Tobacco Price Increase and Smoking Cessation in Japan, a Developed Country With Affordable Tobacco: A National Population-Based Observational Study.

BACKGROUND: Longitudinal assessment of the impact of tobacco price on smoking cessation is scarce. Our objective was to investigate the effect of a price increase in October 2010 on cessation rates according to gender, age, socioeconomic status, and level of tobacco dependence in Japan. METHODS: We used longitudinal data linkage of two nationally representative studies and followed 2702 smokers for assessment of their cessation status. The odds ratios (ORs) for cessation were calculated using logistic regression. To estimate the impact of the 2010 tobacco price increase on cessation, data from 2007 were used as a reference category. RESULTS: Overall cessation rates significantly increased from 2007 to 2010, from 3.7% to 10.7% for men and from 9.9% to 16.3% for women. Cessation rates were 9.3% for men who smoked 1-10 cigarettes per day, 2.7% for men who smoked 11-20 cigarettes per day, and 2.0% for men who smoked more than 20 cigarettes per day in 2007. These rates increased to 15.5%, 10.0%, and 8.0%, respectively, in 2010. The impact was stronger among subjects who smoked more than 11 cigarettes per day than those who smoked 1-10 cigarettes per day in both sexes: ORs for 2010 were 4.04 for those smoking 11-20 cigarettes per day, 4.26 for those smoking more than 20 cigarettes per day, and 1.80 for those smoking 1-10 cigarettes per day in the main model in men. There were no obvious differences in the relationship between tobacco price increase and smoking cessation across age and household expenditure groups. CONCLUSIONS: The tobacco price increase in Japan had a significant impact on smoking cessation in both sexes, especially among heavy smokers, with no clear difference in effect by socio-demographic status.

Effects of the Cessation of Mass Screening for Neuroblastoma at 6 Months of Age: A Population-Based Study in Osaka, Japan.

BACKGROUND: In 2004, the Japanese government halted the 6-month mass screening program for neuroblastoma. We investigated whether its cessation had led to an increase not only in mortality due to this disease but also in the incidence of advanced-stage disease among older children. METHODS: Study subjects were neuroblastoma patients retrieved from the population-based Osaka Cancer Registry. Trends of incidence and mortality from neuroblastoma were analyzed by calendar year and birth cohort. Prognostic factors, including stage and v-myc avian myelocytomatosis viral oncogene neuroblastoma derived homolog (MYCN) oncogene status, were compared before and after the cessation of mass screening. RESULTS: Age-standardized incidence rates in 2005-2009 (the cessation period of mass screening; 11.1 per million) were similar to those in 1975-1979 (the pre-screening period; 8.6 per million). Age-standardized mortality rates tended to decrease from 1975-1979 (4.0 per million) to 2005-2009 (2.7 per million) in parallel with the improvement in survival. Analysis by birth cohort indicated that the mortality rates in 2004-2005 (after cessation) for children 0-4 years of age were lower than those in 1975-1979 (O:E ratio 0.25; 95% confidence interval, 0.03-0.90). For children 1-9 years of age, there was a not significant difference in the distribution of stage, MYCN oncogene status, and DNA ploidy between 1991-2003 (the mass screening period) and 2004-2008 (after cessation). CONCLUSIONS: The cessation of mass screening for neuroblastoma does not appear to have increased mortality due to this disease or incidence of advanced-stage disease among older children.

Investigation of Spatial Clustering of Biliary Tract Cancer Incidence in Osaka, Japan: Neighborhood Effect of a Printing Factory.

BACKGROUND: In 2013, an unusually high incidence of biliary tract cancer among current or former workers of the offset color proof printing department of a printing company in Osaka, Japan, was reported. The purpose of this study was to examine whether distance from the printing factory was associated with incidence of biliary tract cancer and whether incident biliary tract cancer cases clustered around the printing factory in Osaka using population-based cancer registry data. METHODS: We estimated the age-standardized incidence ratio of biliary tract cancer according to distance from this printing factory. We also searched for clusters of biliary tract cancer incidence using spatial scan statistics. RESULTS: We did not observe statistically significantly high or low standardized incidence ratios for residents in each area categorized by distance from the printing factory for the entire sample or for either sex. The scan statistics did not show any statistically significant clustering of biliary tract cancer incidence anywhere in Osaka prefecture in 2004-2007. CONCLUSIONS: There was no statistically significant clustering of biliary tract cancer incidence around the printing factory or in any other areas in Osaka, Japan, between 2004 and 2007. To date, even if some substances have diffused outside this source factory, they do not appear to have influenced the incidence of biliary tract cancer in neighboring residents.

Long-term survival and conditional survival of cancer patients in Japan using population-based cancer registry data.

Although we usually report 5-year cancer survival using population-based cancer registry data, nowadays many cancer patients survive longer and need to be followed-up for more than 5 years. Long-term cancer survival figures are scarce in Japan. Here we report 10-year cancer survival and conditional survival using an established statistical approach. We received data on 1,387,489 cancer cases from six prefectural population-based cancer registries in Japan, diagnosed between 1993 and 2009 and followed-up for at least 5 years. We estimated the 10-year relative survival of patients who were followed-up between 2002 and 2006 using period analysis. Using this 10-year survival, we also calculated the conditional 5-year survival for cancer survivors who lived for some years after diagnosis. We reported 10-year survival and conditional survival of 23 types of cancer for 15-99-year-old patients and four types of cancer for children (0-14 years old) and adolescent and young adults (15-29 years old) patients by sex. Variation in 10-year cancer survival by site was wide, from 5% for pancreatic cancer to 95% for female thyroid cancer. Approximately 70-80% of children and adolescent and young adult cancer patients survived for more than 10 years. Conditional 5-year survival for most cancer sites increased according to years, whereas those for liver cancer and multiple myeloma did not increase. We reported 10-year cancer survival and conditional survival using population-based cancer registries in Japan. It is important for patients and clinicians to report these relevant figures using population-based data.

Socioeconomic inequalities in cancer survival: a population-based study of adult patients diagnosed in Osaka, Japan, during the period 1993-2004.

BACKGROUND: Long-term recession of the Japanese economy during the 1990s led to growing social inequalities whilst health inequalities also appeared. The 2007 National Cancer Control Program of Japan targeted "equalisation of cancer medical services", but the system to monitor health inequalities was still inadequate. We aimed to measure socioeconomic inequalities in cancer survival in Japan. MATERIAL AND METHODS: We analysed 13 common invasive, primary, malignant tumours diagnosed from 1993 to 2004 and registered by the population-based Cancer Registry of Osaka Prefecture. An ecological socioeconomic deprivation index based on small area statistics, divided into quintile groups, was linked to patients according to their area of residence at the time of diagnosis. We estimated one-, five-year and conditional five-year net survival by sex, period of diagnosis (1993-1996/1997-2000/2001-2004) and deprivation group. Changes in survival over time, deprivation gap in survival, and change in deprivation gap were estimated at one and five years after diagnosis using variance-weighted least square regression. RESULTS: The deprivation gap in one-year net survival was narrower than in five-year net survival and conditional five-year survival. During the study period, there was no change in deprivation gap, except for reductions for pancreas (men) and stomach (women), and an increase for lung (men) in one-year survival. We observed a linear association between level of survival and deprivation gap at five years and conditional five years, but no association at one-year survival. CONCLUSION: A wide deprivation gap in survival was observed in most of the adult, solid, malignant tumours, within the universal healthcare system in Japan. Overall, cancer survival improved in Osaka without any widening of inequalities in cancer survival in 1993-2004, shortly after the long-term economic recession and deep modifications in the social and work environments in Japan. The longer term impact of the recession on inequalities in cancer survival needs to be monitored using population-based cancer registry data.

Does removal of out-of-pocket costs for cervical and breast cancer screening work? A quasi-experimental study to evaluate the impact on attendance, attendance inequality and average cost per uptake of a Japanese government intervention.

Reducing out-of-pocket costs is known to improve mammography attendance, but an evidence gap remains concerning Pap smear testing. The Japanese government implemented a politically determined intervention to remove out-of-pocket costs for Pap smear tests and mammography attendance, costing US$148 million, in 2009. It targeted women when they reached the first year of a 5-year age group (i.e., 20, 25, 30 years) with the aim of reducing attendance inequality. Our objective is to evaluate the intervention in terms of uptake and average cost per uptake for cancer screening attendance and to assess socioeconomic inequalities in cancer screening attendance pre- and postintervention. A quasi-experimental study utilizing national repeated cross sections, observed pre- and postintervention, which compared intervention and comparison groups by the Difference-in-Differences method, was conducted. Outcome measures were uptake of cancer screening attendance resulting from the intervention with average cost per uptake and broad inequality indicators for cancer screening attendance according to socioeconomic inequality. In total, 34,043 age-eligible, noninstitutionalized women were analyzed. Uptake among the overall population was 13.9% point in the age- and income-adjusted model for Pap smear and 9.8% point for mammography, with an average cost of US$139 per uptake. The intervention increased inequality indicators in Pap smear attendance (more than +100%) but decreased inequality in mammography attendance (ranging from -12.9 to -74.1%) within the intervention group. In conclusion, removing out-of-pocket costs improves female cancer screening uptake in Japan but may not be cost-saving. Although cost removal reduces inequalities in attendance for mammography, it appears to increase inequalities in Pap smear attendance.

Conditional survival for longer-term survivors from 2000-2004 using population-based cancer registry data in Osaka, Japan.

BACKGROUND: We usually report five-year survival from population-based cancer registries in Japan; however these survival estimates may be pessimistic for cancer survivors, because many patients with unfavourable prognosis die shortly after diagnosis. Conditional survival can provide relevant information for cancer survivors, their family and oncologists. METHODS: We used the period approach to estimate the latest 10-year survival of 38,439 patients with stomach, colorectal, lung, breast and prostate cancer diagnosed between 1990 and 2004 and followed-up from 2000-04 in Osaka, Japan. Conditional survival is an estimate, with the pre-condition of having already survived a certain length of time. Conditional five-year relative survival of one to five years after diagnosis was calculated by site, age and stage for survivors under the age of 70. RESULTS: Five-year relative survival for stomach cancer was 60%. Conditional five-year relative survival was 77% one year after diagnosis and 97% five years after diagnosis. This means that 97% of patients who survive five years after diagnosis can survive a further five years. Conditional five-year relative survival improved successively with each additional year that patients lived after diagnosis for stomach, colorectal and lung cancer. These figures for breast and prostate cancer were stable at high survival. Liver cancer did not show an increase in conditional five-year survival. CONCLUSION: Conditional five-year survival is a relevant figure for long-term cancer survivors in Japan. It is important for population-based cancer registries to provide figures which cancer patients and oncologists really need.

Incidence of soft tissue sarcoma focusing on gastrointestinal stromal sarcoma in Osaka, Japan, during 1978-2007.

To clarify the incidence of soft tissue sarcoma and gastrointestinal stromal sarcoma in Osaka, Japan, we analyzed Osaka Cancer Registry's data. We identified a total of 6998 cases, except for those of bones and joints, during 1978-2007. The age-adjusted incidence rate of those sarcomas was 2.7 per 100 000 (male 2.8, female 2.6) person-years. The trend in the incidence for the last 10-year period (1998-2007) increased significantly overall and for females, while it was not significant for males. Except for cases not otherwise specified, the most prevalent histological subtype was leiomyosarcoma in digestive organs and gastrointestinal stromal sarcoma, followed by leiomyosarcoma excluding that in digestive organs and liposarcoma. Gastrointestinal stromal sarcomas were registered for the first time in 1988 and have increased since 1999, while leiomyosarcomas in digestive organs have decreased. Gastrointestinal stromal sarcoma might have been diagnosed as leiomyosarcoma in digestive organs before using immunohistochemistry.

Descriptive epidemiology of bile duct carcinoma in Osaka.

OBJECTIVE: An outbreak of bile duct carcinoma has been reported among workers in a certain printing company in Osaka, Japan, where there was no descriptive epidemiological study. We conducted descriptive studies of bile duct carcinoma in Osaka. METHODS: Based on the data from the Osaka Cancer Registry, the incidence and survival rate of intrahepatic and extrahepatic bile duct carcinomas, gallbladder carcinomas and hepatocellular carcinomas were analyzed. The study period was between 1975 and 2007, and total 108 407 incidents were retrieved from the Osaka Cancer Registry. Age- and sex-specific incidence rates and age-standardized incidence rates were calculated. Standardized incidence ratios were evaluated for each municipality in Osaka prefecture. Relative 5-year survival rates were also calculated for the cases diagnosed between 1993 and 2005. RESULTS: Age-standardized incidence rates of bile duct carcinomas increased distinctly from the middle of the 1970s to the early 1980s in males and the 1990s in females. However, no distinct increase in the incidence rates was observed in 2000. Standardized incidence ratios of those did not exceed the unity significantly in males between 1992 and 2007. In females, standardized incidence ratios exceeded the unity significantly in a few regions without any relation to the location of the printing company where the outbreak was reported. The relative 5-year survival rate is generally poor; however, patients who were diagnosed with localized disease at the age of 25-49 years showed a better survival. CONCLUSION: Neither change in trend nor regional accumulation of bile duct carcinoma was confirmed in Osaka, corresponding to the outbreak reported in the printing company.

Incidence of metachronous second primary cancers in Osaka, Japan: update of analyses using population-based cancer registry data.

Cancer survivors are at excess risk of developing second primary cancers, but the precise level of risk in Japanese patients is not known. To investigate the risk of survivors developing second primary cancers, we conducted a retrospective cohort study using data from the Osaka Cancer Registry. The study subjects comprised all reported patients aged 0-79 years who were first diagnosed with cancer between 1985 and 2004 in Osaka and who survived for at least 3 months, followed-up through to December 2005. A metachronous second primary cancer was defined as any invasive second cancer that was diagnosed between 3 months and 10 years after the first cancer diagnosis. The main outcome measures were incidence rates per 100,000 person-years, cumulative risk and standardized incidence ratios (SIR) of second primary cancer. Metachronous second primary cancers developed in 13,385 of 355,966 survivors (3.8%) after a median follow-up of 2.5 years. Sex-specific incidence rates of metachronous second primary cancer per 100,000 person-years increased with age, and were higher among men than women (except for the 0-49 years age group), but these rates did not differ over the study period. The 10-year cumulative risk was estimated as 13.0% for those who first developed cancer at 60-69 years of age (16.2% for men, 8.6% for women). The SIR among those with first cancer diagnosed at 0-39 and 40-49 years of age were 2.13 and 1.52, respectively, in both sexes, whereas the SIR among cancers of the mouth/pharynx, esophagus and larynx were much higher than one as for site relationships. We showed that cancer survivors in Osaka, Japan, were at higher risk of second primary cancers compared with the general population. Our findings indicate that second primary cancers should be considered as a commonly encountered major medical problem. Further investigations are required to advance our understanding to enable the development of effective measures against multiple primary cancers.

Trend analysis of cancer incidence in Japan using data from selected population-based cancer registries.

Population-based cancer registries are operated by over 80% of prefectures in Japan. However, only a limited proportion of the registries can provide long-term incidence data. Here, we aimed to establish a method for monitoring cancer incidence trends in Japan using data from selected prefectures. Based on the availability of long-term (≥ 20 years) high-quality data, we collected incidence data from five prefectures (Miyagi, Yamagata, Fukui, Osaka, and Nagasaki), which included an annual average of 54,539 primary cancer cases diagnosed between 1985 and 2004. Cancer mortality data for 1995-2004 were obtained from the vital statistics. Representativeness and homogeneity of the trends were examined by funnel plot analysis of log-linear regression coefficients calculated for the most recent 10 years of data (1995-2004) of age-standardized rates (ASR). The ASR of incidence for five prefectures in total (5-pref total) showed a significant decrease, with an annual percent change (APC) of -1.0 (95% confidence interval [CI] -1.4: -0.6) for males and -0.4 (95% CI -0.8: -0.1) for females. Excluding data from Osaka (4-pref total) reversed the decreasing trend; the corresponding APC was +0.4 (95% CI -0.2: +1.0) for males and +0.7 (95% CI +0.5: +0.9) for females. The APCs for the ASR of mortality for the 4-pref total (males, -1.5; females, -1.3) were more representative of nationwide data (males, -1.4 [95% CI -1.7: -1.2]; females, -1.1 [95% CI -1.4: -0.9]) than those for the 5-pref total (males, -1.7; females, -1.4). We conclude that using data from Miyagi, Yamagata, Fukui, and Nagasaki prefectures, with continuous monitoring of the representativeness of the data, is a provisionally relevant way to evaluate cancer incidence trends in Japan.

Trends in 'cure' fraction from colorectal cancer by age and tumour stage between 1975 and 2000, using population-based data, Osaka, Japan.

Since the 1960s, Japan has experienced a striking increase in the incidence of colorectal cancer, now the second most common cancer in the country. Meanwhile, the management of colorectal cancer has changed dramatically with the implementation of, for example, screening, endoscopy and adjuvant chemotherapy. It is therefore of interest to monitor the long-term trends in population 'cure' in Japan. We analysed 33 885 colorectal cancer cases diagnosed between 1975 and 2000 in Osaka. We applied the multivariable mixture cure model to estimate cure fraction and median survival time (MST) for 'uncured' patients, by sex, age, stage, period at diagnosis and subsite. For colon cancer, the cure fraction increased by about 25%, while MST for the uncured was prolonged from 8 to 12 months. The cure fraction was 5% higher in men than in women, while MST was similar in both. The cure fraction also increased for localized and regional tumours. For rectal cancer, the cure fraction increased by about 25-30%, but remained lower than for colon cancer. From the late 1970s, the cure fraction for colorectal cancer increased dramatically due to better management of detection and care for colorectal cancer. This improvement was obtained at the cost of shorter MST for uncured patients.

Clinical utility of apparent diffusion coefficient (ADC) values in patients with prostate cancer: can ADC values contribute to assess the aggressiveness of prostate cancer?

PURPOSE: To retrospectively evaluate the relationship between apparent diffusion coefficient (ADC) values and Gleason score (GS) in prostate cancer. METHODS: A total of 60 patients who underwent radical prostatectomy for clinically localized prostate cancer were selected for this study. Diffusion-weighted magnetic resonance (MR) images were obtained using a 1.5 T system. ADC values were analyzed between three groups: GS of 6 or less (n = 7); GS of 7 (n = 37); and GS of 8 or higher (n = 16). ADC values of the three GS groups were statistically analyzed in order to determine the relationship with GS. In the 37 patients with GS = 7 the difference in ADC values between GS 3+4 and GS 4+3 was analyzed. RESULTS: Median ADC values (10⁻³ mm² /s) of the three GS groups were 1.04 (GS = 6 or less), 0.867 (GS = 7), and 0.729 (GS = 8 or higher). Although there was considerable overlap among the groups, the differences in ADC were statistically significant (P < 0.0001). There was a significant inverse correlation between GS and ADC values (z = -0.437, P < 0.0005). Median ADC values (10⁻³ mm² /s) of GS 3+4 and GS 4+3 patients were 0.88 and 0.814, respectively (P < 0.05). CONCLUSION: ADC values showed a negative correlation with GS. Pathologically, however, there was considerable intrasubject heterogeneity.

Trends in the incidence of primary intracranial tumors in Osaka, Japan.

We analyzed the trends in the age-standardized incidence rates of 10,460 cases of primary intracranial tumors diagnosed during 1975 and 2004, Osaka, Japan using the Joinpoint regression analysis. During the period 1975-2004, the age-standardized incidence rates of total intracranial tumors increased until 1987 at 3.1% per year and then decreased significantly at -1.8% per year. The time trends were different according to the age groups. In the age group 0-19, the rate did not exhibit substantial increase or decrease. In the age group 20-74, the rates increased significantly until 1988 and then leveled off until 1999 and finally decreased. Whereas in the age group 75 and over, the rates increased drastically until 1984 and then leveled off. During the recent 10 year period 1995-2004, the age-standardized incidence rates of meningioma decreased significantly, but those of glioblastoma did not.

Population-based survival of cancer patients diagnosed between 1993 and 1999 in Japan: a chronological and international comparative study.

OBJECTIVE: The purpose of the present study was to collect data from population-based cancer registries and to calculate relative 5-year survival of cancer patients in Japan. We also sought to determine time trends and to compare the results with international studies. METHODS: We asked 11 population-based cancer registries to submit individual data for patients diagnosed from 1993 to 1999, together with data on outcome after 5 years. Although all these registries submitted data (491 772 cases), only six met the required standards for the quality of registration data and follow-up investigation. The relative 5-year survival calculated by pooling data from 151 061 cases from six registries was taken as the survival for cancer patients in Japan. RESULTS: Relative 5-year survival (1997-99) was 54.3% for all cancers (males: 50.0%, females: 59.8%). Survival figures for all sites changed slightly over the 7-year period, from 53.2% for the first 4 years of the study (1993-96) to 54.3% for the last 3 years (1997-99), however, a major improvement was observed in several primary sites. Some overall survival was lower in Japan than in the USA, but similar to that in European countries. Specifically, survival for uterine cancer, prostate cancer, testis cancer, lymphoma and leukemia was much lower in Japan than in other countries. However, survival was better in Japan mainly for cancers of the esophagus, stomach, colon, liver and gallbladder. CONCLUSION: The study suggests an improvement in cancer survival in several primary sites in Japan, which is consistent with the development of treatments and early detection.

Incidence and survival trends for childhood cancer in Osaka, Japan, 1973-2001.

Mortality for childhood cancer has declined in Osaka, as well as all over Japan, since the 1970s, but whether this decline can be explained by trends of incidence or survival of childhood cancer has not been examined. A total of 5960 malignant tumors diagnosed between 1973 and 2001 in children <15 years of age were registered at the Osaka Cancer Registry in Japan. The time trends for childhood cancer were analyzed over 29 years for incidence and 20 years for survival. Leukemia was the most common among childhood cancer for both sexes and accounted for one-third of all cases. The age-standardized annual incidence rate of all tumors was highest in 1988-1992: 155.1 per million for males and 135.9 for females. Five-year survival for all tumors improved from 50.1% in 1978-1982 to 73.0% in 1993-1997 for males and from 52.3% to 76.3% for females. Thus, the constant decline in mortality in childhood cancer was primarily due to improved survival between the 1970s and 1980s and reduced incidence after the 1990s.

Slight dilatation of the main pancreatic duct and presence of pancreatic cysts as predictive signs of pancreatic cancer: a prospective study.

PURPOSE: To prospectively determine whether slight dilatation of the main pancreatic duct and pancreatic cysts detected at ultrasonography (US) are predictive signs of pancreatic cancer. MATERIALS AND METHODS: The research protocol was approved by the institutional review board, and written informed consent was obtained from all participants. One thousand fifty-eight subjects (age range, 36-80 years; mean, 61.8 years) with various kinds of abnormal US findings in the pancreas were enrolled from 1999 to 2002, after exclusion of pancreatic neoplasm and other malignant diseases. The endpoint was the subsequent development of pancreatic cancer, and the outcome was determined at the end of December 2007. To identify independent predictive variables for the subsequent development of pancreatic cancer, various baseline characteristics were examined by using a Cox regression model and a Cox proportional hazards model. The cumulative incidence of pancreatic cancer was estimated by using the Kaplan-Meyer method. RESULTS: During the mean follow-up of 75.5 months (+/- 17.3[standard deviation]), pancreatic cancer subsequently developed in 12 of 1058 subjects. The risk of pancreatic cancer was significantly elevated in subjects with slight dilatation (> or = 2.5 mm) of the main pancreatic duct or presence of cyst (s) (> or = 5 mm). The respective hazard ratios were 6.38 (P = .018) and 6.23 (P = .003). For subjects with both findings, the 5-year cumulative risk of pancreatic cancer was 5.62% (95% confidence interval: .37%, 13.03%), and the age-and sex-adjusted hazard ratio compared with the risk in the absence of these findings was 27.50 (P = .002). CONCLUSION: Main pancreatic duct dilatation (> or = 2.5 mm) and presence of a pancreatic cyst (> or = 5 mm) were both strong independent predictors of the subsequent development of pancreatic cancer. (c) RSNA, 2010.

Long-Term Prospective Study of 6104 Survivors of Arsenic Poisoning During Infancy Due to Contaminated Milk Powder in 1955.

BACKGROUND: In 1955, an outbreak of arsenic poisoning caused by ingestion of arsenic-contaminated dry milk occurred in western Japan. We assessed the excess mortality among Japanese who were poisoned during this episode as infants. METHODS: We identified and enrolled 6104 survivors (mean age at enrollment, 27.4 years) who had ingested contaminated milk when they were age 2 years or younger; they were followed until 2006 (mean duration of followup,24.3 years). Death certificates of subjects who died between 1982 and 2006 were examined to calculate cause specific standardized mortality ratios (SMRs) using the mortality rate among Osaka residents as the standard. RESULTS: There was no significant excess overall mortality (SMR: 1.1, 95% confidence interval: 1.0­1.2). However,significant excess mortality in both sexes was observed from diseases of the nervous system (3.7, 1.9­6.2). Excess mortality from all causes of death decreased to unity beyond 10 years after study enrollment. The 408 men who were unemployed at the time of enrollment in the study had a significantly elevated risk of death from diseases of the nervous system (25.3, 10.8­58.8), respiratory diseases (8.6, 3.1­16.8), circulatory diseases (3.2, 1.6­5.2), and external causes (2.6, 1.4­4.1). CONCLUSIONS: As compared with the general population, survivors of arsenic poisoning during infancy had a significantly higher mortality risk from diseases of the nervous system.

Trends in cancer incidence and mortality in Osaka, Japan: evaluation of cancer control activities.

It is essential to analyze trends in cancer incidence and mortality in the evaluation of cancer control activities. Previous studies from Japan, however, described trends in cancer incidence and mortality only qualitatively. There have been few studies that evaluated the trends quantitatively. We calculated age-standardized mortality rates (1968-2006) and incidence rates (1968-2002) for overall cancer sites and for each major site (stomach, colorectal, liver, lung, prostate, breast, and uterus) in Osaka. We applied a joinpoint regression model to the trends in incidence and mortality, in order to identify the joinpoint and estimate annual percentage change. Then, we quantified the contribution of individual cancer sites to the change in overall cancer mortality rate. For the sites that made a major contribution, we estimated the contribution of the incidence reduction to the mortality reduction. In Osaka, the overall cancer mortality started to decrease from 1998. The decrease was largely attributable to the reduction of stomach and liver cancer mortality (73% for men, 53% for women). The reduction of mortality from the two cancer sites could be explained by the decrease in their incidences (more than 80% for stomach, approximately 100% for liver). Female breast cancer incidence and mortality were both increased probably due to lifestyle changes and delayed introduction of an effective screening program among Japanese. In conclusion, the decreased overall cancer mortality in Osaka during the study period was mainly due to natural decreases in the incidence of stomach and liver cancer, which were attributable to the decrease in risk factors.

Regional differences in population-based cancer survival between six prefectures in Japan: application of relative survival models with funnel plots.

We used new methods to examine differences in population-based cancer survival between six prefectures in Japan, after adjustment for age and stage at diagnosis. We applied regression models for relative survival to data from population-based cancer registries covering each prefecture for patients diagnosed with stomach, lung, or breast cancer during 1993-1996. Funnel plots were used to display the excess hazard ratio (EHR) for each prefecture, defined as the excess hazard of death from each cancer within 5 years of diagnosis relative to the mean excess hazard (in excess of national background mortality by age and sex) in all six prefectures combined. The contribution of age and stage to the EHR in each prefecture was assessed from differences in deviance-based R(2) between the various models. No significant differences were seen between prefectures in 5-year survival from breast cancer. For cancers of the stomach and lung, EHR in Osaka prefecture were above the upper 95% control limits. For stomach cancer, the age- and stage-adjusted EHR in Osaka were 1.29 for men and 1.43 for women, compared with Fukui and Yamagata. Differences in the stage at diagnosis of stomach cancer appeared to explain most of this excess hazard (61.3% for men, 56.8% for women), whereas differences in age at diagnosis explained very little (0.8%, 1.3%). This approach offers the potential to quantify the impact of differences in stage at diagnosis on time trends and regional differences in cancer survival. It underlines the utility of population-based cancer registries for improving cancer control.