Stomach cancer (cancer epidemiology and prevention, second edition)Nomura AM
One outstanding feature of stomach cancer has been the remarkable decline in its mortality rate, worldwide, over the past 50 years or so (Haenszel, 1958; Kurihara et al 1984), In 1930 it was the leading cause of death due to cancer in the United States (American Cancer Society, 1995). since then, the U.S. mortality rate for stomach cancer has decreased to about one-fifth of its earlier rate. These data provide encouragement that a similar reduction is achievable for other cancers and support the view that environmental causes play a major role in the occurrence of gastric cancer.
Cancer Epidemiology and Prevention. 1996;707-24 PMID: None
Serum cholesterol and mortality among Japanese-American men. The Honolulu (Hawaii) Heart ProgramStemmermann GN, Chyou PH, Kagan A, Nomura AM, Yano K
Hawaiian men of Japanese ancestry followed up for 18 or more years after a baseline examination showed a quadratic distribution of death rates at different levels of serum cholesterol. Mortality from cancer progressively decreased and mortality from coronary heart disease progressively increased with rising levels of serum cholesterol. There was a positive association between baseline serum cholesterol levels and deaths from coronary heart disease at 0 to 6 years, 7 to 12 years, and 13 years and longer after examination. The inverse relationship between cancer and serum cholesterol levels was stronger in the first 6 years than in the next 6 years and, although still inverse, lost statistical significance after 13 years. Cancers of the colon and lung showed the strongest association with low baseline serum cholesterol levels, while gastric or rectal cancer failed to show this association. Organ specificity and persistence of the inverse association beyond 6 years suggest that the nutritional demands of cancers may not entirely explain the inverse association with some cancers. The quadratic distribution of deaths in this cohort remained after coronary heart disease, stroke, and cancer were removed from the analysis. For the entire period of observation, the lowest mortalities were found in men with serum cholesterol levels between 4.65 and 6.18 mmol/L (between 180 and 239 mg/dL). Manipulation of serum cholesterol levels below this level would not be desirable if this were to result in increased risk of death from cancer or other disease. This study does not rule out this possibility.
Arch Intern Med. 1991 May;151(5):969-72. PMID: 2025146
Late mortality after partial gastrectomyStemmermann GN, Heilbrun LK, Nomura AM, Rhoads GG, Glober GA
A 10-year prospective study of Hawaii Japanese males with partial gastrectomy shows that the age-adjusted mortality rates in men with partial gastrectomy were slightly higher than in those with an intact stomach, but the difference failed to achieve statistical significance. This excess of mortality is due, in part, to excess smoking by men who had ulcers of the stomach. Although death due to stroke and lung cancer showed the most substantial deviations from the base population, this can be attributed only in part to the tendency of men with these diseases to be smokers. Other factors, possibly related to nutrition, also contribute to the increased risk of mortality from these diseases. Death from coronary heart disease, an illness with a substantial association with smoking in men with an intact stomach was less frequent in men with gastrectomy but the difference was not statistically significant. It would appear that men with partial gastrectomy had other characteristics that weakened the impact of smoking upon coronary disease risk--low blood pressure, low serum cholesterol, low body weight and increased alcohol consumption.
Int J Epidemiol. 1984 Sep;13(3):299-303. PMID: 6490300
Serum cholesterol and mortality in a Japanese-American population: the Honolulu Heart programKagan A, McGee DL, Yano K, Rhoads GG, Nomura AM.
The authors have examined the relation of baseline serum cholesterol level to subsequent 9-year mortality in a cohort of Japanese-American men. The baseline serum cholesterol level was positively related to coronary heart disease mortality. It was inversely related to total cancer mortality and to mortality from cancers of the esophagus, colon, liver and lung and to malignancies of the lymphatic and hematopoietic system. When mortality in the first two years after examination was removed from consideration in an attempt to allow for existing clinical or subclinical disease, the inverse relation to cancer persisted but was statistically significant only for colon cancer and lung cancer among the common sites as well as for malignancies of the lymphatic and hematopoietic system. When known prevalence cases of cancer were eliminated from the computation, the inverse relation between cholesterol level and cancer mortality persisted significantly only for colon among the common cancer sites. The relation of baseline serum cholesterol level to total mortality in this cohort was quadratic; that is, there was an excess of deaths associated with serum cholesterol level at the high end of the distribution (mainly due to coronary heart disease) and at the low end (mainly due to cancer).
Am J Epidemiol. 1981 Jul;114(1):11-20. PMID: 7246518