We examined the relation between coffee drinking and hepatocellular carcinoma (HCC) mortality in the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study). In total, 110 688 cohort members (46 399 male and 64 289 female subjects) aged 40 -79 years were grouped by coffee intake into three categories: one or more cups per day, less than one cup per day and noncoffee drinkers. Cox proportional hazards model by SAS was used to obtain hazard ratio of HCC mortality for each coffee consumption categories. The hazard ratios were adjusted for age, gender, educational status, history of diabetes and liver diseases, smoking habits and alcohol. The hazard ratio of death due to HCC for drinkers of one and more cups of coffee per day, compared with non-coffee drinkers, was 0.50 (95% confidence interval 0.31 -0.79), and the ratio for drinkers of less than one cup per day was 0.83 (95% confidence interval 0.54 -1.25). Our data confirmed an inverse association between coffee consumption and HCC mortality. (Tabor, 1998). Heavy alcohol consumption (La Vecchia et al, 1988;Tanaka et al, 1992) and dietary aflatoxins (Bulatao-Jayme et al, 1982;Yu et al, 1999) increase the risk of HCC, while diabetes (La Vecchia et al, 1997), smoking (La Vecchia et al, 1988;Yu et al, 1999) and low education level (La Vecchia et al, 1988) are also reported risk factors.Coffee drinking has been inversely related to the risk of liver cirrhosis in several studies (Klatsky and Armstrong, 1992;Klatsky et al, 1993;Corrao et al, 1994Corrao et al, , 2001La Vecchia et al, 1998;Gallus et al, 2002a), although no significant relation was found in two case -control studies from Italy (La Vecchia et al, 1989) and Greek (Kuper et al, 2000). To investigate further an association between coffee drinking and HCC mortality, we analysed data from the Japan Collaborative Cohort Study for Evaluation of Cancer Risk sponsored by Monbusho (JACC Study). SUBJECT AND METHODS SubjectsSubjects were 110 792 cohort members (46 465 males and 64 327 females) aged 40 -79 years from JACC Study, the design of which has been previously described (Ohno et al, 2001). The subjects were followed up from 1988 -1990 until the end of 1999. Residential and survival status was confirmed by searching in roster of residents for moving out or death, and in death certificate for cause and date of death under the permission from the Director-General of Prime Minister's Office.End point for the present study was death from HCC, coded as C22.0 in International Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). Subjects with HCC at baseline or died from HCC within 2 years after registration in the study were excluded from the analysis. Subjects coded C22.9 (hepatic malignancy not otherwise specified) were also excluded from the analysis. The total number of subjects was 110 688 (46 399 males and 64 289 females). The subjects who died of HCC during the observation periods were 287 male and 114 female subjects. Questionnaire and data correctionAfter obtainin...

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The highest incidence of stomach cancer worldwide and a relatively high incidence of liver cancer are found in the Japanese population. 1 There is considerable geographical variation in cancer mortality in Japan: e.g. the western region has a higher liver cancer mortality rate than the northern region. 2 Such differences in mortality might be explained by hepatitis virus infection in the case of liver cancer, [3][4][5][6][7][8] and by diet and Helicobacter pylori infection in the case of stomach cancer. 9 However, statistics indicate that other environmental factors play an important role in carcinogenesis for such sites. For example, an increasing trend of liver cancer mortality is observed in men but not in women, 10 despite the absence of a gender difference in hepatitis viral infection rates. 11 Liver and stomach cancers are not generally considered to be causally related to cigarette smoking. 12 Although an elevated risk of these cancers in smokers has been observed in a number of studies, including large-scale cohort studies, [13][14][15][16][17][18] the magnitude of the association was relatively small. 19 In fact, contradictory findings were shown for these cancers in previous studies, including those on Japanese subjects. 4,13,16,[20][21][22][23][24][25][26][27] The present study examined prospectively, using data from a study that was conducted in the region with the highest mortality rate for liver cancer in Japan, whether cigarette smoking increases the risk of liver and stomach cancers. © International Epidemiological Association 2000 Printed in Great BritainProspective study on the relation of cigarette smoking with cancer of the liver and stomach in an endemic region Background Smoking has not been confirmed as a risk factor for cancers of the liver and stomach. The authors examined prospectively the relationship between smoking and these cancers in an endemic region. MethodsThe data used were a cohort study on the relationship between lifestyle and health in the region having the highest liver cancer mortality in Japan. Of the cohort members, 4050 males aged у40 years were included in the present analysis with a 9-year mean follow-up. Cox proportional hazards regression was used to estimate relative risks (RR) for cancer of the liver, stomach, smokingrelated sites and others, while adjusting for age, residence, and alcohol intake. ResultsBy the end of the study period, 59 cases of liver cancer and 53 cases of stomach cancer were identified. Current smokers, compared to subjects who had never smoked, had a threefold risk of liver cancer (RR = 3.3; 95% CI : 1.2-9.5) and a twofold risk of stomach cancer (RR = 2.2; 95% CI : 0.8-5.7). Sub-cohort analysis showed that adjustment for history of chronic liver disease did not attenuate the risk of liver cancer. Light/medium smokers had almost the same risk of these cancers as heavy smokers, while they showed a relatively low risk of smokerelated cancers. ConclusionsThe present results indicate that smoking is a risk factor of liver and stomach cancer in a ...

To explore the association between dietary habits and risk of hepatocellular carcinoma (HCC) mortality in Japan, univariate analyses was performed using data from the JACC Study. A cohort of 46,465 males and 64,327 females aged 40 to 79 in 19 prefectures in Japan completed the baseline survey during 1988-1990 and were followed up until the end of 1999. The hazard ratio (HR) of HCC mortality for each food item by gender, age group (40-59 and 60-79 years) and history of liver diseases was obtained by Cox proportional hazards model. Some categories, such as boiled rice, ham and sausage, chicken, fish and pickles among men without history of liver diseases and those of miso-soup, fish, carrots and squash, and potatoes among women without history of liver diseases showed a significant inverse association with HCC mortality. Frequent intake of eggs was significantly associated with increased HCC mortality in men without history of liver diseases. Potatoes and foods boiled down in soy sauce (tsukudani) showed a significant positive association, and pickles had a significant inverse association with HCC mortality in men with history of liver diseases. Frequent intake of coffee showed a significant inverse association with HCC mortality both in men and women with history of liver diseases. It is considered that further analysis using a multivariate Cox proportional hazards model including other confounding factors will be required for a more meaningful interpretation of the data.

Objective: We investigated the relationship between the intake of fish and the risk of death from prostate cancer. Design: Data were derived from a prospective cohort study in Japan. Fish consumption obtained from a baseline questionnaire was classified into the two categories of 'low intake' and 'high intake'. The Cox proportional hazards model was used to estimate hazard ratios (HR) and 95 % confidence intervals. Subjects: Data for 5589 men aged 30-79 years were analysed. Results: A total of twenty-one prostate cancer deaths were observed during 75 072 person-years of follow-up. Mean age at baseline study of these twenty-one subjects was 67?7 years, ranging from 47 and 79 years old. Results showed a consistent inverse association of this cancer between the high v. low intake groups. The multivariate model adjusted for potential confounding factors and some other food items showed a HR of 0?12 (95 % CI 0?05, 0?32) for the high intake group of fish consumption. Conclusions: These results support the hypothesis that a high intake of fish may decrease the risk of prostate cancer death. Given the paucity of studies examining the association between prostate cancer and fish consumption, particularly in Asian populations, these findings require confirmation in additional cohort studies.

We examined hepatocellular carcinoma mortality in relation to coffee consumption and anti-hepatitis C virus (HCV) antibody seropositivity in a nested case -control study involving 96 cases. The multivariate-adjusted odds ratios (95% confidence interval) for daily coffee drinkers vs non-drinkers were 0.49 (0.25 -0.96), 0.31 (0.11 -0.85), and 0.75 (0.29 -1.92) in all cases, in HCV-positive and in HCV-negative individuals, respectively.

We evaluated the interaction between hepatitis C virus (HCV) and cigarette smoking on death from hepatocellular cancer in The Japan Collaborative Cohort Study. The odds ratio of death from HCC for smoking was 9.60 (1. 50 -61.35) Many studies have reported that chronic hepatitis C virus (HCV) infection is a risk factor for hepatocellular carcinoma (HCC) (Mori et al, 2000;El-Serag, 2002;Sun et al, 2003;Ayoola and Gadour, 2004), HCV appearing to be more hepatocarcinogenic than hepatitis B virus (HBV) (Pang et al, 2005). While alcohol is a well established risk factor for HCC, there is evidence that cigarette smoking is also a risk factor (Mukaiya et al, 1998;Mizoue et al, 2000;Chen et al, 2003), though some studies reported no or an insignificant association (La Vecchia et al, 1988;Evans et al, 2002). Recently, an association between diabetes mellitus and HCC (or HCV) has been reported (Caronia et al, 1999;Toyoda et al, 2001). We evaluated the interaction between HCV infection and cigarette smoking by means of a nested case -control study from a large cohort. MATERIALS AND METHODSThe Japan Collaborative Cohort Study (JACC Study) for Evaluation of Cancer Risk sponsored by the Ministry of Education, Science, Sports and Culture of Japan (Monbusho) is a large prospective cohort study, which was mounted from 1988 to 1990 in 45 areas in Japan. The number of subjects is 110 792 (46 465 males and 64 327 females) who were 40 -79 years of age at the time of the baseline survey. Individual informed consent to participate in the study was obtained in 36 out of 45 areas . The subjects were asked to complete a self-administered questionnaire about past medical history, various life style factors and marital status as baseline information. The detailed design of the JACC study has been described previously (Ohno and Tamakoshi, 2001;Watanabe et al, 2005). During the approximately 10 years of follow-up through December 31, 1999, there were 550 deaths from liver cancer that were coded as C22 in the International Classification of Diseases and Related Health Problems, 10th Revision. Those survey participants who underwent healthscreening checks sponsored by municipalities were asked to donate blood samples during the same period as the questionnaire survey. Eventually, 39 242 subjects provided blood samples . Baseline serum samples had been collected 120 of the 550 subjects who died of liver cancer. As the control group, sera of 11 543 subjects from the same geographical areas as the 120 deaths also were screened for anti-HCV. Deaths (nine) coded as C22.9 (liver cancer not otherwise specified) were excluded from this analysis, while deaths (five) coded as C22.1 (intrahepatic cholangiocarcinoma and cholangiohepatoma; included among non-HCC deaths), leaving 106 deaths from HCC that were regarded as the end point of this analysis. The total subjects were 11 654 but as the sera of 34 cases and controls could not be screened because of insufficient serum volume, the sera of 11 620 subjects were screened for antibody to HCV (anti-HCV) an...

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