The overall trend of cancer mortality in Japan has been decreasing since the 1960s (agestandardized death rates for ages 30-69), some 20-30 years earlier than in other industrialized countries. Cancer mortality was heavily influenced by Japanese postwar economic recovery, which led to improved living conditions and better control of some common forms of cancer (stomach, cervical) largely caused by infectious agents. However, Japanese wealth and development have also been associated with risky personal behaviors (smoking, drinking) and other conditions, leading to increases in cancers with no known or else very weak links to infection. We call this shift away from infectious and toward non-infectious causes of prevalent forms of cancers the "cancer transition," by analogy to Omran's "epidemiologic transition." The cancer transition described here in the case of Japan must be a part of efforts to revise and update the epidemiologic transition, which should incorporate new knowledge about the role of infection in chronic disease morbidity and mortality.

Allostatic load (AL) is thought to represent the physiological toll that builds up over the life course as a consequence of the body's response to stress. An important aim of this paper is to test this widely held -but little investigated -understanding of what AL represents. More specifically, using the Social Environment and Biomarkers of Aging Study (SEBAS), a nationally representative survey of Taiwan conducted in the year 2000, this paper scrutinizes the connection between stressful life histories and neuroendocrine allostatic load (NAL). The 2000 SEBAS is a cross-sectional survey with over 1,000 participants (of men and women) age 54-91 and contains both conventional social variables and a number of physiological measures. Stressful life histories are operationalized through the use of two sets of indicators: one set makes use of respondents' subjective interpretations of various life domains and the other makes use of non-subjective data about conditions that are expected to be stressful (e.g., widowhood, living alone, low education). NAL is an index of four neuroendocrine biomarkers (cortisol, dehydroepiandrosterone sulfate (DHEAS), epinephrine, norepinephrine) collected in blood and urine samples under resting, basal states.The major findings of this paper are twofold. First, there is little evidence to support the hypothesis that baseline levels of the neuroendocrine markers stem from stressful life histories. Second, report of current stress (among women only) is positively correlated with higher NAL levels. Taken together, these findings question whether the neuroendocrine markers of the AL construct reflect long-term processes over the life course. Indeed, evidence here suggests that the neuroendocrine markers may reflect the exact opposite -a transient state at the time of the study.

Key Points Question As nations develop, do they experience a systematic pattern in cancer trends by type, distinguishing between infectious-related and noninfectious-related cancers? Findings This cross-sectional study of 6 countries’ cancer mortality data from 1950 to 2018 found that a crossover in trends between the 2 main types of cancers (infectious-related and noninfectious-related) took place around 1990 in Japan and in the mid-1950s in Norway. For the other countries in the study, the trends in the 2 types of cancers do not intersect as they do for Japan and Norway, but those other nations still exhibit a cancer transition with declining rates of infectious-related cancers and rates of noninfectious-related cancers initially increasing, before eventually declining. Meaning These findings support the theory that cancer transitions are occurring in the US, select European nations, and Japan.

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