Dietary factors and esophageal cancer in the Caspian Littoral of Iran.

A study was undertaken to attempt to relate the distribution of exogenous factors to the varying incidences of esophageal cancer in the Caspian Littoral of Iran. For the study, 38 villages were chosen by random sampling in 14 regions defined by their esophageal cancer incidence and environmental characteristics. Information was obtained on the dietary, social, and cultural features of each village. In addition, an extensive 5-day study of 6 randomly selected households in each of the 38 villages was conducted. The study consisted of measured dietary intake, a historical food consumption questionnaire, and clinical examinations of adult occupants. Preliminary results show no single factor responsible for the etiology of esophageal cancer. However, there were some major dietary differences between the regions of different esophageal cancer risk. Bread was the chief staple food in high-incidence areas; rice, in low-incidence areas. In high-incidence areas, there was a low intake of vitamins A and C, riboflavin, animal protein, and fresh vegetables and fruit, but a greater consumption of sheeps and goat's milk. Analyses of food samples for aflatoxins, polycylic aromatic hydrocarbons, and nitrosamines showed low levels of these carcinogens in areas of high and low incidences. The use of tobacco and alcohol was not found to be of significance.

Induction of SCE by opium pyrolysates in CHO cells and human peripheral blood lymphocytes.

The induction of sister chromatid exchange (SCE) by opium pipe scrapings (sukhteh, Su) and the pyrolysis products of opium (Op) and of its major alkaloids, morphine (Mo), have been compared with that of cigarette smoke condensate (CSC). All pyrolysates induced SCE and the frequency was further increased by the inclusion of S9-mix in the protocol. The pyrolysates of Op induced considerably more SCE than CSC when the same concentrations were compared on a weight basis, and the rank in order of potency in CHO cells was MO greater than Op greater than CSC greater than Su. The Op pyrolysates may therefore contribute a significant risk factor to the observed high incidence of oesophageal cancer in areas of Iran where heavy Op usage occurs.

Ingested mutagens from opium and tobacco pyrolysis products and cancer of the oesophagus.

Substances which are commonly sucked or chewed in two areas where the incidence of oesophageal cancer is high, the Transkei and north-east Iran, were tested in bacterial mutagenicity assays. Pyrolysed substances, opium dross in north-east Iran and tobacco pipe residues in the Transkei, displayed mutagenic activity in Salmonella typhimurium strains TA98 and TA100 in the presence of rat liver microsomes.

Characterization of the train-of-four response in fast and slow muscles: effect of d-tubocurarine, pancuronium, and vecuronium.

The in vivo cat soleus and gastrocnemius muscles were used to compare isometric contraction strength and the train-of-four (T4) response (2 Hz for 2 s) of two muscle types (fast and slow) during onset of competitive neuromuscular blockade in order to determine the extent of the correlation between twitch depression and T4 fade. Prior to drug administration the muscles that were studied differed significantly in that the T4 ratio was 1.0 in the gastrocnemius and only 0.87 in the soleus. Three competitive neuromuscular-blocking agents were compared: d-tubocurarine, pancuronium, and vecuronium. d-Tubocurarine was found to produce a close correlation between the degrees of twitch strength depression and T4 for both muscles. However, these muscles demonstrated significantly different ED50 values (105 micrograms/kg for gastrocnemius, 150 micrograms/kg for soleus). Pancuronium also produced a similar relationship between twitch strength depression and T4 decrement for each muscle. In this case, however, there was little difference in their ED50 values for twitch depression (11.5 micrograms/kg for gastrocnemius, 13 micrograms/kg for soleus). The effects of vecuronium were quite different from the other two muscle relaxants. Although vecuronium produced a comparable correlation between twitch tension and T4 fade in fast muscle, no such relationship was found to exist in slow muscle. Even when the twitch strength was blocked to 18% of control, the soleus T4 response was depressed to only 75% of control. These results highlight major differences among competitive neuromuscular-blocking agents and suggest multiple sites of action.

Oesophageal cancer studies in the Caspian littoral of Iran: some residual results, including opium use as a risk factor.

A study was conducted in northern Iran in areas of very high, high and moderately low incidence of oesophageal cancer. Morphine metabolites in urine as an indicator of opium use, and a variety of nutritional and biochemical measures, including salivary antipyrine half-life, were determined in households with a case of oesophageal cancer and in control households. Results on 1,590 individuals showed that the prevalence of appreciable levels (greater than or equal to 1 microgram/ml) of urinary morphine metabolites was much higher in areas of high and very high incidence of oesophageal cancer than in low-incidence areas, particularly for those under age 50 years in both sexes, where a 6-fold difference was seen. Members of households with a case of oesophageal cancer had a higher prevalence of positive urinary morphine metabolite findings than members of control households from the same village. Salivary anti-pyrine half-life (AP-T1/2), as a measure of hepatic drug metabolizing capacity, was estimated in 120 subjects. No relationship was seen with use of opium, region of residence, case-control status of household, age or sex. Experimental studies have meanwhile identified mutagenic substances with carcinogenic potential in opium pipe scrapings, used widely in the study region, opium pyrolysates and morphine pyrolysates. Our data give additional support to the hypothesis that opium use, in the form of its pyrolysates, is one of the factors involved in the aetiology of oesophageal cancer in the region.

Risk factors for lung cancer in Singapore Chinese, a population with high female incidence rates.

The high incidence of lung cancer in Chinese females in Singapore, especially among those belonging to the Cantonese dialect group, and the relatively high rates in Chinese males have been studied by means of interviews of cases and controls. A significant dose-response effect of cigarette smoking was found for all male and female groups, but neither smoking nor any other exposure explains the high incidence of lung cancer observed in Cantonese females who exhibit high rates of adenocarcinoma appraently unrelated to smoking. In general, persons with a low consumption of green vegetables were at higher risk for lung cancer. This finding might be due to an increased susceptibility in the presence of a relative deficiency of vitamin A.

Mutagens produced by the pyrolysis of opium and its alkaloids as possible risk factors in cancer of the bladder and oesophagus.

Samples of opium pipe scrapings (opium dross, called sukhteh locally), but not of crude opium, collected in an area with a high incidence of oesophageal cancer in north-east Iran, were shown to contain pro-mutagens, producing mostly frameshift mutations in Salmonella typhimurium strains TA1538 and TA98 after metabolic activation. Pyrolysis of opium and of its major alkaloid, morphine, yielded smoke condensates with mutagenic activities 10 and 100 times higher, respectively, than that of the sukhteh samples tested. Heterocyclic aromatic hydrocarbons and primary aromatic amines present at different concentrations in these three pyrolysates are considered to be the major active principles. Opium addiction has been implicated as a risk factor in bladder cancer in humans and the ingestion of opium pyrolysates, in conjunction with dietary deficiencies, may be related to the high incidence of oesophageal cancer in north-east Iran, although causality has not been established.