Differences in breast cancer between Japan and the United States.

Two surgically treated series of 375 Japanese and 352 American women with breast cancer were compared with respect to overall survival and recurrence-free survival rates. Recurrence-free survival rates in Japanese women were superior to those in American women. Overall survival rates were also better in Japanese women, although the difference was not nearly as great as for recurrence-free survival. This seemed due to an improved survival after metastasis in the American women. In analyzing recurrence-free survival rates by age, we found that Japanese women 40 to 54 years old had better recurrence-free survival rates than other age subgroups. This age advantage was not observed in American women. For other age groups, there was relatively little advantage in survivorship in the Japanese series.

Distribution of aryl hydrocarbon hydroxylase inducibility in cultured human lymphocytes.

We measured aryl hydrocarbon hydroxylase (AHH) in cultured human lymphocytes. A striking seasonal variation in AHH activity was observed with induced AHH activity levels from January through May measuring approximately 20% of the values during the remainder of the year. AHH inducibility was determined by comparing lymphocytes from the same person cultured with and without the inducer 3-methylcholanthrene. If measurements are limited to the summer and fall seasons when AHH activity is high, AHH inducibility is reproducible for most persons with repeat determinations on the same person averaging 11% from the mean. The values of AHH inducibility in 53 persons ranged from 0.9 to 5.0, but the distribution of values did not fall into three distinct, nonoverlapping classes as reported by others. We were not able to determine the distribution of AHH inducibility in lung cancer patients since lymphocytes from less than half of the patients tested could be successfully cultured.

Cumulative genetic damage in children exposed to preconception and intrauterine radiation.

Using a mathematical model and newly developed computer software, the data from the Tri-State Leukemia Survey involving different combinations of radiation exposures to the father and mother prior to conception and to the mother during pregnancy were analyzed. The hypothesis that radiation exposure produces genetic damage which may be expressed in the child both as indicator disease and as leukemia was tested. The genetic damage was estimated in terms of the proportion affected by a given exposure. The relative risk of leukemia and certain other indicator diseases among those "affected" could then be estimated. The results were obtained by direct minimization of the total chi-square. The results show that there are at least two distinguishable risk groups, one group with lower (one or two exposures), and the other group with higher (two or three) radiation exposures. The estimates for the proportion affected are 0.13 and .04 for the lower and higher exposure groups, respectively. The relative risks of leukemia and indicator diseases are 25.0 and 5.0, respectively. The 95% confidence intervals for the proportion affected in the lower and higher exposure categories are (.0075, .02) and (.028, .055), respectively, and for the relative risk of leukemia are (16.0, 35.0). These results have confirmed and extended the findings of our preliminary report published in the Journal of the American Medical Association in May 1977.

The metastatic spread of kidney and prostate cancers in man.

This research was performed on 66 autopsy reports of kidney cancers and 58 autopsy reports of prostate cancers. Two alternative hypotheses were tested, i.e. whether metastases spread at random from the primary tumor throughout the body or whether the metastatic spread occurs in steps, referred to as a cascade spread, requiring one or more disseminating sites. It was found that in cancer of the prostate two disseminating sites exist, i.e. bones and lungs. Metastases from the primary tumor appear first in the skeleton and then in the lungs, not vice versa. In cancer of the kidney, the lungs are the major disseminating site. The lymphatic areas did not seem to play a major role in the dissemination of both cancers; on the contrary, the presence of metastases in the lymph nodes seem to depend on the presence of carcinomatous cells in key sites, i.e. the skeleton and the lungs. These results, however, should be interpreted with caution, as explained in the text. Considerations were proposed for future research.

Automatic encoding of clinical narrative.

An experiment in the automatic encoding of English-language medical data is described. The encoding program has two stages. First, the free-text input is parsed and the information is arranged in a tabular format by a general-purpose natural language processor developed at New York University. Then a simple code-dependent subprogram assigns numerical values to the entries on the basis of the positions the input words occupy in the information format. Results of a blind test of the encoding program using the code employed at Roswell Park Memorial Institute for earliest symptoms of head-neck cancer are presented.

Occupational cancer in men exposed to dust and other environmental hazards.

Data using a series of approximately 14,000 patients admitted to Roswell Park Memorial Institute for Cancer Research between 1956 and 1965 have been analyzed for occupations cancer risks. A detailed epidemiological schedule involving occupational history, smoking, drinking, and various other etiological factors was taken prior to interview. A mass screening of these data for about 20 different sites of cancer and 50 suspect occupations was conducted, using age-adjusted relative risks. A number of relationships was found between particular occupations and cancers. This report gives a survey of these relationships for men in a subset of the occupations screened, i.e., those occupations where exposure to dust would be suspected. Unlike most previous occupational studies, this one has a broad focus on a set of occupations and cancer sites rather than a narrow focus on one specific occupation or cancer site. This broader survey provides useful insights into the role of occupational hazards in the overall public health problem of cancer and is not a substitute for intensive investigation of specific occupation-site relationships (which cannot be done here). It can, however, provide guidance on which relationships are likely to be of public health significance, and what directions the deeper investigations might take. This kind of perspective is provided for the 22 occupation-cancer-site combinations where the age-adjusted relative risk is significant at the 5% probability level.