Correlation between histologic grade of malignancy and copy number of c-erbB-2 gene in breast carcinoma. A retrospective analysis of 176 cases

A system of histologic grade of malignancy in human breast carcinoma was devised by significantly modifying the way of evaluating number of mitoses and architectural atypia in the histologic grading of Bloom and Richardson. The modified grading system was applicable to all histologic subtypes of adenocarcinoma and showed a good association with prognosis of breast carcinoma patients in retrospective analysis of 176 consecutive surgical cases (P less than 0.0001). Of the three components of histologic grade, architectural atypia and number of mitotic figures independently had a significant effect on the prognosis. The copy number of c-erbB-2, a prognostic factor independent of tumor size and nodal status, was strongly correlated with the histologic grade, number of mitotic figures, and degree of nuclear atypia (P less than 0.001, each). Cox's regression model analysis showed that nodal status and histologic grade were two determinants of prognosis, and the independent effect of c-erbB-2 amplification was absorbed within that of the histologic grade. Although the importance of c-erbB-2 gene copy number seemed to be inferior to that of the histologic grade, both were shown to be strongly associated with the aggressiveness of the tumor itself rather than the extent of tumor spread.

Immunohistochemical study on overexpression of c-erbB-2 protein in human breast cancer: its correlation with gene amplification and long-term survival of patients

Using a polyclonal antibody monospecific to the c-erbB-2 oncogene product, an immunohistochemical study on the expression of c-erbB-2 protein was performed in formalin-fixed, paraffin-embedded tissue sections from 176 primary breast carcinomas in which amplification of the c-erbB-2 gene had been detected in 28 cases. Expression of the c-erbB-2 protein was detected in 44 cases (25%), being strongly positive in 27 (15%) and weakly positive in 17 (10%). All cases with amplification of c-erbB-2 showed positive staining of its protein. There were only four cases in which c-erbB-2 was strongly expressed without amplification of the gene. In the group showing strongly positive staining, both overall and disease-free survival were significantly poorer than in the remainder of the cases. Using Cox's regression model analysis, overexpression of c-erbB-2 protein was demonstrated to be an effective prognostic factor independent of nodal status or tumor size.

Cancer mortality among Japanese residents of the city of São Paulo, Brazil

Death certificates of Japanese residents of the city of São Paulo, Brazil from 1979 to 1981 were analyzed for cancer deaths by means of the standardized mortality ratio (SMR) and the standardized proportional mortality ratio (SPMR). Compared with residents of Japan, a significantly higher SMR value was obtained from Japan-born residents of São Paulo for prostate cancer, whereas lower values were obtained for cancer of the liver and gall-bladder in both sexes, of the esophagus and rectum in males, and of the lung in females. SMR values were higher for cancer of the stomach in both sexes but lower for those of the esophagus and prostate in males and of the gall-bladder and breast in females, when compared with the general population of São Paulo. Among Japan- and Brazil-born residents, stomach cancer in women revealed a significant stepwise decrease by generation when SPMR was used as an indicator. The high proportion of stomach cancer in males, however, was as high among the Brazil-born generation as in Japan. The SPMR of liver cancer decreased to the low level of the general population of São Paulo, even among the first generation. These changes in cancer patterns are discussed in relation to those among Japanese residents in the United States.

[Ecological study on cancer mortality and lifestyle in Japan]

Cancer mortality varies even in the uni-racial population of Japan. Age-adjusted mortality rate of stomach cancer in the highest prefecture is almost three times higher than the lowest. A cross-sectional study in five populations in Japan is being conducted in order to clarify the relationship between cancer mortality and lifestyle risk factors using some biochemical markers, i.e. nutrients (vitamins, trace minerals, lipids), hormones, etc. Each area has approximately population 100,000 and a total of 170 randomly selected males aged 40 to 49 are included. Wives of selected men are also included. Blood and urine sampling will also be done, with an interview and medical examination. Survey in Iwate and Okinawa prefectures has been completed in 1990 which will be extended to Nagano and Akita prefectures in 1990 and Tokyo metropolitan in 1991.

Clinical and radiologic assessments of the results of hepatectomy for small hepatocellular carcinoma and therapeutic arterial embolization for postoperative recurrence

To study the prognostic significance of the state of the residual liver after hepatectomy for small hepatocellular carcinoma (s-HCC) no larger than 5 cm in diameter, 123 patients were followed for periods from 9 months to 9 years and 1 month. The following results were obtained: (1) recurrence occurred in the residual liver in 58 patients (54.2%) after an average of 14.9 months from hepatectomy; (2) at recurrence diagnosed by imaging, 12 of 48 recurrent patients showed negative alpha-fetoprotein; (3) computed tomography (CT) had a high sensitivity (71.4%) in detecting recurrence; (4) 5-year survivals for all patients (n = 123) who had hepatectomy, and for those without recurrence (n = 49) or with recurrence (n = 58) were 19.1%, 48.9%, and 11.0%, respectively; and (5) survivals for the patients who developed recurrence and who did and did not receive embolization treatment (n = 32, 23, respectively) were 70.3% and 37.1% at 1 year, 45.0% and 0% at 3 years, and 14.9% and 0% at 5 years, respectively. It is important to recognize that the patient who has undergone surgery even for s-HCC should be followed as a super high-risk patient at regular intervals using CT. Therapeutic embolization for recurrent patients improved the survival after recurrence.

Mortality and cause of death among first-generation Japanese in São Paulo, Brazil

The death certificates of first-generation Japanese in the city of São Paulo, Brazil, were analysed for underlying causes of death, and standardized mortality ratio (SMR) values were calculated using the age-specific mortality rates for Japan and São Paulo. Mortality rates for all causes were lower than those of the general population in São Paulo for all age groups and both sexes, and were almost equal to those in Japan. Compared with the mortality in Japan, significantly higher SMR values were obtained for diabetes mellitus, ischaemic heart disease, respiratory diseases (females), motor vehicle accidents, and homicide (males), whereas SMR values were low for all causes (males), other heart diseases, cerebrovascular disease, chronic liver diseases (males), suicide, and malignant neoplasms (males). On the other hand, compared with the mortality for São Paulo, SMR values were significantly low for most causes of death. The potential cultural and social factors contributing to these changes in mortality pattern are discussed.

[Cervico-thoracic-abdominal lymph node dissection for carcinoma of the thoracic esophagus]

Over the period from 1982 to 1988, 127 cases with carcinoma in the thoracic esophagus underwent curative resection through a right thoracotomy. Cervicothoracic-abdominal lymph node dissection was performed in twenty-seven cases. No operative death occurred and only one hospital death (4%) was recorded. The only postoperative complication was recurrent laryngeal nerve palsy. Based on the adjusted survival-rate curves using Cox's method, there was significant difference in prognosis in favor of these 27 cases that received cervicothoracic-abdominal lymph node dissection over those that did not. The survival rate of all curatively operated cases was noticeably improved by using this procedure. Of those that underwent dissection only, or dissection with postoperative radiotherapy or chemotherapy, the best prognosis could be reached by a combination of the cervicothoracic-abdominal lymph node dissection and postoperative chemotherapy. From follow-up data regarding recurrence rates, a more extended dissection and complete removal of lymph nodes in the left upper mediastinum and retroperitoneum should further improve the long-term prognosis.

Correlation between long-term survival in breast cancer patients and amplification of two putative oncogene-coamplification units: hst-1/int-2 and c-erbB-2/ear-1

The incidence and association with 10-year survival of amplification in five protooncogenes or transforming genes were retrospectively examined using DNAs extracted from formalin-fixed, paraffin-embedded blocks of tissues obtained from 176 consecutive patients surgically treated for primary breast carcinoma. The incidences of greater than threefold amplification of hst-1, int-2, c-erbB-2, ear-1 (one of c-erbA), and c-myc were 12, 13, 16, 10, and 4.0%, respectively. hst-1 and int-2 were almost always coamplified (21/22), while c-erbB-2 and ear-1 were frequently coamplified (18/28) with almost the same copy number. The hst-1 and int-2 pair and the c-erbB-2 and ear-1 pair, localized on chromosomes 11q13 and 17q21-22, respectively, in normal cells, were inferred to be constituents of different amplification units. Amplification of hst-1 and/or int-2 was detected preferentially in the younger age group, and was correlated with poorer prognosis in cases carrying four or more copies of the genes. Amplification of c-erbB-2 and/or ear-1 was strongly correlated with poor prognosis in all 176 patients, especially those with lymph node metastasis. Amplification of c-myc was also correlated with poor prognosis. Cox's life-table regression analysis showed that amplification of c-erbB-2 had a prognostic value, which was independent of other known prognostic factors such as lymph node status and tumor size.

Prognostic contributions of Helix pomatia and carcinoembryonic antigen staining using histochemical techniques in breast carcinomas

Helix Pomatia (HPA) and carcinoembryonic antigen (CEA) staining were studied in 113 primary breast carcinomas, 63 metastatic lymph nodes and 10 resected local recurrences, using the avidin-biotin-peroxidase complex (ABC) method. Positive percentage rates were 41 (46/113) for HPA and 24 (27/113) for CEA in primary tumors, and 80 (8/10) for HPA but only 10 (1/10) for CEA in metastatic lesions. HPA staining showed a statistically significant correlation with negative estrogen receptor (ER) status (r -0.25, P = 0.05) and high nuclear grade (r 0.20, P = 0.04). Cancers with positive HPA staining were associated with a lower survival rate than those without (P = 0.0001), irrespective of menopausal status. CEA staining showed a marginal correlation with survival (P = 0.06: log rank test). The five-year survival rate of 21 cases positive for these two markers was only 5%. Multivariate analysis revealed HPA staining to be the best prognostic factor. The data indicated that HPA staining might be a valuable prognostic factor for breast cancer patients, especially when combined with CEA staining.

Multi-step carcinogenesis model for adult T-cell leukemia

The age-specific occurrence of adult T-cell leukemia (ATL) was analyzed using 357 cases collected during nationwide surveys carried out between 1982 and 1985 in Japan. A simple Weibull distribution function fitted well as a model. The mode of ATL onset was log-linear in this model and the curves for males and females overlapped completely. The presence of age-dependent accumulation of leukemogenic events within human T-cell leukemia virus type 1-immortalized T cells was suggested prior to the development of ATL, and the approximate number of independent leukemogenic events in ATL is estimated to be five. This stochastic analysis supported a multi-step carcinogenesis as an appropriate model for ATL.

Ethnic differences in blood pressure level between Japanese school children in Bolivia and native Bolivians

Blood pressure levels were measured in 626 children (138 Japanese, 477 Bolivian and 11 of mixed blood) in a Japanese agricultural settlement in Bolivia. Systolic (SBP) and diastolic (DBP) blood pressure was higher in Japanese children than in Bolivian children at each measured age by 4.09 mmHg (P = 0.0001) and 2.25 mmHg (P = 0.0038), respectively, using analysis of covariance. Although the slope of the regression line both for SBP and for DBP with age tended to be greater in Japanese, this was not statistically significant. There were no ethnic differences in height, weight or body mass index, however, which are usually indicators that correlate well with blood pressure. Ethnic differences in blood pressure were also shown at each of the measured values of height (SBP: 3.93, DBP: 2.19) and weight (SBP: 4.03, DBP: 2.23). Factors causing these ethnic differences are discussed in relation to cultural and genetic considerations.

[Epidemiological study using molecular biologic markers]

It seems to be important for the epidemiological study on cancer etiology to conduct molecular biological approach. IARC/WHO held "International Course on Molecular Biology for Epidemiologist" in order to promote the molecular epidemiology. I described here the content of the course and our study on lung cancer etiology using c-Ha-ras VTR marker of leukocyte DNA in peripheral blood, and discussed the possibility of molecular epidemiology.

Infectious states of human T lymphotropic virus type I and hepatitis B virus among Japanese immigrants in the Republic of Bolivia

Serologic tests for human T lymphotropic virus type I (HTLV-I) and hepatitis B virus infections were conducted in 1986 in two Japanese immigrant colonies located in Santa Cruz, Bolivia. A total of 322 adults (283 Japanese and 39 Bolivians) over age 35 years and 305 children (166 Japanese, 124 Bolivians, and 15 of mixed blood) aged 8-17 years were sampled at the time of a routine health checkup. The prevalence of antibody to HTLV-I was 17% in first-generation Japanese immigrants and 6% in second- or third-generation Japanese children. Prevalences among native Bolivians were 3% and 5% in adults and children, respectively. Seropositive Japanese immigrants and mothers showed clustering according to birthplace in endemic areas of Japan. The prevalence of either hepatitis B virus surface antigen (HBsAg) or antibody to HBsAg was 48% in Japanese adults, 21% in Japanese children, 13% in Bolivian adults, and 1% in Bolivian children. Seropositive adults did not show clustering according to birthplace, but children in one colony showed clustering and a narrow age range. A correlation of seropositivity between husbands and wives was found only for HTLV-I. The seropositivity was independent of whether an HTLV-I or a hepatitis B virus infection marker was present.

Chromosome fragility of lymphocytes from breast cancer patients in relation to epidemiologic data

The chromosomal fragility of peripheral blood lymphocytes from 50 women, undergoing operations for breast tumors (47 carcinomas, 2 intraductal papillomatoses and 1 malignant lymphoma) was studied to ascertain the association between chromosome fragility and epidemiologic data, such as a family or personal history of cancer, hormonal status, etc. Under conditions of folic acid and thymidine depletion, the average number of gaps and breaks on the patients' lymphocyte chromosome was 6.02 +/- 5.28 and that in the control medium was 2.0 +/- 2.0 while those of healthy controls were 5.8 +/- 5.5 and 1.36 +/- 1.22. These gaps and breaks were mostly seen in group A chromosomes (4.1 +/- 2.6) in 24 patients, including the 2 with benign tumors and the 1 with the lymphoma as well as 11 healthy controls. They were frequent in group B (3.0 +/- 0) in 3 patients, in group C (4.3 +/- 2.9) in 11 patients, and in groups D (2.0 +/- 1.0) and E (3.0 +/- 1.0) in 3 patients from each. This different distribution of gaps and breaks correlated neither with the patients' age nor with their tumor's histology, but patients having a late menarche were distributed in non-A groups. There was low inducibility of breaks in patients with a family history of breast cancer and/or relatively rare cancers. The availability of common fragile sites for studying an individual's susceptibility to cancer is discussed. One patient showed a bromodeoxyuridine-requiring heritable 10q25 fragile site. Another, with triple primary cancers, showed a constitutional translocation of t(5;19)(q15;q13).

Major prognostic factors of adult patients with advanced T-cell lymphoma/leukemia

Eighty-one adult patients with advanced T-cell lymphoma/leukemia including 54 with adult T-cell leukemia/lymphoma (ATL), who were treated between 1981 and 1983 with vincristine, cyclophosphamide, prednisolone, and doxorubicin (VEPA) or VEPA plus methotrexate (VEPA-M) in randomized fashion, were evaluated for pretreatment characteristics. The overall complete response (CR) and the 4-year survival rates were 39.5% and 19.4%, respectively, and 69% of 32 CR patients had relapses, indicating the need for development of new effective regimens for the disease. In a multiple logistic regression analysis, only three factors, leukemic manifestation, poor performance status (PS), and a high lactate dehydrogenase (LDH) level, were significantly associated with the poor response rate. In a Cox proportional hazards model analysis, shortened survival was again significantly associated with poor PS and a high LDH level, but not with a clinical diagnosis of ATL. The two factors, PS and LDH level, that were found to be significantly associated with both CR and survival rates, were used to construct a model containing six categories of patients at increasing risk for poor response and shortened survival. These categories divided the patients into three groups with respective CR and 4-year survival rates of 75% and 53% for low-risk, 45% and 15% for moderate-risk, and 15% and 0% for high-risk. The results indicate that PS and LDH levels were the most important in predicting the response and survival of an adult patient with advanced T-cell lymphoma/leukemia. The prognosis of patients with usual peripheral T-cell lymphoma, excluding ATL, was comparable with that of advanced B-cell lymphoma. These results have important implications for the design of new prospective therapeutic trials.

Major prognostic factors of adult patients with advanced B-cell lymphoma treated with vincristine, cyclophosphamide, prednisone and doxorubicin (VEPA) or VEPA plus methotrexate (VEPA-M)

Eighty-two adult patients with advanced B-lymphoma, treated between 1981 and 1983 with VEPA (vincristine, cyclophosphamide, prednisolone and doxorubicin) or VEPA-M (VEPA plus methotrexate) in a prospective randomized fashion, were evaluated for pretreatment characteristics. The overall complete response (CR) and the 4-year survival rates were 74% and 45%, respectively. The relapse rate was 51%. Stage of disease only was negatively associated with the CR rate in a multivariate analysis. The primary extranodal tumor site other than upper gastrointestinal (GI) tract and high grade pathology were found to affect disease-free survival adversely in a Cox proportional hazards model. Poor performance status, advanced stage, primary extranodal tumor site other than upper GI tract, advanced age, high grade pathology and prior therapy by either surgery or radiation, were significantly associated with shortened survival in a Cox proportional hazards model. These results indicate advanced B-lymphoma in Japan to be generally similar to advanced non-Hodgkin's lymphoma in the West in terms of prognostic factor characteristics, but the importance of the primary site in predicting survival has not been reported in the West. Also, the lack of a survival plateau in patients with diffuse large cell lymphoma indicates more intensive chemotherapy regimens than VEPA or VEPA-M to be needed. It was also found that the significant prognostic factors in patients with advanced B-lymphoma were very different from those with T-lymphoma. The five factors: pathology, stage, primary site, age, prior therapy by surgery or radiation, for which the risk ratio was more than 2.3, were used to construct a model containing 23 categories of patients running an increasing risk of shortened survival; this divided patients into three groups. The CR and 4-year survival rates of low-, moderate- and high-risk groups were 90% and 74%, 74% and 58%, and 50% and 5%, respectively. The risk-grouping provides indications for determining optimal therapy for individual patients and the need for new therapeutic trials in patients at high risk.

Preoperative radioactive therapy for esophageal carcinoma. Randomized evaluation trial in eight institutions

A cooperative, prospective, randomized study to evaluate the effectiveness of preoperative irradiation in curatively resected esophageal carcinoma was performed in 364 cases in eight institutions from August 1982 to November, 1983. Based on the survival curves, postoperative irradiation alone was superior to preoperative plus postoperative irradiation. Because of the progression of the disease and complications after operation, there were many inevaluable cases in this study. However, analysis revealed there was no bias caused by a greater number of unfavorable patients being selectively included in inevaluable cases in the postoperative irradiation only group. Our data question the value of preoperative irradiation being performed in addition to resection plus postoperative irradiation.

Natural history of aortic and coronary atherosclerosis in Tokyo

The natural history of atherosclerosis in Tokyo was explored in 1,206 unselected consecutive hospital and forensic medicine autopsies performed on deceased persons of both sexes aged 0 to 89 yr. The extent of intimal atherosclerotic lesions in the aorta and coronary arteries was estimated visually after staining with Sudan IV and recorded as the percentage of intima with fatty streaks (FS) and raised lesions (RL). The extent of atherosclerosis by sex and age was compared in two sources of subjects and various broad disease categories associated with the terminal event causing death. Comparisons of hospital cases with forensic medicine cases, by sex, over five arterial segments and nine 10-yr age groups, did not show significant differences in the extent of atherosclerosis between the two sources of cases. However, RL at all age groups over 40 yr in general showed a tendency to be slightly more extensive in the hospital cases. As is commonly reported for certain other population groups, our results showed more extensive atherosclerosis in Japanese men than in Japanese women. The comparisons of the extent of atherosclerosis among five broad disease categories causing death--coronary heart disease (CHD), cerebrovascular disease (CVD), cases with evidence of both CHD and CVD (OVL), cases with CHD-related diseases such as diabetes and hypertension (CHD-rel), and all other diseases, accidents, homicides, and suicides (Basal)--showed more extensive atherosclerosis among CHD and OVL cases when compared with the basal group as control reference.(ABSTRACT TRUNCATED AT 250 WORDS)

Prediction of the gastric cancer mortality in 2000 in Japan

Gastric cancer mortality in Japan in the year 2000 has been predicted from sex- and age-specific incidences and mortality trends and patient cure rates. The difference between the log-linear decrease in incidence and the log-quadratic decrease in mortality was considered to be the result of early diagnosis and treatment. Even on the assumption that 90% of patients could be cured in 2000, the number of deaths was estimated to be about 10,000. The decreasing incidence of cases brought about by birth cohort effects may contribute towards lowering the number of patients. The importance of health education in lowering the incidence of gastric cancer, by teaching people to keep up a sound life style, is discussed.

Prevalence of antibodies to human T-cell leukemia/lymphoma virus type I and human immunodeficiency virus in Japanese immigrant colonies in Bolivia and Bolivian natives

This study was performed to estimate human T-cell leukemia-lymphoma virus type-I (HTLV-I) infection and human immunodeficiency virus (HIV) infection in Japanese immigrant colonies in Bolivia, where no seroepidemiological study of HTLV-I or HIV has ever been reported, among 647 healthy adults and children of Japanese descent and Bolivian natives living in the same colonies. The overall prevalence of HTLV-I antibody was 12.6% (59/469) among Japanese immigrant populations, but increased with age, being 16.2% (49/303) among adults and 6.0% (10/166) among children; no significant difference in relation to sex was noted. The first generation immigrants (issei) from Kyushu, the large southwestern island of Japan where adult T-cell leukemia (ATL) is endemic, had 19.0% (49/258) HTLV-I seroprevalence, while issei from outside Kyushu had none (0/39). Among Bolivian members of the community, consisting mostly of Indians and persons of Spanish descent, the HTLV-I seroprevalence was 4.3% (7/164) overall, 2.4% (1/42) among adults and 4.9% (6/122) among children. No antibody to HIV was detected among Japanese or Bolivian populations. The results of this study show that: (1) there is a considerable number of HTLV-I carriers among Japanese immigrant populations in Bolivia, especially among immigrants from Kyushu, (2) there exist some HTLV-I carriers among Bolivian natives, raising the possibility of HTLV-I transmission by co-habitation with Japanese immigrants, (3) HIV is far from endemic in this district of Bolivia, at present.

Smoking, occupation and family history in lung cancer patients under fifty years of age

A hospital based case-control study was conducted to investigate the factors affecting the development of lung cancer among young adults. A total of 185 inpatients (males: 128, females: 57) aged from 30 to 49 have been histologically classified in the National Cancer Center Hospital during the last 10 years. Most frequent was adenocarcinoma in both males (57.0%) and females (73.7%). Basic factors were obtained from clinical charts including smoking history, occupation and family history of cancers. Elevated risks were found for squamous cell carcinoma in patients with a history of smoking (all had smoked v. 15/20 for controls) and an occupation possibly related to respiratory irritations (15/20 v. 3/20 for controls). Heavy smokers were distributed more in the cancer patients. Moreover, the average Smoking Index among those without "at risk" occupation was 1,002 with the least being 700, while that with such an occupation was 723. Heavy smoking alone and a smoking/occupation combination could contribute to an early onset of squamous cell carcinoma. On the other hand, there were no significant risk factors for adenocarcinoma, the relative risk from a history of smoking being less than 1.00 and from a family history of cancer, approximately 1.00.

Case-control study on histologically determined multiple primary lung cancer

Between 1965 and 1985, 72 (64 male and 8 female) cases of multiple primary lung cancer (MPLC) in the National Cancer Center Hospital, Japan, were reviewed, and a retrospective hospital-based case-control study was performed with special reference to the patients' smoking and family histories. Control cases were selected from patients with unicentric lung cancer (ULC) with a longer survival time than that for other patients with whom they were matched for age, sex, histologic examination of primary lung cancer, and residence in prefecture. The overall percentage of MPLC was higher in males (3.1%) than in females (1.8%). Of the total number of cases, 46 were synchronous and 26, metachronous. The same histology was recognized in 38 cases (53%), and squamous cell carcinomas were observed in 65% of MPLC cases, all of whom were smokers. At least half of the MPLC found in nonsmokers were adenocarcinomas. Habitual smokers, with a Brinkman index (BI) of more than 50, accounted for 90% of all cases of MPLC, although 81% of the controls were also habitual smokers. A positive relationship dependent on the number of cigarettes smoked was observed between the BI of smokers and the proportion suffering MPLC. There was a family history of cancer in 47% of MPLC cases while, for controls, this figure was 40%. It was found that 67% of patients with MPLC and 61% with ULC were drinkers. The influence of cigarette smoking on MPLC was confirmed, especially in the cases of squamous cell carcinoma and small-cell carcinoma.

Trend of lung cancers in the National Cancer Center of Japan and comparison with that of Japanese pathological autopsy records

Trends in the histologic types of lung cancers during 1966-1985 by 5-year intervals were analyzed by using 4,419 cases in the National Cancer Center Hospital, Japan. Histologically confirmed cases increased to 76.6% in the last 5-year interval. The proportions of histological types in males have remained relatively unchanged; about 40% squamous cell carcinoma, one-third adenocarcinoma, and about 10% each of large cell carcinoma, small cell carcinoma and other types. In females, an increase of adenocarcinoma from 52% to 69.1% and a decrease of squamous cell carcinoma from 21% to 11.4% were noteworthy, and the other three types amounted to less than 10% each. These trends were compared with those obtained from the Annals of Pathological Autopsy Records in Japan during 1974-1983, which contained 26,844 lung cancer cases; the results were similar except for an increase of small cell carcinoma. The recent increase of small cell carcinoma was considered to be due to a change in diagnostic categorization, associated with a decreased rate of undifferentiated carcinoma. However, the increase of small cell carcinoma as well as adenocarcinoma in younger patients requires further study from both demographic and etiological viewpoints.

Comparison of coronary atherosclerosis in middle-aged Norwegian and Japanese men. An autopsy study

We compared the extent of lesions in the coronary arteries of autopsied middle-aged men from Oslo, Norway, with lesions in autopsied men of similar ages in Tokyo, Japan. Certain risk factors for coronary heart disease as serum cholesterol, triglycerides, and blood pressure were also available from these men in the two locations. Our comparisons reveal large differences in the extent of atherosclerosis between Oslo and Tokyo, which are reflected in the levels of the risk factors, particularly serum cholesterol levels. Our findings suggest that preventive strategies could retard the development of atherosclerosis and coronary heart disease without the economic and nutritional problems that affect technically underdeveloped societies where atherosclerosis and coronary heart disease are not prevalent.