Urban-rural variation in cancer incidence in Denmark 1943-1987

Urban and rural cancer incidence in Denmark in 1943-1987 was analysed. A consistent urban excess was found for all sites combined for individuals of each sex, irrespective of age at diagnosis. The capital:rural incidence ratio was 1.42 for men and 1.25 for women, and these ratios were not affected to any great extent using another definition of urban areas. Urban:rural ratios were highest for cancers of the respiratory, urinary and upper digestive tracts. The differences cannot be explained by tobacco and alcohol consumption alone. Other risk factors linked to urbanisation may contribute importantly to the "urban factor", and analytical studies of data at an individual level are required to establish their relative importance. Our findings contradict the generally accepted view that there is no urban-rural difference in cancer incidence in the relatively small, homogeneous population of Denmark.     

The geographic variation in stroke incidence in two areas of the southeastern stroke belt: the Anderson and Pee Dee Stroke Study

BACKGROUND and PURPOSE: South Carolina and the southeastern United States have maintained the highest stroke mortality in the country. The Anderson and Pee Dee Stroke Study is an assessment of cerebrovascular disease incidence in 2 geographically defined communities in the stroke belt. METHODS: Strokes were identified in the Anderson and Pee Dee areas of South Carolina. All hospitalized and out-of-hospital deaths occurring during 1990 among the residents of these 2 areas were included. Strokes were classified by an independent panel of neurologists using a standard protocol that included specific criteria for stroke and subtypes. RESULTS: The overall age-adjusted stroke incidence rates (per 100 000 population) were significantly higher in the Pee Dee population (293.1) compared with Anderson (211.2). The geographic differences were more dramatic in the younger age groups of 35 to 64 years. Likewise, incidence rates for blacks were nearly twice the rates for whites. The rates in the Pee Dee were higher than the rates from other studies in the United States and other parts of the world. Although the stroke subtypes did not vary between the 2 regions, race-sex differences were identified. CONCLUSIONS: High stroke incidence and disease rates persist for all 4 race-sex groups in the Southeast and reflect similar risks as mortality rates. However, geographic variability in stroke rates suggests that the pattern of disease in the region is not so much a "belt" of increased stroke in contiguous areas but rather more a "necklace" of different levels of risk. These results should be useful in the identification of factors associated with this geographic enigma.     

Circadian variation in incidence of cardioembolism

Cardioembolism is most likely to occur after waking in the morning. The identification of periods of high risk for cardioembolism may have important therapeutic implications, such as matching drug effects with vulnerability.     

Low prevalence of human papillomavirus in a geographic region with a high incidence of head and neck cancer

BACKGROUND: The main purpose of this study was to determine the prevalence of human papillomavirus (HPV) infection in patients with head and neck carcinomas from Brazil. MATERIALS AND METHODS: Forty-five patients with head and neck squamous cell carcinoma were included in the study, from 1995 to 1996. Forty-two were male and 3 female, with age ranging from 32 to 82 years (median 61). Five patients (11%) did not have previous history of use of tobacco and 38 (90.5%) were heavy smokers. Tumor sites were pyriform sinus, 10; tongue, 11 (oral, 6; base, 5); larynx, 7; floor of mouth, 3; tonsil, 6; retromolar area, 3; inferior gingiva 2; buccal mucosa, 2; and maxillary sinus in 1 patient. Twenty-five were stage IV, 17 stage III, and 3 stage II. RESULTS: The presence of HPV DNA was detected in 5 of 45 patients (11%), all of them with HPV 16. Two patients had HPV DNA in normal mucosa and tumor tissue, 1 patient had HPV DNA only in the normal mucosa and tumor tissue, 1 patient had HPV DNA only in the normal mucosa, and 2 patients were positive for HPV DNA in tumor tissue. Four patients were male and 1 was female; 2 patients were nonsmokers. Three patients had tonsil carcinoma, 1 patient had a tongue carcinoma, and 1 patient had a pyriform sinus cancer. CONCLUSIONS: The role of chemical carcinogens seems to be more important in the genesis of head and neck cancer than is HPV infection. The presence of HPV DNA in 5 of 45 patients stimulates further investigation to determine the role of HPV as a risk factor for head and neck carcinoma.     

Lung cancer among steelworkers in Ontario

A population-based case-control study was carried out to follow up observations of increased lung cancer risk in the steel pouring areas of two Ontario steel mills. Study subjects were all men, aged 45-75 years, who died of lung cancer in the cities of Hamilton or Sault Ste-Marie, Ontario from 1979-1988. Nine hundred sixty-seven lung cancer victims were matched with 2,827 control subjects who died of other causes. Work histories were provided by the employers of steelworkers. In comparison with other residents of their cities, the relative risk of death from lung cancer was 0.85 (95% confidence interval [CI]: 0.58-1.23) for steelworkers in Sault-Ste Marie and was 1.10 (95% CI: 0.89-1.37) for steelworkers in Hamilton. In internal comparisons within the steel companies, increased lung cancer risk was observed among foundry, coke oven, and pouring pit workers. Retrospective hygiene assessment suggested that the increased risk of lung cancer among steel pourers might be related to the use of tar-based mold coating agents or to exposure to mineral fibers.     

Seasonal variation in the incidence of Hodgkin's disease

Earlier literature suggested there may be a seasonal rhythm of onset of Hodgkin's disease. This issue has been re-examined using population-based prospectively-collected data with high ascertainment levels. The Data Collection Study (DCS) of the Leukaemia Research Fund (LRF) Centre for Clinical Epidemiology (University of Leeds) generated the information used, which was based on a population of 13.5 million--about one quarter of England and Wales--over 10 years. The RYE histopathological classification was employed. The findings show that in patients with nodular sclerosing histopathology there was a highly significant circannual rhythm with a low amplitude (extent of seasonal variation) and a peak in March. A significant, but different, rhythm with a high amplitude and a peak in August was found in lymphocyte predominant Hodgkin's disease. However, this finding is less certain, due to smaller numbers and a lower significance level. The main conclusion is that there is a highly significant seasonality in nodular sclerosing Hodgkin's disease. The findings provide further evidence that nodular sclerosing and lymphocyte predominant may be two different diseases. The differing seasonality rhythms may provide aetiological clues.     

Cranial allometry and geographic variation in slow lorises (Nycticebus)

A series of 20 craniodental measurements was obtained for two sister taxa: Nycticebus coucang (common slow loris) and N. pygmaeus (pygmy slow loris). Multivariate analysis of variance was performed with adult data to describe patterns of subspecific and specific variation in this genus. The geometric mean of adult cranial dimensions was compared to field data on latitudinal coordinates for available specimens to investigate if size variation in Nycticebus is clinal in nature. Ontogenetic series for larger-bodied N. coucang and smaller-bodied N. pygmaeus were compared to test the hypothesis that species and subspecific variation in skull form results from the differential extension of common patterns of relative growth. A MANOVA provides independent support of Groves's [pp. 44-53 in Proceedings of the Third International Congress on Primatology, Vol. 1 (Basel: S. Karger), in 1971)] classification of Nycticebus into two species, with four subspecies in the common slow loris and one form of the pygmy slow loris. Within N. coucang, cranial proportions for all four subspecies are ontogenetically scaled, and size differentiation is mainly clinal (Bergmann's Rule). N. c. bengalensis represents the most northerly disposed and the largest form. N. c. javanicus represents the next-largest form and is located in a southerly direction the next-farthest away from the equator. N. c. coucang and N. c. menagensis are both equatorial; however, the latter subspecies is the smallest. A genetic basis for some of the taxonomic variation between N. c. coucang and N. c. menagensis is supported by such nonclinal variation in body size. Variation in the presence/absence of I2 is not size-related but rather tracks geographic proximity and isolating factors which predate the most recent inundation of the Sunda Shelf. Although they inhabit a nonequatorial environment, pygmy slow lorises are the smallest of all Nycticebus. As N. pygmaeus is sympatric with N. c. bengalensis, the largest slow loris, it appears that the evolution of its smaller body size represents a case of character displacement. Unlike N. coucang, skull size becomes significantly smaller in more northern N. pygmaeus. This may also reflect character displacement between sympatric sister taxa underlain by a cline-dependent ecological factor which is marked in more northerly latitudes. On the other hand, the negative correlation between body size and latitude in N. pygmaeus could be due to the influence of nonprimate fauna, such as predators, which themselves evince a similar clinal pattern. Analyses of relative growth indicate that skull proportions in the two species of Nycticebus are ontogenetically scaled in two-thirds of the cases. All but one of the seven comparisons (interorbital breadth) which do not indicate ontogenetic scaling represent part of the masticatory complex. This likely reflects a reorganization of N. pygmaeus maxillomandibular proportions linked to smaller size and changes in diet.     

Age-specific variation in aneuploidy incidence among biochemical screening programs

A human cytomegalovirus mutant that was isolated for resistance (10-fold) to the antisense oligonucleotide fomivirsen (ISIS 2922) exhibited cross-resistance to a modified derivative of fomivirsen with an identical base sequence but little or no resistance to an oligonucleotide with an unrelated sequence. No changes in the mutant's DNA corresponding to the fomivirsen target sequence were found.     

Trends in cancer incidence in Connecticut

SOHO (Small Office/Home Office) has recently become popular, as it makes working at home possible. Computers or Local Area Networks(LAN) connected to the office network from home are necessary for the implementation of this concept. Kyushu University has begun a service connecting home computers to the campus LAN for researchers, staff and students of the Faculty of Medicine. We have two different telephone connection methods. One connects the campus LAN and the home computer LAN using routers through the Integrated Services Digital Network (ISDN). The other connects computers at home to the workstation in the university, using modems and the PPP (Point to Point Protocol) through a public telephone analog line. This paper outlines our university SOHO connection system and discusses the merits and demerits of using telephone line connections.     

Rhegmatogenous retinal detachments. Seasonal variation and incidence

Seasonal variations in the relative incidence of rhegmatogenous retinal detachment were reported as a trend in several studies on the database of relatively limited cohort sizes. PATIENTS AND METHODS: An analysis on this topic was performed with a long-term database. A total of 3073 files of patients with rhegmatogenous retinal detachment, covering 11 years of observation, were reviewed for this study. Patients with signs of long-standing detachment or other predisposing diseases were excluded, so that a basic study population of 2314 patients remained for the analysis. RESULTS: The averaged seasonal incidence of rhegmatogenous detachments revealed a significant (P < 0.005) mid-summer peak (n in July = 228) and a winter trough (mean of December-January = 161; difference = 36%). Phase and curve fitting of the seasonal variations in the number of retina detachment cases was similar to the seasonal variation of the astronomic duration of the day (P < 0.001). The relation was closer compared to the average duration of light exposure per day calculated from behavioural data and the astronomic length of light phase (P < 0.0002). CONCLUSION: This long-time study revealed a close correlation of the relative seasonal incidence of retinal detachment and the seasonal variation of light hours per day. So far, this observations cannot be explained pathogenetically. Two basic hypotheses ought to be investigated further: (1) The influence of light on the generation of toxic oxygen radicals and the subsequent destruction of the vitreous and (2) possible light-induced changes in vitreoretinal adhesion.     

Observed cancer incidence in southwest korea

A review of the 9997 cancers recorded in the Presbyterian Medical Center Cancer Registry at this teaching hospital in Southwest Korea during the 15-year period from 1963--1977 forms the basis for this study. Gastric cancer was the leading malignant neoplasm in males, comprising 40.5%. Among women, cancer of the uterine cervix (27%) was slightly more common than gastric cancer (25.5%). All cancers with the exception of that arising in the uterine cervix were more common in rural than in urban population groups. The 15-year period was divided into three-year segments to detect any change in observed incidence during this period of rapid economic growth. No definite trends could be observed except a mild decrease in the incidence of female gastric cancer.     

The future of psychiatric hospitals in Ontario

The purpose of this paper is to review past and present roles and to speculate on the future of the Ontario provincial psychiatric hospitals (PPHs). Currently, and for the very immediate future only, there are 10 PPHs that are owned and operated by the Ministry of Health of Ontario, each serving a specified population ranging from 250,000 to over 3,000,000. In addition to clinical expertise, provincial psychiatric hospitals contribute greatly to teaching and research. Ontario's mental health reform movement has called for a shift of resources to the community and a downsizing of PPHs by 2003. In response to fiscal pressures, in 1996 provincial legislation was passed to establish the Health Services Restructuring Commission (HSRC) as a stand-alone corporation with powers to restructure and reengineer health services in Ontario. The HSRC has to date recommended the closure of 4 PPHs by 1999 and the integration of theses services into other medical facilities. While a rebalancing of the mental health system does need to take place, the fiscally driven haste to close hospitals has created a crisis atmosphere in PPHs for staff and patients. It is also unlikely that the necessary community resources will be in place to buffer these changes. The new restructuring plans not only set unrealistic timelines, they seem to underestimate the importance PPHs have played in teaching, research and the advancement of clinical treatment and rehabilitation of the severely mentally ill. It may be that, in the long run, service integration and divestment/closure of the PPHs will result in better access to services closer to smaller communities and in the destigmatization of the mentally ill, however, without close evaluative monitoring and appropriate leadership, it could also lead to decreased research, training and quality of care.     

Evidence for hepatocarcinogenic activity of pentachlorobenzene with intralobular variation in foci incidence

Pentachlorobenzene (PeCB) is an important environmental contaminant derived primarily from the by-product contamination of the popular fungicides hexachlorobenzene and pentachloronitrobenzene. Its tumor-promoting activity was studied in a medium-term initiation/promotion assay in male F344 rats. Animals were given a single i.p. injection of diethylnitrosamine (200 mg/kg body weight) and 2 weeks later were administered 0.1 or 0.4 mmol/kg per day PeCB by gavage in a corn oil vehicle, 7 days/week. At the end of week 3, rats were subjected to a partial hepatectomy. Results showed that PeCB, at both doses, significantly increased both the number and area of glutathione S-transferase pi (GST-P) foci (>0.2 mm diameter) (P < 0.05). This trend was dose-dependent. In addition to increases in preneoplastic foci, liver glutathione concentrations and glutathione-associated enzymes showed significant changes in animals treated with PeCB. Glutathione reductase (GR) and gamma-glutamylcysteine synthetase (gamma-GCS) were both significantly induced in the centrilobular region. Changes in oxidized glutathione concentrations corresponded with the increase in GR activity with decreases of 40 and 30% in the low and high dose groups, respectively. No significant changes were detected in reduced glutathione concentrations. Together with changes in GR and gamma-GCS expression, a decrease in GST-P foci around the central veins was significant (P = 0.004) at the high dose. In these animals, 26% of the foci were classified as centrilobular whereas 37 and 39% of the foci were centrilobular in the low dose and control groups, respectively. Because of the co-localized nature of the changes in glutathione-associated enzymes and the decreased incidence of centrilobular foci, our results suggest that the reduced cellular environment may ultimately play a role in negatively selecting for foci growth.     

Spatial variation of natural radiation and childhood leukaemia incidence in Great Britain

This paper describes an analysis of the geographical variation of childhood leukaemia incidence in Great Britain over a 15 year period in relation to natural radiation (gamma and radon). Data at the level of the 459 district level local authorities in England, Wales and regional districts in Scotland are analysed in two complementary ways: first, by Poisson regressions with the inclusion of environmental covariates and a smooth spatial structure; secondly, by a hierarchical Bayesian model in which extra-Poisson variability is modelled explicitly in terms of spatial and non-spatial components. From this analysis, we deduce a strong indication that a main part of the variability is accounted for by a local neighbourhood 'clustering' structure. This structure is furthermore relatively stable over the 15 year period for the lymphocytic leukaemias which make up the majority of observed cases. We found no evidence of a positive association of childhood leukaemia incidence with outdoor or indoor gamma radiation levels. There is no consistent evidence of any association with radon levels. Indeed, in the Poisson regressions, a significant positive association was only observed for one 5-year period, a result which is not compatible with a stable environmental effect. Moreover, this positive association became clearly non-significant when over-dispersion relative to the Poisson distribution was taken into account.     

An examination of spatial variation in mercury concentrations in otter (Lutra canadensis) in south-central Ontario

Hair samples were collected from otter (Lutra canadensis) trapped in several parts of south-central Ontario, Canada. The concentrations of total Hg in hair were compared with methyl mercury concentrations in liver tissues from the same individuals to determine if hair is a suitable monitoring tissue. Hg in the two tissues was significantly correlated. Hair was used to monitor Hg in 51 individuals from four townships. The concentrations of total Hg in hair ranged from 4 to 20 micrograms/g. No significant variation among the four sample regions existed. Generally the highest concentrations were found in the youngest members of the population. Some possible explanations for the observations are presented.     

High temporal, geographic, and income variation in body mass index among adults in Brazil

OBJECTIVES: Population-based data on body mass index for developing countries are scarce. Body mass index data from two Brazilian surveys were examined to determine regional and temporal variations in the prevalences of underweight, overweight, and obesity. METHODS: Nationwide surveys in 1974/75 and 1989 collected anthropometric data in Brazil from 55,000 and 14,455 households, respectively. Trained interviewers used the same methods to measure weight and stature in both surveys, and survey designs were identical. Prevalences of underweight, overweight, and obesity were determined for persons 18 years of age and older. RESULTS: In the 1989 survey, body mass index varied greatly according to region of the country, urbanization, and income. In the wealthier South, the prevalence of overweight/obesity was the highest and the prevalence of underweight was the lowest; in the poorer rural Northeast, these patterns were reversed. For both surveys, overweight/obesity was more common among women than among men and peaked at age 45 to 64 years in both sexes. Over the 15 years between surveys, the prevalence of both overweight and obesity increased strikingly. CONCLUSIONS: In contrast to findings in developed countries, obesity in Brazil was positively associated with income and was much more prevalent among women than among men. For Brazilian women, the overall prevalence of overweight was nearly as high as that among women in the United States.     

The risk of non-melanoma skin cancer incidence in the Japanese atomic bomb survivors

The latest Japanese atomic bomb survivor non-melanoma skin cancer incidence dataset is analysed and indicates substantial curvilinearity in the dose-response curve, consistent with a possible dose threshold of about 1 Sv, or with a dose-response in which the excess relative risk is proportional to the fourth power of dose, with a turning-over in the dose-response at high doses (> 3 Sv). The time distribution of the radiation-induced excess risk is best described by a model in which the relative excess risk is proportional to a product of powers of time since exposure and attained age. The fits of generalized relative risk models with exponential functions of time and age at exposure (and in particular of attained age) to adjust the relative risk are less satisfactory, as also are the fits of other models in which products of powers of time since exposure, age at exposure and attained age adjust the excess absolute risk. Sensitivity analyses indicate the importance of likely adjustments to the Hiroshima neutron doses for the optimal model parameters, particularly if values of the neutron relative biological effectiveness (RBE) of more than 5 are assumed. If adjustments recently proposed are made to the Hiroshima neutron doses, then using the optimal model (in which excess risk is proportional to the fourth power of dose) the best estimate of the neutron RBE is 1.3 (95% CI < 07.1). However, uncertainties in skin dose estimates for the atomic bomb survivors means that the findings with respect to the neutron RBE and the non-linearity in the dose-response curve should be treated with caution.     

The incidence and Dukes'' staging of colorectal cancer over 3 decades

AIMS: Two previous studies (1966-1971 and 1979-1983) of patients with colorectal cancer (CRC) have been reported from our hospital. A large increase in the incidence of CRC was noted, and an improvement in Dukes' staging of tumours at treatment. We report a series of patients admitted with newly diagnosed CRC to evaluate this trend further. METHODS: A prospective study was made of all patients with newly diagnosed CRC admitted to the John Radcliffe Hospital, Oxford in 1995. Means of diagnosis and Dukes' staging were recorded. RESULTS: In 1 year 177 patients were admitted with newly diagnosed CRC. Previous studies had shown an increase from 52.8 to 103.4 patients per year. The number of patients diagnosed by colonoscopy doubled from 19.4% in 1979-1983 to 41% in 1995. No significant change in the proportion of patients with Dukes' A or B tumours was found. CONCLUSION: The number of patients treated annually with CRC in a stable population has more than trebled in the last 3 decades. A real increase in the incidence of CRC is likely as this rise cannot be explained solely by changing referral patterns or an ageing community. There are no significant changes in presentation patterns despite the availability of colonoscopy since 1975.