Epidemiology of cancer in Australia.
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Biomedical subjects
Publications and source records attributed to B K Armstrong.
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Fifty-four healthy, omnivore normotensive volunteers aged 20-59 years were randomly allocated either to a control group eating a low polyunsaturated to saturated fat ratio (P/S ratio) diet (0.3) throughout, or to one of two experimental groups eating a high P/S ratio diet (1.0) for one of two 6-week experimental periods. Changes in other components were avoided. Twenty-four hour diet records showed substantial changes in the P/S ratio for experimental groups when on the high P/S ratio diet (0.3 to 1.0). There were significant increases in relative concentrations of linoleic acid in plasma phospholipids when on the high P/S ratio diet. There was no consistent effect of dietary P/S ratio elevation from 0.3 to 1.0 on group mean systolic and diastolic blood pressures. Adjustment of blood pressure changes for changes in electrolytes, other dietary components, plasma lipids, weight and other lifestyle variables did not alter this result. It was concluded that the blood pressure lowering effect of a vegetarian diet reported previously was unlikely to have been due to changes in dietary P/S ratio.
The case history and clinical course of a young adult patient who had diabetes mellitus and developed anorexia nervosa is described. This patient was referred for long-term inpatient treatment after short-term treatment efforts had failed. Inpatient treatment utilizing behavior modification, psychodynamic therapy, and family interventions in a long-term therapeutic milieu is discussed. This case is also contrasted with previous accounts of diabetic adolescents who developed anorexia; however, it is noted that no other reports exist of cases of anorexia developing in adult insulin-dependent diabetic patients. The necessity of integrating a variety of therapeutic techniques in such cases is discussed.
Varied methods of primary surgical treatment of 189 cases of cutaneous malignant melanoma studied in Western Australia had no statistically significant effect on prognosis. The results indicate that wide excision is not justified as the standard treatment of cutaneous malignant melanoma.
The survival of 354 claimants for compensation for pulmonary asbestosis among former workers of the Wittenoom crocidolite mine and mill in Western Australia has been examined. There were 118 deaths up to December 1982. The median time between start of work and claim for compensation was 17 years. The standardised mortality ratio (SMR) for deaths from all causes was 2.65 (p less than 0.0001). The SMR for pneumoconiosis was 177.2 (p less than 0.0001), bronchitis and emphysema 2.6 (p = 0.04), tuberculosis 44.6 (p less than 0.0001), respiratory cancer (including five deaths from malignant pleural mesothelioma) 6.4 (p less than 0.0001), gastrointestinal cancer 1.6 (p = 0.22), all other cancers 1.6 (p = 0.17), heart disease 1.4 (p = 0.07), and all other causes 2.18 (p = 0.004). Plain chest radiographs taken within two years of claiming compensation were found for 238 subjects and were categorised independently by two observers according to the International Labour Organisation criteria without knowledge of exposure or compensation details. Profusion of radiographic opacities, age at claiming compensation, work in the Wittenoom mill, and degree of disability awarded by the pneumoconiosis medical board were significant predictors of survival, but total estimated exposure to asbestos was not. Radiographic profusion and degree of disability were, however, predictable by total exposure. The median survival from claim for compensation was 17 years in subjects with ILO category 1 pneumoconiosis, 12 years in category 2, and three years in category 3.
Adequate data on the carcinogenicity of saccharin and cyclamate to humans are available only for the urinary bladder. In the studies available, exposure to saccharin and to cyclamate cannot be distinguished readily. Descriptive studies have shown no evidence of time trends in bladder cancer that can be related to use of saccharin or cyclamate. Likewise, studies of diabetics, who have used more saccharin and cyclamate than other people, have shown no evidence of an increased risk of bladder cancer. This association, however, is probably confounded negatively by cigarette smoking. Thirteen case-control studies have addressed the relationship of saccharin and cyclamate intake to bladder cancer in individuals. While statistically significant positive associations have been observed, a similar number of significant negative associations has also been observed. Studies of the dose-response relationships have also shown no consistent pattern. Studies of saccharin and cyclamate use with smoking habits have shown no consistent interaction with heavy smoking, as might be expected from a promotional effect. In some studies, however, an increased risk with saccharin and cyclamate use has been observed in female non-smokers--a group otherwise at low risk for bladder cancer.
The effect on blood pressure of an ovo-lacto-vegetarian (OLV) diet was assessed in a randomized controlled crossover trial. Fifty-eight mild untreated hypertensive subjects recruited from the Perth Centre for the 1983 National Heart Foundation (NHF) Risk Factor Prevalence Survey were randomly allocated to one of three groups: the first maintained their usual diet throughout 12 weeks; the other two were given an OLV diet for either the first or second 6 weeks of the 12-week trial. A significant fall in systolic blood pressure, on average of the order of 5 mmHg, was associated with eating an OLV diet. Blood pressure change was unrelated to change in urinary sodium, potassium or body weight, but was related to initial blood pressures. Although an OLV diet may have an adjunctive role in control of mild hypertension, in view of likely problems with acceptability the dietary components responsible for the blood pressure changes need to be identified.
Serial plain chest radiographs taken between 1943 and 1982 for 280 claimants for compensation for asbestosis and 32 claimants for malignant pleural mesothelioma from the Wittenoom asbestos industry were reviewed by two observers to identify diffuse pleural thickening and pleural effusion. A pleural effusion which appeared and resolved within two years without radiographic or clinical evidence of underlying malignancy, infection or cardiac failure was seen in 15 cases by reader 1 and 24 cases by reader 2. Eighteen cases of effusion, determined from clinical records to be caused by malignant pleural mesothelioma, were seen by reader 1 and 20 by reader 2. The latent periods between commencing work and the first radiograph showing effusion were much shorter for subjects with benign asbestos pleural effusion than for subjects with effusion due to malignant pleural mesothelioma, although there was considerable overlap in the range. The longest latent period for benign asbestos pleural effusion was 22 years and the shortest period for effusion due to malignant pleural mesothelioma was 12 years. The latent period for benign asbestos pleural effusion was inversely related to total cumulative exposure, whereas that for effusion due to malignant pleural mesothelioma was significantly shorter for subjects who had worked in the mill than for those who had worked in the mine. A long latent period and a history of working in the mill were significant discriminators for a malignant as opposed to a benign basis for an effusion. The appearance of a benign asbestos pleural effusion appeared to be a risk factor for the severity of subsequent diffuse pleural thickening.(ABSTRACT TRUNCATED AT 250 WORDS)
A population-based case-control study of cutaneous malignant melanoma occurring during 1980-81 was conducted in Perth, Western Australia. Three hundred and thirty-seven cases and 349 matched controls were reinterviewed in 1983 with regard to their fluorescent light exposure. The incidence rate of all melanomas was not associated with rate of exposure or cumulative exposure to all fluorescent lights or just those without diffusers. Separate analyses by histogenetic type and, where possible, body site of melanoma showed, in most instances, no consistent association between incidence rate of melanoma and exposure to fluorescent lights without diffusers. Incidence of melanomas of unclassifiable histogenetic type, however, increased with increasing duration of exposure (P-value for trend .02). This association was weaker and the P-value higher (.11) when exposure was considered only in residential rooms and offices, where light fittings are closest to the subject. Adjustment for the effects of total and intermittent sun exposure on melanoma rates did not alter the above trends appreciably.
Interpersonal linkages were studied in 178 Hodgkin's disease patients, aged 60 years or younger, who lived in Western Australia between 1964 and 1975, and in their matched controls. Eighty-nine living subjects were interviewed about places and periods of residence, school attendance and employment, and possible linkages were computed based on concurrence of these events. Subjects were also shown the names of all patients and controls and asked to mark the names they recognized, giving details of acquaintanceships. The acquaintanceship method yielded more and the concurrence method fewer case-case links than expected. Little overlap occurred in linkages identified by the two methods. The acquaintanceship method is thought to be the more reliable. Risk factors suggested in the literature were also investigated. Increased risk of Hodgkin's disease in living patients was associated with being unmarried, being born outside Western Australia, smoking cigarettes, and having lived and worked on a farm and worked with animals. These effects did not explain the excess of case-case linkages found by the acquaintanceship method.
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In a gynaecological cancer survey of 1026 women aged 21 years and over in May 1967, 74 women were found to have cervical cytological changes (designated as mild atypia in 71), which were followed to April 1982. No case of cervical cancer was found (0.3 were expected on the basis of population rates). Six women had had hysterectomies (6.2 were expected on the basis of rates of hysterectomy in the region of the survey). Reports on cervical smears taken since January 1, 1980, were available for 46 (75%) of 61 women who were alive and had not had a hysterectomy. Of these, 11 showed mild atypia; the remainder were within normal limits.
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Crocidolite was mined and milled at Wittenoom Gorge in Western Australia from 1943 to 1966. Between 1960-1964 and 1980-1982, the estimated incidence of malignant mesothelioma in Western Australia rose from 0.6/100 000 in men and less than 0.1/100 000 in women, aged 35 years or older, to 6.6/100 000 in men and 0.7/100 000 in women in this age group. Overall, 97 (70%) of 138 patients with malignant mesothelioma had definite or probable exposure to asbestos; 76 of these (55%) to Western Australian crocidolite. Of the latter 76 patients, 56 had worked in the mine or mill at Wittenoom and 4 had non-occupational exposure in the Wittenoom area; the remaining 16 had been exposed to crocidolite elsewhere in the State. There were only 4 (3%) patients with malignant peritoneal mesothelioma, of whom three had been exposed to crocidolite.
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