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Gotoda T.,National Cancer Center Hospital | Iwasaki M.,Research Center for Cancer Prevention and Screening | Kusano C.,National Cancer Center Hospital | Seewald S.,Gastroenterology Center | Oda I.,National Cancer Center Hospital
British Journal of Surgery

Background: Criteria for endoscopic resection in patients with early gastric cancer (EGC) have been expanded recently by the National Cancer Centre (NCC). This study compared long-term outcomes in patients with EGC who underwent endoscopic treatment according to guideline criteria with those treated according to expanded criteria. Methods: Baseline and outcome data from patients undergoing curative endoscopic resection for EGC between January 1999 and December 2005 were collected from electronic medical records. Survival time hazard ratios and 95 per cent confidence intervals were calculated using the Cox proportional hazards model. Results: Of 1485 patients who had a curative resection, 635 (42.8 per cent) underwent resection according to traditional criteria and 625 (42.1 percent) according to expanded criteria. There was no significant difference in overall survival between the groups. Conclusion: Patients who have treatment following the expanded criteria have similar long-term survival and outcomes to those treated according to guideline criteria. Copyright © 2010 British Journal of Surgery Society Ltd. Source

Goto A.,Diabetes Research Center | Goto M.,Diabetes Research Center | Noda M.,Diabetes Research Center | Tsugane S.,Research Center for Cancer Prevention and Screening

Background:The definition of incident type 2 diabetes varies across studies; hence, the actual incidence of type 2 diabetes in Japan is unclear. Here, we reviewed the various definitions of incident type 2 diabetes used in previous epidemiologic studies and estimated the diabetes incidence rate in Japan.Methods:We searched for related literature in the MEDLINE, EMBASE, and Ichushi databases through September 2012. Two reviewers selected studies that evaluated incident type 2 diabetes in the Japanese population.Results:From 1824 relevant articles, we included 33 studies with 386,803 participants. The follow-up period ranged from 2.3 to 14 years and the studies were initiated between 1980 and 2003. The random-effects model indicated that the pooled incidence rate of diabetes was 8.8 (95% confidence interval, 7.4-10.4) per 1000 person-years. We observed a high degree of heterogeneity in the results (I2 = 99.2%; p < 0.001), with incidence rates ranging from 2.3 to 52.6 per 1000 person-years. Three studies based their definition of incident type 2 diabetes on self-reports only, 10 on laboratory data only, and 20 on self-reports and laboratory data. Compared with studies defining diabetes using laboratory data (n = 30; pooled incidence rate = 9.6; 95% confidence interval = 8.3-11.1), studies based on self-reports alone tended to show a lower incidence rate (n = 3; pooled incidence rate = 4.0; 95% confidence interval = 3.2-5.0; p for interaction < 0.001). However, stratified analyses could not entirely explain the heterogeneity in the results.Conclusions:Our systematic review and meta-analysis indicated the presence of a high degree of heterogeneity, which suggests that there is a considerable amount of uncertainty regarding the incidence of type 2 diabetes in Japan. They also suggested that laboratory data may be important for the accurate estimation of the incidence of type 2 diabetes. © 2013 Goto et al. Source

Tsugane S.,Research Center for Cancer Prevention and Screening
Journal of Gastroenterology and Hepatology (Australia)

The health impact of alcohol drinking, cigarette smoking and obesity differs between Asian and Western countries. The epidemiology of cancer and death related to these lifestyles are described in this article. In Japan, heavy alcohol drinking and cigarette smoking are rather high in men. While there is a worldwide anti-smoking policy, Japan is still on the way to aiming at this goal, and this delay in health promotion has maintained the high impact of smoking, whether active or passive, on people's health in that country. Public health policy should focus more strongly on the control of smoking and heavy drinking, especially among men. Maintaining the consumption of alcohol at a level below 46g a day in men and 23g a day in women appears to minimize the risks of mortality and cancer in the Japanese population. On the other hand, the obesity rate is low and being underweight is common both in men and women. Proportions of cancer attributable to a body mass index of 25 or more are only 0.5% in men and 1.1% in women. Given that many previous studies in Japanese and Asian populations have associated a low body mass index with an increased risk of cancer, the impact of being underweight-not only obese-may warrant further investigation. © 2012 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd. Source

Inoue M.,Research Center for Cancer Prevention and Screening
Journal of Epidemiology

In Japan, cancer has long been recognized as a major component of the overall pattern of disease. Currently, there is a need to implement practical control measures with specific numerical targets appropriate for the Japanese population. Using data from the Japan Public Health Center-based Prospective Study, the author estimated the impact of major risk factors on overall cancer risk among a Japanese population. These risk factors included tobacco smoking, alcohol drinking, body mass index, history of diabetes, physical activity, and metabolic factors and their aggregates. The results show that tobacco smoking and heavy alcohol drinking were significantly positively associated with overall cancer risk, and that total physical activity was significantly inversely associated with the risk of cancer. Although people with a history of diabetes may be at increased risk of cancer, extreme body mass index and metabolic factors in the aggregate had little impact on overall cancer risk in the Japanese population. Copyright © 2010 by the Japan Epidemiological Association. Source

Tsugane S.,Research Center for Cancer Prevention and Screening | Inoue M.,Research Center for Cancer Prevention and Screening
Cancer Science

Over the last 60 years, Japanese people have experienced a rapid and drastic change in lifestyle, including diet. Suspicions have been raised that so-called 'Westernization', characterized by a high-calorie diet and physical inactivity, is associated with increasing trends in the incidence of cancer of the colon, liver, pancreas, prostate, and breast, as well as type 2 diabetes. Epidemiological evidence from our prospective study, the Japan Public Health Center-based Prospective (JPHC) study, and systematic literature reviews generally support the idea that factors related to diabetes or insulin resistance are associated with an increased risk of colon (mostly in men), liver, and pancreatic cancers. These cancers are inversely associated with physical activity and coffee consumption, which are known to decrease the risk of type 2 diabetes. The suggested mechanism of these effects is that insulin resistance and the resulting chronic hyperinsulinemia and increase in bioavailable insulin-like growth factor 1 (IGF1) stimulate tumor growth. In contrast, associations with diabetes are less clear for cancer of the colon in women, and breast and prostate, which are known to be related to sex hormones. The effect of insulin resistance or body fat on sex-hormone production and bioavailability may modify their carcinogenic effect differently from cancers of the colon in men, and liver and pancreas. In conclusion, there is substantial evidence to show that cancers of the colon, liver, and pancreas are associated with insulin resistance, and that these cancers can be prevented by increasing physical activity, and possibly coffee consumption. © 2010 Japanese Cancer Association. Source

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