[Show abstract][Hide abstract] ABSTRACT: Accurate cancer incidence data are needed to plan, monitor and evaluate national cancer control programs. In Japan, however, such information is not available owing to incomplete cancer registries. In order to attain incidence estimation adjusted to account for this incomplete information, we have developed a new method.
We developed a nonlinear regression model between observed incidence/mortality ratios and proportions of death certificate notification to observed incidence in various cancer registries. This model enables us to obtain the 'true incidence/mortality ratio', which, in the regression curve, is at zero point for the proportion of death certificate notifications. This is an ideal registration state without any missing cases. By multiplying it by the number of cancer mortalities from the National Vital Statistics, corrected cancer incidence can be estimated.
Applying this method for the estimation of the Japanese cancer incidence in 1997, we obtained the 'true incidence/mortality ratios' of 2.074 for men and 2.587 for women. Cancer incidences in Japan for 1997 were thus estimated to be 346,000 for men and 280,000 for women.
A new method is proposed to estimate the national cancer incidence after adjusting for completeness of cancer registries. This method enables us to more accurately estimate the cancer incidence in a country where several cancer registries exist with various degrees of completeness of registration.
Japanese Journal of Clinical Oncology 03/2007; 37(2):150-5. · 1.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The present study aimed to elucidate the changing patterns of smoking among successive birth cohorts in Japan.
Birth-cohort-specific smoking prevalence was estimated for birth cohorts born from 1900 to 1952, using data pooled from four prospective studies (242,330 men and 274,075 women), and for birth cohorts born from 1925 to 1977, using National Nutrition Survey data.
For men, two peaks were observed in smoking prevalence, in the 1925 and late-1950s birth cohorts, while a trough was observed for the 1938 birth cohort. For women, ever smoking prevalence was lowest among the 1930s birth cohorts. After the female 1940s birth cohorts, no peak was observed until the end of our observations, the 1970s birth cohorts. Although Japanese women have historically tended to start smoking at later ages, recently, smoking habits have widely expanded among females in young birth cohorts.
Smoking trends in Japanese men and women vary by birth cohorts. Smoking cessation should continue to be strongly promoted among men, although the younger generation has widely adopted a nonsmoking lifestyle. For women, efforts for preventing the onset of smoking, while necessary among the younger generation, should even be enhanced among middle-aged women.
Preventive Medicine 03/2006; 42(2):120-7. · 3.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Trends in lung cancer mortality among young adults, which are important for projecting future trends, have not been explored previously in Japan.
Using data from the National Vital Statistics between 1958 and 2003, we compiled lung cancer mortality by sex and 5-year birth cohort among young adults aged 20-49.
Mortality among those aged 20-29 has consistently decreased regardless of sex. There were birth cohort effects in mortality from lung cancer, although these were less evident among women than among men. Both men and women born in the 1930s had lower mortality rates, while those born after 1940 had higher lung cancer mortality rates. Mortality rates appear to be declining for male birth cohorts born after 1950 and female birth cohorts after 1960, although these trends may not be stable due to the small number of deaths in these cohorts.
Lung cancer mortality trends appear to be decreasing among young adults. This might be associated with the lower mortality of birth cohorts after 1950 for men and the 1960s birth cohorts for women. Careful monitoring is needed to confirm continuation of these declining trends.
Japanese Journal of Clinical Oncology 05/2005; 35(4):177-80. · 1.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Genetic polymorphisms have proposed a new insight in smoking behavior. Genes in serotonin system are one of the candidates because of serotonin's role in mood regulation. A polymorphism C218A in intron 7 of the tryptophan hydroxylase (TPH) gene has been hypothesized in relation to smoking predisposition.
We examined the association on two Japanese populations: one was from the first-visit outpatients of Aichi Cancer Center Hospital during 3-month period between April and June, 2001 (N=591), and the second was from the examinees who attended a health checkup program supported by the Nagoya municipal government in 2000 (N=446). Written documents on informed consent were obtained and lifestyle questionnaires were recorded. TPH C218A genotypes were determined by the polymerase chain reaction with confronting two-pair primers (PCR-CTPP) method.
The frequencies of the C- and A-allele were 52% and 48%, respectively, which was in Hardy-Weinberg equilibrium. As for current smoking status, no associations were statistically observed. It was, however, indicated that smokers with A/A genotype started smoking earlier in their life. Among male health examinees, mean ages at starting smoking were 18.7 (A/A), 19.9 (C/A), and 22.4 years (C/C), (P<0.01). Also, on the Aichi Cancer Center Hospital subjects aged 60 and older, mean ages were 19.0 (A/A), 20.2 (C/A), and 20.3 years (C/C) for males and 22.3 (A/A), 31.0 (C/A), and 33.0 years (C/C) for females (P<0.05).
The present study demonstrated that the TPH C218A polymorphism in intron 7 had no association with current smoking status in Japanese population. The hypothesis of early smoking initiation of A/A genotype was partially in agreement.
Journal of Epidemiology 05/2004; 14(3):94-9. · 2.11 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: According to the National Vital Statistics data, age-standardized mortality rates (ASRs) of lung cancer have shown slightly declining trends in Japan for both men and women. In order to evaluate whether this tendency will continue, a Bayesian age-period-cohort (APC) model was applied using the National Vital Statistics data from 1952 to 2001. In the projection, a Gaussian autoregressive prior model was applied to smooth age, period, and cohort effects from its 2 immediate predecessors by extrapolation. Posterior distributions from which we drew inferences on mortality rates were derived from 15,000 iterations using 5000 burn-in iterations. We defined the median of the iterated values as the overall summary mortality rate of the iterated results. Our results suggest that the number of deaths due to lung cancer will double for men and women during the next 3 decades due to the aging of the baby-boomer generation (individuals who were born between 1947 and 1951). Currently declining trends in some age groups will reverse and start to increase again in the next decades. However, for recent birth cohorts, the results of the projection varied according to whether the data set included early age group mortality or not. Lung cancer mortality in the future depends on the risk factors engaged in by today's young people, especially smoking. Strong promotion of anti-smoking measures and careful surveillance for lung cancer are needed.
Cancer Science 11/2003; 94(10):919-23. · 3.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Cerebrovascular disease was a leading cause of death from 1955 to 1980 in Japan. The mortality rate from this disease has decreased sharply in recent decades. This downward trend seems to correspond to the dietary habits of Japanese. Data from a large prospective cohort study were analyzed to examine the association between dietary habits and cerebrovascular disease mortality in Japan. The subjects for this analysis were 223,170 men and women aged 40 to 69 at baseline in December 1965. There were 6,168 deaths in men and 4,862 deaths in women due to cerebrovascular disease (ICD7: 330-334) during the follow-up period from January 1966 to December 1981. Rate ratio (RR) and 95% confidence interval (95% CI) adjusted for sex, attained age, follow-up period, prefecture, cigarette smoking, alcohol drinking and occupation was used for comparison. In this study, the risk of mortality from cerebrovascular disease was inversely associated with dairy milk, meat and fish consumption. Therefore the joint effect of dairy milk, meat and fish (DMF) as animal fat and protein was of interest. In the binary analysis, DMF (D, M, F) means the combination of dairy milk (1-3 times/week or more), meat (1-3 times/week or more) and fish (4 times/week or more). Thus DMF (d, m, f) was the reference group having dairy milk (less than 1 time/week), meat (less than 1 time/week) and fish (less than 4 times/week). For the disease, the RR of DMF (D, M, F) was 0.68 with 95% CI of 0.63 to 0.74, relative to the reference group. Furthermore the joint effect of DMF was more strongly associated with cerebral haemorrhage (ICD7: 331, DMF (D, M, F); RR: 0.63, 95% CI: 0.55-0.70) than with cerebral embolism and thrombosis (ICD7: 332, DMF (D, M, F); RR: 0.79, 95% CI: 0.70-0.89). These findings suggest that the increasing intake of animal fat and/or protein may have played a key role in reducing cerebrovascular disease in Japan.
Journal of Epidemiology 09/1999; 9(4):268-74. · 2.11 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To clarify mortality risks of oesophageal cancer associated with hot tea, alcohol, tobacco and diet, further analyses on the data from a large prospective cohort study in Japan were conducted. The subjects for analysis were 220,272 men and women aged 40 to 69 at the baseline of 1965. There were 440 oesophageal cancer deaths during the period from January 1966 to December 1981. Person-years at risk were 3,065,182 in total. Rate ratio and 95% confidence interval adjusted for attained age, prefecture, occupation and sex were (RR (95% CI)): 1.6 (1.2-2.0) for hot tea (drinking green tea at high temperatures) in comparison with not-hot tea (drinking green tea at moderate temperatures); 2.4 (1.8-3.1) for daily (4 times/week or more) alcohol drinking in comparison with non-drinking; and 2.3 (1.7-3.1) for heavy smoking (15 cigarettes/day or more) in comparison with non-smoking. Dose-response relationships were found in alcohol drinking and smoking among men and women (p for trend; p < 0.001). The rate ratios were not significantly associated with the dietary factors except for green-yellow vegetables (1-3 times/month or less in comparison with daily; RR = 2.0, 95% CI: 1.2-3.1), where a no dose-response trend was observed (p = 0.45). In comparison based on the binary variables, the RR for the subjects with daily alcohol drinking and current smoking was 3.9 with 95% CI of 2.7 to 5.4, relative to those exposed to neither habit. The joint effect of alcohol drinking (A) and smoking (S) was more than additive (A*S > A + S: 3.9 > 1 + (1.0-1) + (1.6-1)). Further sub-analysis showed that the RR for the subjects with daily alcohol drinking, current smoking and hot tea was 5.7 with 95% CI of 3.7 to 8.9, when the reference was the subjects with not-daily alcohol drinking, non-smoking and not-hot tea. Similar results were obtained from further adjustment of green-yellow vegetables. It is concluded that mortality risks of oesophageal cancer in the present cohort were substantially associated with thermal effect of hot tea, alcohol drinking, smoking and lower consumption of green-yellow vegetables. This finding suggests that life-style modification for smoking and dietary habits is essential to reduce the risks of oesophageal cancer in Japan.
Journal of Epidemiology 11/1998; 8(4):235-43. · 2.11 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report here a historical cohort study on cancer mortality among Minamata disease (MD) patients (n = 1,351) in Kagoshima and Kumamoto Prefectures of Japan. Taking into account their living area, sex, age and fish eating habits, the residents (n = 5,667; 40 years of age or over at 1966) living in coastal areas of Kagoshima, who consumed fish daily, were selected as a reference group from the six-prefecture cohort study conducted by Hirayama et al. The observation periods of the MD patients and of the reference group were from 1973 to 1984 and from 1970 to 1981, respectively. Survival analysis using the Poisson regression model was applied for comparison of mortality between the MD patients and the reference group. No excess of relative risk (RR) adjusted for attained age, sex and follow-up period was observed for mortality from all causes, all cancers, and non-cancers combined. Analysis of site-specific cancers showed a statistically significant decrease in mortality from stomach cancer among MD patients (RR, 0.49; 95% confidence interval, 0.26-0.94). In addition, a statistically significant eight-fold excess risk, based on 5 observed deaths, was noted for mortality from leukemia (RR, 8.35; 95 % confidence interval 1.61-43.3). It is, however, unlikely for these observed risks to be derived from methylmercury exposure only. Further studies are needed to understand the mechanisms involved in the observed risks among MD patients.
Journal of Epidemiology 10/1996; 6(3):134-8. · 2.11 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A computerized simulation model developed to evaluate the potential impact of primary and secondary prevention is discussed from methodologic perspectives. In the simulation model, named CANSAVE (Cancer Strategy Analysis and Validation of Effect), the natural history of cancer was modeled as a Markovian stochastic process from cancer-free state to death. The lung cancer death rate among Japanese males was projected for 50 years to the year 2041. The simulation showed that the age-adjusted death rate would increase and reach a peak of 166 per 100,000 in 1989 and then decrease to 148 in 2003. It then shows a tendency to increase again, up to 255 in 2028. This change may be attributed to a lower smoking initiation rate among those born in the 1930s. Promotion of mass screening programs exhibits a more prompt effect than antismoking efforts, but the reduction in annual deaths is expected to be only 11%, even if a 100% participation is realized by the year 2000. The reduction in smoking initiation rate, on the other hand, begins to show a visible effect very slowly. It was predicted that a 1% annual reduction in smoking initiation rate would result in a 20% decrease in the number of deaths in 2041. The smoking cessation program is in the middle with regard to promptness. The predicted reductions in lung cancer deaths in 2041 were 13, 47, and 66%, respectively, when the annual smoking cessation rate was increased from 0.46% (present status) to 1, 3, and 5%. The combined application of all three preventive measures seems essential to realize the most effective reduction in lung cancer deaths.
[Show abstract][Hide abstract] ABSTRACT: The lung cancer death rate among Japanese males was projected for 50 years to the year 2041 by a computerized simulation model. Long-term effects of anti-smoking measures and mass screening on lung cancer deaths were also evaluated. The simulation showed that the age-adjusted lung cancer death rate would increase and reach a peak of 166 per 100,000 in 1989 and then decrease to 148 per 100,000 in 2003. It then shows an increasing tendency again, up to 255 per 100,000 in 2028. The smoking initiation rates estimated from the observed lung cancer death rates showed that the changes in death rates may be attributed to a lower smoking initiation rate among those born in the 1930's. Promotion of mass screening programs is effective more quickly than anti-smoking measures but the reduction in annual cancer deaths is expected to be only 11%, even if 100% participation is achieved by the year 2000. A reduction in smoking initiation rate, on the other hand, affects lung cancer deaths very slowly. It was predicted that a 1% annual reduction in smoking initiation rate would result in a 20% decrease in the number of lung cancer deaths in 2041. A smoking cessation program is intermediate with regard to promptness. The predicted reductions in lung cancer deaths in 2041 were 13%, 47%, and 66%, respectively, when the annual smoking cessation rate was increased from 0.46% (present status) to 1%, 3%, and 5%. In conclusion, the combined application of all three preventive measures seems essential to realize the most effective reduction in lung cancer deaths.
Japanese journal of cancer research: Gann 04/1992; 83(3):251-7.
[Show abstract][Hide abstract] ABSTRACT: A computerized simulation model was developed to evaluate the potential impact of primary and secondary prevention on lung cancer mortality in Japan. The natural history of lung cancer was modeled as a Markovian stochastic process from cancer-free to preclinical, clinical, and finally to terminal states. The increase in mortality rate of lung cancer among males aged 75 to 79 years has been the major force of increase in the total number of lung cancer deaths in Japan. The simulation showed that this tendency would continue until the late 1990s, presumably due to the increase in the proportion of ever-smokers in that cohort, who started smoking at an earlier age than did prior generations. It was shown that the number of lung cancer deaths can be reduced either by smoking cessation or screening programs, and that the reduction is proportional to the increase in the annual smoking-cessation rate and to the annual increment in the screening rate. However, only two to three percent reduction of lung cancer deaths in the year 2001 can be expected when the annual smoking-cessation rate is raised from the current value of 0.46 percent to five percent during the period from 1991 to 2000 or when the screening rate is increased by three percent annually for the same period.
Cancer Causes and Control 06/1991; 2(3):147-55. · 3.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In an analysis of a follow-up study of a fixed population of 73,330 atomic bomb survivors in Hiroshima and Nagasaki, the slope of an estimated dose response between ionizing radiation and leukemia mortality was found to be steeper (P less than 0.002), by a factor of 2.4, among those who reported epilation within 60 days of the bombings, compared to those who did not experience this sign of acute radiation exposure. The strength of this empirical finding as evidence of biological association in individual radiosensitivity for these two end points is studied here. The major factor complicating the interpretation of this finding as evidence of such an association is the degree of imprecision of the radiation dosimetry system used in assignment of radiation doses to the A-bomb survivors. Using models recently suggested for dealing with dosimetry errors in epidemiological analysis of the A-bomb survivor data, the sensitivity of the apparent association between leukemia mortality and severe epilation to the assumed level of dosimetry error is investigated.
Radiation Research 03/1991; 125(2):206-13. · 2.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We estimated the effective duration of cigarette smoking using the data of lung cancer mortality among male smokers of a large-scale cohort study in Japan and evaluated its role in the lung cancer risk difference between male smokers of the Japanese cohort and the British physicians' cohort. By selecting male cohort members who answered that they had started smoking at ages 18-22 (average = 20.3), the subjects of our analysis, which numbered 49,013, were made relatively homogeneous in terms of age at which smoking was started. Assuming lung cancer mortality to be proportional to the 4.5th power of the effective duration of cigarette smoking, i.e., (age-theta)4.5, as was proposed on the basis of the British cohort study by Doll and Peto, the parameter theta was estimated to be 29.4 for male smokers aged 40-64 in 1966; therefore, the estimated duration of cigarette smoking was, on average, 9.1 years (95% confidence interval = 5.8-11.6) shorter than that calculated from the reported age at which smoking was started. Our findings suggested that the low lung cancer mortality relative to daily cigarette consumption in Japan resulted from the shorter duration of cigarette smoking in the Japanese cohort, possibly due to the severe shortage of cigarettes during and shortly after World War II. Once the effective duration of cigarette smoking was adjusted, lung cancer mortality in the range of 5-34 cigarettes per day was fairly comparable to that observed among the cohort of male British physicians.
Japanese journal of cancer research: Gann 01/1990; 80(12):1165-70.