食管癌高发区贲门癌、胃癌流行强度分析及其对内镜筛查的启示

 目的 分析涉县等食管癌高发区贲门癌、胃癌的流行强度，明确其防治任务，探讨具体控制途径。方法 对比分析涉县、林县、磁县全人群肿瘤登记的食管癌、贲门癌、胃癌发病率与死亡率以及内镜筛查6233例40-69岁人群三种癌及癌前病变的检出率。结果 太行山南麓食管癌高发区食管癌、贲门癌和胃癌发病率或死亡率的合计占到全身恶性肿瘤的70％～80％。涉县2000-2004年贲门癌发病率男女性分别为69．9／10万和41．5／10万，死亡率男女性分别为54．3／10万和33．2／10万。高发区运用内镜碘染色指导活检技术筛查，食管鳞状上皮癌前病变及早期癌的检出率高，但贲门和胃腺上皮癌前病变及早期癌的检出率相对较低。结论 太行山南部食管癌高发区存在贲门癌和胃癌共同高发的现象，要想通过旱诊早治从整体上降低该地区上消化道癌的死亡率，必须加强内镜对贲门和胃腺上皮癌前病变及早期癌检出的研究。     

食管癌高发区上消化道癌整体高发对病因及预防的启示

目的：探讨食管癌高发区食管癌和贲门癌集中高发对病因和预防的启示作用。方法：通过分析涉县、林州、阳城、磁县1988年1月至2002年12月年男女性食管、贲门、非贲门胃癌发病率的分布，揭示太行山南部食管癌高发区上消化道癌整体高发的特点，然后根据既往移民研究的结果、亚硝胺类动物诱癌的特点以及表观遗传流行病学和生物进化论的原理，对该地域上消化道癌的病因形成假说，并探讨通过改良饮水进行病因学预防的重要性。结果：涉县、林州、阳城、磁县食管、贲门、非贲门胃癌三者发病率的合计均占全身恶性肿瘤的70%～80%。纯山区的涉县以贲门和非贲门的胃腺癌多见，占上消化道癌60%以上；而山区、丘陵、平原各1/3的磁县以食管鳞癌多见，占70%以上；林州和阳城大部分为山区，食管鳞癌和胃腺癌各占约50%。高发区这种上消化道癌的部位构成随地势变化的现象与亚硝胺类动物诱癌实验的结果相似，可能与不同地势下亚硝胺的种类或丰度的差别有关。亚硝胺可通过先天启动、后天积累、二次促癌，以片起源或多点起源的方式导致上消化道癌整体高发。结论：太行山南部食管癌高发区存在环境致癌因素，在该地域寻找能标定个体风险或早期事件的生物学指标是一个今后应致力研究的方向，但通过先期改良饮水等病因预防措施也许有助于更快地把超额的发病率降低到国外人群的水平。     

2019年度广西上消化道癌机会性筛查结果分析

目的分析广西地区2019年度上消化道癌机会性筛查数据,为上消化道机会性筛查工作提供指导。方法回顾性分析从广西上消化道癌管理系统收集的2019年度(2019年7月1日—2020年6月30日)参加广西上消化道癌机会性筛查的临床病历资料。计算活检率,食管/胃肿瘤性病变检出率,食管癌/胃癌早诊率,并在不同性别组以及年龄组之间进行比较。结果共10357例受检者纳入上消化道癌机会性筛查,其中5897例进行活检组织病理学检查,食管、贲门、胃分别活检882例、178例、5392例,活检率分别为14.96%、3.02%、91.44%。共检出食管肿瘤性病变126例(1.22%),早期癌37例(29.37%);胃肿瘤性病变210例(2.03%),早期癌66例(31.43%);贲门肿瘤性病变19例(0.18%),早期癌4例(21.05%);胃及贲门肿瘤性病变229例(2.21%),胃及贲门早期癌70例(30.57%)。肿瘤性病变检出率在性别和年龄分组中比较,差异均有统计学意义(均P<0.001)。食管癌、胃癌早诊率在性别和年龄分组中比较,差异均无统计学意义(均P>0.05)。在80岁之前,食管、胃(包括贲门)肿瘤性病变的检出率均随年龄上升而上升(χ^(2)=46.716,P<0.001;χ^(2)=51.989,P<0.001)。结论2019年度广西上消化道癌机会性筛查检出率及早诊率均不高,需进一步提高人群的防癌意识,尤其是年龄≥40岁的男性人群。     

河北省40年结直肠癌发病和死亡分析

背景与目的:结直肠癌是常见的消化道肿瘤之一,2012年全球约有136万结直肠癌新发病例,是世界第3高发恶性肿瘤,居恶性肿瘤死亡第4位,严重威胁着人类健康.该研究通过肿瘤登记地区结直肠癌发病死亡情况估计河北省结直肠癌疾病负担,与河北省三次全死因回顾调查资料比较,分析结直肠癌死亡率的时间变化趋势.方法:河北省肿瘤登记办公室收集到9个肿瘤登记处上报的2010—2012年恶性肿瘤发病和死亡资料.数据分性别、年龄别(0、1~4、5~9、10~14……80以上)计算恶性肿瘤发病率、死亡率和构成;采用2000年中国标准化人口构成和Segi's世界人口构成分别计算中国和世界人口年龄标准化发病率和死亡率.整理分析河北省1973—1975年、1990—1992年和2004—2005年三次全死因回顾调查的结直肠癌数据.采用Joinpoint回归模型分析磁县肿瘤登记处1988—2012年和涉县肿瘤登记处2000—2012年结直肠癌发病和死亡趋势.结果:河北省肿瘤登记地区2010—2012年结直肠癌新发病例2303例,死亡1229例.结直肠癌发病率为16.48/10万(男性18.12/10万,女性14.77/10万),中国人口标准化发病率为13.74/10万;结直肠癌死亡率为8.79/10万(男性10.23/10万,女性7.31/10万),中国人口标准化死亡率7.59/10万.河北省2010—2012年结直肠癌死亡率较1973—1975年升高了28.03%.磁县1988—2012年男性结直肠癌发病率年度平均变化百分比(annual percentage changes,APC)为3.55,死亡率APC为1.64.涉县2000—2012年男性结直肠癌发病率APC为4.68,女性为9.17.涉县2000—2012年男性结直肠癌死亡率APC为5.61.结论:河北省近40年结直肠癌发病与死亡呈现上升趋势.加强结直肠癌筛查,降低结直肠癌发病率和死亡率是河北省一项重要任务.     

Prospective study of risk factors for esophageal and gastric cancers in the Linxian general population trial cohort in China

Esophageal cancer incidence and mortality rates in Linxian, China are among the highest in the world. We examined risk factors for esophageal squamous cell carcinoma (ESCC), gastric cardia cancer (GCC), and gastric noncardia cancer (GNCC) in a population-based, prospective study of 29,584 adults who participated in the Linxian General Population Trial. All study participants completed a baseline questionnaire that included questions on demographic characteristics, personal and family history of disease, and lifestyle factors. After 15 years of follow-up, a total of 3,410 incident upper gastrointestinal cancers were identified, including 1,958 ESCC, 1,089 GCC and 363 GNCC. Cox proportional hazard models were used to estimate risks. Increased age and a positive family history of esophageal cancer (including ESCC or GCC) were significantly associated with risk at all 3 cancer sites. Additional risk factors for ESCC included being born in Linxian, increased height, cigarette smoking and pipe smoking; for GCC, male gender, consumption of moldy breads and pipe smoking; and for GNCC, male gender and cigarette smoking. Protective factors for ESCC included formal education, water piped into the home, increased consumption of meat, eggs and fresh fruits and increased BMI; for GCC, formal education, water piped into the home, increased consumption of eggs and fresh fruits and alcohol consumption; and for GNCC, increased weight and BMI. General socioeconomic status (SES) is a common denominator in many of these factors and improving SES is a promising approach for reducing the tremendous burden of upper gastrointestinal cancers in Linxian.     

磁县2003—2012年上消化道癌发病率分析

目的 分析磁县食管癌高发区10年间上消化道癌发病情况,为肿瘤防治提供依据。方法 按照肿瘤登记规范,收集整理,评价上消化道癌发病情况,利用磁县登记处积累的2003—2012年登记资料,分析上消化道癌发病率的变化趋势。计算粗发病率、中国标化率和世界标化率的变化百分比,配合调整率的线性回归模型,估计发病率的年度变化百分比值（annual percent change, APC）,同时分析食管癌、贲门癌、远端胃癌发病构成年度变化。结果 2003—2012年磁县上消化道癌平均粗发病率为165.36/10万,年度发病率有下降趋势;食管癌平均粗发病率为108.05/10万,年度发病率有逐年下降趋势;贲门癌平均粗发病率为31.21/10万,逐年上升趋势;远端胃癌平均粗发病率为26.10/10万,男性是上升趋势,而女性则是下降趋势。结论 食管癌发病率下降明显,但仍是磁县所有恶性肿瘤发病的首位,贲门癌发病率上升明显,提示上消化道癌防治重点是加强贲门癌及远端胃癌的综合防治研究,早诊早治非常重要。     

中国4个食管癌高发区上消化道癌的流行现状

[目的]描述我国食管癌高发区食管癌和胃癌亚部位的流行特征,为高发区上消化道癌的病因研究提供依据。[方法]对河北省磁县、涉县、河南省林州和山东省肥城4个食管癌高发区2006~2008年的登记资料进行重新复核,分析食管癌、胃癌的亚部位分布及流行趋势。[结果]4个肿瘤登记处2006~2008年食管癌新发病例7025例,男性4267例(60.7%),女性2758例(39.3%);胃癌新发病例共计5473例,其中男性3778例(69.0%),女性1695例(31.0%)。食管癌亚部位以食管中段较多,共2707例,占38.5%;胃癌亚部位以贲门癌发病为主,共2935例,占全部胃癌新发病例的53.6%。食管癌、胃癌3年的发病变化相对稳定;而亚部位发病中,贲门癌在胃癌中所占的比例逐年升高。[结论]贲门癌在食管癌高发区比例较高,且发病有上升趋势,应加强对高发区贲门癌病因学的研究。肿瘤亚部位提供重要信息,应在肿瘤登记处加强对亚部位的收集。     

Incidence and mortality rate of esophageal cancer has decreased during past 40 years in Hebei Province,China

Background

Hebei province is located in North of China with of approximately 6% of whole national population. It is known as a high-risk area for esophageal cancer in China and worldwide. The aim of our study was to estimate the esophageal cancer burden and trend in Hebei Province.

Methods

Eight cancer registries in Hebei Province submitted cancer registry data to the Hebei Provincial Cancer Registry Center. All data were qualified and compiled for cancer statistics in 2011. The pooled data were stratified by gender and age group (0, 1-4, 5-9, 10-14…80+). Incidence and mortality rates were age-standardized to World Segi’s population standard and expressed per 100,000 persons. In addition, proportions and cumulative incidence/mortality rates for esophageal cancer were calculated. Esophageal cancer mortality data during the periods 1973-1975, 1990-1992, and 2004-2005 were extracted from the national death surveys. Mortality and incidence rate data from Cixian and Shexian were obtained from population-based cancer registries in each county.

Results

The estimated number of newly diagnosed esophageal cancer cases and deaths in 2011 in Hebei Province was 24,318 and 18,226, respectively. The crude incidence rate of esophageal cancer was 33.37/100,000 (males, 42.18/100,000 and females, 24.31/100,000). The age-standardized rate by world standard population (ASRW) was 28.09/100,000, ranking third among all cancers. The esophageal cancer mortality rate was 25.01/100,000 (males, 31.40/100,000 and females, 18.45/100,000), ranking third in deaths among all cancers. The mortality rates of esophageal cancer displayed a significant decreasing trend in Hebei Province from 1973-1975 (ASRW =48.69/100,000) to 2004-2005 (ASRW =28.02/100,000), with a decreased rate of 42.45%. In Cixian, the incidence of esophageal cancer decreased from 250.76/100,000 to 106.74/100,000 in males and from 153.86/100,000 to 75.41/100,000 in females, with annual percentage changes (APC) of 2.13 and 2.16, while the mortality rates declined with an APC of 2.46 for males and 3.10 for females from 1988 to 2011. In Shexian, the incidence rate decreased from 116.90/100,000 to 74.12/100,000 in males and from 46.98/100,000 to 40.64/100,000 in females, while the mortality rates declined, with an APC of 4.89 in males from 2003 to 2011.

Conclusions

Although the incidence and mortality rates of esophageal cancer remain high, an obvious decreasing trend has been observed in Hebei Province, as well as in high-risk regions, such as Cixian and Shexian, over the past 40 years.     

2011—2016年河北省肿瘤登记地区食管癌发病和死亡流行情况分析

目的 食管癌是最常见的消化道恶性肿瘤之一,河北省则位于食管癌的高发区。本研究旨在分析2011—2016年河北省食管癌最新的流行趋势和特征。方法 对河北省27个肿瘤登记处的食管癌发病和死亡资料进行统计分析。按城乡、性别和年龄组分析发病率和死亡率。采用中国2000年普查人口和Segi′s世界人口计算年龄标准化率。应用灰色模型对高发区磁县和涉县的死亡率进行预测。结果 2011—2016年,河北省共报告食管癌14 905例,死亡9 933例,粗发病率为21.73/10万,粗死亡率为14.48/10万。发病率和死亡率均呈男性高于女性,农村高于城市的特点。河北省食管癌发病率和死亡率有下降趋势(P＜0.001)。磁县、涉县高发区发病率和死亡率呈长期下降趋势,预测未来十年食管癌死亡率将继续下降。结论 河北省食管癌发病率和死亡率呈稳步下降趋势,但其疾病负担仍然较重。食管癌的一级预防、早发现、早治疗应更关注农村居民和男性人群。     

贲门癌发病危险因素的病例对照研究

目的 探讨贲门癌发病的危险因素.方法 选择食管癌高发区河北省磁县、河北省涉县、河南省林州市、山东省肥城市及胃癌高发区辽宁省庄河市,每个地区选择2008年1月以后发病的贲门癌50例.采用以人群为基础的1∶3配对病例对照研究,用专门设计的调查表,分别对250例患者和750例对照进行问卷调查.并采用SPSS 13.0软件COXREG命令拟合条件Logistic回归模型,对相关变量进行分析.结果 单因素分析显示,吸烟、饮酒、饮食不规律、就餐姿势不正确、饮食口味重、常吃干果干菜、腌制食品、油炸食品、热烫食品、消化系统疾病史、胃食管反流性疾病可增加贲门癌发病的危险性,多吃豆类食品、体质指数(BMI)≥25则为保护因素.多因素分析显示,消化系统疾病史、常吃干果干菜、饮食不规律、常吃烫热食品、常吃腌制食品、吸烟、胃食管反流性疾病是贲门癌发病的危险因素,比值比(OR)分别为42.889、5.932、4.911、4.144、3.287、2.355和1.930;常吃豆类食品、BMI≥25是贲门癌发病的保护性因素,OR值分别为0.254和0.492.结论 生活行为习惯是贲门癌发病的重要影响因素,在高发区人群中开展健康教育,干预其不良生活行为和饮食习惯,将有助于降低贲门癌的发病率.     

Epidemiology of head and neck cancer: Magnitude of the problem

Head and neck cancer comprises squamous cell carcinomas of the upper aerodigestive tract. There are similarities in their natural history, epidemiology and control. For these cancers premalignant changes can be identified. Smoking and drinking are the major risk factors. The geographical variations in incidence and mortality are indicative of differences in the prevalence of risk factors between countries. The dramatic increase in head and neck cancers is cause for great concern, particularly in Central-Eastern Europe. The great majority of these cancers could be prevented by reducing the prevalence of established risk factors. Screening could be used to detect both precancerous lesions and early invasive cancers; however, no study as yet has demonstrated a reduced incidence and mortality resulting from screening. When setting strategies for prevention, the socioeconomic differentials in incidence and mortality from head and neck cancers need to be taken into account.     

应用内镜普查研究食管癌高发区贲门癌的发病情况

目的：了解食管癌高发区贲门癌的发病情况。制定更为有效的预防策略。方法：在食管癌高发区应用电子内镜直接碘染色检查法对高危人群共行3次内镜普查。结果：1）贲门癌的癌前病变即贲门腺上皮重度不典型增生的检出率为0.62%-1.50%。2）早期贲门癌的检出率分别为0.44%,0.68%及0.64%。中晚期贲门癌检出率分别为0.22%,0.17%及0.21%。3）91.30%-95.00%贲门重度不典型增生及早期贲门癌病变位于贲门时钟位（顺时针）10点位-2点位，大多数贲门癌前病变及早期贲门癌内镜下主要表现为贲门粘膜糜烂或浅溃疡。4）食管癌与贲门癌检出率之比为2.4-4.1:1。结论：在食管癌高发区直接应用内镜进行普查。除对食管癌及其癌前病变有较高的检出率外。对贲门癌及其癌前病变也有较高的检出率。因此在食管癌高发区也应重视贲门癌的防治及研究工作。     

Epidemiologic features of upper gastrointestinal tract cancers in Northeastern Iran

Previous studies have shown that oesophageal and gastric cancers are the most common causes of cancer death in the Golestan Province, Iran. In 2001, we established Atrak Clinic, a referral clinic for gastrointestinal (GI) diseases in Gonbad, the major city of eastern Golestan, which has permitted, for the first time in this region, endoscopic localisation and histologic examination of upper GI cancers. Among the initial 682 patients seen at Atrak Clinic, 370 were confirmed histologically to have cancer, including 223 (60%) oesophageal squamous cell cancers (ESCC), 22 (6%) oesophageal adenocarcinomas (EAC), 58 (16%) gastric cardia adenocarcinomas (GCA), and 58 (16%) gastric noncardia adenocarcinomas. The proportional occurrence of these four main site-cell type subdivisions of upper GI cancers in Golestan is similar to that seen in Linxian, China, another area of high ESCC incidence, and is markedly different from the current proportions in many Western countries. Questioning of patients about exposure to some known and suspected risk factors for squamous cell oesophageal cancer confirmed a negligible history of consumption of alcohol, little use of cigarettes or nass (tobacco, lime and ash), and a low intake of opium, suggesting that the high rates of ESCC seen in northeastern Iran must have other important risk factors that remain speculative or unknown. Further studies are needed to define more precisely the patterns of upper GI cancer incidence, to test other previously suspected risk factors, and to find new significant risk factors in this high-risk area.     

Clustering and Geographic Variation of Upper Gastrointestinal Cancers in a High-risk Region of Esophageal Cancer in Northern China

Aim: Geographic variation of upper gastrointestinal carcinomas (UGIC) was assessed in a high-risk regionin northern China. Methods: Shexian, Linzhou, Yangcheng and Cixian are four counties with world agestandardizedincidence rates (ASR) of esophageal cancer as high as 124.9, 99.5, 160.1, and 164.9 per 100,000respectively for males, and 70.8, 68.8, 92.1, and 104.6 for females for 1998 to 2002. Geographically, Shexian isentirely mountainous, Linzhou and Yangcheng are mostly mountainous, and Cixian is one-third mountains, onethirdhills, and the other third plains. The corresponding populations is 382,000, 982,000, 395,000 and 625,000 asin 2000. In the present analyses, the world ASRs of esophageal squamous cell carcinoma (ESCC), adenocarcinomaof the esophagogastric junction (AEG), gastric non-cardia carcinoma (GNCC), and the percentages of these inoverall tumor ASRs for 1998 to 2002 were compared across the four counties to show geographic variation andclustering. Additionally, site-specific detection rates of precursors and cancers in our population-based endoscopesurveys with local 40- to 69-year-old residents were also compared between a Cixian commune (2,013 surveyed)and a Shexian commune (1,514). Results: ASRs for ESCC, AEG, and GNCC combined amount to 210.5 to325.8 per 100,000 in men and 117.5 to 185.7 in women, accounting for respectively 70.6 to 82.1% and 53.4 to77.0 % of the all ASRs. In geographic distribution, the percentages of AEG and GNCC in UGICs increasedfrom Cixian (males 32.8%, females 22.1%) to Yangcheng (50.7%, 38.6%) and Linzhou (52.7%, 41.4%), andfurther to Shexian (61.7% , 61.9); while that of ESCC decreased in the same direction from Cixian, to Yangchengand Linzhou, and further to Shexian (67.2% , 77.9% ; 49.3% , 61.4% and 47.3%, 58.6% ; to 38.3% , 38.1%).Similarly, the detection rates of low- and high-grade intraepithelia neoplasia as well as cancers of the esophaguswere significantly higher in the Cixian commune than the Shexian commune (8.7, 4.4, 0.7% vs 7.0, 3.2, 0.4%P=0.004 ); but the rates for the esophagogastric junction were systematically and significantly lower in the Cixianthan in the Shexian commune (2.2, 0.5, 0.8 % Vs 3.3, 0.9, 1.7 %, P=0.001). Conclusions: Clustering of uppergastrointestinal carcinomas may suggest the existence of common risk factors, while geographic variation intopography/histology may be related to regional differences in carcinogen exposure. These observations identifya need for environment improvement, such as programs to improve drinking water conditions. To study highsusceptibility in a historically low mobile population, international collaborative research in this region mayprove to be very fruitful.     

2012—2016年河北省肿瘤登记地区肝癌发病和死亡流行情况分析

目的 分析河北省肝癌的发病和死亡状况及其趋势变化,为制订肝癌防治策略提供科学依据。方法 收集河北省2012—2016年27个肿瘤登记地区的肝癌发病和死亡数据,按城乡（城市/农村）、性别和年龄组分析肝癌发病率和死亡率。应用2000年中国人口普查和Segi's世界人口计算年龄标准化率。采用Joinpoint模型对磁县和涉县肝癌发病率和死亡率进行趋势分析。结果 2012—2016年,河北省共报告肝癌发病病例12 906例,死亡病例11 522例,粗发病率和死亡率分别为20.16/10万和18.00/10万。河北省肝癌发病率和死亡率均有一定程度下降,在女性和城市人口中下降幅度最大。磁县和涉县肝癌的发病率和死亡率呈长期下降趋势,但仍有一定波动。结论 河北省肝癌负担仍然较重,但发病率和死亡率呈下降趋势。未来应加大对农村居民和男性肝癌预防,以早期发现和治疗。     

中国食管癌高发区磁县上消化道癌两个时期发病率的比较与分析

  目的  探讨我国食管癌高发区磁县上消化道癌不同时期发病率情况。  方法  分析磁县2003~2012年上消化道癌发病资料,计算年度发病率,中国人口结构标化发病率(简称中标率)和世界人口结构标化发病率(简称世标率),并分割为前后两个时期,进行年度及各年龄组比较。  结果  2003~2012年上消化道癌粗发病率为165.36/10万。其中2003~2007年粗发病率为171.55/10万,2008~2012年粗发病率为151.41/10万,后5年发病率较前5年有所降低;其中食管癌2003~2012年粗发病率为108.05/10万,前后两个时期比较(2003~2007年为116.87/10万,2008~2012年为99.58/10万),后5年较前5年明显下降;贲门癌2003~2012年总体粗发病率为31.21/10万,两个时期比较(2003~2007年为29.11/10万,2008~2012年为33.23/10万)后5年较前5年有所升高;远端胃癌2003~2012年总体粗发病率为26.10/10万,两个时期比较(2003~2007年粗发病率为25.57/10万,2008~2012年为26.60/10万)后5年较前5年略有增高。  结论  食管癌发病下降明显,但仍是磁县居民发病的首位,贲门癌明显上升,远端胃癌男性增高明显,而女性略有下降,提示需重点开展贲门癌及远端胃的防治,早诊早治非常重要。      

2011~2015年甘肃省高台县上消化道癌早诊早治项目内镜筛查结果分析

[目的]总结分析5838例无症状人群上消化道癌内镜筛查结果.[方法]将高台县40～69岁的高危人群设定为上消化道癌筛查人群,采用整群抽样法进行抽样.对筛查人群进行内镜检查+碘染色及指示性活检,并对筛查结果进行统计分析.[结果] 2011～2015年完成胃镜筛查病例5838例,共检出高级别上皮内瘤变及癌140例,检出率为2.40％,其中食管癌检出率为0.98％(57例),贲门癌为0.57％(33例),胃癌(非贲门)为0.86％(50例).早期病例94例,早诊率为67.14％.应随访例数162例,实际随访105例,随访率为63.64％.随访中新发现病例6例,6例全部为早期病例,随即全部进行治疗.随访早诊率为100％,随访治疗率为100％.[结论]内镜检查+碘染色加指示性活检能有效发现可干预的癌前病变及早期癌.提高筛查项目点团队的专业技术能力,加强对高危人群的随访、治疗以及癌症防治知识的宣传,是开展上消化道癌症早诊早治项目的关键.     

The road to the discovery of the p53 protein: The Steiner Cancer Prize Award Lecture

Linxian, China has some of the highest rates of esophageal/gastric cardia cancer in the world. In 1983, esophageal balloon cytology screening was performed in 3 communes in northern Linxian. Of the participants, 10,066 with no evidence of cancer were followed prospectively for 71/2 years to evaluate the ability of the initial cytologc diagnoses to identify individuals at increased risk for developing cancer of the esophagus or gastric cardia. A total of 747 incident cases of esophageal or cardia cancer and 322 deaths due to these tumors were identified during the follow-up period and used in this analysis. The risks for esophageal or cardia cancer incidence and mortality increased in parallel with the presumed severity of the 1983 Chinese cytologic diagnoses. After adjusting for potential confounding factors, relative risks for esophageal or cardia cancer incidence, by initial cytologic diagnosis, were normal = 1.00 (reference), hyperplasia = 1.25, dysplasia 1 = 2.20, dysplasia 2 = 4.22 and near-cancer = 5.96. Our results suggest that esophageal balloon cytology, as performed and interpreted in Linxian in 1983, successfully identified individuals at increased risk for developing cancer of the esophagus or gastric cardia. © 1994 Wiley-Liss, Inc.     

Oral cancer in the UK: to screen or not to screen

Although oral squamous cell carcinoma accounts for only a small proportion of malignant neoplasms in the UK, oral cancer incidence and mortality rates have been rising in recent years. The natural history of oral cancer is not adequately understood at present and there is very little information about the epidemiology of precancerous lesions in the UK. There are also insufficient data to provide firm evidence that the percentage of cases arising de novo is greater in the UK and the Western world as compared to the Indian subcontinent. Screening for oral cancer by visual examination is simple, inexpensive and causes little discomfort; however, there is no evidence for the effectiveness of screening for oral cancer either in reducing mortality from the disease or in reducing the incidence of invasive disease by detection and treatment of precancerous lesions. There is currently insufficient evidence to recommend population screening for oral cancer in the UK. Measures aimed at primary prevention of the disease may be a more feasible method of disease control at present.     

Prospective study of serum vitamin E levels and esophageal and gastric cancers

Participants in the General Population Trial, a randomized nutrition intervention trial in Linxian, China, who received a combination of selenium, beta-carotene, and vitamin E supplements, had statistically significantly lower cancer mortality rates than those who did not receive the supplements. In the current study, we used a case-cohort design to examine the association between pre-trial serum vitamin E levels and the risks of developing esophageal and gastric cancers during the trial. We measured serum alpha- and gamma-tocopherol and cholesterol levels in 1072 case patients with incident esophageal squamous cell carcinoma (ESCC), gastric cardia cancer (GCC), or gastric noncardia cancer (GNCC) and in 1053 control subjects. The relative risks for comparisons of the highest to the lowest quartiles of serum alpha-tocopherol were 0.63 (95% confidence interval [CI] = 0.44 to 0.91) for ESCC, 0.84 (95% CI = 0.55 to 1.26) for GCC, and 2.05 (95% CI = 0.89 to 4.75) for GNCC. Serum gamma-tocopherol level was not associated with the incidence of any of these cancers. Our findings provide support for the role of alpha-tocopherol in the etiology of upper gastrointestinal cancers.