Cancer in the Elderly: A Prospective Study Among Hawaiian Japanese Men

In the United States, little has been done to compare the cancer risk of elderly subjects, aged 65 and older, with that of younger subjects. Although the elderly constitute only 12% of the population, they are diagnosed with more than 50% of the cancers. The study consisted of 7, 783 Japanese-American men, born from 1900-1919 and examined from 1965-1968. During 154, 000 person-years of follow-up, 1, 478 incident cases of cancer were identified. The incidence rate of cancer was high among the elderly (142.7 per 10, 000 person-years) compared with younger subjects (48.2 per 10, 000 person-years), yielding a significant (p < 0.05) rate ratio of 3.0. Of the site-specific cancers, prostate cancer showed the highest rate raio of 7.0, followed by oral, stomach, lung, and colon cancer. In addition, the five-year age-specific rates for stomach and colon cancer rose directly with age. A similar pattern was also observed for lung and prostate cancer in men before age 80, but the rates declined thereafter. The findings from this study suggest that the reduction in risk for cancers of the prostate, oral cavity, stomach, lung, and colon must be viewed as a major goal for improving the public health in the elderly population.

Updated analysis of SWOG-directed intergroup study 0116: a phase III trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection

PURPOSE

Surgical resection of gastric cancer has produced suboptimal survival despite multiple randomized trials that used postoperative chemotherapy or more aggressive surgical procedures. We performed a randomized phase III trial of postoperative radiochemotherapy in those at moderate risk of locoregional failure (LRF) following surgery. We originally reported results with 4-year median follow-up. This update, with a more than 10-year median follow-up, presents data on failure patterns and second malignancies and explores selected subset analyses.

PATIENTS AND METHODS

In all, 559 patients with primaries ≥ T3 and/or node-positive gastric cancer were randomly assigned to observation versus radiochemotherapy after R0 resection. Fluorouracil and leucovorin were administered before, during, and after radiotherapy. Radiotherapy was given to all LRF sites to a dose of 45 Gy.

RESULTS

Overall survival (OS) and relapse-free survival (RFS) data demonstrate continued strong benefit from postoperative radiochemotherapy. The hazard ratio (HR) for OS is 1.32 (95% CI, 1.10 to 1.60; P = .0046). The HR for RFS is 1.51 (95% CI, 1.25 to 1.83; P < .001). Adjuvant radiochemotherapy produced substantial reduction in both overall relapse and locoregional relapse. Second malignancies were observed in 21 patients with radiotherapy versus eight with observation (P = .21). Subset analyses show robust treatment benefit in most subsets, with the exception of patients with diffuse histology who exhibited minimal nonsignificant treatment effect.

CONCLUSION

Intergroup 0116 (INT-0116) demonstrates strong persistent benefit from adjuvant radiochemotherapy. Toxicities, including second malignancies, appear acceptable, given the magnitude of RFS and OS improvement. LRF reduction may account for the majority of overall relapse reduction. Adjuvant radiochemotherapy remains a rational standard therapy for curatively resected gastric cancer with primaries T3 or greater and/or positive nodes.

Association of Helicobacter pylori infection and diet on the risk of gastric cancer: a case-control study in Hawaii

OBJECTIVE

The risk factors most strongly associated with gastric cancer are the gastric bacteria Helicobacter pylori and diet. Utilizing data from a case-control study among residents in Hawaii, we examined the association of diet, presence of H. pylori, and non-cardia gastric cancer risk.

METHODS

Serum taken at diagnosis for cases (n = 212) and at interview for controls (n = 336) was assayed for IgG antibodies to H. pylori group antigens and to a recombinant fragment of the cytotoxin-associated antigen A (CagA) protein, and subjects completed food frequency questionnaires. Risk measures were calculated using logistic regression. The likelihood ratio test was used to assess interactions.

RESULTS

Inverse associations were found between gastric cancer risk and increasing intake of several micronutrients and vegetables among all individuals. For H. pylori/CagA-positive subjects, significant trends were present for total, green, and yellow vegetables, while a significant trend was present only for yellow vegetables among H. pylori/CagA-negative individuals. For intestinal gastric cancer, there was a suggestion that intake of vegetables, especially cruciferous vegetables, had a stronger protective effect for the H. pylori/CagA-positive group.

CONCLUSIONS

Diet may play a greater role in the etiology of non-cardia gastric cancer among individuals with evidence of H. pylori infection than among those without.

The relation of pepsinogen group II (PGII) expression to intestinal metaplasia and gastric cancer

AIMS

A substantial minority of intestinal metaplasia (IM)-associated stomach cancers express a gastric product-pepsinogen group II (PGII). The aim of this study was to examine PGII expression as it relates to IM and to tumour heterogeneity.

METHODS AND RESULTS

The extent of IM was divided into four levels: none, minimal, moderate, extensive. Stomach specimens (N = 165) were stained for PGII and two tumour markers, epidermal growth factor receptor (EGFr) and p53. PGII was more likely to be expressed with moderate or extensive IM than with minimal or no IM (P = 0.05). Cancers that expressed PGII were more likely to be of high stage than those that did not (P = 0.035). Of 25 cases that expressed all three markers (PGII, EGFr, p53), 20 (80%) had stage 3 or 4 disease, compared with 11 (37%) advanced cancers expressing none of the markers (P = 0.001). Cancers expressing one or two markers were between these extremes.

CONCLUSIONS

PGII+ cancers in IM-associated gastric cancers may derive from residual gastric glands, or may arise from postinduction reversion to a gastric phenotype from intestinalized cells. This is supported by the more frequent association of PGII expression with the most extensive degrees of IM and its association with high-stage cancers that display heterogeneity in tumour marker expression.

Helicobacter pylori, pepsinogen, and gastric adenocarcinoma in Hawaii

BACKGROUND

The objective was to investigate the association of Helicobacter pylori and serum pepsinogen (PG) levels with gastric adenocarcinoma.

METHODS

Serum obtained from 299 patients at the time of cancer diagnosis and from 336 population-based control subjects was tested for PG I, PG II, and antibodies to H. pylori and to CagA.

RESULTS

Subjects with low PG I levels or low PG I/II ratios were at increased risk for cardia and noncardia gastric cancer, whereas those with H. pylori or CagA seropositivity had an elevated risk for noncardia cancer only. Subjects seropositive for either H. pylori or CagA who had low PG I levels had the highest odds ratio (OR) (9.21 [95% confidence interval {CI}, 4.95-17.13]) for noncardia cancer, compared with subjects with neither factor. Elevated risks were also found among subjects with only 1 factor (OR, 5.40 [95% CI, 2.61-11.20] for low PG I level only; OR, 4.86 [95% CI, 5.90-8.13] for H. pylori or CagA seropositivity only). This pattern persisted when PG I/II ratio replaced PG I level and when CagA seropositivity alone replaced H. pylori immunoglobulin G or CagA seropositivity.

CONCLUSIONS

The results suggest that persons with both H. pylori or CagA seropositivity and a low PG I level or PG I/II ratio are highly susceptible to development of noncardia gastric cancer.

Prospective study of the association of serum triglyceride and glucose with colorectal cancer

To determine if serum triglyceride and glucose levels are associated with colorectal cancer, a prospective study among 7619 Japanese-American men was conducted. From 1968 to 1998, 376 colon and 124 rectal cancer incident cases were diagnosed. A strong positive association of alcohol intake and pack-years of cigarette smoking with colorectal cancer was observed. Body mass index and heart rate were also positively related to colon, but not to rectal cancer. In contrast, serum triglyceride did not predict the development of either colon or rectal cancer. There was a modest association of serum glucose in the highest quartile group with rectal cancer (relative risk = 1.33; 95% confidence interval, 0.79-2.26), but it was not statistically significant. This study did not find a strong positive association of serum triglyceride or glucose with colorectal cancer, but additional studies including other metabolic consequences associated with increased serum triglyceride and glucose may clarify the relationship.

Serum Vitamins and the Subsequent Risk of Bladder Cancer

PURPOSE

We determined whether serum vitamins are inversely related to bladder cancer risk.

MATERIALS AND METHODS

A cohort of 9,345 Japanese-American men was examined from 1971 to 1977. At examination a blood specimen was obtained and the serum was frozen. After a surveillance period of more than 20 years 111 tissue confirmed incident cases of bladder cancer were identified. Stored serum and that of 111 age matched controls were tested by high pressure liquid chromatography for certain micronutrients, including lutein, zeaxanthin, anhydrolutein, alpha-cryptoxanthin, beta-cryptoxanthin, lycopene, dihydrolycopene, alpha-carotene, beta-carotene, total carotenoids, retinol, alpha-tocopherol, beta-tocopherol, gamma-tocopherol, delta-tocopherol and total tocopherols.

RESULTS

Based on quartiles of serum micronutrient levels the ORs for bladder cancer were determined using the general estimating equations approach. There were statistically significant inverse linear trends in risk for alpha-carotene (p <0.01), beta-carotene (p = 0.03), lutein plus zeaxanthin (p = 0.03), beta-cryptoxanthin (p = 0.04) and total carotenoids (p = 0.02). However, after adjustment for pack-years of cigarette smoking none of the inverse trends remained significant.

CONCLUSIONS

These results suggest that cigarette smoking, which is a strong risk factor for bladder cancer, may explain the apparent protective effect of individual and total carotenoids against this common cancer.

Serum insulin-like growth factor I and subsequent risk of colorectal cancer among Japanese-American men

Recent reports suggest that colorectal cancer is positively related to insulin-like growth factor I (IGF-I) and inversely related to insulin-like growth factor binding protein 3 (IGFBP-3). To evaluate these associations further and separately for colon and rectal cancer, the authors conducted a nested case-control study in a cohort of 9,345 Japanese-American men examined in Hawaii in 1971-1977. A total of 177 incident colon cancer cases and 105 incident rectal cancer cases were identified from 1972 to 1996. These patients' stored sera and those of 282 age-matched controls were measured for IGF-I and IGFBP-3. The adjusted mean level of IGF-I was higher in colon cancer cases than in controls (154.7 ng/ml vs. 144.4 ng/ml; p = 0.01). However, the multivariate odds ratio for the highest quartile compared with the lowest was just 1.8 (95% confidence interval: 0.8, 4.3). Adjusted mean IGF-I levels were similar between rectal cancer cases and their controls. For IGFBP-3, adjusted mean levels were lower for both colon and rectal cancer cases than for their matched controls, but the differences were not significant. The IGF-I results weakly support findings from other studies and suggest that there are differences in IGF-I findings between colon and rectal cancer cases. It is possible that IGF-related risk is confounded by other factors that may vary among different cohorts. Further research is needed to clarify these relations.

Case-control study of diet and other risk factors for gastric cancer in Hawaii (United States)

OBJECTIVE

To investigate the association of diet and other factors with gastric adenocarcinoma of the distal stomach.

METHODS

Three hundred cases and 446 population-based controls were interviewed with a quantitative, food frequency questionnaire, which listed over 250 foods. The questionnaire also included information on smoking history, alcohol intake, education, medical history, medication use, and a family history of cancer.

RESULTS

Cigarette smoking, family history of gastric cancer and personal history of gastric ulcer were positively associated with gastric cancer, while education and past use of non-steroidal anti-inflammatory drugs were inversely related to risk. The consumption of all vegetables, mainly dark green, light green, and yellow vegetables, reduced risk. Many of these vegetables contain beta-carotene, vitamin C, vitamin E or folate, which were also inversely related to gastric cancer risk. When these nutrients were analyzed simultaneously, the inverse association was mainly with beta-carotene. The intake of processed meats and bacon was positively associated with gastric cancer risk, but primarily in men. When we simultaneously adjusted these meats for the intake of the different vegetables, the association was no longer significant.

CONCLUSIONS

These findings provide additional support that the consumption of dark green and yellow vegetables are protective against adenocarcinoma of the distal stomach.

TP53 and gastric carcinoma: a review

In this article, we survey the major p53 (TP53) alterations identified in gastric carcinomas and their precursors. These include p53 expression, mutations, and loss of heterozygosity (LOH). Not only are the various abnormalities summarized, but in addition there is a survey of the literature with respect to the impact of these changes on patient prognosis and treatment response. The majority of published studies involve the immunohistochemical detection of the protein. These use different antibodies, different detection techniques, and different methods of interpretation. Therefore not surprisingly, the results of many of the studies are contradictory with one another. Overall, however, it appears that p53 alterations occur early in the development of gastric carcinoma, being present even in the nonneoplastic mucosa and they increase in frequency as one progresses along the pathway of gastric carcinoma development. p53 immunoreactivity is seen in 17%-90.7% of invasive gastric carcinomas. p53 alterations occur much more commonly in proximal lesions than in distal ones, suggesting that the molecular events leading to the development of gastric carcinoma may be very different in proximal vs. distal tumors. p53 mutations occur in 0%-77% of gastric carcinomas. The mutations are distributed widely across the gene from exons 4-11 with hot spots of mutation at codons 175, 248, 273, 282, 245, and 213. G:C>A:T transitions at CpG sites are the commonest type of mutation. At least 60% of carcinomas with mutations also exhibit p53 LOH.

Gastric carcinoma distal to the cardia: a review of the epidemiological pathology of the precusors to a preventable cancer

A distinctive gastritis precedes the development of cancer distal to the cardia. Helicobacter pylori infection and the use of pickled foods as substitutes for fresh fruits and vegetables constitute the most important environmental factors that generate this gastritis. This review describes the anatomical changes that characterise the step-by-step evolution of a process that begins in childhood and culminates in invasive cancer in middle and old age. Progression of the gastritis can be followed by measuring the host antibody response to the H. pylori infection and by serum assays that indicate loss of parietal cell mass. Cancer of the distal stomach will disappear if adequate, sanitary housing and year-round fresh vegetables are made available to all economic levels of society. Programmes that offer these reforms must be sustained over several generations, since the anatomical changes that precede gastric cancer are probably not reversible and begin early in life. In the absence of these reforms, death from gastric cancer may be prevented if patients with asymptomatic, early cancers are identified. High H. pylori antibody levels and serum pepsinogen assays may be used to identify persons with the extensive gastritis that favours the presence of such early cancers.

Helicobacter pylori CagA seropositivity and gastric carcinoma risk in a Japanese American population

Helicobacter pylori colonization is associated with gastric cancer, but whether and to what extent the risk is greater for strains with the cagA gene than for those without needs to be determined. Between 1967 and 1977, 9963 Japanese American men were recruited and examined. By 1996, incident cases of gastric carcinoma of the distal stomach had been diagnosed in 261 men. Stored serum samples from these case patients and 261 age-matched control subjects were tested for immunoglobulin G antibodies to H. pylori and to the CagA product of H. pylori, using antibody-specific enzyme-linked immunosorbent assays. Compared with H. pylori-negative, CagA-negative men, H. pylori-positive, CagA-negative men had an odds ratio (OR) of 2.7 (95% confidence interval [CI], 1.3-5.6) for intestinal gastric carcinoma. Men seropositive for both H. pylori and CagA had an OR of 4.1 (95% CI, 2.2-7.7). This suggests that colonization by an H. pylori strain with the cagA gene is associated with a greater risk of intestinal gastric carcinoma.

Gastric carcinoma: pathology findings in a multiethnic population

OBJECTIVES

To assess the pathology of gastric carcinoma and to determine whether carcinoma of the cardia occurs more often among whites than among other ethnic groups in Hawaii. This study focuses on demographic differences in subsite locations and histologic types of gastric carcinoma.

METHODS

We reviewed 532 sequential gastric carcinomas accessioned between 1993 and 1999 in the Hawaii Tumor Registry. Pathology reports and slides were reviewed by the study pathologist.

RESULTS

Carcinoma of the cardia occurred in 51 (15.8%) of 323 males compared with 18 (8.6%) of 209 females (P = 0.02, after age adjustment). The age-adjusted percent of cardia cases was 41.8% for Hawaiian white males compared with 13.4% for men of all other ethnic groups (P = 0.0002). The age-adjusted percent of cardia cases was 22.4% for Hawaiian white females compared with 7.3% for females of other groups. (P = 0.08). At all age levels, females had more frequent diffuse carcinomas and less frequent intestinal type gastric carcinomas than men. The age-adjusted percent with diffuse carcinoma was 35.3% for females and 13.7% for males (P < 0.0001). Also, the sex-adjusted percent with diffuse carcinoma was 26.0% for patients younger than 75 years of age compared with 17.0% for patients 75 years or older (P = 0.01). Conversely, the sex-adjusted percent with intestinal carcinoma was 67.9% for patients younger than 75 years of age compared with 77.1% for patients 75 years or older (P = 0.02). The proportion of cases showing precursor lesions (intestinal metaplasia or superficial gastritis) increased progressively with the distance of the carcinoma from the cardia.

CONCLUSIONS

Carcinoma of the cardia is predominantly a tumor of white males and is not associated with the multifocal gastritis characteristically found with carcinoma distal to the cardia. Diffuse gastric carcinoma shows no ethnic predilection, but expression of this phenotype is clearly related to the age and gender of the patient.

Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction

BACKGROUND

Surgical resection of adenocarcinoma of the stomach is curative in less than 40 percent of cases. We investigated the effect of surgery plus postoperative (adjuvant) chemoradiotherapy on the survival of patients with resectable adenocarcinoma of the stomach or gastroesophageal junction.

METHODS

A total of 556 patients with resected adenocarcinoma of the stomach or gastroesophageal junction were randomly assigned to surgery plus postoperative chemoradiotherapy or surgery alone. The adjuvant treatment consisted of 425 mg of fluorouracil per square meter of body-surface area per day, plus 20 mg of leucovorin per square meter per day, for five days, followed by 4500 cGy of radiation at 180 cGy per day, given five days per week for five weeks, with modified doses of fluorouracil and leucovorin on the first four and the last three days of radiotherapy. One month after the completion of radiotherapy, two five-day cycles of fluorouracil (425 mg per square meter per day) plus leucovorin (20 mg per square meter per day) were given one month apart.

RESULTS

The median overall survival in the surgery-only group was 27 months, as compared with 36 months in the chemoradiotherapy group; the hazard ratio for death was 1.35 (95 percent confidence interval, 1.09 to 1.66; P=0.005). The hazard ratio for relapse was 1.52 (95 percent confidence interval, 1.23 to 1.86; P<0.001). Three patients (1 percent) died from toxic effects of the chemoradiotherapy; grade 3 toxic effects occurred in 41 percent of the patients in the chemoradiotherapy group, and grade 4 toxic effects occurred in 32 percent.

CONCLUSIONS

Postoperative chemoradiotherapy should be considered for all patients at high risk for recurrence of adenocarcinoma of the stomach or gastroesophageal junction who have undergone curative resection.

Variant form of diffuse corporal gastritis in NHE2 knockout mice

Mice lacking the NHE2 Na+/H+ gene develop gastritis of the glandular mucosa as early as the tenth day of life, achieving maximal intensity of inflammation from 17 to 19 days after birth and maximal atrophy at one year. We assessed the effects of this process in such mice to 16 months of age. The stomach of NHE2 null mutants was examined at 10, 17 to 20, 24 to 35 and 49 to 70 days, and at 12 to 16 months. The NHE2 wild-type (+/+) and NHE2 heterozygous (+/-) mice were compared with the NHE2 homozygous mutant mice (-/-). The stomach of the mutant mice at all ages was characterized by a substantially reduced number of parietal cells. The 10-day-old mouse stomach had a transmural infiltrate of primarily neutrophils. With increasing age, neutrophils were replaced by lymphocytes and plasma cells in the glandular mucosa of the mutant mice. Young adult 49- to 70-day-old mice had surface cell hyperplasia and expansion of the replicating cell population. Hyperplasia of enterochromaffin-like cells and antral gastrin cells accompanied profound fundic gland and surface cell hyperplasia, and became progressively more severe with increasing age of the NHE2-/- mice. Neoplasms were not found in the mutant or control mice. This gastritis differs from that of autoimmune gastritis in that it is transmural, begins in infancy, and is associated with a predominantly neutrophilic infiltrate in its early stages. Some of the histologic changes in the adult mice can be explained on the basis of prolonged achlorhydria. This mouse may be a suitable model for prolonged effects of achlorhydria.

Serum selenium and subsequent risk of prostate cancer

It is suspected that selenium is protective against prostate cancer. To test this hypothesis, we conducted a nested case-control study in a cohort of 9345 Japanese-American men examined between 1971 and 1977. At the time of examination, a blood specimen was obtained, and the serum was frozen. After a surveillance period of more than 20 years, 249 tissue-confirmed incident cases of prostate cancer were identified. Their stored sera and those of 249 matched controls were measured for selenium levels. Odds ratios for prostate cancer, based on quartiles of serum selenium levels, were determined using the General Estimating Equations approach. The multivariate odds ratio for the highest quartile was 0.5 (95% confidence interval, 0.3-0.9) with a two-sided P for trend of 0.02. The inverse association was more notable for cases with advanced disease and for cases diagnosed 5-15 years after phlebotomy. However, the association was mainly present in current or past cigarette smokers rather than nonsmokers, which leads to caution in the interpretation of the results.

The relation of p53 gene mutations to gastric cancer subsite and phenotype

OBJECTIVES

We investigated p53 gene mutations in advanced gastric cancers by direct DNA sequencing, in order to determine the frequency of mutations in gastric cancers having different epidemiological backgrounds, tumors of the cardia were compared with those arising in the antrum or corpus. Intestinal type cancers were compared with diffuse or other histologic types. We have chosen to assess the frequency of mutations solely based on DNA sequencing.

METHODS

Paraffin embedded tissues from 100 gastric cancers were evaluated. The mutational status of the p53 gene in exons 5 through 9 were determined by direct sequencing of PCR products.

RESULTS

Mutations in exons 5, 6, 7 and 8 were found in 35 of 100(35%)stomach cancers. One tumor had mutations in both exons 5 and 8. No mutations were detected in exon 9. p53 gene mutations were significantly more frequent in cancers of the cardia (19/35; 54%) than the antrum and corpus (16/65 (25%)) (p < or = 0.005). p53 mutations were more frequent in intestinal type cancers (28/67; 42%) than diffuse cancers or other histologic types of cancer (7/33; 21%), but the difference was not statistically significant.

CONCLUSIONS

Cancers of the cardia more frequently contain p53 mutations than do antral and corpus cancers, suggesting that cancers in the proximal and distal stomach evolve through different molecular pathways.

p53 immunoreactivity and single-strand conformational polymorphism analysis often fail to predict p53 mutational status

The intent of this study was to investigate the ability of p53 expression and single-strand conformational polymorphism analysis (SSCP) to predict p53 mutational status in archival, paraffin-embedded tissues of gastric cancer. We evaluated paraffin-embedded tissues from 78 patients with advanced gastric cancer. The mutational status of the p53 gene (exons 5-9) was examined by SSCP analysis and by direct sequencing. These results were compared with p53 expression as assessed by immunohistochemical analysis (IHC). We graded p53 expression on a scale from 0 to 8 on the basis of both the intensity and the number of cells staining. Overall, we detected p53 immunoreactivity in 75.6% of the gastric cases; 19 (32.2%) of these cases scored from 1 to 4, and 40 (67.8%) cases scored from 5 to 8. p53 gene mutations were detected in 18 cases (23.1%) by SSCP and in 28 cases (36%) by direct sequencing. Thus, SSCP failed to detect 38% of the mutations found by sequencing. The majority of missed mutations involved exons 7 and 8. The concordance between IHC and SSCP was 37%, and the concordance between IHC and direct sequencing was 50%. Forty-five percent of cases positive by IHC failed to show mutations in exons 5 through 9. Five percent of cases negative by IHC (4 cases) contained mutations. One had a 1-base pair insertion; one had a mutation that resulted in a stop codon; the third had a mutation in exon 8; and the fourth had a mutation in both exons 5 and 8. Our findings indicate that p53 immunoreactivity correlates with the presence or absence of gene mutations in 50% of advanced gastric cancers when exons 5 through 9 are examined and that IHC cannot be reproducibly used as a marker of mutation in the most commonly mutated exons of the p53 gene. Furthermore, the sensitivity of SSCP for detecting mutations is only 62%. Thus, SSCP analysis cannot be used reliably to screen for p53 mutations.

Immunohistologic analysis of gastrointestinal and pulmonary carcinoid tumors

Carcinoid tumors are potentially malignant neoplasms that arise in various body sites, including the lung and gastrointestinal tract. Those that appear cytologically atypical are more likely to behave aggressively than more typical carcinoid tumors. However, in the absence of cytological atypia or large tumor size, it is difficult to predict the biology of an individual tumor, because some lesions metastasize, whereas others do not. This study had four aims: (1) To study the expression pattern of p53, Ki-67, NCAM, and S-100 in carcinoid tumors and to relate these expression patterns to classical histopathologic features and to tumor location. (2) To identify nonhistological markers that might more accurately predict the early behavior of carcinoid tumors. (3) To determine whether sustentacular cells are present in carcinoid tumors arising in tissues derived from different embryological derivatives. (4) To determine the synaptophysin and chromogranin immunoreactivity in neuroendocrine tumors arising in various locations. The immunostaining reactions were quantitatively scored by three observers. Only 3 of the 39 tumors (all histologically atypical) were strongly positive for Ki-67; two of these were also strongly p53 immunoreactive. NCAM immunostaining differed according to the site of origin: 76.5% of foregut lesions, 58% of the midgut lesions, and 20% of hindgut lesions were positive. S-100 immunostaining ranged from 41% in foregut lesions to 50% in both the hindgut- and midgut-derived tumors. S-100-positive sustentacular cells were present in 20.5% of carcinoid tumors. All tumors stained with antibodies against synaptophysin. In contrast, 100% of midgut, 60% of hindgut, and 88% of foregut tumors were chromogranin positive. Carcinoid tumors tend to have low proliferative rates. p53 immunostaining tends to be strongly positive in tumors that are histologically atypical, but it is negative in typical carcinoid tumors arising in the gastrointestinal tract and lungs. Immunostaining reactions with antibodies to NCAM, S-100, and chromogranin differ depending on the site of origin. Synaptophysin stains 100% of carcinoid tumors regardless of their site of origin. In contrast, antibodies to chromogranin fail to stain 40% of hindgut tumors and 12% of foregut carcinoid tumors. S-100-positive sustentacular cells are present in foregut and midgut tumors but not in hindgut tumors.

Serum vitamin D metabolite levels and the subsequent development of prostate cancer (Hawaii, United States)

OBJECTIVES

Because several serum studies of vitamin D metabolites have produced equivocal results on their relation to prostate cancer risk, the purpose of this study is to evaluate this association further.

METHODS

A nested case-control study in a cohort of 3,737 Japanese-American men examined from 1967 to 1970 was conducted in Hawaii (United States). At the time of examination, a single blood specimen was obtained, and the serum was frozen. After a surveillance period of over 23 years, 136 tissue-confirmed incident cases of prostate cancer were identified. Their stored sera and those of 136 matched controls were measured for the following: 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, calcium, phosphorus, and parathyroid hormone.

RESULTS

There were no notable differences between cases and controls in their median serum levels of the five laboratory measurements. Odds ratios (OR) for prostate cancer, based on the quartiles of serum levels in controls, were also determined. The ORs for the highest quartiles relative to the lowest were 0.8 (95 percent confidence interval [CI] = 0.4-1.8) for 25-hydroxyvitamin D and 1.0 (CI = 0.5-2.1) for 1,25-dihydroxyvitamin D.

CONCLUSION

It is possible that the lack of sufficient numbers of study subjects with low vitamin D levels affected the results. Nonetheless, the findings suggest that there is a lack of a strong association between vitamin D and prostate cancer.

Taking a family history in cancer patients with a simple questionnaire

A one-page family history questionnaire was validated in two European areas covered by population-based cancer registries. Information on malignant tumor occurrence in first degree relatives was collected from 193 cancer patients in Trieste, Italy and from 64 in Basel, Switzerland. They were then compared with the corresponding data stored in the registries' files. The sensitivity of the questionnaire was 85% (Trieste) and 74% (Basel), the specificity was 97% in both studies and the overall accuracy 95% (Trieste) and 94% (Basel). The questionnaire is recommended for use in different geographical areas covered by population based registries for comparative analyses of cancer related family histories.

Serum micronutrients and prostate cancer in Japanese Americans in Hawaii

Numerous dietary studies and several serum micronutrient studies have produced equivocal results on the relation of vitamins A and E to prostate cancer risk. To evaluate this association further, we conducted a nested case-control study in a cohort of 6860 Japanese-American men examined from 1971 to 1975. At the time of examination, a single blood specimen was obtained, and the serum was frozen. After a surveillance period of more than 20 years, 142 tissue-confirmed incident cases of prostate cancer were identified. Their stored sera and those of 142 matched controls were measured by high-performance liquid chromatography for the following: total carotenoids, lutein, zeaxanthin, beta-cryptoxanthin, lycopene, alpha-carotene, beta-carotene, total retinoids, retinol, total tocopherols, alpha-tocopherol, delta-tocopherol, and gamma-tocopherol. Odds ratios for prostate cancer, based on quartiles of serum micronutrient levels, were determined using conditional logistic regression analysis. The odds ratio for the highest quartiles were 1.8 (95% confidence interval, 0.9-3.9) for beta-cryptoxanthin, 1.6 (0.8-3.5) for beta-carotene, 0.8 (0.4-1.5) for retinol, and 0.7 (0.3-1.5) for gamma-tocopherol, but none of the differences was statistically significant. For the other micronutrients, the results were also unremarkable. The findings of this study indicate that none of the micronutrients is strongly associated with prostate cancer risk.

Serum micronutrients and upper aerodigestive tract cancer

Numerous dietary studies have found that vegetables and fruits protect against upper aerodigestive tract cancer. To evaluate the role of beta-carotene and other specific carotenoids, a nested case-control study using prediagnostic serum was conducted among 6832 American men of Japanese ancestry examined from 1971 to 1975. During a surveillance period of 20 years, the study identified 28 esophageal, 23 laryngeal, and 16 oral-pharyngeal cancer cases in this cohort. The 69 cases were matched to 138 controls. A liquid chromatography technique, designed to optimize recovery and separation of the individual carotenoids, was used to measure serum levels of lutein, zeaxanthin, beta-cryptoxanthin, lycopene, alpha-carotene, beta-carotene, retinol, retinyl palmitate, and alpha-, delta-, and gamma-tocopherol. With adjustment for cigarette smoking and alcohol intake, we found that alpha-carotene, beta-carotene, beta-cryptoxanthin, total carotenoids and gamma-tocopherol levels were significantly lower in the 69 upper aerodigestive tract cancer patients than in their controls. Trends in risk by tertile of serum level were significant for these five micronutrients. These significant trends persisted in cases diagnosed 10 or more years after phlebotomy for the three individual carotenoids and total carotenoid measurements. The odds ratios for the highest tertile were 0.19 (95% confidence interval, 0.05-0.75) for alpha-carotene, 0.10 (0.02-0.46) for beta-carotene, 0.25 (0.06-1.04) for beta-cryptoxanthin, and 0.22 (0.05-0.88) for total carotenoids. When the cases were separated into esophageal, laryngeal, and oral-pharyngeal cancer, both alpha-carotene and beta-carotene were consistently and strongly associated with reduced risk at each site. The findings suggest that alpha-carotene and other carotenoids, as well as beta-carotene, may be involved in the etiology of upper aerodigestive tract cancer.

Serum androgens and prostate cancer

It is suspected that male hormones are associated with the risk of prostate cancer. To test this hypothesis, we conducted a nested case-control study in a cohort of 6860 Japanese-American men examined from 1971 to 1975. At the time of examination, a single blood specimen was obtained, and the serum was frozen. After a surveillance period of more than 20 years, 141 tissue-confirmed incident cases of prostate cancer were identified, and their stored sera and those of 141 matched controls were assayed for total testosterone, free testosterone, dihydrotestosterone, 3-alpha-androstanediol glucuronide, androsterone glucuronide, and androstenedione. Odds ratios for prostate cancer, based on quartiles of serum hormone levels, were determined using conditional logistic regression methods. The odds ratios for the highest quartiles were 1.37 (95% confidence interval, 0.73-2.55) for 3-alpha-androstanediol glucuronide and 1.24 (95% confidence interval, 0.62-2.47) for androstenedione, but none of the differences was statistically significant. The results were unremarkable for the other four hormonal measurements. In addition, the patients and controls were compared by hormonal ratios (i.e., total testosterone:dihydrotestosterone), but the results were also unremarkable. The findings of this study indicate that none of these androgens is strongly associated with prostate cancer risk.

A prospective study of colon and rectal cancer among Hawaii Japanese men

The goals of this study were to assess the association of diet, alcohol, smoking, and other life-style factors with the risk of colon and rectal cancer and to examine the differences in the risk factors associated with each cancer site. Information on diet, alcohol, smoking, and other life-style factors was obtained from 7945 Japanese-American men who were living in Hawaii and examined from 1965 through 1968. After 174,514 person-years of observation, 330 incident cases of colon cancer and 123 incident cases of rectal cancer were diagnosed by histology. The risk of both colon and rectal cancer increased with age, alcohol intake, and pack-years of cigarette smoking. For colon cancer, there was also a direct association with body mass index and heart rate, while an inverse association was observed with serum cholesterol, intake of monounsaturated fatty acid, and percentage of calories from fat. For rectal cancer, the risk decreased with an increase in the intake of carbohydrates as percentage of calories. These findings suggest that some of the risk factors for colon cancer are different from those for rectal cancer.

Hepatitis B and C virus serologies among Japanese Americans with hepatocellular carcinoma

A cohort of 5924 Japanese American men was examined between 1967 and 1970 for hepatocellular carcinoma (HCC). By 1992, 24 incident cases of HCC were histologically confirmed in the group. Frozen serum samples from the 24 men with HCC and 72 age-matched controls were tested for hepatitis B surface antigen (HBsAg), antibodies to hepatitis B core antigen, antibodies to HBsAg, and antibodies to hepatitis C virus. HBsAg was detected in 15 (62.5%) of 24 HCC cases compared with 2 (2.8%) of 72 controls (odds ratio, 43.0; 95% confidence interval, 5.7-325.5). None of the cases and only 1 control had antibody to hepatitis C virus. This study demonstrates a strong association between hepatocellular carcinoma and hepatitis B virus infection, but not with hepatitis C virus infection, among men of Japanese ancestry in Hawaii.

Pathologic and phenotypic features of gastric cancer

This article covers the basic pathologic features of gastric cancer. Gastric cancer is not a single entity but consists of several major tumor types. The risk factors for their development and their pathological features are discussed. The two major forms of gastric cancer, intestinal and diffuse, are described, as are the settings in which they arise. A number of prognostic factors exist for gastric cancer, including traditional pathologic variables such as histological staging grade and tumor type. Some more recent potential markers involve determinants of biologic behavior. The more frequently encountered types are covered, as well as their clinical implications. Finally, a scheme for standardized handling of gastric resection specimens is presented.

Racial factors cannot explain superior Japanese outcomes in stomach cancer

OBJECTIVE

To compare the stage-stratified survival of Japanese patients treated in Honolulu according to Western techniques with that of Japanese patients treated in Tokyo according to Japanese techniques, thus eliminating race as a potentially confounding variable.

DESIGN AND PATIENTS

Of 312 Honolulu Japanese patients surviving Western-type gastric resection for neoplasm between 1974 and 1985, 279 were identified with invasive gastric adenocarcinoma unassociated with any second malignancy. This Honolulu cohort, treated by Western methods, was retrospectively compared with a similar, previously described cohort of 3176 Tokyo Japanese patients treated according to Japanese methods.

MAIN OUTCOME MEASURES

American Joint Committee on Cancer/Union Internationale Contre le Cancer criteria for stage-stratified survival.

RESULTS

Despite non-TNM prognostic factors favoring higher survival for the Honolulu Japanese patients, for every TNM stage, we observed higher survival for the Tokyo Japanese patients who were treated according to Japanese techniques. For stage I disease, the survival rates were 86% vs 96%, respectively (P < .001); for state II, 69% vas 77% (P = .15); for stage III, 21% vs 49% (P < .001); and for stage IV, 4% vs 14% (P < .001).

CONCLUSIONS

Because all patients in this study are Japanese, race-related factors or the "different-disease" hypothesis cannot explain these results. Lymphadenectomy-related stage-migration and/or differing therapeutic efficacy seem more likely explanations.

Gastric cancer among the Japanese in Hawaii

The incidence rate of gastric cancer among men of Japanese ancestry living in Hawaii is about one-third as high as that of their counterparts living in Japan. Because of this difference, a prospective study was conducted to identify factors related to the development of gastric cancer in Hawaii. Eight thousand and six (8,006) men born from 1900-1919 were examined from 1965 to 1968 and followed for over 25 years. During this time, 250 incident cases of gastric cancer were identified. The study has found the following: 1) prior infection with Helicobacter pylori bacteria increased the risk for stomach cancer; 2) cigarette smoking was positively associated with gastric cancer with age at which smoking started being an important risk factor; 3) after taking cigarette smoking into account, alcohol intake was not related to stomach cancer risk; 4) a low pepsinogen I level identified subjects at increased risk for the intestinal histologic type of gastric cancer; 5) a low serum ferritin level was a marker for increased risk of stomach cancer; 6) there was a weak indication that the intake of vegetables and fruits was inversely related to gastric cancer; 7) there was no association of stomach cancer with levels of serum cholesterol, serum uric acid, serum micronutrients (retinol, beta-carotene or alpha-tocopherol) or blood hematocrit; 8) there was also no association of gastric cancer with body mass index or physical activity.

Infection with Helicobacter pylori strains possessing cagA is associated with an increased risk of developing adenocarcinoma of the stomach

To determine whether infection with a Helicobacter pylori strain possessing cagA is associated with an increased risk of development of adenocarcinoma of the stomach, we used a nested case-control study based on a cohort of 5443 Japanese-American men in Oahu, Hawaii, who had a physical examination and a phlebotomy during 1967 to 1970. We matched 103 H. pylori-infected men who developed gastric cancer during a 21-year surveillence period with 103 H. pylori-infected men who did not develop gastric cancer and tested stored serum specimens from patients and controls for the presence of serum IgG to the cagA product of H. pylori using an ELISA. The serum IgG assay using a recombinant CagA fragment had a sensitivity of 94.4% and a specificity of 92.5% when used in a clinically defined population; serological results were stable for more than 7 years. For men with antibodies to CagA, the odds ratio of developing gastric cancer was 1.9 (95% confidence interval, 0.9-4.0); for intestinal type cancer of the distal stomach, the odds ratio was 2.3 (95% confidence interval, 1.0-5.2). Age < 72 years and advanced tumor stage at diagnosis were significantly associated with CagA seropositivity. We conclude that infection with a cagA-positive H. pylori strain in comparison with a cagA-negative strain somewhat increases the risk for development of gastric cancer, especially intestinal type affecting the distal stomach.

Diet, alcohol, smoking and cancer of the upper aerodigestive tract: a prospective study among Hawaii Japanese men

A cohort study of upper aerodigestive tract cancer was conducted among 7,995 Japanese-American men who were interviewed and examined from 1965 to 1968. Information was collected about smoking history and alcohol and dietary intake. After 24 years, 92 incident cases with histological confirmation of diagnosis were identified. Current cigarette smokers at time of examination had a 3-fold risk for upper aerodigestive tract cancer compared with never-smokers. A dose-response relationship was present with increasing amount and duration of cigarette use. Consumption of beer, wine, spirits and total alcohol was strongly associated with increased risk. Of 23 food and beverage categories, only candy/jelly/soda pop consumption had a statistically significant inverse trend. Frequent consumption of fruit was also inversely associated with this cancer. In contrast, the risk tended to be positively associated with consumption of rice, seaweed, tofu or tsukudani (a mixed dish of fish, sugar, soy sauce and seaweed), but the dose-response relationship was not statistically significant. For nutrient intake, increased calcium and fat intake decreased the risk for this cancer.

Intestinal metaplasia of the stomach. A status report

Intestinal metaplasia in the stomach increases the risk of gastric cancer, and the increased risk is proportional to the extent of the metaplasia. This risk could be generated by one or more mechanisms: (1) the metaplastic tissue is an early step in a multistep induction process; (2) the metaplastic tissue is an epigenetic change that raises the pH of gastric juice by replacing oxyntic mucosa, favoring the growth of a bacteria capable of generating endogenous mutagens; and/or (3) the metaplasia is only a marker for chronic gastritis due to H. pylori infection or pernicious anemia. With the last mechanism, the inflammatory response favors intramural mutagenesis that might result in metaplasia or neoplasia as independent events. Finding gene rearrangements common to both metaplastic and neoplastic tissue may establish a direct link between them, but too few have been identified to account for the large number of stomach cancers that develop in high risk populations. Histochemical and immunochemical stains that identify enzymes or mucosubstances may suggest that metaplastic epithelial cells resemble small or large intestinal cells, but they are distinctly different from both. Moreover, these stains do not indicate whether a given cytologic change is genetic or epigenetic; therefore, they cannot be used to define the relationship between metaplasia and neoplasia. It is unnecessary for practicing physicians to await resolution of this question. It can be assumed that any person with extensive metaplasia is at high risk for gastric cancer and should be subject to periodic screening. The extent of the metaplastic process is probably more important than the metaplastic subtype.

Intestinal metaplasia of the stomach. A status report

Intestinal metaplasia in the stomach increases the risk of gastric cancer, and the increased risk is proportional to the extent of the metaplasia. This risk could be generated by one or more mechanisms: (1) the metaplastic tissue is an early step in a multistep induction process; (2) the metaplastic tissue is an epigenetic change that raises the pH of gastric juice by replacing oxyntic mucosa, favoring the growth of a bacteria capable of generating endogenous mutagens; and/or (3) the metaplasia is only a marker for chronic gastritis due to H. pylori infection or pernicious anemia. With the last mechanism, the inflammatory response favors intramural mutagenesis that might result in metaplasia or neoplasia as independent events. Finding gene rearrangements common to both metaplastic and neoplastic tissue may establish a direct link between them, but too few have been identified to account for the large number of stomach cancers that develop in high risk populations. Histochemical and immunochemical stains that identify enzymes or mucosubstances may suggest that metaplastic epithelial cells resemble small or large intestinal cells, but they are distinctly different from both. Moreover, these stains do not indicate whether a given cytologic change is genetic or epigenetic; therefore, they cannot be used to define the relationship between metaplasia and neoplasia. It is unnecessary for practicing physicians to await resolution of this question. It can be assumed that any person with extensive metaplasia is at high risk for gastric cancer and should be subject to periodic screening. The extent of the metaplastic process is probably more important than the metaplastic subtype.

International comparison on ras gene mutations in latent prostate carcinoma

Latent carcinomas of the prostate, discovered at autopsy in men with no prior treatment for prostatic disease, were studied for ras proto-oncogene mutations. Subjects included 21 Japanese, 15 U.S. whites, 15 U.S. blacks, 20 Hawaiian Japanese and 10 Colombians. PCR and sequence-specific oligonucleotide hybridization identified mutations in 5 Japanese, in 1 Hawaiian Japanese, in 1 U.S. black, in 1 U.S. white and in 3 Colombians. The 5 Japanese tumor samples contained 3 point mutations in codon 12 of K-ras and 2 mutations in codon 12 of N-ras respectively. One tumor in a Hawaiian Japanese man also showed a K-ras point mutation at codon 12. Two Colombians and one U.S. black man had tumors with mutations at codon 61 of H-ras, while 1 Colombian showed an N-ras mutation at this codon. The overall frequency of ras gene mutations was low, but point mutations in codon 12 were most common in latent tumors of Japanese, who experienced the lowest incidence and mortality from this tumor. Latent tumors in men from ethnic groups with high mortality and incidence rates showed fewer ras mutations than the Japanese, and these were more likely to involve codon 61. This finding is consistent with prior studies of more aggressive clinical cancers in Japanese men that indicated a higher frequency of mutations at codon 61.

Helicobacter pylori infection and the risk for duodenal and gastric ulceration

OBJECTIVE

To determine whether a preexisting Helicobacter pylori infection increases the risk for developing duodenal or gastric ulcer.

DESIGN

A nested case-control study based on a cohort of 5443 Japanese-American men who had a physical examination and a phlebotomy from 1967 to 1970.

SETTING

All 10 general hospitals on the Hawaiian island of Oahu.

PATIENTS

150 patients with gastric ulcer and 65 patients with duodenal ulcer identified in the cohort of study participants after a hospital surveillance period of more than 20 years.

MEASUREMENTS

Stored serum specimens from patients and from matched controls were tested for the presence of serum IgG antibody to H. pylori using enzyme-linked immunosorbent assay.

RESULTS

93% of the 150 patients with gastric ulcer and 78% of the matched controls had a positive antibody level for H. pylori-specific IgG, yielding an odds ratio of 3.2 (95% CI, 1.6 to 6.5). For duodenal ulcer, 92% of the 65 patients and 78% of the matched controls had a positive test result, yielding an odds ratio of 4.0 (CI, 1.1 to 14.2). As the level of antibody to H. pylori increased, a statistically significant increase was noted in the risk for gastric and duodenal ulcer. The association with H. pylori infection was statistically significant for both types of ulcer, even when the diagnosis was made 10 or more years after the serum sample had been obtained.

CONCLUSION

Preexisting H. pylori infection increases the risk for subsequent development of either duodenal or gastric ulcer disease.

The frequency of latent prostatic carcinoma in young males: the Japanese experience

Prostates obtained at autopsy from five different ethnic groups were serially step-sectioned and examined microscopically using identical techniques and diagnostic criteria. The groups consisted of African-American and white males from the United States of America, Japanese immigrants in Hawaii, and Japanese men in Japan. The prostates were collected between 1965 and 1979. The fifth group consisted of newly collected prostates from indigenous Japanese between 1982 and 1986. The frequency of latent prostatic carcinoma from men under 50 years of age was compared to each other and with those from men over 50 years of age. Latent carcinoma was not found in men between 30 and 39 years old in any groups except indigenous Japanese men (6%) who died from 1982 to 1986. The frequency of latent carcinoma in the patients in fifth decade varied from 0 to 20%. Latent tumor was not found in the African-Americans in the fifth decade. There was an age-dependent increase in prostate cancer in all groups. The Japanese prostates from 1982 to 1986 had a higher rate of latent cancer than the ones from 1965 to 1979 in each decade. International comparison of the latent prostatic carcinoma from the patients under 50 years of age showed similar tendency as those from over 50 years old, Japanese men had a marked increase in the frequency of latent prostate cancer from 1965-1979 to 1982-1986. These data suggest that the prevalence of prostate cancer may be increasing worldwide.

A prospective study of weight, body mass index and other anthropometric measurements in relation to site-specific cancers

The association of weight, body mass index and other anthropometric measurements with cancer was investigated in a cohort of 7,840 men, examined and interviewed from 1965-1968 in Hawaii. After 23 years of follow-up, histologically confirmed incident cases of prostate (n = 306), colon (n = 289), lung (n = 236), stomach (n = 229) and rectal (n = 108) cancer were identified. Body weight was positively associated with prostate cancer. This direct association was stronger for cases diagnosed 11 or more years after examination than for those diagnosed earlier. A similar pattern was also present for the risk of colon cancer in association with weight and body mass index. For lung cancer, increased subscapular and triceps skinfold thickness were each associated with decreased risk with adjustment for cigarette smoking, but the inverse association did not persist as the time interval from exam to cancer diagnosis lengthened. There was no significant association between anthropometric measurements and stomach or rectal cancer.

Relationship of serum uric acid to cancer occurrence in a prospective male cohort

Uric acid is a potent antioxidant and thus might protect against cancer. To test this hypothesis, we examined the relationship of serum uric acid to subsequent cancer incidence in a cohort of Japanese men in Hawaii. The study population consisted of 7889 men identified in the years 1965-1968 and followed by active hospital surveillance through November 1991. Cancer risk by serum uric acid level was analyzed using Cox proportional hazards regression with adjustment for age and, where indicated, smoking, alcohol use, and body mass index. No significant associations were seen for total cancer (1544 cases), or for cancers of the stomach (214), colon (272), rectum (105), lung (223), bladder (89), or hematopoietic system (77). For prostate cancer (293 cases), a positive association was found (relative risk for highest versus lowest quartile of serum uric acid = 1.5; 95% confidence interval 1.1-2.1; p for trend = 0.04). When the interval from examination to diagnosis was considered, this association was strongest for cases diagnosed in the first 10 years, was attenuated after 15 years, and disappeared completely after 20 years. The findings from this study do not support the hypothesis that uric acid protects against cancer occurrence.

Immunocytochemical identification of a relaxin-like protein in gastrointestinal epithelium and carcinoma: a preliminary report

Immunostaining with antibodies to human relaxin (H2) suggests the presence of a relaxin-like peptide in the gastrointestinal tract and its tumours. The peptide is present in the cytoplasm of non-neoplastic cells at sites of cell exfoliation: the surface cells of the stomach, the small intestinal villi and the surface cells of the colon. It also occurs in the cytoplasm of gastric parietal cells and carcinomas of both the stomach and the colon. Relaxin has been shown to stimulate collagenase gene expression and to down-modulate collagen synthesis and secretion in human skin fibroblasts. The distribution of relaxin shown here suggests that it could play a role in the detachment of non-neoplastic cells from their basement membranes at the end of the cell cycle and in the penetration of carcinoma cells through the basement membrane.

Histopathological predictors of breast cancer death among Caucasians and Japanese in Hawaii

In the United States, Caucasian women are at higher risk of death from breast cancer than age-matched Japanese-Americans. The tumors of Japanese-Americans exhibit a greater uniformity of nuclear grade (NG), greater degrees of intratumoral lymphocytic infiltration (LI), and more conspicuous sinus histiocytosis (SH) in the regional lymph nodes. To assess the impact of histopathology upon the ethnic disparity in breast cancer mortality, we compared the survival experience of Japanese and Caucasian women with breast cancer in Hawaii. The study group consisted of 443 women, aged 45-74, whose cancers were diagnosed between 1975 and 1980. Survival status at 9 or more years after diagnosis, known for 416 of these women, was used in the analyses. Age and tumor stage at diagnosis were significant predictors of breast cancer death in the logistic regression analysis. When histopathological predictor variables (NG, LI, and SH) were included in the model, age, stage, NG, and LI were independently predictive. Although NG predicted stage among all patients, and SH predicted stage among the women with invasive disease, race was an independent predictor breast cancer stage in multivariate analyses. Finally, analysis within stage subgroups revealed that race was independently predictive of cancer death among women with localized disease (confined to the breast) but not among women with regional spread (local extension or axillary nodes involves). These results indicate that histopathological differences contribute to, but only partially explain, the disparity in breast cancer mortality between Caucasians and Japanese in Hawaii.

A prospective study of diet, smoking, and lower urinary tract cancer

The association of diet and smoking with bladder cancer was investigated in a cohort study conducted in Hawaii. The study included 7995 Japanese-American men who were born between 1900 and 1919, and were examined from 1965 to 1968. After 22 years of follow-up, 96 incident cases of bladder cancer were diagnosed. Current cigarette smokers had a 2.9-fold risk of bladder cancer, compared with nonsmokers. A direct dose-response relation was observed, based on pack-years of cigarette smoking. Consumption of fruit was inversely associated with the risk of bladder cancer (P = 0.038). The relative risk was 0.6 among subjects who had the most frequent (> or = 5 times/wk) intake of fruits compared to those with the least intake (< or = 1 time/wk). A weaker inverse association with milk intake was also observed (P = 0.07). Frequent consumption of fried vegetables, pickles, or coffee increased the risk of bladder cancer, but none of these foods showed a significant dose-response relationship. There was no association of other selected foods, alcohol, total calories, protein, fat, or carbohydrates with bladder cancer risk.

Epstein-Barr virus-associated gastric adenocarcinoma among Japanese Americans in Hawaii

This study confirms the observation that some gastric adenocarcinomas contain Epstein-Barr viral (EBV) sequences in their carcinoma cells. EBV sequences were detected by polymerase chain reaction and in situ hybridization in the tumors of 19 of 187 (10.2%) Japanese-American men and women living in Hawaii. The EBV-associated gastric cancers were more frequently present in men than in women: 14 of 99 (14.3%) men versus 5 of 88 (5.7%) women (P = 0.046). EBV type A was found in 17 of the 19 EBV-associated cancers, a finding consistent with the type A predominance in Japanese populations. Intestinal and diffuse-type tumors were both EBV-positive, and moderate to marked inflammation was usually present. The virus was not found in adjacent normal nonneoplastic mucosal cells or in mucosa showing intestinal metaplasia. EBV-associated tumors were found at stages 1 or 2 in 53% of cases, compared with 36% of the EBV-negative cancers (P = 0.13). The presence of EBV did not appear to influence survival. The relatively high incidence of gastric cancer compared to other EBV-associated tumors makes EBV-associated gastric cancer potentially one of the most common EBV-related tumors in the United States.

Helicobacter pylori and gastric cancer

This review focuses on the similarities between the epidemiology of gastric cancer and the epidemiology of Helicobacter pylori. Their demographic patterns and the results of studies regarding familial and environmental risk factors are described. The association of gastric cancer and H. pylori infection with both gastric ulcer and chronic atrophic gastritis is also characterized and the possibility that a H. pylori infection could lead to gastric cancer is discussed.

Lung cancer: a prospective study of smoking, occupation, and nutrient intake

A cohort study of lung cancer was conducted among 7,961 Japanese-American men who were interviewed and examined during 1965-1968. Information was collected about their smoking history, occupation, and nutrient intake. After 22 y, 227 incident cases of lung cancer were identified. Cigarette smoking significantly increased lung cancer risk. The relative risk (RR) was 3.1 for past smokers and 11.4 for current smokers, compared with never smokers. We separated lung cancer cases according to histological type, and it was found that current smokers had a RRs of 16.0 for squamous/small-cell carcinoma and 6.8 for adenocarcinoma of the lung. Unskilled manual workers had a significantly higher risk (RR = 1.5; 95% confidence interval, 1.1-2.2) for lung cancer than workers who were engaged in nonmanual occupations. There was no association between lung cancer and the 24-h intake of total calories, protein, fat, dietary cholesterol, carbohydrates, and alcohol, but this may have resulted from the limitations of a 24-h dietary questionnaire.

A prospective study of alcohol, diet, and other lifestyle factors in relation to obstructive uropathy

The association of alcohol, diet, and other lifestyle factors with obstructive uropathy was investigated in a cohort of 6581 Japanese-American men, examined and interviewed from 1971 to 1975 in Hawaii. By studying this migrant population with its heterogeneous exposures, it increases the probabilities of identifying potential risk factors of this prostate disorder. After 17 years of follow-up, 846 incident cases of surgically treated obstructive uropathy were diagnosed with benign prostatic hyperplasia. Total alcohol intake was inversely associated with obstructive uropathy (P < 0.0001). The relative risk was 0.64 (95% confidence interval: 0.52-0.78) for men drinking at least 25 ounces of alcohol per month compared with nondrinkers. Among the 4 sources of alcohol, a significant inverse association was present for beer, wine, and sake, but not for spirits. Buddhist (vs. other) religion, rural (vs. urban) birthplace, and the presence of prostate symptoms were each associated with increased risk of obstructive uropathy, but no association was found with education, number of marriages, or cigarette smoking. Increased beef intake was weakly related to an increased risk (P = 0.047), while no association was found with the consumption of 32 other food items in the study.