Trends in gynecologic cancer mortality in East Asian regions / 부인종양

OBJECTIVE: To evaluate uterine and ovarian cancer mortality trends in East Asian countries. METHODS: For three Asian countries and one region (Japan, Korea, Singapore, and Hong Kong), we extracted number of deaths for each year from the World Health Organization (WHO) mortality database, focusing on women > or =20 years old. The WHO population data were used to estimate person-years at risk for women. The annual age-standardized, truncated rates were evaluated for four age groups. We also compared age-specific mortality rates during three calendar periods (1979 to 1988, 1989 to 1998, and 1999 to 2010). Joinpoint regression was used to determine secular trends in mortality. To obtain cervical and uterine corpus cancer mortality rates in Korea, we re-allocated the cases with uterine cancer of unspecified subsite according to the proportion in the National Cancer Incidence Databases. RESULTS: Overall, uterine cancer mortality has decreased in each of the Asian regions. In Korea, corrected cervical cancer mortality has declined since 1993, at an annual percentage change (APC) of -4.8% (95% confidence interval [CI], -5.3 to -4.4). On the other hand, corrected uterine corpus cancer mortality has abruptly increased since 1995 (APC, 6.7; 95% CI, 5.4 to 8.0). Ovarian cancer mortality was stable, except in Korea, where mortality rates steadily increased at an APC of 6.2% (95% CI, 3.4 to 9.0) during 1995 to 2000, and subsequently stabilized. CONCLUSION: Although uterine cancer mortality rates are declining in East Asia, additional effort is warranted to reduce the burden of gynecologic cancer in the future, through the implementation of early detection programs and the use of optimal therapeutic strategies.

The impact of modifiable risk factors on mortality from prostate cancer in populations of the Asia-Pacific region.

Mortality from cancer of the prostate is increasing in the Asia-Pacific, when much of this region is undergoing a transition to a Western lifestyle. The role that lifestyle factors play in prostate cancer appears limited, but existing data mainly are from the West. We conducted an individual participant data analysis of 24 cohort studies involving 320,852 men (83% in Asia). Cox proportional hazard models were used to quantify associations between risk factors and mortality from prostate cancer. There were 308 deaths from prostate cancer (14% in Asia) during 2.1 million person-years of follow-up. The age-adjusted hazard ratio (95% confidence interval; CI) for men with body mass index (BMI) 28 kg/m2 or more, compared with below 25, was 1.55 (1.12 - 2.16); no such significant relationship was found for height or waist circumference. The BMI result was unchanged after adjustment for other variables, was consistent between Asia and Australia/New Zealand (ANZ) and did not differ with age. There was no significant relationship with diabetes, glucose or total cholesterol (p > or = 0.18). Smoking, alone, showed different effects in the two regions, possibly due to the relative immaturity of the smoking epidemic in Asia. In ANZ, the multiple-adjusted hazard ratio for an extra 5 cigarettes per day was 1.12 (95%CI: 1.03 - 1.22), whereas in Asia it was 0.77 (0.56 - 1.05). Body size is an apparently important determinant of prostate cancer in the Asia-Pacific. Evidence of an adverse effect of smoking is conclusive only in the predominantly Caucasian parts of the region.

The role of lifestyle risk factors on mortality from colorectal cancer in populations of the Asia-Pacific region.

Although colorectal cancer is one of the leading malignancies worldwide, there are few data on aetiological relationships from the Asia-Pacific region. Therefore, a collaborative study was conducted involving over half a million subjects from 33 cohort studies in the region. Age-adjusted death rates from colorectal cancer, over an average of 6.8 years follow-up, were 12 and 14 per 100,000 person-years among Asian women and men, respectively; corresponding values in Australasia were 31 and 41. Height was strongly associated with death from colorectal cancer: an extra 5 cm of height was associated with 10% (95%confidence interval, 3% - 18% additional risk, after adjustment for other factors. Smoking increased risk by 43% (9% - 88%), although no significant dose-response relationship was discerned (p>0.05). Other significant (p <0.05) risk factors were body mass index and lack of physical activity. There was no significant effect on colorectal cancer mortality for alcohol consumption, waist circumference, fasting blood glucose or diabetes, although the latter conferred a notable 26% additional risk. Height may be a biomarker for some currently unknown genetic, or environmental, risk factors that are related both to skeletal growth and mutanogenesis. Understanding such mechanisms could provide opportunities for novel preventive and therapeutic intervention.

Cancer burden and trends in the Asian Pacific Rim region.

This paper describes the current cancer burden and time trends, discusses dominant risk factors and prevention and control strategies, and makes future projections for the top eight cancers (stomach, lung, liver, colon/rectum, esophagus, breast, cervix, and leukemia) in the Asian Pacific Rim region. The future cancer trends through to the year 2050 are projected based on population dynamics, including population growth and ageing. In 2000, the Asian Pacific Rim had over 3 million new cancer cases, over 2 million cancer deaths, and 5.4 million people living with cancer. In 2050, 7.8 million new cancer cases and 5.7 million deaths from cancer are projected. The current cancer burden and the future projection provide facts that cancer is and will be a very serious public health problem in the Asian Pacific Rim region and will assist public health officers and cancer researchers in the design and establishment of public health policies, prioritization of future research, and application of current knowledge in the prevention and control of cancer.

Echinostomiasis--a snail-borne intestinal trematode zoonosis.

Numerous echinostome trematodes are found in the intestines of birds and mammals throughout the world, and echinostomiasis in humans has been attributed to approximately 16 different species. In humans it is usually regarded as a rare intestinal parasite of little clinical importance except in heavy infections. Diagnosis of echinostomiasis is made by identification of eggs during fecal examination; however, speciation of echinostomes requires morphological study of adult worms following anthelminthic treatment. The complex life cycles of echinostomes are all linked to freshwater habitats. A mammalian or avian definitive host, one or two molluscan hosts, and one or two freshwater stages are usually required to complete the life cycle. In addition, amphibians and fish have been implicated in the transmission of some species. Prevention of human cases is dependent on eating habits, since raw or insufficiently cooked molluses, and to a lesser extent fish and amphibians, are sources of infection for humans. Human cases have been effectively, albeit accidentally, controlled by the introduction of fish which prey on the larval stages of the essential molluscan hosts.

Asian Taenia saginata: species or strain?

Asian Taenia has a special epidemiological pattern. Many people eat raw and/or undercooked pork and pig viscera more often than that of cattle and acquire a T. saginata-like tapeworm infection. The pig has been found to be the most favorable laboratory intermediate host for four geographical strains of Asian Taenia. Numerous pinpoint cysticerci have been found in naturally infected livers of one wild boar and six domestic pigs in Taiwan. It is likely that pigs are the natural intermediate host of Asian Taenia in endemic areas other than Taiwan. Moreover, the cysticerci of Asian Taenia are only found in the livers of the infected animals and have similar morphological characteristics, which are distinguishable from the cysticerci of T. saginata and T. solium. These cysticerci are small in size and armed with two rows of rudimentary hooklets and can develop to maturity in as short a period as 4 weeks. It is possible that Asian Taenia is a different species or at least a different strain.

Intrahepatic biliary lithiasis.

It has been known that intrahepatic biliary lithiasis (IHBL) is prevalent in East Asia including Japan, South Korea, Taiwan, Malaysia, Hong Kong, and Singapore. In contrast, the entity has drawn little attention in Europe and the United States where only scattered reports appear. IHBL can be placed in the category of the benign disease. Its distinctive clinical picture is an intractable course necessitating multiple surgical interventions because recurrence is usual, rather than exceptional. This is in distinct contrast to ordinal stones which originate in the gallbladder. Patients with IHBL do not rarely die of progressive hepatic damage resulting from longstanding obstructive jaundice, cholangitis, liver abscess, septicemia, and so forth.

The epidemiology of diabetes in childhood with special reference to the Orient: implications for mechanism of beta cell damage.

Epidemiologic studies are providing important new insights into the etiology and clinical course of IDDM as well as providing critically needed data on the magnitude of the problem in different parts of the world. The development of national IDDM registries have documented extraordinary differences in diabetes incidence and prevalence, with the highest incidence figures in Finland (greater than 30/100,000/yr) and the lowest in the Orient with Korea reporting incidence rates below 1 and Japan between 1.0-2.4/100,000/yr. The great geographic variation in expression of diabetes in childhood is strongly supportive of environmental factors playing a major role in the etiology of disease. Our studies document a linear correlation between IDDM incidence and distance from the equator and a similar but inverse correlation with mean annual environmental temperature. Other workers find a direct correlation with dairy product consumption. Factors that may play a role in beta cell damage include viral infections, environmental toxins, nutrients and stress factors. Because of the low incidence of IDDM among children living in Asia it is most important to expand the current national registries in the Asian countries and begin a careful study of the environmental differences within Asian countries as well as comparison of studies between countries with very high incidence rates and those with the lowest rates.