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The reactivation of the hepatitis B virus (HBV) following systemic chemotherapy reportedly caused acute liver dysfunction as a fatal complication. HBV reactivation sometimes occurs even after the cessation of chemotherapy, especially in the patients with hematological malignancies. A retrospective survey of patients with hepatitis B surface (HBs) antigen-negative cancer with HBs and/or HBc antibodies was conducted by a multidisciplinary chemotherapy team to determine the examination rate of the HBV DNA test after the completion of chemotherapy. Among 83 patients with a resolved HBV infection, who were followed up for more than 3 months, only 17 patients underwent HBV DNA monitoring every 1-3 months (17/83; 20.5%). Since September, 2022, the chemotherapy team has informed the attending physician regarding the continuous HBV DNA monitoring in patients with cancer with a resolved HBV infection until 12 months after the cessation of chemotherapy.

Epidermal growth factor receptor (EGFR) has received significant attention for its therapeutic potential for pain relief. The relief of neuropathic pain after treatment with anti-EGFR antibodies or tyrosine kinase inhibitors has been previously described. However, few reports have investigated the association of cancer-related nociceptive pain or chronic chemical induced peripheral neuropathy with the analgesic effects of EGFR inhibition. Therefore, we conducted a retrospective survey of 191 patients with colorectal cancer receiving chemotherapy plus molecular targeting drugs to examine the analgesic effects of anti-EGFR antibodies against either cancer pain or oxaliplatin-induced peripheral neuropathy. We identified a significant difference in the improvement rates of nociceptive pain between panitumumab- and bevacizumab-treated patients (100% vs. 9.1%; p < 0.01), but not oxaliplatin-induced peripheral neuropathy. In conclusion, panitumumab may be effective at reducing cancer-related nociceptive pain.

Background: Immune checkpoint inhibitors (ICIs) sometimes cause immune-related adverse events (irAEs), the timing of occurrence of which is difficult to predict. We created a system to safely manage the patients treated with ICIs who visit hospital during an emergency. Methods: We utilized the Plan-Do-Check-Act (PDCA) cycle method to improve the quality of countermeasures for irAEs in the emergency room. First, an icon showing the patients treated with ICIs was developed for inclusion in electronic medical records. Second, ICI-specified urgent sets of clinical laboratory tests were prepared to cover the spectrum of irAEs. Third, a direct call system to either the attending physician or the chemotherapy team was established. A flow chart for managing irAEs has been prepared since September 2018. We retrospectively analyzed the electronic medical records from September 2018 to December 2020 to determine the effectiveness of the developed system. Results: In the first cycle of PDCA, 24 patients administered ICIs were retrospectively surveyed and seven visited the emergency room. Six cases were examined according to the flow chart, whereas the other patient complaining of grade 2 diarrhea were not examined because of incomplete knowledge regarding ICIs and irAEs. As part of the “Act” step, we reminded the doctors of the flow chart and gave a lecture to the residents on how to manage irAEs. During the second and seventh cycle, no cases were observed without consulting the flow chart. Conclusions: Quality improvement activities for the management of irAEs were conducted using the PDCA cycle methodology. Patients on ICIs are now being continuously monitored to further improve management quality.

Background Delirium -characterized by an acute or subacute decline in cognitive functioning- and confusion are risk factors for falls and its related injuries. Therefore, we designed a unified clinical pathway to reduce the risk of delirium among hospitalized patients. Methods A unified approach of pharmacotherapy for managing insomnia and confusion, which is subdivided based on the patients’ age (

BackgroundImmune checkpoint inhibitors (ICIs) sometimes cause immune-related adverse events (irAEs), the timing of occurrence of which is difficult to predict. We created a system to safely manage the patients treated with ICIs who visit hospital during an emergency.MethodsWe utilized the Plan-Do-Check-Act (PDCA) cycle method to improve the quality of countermeasures for irAEs in the emergency room. First, an icon showing the patients treated with ICIs was developed for inclusion in electronic medical records. Second, ICI-specified urgent sets of clinical laboratory tests were prepared to cover the spectrum of irAEs. Third, a direct call system to either the attending physician or the chemotherapy team was established. A flow chart for managing irAEs has been prepared since September 2018. We retrospectively analyzed the electronic medical records from September 2018 to December 2020 to determine the effectiveness of the developed system.ResultsIn the first cycle of PDCA, 24 patients administered ICIs were retrospectively surveyed and seven visited the emergency room. Six cases were examined according to the flow chart, whereas the other patient complaining of grade 2 diarrhea were not examined because of incomplete knowledge regarding ICIs and irAEs. As part of the “Act” step, we reminded the doctors of the flow chart and gave a lecture to the residents on how to manage irAEs. During the second and seventh cycle, no cases were observed without consulting the flow chart.ConclusionsQuality improvement activities for the management of irAEs were conducted using the PDCA cycle methodology. Patients on ICIs are now being continuously monitored to further improve management quality.

Backgrounds: Colorectal cancer is an important contributor to cancer morbidity and mortality. Given that many older adult patients often have concomitant diseases and impairments in organ function, they are at increased risk for chemotherapy toxicity. Therefore, it is important to identify prognostic factors in older patients undergoing chemotherapy. Methods: We performed a retrospective chart review of colorectal cancer patients treated at Nagoya Memorial Hospital between 2012 and 2017 and selected those who received chemotherapy for metastatic colon cancer. Overall survival was calculated from the beginning of chemotherapy until death or the most recent follow-up date. We used the Kaplan-Meier method to plot survival curves and performed a statistical comparison using a log-rank test. In addition, multivariate analysis was performed using stepwise Cox proportional hazards models. Finally, a comprehensive geriatric assessment was conducted for older patients. The chart review was approved by the ethics committee of Nagoya Memorial Hospital. Results: The overall survival of metastatic colon cancer patients was not markedly different between patients aged ≥ 65 years of age (N = 37). Neither lesion site nor the RAS status affected survival, whereas the usage of three kinds of cytotoxic agents prolonged longevity. In a multivariate analysis of patients ≥ 65 years of age, the only independent prognostic factor for survival was the functional capacity, as measured by the Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence. Conclusions: A combination of the comprehensive geriatric assessment and TMIG index was useful for predicting the longevity in patients with metastatic colon cancer ≥ 65 years of age.

Background We collaborated with the regional pharmaceutical associations near Nagoya Memorial Hospital and created a communication sheet for pharmaceutical cooperation between the hospital and health insurance pharmacies. Methods The communication sheet for pharmaceutical cooperation was issued in October 2014. We conducted a questionnaire survey of both cancer patients and community pharmacists 1 year after the implementation of the use of this sheet. Based on the results of the survey, we modified our communication sheet and added a unified reply form in October 2016. We examined the number of replies from community pharmacists from October 2014 to April 2019. We then analyzed how community pharmacists instructed and communicated with cancer patients using the results of both the questionnaire survey and the reply form, which were compared before and after introducing the modified version of the communication sheet. Results During the 5 years of observation, 743 communication sheets were sent from Nagoya Memorial Hospital to community pharmacists. As a result of pharmaceutical cooperation in using the communication sheet, 96.4% of prescribed medication were immediately prepared in health insurance pharmacies on that day. The communication sheet also enhanced the conversations between cancer patients and pharmacists. The introduction of the unified reply form increased the response rate of community pharmacists from 1.7 to 69.5% (p p < 0.05). However, this hindrance was reduced by the use of the modified form. Conclusions The communication sheet for pharmaceutical cooperation is useful for bidirectional information sharing between hospitals and health insurance pharmacies, which may enable pharmacists to provide cancer patients with medication instructions in coordination with hospitals and increase the quality of outpatient pharmacy services.

Background Various kinds of immune-related adverse events (irAEs) are caused by the usage of immune checkpoint inhibitors (ICI), which occasionally develop to severe conditions such as colitis and adrenal gland insufficiency. Since we are unable to anticipate when irAEs may occur, it is crucial to be informed of administration history of ICI on urgent visit. Methods We have utilized PDCA cycle Method to improve the quality of countermeasures for irAEs at the emergency room (ER). First, we invented an icon showing the patients treated with ICI on electronic medical records. Second, ICI-specified urgent sets of clinical examination were made to cover the spectrum of irAEs. Third, direct call system to either attending physician or chemotherapy team was established. And then a flow chart to manage irAEs has been prepared since September 2018. Retrospective examination was conducted to check whether the invented system work properly.[Results] Among 19 patients on ICI, four visited ER during these 4 months.Three cases were seen according to the flow chart, while one with grade 2 diarrhea was found not to undertake any examinations at ER, due to the complete lack of knowledge concerning ICI and irAEs.We informed all of the doctors of this flow chart at doctors’ office committee and gave a lecture for the residents about the significance of irAEs and how to manage these patients at ER. Conclusions We are monitoring patients on ICI to check whether their management be performed in safety on urgent visit.

Background Metastatic gastric cancer has a poor prognosis. Overall survival in these patients is approximately 1 years, despite the development of chemotherapeutic and biological agents. The incidence of long-term survivors of metastatic gastric cancer beyond 5 years after the initiation of chemotherapy has been reported to be less than 10%. Methods The characteristics of long-term survivors were compared with those of poor responders to determine the specific factors that regulate chemosensitivity. Those who died within six months after the initiation of chemotherapy were considered as poor responders in this analysis. Medical records were retrospectively reviewed to determine the clinicopathological features of metastatic gastric cancer patients receiving chemotherapy in Nagoya Memorial Hospital. Statistical analyses were carried out by Fisher’s exact test and then a multivariate analysis. Differences with P values less than 0.05 were considered statistically significant. The chart review was approved by ethics committee of Nagoya Memorial Hospital. Results We experienced 8 long-term survivors and 12 poor responders. The analysis showed that number of metastatic sites might be different between 2 groups (P = 0.0144). The objective response rates of long-term survivors and poor responders were 62.5% (CR 4, PR 1) and 0%, respectively. Conclusions We found that tumor burden might be associated with the prognosis of affected patients. Good response to systemic chemotherapy should be essential for prolonged survival of patients with distant metastases.

We present a 72-year-old woman with sigmoid colon cancer in whom the somatic pain was alleviated rapidly after the administration of anti-epidermal growth factor antibodies. Our patient had received 4 cycles of FOLFIRI therapy (irinotecan, 5-fluorouracil, and leucovorin) in combination with panitumumab (Pmab) for the treatment of unresectable primary cancer accompanied with multiple liver metastases and peritonitis carcinomatosa. As grade 3 paronychia eventually occurred, chemotherapy was stopped. After recovery of the grade 3 paronychia, Pmab was re-introduced and administered every alternate cycle to reduce the extent of adverse events. The patient had complained of somatic pain in the lower right abdomen just before re-initiating Pmab administration. The pain intensity decreased immediately after the administration of Pmab. On the next day her pain had remarkably alleviated and she was free from pain for a week. This phenomenon was repeatedly observed. After the re-introduction of Pmab, tumor response was evaluated on computed tomography, which showed progressive disease. We demonstrated that Pmab was effective in the alleviation of somatic pain, although the size of the tumors gradually increased.

Background: Despite the significant advances in chemotherapy, the prognosis of unresectable gastric cancer is still very poor and the role of immunotherapy remains to be clarified. We examined whether lentinan, a biological response modifier, could enhance the chemotherapeutic effects. Materials and methods: A retrospective cohort study was conducted to evaluate the survival benefits of lentinan among the patients with gastric cancer receiving chemotherapy. To investigate the mechanisms underlying the clinical effects of lentinan, its cytotoxic activity was accessed by cell proliferation assay. The expression of molecules relevant to immune checkpoints were analyzed by real-time PCR using human gastric cancer cell lines; MKN1, MKN45, and NUGC3. Results: The addition of lentinan prolonged the survival of patients with gastric cancer receiving S-1 based chemotherapy. Lentinan reduced the constitutive expression of PD-L1 in all cell lines mainly by suppressing the MAPK pathway. Conclusion: Lentinan at clinical concentrations stimulates tumor-specific adaptive immunity through PD-L1 downregulation, which may enhance chemotherapy-induced tumor clearance and patient survival.

Severe oral mucositis induced by cancer chemotherapy can cause intolerable pain and increase the risk of systemic infections, necessitating dose reduction and discontinuation of antineoplastic agents. Moreover, this adverse effect may have an impact on patient nutrition and quality of life. An effective and prophylactic intervention should be useful for alleviating this complication. Because Nagoya Memorial Hospital has neither a dentistry nor an oral surgery department, we collaborated with dental associations near the hospital. First, we performed a questionnaire survey on the present status of the members of the local dental associations. The survey showed that 86% of the community dentists were interested in communicating with our hospital. In addition, they agreed to provide us with information on their specialty and status of amenities. In discussion with the community dentists, we decided on fax-based communication for collaboration to improve the quality of oral management in cancer patients. Three seminar series were conducted to share updated information on cancer treatment and enhance communication between the medical doctors and the dentists. Our hospital has registered 129 community dentists and enrolled 81 cancer patients in this medical and dental cooperation initiative.

Objective : Bevacizumab has been increasingly used in combination chemotherapy for the treatment of metastatic or recurrent colorectal cancer. The aim of this report is to underline the possible risks associated with bevacizumab use. Methods : Between July 2005 and March 2013, a total of 130 patients with metastatic colorectal cancer who received oxaliplatin as first-line chemotherapy were divided into 2 groups those treated with bevacizumab (group A) and those without (group B), and compared. The primary endpoint was to clarify the profile of bevacizumab - induced adverse effects. Secondary endpoints examined therapeutic effects, including overall survival (OS). Results : The incidence of major side effects was almost equivalent, except for bleeding, between the 2 groups. With regard to the therapeutic effects, 1 patient in group A showed complete disappearance of multiple lung metastases without any evidence of recurrence. The median OS was 926 days (95% confidence interval [CI], 756 - 1257) in group A and 534 days (95% CI, 421 – 621) in group B ( p < 0.01). Conclusion : The results demonstrate that bevacizumab prolonged survival in these patients although there was an increased risk of clinically significant bleeding.

Aim: To examine the efficacy of oral rinsing against chemotherapy-induced stomatitis. Methods: Consecutive fluoropyrimidine-treated patients with stomach and colorectal cancer were enrolled from April 2009 to March 2011 (n=43; Group 1) and from January 2012 to December 2012 (n=45; Group 2). The incidence and severity of stomatitis were compared between Group 1 patients, who were instructed to gargle with lemonflavored water 6 times daily, and Group 2 patients, who did not receive any specific guidance. Among patients in the gargle group, we determined the rate of gargling compliance as well as quality of life (QOL) scores, and evaluated the impact of rebamipide use on patient outcomes. Results: The incidence of stomatitis was significantly reduced in Group 1 (14.0%) compared to that in Group 2 (33.3%) and its severity in the former group was milder. Among patients using lemon-flavored water, concomitant rebamipide use had no statistically significant impact on stomatitis incidence (with versus without rebamipide, 19.0% versus 9.0%), the rate of gargling compliance (96.4% versus 94.2%), or QOL scores. Conclusions: Oral rinse with lemon-flavored water is useful for the symptomatic control of fluoropyrimidineinduced stomatitis, regardless of the presence or absence of rebamipide.

The prevalence of depression has been reported to be higher in cancer patients, especially those of advanced stage, compared to normal controls. However, depression is often under-recognized in clinical oncology settings. And this psychological problem is not routinely assessed even in patients with inoperable metastatic cancer who often have psychological disorders. Psychological distress including depression, is affected by physical, psychosocial, and clinical factors. In order to detect psychiatric problems at the early stage, we assessed the mental conditions of 47 inpatients with metastatic gastric and colorectal cancerusing the Japanese version of Zung's Self Rating Depression Scale(SDS)and analyzed the relationships between these factors and SDS scores. While SDS scores of our patients did not differ according to their gender, age, performance status (PS), ortypes of patients' character, they were significantly higher in Group B(cancer patients with palliative care alone), compared to Group A(those receiving chemotherapy)(p0. 001). As the disease in the four identical patients progressed to the terminal stage, their scores were significantly increased, respectively(p0. 05). These results suggest that psychological intervention should be more critical for terminally ill patients without any indication of chemotherapy.

The importance of age at menarche, age at menopause, height, and obesity as risk factors for breast cancer, and the possible interactions among these factors in breast cancer causation were investigated in a data set collected in the late 1960's, in an international multicenter case-control study. Multiple logistic regression procedures were used to model data from 3,993 breast cancer cases and 11,783 controls from 7 study centers representing the range of international variation of breast cancer incidence. Height and obesity (measured through the weight/height2 index) were independent risk factors for breast cancer among post-menopausal but not pre-menopausal women; post-menopausal women taller by 10 cm had a 12% higher risk of breast cancer (95% confidence interval, CI, 3-21%) and post-menopausal women of average height (say 158 cm) had an 11% higher risk of breast cancer (CI 7-16%) when they were heavier by 10 kg (and, therefore, more obese by 4 kg/m2). Age at menarche was a risk factor among both pre-menopausal and post-menopausal women, a delay of 2 years corresponding to a 10% reduction in breast cancer risk (CI 6-15%). Age at menopause was also a breast cancer risk factor, women with menopause at each 5 year age difference having a 17% higher risk of breast cancer (CI 11-22%). There is evidence of an interaction (deviation from the logistic regression-postulated multiplicativity) between obesity and age at menarche, implying that the protective effect of late menarche may not apply to overweight women or that late menarche may become detrimental in obese women. The estimated relative risk coefficients, when applied to average risk factor levels observed among control women, can explain only a small fraction of the difference in breast cancer incidence between Boston and Tokyo.

Rats fed from weaning on semi-purified diets supplemented either with linoleate-rich safflower oil (S) or alpha-linolenate-rich perilla oil (P) were mated. Half of the progeny were weaned to the original diet of the dams (SS and PP), the other two groups were shifted to diets enriched in the other fatty acid (SP and PS). Brightness-discrimination learning ability was tested daily for 30 d beginning at 11 weeks of age, with a bright light as the positive stimulus. The learning performance was inferior in the group fed the safflower diet through two generations (SS) as compared with groups fed the perilla diet through two generations (PP) or for which the diets were shifted at weaning (PS and SP). The docosahexaenoate content of brain phospholipids was significantly less in the SS group compared with the three other groups. After 30 d of the learning test, the effect of shifting the stimulus was tested for another 30 d, this time using a dim light as the positive stimulus. The learning performance was superior in the PP group to the SS group throughout the latter 30 sessions, the difference being even more obvious than during the first 30 d. These results indicate that the decrease in the discrimination-learning ability induced by alpha-linolenate deficiency is a relatively reversible process; both the docosahexaenoate content in brain and the learning performance were restored by supplementing alpha-linolenate after the weaning.

Data from a large international case-control study of breast cancer suggested that women born to young mothers had a 25% lower risk of breast cancer. The association was not secondary to a tendency for these women themselves to have had children at early ages. The data provided no indication of a meaningful association between breast cancer risk and birth rank. Confounding was controlled by stratification according to a summary confounder score.

In an effort to assess the relative importance of age at first birth, age at subsequent births, and total parity to the occurrence of breast cancer, reproductive data from 4,225 women with breast cancer and 12,307 hospitalized women without breast cancer were analyzed by a multiple logistic regression model. Age at first birth was confirmed to be the most important reproductive risk indicator; it was associated with a 3.5 % increase of relative risk for every year of increase in age at first birth (the 95 % confidence interval of this estimate was 2.3 to 4.7 % increase per year). However, age at any birth after the first was also an independent and statistically significant risk indicator; it was associated with a 0.9% increase of relative risk for every year of increase in age at any (and every) birth (the 95 % confidence interval of this estimate was 0.4 to 1.5 % increase per year). There is evidence that the age of approximately 35 years represents for every birth a critical point; before this age any full-term pregnancy confers some degree of protection; after this age any full-term pregnancy appears to be associated with increase in breast cancer risk. The effect of parity is determined by the age of occurrence of the component pregnancies. While most pregnancies occur under the age of 35, the distribution varies from population to population, and this may account for the differences between populations in whether or not a protective effect is seen for births after the first, and if it is seen, its extent.

In a previous report three year survival rates in breast cancer were related to geography, socio-economic status and age at first pregnancy. Here, results from 5 years of follow-up observations are summarized with respect to incidence risk factors. Age-adjusted 5 year survival rates were 57·3% in Boston, Massachusetts, 49·5% in Glamorgan, Wales, 41·9% in Slovenia, Yugoslavia, and 74·9% in Tokyo, Japan; corresponding age-adjusted annual incidence rates per 100,000 were 55·0, 38·8, 24·4 and 12·9 . Although survival rates varied markedly among these areas, there was not a consistent relationship between incidence rate and probability of survival. Differences in survival rates between Boston, Glamorgan and Slovenia were reduced when examined according to extent of disease at diagnosis, but the relatively high survival rate in Tokyo was not explained. Survival rates tended to increase, although inconsistently, with increasing socioeconomic status as measured by duration of schooling. Probability of survival was not related to childbearing or, for parous patients, to age at first full-term birth.

Histologic slides from representative series of breast cancer patients in Boston, where the incidence rate of breast cancer is high, and in Tokyo, where the incidence rate is low, were reviewed by pathologists who did not know the city of origin of the material. Intraductal, medullary and colloid histologic types were relatively more frequent in Tokyo. Also more frequent in Tokyo were tumors with circumscribed margins and a high degree of cellular reaction. Tumors of small-cell or invasive ductal histologic type and tumors with a high degree of fibrosis were more frequent in Boston than in Tokyo.

In a recent study, 5-year survival rates for breast cancer patients in Boston (Massachusetts), Glamorgan (Wales), Slovenia (Yugoslavia) and Tokyo (Japan) were 57.3%, 49.5%, 41.9% and 74.9%, respectively. In this report, data are presented on the types of treatment used in the four areas and on the relationship of differences in treatment practices to the differences in survival rates. Generally, surgically treated patients who also had radiotherapy had lower survival rates than patients in the same area who had similar operations without radiotherapy. In each area, the survival rate was higher for patients who had radical mastectomy than for those who had simple mastectomy. The Japenese patients had the highest survival rate within nearly every treatment and extent-treatment category. Thus, the high survival rate of these patients was not explained by the variables considered. Survival differences between Boston, Glamorgan and Slovenia were largely explained by differences in extent of disease and type of treatment. As the nature of the treatment—survival trends was consistent with the interpretation that treatment tended to be selected according to apparent prognosis, the degree to which treatment customs were determinants of the differences in survival rate among the three areas is uncertain. Differences Internationales Dans Le Traitement Du Cancer Du Sein Et Le Taux De Survie Ment suivi un traitement radiotherapique avaient des taux de survie inferieurs a ceux des patientes de la měme region qui avaient subi des operations analogues sans radiotherapie. Dans chaque region, le taux de survie etait plus eleve pour les patientes qui avaient eu une mastectomie radicale que pour celles qui avaient eu une mastectomie simple. Comme le taux de survie des patientes japonaises etait le plus eleve, quel qu'ait ete le traitement et la categorie (extension de la maladie/traitement), ou presque, il ne s'expliquait pas par les variables retenues. Les differences entre les taux de survie a Boston, dans le comte de Glamorgan et en Slovenie s'expliquaient en grande partie par les differences dans l'extension de l'affection et le type du traitement. Comme la nature des courbes traitement-survie concordait avec l'interpretation selon laquelle le traitement est choisi en fonction du pronostic apparent, il y a incertitude en ce qui concerne la mesure dans laquelle les differences de taux de survie entre les trois regions considerees sont imputables a la nature du traitement.

Variation in survival of breast cancer patients has been examined for relationship to three demographic variables known to affect incidence rates—geography, socioeconomic status and age at birth of first child. Three-year relative survival ratios in two areas with high incidence rates (Boston, USA and Glamorgan, Wales) were 75.3% and 66.4%, respectively. In an area with a low incidence rate (Tokyo, Japan) the ratio was 85.6%. The overall survival ratios differed significantly between areas, but the pattern is not such as to suggest a consistent correlation — either positive or negative — with incidence rates. The differences in survival ratios between areas were not explained by differences in the extent of disease at diagnosis. Survival ratios did not vary consistently with socioeconomic status, as measured by duration of schooling. Neither childbearing nor age at which porous patients first became pregnant was related to probability of survival.

Survival rates for patients with breast cancer have been reported to be higher in Japan than in the United States. It has also been reported that histologic features associated with more favorable survival are more frequent in Tokyo than in the United States. In this report data are presented on the question of whether differences in breast cancer histology could account for the differences in survival rate between Tokyo and two western areas–Boston, USA, and Glamorgan, Wales. Intraductal carcinoma was found to be most frequent in Tokyo and least frequent in Boston, but survival differences between the two cities were found when non-invasive cases were excluded. Low (relatively malignant) nuclear grade was observed most often in Glamorgan; there was little difference in frequency of this characteristic between Boston and Tokyo. Since nuclear-grade specific survival ratios were highest in Tokyo, this histologic feature also does not account for the better survival experience of Japanese patients. Tumors of medullary histologic type and those with high degrees of lymphoid infiltration were most frequent in Japan and least frequent in Boston. However, the relationships of histologic type and lymphoid infiltrate to survival were not consistent in the three areas, and the higher survival ratio of the Japanese patients could not be related to these characteristics.

a marked increase in the birth rate, and by the sudden decrease in the death rate made possible by antibiotics and the application of public health measures of the Western type. Recognizing the threatening imbalance between population and resources, the Japanese Government appointed a Population Council. This body, in 1949, recommended that the Government should promptly make possible the control of family size, not by induced abortion, by conception control (1). Since it was not known at that time which methods would be more acceptable and effective in Japan or how the needed instruction and supplies could best be distributed, we undertook a study to learn how the recommendation of the Population Council could best be carried out. The results after two years were reported in the Japanese Medical Journal (2) and the Archives of Population (3) and, after five years, at the World Population Conference, held at Rome in 1954, and at the Fifth International Conference on Family Planning, held at Tokyo in 1955 (4) (5). This article tells of the progress through seven years. THE VILLAGES CHOSEN