We studied 2 counties in southern China, which are close to each other but show very different mortality rates from esophageal cancer. We collected 12 hr urine samples and analyzed them for NPRO, other nitrosamino acids, nitrate and ASC. The potential for forming NPRO and the effect on inhibition by ASC were recorded. Urine was collected after (i) no treatment, (ii) a dose of proline and (iii) proline with ASC. Intake and excretion of nitrate were significantly greater in the high-risk area. After the proline dose, urinary excretion of NPRO was significantly greater in the high-risk area. The inhibitory effect of ASC after taking it with proline was less in the high-risk area. Hence, the high-risk area showed greater potential for forming NPRO, and this formation was less inhibited by ASC. 5 in women), 7 times the average rate in China, and has persistently remained high. However, Lufeng County on the coastal area, about 80 km from Nan'ao, shows a very different mortality rate (10/10 5 ). We also found that the TNOC detection rate in the diet, TNOC daily intake and urinary excretion and daily intake of volatile nitrosamines in Nan'ao were significantly greater than values in Lufeng. 3 There was powerful synthesis of N-nitrosopiperidine in the Nan'ao diet after cultivation with sodium nitrite at 37°C for 4 hr. 4 Most NOCs are strong carcinogens in animals and may play an important part in the etiology of esophageal cancer in northern China, 5-10 but there remains a lack of confirmed evidence. The human body contacts NOCs by exogenous exposure and endogenous synthesis. The latter may be the main contact pathway in humans. The urinary NPRO model is a sensitive method for estimating the potential for forming NPRO in vivo. Hence, we believe that the NOC effect on the etiology of esophageal cancer should receive the most attention. In this report, we compared the differences in potential for forming NOCs in vivo and the effect on inhibiting this formation by ASC between Nan'ao and Lufeng subjects, to further evaluate the effects of NOC endogenous formation on the etiology of esophageal cancer and to provide meaningful clues for taking preventive measures.
MATERIAL AND METHODS
Chemicals and reagentsThe 5 NAAs used as standards were obtained from the Chinese Academy of Medical Science (Beijing, People's Republic of China), which synthesized and ascertained the standards. 9 NAA standards were NPIC, NPRO, NTCA, NMTCA and NSAR. L-Proline and ASC were obtained from Sigma (St. Louis, MO). Diazomethane was prepared by the action of potassium hydroxide on Nnitroso-N-methyl-p-toluenesulfonamide (Merck, Darmstadt, Germany) in ether. Cadmium powder for reducing nitrate to nitrite was obtained from Wako (Osaka, Japan). All other reagents were commercially available and used without further purification.
Study subjects and sample collectionNan'ao County and Lufeng County were selected, respectively, as high-and low-risk areas for esophageal cancer. The distance between Nan'ao and the mainland is about 8 km, and Lufeng is situated o...