Shanghai Cancer Research Articles

The carcinogenic potential of extractable organic matter from urban airborne particles in Shanghai, China

The genotoxicity of extractable organic matter (EOM) from airborne particles in Shanghai has been determined using short-term bioassays. EOM samples were investigated using cell morphological transformation and two-stage model of mouse skin tumorigenicity assays to detect their carcinogenic activity. DNA adducts were detected using the 32 P -postlabeling technique. The results showed that EOMs induced cell morphological transformation and played a role in tumor-initiating carcinogenesis. The EOMs of airborne particles from different districts of Shanghai had similar carcinogenic activity except the result of sample E (at downtown of Shanghai) was relatively high. The polycyclic aromatic hydrocarbon (PAH) fraction makes a major contribution to carcinogenic activity according to the results of cell morphological transformation assay. DNA adducts were also detected in skin, liver, and kidney of mouse after treatment with EOMs. It is suggested that the urban airborne particles in Shanghai, which show carcinogenic potential and genotoxic activity in our bioassays, may be responsible for the increased incidence of lung cancer in Shanghai in last few years.

Cigarette and alcohol consumption and the risk of colorectal cancer in Shanghai, China.

The relation of cigarette smoking and alcohol drinking to colorectal cancer risk has been inconsistent in the epidemiological literature. In a population-based case-control study of colorectal cancer in Shanghai, China, where the incidence rates are rising sharply, we examined the association with tobacco and alcohol use. Cases were aged 30-74 years and newly diagnosed with cancers of the colon (N = 931) or rectum (N = 874) between 1990 and 1992. Controls (N = 1552) were randomly selected among Shanghai residents, frequency-matched to cases by gender and age. Information on lifetime consumption of tobacco and alcohol, as well as demographic and other risk factors, was obtained through in-person interviews. Associations with cigarette smoking and alcohol use were estimated by odds ratios (ORs) and 95% confidence intervals (CIs). Among women, the prevalence of smoking and alcohol drinking was low, and no significant association with colon or rectal cancer was observed. Although cigarette smoking among men was not related overall to colon or rectal cancer risk, there was a 50% excess risk of rectal cancer (OR 1.5, 95% CI 0.9-2.5) among those who smoked 55 or more pack-years. Among men, former alcohol drinkers had an increased risk of colon cancer (OR 2.3, 95% CI 1.4-3.7) but not rectal cancer, while current drinkers had a 30-50% excess risk of colon cancer only among those with long-term (30+ years) and heavy (>560 g ethanol/week) consumption. The excess risks were mainly associated with hard liquor consumption, with no material difference in risk between proximal and distal colon cancer. Although cigarette smoking and alcohol drinking in general were not risk factors for colorectal cancers in Shanghai, there were small excess risks for rectal cancer among heavy smokers and colon cancer among heavy drinkers.

Prostate cancer, benign prostatic hyperplasia and physical activity in Shanghai, China.

Studies suggest that increased levels of physical activity might decrease the risk of prostate cancer. We ascertained lifetime measures of activity in a population-based case-control study of prostate cancer in Shanghai, China to investigate physical activity in a population where the incidence of prostate cancer is low but rising. In all, 238 men with prostate cancer, diagnosed 1993-1995, were identified through a rapid reporting system. A second group of 206 men with benign prostatic hyperplasia (BPH) was matched to prostate cancer cases, and 471 age-matched and population-based controls were identified from urban Shanghai. Through personal interviews, we ascertained all daily, occupational, and recreational activities at ages 20-29, ages 40-49, and in 1988 to generate hours spent sleeping, sitting, in moderate activity, and in vigorous activity. Time spent per week in different activities was converted to metabolic equivalents (MET-h) and energy expended. Time spent in, MET-h of, and energy expended in physical activities were not consistently related to either prostate cancer or BPH when compared to controls. Few men reported regular vigorous activity. Occupational activity, based on an energy expenditure index using job titles, was suggestively associated with a decreased risk of BPH, but not associated with prostate cancer. Associations did not vary according to age or stage of prostate cancer at diagnosis. Our results, based on regular physical activity, occupational activity, hours in activities, MET-h, and energy expended, did not support a protective role of physical activity in prostate cancer or BPH for men in a low-risk population.

Study on molecular pathology in non-small cell lung cancer in Shanghai

To investigate the molecular pathogenesis of non-small cell lung cancer (NSCLC) in Shanghai. About 200 patients with NSCLC from Shanghai urban residents entered in this study. Oncogenes (C-myc, C-erbB2 and EGFR), tumor suppressor genes (p53 and p15) and some chromosomes instability (3p14, 3p25 and 17p13.3) were determined respectively by DNA slot blot, PCR, PCR-SSCP, and DNA sequences. The rate of co-amplification of oncogenes from 174 cases of NSCLC was significantly higher in stage III(50.6%, 40/79) and II (31.1%, 14/45) than that in stage I (16%, 8/50). Total rate of mutations in p53 gene exons was 49.2%(31/63), while the rate of exon 8 point mutation was the highest. The rate of loss of homozygosity of p15 gene was higher in stage III (61.4%, 43/70) than that in stage I (34.6%, 18/52) (P<0.05). 40%(8/20) of loss of heterozygosity at 17p13.3 and 66.7%(108/162) at 3p14 or 3p25 were observed. The rate of co-deletion on 3p14 and 3p25 of adenocarcinoma was higher than that of squamous cell carcinoma. The results suggest that the features of molecular pathogenesis in this series include: (a) 3p deletion in precancerous lesion; (b) p53 mutation and 17p13.3 deletion in carcinoma in situ; (c) amplification of oncogenes for C-myc, c-erbB2, EGFR and deletion of p15 gene in invasion and metastasis carcinoma of the lung.

Population-based, case-control study of HER2 genetic polymorphism and breast cancer risk.

Background: Alterations of the HER2 (also known as erbB-2 or neu) proto-oncogene have been implicated in the carcinogenesis and prognosis of breast cancer. A polymorphism at codon 655 (GTC/valine to ATC /isoleucine [Val 655 Ile]) in the transmembrane domain-coding region of this gene has been identified and may be associated with the risk of breast cancer. We evaluated this hypothesis in a subgroup of women who participated in a large-scale, population-based, case‐ control study of breast cancer in Shanghai, China. Methods: Genomic DNA from 339 patients with breast cancer and 361 healthy control subjects was examined for the Val 655 Ile polymorphism with a polymerase chain reaction‐restriction fragment-length polymorphism-based assay. All study subjects completed a structured questionnaire during an inperson interview. All P values are from two-sided tests. Results: We found that 25.1% of the case patients and 21.7% of the control subjects were heterozygous for the Val allele and 3.2% of the case patients and 0.3% of the control subjects were homozygous for this allele (P = .005). Compared with women with the Ile/Ile genotype, women who had the Ile/Val or Val/Val genotype had an elevated risk of breast cancer (odds ratio [OR] = 1.4; 95% confidence interval [CI] = 1.0‐ 2.0; P = .05) after adjustment for age, educational level, study period, history of breast fibroadenoma, leisure physical activity, and age at first live birth. The risk was elevated even more among women who were homozygous for the Val allele (OR = 14.1; 95% CI = 1.8‐113.4). The association was more pronounced among younger women ( 45 years). The adjusted OR associated with the Val allele was 1.7 (95% CI = 1.1‐2.6) for younger women and 1.0 (95% CI = 0.5‐1.9) for older women. Conclusions: Results of this study suggest that polymorphisms of the HER2 gene may be important susceptibility biomarkers for breast cancer risk, particularly among younger women. [J Natl Cancer Inst 2000;92:412‐7]

Population-based, case-control study of HER2 genetic polymorphism and breast cancer risk.

Alterations of the HER2 (also known as erbB-2 or neu) proto-oncogene have been implicated in the carcinogenesis and prognosis of breast cancer. A polymorphism at codon 655 (GTC/valine to ATC /isoleucine [Val(655)Ile]) in the transmembrane domain-coding region of this gene has been identified and may be associated with the risk of breast cancer. We evaluated this hypothesis in a subgroup of women who participated in a large-scale, population-based, case-control study of breast cancer in Shanghai, China. Genomic DNA from 339 patients with breast cancer and 361 healthy control subjects was examined for the Val(655)Ile polymorphism with a polymerase chain reaction-restriction fragment-length polymorphism-based assay. All study subjects completed a structured questionnaire during an in-person interview. All P values are from two-sided tests. We found that 25.1% of the case patients and 21.7% of the control subjects were heterozygous for the Val allele and 3.2% of the case patients and 0. 3% of the control subjects were homozygous for this allele (P =.005). Compared with women with the Ile/Ile genotype, women who had the Ile/Val or Val/Val genotype had an elevated risk of breast cancer (odds ratio [OR] = 1.4; 95% confidence interval [CI] = 1.0-2.0; P =. 05) after adjustment for age, educational level, study period, history of breast fibroadenoma, leisure physical activity, and age at first live birth. The risk was elevated even more among women who were homozygous for the Val allele (OR = 14.1; 95% CI = 1.8-113.4). The association was more pronounced among younger women (</=45 years) than among older women (>45 years). The adjusted OR associated with the Val allele was 1.7 (95% CI = 1.1-2.6) for younger women and 1.0 (95% CI = 0.5-1.9) for older women. Results of this study suggest that polymorphisms of the HER2 gene may be important susceptibility biomarkers for breast cancer risk, particularly among younger women.

Mutagenic drinking water and risk of male esophageal cancer: a population-based case-control study.

Drinking mutagenic downstream water from the Huangpu River was hypothesized to have increased the risk for male esophageal cancer in Shanghai, China. The authors conducted a population-based case-control study of a total of 71 esophageal cancer deaths and 1,122 controls collected during a 5-year follow-up period, 1984-1988, from four male cohorts born before January 1, 1944, living in four communities consuming water with different mutagenicities in the Shanghai area. The controls represented a 1% random sample of the defined living cohorts selected at the end of each of the 5 years of follow-up. Logistic regression showed an odds ratio of 2.77 (95% confidence interval: 1.52, 5.03) for drinking mutagenic downstream water from the river versus drinking nonmutagenic upstream water after controlling for possible confounders including age, disease history (hepatitis, cirrhosis, schistosomiasis, digestive tract ulcer), hazardous occupational history, pesticide exposure, lifestyle factors (cigarette smoking, tea intake, and alcohol intake), dietary habits (intake of pickled vegetables, maize, peanuts, and cured meat), education, poverty, urban environment, and water chlorination.

Occupation and pancreatic cancer risk in Shanghai, China.

Any association between occupation and pancreatic cancer risk has not been conclusively demonstrated. A population-based case-control study was conducted to examine occupational risks of pancreatic cancer in Shanghai, China. The study included 451 pancreatic cancer patients newly diagnosed in 1990-1993 and 1,552 controls randomly selected from Shanghai residents. Information on a lifetime job history and other factors was obtained in a face-to-face interview. Among men, an increased risk of pancreatic cancer was associated with employment as an electrician (OR = 7.5, CI = 2.6-21.8), and a positive trend in risk with increasing duration of employment was apparent (P for trend = 0.0003). Exposure to electric magnetic fields (EMF) as measured by a job exposure matrix also was associated with an increased risk among electricians. Threefold risks were observed for men with the highest level of intensity and for those with the highest probability of EMF exposure, although women with heavy EMF exposure did not experience increased risk. Among men, elevated risks also were found for metal workers (OR = 2.1, CI = 1.0-4.8); toolmakers (OR = 3.4, CI = 14-7.1); plumbers and welders (OR = 3.0, CI = 1.2-7.5); and glass manufacturers, potters, painters, and construction workers (OR = 2.6, CI = 1.1-6.3). Among women, textile workers experienced an increased risk (OR = 1.4, CI = 0.8-2.6). Our results suggest that occupations associated with exposures to metal and textile dusts or certain chemicals may increase the risk of pancreatic cancer. The elevated risk among electricians may warrant further study to evaluate the possible role of EMF or other exposures.

Occupation and pancreatic cancer risk in Shanghai, China

Background Any association between occupation and pancreatic cancer risk has not been conclusively demonstrated. A population-based case-control study was conducted to examine occupational risks of pancreatic cancer in Shanghai, China. Methods The study included 451 pancreatic cancer patients newly diagnosed in 1990–1993 and 1,552 controls randomly selected from Shanghai residents. Information on a lifetime job history and other factors was obtained in a face-to-face interview. Results Among men, an increased risk of pancreatic cancer was associated with employment as an electrician (OR > 7.5, CI = 2.6–21.8), and a positive trend in risk with increasing duration of employment was apparent (P for trend > 0.0003). Exposure to electric magnetic fields (EMF) as measured by a job exposure matrix also was associated with an increased risk among electricians. Threefold risks were observed for men with the highest level of intensity and for those with the highest probability of EMF exposure, although women with heavy EMF exposure did not experience increased risk. Among men, elevated risks also were found for metal workers (OR > 2.1, CI > 1.0–4.8); toolmakers (OR > 3.4, CI > 1.4–7.1); plumbers and welders (OR > 3.0, CI > 1.2–7.5); and glass manufacturers, potters, painters, and construction workers (OR > 2.6, CI > 1.1–6.3). Among women, textile workers experienced an increased risk (OR > 1.4, CI > 0.8–2.6). Conclusions Our results suggest that occupations associated with exposures to metal and textile dusts or certain chemicals may increase the risk of pancreatic cancer. The elevated risk among electricians may warrant further study to evaluate the possible role of EMF or other exposures. Am. J. Ind. Med. 35:76–81, 1999. Published 1999 Wiley-Liss, Inc.

Dietary habits and stomach cancer in Shanghai, China.

Stomach cancer remains the second leading cancer in incidence in Shanghai, China, despite its decline over the past 2 decades. To clarify risk factors for this common malignancy, we conducted a population-based case-control study in Shanghai, China. Included in the study were 1,124 stomach cancer patients (age 20-69) newly diagnosed in 1988-1989 and 1,451 controls randomly selected among Shanghai residents. Usual adult dietary intake was assessed using a comprehensive food frequency questionnaire. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression models. Risks of stomach cancer were inversely associated with high consumption of several food groups, including fresh vegetables and fruits, poultry, eggs, plant oil, and some nutrients, such as protein, fat, fiber and antioxidant vitamins. By contrast, risks increased with increasing consumption of dietary carbohydrates, with odds ratios (ORs) of 1.5 (95% confidence interval [CI] 1.1-2.1) and 1.9 (95% CI 1.3-2.9) in the highest quartile of intake among men (p for trend=0.02) and women (p=0.0007), respectively. Similar increases in risk were associated with frequent intake of noodles and bread in both men (p=0.07) and women (p=0.05) after further adjustment for fiber consumption. In addition, elevated risks were associated with frequent consumption of preserved, salty or fried foods, and hot soup/porridge, and with irregular meals, speed eating and binge eating. No major differences in risk were seen according to subsite (cardia vs. non-cardia). Our findings add to the evidence that diet plays a major role in stomach cancer risk and suggest the need for further evaluation of risks associated with carbohydrates and starchy foods as well as the mechanisms involved.

Rising incidence of biliary tract cancers in Shanghai, China.

Cancers of the biliary tract, including cancers of the gallbladder, extra-hepatic bile ducts, and ampulla of Vater, are relatively uncommon malignancies. From 1972 to 1994, biliary tract cancer was the most rapidly rising malignancy in Shanghai, China, with a 119% increase in men and 124% in women. The increase in incidence was seen for all 3 subsites, both sexes, and all age groups. Future studies are needed to identify reasons for the large increases in these rates.

Diet and breast cancer in Shanghai and Tianjin, China

Various aspects of adult diet have been linked to breast cancer development. These include intake of fat (risk factor), and intake of fibre, soy protein and vitamins A, C and E (protective factors). Results of previous studies have been inconsistent. We examined the possible associations between breast cancer and various indices of nutrient and food intake in two Chinese populations who are at relatively low risk for breast cancer (one-fifth the rate in US white women). Two case-control studies of breast cancer were conducted in the cities of Shanghai and Tianjin, China. In Shanghai, 534 women aged 20-69 years with histologically confirmed breast cancer were recruited, whereas in Tianjin 300 women aged 20-55 years with histologically confirmed breast cancer were interviewed. All controls were community controls who were individually matched to the cases by sex and age (case-control ratio = 1:1). All interviews were conducted in person. Findings from the two studies were similar, although the diets in Shanghai and Tianjin were different in many respects. Cases and controls were similar in their consumption of soy protein, measured either in absolute levels or as percentages of total protein. Overall, all components of dietary fat (saturated fat, monounsaturated fat, polyunsaturated fat) showed a modest, non-significant association with breast cancer after adjustment for energy intake and other non-dietary risk factors for breast cancer. Intake of crude fibre, carotene and vitamin C, on the other hand, exhibited strong, statistically significant inverse associations with breast cancer risk. The last three indices were highly correlated, rendering it impossible to disentangle their individual effects; they were closely associated with intake of green vegetables in the two study populations. Vitamin E intake was unrelated to breast cancer risk in Shanghai and Tianjin. In the multivariate logistic regression model which included all non-dietary risk factors for breast cancer and energy intake, Shanghai women in the lowest tertile of crude fibre intake and highest tertile of fat intake had a 2.9-fold increased risk for breast cancer relative to those in the highest tertile of crude fibre intake and lowest tertile of fat intake. The comparable relative risk in Tianjin women was 2.4. Our data indicate a strong protective effect against breast cancer development with intake of foods rich in fibre, vitamin C and carotene. Our results are also compatible with dietary fat having a modest, positive effect on breast cancer risk within the range of exposure experienced by women in China.(ABSTRACT TRUNCATED AT 250 WORDS)

Differences in colorectal cancer between China and Japan

It is well known that most tumours are attributed to life style, especially the tumours of the digestive system. Clinical and histopathological investigation of tumours in different human groups and societies, and analysis of the variations will provide evidence for this, and is one of the approaches to study carcinogens. Clinical data obtained from 391 patients with colorectal cancer at the Sakai Municipal Hospital, Japan, and Shanghai Jinshan Hospital and Cancer Hospital, China, from 1987 to 1992, included the sex, age and tumour subsite. Sections of histological specimens were also retrieved. The results were compared between two countries. The average age of patients with colorectal cancer in Shanghai was 8.5 years less than in the Sakai group. The age peak of the former was 51-60, and in the latter, 61-70 years. The most frequent site of the cancer in the Shanghai group was the rectum, contrasting with the higher percentage of sigmoid colon cancer in Sakai group. There was also a significant difference in histological subtype of the cancer between the two groups. Mucinous adenocarcinoma was notably more common in the Shanghai group than in the Sakai group, and the high frequency was mainly in the colon. All of the variations were suggested to be attributable to differing socioeconomic circumstances and lifestyle, especially the dietary habits of the countries.

Risk factors for esophageal cancer in Shanghai, China. II. Role of diet and nutrients.

A population-based case-control study of esophageal cancer (902 cases, 1,552 controls) in Shanghai, China, investigated the etiologic role of diet. After adjustment for cigarette smoking, alcohol consumption and other risk factors, increasing consumption of fruits, dark orange vegetables and beef or mutton was associated with statistically significant decreasing trends in risk for esophageal cancer. In general, risks were about 40% lower among those in the upper vs. lower quartiles of intake of these foods. Fivefold increases in risk were observed among those who consumed burning hot soup or porridge, with smaller excesses for preserved vegetables, salty and deep fried foods. Nutrient analysis revealed that increased dietary intake of protein, carotene, vitamins C and E and riboflavin was associated with reduced esophageal cancer risk. Our findings support the notion that the reported temporal increases in the per capita consumption of fruits, vegetables and animal products contribute to the substantial reduction in the incidence of esophageal cancer in Shanghai, particularly since cigarette and alcohol use has not decreased.

Risk factors for esophageal cancer in Shanghai, China. I. Role of cigarette smoking and alcohol drinking

A population-based case-control study of esophageal cancer was conducted in urban Shanghai involving interviews with 902 cases and 1,552 controls. Risk of esophageal cancer was increased among tobacco smokers and alcohol drinkers. Odds ratios (OR) for smoking were 2.1 and 1.6 for men and women, respectively, and increased with number of cigarettes smoked per day, duration of smoking, number of pack-years and decreasing age at start of smoking. For men who were current alcohol drinkers OR was 1.4, with the excess risk primarily among heavy drinkers. Few women drank alcoholic beverages. The combined effect of heavy smoking and drinking among men was pronounced: OR was 12.0 for those who smoked more than 1 pack per day and drank more than 750 g of ethanol per week. The relation with smoking appeared stronger for cancers of the middle and lower thirds of the esophagus than for the upper third, while patterns of risk for squamous cell carcinoma and adenocarcinoma were similar. Heavy drinking affected all 3 subsites, with increased risks mainly limited to squamous cell carcinoma. Cigarette smoking and alcohol drinking combined accounted for almost 50% of all esophageal cancers among men in Shanghai; among women, 14% of cases were attributed to smoking. Our study confirms that smoking and drinking are important risk factors for esophageal cancer in China, thereby paralleling findings from developed countries.

Occupation, physical activity, and risk of prostate cancer in Shanghai, People's Republic of China

Based on occupational data for all (n = 264) prostate cancer cases diagnosed during 1980-84 in urban Shanghai and on employment information from the 1982 census, standardized incidence ratios (SIR) were calculated for occupational groups classified by job type and physical activity level. White-collar workers (professionals, government officials, clerical workers, salespersons) had an elevated incidence of prostate cancer, although the excesses were not significant. In addition, when jobs were classified by time spent sitting or energy expenditure, men employed in occupations with low physical activity levels tended to have moderately elevated risks of prostate cancer. Findings from this study in an area with one of the world's lowest incidence rates of prostate cancer add to the accumulating evidence that jobs with a low level of physical activity are associated with an increased prostate-cancer risk.

Risk of male lung cancer attributed to coal combustion indoors in Shanghai : Tao X, Hong C-J, Yu S, Zhu H. School of Public Health, Shanghai Medical University, Shanghai 200032. Public Health Rev 1991;1992; 19:127–34

Lung cancer is now the leading cause of death among all male cancers in Shanghai. Besides the smoking habit, the indoor air pollution from coal combustion may also make some contribution. The purpose of our study is to explore the risk of lung cancer death in male residents who live in coal-using families. Stratified by two extreme levels of ambient sulphur dioxide (SO2) and inhalable particulate (IP) concentrations, 4 areas were chosen in the city proper: Area A (low SO2, low IP); Area B (high SO2, low IP); Area C (low SO2, high IP) and Area D (high SO2, high IP). Within each of these areas, two neighboring residential groups were chosen, one of which uses coal as fuel (group 1), with the other using coal gas or liquified petroleum gas as fuel (group 0). The percentages of smokers and the ambient environment of the two chosen groups within each area are comparable. Total person-years observed is 117,039 from 1 January 1978 to 31 December 1987 for all males in the 8 groups. The mortalities (per 100,000 person-years) of male lung cancer in the 8 groups are as follows: A0-22.33, A1-37.64; B0-27.14, B1-30.72; C0-41.77, C1-54.99; D0-49.97, D1-78.11. The result shows that male lung cancer mortality in the coal-using group is higher than that in the coal-gas-using group within each area. Mantel-Haenszel's Relative Risk (RRMH) of male lung cancer in coal-using groups is 1.44 stratified by ambient SO2 and IP and smoking levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Declining incidence is greater for esophageal than gastric cancer in Shanghai, People's Republic of China

Temporal trends in the incidence of esophageal and gastric cancers during 1972 to 1989 were addressed in urban Shanghai, the location of China's longest standing cancer registry. Over the 18 year study period, esophageal cancer rates decreased more than 50% from 28.8/100,000 person-years in 1972-74 to 13.3/100,000 in 1987-89 among men and from 11.3/100,000 to 5.4/100,000 among women. Reductions were apparent in each age group, but most pronounced among younger generations, with more than a 75% decline in incidence among those under age 55 years. The incidence rate for stomach cancer among men decreased 20% from 62.0/100,000 in 1972-74 to 50.1/100,000 in 1987-89. The reduction among women, however, was minor, from 23.9/100,000 to 23.2/100,000. The patterns varied by age, with declines among persons 45-64 years and increases among those in older and younger age groups. The determinants of these trends are not clear, but appear related in part to dietary changes.

Occupational risks for primary liver cancer in Shanghai, China.

Using occupational data for over 3,400 primary liver cancer cases diagnosed between 1980 and 1984 reported to the Shanghai Cancer Registry, and employment information from the 1982 census for the Shanghai population, standardized incidence ratios were computed to generate leads to occupational risks of liver cancer. Among men, a statistically significant excess number of cases was observed for chemical processors, textile workers, wood workers, blacksmiths and machine-tool operators, and material handlers and dock workers. Increased incidence of liver cancer also was observed among female transport equipment operators. These findings indicate that a number of similar occupations are associated with increased risk of primary liver cancer in western countries and China. Although causal inferences cannot be drawn from these data, our study adds to the limited evidence of the potential role of occupational exposures in liver carcinogenesis.

A Population-based Case-Control Study of Dietary Factors and Endometrial Cancer in Shanghai, People's Republic of China

The relation between diet and endometrial cancer was examined in a population-based case-control study conducted in Shanghai, People's Republic of China, between 1988 and 1990, involving interviews with 268 cases and 268 controls aged 18-74 years. The subjects' usual dietary intake of 63 major foods during the previous 10 years (disregarding any recent changes) was measured by means of a structured quantitative food questionnaire. Although women in the highest quartile of total caloric intake had a 2.1-fold increased risk of endometrial cancer, risk varied according to the source of calories. The highest quartiles of caloric intake from fat and protein were associated with odds ratios of 3.9 and 3.1, respectively, while calories from carbohydrates, the major contributor of total calories in this population, were not related to risk. The association of fat and protein with endometrial cancer risk was confined to foods of animal origin in the diet. After adjustment for age, body mass index (weight (kg)/height (m)2), and number of pregnancies, odds ratios were 3.5 (95% confidence interval (CI) 2.0-6.0) and 3.0 (95% CI 1.7-5.1) for women in the highest quartiles of intake of animal fat and animal protein, respectively. Food group analyses showed a similar pattern, with high consumption of meat, eggs, and fresh fish being associated with elevated risks. After adjustment for total calories, no significant association of risk was found with intake of vegetables or dark green/yellow vegetables, or with estimated carotene intake, although fruit and allium vegetables were associated with some reduction in risk. These results suggest that diets rich in animal fat and animal protein may play an important role in the etiology of endometrial cancer.