Cancer mortality among Chinese migrants: a review

Changing Patterns in Cancer Mortality from 1987 to 2020 in China

BACKGROUND

China has the highest number of new cancer cases and deaths worldwide, posing huge health and economic burdens to society and affected families. This study comprehensively analyzed secular trends of national cancer mortality statistics to inform future prevention and intervention programs in China.

METHODS

The annual estimate of overall cancer mortality and its major subtypes were derived from the National Health Commission (NHC). Joinpoint analysis was used to detect changes in trends, and we used age-period-cohort modeling to estimate cohort and period effects in Cancers between 1987 and 2020. Net drift (overall annual percentage change), local drift (annual percentage change in each age group), longitudinal age curves (expected longitudinal age-specific rate), and period (cohort) relative risks were calculated.

RESULTS

The age-standardized cancer mortality in urban China has shown a steady downward trend but has not decreased significantly in rural areas. Almost all cancer deaths in urban areas have shown a downward trend, except for colorectal cancer in men. Decreasing mortality from cancers in rural of the stomach, esophagus, liver, leukemia, and nasopharynx was observed, while lung, colorectal cancer female breast, and cervical cancer mortality increased. Birth cohort risks peaked in the cohorts born around 1920-1930 and tended to decline in successive cohorts for most cancers except for leukemia, lung cancer in rural, and breast and cervical cancer in females, whose relative risks were rising in the very recent cohorts. In addition, mortality rates for almost all types of cancer in older Chinese show an upward trend.

CONCLUSIONS

Although the age-standardized overall cancer mortality rate has declined, and the urban-rural gap narrowed, the absolute cancer cases kept increasing due to the growing elderly population in China. The rising mortality related to lung, colorectal, female breast, and cervical cancer should receive higher priority in managing cancer burden and calls for targeted public health actions to reverse the trend.

Novel Combinatorial Approaches to Tackle the Immunosuppressive Microenvironment of Prostate Cancer

Prostate cancer (PCa) is the second-most common cancer in men worldwide and treatment options for patients with advanced or aggressive prostate cancer or recurrent disease continue to be of limited success and are rarely curative. Despite immune checkpoint blockade (ICB) efficacy in some melanoma, lung, kidney and breast cancers, immunotherapy efforts have been remarkably unsuccessful in PCa. One hypothesis behind this lack of efficacy is the generation of a distinctly immunosuppressive prostate tumor microenvironment (TME) by regulatory T cells, MDSCs, and type 2 macrophages which have been implicated in a variety of pathological conditions including solid cancers. In PCa, Tregs and MDSCs are attracted to TME by low-grade chronic inflammatory signals, while tissue-resident type 2 macrophages are induced by cytokines such as IL4, IL10, IL13, transforming growth factor beta (TGFβ) or prostaglandin E2 (PGE2) produced by Th2 cells. These then drive tumor progression, therapy resistance and the generation of castration resistance, ultimately conferring a poor prognosis. The biology of MDSC and Treg is highly complex and the development, proliferation, maturation or function can each be pharmacologically mediated to counteract the immunosuppressive effects of these cells. Herein, we present a critical review of Treg, MDSC and M2 involvement in PCa progression but also investigate a newly recognized type of immune suppression induced by the chronic stimulation of the sympathetic adrenergic signaling pathway and propose targeted strategies to be used in a combinatorial modality with immunotherapy interventions such as ICB, Sipuleucel-T or antitumor vaccines for an enhanced anti-PCa tumor immune response. We conclude that a strategic sequence of therapeutic interventions in combination with additional holistic measures will be necessary to achieve maximum benefit for PCa patients.

Diet and Lifestyle in Prostate Cancer

A variety of diet and lifestyle factors have been studied with respect to prostate cancer risk in large, prospective cohort studies. In spite of this work, and in contrast to other common cancers, few modifiable risk factors have been firmly established as playing a role in prostate cancer. There are several possible explanations for the lack of well-established risk factors. First, prostate cancer has among the highest heritability of all common cancers; second, early life exposures may play an important role in risk, rather than mid- and later-life exposures assessed in most epidemiological studies. Finally, prostate-specific antigen (PSA) screening plays a critical role in prostate cancer detection and incidence rates, which has important implications for epidemiological studies.Among modifiable risk factors, smoking and obesity are consistently associated with higher risk specifically of advanced prostate cancer. There is also considerable evidence for a positive association between dairy intake and overall prostate cancer risk, and an inverse association between cooked tomato/lycopene intake and risk of advanced disease. Several other dietary factors consistently associated with risk in observational studies, including selenium and vitamin E, have been cast into doubt by results from clinical trials. Results for other well-studied dietary factors, including fat intake, red meat, fish, vitamin D, soy and phytoestrogens are mixed.In practical terms, men concerned with prostate cancer risk should be encouraged to stop smoking, be as physically active as possible, and achieve or maintain a healthy weight. These recommendations also have the advantage of having a positive impact on risk of type 2 diabetes, cardiovascular disease, and other chronic diseases. Reducing dairy intake while increasing consumption of fish and tomato products is also reasonable advice.

Exploring reasons for ethnic disparities in diet- and lifestyle-related chronic disease for Asian sub-groups in New Zealand: a scoping exercise

OBJECTIVES

The current study aimed to explore if the impact of various risk factors for chronic disease differed for people of Chinese, Indian and New Zealand European and Other (NZEO) ethnicities.

DESIGN

Data analysed for this paper was extracted from the 2003-04 and the 2006-07 NZ Health surveys for adults aged 25-70 which used a cross-sectional survey design. Data from both the survey waves were combined and all statistical analysis was done using SAS version 9.2 or 9.3. Ethnicity of participants was coded using a priority-based classification system as (1) Indian, (2) Chinese, (3) Other Asian, (4) NZEO, (5) Maori and (6) Pacific. Only data for Indians, Chinese and NZEO were used for the current study. Prevalence estimates and 95% confidence intervals for chronic disease and the associated risk factors were generated to describe the sample. Logistic regression analysis was used to examine whether the difference in the change in risk of chronic disease with different exposures was different according to ethnicity.

RESULTS

Higher deprivation resulted in increased risk of chronic disease in Indian and Chinese males but not in NZEO males (p = .03). There was a weak evidence for a differing effect of physical activity (p = .10) on chronic disease with the protective effect not seen in Indian or Chinese participants.

CONCLUSION

The results of the current study indicate that some factors such as socio-economic deprivation and physical activity may impact differently on the prevalence of chronic disease according to ethnicity. The authors recommend further investigation of these factors using improved and innovative methodology and high-quality ethnicity data to better understand the factors underpinning ethnic disparities in disease prevalence among Asian sub-groups.

A profile of New Zealand 'Asian' participants of the 2008/09 Adult National Nutrition Survey: focus on dietary habits, nutrient intakes and health outcomes

OBJECTIVE

To investigate similarities and differences in dietary habits, nutrient intakes and health outcomes of South Asians (SA) and East and South-East Asians (ESEA) and the New Zealand European and Other (NZEO) group, and to examine differences within 'Asian' subgroups according to duration of residence.

DESIGN

Nutrient intake data from 24 h diet recalls and data from the dietary habits questionnaire, anthropometry and biochemical analyses from the cross-sectional 2008/09 Adult National Nutrition Survey in New Zealand were compared for participants categorized as SA, ESEA and NZEO.

SUBJECTS

Adults aged 15 years and older (n 2995).

SETTING

New Zealand households.

RESULTS

SA were more likely to 'never' eat red meat in comparison to NZEO (P<0.001) and among females also in comparison to ESEA (P<0.05). Intakes of fats and some micronutrients (riboflavin, vitamin B6, B12, Se) were lower among SA than NZEO (P<0.05). Lower intakes of Zn and vitamin B12 were reported by SA females compared with ESEA and NZEO females (P<0.05). A higher percentage of SA were obese using ethnic-specific cut-offs, had lower indices of Fe status and reported diagnosed diabetes compared with NZEO and ESEA. Recent SA male migrants had higher intakes of β-carotene, vitamin C and Ca compared with long-term migrants (P<0.05).

CONCLUSIONS

The results of the present study indicate that dietary habits, nutrient intakes, blood profile and body size differ significantly between Asian subgroups. It also provides some evidence for changes in dietary intakes according to duration of residence especially for SA males.

Pathological stage significantly predicts survival in colorectal cancer patients: a study from two tertiary care centers in India

SUMMARY

Aims: An increase in incidence of early-onset colorectal cancer (EOCRC) in developing countries, including India, is reported recently; however, systematic analyses of clinico-pathological features and disease prognosis has seldom been undertaken. Materials & methods: We studied clinical data pertaining to 1259 colorectal adenocarcinoma patients from two tertiary cancer centers in south India. Results: Approximately 45% of patients were aged below 50 years and poor grade and late-stage tumors were significantly associated with early disease onset. Although tumor grade and stage significantly influenced disease-free survival independently, significant association between survival and age of onset or tumor location was not detected unlike previous observations. Conclusion: Given the sizeable proportion of EOCRC, implementation of the revised Bethesda guidelines may not be tenable in India. More importantly, the previous observation of EOCRC being significantly associated with poor survival could, in part, be due to a higher proportion of advanced-stage tumors.

Cooking oil fumes and lung cancer: a review of the literature in the context of the U.S. population

There is growing evidence that exposure to cooking oil fumes (COF) is linked to lung cancer. Existing literature on this risk was reviewed, specifically as it may relate to potentially at-risk populations such as Chinese immigrants and restaurant workers in the United States. Studies were identified by searching the NCBI database with key terms. All studies that examined the significance, prevalence, and/or mechanism(s) of the association between COF exposure and cancer (all types) were included. A majority of epidemiologic studies found associations between lung cancer and COF exposure. All studies that examined the mechanisms underlying the risk found evidence for mutagenic and/or carcinogenic compounds in COF extract and/or molecular mechanisms for COF-induced DNA damage or carcinogenesis. The evidence reviewed underscores the need to thoroughly investigate the association among at-risk groups in the United States, as well as to develop and assess concrete interventions to reduce these risks.

Cancer incidence among Canadian immigrants, 1980-1998: results from a national cohort study

Canadian immigrants have lower overall cancer risk than the Canadian-born population. Less is known about risks for immigrant subgroups and site-specific cancers. Linked administrative data sets were used to compare cancer incidence between subgroups of immigrants to Canada and the general Canadian population. The study involved 128,962 refugees and 241,010 non-refugees. Standardized incidence ratios (SIRs) were calculated for all-site and site-specific cancers by immigration categories and regions of birth. Relative to the general Canadian population, incidence of all-site cancer was lower among immigrants overall, by sex and refugee status (non-refugee SIRs 0.25: men, 0.24: women; refugee SIRs 0.31: both). Significantly higher SIRs resulted for liver, nasopharyngeal and cervical cancers, including liver cancer among South-East Asian and North-East Asian immigrants, and nasopharyngeal cancer among North-East Asian non-refugees. Hypothesized explanations for variation in cancer incidence include earlier viral infection in the country of origin.

Disparities in mortality patterns among Canadian immigrants and refugees, 1980-1998: results of a national cohort study

This study examines mortality patterns among Canadian immigrants, including both refugees and non-refugees, 1980-1998. Records of a stratified random sample of Canadian immigrants landing between 1980-1990 (N = 369,936) were probabilistically linked to mortality data (1980-1998). Mortality rates among immigrants were compared to those of the general Canadian population, stratifying by age, sex, immigration category, region of birth and time in Canada. Multivariate analysis examined mortality risks for various immigrant subgroups. Although immigrants presented lower all-cause mortality than the general Canadian population (SMR between 0.34 and 0.58), some cause-specific mortality rates were elevated among immigrants, including mortality from stroke, diabetes, infectious diseases (AIDS and hepatitis among certain subgroups), and certain cancers (liver and nasopharynx). Mortality rates differed by region of birth, and were higher among refugees than other immigrants. These results support the need to consider the heterogeneity of immigrant populations and vulnerable subgroups when developing targeted interventions.

The impact of duration of residence on cause-specific mortality: a cohort study of migrants from the Former Soviet Union residing in Israel and Germany

A cohort study of migrants from the Former Soviet Union in Israel (N=528,848) and in Germany (N=34,393) was conducted. The impact of length of residence on cause-specific mortality was investigated using Poisson regression and differences between the migrant groups were assessed. In both migrant cohorts, all cause mortality in males but not in females significantly decreased with increasing duration of residence (RR=0.76, 95% CI: 0.73-0.79 for 9+years of residence compared to 0-3 years), specifically in Israel for infectious diseases, cancer and CVD. For male and female migrants in Israel there was a large reduction in external cause mortality. The cancer risk in male migrants declined from 1 to 0.76 (95% CI: 0.69-0.83) and in female migrants to 0.85 (95% CI: 0.78-0.93) after nine and more years of stay. Adjusting for several covariables, there were differences between migrants in the cause of death patterns in the two host countries, which may be associated with differences in their initial conditions or with effects of the destination country. The study highlights the need for migrant-specific prevention approaches.

Gastric cancer

Gastric cancer is the second most frequent cause of cancer death worldwide, although much geographical variation in incidence exists. Prevention and personalised treatment are regarded as the best options to reduce gastric cancer mortality rates. Prevention strategies should be based on specific risk profiles, including Helicobacter pylori genotype, host gene polymorphisms, presence of precursor lesions, and environmental factors. Although adequate surgery remains the cornerstone of gastric cancer treatment, this single modality treatment seems to have reached its maximum achievable effect for local control and survival. Minimally invasive techniques can be used for treatment of early gastric cancers. Achievement of locoregional control for advanced disease remains very difficult. Extended resections that are standard practice in some Asian countries have not been shown to be as effective in other developed countries. We present an update of the incidence, causes, pathology, and treatment of gastric cancer, consisting of surgery, new strategies with neoadjuvant and adjuvant chemotherapy or radiotherapy, or both, novel treatment strategies using gene signatures, and the effect of caseload on patient outcomes.

Gastric cancer

Gastric cancer is the second most frequent cause of cancer death worldwide, although much geographical variation in incidence exists. Prevention and personalised treatment are regarded as the best options to reduce gastric cancer mortality rates. Prevention strategies should be based on specific risk profiles, including Helicobacter pylori genotype, host gene polymorphisms, presence of precursor lesions, and environmental factors. Although adequate surgery remains the cornerstone of gastric cancer treatment, this single modality treatment seems to have reached its maximum achievable effect for local control and survival. Minimally invasive techniques can be used for treatment of early gastric cancers. Achievement of locoregional control for advanced disease remains very difficult. Extended resections that are standard practice in some Asian countries have not been shown to be as effective in other developed countries. We present an update of the incidence, causes, pathology, and treatment of gastric cancer, consisting of surgery, new strategies with neoadjuvant and adjuvant chemotherapy or radiotherapy, or both, novel treatment strategies using gene signatures, and the effect of caseload on patient outcomes.

Symptom management in hepatocellular carcinoma

Hepatocellular carcinoma (HCC) annually causes about one million deaths. Because of advanced stage at diagnosis, HCC carries a five-year survival rate of less than 5% in patients diagnosed with unresectable disease. Incidence for HCC is higher in men and individuals of Asian descent, where viral hepatitis, a leading cause of HCC, is endemic. This article will provide an overview of the complex symptom management of patients with HCC. The occurrence of multiple symptoms, including pain, fatigue, weight loss, and obstructive syndromes (e.g., ascites, jaundice) in patients with HCC is common. Because of limitations in the efficacy of current treatment options, aggressive symptom management is key to preserving physical functioning and quality of life in patients with HCC. A multidisciplinary team approach to symptom management of patients with HCC is critical, with oncology nurses playing an integral role.

Cancer incidence and mortality patterns among specific Asian and Pacific Islander populations in the U.S

Objectives

We report cancer incidence, mortality, and stage distributions among Asians and Pacific Islanders (API) residing in the U.S. and note health disparities, using the cancer experience of the non-Hispanic white population as the referent group. New databases added to publicly available SEER*Stat software will enable public health researchers to further investigate cancer patterns among API groups.

Methods

Cancer diagnoses among API groups occurring from 1 January 1998 to 31 December 2002 were included from 14 Surveillance, Epidemiology, and End Results (SEER) Program state and regional population-based cancer registries covering 54% of the U.S. API population. Cancer deaths were included from the seven states that report death information for detailed API groups and which cover over 68% of the total U.S. API population. Using detailed racial/ethnic population data from the 2000 decennial census, we produced incidence rates centered on the census year for Asian Indians/Pakistanis, Chinese, Filipinos, Guamanians, Native Hawaiians, Japanese, Kampucheans, Koreans, Laotians, Samoans, Tongans, and Vietnamese. State vital records offices do not report API deaths separately for Kampucheans, Laotians, Pakistanis, and Tongans, so mortality rates were analyzed only for the remaining API groups.

Results

Overall cancer incidence rates for the API groups tended be lower than overall rates for non-Hispanic whites, with the exception of Native Hawaiian women (All cancers rate = 488.5 per 100,000 vs. 448.5 for non-Hispanic white women). Among the API groups, overall cancer incidence and death rates were highest for Native Hawaiian and Samoan men and women due to high rates for cancers of the prostate, lung, and colorectum among Native Hawaiian men; cancers of the prostate, lung, liver, and stomach among Samoan men; and cancers of the breast and lung among Native Hawaiian and Samoan women. Incidence and death rates for cancers of the liver, stomach, and nasopharynx were notably high in several of the API groups and exceeded rates generally seen for non-Hispanic white men and women. Incidence rates were lowest among Asian Indian/Pakistani and Guamanian men and women and Kampuchean women. Asian Indian and Guamanian men and women also had the lowest cancer death rates. Selected API groups had less favorable distributions of stage at diagnosis for certain cancers than non-Hispanic whites.

Conclusions

Possible disparities in cancer incidence or mortality between specific API groups in our study and non-Hispanic whites (referent group) were identified for several cancers. Unfavorable patterns of stage at diagnosis for cancers of the colon and rectum, breast, cervix uteri, and prostate suggest a need for cancer control interventions in selected groups. The observed variation in cancer patterns among API groups indicates the importance of monitoring these groups separately, as these patterns may provide etiologic clues that could be investigated by analytic epidemiological studies.

Cancer mortality rates among first and second generation migrants in the Netherlands: Convergence toward the rates of the native Dutch population

This study investigates the difference in cancer mortality rates between migrant groups and the native Dutch population, and determines the extent of convergence of cancer mortality rates according to migrants' generation, age at migration and duration of residence. Data were obtained from the national cause of death and population registries in the period 1995-2000. We used Poisson regression to compare the cancer mortality rates of migrants originating from Turkey, Morocco, Surinam, Netherlands Antilles and Aruba to the rates for the native Dutch. All-cancer mortality among all migrant groups combined was significantly lower when compared to that of the native Dutch population (RR = 0.55, CI: 0.52-0.58). For a large number of cancers, migrants had more than 50% lower risk of death, while elevated risks were found for stomach and liver cancers. Mortality rates for all cancers combined were higher among second generation migrants, among those with younger age at migration, and those with longer duration of residence. This effect was particularly pronounced in lung cancer and colorectal cancer. For most cancers, mortality among second generation migrants remained lower compared to the native Dutch population. Surinamese migrants showed the most consistent pattern of convergence of cancer mortality. The generally low cancer mortality rates among migrants showed some degree of convergence but did not yet reach the levels of the native Dutch population. This convergence implies that current levels of cancer mortality among migrants will gradually increase in future years if no specific preventive measurements are taken.

Health issues associated with the smuggling and trafficking of migrants

Approximately 4 million persons annually may be smuggled illegally across international borders. In 1997 it was estimated that 700,000 women or children were smuggled across international borders, of whom 175,000 were estimated to come from the former Soviet bloc; approximately 45,000-50,000 smuggled women and children arrived in the United States in that year. This article develops a framework to consider the impact of human trafficking on health within the context of migrant health and the destination population's health. Health risks are assumed by the individual being smuggled during the pre-journey, migratory, and arrival phases. In addition, the recipient country's population may also incur additional health burdens related to illegal arrivals from higher disease prevalence areas of the world. Some of this disease risk potential may be from transmissible agents, but there is increasing concern, and some evidence, that noncontagious diseases may be a significant problem associated with human trafficking. The global consideration of human smuggling and the individual and social impact on health are the focus of this paper.

Milk Consumption in Relation to Incidence of Prostate, Breast, Colon, and Rectal Cancers: Is There an Independent Effect?

Milk contains a wide variety of ingredients, such as nutrients, hormones, and chemical contaminants. Whether milk consumption is associated with the risk of prostate, breast, colon, and rectal cancers is unclear and was evaluated in this study. Data on milk consumption for 9 time periods (1964-1994) and incidence rates of prostate, female breast, colon, and rectal cancers, mostly around 1993-1997, in 38 countries were obtained from the Food and Agriculture Organization and World Health Organization, respectively. Milk consumption was strongly correlated with incidence rates of prostate cancer (r = 0.65-0.69; all P < 0.0001) and breast cancer (r = 0.64-0.74; all P < 0.0001) in all the nine time periods examined. A modest positive correlation was found for colon and rectal cancers in both sexes (all P < 0.05, except for rectal cancer in the first three time periods). The previous findings remained essentially unchanged after adjustment for vegetable, alcohol, and cigarette consumption but disappeared after further adjustment for non-milk fat consumption, except for breast cancer in the last three time periods. The present study does not support an overall substantial effect of milk consumption on the risk of prostate, breast, colon, and rectal cancers at the population level.

Epidemiology of hepatocellular carcinoma

Year 2000 estimates of the incidence of cancer indicate that primary liver cancer remains the fifth most common malignancy in men and the eighth in women. The number of new cases has been predicted as 564,000, corresponding to 398,000 in men and 166,000 in women. The geographic areas at highest risk are located in Eastern Asia, Middle Africa, and some countries of Western Africa. Changes in incidence among migrant populations underline the predominant role of environmental factors in the etiology of primary liver cancer. In high-risk countries, the early cases of primary liver cancer occur already at ages 20 and above, underlying the impact of viral exposures early in life. In countries at low risk, primary liver cancer is rare before the 50s, translating the impact of late exposures with moderate risks and long latency intervals. Sex ratios are typically between 2 and 4. The incidence of primary liver cancer is increasing in several developed countries including the United States, and the increase will likely continue for several decades. The trend has a dominant cohort effect related to exposures to hepatitis B and C viruses. The variability of primary liver cancer incidence is largely explained by the distribution and the natural history of the hepatitis B and C viruses. The attributable risk estimates for the combined effects of these infections account for well over 80% of liver cancer cases worldwide. Primary liver cancer is the first human cancer largely amenable to prevention using hepatitis B virus vaccines and screening of blood and blood products for hepatitis B and C viruses.

Primary liver cancer: worldwide incidence and trends

Estimates from the year 2000 indicate that liver cancer remains the fifth most common malignancy in men and the eighth in women worldwide. The number of new cases is estimated to be 564,000 per year, including 398,000 in men and 166,000 in women. In high-risk countries, liver cancer can arise before the age of 20 years, whereas, in countries at low risk, liver cancer is rare before the age of 50 years. Rates of liver cancer in men are typically 2 to 4 times higher than in women. The incidence of primary liver cancer is increasing in several developed countries, including the United States, and the increase will likely continue for some decades. The trend is a result of a cohort effect related to infection with hepatitis B and C viruses, the incidence of which peaked in the 1950s to 1980s. In selected areas of some developing countries, the incidence of primary liver cancer has decreased, possibly as a result of the introduction of hepatitis B virus vaccine. The geographic variability in incidence of primary liver cancer is largely explained by the distribution and the natural history of the hepatitis B and C viruses. The attributable risk estimates for the combined effects of these infections account for well over 80% of liver cancer cases worldwide. Primary liver cancer is the first human cancer largely amenable to prevention using hepatitis B virus vaccines and screening of blood and blood products for hepatitis B and C viruses.

Genomic priorities and public health

Given the continuing difficulty of identifying genes for complex disorders in a robust, replicable manner, and the extensive resources devoted to this effort, it is becoming increasingly important to analyze the relative benefits of genomics research for public health applications and for the understanding of disease pathogenesis. To establish priorities for genetics research, we review and evaluate several characteristics of selected exemplary complex diseases, including phenotypic accuracy, knowledge of specific and nonspecific genetic and environmental risk factors, and population prevalence and impact. We propose that complex diseases with the strongest evidence for genetic etiology, limited ability to modify exposure or risk factors, and high public health impact should have the highest priority for genetics research.

Intergrin gene expression profiles of humanhepatocellular carcinoma

AIM: To investigate gene expression profiles of intergrin genes in hepatocellular carcinoma (HCC) through the usage of Atlas Human Cancer Array membranes, semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) and Northern blot.

METHODS: Hybridization of cDNA array membrane was performed with α³²P-labeled cDNA probes synthesized from RNA isolated from hepatocellular carcinoma and adjacent non-cirrhotic liver. AtlasImage, which is a software specific to array, was used to analyze the result. RT-PCR of 24 pairs specimen and Northern blot of 4 pairs specimen were used to confirm the expression pattern of some intergrin genes identified by Atlas arrays hybridization.

RESULTS: Among 588 genes spotted in membrane, 17 genes were related to intergrin. Four genes were up-regulated, such as intergrin alpha8, beta1, beta7 and beta8 in HCC. Whereas there were no genes down-regulated in HCC. RT-PCR and Northern blot analysis of intergrin beta1 gene gave results consistent with cDNA array findings.

CONCLUSION: Investigation of these intergrin genes should help to disclose the molecular mechanism of the cell adhesion, invasive and metastasis of HCC. A few genes are reported to have changed in HCC for the first time. The quick and high-throughout method of profiling gene expression by cDNA array provides us overview of key factors that may involved in HCC, and may find the clue of the study of HCC metastasis and molecular targets of anti-metastasis therapy. The precise relationship between the altered genes and HCC is a matter of further investigation.

Liver cancer

The prognosis of patients with HCC remains dismal. Even in the subgroups of patients who have the most favorable characteristics and are eligible for surgical resection, the 5-year survival rate is less than 25%. For patients with more advanced disease, the median survival time is less than 1 year. The good news in HCC research is that the disease can be prevented. In Taiwan, the rate of HCC in children aged 6 to 9 years decreased from 5.2 per million population before the neonatal vaccination program began in 1984 to 1.3 per million population in the first vaccinated cohort. Treatment of viral hepatitis with IFN may decrease the rates of long-term development of HCC. Other agents that may prevent second primary tumors following resection of HCC, such as polyprenoic acid and acylic retinoid, are also being investigated.

Epidemiology of hepatocellular carcinoma

The epidemiology of hepatocellular carcinoma (HCC) is characterized by marked differences between genders, ethnic groups, and geographic regions. These variations are explained by the nature, frequency, and time of acquisition of the major risk factors for cirrhosis--namely hepatitis B virus, hepatitis C virus (HCV), and alcoholic cirrhosis. The incidence and mortality of HCC has been rising in the US over the last two decades and is progressively affecting younger persons. The evidence indicates that HCV infection is responsible for the current trends.

Chinese women: behaviors and attitudes toward breast cancer education and screening

A study eliciting Chinese Women's Attitudes and behaviors toward breast cancer screening to identify and overcome barriers to providing access to health promotion information.

Ethnicity and migration as determinants of human prostate size

The roles of ethnicity and migration in determining the size of human prostate zones during midlife were explored. Prostate size was measured by planimetric ultrasound in 163 men residing in Sydney who were either Australian non-Chinese (AR; n = 116) or Chinese migrants (ACM; n = 47) and had lived in Australia for a median of 7.3 yr (range, 0.2-25 yr). These were compared with Chinese men residing in China (CR; n = 210). Central and total prostate volumes were estimated by a single observer using the same equipment at both sites. After adjustment for age, central and total prostate volumes were significantly smaller, and plasma prostate-specific antigen and 5alpha-dihydrotestosterone (DHT) concentrations and International Prostate Syndrome Scores were significantly lower, in CR compared with either ACM or AR, whereas the scores of the latter two groups were similar. Almost all of the population difference in total prostate volumes could be accounted for by differences in central prostate volumes. The strongest correlates of age-adjusted prostate volume were prostate-specific antigen and DHT, the latter presumably reflecting the quantitative importance of prostatic stromal type II 5alpha-reductase activity to circulating DHT concentrations. Sex hormone-binding globulin concentrations were significantly higher in CR and significantly lower in ACM compared with those in AR, but the significance of these observations is unclear. These findings highlight the importance of the central zone of the prostate as well as provide evidence for an environmental factor influencing prostate growth. This factor operates over a relatively short time period compared with the evolution of prostate disease. Hence, this study provides evidence that ethnicity and geographical factors, such as migration, can influence the growth of the normal human prostate during midlife and may facilitate future studies of the origins and pathogenesis of human prostate disease.

Hepatocellular carcinoma

Hepatocellular carcinoma (HCC) for most patients is a terminal complication of chronic inflammatory and fibrotic liver disease. With regrettably few exceptions, treatment is largely palliative, and long-term survival is rare. However, the major causes of HCC worldwide are known and preventable. Hepatitis B and C exist only in man; the viruses have no known non-human reservoirs. Transmission of the viruses can be interrupted by vaccination against hepatitis B virus infection and improvements in medical techniques for hepatitis C, for which no vaccine has yet been developed.

New concepts in tissue specificity for prostate cancer and benign prostatic hyperplasia

Of the hundreds of species of mammals, all of which have prostate glands, only humans and dogs are known to suffer from benign prostatic hyperplasia (BPH) and prostate carcinoma. In humans, prostate carcinoma is common, yet carcinomas of other sex accessory tissues are rare. In addition, different anatomic regions within the prostate gland have very different rates of BPH and carcinoma. In this article, we explore ideas and potential mechanisms relating to these paradoxical findings that may help explain the species, organ, and zone specificity of BPH and prostate cancer. We present an evolutionary argument that attempts to relate a high-fat diet, with its potential for generating oxidative DNA damage, to the species selectivity of prostate cancer. In addition, we outline an argument based on our preliminary studies indicating that chronic inflammation and the associated increase in cell turnover in the setting of increased oxidative stress may help to account for the organ selectivity of genitourinary carcinomas.

Quality of reviews in epidemiology

OBJECTIVES

This study examined the quality of recent reviews in epidemiology.

METHODS

All 1995 issues of 7 widely read epidemiology journals were searched to identify reviews.

RESULTS

Twenty-nine reviews were identified. Methodology was not specified or incomplete for literature searches in 79% of reviews; the same was true for inclusion criteria in 83% and for combining studies in 62%. More than 60% of the reviews were not methodologically systematic.

CONCLUSIONS

There is a need to improve the quality of review papers in epidemiology. If systematic methodology were followed more frequently, epidemiologic science and its application could be improved.

Breast cancer: weighing the evidence for a promoting role of dietary fat

It has been hypothesized that a high-fat diet promotes the development of postmenopausal breast cancer. This contention is supported by data showing high international correlations between fat intake and breast cancer rates, modest positive associations with a high-fat diet in case-control studies, and animal model studies that have consistently demonstrated that dietary fat influences mammary cancer development at several stages in the carcinogenic process. A number of plausible biologic mechanisms have been suggested that may explain such promotional effects. In contrast, dietary fat intake is unrelated to the risk of breast cancer in cohort studies. The conflicting findings from cohort studies have created uncertainty regarding nutritional recommendations and breast cancer prevention. After reviewing key scientific findings that are relevant to this issue, the following conclusion is drawn: In the absence of data from dietary intervention trials, the weight of available evidence suggests that the type and amount of fat in the diet is related to postmenopausal breast cancer and that the inability to detect associations within populations (cohort studies) is because of measurement error and the relative homogeneity of diets measured. It is expected that the results from intervention trials will clarify this issue.

A case-control study of breast cancer in Taiwan--a low-incidence area

To investigate risk factors for breast cancer in Taiwan, a low-incidence area, a case-control study was conducted. This comprised 244 subjects with diagnosed and pathologically confirmed breast cancer (age range 20-80 years) and 450 female ophthalmology outpatients as controls. Univariate and multiple logistic regression analysis suggests that breast cancer in Taiwan is aetiologically similar to breast cancer in high to moderate-incidence areas. A family history of breast cancer appears to be the most important factor contributing to the risk of breast cancer (odds ratio = 4.69). The effect of reproductive hormones (represented by the years of history of menses in premenopausal women, odds ratio = 3.35; or the age at menarche in post-menopausal women, odds ratio = 2.67) plays a significant role in tumorigenesis. Breast feeding appears to be a particularly important protective factor in Taiwanese women (odds ratio = 0.57).

Preventing colorectal cancer

After decades of little apparent progress against colorectal cancer, we now have the means to avert many of the deaths associated with this malignancy. Earlier diagnosis, either through screening for fecal occult blood or by endoscopy, has been clearly shown to be effective in reducing mortality. There are also prospects for preventing colorectal cancer occurrence through life-style change, since epidemiological studies consistently show that a dietary pattern of high intake of fruits, vegetables, and fiber is associated with a substantially decreased risk of these tumors. A further approach to prevention is the use of pharmacologic agents. Several randomized prevention trials to assess possible preventive drugs or nutrient supplements have focused on patients treated for colorectal adenomas. These trials are feasible, but they pose important challenges in protocol design, recruitment, and patient compliance. Nonsteroidal anti-inflammatory drugs (NSAIDs), especially aspirin, currently appear to be the most promising agents for testing in future trials.