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Sobue T.,Center for Cancer Control and Information Services
Fukushima journal of medical science | Year: 2011

When evaluating cancer risk of low-dose radiation, it is difficult to distinguish the actual effect from that of chance, bias, and confounding as they become relatively large. This is why the relation between radiation doses of less than 100 mSv and cancer risk is considered unknown. Based on data of atomic bomb survivors in Hiroshima and Nagasaki, the cancer risk at 100 mSv is calculated at 1.05 times. On the other hand, the risk ratio for the relation between passive smoking and lung cancer is estimated at approximately 1.3 and judging the actual effects faced difficulties. It is almost impossible for epidemiology research alone to show that the risk ratio of 1.05 is the actual effects of radiation. The ICRP estimation, " exposure to 100 mSv increases cancer risk by 0.5%" , has been frequently cited, however, it is not a simple excess lifetime risk of death. It will be more appropriate to indicate a value with clear definition to people in general, such as excess lifetime risk of death or excess lifetime risk of morbidity rather than the value obtained from such complicated process. Radiation epidemiology equally uses ratio and difference to indicate degrees of risk increase. Difference largely changes depending on effects of background factors whereas ratio is often relatively stable. Therefore the use of ratio would be more appropriate when comparing other cancer risk factors. Source


Allemani C.,London School of Hygiene and Tropical Medicine | Weir H.K.,Centers for Disease Control and Prevention | Carreira H.,London School of Hygiene and Tropical Medicine | Harewood R.,London School of Hygiene and Tropical Medicine | And 19 more authors.
The Lancet | Year: 2015

Background Worldwide data for cancer survival are scarce. We aimed to initiate worldwide surveillance of cancer survival by central analysis of population-based registry data, as a metric of the effectiveness of health systems, and to inform global policy on cancer control. Methods Individual tumour records were submitted by 279 population-based cancer registries in 67 countries for 25·7 million adults (age 15-99 years) and 75 000 children (age 0-14 years) diagnosed with cancer during 1995-2009 and followed up to Dec 31, 2009, or later. We looked at cancers of the stomach, colon, rectum, liver, lung, breast (women), cervix, ovary, and prostate in adults, and adult and childhood leukaemia. Standardised quality control procedures were applied; errors were corrected by the registry concerned. We estimated 5-year net survival, adjusted for background mortality in every country or region by age (single year), sex, and calendar year, and by race or ethnic origin in some countries. Estimates were age-standardised with the International Cancer Survival Standard weights. Findings 5-year survival from colon, rectal, and breast cancers has increased steadily in most developed countries. For patients diagnosed during 2005-09, survival for colon and rectal cancer reached 60% or more in 22 countries around the world; for breast cancer, 5-year survival rose to 85% or higher in 17 countries worldwide. Liver and lung cancer remain lethal in all nations: for both cancers, 5-year survival is below 20% everywhere in Europe, in the range 15-19% in North America, and as low as 7-9% in Mongolia and Thailand. Striking rises in 5-year survival from prostate cancer have occurred in many countries: survival rose by 10-20% between 1995-99 and 2005-09 in 22 countries in South America, Asia, and Europe, but survival still varies widely around the world, from less than 60% in Bulgaria and Thailand to 95% or more in Brazil, Puerto Rico, and the USA. For cervical cancer, national estimates of 5-year survival range from less than 50% to more than 70%; regional variations are much wider, and improvements between 1995-99 and 2005-09 have generally been slight. For women diagnosed with ovarian cancer in 2005-09, 5-year survival was 40% or higher only in Ecuador, the USA, and 17 countries in Asia and Europe. 5-year survival for stomach cancer in 2005-09 was high (54-58%) in Japan and South Korea, compared with less than 40% in other countries. By contrast, 5-year survival from adult leukaemia in Japan and South Korea (18-23%) is lower than in most other countries. 5-year survival from childhood acute lymphoblastic leukaemia is less than 60% in several countries, but as high as 90% in Canada and four European countries, which suggests major deficiencies in the management of a largely curable disease. Interpretation International comparison of survival trends reveals very wide differences that are likely to be attributable to differences in access to early diagnosis and optimum treatment. Continuous worldwide surveillance of cancer survival should become an indispensable source of information for cancer patients and researchers and a stimulus for politicians to improve health policy and health-care systems. Funding Canadian Partnership Against Cancer (Toronto, Canada), Cancer Focus Northern Ireland (Belfast, UK), Cancer Institute New South Wales (Sydney, Australia), Cancer Research UK (London, UK), Centers for Disease Control and Prevention (Atlanta, GA, USA), Swiss Re (London, UK), Swiss Cancer Research foundation (Bern, Switzerland), Swiss Cancer League (Bern, Switzerland), and University of Kentucky (Lexington, KY, USA). © 2015 Allemani et al. Open Access article distributed under the terms of CC BY. Source


Nakahara S.,Mariana University | Katanoda K.,Center for Cancer Control and Information Services | Ichikawa M.,University of Tsukuba
Journal of Epidemiology | Year: 2013

Background: In Japan, introduction of severe drunk-driving penalties and a lower blood alcohol concentration (BAC) limit in June 2002 was followed by a substantial reductionin fatal alcohol-related crashes. However, previous research suggests that this reductionstarted before the legal amendments. The causes of the decrease have not been studied in detail. Methods: Monthly police data on fatal road traffic crashes from January 1995 to August 2006 were analyzed using a joinpoint regression model to identify change-points in the trends of the proportion of drunk-driving among drivers primarily responsible for fatal crashes. We analyzed the data by BAC level (=0.5 or <0.5 mg/ml), then conducted analyses stratified by vehicle type (car or motorcycle) and age group (<45 or =45 years) only for the proportion of those with a BAC of 0.5 mg/ml or higher. Results: Among all drivers,the proportion of those with a BAC of 0.5 mg/ml or higher and those with a BAC greater than 0 but less than 0.5 mg/ml showed a change-point from increase to decrease in February 2000 and in May 2002, respectively. The proportion of those with a BAC of 0.5 mg/ml or higher showed a change-point from increase to decrease in October 1999 among car drivers and in April 2000 among drivers younger than 45 years. There was no change-point among motorcyclists. A change-point from no trend to a decrease in January 2002 was observed among those 45 years or older. Conclusions: The change-point identified around the end of 1999 to the start of 2000 suggests that a high-profile fatal crash in November 1999, which drew media attention and provoked public debate, triggered subsequent changes in drunk-driving behavior. © 2013 Japan Epidemiological Association. Source


Iwatani T.,Tokyo Medical and Dental University | Matsuda A.,Center for Cancer Control and Information Services | Kawabata H.,Toranomon Hospital | Miura D.,Toranomon Hospital | Matsushima E.,Tokyo Medical and Dental University
Psycho-Oncology | Year: 2013

Objective The aims of the present study were as follows: (i) to clarify the proportion of women who experience psychological distress during breast cancer diagnosis and (ii) to identify the predictors of psychological distress related to the diagnostic process. Methods This was a longitudinal prospective study of women who required further breast examination. Questionnaires were administered at pre-medical consultations (Time 1), after describing radiological examination (Time 2), and after explaining pathological findings (Time 3). All participants completed Hospital Anxiety and Depression Scale (HADS), Functional Assessment of Cancer Therapy - Breast, and Functional Assessment of Chronic Illness Therapy - Spiritual subscale at Time 1 to identify predictors. Participants also completed HADS at Times 2 and 3 to identify the presence or absence of psychological distress. Results Of the 222 eligible patients, at Time 2, 31 (22.6%) participants with no clinical abnormalities and 39 (45.9%) participants with abnormal findings had HADS scores of ≥11 points (χ2 test, 13.14; p < 0.001). At Time 3, 14 (28.0%) participants with benign breast changes and 24 (68.6%) participants with breast cancer had scores of ≥11 (χ2 test, 13.71; p < 0.001). Higher HADS scores at Time 1 were associated with the presence of psychological distress at all stages of breast cancer diagnosis. Advanced tumor stage was a predictor of psychological distress for participants with breast cancer (odds ratios = 3.314, 95% confidence interval = 1.033-9.509; p = 0.044). Conclusion These results suggest that intensive psychological intervention is necessary for breast cancer patients with large tumors, as well as for women with suspected breast cancer with high HADS scores at pre-consultation. Copyright © 2012 John Wiley & Sons, Ltd. Copyright © 2012 John Wiley & Sons, Ltd. Source


Morita T.,Palliative Care Team and Seirei Hospice | Miyashita M.,Tohoku University | Yamagishi A.,Keio University | Akiyama M.,Keio University | And 8 more authors.
The Lancet Oncology | Year: 2013

Background: Improvement of palliative care is an important public health issue, but knowledge about how to deliver palliative care throughout a region remains inadequate. We used surveys and in-depth interviews to assess changes in the quality of palliative care after regional interventions and to gain insights for improvement of palliative care at a regional level. Methods: In this mixed-methods study, a comprehensive programme of interventions for regional palliative care for patients with cancer was implemented from April 1, 2008, to March 31, 2011 in Tsuruoka, Kashiwa, Hamamatsu, and Nagasaki in Japan. Interventions included education, specialist support, and networking. We surveyed patients, bereaved family members, physicians, and nurses before and after the interventions were introduced. We also did qualitative interviews with health-care professionals after the interventions were introduced. Primary endpoints were numbers of home deaths, coverage of specialist services, and patient-reported and family-reported qualities of care. This trial is registered with UMIN Clinical Trial Registry, Japan (UMIN000001274). Findings: 859 patients, 1110 bereaved family members, 911 physicians, and 2378 nurses provided analysable preintervention surveys; 857 patients, 1137 bereaved family members, 706 physicians, and 2236 nurses provided analysable postintervention surveys. Proportions of home deaths increased significantly, from 348 of 5147 (6·76%) before the intervention programme to 581 of 5546 (10·48%) after the intervention programme (p<0·0001). Furthermore, 194 of 221 (87·78%) family members of patients who died at home answered that these patients had wanted to die at home. The ratio of patients who received palliative care services to all patients who died of cancer increased significantly (from 0·31 to 0·50; p<0·0001). The patient-reported (effect size 0·14; adjusted p=0·0027) and family-reported (0·23; p<0·0001) qualities of care were significantly better after interventions than before interventions. Physician-reported and nurse-reported difficulties decreased significantly after the introduction of the interventions. Qualitative interviews showed improved communication and cooperation between health-care professionals because of greater opportunities for interactions at various levels. Interpretation: A regional programme of interventions could improve the quality of palliative care. Improvement of communication between health-care professionals is key to improvement of services. Funding: Third Term Comprehensive Control Research for Cancer Health and Labor Sciences Research Grants of the Ministry of Health, Labour and Welfare of Japan. © 2013 Elsevier Ltd. Source

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