Cancer incidence in migrants to New South Wales

Incidence profile of four major cancers among migrants in Australia, 2005-2014

PURPOSE

To compare the incidence profile of four major cancers in Australia by place of birth.

METHODS

In this retrospective population-based cohort study, the analysis included 548,851 residents diagnosed with primary colorectum, lung, female breast, or prostate cancer during 2005-2014. Incidence rate ratio (IRR) and 95% confidence intervals (CI) were calculated for migrant groups relative to Australian-born.

RESULTS

Compared with Australian-born residents, most migrant groups had significantly lower incidence rates for cancers of the colorectum, breast and prostate. The lowest rates of colorectal cancer were among males born in Central America (IRR = 0.46, 95% CI 0.29-0.74) and females born in Central Asia (IRR = 0.38, 95% CI 0.23-0.64). Males born in North-East Asia had the lowest rates of prostate cancer (IRR = 0.40, 95% CI 0.38-0.43) and females born in Central Asia had the lowest rates of breast cancer (IRR = 0.55, 95% CI 0.43-0.70). For lung cancer, several migrant groups had higher rates than Australian-born residents, with the highest rates among those from Melanesia (males IRR = 1.39, 95% CI 1.10-1.76; females IRR = 1.40, 95% CI 1.10-1.78).

CONCLUSIONS

This study describes cancer patterns among Australian migrants, which are potentially helpful in understanding the etiology of these cancers and guiding the implementation of culturally sensitive and safe prevention measures. The lower incidence rates observed for most migrant groups may be maintained with continued emphasis on supporting communities to minimize modifiable risk factors such as smoking and alcohol consumption and participation in organized cancer screening programmes. Additionally, culturally sensitive tobacco control measures should be targeted to migrant communities with high lung cancer incidence rates.

Cancer Incidence in Migrants in Australia: Patterns of Three Infection-Related Cancers

BACKGROUND

Australia provides an ideal population-base for cancer migration studies because of its multicultural society and high-quality cancer registrations. Among migrant groups there is considerable variability in the incidence of infection-related cancers; thus, the patterns of three such cancers were examined among migrant groups relative to Australian-born residents.

METHODS

Using national incidence data for cancers of the stomach, liver, and cervix diagnosed during 2005 to 2014, incidence rates were compared for selected migrant groups with the Australian-born population using incidence rate ratios (IRR), from a negative binomial regression model.

RESULTS

Wide variations in incidence between countries/regions of birth were observed for all three cancers (P < 0.0001). The patterns were similar for cancers of the stomach and liver, in that migrants from countries/regions with higher incidence rates maintained an increased risk in Australia, with the highest being among South American migrants (IRR = 2.35) for stomach cancer and among Vietnamese migrants (5.44) for liver cancer. In contrast, incidence rates of cervical cancer were lower for many migrant groups, with women from Southern Asia (0.39) and North Africa (0.42) having the lowest rates. The rate of cervical cancer was higher in migrants from New Zealand, Philippines, and Polynesia.

CONCLUSIONS

Several Australian migrant groups were found to experience a disproportionate burden of infection-related cancers; further studies of associated risk factors may inform the design of effective interventions to mediate these disparities.

IMPACT

By identifying these migrant groups, it is hoped that these results will motivate and inform prevention or early detection activities for these migrant groups. See related commentary Dee and Gomez, p. 1251.

Cancer Incidence and Mortality Among Ethnic German Migrants From the Former Soviet Union

Germany is a country known for immigration. In 2015, 21% of the general population in Germany consisted of individuals with a migration background. This article focuses on cancer-specific incidence and mortality among one of the biggest migrant groups in Germany: the resettlers. Resettlers are ethnic Germans who mainly immigrated from the Russian federation and other countries of the former Soviet Union after its collapse in 1989. We investigated differences between resettlers and the general German population, regarding (i) incidence and mortality of malignant neoplasms, (ii) time trends of the corresponding incidence and mortality, and (iii) cancer stage at diagnosis. We provide data from two resettler cohorts covering an observation time of 20 years: one cohort on cancer incidence (N = 32,972), and another cohort on mortality (N = 59,390). Cancer-specific standardized incidence ratios (SIR) and standardized mortality ratios (SMR) for all malignant neoplasms combined and the most common cancer-sites were calculated between resettlers and the general German population. Time trend analyses using Poisson regression were performed to investigate the developments of SIRs and SMRs. To investigate differences in stage at diagnosis, logistic regression was performed, calculating Odds Ratios for condensed cancer stages. We observed higher incidence and mortality of stomach cancer [SIR (men) 1.62, 95%CI 1.17-2.19; SMR (men) 1.62, 95%CI 1.31-2.01; SIR (women) 1.32, 95%CI 0.86-1.94; SMR (women) 1.52, 95%CI 1.19-1.93] and higher mortality of lung cancer [SMR (men) 1.34, 95%CI 1.20-1.50] among resettlers compared to the general German population, but lower incidence and mortality of colorectal (both sexes), lung (women), prostate and female breast cancer. However, time trend analyses showed converging incidence risks of cause-specific incidence over time, whereas differences of mortality did not show changes over time. Results from logistic regression suggest that resettler men were more often diagnosed with advanced cancer stages compared to the Münster population. Our findings suggest that risk factor patterns of the most common cancer-sites among resettlers are similar to those observed within the Russian population. Such increases in prostate, colorectal and breast cancer incidence may be the consequence of improved detection measures, and/or the adaptation of resettlers to the German lifestyle.

Cancer risk diversity in non-western migrants to Europe: An overview of the literature

BACKGROUND

Cancer risk varies geographically and across ethnic groups that can be monitored in cancer control to respond to observed trends as well as ensure appropriate health care. The study of cancer risk in immigrant populations has great potential to contribute new insights into aetiology, diagnosis and treatment of cancer. Disparities in cancer risk patterns between immigrant and autochthonous populations have been reported many times, but up to now studies have been heterogeneous and may be discordant in their findings. The aim of this overview was to compile and compare studies on cancer occurrence in migrant populations from non-western countries residing in Western Europe in order to reflect current knowledge in this field and to appeal for further research and culturally sensitive prevention strategies.

METHODS

We included 37 studies published in the English language between 1990 and April 2010 focussing on cancer in adult migrants from non-western countries, living in the industrialised countries of the European Union. Migrants were defined based on their country of birth, ethnicity and name-based approaches. We conducted a between-country comparison of age-adjusted cancer incidence and mortality in immigrant populations with those in autochthonous populations.

FINDINGS

Across the board migrants from non-western countries showed a more favourable all-cancer morbidity and mortality compared with native populations of European host countries, but with considerable site-specific risk diversity: Migrants from non-western countries were more prone to cancers that are related to infections experienced in early life, such as liver, cervical and stomach cancer. In contrast, migrants of non-western origin were less likely to suffer from cancers related to a western lifestyle, e.g. colorectal, breast and prostate cancer.

DISCUSSION

Confirming the great cancer risk diversity in non-western migrants in and between different European countries, this overview reaffirms the importance of exposures experienced during life course (before, during and after migration) for carcinogenesis. Culturally sensitive cancer prevention programmes should focus on individual risk patterns and specific health care needs. Therefore, continuously changing environments and subsequently changing risks in both migrant and autochthonous populations need to be observed carefully in the future.

Ethnic and socioeconomic trends in testicular cancer incidence in New Zealand

Ethnic differences in testicular cancer incidence within countries are often sizeable, with white populations consistently having the highest ethnic-specific rates. Many studies have found that high socioeconomic status is a risk factor for testicular cancer. The objectives of this article are to test whether trends in testicular cancer incidence have varied by ethnicity and socioeconomic position in New Zealand between 1981 and 2004. Five cohorts of the entire New Zealand population for 1981-1986, 1986-1991, 1991-1996, 1996-2001 and 2001-2004 were created, and probabilistically linked to cancer registry records, allowing direct determination of ethnic and household income trends in testicular cancer incidence. There were more than 2,000 cases of testicular cancer over the study period. We found increasing rates of testicular cancer for all ethnic and income groups since 1990s. Maori had higher rates, and Pacific and Asian lower rates than European/other men with rate ratios pooled over time of 1.51 (95% CI 1.31-1.74), 0.40 (95% CI 0.26-0.61) and 0.54 (95% CI 0.31-0.94), respectively. Overall, men with low incomes had higher risk of testicular cancer than those with high incomes (pooled rate ratio for lowest to highest income groups = 1.23; 95% CI 1.05-1.44). There was no strong evidence that disparities in testicular cancer incidence have varied by ethnicity or household income over time. Given the lack of understanding of the etiology of testicular cancer, the unusual patterns identified in the New Zealand context may provide some etiological clues for future novel research.

Immunosuppression and other risk factors for lip cancer after kidney transplantation

Incidence of lip cancer is markedly increased after kidney transplantation. Immunosuppression and other risk factors for lip cancer were investigated in a population-based, nationwide cohort of 8,162 kidney transplant recipients registered on the Australia and New Zealand Dialysis and Transplant Registry (1982-2003). Lip cancer diagnoses were ascertained using probabilistic data linkage with the Australian National Cancer Statistics Clearing House. Standardized incidence ratios were used to compare lip cancer risk by subsite of lip and during periods of transplant function and failure. Risk factors during the first functioning transplant were examined using multivariate Poisson regression. Lip cancer was diagnosed in 203 patients. All cases were of squamous cell origin and mostly (77%) affected the lower vermillion. Cases occurred predominantly during periods of transplant function, with incidence decreasing to pretransplantation level on transplant failure and cessation of immunosuppression. During transplant function, cancer of the lower vermillion was associated with increasing year of age [incidence rate ratio (IRR), 1.03; 95% confidence interval (95% CI), 1.02-1.05], greater time since transplantation (P < 0.001), smoking (IRR, 2.13; 95% CI, 1.12-4.07), and current use of azathioprine (IRR, 2.67; 95% CI, 1.39-5.15) or cyclosporine (IRR, 1.63; 95% CI, 1.00-2.65). Female sex (IRR, 0.29; 95% CI, 0.18-0.46) and non-Australian/New Zealand country of birth (P = 0.006), surrogate indices of reduced exposure to solar UV radiation, were significantly protective. Lip cancer after transplantation is strongly related to the current receipt of immunosuppression. During transplant function, lip cancer risk is associated with the duration of immunosuppression, receipt of specific immunosuppressive agents, and UV exposure.

Breast Cancer among Immigrants: A Systematic Review and New Research Directions

This paper highlights the relationship between migration and female breast cancer. A comprehensive review aimed at identifying risk and protective factors that cut across races and ethnicities was performed. A total of 79 studies (1971-2005) from 16 countries were reviewed. The findings are consistent with existing knowledge about the importance of potentially modifiable environmental and behavioral determinants of risk, acting both pre- and post-migration. While the acculturation-based risk transition model is strong, it is not always supported. As a new direction for migrant studies, we extrapolate the review findings to the experience of Eastern European (EE) immigrants. Health data on this population, typically characterized by low health motivation and passive receipt of preventive efforts, are largely unavailable. Based on relevant theory, empirical and qualitative studies, two breast cancer prevention models for the EE immigrant population are proposed and the need for future research using ethnically disaggregated data is discussed.

Update on cancer control in women

The global cancer burden in women appears to have stabilized according to the most recent estimates available although the distribution of cancer types appears to be changing with a sharp contrast between the increase in the absolute numbers of breast cancers and a decline in cervix cancers. Prospects for cancer control in women appear to be good within our current knowledge and deserve close attention. Rates of lung cancer in women are increasing substantially in many countries and seem set to overtake breast cancer as the commonest form of cancer death in women in many parts of the world. These changes are due to the effects of cigarette smoking, a habit which women widely embraced during the second half of the last century. The high levels of smoking currently in young women, which have yet to have their full impact on death rates, constitute an important hazard not only for future cancer risks but for several other important causes of death. There is strong and consistent evidence that increased consumption levels of fruit and vegetables is associated with reduced risks of many common forms of cancer including breast cancer. Although the breast is the commonest form of cancer in women in most western countries, the etiology of this disease remains elusive and preventable causes remain to be identified. Endogenous hormones also appear to have a role in cancer risk in women: oral contraceptives seem to increase slightly the risk of breast cancer in users in the use and in the immediate post-use period, but 10 years after cessation the risk again returns to that of never users. Oral contraceptive usage also appears to be protective against ovarian and endometrial cancer. The use of hormonal replacement therapy (HRT) appears to increase the risk of endometrial cancer and a positive association with breast cancer risk appears to exist. Within our current knowledge of the epidemiology of cancer in women, the most important preventive strategies would appear to be the prevention of cigarette smoking and increased dietary intake of vegetables and fruits. Screening has also shown to be effective in reducing incidence and mortality of cervix cancer and mortality from breast cancer. Although more work is needed, it is becoming clear that there could be an important role of HPV testing to further enhance cervix cancer screening. There are important variations in survival from a variety of cancers which are due to factors unrelated to the tumor behavior and that there are significant variations in survival from cancer. Reduction of these gaps could lead to a reduction in cancer mortality and contribute towards increased prospects for cancer control in women.

Cancer mortality in migrants from the British Isles and continental Europe to New South Wales, Australia, 1975-1995

Routinely collected data for New South Wales were used to analyse cancer mortality in migrants from the British Isles, southern Europe and eastern Europe according to duration of residence in Australia. A case-control approach compared deaths from cancer at one site with deaths from all other cancers, adjusting for age, sex and calendar period. Compared with the Australia-born, migrants had a significantly lower risk of dying from cancers of the mouth/pharynx and prostate (migrants from each region), colon/rectum (from the British Isles and southern Europe) and lung (female southern European migrants), evident from the time of migration and maintained for 30 years after migration. Whereas a deficit of deaths from colorectal cancer remained in migrants from southern Europe, a clear gradient of increasing risk with duration of stay in Australia was apparent. A similar trend was seen with respect to kidney cancer in southern European migrants. Persistent excess risks of death from stomach cancer were seen in all migrant groups, from lung cancer in British migrants and from liver cancer in southern and eastern European migrants. Although the risk of death from breast cancer increased significantly with duration in Australia in southern European migrants, the increase was not monotonic, as the relative risk in the first 10 years after migration was almost the same as that after more than 30 years. The pattern of risk for cancers of the prostate and mouth/pharynx suggests some protective role for inheritance or maintained cultural factors.

Cancer epidemiology in migrant populations

Migrant studies have taken advantage of the wide geographical variation in cancer risk. Cancer rates in migrants, obtained from routinely collected incidence or mortality statistics, are compared with those in the host country and in the country of origin; the rate of change with time since migration (or age at migration) and in subsequent generations is assessed; and the results are interpreted in the light of differences in socio-economic status and the degree of cultural assimilation. Rapid changes in cancer risk following migration imply that life-style or environmental factors are of overriding importance in aetiology. The susceptibility of fair-skinned races to ultraviolet (UV)-associated skin cancers is an example of racial differences based on inherited factors, but the long-term excess or deficit of other cancers in migrants has not yet been attributed definitively to genetic rather than persisting life-style factors. Are there racial differences in metabolism, DNA repair mechanisms or altered expression of oncogenes or tumour suppressor genes? Several genetic polymorphisms affecting the metabolism of known occupational carcinogens or hormonal factors do vary by race. While classical epidemiology has shown that the environment predominates in determining cancer incidence, molecular epidemiology has identified several examples of genetically determined differences between races.

Differences in patterns of care of prostate cancer, New South Wales, 1991

BACKGROUND

In this time of uncertainty about the benefits of earlier diagnosis for prostate cancer and the optimal choice of treatment in various clinical scenarios, we addressed the hypothesis that two groups in the population, namely country dwellers and migrants from non-English-speaking countries, were less likely to be offered new methods of diagnosis and treatment for prostate cancer.

METHODS

Incident cases of prostate cancer in 1991 were identified through the population-based New South Wales Central Cancer Registry. For 73% of eligible cases information relating to diagnosis, staging and treatment was abstracted onto a checklist from clinical records in urologists' consulting rooms and in public hospitals.

RESULTS

Transrectal ultrasound and prostatic biopsy were used for diagnosis significantly more often in urban than in rural cases while the reverse was true for transurethral resection of the prostate. Intravenous pyelography, ultrasound (other than transrectal) and bone scans were performed for staging more frequently in urban than rural cases. Rural cases were more likely to be treated with anti-androgens than urban cases and less likely to be given luteinizing-hormone releasing hormone (LH-RH) agonists. The pattern of use of various diagnostic and staging procedures for 1991 rural cases resembled that for urban men diagnosed with prostate cancer in 1986 rather than that for 1991 urban cases.

CONCLUSIONS

At least in part, these urban-rural differences could be explained by the fact that some patients in the country would have been treated by general surgeons rather than urologists. The patterns of care for non-English-speaking migrants resembled those for the Australian-born and for English-speaking migrants.

Socioeconomic differentials in cancer incidence and mortality in urban New South Wales, 1987-1991

Cancer incidence and mortality in urban residents of New South Wales (NSW), 1987 to 1991, were analyzed according to socioeconomic status (SES) for males (m) and females (f). Incidence rates displaying a negative gradient with SES at P < 0.01 included: cancers of the mouth and pharynx (m), oesophagus (m), stomach (m,f), liver (m), pancreas (m), larynx (m), lung (m,f), cervix, kidney (m,f) and all cancers combined (m). Negative mortality gradients at P < 0.01 were observed for mouth and pharynx (m), stomach (m,f), rectum (m), liver (m), larynx (m), lung (m,f) and cervix, and all cancers (m,f). Those sites for which incidence showed a positive gradient with SES included: colon (m,f), melanoma (m,f), breast (f), prostate and testis. For cancer mortality for specific sites no significant (P < 0.01) positive gradients were observed, although for melanoma (m,f) a positive gradient at P < 0.05 was found. Mortality for all cancers considered together in both sexes was significantly higher in the low SES group compared to the high SES group. This is partly because the more-fatal cancers are more common in the lower SES groups. Diet, tobacco use, reproductive factors, occupational and sun exposures are likely to be associated with the patterns observed but are not investigated in this study. Variations in health care between SES groups may also be partly responsible for some of the differences.

Changes in cancer incidence and mortality in New South Wales

OBJECTIVE

To assess changes in cancer incidence and mortality in New South Wales (NSW) between 1973-1977 and 1988-1992.

DESIGN

Descriptive analysis of statutory cancer notifications to the NSW Central Cancer Registry.

OUTCOME MEASURES

Age-standardised incidence and mortality rates calculated with the "world" standard population.

RESULTS

Overall cancer incidence rose markedly, from 251 to 318 per 100,000 in men and from 202 to 241 per 100,000 in women. The rise was greatest in the 60-and-over age group. Cancer mortality fell marginally in men (from 166 to 162 per 100,000) and did not change in women (100 per 100,000 in both periods). It fell in the under-60 age group, and remained stable or rose in older people. Prostate and breast cancers and melanoma of the skin accounted for about half the increase in incidence. Both incidence and mortality increased significantly (P < 0.01) for melanoma and non-Hodgkin's lymphomas in men and lung cancer in women, and fell substantially for stomach cancer in both sexes, lung cancer in men and cervical cancer in women. Despite increasing incidence, mortality, also fell for testicular cancer in men and rectal cancer in women and for leukaemias in children.

CONCLUSIONS

The major factor causing the increased incidence of overall cancer was earlier detection. Altered exposure to risk factors could be identified for only a minority of the changes.

Cancer incidence in Asian migrants to New South Wales, Australia

Cancer incidence during 1972-90 in Asian migrants to New South Wales, Australia, is described. Overall cancer incidence was lower than in the Australia born in most migrant groups, and this reached significance in migrants born in China/Taiwan, the Philippines, Vietnam and India/Sri Lanka, and in male migrants born in Indonesia. For the majority of cancers, rates were more similar to those in the Australia born than to those in the countries of birth. For cancers of the breast, colorectum and prostate, rates were relatively low in the countries of birth, but migrants generally exhibited rates nearer those of the Australia born. For cancers of the liver and cervix and, in India/Sri Lanka-born migrants, of the oral cavity, incidence was relatively high in the countries of birth but tended to be lower, nearer Australia-born rates, in the migrants. For these cancers, environmental factors related to the migrant's adopted country, and migrant selection, appeared to have a major effect on the risk of cancer. For certain other cancers, incidence was more similar to that in the countries of birth. Nasopharyngeal cancer, and lung cancer in females, had high rates in both the countries of birth and in migrants to Australia. Nasopharyngeal cancer rates were highest in China/Taiwan and Hong Kong-born migrants, and were also significantly high in migrants from Malaysia/Singapore, Vietnam and the Philippines. Rates of lung cancer were significantly high in women born in China/Taiwan, and the excess was greater for adenocarcinoma than for squamous cell carcinoma. Melanoma had low rates in both the migrants and in the countries of birth. For these cancers, it was probable that genetic factors, or environmental factors acting prior to migration, were important in causation.

The mortality rate of the province of birth as a risk indicator for lung and stomach cancer mortality among Genoa residents born in other Italian provinces

This study analyses the relationship between migration and mortality for lung and stomach cancer, these diseases being those considered susceptible to changes in environmental conditions and individual habits that usually follow migration. Mortality rate of the province of birth was used as the index of risk related to migration. Data were analysed using the Poisson regression model for grouped data. Results indicate that migration determines modifications in the mortality rates of the migrant populations for the diseases under study. For lung cancer, the analysis showed a greater risk for migrants originating from areas with high rates and that migrants had a reduced risk in comparison with natives of Genoa. With regard to stomach cancer, the study revealed that migrants originating from high risk areas had higher relative risks than the Genoa natives, even if these were lower than expected when compared to the risks of the populations in the regions from which the migrants originated.

Cancer incidence in migrants to New South Wales (Australia) from the Middle East, 1972-91

The incidence of cancer in migrants to New South Wales (NSW) from Cyprus, Egypt, Iran, Iraq, Israel, Lebanon, Syria, and Turkey has been compared with that in the Australian-born population using data from the NSW Central Cancer Registry for 1972-91. Age-standardized incidence rates showed overall cancer incidence to be less common in migrants from each Middle Eastern country than in the Australian-born. There was a clear pattern of generally low rates for cancers of the mouth and pharynx, esophagus, colon and rectum, lung (men only), ovary, prostate and testis, and melanoma. Cancers which tended to be more common in migrants were nasopharynx, stomach (women only), liver (men only), gallbladder (chiefly in women), bladder (men only), and thyroid. Breast cancer did not show a uniform pattern among migrant groups, rates being high in the Egyptian-born but low in Lebanese-born women. The overall low incidence of cancers related to tobacco and alcohol, and to a 'high fat, low fiber' diet, emphasizes the potential role of preventable lifestyle factors in the burden of cancer in Australia.

Stage 1 endometrial cancer: treatment modalities and factors influencing recurrence

One hundred and nineteen patients treated for FIGO Stage 1 endometrial adenocarcinoma were reviewed retrospectively to determine if adjuvant radiotherapy reduced disease recurrence. The patients had all been treated in the Hunter Region of New South Wales over a 10-year period from 1978 to 1988. Median follow up was 82 months with a range of 24 to 163 months. Treatment consisted of surgery alone (75.6%), surgery and brachytherapy (17.6%), surgery and megavoltage therapy (4.2%), and surgery with both brachytherapy and megavoltage therapy (2.5%). The overall recurrence rate was 10.1%. Recurrence at the vaginal vault alone occurred in 3.4%. The median time to recurrence was 25.0 months. A statistically significant correlation was found between overall recurrence risk and poorly differentiated lesions (p < 0.0001). Just failing to reach statistical significance were age over 70 years (p < 0.06) and patient weight less than 70 kg (p = 0.06). Depth of myometrial invasion (p = 0.17), use of adjuvant radiotherapy (p = 0.17) and uterine cavity size (p = 0.48) were not significantly correlated with risk of recurrence. The 5-year survival rate was 93.8%.

Cancer incidence in Estonian migrants to Sweden

Cancer incidence in Estonians who took refuge in Sweden in 1944-1945 has been compared with that in the total Swedish population and that among Estonians in Estonia in 1974-1985 using data from the Swedish and the Estonian countrywide population-based cancer registries. The vast majority of the Estonian immigrants studied had been living in Sweden for 30 years when the follow-up with respect to cancer incidence started in this investigation. In spite of the long residence in Sweden, differences in cancer incidence could be observed between these immigrants and the total Swedish population. The age-standardized incidence of stomach cancer was higher in the Estonian migrants than in the total Swedish population (SIR = 1.6 and 2.1 for males and females, respectively). Breast cancer incidence was lower in the migrant women (SIR = 0.75) and lung cancer incidence higher in migrant men (SIR = 1.5). An increased incidence of colorectal cancer was also found for both sexes in the migrant population (SIR = 1.4 for both males and females). A comparison between Estonians in Estonia and the total Swedish population revealed that the cancer incidence for the Estonians was lower than expected at age 70 and over. Male lung cancer and stomach cancer showed a higher incidence in the Estonian population than in the Swedish and in the migrant populations. The migrant population showed an intermediate incidence relative to Estonians in Estonia and the entire Swedish population. The colon-cancer risk in Estonian migrants to Sweden was higher than the risk for Estonians in Estonia and for the Swedish population. This contrasts with most findings in the present and other studies on intermediate risks of migrants compared to the risks in the country of origin and in the new country of residence.

Malignant melanoma in different ethnic groups in Israel. Incidence and biologic behavior

BACKGROUND

The Jewish population of Israel is divided into two ethnic groups: Ashkenazic Jews (AJ) who immigrated from Europe and are fair-skinned, and Sephardic Jews (SJ) who immigrated from the Orient and Africa and who are dark-skinned. The biologic behavior of malignant melanoma (MM) in these two groups has not been investigated.

METHODS

Three hundred forty-eight of 380 patients with MM, who could be accurately grouped ethnically, constitute this study group. The gender, site and depth of primary tumor, metastatic involvement and survival analysis, including univariate analysis for level of invasion, were examined.

RESULTS

Of 348 patients with MM, 285 were AJ and 63 were SJ. The female:male ratio was 2:1 and 0.9:1, for AJ and SJ, respectively (P < 0.05). Lesion site distribution was similar. The lesions were more invasive in SJ, 53% Clark level 4-5 versus 41% in AJ (P < 0.05). The 5-year survival was worse in SJ relative to AJ--50% versus 71% for female patients and 30% versus 62% for male patients--but did not reach statistical significance (NS). The actuarial 10-year survival showed poorer survival for female SJ: 27% versus 67% in female AJ (P < 0.05) and male SJ; 32% versus 65% in male AJ (P < 0.01). For all stage I MM, the actuarial 10-year survival was in male patients 32% versus 79% (P < 0.05), and in female patients, 27% versus 72% (P < 0.05) in SJ and AJ, respectively. For the more invasive lesions (Clark levels 4 and 5), the actuarial 10-year survival was for male patients 19% versus 75% (P < 0.05) and for female patients, 65% versus 67% (NS) in SJ and AJ, respectively.

CONCLUSIONS

The dark-skinned SJ tend to have MM less than the fair-skinned AJ, but once MM occurs in SJ, it appears to have a more virulent nature.

Endometrial cancer: trends in incidence and survival: a preventable disease?

Endometrial cancer is the commonest gynaecological cancer. Its relative increase in incidence over recent decades has been generally associated with a reduction in mortality. Evidence is presented to show a considerable variation in incidence worldwide; Australia, like England and Wales, has a comparatively low incidence. The incidence is highest in parts of the United States where it has shown an annual fall of nearly 3% between 1973 and 1987. The influence of hysterectomy, oral contraception and hormone replacement therapy at the menopause are discussed relative to incidence and prevention of the disease. Obesity and its prevention are also shown to have an influence on incidence and its ethnic variation worldwide. Despite a minor improvement in survival in FIGO published figures, the recent COSA-UK-NZ 'high risk' trial highlights the importance to the patient of closely monitored clinical trials.

Cancer incidence in New South Wales, Australia

In 1972, cancer registration began in New South Wales (NSW), the most populous state in Australia. The operations of the Registry are described. By 1990, approximately 316,000 new cases of cancer had been notified from a population that had increased from 4.6 to 5.8 million. In 1981-1984, the most common sites in men were lung, prostate, colon, melanoma and bladder, and in women, breast, melanoma, colon, lung and unknown primary site. Cancers which, between 1973-1976 and 1981-1984, had increased in reported incidence by more than 25% were pharynx and kidney in both sexes, rectum, testis and melanoma in men, and lung and bladder in women; those decreasing by more than 10% were stomach in both sexes, oesophagus in men and cervix in women. Age-standardised incidence rates for melanoma (27.4 [m] and 23.8 [f] per 100,000 in 1987) and cancer of the renal pelvis in women (1.7 per 100,000 in 1989) are among the highest in the world.