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Study objectives: To develop and validate a model for estimating the risk of lung cancer death in current and former smokers. The model is intended for use in analyzing a [...]

Background. Remarkable increases in lung cancer risk recently have been observed in the Central and Eastern European (CEE) area. This study examines the patterns of lung cancer mortality rates and cigarette sales in 1960-1989 in seven CEE countries with a total population of 97.5 million and 43,000 deaths from lung cancer in the last year under study. Methods. Trends in cigarette sales and mortality rates from lung cancer in seven CEE countries were compared for the years 1960-1989. Results. Among males, recent lung cancer death rates were the highest in Europe, and trends by country largely reflected the varied prevalence and duration of smoking in previous decades. For females, lung cancer mortality rates were much lower, although there were exponential rate increases. In the more recent birth cohorts, there were some declines in mortality rates among males, but not among females. Conclusions. The rising cigarette consumption through the 1960s, 1970s, and, in some countries, the 1980s is accompanied in most of the countries by rising lung cancer mortality rates for young adults. This increasing cigarette consumption will determine future trends in lung cancer, which will increase well beyond the turn of the century and will continue longer for females than for males. This outlook underlines the urgent need for comprehensive lung cancer prevention with the concerted control of smoking as a priority. The role of cofactors and their interaction with smoking deserve further exploration. Cancer 1995; 75:2452-60. Key words: lung cancer, trends, smoking, mortality rates, epidemiology.

The two most common forms of primary liver cancer are hepatocellular carcinoma and cholangiocarcinoma. Hepatocellular carcinoma arises from liver cells themselves, while cholangiocarcinoma arises from cells lining the ducts that carry bile from the liver. Hepatocellular carcinoma is associated with chronic infection with hepatitis B, exposure to the toxic substance aflatoxin (which occurs in some molds) and other factors, such as alcohol consumption. In the United States, hepatocellular carcinoma is by far the more common type of liver cancer; only 7.7 percent of liver cancers are cholangiocarcinoma in the US. In contrast, cholangiocarcinoma is quite common in some parts of Southeast Asia. In the northeastern portion of Thailand, more than 60 percent of liver tumors are cholangiocarcinoma. In Thailand, liver cancer is the most common cancer among men and the third most common among women. Investigators have noticed that the geographical distribution of cholangiocarcinoma seems to parallel that of some liver flukes, parasitic flatworms which infect the liver. A study was conducted in five different regions of Thailand to compare the exposure to different risk factors with the incidence of the two main types of liver cancer. The results showed that there was little difference among the five regions in the exposure to aflatoxin or the prevalence of chronic hepatitis B infection. The rate of hepatocellular carcinoma was also similar among the geographical regions, as might be expected from the similarity of the risk factor exposure. However, the researchers found that the rate of cholangiocarcinoma was greatest in regions with high levels of exposure to a local liver fluke known as Opisthorchis viverrini. The rate of cholangiocarcinoma in Bangkok, where the rate of liver fluke infection is low, is about 36 percent that of Thailand as a whole. In contrast, the rate of cholangiocarcinoma in the Ubon region, where O. viverrini is endemic, is 334 percent that of Thailand as a whole. These results suggest that liver parasites play an important role in the development of cholangiocarcinoma, and that reductions in parasite infection in some rural areas of Thailand would seem likely to result in reductions in the rate of this liver cancer as well. (Consumer Summary produced by Reliance Medical Information, Inc.)

To the Editor: The article by Strauss et al, "Screening for Lung Cancer Re-examined," which appeared in the April 1993 Supplement Of Chest (1) and despite being described by the [...]

Examines the association between exposure to Agent Orange, a herbicide used in the course of military operations in South Vietnam, and the occurrence of soft-tissue sarcoma and non-Hodgkin lymphoma.