Thomas R. Bender

Nasopharyngeal carcinoma in alaskan eskimos, indians, and aleuts: A review of cases and study of epstein‐barr virus, HLA, and environmental risk factors

The records of thirty‐one patients with nasopharyngeal carcinoma (NPC) diagnosed from 1966 through 1976 among the Alaskan native population (Eskimo, Aleut, Indian) were reviewed. There were 25 males and six females, which results in relatively high incidence rates per 100,000 of 13.5 for males and 3.7 for females. Clinical and pathologic features were similar to those found among southern Chinese NPC patients. Five‐year survival rate was 48%. Antibodies to Epstein‐Barr virus were higher in NPC patients than in patients with other tumors or matched controls. On histocompatibility testing Sin‐2 was not detected, nor was there significantly increased frequency of A2. Instead, BW40 and a second locus blank occurred more often among NPC patients than among other groups. In response to a questionnaire, NPC patients more often reported use of salt fish in the childhood diet, smoking of cigarettes, and exposure to noxious inhalants than did controls, but the differences were not statistically significant.

Evaluation of an Alaskan streptococcal control program: Importance of the program's intensity and duration

Prospective follow-up information from the throat culturing results of 1,653 Eskimo children in 12 Alaskan villages was used to evaluate the effect of duration and intensity of a streptococcal control program begun in 1971 while controlling for several other risk factors related to streptococcal colonization. Relative risks of colonization for each of the subsequent study years relative to the first year indicate that the risk of colonization decreased over the duration of the study by 42% in Year 2 to 55% in Year 4 (P less than 0.0001). Cost-cutting measures such as lengthening the time interval between routine throat cultures led to a 37% increase in the risk of colonization (P = 0.0002). A comparison of the number of cases of acute rheumatic fever during the 5-year period before the streptococcal control program with the number of cases during the 5-year program period showed that cases in villages with the program decreased from 11 to 0. In a similar group of comparison villages without the program, the number of cases decreased from 7 to 4. A benefit-cost study of the program indicates that benefit exceeds cost. These findings and the changes in the carriage of streptococcal organisms during the control program underscore the importance of such long-term programs with regularly scheduled culturing in high-risk populations of children.