[Show abstract][Hide abstract] ABSTRACT: To find a clue to lung cancer etiology in Japan, differences in the pattern of lung cancer histology and related time trends between Osaka, Japan, and the North West Region of England were investigated. Material comprised all incident lung cancer cases registered in both regional registries (14,521 in the Osaka Cancer Registry and 29,859 in the North West Regional Cancer Registry). (1) The age-standardized incidence rate of lung cancer was higher in the North West Region than in Osaka (80.4 among males and 20.9 among females per 100,000 population in 1979–82 versus 32.1 and 9.2 respectively). (2) A higher proportion of adenocarcinoma was observed in Osaka (36.3% in males and 62.0% in females) than in the North West Region (12.3% and 18.9% respectively). (3) Using the relative frequencies of each histological type according to sex and age-group, age-standardized incidence rates were calculated for the main lung cancer histological types. It was shown that the incidence rates of adenocarcinoma were similar in the two areas (10.6 in males and 5.3 in females in Osaka versus 10.0 and 3.5 in the North West Region, respectively) while those of squamous cell and small cell carcinomas were much higher in the North West Region than in Osaka. (4) Time trends of incidence rates showed an increase only for adeno- and small cell carcinomas in Osaka. Slight increases were observed for adenocarcinoma in both sexes and for squamous cell carcinoma in females in the North West Region. (5) Considering cigarette consumption and the relative risks of smoking in the two areas, the possible existence of other risk factors for adenocarcinoma in both sexes in Japan, besides active smoking, was suggested.
[Show abstract][Hide abstract] ABSTRACT: To examine what kinds of factors could have caused the geographic variation observed in lung cancer morbidity in Japan, a correlation study was performed comparing various regional traits. The same study was also conducted on large intestinal cancer, aiming to distinguish the possible urban factors associated with both cancers. Lung cancer was highly correlated with industrialization-related factors such as localization of manufacturing industries, automobile traffic and air pollution, whereas colon cancer was correlated with the population density of workers in the tertiary industries such as services, trade and government. A multiple regression analysis could not detect any single factor with an exceptionally strong influence on either cancer. The present findings suggest that the hazardous environmental condition of urban areas has, to some extent, contributed to the recent increase of lung cancer cases in this country.
[Show abstract][Hide abstract] ABSTRACT: The histologic types of lung cancer cases diagnosed in 1979-1980 (n=799) and 1987 (n=587) were independently reviewed by two pathologists in order to investigate the reproducibility of the diagnosis of the histologic type when the WHO classification (1981) was used. The specimens from 354 surgical cases and biopsy or cytology specimens from 1032 non-surgical cases were reviewed. The inter-observer agreement was 87.9% (kappa=0.79) for surgical cases and 81.4% (kappa=0.72) for non-surgical cases. When compared to the original diagnosis, the agreement was 86.8% (kappa=0.78) for surgical and 86.4% (kappa=0.79) for non-surgical cases in 1979-1980 and the agreement was 92.8% (kappa=0.87) for surgical and 89.1% (kappa=0.83) for non-surgical cases in 1987. By histologic type, no difference in the agreement was observed except for large cell carcinoma. The distribution of histologic types after the review differed only slightly (less than 6%) from the original distribution. This suggests that in Osaka, Japan, the diagnosis based on the WHO classification (1981) had only a limited influence on the distribution of histologic types, and is not a major reason for the changing trends in lung cancer incidence by histologic type.
Japanese journal of cancer research: Gann 02/2000; 91(1):1-8. DOI:10.1111/j.1349-7006.2000.tb00853.x
[Show abstract][Hide abstract] ABSTRACT: We investigated trends of lung cancer incidence from 1974 to 1993 by histologic type, using data from the population-based cancer registry in Osaka, Japan. Since the proportion of cases with histologic types identified was not sufficiently high, sex- and age-specific incidence rates by histologic types were estimated assuming that the distribution of histologic types was the same across the same sex and age group regardless of reporting status. Cumulative risk from 0 to 74 years old for total lung cancer increased 1.3-fold from the period 1974-77 to 1986-89 and then plateaued in the period 1990-93 for both males and females. When divided into histologic types, cumulative risk for incidence of squamous cell carcinoma was almost constant during the study period for both males and females. During the same period, adenocarcinoma increased up to 1.4-fold for both males and females. This increase seemed to have reached a plateau recently for males, but not for females. Small cell carcinoma increased monotonously up to 1.6- to 1.7-fold for both males and females. Large cell carcinoma showed over 2-fold increase for both males and females; however, the estimates fluctuated due to the small number of cases. This study provides further evidence of a relative increase of adenocarcinoma compared to squamous cell carcinoma. Recent trends of tapering increase of lung cancer incidence should be confirmed by further observation.
Japanese journal of cancer research: Gann 02/1999; 90(1):6-15. DOI:10.1111/j.1349-7006.1999.tb00659.x
[Show abstract][Hide abstract] ABSTRACT: Population-based cancer registries in Japan were first established in the cities of Hiroshima and Nagasaki in 1957-1958 for assessing radiation effects and in Miyagi in 1959 for promoting epidemiological researches, while most other prefectures in Japan set up cancer registries as a part of their own cancer programs. This resulted in the broader use of registry data in Japan. In 1975, the Research Group for Population-based Cancer Registration in Japan was first organized with a research grant under the National Cancer Research Promotion Program. Since then, continuous efforts have been made by the Group to improve the quantity and quality of registry data and to develop methodologies to utilize it. Studies being conducted using registry data cover (1) descriptive epidemiology, (2) analytical epidemiology, (3) evaluation of screening programs, and (4) evaluation of regional cancer medical care. In 1992, 32 regional cancer registries which were operating in Japan set up the Japanese Association of Cancer Registries. However, there are still many difficulties to overcome in order to achieve completeness of reporting in registries. Further improvement of reporting rate, together with standardization of registry data are left for future efforts.
[Show abstract][Hide abstract] ABSTRACT: Survival rates for childhood cancers were analyzed with a total of 2,209 cases who were registered in a population-based cancer registry in Osaka, Japan in 1975-1984. These cases were reclassified according to Birch's classification and the survival rate of each diagnostic group was calculated by Kaplan-Meier methods. Death certificate-only cases, which amounted to 3.9% of all incidence, were excluded from the calculation. The five-year cumulative survival rate for both sexes was 46% for all cancer children. Among 12 major diagnostic groups, the most favorable survival was seen in retinoblastoma (87.5%), followed by renal tumors, epithelial neoplasms, and gonadal and germ-cell tumors. The outcome was unfavorable in leukemias, sympathetic nervous system tumors, hepatic tumors and malignant bone tumors. Comparing the survival in 1975-1979 with that in 1980-1984, the rate for all childhood cancer rose from 41% to 51%. Improvement in survival was also observed in 4 groups; acute lymphocytic leukemia, acute non-lymphocytic leukemia, non-Hodgkin's lymphoma and osteosarcoma. One attributable factor for the rise of survival was proved to be improvement of medical treatment by Cox's hazard model analysis. Comparison of survival rates in Osaka with those in England and the U.S. revealed that the prognosis for acute lymphocytic leukemia and acute non-lymphocytic leukemia was less favorable in Osaka than in England and the U.S.
Japanese journal of cancer research: Gann 02/1995; 86(1):13-20. DOI:10.1111/j.1349-7006.1995.tb02982.x
[Show abstract][Hide abstract] ABSTRACT: This study addresses the disparity in cancer survival rates among hospitals in Osaka, Japan. Using data from the Osaka Cancer Registry, four-year survival rates for stomach cancer patients (n = 8,845) diagnosed in 1976, 1981 and 1986, and lung cancer (n = 9,795) and breast cancer patients (n = 7,377) diagnosed in 1975-77, 1980-82 and 1985-87 were calculated according to four hospital categories (teaching hospitals, large hospitals: 400 + beds excluding teaching hospitals, medium-size hospitals: 150-399 beds, and small hospitals: 20-149 beds). Cox's proportional hazards model was employed with adjustment for sex, age, clinical stage at diagnosis, and treatment status. Stomach and lung cancer patients treated in large, medium-size and small hospitals showed significantly higher risks of death than those treated in teaching hospitals in 1975-87. Interhospital differences in breast cancer survival appeared to increase in 1975-87, whereas those in stomach and lung cancer survivals decreased during the same period.
Japanese journal of cancer research: Gann 08/1994; 85(7):680-5. DOI:10.1111/j.1349-7006.1994.tb02414.x
[Show abstract][Hide abstract] ABSTRACT: A population-based cancer registration scheme started in three areas in Japan in the 1950s solely for studying cancer incidence in their respective areas. Soon thereafter, several prefectural governments started their own schemes as part of their cancer control programs, effectively expanding the aims of cancer registration: to clarify cancer facts, to elevate the medical care for cancer patients, and to plan and evaluate cancer control programs. The Osaka Cancer Registry (OCR) started in 1962, and has been using epidemiological methods as a tool in constructing its registration scheme, as well as analyzing and utilizing registry data. This report deals with the results obtained in the OCR, classifying these results into four activities of epidemiology. 1. Clarifying cancer facts (descriptive epidemiology): The OCR has been observing incidence, medical care for cancer patients, distribution of cases by clinical stage, and the 5-year relative survival rate, and has estimated the prevalence rate, cured-case rate, and future incidence into the 21st century. Population-based data on histology and multiple cancers collected at the OCR have also contributed to the new approaches in cancer epidemiology. 2. Research on risk factors (analytical epidemiology): The OCR developed a computerized record-linkage system in 1970. This not only made registry work more effective and reliable, but many cohort studies were able to be conducted with relatively little effort and highly reliable results. The cancer case file in the OCR has been linked with the newly prepared data file of the study group, and cancer incidence among the study group has been observed. Finally, cancer risks of possible causal factors in that group have been estimated quantitatively. 3. Evaluation of control programs: Secondary prevention programs (early detection) have been conducted in Japan as major cancer control programs, because effective risk factors were not previously defined. OCR data have been used for estimating sensitivity and specificity of screening tests for various cancers, as well as for evaluating the effect of clinical work on improving survival and on decreasing cancer deaths. 4. Planning future cancer control programs: The OCR has reported on the probable rapid increase of cancer incidence in the 21st century, especially of elderly cancer cases, and cancer cases with poor survival. To control these difficult problems, new cancer programs should be urgently designed and implemented. The authors have recommended that programs be prepared by cancer site, and have already presented a detailed program for lung cancer control.
Nippon Eiseigaku Zasshi (Japanese Journal of Hygiene) 07/1994; 49(2):543-58. DOI:10.1265/jjh.49.543
[Show abstract][Hide abstract] ABSTRACT: Lung cancer incidence figures in Japan were estimated as 30,000 for males and 11,000 for females for 1989 and represented the second and the fifth leading site of cancer, respectively, according to the Research Group for Population-based Cancer Registration in Japan. It is also estimated that lung cancer will steadily increase in the future. In relative frequencies of the major histological types, squamous cell carcinoma showed a decreasing trend, while small as well as large cell carcinomas showed an increasing trend in Osaka. In the distribution of clinical staging, the proportion of localized cases accounted for only 20% of the lung cancers in 1990. Five-year relative survival rates for lung cancer were 11.3% for all patients and 43.0% for localized cases in Osaka in 1984-1986. The rates were reported as 13.5% and 36.6% for total patients and localized cases, respectively, among caucasians from the SEER Program, a NCI project including 10 population-based cancer registries in the US. No noticeable difference was observed between Japan and the US. To control lung cancer in Japan it is considered vitally important and urgent to develop (1) new examination methods for diagnosing lung cancer in the earlier stage, (2) an efficient and effective cessation campaign for cigarettes smoking and (3) non-smoking based education.
Gan to kagaku ryoho. Cancer & chemotherapy 06/1994; 21(6):727-35.
[Show abstract][Hide abstract] ABSTRACT: This study was conducted to examine the incidence rates and cumulative risks of second primary cancers in Osaka and to compare the observed number of second primary cancers with the expected number calculated using cancer incidence rates among Osaka residents. Study subjects were all reported cases aged 0-79 who were first diagnosed as having a first primary cancer between 1966-86. Incidence of second primary cancer among the study subjects was examined through to the end of 1989. The total number of study subjects was 217,307. During the follow-up period (mean duration: 3.7 years), second primary cancers developed in 5,071 patients (2.3%). Incidence of synchronous (interval < 3 months) and metachronous (interval > or = 3 months) second primary cancers increased in the later years. Incidence rates of second primary cancers were significantly associated with gender (male), age and calendar year at diagnosis of the first cancer. Based on the incidence rates, cumulative risk of developing metachronous second primary cancer was calculated. The ten-year cumulative risk was estimated as 10% for those who developed their first cancer during their sixties in 1978-83. The observed number of second primary cancers (including synchronous) was compared with the expected number. The ratios of observed-to-expected numbers were generally lower than 1.0 among those who developed their first cancer in 1966-77, while these ratios were higher than 1.0 among those who developed their first cancer in 1978-86. The ratios were much higher than 1.0 among those who developed their first cancer in their childhood and youth. Patients who had developed cancer of the colon, larynx, lung, bladder, or breast (female) showed significantly higher risk of developing second primary cancer during the period 1-4 years after diagnosis of the first cancer.
Japanese journal of cancer research: Gann 05/1994; 85(4):339-45. DOI:10.1111/j.1349-7006.1994.tb02364.x
[Show abstract][Hide abstract] ABSTRACT: In 1971-1988, 4,021 malignant tumors occurring among children under 15 years of age were registered in the Osaka Cancer Registry, a population-based registry which covers Osaka Prefecture, Japan. These patients were reclassified into 12 diagnostic groups by Birch's scheme using information on clinical diagnosis, histology and primary site. The annual age-standardized incidence rate for childhood cancer per million children was 130.3 for males and 104.9 for females in 1971-88. Comparing the incidence rates for both sexes in 1981-88 with those in 1971-80 in Osaka, we observed a significant decrease of acute non-lymphocytic leukemia (ANLL) and a significant increase of all cancers, acute lymphocytic leukemia, non-Hodgkin lymphoma, sympathetic nervous system tumors, soft-tissue sarcomas, and gonadal and germ-cell tumors. Age-standardized incidence rates in around 1971-80 of the above-mentioned diagnostic groups were compared among 4 population-based registries; Osaka, Miyagi (Japan), SEER (U.S.), and the National Registry of Childhood Tumors (England and Wales). Rates for ANLL and gonadal and germ-cell tumors were higher and those for other diagnostic groups were lower in Osaka, especially for Hodgkin's disease. Thus, in 1980-88 in Osaka, rates for Hodgkin's disease remained low and rates for gonadal and germ-cell tumors increased, though rates for other cancers appeared to resemble the levels in caucasian populations. The incidence of childhood cancer in Japan was estimated according to the diagnostic groups in Birch's scheme.
Japanese journal of cancer research: Gann 03/1994; 85(2):139-46. DOI:10.1111/j.1349-7006.1994.tb02074.x
[Show abstract][Hide abstract] ABSTRACT: The present study was an investigation of variations in cancer survival rates among hospitals in Japan, focusing in particular on the number of hospital beds as an institutional characteristic. Using data from 11 population-based cancer registries, the three-year survival rates for stomach cancer (n 1665), colorectal cancer (n 1090) and lung cancer (n 895) patients diagnosed in 1985 were calculated according to three different hospital categories (100-299, 300-499, 500+ beds). Cox's proportional hazards model was conducted, with adjustments for sex, age, clinical stage at diagnosis and treatment status, excluding patients who had been detected by screening (asymptomatic cases). The stomach and lung cancer patients treated in small hospitals (100-299 beds) were at a significantly higher risk of death than those treated in large hospitals (500+ beds) (hazard ratio (HR) = 1.36, 95% confidence interval (CI) = 1.11-1.65; HR = 1.41, 95% CI = 1.13-1.77, respectively). Similar findings were observed among colorectal cancer patients although they were not statistically significant. The findings can provide some information useful for the development of future public health policies aimed at controlling cancer mortality rates in our country.
Japanese Journal of Clinical Oncology 07/1993; 23(3):191-8. · 1.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Recent improvements in cancer medical care in Osaka have resulted in the elevation of survival rates of cancer patients, except for the so-called "refractory" cancers. Five-year relative survival rates for reported patients diagnosed in 1981-1983 were higher than 60% for cancers of the breast, uterus and bladder, and around 40% for rectum, colon and stomach cancers. However, cancers of the liver, gallbladder, pancreas, and lung continued to show very low survival rates of less than 10%. In higher age-groups, advanced cases occupied a larger proportion while cases which received curative resection occupied a smaller proportion. Reflecting this, survival rates were lower in age-groups higher than 75, and the reduction of age-differences between younger and older groups was not observed during the decade. Cancer incidence for all sites in Japan was estimated by the Research Group for Population-based Cancer Registries to be 320,000 in 1985. The stomach, colorectal, lung, liver, and breast were the five leading cancer sites. According to the authors' studies, cancer incidence is projected to be 740,000 in Japan in 2015, of which 40% would be patients of "refractory" cancers and 62% would be aged patients in their upper than 70, though these were 19% and 32% in 1985. In order to combat this difficult situation in the near future, the following activities are urgently required: (1) Promotion of primary preventive measures for incurable cancers. (2) Development of specific therapy programs taking into account of QOL for aged patients as well as advanced patients. (3) Promotion of secondary preventive measures for aged people as well as younger people.
Gan to kagaku ryoho. Cancer & chemotherapy 08/1992; 19(7):933-40.
[Show abstract][Hide abstract] ABSTRACT: The risk of developing a second primary cancer following laryngeal cancer was estimated by following-up 472 male laryngeal cancer patients for an average of 8.6 years by means of record linkage to the Osaka Cancer Registry. Of these patients, 115 developed a second cancer other than laryngeal cancer, whereas the expected number derived from the incidence rates among Osaka residents was 51.4 (relative risk (RR) = 2.2, 95% confidence interval = 1.85-2.69). Cumulative risk of developing a second primary cancer was estimated to be 31.1% at 15 years after laryngeal cancer. By site, the risks were significantly increased for tobacco-related cancers, RR = 24.5, 6.1 and 2.3 for cancers of the oral cavity & pharynx, esophagus and lung, respectively. Also, the risks were higher among heavy smokers for cancer of the oral cavity & pharynx and esophagus than among light smokers. No adverse effects of radiotherapy for laryngeal cancer on the development of thyroid cancer, lymphoma and leukemia were observed. The present study suggests the necessity of following-up laryngeal cancer patients over a long period in order to enable the early detection of tobacco-related cancer.
Japanese journal of cancer research: Gann 04/1992; 83(4):334-9.
[Show abstract][Hide abstract] ABSTRACT: The risk of developing a second primary cancer following laryngeal cancer was estimated by following-up 472 male laryngeal cancer patients for an average of 8.6 years by means of record linkage to the Osaka Cancer Registry. Of these patients, 115 developed a second cancer other than laryngeal cancer, whereas the expected number derived from the incidence rates among Osaka residents was 51.4 (relative risk (RR) = 2.2, 95% confidence interval = 1.85 2.69). Cumulative risk of developing a second primary cancer was estimated to be 31.1% at 15 years after laryngeal cancer. By site, the risks were significantly increased for tobacco-related cancers, RR = 24.5, 6.1 and 2.3 for cancers of the oral cavity & pharynx, esophagus and lung, respectively. Also, the risks were higher among heavy smokers for cancer of the oral cavity & pharynx and esophagus than among light smokers. No adverse effects of radiotherapy for laryngeal cancer on the development of thyroid cancer, lymphoma and leukemia were observed. The present study suggests the necessity of following-up laryngeal cancer patients over a long period in order to enable the early detection of tobacco-related cancer.
[Show abstract][Hide abstract] ABSTRACT: The frequencies of second primary cancers following colon and rectal cancers were estimated using the Osaka Cancer Registry's population-based data for Osaka, Japan. A series of 7,312 colon and 6,923 rectal cancer cases newly diagnosed in the period of 1966-1986 were followed up until the end of 1986. The average follow-up period was 3.6 years for colon cancer and 3.7 years for rectal cancer. Significantly elevated risks of second primary cancers following colon cancer were observed for cancers of the rectum (O/E = 2.0; 95% confidence interval (CI) = 1.1-3.4 among males, O/E = 4.3; 95% CI = 2.4-7.2 among females), corpus uteri (O/E = 8.2; 95% CI = 3.3-16.9), ovary (O/E = 4.3; 95% CI = 1.0-5.0), and female thyroid gland (O/E = 4.7; 95% CI = 1.7-8.8). These findings were more notable among right-sided colon cancer patients than left-sided colon cancer patients. The elevated risks of second primary cancers were particularly evident among patients younger than 50 years of age at the time of diagnosis of the initial cancer (colon cancer: O/E = 3.1 among males, 3.4 among females, rectal cancer: O/E = 1.7 among males, 1.3 among females). These findings suggest that younger colorectal cancer patients should undergo more careful checkups throughout their lives.
Japanese journal of cancer research: Gann 01/1992; 82(12):1356-65. DOI:10.1111/j.1349-7006.1991.tb01806.x
[Show abstract][Hide abstract] ABSTRACT: The risk of developing a second primary cancer following stomach cancer was estimated from data accumulated in the Osaka Cancer Registry. Of the 38,777 male patients and 22,391 female patients newly diagnosed in the period 1966-1986 who were followed up until the end of 1986, 778 and 267 developed a second cancer other than stomach cancer, respectively, whereas the expected numbers had been 928.8 (RR = 0.84, 95% CI = 0.78-0.90) and 297.7 (RR = 0.90, 95% CI = 0.79-1.01). The risks were higher among younger patients (aged 30-54 at the diagnosis of stomach cancer) than among older patients (aged 55-69 at the diagnosis of stomach cancer). Significantly elevated risks were observed for cancers of the oral cavity & pharynx (RR = 1.56), colon (RR = 1.61) and rectum (RR = 1.56) for males, and oral cavity & pharynx (RR = 2.59) for females as second cancers. Results were substantially similar among the localized stomach cancer patients. Among younger male patients with gastrectomy, the risk of developing pancreatic cancer was elevated 10 or more years after stomach cancer diagnosis. The present study suggests the necessity of following up stomach cancer patients in order to enable the early diagnosis of digestive tract cancer.
Japanese journal of cancer research: Gann 07/1991; 82(7):762-70. DOI:10.1111/j.1349-7006.1991.tb02700.x
[Show abstract][Hide abstract] ABSTRACT: A retrospective cohort study was carried out on asbestos workers who had received health examinations in 1972 to 1974 conducted by the Osaka Health Center. The subjects, total of 789 (329 males, 460 females) were followed-up for 10 years (Jan. 1, 1975-Dec. 31, 1984). There were sixty-one deaths in the cohort--4 tuberculosis, 12 malignant neoplasms (4 stomach cancers, 8 respiratory cancers including one case of pleural mesothelioma), 18 circulatory diseases, 24 respiratory diseases, and 3 other causes of death. Standardized mortality ratio (SMR) was calculated age and sex-specific death rates for the general population in Osaka between 1975-79 and 1980-84. SMR for all causes of death, stomach cancer, respiratory cancer, circulatory diseases, and respiratory diseases were 1.15, 3.29, 0.75, 3.88, 0.93 and 8.63 respectively. Respiratory cancer and respiratory diseases showed statistically significant (p less than 0.01) excess death with a mean death age of 59 and 56 years old respectively.
[Nippon kōshū eisei zasshi] Japanese journal of public health 05/1991; 38(4):267-71.