Confidentiality in the cancer registry.
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Biomedical subjects
Publications and source records attributed to C S Muir.
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The geographical distribution of cancer of the oesophagus shows wide inter- and intra-national variation both in mortality and sex ratio. Numerous analytical studies have demonstrated alcohol and tobacco as important risk factors. Poor diet, particularly those lacking fresh fruit and vegetables, appears to be an equally important determinant in certain areas. In addition to alcohol and tobacco, Maté drinking in Southern South America independently increases risk. The possible role of thermal injury when Maté is drunk hot is still being investigated. Analysis of incidence data by histological subtype and site of disease has revealed rising rates for adenocarcinomas, generally of the lower third of the oesophagus, and predominantly in males. These data are paralleled by increasing rates of adenocarcinoma of the cardia of the stomach. The aetiology of these tumours in adjacent sites remains to be fully investigated but one known predisposing factor is the presence of Barrett's oesophagus. This poor prognosis disease does not appear amenable to widespread screening. Preventative measures would necessarily incorporate plans to reduce alcohol and tobacco use while improving the marginal diets of many populations.
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To assess whether the increase in malignant melanoma incidence could be due, at least in part, to changes in histological criteria of malignancy, pathologists in Australia, France, Italy, New Zealand, Norway, Sweden, the United Kingdom, the United States and the USSR reviewed diagnoses of 50 consecutive pigmented naevi (40 junctional and compound; 10 intradermal) and 20 consecutive malignant melanomas made in each participating centre around 1930, around 1955 and around 1980. Collaborating pathologists re-read the material, 2,665 cases in all, either from the original slide (82%) or from a recut block (17%), gave their diagnosis and indicated whether the lesion was benign (B), dubious benign (DB), dubious malignant (DM) or malignant (M). As the distribution of review diagnoses was much the same whether the original slide or one made from a recut block was read, the material was pooled. Overall, 2.8% of cases originally reported as B/DB were reviewed as DM/M, while 4.4% of the DM/M diagnoses were held to be B/DB. The shifts between categories were greatest around 1955 and least around 1980, suggesting increasing uniformity of interpretation. All available blocks were recut and sections sent to IARC for review: 1.7% (22) of 1293 B/DB diagnoses were considered to be DM/M and 3.3% (18) of 551 DM/M diagnoses were considered to have been B/DB. The consistently low frequency of shift in diagnostic category, whether the material was reviewed in the collaborating laboratories or by one pathologist at IARC, in a study designed to give maximum attention to those lesions--the junctional and compound naevi--in which a change in opinion as to malignancy would be most likely to arise, suggests that pathologists, irrespective of geographical location, are using common criteria. These findings argue against changes in histological interpretation as being responsible for more than a small portion of the continuous increase of some 3% to 8% per annum observed in malignant melanoma incidence. Other explanations, such as an increase in the frequency or potential for malignant transformation of precursor lesions, must be sought. The anatomical distribution of the malignant melanomas examined followed the usual site pattern by sex, and their thickness was observed to decrease over the period of the study in most centres.
Prostate cancer is one of the most frequent tumours in males. Globally about 235,000 new cases were estimated to occur in 1980. The cancer is particularly frequent in North America, where rates in blacks are often double those in whites, and in several European countries, being rare in much of Asia. After migration to the US, Chinese and Japanese show substantial increases. Incidence may be distorted by inclusion of varying numbers of so-called 'latent' cancers; for some comparisons mortality data are preferable. 'Small' latent cancers seem to be uniformly distributed irrespective of the incidence of the clinically manifest form. The incidence of prostate cancer seems to be increasing in most populations, particularly in Asia and Eastern Europe. In general, mortality follows suit. Birth cohort analysis shows that for US non-whites, cohorts born before 1896-1900 showed an increase in mortality for all age groups, but the death rates fell for cohorts born subsequently, a phenomenon also observed in Australia and England and Wales.
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The numbers of new cancer cases in 16 common sites occurring in 1980 have been estimated for 24 areas of the world for which the United Nations produces population estimates. For the world as a whole, the total number of new cases was 6.35 million, almost exactly evenly divided between the developed and developing countries. In males, the most important sites were lung, stomach, colon/rectum, mouth/pharynx, prostate and oesophagus, and in females breast, cervix, colon/rectum, stomach, corpus uteri and lung. When the two sexes are combined, stomach cancer emerges as the most common cancer in 1980 (669,400 new cases per year), but this estimate is only slightly greater than that of lung cancer (660,500 new cases), and comparisons with earlier estimates for 1975 suggest that, with declining incidence rates for stomach cancer and the continuing rise for lung cancer, the latter would become the most common cancer in the world by the end of 1981. The implications for cancer control in the developed and developing countries of the world are discussed.
To find a clue to lung cancer etiology in Japan, differences in the pattern of lung cancer histology and related time trends between Osaka, Japan, and the North West Region of England were investigated. Material comprised all incident lung cancer cases registered in both regional registries (14,521 in the Osaka Cancer Registry and 29,859 in the North West Regional Cancer Registry). (1) The age-standardized incidence rate of lung cancer was higher in the North West Region than in Osaka (80.4 among males and 20.9 among females per 100,000 population in 1979-82 versus 32.1 and 9.2 respectively). (2) A higher proportion of adenocarcinoma was observed in Osaka (36.3% in males and 62.0% in females) than in the North West Region (12.3% and 18.9% respectively). (3) Using the relative frequencies of each histological type according to sex and age-group, age-standardized incidence rates were calculated for the main lung cancer histological types. It was shown that the incidence rates of adenocarcinoma were similar in the two areas (10.6 in males and 5.3 in females in Osaka versus 10.0 and 3.5 in the North West Region, respectively) while those of squamous cell and small cell carcinomas were much higher in the North West Region than in Osaka. (4) Time trends of incidence rates showed an increase only for adeno- and small cell carcinomas in Osaka. Slight increases were observed for adenocarcinoma in both sexes and for squamous cell carcinoma in females in the North West Region. (5) Considering cigarette consumption and the relative risks of smoking in the two areas, the possible existence of other risk factors for adenocarcinoma in both sexes in Japan, besides active smoking, was suggested.