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Statistical Study of the Possible Relationship between Mineral Constituents in Drinking-water and Cancer Mortality in the Netherlands (Period 1900-1940)

A study of mortality rates for cancer of different sites and for a number of other diseases did not reveal any correlation between area mortality and the widely different amounts of Ra/sup 226/ and its daughter products known to be present in the drinking waters available in England and Wales. The areas of Wales that show surplus mortality from gastric cancer possess drinking water supplies with very low contents of natural radioactivity. Surplus gastric cancer tends to appear in regions having soft drinking waters derived from surface drainage, and often having a low pH at their source. Surplus mortality rates, due to diabetes mellitus among females and to vascular lesions affecting the central nervous system in both sexes, also appear in the soft water regions of England and Wales. This trend is not displayed by cancer of other sites nor does it appear in the mortality data for a number of other diseases. (TCO)

1. Die Krebssterblichkeit hat in Berlin seit der Vorkriegszeit abgenommen. 2. Die Abnahme beschrankt sich im wesentlichen auf die krebsbefallenen Organe, bei denen es durch therapeutische Masnahmen zunehmend gelingt, den Tod abzuwenden.

Die Haufigkeit und Altersverteilung der einzelnen Organcarcinome wird fur die Schweiz uber den Verlauf von 1910–1967 analysiert. Der Trend der altersstandardisierten Malignomsterblichkeit in den letzten 50–60 Jahren zeigt in der Gesamtzahl einen deutlichen Ruckgang, bei den Frauen um 25%, bei den Mannern geringer, um 10%. Die Abnahme ist in erster Linie auf den Ruckgang des Magencarcinoms, dann des Oesophaguscarcinom, bei den Frauen auch des Uteruscarcinom zuruckzufuhren. Einen ausgesprochenen Anstieg weist das Bronchialcarcinom des Mannes, welches seit 1960 die haufigste Krebsart ist und seit 1910 um das 24fache zugenommen hat, auf. Einen Anstieg zeigt ferner das Prostatacarcinom (um das 5fache) und bei beiden Geschlechtern, immerhin in leichtem Ausmas, das Pankreascarcinom. Die vier haufigsten Krebskrankheiten werden im Ablauf der einzelnen Altersgruppen von 1910 zu 1965 verglichen, dann auch die absoluten und rohen Todesziffern. Die Ursachen der Anderungen in der Organkrebshaufigkeit sind nach Eliminierung des Wechsels im Altersaufbau der Bevolkerung, der therapeutischen Effekte, wie beim Cervix-carcinom, und der verbesserten Diagnostik, die sich namentlich beim Pankreas und Ovarial-carcinom auswirkt, in den exogenen carcinogenen Faktoren zu suchen. Wegweisend hierfur ist die Bewertung ausgesprochener Geschlechtsunterschiede. Carcinome mit hohen Quotienten fur Manner (Respirationstrakt, Speiserohre, Harnblase) legen eine Beziehung zu den Tabakrauchcarcinogenen nahe. Hohe Quotienten fur Frauen finden sich nur beim Gallenblasen- und Schilddrusencarcinom, hier eventuell in Beziehung zu Schwangerschaft und zu hormonalen Einflussen. Statistische Erhebungen belegen die Wandlungen in der Carcinomsterblichkeit, die fur die Jahre 1952–1965 noch im Detail dargelegt werden.

Through the exceptional courtesy of Dr. J. H. VanZanten, Director of the Municipal Bureau of Statistics for the city of Amsterdam, I have been furnished with manuscript data for each and every death from cancer in that city during the period 1920–1929, for the purpose of a more detailed analysis as to the mortality in the different religious sects, with due regard to sex and to organs and parts of the body affected. In the aggregate there were 9,405 deaths, which is sufficient for a study of the facts such as I do not think has heretofore been attempted. The returns as furnished in manuscript differ somewhat from the official figures appearing in the Statistical Year Book of Amsterdam. The numerical differences are shown in Table I. For the indicated differences in the returns, I am unable to give a satisfactory explanation except that it is quite probable that, in my own returns, deaths from sarcoma have been included, which have probably been omitted from the official publications. It is also quite possible that the person abstracting the manuscript data from the official death certificates used a somewhat different classification in cases in which cancer was associated with some other contributory cause of importance. The excess in the cancer deaths in my own returns is 299 for a ten-year period, while the figures are identical for the year 1929. The number given cannot be considered sufficiently impressive to indicate important errors.

It is hypothesized that the cancer patient has, more often than chance alone would permit, lost a major cathexis some time before the development of the neoplasm. Certain predictions as to relative cancer mortality rates in different groups are made from this hypothesis. An examination of the statistical literature in the cancer field bears out these predictions and offers additional evidence. The possible validity of this hypothesis suggests that further investigation would be highly desirable.

The U.S. cancer mortality per 100,000 for both sexes rose, from 1950 to 1967, for blacks from 147 to 177, an increase of 20%, while it remained unchanged for whites at 150. The female cancer mortality rate declined for blacks from 146 to 142, a decrease of only 3%, while it declined for whites from 139 to 126, a decrease of 9%. The male cancer mortality rate rose for blacks from 147 to 220, an increase of 50%, while it increased for whites from 158 to 181, an increase of only 16%. In 1950, the cancer mortality rate for both sexes was 2% lower for blacks than for whites, but, by 1967, it had become 18% higher. Of the 58 most frequent U.S. sex-specified cancer types, 29 increased slower in whites, 9 decreased faster in whites, 14 showed no significant differences, and only 4 (malignant melanoma and reticulum cell sarcoma in both sexes) increased faster in whites. Environmental factors are the most likely causes for this alarming rise of cancer in U.S. blacks.

In Österreich laufen Bestrebungen, eine verläßliche Krebsstatistik zu erstellen, um feststellen zu können, ob innerhalb verschiedener Regionen des Landes Unterschiede der Krebsmortalität oder -mor-bidität bestehen. Diese Statistik soll einerseits für die Gesundheitsverwaltung Grundlagen für die Entwicklung eines Krebskontrollprogramms schaffen und es ermöglichen, die Zweckmäßigkeit ergriffener Maßnahmen zu beurteilen, andererseits zuverlässiges Material für epidemiologische Untersuchungen liefern. Zur stichprobenweisen Uberprüfung der Verläßlichkeit der Unterlagen über die Krebssterblichkeit konnten bereits Daten aus der im Aufbau befindlichen Krebsmorbiditätsstatistik (Krebsregister) herangezogen werden. Die sich ergebenden Arbeitshypothesen zu weiteren gezielten Untersuchungen werden dargelegt und unter dem Gesichtspunkt internationaler Zusammenarbeit diskutiert. Eine Bestandsaufnahme der bestehenden Unterlagen wurde durchgeführt und untersucht, welche zeitlichen und regionalen Unterschiede der Krebssterblichkeit in Österreich bestehen. Einige Ergebnisse dieser Analysen werden kurz mitgeteilt.

Under the title “Is Cancer Mortality increasing or decreasing?” Wolff (1935) has discussed a problem of world-wide interest. He comes to the conclusion that, in German-speaking countries the risk of dying from cancer is not increasing in the sense that the ordinary man attaches to the phrase. He enquires whether the undoubted absolute increase in cancer mortality may not be a mere function of the ageing of the population, a feature common to all civilised countries; and he concludes that, for Berlin, the altered age structure of the population has caused the increase in the general rate of mortality from cancer, and that—taking certain other factors also into con sideration—it may fairly be concluded that in Berlin the rate of mortality from cancer has declined.

The social class risks of death from cancer among California men, at ages 20 to 64 in 1949 to 1951, were analyzed and compared with similar mortality experienced in England and Wales. Historical data on social class mortality are available for England but not for California. As recently as 1930 to 1932 the mortality risk due to oral and pharyngeal cancer was greater in lower social classes in England and Wales. By 1950 the over-all death rate for these cancers, regardless of social class, had decreased considerably more in England and Wales than in the United States. The decrease was accompanied by the virtual disappearance of the social class gradient in the former country. California data, however, disclosed a pronounced social class difference in 1950. Cancer of the stomach in England and Wales continued to show the same result from 1921 to 1951, that is, a twofold higher relative risk in lower social classes. In California the relative risk was about threefold in 1950. The over-all death rates for this site of cancer showed little or no change from 1930 to 1950 in the former country, but a 40 per cent decrease in the United States. A similar social class risk for cancer of the esophagus seems to be changing in England and Wales, but was pronounced in California. With the inclusion of cancer of the lung, which reveals a minor social class difference, lower social class is associated with an unfavorable relative risk of cancer at sites comprising 39 per cent of total cancer mortality in California men. Cancers of some other parts of the body show direct associations with higher social class but each requires additional evidence for confirmation.

The 1962-66 cancer mortality of Polish migrants to Australia is compared with the cancer mortality prevailing in Poland and in Australia. Small numbers compel to limit the analysis to the most frequent cancer sites only. The main findings are: (a) Stomach cancer mortality of Polish migrants to Australia is intermediate between the high mortality in Poland and the much lower one in Australia. (b) Intestinal tract and breast cancer mortality of Polish migrants is displaced upwards, from the low Polish level to the much higher Australian one. (c) Lung cancer mortality of Polish male migrants does not differ distinctly from the mortality observed both in the country of origin and of adoption of these migrants. The presented findings are compared with the results of a similar study of Polish migrants to the U.S. Aims for future studies are briefly outlined.

(1967). Air Pollution and Cancer Mortality. Archives of Environmental Health: An International Journal: Vol. 15, No. 3, pp. 356-361.

Age-adjusted death-rates from several types of cancer were correlated for nine census divisions of the United States with the temperature index (mean annual temperature+range). Mortalities from many types of cancer were negatively correlated with temperature index and positively correlated with both per-caput income and physician/ population ratio. It is suggested that geographical differences in cancer mortality could be associated with both artefacts and indirect causative factors, rather than reflecting a direct environmental effect on cancer risk, and that such differences require careful interpretation.

Summary An investigation on soil pH and oesophageal cancer mortality rates in Chile was made. Also the association between soil pH and rainfall in the different Chilean Provinces was studied. It was found that alkaline soils were associated with geographical areas having the highest age-adjusted death rates from oesophageal cancer. Rainfall was negatively associated with soil pH, that is to say, areas with the lowest rainfall had the highest pH values (alkaline soils). These studies confirm the investigations carried out in the northern coast of Iran.

SMITH’S review of cancer mortality among Chinese in the United States as of 19491952 represented the first systematic compilation of the cancer experience in this racial group [I]. Prior to that time the occasional and fragmentary analyses of clinical and autopsy materials assembled in several countries lent support to the idea that the Chinese site profile of cancer risks differed on several counts from that observed for U.S. whites [l]. The 1959-1962 mortality tabulations for the continental United States and Hawaii included information on country of birth making possible the investigation of differences in risk between foreignand native-born Chinese. Since Smith’s publication, mortality and incidence data for selected Chinese populations in Asia have become available and the literature based on clinical and necropsy series has continued to grow. In reporting the more recent 1959-1962 data we have endeavored to place them in context with findings on Chinese populations elsewhere and to identify configurations of results that may suggest leads for further cancer studies of Chinese populations.

In discussions of the relationship of climate and geography to health, attention has been especially directed toward communicable diseases. This perhaps is to be expected, since these are the diseases against which most control measures have been directed. Geographic variations in the prevalence of conditions due to other possible factors, however, have not been overlooked. Of particular interest with respect to cancer is the fact that Dr. John S. Billings pointed out the wide geographic variation in cancer mortality as revealed by the United States Census of 1880 (fig. 1). Although the data were admittedly incomplete, they indicated that cancer most frequently occurred among persons living in the states extending from New England to the Great Lakes and in the Pacific Coast states. 1 Among the items taken up for study by the United States Public Health Service after the passage of the National Cancer Institute Act of 1937 was

In recent years there have been an increasing number of studies of the psychological components of the etiology and pathogenesis of neoplastic disease. Reviews of this literature and discussions of some of the theoretical problems involved include Kowal, 1 Petschke, 2 Greene, 3,4 and LeShan. 5 In general these appear to indicate the existence of certain life-history patterns in a statistically significant larger percentage of examined cancer patients than of equated controls. Several studies (Peller; 6,7 LeShan and Worthington; 8 LeShan, Marvin, and Lyerly 9 ) have shown that it is possible to use these clinical hypotheses to help clarify otherwise anomalous variations in the cancer mortality statistics. One particular aspect of these life-history patterns has been the finding of an underlying emotional orientation which can be described as a bleak and hopeless despair about ever achieving any real satisfactions or meaning in life, apparently existing prior

A Study of Tuberculosis and Cancer Mortality Rates with Special Reference to Lung Cancer Rates