Establishment of an Asian Cancer Registry Network - problems and perspectives.

Cancer registration is the base for our understanding of the burden of neoplastic disease in our populations at the local, regional and national levels. Comparability of data is essential for interpretation and this in turn depends on standardization of methodology and the diagnostic and other criteria applied. If this is to be achieved across Asia, some form of international organization is clearly necessary. The question therefore should be whether the existing arrangement is adequate, and if this is not the case how a network in Asia might be established with due consideration of aims and attainable objectives. The present commentary focuses on the contributions made by the International Association of Cancer Registries (IACR) and individual country-based or region-based associations already active in Asia. Building on an analysis of the present status in Asia, as well as experience of the European Network of Cancer Registries (ENCR) and the North American Association of Central Cancer Registries (NAACCR), potential problems and possible solutions are here reviewed, with coverage of both organizational and financial constraints. An argument is presented here that there is a rationale for some form of an Asian Network of Cancer Registries, supported by the International Agency for Research on Cancer (IARC) and the UICC-Asian Regional Office, working alongside the IACR and existing national organizations and research institutes.

Genomic epidemiology cohorts in Korea: present and the future.

Human genome epidemiology involves the application of genetic technology to assess the impact of variations at the DNA level on health and disease. Recent developments in molecular biology allow epidemiologists to use biomarkers to determine an individuals predisposition to disease and to detect disease at an early stage. Moreover, advances in genomics and proteomics could play a central role in research into disease prediction and prevention. Large scale population-based cohort prospective studies offer the most comprehensive approach to the delineation of gene function, the effects of the environment, and their interactions. The Korean Multi-center Cancer Cohort (KMCC), under construction since 1993, is the first multi-center prospective cohort to identify risk factors for cancer in Korea. Data on general lifestyle, physical activity, diet, reproductive factors, and agricultural exposure are obtained through direct interview using a structured questionnaire. Anthropometric measurements and clinical laboratory findings are also collected using a web-based data entry system. Moreover, biological materials have been banked [blood (serum, plasma, buffy coat, packed erythrocytes) is stored at -70 degrees C and urine at -20 degrees C] for future analysis. Several other cohorts including the Korean National Cancer Center (KNCC) Cohort, the Korean Health Examinees (KOEX) Cohort, the Korean Health and Genome Epidemiologic Study (KHGES), and the Yang Pyeong Cohort have also been launched since the KMCC cohort was initiated. Even though these cohorts have collected similar data and biospecimen, questionnaires and protocols used have not been standardized. However, these cohort studies are of increased scope and have been designed to detect risk factors for cardiovascular disease, metabolic syndrome, and cancer. Subjects have been followed up actively by health personnel in different regions and by using record linkages with the central cancer registry, and the national death certificate and national health insurance claim databases. As of August 2004, the total number of subjects enrolled in all cohorts with archived biologic specimens was around 80,000. A new genomic cohort has been launched since 2001 in Korea, for which the target number of subjects is 250,000 men and women over the next 5 years. This article describes the goals and the designs of each of the above-mentioned cohorts.

Long-term prediction of female breast cancer mortality in Korea.

Not only the incidence but also the mortality of female breast cancer has been steadily increasing in Korea since the 1980s. Epidemiologic evidence on changes in lifestyle and risk factors related with breast cancer, and data from migrant studies strongly suggest that breast cancer might further increase. In order to estimate the long-term trend in mortality of breast cancer in Korean women, we analyzed age-specific mortality rates for breast cancer over the past 20 years, and made a projection up to 2020 using a linear regression model with the Poisson distribution. The age-adjusted mortality rates for breast cancer per 100,000 persons were 2.84 in 1983, 4.91 in 1993, and 6.26 in 2003. The predicted expected age-adjusted mortality rates for breast cancer are 6.51 for 2005, 7.37 for 2010, 8.22 for 2015, and 9.07 for 2020, with an estimated annual increment of breast cancer mortality of 0.1704. Accordingly, 1,564 women in 2005 and 3,087 in 2020 will be expected to die of breast cancer in Korea. Compared with the rate in 1983, this indicates a more than 3-fold increase by 2020. On the basis of our results, female breast cancer in Korea will linearly increase for the forseeable future if the trend over the past 20 years continues.

Grand challenges in global health and the practical prevention program? Asian focus on cancer prevention in females of the developing world.

In response to the request for 'Breakthrough Questions' for 'Grand Challenges in Global Health' recently published in Nature, the Asian Pacific Organization for Cancer Prevention should focus its attention on what projects are of the highest priority for integration with its Practical Prevention Program (PPP). The most common female cancers in most of the countries of Asia are carcinoma of the breast, followed by the uterine cervix. While the incidences of breast adenocarcinomas are still generally lower than in the Western world they are rapidly increasing, and squamous cell carcinomas of the cervix are a major problem. Clearly there are many areas which would reward research. One factor which appears of major relevance in the mammary gland case is the diet, and particularly the phytoestrogens included in 'tofu', along with physical exercise. The age at which these could be operating needs to be elucidated, with reference to timing of menarche and menopause, and also breast mammographic density, another predictor of likelihood of neoplasia. In the cervix, the predominant influence is well established to be persistent infection with a high risk 'oncogenic' type of human papilloma virus (HPV). Vaccines therefore hold much promise, 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. The roles of smoking and antioxidant intake in particular deserve emphasis. In Asia, with the considerable variation evident in both breast and cervical cancer incidence rates, as well as in cultural and other environmental factors, we are in a very favourable position to meet two specific challenges: 1). elucidation of how diet in adolescence determines susceptibility to neoplasia of the mammary glands; and 2). determination of what governs persistence of HPV infection. Realisation of these pivotal research aims, with especial emphasis on the context of the PPP, is our shared goal.