This study was conducted to examine the incidence rates and cumulative risks of second primary cancers in Osaka and to compare the observed number of second primary cancers with the expected number calculated using cancer incidence rates among Osaka residents. Study subjects were all reported cases aged 0–79 who were first diagnosed as having a first primary cancer between 1966–86. Incidence of second primary cancer among the study subjects was examined through to the end of 1989. The total number of study subjects was 217,307. During the follow‐up period (mean duration: 3.7 years), second primary cancers developed in 5,071 patients (2.3%). Incidence of synchronous (interval <3 months) and metachronous (interval ≥ 3 months) second primary cancers increased in the later years. Incidence rates of second primary cancers were significantly associated with gender (male), age and calendar year at diagnosis of the first cancer. Based on the incidence rates, cumulative risk of developing metachronous second primary cancer was calculated. The ten‐year cumulative risk was estimated as 10% for those who developed their first cancer during their sixties in 1978–83. The observed number of second primary cancers (including synchronous) was compared with the expected number. The ratios of observed‐to‐expected numbers were generally lower than 1.0 among those who developed their first cancer in 1966–77, while these ratios were higher than 1.0 among those who developed their first cancer in 1978–86. The ratios were much higher than 1.0 among those who developed their first cancer in their childhood and youth. Patients who had developed cancer of the colon, larynx, lung, bladder, or breast (female) showed significantly higher risk of developing second primary cancer during the period 1–4 years after diagnosis of the first cancer.
The risk of developing a second primary cancer following laryngeal cancer was estimated by following‐up 472 male laryngeal cancer patients for an average of 8.6 years by means of record linkage to the Osaka Cancer Registry. Of these patients, 115 developed a second cancer other than laryngeal cancer, whereas the expected number derived from the incidence rates among Osaka residents was 51.4 (relative risk (RR) = 2.2, 95% confidence interval = 1.85 2.69). Cumulative risk of developing a second primary cancer was estimated to be 31.1% at 15 years after laryngeal cancer. By site, the risks were significantly increased for tobacco‐related cancers, RR = 24.5, 6.1 and 2.3 for cancers of the oral cavity & pharynx, esophagus and lung, respectively. Also, the risks were higher among heavy smokers for cancer of the oral cavity & pharynx and esophagus than among light smokers. No adverse effects of radiotherapy for laryngeal cancer on the development of thyroid cancer, lymphoma and leukemia were observed. The present study suggests the necessity of following‐up laryngeal cancer patients over a long period in order to enable the early detection of tobacco‐related cancer.
We investigated trends of lung cancer incidence from 1974 to 1993 by histologic type, using data from the population-based cancer registry in Osaka, Japan. Since the proportion of cases with histologic types identified was not sufficiently high, sex-and age-specific incidence rates by histologic types were estimated assuming that the distribution of histologic types was the same across the same sex and age group regardless of reporting status. Cumulative risk from 0 to 74 years old for total lung cancer increased 1.3-fold from the period 1974-77 to 1986-89 and then plateaued in the period 1990-93 for both males and females. When divided into histologic types, cumulative risk for incidence of squamous cell carcinoma was almost constant during the study period for both males and females. During the same period, adenocarcinoma increased up to 1.4-fold for both males and females. This increase seemed to have reached a plateau recently for males, but not for females. Small cell carcinoma increased monotonously up to 1.6-to 1.7-fold for both males and females. Large cell carcinoma showed over 2-fold increase for both males and females; however, the estimates fluctuated due to the small number of cases. This study provides further evidence of a relative increase of adenocarcinoma compared to squamous cell carcinoma. Recent trends of tapering increase of lung cancer incidence should be confirmed by further observation.Key words: Lung cancer -Histologic type -Incidence -Trend -Smoking Recent trends of lung cancer incidence are showing different patterns by country. 1) In the US and UK, where lung cancer incidences were relatively high and smoking control has been successfully implemented, incidence of lung cancer in males has reached a peak and now is in the decreasing phase, starting from younger age groups. In contrast, in Eastern Europe, where smoking control has been less successful, the incidence is still increasing. These trends have been greatly influenced by the trends of smoking prevalence. It is well known that the magnitude of association between lung cancer and cigarette smoking differs by histologic types. Squamous cell carcinoma and small cell carcinoma show a 10-to 20-fold increase among current smokers compared to non-smokers, while adenocarcinoma shows a 2-to 5-fold increase.2) Therefore, smoking prevalence influences the trends of incidences differently among histologic types.In the US and Europe, several hospital-based studies, [3][4][5][6] autopsy series 7) and population-based studies [8][9][10][11][12][13][14][15][16] have examined the trends of lung cancer incidence by histologic type. In Asian countries there have been hospitalbased studies, [17][18][19][20] and a population-based study. 21) Most of the studies showed a relative increase of adenocarcinoma as compared to squamous cell carcinoma in both males and females, especially in younger age groups. Lung cancer incidence in Japan has been relatively low compared to other countries. It is reported that cumulative risk (0-74 years old) of lung c...
The risk of developing a second primary cancer following stomach cancer was estimated from data accumulated in the Osaka Cancer Registry. Of the 38,777 male patients and 22,391 female patients newly diagnosed in the period 1966–1986 who were followed up until the end of 1986, 778 and 267 developed a second cancer other than stomach cancer, respectively, whereas the expected numbers had been 928.8 (RR=0.84, 95%CI=0.78‐0.90) and 297.7 (RR = 0.90, 95%CI = 0.79‐1.01). The risks were higher among younger patients (aged 30–54 at the diagnosis of stomach cancer) than among older patients (aged 55–69 at the diagnosis of stomach cancer). Significantly elevated risks were observed for cancers of the oral cavity & pharynx (RR=l.56), colon (RH = 1.61) and rectum (RR = 1.56) for males, and oral cavity & pharynx (RR = 2.59) for females as second cancers. Results were substantially similar among the localized stomach cancer patients. Among younger male patients with gastrectomy, the risk of developing pancreatic cancer was elevated 10 or more years after stomach cancer diagnosis. The present study suggests the necessity of following up stomach cancer patients in order to enable the early diagnosis of digestive tract cancer.
In 1971–1988, 4,021 malignant tumors occurring among children under 15 years of age were registered in the Osaka Cancer Registry, a population‐based registry which covers Osaka Prefecture, Japan. These patients were reclassified into 12 diagnostic groups by Birch's scheme using information on clinical diagnosis, histology and primary site. The annual age‐standardized incidence rate for childhood cancer per million children was 130.3 for males and 104.9 for females in 1971–88. Comparing the incidence rates for both sexes in 1981–88 with those in 1971–80 in Osaka, we observed a significant decrease of acute non‐lymphocytic leukemia (ANLL) and a significant increase of all cancers, acute lymphocytic leukemia, non‐Hodgkin lymphoma, sympathetic nervous system tumors, soft‐tissue sarcomas, and gonadal and germ‐cell tumors. Age‐standardized incidence rates in around 1971–80 of the above‐mentioned diagnostic groups were compared among 4 population‐based registries; Osaka, Miyagi (Japan), SEER (U.S.), and the National Registry of Childhood Tumors (England and Wales). Rates for ANLL and gonadal and germ‐cell tumors were higher and those for other diagnostic groups were lower in Osaka, especially for Hodgkin's disease. Thus, in 1980–88 in Osaka, rates for Hodgkin's disease remained low and rates for gonadal and germ‐cell tumors increased, though rates for other cancers appeared to resemble the levels in caucasian populations. The incidence of childhood cancer in Japan was estimated according to the diagnostic groups in Birch's scheme.
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