Site Distribution Of Cancer Research Articles

Crohn's disease-related versus sporadic colorectal cancer: A stage-matched case-control study based on four decades of experience.

This study compares surgical and oncological outcomes in patients with Crohn's disease (CD)-related colorectal cancer (CRC) to those with sporadic CRC. Patients treated between 1983 and 2013 were matched by stage, age, gender, American Society of Anesthesiologists (ASA), cancer site, and adjuvant chemotherapy. For stages I and II, 107 patients were matched (58.9% male, mean age 59 years, 59.8% with ASA score 3). Tumor sites included the right (17.7%), transverse (4.7%), left colon (15.9%), and rectum (61.7%). CD patients exhibited longer operative times, higher pT stages, and 2.60 times the odds of postoperative complications (p = 0.03). Overall and disease-free survival were similar. For stage III, 54 patients were matched (57.4% male, mean age 54 years, 46.3% with ASA score 3). The cancer site distribution was right (29.7%), transverse (3.7%), left colon (18.5%), and rectum (48.1%). CD patients had longer operative times, increased blood loss, more involved lymph nodes, higher pT- and pN-stages. The rates of postoperative complications were not different (p = 0.19). CD-related CRC patients had similar overall (p = 0.06), and local recurrence-free survival (p = 0.07). Despite facing worse perioperative and pathological characteristics, survival differences in stages I-III CD-related CRC compared with sporadic CRC patients were not significantly different.

EPRO-based digital symptom monitoring in a community oncology practice to reduce emergency room and inpatient utilization.

1508 Background: We have previously reported on the successful implementation of an electronic patient-reported outcomes (ePRO)-based symptom monitoring tool in a community oncology practice. Basch et al reported that use of such a tool in the academic trial setting reduced ER visits and hospitalizations. We have examined the impact of the tool on ER and inpatient utilization in this real world patient population. Methods: Highlands Oncology Group (HOG) is a 21 physician oncology group located in Northwest Arkansas. Beginning in June 2020, HOG offered patients receiving parenteral cancer therapy enrollment onto Expain, an EMR-integrated ePRO system which enables remote symptom monitoring during therapy. EMR data were linked with the Arkansas State Health Alliance for Records Exchange (SHARE), the state’s Health Information Exchange (HIE), to obtain ER visits/hospitalization data. All patients at HOG treated between September 30, 2020 and November 30, 2021 were included in this analysis. Clinical and demographic characteristics were compared in patients who enrolled on Expain versus those who did not, and corresponding p-values were calculated using Mann-Whitney and Chi-square tests. Crude rates for ER visits / hospitalizations were calculated as the total number of events per total person-time. Results: There were 855 patients enrolled on the ePRO system. Concurrently, in the same practice, 1773 patients were treated but not enrolled. Reasons for non-enrollment included patient’s choice to not participate and patient not yet offered enrollment due to rolling enrollment. The non-ePRO cohort was slightly older (66.7 vs 63.3 yrs, p <.001), more commonly male (47.3% vs 39.3%, p <.001) and less likely to be White (85.3% vs 89.4%, p = 0.003). The cohorts were comparable with respect to cancer site distribution and included a diverse and representative distribution of common malignancies receiving systemic therapy in a community practice. The proportion of patients with metastatic disease was comparable (ePRO 52.9% vs non-ePRO 51.6%, p = 0.55). Health resource utilization rates were lower for patients in the ePRO cohort: ER visits: 1.72 vs 2.34 per 100 patient-months, rate ratio and 95% CI = 0.74 (0.60, 0.92), p-value = 0.005; hospitalizations: 4.76 vs 5.41 per 100 patient-months, rate ratio and 95% CI = 0.87 (0.77, 0.99), p-value = 0.04. Conclusions: Our findings confirm the substantial benefits of using an ePRO tool in reducing health care resource utilization, and extend the initial findings of previous publications in the academic, clinical trial setting to the real world setting. This observational data is subject to confounding factors and we are evaluating the robustness using various methods to address non-comparability of the cohorts. We are further examining the benefits in specific patient subsets and attempting to correlate these benefits with improved survival.

The histopathological evaluation based on the indocyanine green fluorescence imaging of regional lymph node metastasis of splenic flexural colon cancer by near-infrared observation.

The purpose of this study was to investigate the relationship between the fluorescence on indocyanine green fluorescent imaging (ICG-FI) and the histopathological findings of regional lymph node (LN) metastasis of splenic flexural colon cancer. From July 2013 to December 2018, consecutive patients with splenic flexural colon cancer with a preoperative diagnosis of N0 who underwent laparoscopic surgery were enrolled. The distribution of cancer sites in metastatic LNs (completely/not completely occupied by metastatic foci) was evaluated with hematoxylin and eosin-stained preparations. We compared the relationship between the distribution of cancer site and fluorescence of paraffin block in metastatic LNs. Seventy-two patients were enrolled, of whom 13 (18.1%) had metastatic LNs. A total of 25 metastatic LNs were evaluated. The median short axis of the occupied LNs was 4.5 mm, which was significantly larger than that of the non-occupied LNs (3.0 mm; p = 0.036). In the near-infrared observation of the paraffin block, the completely occupied LNs showed no fluorescence, regardless of the LN size, but 8 of 10 non-occupied LNs showed fluorescence (p < 0.001). Even the non-occupied LNs that showed fluorescence, the cancer site did not show fluorescence. The occupied LNs showed no fluorescence, but 80% of the non-occupied LNs showed fluorescence. Even in non-occupied LNs that showed fluorescence, the cancer site did not show fluorescence. This demonstrated LN dissection should not be omitted, even if no fluorescence is noted on intraoperative ICG-FI.

Cancer site distribution in district hospital in central India.

e13627 Background: Many state governments have started district cancer care program to offer cancer services in district general hospitals. These places are most frequented by every level of population. The access is free, close to their residence and has an equitable atmosphere. The program created de-facto registry of local cancer patients. We, here analyze trends of various types of cancer in one such hospital of central India. Methods: All patients reporting to this unit for various support in cancer are registered with unique id. The registry takes their local residential details and details of the medical history related to cancer. They are offered support all through their journey of cancer from diagnostics to end of life care, palliative care. Data of 2014-2019 are analysed from District Ujjain in central India. Results: Total of 3562 patients were registered with proven diagnosis of cancer. There were 1805 male (50.7%) and 1757 females (49.3%.In female group age varied between 2to 97 years, with a mean of 51.41 and median age of 50 years. In male group,the age ranged between 1 to 92, with mean age of 53.46 and median of 55 years. The five commonest cancer amongst female included breast, head and neck, ovary, cervix and lung. In males the commonest five were-Head and neck, lung, prostate, oesophagus and colo-rectal (Table). The group of head and neck cancer include all sites of the head and neck area together. Conclusions: The pattern of cancer in districts is giving new geopathological information. It is clear that tobacco related cancer predominates in male and female both, but breast cancer is number one even in a relatively rural area. In female ovary is increasing and cervix is coming down compared to national data.In view of governments putting in extensive pressure on early detection schemes in India,this data is extremely important. Based on these realistic data, the strategy may be changed for the district. [Table: see text]

Use of a case-mix approach to study the trends in the incidence of second primary cancers

PurposeTo analyze trends in second primary cancer (SPC) incidence by using a case-mix approach to standardize on first cancer site distribution. MethodsCases registered by 13 French cancer registries between 1989 and 2010 and followed-up until June 2013 were included. The person-year approach was used to compute standardized incidence ratios (SIRs) of metachronous SPC. Usual SIRs and cancer site–specific weighted SIRs called “case-mix SIRs” (cmSIRs) were estimated by sex and calendar period of first cancer diagnosis. Calendar trends in SIRs and cmSIRs were compared. ResultsMore than 2.9 million person-years at risk were included. Among males, SIRs dropped from 1.49 to 1.23 between 1989–1994 and 2005–2010, while cmSIRs decreased from 1.40 to 1.27. This difference seems mainly related to a stronger representation of prostate cancers (at lower risk of SPC) and a weaker contribution of bladder and head and neck cancers (at higher risk of SPC) in recent periods of diagnosis. Among females, both SIRs and cmSIRs have remained stable at around 1.22 and 1.21, respectively. ConclusionsThe cmSIR is an indicator that is not influenced by changes in first cancer site distribution. Its use should be encouraged to assess second cancer incidence control.

Associations Between Sexual Orientation and Overall and Site-Specific Diagnosis of Cancer: Evidence From Two National Patient Surveys in England.

PurposeTo address gaps in evidence on the risk of cancer in people from sexual minorities.Patients and MethodsWe used data from 796,594 population-based English General Practice Patient Survey responders to explore the prevalence of self-reported diagnoses of cancer in the last 5 years among sexual minorities compared with heterosexual women and men. We analyzed data from 249,010 hospital-based English Cancer Patient Experience Survey responders with sexual orientation as a binary outcome, and International Classification of Diseases, Tenth, Revision, diagnosis as covariate—38 different common and rarer cancers, with breast and prostate cancer as baseline categories for women and men, respectively—to examine whether people from sexual minorities are over- or under-represented among different cancer sites. For both analyses, we used logistic regression, stratified by sex and adjusted for age.ResultsA diagnosis of cancer in the past 5 years was more commonly reported by male General Practice Patient Survey responders who endorsed gay or bisexual orientation compared with heterosexual men (odds ratio [OR], 1.31; 95% CI, 1.15 to 1.49; P < .001) without evidence of a difference between lesbian or bisexual compared with heterosexual women (OR, 1.14; 95% CI, 0.94 to 1.37; P = .19). For most common and rarer cancer sites (30 of 33 in women, 28 of 32 in men), the odds of specific cancer site diagnosis among Cancer Patient Experience Survey respondents seemed to be independent of sexual orientation; however, there were notable differences in infection-related (HIV and human papillomavirus [HPV]) cancers. Gay or bisexual men were over-represented among men with Kaposi’s sarcoma (OR, 48.2; 95% CI, 22.0 to 105.6), anal (OR, 15.5; 95% CI, 11.0 to 21.9), and penile cancer (OR, 1.8; 95% CI, 0.9 to 3.7). Lesbian or bisexual women were over-represented among women with oropharyngeal cancer (OR, 3.2; 95% CI, 1.7 to 6.0).ConclusionLarge-scale evidence indicates that the distribution of cancer sites does not vary substantially by sexual orientation, with the exception of some HPV- and HIV-associated cancers. These findings highlight the importance of HPV vaccination in heterosexual and sexual minority populations.

Interval cancers in a national colorectal cancer screening programme.

Little is known about interval cancers (ICs) in colorectal cancer (CRC) screening. The purpose of this study was to identify IC characteristics and compare these with screen-detected cancers (SCs) and cancers in non-participants (NPCs) over the same time period. This was an observational study done in the first round of the Scottish Bowel Screening Programme. All individuals (772,790), aged 50-74 years, invited to participate between 1 January 2007 and 31 May 2009 were studied by linking their screening records with confirmed CRC records in the Scottish Cancer Registry (SCR). Characteristics of SC, IC and NPC were determined. There were 555 SCs, 502 ICs and 922 NPCs. SCs were at an earlier stage than ICs and NPCs (33.9% Dukes' A as against 18.7% in IC and 11.3% in NPC), screening preferentially detected cancers in males (64.7% as against 52.8% in IC and 59.7% in NPC): this was independent of a different cancer site distribution in males and females. SC in the colon were less advanced than IC, but not in the rectum. ICs account for 47.5% of the CRCs in the screened population, indicating approximately 50% screening test sensitivity: guaiac faecal occult blood testing (gFOBT) sensitivity is less for women than for men and gFOBT screening may not be effective for rectal cancer.

Involving clinic patients in systematic symptom reporting to improve cancer care: Exploring prevalence of sleep disturbances (SD) and fatigue (FAT).

68 Background: SD and FAT occur in 30-50% of cancer patients. Patient-reported outcome measure surveys are avenues through which healthcare providers (HCP) can receive symptom-related clinically relevant information directly from patients, and engage them in their own care plan. By asking patients to report symptoms rapidly through tablet/computer-based technology, HCPs can involve patients in the delivery of care. Methods: In a pilot study evaluating utility of systematic symptom reporting, 336 adult cancer patients across all stages and disease sites who were attending outpatient cancer clinics at Princess Margaret Cancer Centre (PMCC) (Toronto, Canada) completed electronic tablet-administered secure surveys on SD (Insomnia Severity Index) and FAT patterns (FACT-fatigue). These tools measured both symptom severity and interference with function. Results: With a median age of 59 (19-91) years, 55% female, across a broad distribution of cancer sites, 56% of our sample reported moderate to very severe (MTVS) SD over the last 7 days: 31% had MTVS difficulty falling asleep; 43% had MTVS difficulties staying asleep; 36% had MTVS problems waking up too early. While 62% who had MTVS SD were not distressed by their SD, 95% who were distressed by their SD met the criteria of MTVS SD. 78% of patients had any level of FAT over the last 7 days, with 40% reporting MTVS FAT. While 40% who had MTVS FAT were still able to perform their usual activities, 67% of patients who were not able to do their usual activities had MTVS FAT. Conclusions: Across all stages and disease sites of cancer patients at PMCC, the prevalence of SD and FAT was both high. Severity and interference with function by FAT and SD were often distinct and non-overlapping. Involving patients in the systematic evaluation of symptoms, particularly using newer tablet-based technology within the clinic, was feasible. Through the use of patient reported electronic applications, patients could easily and systemically report their symptoms in real-time. FAT management has always been a high priority at our institution. However, based on our results, a cancer center-wide self-management plan is being considered for SD.

Fundamentals of cancer epidemiology – 2nd edition

Recognizing the increasing cancer burden worldwide, Nasca & Pastides provide a basic understanding of cancer epidemiology, with a particular focus on cancer biology, gene–environment associations in the cancer etiology and major risk factors for cancer. The intended readers are students in public health schools and related medical and para-medical fields as well as those working in cancer control on a regional, national and international level. Since, according to the authors, there is no textbook dealing with cancer epidemiology for first-time students, this book aims to be such a textbook for those with basic knowledge in epidemiology. Nasca & Pastides begin by emphasizing the importance of describing the cancer burden and trends using appropriate measures. Then they explain what cancer is and how it can be diagnosed and categorized using different cancer classification schemes (e.g staging, coding). Chapters 3–7 contribute to the methodological and technical knowledge on cell biology and on study types, which are of particular relevance for investigating carcinogenicity, biomarkers and genetic risk factors. Among them are experimental studies, molecular–epidemiological studies, studies on gene–environment interactions and genetic epidemiology studies. The subsequent chapters (8–16) describe risk factors for cancer in a detailed and comprehensive way. Not only are classic lifestyle and well known risk factors such as tobacco, alcohol, diet and occupational hazards considered but also genetic factors, ionization and radiation, infections, immunological factors and hormones. Possible dose–response relationships are addressed and figures and illustrations help to understand the etiology and terminology. The chapters on risk factors are internally structured in different ways, some by cancer sites, others by the particular factors associated with the increased risks, taking into account the different study types that address these associations. One whole chapter is dedicated to the risk factors for and occurrence of childhood cancers and points out the need for the life–course perspective in cancer research. This chapter was newly added into this second edition. The last section gives an introduction to cancer screening as a method for early detection using certain cancers as examples to demonstrate different screening concepts. Although the chapter on infectious agents and occupational carcinogens addresses the disproportionate geographical burden between high- and low-income countries, not much information in general is provided on geographical differences in cancer burden and survival. Using “descriptive epidemiology” as a chapter heading, one would expect more technical information on what this is. The book makes us aware of the need to take care in interpreting comparisons, trends and data on cancer occurrence; however, it does not state how to carefully interpret these statistics. The authors use tables and figures that aid in understanding the burden of cancer and distribution of cancer sites as well as the categorization within different cancer classification schemes. Several illustrations are used to make etiology and biology of cancer understandable also to non-medical professionals. The appendix provides a detailed glossary with a particular focus on biological and medical terminology, a feature that is usually available in reference books used by medical students. Appendix B lists web sites without indicating the kind of information they could provide to the reader. A more helpful table for major cancer web resources is available on page 3. Every chapter ends with a summary and discussion questions. However, it would be helpful to provide specific answers to these questions in the appendix, which would make an improvement to the relatively ineffectual appendices. The book is an important reference book for students, whether beginners or post-graduate students. It is written in a clear language, is well ordered and accurate. Nevertheless, several cancer epidemiology textbooks are already available from IARC (International Agency for Research on Cancer). Thus the main strength of this book is its strong biological and medical basis as well as the up-to-date reference to the continuum of genetics and biomarkers in cancer epidemiology. Although health policy-makers are not the priority audience, and few words are said on cancer control activities, an introduction in this field would significantly add to Fundamentals of cancer epidemiology. ■

Current status of gynecologic cancer in Japan

To make an overview of the current status of gynecologic cancer in Japan, we reviewed the recent incidence of cervical, endometrial, and ovarian cancer in Japanese women. The incidence of all three cancers has increased, but trends differ respectively. In age specific cancer site distribution data, the uterus and ovary are leading sites of high incidence among Japanese women younger than 40 years of age. Therefore, fertility sparing cancer treatment has received much attention. Several multicenter clinical trials have been done by Japanese groups, and some excellent evidence has been collected for endometrial and ovarian cancer. A promising international collaboration trial for ovarian clear cell carcinoma is also underway at the present time.

Colorectal cancer in hereditary breast cancer kindreds.

This study compared characteristics of colorectal cancer between families with dominant breast cancer inheritance and the general population. The cumulative incidence of colorectal cancer was also studied in genetically determined breast cancer syndrome subjects with BRCA1 and BRCA2 mutations and compared with the general population. Subjects included 42 patients with colorectal cancer from 32 clinically determined hereditary breast cancer kindreds based on the autosomal dominant inheritance of breast cancers and early age of onset. The general population colorectal cancer cohort was composed of 755 patients from a tumor registry. Lifetime risk of colorectal cancer was determined in 164 BRCA1 and 88 BRCA2 gene mutation carriers and compared with the general population. Mean age of colorectal cancer onset, anatomic site distribution, histologic stage at presentation, and five year stage-stratified survival rates were compared between clinically determined hereditary breast cancer family members and the general population. The lifetime risk of colorectal cancer in male BRCA1 and BRCA2 mutation carriers was 5.6 percent, which was not different from 6 percent in males from the general population. Likewise, the lifetime colorectal cancer risk in female BRCA1 and BRCA2 mutation carriers was 3.2 percent, which was not different from 5.9 percent in females from the general population. Mean age of onset +/- standard error for patients with colorectal cancer was 60 +/- 2 years for hereditary breast cancer kindreds compared with 67 +/- 0.4 years for the general population (P = 0.0004). Colorectal cancer site distribution did not vary between hereditary breast cancer and the general population. Overall colorectal cancer stage distribution was significantly different, with more Stage I and fewer Stage IV cancers in subjects with hereditary breast cancer compared with the general population (P = 0.01). Overall five year stage-stratified colorectal cancer survival rate +/- standard error was 66 +/- 8 percent for hereditary breast cancer kindreds and 46 +/- 2 percent for the general population (P = 0.023). Lifetime cumulative colorectal cancer incidence in subjects with BRCA1 and BRCA2 gene mutations was not different from the general population. However, significant differences in colorectal cancer were noted between hereditary breast cancer family members and the general population. Hereditary breast cancer-associated colorectal cancer had an earlier age of onset, lower tumor stage, and better survival rate than the general population. Except for age of onset, colorectal cancer in hereditary breast cancer kindreds exhibited more favorable characteristics than colorectal cancer in the general population.

Second Malignancies in Patients With Hairy Cell Leukemia in British Columbia: A 20-Year Experience

AbstractThe purpose of this study was to compare the relative risk of second malignancies in a cohort of patients with hairy cell leukemia (HCL) against the normal population. Potential effects of type of treatment and duration of follow-up and the site distribution of cancer were also examined. Between 1976 and 1996, 117 patients were diagnosed with HCL in British Columbia who were referred to the British Columbia Cancer Agency (BCCA) for treatment. All additional malignancies were traced using a provincial population-based cancer registry and follow-up records from the BCCA. There were 90 men and 27 women. Median age at diagnosis was 53 years. The median follow-up time was 68 months. Twenty-three patients underwent primary splenectomy, 65 received interferon alpha, 24 deoxycoformycin, and 67 cladribine (2-chlorodeoxyadenosine). Thirty-six patients had an additional malignancy (30.7%) with a total of 44 tumors. Six patients (5.1%) had two or more malignancies. Twenty-five patients had malignancies diagnosed after HCL (21.3%), three concurrent with HCL (2.6%), and 12 preceding HCL (10.2%). Second tumors (n = 28 tumors) occurred at a median of 40 months after HCL (range, 3 to 167). The relative rate (RR) of second malignancy among men and women was 2.91 (P < .001) and 1.65 (P = .23), respectively, compared with age and secular trend-matched controls. There were eight prostate cancers, nine nonmelanoma skin cancers, two lung cancers, and four gastrointestinal adenocarcinomas. The RR (90% confidence interval [CI]) in the various treatment groups were: splenectomy (RR = 0.21 to 3.81), purine analogues (RR = 0.60 to 5.69), interferon then purine analogues (RR = 1.60 to 4.31), interferon alone (RR = 1.57 to 8.40). Cancer risk peaked at 2 years after HCL (RR = 4.13) and fell steadily afterwards, reaching a RR of 1.82 at 6 years. Twenty patients died, six due to HCL, 10 due to second malignancies, and four of unrelated causes. HCL patients appear to be inherently prone to malignancies. This appears to be more related to HCL tumor burden than to genetic predisposition or treatment effect. RR tends to fall with time after effective treatment. However, close monitoring for and vigorous prevention of cancer in HCL patients is advisable.© 1998 by The American Society of Hematology.

Second Malignancies in Patients With Hairy Cell Leukemia in British Columbia: A 20-Year Experience

The purpose of this study was to compare the relative risk of second malignancies in a cohort of patients with hairy cell leukemia (HCL) against the normal population. Potential effects of type of treatment and duration of follow-up and the site distribution of cancer were also examined. Between 1976 and 1996, 117 patients were diagnosed with HCL in British Columbia who were referred to the British Columbia Cancer Agency (BCCA) for treatment. All additional malignancies were traced using a provincial population-based cancer registry and follow-up records from the BCCA. There were 90 men and 27 women. Median age at diagnosis was 53 years. The median follow-up time was 68 months. Twenty-three patients underwent primary splenectomy, 65 received interferon alpha, 24 deoxycoformycin, and 67 cladribine (2-chlorodeoxyadenosine). Thirty-six patients had an additional malignancy (30.7%) with a total of 44 tumors. Six patients (5.1%) had two or more malignancies. Twenty-five patients had malignancies diagnosed after HCL (21.3%), three concurrent with HCL (2.6%), and 12 preceding HCL (10.2%). Second tumors (n = 28 tumors) occurred at a median of 40 months after HCL (range, 3 to 167). The relative rate (RR) of second malignancy among men and women was 2.91 (P &lt; .001) and 1.65 (P = .23), respectively, compared with age and secular trend-matched controls. There were eight prostate cancers, nine nonmelanoma skin cancers, two lung cancers, and four gastrointestinal adenocarcinomas. The RR (90% confidence interval [CI]) in the various treatment groups were: splenectomy (RR = 0.21 to 3.81), purine analogues (RR = 0.60 to 5.69), interferon then purine analogues (RR = 1.60 to 4.31), interferon alone (RR = 1.57 to 8.40). Cancer risk peaked at 2 years after HCL (RR = 4.13) and fell steadily afterwards, reaching a RR of 1.82 at 6 years. Twenty patients died, six due to HCL, 10 due to second malignancies, and four of unrelated causes. HCL patients appear to be inherently prone to malignancies. This appears to be more related to HCL tumor burden than to genetic predisposition or treatment effect. RR tends to fall with time after effective treatment. However, close monitoring for and vigorous prevention of cancer in HCL patients is advisable. © 1998 by The American Society of Hematology.

Bloom's syndrome. XX. The first 100 cancers

As of 1996 the 100th cancer was diagnosed in Bloom's syndrome. The cancers have been regularly documented since 1960 in a program of surveillance referred to as the Bloom's Syndrome Registry. Tabulated here are their types and ages of onset. The 100 cancers arose in 71 of the 168 registered individuals. Represented in Bloom's syndrome are both the cancers that commonly affect the general population and the rare tumors of early childhood. This body of information has become sufficiently large to be useful to geneticists and physicians in advising affected families concerning cancer risk. Of more general significance, however, the distribution of cancer sites and types sets Bloom's syndrome apart from other cancer-predisposing genetically determined conditions, affirming its experimental value as a model for analyzing the nonenvironmental component in the etiology of the generality of human cancer.

A note on the distribution of cancer in some endogamous groups in Western India.

Endogamous groups in Western India have been known to have a wide degree of genetic diversity. Analysis of the data available on some of the endogamous groups belonging to two main communities attending the Tata Memorial Hospital, Bombay, viz. Hindus from Maharashtra, and Hindus from Gujarat show that one of the endogamous groups, the Maharashtrian Brahmin has a significantly different pattern of cancer site distribution compared to the other groups studied. Maharashtrian Brahmins have a low relative frequency of cancer of the oral cavity and high relative frequencies of cancer of the oropharynx and cancer of the oesophagus. The tobacco chewing habit pattern seems to have a bearing on the proportion of cancer of the oral cavity observed in the groups studied. However, in the case of cancer of the oropharynx and cancer of the oesophagus, factors besides smoking and chewing habits seem to be playing a role. A further study is indicated to clarify the points raised by the study.