G. J. Macfarlane

Oral cancer in Scotland: changing incidence and mortality.

OBJECTIVES--To determine the incidence of oral cancer in Scotland between 1960 and 1989 and oral cancer mortality from 1911 to 1989. SETTING--Data were obtained on oral cancer incidence from the information and statistics division of the Common Services Agency of the Scottish Health Service and mortality data from the office of the registrar general for Scotland. RESULTS--Mortality from intraoral cancers in Scotland substantially declined throughout this century until the mid-1970s. This trend, however, was then reversed, and fourfold increases in incidence were observed in younger age groups after 1960. Death rates in these younger age groups increased to levels previously recorded in the 1940s. These increases seemed to be cohort based and may therefore continue into the future. CONCLUSIONS--Reasons for increasing rates among younger age groups are speculative and rely on combining knowledge about risk factors and available ecological data. Though increases in incidence at younger ages do not result in a large change in the number of cases diagnosed, possible similar increases continuing into older ages, when oral cancer is more common, will correspond to a much larger increase in the actual number of cases. Given that such a large attributable risk is associated with tobacco and alcohol, however, these increases may be preventable.

Epidemiology of mouth cancer in 1989: a review.

‘I want to say a sentence to you and then I want to interpret that sentence in about four different ways, all of which are related to what we are talking about. And the sentence is, “Each person is his own central metaphor”.’ Mary Catherine Bateson1

International Comparison of the Community Prevalence of Symptoms of Prostatism in Four Countries

We conducted an international comparison of the prevalence of urinary symptoms of prostatism in 4 countries, using a community-based random sampling of subjects, similar study procedures, and a single definition of cases that was based on a standardized symptom questionnaire. In Scotland 1,994 medically eligible men aged 40-79 years agreed to participate from 3 communities of the Forth Valley. In France, a nation-wide survey was conducted cross-sectionally in a representative sample of 2,011 French men aged 50-84 years. In the USA, the Olmsted County (OC) study recruited an age- and urban/rural-stratified random sample of 2,115 county residents drawn from medically eligible men aged 40-79 years. In Japan, 290 men aged 40-79 years from a fishing village participated in the study. Response rates were 55, 53, 55, and 43% in Scotland, France, OC and Japan, respectively. Urinary symptoms were assessed by the International Prostate Symptom Score (I-PSS), after metrologic validation in English and cross-cultural adaptation of the questionnaire. The prevalence of moderate to severe symptoms (I-PSS > 7) were 14, 18, 38, and 56% in France, Scotland, OC and Japan, respectively. This pattern was consistent within decades of age, and was found for most of the individual urinary symptoms. The proportion of men in Japan reporting very low I-PSS (0 or 1) was approximately 2, 4 and 8 times less frequent, than in OC, Scotland, and France, respectively. Differences in the prevalence of reported urinary symptoms might reflect between-country differences in the true prevalence of benign prostatic hyperplasia. However, cross-cultural differences in the perception and/or willingness to report urinary symptoms may play an important role in the observed differences. Further study will be required to elucidate the underlying causes of the observed differences.

Epidemiology of pancreas cancer (1988)

SummaryThis article reviews the epidemiology of cancer of the pancreas, both descriptive and analytical, at all times cognizant of the problems of misdiagnosis, particularly underdiagnosis, of this lethal disease that continue to hinder epidemiological studies. Pancreas cancer is consistently reported to occur more frequently in men than in women, in blacks than in whites, and in urban rather than rural population groups. In some countries, the mortality rates continue to rise, whereas in others, declining levels of disease can be seen among members of younger birth cohorts. Although some of these patterns can be explained by variation in pancreas cancer risk factors, many cannot. Analytical studies consistently demonstrate that cigaret smoking increases the risk of cancer of the pancreas, and this appears, at the present time, to be the only clearly demonstrated risk factor for pancreatic cancer. Although the association with disease risk and coffee consumption, alcohol consumption, occupational exposures, diabetes, pancreatitis, and other factors requires clarification, it appears likely that the most fruitful research area in the coming years may involve exploration of pancreatic cancer risk and nutritional practices.

Breast cancer in women with primary biliary cirrhosis

melphalan. He required hospital admission on the occasions of his chemotherapy and for eight episodes of peritonitis related to the dialysis. The last four episodes of peritonitis were within two months of his death. Other than this he lived an independent life. He finally succumbed to a Gram negative septicaemia associated with myelosuppression and hypercalcaemia 55 months after presentation. We suggest that chronic dialysis should be offered to patients with myeloma on their individual merits rather than adopting the pessimistic view expressed by Dr Hamblin. A R MORTON AM HOLMES S WALDEK Departnment ofMedicine and Renal Unit, Hope Hospital, Salford M6 8HD

European school of oncology advisory report to the European Commission for the Europe against cancer programme: Oral carcinogenesis in Europe

A European School of Oncology Advisory Group has reviewed current knowledge on the epidemiology, treatment and prevention of cancer of the oral cavity. While the major factors in the aetiology of such cancers are thought to be well understood, i.e. tobacco and alcohol consumption, current increases in the occurrence of the disease, especially in young adults throughout Europe, are cause for concern. The reasons for such increases are not clearly evident and the Advisory Group has suggested further work which is required to be carried out to understand the aetiology. In treatment of the disease there have been no major improvements in survival for patients in recent decades and the importance of examining new radiotherapy modalities and defining the role of chemotherapy is emphasized. Primary prevention of oral cancer could be achieved by stopping smoking tobacco, limiting alcohol consumption to a minimum (2-3 drinks per day) and increasing intake of fruits and vegetables. To supplement these actions, while neither population screening programmes nor screening trials could be recommended by the Advisory Group, initial chemoprevention trials have produced some promising results and this represents an interesting area which is the focus of much current research.

Analysis of quantitative data by quantiles in epidemiologic studies: classification according to cases, noncases, or all subjects?

Quantitative exposure data in epidemiologic studies are frequently analyzed by ordered categories. Categorization by quantiles can be based on the distribution of (1) cases, (2) noncases, and (3) all subjects. The advantages of the three schemes in determining quantiles were compared. They were found to give the same power regarding a test for trend over a wide range of study situations. Considerations on the representativeness and the ease of the analysis implementation could dictate the choice of the categorization scheme.

Prognostic factors in thyroid tumours

Using Coxs Proportional Hazard Model, we have demonstrated the influence of age, sex, microscopic tumour type, extent of primary tumour, nodal status and the presence of metastases on prognosis, in our population of 441 patients with thyroid carcinoma. The TNM classification contributes significantly to survival, but does not include other contributory prognostic variables, whereas the prognostic index developed by the EORTC thyroid study group, which takes account of age and histology, proved a reliable predictor of survival for our patient group.

Epidemiological features of gastric and oesophageal cancers in Slovakia

Data from Slovakia were analysed to determine whether, in accordance with observations made in western Europe and the United States, there is an increasing occurrence of tumours around the oesophagogastric junction. However, the increase in oesophageal cancers in this area was found to be attributable to squamous cell carcinomas. This is in keeping with observations made in central and eastern Europe of an increase in the incidence of tobacco- and alcohol-related cancers.

The descriptive epidemiology of pharyngeal cancer in Scotland

There have been recent reports of substantial increases occurring in the incidence of and/or mortality from tongue and mouth cancers in several countries. In this paper using data from Scotland (1960–89) we report on time trends in pharyngeal cancer. Similar increases in rates are evident for cancers of the oropharynx and hypopharynx while there has been little change in the occurrence of nasopharyngeal cancer (which has distinct aetiological factors). It therefore seems that reported changes in the incidence of and mortality from oral cancer may be real, and in Scotland, this is most probably due to changes in alcohol consumption.