Trends in cancers of the upper alimentary and respiratory tracts in women in bombay, India.

Cancers of the upper alimentary and respiratory tracts are proven to be causally associated with tobacco use and are therefore preventable. These cancers form 50% of all cancers in men and 20% in women in Bombay. This study reports on the trends in women for these cancers (observed in the Bombay Cancer Registry during 1964-81) which were found to be by and large similar to those reported elsewhere for males. A significant decline in age-adjusted rates (AAR) for Cancer of the oropharynx (Average Percentage Change: APC=-3.22, P<0.05) and for Cancer of the larynx (APC=-1.88, P<0.05) were observed. For cancer of the tongue, although the AAR did not show a significant decline, examination of trends in 10 yearly age-groups showed a significant decrease in 25-34 year group (APC=-7.09, P<0.01) indicating that in future years the decline in AAR is likely to attain significance. The decline in predominantly bidi (a popular form of smoking in India) dependent cancers is likely to be a reflection of a significant decline in prevalence of smoking in women with decrease in age. Age-adjusted rates for cancers at other sites in the alimentary and respiratory tracts were generally stable and underscored the need for a tobacco control program in women (along with men) to achieve a non-tobacco culture.

Use of ANOVA to estimate inter- and intra-reader variability for a group of readers in thorough QT/QTc studies.

The E14 guidelines of the International Conference on Harmonization require that all new drugs that have systemic bioavailability be subjected to a thorough QT/QTc study to look for possible effects on cardiac repolarization. Recent publications have discussed various aspects of thorough QTc studies. The thorough QTc study is designed to detect a mean drug-induced QTc prolongation of >5 ms with an upper bound of the 95% one-sided confidence limits of >10 ms. The E14 guideline has spelled out the procedures to be followed in a thorough QT/QTc study, including choice of subjects, methods of electrocardiogram (ECG) acquisition, details of ECG analysis, and statistical analysis of the study data. Since the measurement of the QT interval is a relatively subjective assessment, the ECGs must be analyzed in a central ECG laboratory by "a few skilled readers." In order to maintain quality in ECG interpretation, the E14 guidelines have two requirements. First, as a measure of the assay sensitivity, the study must include an active control known to prolong the QTc interval. Second, a certain percentage of ECGs must be subjected to an inter- and intra-reader variability analysis; these data are submitted to the regulatory authorities along with the study results.

Histological and epidemiological features of breast cancer in different religious groups in greater Bombay.

In this paper an attempt has been made to study the histologic and epidemiologic features of breast cancer in women from various religious groups of Greater Bombay. The crude and age-adjusted incidence rates are seen to be the highest in the Parsi community followed by the Christian, Moslem, and Hindu groups. In all the religious groups, an increase in incidence of breast cancer is first seen in the third decade. This is followed by a sharp increase up to the age of 50-54, leading to a slight drop, and then a consistent but slower rise in the older ages. The high risk of developing this cancer in Parsi women as compared with the Christian, Moslem, and Hindu experience may be due to a higher proportion of Parsi women remaining unmarried, their higher age at marriage, lower age at first pregnancy, broad spacing of pregnancies, and fewer numbers of pregnancies. The distribution according to histologic types of breast cancer in India is characterized by a high frequency of infiltrating duct carcinoma. Medullary, lobular, and squamous cell carcinoma were typical histological varieties of the older age groups, whereas ductal carcinoma was encountered mostly in premenopausal women.

Cancer in Indian Moslems.

Moslems are the followers of Islam who, during the time of the Ghaznavid dynasty of Afghanistan, invaded India for the first time. Islam attaches equal importance to material and spiritual aspects of human life. Men and women have equal cultural rights. Marriage is positively enjoined and vigorously encouraged. Circumcision is compulsory before boys attain the age of 7. More than one wife (up to four) is permitted in Islamic Society. Differences in the habits, customs, and ethnic characteristics have all provided important leads for the study of cancer in this community. It is a sign of the times that some of the religious and social customs that were rigidly upheld by the older generations are rapidly giving way to "Modernism." Hence an attempt has been made to examine the differences found in the site-specific cancer risks in the Moslem community in Bombay. Analysis of the data was undertaken by sex- and age-adjusted and age-specific incidence rates. The common sites of cancer were found to vary greatly between the Moslem and non-Moslem populations of Greater Bombay. In Moslem men, the lung appears to be at highest risk, followed by the larynx, esophagus, tongue, and hypopharynx, whereas in non-Moslem men, the esophagus is the commonest site, followed by the lung, larynx, and tongue. In women, breast and cervix cancers, which rank first and second, respectively, in frequency in Moslems, reverse their positions in non-Moslem women.

Cancer incidence in Indian Christians.

Differences in habits, customs and ethnic characteristics have provided important leads for the study of cancer in Indian Christians. It is a sign of the times that some of the social customs rigidly upheld by the older generations are rapidly giving way to "Modernism". An attempt has been made to examine the differences found in the site-specific cancer risks in this community in Bombay. An analysis of the data has been made by sex and age-adjusted and age-specific incidence rates. The common sites of cancer were found to vary greatly between the Christian and non-Christian populations of Greater Bombay. In Christian males, the lung appears to be at highest risk, followed by the stomach, oesophagus and larynx, whilst in non-Christian males the oesophagus is the commonest site followed by the lung, larynx and tongue. In females, breast and cervical cancers, which occupy the first and second ranks in Christians reverse their position in non-Christian women.

Cancer in the Sindhi population of Greater Bombay.

The Sindhis are a Hindu subgroup identified by their place of origin and their written spoken language. These are the people who were originally inhabitants of the Province of Sind, which formed a part of the large Bombay Presidency in Undivided India before 1947. The Sindhi Hindus migrated en masse to India after partition. An attempt has been made here to examine the differences found in the site-specific cancer risks among the Sindhi community, the other Hindu groups (such as the Marathi and Gujrati populations) and the Parsi community of Greater Bombay. As the Indian Census Board does not provide age distribution details for the Sindhis, analysis of the data was undertaken employing frequency ratios. Age-standardized cancer ratios (ASCAR) were also utilized for certain calculations. The common sites of cancer appear to vary greatly between the total Bombay population and the Sindhi group. In Sindhi men, for example, cancers of the lung, large bowel, prostate, kidneys and leukemias are most commmonly seen, whereas laryngeal and oesophageal cancers predominate in the general population of Bombay. In Sindhi women the breast, uterus, ovary, and skin are the preferred sites, whereas cancers of the cervix and leukemias are predominant in the general population of Bombay. It is interesting to note that there is a degree of similarity in the incidence of cancer at certain anatomical sites, such as the prostate, large intestine, and leukemias in males, and breast, cervix, ovary and uterus in females, between the Sindhi and Parsi communities of Greater Bombay.

Differences observed in the site incidence of cancer, between the Parsi community and the total population of greater Bombay: a critical appraisal.

The Bombay Cancer Registry has been in operation since June 1963 and reliable morbidity data on cancer have since been obtained for the first time in India, from a precisely outlined population base delineated by residential qualifications within strict geographicalboundaries. An attempt has been made to examine the differences noticed in the site-specific cancer risks, between 2 groups of people living in this area-the Parsi community and the total Bombay population. The over-all age adjusted rates for the Parsis were found to be lower than those for the total population and more noticeably, their site-specific risks seem to differ radically from the Greater Bombay pattern. Thus, cancers of the buccal cavity, pharynx, larynx, oesophagus and cervix uteri, which are frequently seen in the total Bombay population, are less commonly observed in the Parsi community. On the other hand the Parsi rates are higher at sites such as the female breast, body of uterus, ovary, prostate and skin and for all leukaemias. Even though the population pyramid of the Parsi community is very different from that of the total population of Bombay, age correction does not change the basic outline of risk patterns noted in the 2 groups. Such site-specific contrasts are believed to be due to differences present in the habits, customs and economic status of the two groups. (A study of the probable aetiological factors of epidemiological importance involved in this segment of the population, is already under way in Bombay, in an effort to identify the reasons for the differences noted in cancer risks at different sites.)