Prevention and Health Education : How Recent Advances in the Science and Art of Health Education have been Applied in Practical Ways within Medical and other Settings for Prevention and Public Health

The terms health education, patient education, self-care education, school health education, and health promotion ‍are distinguished from each other as follows. Health education is a subset or strategy within each of these but is the ‍primary and dominant strategy in health promotion. Health education occurs through the health care providers in ‍various settings: worksites, medical, community agencies and schools. Nurses and midwives are the most important ‍health care providers to train people for health promotion and cancer prevention. We appreciate the importance of ‍the “Fight against Cancer” movement in the primary health care centre and its health care providers who inform ‍people about cancer and its symptoms, how to find lesions and early stages, and how to avoid hazardous factors. ‍This is as process of continuous information transfer by in-service education. Primary prevention should encompass ‍all actions aimed to reducing the occurrence of cancer. In reviewing recent advances in science and how the art of ‍health education has been applied in practical ways within medical and other settings for prevention and public ‍health, we can point ot the necessity for facilities like an APOCP Training Centre as a venue for scientific courses.     

Attitudes of Patients to Alternative Medicine For Cancer Treatment

Awareness of attitudes to different types of medicine is very important for estabishment of cancer prevention ‍programs. Alternative medicine has become an important feature of oncology regardless of geographic region, and ‍in India, the majority of cancer patients present at late advance stage of disease when curative treatment cannot be ‍initiated. Given the lack of facilities it is no surprise that many Indian cancer patients try various complementary ‍and alternative medicines, depsite the fact that little is known about their therapeutic efficacy and toxicity. A study ‍was conducted in 300 biopsy proven cancer patients undergoing alternative cancer therapy with Psorinum in Kolkata. ‍The main aim of the study was to analyze the patients’/ caregivers narratives regarding the therapy they have been ‍trying. One hundred and ninety five patients (65%) have consulted their oncologists before trying this therapy. ‍About 18.5 % of the patients expressed satisfaction with the therapy due to the holistic nature and team approach ‍employed for patient management. The cost of the therapy was within the reach of many cancer patients belonging ‍to the underprivileged segment of the society, contributing to its immense popularity in Kolkata. Whether this can ‍be translated into a willingness to use similar natural compounds for cancer prevention and treatment purposes now ‍needs to be analysed.     

Magnitude of Arsenic Toxicity in Tube-well Drinking Water in Bangladesh and Its Adverse Effects on Human Health Including Cancer: Evidence from a Review of the Literature

Only after a decade from 1993, arsenic contamination of groundwater in Bangladesh has been reported as the ‍biggest arsenic catastrophe in the world. It is a burning public health issue in this country. More than 50 percent of ‍the total population is estimated at risk of contamination. Already thousands of people have been affected by the ‍disease arsenicosis. Many more may be on the way to manifest lesions in future. We conducted a review of previous ‍studies and published articles including MEDLINE database on this issue. We found that 59 districts out of 64 have ‍been already affected by arsenic in underground drinking water, where this particular source of drinking water is ‍the main source for 97 percent of the rural people. The water is unfortunately now a great threat for the human ‍being due to high level of arsenic. Continuous arsenic exposure can lead people to develop arsenicosis, which in turn ‍elevates the risk of cancer. Skin lesions are the most common manifestations in arsenicosis patients. Relatively poor ‍rural people and other socio-economically disadvantaged groups are more affected by this exposure. Until now ‍cancer patients have been relatively limited in Bangladesh. One of the reasons may be that several years are needed ‍to show cancer manifestations from the beginning of arsenic exposure. But it is suspected that after some years a ‍large number of patients will appear with cancer in different sites for arsenic exposure in drinking water. Various ‍studies have been conducted in arsenic affected countries - notably in Argentina, Chile, China, Japan, and Taiwan - ‍to find the potential of arsenic exposure to cause development of cancer. Among the arsenic related cancers, liver, ‍lung, skin, bladder and kidney cancers are reported to be prevalent in these countries. Unfortunately no scientific ‍study has been yet conducted in Bangladesh to find the relationship between arsenic exposure and cancers in different ‍sites of the body. So our aim is to conduct an ecological as well as a case-control study in the country in the future. ‍     

Allele Frequencies of 25 Polymorphisms Pertaining to Cancer Risk for Japanese,Koreans, and Chinese

Allele frequencies are rather constant among different ethnic groups in many genetic polymorphisms, but some ‍polymorphisms vary in the allele frequency depending on the time when the germ-line base exchanges occurred in ‍the history of humans and on the adaptability of the phenotypes to given environment. This review documented the ‍allele frequencies of polymorphisms pertaining to cancer risk for Japanese, Koreans, and Chinese. Twenty-five ‍polymorphisms of 21 genes whose allele frequencies were available for at least two out of the three ethnic groups ‍were selected. They were ALDH2 Glu487Lys, COMT Val158Met, CYP1A1 MspI and Val/Ile, CYP1B1 Leu432Val, ‍CYP2E1 RsaI, CYP17 T-34C, ER C975G, GSTM1, GSTT1, GSTP1 Ile105Val, IL-1B C-511T, IL-1RN 86-bp VNTR ‍(variable number of tandem repeats), MTHFR C677T and A1298C, NAT1, NAT2, NQO1 Pro187Ser, OGG1 Ser326Cys, ‍p21 Ser31Arg, p53 Arg72Pro, TNF-A G-308A and G-238A, and XRCC1 Arg194Trp and Arg399Gln. The allele ‍frequencies were found for 24 in Japanese, 16 in Koreans, and 24 in Chinese. All of the polymorphisms had similar ‍allele frequencies for these ethnic groups, except the following polymorphisms; ALDH2 Glu487Lys whose Lys allele ‍was more common for Japanese and Taiwanese, COMT Val158Met whose Met allele was more common for Japanese, ‍and NAT2 rapid/slow whose slow alleles were more common for Chinese. When compared with the allele frequencies ‍among Caucasians, the following minor alleles were more frequent among Japanese/Koreans/Chinese; ALDH2 478Lys, ‍CYP1A1 m1 and m2, CYP2E1 c2, ER 975G, GSTT1 null, NAT1 *10, NQO1 187Ser, OGG1 326Cys, p21 31Arg, and ‍XRCC1 194Trp, and less frequent in COMT 158Met, GST-P1 105Val, IL-1RN non-4R, MTHFR 1298C, and TNF-A - ‍308A. The differences in genetic background may affect the impact on the lifestyle factors and/or genotypes examined ‍in epidemiological studies. However, the influences of the variations in the allele frequency seemed to be limited ‍among Japanese, Koreans, and Chinese. The substantial differences in the allele frequency from Caucasians could ‍modify the influences of lifestyle factors and polymorphism genotypes, resulting in the inconsistent results of ‍epidemiologic studies. ‍     

The Metabolic Syndrome is Associated with Increased Risk of Colorectal Adenoma Development: The Self-Defense Forces Health Study

The metabolic syndrome, a cluster of metabolic abnormalities linked to insulin resistance, has attracted much ‍interest as a risk factor for cardiovascular disease and type 2 diabetes. Hyperinsulinemia is also a postulated biological ‍risk factor for colorectal carcinogenesis. We therefore here examined the relation between the metabolic syndrome ‍and colorectal adenoma development. The study subjects were 756 cases of colorectal adenoma and 1751 controls ‍with no polyps who underwent total colonoscopy during the period January 1995 to March 2002 at two Self Defense ‍Forces (SDF) hospitals in Japan. The metabolic syndrome was defined with reference to abdominal obesity in ‍combination with any two of the following conditions: elevated triglycerides (≥150 mg/dL); lowered HDL cholesterol ‍(<40 mg/dL); elevated blood pressure (systolic blood pressure ≥130 mmHg and/or diastolic blood pressure ≥ 85 ‍mmHg); and raised fasting glucose (≥110 mg/dL). Abdominal obesity was defined as a waist circumference of 85cm ‍or more(Japanese criterion) or ≥ 90cm (Asian criterion). Statistical adjustment was made for age, hospital, and rank ‍in the SDF. The metabolic syndrome was found to be associated with a moderately increased risk of colorectal ‍adenomas whether either of the Japanese and Asian criteria was used; adjusted odds ratios with the Japanese and ‍Asian criteria were 1.38 (95% confidence interval [CI] 1.13-1.69) and 1.48 (95% CI 1.13-1.93), respectively. Increased ‍risk was more evident for proximal than distal colon or rectal adenomas, and was almost exclusively observed for ‍large lesions (≥ 5mm in diameter). Thus the metabolic syndrome appears to be an important entity with regard to ‍the prevention of colorectal cancer, as well as cardiovascular disease and type 2 diabetes.     

Precise Definition of Anonymization in Genetic Polymorphism Studies

Anonymization is an essential tool to protect privacy of participants in epidemiologiocal studies. This paper ‍classifies types of anonymization in genetic polymorphism studies, providing precise definitions. They are: 1) unlinkable ‍anonymization at enrollment without a participant list; 2) unlinkable anonymization before genotyping with a ‍participant list; 3) linkable anonymization; 4) unlinkable anonymization for outsiders; and 5) linkable anonymization ‍for outsiders. The classification in view of accessibility to a table including genotype data with directly identifiable ‍data such as names is important; if such tables exist, staff may obtain genotype information about participants. The ‍first three modes are defined here as anonymization unaccessible to genotype data with directly identifiable information ‍for research staff. Anonymization with a key code held by participants is possible with any of the above anonymization ‍modes, by which participants can access to their own genotypes through telephone or internet. A guideline issued on ‍March 29, 2001 with collaboration of three Ministries in Japan defines “anonymization in a linkable fashion” and ‍“anonymization in an unlinkable fastion”, “for the purpose of preventing the personal information from being ‍divulged externally in violation of law, the present guidelines or a research protocol”, but the contents are not clear ‍in practice. The proposed definitions will be useful when we describe and discuss the preferable mode of anonymization ‍for a given polymorphism study.     

Assessment of Risk Factors in Laryngeal Cancer in India : A Case- Control Study

Cancer of the larynx is fourteenth most common cancer in the world. Limited data are available from India on ‍associations with risk factors and hence the present hospital based matched case-control study was conducted. ‍Three hundred and five laryngeal cancer patients and an equal number of healthy controls matched for their age ‍within 2 years, sex and place of residence constituted the study population. A pre-tested, semi-structured questionnaire ‍was administered to each individual to elicit information on their socio-demographic profile, food habits and risk ‍factors and dietary consumption patterns. Univariate logistic regression analysis and multivariate forward stepwise ‍conditional logistic analysis were performed. In the univarite analysis a lower consumption of roots and tubers ‍green leaf vegetable other vegetables and fruits, and higher consumption of milk, eggs, meat, tea, alcohol , smoking, ‍consumption of betel leaf with tobacco as well as a preference for spicy and fried foods emerged as significant ‍positive variables. After adjusting for education, years of use of alcohol, smoking, chewing of betel leaf with tobacco ‍in the model, low green leafy vegetables and preference for spicy foods were found to be positively related to the risk ‍of laryngeal cancer. There was a significant difference in the dietary consumption patterns of laryngeal cancer ‍patients and controls, indicating a role for nutritional factors in the etiology of laryngeal cancer in the Indian ‍population. ‍     

A unique seroepidemiological pattern of HBV,HCV and HTLV-I in Nenets and Komi in Northwestern Russia

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 105 residents (male:female=19:86) regarded as Nenets partly mixed with ‍Komi, in the region of Krasnoe, the Nenets Autonomous District of the Arkhangelsk Region, in northwestern Russia ‍in 2004. Blood was drawn from apparently healthy volunteers at ages of 41.6+16.5 (range 14-85) years. HBsAg, ‍HBsAb, HBcAb, HBeAb and HCV Ab were measured by microparticle enzyme-immunoassay, and HTLV-I Ab was ‍measured by particle agglutination. Prevalences of HBsAg(+), HBsAb(+), HBcAb(+) and HBeAb(+) were 0.0%, ‍29.5.%, 20.0% and 7.6%, respectively. The overall HBV infection rate (positive HBsAb or HBcAb) was 34.3%, ‍while no positive HCV or HTLV-I Abs could be detected. A serological subgroup with positive HBsAb and negative ‍HBcAb, consisting of 15(14.3%) females, contrasted sharply to other serological subgroups in sex, age, parent’s ‍ethnicity, positive HBeAb rate, and HBcAb inhibition%. We conclude that HBV is prevalent with unique serological ‍patterns among the Nenets, while HCV and HTLV-I infections are negligible.     

A Pilot Study on Inducement of Smoking Cessation by a Simple 5A (Asking,Advice, Assess,Assist, and Arrange) Approach at Outpatient Clinics

Asking smokers about their smoking status, followed by advice to quit smoking, assessing the intention to quit , ‍assistance with cessation, and arrange of follow-up (5A) is recommended for induction of smoking cessation. To ‍obtain preliminary data on effects of “5A” , we investigated the smoking cessation rate with two modes in the phase ‍I: 1) self-administered questionnaire and 2) doctor’s interview at respiratory disease clinics of three general hospitals ‍in Japan, and another mode in phase II: 3) doctor’s interview with an additional pamphlet at one of the three ‍hospitals. The interviews for smokers were conducted by doctors in charge of treatment. Subject smoking habits ‍were followed up by postal surveys three months after the enrollment. In phase I, 359 outpatients were recruited and ‍189 smokers responded, among whom 27 patients (7.5% of 359 outpatients) had quit smoking at the three months ‍after the enrollment. The cessation rate of the self-administered questionnaire group (8.4% of 238 smokers) did not ‍differ significantly from that of doctors’ interview group (5.8% of 121 smokers). Age and intention to quit at enrollment ‍were found to be independent predictors of smoking cessation. Patients aged 50 years or older (odds ratio=5.05, 95% ‍confidence interval 1.89-13.54), and participants with an intention to quit (odds ratio=6.78, 95% confidence interval ‍2.66-17.30) were more likely to be successful in quitting. In phase II, another 212 smokers of one hospital were ‍interviewed by doctors in charge and provided with an additional pamphlet describing how to practice to dislike ‍smoking. No significant difference in the cessation rate was observed between phase I and phase II (5.8% vs. 8.0%). ‍In conclusion, there were no differences among the three modes of “5A”, but 7.7% of the 571 outpatients visiting ‍respiratory divisions quit smoking with this simple “5A”. The findings may indicate that this simple practice at ‍clinics is useful for smoking cessation strategy, although randomized trials are now required.     

Minimal Sizes of Cases with a Susceptible Genotype and Minimal Odds Ratios among Susceptible Individuals in Case-control Studies

Objective: Disease risk elevation due to an environmental factor only for individuals with a susceptible genotype ‍is a typical example of gene-environment interaction. In order to identify risk factors interacting with susceptible ‍genotypes in case-control studies, presumptions on minimal size of cases with the susceptible genotype (Smin) and ‍odds ratio (OR) among the susceptible individuals (ORsusceptible) are useful. ‍Model: Proportion of exposed cases (P1) and OR for whole cases (ORwhole) statistically detectable in a case-control ‍study can be calculated in a conventional method. P1 was assumed to be a weighted sum of the exposed among cases ‍with the genotype (Px) and cases without the genotype (equal to proportion of the exposed among controls, P0), i.e., ‍S Px + (1 - S) P0, where S is the size (proportion) of cases with the genotype. For each calculated P1, S became the ‍minimum (Smin) in case of Px = 1. ORsusceptible was calculated by {Px (1 - P0)} / {(1 - Px) P0}. ‍Results: Smin and ORsusceptible were listed for the combinations of the above components. For example, a detectable ‍P1 was 0.638 for P0=0.5 in a case-control study with 200 cases (N1) and 200 controls (N0), when á error of a two-sided ‍test was 0.05 with an 80% of power. In case of P1=0.638, ORwhole was 1.77, producing Smin=0.277 for infinite ORsusceptible. ‍It indicates that an environmental factor cannot be detected in case that a high-risk genotype frequency is less than ‍0.277. ‍Interpretation: If the size of cases with a susceptible genotype is expected to be less than Smin, case-control studies ‍are unlikely to detect a significant OR of the environmental factor.     

A Model of Practical Cancer Prevention for Out-patients Visiting a Hospital: the Hospital-based Epidemiologic Research Program at Aichi Cancer Center (HERPACC)

To promote a cancer prevention program at hospital, we started the hospital-based epidemiologic research program at ‍Aichi Cancer Center (HERPACC) in 1988. Because patients visiting hospitals are very concerned not only about their ‍own health condition but also practical way of disease prevention, we consider outpatients, especially those free of ‍cancer, as ideal targets to make a model program and a practical cancer prevention strategy for general people. To ‍confirm risk and protective effects of lifestyle factors like dietary habits, smoking and drinking, and exercise on cancer ‍in Japanese, we have been undertaking large-scale case-referent comparative studies of main cancer sites (stomach, ‍colorectal, lung, breast and uterine cancers) using the data generated by HERPACC. The risk of respiratory tract cancer ‍was definitely elevated by habitual smoking and that of upper digestive tract cancer by combined habitual smoking and ‍drinking. Frequent intake of raw vegetables and/or fruit in contrast reduced the risk of lung cancer among smokers. ‍Current obesity was positively associated with risk of post-menopausal breast cancer, recently on the increase in Japan. ‍However, all sites of cancer were linearly decreased with frequency of exercise in both males and females. Based on ‍these pieces of evidence and other main results obtained from the HERPACC studies, prevention trials with provision ‍of information about protective and risk factors for main sites of cancers to outpatients have been planned in parallel to ‍continuation of HERPACC.     

Report: 15th Asian Pacific Cancer Conference

To promote a cancer prevention program at hospital, we started the hospital-based epidemiologic research program at ‍Aichi Cancer Center (HERPACC) in 1988. Because patients visiting hospitals are very concerned not only about their ‍own health condition but also practical way of disease prevention, we consider outpatients, especially those free of ‍cancer, as ideal targets to make a model program and a practical cancer prevention strategy for general people. To ‍confirm risk and protective effects of lifestyle factors like dietary habits, smoking and drinking, and exercise on cancer ‍in Japanese, we have been undertaking large-scale case-referent comparative studies of main cancer sites (stomach, ‍colorectal, lung, breast and uterine cancers) using the data generated by HERPACC. The risk of respiratory tract cancer ‍was definitely elevated by habitual smoking and that of upper digestive tract cancer by combined habitual smoking and ‍drinking. Frequent intake of raw vegetables and/or fruit in contrast reduced the risk of lung cancer among smokers. ‍Current obesity was positively associated with risk of post-menopausal breast cancer, recently on the increase in Japan. ‍However, all sites of cancer were linearly decreased with frequency of exercise in both males and females. Based on ‍these pieces of evidence and other main results obtained from the HERPACC studies, prevention trials with provision ‍of information about protective and risk factors for main sites of cancers to outpatients have been planned in parallel to ‍continuation of HERPACC.     

Cancer in Women in Kerala - a Transition from a Less-developed State

An epidemiologic assessment of the problem of cancer in women in Kerala based on 3 Population Cancer Registry ‍data and a Hospital Based data is presented. Kerala’s Socio-economic and demography presents an intermediate ‍development from a less developed to a better-developed state. As yet, the women follow a tradition-based life style. ‍Cancer incidence rate in Kerala was only 80% of urban rates than seen in Urban Metropolis in India. The pattern of ‍site distribution has shown that GI, Breast & Cervix cancers are the predominant cancers. Oral cavity cancers also ‍show a high frequency. Thyroid cancer has a higher incidence rate in Kerala compared to other areas. Lung cancer ‍among women has higher incidence rate in Karunagappally women. A high prevalence of tobacco use is reported ‍among the men in the above area. Breast cancer incidence rate in the rural areas was only 60% of the rate seen in ‍Urban Trivandrum. Unlike in other rural and urban areas of India Cervix cancer has a low incidence rate in Kerala ‍women. This may be due to better education and also due to the changes in marital and other life style practices. ‍Only 15% of cancer patients attend for medical assistance in localized stage of disease. The need for public education ‍is highlighted and focusing on tobacco use control, self-examination and screening.     

Increasing Incidence of Colorectal Cancer and the Preventive Strategy in Japan

Background: In Japan, the westernization of lifestyle, especially dietary habits, has progressed remarkably since1950 and is presumably directly related to the increasing incidence of colorectal cancer (CRC). The aim of thisepidemiology note was to summarize the most recent trends in CRC incidence and predictions until 2020 for suggestingthe preventive strategies in Japanese. Methods: Using the newest published data in Japan, the most recent trends inCRC incidence and the predicted numbers of incident cases of CRC until 2020 were summarized. Results: Dietaryintake of milk, meat, eggs and fat/oil demonstrated remarkable increment through 1950 to 1970, and since then hasremained relatively constant. Compared with values for 1975, age-adjusted incidence rates for colon and rectalcancers were estimated to be 3.7 and 1.9 times higher among men and 2.9 and 1.3 times higher among women by1995 or 2000, respectively, and then to plateau. Considering progression of aging of the society, numbers of incidentcases for colon cancer among men and women have been predicted to increase 9.5 and 7.5 times by 2005 and 12.3 and10.5 times by 2020, respectively, from the 1975 baseline. Likewise, the figures for rectal cancer have been predictedto increase. Conclusion: The increment of CRC incidence is assumed to coincide with such changes in dietary intakeafter approximately 20-years lag. Concrete programs for lifestyle modification and more emphasis of early cancerscreening are now needed for prevention purposes.     

Individuals with HGV-RNA are at High Risk of B Cell Non - Hodgkin’s Lymphoma Development

Lymphoma is a common hematological malignancy. Hepatitis viruses, especially hepatitis B and hepatitis C, are ‍known risk factors for development of non-Hodgkin lymphomas. However, there are a number of patients with ‍hepatitis in whom no virus can be identified and it was therefore postulated that there may be other agents which ‍may be causing hepatitis. Many new hepatitis viruses have indeed been identified and proposed to have possible ‍roles in pathogenesis of many disorders. Hepatitis G virus (HGV) is an example of a newly detected hepatitis virus. ‍Whethere there is a correlation between infection and development of non-Hodgkin’s lymphoma is of interest. ‍Therefore an appraisal of the prevalence of HGV RNA among patients with B cell non-Hodgkin’s lymphoma ‍comparing with healthy control subjects was performed. According to the literature review, three reports covering ‍247 cases of non Hodgkin’s lymphoma were recruited. The overall prevalence of HGV RNA positivity was found to ‍be 7.2 % (18/247). Of the three reports, only two had complete data on the prevalence in both patients with B cell ‍non - Hodgkin’s lymphoma and healthy control subjects andwere used for further metanalysis study, covering 178 ‍cases and 355 healthy subjects. The overall antibody positive rate in the patients and healthy subjects were 8.4 % ‍(15/178) and 0.8 % (3/355), respectively, with an odds ratio is 10.8. According to this study, it can be seen that ‍individuals who are HGV RNA positive may be at very high risk of B cell non-Hodgkin’s lymphoma development.     

Differences in Lifestyle of a Smoking and Non-smoking Population in Japan

If smokers have different lifestyle including dietary habit in comparison to non-smokers, this difference have an ‍influence on the evaluation of the risks of smoking for tobacco-related diseases or the design of anti-smoking campaigns. ‍In Japan, 1,745 men over the age of 40 were surveyed regarding health consciousness in 1996 and 2,136 men between ‍the ages of 50 and 65 were surveyed regarding dietary habits in 1993-1994. Comparative analysis was done among ‍the smoking and non-smoking groups. The rate of participation in cancer mass-screening for smokers was significantly ‍lower than for non-smokers. Smokers had consumed significantly lower amounts of vegetables, fruits and beans, ‍which are well known beneficial factors for health than non-smokers, and had consumed more salt, salty food and ‍alcohol, which are well known risk factors for health. It is suggested that smokers have disadvantageous characteristics ‍for promoting and maintaining a healthy lifestyle more than in non-smokers. Accordingly, to evaluate the risk of ‍smoking for tobacco-related diseases in epidemiological researches, we should properly treat these data as confounding ‍factors. Furthermore, anti-smoking campaigns should be performed considering these differences.     

A Pilot Study on Genotype Announcement to Induce Smoking Cessation by Japanese Smokers

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.     

Dietary Habits and Cancer Mortality Among Middle Aged and Older Japanese Living in Hokkaido,Japan by Cancer Site and Sex

Dietary factors are thought to be closely associated with the development of human cancers and hence numerous studies ‍in this area have already been conducted in the United States and other Western countries. Comparatively few prospective ‍studies have been published in Japan, especially for Hokkaido people. The present investigation was therefore performed to ‍assess links between four leading cancers and some of the Japanese common dietary factors through a cohort study (1984- ‍2002) in Hokkaido by analyzing 1,524 men and 1,634 women separately aged 40 and over. Adjusted Cox proportional ‍hazard regression was used to calculate the relative risk (RR) for each dietary factor. For men, two dietary factors, miso ‍soup (RR=0.2, 95% confidence interval (95%CI)=0.1-0.8) and pickled vegetables (RR=0.2, 95%CI=0.1-0.8) were associated ‍with lower risk for stomach and colorectal cancer respectively. For women, three factors, namely salty confectionary (RR=3.5, ‍95%CI=1.1-10.9), black tea (RR=3.8, 95%CI=1.1-13.6), and carbonated drink/juice (RR=3.9, 95% CI=1.4-11.1) appeared ‍related to an elevated risk of stomach cancer. However, further analysis simultaneously with all other adjusted factors ‍indicated only carbonated drink/juice (RR=3.1, 95%CI=1.1-8.9) to present a significant risk factor for stomach cancer. One ‍factor, namely wild edible plants (RR=3.3, 95%CI=1.1-9.8), increased the risk for colorectal cancer in women. None of the ‍dietary components were significantly associated with lung or pancreatic cancers. This study also indicated a wide variation ‍in the impact of dietary factors by sex and cancer site, in line with earlier work, poonting to a necessity for careful interpretation. ‍Further epidemiological investigations by sex with more study subjects and confounding factors will be useful for determining ‍the contribution of individual dietary factors to development of human cancers in Hokkaido, Japan.     

An Estimate of the Potential for Cancer Prevention in Japan

Cancer prevention is an important strategy in cancer control and it consists of primary prevention and secondaryprevention. Major avoidable or manageable risk factors for cancer identified from previous studies are tobacco,diet and infection. Some cancer could be prevented by controlling those risk factors. In Japan screenings for gastriccancer, cervical cancer, lung cancer, breast cancer and colo-rectal cancer have been widely conducted under the Lawof Health Maintenance for the Aged. In planning and evaluating cancer control activities in Japan, it was considereduseful to estimate the potential of primary and secondary prevention of cancer. The author estimated the potentialof cancer prevention in Japan twice previously in 1990 and 1999. In this paper the potential of cancer prevention inJapan was re-estimated by using a different method and more recent data. From the present study it was estimatedthat about 25% of cancer occurrence could be prevented by control of smoking, diet and infection, about 9-15% ofcancer deaths could be prevented by cancer screening, and about 6- 10 % of cancer deaths could be prevented byapplication of the state-of-the art diagnosis and treatment of cancer, altogether about 40-50% of cancer occurrences/deaths could be prevented if all possible measures for cancer prevention are applied to the general public and cancerpatients in Japan.     

Knowledge of the Effects of Sun Exposure of Turkish High School Students and Their Sun Bathing Habits

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. ‍