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.     

Physical Activity in the Prevention of the Most Frequent Chronic Diseases: an Analysis of the Recent Evidence

The Japan Multi-institutional Collaborative Cohort Study (J-MICC Study) launched in 2005, supported bya research grant for Scientific Research on Special Priority Areas of Cancer from the Japanese Ministry ofEducation, Culture, Sports, Science and Technology. Although the main purpose is to confirm and detectgene-environment interactions of lifestyle-related diseases, mainly of cancer, through the cohort analyses, itincludes cross-sectional analyses on lifestyle factors, biomarkers, and genotypes, as well as confirmation/screening of new biomarkers usable for early diagnosis of cancer. The endpoints are cancer diagnosis and death.The participants diagnosed as cancer will be identified through population-based cancer registries, hospitalcancer registries, mail questionnaires, questionnaires at repeated visits, death certificates, health insurance data,and second survey questionnaires. Subjects are individuals aged 35 to 69 years enrolled from respondents tostudy announcements in specified areas, inhabitants attending health checkup examinations by localgovernments, visitors at health checkup centers, and patients at a cancer hospital. The number of subjects wasset to be 100,000 throughout Japan. The enrollment period is from April 2005 to March 2010. The second surveyis scheduled 5 years after their enrollment. The participants will be followed until 2025. The J-MICC CentralOffice is placed at Nagoya University Graduate School of Medicine. Ten participating research groups (CohortStudy Executing Groups) send baseline data and blood samples (buffy coat, serum, and plasma) anonymizedwith an identification number (J-MICC ID) to the Central Office. The data of second survey and follow-up willbe linked using J-MICC ID. This study is expected to produce many findings on lifestyle and genetic traitsassociated with lifestyle-related diseases including cancer among Japanese.     

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.     

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. ‍     

医院健康科普教育对癌症防治的作用及探讨

健康科普教育对癌症防治具有重要的意义,可以改进生活方式,预防癌症发生;减少医疗费用,减轻就医负担;促使患者积极配合治疗;推动癌症医学研究的进步.中国医学科学院肿瘤医院以满足群众的需求为中心,不断丰富健康科普教育活动的内容和形式,取得了较好效果.但仍有很多需要改进的地方:提高科普教育人员的整体素质;创新健康科普教育的内容和形式;加强与媒体沟通合作.     

Hormone Receptor Status of Operable Breast Cancers in Indonesia: Correlation with Other Prognostic Factors and Survival

Objective: The aim of this study was to evaluate the hormone receptor status of operable breast cancers inYogyakarta, Indonesia , and its correlation with other established prognostic factors and overall survival. Materialsand Methods: Operable breast cancers in Yogyakarta were studied clinically, pathologically andimmunohistochemically for tumor size, lymph node status, histological grade, mitotic index, ER, PR, c-erbB2, p53and MIB-1 proliferation index. Correlations of ER and PR with those prognostic factors were determined, andpatients were longitudinally followed for overall survival. Results: Breast cancer showed an aggressive phenotypewith large tumor size, positive lymph nodes, high histologic grade, high mitotic index, positive c-erbB2, p53 andMIB- 1 proliferation index. Positive ER and PR did not improve the prognosis significantly, and adjuvant treatmentwith tamoxifen did not increase overall survival.     

射阳县居民癌症防治知识健康教育传播需求调查情况分析

[目的]探讨射阳县居民主要癌症防治知识知晓情况与防治知识健康教育需求。[方法]采用分层随机抽样方法,在全县所有镇20～69岁居民中抽取2296人作为调查对象,采取统一的问卷进行面对面现场调查,内容包括癌症防治知识的获得途径,希望了解的癌症信息,癌症主要危险因素、可疑表现、癌症的可防可治等内容的了解情况。[结果]居民既往和希望获得癌症防治知识的途径均为电视与广播;有70%以上的居民了解预防的重要性和效果,但对于致癌因素特别是不良的生活方式等能够导致癌症认识不足,仅有45.27%认为不合理饮食、16.30%认为肥胖是癌症的主要危险因素;有83.08%希望了解如何预防,63.35%希望了解癌症的表现。[结论]要继续充分发挥电视、广播传播媒介的作用,要以癌症预防与如何早期发现宣传为侧重点,提高居民癌症预防与早期发现能力。     

肝癌的病因及预防研究新进展

目前已确定肝癌的主要病因为乙型肝炎病毒和黄曲霉毒素 ,丙型肝炎病毒、遗传病因及饮水污染问题也得到重视 ;激素、糖尿病等因素备受关注。围绕主要病因开展人群干预已取得较大进展 ,化学预防研究中采用补硒、吡噻硫酮和叶绿酸等业已证明有良好的效果 ,癌前期患者的诊治对肝癌的预防有重要的意义。     

Cancer Nursing Research Output and Topics in the First Decade of the 21st Century: Results of a Bibliometric and Co-word Cluster Analysis

Objective: Many countries carry a high cancer burden and comprehensive cancer nursing is becoming increasingly complicated and difficult. Summarizing the recent research focus on cancer nursing may provide a snapshot of this field for those nurses or nurse educators who are in need of a quick overview of the research and its utilization. Methods: Candidate publications from January 1st 2001 to March 31st 2011 were collected by searching PubMed with the MeSH word ‘oncologic nursing’ and without language restriction. Bibliometric techniques used in this study included a statistical analysis of publication counts by authors, countries and journals and a co-word cluster analysis of highly-frequent MeSH words. Results: A total of 2933 publications about cancer nursing from 246 journals were indexed in PubMed, with Oncology Nursing Forum identified as the top contributing journal in the field. The United States, the United Kingdom and Canada were the largest three producer countries about cancer nursing. A total of 34 highly-frequent MeSH words for more than 100 times’ occurrences in the papers about oncologic nursing were extracted for cluster analysis. These words were classified into 3 aspects: (1) nursing practice; (2) nursing evaluation and education; (3) nursing-related social support. Conclusions: Stable growth has occurred in the research field of cancer nursing. The limited amount of the publications from developing countries indicates that the field is still under-developed. Emerging topics of nurse-patient relations and social support provide some hints of the need to provide more target training for the nurses and nurse students in the field of cancer nursing.     

Perspectives on Strategies for Establishing Cancer on the Global Health Agenda: Possibilities of Creating Infrastructure for Cancer Prevention Information using School

The Asia Cancer Forum is a body that is committed to strategic analysis in the area of cancer research. Theultimate objective of the Forum is to achieve the inclusion of cancer in the Millennium Development Goals(MDGs) of the United Nations. The MDGs have a tremendous influence on the setting of the global healthagenda and the inclusion of cancer within their scope would be greatly beneficial to the global development ofcancer research. Although diseases such as HIV/AIDS and malaria remain priority issues for global health, thetime has come for policy transformation. Preventive activities and measures require a long period of time beforeresults become apparent and as the cost-benefit effect of allocated funds cannot be measured in the short-term,preventive activities have therefore tended to be given a low priority in terms of national policy. We must take along-term perspective that looks ahead to the issues that will face future generations. Transcending challengespresented by cultural diversity, we must work to position cancer as a central theme on the global health agenda,even in the face of limited medical resources. Promoting cancer prevention activities through readily availableinfrastructure in the form of health classes in schools is also of great significance in terms of setting the agendafor global health. As a joint China-Japan research project, in China a questionnaire survey has been implementedthrough school pupils, with pupils and parents being asked about health classes implemented in schools. Fromthe perspective of formulating strategy for establishing cancer on the global health agenda we will use the datagained from the surveys to analyze and examine the possibilities and significance of creating an infrastructurefor a multilateral information network about cancer prevention.     

Preventive Effects of a Flavonoid Myricitrin on the Formation of Azoxymethane-induced Premalignant Lesions in Colons of Rats

The preventive effect of dietary exposure to a flavonoid myricitrin of azoxymethane (AOM)-induced aberrantcrypt foci (ACF) and beta-catenin-accumulated crypts (BCAC) formation was investigated in male F344 rats.Thirty-four rats were divided randomly into five experimental groups. Rats in groups 1-3 were given subcutaneousinjections of AOM (15 mg/kg body weight) once a week for 3 weeks. Starting 1 week before the first injection ofAOM, rats in groups 2 and 3 were fed a diet containing 500 or 1000 ppm myricitrin, respectively, for 11 weeks.Rats in group 4 were fed a diet containing 1000 ppm myricitrin. Rats in groups 1 and 5 were given the basal dietalone during the study. The experiment was terminated 11 weeks after the start. The frequency of ACF per colonin group 3 treated with AOM and 1000 ppm myricitrin was significantly lower than that in group 1 treated withAOM alone (p<0.01). Furthermore, dietary myricitrin at both doses (groups 2 and 3) significantly inhibited theformation of BCAC when compared to group 1 (p<0.05). These results indicate that myricitrin had possiblechemopreventive effects in the present short-term colon carcinogenesis bioassays and suggest that longer exposuremay cause suppression of tumor development.     

An Outline of the Need for Psychology Knowledge in Health Professionals: Implications for Community Development and Breast Cancer Prevention

Knowledge of health and community psychology in health professionals influences psychosocial and community determinants of health and promoting participation in disease prevention at the community level. This paper appraises the potential of knowledge on psychology in health care professionals and its contribution to community empowerment through individual behavior change and health practice. The authors proposed a schematic model for the use of psychological knowledge in health professionals to promote participation in healthinterventions/disease prevention programs in developing countries. By  implication, the paper provides a vision on policies towards supporting breast cancer secondary prevention efforts for community health development in Asian countries.     

Examining the Pathoplastic Moderating Role of Education on the Association between Depressive Mood and Self-Rated Health among Cancer Survivors: A Population-Based Study

Objective: Self-rated health (SRH) is a salient patient outcome for cancer survivors, and depressive mood and education are known determinants of cancer survivors’ SRH. Moving beyond the well-established direct association between depressive mood, education, and SRH among cancer survivors, this epidemiological study investigated the pathoplastic role of education on depressive mood in relation to SRH among a nationally representative sample of cancer survivors in the United States. Methods: The 2019 National Health Interview Survey was analyzed using data from adult participants (≥18 years old) who self-reported as cancer survivors (n = 3844). Ordered logistic regression was used to evaluate the direct impact of depressive mood and education in relation to SRH. In addition, the pathoplastic moderating effect was evaluated using ordered logistic regression with an interaction term of depressive mood and education in the regression model. All analyses adjusted for complex sample weights so that findings are nationally representative. Results: After adjusting for all covariates, U.S. cancer survivors’ depressive mood was significantly associated with lower SRH, and U.S. cancer survivors’ higher education was significantly associated with higher SRH. As a pathoplastic moderator, cancer survivors’ education significantly moderated the association between depressive mood and SRH. The negative association between depressive mood and SRH was significantly greater among those with higher education. Conclusion: Moving beyond the direct association between depressive mood, education, and SRH, education served as a pathoplastic moderator in relation to depressive mood and SRH. Psycho-oncology providers need to be mindful of the “protective-risk” effect of education in relation to cancer survivors’ depressive mood and SRH.     

Current Status of Knowledge,Attitude and Practice (KAP) and Screening for Cervical Cancer in Countries at Different Levels of Development

Cancer of the uterine cervix is a worldwide menace taking innumerable womens’ lives. The literature is vastand a large number of studies have been conducted in this field. Analyses have shown significant differencesexist in terms of screening and HPV testing facilities among high income and low to middle income countries. Inaddition, acute lack of awareness and knowledge among the concerned population is particularly noted in ruralareas of the low income countries. A detailed review of Indian case studies revealed that early age of marriageand childbirth, multiparity, poor personal hygiene and low socio-economic status among others are the principalrisk factors for this disease. This review concludes that a two pronged strategy involving strong government andNGO action is necessary to minimize the occurrence of cervical cancer especially in low and medium incomecountries.     

Oestrogen receptor downregulation: an opportunity for extending the window of endocrine therapy in advanced breast cancer.

BACKGROUND: Advanced breast cancer is largely incurable and current treatment modalities are aimed towards restricting tumour growth, prolonging survival, palliating symptoms and maintaining quality of life (QoL). The development of breast cancer is strongly influenced by endogenous oestrogens (and other growth factors), leading to a strong focus on the development of antioestrogenic compounds for the treatment of hormone-sensitive advanced disease. DESIGN: This is a review of current endocrine therapies available for postmenopausal women with advanced breast cancer, examining the likely impact of newer agents on treatment strategies. RESULTS: In postmenopausal women, current treatment options include tamoxifen, aromatase inhibitors (AIs) and megestrol acetate. Fulvestrant ('Faslodex') is a new, well-tolerated, oestrogen receptor antagonist that has no known agonist effect and is at least as effective as the AI anastrozole for the treatment of postmenopausal patients with metastatic or advanced breast cancer who have progressed on prior endocrine therapy. Fulvestrant maintains QoL throughout successful treatment. CONCLUSIONS: Fulvestrant represents a new treatment option for postmenopausal women with advanced disease. New agents that appear to lack cross-resistance with existing treatments may be used to extend the time period during which endocrine therapy may be employed before the need for cytotoxic chemotherapy.     

Prevention is better than cure and collaboration better than insularity: reasons why oncologists should embrace the international, public health and care of the elderly agendas in their research activities

O'CONNOR S.J. (2011) European Journal of Cancer Care 20 , 283–285
Prevention is better than cure and collaboration better than insularity: reasons why oncologists should embrace the international, public health and care of the elderly agendas in their research activities     

How Cancers Escape Immune Destruction and Mechanisms of Action for the New Significantly Active Immune Therapies: Helping Nonimmunologists Decipher Recent Advances

With the Food and Drug Administration and other worldwide regulatory authorities’ approval of ipilimumab (Yervoy), sipuleucel-T (Provenge), nivolumab (Opdivo), and pembrolizumab (Keytruda), oncologic therapy has now moved into noncancer cell targets within the immune system. For many nonimmunologists, understanding how these vastly different therapies work to improve survival, like no other therapies have in the past, is a challenge. The present report reviews the normal function of the immune system, how cancers escape the normal immune system, and how these new therapies improve immune system reactions against cancers.

Implications for Practice:

Oncologists have tremendous experience with therapies that target the cancer cells. New biologic agents have been rapidly introduced recently that target not cancer cells, but the patient’s immune cells. The mechanisms of action of these immune-based biologic agents are within the host immune system. To understand these new biologic therapies, basic knowledge of normal and abnormal immune function is essential. The present report explains the up-to-date basic immune normal and abnormal function and prepares the oncologist to understand how the new drugs work, why they work, and why there are associated adverse events.     

Relative and combined performance of mammography and ultrasonography for breast cancer screening in the general population: a pilot study in Tochigi Prefecture, Japan

BACKGROUND: Breast cancer screening by mammography is thought to be effective in reducing breast cancer mortality while ultrasonography is not accepted as a population screening modality, although the latter has been suggested to be useful in detection of cancer in the dense breast, relatively more typical for a younger woman. METHODS: Mammography with medio-lateral oblique view was offered on trial in 1999-2000 for 3453 female residents in Tochigi prefecture who also underwent clinical breast examination and ultrasonography. The municipalities that provided cancer screening were informed of the final diagnosis for women with positive findings in the screening trial by doctors who performed the diagnostic evaluation. Linkage was also made between the list of participants in the trial and registrations at Tochigi Cancer Registry for breast cancer cases diagnosed during 1999-2001. RESULTS: Thirteen cases with breast cancer were identified during a 2-year follow-up period: 10 were diagnosed subsequent to positive finding in the trial; two were negative in the trial and diagnosed 23 and 24 months after, respectively; and one had a positive finding at the trial but was undiagnosed at first and then diagnosed 18 months after the trial. Among the 11 cases judged as positive in the trial, four were judged only by mammography while three were judged only by ultrasonography. Those mammography alone-detected cases were relatively young, at 36, 40, 47 and 54 years of age, respectively, while the ultrasonography alone-detected cases were aged 50, 55 and 68, respectively. CONCLUSIONS: Combined screening with mammography and ultrasonography may be feasible. A larger study is required to evaluate relative performance of mammography and ultrasonography in detail by characteristics of examinees and their breasts.