[Trends & current status in cancer of the biliary tract].
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Biomedical subjects
Publications and source records attributed to Itsuro Yoshimi.
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BACKGROUND: An association between coffee drinking and reduced risk of liver cancer has been suggested by animal studies, but epidemiologic evidence of such an association in a high-risk population is lacking. We conducted a large-scale population-based cohort study of the association between coffee drinking and hepatocellular carcinoma (HCC) in a Japanese population. METHODS: Newly diagnosed case patients (250 men and 84 women) with HCC were identified from a 10-year follow-up of the Japan Public Health Center-based Prospective Study, which consists of 90,452 middle-aged and elderly Japanese subjects (43,109 men and 47,343 women). Case patients were grouped according to coffee intake and were stratified by hepatitis virus infection, sex, age, diet, lifestyle factors, and previous history of liver disease. Multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CIs) for HCC were calculated with Cox proportional-hazards modeling. All statistical tests were two-sided. RESULTS: Subjects (men and women combined) who consumed coffee on a daily or almost daily basis had a lower HCC risk than those who almost never drank coffee (HR = 0.49 [95% CI = 0.36 to 0.66]); risk decreased with the amount of coffee consumed (compared with nondrinkers, the HR for 1-2 cups per day = 0.52 [95% CI = 0.38 to 0.73]; for 3-4 cups per day = 0.48 [95% CI = 0.28 to 0.83]; for > or =5 cups per day = 0.24 [95% CI = 0.08 to 0.77], P(trend) < .001). The risk of liver cancer in almost never drinkers in this population was 547.2 cases per 100,000 people over 10 years, but it was 214.6 cases per 100 000 people with drinking coffee on a daily basis. The inverse association persisted when the participants were stratified by lifestyle factors. Similar associations were observed when the analysis was restricted to hepatitis C virus-positive patients (all daily drinkers compared with nondrinkers: HR =0.57 [95% CI = 0.37 to 0.86]), to hepatitis B virus-positive patients (HR = 0.60 [95% CI = 0.31 to 1.18]) and to subjects with no past history of chronic liver disease (HR = 0.45 [95% CI = 0.30 to 0.67]). CONCLUSIONS: In the Japanese population, habitual coffee drinking may be associated with reduced risk of HCC.
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BACKGROUND: Trends in lung cancer mortality among young adults, which are important for projecting future trends, have not been explored previously in Japan. METHODS: Using data from the National Vital Statistics between 1958 and 2003, we compiled lung cancer mortality by sex and 5-year birth cohort among young adults aged 20-49. RESULTS: Mortality among those aged 20-29 has consistently decreased regardless of sex. There were birth cohort effects in mortality from lung cancer, although these were less evident among women than among men. Both men and women born in the 1930s had lower mortality rates, while those born after 1940 had higher lung cancer mortality rates. Mortality rates appear to be declining for male birth cohorts born after 1950 and female birth cohorts after 1960, although these trends may not be stable due to the small number of deaths in these cohorts. CONCLUSION: Lung cancer mortality trends appear to be decreasing among young adults. This might be associated with the lower mortality of birth cohorts after 1950 for men and the 1960s birth cohorts for women. Careful monitoring is needed to confirm continuation of these declining trends.
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Trends of cancer mortality in Japan were reviewed in comparison with all-cause mortality, by major sites and age groups. The proportion of cancer mortality to all-cause mortality is on the increase among young children, and the middle-aged population, due to the decreased mortality other than cancer. The number of deaths from cancer is still on the increase, mainly due to the aging population. But the age-standardized rates now seem to be leveling off among males and bottoming out for females. The trends are not simple, because the cancer mortality has been influenced by many factors such as the rapidly aging population or the drastic change in the social situation after World War II. In lung or liver cancer, the apparent birth cohort effect was observed; there were birth cohorts suggested to have lower or higher cancer mortality. Such birth cohort effects were related to the trends in strong risk factor such as tobacco smoking or hepatitis virus, and thus may influence the trends of cancer mortality. Therefore, on estimating the future trends of cancer mortality in Japan, it is important to take into account such trends in risk factors.
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OBJECTIVES: This study prospectively evaluated the associations of human T-lymphotropic virus type-I (HTLV-I) infection with survival and cancer incidence. METHODS: The study base comprised 4297 adults (aged 40-69 years in 1993) who had either visited the outpatient clinic or who had received annual health check-ups at the A Hospital, Nagasaki, Japan, between 1985 and 1992 (HTLV-I seropositivity = 24.7%). During the follow-up period (1993-1999 or 2000), 290 deaths and 261 cases of malignant neoplasms occurred, including ten deaths and six incident cases of adult T-cell leukemia/lymphoma (ATL). RESULTS: After adjustment for gender, age and other covariates, HTLV-I seropositivity was associated with an increased mortality from all-causes excluding ATL (rate ratio, RR = 1.3, 95% confidence interval, CI = 1.0-1.7), all non-neoplastic diseases (RR = 1.5, 95% CI = 1.0-2.3) and heart diseases. HTLV-I infection was not found to be associated with an increased risk of developing total cancers other than ATL (RR = 0.98, 95% CI = 0.74-1.3), colorectal cancers, liver cancer or lung cancer, but was associated with a reduced risk of gastric cancer (RR = 0.42, 95% CI = 0.17-0.99). CONCLUSIONS: HTLV-I infection is associated with increased mortality from all-causes excluding ATL and all non-neoplastic diseases. HTLV-I carriers may not be at increased general cancer risk, but at reduced risk of gastric cancer.
Trends in the incidence rate of lung cancer by histological type were examined, based on data from the Osaka Cancer Registry (OCR), Japan and the Surveillance, Epidemiology and End Results Program (SEER), USA. Among males, an increasing trend was observed for adenocarcinoma in both registries. In the OCR, the incidence rate of adenocarcinoma has recently overtaken that of squamous cell carcinoma, whereas in the SEER, adenocarcinoma had already taken the lead since 1990-93. For squamous cell carcinoma, the decreasing trends in the OCR were consistent with a previous study, whereas in the SEER, the decline was earlier and steeper. For small cell carcinoma, the incidence rate was leveling off in the OCR, whereas it was already in decline in the SEER. For large cell carcinoma, the decreasing trend began earlier in the SEER. Among females in both registries, the incidence rate of adenocaricinoma has clearly been on the increase, whereas in other histological types the incidence rates were decreasing or at least leveling off. As for the age-specific incidence rate, different patterns were observed between the two registries: in the OCR, the incidence rate was on the increase in older age groups such as 70-74 years and also in younger age groups such as 45-49 years, whereas it decreased in intermediate age groups such as 55-59. In contrast, stable decreasing trends were observed in the SEER, except for adenocarcinoma. The increase in incidence rate observed among younger age groups in the OCR should be carefully monitored.
According to the National Vital Statistics data, age-standardized mortality rates (ASRs) of lung cancer have shown slightly declining trends in Japan for both men and women. In order to evaluate whether this tendency will continue, a Bayesian age-period-cohort (APC) model was applied using the National Vital Statistics data from 1952 to 2001. In the projection, a Gaussian autoregressive prior model was applied to smooth age, period, and cohort effects from its 2 immediate predecessors by extrapolation. Posterior distributions from which we drew inferences on mortality rates were derived from 15,000 iterations using 5000 burn-in iterations. We defined the median of the iterated values as the overall summary mortality rate of the iterated results. Our results suggest that the number of deaths due to lung cancer will double for men and women during the next 3 decades due to the aging of the baby-boomer generation (individuals who were born between 1947 and 1951). Currently declining trends in some age groups will reverse and start to increase again in the next decades. However, for recent birth cohorts, the results of the projection varied according to whether the data set included early age group mortality or not. Lung cancer mortality in the future depends on the risk factors engaged in by today's young people, especially smoking. Strong promotion of anti-smoking measures and careful surveillance for lung cancer are needed.