Marylon Coates

Risk of cancer in people with AIDS.

OBJECTIVES To determine whether the incidence of cancers other than the AIDS-defining cancers is increased in people with AIDS, and to determine if cancer incidence increases with time, a surrogate marker of declining immune function. DESIGN Register-based retrospective cohort study in New South Wales, Australia. Age-, sex-, and period-adjusted standardized incidence ratios (SIR) were calculated for individual cancers occurring in 1980-1993 in people with AIDS registered before 1996. RESULTS During the study period, 3616 people were registered with AIDS; 716 cases of AIDS-defining cancer and 62 cases of non-AIDS-defining cancer were identified. People with AIDS had a significantly increased incidence of Hodgkins disease [SIR 18.3; 95% confidence interval (CI) 8.39-34.8], multiple myeloma (SIR 12.1; 95% CI 2.50-35.4), leukaemia (SIR 5.76; 95% CI 1.57-14.7), lip cancer (SIR 5.94; 95% CI 1.92-13.8) and lung cancer (SIR 3.80; 95% CI 1.39-8.29). The incidence of Hodgkins disease increased significantly around the time of AIDS diagnosis (P = 0.008 for trend with time), suggesting an association with immunodeficiency. CONCLUSIONS This study provides strong support for the hypothesis that Hodgkins disease is an AIDS-associated condition. There was an increased incidence of several other forms of cancer, some of which are known to occur at increased rates in transplant recipients who have received immunosuppressive therapy. Improved survival in people with HIV infection may lead to increases in the number that develop these forms of cancer.

Cancer incidence in Asian migrants to New South Wales, Australia

Cancer incidence during 1972-90 in Asian migrants to New South Wales, Australia, is described. Overall cancer incidence was lower than in the Australia born in most migrant groups, and this reached significance in migrants born in China/Taiwan, the Philippines, Vietnam and India/Sri Lanka, and in male migrants born in Indonesia. For the majority of cancers, rates were more similar to those in the Australia born than to those in the countries of birth. For cancers of the breast, colorectum and prostate, rates were relatively low in the countries of birth, but migrants generally exhibited rates nearer those of the Australia born. For cancers of the liver and cervix and, in India/Sri Lanka-born migrants, of the oral cavity, incidence was relatively high in the countries of birth but tended to be lower, nearer Australia-born rates, in the migrants. For these cancers, environmental factors related to the migrants adopted country, and migrant selection, appeared to have a major effect on the risk of cancer. For certain other cancers, incidence was more similar to that in the countries of birth. Nasopharyngeal cancer, and lung cancer in females, had high rates in both the countries of birth and in migrants to Australia. Nasopharyngeal cancer rates were highest in China/Taiwan and Hong Kong-born migrants, and were also significantly high in migrants from Malaysia/Singapore, Vietnam and the Philippines. Rates of lung cancer were significantly high in women born in China/Taiwan, and the excess was greater for adenocarcinoma than for squamous cell carcinoma. Melanoma had low rates in both the migrants and in the countries of birth. For these cancers, it was probable that genetic factors, or environmental factors acting prior to migration, were important in causation.

Cancer mortality in East and Southeast Asian migrants to New South Wales, Australia, 1975–1995

SummaryRoutinely collected data for New South Wales were used to analyse cancer mortality in migrants born in East or Southeast Asia according to duration of residence in Australia. A case-control approach compared deaths from cancer at particular sites with deaths from all other cancers, adjusting for age, sex and calendar period. Compared with the Australian-born, these Asian migrants had a 30-fold higher risk of dying from nasopharyngeal cancer in the first 2 decades of residence, falling to ninefold after 30 years, and for deaths from liver cancer, a 12-fold risk in the first 2 decades, falling to threefold after 30 years. The initial lower risk from colorectal, breast or prostate cancers later converged towards the Australian-born level, the change being apparent in the third decade after migration. The relative risk of dying from lung cancer among these Asian migrants was above unity for each category of duration of stay for women, but at or below unity for men, with no trend in risk over time. An environmental or lifestyle influence for nasopharyngeal and liver cancers is suggested as well as for cancers of colon/rectum, breast and prostate.

Cancer mortality in migrants from the British Isles and continental Europe to New South Wales, Australia, 1975-1995.

Routinely collected data for New South Wales were used to analyse cancer mortality in migrants from the British Isles, southern Europe and eastern Europe according to duration of residence in Australia. A case‐control approach compared deaths from cancer at one site with deaths from all other cancers, adjusting for age, sex and calendar period. Compared with the Australia‐born, migrants had a significantly lower risk of dying from cancers of the mouth/pharynx and prostate (migrants from each region), colon/rectum (from the British Isles and southern Europe) and lung (female southern European migrants), evident from the time of migration and maintained for 30 years after migration. Whereas a deficit of deaths from colorectal cancer remained in migrants from southern Europe, a clear gradient of increasing risk with duration of stay in Australia was apparent. A similar trend was seen with respect to kidney cancer in southern European migrants. Persistent excess risks of death from stomach cancer were seen in all migrant groups, from lung cancer in British migrants and from liver cancer in southern and eastern European migrants. Although the risk of death from breast cancer increased significantly with duration in Australia in southern European migrants, the increase was not monotonic, as the relative risk in the first 10 years after migration was almost the same as that after more than 30 years. The pattern of risk for cancers of the prostate and mouth/pharynx suggests some protective role for inheritance or maintained cultural factors. Int. J. Cancer 83:179–185, 1999.

Cancer incidence in migrants to New South Wales (Australia) from the Middle East, 1972-91

The incidence of cancer in migrants to New South Wales (NSW) from Cyprus, Egypt, Iran, Iraq, Israel, Lebanon, Syria, and Turkey has been compared with that in the Australian-born population using data from the NSW Central Cancer Registry for 1972–91. Age-standardized incidence rates showed overall cancer incidence to be less common in migrants from each Middle Eastern country than in the Australian-born. There was a clear pattern of generally low rates for cancers of the mouth and pharynx, esophagus, colon and rectum, lung (men only), ovary, prostate and testis, and melanoma. Cancers which tended to be more common in migrants were nasopharynx, stomach (women only), liver (men only), gallbladder (chiefly in women), bladder (men only), and thyroid. Breast cancer did not show a uniform pattern among migrant groups, rates being high in the Egyptian-born but low in Lebanese-born women. The overall low incidence of cancers related to tobacco and alcohol, and to a ‘high fat, low fiber’ diet, emphasizes the potential role of preventable lifestyle factors in the burden of cancer in Australia.

Socioeconomic differentials in cancer incidence and mortality in urban New South Wales, 1987–1991

Abstract: Cancer incidence and mortality in urban residents of New South Wales (NSW), 1987 to 1991, were analysed according to socioeconomic status (SES) for males (m) and females (f). Incidence rates displaying a negative gradient with SES at P < 0.01 included: cancers of the mouth and pharynx (m), oesophagus (m), stomach (m,f), liver (m), pancreas (m), larynx (m), lung (m,f), cervix, kidney (m,f) and all cancers combined (m). Negative mortality gradients at P < 0.01 were observed for mouth and pharynx (m), stomach (m,f), rectum (m), liver (m), larynx (m), lung (m,f) and cervix, and all cancers (m,f). Those sites for which incidence showed a positive gradient with SES included: colon (m,f), melanoma (m,f), breast (f), prostate and testis. For cancer mortality for specific sites no significant (P < 0.01) positive gradients were observed, although for melanoma (m,f) a positive gradient at P < 0.05 was found. Mortality for all cancers considered together in both sexes was significantly higher in the low SES group compared to the high SES group. This is partly because the more‐fatal cancers are more common in the lower SES groups. Diet, tobacco use, reproductive factors, occupational and sun exposures are likely to be associated with the patterns observed but are not investigated in this study. Variations in health care between SES groups may also be pardy responsible for some of the differences.

Second primary cancers following cancers of the kidney and prostate in New South Wales (Australia), 1972–91

Data from the New South Wales (NSW) (Australia) Central Cancer Registry for the period 1972–91 were examined to determine the risk of second primary cancers following an initial invasive cancer of the renal parenchyma (ICD-9 code 189.0), renal pelvis (code 189.1), or prostate (code 185). Eligible cases were restricted to those who had survived for at least two months after diagnosis of the first primary cancer. Expected numbers of cancers were obtained by assuming that subjects experienced the same cancer incidence as prevailed in the corresponding general population and applying gender-, age-, and calendar-specific rates to the appropriate person-years at risk. The relative risk (RR) of a second primary cancer was taken to be the ratio of observed to expected numbers of second cancers. Following prostatic cancer, there was an overall deficit of cancers at all sites combined (RR=0.79, 95 percent confidence interval [CI]=0.75–0.84), and no site had a significantly raised RR. Taking this into consideration, there appeared to be a reciprocal relationship of increased risk of prostatic cancer (RR=1.7, CI=1.2–2.3) following an initial cancer of the renal parenchyma and of renal parenchymal cancer (RR=1.2, CI=0.8–1.7) after cancer of the prostate. An increased risk of bladder cancer occurred following renal parenchymal (RR=3.4, CI=1.1–8.0, for women only) as well as after renal pelvic cancer (men:RR=8.7, CI=5.4–13; women:RR=39, CI=26–56). A tobacco-related pattern of excess risk was seen after renal pelvic cancer but not after cancer of the renal parenchyma. These data illustrate that an excess of second primary cancers may reflect shared etiologic factors or increased medical surveillance.

Cancer incidence in New South Wales, Australia

In 1972, cancer registration began in New South Wales (NSW), the most populous state in Australia. The operations of the Registry are described. By 1990, approximately 316,000 new cases of cancer had been notified from a population that had increased from 4.6 to 5.8 million. In 1981-1984, the most common sites in men were lung, prostate, colon, melanoma and bladder, and in women, breast, melanoma, colon, lung and unknown primary site. Cancers which, between 1973-1976 and 1981-1984, had increased in reported incidence by more than 25% were pharynx and kidney in both sexes, rectum, testis and melanoma in men, and lung and bladder in women; those decreasing by more than 10% were stomach in both sexes, oesophagus in men and cervix in women. Age-standardised incidence rates for melanoma (27.4 [m] and 23.8 [f] per 100,000 in 1987) and cancer of the renal pelvis in women (1.7 per 100,000 in 1989) are among the highest in the world.

The occurrence of cancer in a cohort of New South Wales coal miners

Abstract: To describe the incidence of cancer in coal miners in New South Wales (NSW) between 1973 and 1992, an inception cohort of all male coal industry employees who entered the industry between 1 January 1973 and 31 December 1992 was constructed from the medical examination records of the Joint Coal Board. This cohort was matched with the NSW State Cancer Registry to determine the occurrence and type of cancer. In the cohort of 23 630 men, 297 developed 301 primary cancers in the 20–year period of observation. The standardised incidence ratio (SIR) for all cancers was 0.82. Stomach cancer has been reported to be common in coal miners but the SIR for stomach cancer was not higher than average in this cohort. A cluster of non–Hodgkins lymphoma has been reported in a NSW coal mine but an increased risk of this cancer was not evident in the industry as a whole. Similarly a cluster of cases of brain tumour has been reported. In this cohort, the SIR for brain tumour was 1.05 (95 per cent confidence interval (CI) 0.57 to 1.76) and a risk for brain tumour remains unconfirmed. The SIR for malignant melanoma was 1.13 (CI 0.90 to 1.39) altogether and 2.02 (CI 1.31 to 2.98) for those workers who started in an open–cut mine. Overall, there does not appear to be a general risk of cancer in the NSW coal industry. Open–cut miners have an increased risk of malignant melanoma, which may be related to their exposure to the sun at work.

Epidemiological characteristics of Kaposi's sarcoma prior to the AIDS epidemic.

Twenty-six cases of Kaposis sarcoma (KS) were recorded by the New South Wales Central Cancer Registry between 1972 and 1982, prior to the first AIDS diagnoses in Australia. The overall annual incidence was 0.47 per million. Incidence was three times higher in males. The highest incidence was in people born in the Middle East and in males born in southern and eastern Europe.