Incidence of thyroid cancer in the selected areas of iodine deficiency in Poland.

The aim of the study was to evaluate the incidence rate (IR), trend and histotype of the differentiated thyroid cancer in the selected areas with varying iodine deficiency. The study was carried out in three areas: Krakow, (Carpathian endemic goiter area with 1.99 million mixed rural and urban population), Gliwice (Upper Silesia--moderate iodine deficiency area mostly industrial with 4.89 million inhabitants) and Olsztyn (slight iodine deficiency area, mainly rural with 0.77 million inhabitants). Between 1990 and 2001, in the study area 2691 newly diagnosed cases of malignant neoplasms of the thyroid gland were registered. In over 80% of patients it was differentiated thyroid cancer: mainly in women over 40 years, with F/M ratio 5.8. The highest percentage of papillary cancer 72.9% was observed in Olsztyn and lowest--50.0%--in Krakow and Nowy Sacz districts. In this period of time incidence rate of differentiated thyroid cancer in women increased in Kraków, Gliwice, and Olsztyn from 1.51 to 9.34 in 1998 1.27 to 5.74 in 1999 and from 2.52 to 11.35 in 2001 respectively. In the youngest (0-20 years) age group no significant increase of IR was observed. Between 1998 and 2001 the dynamics of increase of the thyroid cancer incidence markedly diminished. In conclusion it was hypothesised that an increase in IR of differentiated thyroid cancer in the study area was caused mainly by the suspension of iodine prophylaxis in 1980 and was diminished by the introduction of an obligatory model of iodine prophylaxis in 1996/1997. It was modified in terms of histotype and dynamics of increase by exposure to ionizing radiation. A very specific group at risk on the population level were women aged 20-40 years in the reproductive age exposed to iodine deficiency after suspension of iodine prophylaxis in 1980 and to radiation after the Chernobyl accident in 1986.

[Occurrence of papillary and follicular thyroid cancer among Silesian women]. / Wystepowanie brodawkowatego i pecherzykowego raka tarczycy u kobiet slaskich.

In the years 1990-2000 within Silesia District 1067 thyroid cancer cases were diagnosed. From the total, papillary carcinoma established 59.9% (639 cases), and follicular carcinoma--26.0% (276 cases). An existence of some distinct endemic areas--for both papillary and follicular thyroid cancers simultaneously was confirmed. The etiologic background is unclear, but the significant impact of environmental iodine supply seems unprobable.

[Geographic differences in iodine supply in the Silesia terrain in relation to thyroid cancer risk]. / Zróznicowanie geograficzne podazy jodu na ternie województwa slaskiego w aspekcie ryzyka raka tarczycy.

Risk factors associated with differentiated thyroid carcinoma depend on its histotype. Follicular carcinoma is described as a predominant type in the areas with iodine deficiency, in opposite to papillary thyroid cancer. The incidence of thyroid cancer and its histotypes varies considerably throughout Silesia (data obtained from the Institute of Oncology Cancer Register, Gliwice). The factors responsible for these differences are unknown. The aim of our study was to evaluate the present iodine supply in Silesia region and to relate it to the incidence of the various histotypes of thyroid carcinoma. Urinary iodine excretion observed in 7-11 year-old-children was used as a parameter of iodine supply and measured in the group of 1037 school children in sixteen localities, equally dispersed throughout Silesia. Urine samples were obtained to measure iodine concentration by the modified Sandell-Kolthoff's catalytic method. Mean incidence rates of papillary and follicular thyroid carcinoma were calculated for regions of Silesia by averaging the rates of the communities in each region. Despite the intensive iodine prophylaxis the persistent symptoms of iodine deficiency were observed. There were significant differences in children's ioduria among investigated regions. The percentage of low ioduria (lower then 100 micrograms/l) varied from 35.7% to 87.7%. We observed no correlation between age-adjusted rates for histotypes of thyroid carcinoma and the percentage of urine iodine below 100 micrograms/l, which served as an estimation of iodine deficiency. Our study indicates that Silesia is still an area of moderate iodine deficiency. We were unable to explain the factors responsible for the observed differences in the incidence rates of papillary and follicular thyroid carcinoma.

[The incidence of laryngeal cancer among males in the upper Silesia]. / Zachorowalnosc na raka krtani na Górnym Slasku.

In the years 1986-1990 within Upper Silesia Region (Katowice Voivodeship) 1240 larynx cancer cases were diagnosed. Larynx cancer standardized incidence rates there are: 12,5 cases per 100 thousand on the whole area, maximal--28.6 and minimal--2.2 per 100 thousand, taking into consideration 93 administrative units (45 towns and 48 community councils). Larynx cancer incidence rates were dynamically increasing every year by 3%. There has not been attained geographic correlation between highest larynx cancer incidence level and highest ambient air pollution.

[The risk of laryngeal cancer among coal miners in the light of radioactivity of mines and tobacco smoking]. / Ryzyko raka krtani wsród górników wegla kamiennego w swietle radioaktywnosci kopaln I palenia tytoniu.

Until recently the exposure associated with the short-lived radon daughters (S-LRD) was thought to apply exclusively to uranium ore mines. The last few years have brought information on the presence of this hazard in non-uranium raw materials mines, e.g. in hard coal mines. It was ascertained that the hard coal mines exposure to the S-LRD lead to increase of frequent of larynx cancer cases in this population on the Upper Silesia Region. 67 Upper Silesia hard coal mines were divided for three groups: I.--(4 number of mines), highest hazard, i.e. < 2.5 microJ/m2 (mean value of potential alpha-energy concentration of S-LRD; II degrees-28, mean hazard, i.e. > 0.4- < 2.5 microJ/m3; III.--35, lowest hazard (risk relative level-RR = 1.00), i.e. < 0.4 microJ/m3. In compare these 3 groups taking into consideration tobacco smoking standardized we have following results of the RR: for suffering natives from larynx cancer: I.--2.86 (at p < 0.05), II.--1.08, at III.--1.00, and for immigrants: I.--6.97 (at p < 0.05), II.--2.09, at III.--1.00 (it is reference level.

[Analysis of laryngeal cancer mortality in males in the Upper Silesia]. / Analiza umieralnosci na raka krtani u mezczyzn na Górnym Slasku.

In the years 1985-1990 within Upper Silesia Region (Katowice Voivodeship) 25 696 males died as the result of malignant neoplasms in total, in this, 1036, i.e. 4.0% for larynx cancer. Every year died then average 173 men. Larynx cancer standardized mortality rates there are: 8.9 cases per 100 thousand on the whole area, maximal--21.4 and minimal--1.2 per 100 thousand (comparison between 45 towns and 48 community councils). Larynx cancer mortality rates among males were dynamically increasing every year by 2.8%, what confirmed by the cohort analysis as well. There has not been obtained spatial correlation between highest larynx cancer mortality level and high ambient air pollution either.

[Geography of lung cancer incidence among women and men of Upper Silesia in the years 1986-1990]. / Geografia zachorowalnosci na raka pluca wsród mezczyzn i kobiet na Górnym Slasku w latach 1986-1990.

During a five period (1986-1990) in Katowice province (Upper Silesia) there were 6,140 cases of lung cancer in males and 1,039 females recorded. The standardized (according to age structure of the world population) incidence of lung cancer in both groups, in 93 administrative units (45 cities, 48 communities) significantly vary and are geographically unevenly distributed. The incidence in selected areas in males can be compared with values characterizing regions of the world with highest indices (> 95 per 100,000); whereas in females the incidence of lung cancer is much lower. The prognosis for lung cancer incidence in the Upper Silesia, according to the regression analysis is pessimistic.

[Geography of mortality from all malignant neoplasms (Nr 140-208 according to the international classification of diseases) in the Katowice province in the years 1985-1990]. / Georgrafia umieralnosci na nowotwory zlosliwe ogólem (Nr 140-208 wg M.Kl.Ch) w województwie katowickim w latach 1985-1990.

In the Province of Katowice, taking into account 93 administration units (45 towns and 48 communes), the geography of mortality from all malignant neoplasms of men and women in the years 1985-1990 was established. Some regions of the Province are at particular risk: form men they are mainly regions with mortality index exceeding 240 cases per 100,000 (Fig. 1), and for women regions with mortality index exceeding 130 cases per 100,000 (Fig. 2). In comparison to the available statistics of mortality from malignancies from other countries (and in them especially from industrialized regions similar to Upper Silesia) the level of the risk for malignancy development in the population is, as a rule, higher in Upper Silesia. The cohort analysis demonstrates in turn further progression of mortality from malignancies in the Upper Silesian populations in the next years.

[Epidemiological risk factors of larynx cancer among natives and immigrants in the Upper Silesian region]. / Epidemiologiczne czynniki ryzyka raka krtani wsród autochtonów i imigrantów Górnego Slaska.

A case-control study has been used to analyse risk factors such as tobacco smoking, pollution exposure in the microenvironment of the place of work, ambient air pollution in the living place among natives and immigrants for larynx cancer in Upper Silesia Region. There were tested 399 cases (269 natives and 130 immigrants) and 942 controls (557 and 385 respectively). Tobacco smoking and exposure to air pollution in the place of work is connected with increased incidence of larynx cancer risk among natives and immigrants. It was shown that there is no connection between larynx cancer and the degree of air pollution in the living place among natives.

[Lung cancer among the autochthonous population and among immigrants Upper Silesia in relation to smoking, exposure to harmful factors at work and atmospheric pollution]. / Rak pluca wsród autochtonów i imigrantów Górnego Slaska a palenie tytoniu, narazenia w mikrosrodowiskach pracy i zanieczyszczenia atmosfery.

By the case-control method 367 patients with lung carcinoma coming from the autochthonous population of Upper Silesia and 253 similar patients from the population of immigrants from other areas were compared (620 cases, in all) treated in the Institute of Oncology in Gliwice in the years 1982-1989. They accounted for about 85% of all male patients with this tumour. In the analysis three zones of Upper Silesia with varying concentrations of atmospheric pollution, where the patients lived, were considered, estimating the risk of this tumour in relation to pollution level, and standardizing the risk for tobacco smoking and considering data related to the exposure to harmful factors in occupational work. The analysis showed that the so called summarized index of relative risk was about 2.5 times greater for the autochthonous as well as immigrant populations in the zone of greatest atmospheric pollution with statistically significant differences in relation to the relatively most favourable zone (accepted as 1.00) However, the risk was progressively rising only in the autochthonous population (in all 3 zones). That showed that the risk of lung carcinoma was increasing in this population with increasing atmospheric pollution. This evident progression of risk was not found in the population of immigrants, although the risk level in this population living in the zone of greatest pollution was similar to that in the autochthonous population.

[Lung cancer mortality rate in the Upper Silesia 1985-1990]. / Czestosc zgonów na raka pluca na Górnym Slasku w latach 1985-1990.

Mortality rates in the years 1985-1990 in males and females with lung cancer in the Katowice province were analysed. Partial rates according to age groups and "raw" rates were calculated. Basing on these, standardized rates were assessed (related to administrative units: 45 cities and 48 districts). The regions with the highest and lowest risk of mortality due to lung cancer were identified using the isarytmic method and standardized rates. The regions with the highest risk are those with a mortality rate for males of 85 per 100,000 and 13 per 100,000 for females. A statistically significant difference was seen between some regions (p = 0.01). The cohort analysis predicts that in the immediate future, an increase of mortality rates in rat es due to lung cancer can be predicted. Also a very dynamic increase in mortality rates in females can be foreseen.

Etiological factors in invasive corpus uteri carcinoma.

The case-control method was applied in order to test how various types of diet as well as past diseases, tobacco smoking and occupational exposure may affect the risk of incidence of corpus uteri cancer in the population of natives and among immigrant women. The highest risk of incidence was noted in the group of natives persistently using a diet rich in meat, animal fat, amylum meals and sugar but lacking raw vegetables. Such a high risk was not observed in the group of immigrant women what might be caused by more frequent change of the type of diet. Some past diseases (arterial hypertension, diabetes, diseases of organs of reproduction and urinary system) do affect a relatively high risk of corpus uteri carcinoma in both populations. However, no noteworthy results have been obtained in the risk of corpus uteri carcinoma as far as tobacco smoking and occupational exposure are concerned.

[Analysis of selected risk factors in invasive cervical cancer among autochthonous women (born in Upper Silesia) and migrants]. / Analiza wybranych czynników ryzyka w inwazyjnym raku szyjki macicy u autochtonek (rdzennych Górnoslazaczek) oraz wsród kobiet migrujacych.

The risk of invasive cervical carcinoma (No 180 by the International Classification of Diseases in 1975) was analysed in comparison to a control group of 599 healthy women. From these populations two subgroups were isolated: autochthonous women born in Upper Silesia (162 cases + 408 control women) and immigrants (107 cases + 191 controls). The risk of carcinoma was higher in the second subgroup. The analysis demonstrated a significant correlation between the risk of invasive cervical carcinoma among women doing heavy work with exposure to industrial dusts and gases in working environment. A significantly higher risk of invasive cervical carcinoma was observed also in the populations of women who had lithiasis (cholelithiasis, nephrolithiasis, bladder calculosis), diabetes, hypertension and venereal diseases or had had operations on the genital system, mainly for erosions and myomas.

Malignant neoplasms of the stomach and the quality of drinking water.

This paper evaluates the influence of the quality of drinking water on the incidence of malignant stomach cancer. Both the author's own data and the data collected from published papers are used in this evaluation. The conclusion is that the quality of drinking water can have some influence on the frequency of stomach cancer incidence, especially among the population of autochthons (who have been using such water for a long time). However, taking into consideration all papers quoted here, it seems that there are also various other factors which can influence the incidence of stomach cancer.

Tobacco smoking and exposure to dust and gas pollution in the place of work and lung cancer risk.

A case-control study has been applied to analyze lung cancer risk, isolating four histopathological groups: differentiated forms of cancer (most often carcinoma planoepitheliale and adenocarcinoma), undifferentiated carcinomas (mainly carcinoma microcellulare and solidum), cancers histologically undeterminated (carcinoma) and cancers not verified histologically, but confirmes radiologically and clinically. 210 patients have been compared with the group of 420 men not suffering from any form of cancer. The results of the undertaken attempt to evaluate lung cancers in relation to certain etiological factors (conditions in the microenvironment of the place of work and tobacco smoking) showed that the influence of tobacco smoking (independently of the kind of tobacco and the form of smoking) on lung cancer incidence was more and more firmly established, and the frequency of incidence increased with the length of the period of smoking. Tobacco smokers and those simultaneously exposed to various dusts and dusts with gases in their microenvironment of the place of work were characterized by higher lung cancer risk (in fact independently on the histological form of the neoplasms), as compared to nonsmokers and those never exposed to air pollution.

Larynx cancer risk factors.

The larynx cancer relative risk has been evaluated (328 cases) in the stationary-native Upper Silesians (63.7%) and migrating (36.3%) male population. The particular control groups (656 men) included 418 and 238 men respectively not suffering from malignant neoplasms. The essentially higher larynx cancer incidence risk has been shown for men manual labor and exposed to the influence of various dusts, gases and vapors and other pollutants in their place of work. The increased substantial incidence risk is also true for men who smoke tobacco and are professionally exposed to the pollution. The results in regard to the consumption of raw and boiled vegetables suggest that these may be inhibitors of the neoplasmatic process in the area of larynx (although not only). The frequency of the consumption of alcohol--vodka or beer--increases the larynx cancer incidence risk both among autochthons and immigrants. Nevertheless, the data concerning the amount of alcohol consumed are less valuable here; they do not allow to establish fully reliable quantitative levels of the beer or vodka consumed. In comparison with the literature of the subject, divergent data have been obtained as far as the joint influence of drinking alcohol with simultaneous smoking of tobacco and professional exposure are concerned.

Study of risk factors in invasive cancer of the corpus uteri.

With the application of the case-control method, 173 patients suffering from invasive cancer of the corpus uteri (plus 346 women not suffering from this type of cancer and any type of neoplastic disease who formed control group) were analyzed. High incidence risk was ascertained for women who suffered previously from various diseases of reproductive organs, circulatory system, thyroid, diabetes, certain diseases of alimentary, urinary and also respiratory tract. Tobacco smoking together with the immediate exposure to dusts and gases in the microenvironment of work does not influence the increase of incidence risk of this organ, but certain type of diet which can be characterized by the high consumption of meat, animal fat and sugar with the lack of raw vegetables in diet influences the incidence risk of invasive cancer of the corpus uteri.