An epidemiological study of posterior uveal melanoma in Israel, 1961-1989.

Trends in the incidence rate of uveal melanoma in Israel during the period 1961-1989 among Jews of various geographical origins and among non-Jews were examined, and found to be stable over time. Based on data of the Israel Cancer Registry, 515 cases were included in the final study population after an independent case-finding ascertainment survey. The average annual incidence rate per million for all Jews was 5.7 for both males and females; the rates for non-Jews were: males 1.6, females 1.3. Incidence rates within the Jewish sub-populations show significant differences. The highest rates by sub-population were for Jews born in Europe or America (7.5 for males and for females), followed by Jews born in Israel (males 6.8, females 6.7); and lowest in Jews born in Africa (males 2.1, females 2.3) and Asia (males 1.6, females 2.8). Jews born in Israel had rates lower than Jews born in Europe and America during the 1960s, but in the 1980s the situation was reversed. Results suggest that rate differences between population groups and over time stem from constitutional factors or from the direct or indirect effect of sunlight radiation, whether early in life or from cumulative exposure.

Incidence of cutaneous malignant melanoma in Israel, 1960-1989.

BACKGROUND: The cutaneous malignant melanoma (CMM) incidence rate in most affluent countries has increased over the last three or four decades. Despite specific attention, evidence for a role of factors other than sun and ultraviolet exposure is weak. OBJECTIVE: To update time trends of CMM in Israel. METHOD: A population-based cancer registry data base of CMM among Jews and non-Jews by age and gender was analyzed. A quality control survey was conducted to insure complete coverage and data validation for the period 1960-1989. RESULTS: The incidence rate of CMM in All Jews increased throughout the study period, with a monotonic annual increase of 4.8% for males and 4.3% for females. There was a steep increase in incidence until the mid-1970s, with an a posteriori levelling-off. Also, incidence was higher in females than in males. There were variations in incidence among Jewish subpopulations. Israel-born Jews are the highest incidence subgroup (average age-adjusted incidence rate (AAIR) 7.8 and 9.4 per 100,000 for males and females, respectively), followed by Jews born in Europe and America (AAIR, 6.1 and 7.3 per 100,000 for males and females, respectively). The lowest rate was for Jews born in Africa and Asia (AAIR, 1.3 per 100,000 for both males and females). Analysis of age-truncated rates reveals that Jews born in Europe, America, and Israel, mainly at age 45-64, have increasing CMM incidence. Non-Jews have a stable rate which could either be real or an artifact of underdiagnosis. CONCLUSIONS: The different time trend incidence patterns between subpopulations could be due to differing cumulative sun exposure over the last 40-50 years, mainly in those at age 45 and over. The levelling-off of the invasive CMM incidence rate, mainly in native Israeli Jews under age 45, could be attributed to increasing awareness and early diagnosis.

Descriptive epidemiology of malignant tumors in Ethiopian Jews immigrating to Israel, 1984-89.

This descriptive epidemiological study analyzes the frequency of cancer after the arrival of Ethiopian immigrants as reported to the Israel Cancer Registry from 1984 to 1989. The study cohort comprised 8,272 individuals (estimated 4,253 males and 4,019 females) with 27,966 and 26,848 person-years observed for males and females, respectively. Overall cancer incidence in this migrant cohort was low for both genders compared to cancer incidence among Jews born in Israel. The standardized incidence ratio (SIR) (in percentage) for cancers at all sites was 39 [95% confidence interval (CI) = 22-64] and 63 (95% CI = 41-92) for males and females, respectively. Male primary liver cancer and female thyroid cancer had high SIRs. All other sites had either average or low SIRs. No cases of neoplasms were reported in the respiratory system. Except for primary liver cancer, digestive neoplasms had an inverse male: female ratio.

A cohort analysis of cervical cancer in Israeli Jewish women.

The incidence of squamous cell cervical cancer was studied in Jewish Israeli women between 1961 and 1981. The 1052 cases and the 27,832,272 women-years of observation were divided according to continent-of-origin, year-of-birth, and immigration-wave cohorts. Age-adjusted odds ratios were calculated for each cohort and compared. The incidence of cervical cancer was shown to have changed according to cohort year of birth, most significantly in women born in Europe and America. The highest risk in this group was seen in women born in 1891-1895 and 1941-1945 and the lowest in women born between 1926 and 1935. A high risk was also observed in all cohorts of North African women. There was a sharp rise in risk for women of all origins born after 1940. Immigration to Israel at a younger age was correlated with reduced risk for cervical cancer. It has been shown that epidemics of sexually transmitted diseases (STDs) are followed in time by epidemics of cervical cancer. Since there was an epidemic of STDs in Israel between 1967 and 1970, our results also suggest that there is a rise in the risk for cervical cancer in women who were sexually active during the epidemic of STDs. Because of the low rates for cervical cancer traditionally observed in Israeli women, routine screening was not done in Israel in the past. Should the relative risk for cervical cancer in women exposed during the 1967-1970 epidemic continue to be high, screening may prove worthwhile.

Log-linear models for cancer risk among migrants.

Epidemiological studies of migrants have played an important role in separating the environmental and genetic components of cancer aetiology. The statistical analyses of these studies have typically involved calculating age- and sex-adjusted rates by country of birth. We describe methods which permit the effect of duration of residence in the host country to be estimated after adjusting for other temporal effects such as age, and period or cohort. The methods, which are based on log-linear modelling, can also be applied in a case-control manner if appropriate denominator populations are unavailable. Examples are given in which the more traditional methods of analysis may have yielded misleading results.

Cancer in Jewish migrants to Israel.

Data on the incidence of 15 cancers in the Jewish population of Israel from the period 1961-1981 have been studied with emphasis on the risk of disease in relation to birthplace, calendar time, and duration of residence in Israel. The results show wide variations in incidence by birthplace, from less than 2-fold for pancreatic cancer to a 40-fold difference for oesophageal cancer in females; the reasons for these are often little understood. The potential importance of environmental agents in aetiology for different migrant groups is discussed in relation to the size and rapidity of changes in risk related to the duration of residence in Israel.

Cancer incidence in young offspring of Jewish immigrants to Israel. A methodological study. I. Nasopharyngeal malignancies and Ewing sarcoma.

Differences in cancer incidence among various immigrant groups in Israel raised the question of persistence in their descendants. The methodological problems of identification of both parents and their origins, the choice of the denominator, and the long period of observation necessary for the rare childhood tumors have been examined. From 22-years data of the Israel Cancer Registry (ICR), three malignancies were chosen as examples: epithelial carcinoma of nasopharynx (31 cases), non-Hodgkin's lymphoma of nasopharynx (14 cases), and Ewing sarcoma (55 cases). The actual number of cases, in spite of the long period of incidence, is small and the computed significance must be accepted with reservation. There are two outstanding findings: the higher incidence in males as well as in females for nasopharynx carcinoma corresponds to that of their African-born parents; an increasing trend in the second 11-years period for Ewing sarcoma. Similar studies on leukemias, lymphomas, and others with a greater number of cases can be expected to have more reliable results. This survey relied on the majority of patients with immigrant parents, mostly of the same origin. In the following years, second and later generations of Israel-born and an increasing part of intermarriages will severely impede similar studies.

Lung cancer in Israel, 1962-1982. I. Jews and Arabs.

The magnitude and dynamics of lung cancer incidence in Jews and Arabs in Israel between the years 1962 and 1982 were studied. In general, age-standardized incidence rates increased consistently between the years 1962 and 1976 among Jewish (24% increase) and Arab (39%) males, and to a lesser degree among Jewish females (15%). Arab females had the highest (77%) increase. From 1977 to 1982 a general decrease in incidence rates, which was largest among Arab males (19%) and females (15%), was noted. Rates among Jewish males are currently 26% higher than among Arab males, and are 162% higher among Jewish females than in Arab females. Lung cancer rates in both males and females in Israel (Jews and Arabs) are lower than in most developed countries in the world. Among the possible reasons are differences in the population risk factors profile, availability of health care and the level of diagnosis and ascertainment of cases.

Some epidemiologic aspects of carcinoma of the vulva in Israel.

A nationwide study of squamous cell carcinoma of the vulva in Israeli Jewish women has been conducted for a comparison of the incidence, the age pattern and the ethnic distribution of squamous cell carcinoma of the vulva to those of squamous cell carcinoma of the cervix. The mean annual incidence rates by age in squamous cell carcinoma of the vulva rise continuously to age 70 + while in squamous cell carcinoma of the cervix a plateau is reached at age 40 to age 69. In contrast to the relatively low incidence of squamous cell carcinoma of the cervix in Israeli Jewish women, the age-specific incidence rates of squamous cell carcinoma of the vulva are similar to those of white women in the United States. On the other hand, there is a trend to a higher incidence of both squamous cell carcinoma of the cervix and squamous cell carcinoma of the vulva in the North African ethnic group of Israeli Jewish women.

Occurrence of additional primary neoplasms in patients with laryngeal carcinoma in Israel (1960-1976).

One thousand-six-hundred and sixty cases of laryngeal cancer were diagnosed in Israel during the years 1960-1976. In 98 of these cases another primary cancer accompanied the laryngeal carcinoma. Patients whose second primary cancer was basal or squamous cell carcinoma of the skin were not included in this study. Therefore, the results reported here deal with 84 patients. The prevalence of multiple primary cancer in patients with laryngeal carcinoma was found to be 5%. Lung cancer is the other primary tumor accompanying laryngeal carcinoma most frequently (29% of the additional tumors) followed by colorectal and bladder cancers. Most of the additional tumors (83%) appeared in a metachronic form with an average time interval of six years. In most metachronic tumors laryngeal carcinoma appeared as the first tumor (86%). Eighty percent of the patients were dead by August 1978. The majority (74%) succumbed due to the additional tumor and only 4% died of laryngeal carcinoma.

Epidemiological review of breast cancer in Israel.

Breast cancer is the most common malignant disease in women in Israel. Approximately 1,000 new cases are diagnosed yearly. The peak incidence in all the population groups and periods observed is after the menopause. A steady increase in female breast cancer indicence was observed over a 17-yr period. The greatest increase occurred in the low-incidence group of Jews born in Asia/Africa.

Male breast cancer in Israel: selected epidemiological aspects.

The 17-yr incidence of male breast cancer was analyzed from data of the Israel Cancer Registry for Jews and non-Jews, and for the Jewish subgroups of European/American-born and Asian/African-born. The 187 observed cases among Jewish males in Israel were compared with the 194 cases reported in the U.S. Third National Cancer Survey and with female breast cancer rates for the same period. Results show that the dependence of male breast cancer (MBC) on the female rate seems to exist in both countries. The disputed observation of a higher rate of MBC among Jews is supported by the higher rates of MBC in Israel than in the USA. Data on the laterality and histological features of MBC are presented. The series included eight cases among non-Jews (Arabs). The on going survey of the Israel Cancer Registry revealed four families in which both husband and wife had breast cancer and one family with breast cancer in both father and son.

Mesothelioma in children.

A literature review of mesothelioma in children is presented. The role of nonoccupational exposure to asbestos fibres in the etiology of mesothelioma, and the relatively short latent period of the disease in children are discussed. The transplacental transfer of asbestos fibres and the physiology of the immunological system during intrauterine life and infancy may explain some of the differences between mesotheliomas in children and those in adults.

Cancer patterns in Israel: selected aspects.

Data on cancer incidence in Israel have been collected by the Israel Cancer Registry since 1960. Overall incidence patterns are similar to those observed in other "Westernized" countries. In the total Jewish population, lung cancer accounts for one in seven cancers in males and breast cancer, for one in four cancers in females. The main time trends are: a decrease in stomach cancer, a halt in the increase of male lung cancer and a continuing rise for female lung cancer, female breast cancer, cancer of the colon and rectum, and malignant melanoma. Cancer of the uterine cervix may be on the rise in Israel-born women. The relatively high incidence of cancer of the esophagus in immigrants from Iran and Yemen and of cancer of the nasopharynx in immigrants from North Africa probably reflect incidence patterns in their countries of origin.

Breast cancer in Israel: laterality and survival.

Laterality was examined in 10,702 cases of breast cancer in Israeli Jewish women. The overall left-right ratio was 1.04 and was higher in women over 60. The only population group with a left-right ratio less than 1 was the group of women born in Asian and Middle Eastern countries outside of Israel. There were no differences between the survival curves of women with right- or left-sided breast cancers at any stage. It is concluded that laterality of tumor is not an indicator of survival in breast cancer.