This chapter reviews the data on occurrence of cancers that are potentially caused by alcohol drinking (cancers of the upper gastrointestinal and respiratory tracts, and liver cancer) in relation to social class. In order to assess the role of alcohol drinking in the observed social class gradients of these cancers, we have particularly looked for consistency in the gradients of different alcohol-related cancers, and used lung cancer occurrence to judge the role of tobacco smoking, which is the major other determinant of these diseases. Additional data on levels of alcohol drinking and on the occurrence of other alcohol-related morbidity are brought into the discussion where available. A role of alcohol drinking in the observed negative social class gradients for alcohol-related cancers is very likely in men in France, Italy and New Zealand. Evidence that is less strong, but is suggestive of a role of alcohol drinking, is seen for men in Brazil, Switzerland, the United Kingdom and Denmark. Although a role of alcohol drinking is likely or possible in certain populations, other factors may contribute as well, most notably tobacco smoking and dietary habits. Additional data on the frequency of complications after surgical procedures in alcohol drinkers are reviewed briefly.
A cohort comprising 11,452 women and based on virtually all cases of first incidence of breast cancer in Sweden in 1964-67 was followed for 13-16 completed years--corresponding to 94,078 person-years of observation--for the occurrence of subsequent primary tumors other than in the breast. A slight excess in the total number of second malignant diseases (695 observed vs. 633.7 expected; relative risk (RR) = 1.10) was possibly partly due to a higher autopsy rate with more frequent detection of preclinical cancers in the cohort than in the background population. A significant risk increase was confirmed for endometrial cancer after the age of 70 years (RR = 2.4; 95% confidence limits = 1.6-3.5) but not for ovarian cancer (RR = 1.2) or tumors of the large bowel (RR = 1.2), rectum (RR = 1.1), or any other site. It was concluded that: 1) so many subgroups were analyzed in this study that the significant association with endometrial cancer might be due to the play of chance alone and, therefore, needs further confirmation, 2) there is no common genetically linked susceptibility to primary cancer of the breast and that of other sites, 3) the hypothesis that cancers of the breast and large bowel share major etiologic factors was not supported, and 4) it is unlikely that secondary cancers significantly contribute to the late excess mortality in breast cancer patients.
Esophageal atresia (EA) predisposes to gastroesophageal reflux that is associated with intestinal metaplasia and may result in development of adenocarcinoma of the esophagus. To date, the literature has reported 5 cases of esophageal cancer in adult patients treated for EA. The aim of this study was to find out the incidence of esophageal cancer in adult patients with repaired EA.
Five hundred two consecutive patients treated for EA from 1949 to 1978 were followed-up for cancer through the files of the population-based countrywide cancer registry from 1967 to 2004. The number of cancer cases observed and person-years at risk were counted, and the expected number of cancer cases estimated from the national cancer incidence rates. The standardized incidence ratios (SIRs) were calculated by dividing the number of cancer cases observed by the expected numbers.
None of the 502 patients were lost to follow-up; 230 patients who died before 1967 younger than the median age of 8 days were excluded from further analysis. The 272 remaining patients (142 males) were eligible for follow-up (median age, 35 years; range, 2 days to 56 years). Three cases of cancer were found (SIR, 1.0; 95% confidence interval, 0.20-2.8). One was lymphoma in small intestine, 1 was leukemia, and 1 carcinoma of the uterus but no cases of esophageal cancer.
Our study is able to exclude long-term risk for esophageal cancer after repair of EA 500-fold higher than that of the normal population. Considering the relatively young age of the survivors, further studies and continued follow-up are warranted to elucidate risk for esophageal cancer and need for endoscopic surveillance after repair of EA.
Cancer morbidity and mortality were studied in areas of the Kaluga oblast contaminated with radionuclides. The main objective of the study was to assess the influence of radiation exposure on existing levels of cancer morbidity and mortality. Time trends and relative population risks were analysed. Based on this analysis, it was concluded that the current levels of morbidity from cancers among the populations residing in the studied areas were primarily a result of a complex of factors which predated the exposure from the Chernobyl accident. However, there seems to be an unfavourable trend concerning malignant neoplasms of the respiratory organs for women residing in the contaminated areas. To date, no statistically significant effect of radiation on cancer morbidity (except for thyroid cancer in women) has been noted. The levels of cancer morbidity and mortality in the contaminated areas generally reflect the changes in cancer incidence in the oblast as a whole. The findings are consistent with international data on latent periods for the induction of radiogenic cancers and the biological effects for similar levels of exposure to populations residing in contaminated territories. Further studies are necessary in order to monitor possible effects that are related to the accident.
The frequency of carcinoids was studied in a 12-year-period (1958-1969) in Malmö, a town with a population of 220,000 at the beginning of the period and 250,000 at the end of it. Of all persons who had died in Malmö, 46 per cent were necropsied in the first year of the study and 70 per cent in the last (altogether 62.6 per cent). The series was examined in a uniform way at one department of pathology. Carcinoid tumours were found in 1.22 per cent (199 patients) of patients comprised in the entire necropsy series (16,294 autopsies). Bronchial carcinoid accounted for 0.1 percent, the remaining lesions were found in the digestive tract. About 90 per cent of the carcinoids were found incidentally at necropsy. During the same period, 44 carcinoids were diagnosed in surgical specimens examined in Malmö. The average annual frequency of carcinoid in the entire series was about 8.4 per 100,000 inhabitants, which is about 7 times as high as that recorded in the National Cancer Register applying to the whole of Sweden. The value of such country-wide reports is discussed. The carcinoid syndrome is extremely rare and was observed only once during the entire 12-year-period. The localization, frequency of metastases and sex-distribution of carcinoids are described and discussed in detail.
OBJECTIVE: To analyze population-based incidence, anatomic distribution and patient characteristics of gastrointestinal carcinoid tumours. BACKGROUND: Neuroendocrine carcinomas (NE, carcinoid tumours) arise from neuroendocrine cells and are most commonly found in gastrointestinal tract and lungs. Previous studies on carcinoids report varying incidence rates, location of tumours and patient survival rates. METHODS: Retrospective study. 88 patients were diagnosed with carcinoids located in the gastrointestinal tract in the period 1983-2003 in the Norwegian counties Hordaland and Sogn og Fjordane. Patient and tumour characteristics, treatment and survival were analyzed in a sub-group of 51 patients treated at Haukeland University Hospital. RESULTS: Incidence of carcinoids was 0.8 when analyzed from the counties Hordaland and Sogn og Fjordane as well as when analyzed from Haukeland University Hospital. There were 26 men and 25 women. Median age at surgery was 61 years (range 17-87 years). The tumours were located in the small bowel in 53%, appendix 18%, colon 4%, rectum 4%, stomach 8% and duodenum 10%. Five-year survival rate was 50% in stomach, 80% in duodenum, 43% in the small bowel, 100% for tumours in appendix, 40% in colon and 100% in rectum. CONCLUSION: Carcinoid tumours are relatively uncommon neoplasms and most of them are found in the small bowel. Carcinoids in the ileum tend to be more aggressive and carry a poorer prognosis than carcinoids at other locations. Tumours in the appendix are found at lower age and in an early stage. They rarely metastasize and have an excellent prognosis.