Stomach cancer among New Mexico's American Indians, Hispanic whites, and non-Hispanic whites

Stomach cancer incidence rates vary by ethnic group in New Mexico, with American Indians and Hispanic Whites at higher risk than the state's non-Hispanic White population. To further characterize the descriptive epidemiology of this disease in New Mexico, we investigated temporal trends in stomach cancer mortality and incidence rates. Stomach cancer mortality rates declined over a 25-year period (1958-1982) among New Mexico's Hispanic and non-Hispanic Whites. Birth cohort analysis suggests that much of the decline was achieved prior to 1968. Stomach cancer mortality rates did not drop among American Indians during the same period. Stomach cancer incidence rates remained constant for Hispanic Whites, non-Hispanic Whites, and American Indian males over a 13-year period (1969-1982), but more than doubled among American Indian females. Although environmental factors have been implicated in the etiology of stomach cancer, little is currently known about the distribution of such risk factors among the ethnic groups described in this report. The environmental and biological correlates of sex, ethnicity, and socioeconomic status that determine stomach cancer risk merit further investigation in New Mexico.

Survival after cancer surgery of elderly patients in New Mexico, 1969-1982

To examine the effects of advancing age, sex, and ethnicity on estimated 30-day survival after surgery for cancer, we reviewed population-based data on 16,130 cancer cases collected by the New Mexico Tumor Registry from 1969-1982. For surgery at most sites, mortality increased with increasing age. The highest mortality was observed for sites requiring laparotomy or thoracotomy. Sex and ethnicity (Hispanic versus non-Hispanic white) had little effect on short-term survival. Comparison of short-term survival for two time periods, 1969-1975 and 1976-1982, showed a strong trend of improving survival for many sites.

Ethnic differences in mortality from acute rheumatic fever and chronic rheumatic heart disease in New Mexico, 1958-1982

To examine time trends and differences in mortality rates from acute rheumatic fever and chronic rheumatic heart disease in New Mexico's Hispanic, American Indian, and non-Hispanic white populations, we analyzed vital records data for 1958 through 1982. Age-adjusted mortality rates for acute rheumatic fever were low and showed no consistent temporal trends among the three ethnic groups over the study period. Age-adjusted and age-specific mortality rates for chronic rheumatic heart disease in Hispanic and non-Hispanic whites decreased over the 25-year period, although rates were higher among Hispanics than among non-Hispanics during most of the time period. In American Indians, age-adjusted mortality rates for chronic rheumatic heart disease increased between 1968 and 1977 to twice the non-Indian mortality rates during the same period. Despite this increase in mortality from chronic rheumatic heart disease among New Mexico's American Indians from 1968 to 1977, the New Mexico data generally reflect national trends of decreasing mortality from chronic rheumatic heart disease.

Cancer treatment protocols. Who gets chosen?

We compared the age distribution of all adults in New Mexico with cancer incident from 1959 through 1982 with that of all adult New Mexican patients enrolled in cancer treatment protocols sponsored by the Southwest Oncology Group (New Mexico). For all cancer sites, elderly patients were substantially underrepresented in the Southwest Oncology Group protocols. While 31% of all adult patients with cancer were over age 70 years, only 7% of patients with cancer enrolled in Southwest Oncology Group protocols were in that age group. The underrepresentation of elderly individuals in cancer treatment protocols will make it difficult to determine optimal therapies for older patients with cancer.

Mortality from lung cancer and chronic obstructive pulmonary disease in New Mexico, 1958-82

We examined mortality from lung cancer and from chronic obstructive pulmonary disease in Hispanic White, Other White, and Native American residents of New Mexico during the period 1958-82. Age-specific mortality was calculated by combining death certificate data with population estimates based on the 1960, 1970, and 1980 censuses that were adjusted for inconsistencies in the designation of race and ethnicity. In Other Whites, age-adjusted mortality rates from lung cancer and from chronic obstructive pulmonary disease increased progressively in males and females. Mortality rates for both diseases also increased in Hispanics during the study period, but the most recent rates for Hispanics were well below those for Other Whites. Age-specific mortality rates for lung cancer declined for more recently born Hispanic women at older ages. In Native Americans, rates for both diseases were low throughout the study period and did not show consistent temporal trends.

Ischemic heart disease mortality in Hispanics, American Indians, and non-Hispanic whites in New Mexico, 1958-1982

To describe trends in mortality from ischemic heart disease in New Mexico's Hispanic, American Indian, and non-Hispanic white populations, we used vital records data collected from 1958 through 1982. We calculated age-adjusted and age-specific mortality rates for ischemic heart disease for each of the state's principal ethnic groups. Death certificate data were used in combination with population estimates based on the censuses of 1960, 1970, and 1980. Age-adjusted mortality rates for ischemic heart disease among Hispanics, American Indians, and non-Hispanic white men were consistent with nationwide patterns of rising mortality rates during the 1960s followed by declining rates. Mortality rates from ischemic heart disease in all three ethnic groups in New Mexico were lower than national rates for whites. Rates for Hispanics in New Mexico were lower than for non-Hispanic whites; rates for American Indians were the lowest among the three groups. These data support previous observations that Hispanics and American Indians in the Southwest are at decreased risk for mortality from ischemic heart disease in comparison with U.S. whites.

Intraabdominal operations in patients with leukemia

We reviewed results of intraabdominal operations in 23 patients with acute or chronic leukemia to address morbidity, mortality, and factors associated with complications. We found a higher mortality rate among those who had emergency procedures as opposed to elective procedures. Three of four patients who needed reoperation and all four patients with ischemic or perforated viscus died, all from sepsis. Factors such as age, preoperative leukocyte or granulocyte count, or preoperative use of steroids or antineoplastic drugs did not affect the outcome. We therefore recommend early surgical intervention in these patients, even in the face of granulocytopenia, thrombocytopenia, or active medical treatment.

Changing treatment of breast cancer in New Mexico from 1969 through 1985

A review of information from the New Mexico Tumor Registry on women diagnosed as having primary breast cancer from 1969 through 1985 revealed temporal changes in the surgical treatment of this disease. After 1980 the percentage of women receiving breast-conserving surgery for local-stage disease increased from 6% to 25%. Most surgeons performing operations for breast cancer had not performed a breast-conserving operation before 1981 but had used this procedure at least once in the period from 1981 through 1985. Women younger than 50 years or older than 80 years were most likely to undergo this procedure. In that period, radiotherapy after breast-conserving surgery could not be documented for 26% of the women 65 years old or younger or for 56% of the women aged 65 years or older. Thus, there has been a marked shift in New Mexico in the surgical approach to local-stage breast cancer in the 1980s. This shift involved most surgeons treating the disease and included women of all age groups. The apparent lack of adjuvant radiotherapy in some women receiving conservative surgeries may prove to be a deleterious consequence of this change in surgical management.

Bladder cancer, drinking water source, and tap water consumption: a case-control study

Data from a population-based case-control interview study of incident bladder cancer in 10 areas of the United States were used to estimate relative risks among white men (2,116 cases, 3,892 controls) and women (689 cases, 1,366 controls) according to beverage intake level and type of water source. Individual year-by-year profiles of water source and treatment were developed by linking lifetime residential information with historical water utility data from an ancillary survey. Risk of bladder cancer increased with intake level of beverages made with tap water. The odds ratio (OR) for the highest vs. lowest quintile of tap water consumption was 1.43 [95% confidence interval (CI) = 1.23, 1.67; chi 2 for trend = 26.3, P less than .001]. The risk gradient with intake was restricted to persons with at least a 40-year exposure to chlorinated surface water and was not found among long-term users of nonchlorinated ground water. The ORs for the highest vs. lowest quintiles of tap water intake were 1.7 and 2.0, respectively, among subjects with 40-59 and greater than or equal to 60 years' exposure. Duration of exposure to chlorinated surface water was associated with bladder cancer risk among women and nonsmokers of both sexes. Among non-smoking respondents with tap water consumption above the population median, the OR increased with exposure duration to a level of 3.1 (CI = 1.3, 7.3; chi 2 for trend = 6.3, P = .01) for greater than or equal to 60 years of residence at places served by chlorinated surface water (vs. non-chlorinated ground water users). These results extend findings of earlier epidemiologic studies and are consistent with environmental chemistry and toxicologic data demonstrating the presence of genotoxic by-products of chlorine disinfection in treated surface waters.

Prevalence of benign, atypical, and malignant breast lesions in populations at different risk for breast cancer. A forensic autopsy study

A forensic autopsy series of 519 women more than 14 years old was studied for prevalence of benign, atypical, and occult malignant breast lesions. The women included Anglos (non-Hispanic whites), Hispanics, and American Indians from New Mexico and Eastern Arizona. These three ethnic/racial groups are at markedly different risk for the development of breast cancer (Anglo 89 of 100,000 women per year, Hispanic 45.5, and American Indian 24.9. There were striking ethnic/racial and age-related differences in both the prevalence and magnitude of all forms of nonproliferative and proliferative fibrocystic disease. The various subsets of fibrocystic disease were highly associated with each other. Such lesions as apocrine metaplasia, sclerosing adenosis, and lobular microcalcification showed as much difference according to ethnic/racial background and age as the more common cystic change and duct epithelial hyperplasia. Atypical lobular and ductal hyperplasia, carcinoma in situ, and occult invasive carcinoma were uncommon and also occurred in ethnic/racial groups in a pattern that parallels the cancer risk in those groups.

Survival of American Indian and Hispanic cancer patients in New Mexico and Arizona, 1969-82

Survival was examined by ethnic group for 31,465 incident cancer cases diagnosed from 1969 through 1982 in Hispanic and non-Hispanic whites residing in New Mexico and in American Indians residing in New Mexico and Arizona. In comparison with the 1- and 5-year survival rates following the diagnosis of cancer for non-Hispanic whites, those for American Indians were generally poorer and, to a lesser extent, those for Hispanics were also poorer. The American Indian and Hispanic patients tended to have more advanced disease at the time of diagnosis, although this pattern was not consistent across all sites. For many primary cancer sites, American Indian patients were less likely to receive treatment for their cancer than were non-Hispanic whites. Hispanics were also less likely to be treated for cancers of some sites, although the differences were not as large as for American Indians. However, after adjustment for stage and treatment, American Indians demonstrated significantly poorer survival than non-Hispanic whites for cancers of many sites. After adjustment for stage and treatment, survival in Hispanics was generally comparable to that in non-Hispanic whites.

Factors influencing discrepancies between premortem and postmortem diagnoses

A study of 2067 autopsies collected from 32 university and community hospitals of various sizes located throughout the United States showed the rate of discrepancies between premortem and postmortem diagnoses to be influenced by the type and size of hospital, the age and sex of the patient, and the disease responsible for the patient's death. Of equivocal or no influence were the length of the terminal hospitalization, the degree of clinical involvement in the case of the person responsible for establishing the discrepancy level, and the autopsy rate, at least as it applies to community hospitals.

Gastric carcinoma in the young: a clinicopathological and immunohistochemical study

Seventeen patients 40 yr of age and less with gastric carcinoma were studied retrospectively. Clinicopathological findings and survival data were collected on all patients. Immunohistochemistry for serotonin, gastrin, somatostatin, carcinoembryonic antigen, beta-human chorionic gonadotropin, and alpha-fetoprotein was performed and the results correlated with pathological and survival data. Patients were divided into two groups according to the presence or absence of endocrine markers in their tumors. The group with endocrine immunoreactivity tended to present with less advanced disease and had longer survival than the group without endocrine immunoreactivity (p less than 0.05). Although the number of patients in the study is too small to reach definite conclusions, our results are interesting in light of current knowledge of the pathobiology of gastric carcinoma and have important implications for future investigations.

Childhood cancer epidemiology in New Mexico's American Indians, Hispanic whites, and non-Hispanic whites, 1970-82

The statewide population-based New Mexico Tumor Registry identified 473 malignant tumors among children of ages 0-14 years, during the period 1970-82. There were 235 non-Hispanic whites (50%), 189 Hispanic whites (40%), 38 American Indians (8%), and 11 other nonwhites (2%). The average annual age-adjusted incidence rates per million for non-Hispanic whites were 138.6 for males and 108.3 for females; for Hispanic whites, the rates were 108.5 for males and 80.9 for females; for American Indians, the rates were 75.5 for males and 78.0 for females. The incidence rates for all sites of cancer combined were lower for Hispanics and American Indians than for New Mexico's non-Hispanic whites and U.S. whites. Leukemia was the most common cancer in all racial-ethnic groups. In comparison with U.S. whites, American Indians were at low risk for leukemias, lymphomas, central nervous system (CNS), sympathetic nervous system (SNS), and kidney tumors and were at high risk for retinoblastoma, bone, and sex organ tumors. Hispanics were at low risk for CNS, SNS, kidney, sex organ, and liver tumors. Hispanic and non-Hispanic white males both were at increased risk for melanoma.

Stage at diagnosis of cancer varies with the age of the patient

The stage of a cancer at diagnosis is multiply determined, theoretically depending on such disparate factors as tumor biology, patient education, and physician behaviors. Data from all Hispanic and non-Hispanic white residents of New Mexico diagnosed with a malignancy from 1969 through 1982 were analyzed to determine the relationship between the age of the patient and the stage of cancer at the time of diagnosis. Three general patterns were apparent. For cancers of the bladder, breast, cervix, ovary, thyroid, and uterus, and for melanoma, there were significant linear trends for the cancers to be diagnosed at more advanced stages in older patients. For cancers of the lung, pancreas, rectum, and stomach, there were significant linear trends for cancers to be diagnosed at an earlier stage in older patients. For cancers of the colon, kidney, liver, and prostate, there were no significant linear trends in stage at diagnosis versus age of the patient.

Cystosarcoma phyllodes: epidemiology, pathohistology, pathobiology, diagnosis, therapy, and survival

Cystosarcoma phyllodes is a very rare tumor which maybe difficult to diagnose clinically. The epidemiology and pathobiology are different from those of breast carcinoma. Risk factors, multicentricity, bilaterality, as associated with breast carcinoma, are not observed in patients with cystosarcoma phyllodes. Although the term "sarcoma" indicates a malignant tumor, only 10%-30% of cystosarcomas are histologically diagnosed as malignant; clinical diagnosis of malignancy does not exceed 10%. Axillary node involvement is rare, but hematogenous spread of cystosarcoma occurs into lung, pleura, bone, and liver. Clinically, cystosarcoma is a large (usually 3-5 cm in diameter) painless tumor with sudden growth acceleration especially during pregnancy. Cystosarcoma is usually circumscribed, containing firm and soft areas. The differential diagnosis has to include fibroadenoma, fibrocystic disease, mastitis, abscess, and medullary carcinoma. Neither clinical, mammographic or sonographic signs exist to predict a benign or malignant tumor. Therapy of cystosarcoma is not uniformly agreed upon. Radical, modified-radical, and simple mastectomy and tumorectomy are typical treatments; therapeutic results are the same for each treatment modality. For histologically diagnosed malignant cystosarcoma, the relative 5-year survival rate is about 80%. Clinically, malignant metastatic cystosarcoma is incurable; radiotherapy, endocrine treatment, and polychemotherapy are all ineffective. Because of the specific tumor pathobiology of cystosarcoma and its rarity, evaluation of treatment modalities and comparison of survival rates are difficult.

Uranium mining and lung cancer in Navajo men

We performed a population-based case-control study to examine the association between uranium mining and lung cancer in Navajo men, a predominantly nonsmoking population. The 32 cases included all those occurring among Navajo men between 1969 and 1982, as ascertained by the New Mexico Tumor Registry. For each case in a Navajo man, two controls with nonrespiratory cancer were selected. Of the 32 Navajo patients, 72 per cent had been employed as uranium miners, whereas no controls had documented experience in this industry. The lower 95 per cent confidence limit for the relative risk of lung cancer associated with uranium mining was 14.4. Information on cigarette smoking was available for 21 of the 23 affected uranium miners; eight were nonsmokers and median consumption by the remainder was one to three cigarettes daily. These results demonstrate that in a rural nonsmoking population most of the lung cancer may be attributable to one hazardous occupation.

A melanoma case-control study at the Los Alamos National Laboratory

We conducted a melanoma case-control study at the Los Alamos National Laboratory to investigate whether related occupational exposures or personal characteristics of employees could be identified. This study was prompted by a recent report from the Lawrence Livermore National Laboratory that melanoma was much more frequent than expected among employees and that persons suffering from melanoma more often worked as chemists. Our investigation did not uncover an association with plutonium body burden, cumulative external radiation exposure, or employment as a chemist or a physicist. The major finding was that cases were more educated than controls. Melanoma risk was 2.11 among college-educated employees and increased to 3.17 among those with graduate degrees (Mantel-extension linear trend probability = 0.038). This finding is consistent with the often reported increased melanoma incidence among persons of higher social class. It points to personal characteristics, particular to persons of higher educational attainment, as risk factors for melanoma at the Los Alamos National Laboratory.

Survey research in New Mexico Hispanics: some methodological issues

A prevalence survey of respiratory diseases was conducted in Albuquerque, New Mexico, with the objective of explaining differing patterns of respiratory disease epidemiology in Hispanic and non-Hispanic whites (Anglos). The study population was selected at random from the 1978 R.L. Polk & Co. Directory. This paper focuses on methodological issues raised during the conduct of the study: response rates, potential language barriers and bias, and identification of Hispanics by surnames. Mail, telephone, and personal interview approaches were used to obtain adequate response rates, which ranged from 60% in Hispanic males to 78% in Anglo females; 22% of Hispanic males refused interview. Fewer Hispanics returned mailed questionnaires than responded to telephone interviewing. Spanish language was increasingly preferred as the respondent's age increased. Two methods of ethnic identification by surname (1980 Census List of Spanish Surnames and a computer program, GUESS (Generally Useful Ethnic Search System) were compared to the self-reported ethnicity of respondents. The GUESS Program was more sensitive than the census list, but the census list was more specific. The combination of both methods produced a 90% sensitivity and 97% specificity in males. Intermarriage reduced the accuracy in females.

Selected characteristics of cervical cancer incidence cases

Selected demographic characteristics associated with incidence cases of uterine cervical squamous severe dysplasia and carcinoma were determined. The mean age at histologic detection for all patients with Papanicolaou smears at not greater than three-year intervals was 31.0 years, with a range of 19 to 63. Invasive carcinomas were predominantly of the microinvasive type, and the mean age of patients was 34.1 years. The mean interval for conversion from cytologic negativity or mild dysplasia was 2.2 years, and two basic patterns of conversion were recognized: (1) continuously increasing atypia and (2) retrogressive cytologic findings. Most instances of the latter type probably were due to inadequacies of cellular sampling. No significant correlation was found between conversion interval and age of patient. A case-control comparison of gravidity and parity showed statistically significantly higher values among index cases for both measures for ages 20 to 29 but not for 30 years or older, implicating youthful pregnancy as an etiologic factor in cervical carcinogenesis.

Use of hair dyes and risk of bladder cancer

The relation between use of hair dyes and risk of bladder cancer was assessed using data from a case-control study of bladder cancer. Incident cases (2982) and general population controls (5782) were interviewed. The overall estimate of relative risk of bladder cancer for users of hair dyes was 1.0 (95%) confidence interval, 0.9 to 1.2) compared to nonusers. No consistent pattern of association was detected between bladder cancer risk and various indices of timing or intensity of exposure to hair dyes. Various explanations of the lack of association are discussed.

Malignant melanoma of the skin in New Mexico 1969-1977

We assessed the occurrence of malignant melanoma of the skin in New Mexico from 1969-1977. Incidence data, collected by the New Mexico Tumor Registry, were supplemented with mortality data supplied by the State Bureau of Vital Statistics. These data were analyzed for variation by site, sex, and ethnic group. Malignant melanoma occurrence varied with ethnicity. Incidence rates for non-Hispanic whites (Anglos) exceeded comparison US rates, and were approximately six times higher than for other ethnic groups. Annual incidence rates for Hispanics, American Indians, and blacks of both sexes ranged from 0.0-1.8 cases per 100,000. As anticipated from other studies, the lower extremities were the most common site in Anglo women, and the trunk was the most common site in Anglo men. In contrast, the trunk was the most common site for both Hispanic men and women. A statistically significant trend of increasing incidence was demonstrated only for the Anglo women. Mortality rates varied widely during the study period and did not correlate with incidence rates.

Malignant melanoma incidence at the Los Alamos National Laboratory

In an analysis of melanoma incidence for 1969 to 1978 among 11 308 workers at the Los Alamos National Laboratory in New Mexico 6 cases were detected in the total cohort, in which 5.69 cases would be expected (standardised incidence ratio [SIR] = 105; 90% confidence interval [CI] = 51,198) on the basis of incidence rates for the State of New Mexico, specific for age, sex, and ethnic origin. Among the White non-Hispanic men, 3 cases were detected, whereas 4.4 would be expected. The associated SIR of 68 (90% CI = 23, 163) does not suggest excess melanoma incidence in this subcohort. A direct comparison with Statewide incidence rates gave similar results. These results do not agree with the threefold excess of malignant melanoma incidence found among White male employees at the Lawrence Livermore National Laboratory.

Respiratory disease in a New Mexico population sample of Hispanic and non-Hispanic whites

To characterize the epidemiologic features of respiratory diseases among Hispanics, we conducted a prevalence survey in Bernalillo County, New Mexico. The ATS-DLD-78 respiratory symptoms questionnaire was completed by 633 Hispanics and 1,038 Anglos (non-Hispanic whites) with an overall response rate of 72%. The prevalence of major respiratory diseases differed between the groups. Physician-confirmed chronic bronchitis or emphysema, and asthma were reported less often by Hispanics. Although patterns of cigarette usage (current, previous, never) were similar, current and cumulative cigarette consumption was significantly lower in Hispanics. Most differences in symptom frequency and the lower Hispanic prevalence of chronic bronchitis or emphysema were attributable to lower cigarette consumption by Hispanics. However, the prevalence of asthma remained significantly lower among Hispanics after controlling for cigarette smoking. These results documented differences in the prevalence of respiratory disease between the Hispanics and Anglos, which were partially explained by the distributions of known risk factors.

Carcinoma of the cervix in Southwestern American indians: results of a cytologic detection program

Age-specific detection rates for newly diagnosed in situ and invasive uterine cervical carcinoma were determined in a nine-year cytologic cancer detection program during which 34,700 Southwestern American Indian women and 46,200 medically indigent non-Indian women were screening for cervical cancer. For patients less than 35 years of age, cervical carcino a was found more frequently among Indians and Spanish-American Caucasians than among other Caucasian women. At ages 60 and older, the Indian cervical cancer rate was much higher than that of non-Indians. The detection rate for invasive cervical carcinoma among Indian patients is inversely related to the proportion screened at 30 years of age or older. Although at least 60% of Indian women 20 years old, and older, in the geographic area served by the detection program were screened for cervical cancer during the nine-year period, only 27% of those 50 years or older were screened. The age-related variation in screening percentage, in conjunction with the disproportionately large numbers of younger low-risk women, serves to explain the finding of significant invasive cervical carcinoma in an extensively screened population.

Respiratory disease mortality in New Mexico's American Indians and Hispanics

To determine the effect of ethnic group on respiratory disease occurrence, average annual sex, ethnic, and disease specific mortality rates for the period of 1969 to 1977 were calculated for New Mexico's American Indian, Hispanic, and Anglo populations. Incidence data were available for respiratory tract cancer. This study corroborates previous findings of reduced mortality from lung cancer in American Indians of both sexes and in Hispanic males. American Indian mortality from tuberculosis and from influenza and pneumonia was high. Hispanic males and American Indians of both sexes showed low mortality rates for chronic obstructive pulmonary disease (COPD). Differing cigarette usage is the most obvious explanation for the variations in COPD and lung cancer occurrence with ethnic group.

Comparative late effects of X-rays and negative pimesons on the mouse kidney

A system is described for comparing various modalities and fractionation schedules of radiation by means of their long-term morphologic effects upon the mouse kidney. The comparison system utilizes a grading scale for histopathologic changes in which a given histologic grade depends upon meeting defined threshold criteria, rather than quantitation of a particular measurement. Renal tubular alterations served as the basis for comparison, since they appeared more reliably defined than glomerular changes. The radiation dose that induced a specific threshold effect in kidneys from 50% of the animals at 6 months was defined as the effective dose-50%, or ED50.ED50 was found for x-rays and negative pimesons administered in 1, 2, or 5 fractions. From these data, the relative biologic effectiveness (RBE) of negative pi-mesons with respect to x-rays was determined for each fractionation schedule.

Altitude and ischemic heart disease in tricultural New Mexico: an example of confounding

The relationship of male white ischemic heart disease (IHD) death rates to altitude falls to negligible levels when New Mexico populations are separated into Hispanic and Anglo. Low rates of IHD mortality characterize Hispanic males in New Mexico regardless of altitude. In comparison, New Mexico Anglo males have rates near the US average. The variable showing the most consistent positive relationship with altitude is per cent Hispanic. Mortimer et al. (N Engl J Med 296:581--587, 1977) reported a reduction in coronary heart disease mortality in New Mexico white males with an increase in altitude. The current authors claim that this is an example of confounding. They find that the relationship between IHD mortality and altitude is largely due to the intervening variable, per cent Hispanic. Ethnicity demands major attention in epidemiologic studies in tricultural New Mexico.

Gallbladder disease and gallbladder cancer among American Indians in tricultural New Mexico

Previous studies have reported high rates of gallbladder disease and gallbladder cancer among all American Indians. Data from the New Mexico Tumor Registry confirm these findings, specifically showing high rates for New Mexico's American Indians, as well as for the state's Spanish population. This review explores several risk factors, including parity, obesity, age, cholesterol level, and genetic factors. From the available evidence, genetic factors appear to be the most important, with parity a contributing factor.

Multiple primary cancers: relative risk in New Mexico's triethnic population

A review of the population-based New Mexico Tumor Registry data identified 446 patients with nonsimultaneous multiple primary cancers, excluding non-melanoma skin cancers and carcinomas in situ of the uterine cervix. Expected numbers of cases were established by observing the person-years of exposure to the risk of developing a second or subsequent primary cancer and then applying the appropriate locally determined age-, sex-, ethnic-, and site-specific cancer incidence rates. The relative risk (observed/expected) of developing a second primary cancer was elevated for "Anglo" and Spanish American cancer patients in comparison with the risk of developing a first primary cancer in persons who have never had one. Only six cases of nonsimultaneous multiple primary cancer were observed (6.39 expected) in the region's American Indian population. There were differences in site-site associations among the three ethnic groups, but in many categories there were too few cases for analysis.

Carcinoma of the gallbladder in a population of Southwestern American Indians

The clinical and pathological characteristics of gallbladder carcinoma were studied in a group of 56 Southwestern American Indian patients. This is the third most common malignant tumor among American Indian females in a population served by the New Mexico Tumor Registry accounting for 8.5% of specific cancer diagnoses by site. Carcinoma of the gallbladder is relatively more common within the Indian population than among Spanish Americans or Anglos living in this area. This is true for both sexes. No significant differences in average age at diagnosis, ratio of female to male patients, signs and symptoms, stage at diagnosis or survival were detected in comparison with studies pertaining to gallbladder carcinoma in non-Indian populations. A squamous cell carcinoma component was unusually common however, and carcinoma in situ or atypical adenomatous hyperplasia of the mucosa was frequently documented adjacent to invasive carcinoma. Although gall stones were present in tumor containing gallbladders in 93% of cases, elective cholecystectomy for cholelithiasis is probably not a practical means of prevention of this tumor in view of the unusual frequency of cholelithiasis in Indian women. Pharmacological conversion of bile to a non-lithogenic form may deserve consideration as prophylaxis against both cholelithiasis and carcinoma of the gallbladder in this population.

Aging in Hiroshima and Nagasaki atomic bomb survivors. Speculations based upon the age-specific mortality of persons with malignant neoplasms

Evaluation of 1639 malignant tumors from 3067 autopsies of members of the Extended Life Span Study Sample reveals that death occurs earlier in those persons most heavily irradiated ([unk]100 rad) compared with those persons who were less exposed. This effect is particularly pronounced in the younger age categories and among females and is not attributable to a specific neoplasm. Assuming that a positive correlation exists between aging and the age-specific mortality of persons with neoplasms, it is concluded that this response is consistent with other observations which suggest the presence of accelerated or precocious aging in the most heavily irradiated group of survivors.