Megumi Hori

An updated report on the trends in cancer incidence and mortality in Japan, 1958–2013

The analysis of cancer trends in Japan requires periodic updating. Herein, we present a comprehensive report on the trends in cancer incidence and mortality in Japan using recent population-based data. National cancer mortality data between 1958 and 2013 were obtained from published vital statistics. Cancer incidence data between 1985 and 2010 were obtained from high-quality population-based cancer registries of three prefectures (Yamagata, Fukui and Nagasaki). Joinpoint regression analysis was performed to examine the trends in age-standardized rates of cancer incidence and mortality. All-cancer mortality decreased from the mid-1990s, with an annual percent change of -1.3% (95% confidence interval [CI]: -1.4, -1.3). During the most recent 10 years, over 60% of the decrease in cancer mortality was accounted for by a decrease in stomach and liver cancers (63% for males and 66% for females). The long-term increase in female breast cancer mortality, beginning in the 1960s, plateaued in 2008. All-cancer incidence continuously increased, with annual percent changes of 0.6% (95% CI: 0.5, 0.8) between 1985 and 2005, and 1.8% (95% CI: 0.6, 2.9) between 2005 and 2010. During the most recent 10 years, almost half of the increase in cancer incidence was accounted for by an increase in prostate cancer (60%) in males and breast cancer (46%) in females. The cancer registry quality indices also began to increase from ∼2005. Decreases in stomach and liver cancers observed for incidence and mortality reflect the reduced attribution of infection-related factors (i.e. Helicobacter pylori and hepatitis virus). However, it should be noted that cervical cancer incidence and mortality rates began to increase from ∼1990.

Atrial natriuretic peptide prevents cancer metastasis through vascular endothelial cells

Significance Postoperative cancer recurrence is a major problem following curative cancer surgery. Perioperative systemic inflammation induces the adhesion of circulating tumor cells released from the primary tumor to the vascular endothelium of distant organs, which is the first step in hematogenous metastasis. We have previously reported that administration of atrial natriuretic peptide (ANP) during the perioperative period reduces inflammatory response and has a prophylactic effect on postoperative cardiopulmonary complications in lung cancer surgery. Here, we demonstrate that cancer recurrence after lung cancer surgery was significantly lower in ANP-treated patients than in control patients (surgery alone). We show that ANP prevents cancer metastasis by suppressing the inflammatory reaction of endothelial cells, thereby inhibiting cancer cell adhesion to vascular endothelial cells. Most patients suffering from cancer die of metastatic disease. Surgical removal of solid tumors is performed as an initial attempt to cure patients; however, surgery is often accompanied with trauma, which can promote early recurrence by provoking detachment of tumor cells into the blood stream or inducing systemic inflammation or both. We have previously reported that administration of atrial natriuretic peptide (ANP) during the perioperative period reduces inflammatory response and has a prophylactic effect on postoperative cardiopulmonary complications in lung cancer surgery. Here we demonstrate that cancer recurrence after curative surgery was significantly lower in ANP-treated patients than in control patients (surgery alone). ANP is known to bind specifically to NPR1 [also called guanylyl cyclase-A (GC-A) receptor]. In mouse models, we found that metastasis of GC-A–nonexpressing tumor cells (i.e., B16 mouse melanoma cells) to the lung was increased in vascular endothelium-specific GC-A knockout mice and decreased in vascular endothelium-specific GC-A transgenic mice compared with control mice. We examined the effect of ANP on tumor metastasis in mice treated with lipopolysaccharide, which mimics systemic inflammation induced by surgical stress. ANP inhibited the adhesion of cancer cells to pulmonary arterial and micro-vascular endothelial cells by suppressing the E-selectin expression that is promoted by inflammation. These results suggest that ANP prevents cancer metastasis by inhibiting the adhesion of tumor cells to inflamed endothelial cells.

Incidence of multiple primary cancers and interval between first and second primary cancers

In this retrospective study, we aimed to clarify the risk of developing a second primary cancer and to determine the periods of high risk of second primary cancers. Subjects were all patients who had been diagnosed with a first primary cancer and registered with the Nagasaki Prefecture Cancer Registry between 1985 and 2007. We calculated the standardized incidence ratio (SIR) of second primary cancer according to site and years after diagnosis of the first primary cancer. A second primary cancer developed in 14 167 of 174 477 subjects (8.1%) during a median follow‐up of 1.8 years. The SIR of all cancer was 1.10 (95% confidence interval, 1.08–1.11). Some specific relationships were observed between sites with risk factors in common, such as smoking, drinking, and hormone status. The SIRs were relatively high after approximately 10 years for all sites, and trends differ among cancer sites. We showed that cancer patients are at higher risk of a second primary cancer than the general population. In respect of the risk of a second primary cancer, physicians should be alert for cancers that have risk factors in common with the first primary cancer.

Comparison between Overall, Cause-specific, and Relative Survival Rates Based on Data from a Population-based Cancer Registry

Three kinds of survival rates are generally used depending on the purpose of the investigation: overall, cause-specific, and relative. The differences among these 3 survival rates are derived from their respective formulas; however, reports based on actual cancer registry data are few because of incomplete information and short follow-up duration recorded on cancer registration. The aim of this study was to numerically and visually compare these 3 survival rates on the basis of data from the Nagasaki Prefecture Cancer Registry. Subjects were patients diagnosed with cancer and registered in the registry between 1999 and 2003. We calculated the proportion of cause of death and 5-year survival rates. For lung, liver, or advanced stage cancers, the proportions of cancer-related death were high and the differences in survival rates were small. For prostate or early stage cancers, the proportions of death from other causes were high and the differences in survival rates were large. We concluded that the differences among the 3 survival rates increased when the proportion of death from other causes increased.

A randomised controlled trial of the resistive heating blanket versus the convective warming system for preventing hypothermia during major abdominal surgery.

We compared resistive heating (RH) and upper-body convective warming (CW) in 70 patients (RH 33, CW 31, 6 excluded) undergoing major abdominal surgery. The effect of RH was not inferior to that of CW for the time-weighted average core temperature, and the lower limit of 95% CW was greater than −0.5°C. Resistive heating showed no inferiority in maintaining core temperature compared with convective warming.

Childhood, adolescent and young adult cancer incidence in Japan in 2009–2011

Population-based cancer registry data in Japan for 2009–2011 revealed predominant cancers to change dramatically from childhood to young adulthood.

Estimation of lifetime cumulative incidence and mortality risk of gastric cancer

Lifetime cumulative incidence and mortality risk for gastric cancer was estimated by risk classifications, which will be useful for designing individually tailored prevention strategy.

Morphological distribution of thyroid cancer from Cancer Incidence in Five Continents Vol. X

In order to compare the morphological distribution of cancer incidence worldwide, we abstracted the incidence in 2003–2007 from Cancer Incidence in Five Continents Vol. X (CI5-X). The International Agency for Research on Cancer provides the CI5 detailed databases on the incidence of cancer recorded by cancer registries (regional and national) worldwide. We used the number of incidences in Japan, the Republic of Korea, the USA, Brazil, the UK, Italy and Australia from the CI5 databasewhich contains incidence for selected cancer registries published in CI5-X for 2003– 2007. The Republic of Korea and the USA (NPCR: National Program of Cancer Registries) reported the cancer incidence covered by all the country; however, the remaining countries reported the cancer incidence by registry. We aggregated eight registries in Japan, two registries in Brazil, four registries in the UK, 21 registries in Italy, and five registries in Australia. We compared the morphological distribution between countries for thyroid cancer coded as C73 (ICD10). The incidence of thyroid cancer in females is significantly higher than that in males. Age-standardized rates for males with thyroid cancer, using world standard population, ranged from 1.2 to 6.4 per 100 000, and the rates for females ranged from 3.3 to 37.4 per 100 000, in the countries studied. Thyroid cancer was one of the 10 most common cancers among males in the Republic of Korea, and among females in the Republic of Korea, the USA, Brazil, Italy and Australia. Figure 1 shows the distribution of morphology for thyroid cancer for males; Fig. 2 shows these data for females. For both sexes, papillary carcinomawas the most common type of thyroid cancer. For females, the proportion of papillary carcinomawas approximately 60% in the UK, 70% in Japan and Brazil, 80% in Italy and Australia, 90% in the USA, and over 90% in the Republic of Korea. Formales, the proportion was lower than for females. After excluding other specified and unspecified carcinoma and unspecified morphology, follicular carcinomawas the second most common type of thyroid cancer in the all countries studied. The proportions of other specified carcinoma and unspecified morphology were relatively high in Japan. In Brazil, the proportions of unspecified carcinoma and unspecified morphology were high. For both sexes in the UK, the proportion of follicular carcinomawas relatively high. The proportion of medullary carcinoma was about 1–8% for males and 0.5–4% for females, and the proportion of anaplastic carcinoma was about 1–5% for males and 0.2–3% for females in all the countries studied. The proportions of sarcoma and other morphology were extremely low among both sexes in the all countries studied, and accounted for less than 0.5%.

Incidence rate for melanoma of skin cancer in Japanese in Japan and in the United States from the Cancer Incidence in Five Continents

In order to make a comparison of melanoma of skin cancer incidence rates between Japanese in Japan and those in the United States, we abstracted the age-standardized incidence rates (ASRs) from the Cancer Incidence in Five Continents Vol. I–X (CI5). The International Agency for Research on Cancer provides the CI5 databases on the incidence of cancer recorded by cancer registries (regional and national) worldwide. We used ASRs for Japanese from the following cancer registries, Miyagi, Nagasaki and Osaka in Japan, and California-Los Angeles,

Predicting Preoperative Hemodynamic Changes Using the Visual Analog Scale

PURPOSE This study aimed to investigate how both visual analog scale cutoff scores and State-Trait Anxiety Inventory scores relate to hemodynamic changes in patients entering the operating theater. DESIGN A prospective observational study. METHODS The study subjects included 130 prospectively enrolled patients who were scheduled for abdominal surgery under combined epidural-general anesthesia and who underwent preoperative anxiety level measurements using both scales. FINDINGS The heart rate and systolic blood pressure on entering the operating theater were significantly higher than those at baseline in the high and low/moderate anxiety groups. Variations in heart rate and systolic blood pressure were significantly higher, whereas peripheral blood flow was significantly lower in the high anxiety group compared with the low/moderate anxiety group. CONCLUSIONS Using the visual analog scale to measure anxiety can improve our understanding of the hemodynamic changes that occur when patients enter the operating theater.