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.

Comparison of survival of adolescents and young adults with hematologic malignancies in Osaka, Japan.

The survival gap between adolescents and young adults (AYAs) with hematological malignancies persists in many countries. To determine to what extent it does in Japan, we investigated survival and treatment regimens in 211 Japanese AYAs (15-29 years) in the Osaka Cancer Registry diagnosed during 2001-2005 with hematological malignancies, and compared adolescents (15-19 years) with young adults (20-29 years). AYAs with acute lymphoblastic leukemia (ALL) had a poor 5-year survival (44%), particularly young adults (29% vs. 64% in adolescents, p = 0.01). Additional investigation for patients with ALL revealed that only 19% of young adults were treated with pediatric treatment regimens compared with 45% of adolescents (p = 0.05). Our data indicate that we need to focus on young adults with ALL and to consider establishing appropriate cancer care system and guidelines for them in Japan.

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.

Maternal and paternal indoor or outdoor smoking and the risk of asthma in their children: a nationwide prospective birth cohort study.

BACKGROUND: Little is known about the differential impact of combinations of parental smoking behavior (indoor or outdoor smoking, or not smoking) on preventing childhood asthma. Our objective was to examine the association between parental smoking behavior and children's asthma. METHODS: A nationally representative population-based birth cohort of 40,580 babies, aged 0.5 years in 2001 (response rate, 87.8%), was studied to estimate adjusted odds ratios of combinations of maternal and paternal indoor or outdoor smoking at home for physician visits and hospitalization for childhood asthma up to 8-years-old, and population attributable fractions. RESULTS: Odds of hospitalization for asthma among children whose father alone smokes indoors at home did not largely increase (up to 20%). However, if the mother also smokes indoors at home, the odds strongly increased. After adjusting for demographic, perinatal and socioeconomic factors, the increase in odds for children whose father and mother both smoke indoors compared to children with non-smoking parents was 54% (95% confidence interval: 21-96%), 43% (8-90%) and 72% (22-143%) for children aged 0.5<-2.5, 2.5<-4.5 and 4.5<-8 years-old, respectively. The odds ratios of smoking outdoors did not largely differ from those of smoking indoors. Our estimation of population attributable fractions revealed that if all parents in Japan quit smoking, hospitalization of children for asthma could be reduced by 8.3% (2.2-14.3%), 9.3% (0.9-17.6%) and 18.2% (7.7-28.8%), respectively. CONCLUSIONS: Parental indoor smoking at home increased and exacerbated children's asthma. Smoking at home, whether it is indoors or outdoors, may increase the risks for asthma attacks of their children.

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.

Complete workplace indoor smoking ban and smoking behavior among male workers and female nonsmoking workers' husbands: a pseudo cohort study of Japanese public workers.

A pseudo cohort study using national cross-sections (2001, 2004, 2007, and 2010) was conducted to examine differences in smoking prevalence under different smoking ban policies such as a complete workplace indoor smoking ban (early or recent implementation) and a partial smoking ban among male public workers and husbands of female nonsmoking public workers. The effectiveness of smoking bans was estimated by difference-in-differences (DID) with age group stratification. The results varied considerably by age and implementation period. Although DID estimates (positive value of DID estimate represents smoking cessation percentage) for both smoking bans on total male smoking were not significant, the over-40 age group indicated a significant DID estimate of 5.0 (95% CI: 0.2, 9.8) for the recent smoking ban. For female workers' husbands' smoking, the over-40 age group indicated positive, but not significant, DID estimates for the early and recent smoking bans of 7.2 (-4.7, 19.2) and 8.4 (-2.0, 18.7), respectively. A complete indoor workplace smoking ban, particularly one recently implemented among public office workers aged over 40, may reduce male workers' smoking and female workers' husbands' smoking compared with a partial smoking ban, but the conclusion remains tentative because of methodological weaknesses in the study.

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.

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.

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.

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.

Cancer incidence and mortality in Osaka, Japan: future trends estimation with an age-period-cohort model.

In previous studies we predicted future trends in cancer incidence for each prefecture in order to plan cancer control. Those predictions, however, did not take into account the characteristics of each prefecture. We therefore used the results of age-period-cohort analysis of incidence and mortality data of Osaka, and estimated the incidence and mortality of cancers at all sites and selected sites. The results reflect the characteristics of Osaka, which has and is expected to have large number of patients with liver cancer. We believe our results to be useful for planning and evaluating cancer control activities in Osaka. It would be worthwhile to base the estimation of cancer incidence and mortality in each prefecture on each population-based cancer registry.

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.

Role of age and tumour stage in the temporal pattern of 'cure' from stomach cancer: a population-based study in Osaka, Japan.

OBJECTIVES: To evaluate progress in stomach cancer care in Japan since 1975. DESIGN: Population-based study of data extracted from the Osaka Cancer Registry. SETTING: Population-based cancer registry in the area of Osaka Prefecture. PARTICIPANTS: All 66,032 cases diagnosed with a stomach cancer in Osaka Prefecture, Japan between 1975 and 2000 and registered in the Osaka Cancer Registry. MAIN OUTCOME MEASURES: 'Cure' fraction and median survival time for 'uncured' patients were estimated with multivariable mixture 'cure' model. The role played by age and stage at diagnosis on the changes in 'cure' parameters between 1975 and 2000 was evaluated. Missing stage was handled by multiple imputation approach. RESULTS: More than 50% of the patients diagnosed with a stomach cancer in 1996-2000 were estimated 'cured' from their cancer, corresponding to a 20% increase since 1975-1980. Median survival time for 'uncured' patients however remained unchanged at about 8 months. 'Cure' fraction was over 85% for localised tumours and 30% for regional tumours, but stayed as low as 2.5% for distant metastatic cancers. Improvement was underestimated by about 10% because of ageing of cancer patients. Changes in stage distribution explained up to 40% of the increase in 'cure' fraction among men and up to 13% in women. Overdiagnosis was unlikely to play any role in these patterns. CONCLUSIONS: 'Cure' fraction from stomach cancer dramatically increased in Osaka, Japan since 1975, partly because of earlier stage at diagnosis, but mostly due to improvement in treatment of stomach cancer patients. This study, based on a leading country in term of stomach cancer management, provides insightful results for other countries in which 'cure' fraction is usually much lower.

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.

Comparison of trends in cancer incidence and mortality in Osaka, Japan, using an age-period-cohort model.

BACKGROUND: We aimed to estimate the effects of age, period and birth cohort on trends in cancer incidence and death for all sites and selected sites of cancer in Osaka using an age-period-cohort model. METHODS: Cancer incidence data during 1968-2003 were obtained from the Osaka Cancer Registry, and cancer mortality with population data in Osaka during 1968-2007 were obtained from vital statistics departments. We estimated age, period and birth cohort effects for incidence and mortality using Nakamura's Bayesian Poisson age-period-cohort model. RESULTS: For most sites of cancer, linear ageing effects were observed, the exceptions being breast and cervix which levelled-off at around 40 years old, while period effects were small. Decreasing cohort effects were observed in stomach and liver cancer. Cohort effects peaked at the generation born in the early 1950s for colorectal, lung, breast cancers. For most sites of cancer, incidence and mortality showed similar trends, but in the late cohorts for cervical cancer, cohort effects decreased in mortality, while increasing in incidence. CONCLUSION: Period effects reflecting immediate effects to cancer incidence and mortality, such as development of the effective treatment and screening programme were stable in most sites of cancer. Cohort effects influenced by long-term risk factors were prominently observed for every site, decrease in stomach and liver cancer cases being related to reduction in risk factor prevalence. Cancer control activities could be evaluated through the results, indicating utility for future cancer control planning.

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.