A retrospective case-control study of 7 I 3 male oral-cancer patients seen at Tata Memorial Hospital, Bombay, during 1980-1 984 was undertaken to assess the association between chewing, smoking and alcohol habits. Male controls were chosen among those persons who attended the hospital during the same period and were diagnosed as free from cancer, benign tumour and infectious disease. Statistical analysis was based on unconditional logistic regression and the confidence interval for RR was calculated using the standard error of the estimates. Established factors such as tobacco chewing and bidi smoking showed a significant association with oral cancer. For the alcohol habit, the relative risk was 1.42 and the doseresponse relationship, in terms of frequency and duration of the habit, was also observed. The illiterate group showed an almost 2-fold significant excess risk compared to the literate group. After adjusting for confounding variables such as age, residence, illiteracy and known factors such as tobacco chewing and bidi smoking, the study has brought out the significance of a non-vegetarian diet as a high-risk factor for oral cancer compared to a vegetarian diet. Further studies are required to identify specific items in the non-vegetarian diet which may be associated with oral cancer.

S_ary A case-control study of 689 breast cancer patients seen at Tata Memorial Hospital during the period 1980-84 was carried out. During the same period 711 females who attended the hospital without a history of benign breast lesions or gynaecological complaints were selected as controls. Patients were interviewed by trained investigators to collect data on reproductive factors, menstrual history, tobacco smoking and chewing habit, dietary practices (vegetarian and non-vegetarian diet) and alcohol consumption. Cases and controls were stratified into four age groups (<35 years, [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] (Bombay, Maharashtra, others). Odds ratios were calculated by univariate methods as well as by stratified analysis. The Mantel and Haenzel (1959) summary chi-squared test was used for testing statistical significance and a test-based estimation procedure was used for calculation of confidence intervals for odds ratios (Kleinbaum et al., 1982). ResultsGeneral features of breast cancer cases and controls are shown in Table I. The average age of cancer patients was 46.2 years, whereas it was 42.8 years for controls. The religious distribution between cases and controls did not differ and hence is not adjusted for in the analysis. Reproductive factors in cases and controls are presented in Table II. Factors such as age at menarche, age at marriage, age at first pregnancy and number of pregnancies appeared to be similar between the cancer cases and controls.The relative risks (RRs) for factors studied are presented in Table III. Cases and controls were stratified by four age groups and three places of residence. In our study, unmarried women had a 2.3 times higher risk of developing breast cancer than married women. The nulliparous women had 2.2 times the risk of parous women (P<0.OO1). Breast feeding,

Stomach cancer incidence rates are much lower in India than elsewhere, but the stomach remains one of the 10 leading sites of cancer in both sexes in most of the metropolitan registries. This is an unmatched case-control study of stomach cancer carried out at Tata Memorial Hospital (TMH), Mumbai. Our purpose was to identify the association of tobacco and alcohol use, occupational hazards, diet, consumption of beverages like tea and coffee, the living environment, cooking media and literacy with stomach cancer. Our study included 170 stomach cancer cases and 2,184 hospital controls interviewed during the period 1988 -1992. Tobacco chewing, bidi or cigarette smoking and alcohol drinking did not emerge as high risk factors for stomach cancer. Consumption of dry fish at least once a week compared to never or once a every 2 weeks showed a 12-fold excess risk (OR ‫؍‬ 12.4, 95% CI 7.0 -22.1, p < 0.0001) for stomach cancer among the nonvegetarian food items considered. A protective effect of tea consumption (OR ‫؍‬ 0.4, 95% CI 0.2-0.9, p ‫؍‬ 0.03), showing 59% reduction in risk, was identified, which could be of use for possible control and prevention of this cancer.

Summary This is a study of 5595 head and neck cancer patients treated during 1987-89 at TMH, Mumbai. The study included 1970 oral cancers , 1495 oropharyngeal cancers (ICD 1410(ICD , 1453, 1255 hypopharyngeal cancers (ICD 148), 125 nasopharyngeal cancers (ICD 147) and 750 laryngeal cancers (ICD 161). The clinical extent of disease at presentation was based on TNM group staging (UICC 1978). For the majority of sites, patients attended the hospital during stage IlIl and stage IV of the disease; the only exception was for cancers of the lower lip, anterior tongue and vocal cord when between 46.2% and 56.5% of patients with localized cancer (stage and 11) were seen. Generally, surgery either alone or with radiation has been administered for oral cancer patients whereas radiation either alone or in combination with chemotherapy was administered for other head and neck sites. The overall 5-year survival rate was in the range of 20-43% for oral cancer, 8-25% for pharyngeal cancers and 25-62% for laryngeal cancer. The 5-year relative survival rates were more or less in agreement with the results published by the Eurocare study for head and neck cancers. The importance of primary prevention in head and neck cancer is stressed.Keywords: head and neck cancer; survival; TNM; stage; treatment Incidence data that are available from six metropolitan cities and one rural registry in India indicate that head and neck cancer is a common problem there (IARC, 1992). Many epidemiological studies carried out in the sub-continent have shown the association of tobacco, alcohol and some dietary items with head and neck cancer. Although primary prevention may be the ideal choice for the control of head and neck cancer, secondary prevention through therapeutic intervention has an equal and important role to play. Management of head and neck cancer in a high-risk population and its response to conventional treatment and survival have not been reported in detail. The aim is to analyse individual sites of head and neck cancer according to stage of the disease, primary treatment and other prognostic factors for 5-year survival.Comparison is also made with survival in European countries. PATIENTS AND METHODSThis is a retrospective analysis of 5595 eligible head and neck cancer patients who were diagnosed and treated at Tata Memorial Hospital, Mumbai, during the period 1987-89. The eligibility criteria for inclusion of patients in the study were: (1) no prior cancer-directed treatment at the time of registration; (2) histologically confirmed epithelial cancer; (3) treatment with chemotherapy together with surgery or radiation but not as the only treatment; and (4) at least 50 cases in each subsite of head and neck cancer. The excluded subsites MO and T2 N MO and stage IV comprising T4No MO, T4 N MO, and any T, N2 or N3 MO and any T any N M,. Periodic updating of followup information was carried out either by scrutiny of medical records of attending patients or by postal enquiry responses. In some cases, follow-up information was also obtaine...