Lip cancer probably represents the only genuine change in the cancer pattern disclosed by these records. It seems to have declined steadily over the six decades until to-day it is an uncommon tumour. In the Mengo series there were 11 females and S males; in the Registry series 4 femals and 4 males. All 16 Mengo patients were elderly ; in 15 the lower lip or angle of the mouth was affected, and many were recorded as confirmed smokers using primitive pipes with thin wood or stem pipes. The decline in this tumour may be due to a change in smoking methods rather than in the habit.
In recent years it has become evident that the African population of Uganda has a very different pattern of site and type frequencies of cancer from that which obtains in Europe and North America. This has been established in the last decade, and it is of interest to establish if this is a stable pattern, if it has remained similar over a period of time, and if there is evidence of change in the pattern in view of the development of Uganda under Western modernizing influences. This bears directly on the long controversy of whether " cancer is a disease
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