Patients with hepatitis C virus infection have a greatly increased risk of liver cancer. Further studies are required to clarify the roles of other risk factors, including drinking and smoking habits.

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The role of atrophic gastritis of the gastric corpus (fundal atrophic gastritis) as a high-risk factor was investigated by studying operative findings and follow-up data on 690 patients with benign gastric diseases recorded at the Osaka Cancer Registry. The extent of fundal atrophic gastritis was determined by the endoscopic Congo red test. The patients were followed-up from the time of endoscopic examination (1968 to 1976) to December 31, 1987. The vital status of 654 patients (94.8%) at the end of the observation period was determined. During the follow-up period, 22 patients were found to have gastric cancer. The extent of fundal atrophic gastritis was shown to be closely related with the risk of developing gastric cancer. Patients who had been diagnosed as having severe fundal atrophic gastritis showed significantly higher risk of gastric cancer than patients who had been diagnosed as having little or no fundal atrophic gastritis (5.76-fold, calculated with adjustments for age, sex and the follow-up period). A positive linear relationship was found between the risk of developing gastric cancer and the extent of fundal atrophic gastritis. The observed number of gastric cancers was compared with the expected number calculated from the incidence in Osaka Prefecture. Analysis of the results showed that the observed and expected numbers of gastric cancers in patients with severe fundal atrophic gastritis were 11 and 4.8, respectively, the ratio of observed to expected numbers being 2.3 (p < 0.05). These findings indicate that severe fundal atrophic gastritis is a major risk factor for gastric cancer.

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.

Vital statistics were examined for the years 1955 through 1985 for Japanese natives and United States whites to elucidate changes in cancer mortality and related antecedent patterns of lifestyle in these two populations. Results show that lung cancer rates are rapidly accelerating among Japanese males as a consequence of their prior history of heavy cigarette smoking. Oropharyngeal cancer rates are also rising in Japan paralleling increases in alcohol and tobacco utilization. As the Japanese lifestyle and diet continue to become more "westernized," the rates of malignancies of the breast, ovary, corpus uteri, prostate, pancreas, and colon also continue to rise. Nevertheless, the mortality patterns of certain malignancies, viz., laryngeal, esophageal, and urinary bladder cancer, are discrepant with their established risk factor associations, suggesting the existence of other differences in risk factor exposure between the two countries. Epidemiologists and health educators need to develop innovative international programs of investigation and health promotion with preventive impact on common malignancies associated with risk factors of lifestyle. Cancer 67:746-763, 1991. NCIDENCE AND MORTALITY rates for certain cancers I differ greatly between the US and Japan, as do diet, tobacco use, and alcohol consumption in the two populations. Since the vital statistics records maintained in both countries during the last several decades are comparable in scope and quality, examination of these records can provide valuable clues to the possible relationship between changes in national lifestyles and current shifts in cancer rates. In a 1977 report' we summarized trends and differences in US and Japanese cancer rates that have occurred in conjunction with differences in lifestyles. Since smoking,