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We evaluated the risk of development of second primary cancers, with particular reference to subsequent hepatocellular carcinoma (HCC), in 592 patients diagnosed as non-Hodgkin's lymphoma (NHL), at Osaka Medical Center for Cancer and Cardiovascular Diseases. During 1978-1994, 2,163 person-years of observation were accrued, and 27 of the patients developed a second primary cancer, yielding an observed-to-expected ratio (O/E) of 1.53 [95% confidence interval (CI) = 1.01-2.23]. Significant excess risk was noted for primary liver cancer (PLC; O/E = 4.36, 95% CI = 1.99-8.28; O = 9) and non-lymphocytic leukemia (O/E = 26.17, 95% CI = 5.26-76.46; O = 3). The excess risk of PLC was relatively constant within the first 10 years after the NHL diagnosis. Patients who received chemotherapy as the NHL treatment had a significantly increased risk of PLC (O/E = 5.91, 95% CI = 2.70-11.23; O = 9). Their clinical reports indicated that all nine patients with PLC were diagnosed as HCC, and eight of them had clinical and/or histologic evidence of cirrhosis at the time of HCC diagnosis. None of the nine patients had a history of blood transfusion between the first NHL treatment and the diagnosis of HCC. These findings suggested that Japanese NHL patients might have an increased risk of developing HCC, and they indicated the importance of medical surveillance for liver malignancies, as well as subsequent leukemias. Possible explanations for the excess risk of subsequent HCC are discussed.

We experienced a case of unilateral multiple breast cancer in which two primary tumors arising in the right breast had each lymph node metastasis in accordance with each histologic type of the tumors. An 85-year-old woman was seen at the hospital because of a right breast tumor. There were two palpable tumors comprising of a tumor 4cm in diameter in the EBD area and another tumor 2cm in diameter in the C area of the right breast. Ultrasonography of the right breast visualized the both lesions as hypoechoic and internally heterogenous tumor. The tumor in the C area was poorly demarcated. On mammography spicula were noted in the C area tumor. With needle aspiration cytology a diagnosis of adenocarcinoma was made. A modified radical mastectomy was carried out on December 18, 1995. Histopathologically the tumor in the EBD area was solid ductal carcinoma and another tumor was scirrhous cancer. Lymph node metastases were confirmed in area 1a and 1b; the lymph node metastasis in the 1a area revealed histologic feature of solid ductal carcinoma and that of 1b area histologic feature of scirrhous cancer.

A randomized study was performed in 35 centers in the Kinki area of Japan to determine the effectiveness of ftorafur (FT) plus tamoxifen (TAM) compared with FT monotherapy in postoperative adjuvant therapy for breast cancer. Patients were randomized by the envelope method to receive either FT 600 mg/day or FT 600 mg/day plus TAM 20 mg/day orally for 1 year, starting on day 7 after mastectomy. Between April 1982 and January 1985, 628 patients were assigned to treatment with FT alone and 626 to treatment with FT+TAM. Of these, 571 (90.9%) and 539 (86.1%) patients, respectively, met the eligibility requirements for this study. There were no significant differences in major background factors between the two groups of eligible patients. Five-year survival rates were 91.4% for FT alone and 91.1% for FT+TAM (not significantly different). Five-year disease-free survival rates showed a tendency towards a better prognosis (P=0.090) in the FT+TAM group, with observed rates of 83.0% for FT alone and 86.7% for FT+TAM. Stratified analysis showed that disease-free survival with FT+TAM is better than with FT alone for patients aged 50 years or more (P=0.048) and for patients with from one to three positive nodes (P=0.064).

The method to predict underwater radiated noise from tip vortex cavitation was studied. The growth of a single cavitation bubble in tip vortex was estimated by substituting the tip vortex to Rankine combined vortex. The ideal spectrum function for the sound pressure generated by a single cavitation bubble was used, also the empirical factor for the number of collapsed bubbles per unit time was introduced. The estimated noise data were compared with measured ship's ones and it was found out that this method can estimate noise data within 3dB difference.

In Japan, screening programs for various cancers have been eagerly conducted as part of public health policy. However, these programs have not always produced the results that were originally expected. To improve the ill-planned and unscientific state of the current programs in Japan, two proposals are made.

Discovery of mechanisms that impede the aggressive and metastatic phenotype of human basal triple-negative-type breast cancers (BTNBCs) could provide novel targets for therapy for this form of breast cancer that has a relatively poor prognosis. Previous studies have demonstrated that expression of GATA3, the master transcriptional regulator of mammary luminal differentiation, can reduce the tumorigenicity and metastatic propensity of the human BTNBC MDA-MB-231 cell line (MB231), although the mechanism for reduced metastases was not elucidated. We demonstrate through gene expression profiling that GATA3 expression in 231 cells resulted in the dramatic reduction in the expression of lysyl oxidase (LOX), a metastasis-promoting, matrix-remodeling protein, in part, through methylation of the LOX promoter. Suppression of LOX expression by GATA3 was further confirmed in the BTNBC Hs578T cell line. Conversely, reduction of GATA3 expression by small interfering RNA in luminal BT474 cells increased LOX expression. Reconstitution of LOX expression in 231-GATA3 cells restored metastatic propensity. A strong inverse association between LOX and GATA3 expression was confirmed in a panel of 51 human breast cancer cell lines. Similarly, human breast cancer microarray data demonstrated that high LOX/low GATA3 expression is associated with the BTNBC subtype of breast cancer and poor patient prognosis. Expression of GATA3 reprograms BTNBCs to a less aggressive phenotype and inhibits a major mechanism of metastasis through inhibition of LOX. Induction of GATA3 in BTNBC cells or novel approaches that inhibit LOX expression or activity could be important strategies for treating BTNBCs.

The Japanese male smoking prevalence is still high. Underlying causes are the low quit attempt rate (QAR) and lack of pharmacotherapy (PT) use. Though health checkups are widely and systematically performed in Japan, this setting has not been utilized for intervention to smokers. We aimed to estimate the population effect of disseminating brief intervention (BI) at health checkup facilities combined with encouraging PT utilization. The annual population quit rate (PQR) was modeled as a product of three components: the QAR, utilization of PT, and effectiveness of PT. A policy to disseminate effective BI at health checkup facilities was then incorporated into the PQR model as means to increase the QAR and/or PT utilization. Japanese male smokers aged 40–74 years were the target population, and the baseline year was set at 2005. The PQR and the number of smokers who successfully quit were compared with the baseline to evaluate the BI policy. The BI policy was estimated to increase the PQR from 4.3 to 5.7 % (rate ratio: 1.34) in a scenario where 75 % of smokers having an annual health checkup received BI and 60 % of BI-induced quit attempts were supported by PT, resulting in 177,000 new successful quitters on an annual basis and 3,000 avoidable cancer deaths in 10 years. Comparisons of different scenarios revealed that increasing QAR and encouraging PT were both essential to maximize the effect of BI policy. The dissemination of BI at health checkup facilities encouraging PT utilization is an effective tobacco control policy in Japan.

The concentration of nicotine in hair was measured by a capillary gas chromatograph with a nitrogen-phosphorus detector after hair was dissolved in 2.5 N sodium hydroxide and nicotine was extracted using diethyl ether. In hair samples obtained from 36 smokers, who had smokedor = 3 years, there was a significant positive correlation between the concentration of nicotine and the number of cigarettes consumed daily (r = 0.685; p0.001). The nicotine content of white hair was much less than that of black hair collected from the same subjects with grizzled hair. The above findings were confirmed by an animal experiment, in which nicotine (0.2, 0.6, and 2 mg/kg/day for 2 weeks) was administered intraperitoneally to pigmented rats whose hair had been removed beforehand by plucking from an area of the back of each rat. The hair which grew back in the denuded area was plucked and collected one week after the last administration of nicotine. The nicotine concentration in the brown hair of the back correlated with the given dose (r = 0.824; p0.001). In a separate experiment, hairs were removed from areas of back and thorax, and nicotine delivered to the rats for 4 weeks by an osmotic pump implanted under the skin, showing that the concentration in the whitish hair was much lower than that in brown hair. Finally, hair samples were collected from 14 subjects who had participated in a smoking cessation program over 6 months and who abstained from cigarette smoking. The axial distribution of nicotine along the hair shafts was determined for each subject.(ABSTRACT TRUNCATED AT 250 WORDS)

To examine the percentage of Japanese adult smokers who make quit attempts and succeed in smoking cessation over a 1-year period, and to identify predictors of attempts to stop and successful smoking cessation.This study used Ipsos JSR Company's access panel, whose sampling framework is based on the Basic Resident Register in Japan. We tracked and monitored a selected sample of smokers who were at least 20 years of age through a baseline postal questionnaire survey in 2005 and a follow-up survey 1 year later.The original response rate was 72.1% (1874 of 2600 smokers). There were 1627 current smokers in the baseline survey, and of those, 1358 were followed-up 1 year later.Among the current smokers, 23.0% reported that they had attempted to quit smoking at least once in the past year. Of those who made quit attempts, 25.6% had achieved 1-week abstinence successfully and 13.5% reported having achieved sustained 6-month abstinence successfully at the time of the follow-up survey. The predictors associated with quit attempts were non-daily smoker, higher motivation to quit and previous attempts to stop smoking. Among smokers who made quit attempts, only 13.5% used nicotine replacement therapy. Higher nicotine dependence was associated with lower probability of success in quitting.Japanese smokers attempt to quit at a lower rate than smokers in the United Kingdom and United States, but factors that predict attempts (primarily markers of motivation) and success of attempts (primarily dependence) are similar to those found in western samples.

We describe a case of gastroduodenal ulcer in which pyloric vestibular stenosis exacerbated in a short time and we had difficulties in differentiation from advanced gastric cancer.The case was a 71-year-old male who had had head injury and was being medicated for sustaining headache. On October 16, 1989, the patient was admitted to our hospital because of melena. Upper gastrointestinal series revealed a probable advanced gastric cancer. Borrmann type 4. Biopsy cytology, however, showed no malignant findings. Because of markedly exacerbated stenosis at the pyloric vestibule, pyloric-side gastrectomy and duodenectomy were carried out on November 22. In the excised specimen, giant girdle ulcer (Ul-II) in 3 lines at the lesser curvature, anterior and posterior wall of lower body of stomach, and a whole-circumference stenosis 7 cm in length reaching to the duodenal bulb at the anal-side were observed. Histopathological findings included mild inflammatory findings at mucous membrane, submucosal proliferation of collagen fiber, and marked hypertrophy of intrinsic muscle layer at the whole-circumference stenosis site. This pyloric vestibular stenosis might be due to repeated chronic inflammation. Possible factors causing exacerbation can be medication and circulatory disturbance.

Many breast cancer patients are troubled about telling their school-age children about their illness. However, little attention has been paid to the factors that encourage or discourage them from revealing the illness. This study explored decision-making by breast cancer patients about telling their children about their illness.Participants were 30 breast cancer patients recruited from a regional cancer institution in Japan. Semi-structured interviews were conducted and content analysis was performed.Six preparatory stages of decision-making by Japanese breast cancer patients about telling their children about their illness were identified as follows: contemplation, preparation, action-hospitalization and surgery, action-adjuvant therapy, action-diagnosis, and action-prognosis. We also identified 11 categories of positive aspects and ten categories of negative aspects about revealing their illness to children. The categories of negative aspects with higher frequency were similar to those found by previous research, but categories of positive aspects were unique. The rate of reference to negative aspects in total reduces gradually as the preparatory stage advances, and in action-diagnosis and action-prognosis stages the balance between positive and negative aspects becomes about half and half.Patients, especially in action-hospitalization and surgery, can be expected to tell their children about their illness although they find negative aspects much more compelling than positive aspects and experience great distress. These patients have special needs for support from others.

To elucidate the natural history of colorectal polyps and to observe the influence of endoscopic polypectomy on the incidence of colorectal cancer, we conducted a retrospective cohort study of all patients who had undergone colonoscopic examination at the Center for Adult Diseases, Osaka, between April 1974 and December 1985. The study subjects consisted of a control group (760 non-polyp patients) and a polyp group (648 polyp patients, including 136 treated by polypectomy at the initial examination). These subjects were followed up until the end of 1987 by record linkage with the Osaka Cancer Registry's file to observe the occurrence of colorectal cancer. The O/E (observed/expected numbers derived from the general population) was 5.1 (95% confidence interval = 2.5-9.4) and 1.0 (0.1-3.6) for the polyp and control group, respectively. When subjects in the polyp group were categorized into polypectomy and non-polypectomy sub-groups, the O/E was 2.3 (0.1-12.6) and 8.0 (3.4-15.8) respectively. The relative risk of undergoing polypectomy to developing subsequent cancer was estimated at 0.3 (0.1-2.1). These results suggest an increased risk of developing cancer among polyp patients and the possibility of prophylactic effect of polypectomy against subsequent cancer. A large-scale and long-term follow-up study is required to confirm these findings.

To assess the validity of mass screening tests for gastric cancer conducted with three types of radiographic techniques, i.e., photofluorography by a mirror camera, photofluorography by an image intensifier, and direct radiography, 105,122 persons who underwent a total of 272,667 screening tests during 1970 through 1982 were followed through December 31, 1983 by means of a record linkage to the Osaka Cancer Registry, Osaka, Japan. The results of 1 year's follow-up from screening were defined as the gold standard and test performance values were calculated. Sensitivity of screening with photofluorography by a mirror camera, photofluorography by an image intensifier, and direct radiography was 90%, 89%, and 91%, and specificity was 86%, 92%, and 91%, respectively. The receiver operating characteristics curve for screening with photofluorography by an image intensifier resembled that for direct radiography and these two curves were located somewhat to the left of the curve for screening with photofluorography by a mirror camera. The authors conclude that the validity of screening with photofluorography by an image intensifier is almost equivalent to that of screening with direct radiography and both are superior to that of screening with photofluorography by a mirror camera.

A case-control study was undertaken to evaluate the roles of hepatitis B virus (HBV), blood transfusion, alcohol drinking and cigarette smoking in the etiology of hepatocellular carcinoma (HCC) in Osaka, Japan. A total of 229 cases and 266 hospital controls were included in our study. The relative risks of HCC obtained after adjustment for age, sex and other important variables were 14.3 (95% confidence interval (CI): 5.7-36.3) for HBsAg positives, 4.3 (95% CI: 1.9-9.6) for blood recipients and 3.2 (95% CI: 2.0-5.1) for heavy drinkers. A statistically significant dose-response relationship was observed between the risk of HCC and total alcohol consumption. The overall risk for HCC was also significantly elevated among smokers; however, there was no consistent dose-response relationship between the risk and cigarette consumption. We conclude that HBV, blood transfusion and excessive alcohol drinking play important roles in the etiology of HCC in Osaka, Japan. Further investigation is needed to clarify the possible etiological role of smoking.

A correlation of noise radiated from sheet or bubble cavitation occurring on propeller blade surface is well established. On the other hand, the correlation is not clear on noise radiated from vortex cavitation occurring at a distance from propeller blade. In the present paper, cavitation patterns and noise characteristics of the propeller accompanying only the vortex cavitation were investigated by model tests in a cavitation tunnel and full-scale measurements in order to know the correlation of noise radiated from vortex cavitation of propeller. Comparisons of full-scale cavitation pattern with model scale showed that vortex cavitation depends on not only cavitation number but also Reynolds number. Predicted noise level from model tests using scaling formulas of cavitation noise agreed well with full -scale measurements in the case where vortex cavitation patterns in model and full scale are similar. Cavitation number may vary at Reynolds number to the 0.15 power to keep similarity of pattern of vortex cavitation.

Objective: Research on the impact of breast cancer on Asian women's sexual lives is extremely scarce. This study investigated the sexual changes experienced by breast cancer patients in Japan following surgery, and their sexuality-related information needs. Methods: An anonymous, cross-sectional survey of breast cancer out-patients was conducted in 2005. Data from 85 subjects, who were without recurrence and reported being sexually active pre-surgery, were analyzed. Results: Subjects were mainly in their 40's and 50's, and the median time since surgery was 43 months. Seventy-three (85.9%) had resumed sex after surgery with the median time being 3.5 months after surgery. Among 73 who resumed sex, 43 reported that the frequency of sex decreased, and 72 reported at least one sexually related change. The multiple logistic regression analysis revealed that those who had perceived the sexual relationship with their partner important before surgery (OR, 6.705; 95%CI, 1.320–34.051; p = 0.022) were more likely to maintain the same frequency of sex as before surgery. Perceived changes in respondents' sexual relationship did not necessarily result in deterioration of the couple's overall relationship. Regarding sexuality-related information needs, respondents wished to have information on treatment-induced sexual changes as well as sexual and general inter-couple communication strategies. Conclusion: This research revealed that breast cancer patients in Japan experience various sexual problems following breast cancer treatment. Sexuality-related information should be provided to all patients, regardless of patients age or type of surgery, as a part of routine treatment information giving. Copyright © 2007 John Wiley & Sons, Ltd.

The relationship between smokers' characteristics and success of smoking cessation has been examined in smoking intervention studies, but counselors' characteristics have generally not been considered. The purpose of the present study was to examine the relationship between counselor's skill level and intervention outcome.The subjects were 858 smokers identified at annual health checkup at 6 worksites from January 1998 to September 1999. Smokers received stage-matched individual counseling by 23 trained counselors with feedback of results for carbon monoxide testing and nicotine metabolites in urine. If smokers set a quit date at the initial counseling session they received 4 follow-up telephone calls over 3 months. We further conducted 6 month and 1 year follow-up surveys using self-administered questionnaires. Smoking cessation status was validated by carbon monoxide test or family or colleague witnesses. We evaluated counselors' intervention skills using a structured evaluation form (total score: 0-24) based on videotaped interactions between each counselor and a simulated smoker. The intervention skills were classified into 3 levels, Low (0-14), Middle (15-17) and High (18-24). We performed multiple logistic regression analysis to adjust for smokers' characteristics and multi level analysis to adjust for counselors' characteristics other than counseling skills.Among the 23 counselors, 4, 11 and 8 counselors were assigned to the Low, Middle and High groups, respectively, which counseled 190, 344 and 324 smokers. The 7 day point prevalence abstinence rates at 6 months were 2.1%, 4.7% and 7.4%, respectively (cumulative chi-square test: P0.01). The 6 month sustained abstinence rates at one year were 1.1%, 3.2% and 4.6%, respectively (P0.05). The odds ratios of abstinence rates at 6 months and one year in Middle group were 2.33 (95% CI: 0.75-7.28) and 3.07 (0.65-14.54) respectively, compared to the Low group by multiple logistic regression analysis. In the High group they were 3.66 (1.21-11.04) and 4.86 (1.06-22.28). The results of the multi level analysis were approximately equal to those in the multiple logistic regression analysis.This result suggests that a higher counseling skill level can lead to higher abstinence rates.

Background: Five-year survival is an important index for evaluating the overall effectiveness of cancer diagnosis and treatment. The aim of this study was to monitor trends in 5-year cancer survival in Osaka, Japan, during 1975 –9 4, with adjustment for trends in age and stage at diagnosis. Methods: Five-year crude survival was estimated for cancers of the stomach (39 697 patients), lung (17 400 patients) and breast (11 988 women) in four consecutive 5-year periods, with adjustment for age and/or stage, using the age and stage distribution of cases diagnosed during 1975 –7 9 as standard weights. We estimated the impact of adjusting for either age or stage alone by their proportionate impact on the trend in fully (age- and stage-) adjusted survival. Results: The absolute increase in unadjusted 5-year survival over 20 years was about 20% for stomach cancer, 14% for breast cancer and 5% for lung cancer. Lack of age adjustment would have caused proportionate under-estimation of these trends by 13 –1 4% (stomach), 7% (breast), 14% (lung, men) and 4% (lung, women). Lack of adjustment for the trend toward earlier stage would have caused proportionate over-estimation (152%, men: 133%, women) of stomach cancer survival trends, which seemed more influenced by earlier diagnosis than more effective treatment. For breast cancer, the 31% over-estimation of trend from lack of stage adjustment suggests the impact of earlier diagnosis, while the improvement of survival after additional adjustment for age may be due to more effective treatment. Failure to adjust for stage led to a proportionate 21% under-estimation of lung cancer survival trends for men, and 4% over-estimation for women. Conclusion: This study confirms the importance of adjusting for trends in age and stage distribution when evaluating time trends in cancer survival.

We performed a controlled study to compare the response to cyclophosphamide (CPA), adriamycin (ADM), and fluorouracil (5-FU) (CAF therapy) with that to uracil-tegafur (UFT) plus tamoxifen (TAM) (UFT+TAM therapy), when given as postoperative adjuvant therapy to women with breast cancer. The patients were registered from September 1991 through February 1995 at 51 institutions in the Kinki district of Japan. All patients had stage I, II, or IIIa breast cancer with four or more lymph-node metastases and underwent mastectomy. CAF therapy and UFT+TAM therapy were started within 4 weeks after surgery. CAF therapy consisted of CPA (100 mg/day) on days 1 to 14, followed by 2 weeks of rest, plus ADM (20 mg/m(2)/day) on days 1 and 8 and 5-FU (300 mg/m(2)/day) on days 1 and 8. A total of 6 courses were delivered. UFT+TAM therapy consisted of 3 years of UFT (400 mg/day) plus TAM (20 mg/day), given daily. CAF therapy and UFT+TAM therapy were each assigned to 82 patients. The 5-year survival rate was significantly higher in the UFT+TAM group (82.1%) than in the CAF group (66.2%; p=0.04, logrank test). The 5-year relapse-free survival rate was higher in the UFT+TAM group (61.8%) than in the CAF group (46.3%; p=0.07, logrank test). As for adverse events, the rates of leukopenia, anorexia, nausea and vomiting, general malaise, and hair loss were lower in the UFT+TAM group than in the CAF group. These results suggest that long-term treatment with UFT+TAM may be a useful alternative adjuvant therapy for the management of breast cancer, especially in elderly patients.

Background: Little information is available on the survival of male breast cancer patients because the disease is extremely rare in men. Recent studies indicated there were no gender-differences in the 5-year survival if patients’ age and stage were matched. However, this problem has rarely been studied in Japan. Methods: Using the Osaka Cancer Registry’s data, the 5-year survival was analyzed based on the reported 19 869 cases who lived in Osaka Prefecture excluding Osaka City and were diagnosed in 1975–1997, or who resided in Osaka City and were diagnosed in 1993–1997, because reliable follow-up information was available for them. Results: Breast cancer in males accounted for 0.49% of all cases during 1975–1997. The 5year relative survivals were 71.1% in men and 81.6% in women. The survival in males decreased over older groups due to a lower proportion of localized stage, but not in females. The survival of males in the regional stage was significantly lower than that of females (49.1 versus 73.7%, P , 0.05). Survival of males has increased since 1980 –1 984, while it has been stable in females. Compared with the survival of patients diagnosed in 1975 –1 979, male patients diagnosed in 1995–1997 had a noticeably lower risk of death after adjusting for age and cancer stage. Conclusions: The results suggest male breast cancer patients at the regional stage had a worse 5-year survival rate compared to females. However, this gender-related difference seems to have disappeared with the increased survival of males during the 1990s. Further populationbased studies are required with a greater number of male patients diagnosed after 1990.

Background Survival of cancer patients has been measured only in some limited areas in Japan until recently. The purpose of the present study was to collect data of fairly high quality on the population-based cancer registries and to estimate relative 5-year survival of cancer patients in Japan. Methods We requested 11 population-based cancer registries within the research group to submit individual data of the patients diagnosed from 1993 to 1996, together with the prognosis after 5 years, to the collaborative study secretariat. Ten population-based cancer registries (Miyagi, Yamagata, Niigata, Chiba, Kanagawa, Fukui, Aichi, Osaka, Tottori and Nagasaki) then accepted data submission (373,000 data). Among 10 registries, only 7 registries met the required standards for the quality of registration data and prognosis investigation. The relative 5-year survival calculated by pooling 279,000 data from seven registries was taken as the national estimate of that of cancer patients in Japan. Results The relative 5-year survival was 53.6% for all cancers (males: 49.2%, females: 59.4%); the survivals of stomach, large bowel, prostate and kidney cancer patients were from 62 to 68%; those of breast, uterus, larynx, skin, testis, bladder and thyroid cancer patients were from 74 to 92%; those of liver, gall bladder and bile duct, pancreas and lung cancer patients ranged from 6 to 23%. Conclusion On the basis of the data from seven population-based cancer registries in Japan, we calculated the relative 5-year survival of cancer patients diagnosed from 1993 to 1996 for the first time.

Despite the large number of surgical operations for stomach cancer in Japan, no study based on data from population-based cancer registries has been conducted regarding the relationship between hospital surgical volume for stomach cancer and patients' survival. Using data from the Osaka Cancer Registry (OCR), we performed survival analyses on 28,608 patients aged 35-79 years old who underwent surgery for stomach cancer, according to the extent of disease at diagnosis (localized: cancer is confined to the original organ; regional: cancer spreads to regional lymph nodes; adjacent: cancer infiltrates to adjacent tissue; distant: cancer metastasizes to distant organs). The study was divided into four periods; 1975-79, 1980-84, 1985-89 and 1990-94, according to year of diagnosis. Hospitals were stratified into four groups by total number of stomach cancer operations during each of the study periods, so that the numbers of operations in each group would be approximately equal. Cox's proportional hazards model was used to examine the relationships between hospital volume and 5-year survival according to the extent of disease, after adjustment for age at diagnosis and sex. Positive relationships between hospital volume and 5-year survival were seen in the localized and regional groups during the period 1975-79. These associations, however, decreased in later periods and disappeared in 1990-94 except for the very-low-volume hospitals. Stomach cancer patients treated in these hospitals remained at significantly higher risk of death than in the high-volume hospitals. In the case of the distant group, there was no clear relationship between hospital volume and 5-year survival during the study periods.

We cultured rat mesenchymal stem cells (MSCs) in a medium containing beta-glycerophosphate, ascorbic acid, and dexamethasone to show in vitro osteogenic differentiation of the MSCs. The differentiation was enhanced by adding solubilized type I collagen to the medium as evidenced by higher alkaline phosphatase activity as well as more calcium deposition than that without collagen. The exogenous collagen integrated well with the mineralized bone matrix and maintained the native triple helical structure. These findings indicate that exogenously supplemented type I collagen acts as a component of the extracellular matrix of MSCs, and deposited type I collagen facilitates osteogenic differentiation followed by maturation of mineralized bone matrix.

Liver cancer is one of the leading causes of cancer deaths in Asia and Africa. The epidemiology of liver cancer is distinctive in Japan, where chronic infection with hepatitis C virus (HCV) rather than hepatitis B virus (HBV) plays the major role in the etiology. In this paper, together with a brief review of the descriptive epidemiology of liver cancer and its prevention, Japanese experiences of liver cancer occurrence and some epidemiological studies are described, and Japanese national projects directed against hepatitis and liver cancer are presented. Distinctive time-trends have been observed for liver cancer incidence in Japan. The rates for over 55-59 year olds (both sexes) showed a peak in the birth cohort of 1931-1935, while the rates for less than 50-54 year old females indicate a decreasing trend. The extremely high incidences among birth cohorts around 1931-1935 seems to be related to endemic HCV infection in this generation in Japan. Follow-up studies not only of patients with chronic hepatitis C but also of apparently healthy carriers of HCV showed an increased risk of hepatocellular carcinoma (HCC). Cumulative risk of HCC (40-74 years of age) was estimated as reaching 21.6% (males) and 8.7% (females) among anti-HCV positive voluntary blood donors. Retrospective cohort studies indicated interferon (IFN), with or without ribavirin, to be effective for reducing the risk of HCC among patients with chronic hepatitis C. Periodic examination with ultrasonography and measurement of alpha-fetoprotein has become common practice for early detection of HCCs among patients with chronic hepatitis or liver cirrhosis in Japan. A non-randomized controlled study was conducted to evaluate the effect of periodic examination on mortality, but we failed to show any beneficial effects of screening for liver cancer. In the fiscal year 2002, Japanese National Projects directed against hepatitis and HCC were started, in which blood tests for HCV and HBsAg are offered just once at the age of 40, 45, 50, 55, 60, 65 or 70 for five years. Participants are categorized as either HCV carriers or non-carriers. HCV carriers are further examined by liver disease specialists, seeking indications for IFN therapy. Type C chronic hepatitis patients are recommended to receive IFN therapy with or without ribavirin. This project is expected to become a model of liver cancer control in HCV-endemic countries. Recently however, the US Preventive Service Task Force has recommended against routine screening for HCV infection in asymptomatic adults in the general population who are not at increased risk of infection. This divergence of views is also discussed.

Relative 5-year survival for cervical cancer has been reported to be lower in older women in Japan. A population-based study was carried out to clarify why increased age is associated with decreased survival in spite of a nationwide cervical cancer screening program having been carried out since 1982 in Japan.The Osaka Cancer Registry's data were used to investigate associations between age groups and survival for cervical cancer patients. Survival analysis was restricted to the reported 8966 cases diagnosed in 1975-1996 who lived in Osaka Prefecture (except for Osaka City), or resided in Osaka City in 1993-1996, since active follow-up data on vital status 5 years after the diagnosis were available.Relative 5-year survival for cervical cancer cases was lower in older age groups (88.6% in30 years, 78.1% in 30-54 years, 67.7% in 55-64 years and 54.4% in 65+ years), as was the proportion of the detection by screening (6.3, 9.8, 9.2 and 6.0%), the proportion of the localized stage (83.0, 67.3, 51.0 and 42.7%) and the proportion of women who underwent surgery (79.2, 83.2, 65.6 and 35.2%). Among localized cases detected with screening, the survival in thoseor =55 years old was92% and almost comparable with that in 30 to 54 year olds, but significantly lower among those detected without screening.Lower survival among older women was caused mainly by the presence of more advanced disease at diagnosis. Further extension of the nationwide cervical cancer screening program should result in improved diagnosis of earlier stage disease, which might improve differences of cervical cancer survival among these age groups.

The prolongation of the post-operative life of cancer patients brings new medical demands. The purpose of this paper is to estimate the total number of women patients with breast cancer who will have disability resulting from surgical treatment from 2000 to 2020 in Japan.The estimation was carried out using four indices: the number of cases of women diagnosed with breast cancer, the proportion of surgical operations, the frequency of disability from surgical treatment, and the crude survival rate of the patient group. The crude survival rates of surgically-treated breast cancer patients were estimated by the Weibull model. The frequencies of iatrogenic disabilities were calculated from several reports of complaints of pain in the chest wall or axilla and lymphedema of the arm, and 95% confidence intervals were calculated by the Monte Carlo simulation.The number of women patients with disability from breast cancer treatment from 2000 to 2020 was estimated to be 42,016 (95% CI: 41,236, 42,796) people in 2000 and 72,514 (95% CI: 71,196, 73,832) people in 2020 for pain in the chest wall or axilla, and 22,486 (95% CI: 22,148, 22,823) people in 2000 and 38,692 (95% CI: 38,094, 39,290) people in 2020 for lymphedema of the arm. Treatment supports required for the disability are medication and social support. Cancer patients with disability after treatment need long-term support in their daily life.

The age-standardized incidence rates for cancers of the tongue, oropharynx, hypopharynx, esophagus and lung increased steadily for males during 1965-1999, while for females there has been an increase for oropharynx and lung only.

To date, the biological approach to breast cancer, such as pathologic subtype genetic analysis has been well investigated, and is considered to be the most important approach to under breast cancer treatment. Recently, the importance of a team approach to multidisciplinary medical treatment and holistic medical treatment has been recognized. The five following points are important: 1) recognition of patients’ needs, 2) clarifying responsibility, 3) respect for each other, 4) maintaining good communication, 5) updating the system. Our original ‘team approach path’ is useful as a communication tool between a patient and the staff. Patient satisfaction is the purpose and a team approach is one method of carrying out medical treatment led by a patient as well as the medical treatment and informed decision based on narrative.

British Journal of Cancer (2005) 92, 2095–2096. doi:10.1038/sj.bjc.6602618 www.bjcancer.comPublished online 10 May 2005& 2005 Cancer Research UKSir,Legislation and professional guidance on confidentiality inmedical research has increased significantly in the past 10 years(Stiller, 1993; Working Group to the Royal College of PhysiciansCommittee on Ethical Issues in Medicine, 1994; EuropeanParliament, 1995; The Caldicott Committee, 1997; Department ofHealth, 1999; General Medical Council, 2000; Medical ResearchCouncil, 2000; Coker and McKee, 2001; Confidentiality andSecurity Advisory Group for Scotland, 2002; Council for Inter-national Organizations of Medical Sciences, 2002; InformationCommissioner, 2002).Numerous reports have been issued by national and inter-national bodies (Lowrance, 1997; National Health and MedicalResearch Council, 1999; Canadian Institutes of Health Research,2001; Organisation for Economic Co-operation and Development,2001; Council for International Organizations of Medical Sciences,2002; Lowrance, 2002; Nuffield Council on Bioethics, 2002; WorldMedical Association, 2002a,b; Medical Research Council, 2003;National Institutes of Health, 2004).There is very wide debate over the appropriate balance to bestruck between increasing demands for personal autonomy, on theone hand, and, on the other, the need for society to learn from theexperience of individual patients, in order to understand how bestto control disease – this is also in the interests of individuals. Thedebate has often focused on the confidentiality of individual healthdata and the need for informed consent before such data can beused in research (Vandenbroucke, 1992; Vanchieri, 1993; Stroblet al, 2000; Anderson, 2001; Bastian, 2001; Doll, 2001; Doll andPeto, 2001; Cassell and Young, 2002; Greenberg, 2002; Kulynychand Korn, 2002a,b; Verity and Nicoll, 2002; Coleman et al, 2003;De Vet et al, 2003; Ingelfinger and Drazen, 2004; Peto et al, 2004;Tu et al, 2004; Robling et al, 2005).The International Association of Cancer Registries (IACR)published guidance on confidentiality for cancer registries in theBritish Journal of Cancer in 1992 (Coleman et al, 1992). Somenational and regional cancer registry associations incorporatedthe IACR guidance in their own guidelines. At the IACR scientificmeeting in Tampere, Finland, in 2002, it was decided to update theguidance. A review seemed appropriate after 10 years. EuropeanUnion (EU) legislation on the protection of personal data hadcome into force in all member states during this period, andthe EU Directive (European Parliament, 1995) has served as amodel for national legislation in many countries outside Europe.Rapid developments in web-based communication also motivatedrevision of the guidance, with a view to appropriate use ofthis technology, with the attendant risks of breach of confiden-tiality. The guidance was revised by a small group, endorsed bythe IACR Board in 2004, and made available at www.iacr.com.fr/confidentiality2004.pdf.The main changes from the previous version are: a clear description of the principles of confidentiality, as theyrelate to identifiable data and the registration of cancer; an update of measures to protect data confidentiality; guidance on security for both traditional paper-based systemsand modern electronically based data systems; and expanded recommendations designed to ensure confidentialityin data releases for research, including cross-border transfers.The updated IACR guidance on confidentiality in the cancerregistry should help the cancer research community continue toprovide useful information on the causes, treatment and outcomeof cancer in the entire population, while maintaining the highestethical standards in confidential data collection and research.

The article describes the framework of an on-the-job training program for nurses that teaches them how to better advise hospitalized smokers to stop smoking. The purpose of the study was to evaluate the efficacy of the program.We corducted an on-the-job training program for 4 years aimed at nurses who worked in 2 of 11 wards in our hospital (training wards). The aim of the training program that we developed was to improve nurses' self-efficacy in advising and supporting patients to stop smoking. An average of 40 nurses worked in the two wards at any time during the study period. A self-administered questionnaire was given to nurses working at our hospital before (in 1997) and after (in 2002) the program was undertaken. Changes in cognition and behavior with regard to advice to hospitalized smokers were also compared between nurses working at the training wards and nurses working in the other wards in question, whose number averaged 200 nurses during the period.There were no differences in age distribution, smoking habits and epidemiological knowledge of smoking between the two groups. Self-efficacy in advising and supporting patients to cease smoking was significantly increased among nurses working in the training wards (P=0.02), whereas no significant increase with time was found among nurses working in the other wards (P=0.14). After the program was undertaken, nurses working in the training wards had a significantly higher proportion who always advised hospital smokers to quit according to their predictable stage of change than their counter parts working in the other wards (adjusted odds ratio 2.93, 95% confidence interval 1.27-6.74).The study indicates the job training program to have improved the nurses' self-efficacy, appearing to change their behavior in advising and supporting patients to cease smoking.

This randomized controlled trial assessed the efficacy of a smoking relapse prevention program featuring 3 postdischarge telephone contacts with subjects who had quit smoking on hospitalization.Patients were randomly assigned to public health nurse-mediated behaviorally oriented in-patient counseling focused on relapse prevention (control group, n = 49), or the same inpatient counseling with postdischarge telephone contacts at 7, 21 and 42 days after discharge (intervention group, n = 57). The main outcome measure, smoking cessation rate, was obtained from self-reports at 3, 6 and 12 months after discharge. Smoking cessation at 12 months after discharge was confirmed by urinary nicotine concentration.At 3, 6 and 12 months smoking cessation rates were 83%, 63% and 56% for the intervention group, and 76%, 65% and 51% for control group. After adjustment for sex, age, having any complication, number of family members, smoking status on admission, strength of nicotine dependence and self confidence to quit smoking, the odds ratio of cessation among the intervention group were 1.46 (95% confidence interval (CI): 0.48-4.47), 0.82 (95% CI: 0.31-2.17) and 0.99 (95% CI: 0.40-2.45) at 3, 6 and 12 months after discharge, respectively.This program had limited efficacy to maintain postdischarge smoking abstinence. We should re-consider the modality of smoking cessation program for relapse prevention among hospitalized patients.

In Japan, effective tobacco control programs have not been conducted, although there have been as many epidemiological evidences regarding health risks of tobacco smoking and passive smoking as in western European countries and the United States. This seems due to the attitude of the Japanese Government which is behind the times in promoting public health while the tobacco industry has turned a profit. The onus is on medical doctors who know the health risks of tobacco well enough to make a breakthrough in these difficulties. Medical associations and societies should take actions in shaping public opinion and lobbying for legislation of comprehensive tobacco control policy in correspondence with the WHO Framework Convention on Tobacco Control (FCTC) which the Japanese Government signed on 10 March, 2004.

Based on the estimates by the Research Group for Population-based Cancer Registration in Japan, time-trend of cancer incidence in Japan was described and analyzed. During the period of 1975-1998, the annual total cancer incidence increased 111,000-290,000 in males, and 96,000-208,000 among females. The higher incidence was prominent for cancers of the colorectum, lung, liver, gallbladder and extrahepatic bill duct (both sexes), prostate, and breast (female), whereas it was low or negligible for cancers of the stomach (both sexes) and uterus. The increased cancer incidence was globally attributed to the rapid growth of the Japanese aged population. However, a remarkable increase in the age-standardized incidence rate was also observed for cancers of the colorectum (both sexes), prostate, and breast (female). A decline in the age-standardized incidence rate was continuously observed for cancer of the stomach and uterus. A birth cohort analysis has revealed that the cancer incidence in Japan has been highly affected by the generation. Based on the Cancer Incidence in Five Continents Vol. VIII, the cumulative risk of cancer incidence (0-79 years old) was calculated and compared among the Japanese population (6 registries' data), US-Japanese and US-white. Several characteristics were suggested and discussed for Japanese cancer risk.

In 1988, the Osaka Cancer Prevention and Detection Center developed a self-help smoking cessation program, the "stop smoking" contest, based on the Quit and Win strategy developed in the United States in the early 1980's. It consisted of a two-week preparation period, followed by a four-week complete abstinence period. Participants were asked to try to achieve their goals on their own, using self-help materials, mailed to all applicants. Successful participants--"contest winners"--were awarded prizes by lot. The purpose of the present study is to examine the applicability of the Quit and Win strategy in Japan, through evaluating the effectiveness of the program in general and identifying predictors of successful quitting.We analyzed the results of three consecutive programs conducted in 1998, 1999, and 2000. The programs defined as "participants" all those who demonstrated that their intentions were sincere by signing on for the contest. Of the participants, those who reported complete abstinence for four weeks were defined as "winners." Finally, of the winners, those who reported successful abstinence during the following six- and twelve-month periods were defined as continuing winners. "Abstinent" status was confirmed through self-reporting letters signed by the subject and two witnesses. We hypothesized that successful quitting would be predicted by demographic and smoking-related variables. Predictors of successful quitting were analyzed statistically using logistic regression.Of 4,221 applicants, 2,550 (60%) smokers eventually joined the program as "participants." Forty-six percent of the participants reported complete tobacco abstinence during the four-week contest period. Twenty percent of the participants maintained abstinence during the following six months. Fifteen percent maintained abstinence for a full year. Significant predictors of tobacco abstinent for the four-week contest period were as follows; male, more advanced age, being married, lower nicotine dependence, greater readiness for quitting, higher confidence in quitting, and better health. Of these, sex and psychological characteristics for quitting such as readiness and confidence were the only factors significantly correlated with successful abstinence throughout the follow-up periods. Previous longer abstinence experiences and chronic disease did not predict four-week abstinence, though it was significantly correlated with abstinence maintenance during the follow-up periods.The present "stop smoking" contest, a "Quit and Win" type population-based, self-help smoking cessation program combined with incentives, could be successfully implemented in Japan. The success rate was essentially comparable to those of similar programs previously conducted in other countries, and other types of professional-assisted programs in Japan.

Background Survival of childhood cancer patients is often described in specialized hospitals and/or institutions, but not in the general population. Methods The trends and patterns of childhood cancer survival during 20 years were investigated using the Osaka Cancer Registry's data. The study subjects were 3443 reported cases diagnosed as having the first primary cancer between 1975 and 1994 at the ages of 0-14 years and who lived in Osaka Prefecture, excluding Osaka City. All childhood cancers were classified into 12 diagnostic groups according to the International Classification of Childhood Cancer based on the histology of the cancer. The 5 year relative survival was calculated by the Ederer II method. Results The 5-year relative survival was 58% for all cancers. The survivals of retinoblastoma and kidney tumor patients were as high as 89 and 72%, respectively, whereas those of leukemia and liver tumor patients were as low as 45 and 47%, respectively. When divided into the first and second half-periods, the survival for all cancers was markedly improved from 48 to 68%. The survivals, especially for patients with leukemia, lymphoma, neuroblastoma, hepatoma and gonadal or embryonal tumors, were enhanced by >20% between the first and second half-periods. When these results were compared with those reported in England and Wales and the USA, however, the survivals for many diagnostic groups in Osaka were lower, except that for neuroblastoma. Conclusions The survivals of childhood cancer patients have been markedly improved in Japan, but this finding suggested that the introduction and practice of chemotherapy was insufficient.

The survival of ovarian cancer patients has been reported to be superior at hospitals with a high volume of operations. A population-based study was carried out to assess whether this is true in Japan, where the incidence rate is relatively low as compared with other developed countries. The Osaka Cancer Registry's data were used to investigate associations between hospital procedure volume and survival of ovarian cancer patients. Hospitals were ranked according to the number of operations for ovarian cancer performed per year (high/medium/low/very low). Survival analysis was restricted to the reported 2450 cases who lived in Osaka Prefecture (except for Osaka City) diagnosed in 1975-1995, or those who resided in Osaka City in 1993-1995, since active follow-up data on vital status 5 years after the diagnosis were available. The relative 5-year survival for all ovarian cancer cases was 38.8%, and the survival was higher with greater hospital volume (22.3% / 34.2% / 46.2% / 55.0%). After adjustment for age, histologic type and cancer stage by the Cox regression model, patients receiving care in very-low-volume hospitals were seen to have a 60% higher risk of death than patients receiving care in high-volume hospitals (P < 0.01). Although some limitations existed in this study, the results indicated that further centralization of operative treatment in high-volume hospitals might improve survival of ovarian cancer patients in Japan.

Marrow mesenchymal stem cells are well known for their differentiation into bone-forming osteoblasts and in vitro mineralized tissue formation. However, process details, including tissue structure and cellular environments, remain unclear. The present study demonstrates three-dimensional visualization of tissue fabricated by culturing MSCs in the presence of calcein, a fluorescent marker for bone mineralization. The 3D visualization was performed by computer-assisted confocal laser scanning microscopy and revealed that the in vitro tissue consisted of layers of a mineralized matrix with round cells in the matrix lacunae, an unmineralized matrix (osteoid), and osteoblastic cells on the osteoid surface. The findings show that the mineralization by cultured MSCs is an in vitro counterpart of in vivo bone formation and indicate that the novel technique of visualization without tissue fixation could be useful for continuous monitoring of tissue organization in an ongoing culture.

Despite the large number of surgical operations for stomach cancer in Japan, no study based on data from population-based cancer registries has been conducted regarding the relationship between hospital surgical volume for stomach cancer and patients' survival. Using data from the Osaka Cancer Registry (OCR), we performed survival analyses on 28,608 patients aged 35-79 years old who underwent surgery for stomach cancer, according to the extent of disease at diagnosis (localized: cancer is confined to the original organ; regional: cancer spreads to regional lymph nodes; adjacent: cancer infiltrates to adjacent tissue; distant: cancer metastasizes to distant organs). The study was divided into four periods; 1975-79, 1980-84, 1985-89 and 1990-94, according to year of diagnosis. Hospitals were stratified into four groups by total number of stomach cancer operations during each of the study periods, so that the numbers of operations in each group would be approximately equal. Cox's proportional hazards model was used to examine the relationships between hospital volume and 5-year survival according to the extent of disease, after adjustment for age at diagnosis and sex. Positive relationships between hospital volume and 5-year survival were seen in the localized and regional groups during the period 1975-79. These associations, however, decreased in later periods and disappeared in 1990-94 except for the very-low-volume hospitals. Stomach cancer patients treated in these hospitals remained at significantly higher risk of death than in the high-volume hospitals. In the case of the distant group, there was no clear relationship between hospital volume and 5-year survival during the study periods.

Purpose We examined whether the data registered in the Japanese Patterns of Care Study (PCS) for patients with non–small-cell lung cancer (NSCLC) represent the actual situation of radiotherapy in Japan. The Osaka Cancer Registry (OCR) data, forming the largest database of a regional cancer registry in Japan, were adopted for use as a benchmark against the national condition. Patients and methods We examined 906 patients of the PCS treated between 1995 and 1997 and 845 patients of the OCR registered between 1988 and 1992. The investigation was made by descriptive statistical methods to measure age, stage, combined treatments, type of treated hospitals, and prognosis. Furthermore, the national averages (NAs) of the PCS process (PCS NA) were also calculated to compensate for the imbalance in the PCS data sampling. Results The mean age was 67.3 ± 10.1 in PCS and 64.4 ± 11.0 in OCR ( p p = 0.411), 84.1% in PCS NA. The ratio of the patients at the localized stage was 24.2% in PCS and 15.6% in OCR ( p = 0.001), 21.1% in PCS NA. The ratio of surgery combined was 24.2% in PCS and 28.9% in OCR ( p = 0.026), 25.3% in PCS NA. The ratio of chemotherapy combined was 50.1% in PCS and 67.5% in OCR ( p = 0.001), 47.4% in PCS NA. Because the definitions of institution classification and period of prognostic inquiry were different between the two databases, the 3-year survival rates were calculated for reference. In the nonsurgery group, it was 20.3% in PCS and 11.3% in OCR ( p = 0.001), and in the surgery group it was 52.5% in PCS and 42.2% in OCR ( p = 0.057). Conclusions Ages in the two databases were inconsistent. Sex distributions were consistent. Surgery and chemotherapy were more frequently performed for the OCR patients, and more patients at more advanced stages were also observed in OCR. The PCS NAs of sex, stage, and ratio of surgery combined were at the midpoints between those of PCS and OCR. The survival rate of NSCLC patients in the OCR was significantly inferior to that in the PCS. The follow-up rate of the PCS was lower than that of the OCR. The general features of PCS data showed similarity to OCR data, and the results of the PCS NAs suggested the effectiveness of this method to adjust the sampling imbalance in PCS.