Cancer incidence and survival among American Indians registered for Indian health service care in Montana, 1982-1987.

BACKGROUND: Cancer incidence and cancer survival estimates in American Indians are quite limited. PURPOSE: Our purpose was to estimate cancer incidence and survival in American Indians who were registered for Indian Health Service (IHS) care in Montana. METHODS: We linked databases from the IHS and the Montana Central Tumor Registry (MCTR) to ascertain cases for the time period from January 1, 1982, through December 31, 1987. To calculate survival rates, we used a relative survival method that incorporated age-specific risks for noncancer deaths among American Indians. RESULTS: We identified 344 cases that were compatible with the National Cancer Institute (Surveillance, Epidemiology, and End Results Program) surveillance definition of cancer. Of these cases, 249 (72%) were listed in both the MCTR and the IHS databases; 56 (16%) and 39 (11%) were listed in only the MCTR or the IHS database, respectively. Compared with the overall cancer incidence in U.S. White men, the overall cancer incidence in Montana American Indian men was markedly lower, as was the incidence for colorectal and bladder cancers and for non-Hodgkin's lymphoma. The overall cancer incidence for Montana American Indian women differed less markedly, however, from the overall incidence in U.S. White women. Compared with the cancer incidence in U.S. White women, the incidence in Montana American Indian women was significantly higher for cervical cancer but was significantly lower for colorectal, breast, and uterine cancers. Survival rates from cancer were also examined for the first time in this population. For those sites examined, the survival rates were much lower in Montana American Indians than in U.S. Whites. CONCLUSIONS: We conclude that it is feasible to develop state-specific cancer incidence and survival estimates for American Indians in at least some states in different regions of the United States. Collaboration between the IHS and a state tumor registry is likely to improve the case ascertainment achieved by either agency alone.

Phenotypic heterogeneity in cystic fibrosis.

We have confirmed heterogeneity in CF using a different combination of primary clinical variables than those used in previous studies. Subgroupings of individuals with similar levels of sweat chloride were independent of the clustering based on level of pancreatic enzyme supplementation and degree of pulmonary involvement. Data from families with multiple CF children are consistent with the hypothesis that the genetic etiology of CF involves two or more genes that modify the expression of the primary gene defect.

Middle digestive cancers in Texas Hispanics: a New World syndrome?

To test the hypothesis that middle digestive cancers in Texas Hispanics follow the patterns predicted by the New World Syndrome (1984), cancer incidence rates and relative risks for middle digestive cancers were estimated for 1944-1992. The relative risk for all middle digestive cancers is significantly elevated in Texas Hispanics compared with Anglos, and this risk has increased over time. Elevated risks of these cancers in Texas Hispanics have been explained as resulting from the evolutionary history of Native Americans (American Indians), their genetic relation to Texas Hispanics, and a changing diet and lifestyle. Recent Texas cancer incidence data add further support to the hypothesis. Other current disease prevalence data in Texas Hispanics, percent of the population which is diabetic and percent which is overweight, are also consistent with the New World Syndrome. Expected patterns of disease in males vs females are also confirmed. Factors that do not support the New World Syndrome hypothesis and can be examined by future studies are described. This is the first report since the original describing and updating patterns of middle digestive cancers in Texas Hispanics as resulting from the New World Syndrome. Application of these findings to contemporary medical practice and to cancer prevention are reviewed.

Cancer incidence and mortality in urban versus rural areas of Texas, 1980 through 1985.

Cancer incidence and mortality rates were estimated among three ethnic groups in Texas. Ratios confirmed higher rates of total cancers (all cancer types combined) and of many individual sites in urban versus rural areas for all males and for Anglo females. Urban African-American females had elevated cancer mortality, but incidence did not show significant urban-rural differences. Hispanic females did not exhibit significant urban-rural differences in either incidence or mortality. Cancers of the digestive system and smoking-related cancers follow the general pattern of higher incidence and mortality rates in urban areas, consistent with studies published previously. Despite higher rates of cancer mortality, urban areas have a larger proportion of total cancer cases diagnosed at a premalignant stage. Various hypotheses may be offered to explore the findings of urban-rural differences in cancer incidence and mortality.

Blood groups of bonnet macaques (Macaca radiata), with a brief introduction to seroprimatology.

The human-type A-B-O blood groups of 52 bonnet macaques (Macaca radiata) were determined. Application of method of population genetics indicated the gene frequences to be 0 = 0.173, a = 0.480 and B = 0.347. Cross testing of sera and red cells of the bonnet macaques revealed two blood-type-specific isoagglutinins, one of them strong enough for use as a blood typing reagent. No blood group polymorphism was revealed by testing bonnet macaque red cells with isoantisera produced in rhesus monkeys (M. mulatta) and in crab-eating macaques (M. fascicularis). The rhesus and crab-eating macaque isoantisera reacted either with all or with none of the bonnet macaque red cells tested.

An outbreak of tuberculosis in a shelter for homeless men. A description of its evolution and control.

An outbreak of tuberculosis at a shelter for homeless men was studied in detail to further the understanding of the epidemiology of tuberculosis in this setting. The shelter provides evening accommodations for men aged 50 yr and older. The capacity is approximately 200 clients, and the client pool is approximately 1,000 men/yr. During a 6-wk period in December 1986 and January 1987, seven cases of tuberculosis were diagnosed in shelter clients. Nine cases were reported in clients during the preceding 12 months, and four cases in the year previous to that. The majority of outbreak cases were pulmonary tuberculosis, sputum smear positive. Drug resistance was rare. Phage typing of 15 Mycobacterium tuberculosis isolates revealed one predominant type and four other types. The goals of the control plan (and the steps taken to achieve them) were to render known infectious cases noninfectious (directly observed therapy); to find undiagnosed infectious cases (repetitive mass screenings); to protect exposed clients (repetitive tuberculin skin testing and isoniazid preventive therapy); and to make the shelter environment safe (exclude infectious, noncompliant clients and improve the shelter's ventilation system). Implementation of this plan rapidly terminated the outbreak; following the first mass screening in January 1987, at which six asymptomatic cases were detected, only five additional cases occurred in shelter clients during a 2-yr period of follow-up. The investigation suggested that the outbreak evolved during 1986 as a result of the presence at the shelter of an increasing number of men with undiagnosed infectious pulmonary tuberculosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Cytogenetic studies of renal cell carcinoma.

To examine the possibility that patients with renal cell carcinoma (RCC) have chromosomal abnormalities at a common gene locus, we undertook a study of patients with and without a history of hereditary disease as part of an ongoing population-based case-control study of risk factors in RCC. We identified 112 patients for cytogenetic study. Chromosome preparations were made from peripheral blood cultures with standard and giemsa (GTG) banding techniques. C-banding was used to determine C-polymorphism. Eighty-nine cases had completely normal male and female karyotypes. Twenty-seven of them had C-polymorphism. In 16 patients, random numerical and structural abnormalities were observed. In the remaining seven patients, four had mosaic karyotypes, and the other three showed structural abnormalities. There was no statistically significant difference in the frequency of the abnormal karyotypes between the hereditary and nonhereditary RCC patients. This concludes a negative cytogenetic study of RCC patients that failed to show any constitutional rearrangement in blood cells.

Risk factors in renal cell carcinoma. II. Medical history, occupation, multivariate analysis, and conclusions.

Potential risk factors in renal cell carcinoma (RCC) were studied in a case-control study of 315 RCC cases and 313 hospital and 336 population controls. Risk factors included medical history, radiation exposure, predominant lifetime occupation, exposure to high-risk industries, and summary of important risk factors by a linear logistic regression model based on the comparison of RCC cases and controls selected from hospitals and the general population for 33 variables. A significant increase in urologic, cardiovascular, malignant, digestive, and metabolic disease was observed among cases over population controls. Exposure to radiation increased the risk, especially in females. A predominant lifetime occupation as a professional decreased the risk, whereas work as an operative increased the risk significantly. Work in petroleum-related and dry-cleaning industries were associated with elevated risk. Multivariate analysis comparing cases with each of the control groups for males and females identified obesity as the most important risk factor in RCC. Weight control at an early age might help to prevent the occurrence of a significant proportion of this rare but increasing malignant disease.

Risk factors in renal cell carcinoma: I. Methodology, demographics, tobacco, beverage use, and obesity.

Potential risk factors in renal cell carcinoma (RCC) were studied in a case-control study of 315 RCC cases, 313 hospital and 336 population controls. Risk factors included body mass index, education, smoking, beverage use, and artificial sweeteners. High body mass index, when present at age 20 and maintained, was a significant risk factor in both men and women. The lower the educational levels attained, the higher the risk. There was a weak positive association with cigarette smoking, coffee drinking, tea drinking, and decaffeinated coffee. A strong negative association was found with ever use of alcohol and it was strongest for wine. A positive association was found with use of artificial sweeteners in men. These findings have increased our understanding of the etiology of this rare but increasingly important neoplastic disease in humans.

Cancer incidence among American Indians and Alaska Natives, 1980 through 1987.

OBJECTIVES: This study uses Indian Health Service inpatient data to estimate cancer incidence among American Indians and Alaska Natives. METHODS: Hospital discharge data for 1980 through 1987 were used to identify cases of cancer for 21 sites in women and 18 sites in men. Estimates of incidence were directly standardized to data from the Surveillance, Epidemiology, and End Results Program for the same time frame. RESULTS: Cancers of the gallbladder, kidney, stomach, and cervix show generally high rates among many American Indian and Alaska Native communities, and cancers of the liver and nasopharynx are high in Alaska. Of the relatively common cancers in Whites, American Indians and Alaska Natives experience lower rates for cancers of the breast, uterus, ovaries, prostate, lung, colon, rectum, and urinary bladder and for leukemia and melanoma. Variation among geographic areas and among tribal groups is observed for many important cancer sites. CONCLUSIONS: This study demonstrates significant variations of cancer rates among American Indians and Alaska Natives, with important implications for Indian Health Service cancer control programs. The study also supports the potential use of hospital discharge data for estimating chronic disease among diverse American Indian and Alaska Native communities.