Cancer incidence in migrants to New South Wales from England, Wales, Scotland and Ireland

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.

Treatment and outcomes of melanoma in acral location in Korean patients

PURPOSE

A retrospective study was conducted to review the treatment and outcomes of mainly melanomas in acral location in a single institution in Korea, and to evaluate the prognostic significance of anatomic locations of the tumor.

MATERIALS AND METHODS

A retrospective review was completed on 40 patients between 2001 and 2006 to obtain pertinent demographic data, tumor data, treatment characteristics, and follow-up data.

RESULTS

Forty melanoma patients were identified and analyzed. Of these, 18 were male and 22 were female patients and the mean age at the time of diagnosis was 55.9 years. Of the tumors, 65% were located on the hands and feet with acral lentiginous melanoma being the most common histological subtype. Univariate analysis for the overall melanoma survival revealed that the thickness of the tumor and the clinical stage have prognostic significances. The most significant factor as analyzed by a multivariate analysis was shown to be the advanced clinical stage. Acral melanomas did not show statistically significant differences in the age at diagnosis, thickness of the tumor, stage, ulceration, and survival rates compared to non-acral melanomas. There was also no significant difference in the survival rate between the patients treated by amputation versus wide local excision in acral melanomas.

CONCLUSION

In Korean melanoma patients, thickness and advanced stages are significant factors for poorer prognosis. However, the location of melanoma did not have a significant prognostic value. In treating the melanomas in acral location, local wide excisions resulted in a similar prognosis compared to amputations.

Disparities in gastric cancer outcomes among Asian ethnicities in the USA

BACKGROUND

Survival for gastric cancer is reportedly higher in Asians than for other races. It is unclear whether differences in outcome exist among Asian ethnicities. Our objective was to assess gastric cancer survival in Asian ethnic groups in a large heterogeneous population.

METHODS

Asian-Americans treated for gastric adenocarcinoma between 1988 and 2006 were identified from the Los Angeles County Cancer Surveillance Program. Patients were stratified and compared by ethnicity (Korean, Japanese, Chinese, Vietnamese or Filipino).

RESULTS

Of the 1,817 Asian-Americans in the study cohort, 45% (n = 810) were Korean, 25% (n = 462) were Chinese, 11% (n = 193) were Japanese, 10% (n = 188) were Filipino, and 9% (n = 164) were Vietnamese. For the entire cohort Koreans and Filipinos had the longest and shortest median survival (MS), respectively (22.4 and 10.3 months, respectively; P < 0.001). Multivariate analysis demonstrated that Japanese and Filipino ethnicity independently predicted worse survival compared with Korean ethnicity [hazard ratio (HR) 1.37, 95% confidence interval (CI) 1.08-1.73, P = 0.008; and HR 1.71, 95% CI 1.37-2.13, P < 0.001, respectively]. In the surgical cohort, Koreans and Filipinos had the longest and shortest survival, respectively (MS of 57.8 and 21.7 months, respectively; P < 0.001). Multivariate analysis of the surgical cohort also demonstrated that Japanese and Filipino ethnicity independently predicted worse survival compared with Korean ethnicity (HR 1.61, 95% CI 1.22-2.13, P < 0.001; and HR 1.66, 95% CI 1.24-2.22, P < 0.001, respectively).

CONCLUSION

There are differences in gastric cancer survival among Asian ethnicities. Future studies addressing varying environmental exposures and molecular expression patterns in gastric cancer are warranted to better understand these disparities in outcome.

Extracutaneous malignant melanomas

Extracutaneous malignant melanomas are rare tumors with vexing clinical presentation and grim prognosis. Only 4%-5% of all primary melanomas do not arise from the skin. These tumors are almost uniformly fatal, even in 2006. Although a fairly good number of these lesions were reported in the literature, the lack of a side-by-side analysis of these studies has resulted in tentative conclusions that merely offer a first glimpse at the clinicopathologic diversity of these lesions. To remedy this issue, this article took an aim at presenting a literature review concerning extracutaneous malignant melanomas. It also reports several cases of extracutaneous melanomas, which I came across in my 15 years of surgical and molecular pathology practice. The study raises several notions. Extracutaneous malignant melanomas are rare but extremely aggressive lesions with a grim outcome. They include ocular, metastatic, anorectal, mucosal, nail beds, conjunctival, vaginal, urogenital, orbital, esophageal, and leptomeningial malignant melanomas. The development of these lesions lacks an association with sun damage, family history, or precursor nevi. These lesions cause considerable diagnostic consternation and their distinction from other types of tumors (such as undifferentiated carcinomas, high-grade sarcomas, and lymphomas) is critical both from a diagnostic and prognostic point of view. In the proper clinical, histological, and cytological context, immunopositivity for S100 protein, HMB45, and vimentin allows the distinction of these malignant melanomas from other histologically similar malignancies. To conclude, extracutaneous melanoma should be considered while undifferentiated neoplasms, especially those displaying prominent eosinophilic nucleoli, and the coexistence of epithelioid and spindle cells. Special staining and immunohistochemistry should be resorted to establish the diagnosis.

Ancestral links of Chesapeake Bay region African Americans to specific Bight of Bonny (West Africa) microethnic groups and increased frequency of aggressive breast cancer in both regions

The high frequency of aggressive, early onset, and highly fatal breast cancer among Chesapeake Bay region African Americans suggests that there may be a contributing ancestral component. This study identifies the region's founding African, European, and Native American Indian populations using ethnogenetic layering and identifies the microethnic substructure of each founding continental aggregate. The largest component (38%) of the enslaved Africans brought to the Chesapeake Bay originally came from the coastal and hinterlands of the Bight of Bonny, a region with very high rates of aggressive, early onset breast cancer. Ethnogenetic layering is applied a second time to reveal the microethnic groups of the Bight of Bonny hinterlands with historical links to the Chesapeake Bay region. These analyses identify the specific microethnic groups within this region of Africa that may be the sources of relevant polymorphisms contributing to the etiology of aggressive breast cancer in the Chesapeake Bay. This report suggests a historical link between specific African microethnic groups and a US health disparity.

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.

Skin cancer in skin of color

Skin cancer is less common in persons with skin of color than in light-skinned Caucasians but is often associated with greater morbidity and mortality. Thus, it is crucial that physicians become familiar with skin cancer in persons of color so as to maximize the likelihood of early detection of these tumors. In dark-skinned ethnic groups, squamous cell carcinoma is most common; squamous cell carcinoma and melanoma usually occur on nonsun-exposed sites; and ultraviolet radiation is not an important etiologic factor for skin cancer with the exception of basal cell carcinoma. Races of intermediate pigmentation, such as Hispanics and Asians, share epidemiologic and clinical features of dark-skinned ethnic groups and Caucasians. Skin cancers pose a significant risk in skin of color and clinicians should focus on preventive measures in these groups such as regular skin exams, self-examination, public education, and screening programs.

LEARNING OBJECTIVE

At the completion of this learning activity, participants should be familiar with the epidemiology and unique clinical features of skin cancer in skin of color and be aware of strategies to prevent skin cancer in skin of color.

Sun exposure and risk of melanoma

BACKGROUND

As skin cancer education programmes directed to children and adolescents continue to expand, an epidemiological basis for these programmes is necessary to target efforts and plan for further evaluation.

AIMS

To summarise the epidemiological evidence on sun exposure during childhood and adolescence and melanoma risk.

METHODS

A literature review was conducted using Medline (1966 to December 2004) to identify articles relating to sun exposure and melanoma. The review was restricted to studies that included sun exposure information on subjects 18 years of age or younger.

RESULTS

Migrant studies generally indicate an increased melanoma risk in individuals who spent childhood in sunny geographical locations, and decreasing melanoma risk with older age at arrival. Individuals who resided in geographical locations close to the equator or close to the coast during childhood and/or adolescence have an increased melanoma risk compared to those who lived at higher latitudes or never lived near the coast. The intermittent exposure hypothesis remains controversial; some studies indicate that children and adolescents who received intermittent sun exposure during vacation, recreation, or occupation are at increased melanoma risk as adults, but more recent studies suggest intermittent exposure to have a protective effect. The majority of sunburn studies suggest a positive association between early age sunburn and subsequent risk of melanoma.

CONCLUSION

Future research efforts should focus on: (1) clarifying the relation between sun exposure and melanoma; (2) conducting prospective studies; (3) assessing sun exposure during different time periods of life using a reliable and quantitative method; (4) obtaining information on protective measures; and (5) examining the interrelations between ability to tan, propensity to burn, skin type, history of sunburns, timing and pattern of sun exposure, number of nevi, and other host factors in the child and adolescent populations.

Age at immigration and duration of stay in relation to risk for testicular cancer among Finnish immigrants in Sweden

Although the incidence of testicular cancer is increasing, substantial differences in incidence between countries and populations exist. These differences cannot be explained solely by genetic differences, but environmental exposures, particularly early exposures, have been implicated in the etiology of testicular cancer. To assess whether early exposures contribute to the incidence of testicular cancer, we identified 93 172 Finnish men who immigrated to Sweden between 1969 and 1996 and followed them for the occurrence of testicular cancer. The risk of testicular cancer was lower for Finnish immigrants to Sweden than for the Swedish general population (standardized incidence ratio [SIR] = 0.34, 95% confidence interval [CI] = 0.21 to 0.53). The reduced risk was associated with both seminomas and non-seminomas. Neither age at immigration nor duration of stay in Sweden had any impact on the reduced risk. Although the type of environmental exposures remains unknown, the results strongly indicate that early exposures are major determinants for testicular cancer.

The epidemiology of lip cancer: a review of global incidence and aetiology

Lip cancer (140 ICD-9) is a form of oral cancer that has a distinctive global epidemiology. This review summarises global incidence rates for male and female lip cancer with the aid of cancer atlases. High male lip cancer rates are reported for regions of North America (12.7 per 100 000 per annum), Europe (12.0 per 100 000 per annum) and Oceania (13.5 per 100 000 per annum), while it is virtually unknown in parts of Asia. Factors commonly cited as important in the aetiology of lip cancer include solar radiation, tobacco smoking and viruses. An attempt is made to summarise the evidence for factors that may be important in lip carcinogenesis. While incidence rates are generally stable or falling among males worldwide, they are rising in many female populations. The aetiology of the disease is far from established and much information regarding its pathogenesis is based on anecdotal rather than case-controlled epidemiological evidence. The epidemiology of lip cancer supports the proposal that the lip should be considered as a distinct cancer site, rather than being included with other forms of intraoral cancer.

Studies of cancer in migrants: rationale and methodology

Migrant populations comprise substantial numbers of individuals who have undergone a change in their environment, sociocultural and physical. The corresponding changes in risk for different cancers have, therefore, been widely used to infer the relative importance of environmental factors versus inherited predisposition in cancer aetiology. The uncontrolled experiment of migration also provides an indication of the possible effects of certain preventive interventions at the population level--especially with respect to diet. In the past, there has been a surprising lack of attention to analytical methods for migrant data, and we review the epidemiological methods available to best bring out the relevant differences in risk. The major sources of bias which confuse interpretation are also described. Migrant studies are classified into four groups, in a hierarchy corresponding to the amount of information which they can provide, and examples of each type are provided.

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.