of the larynx. Significant excesses of prostate cancer are probably artifacts associated with increased medical surveillance and higher autopsy rates among cancer patients than in the general population. No deficits of any second cancers were observed. The risk of a second cancer developing did not appear to vary by sex or time since initial diagnosis, except that the risks following cancer of the nasal cavities and sinuses returned to normal levels among long-term survivors. Among persons observed for 10 or more years after their initial diagnosis of cancers of the lung or larynx, the risk of developing a second cancer remained high, i.e., on the order of 50% above expectation. Further analytic studies should clarify the role of smoking, alcohol, other life-style and host factors, and various forms of therapy on the risk of second cancers following cancer of the respiratory system.

Second cancer following cancer of the digestive system in Denmark, 1943-80.

Abstract: Among 4,184 patients with cancer of the esophagus, 55 second primary cancers were observed, whereas 64 were expected [relative risk (RR) = 0.86]. The absence of an excess risk of alcohol- and tobacco-related cancers was not anticipated. A significant 19% deficit of second cancers was found among 30,843 patients with stomach cancer. Cancer of the rectum, kidney, and lung all occurred significantly below expectation. An excess risk of ovarian cancer (RR = 1.9) was seen in women. Reasons for these findings are not entirely clear. Cancer of the small intestine is rare, and despite a relatively short survival expectation, a moderate excess of second cancers was seen among 868 patients (36 vs. 26.8). Only cancers of the liver and gallbladder were significantly elevated, and the possibility of misclassified metastases is discussed. Colon cancer is one of the most common cancers in Denmark, and 29,490 patients with this disease were at slightly lower risk for development of second cancer (RR = 0.96; 95% confidence interval = 0.9-1.0) than the general Danish population, excluding secondary colon cancers. Esophageal, stomach, and liver cancers occurred less frequently than expected. That cancers of the uterine corpus and ovary were significantly increased supports the notion that common risk factors, such as diet and endogenous hormones, influence the development of these cancers. A significant 23% deficit of second cancers was also found among 26,597 patients with cancer of the rectum, excluding secondary rectal cancer. Significant deficits were seen for cancers of the stomach (RR = 0.5), lung (RR = 0.8), and brain (RR = 0.5), and for multiple myeloma (RR = 0.4). The likelihood of underreporting of second cancers, especially of the digestive system, is discussed. However, cancer of sites previously reported to be associated with rectal cancer, e.g., the colon, breast, and uterus, did not occur below expectation. Cancers of the liver and biliary tract occurred in 4,453 patients; their average survival was only 1 year. Except for a slight excess of cancer of the ovary (5 vs. 1.6), the risk of second cancer development for all sites was consistent with unity (RR = 0.90). The risk of second cancers among 7,752 persons with cancer of the pancreas was not greater than expected (88 vs. 85.2). Males were at significant risk of kidney cancer (RR = 3.2), whereas females showed elevated rates of cancers of the uterine corpus (RR = 3.2) and ovary (RR = 3.1). No site occurred significantly below expectation.

Second cancer following cancer of the female genital system in Denmark, 1943-80.

Abstract: Between 1943 and 1980, approximately 53,000 women in Denmark survived 2 or more months after initial diagnosis of cancers of the cervix uteri, corpus uteri, ovaries, fallopian tubes, and ligaments. No significant excess of new cancers was observed following cancers of the cervix and corpus uteri. However, after second cancers of both the cervix and corpus uteri were eliminated from the analysis (because it was likely they were surgically removed or not recorded due to conservative coding practices), 6 and 4% excess risks of borderline significance were found among women with cancer of the cervix and uterus, respectively. A significant 25% excess of all second primary cancers was observed following cancer of the ovary (relative risk = 1.25; 95% CI = 1.14-1.37). Significant excesses of colon and breast cancers followed cancers of the ovary and corpus uteri. Subsequent to cervical cancer, the risk of cancers of the lung, esophagus, bladder, and kidney occurred significantly above expectation. These associations may be explained by common risk factors related to reproduction and possibly diet for cancers of the breast, colon, ovary, and corpus uteri; and to cigarette smoking for cancers of the lung, esophagus, bladder, and cervix uteri. The significant deficit of breast cancer after cervical cancer could be due to different patterns of risk factor (i.e., reproductive and socioeconomic variables) and loss of functioning ovaries as a part of the treatment for cervical cancer. Each of the female genital sites showed significant excesses of second bladder cancers, and the risk increased significantly with time, which indicate a relation to radiotherapy. The pattern of risk of leukemia observed following cancer of the ovary was also compatible with effects of treatment, especially chemotherapy.

Second cancer following cancers of the buccal cavity and pharynx in Connecticut, 1935-1982.

Abstract: Patients diagnosed in Connecticut from 1935 to 1982 with cancers of the tongue, gum, floor, and other parts of the mouth, or pharynx experienced twofold to threefold increased risks of developing a second primary cancer. The excesses were most prominent [relative risk (RR) greater than or equal to 10] for subsequent oral and esophageal cancers but also were observed for cancers at other sites in the digestive and respiratory tracts. The increased risks, which affected both men and women and persisted over time, are most likely related to increased alcohol and tobacco consumption in the patients developing second primaries. The proportion of persons developing a new primary was 9% among the 2,120 patients with cancer of the tongue, 14% for the 3,063 patients with cancer in the gum, floor, or other parts of the mouth, and 8% among the 2,637 persons with pharynx cancer. If one considers that the average length of follow-up was only 3.4 years, these percentages are high and indicate the need for continued surveillance of patients with oral and pharyngeal cancers. Small overall excesses of subsequent cancer occurred among patients with initial lip (RR = 1.3) or salivary gland cancers (RR = 1.2), with twofold risks of oral and respiratory cancers evident for both tumors.

Relationship of dietary vitamin A and ascorbic acid intake to the risk for cancers of the lung, bladder, and prostate in Hawaii.

Abstract: This report presents preliminary findings from 3 case-control studies in Hawaii in which we are examining the relationship of dietary vitamin A and ascorbic acid intake to the risk for cancers of the lung, bladder, and prostate. All 3 studies involved home interviews of cancer patients and neighborhood controls and use of quantitative dietary history method. In the lung cancer study, we found an inverse dose-response effect for total vitamin A intake in males only, with an odds ratio of 1.8 (P less than .05) for the lowest intake quartile relative to the highest; we found no association for ascorbic acid. In the bladder cancer study, we found lower (but not statistically significant) mean intakes of both vitamins in patients compared with controls, with the effect stronger for ascorbic acid. In the prostate cancer study, no effect was detected for total vitamin A or ascorbic acid in men less than 70 years old, but a direct association of vitamin A only with a dose-response gradient was found for men 70 years or older (odds ratio = 1.87; P less than .05, for the highest relative to the lowest intake quartile). Our findings at present indicate that vitamin A has a protective effect against lung and bladder cancers but not against prostate cancer and that ascorbic acid has a protective effect against bladder cancer as well. In our later analyses, we will examine the possibility that the effects of vitamin A vary with histologic type and that this may account for the lack of an association with lung cancer in women.

Some epidemiologic observations of nasopharyngeal carcinoma in Guangdong, People's Republic of China.

Abstract: Chinese in the province of Guangdong have the highest risk of nasopharyngeal carcinoma (NPC) in China. Within Guangdong, variation in rates among the 3 major dialect groups is threefold. The Cantonese who reside in the central region of Guangdong display the highest risk of NPC. Among the Cantonese, those living on boats have twice the risk of those who live on land. These observations are consistent with earlier studies of southern Chinese residing in Hong Kong and Southeast Asia.

Medical and dental x rays as risk factors for recently diagnosed tumors of the head.

Abstract: We used epidemiologic data on 2 tumor sites, the intracranial meninges and the parotid gland, to evaluate the importance of medical and dental x rays as risk factors for radiogenic tumors of the head diagnosed among residents of Los Angeles County in recent years. Exposures to x-ray treatment to the head and to full-mouth dental x-ray series before 1960 appear to be risk factors for both meningiomas and parotid tumors. Evidence from both descriptive and analytic studies suggests that the female over male excess of meningiomas, which is greatest from ages 25 to 54 years, may be partially explained by the excess exposure of young women to dental x rays. Study participants' ability to recall diagnostic x rays accurately is also evaluated by our comparisons of interview data to those available from dental charts. Recall of these events appears to be unbiased and accurate enough to justify the use of interview data in investigations of these risk factors.

Relation of analgesic use to renal cancer: population-based findings.

Abstract: A population-based case-control study of renal cancer (495 cases of renal cell cancer, 74 cases of renal pelvis cancer, and 697 controls) was conducted in the Minneapolis-St. Paul 7-county metropolitan area. Information was obtained on a large number of variables, including the use of analgesic drugs. Long-term use (greater than 36 mo) of phenacetin-containing products was associated in both sexes with a twofold increased risk for renal cell cancer. Long-term use of phenacetin- and acetaminophen-containing products was associated with elevated risks of nearly threefold to eightfold for cancer of the renal pelvis. The separate effects of these analgesics could not be adequately assessed because most long-term users took both products.

Cancer incidence among Filipinos in Hawaii and the Philippines.

Abstract: Cancer incidence rates were compared for Filipinos in Hawaii (1978-81) and Manila (1977). Data for Hawaii were from the statewide Hawaii Tumor Registry; those for Manila were from the Central Tumor Registry of the Philippines. In addition, time trends (4-yr intervals) for cancer among Filipinos in Hawaii were examined for the period 1962-81 and compared with corresponding patterns among Caucasians. For most cancer sites, the rates among Filipinos in Hawaii showed expected increases or decreases from the Manila rates. Notable findings included a dramatic increase in thyroid cancer rates among Filipino women in Hawaii (highest of all ethnic groups), a surprising lack of increase in female breast cancer rates in Hawaii, and a lower than expected increase in colon cancer rates in Hawaii. The time trend analyses showed remarkably similar patterns in Filipinos and Caucasians in Hawaii and no suggestion that differences between the 2 populations are decreasing over time. These observations indicate that useful clues to cancer etiology can be found by further study of the Filipino experience in Hawaii.