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Squamous cell carcinoma (SCC) of the cervix continues to be a major problem in many areas of the Asian- Pacific, particularly in the Indian subcontinent and Papua New Guinea, and to a lesser extent in South-East Asia, Korea and Mongolia. In contrast, levels in the developed countries of the region are low, as is also the case for the Muslim countries of Western Asia, and mainland China. Incidence generally mirrora associated mortality, although with some exceptions reflecting facilities and infrastructure for early detection. Over the last 25 years there has been a marked decrease in incidence rates across most of the Asian Pacific, although less pronounced in India than elsewhere, and there are exceptions where the incidence is on the increase. The predominant risk factor is well established to be persistent infection with a high risk ‘oncogenic’ type of human papilloma virus (HPV), along with multiple partners, other sexually tansmitted diseases and smoking. Consumption of vegetables, in contrast, appears to be protective. Hormonal factors may also play some role. Modifying factors may either impact on neoplasia by directly influencing the processes underlying carcinogenesis, or indirectly by affecting persistence of viral infections. For primary prevention, avoidance of repeated infections and smoking, as well as a high antioxidant intake may be beneficial. Vaccines against HPV also have promise for the future, but a better understanding of the mechanisms underlying spontaneous clearance of both infection and cervical intraepithelial neoplasia (CIN) of different grades is also essential for optimal intervention. For screening, the choice of whether the PAP smear, HPV testing or some form of visual inspection are utilized depends on the resources which are available, all approaches having their own advantages and disadvantages, but with similar sensitivity and specificity. One complication is the increase in adenocarcinoma of the cervix which has been reported in some countries, for which risk factors and most effectice screening may differ from the SCC case. A focus on high risk groups like sex workers might be warranted where financial and technical support are limited. If cervical intraepithelial neoplasias are detected then cryotherapy or the loop electrosurgical excision procedure (LEEP) are effective for their removal. Control of cancer of the cervix, however, demands that a comprehensive approach to screening and management is adopted, necessitating major training of personnel and provision of appropriate resources.
Glutathione S-transferase (GST) enzymes are involved in detoxification of many potentially carcinogenic compounds. Homozygous deletions or null genotypes of GSTT1 and GSTM1 genes and an A to G substitution at nucleotide 313 in GSTP1 have been reported in different populations. Intra-ethnic as well as interethnic differences are known to exist in the frequencies of the above GST genes. The present study was therefore undertaken to determine the prevalence of GSTM1 and GSTT1null alleles, as well as the GSTP1 gene polymorphism, in 370 healthy individuals in a North Indian population. Genotyping of M1 and T1 was performed using a multiplex polymerase chain reaction and the GSTP1 polymorphism was determined by the polymerase chain reaction/restriction fragment length polymorphism (PCR-RFLP) method. The frequencies of GSTM1 and GSTT1 null alleles in normal healthy individuals were observed to be 33.0% and 18.4% respectively. In 7.0% of individuals’ concomitant lack of M1 and T1 genes were observed. For GSTP1, wild (Ile/Ile), heterozygous (Ile/Val) and mutant (Val/Val) genotypes were observed for 44.3%, 50.3% and 5.4% of individuals respectively. The prevalence of the M1 null allele is significantly lower than those documented for English, Turkish, Chinese, Caucasians, Japanese and white (Brazilian and American) populations. However, a significantly higher frequency for T1 null was reported in Chinese and Japanese population. Furthermore, Japanese and African American populations have exhibited significantly higher frequencies of wild and mutant P1 genotypes, respectively, than the Indian population. Thus, our results signify an impact of ethnicity and provide a basis for future epidemiological and clinical studies.
Cancer, long a serious problem in developed countries, is now becoming a serious health concern throughout the world. There has been an alarming increase in the number of new cases of melanoma each year, this cancer increasing at a faster rate than any other neoplasm in some regions. This may be a result of depletion of the ozone layer. An association between non-melanocytic skin cancer and exposure to the sun appears to have first been suggested in 1894; it was not until about 1952 that it was argued that exposure to the sun also causes melanoma. It is commonly believed that skin cancers develop only after long-term exposure to UVR. At the individual level, people who live in sunnier climates comparatively have a higher risk for skin cancer than do people who live in colder climates. This is particularly the case for migrant populations with a fair skin. The present study was conducted to evaluate the knowledge of the young generation in Turkey related to the side effects of sun exposure, and their sun bathing habits. Sun sensitivity, use of sunscreens, sunbathing habits and protective behaviours were determined for a total of 1244 high school students from the answers to a questionnaire completed by them. Data from 627 (50.4 %) females and 617 (49.6 %) males were evaluated. All were aged between 15 and 18 years. Sunscreen use was found to be higher in female students (59 %) than in their male counterparts (45.8 %). The wearing of sunglasses was reported by 36.7 %, whereas the incidence of hat wear was found to be 55.1% overall. The results of this study indicate that, although most high school students are aware of the side effects of sun exposure, they do not pay sufficient attention to protective behaviour. A further study should now be conducted to evaluate the use of sunscreens in a large group.
An epidemiological study of hepatitis viruses type B (HBV) and type C (HCV) and human T-cell leukemia virus type I (HTLV-I) was carried out among 103 residents (male:female=61:42) regarded as Sherpas, at Lukla (Solukhumbu district), Nepal in 2004. Blood was drawn from apparently healthy volunteers at ages of 28.8+12.3 (range 15-66) years. HBsAg, HBsAb, HBcAb, and HCV Ab were measured by microparticle enzyme-immunoassay, and HTLV-I Ab was measured by particle agglutination. Prevalence of HBsAg(+), HBsAb(+), HBcAb(+), and HBsAb(+) or HBcAb(+) were 1.9% 22.3%, 24.3%, and 28.2%, respectively. For HCV Ab, only a borderline reaction was observed in one sample, and for HTLV-I Ab all samples were negative. Nucleotide sequencing of the PreS1, PreS2, and S genes revealed that HBV among Sherpas to be of the A’ (or Aa) genotype, which is prevalent among Nepalese but rare in native Tibetans, suggesting transmission within Nepal rather than association with ancestors’ migration from Tibet as the origin. This is the first r eport of Himalayan Sherpas’ state of infection with HBV , HCV, and HTLV-I.
Folic acid deficiency is very rare in Japan. However, recent concerns in relation to causal relationships between cancer and low folic acid levels necessitate information on actual folate intake by Japanese, which has hitherto not been well studied. We therefore evaluated folate contents of a hospital diet for 7 consecutive days and of 16 lunch boxes purchased at convenience stores. Dietary intake was assessed for weighed food items after cooking using our previously published data on folate contents of various foods and also by using Standard Tables of Food Composition in Japan (STFCJ). Mean daily folate intake from the hospital diet was 723.9 ìg/day using our data but only 359.2 ìg/day if calculated using the STFCJ. Twenty-nine % of the total daily folate intake was through rice. Mean folate intake through lunch boxes was 491.7 ìg/day by our tabulation and 139.5 ìg/day with the STFCJ. Folic acid intake of Japanese is far above the levels taken in other countries and over half of this amount is taken from rice. Levels of folic acid contents (especially in rice) listed in the STFCJ are too low and revision is strongly suggested.
Background and Objective: Each year an estimated of 7,500 new cases of Hodgkin's disease are reported in the United States. It is a type of malignancy, where 75% of patients can recover and be cured with modern therapeutic approaches if presentation is in an early stage. While primary prevention is not a focus of attention, prevention of mortality is thus possible. The main objective of this investigation was to assess the current situation with the disease in Iran, with determination of 5- and 10-year-survival rates. Materials and Methods: This retrospective, descriptive, analytical and cross-sectional study was performed on patients identified in Tabriz Shahid Ghazi hospital. The information obtained through medical files was organized and the rate of response to treatment and overall survival (OS) were computed. Resulting data were analyzed using SPSS10 and Chi-square software. Results: Overall, there were 121 male patients (67%) and 59 females (33%). The patient age (with a median of 31.8+17.1 years) did not show any effect on survival rate. Neck masses were the most common (40%) complaint among new patients, mostly classified as stage III. Mixed cellularity (47.2%) accounted for the most common histological subtype. Complete remission was achieved with the ABVD chemotherapy regimen, included in 37.6% of overall chemotherapy regimens. The five- and 10-year-survival rates were determined to be 65 and 61.3 percent respectively. Conclusion: Chemotherapy was a significantly more effective treatment compared to other modalities, and provided complete remission in 52.7% of patients. Overall, 5- and 10-year-survivals were shown to be highest in patients treated with ABVD and a variant of the MOPP regimen, respectively. As general conclusions, early diagnosis, on time management of the patients, and use of appropriate treatment modalities provide significant prevention of mortality in Hodgkin’s disease patients.
HPV infection is the main cause of cervical cancer; however, factors that promote and maintain HPV infection are still unclear. This study was designed to search for factors responsible for the HPV infection in Northeastern Thai women. A total of 190 volunteers with a normal histopathologic appearance of cervix as controls (n=100) and with squamous cell cervical carcinoma (SCCA) (n=90) were the subjects. Variables of risk factors including sexual behaviors, history of reproduction, history of sexually transmitted diseases and smoking were conducted with selfreport and direct interview. Number of sexual partners and smoking history increased the likelihood of high-risk HPV infection. Multiple sexual partners showed significantly higher 3.94-fold risk for HPV infection (95% CI = 1.82-8.82, p-value<0.001). Smoking history of partner increased the risk for HPV infection 3.03-fold (95%CI=1.42- 6.58, p-value< 0.002). After OR were adjusted, significant difference was still observed in the number of sexual partners (p-value <0.0001) and smoking history of the partner (p-value<0.005). To decrease the incidence of cervical cancer, we should prevent HPV dissemination and be on the alert for having multiple sexual partners and a partner’ s smoking habit, which must be included in our public health planning.
Cancer is becoming an increasingly important cause of premature mortality in developing countries as their populations expand and their lifestyle becomes westernized. The aim of this study was to determine the frequency distribution of various neoplasms among Iranian inpatients, their demographic status and length of stay involved in hospitals during 2000-2002. Records of 17447 inpatients who were hospitalized with malignant tumors in Iranian public hospitals during 2000-2002 were studied. The neoplasms had been coded and classified according to International Classification of Diseases, 10th Revision (ICD-10). The frequency distribution of cancer patients was evaluated by age, sex, place of residence and the length of stay at hospital. There were 9470 male patients (54.3%) and 7977 females (45.7%). The mean ± sd age was 51.2±20.6 with a median of 55 years. The average for females (49.4±19.2 yrs) was significantly lower than that for males (52.8±21.7 yrs) (p<0.001). The five most common cancer sites were the digestive organs (27.6%) followed by lymphoid and haematopoitic tissues (21.4%), breast (10.2%), respiratory and intrathoracic organs (8.8%) and skin (6%). These accounted for 74% of all malignancies. Some 31% of women’s cancers were found in breast or genital organs compared to only 7.6% for males. The male/female ratio was 1.19 with the highest being 2.85 for respiratory organs and the lowest being 0.04 for breast. Mean age of male patients with cancer of the digestive organs, respiratory and intrathoracic organs and skin was significantly lower than that of females (p<0.001). The median length of stay of patients in hospitals each time they were admitted was 6 days. Of the cancer patients, 77.7% lived in urban areas which include only 64.5% of the population. Rural patients with skin cancer accounted for 32.1%. In conclusion, the results of this study carry important implications for future health planning strategies and provide a baseline for further studies on the evaluation of malignancies in Iran.
A case-control study was designed to elucidate roles of dietary and other behavioral influences, in combination with genetic susceptibility factors (genetic polymorphisms), in colorectal carcinogenesis. Both cases and controls were residents in Fukuoka City and three adjacent areas. Cases were patients undergoing surgery for a first diagnosis of colorectal cancer at 8 hospitals in the study area, and controls were randomly selected in the community by frequency-matching with respect to the expected distribution by sex, age (10-year class), and residence . Dietary and other lifestyle factors were ascertained by in-person interview, and venous blood was obtained for genotyping and possible biochemical measurements. The cases were interviewed at each hospital during the period from 2000 to 2003, and controls were surveyed during the period from 2001 to 2002. A total of 840 cases of colorectal cancer and 833 controls were interviewed with participation rates of 80% for the cases and 60% for the controls. Informed consent to genotyping was obtained from 685 cases and 778 controls. Further details of the design and conduct are described with respect to methodological aspects.
Background: Information relating to cancer incidence trends in a community forms the scientific basis for the planning and organization of prevention, diagnosis and treatment of cancer. We here estimated the cumulative risk and trends in incidence of prostate cancer in Mumbai, India, using data collected by the Bombay Population-based Cancer Registry from the year 1986 to 2000. Methods: During the 15 year period, a total of 2864 prostate cancer cases (4.7% of all male cancers and 2.4% of all cancers) were registered by the Bombay Population-based Cancer Registry. For evaluation of the trend, we applied a linear regression model based on the logarithm of the observed incidence rates. The annual percentage changes were also computed for the evaluation. Cumulative incidence rates percentages were calculated by adding up the age specific incidence rates at single ages and then expressed as a percentage. Results: Analysis of the trends in age-adjusted incidence rates of prostate cancer during the period 1986 to 2000 showed no statistically significant increase or decrease and the rates proved stable across the various age groups (00- 49, 50-69 and 70+) also. The probability estimates indicated that one out of every 59 men will contract a prostate cancer at some time in his whole life and 99% of the chance is after he reaches the age of 50. Conclusion: The stability in age adjusted-incidence rates indicates that there are no changes in the etiological factors for prostate cancer in Mumbai, India. These findings may be of general interest because changes in diagnostic practices are confounded in the time trends of prostate cancer change in many western countries preventing inferences on the changes in risk.
Prostate cancer is the most common cancer in male populations in many parts of the world. It is a slowing growing deadly cancer with very few signs and symptoms in the early stage. For screening, prostate specific antigen (PSA) has been proposed as a marker in the serum. It is widely employed in western countries, but use of PSA for prostate cancer screening in developing Asian countries is not generalized. Here, the author performed an appraisal on the diagnostic properties of serum PSA in screening prostate cancer among the Thais. Four reports from the literature were recruited for further metanalysis of a total of 1,321 cases. The overall diagnostic activity with regard to sensitivity, specificity, false positive and false negative rates, values being 95.8 %, 66.2 %, 33.8 % and 4.2 %, respectively. Therefore the test has good sensitivity, and sufficiently good diagnostic properties for screening when compared to digital rectal examination (DRE). However, serum PSA cannot be used for a definitive diagnosis, for which pathological confirmation is also necessary.
Background: Genotype announcements related to susceptibility to hazardous effects of smoking may be effective to induce smoking cessation. Methods: Subjects were municipal government employees, 63 young smokers employed in the previous year and 59 smokers with more than 45 pack-years, who were invited to educational sessions against smoking held in December 2003 and February 2004, respectively. In the session, those who wished genetic susceptibility tests (GSTM1, GSTT1, and NQO1 C609T) were enrolled in the study. The smoking habit was ascertained three times: at the session, one month later, just before the genotype announcement, and at the follow-up three months after the announcement. Results: Fifty eight (92.1%) and 49 (83.1%) smokers participated in the study, respectively. One out of 58 smokers was not a habitual smoker, so was not included in the analysis. The smoking cessation rates were 15.8% (9 participants) and 6.1% (3 participants) just before the genotype announcement, and 7.0% (4 participants) and 10.2% (5 participants) at the follow-up, respectively. All subjects were satisfied with the genotype testing except for two who rather regretted participating, but one of whom actually quit smoking. Conclusion: The present pilot study without controls indicated that the effects of genotype announcements in this framework on smoking cessation were less than might have been expected. The temporary effect of the session on younger smokers may have been due to the participation per se. The potential effects of genotype announcements for heavy smokers should now be examined in studies with adequate controls.
Background: Investigations into mortality from malignant tumors were initiated in the 1970’s in Hebei Province, China, and especially for esophageal cancer the rates were high, Shexian county ranking in first place of the towns that were surveyed. Methods: Since the 1970’s, a register system for all causes of death has been in place. Data for the decades of the 1970’s, 1980’s, 1990’s and 2000’s century were here checked and analyzed by SPSS software. Result: From the decades of the 1970’s onward, the mortality rates of malignant tumors/100,000 were 272.0, 260.1, 211.7 and 180.1, respectively, with significant differences over time (x2 =240.5, P<0.001). The main malignant tumors were esophageal, gastric, liver, lung and cervix cancers. The sum of their percentages of all cancer deaths were 92.1% in the 1970’s, 91.6% in the 1980’s, 92.1% in the 1990’s and 93.9% in the 21st century. The sex ratios (male vs female) were 1.5, 1.5, 1.7 and 2.0 respectively, with an ascending trend. Mortality rates of malignant tumors increased with age, with an obvious geographic distribution. The highest mortality of malignant tumors was evident in the area where the Qingzhang and Zhuozhang rivers join. Conclusion: From 1970’s to the beginning of the 21st century, the mortality rate of malignant tumors has shown a declining trend. The main responsible cancers are in the esophagus, stomach, liver, and lung. Through great efforts for prevention, obvious decrease for esophageal cancer and cervix cancer has been achieved, but the mortality rate for gastric cancer remains high.
To assess the theoretical impact of lifestyle of a cancer family history in first-degree relatives (CFH) and clarify interactions between CFH and lifestyle factors, hospital-based comparison and case-reference studies were conducted in Nagoya, Japan. Totals of 1988 gastric, 2455 breast, 1398 lung and 1352 colorectal cancer patients, as well as 50,706 non-cancer outpatients collected from 1988 to 1998, were checked for lifestyle factors, which included dietary and physical exercise habits, as well as smoking/drinking status. General lifestyle factors with non-cancer outpatients did not differ by the CFH status. Case-reference analyses showed that frequent intake of fruits, raw vegetables, carrots, pumpkin, cabbage and lettuce, as well as frequent physical exercise, were associated with decreased risk for all four sites of cancer, while habitual smoking increasing the risk of gastric, and more particularly, lung cancer. Interestingly, the study revealed the magnitude of odds ratios for the above lifestyle factors obtained from CFH positives to be similar to those from CFH negatives for these four sites of cancer. There were no significant interactions between CFH and any particular lifestyle factor. In conclusion, our results suggest no appreciable influence of CFH on lifestyle related risk factors for gastric, breast, lung, and colorectal cancer. Habitual smoking increased, while frequent physical exercise and raw vegetables intake decreased cancer risk, regardless of the CFH status.
Women of all ages have been found to overestimate both the incidence and the mortality rate from breast cancer and the reasons for this are unclear. A qualitative study asked eighty three women (mean age = 44 years) how likely they thought they were to get breast cancer and to explain the reasoning behind their choice. Based on their responses, women’s perceptions were categorised as: no risk (5%); reasonably accurate (30%); overestimated (22%); and greatly overestimated (43%). Four main themes emerged from the reasons given: ‘Don’t know/guess’, ‘family history’ of breast cancer, ‘age’ related reasoning, and making their decision from the information sheet read prior to answering the questions. The information currently available to women may be creating falsely high estimates of their risk of developing breast cancer as the risk factors of age and family history appear to be poorly understood. Meaningful communication of health risk in need of further improvement if it is to be useful in changing health related knowledge and behaviours.
The purpose of this study was to examine whether crude á-mangostin (a major xanthone derivative in mangosteen pericarp (Garcinia mangostana)) has short-term chemopreventive effects on putative preneoplastic lesions involved in rat colon carcinogenesis. The crude preparation was obtained by simple recrystallization of an ethylacetate extract of mangosteen pericarps. A total of 33 five-week-old male F344 rats were randomly divided into 5 experimental groups. Rats in groups 1-3 were given a subcutaneous injection of 1,2-dimethylhydrazine (DMH)(40 mg/kg body weight) once a week for 2 weeks. Starting one week before the first injection of DMH, rats in groups 2 and 3 were fed a diet containing 0.02% and 0.05% crude á-mangostin, respectively, for 5 weeks. Rats in group 4 also received the diet containing 0.05% crude á-mangostin, while rats in group 5 served as untreated controls. The experiment was terminated 5 weeks after the start. Dietary administration of crude á-mangostin at both doses significantly inhibited the induction and/or development of aberrant crypt foci (ACF) (P<0.05 for 0.02% crude á-mangostin, P<0.01 for 0.05% crude á-mangostin), when compared to the DMH-treated group (group 1). Moreover, treatment of rats with 0.05% crude á-mangostin significantly decreased dysplastic foci (DF) (P<0.05) and â-catenin accumulated crypts (BCAC) (P<0.05), to below the group 1 values. The proliferating cell nuclear antigen (PCNA) labeling indices of colon epithelium and focal lesions in groups 2 and 3 were also significantly lower than in group 1 and this effect occurred in a dose dependent manner of the crude á-mangostin. This finding that crude á-mangostin has potent chemopreventive effects in our short-term colon carcinogenesis bioassay system suggests that longer exposure might result in suppression of tumor development.
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