Document 6430730

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»«MtWUl*r4*i W » ^ U W 4 i 4 * ^ . ^ « i - ^ ^ ^ * « « * i i i . « . « k — - « . * 4 * . ' i > V . V - . - i ^ A U A ' l X l V x X l
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EPIDEMIOLOGY OF CANCER OF THE PROSTATE
-" \«
ERNHST
L. Wvgpjou Kftv Kmmiitt* MAimcm,
IMAC? P. Wnrnfcm, J*., MI>*
M», ANH
Tliii uody of the efriifriniaJqgy of dancer iif dir prostate w*s bnarri on;; ren«*
ipeciirc iur«d£Mion of 500 jtattaus Willi cfturrr of the pMMAlc mul 400 can.
inolj, a mfeif €f tin? wharfs nf an atTJfebiibl 350 jtadcui wbh |>ftfelfttc omccr,
and M review of die Hrrnn-rc The tkafnrtinhijtfeJcart I* ufdeh this juitly
eotiM net coiili-ibuir it itu? larily of «1&ISCK1 pmtcaife ousctr In Japan AnH ift
hicrrsw anions Jvpane** fitt&rfnrantt fn l!» 1K& f rowweft it» low rate nmtnig
jeiriih »uf« HI ill* Xi& itciirs to lie rebut] w a [nvci' rnteuf ju-osiatfc cancer
Among iiirnifgranufmwi Knium Emiif*. VS. Kc^rat« have* Ipgfcvr JucMwirc
rule thnn Cuiatsinn** Xo AigntJUniu rcbluiMiIiip KHI fmuitl ID xocfotooit«mic
*iatu% tmutlftl xlstm. fertility, surial luWtt, }*re>i<Mis d;*r*tic\ mrtgit, Iidgttl.
hair tJhlrJbudon, or liitoratoiydtiia.
D
•it
xM'in:ntKF,\eri>MT ciMranr'niK t'aos-
(ate Is currently the mono* wost commo« cause of caiircr death jn male* it has not
Wen extensively explored uy epidemiologic
methods. In 1SG5 aloac, 15,913 Aiiicrirni:.* died
from Urn disease, constituting tO/t% ot all
male cancer deatln; in the United States."0
• This report proems die finding* of a wrfrospecttve epidemiologic study or raltfCT Of Uic
prostate, and a review of certain factors cuit*
ceivably associated with the occurrence of tins
disease,
The epidemiologic factors of cancer of the
prostatc .'uw heen eoctonsiiHily rcvicu'rd by
Kii^g ei *l.** In tl»p present review otntiictet,
an clTon \MJ made <o oriiig these demo'
graphic nnd c|ndcjniologicdnu iin-to-datc and
co pj-csciu addition*! etiologic atpecti of ihfc
lancct*.
IKCWSTCCE DATA
(Ticlarge difference fn ilicUcntliKites lieivvcen
Japan and the United Sinter prundayly tairJgiihig.TRe relatively lower monaHty rates
wjjoricd iiom Eastern comjKiml with West*
cm Km-opau c*iuittic« mc aha of interest.
The. low rale in Japan aji]>cai9 lobe limited lo
clinical cancer vince autopsy data show that
"Intent" carcimmti in Japanese is»frequent
as in Caucasian mulct of correspond inj~ ages
(Table I).
Compared with die high incidence rale
among U.S. Xcjpincfe African Negroes seem to
Iiaw a law rate foi cancer of the prostate Accarding to die cutcuTAtion hnscd on the nidiNsbnl raorhMlt\ data, lite agc*adju*ted incldeuce rntc of proymit umccrjw 100,000 v w
6J.I
K'fgi'oc^ IClS in Kiperljinsrin$AAi»ei*lcnn
in
rin Soitdi Afncnns, and 4A
A
!
-*-—
"
-•
*
*
* *"• 5»^gcM
—'* that
•* an
J "
UgandMnsJ*-* l l i e differences
envimnmonta!factoror f&ciorc eoiuribute >»
die l)%2i iiiricleiice of protalic cancer fliuou^
U A KfgixK-s.
CeogrApJitc dislributom Worldwide, cancer
T I i M e is a jKtfilive rortcfalliKl hetweew
of the j>i-osintc ii common in VS. novi-Ciiucn- j w r t a t u * ranrfcr nntt femafe brwist r a n t e r In
wans and exuejnety tinconiMOJi amoi^r xht: 1H couuu-ics, tttgut-aing a rominon ftloh^k
Japmitsc** {KIR, 1% White artifacu s«rh » ike bacl^runiKl for Uu«r fiormuno'ivhiicd cstucciS
ivzihteUiy and cjualk) of medical fadlitie^ <K^. if).1*3
and drain ccriifiraicv iary aiv>niu{ the vorM,
7'iW trmdn imrea^*!. in jjmtfatic cancel
ibe xcc»ra<.y PJ vJial Mathti(& in J.tjwn imcktw HMiii»M(\ h:ur brcti itfjoncd by HH)M t«imtrin in It..- J..-J tKnm^^ (Kift. 3)L Wilbin thl'
tHitti-d htnnv ih<* HRjrlJsiKjy dau mcKcM^
Herilli rirtii»djiii«i * Fj"« Knd Mrm*. XrK 'kail:. >onic »tadtrlMi in Ni>i Yutl. Sutr ;mtf :oi JIIrtmM- in CIoiiiHYiiiiM in itii'iU jraisr1-"" {!•«£
f w € * U M w l A I I t « i ! & # * * » , New Y»tl- K\.
in |M>u **• Nfcj r»-ua CVte-Tfi*. aud Jwr Alnowrbl
Hw^Jtat C«" Srttic-.
CffJl \ i a i \ H 1 J \ he- ji-alth sv*««nt^l H*ilh xmptfKe-ffAt tM HE «h* trifc'^tM I t I fattlt|Uf * lit » W
Jit
1
<f.
/
'
4*
**V-.-
&iiiWi*.'W<l«1pywyf* *••"?."•"
•"•frififiirirjriHft!Fi•• ft—-jjt» Mi'-.-Vi-• -
CAXCI:R or rim P s o m r a
•*-•? , i- - - £ " * j - v - d f r n * - * * . - ^ j . ^ ^ * ' ftA>i . ^ . . r . , .
M
• Wptdar ct al
ifaii, sttdi factor* a* Impmved medical cum
M
ami faster rcco^nitlmi of the disease do
lid permit |irop«r iiucrprclaiiow of $%ht
•M»MSWOin-i
SitiM
<i|jm&e* In mcnnllly and n*orbhHty.
Afwtffem Atttavtyfi the mortality-and **>>$
PWniit
morlvUJity data show diflciinx raici for pros*
. I;!»fc cnncct Recording 10 countries* the irate AMlMll
Twr thU diteftso appears lo be, affected by migratory population Movement*- Thfc IKII been ttW*
KfthttUrii
• •*W,Kj^t
tlimtti Sty Haenisel and Kurlhanft study on Avtkfi
^3
Japanese JnmtEgrtmH hi die U.S." I h e Issei,
or ft-jkgejwi-aimn tmtnfjpnu in the UA, Nt*2*|ttnJ
Iwc an inctcased mommy rate tor prostatic KHtarrt*r
oncer, \ihkh auggesrs ihu iu theft* near home
nn cnvfromnenial fcclor or faciei* which did
uot « M in Japan conulbmed 10 the differ*
ence (Kg. 5), An increased mortality rate for
rauccr of the prostate was also found in Polfih pAtMrf
immigrants lo the United Sulci."
Ml
HaciUztfl's 1961 study showed that the C»1tetfc*h
HaudaulUcd mortality ratio for prostatic canWtlU.S.M}fe
*ftf)H«ft
cel' among; foreign-horn compared wUV. rtsifojyum UJ5. Caucasian males vas 89:100b** CWh
In Ihc forracrgroup, thcIovcU mortality ratios fcttM
3
in percent were for men bant in Poland (79),
Austria (72), Rusria (58), and Italy (M)r The
lower mortality noted for fbrcign*«>ro U.S.
FJC I. Afcc-Adjwteil <taili MUri tanccr «f ilic
Caucasians was conlH-mctl by Newill, who re- t a w in $0 toiintrirt, 1961.
> M *
pro*
tftt
TAwt-K I. PcffceAtasa of Latent GtretnonM «f t h * Pmstatc by A c e
Age group
Cotintiy/hutfiEHr
United Slitfe*
Rich"
- Pafon e l « ! /
(H&49)
50*5>
Kraufctf'
(1951)
AusHa
Cnynor1
(»3S)
Jfejtnn
Kanibc 11
<*/2
&i
(V9)
100.0%
ll/I)
(IO/^T
(12/<«>
17.
(3/12)
U.T
(2</l
(7/39)
31 .8%
(7/22)
40.0%
28.9%
ia.4%
(25/241)
(fl^"3f+)
y.2
(27/2
46.0%
(23/50)
S.-3
Moore"
SO*
<o/&)
42.1
C2/W
70-70
2Q..1
(l2/,iy
S.J
Edward cl *1."
Cl»2-JS)
AnSrevr^
<50-<W
«4ft
(U/7I)
CS4/3I2J
i*-2^
5.1%
(Hi**)
amv
OS***}
20.6%
iW/W)
2X.AJI
{C7/2S1)
22 .«K^
(»/3S)
3S JC*X
(1'^/AJi
0%
•H*'»
IA.2
7.1.7
0
(M/
35.3
^»/t
20.2%
20.5%
(47/229)
amy
(H/*K>
(2I/W1)
(l«i/?3)
(5/W)
TI80430782
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••tJiWl ***,** •••*
m. iWwwl** i • M idti i^n»A *w-^«tC •***•*•• S. fctCny/Vj.
•*«»•»•., * • » * '
A
^^^^M-w^i
t
CUMCK*
i. at
Ati$mt 1971
in the old:
who liftve
ahJ^wn
25r-
20-
^InRlcme:
•VMUtt
l**Q *
*gainrt tH
in ihc R
«!«**«
«>«»»
to. I. Corrclalion between
brain i inter fa vowe* and
limine oiwr i* MM^ KW
4*!C0dA9
***>
OM1
The on
of fcrtiUl!
Amtndfa
hy rate i
than the
eYCMiiarr
WWW
tut* •
«tsv*
.iMn
J.
o
a
J.
10
J.
15
20
JL
«
A6t-ADW$TED DEATH RATS OF BREAST CA
PER lOOiOOO
ao
ported tint in the period 1951-58, the age-ad- gradient relating to ]>ro$iatic eauctr.*1*1"***
justed death rate In New York Cily w.it
J5.3/J0O.000 for nativc-hom and Itf/fOfyGOO
for foreign-bom Caucasians."
SusrecrjisD EIIOLOGIC FACTORS
Religion: Neural reported that Jew» had the
lowest mortality front cancer of the prostate of
Maritelstatus and paternity: Although irrethe three main religious KM**ps in New York futable evidence U lacking, i*ntc sexual or reCity, In the period 1953-^8.* Sctdmnn studied productive activity feu hoen niggc^icd to have
varfitioro of cancer death rates fn New York an association to cancer of the prostata* A
City in rotation to socioeconomic ltatus and study in New York City reported that married
religion* groups jointly.*1 The lover death men ag<*d Bi to 7-J had a higher mortality rate
rate tor the Jewish population was consist- from prostatic cancer than iniinanicd men."
ently found wiihtn the saine socioeconomic From the limited data ai-nihble on cancers of
group (F%. 6),
Ihc male gonial organs hy uwfcd slalti*, die
dcitih
race for married Cnucaifau wen in die
ArclaiJvetylow JVecpiuncy of prostatic canU.S.
also
appear* hfcher than for single men.
cer was also reported by Apt for Jews hi SweJn
the
period
of 1010-51, the ajgNidJlsied
den; among Scandinavian Jews the prostatic
death
rates
ptr
lOOjflOo were IIU) for single
cancer mortality rats coosiiiuicd 4JG% of the
inert,
I&8
lor
married
wen. IX. I for widowed
total cancer mortality, whereas awottg the genmettj
mill
20^
far
divnrtvd
niwi.-1'1-01 Por mmeral Swedish population the corrwpondine;
figure wa* M%£ Israel recorded varying inci- Cancast^iK alone, the imc is fibber nuiong
dence rates forjews from different areas, the >iiij;Ie nun than HWITUII mm. Tla' agesadrate* per IttMW) weie 1.9 for jews originatroj; justed dndi i.ttrt fjcr lfWr0(Kt In flic: s:mn- pe
Jn .Africa, r O for fctropean Jews, J f.S for Hod vere ?3,9 foi single itMti. 1R.I if>r maiTied
Aston few*, and 22.0 for J«ws horn in laael."* men, ^fi.9 for wtdottfd mm, and SH7 fur tliSoctoec&Mxkic XAtVi: T h e n &PMM& io be i»o vovc&l «HTI. lliMrrrrr. h K puwible that enraw
do»u«us»i rorruhitioii between the itKkh*»re of m tht iCfMMthig wf m.iih:ti *.i;»rns o n MI inote
prouatk eaMfrr and sorftx-coiwiiiJc slatus {fig. COmmouK- amo>^ wm Cimra^iiMi lhaji OMI6). *J jfiis aspeu has 1X-*-JJ c-xuiivivcly reviewed
fcy King ct at, ami Ihey found IK> regular
MoiUtlhr ifaca fioin HmMwiL hidiaab- that
m
»(
*
1
•
_i
t
2 —*
E
•
{
i
1
L
*tv
FmJ
pHi*U£r J*
- -rifftfuflfrftri -fir v n i • ki*Srft>vhrf t *\ ah r-nmvnum;.w iwftnfr ! « * wn«JuA. • -t« 11ftmi>»
CAHOKH OP TIHC PwarA-rs
>3*2
• 1Vyjkfcr cj al.
hi the older age group* the Incidence vates nie
slightly hl#erforsingle men than for those
vfioliaWi B W mavrlud." In the NctUerUttdt,
& hifilicr wonaihy »tfe from protfaite &m&?
anions married
males Was reported by
Vcrslujs*11 Thfr study found afrequencyat
single men among caiteer patients to be 7-6%
at ages £0-69 ycnl'i and 54% stages 70+years,
ngahtst the comparable figuresfor*h>glc wen
111 the gg&$&al population of 10.3% and
10.2%, respectively*
The only data available on the rclattwnhlp
of fertility to cancel* of the prostate come from
Australia and suggest nritglulyhitter momliiy rate among married inen with children | ! g
than die expected mortality rate** Among | ll
ever-married mep with children* the nuinbeis
M7
Hr
wm*«iwts
ttmtuns
* ,
M
10
hi
*
«3
J'IO. 4. lntl<Wcc pfcl death UIM Jittin cantrt of lh*
piooue lu Coimcttktu awl New Voik Siaks*
V.MfentfMk
of deaths from the male genital organs wcic
474 for ihe *fcc group 55--G4 years, 1,152, C5-74
year*, and M2G, oro* 75 years, while the comparable numbers for cancer of nil sites were
46&, ljl£2, and 1368, respectively. In contrast,
among rsrer-rnarrlcd men without children,
(he mmdjers of deaths from the genital organs
for ihe corresponding age grmt]$ veeve 83.154,
and 153. and the number for ameers of all
site* wrefift. 164, ami 157, respectively.
Circumcision ttiul venereal disease; Havicli
and Kftvich ascribed the lower freijm-ncY of
prostatic cancer In Jews to die practice of chv
cutnehfon m birth,** altlsoii&b this hypothesis
wst* noiMip|3orud by two other investigations.
Gibsou found dial 20% of prostatic c&nrer )»•
tIctus listd been ctrevmrixod at birik and dfl-
20
S*efeA
Sttflium
-F*MC*
13
§ \
3
/
VKettiwUnlS
Getnsny
MJ l< Wilts
*«V
r -.
forteg»l
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«
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TJ80430784
**U*+fAl;Mi*<i,*±m*.,*.,^J*rtm,<**mm.
548
GAKCKR
USkliitT'm ^-M-IWfcU » « V A * ^ 4 C C T 4 - ^ . I . — j J U f W i a ^ .
/firgiox J 1*7J
ttvi«rrir»aMl
WMIC
*>\.
VW. HI
Ainoiig,'
otic ck1**
WfutrialU-MftRUfel
u
4-1
X*
M
Mn^Mttrhfi
ll»jk
J
hi
c
p
MMM
t*r
JW
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P
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c
p
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Hi
G
P
fuitioxiexk
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XI
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Xt
xt
nm>
dcwhip
enrtoeri
inetapb
t»fldD
|joElcr!t
II 177.0
ntinlun
l->;.«w Death Mtel o(»iirer«r
Ihe pratac* bf rdfeErvn* and
tncfotcmmvwlc KWVU. ! ^ r Voit
» « «
Iww it
adenw;
SV^it
nUi an*
4.*
/.»
xr
>P
*.»
4.>
1X4
»r»T
orator*
2U3tn
ntv.>
ltl&4
Iliac
tns oi s
late, a
Taken u
1/X0
UtfJ4<4NUlLHlliuM(r I f f
ir(WJ«Wn».i, «.,)«#!
Willi t\
spile tbc Tail lluil UK Mudy Jack* :iilcqu;iie
contra] clntn on ihEs. aubject, tills perraitflgc*
apjx&rs lo be loo high to snpjxwi a bypoibcife
of protection IJciiigaU'orded by rirctimci*ion.M
In another invcM/gation* Kaphm et al.. in A
rcWcw of hospital records, oiuui reveal w>
significant <liJfeix»nces in freoncHey of circumcision between nnisjewish mates -with
prostatic cancer JIIK! n control group."
RavichK and Ravich nlso suggested that TO
nereftl iitfcctiom illicit promote ihc develop*
JKcnt of prostatic cancer.13 I b i s vas contradicted by Knpbm ct H1„ wlm reported only
31.9% of die prostatic cancerfcronpas having
3 positive hi&iory of venereal disraxc against
43.$% of paifcnfx In a groiip with henj&n
prostatic hyperplasia."
Prostatic cukafi Mid pmi$*th
miction;
Joachim tx-jx>ried the frequency of prostatic
cntnib* fo be «.?.#'; oi JfiO patient* ivith prostatic cancer and J2J% <rf the control^ |«u
even awnmiug die validity <»f ilik aueriation,
it k niidetcmihtcd whether rclrntf \KIVCa rnrdin^rriiir cfft'ci •» tlHtHvitn, ^ctoiKtarr b»
Ihc rnnccr; CM* air u rMKtH|nena* of <otu»t<>!i
clcologtr facio»i-t:' ijiiiiincr and 'J'imwMibamn
obaenttti a hl^h frvcjncnry %«t} «rcai \*aricfy ol
fctcfwkt ill (jMMntoiirjiny «jK*ime»i> ninmrcxl
for csrnrcr of ibc imivrwic.*3 They w w rrfiiii
femm ju-j>aii\c- rrtiibo^iijs. MKh as Klcbstclb.
Viniv,tsuK i.Knl ia»i«-i «f ibr fiitiMwe* va\
-IIXJ JIKMKI in liirir sj^viiiiMis KMIIIICI- r^ji|*intl>w^ hi thh itini mntUl he of Hilri<-vi,
cm in
sttuly t
Kciv V«
filnwl typct A tvlaimit&Ii^ of ranecr <t( ihc
)>roMnce IO Mood Group A was irportcd in n.
study by llunrtc find iJiillin* Among 2M
p.iikiHs with ]ny»t.itic cantfi", (lie fircpicncy
of Moocf (jmup A iiw hOA % agaiiui *ls:*l% «J£jKrfcd b a ^ on n comroj group of 10.0(H) in
•fCromN
cer <k(i
Inter
teen pn
u i c an
discaw _
ihc p n
tionnni'
aiiMysb
trolo*
and tbc
oon>t**<
gimtni!
tribntji
mieivii
jwtk-JH
\«ax? it
\rtnc ««
inK-MH
d»t» K
wi«- "i»
Jrt '<
IjOllttOlJ.
Ttibwco: Tliciv siHrms lo be no A^orTntton
btintuj tbc i}pe or nmoiml of junokin^and
canfa'of iheprosiaic."-"1*"
Mutlijitr priJttarii'x: Cool; i«j>orIc<I n \HAIlive rorrektfon bciu-cen caccvr o( the J>TOMAIC
:md cancer of the nrbmi'T bJatUIcr." Accord*
lug (o a 5Htd>* by Afotrtcl »tnon^ J'*^ jwifrtlis
wJib jM-oiKiiic enmer, 40 Itact cancer of (lie
Wilder rs efdicr ibc primsiy or ifkp secondary
Iiimnr,*2 'f'JKitr ra a Mitxtj; JfkcJif»oml Ifiitt
ilioc rtinJiiip^ relate t»» ilie jnii>lcne;d dc(cx<
lion of pjvniaiic cjinrcr (luring cxaininnifon
and itirgiiy fur bladder rarcilWltu.
SpwtitHrum nnd rxpt^mwntnJh-iiuturcd
ameer in ttnhmh: SfMimmicon* tmu.tr of the
pmuaie in aiiinmK h rviwiiu-K* nui*. mid M-Veral iw*rkw% replied i^ofatctl biM:uiccs ill a
rat a»d ;t )mtw„M ew» dogs1* an oW rbcuii
trnmler,5* I\«I JwotsU'l*.5* and an old C^KMIbagen mi.'*
'}1lf hnpbnH»ljf4t «J ilirfiMial t;tubio»rm
bni l*«*ii nrjKniCil lo Midi ire pemiatit« JIM « . *
w*5, 1I«AC-VCI, Mnir tlicM- raucii*. air ««Kih
MjiKiimitiv fc-K t.uu;K»jn;n »r -k.»<rtmjv r! »*.»r
Admin
XV*u» \
CiiJK 3
<tinti!*>-
IHM IK* Jl-htalM Ut \***\,*U- IJttccl MI UiJW.
*rbkJi r* i*r»na!rv atfi'Mth .nt iiKxr*.* in >}j***-
dl*. Ii-
(
,£r»£V""
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H*, a
549
CANCtttopnitTjiosrATB • yVynderctal
Among mice cxpoicd to ntomic irradiation, *t®mw*h* 58; kidney and bladder. 50; colon
one (limaped adenocarcinoma of tlte I>TOE- and Tectum, S3; leukemia* and lymphomas,
t«e.**
I6i lung, I6s stdn, 12; nwwh* lis oilier sUes,
There tire no reports of nw*Mtic f.-uccr £7), ami 113 noivnuwer (heuijp diseases of
developing In mdmals ** a ©nmeqnems of tit* RAsiroimcsimal KM, B5t orilttijvHUc dlv
endocrine manipulation, although extensive cows, 29; bentfgn dtsratct of the nrlviavy tract,
metaplastic changes have been noted In the 20; minor surgeries, 21 j other, Jin) pallcM*
posterior prostuLcs of mice following the «1- urith no known disease of tficprrataie.
ministration of rstrogp*.* I'wicr aud Paulson
Jiccard sfttdy; In ndditlcm io the Snleiview
have reported the induction of a prostatic study, n review of dierecordsof 350 prostatic
adenocarcinoma hi vitro In the hamster rulnj? cancer p t l e n u admitted to AIKKC3G during
SV40*ftdcsoscyrlbomitdek acid onco$anc vi- 10-1CM2 (ISO patients). 1WQ-K (\m pmicim),
rus; mid this model may prove useful in lull- and iDGOO-J <150 JMIUMX) WH conducted for
background And tahoiatory data. No«** of die
oratory Mudic* ot proiintic cancer.3*
patients whose charm. vera micva-ri had brcn
nutri'icwcd previously. Tin* rhaits of $50
^UTKWAli AKn M M now
male patients with ranrcr ol the colon and
In Addition in the review of the current aa- rectum seen during Gorrcspmuling time \tctltus of the epidemiology of rancei of the pros- ods were reviewed for comparison,
late, a retrospective investigation was undertaken so obtain epidemiologic data on patients
RKSULTS
with clinical wncer of the |*o3tate. *l"ii«s prcctill investigation consists of an interview
Ag/s: The age* at d.agnoslsof prminticeanstudy conduaed ai several hospitals in the ccr t» the inieiview *t«dy ran&cd from 35 to
NMV York City area, and a review of hospital a(j years, ami avenged GSJ2 year*. The agerecordist the Memorial SfowKettoring Can- distribution of the prostatic cancer Clients
ccr Center.
and the control pattern* me presented (Table
*nfe>vfffu» *fvrfy: 1 Vo hundred mid seven- 2), The average a^-stothe 3 periods covered
teen patients with clinical cancer of the pros* by die Accord Mutly were n5.5, 05.4. and 6Ti.4
tale and 200 cosuvtd pnlicnis with JW known yours, rcs^clively. "i'lic«! avornfits are shnilnr
diseases of die prostate w«erc tmcrvicwed in to those found in oilier clinical «udiet^i.t*.W2
the period 1565-67, A«ith epidemiologic qucslinen Aldiough the racial di&irihut)on vardontwire fannii (Study 1). After preliminary ied markedly in different hospital groups,
analysis, an Additional t% cancer and 2fi0 cott* ihere \cere no significant difTerentes in proporirol cases were inter tic wed Uatn 1HGS to 1909, ifon of Kc^o pfliients i>etwecit the prostatic
and the inforniAifoti recorded «n a short form enncer patienii and !he rontrols withhi the
cojissMinji of a brief o^icttioimairc on back- <xnw hmpitid. In thr Memoiinl gix>ii]», Negro
ground mid medical history, liair patlcni dls- patients ron&iituted 10% of thu prostatic enntrlhmion, an<\ fertMitY (Study 11). In mud, the ccr grtnip and 7% of the controlfirotip,Jn
InicrtJev study consists, of .100 prostatic cauew cottd, Negro jwiieuis ronstimtul Jtj% of the
patients, and -tOO controls. Where cpiestioiu pro5UticcHncprj;uiup and 1 ^ of the control
were idcniiral m llir nvo studies, tlic rcsnlu
-were coml>ined. When the texi tminions the
Iniervhnc sntdy aivl com rob, diis. it combined T.UMi: 2 . Ape t>i.viriI)Uti')i» c4 l'ro>t:tlic Ctsiccr
raiimu and Cmlrfils
dnu bxv.nl on Sludiri 1 «K1 1). nnlcsv oilierwise %]KM ifiett.
C Btitrul
I'Wrfulic cancer
In the prosiatir caitcvr ^roii]h 1W men
l \ r cent
*
•
caiiK- frcuu tin* Memorial Sloan-KeurrhiR Cant*iuli*r W
cer Center, i i iruni ifo- >].iitSKiltaii Vett-utn^
SU-&]
26
9
3T
»
AduihuMimNl Hospital. .IIKI 62 fynin the
«a
24
ft
w y>
ii
Krv ^"tk IU»N|«ln!# iW St. iailf'^ no\phal
10}
*A
*ft 61
7i
2]
fVnin, tu tlu- KhiK> Cuttttiy H*isjjit^K In the
#"0
?»
?,^
3A
65 W»
rtrtjircitfcmirp.t£l** (>vm wetr fnmi MSK<X« ;« I I
Sn
It
fr<
1?
l& tittM thr \*.A., and i& kirtrt ilw oilwi lu*-^*.
taik l^lrcl >U«v»*. 'Hn* JlW n»h* timtiul <JV*S
ivrte *idH|MM<nS «l TK i^ttorf f*ai»«t «4 U«*
{
;» ; »
>• i
l*»*u.
.tf
in
ma
i»
A
!«••;
?;
i^
tort
r
-1
!»»•;
***J
• «w.^
•
1
•* . * »
•.V
- y"
^iXU^w^^v;^.*-^ ** -
•
-
.
—
*
•
*
*
•
!
,
.
-
A
«
A
a
.
*
.
-
-
^
f
/
.
J
I
—
'
-
i
.
i
t
.
y
^
^
g
.
^
.
,
**-.. ,
^
^^M.Miw^n^.^
•
- •* •*
— . . JV
>
910
VoLXt
WifgHif 1971
TJU**&& JMueauo* on*oU#iic f^rwc* l^tf<*^
GAMGKH
AB*tf*
hoi. U.
Cmur*t
fic*MlUtr»dt4
Kfc (S>
tone
CwiMMrJSchMl
lUtf-ICfcWl
ۥ** +
. TOTAL
-•a
* 09
»<W
»CM»
ntii)
MllOOfi)
K*
m
9 m
y«i)
new)
<a.j)
1 (3)
*»<«>
jtpd.9)
29 (EH
*?<»<?>
»\M)
23CU.39
JS(«)
S6tI09*3 fHCI*m> U74H45)
group. There w « one Oriental patient Included fn the prostatic cancel groujx, and four
Orientals in die control group.
• A review of MSKCG records revealed a 6%
frciqtttmey of Negroes In the piusiatic cancer
group and a 3% frequency of Nc&rocs m the
colon/rectum cancer group, a dilTc/c-ct of
borderline significance (r* — &9G, d.f. = 1,
M>V>.0&S). In the »mn*jref.iltonor racial
differences In the incidence of prostatic canccr, the morbidity and mortality dhi* are obviously mate meaningful than those of a, particular group of cancer patients.
•JZdttcalhn: There is a suggestion in die literature (hat the high incidence of prostatic
cancer among U. S, Negroes might be related
to lower socioeconomic tfaitts." Therefore,
ike date on educatier were evaluated scjtt*
rttoly for Caucasian and Negro patients.
Among Caucasian patients, (here were no significant differences hi cducittfcnuri levels between die prostatic ameer n»d romrol groups
flVble 5). Among the Negro population, 81%
of the 47 Negro cancer mitatu attended only
grammar school or had no education at all,
and the comparable figure for the 51 Negro
controls was 71%. A further nniilviis by age
group was not possible because of the small
number*. This aspect should he explored with
a larger sampte.
Religion: Auwtig die Caucasian popula-
TAUMC
»p* K#
K*. « 3
* P>
»<?.!}
*ipt.n
IMIS.D
i ieio.4
MtOMW
5* (1^)
roua>
l«{H9
*l(i>W^>
Jmnn
T«*JC
CWW<Mfc JW**'J
»as
1HOA.O
ji a»
m».«k
*» (M>
3fltiM&
« (l».d)
itUMttftt
p}otf, of birth: Of ihc 252 Onwasum |>ai ientt
with {ixostalk cancer, -13% were foreign bom.
Forty-seven percent of the while control pa*
liciitx were fotcijn lx>m. It is inlCTCsting to
note dmt the prostatic cancer yronp contahicd
a iignificanily lower percentile of patients,
who had been in the U. S. for less lhan SO
ycay^ llian thft control group (g* m G.03, d.f.
= 1, p. < JOJ), Table S. Howcren a further
annlyiJJ by age lfnr not possible becanse the
chita were based on too few cases.
Marital status: Mtirftal stsitttsafJptars to he
associated with social, economic, and oilier
variaUes. In the picscnt study, marital Mains
was found in ^try In different hosplial pioups.
Four jicr rem of the prostntic cancer ptients
imd *1% of the controls m the Mernorin! Hospital irere single, while 22% of I be 74 camtr
jKUzcnts *ni\ 20% of the S5 oomreds hi the
!
VJV. IT.
apparsi:
kiCt. 11.
thcrov
tal stat
control
lllei
diepftt
drftcfen
taticca
men, 7
vorccd.
tpoudJi
81%. ai
Fcrli
taincd
blcin
ttospii
canrer
ever in
were it
than a
the en
hasp! I;
cvalun
don \r
tho pv.
site—J
Tlie
wcrcl
canrer
of 11)
out of
for7»
for lb2»%(
difTeu
anyflf
Met
based
canvi
signin
4. Hr*riU« at Pmstallc Caaorr PadvaU »«•! Grmrmk hy M+ (iBWrWwSlJifly^
3^*«. f4.
Cltt^fc
JVMfealMt
um
17i <S1>
tion, the pruritic cunrer group contained n
smaller percent of Jews than the control
group for both ago group* GO-tKf years and 10
and over (Tabic 4). The dificrcncc in UIR age
group G0-60 ycant was of borderline significanre ft* = 4-7. .IX r? 1( .05 > P > JOI). 1 low.
ever, it was noted that tmckr the age cf CD
the jirostaiic cancer vta% nn frequent among
Jews nj non-Jews. Tlieic ana hiter«ting findin^js because [ivcvions studies jiiggciicd a rcla*
lively lou'er iucidence of prostatic cancer
A|rw*r«9
KihU
KV CS» K*. « 8
No. 2
J- -
KP*. (53
soon
ISCMI
K M
«4in^3
tem. t s )
Kfc « »
K* c;i
H HO
Wltlt
ft o n
*-£»»«£> lM00»m
Wt«»*3
K«
CJ*
•it tm
OMIHI
AVA«cs
r*<n. o .
Cmtfd
x«. r*»
K-wcn
K* r*;v
-w c«>
iw tm
i* («)
&W9MKn I*LYM»-»
7**O*I*:» *mnm*&
TA».K
18m »•
1*-
TI80430787
Afc
3&A»TV*««r-\
*y>-
t
j
L
J
lTi V*-H Mfr*'**" *--**"i ir
Mv
rfTllfVH^iir^inlifMrTr*""!-^--'-' - .uirfifoarfrftVimi vj&.yiuivi w.«.'^»,;0.rLi;tei fa»w-.
Cfttttmop^iftPftosTttric •
Wynderetat,
351
V,A. Htwpilal vera ihigle. The ctidercncc is TAHUC & Ne*nl«f of Ycirs In (he US. of CnHGuUa
PraUtic QiJiec* Pstittits and CoatrtU
apprewly due (ovulations hi admission pol*
Betta Htc*i*ecr
Control
Kfctf* Ilovcrer, whhfa a ^ven hojjrfurt group
ihct* were no siplllrant difference* for marlI V cent
No. Pweont
Ko.
ul status between the prostatic cancer autl
'•Gomrol group* (Table B).
The record ctndy which was solely based on
19 ©r lew
6
6
32
16
the patients admitted 10 MSKCU flowed no
20ta2&
21
2i
20
19
tUffcraiccs for marital status between the pros39
Si
40t#&
£0
UtiC cancer group *tol Uio largo bow«t COKCQV 60 or mftro 14
n
14
20
14
group. The former contnbujd 5% of single
149
100%
tbTAM 1M
1M9&
nten, 78% of married men. mid 37% of divorced, separated, or vrldowH men; die corrospending lignrc* for die latter group were S%,
8l%i and 14%, respectively.
stone*, diabetes, hypertension, hepatitis, liver
fertility Data cm fertility wan only ob- cirrhosis or herniorrhaphy, some of which
tained in Study TZ and were found to be varia- Iwive been suspected to bo related to prostatic
ble In the different hospitals. Vroni Memorial cancer in published reporHW1 (Tabic *$•
Hospital, 20% of (lie 45 nicn villi prostatic
Although bused on very few cases, a history
cancer and 17% of the lift controls who And of prostatitis is of InicrcM-51'*1 Jn (his study,
over married vera childuM*. Thu comparable prostatitis vat reported by the Caucasian pafigures for elm V.A. Hospital patients were tients only. Vour per cent of the Osutcnsfrm pafifl% awl S7%, ropcctlrcly. Apparently, tlicre tients wltli cancer of the prostate ntvX 1.7% of
were more childless men nt die V.A. Hospital the Caucasian controls roportcd to liavc had
than at Memorial, btit lite djflcrence between prostatitis, l i t e difference was not statistically
the cancel' and control padenu within one significant. It ts possible that Negroes have the
hospital -was not significant (Tabic 7). In [lie same frequency as Crwcasinns* but a low socioevaluation of such data, proper standardiza- economic status will frequently preclude detion by hospital—which could not be done in tection of this condition. A higher percentage
tlic present study became of die small sample of Negro patients than Caucasians in both the
site—Is necessary.
cancer and control groups reported a history
Tlic fertility data on the Memorial patients of gonorrhea. TWemy*bc per cent of Negro
were broken down by Age. Percentages of die cancer patients and 37% of Negro controls
cancer patients without children were 9 (1 out had a history of gonorrheal Infections* trod
of 11} for the age group under 00 years, 20 (5 10% of Caucasian ouster patients and 8% o£
out of 17) for 60-09 yesrs, snd 18 {$ out of 17) Caucasian controls reported a positive history
for 75 years and over. The comparable figures for gonorrhea. However, there was no Ugniftfor tlic control group were 4% (1 out of 25), canldiflVrettco between the cancer and control
2M% (14 out of 50), and 11% <o out of 44).The groups. It is apparent that gonorrhea can
differences were not statistically s&njficimt at recur and that sonic individuals may be reinfected frequently. Unfortunately* no informaany ago. group,
tion
was obtained on litis point. Also, no data
Medical <mtl surgud htsioiy: All data were
on
lliempy
or any other lactone uiiirh might
htiod on a Iiistory of diseases that had ochave
influenced
the incidence of subsequent
curred at least 2 year* prior to diagnosis. No
prostatitis
were
obtained.
significant differences were found for urinary
VJMX
^•i
6. Martial Statu «f Guiendan IVotUiic Cancer >>»lieflfe and Centrals by ARC, Metaoml lltiefdul
(Jntervier ^udy)
A&40**
A V K ^ I M
UrfM)
*0*
-t
«>
PKS.CS.
7
CmtoM
ISnLca.
OM«I«I
(*
an am
WMN.
ARnftM
AccN>4-
mt&rn*
mm*
mm
m m
h«.n
3 CM
•*
C*bt2«t
II
w
MI
»«»»»
TI8O430788
•^*M ^faft'^Ci ^Ti i«C-~ *j^a*J«*.a....J-^->lH-*A»^^... v-.v .1 x,.. A.irv.--, '.j'
^wOOAwCW
-*••..»».,
"tea
CAKOSK. ^Wfitfa/ 1571
1 Vhitfffy I5ftf4 ©f J Yosttufc Ou««r l*aH<*l*
and O n ttt»l», Memorial Hospital {Wudy U)
1!*BI*
WUlcIi0drcM
TOTAL
(over
manfod)
frw
Ko.
9
Coalnal
n*
20
II
*
ioo&
45
r^rc*nt
!<»»
**
Cfratmcitiont Tlwi-e was no t Ignificaiu d5f.
ference bciwccn (he non-Jewish o n c e r ami
comrol group* in this regard. Out of 172 notJewish cmce** patients to whom the qiicitfrwi
oh circuraefcion was aslcd, ] 7% stated to have
been chcumsiVed, and 15% of M2 control jm
licnts gave a positive history of circumcision.
• Wcfgfil mtd htitftf; There wore no significant differences in weight And Iiefelu of the
prostatici cancer ami control patients (Kigs. ?,
3), Using tire Xfetropoiiian Ufe Insurance
(able, the relative weight for each pntfcm w u
tttfeufeted AS follow:
Xelaiive Height
_ ^ S l ^ L S ^ M 1 1 ~ expected u'ef^ht
expected wcj$u
x J00 (%)
Uah ilisirfbutwi: Data on hah* pattern
were obtained by fnspecdon for head hafr,
beard, chert hair, and leg JiaJr In Scud/ II.
Data were examined in two age groups* under
65 years and OS or more. Of 26 promise « u v
cer patients under <© years of age. 2tf% %we
refcrtircly bald or find no head hair, mid 2 1 %
of SB controls were rdailvely or completely
TA*MC B.
Prtvkxi* Pl&c&tt And 9ix£ety «f lVfitft-.de
Cancer .inJ Control l^tiwil* (Uncivil StodyJ
Kicliuy itoow
RtitdfJM' U<*n«
Other or tmsped*
fiu5 uri&iry
flew*
lllaiietrx
HypftUiwuM
HornnirrW]iIi)f!«pa(ll»v*mlAjr
fauH&ev
CirTh****.
T«4l
o.s
3
22
3X
H
15
0
m
i
t
IX
It
5
2
l*B
bald, A m o t ^ patients aged 65 yenw nr more*
ilie oomi>araMc figures were <J% (M of 3*)
for ihe prfisLilif cancer group and $&% (33 of
SC) for the control group.
The following finding for beard, cllcst hah,
and leg- hair 3t« bated on Quie»*fa» patkot^
otily, TwcaujeiloH-CmKarijm poikn>w ap(X^n*<I
to dtfTor ai^iuTiramly in ihli it^ird. 'I Jiirtu
ciglH |jerccfi( of 21 proitatfc cancer |jairciUs
and 27% of 25o»iuroh hi [hearts group under
65 ywtrx were fcnuid to lutve heavy hem<& hi
the cJder,-t£0 ^tuti^ ] 3 % of *) pi^osi.tlic oncer
j&tfcnts and 12% of 82 controls Iiad h<Mvy
beard* Heavy t1»est hair %ras notod fit 49% of
the cancer paticmx and 45% of tlm COIMIOU
in the y o u n ^ r ape groups And 55% and 31%,
resj>ccitvcjy. in inc older ngepvup. Heavy leg
hs!r WAS foitud in £0% of die evmcer group
and M% of iltc control for die younger age
graup. T h e comparabJc %uivs for [he older
ngc {[roup ivcrc T**', and 10%, rcspc*lively.
None of the above differences between I lie
prostatic cancer ?wl cnnlrol x»o»»I^ was siaiisifcally slgnincani.
Tabiunt ffH«f alcohol: There traiv no >t^iiffcant di/fcrenrcs in lobarco coau.umiMJOn hy
type or muntnT of clc/trettcs smo'kc<i bclwecn
die cancer ami control groups, nor were thetv
any significant dilfereiices in attohol coiisumpiion IJCIUX^J* the iwo groups (i^hk' 0).
Doubts, fmmarfas: There wcrv J7 pxifcnts
yf'uh projuiic cancer in Suidy I. who Jiatl ft
second primary cAncer. Tlic bbddcr was the
w o n common site for the 5econd j>rhnnry cancer. Of 7 cases with doubt** primaries, inchidin^ the bladder, 5 trcie lotmd ttmutitmemisfy
with prostatic cancer, and 2 were found 2
yeais prior to diiignosis of |n^vi;ufc cancer.
Since most of the bladder caiirm wrrc found
at the same rhuc »t (he prostatic cancer, the
Sndh^v $n^iM dial die prostatic cancer h
dcurtr*l by urologists exaniinii^ for bladder
J1ICAI
Of tth
€vitft-l
a)a|x»i
Stan*
rair i*
lhai
amem
J^OUJ
sKti'iiLttlllti
tNIi
ram*?
invite
I'nindcnii-*
mn%*
Iirwi"
fal J4.
endi'i
whht
of lb*
tiuKif
laih '»
and •
t!i '
aiifiiUf i ! '
ijnirt
ot r
Cor.Irol
PKHttilccawtr
No. ft* ami
J
10
1
VcI.W
Nu.
Ife-ee**
II
J
2
r
j
25
Jtg
0.3
&
12
10
16
9
4IW
•I
1.5
imr;
4*
Jlfofid fyfv and fat/tut* blood su&nr; 'lite
htvod iy)K' distrlhuiion of (he prottalic cunecr
parcu-fH* Ym\ himibr i« iJKtl of llw New York
f:iiy jtojHd.*ai*m^ fJVblr 10). Xo sl|;nrflcattt
dHUti'inv\ wen* found Jn faMinj; blood sM»j5ar
knvK btlivrrn [!»M:I»H<TaudruuJrrd piit'iits
ff»Mr III).
r
/Vjfr*j£»«f/*lty «JW inr;*trut «*r Jtt iiliy C|ihk*n}jtttt^ia iuirtfitrf^fltoii »c4mirn; ruriittf*»H 11IMI Luton* m ih« d»\c-fcr^Kmml of r a m « . tlr
t
•
- j..i • •»•«•'• ix*r*& •» •-
r
f
f
r
i
f
f
T
f
t
"
*
^
"
"
*
"
' *
'
T
*
*
*
-
—
-
*
•
•
'
-
"
»
CANCER QV Tint ^HOCTATU
HiograpMc data provide tueful leads, The
moil iiaportaiit clue* to tile etiology of cancel*
of the prosiatc am tl&f Invnxfvcj or rlfcd*aUy
cvidoit, prountic raueer seem* to h& rare in
Jnj»niicic HviUfc in Jnt*n, but inrrcasr.i fli totgeneration Japanese Immigrants to the United
Smicv; thnt in the United States the iiidtUncc
rale is higher far Ncprnex than fot <^naiMms;
that ptojiatic cancer occurs lew frtNnnHUly
amoiijt jews than among other minimis
gatmjtt; aud thnt their approve in be no ionsiiicm relatiomhip of promtic cancer lo\otloecaikooiie itaUU-
-
-
f
^
-
.
-
*
.
.
-
»J*«MWti«l«iTf.HAMA¥t>*tWfc^liWll\*>H.>»i.
-
• IFystfcr £* A?.
38$
Cflrfrol
fMQfo
Prostate Csuc*r
W*3C91
40
iNTKavxixviio* OKKWWVMIOIORH; KIKWXOS
jajmrtesc; The low rate of clinical prwatir
cancer among Japanese and it* npparam incroaw among japannc humigiaiHs to the
5^5»3*« ytfiyr Pff^-yir VQ'+
United Slates may be regarded a* A major epimight
demiologic elite The fact that other *horV'c, $. Hoiftht (UtiiltmifcMi nf pliotUtC CHKCr pamone~re3atcd" cancers, such ns those nl ihc ll en
u and cwurols.
ht*ca;t» nrary, and endometrium, are alw lovr
In Japan MIJ&CXLS (he possibility of a common
endocrfno1o»ic hasw. l-rrctatir hyperplasia
Tolincco smf AVnliol [>,i a nf Prostatic
widen may be honnmic-vetaied benign <&cn&e TAIII.K 9.
Cancer ami C*IIU«1I'jlieuf * (Study 1)
of the prostmc appears ten. fivrpicni hi JapaControl
IVnMitlic ra.
nese tlun in Caucasians; a study hi Hawaii esKG. IVrc*M N'u. Percent
timated thnt die incidence [or benign prosttifr hyperplasia lsZO/iOOO among, Caucaifcuis 7*frrc«v
and 5/1000 among Japanese.11
18
hi general, the incidence of dtonves wch ai
20
175
arteriosclerosis and diabctei thought io be re- C&arvltr wtf&cr
79
Cfeantte* only
*fi
lated to dice, especially total fat intake, U also
2
i
FSpwnidy
12
qiiic law in Japan. The hirresis&d incidence
5
s
II
Cigrt«Ofriy
18
of prostatic cancer among Japanese immi7
11
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19
grants may relate to change** in dietary habits
Utft% 200
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P*o*Utfc Gutetr Patients A»] Cbntabfr (Intavfcw and cure tjtfwccu the Negro and Gttuotsian impuKecord Studio*}
tations fs ihe difference hi the incidence of fnProOMic OA.
Control
flammniory tllsawe of (lie proustfe Iiew^ver,
**jlsir. blood iu#ir No. Percent He. Far cast
accurate nifonnntuHi on the fnritlctice of proitnfttis
fs vtvy dinktili u> chVit by fniei'viav
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orrheal itifeetion among Nrgm ]>.i(icnls with
200+
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TOTAL:
150 «o» 2J1
100%
Cwcasiail (Kltfetlts^ Allhnngli we iiiquhvsd
>hout
R Irfatoiy of gonnrrhen In the present
W.Y.cfcy
sttidy^
si&niJiraiit
'b(a on [he i<:|>calctl hifccUtifcc*, Otscai&w*
tltwt
and
rcc4trrt»K«
ot venereal alisrases were
No. P*c*»t
Ptrcvnt
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35
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85
21
njineatH <hrouic vmcieal infcriions nre a poH
14
19
lenifal caiwe of jnostntitis.1^** hfale irlcnon
9
4
3
An
snonas infection is also of interest, l i t e data
0
J15
47
43
show that male nrigenltal tridimio»»sls is
TOTAL
243
I»%
1W*
frc<jncnt, am! its fnescteiKC mnges (jeiwccn
12% nnd 70%-" A study dealing vthh the occurrence rate of trkliomnntOKic by race might
shat occur after (heir arrival if i the US* since be inierctting.
dietary habits nf most Japanese immfgrqms
Jews: A previous study has suggested that
arc fcnwn ID I>C similar to (hose of circumcision may rcdure ihc r'nV, forroucci*of
Caucasian?.' Tin's facto*- could a ho conceiva- ihe p)-05ta(e.« Tt Is irtic tltat the inddenre
bly affect the differing Incidence intn of other rate ot cancer of the , roseate is idatfi'el^ low
horrooiic-rclated canccrf noted between Japa- in Israel, but within that country it is higher
nese WK! Oiftaxian populations. Latem, or in Jew* from Kuropc Ihan Jews from Asian
non-jnt*arivc carcinoma of the prostate docs nnd African rountrrcs.** Thisfindingsupports
not appear Id be subject to such consider** tfic <Uctniy (licory, as it is rcnsoiKhlc to suptfott* since its hidclcncc rat* among these pop- pose that there J« a higher fat hnake among
ulation groups is similar.
Jews from Europe than tlaose fmin Asia and
A study of Japanese showed tfint patterns AfWcx Jewish hnmfcmm* to the United
vitli \nfosmic cancer had more hotly hair than States haw conic mainly from Rosjh and Vo>
control patients,'1 lit tins study. 13 of 47 land* countries with Jew fnrhlenre of prosintfc
(2fl%} patients had chest hair compared wirb caiu-er. As 20 nnd 00 years aj>o» jeivs from
15% Of the controls. The cattcer patients also these Kavtern Eurojxwn countries nnidc up the
showed a trend cowards heavier beards and m*Jor projx>rtloii of Jetvs in New York City,
appeared to be of more slender build lluui the and ii would he K-n«mah!e to assiime thnt the
contrail 9 Thn finding wasnm suppoiied by pnueui of dJ50Jvcs la their places of origin
live present study. If the amount ©I body Jj;ih was HKitaKtincd in their »e*c country pnd that
is related hoih to gcuctfc and to nutiitional ft was refJirtrtl In the Joiv frr^uency of prosfactors then it is moie Hfcclr that ft is die nil- latic cancer xnloJipJcws found hi iwtfer stud,
trfttoiKd hslnc* which difiVrbctwen the Japa- ies.
nese prostatic and control patterns in that parTJm coun-jH »cr«niitc for ilx- ftitdtn& uf
ticular study.
Ihe pfesent stutly. «Sc*»«&c ycH«iRcr |Kiiicnis
Negrertr l l i e Urn'trd States dajta demon- Willi pm»tntit r;ti>ccr iiKlude the sanK* mimstrate a higher t'ro'tfruc* rate «f psoMs-tiV can- her of J<*fefs n\ wrsnhl he exp«ird m I'IC conerr among Negroes than among CaiumbiK. :i Uttl p.ilimts, it in^y he itiyyt^cd llmi cirrni«Sarong ajftpafemJy mnckttcd to *jcij«lr diHrr* c u»oii jtinys no jolt* in I lit- cilniogY of ptoMatie
enofs because if b not high for A JIM an Ke* C.-UKC-I »txl itHit ihf* low fi<-i[tM-ncy pic\-i«juvly
rrpMi'-tl a}iNtM«; Jctt> tci\ .i HSf^ t >• bax^ivfup
"llwferfciirale amosM* Xegtws in ^initio n !•> the low iiuUli-uic of pio^talii ianrcr in
fiOt lifcc*r Jo be irbteil tat o*-«»Mf i:inK saw* fjirif frtlUJF r* *J OTK^M.
, asw t.auwT* s* » d eaw a n * M •»»» mil** JSMiWnfMiefViV * « * i * o ^ i i « * : Sr«r}?} xwt-
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Set have examined tJio urinary steroid «xcr&- mont or pmsiarie cimcct despite the absence of
lion levels in proMatic cancer patients. Stern recognizable testicular tissue,*5 The patient
fit Hi. reported a tlhcrlmlnam ftniciiou based had received xMmy therapy for tesdento ctmuixm fioiiiKtoironhitu Mwlrastcvone* snul ct- eer 22 yt*avt before developing clh»iGiliyH:vItriDlcxcrcifou wnicliccittlod todisift^JiijJi ]»- dent proMailc cancer. Although the patient
tlcntt with breast and prostatic cancer from presumably had no goambl lisuic, he might
normal control patients." Sommerx studied only huve been liYpogonadnl.
jKiiholn^lfjilIythociidocrhieglniuUsiwl largoi
Since the early works of Jfuggins stud
organ ahcrattom in patients uiib and without Hart^es,-15 ami of Hferbst.** some ]>r<»intic ennjmxtttic cancer, and conclnited that (be mor» cers have been known to regress following caspboiogicftl change* lit the phuilnry, $onad* (ration or OiV.^en therapy. II fc also fci>own
and adrenals provided evidence suggesting tile that patients tcith drrhosisnf the liver lead to
ignirtcant differences in the plasma testosterone
level) of patieim with prostatic cancer, benign
prostatic hyperplasia, and normal eltlcly
coniiols." \Earmosion ct ah v e i n e d thai the
aiidrosierone levels of 21 prostatic oncer patients were lower titan those of 59 well subjeets of similar nge» that Oinr* Wat a lower
ratio of antivottCMnc to ciiocholanojonc jn
the cancer patients, and that although absolute levels of estrone, estradiol, and esuiol
were not jigsnTicanlly different hecwoen (ho
cancer patients and the controls, relatively
lower levels of estrone and estradiol and relalively higher levels of cstrfol were excreted by
the cancer patients.****' These observations arc
consistent with an internal andro&cii-cstrogcn
imiralance in prostatic cancer pnticnis.
Hovc\'cr, die entire question of the rela*
liomhip between prostatic disease and endonine functions is an open one and requires
further fnmtfgatsous niiUxiug the more sophMraied todnuquesof cntlocrinok^c study
cnrrenily available and bearing in mfnd the
dlsilnct (ios5ibiIity ifuit ilic role of endocrine
factors irt the genevis of prosimic oncer may
beiaompernnhcivenrarre&sory than inciting
I'raufcs SAig)*i^ied that xlermie atroj^iy cf
die piostaic inight be a |>rcc-inr^rm% change
attributable UJ incrcaiod cuiofcrm level&^-v*
Kojmnfrs cunfirmecl the relationship between
Sfieroiic atrophy ami cvtiogcns fioni the patholo&k* tiibiin^s on autujivy maierials." A rclattoaatvbip of utnofip atrophy to latent car«'fnooia ha^ been if ported by ii(«M*%M Rirh,1*
and IJari".*1 On ih*-*ithci h.tnil. the relation,
sliJphtiwerii pioMaiirixnrtM a»d airupbymran
kHbun|uc^\irt- JJ* ilif •JIKIM-VIJ MIXVJL ndiow
fiwH^v ^»'*-;4'SW-iI a irbivmdiip l*r«irrr»l |*ok«M^«l uiMln^rttK Mn*«*btw» ani die rkTil^iini w< *4 |**» Uii* <*w*t.fcl
"llVir K mat i«|««iril %w**w*- «l «tnr|u}»
opuicnt and/ov behavior of prostatic cancer
has been investigated. An mttopay M«dy Jiy
Glautt, indicating thai iheve w% a 1mm* incideuce of cancer oC tlic prostate in cirrhotics
(3.3%) than in noivcht hodes (3.0%), scents la
support tins theory.** Itohson repoind similar
finding." Howwr, the pnwiil study did not
Riid significant differences for tlic history of
rirrtosis.
Willi the exception of gross observations of
hoily hair distribution, the present study did
not attempt 10 evaluate «ndocriuolo£ic factors
of possible concern in the development of
prostatic cancer.
Thft low Incidence of prostatic cancer
among tlic Japanese in Jaimn co&>|mcd with
the incidence nf the disease in Caucasians justifie« exploration of potential cndocrinologtc
differences between Japanese: and Caucasians,
Limited studies of this questinn have demon.
siraicd no largcwcale dinrrenre in steroid secrction if jm^tnl on body wWc, ahlionxh SIIKIivs by lhiihirtiok and Jih co^^orker^ iixlicatc
thai the aiulm«tcio»e: t'tiorhoJ;»noloiMr ratio
may he hff>ht*r aincnip JapiKsc than CZanra*
sian VOiBC«.fl A study by Rubnu <>n H |>o$tniaK*pau-inl JapniieM; WHIKII <}U\ not thovn
»ny mitkiantmi^ dtHcmwct in steroid profiles
when compared widi C^iur:tvi:iii Auiciuan
wonicn of »nMl»ir a$»*\** Arcortlin- to Motoh;»dti ci ah. 17 Jajwn«w men. betiMvn SO and
{Myran of a^, excrriffl minary ^nnatlonof>in
ranging brtwmi 2 and lij* mouse unit*,** >iav
jhtr to t\*r rr«»k% in lh*bVr :H«! Slupli*;"1
study of Aim-iiran inrti.9* "I lm\ tar. there '•*}>]x*ai (a IK- IM dmlOU itiHert*ticr% briurot
Jagum-tr wml ;\nvtTX*n\ m rt-»p«n in ancho^
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If tknt* imeu^siMitaiii iKHriiair in ;Jsc«cnetful ••! krwtit4i*u-% hfitnrn ji»jacu-%- :.•*.!
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Importance in htilu*Uci»g the effects of die se- me to ttiej^ittnclc of pvmintic crnteer and the
creied hormones. One such possibility relates extent 10 which the recurrence of #ononh«i
to hormonal veieirtioit. ]( was taftfcttty wig- coukl account fur the drUertmie hi the ineSgcited by Tu'Oinbfy fhat certain citroicm denw r*td or profttmfr r.mrcT l>ciUHr!i Canca•were retained longer fit adipt*e than OIIKT sfa« ami aon.£ii«caiiaii pnpukoorti SJ)OIII[1)»G
IIMIICJ.* Thus* more adifwc tissue pwvstfent
hwesi^ati^? more thoroughly, If gonorrheal
fn n jwtrticntor population cmtltl alter the rffo- Infection hml » major influence an Uie develposition of a particular hormone and 115 effect opinem (if prouatie cancer, one might well cx011 end organs could thereby he altered. J low- fieet tHfTcjftUf Mirtnrronomic j$radiems in die
ever, sukittjiittitstudies by TVombly and aili- uni jiopnkuiom.
era did not confirm the earlier dat*.M lit the
Normal ami benignly byjwrnophicd |>roscurrent study, 110 correlation between body utrc it&ue* roninm higher concentrations of
wight ami prawth: cancer was found.
*hic than i!u those harhormg prostatitis or
Another possibility relates to iwrmonc re- cancer.** Zinc has proved w be a hfahgic anccptors. Remit animal studies have iwlfcatcti tagontsi <»f cadmium in certain livingthai MM inciwwd intake or fat will enhance »y»icm*.** Kipling and M'atcihoiise reported
the rate of breast cancer in certain strain* of that of 2-J8 cadmium tracers observed in 3Hrmice* TMs enhancement wis not cnmidi'tvd minghrtui, Ku^fcmd, 22 died from cancer of
related to an Increased secretion of hormone* die prmtate, *3»nsficandy more than might
or to prolonged retention of such hmmonc*, hare been expected from tin," incidence rates
but rather to at) incr&Ked 4iirtcp(ihilUy of tar- for I lie rfty as ;i whole."* in another study on
get cells.
'he effects of cadmium, Uotdcii imported one
It Is generally bejfeved that the biological ease of carcinoma of the piostittc ama*ig -12
action ol tox hormones relates 10 their effect cadmium (time worfcerf.4* J11 KashWItp, iVinon jpcChic receptor niaeromoteaileA in iuscep- hehtcin «t aL found an association between
tiblc cells. ^VJiife such a reiiitiotiship has been proitotic r.ina'i* and »iix]>omtec! j«iriicubic nlr
shown jn-jinnrfly for estrogenic Iiomiojiej, it pollution, and (Ills nssoriation i.pjx^ncd 10 be
may be assinnod tb.ti similar rewptor* cxis! r^l.iied to different levels of cadnu'iim fn aiV
for aiulrpgcnie steroid?. One hypothesis tliat pollution.1*'
apptflu aitrAeiive is that phismn lipids cii*
Tfictvlaifondilpof TJIICCO the higltraceof
bailee the tiansjwt of honno»i« to die target prostatic cmirrr iiinong tile Negro population
•orgnn and turget celU. The omnpIcNity of the In the Unilcd Sinict nii^lit also be sludictl
problems iimolvcd in studying the eJTcci* of The zinc bnbnrc of the prostate is influenced
androgens in prostatic tissue is evident in the by semen output. Daily M«-retimi of zinc in
review of Wiliiann-Aahmttn and 5h3ma&ifcJ.lm «cmen is apj>rwmintcly t nifc1* Jt h, therePhysiologic Mil patfwlngtc ccmtricralhus: fore, conceivable tliat men villi inp cased se»Benign prostatic Jiy])«plasia has been re- ual activity have a hnwrptwiauc ifmccomuni
pwicd 10 coexist frequently with cancer of die as a result of increased semenfrnscs.Aiiotheiprosiate, with the frequency routing from 9% question k uhdher cMtm% dictaiy farrow
to 29% among pra&tHlir cancer pau'enu.?" betwcai the Xvgra and C^iHrnUaii i>«j)iil;tHoivcver, there appean to be no rcbtiiombip turn arc of eiiolo^ic iinimrtancc. The
of benign {mMtniic Jiyperti-ophy to cancer of radunmn^rncrat^o h belfcved hy .SrlimNlo'(fic prostate, because the farmer 11 n dtseatr of 10 lien factor in hypertension.,The liightT in*
proctatic nmsde MK! irsnilly Irfjjrnr: hi die an- ciftcticc rxtr* of both ]*rostatie tmuer and h*>
tcrioriionghindularpartof thepio-n;itc
pei'ien^'on amcutg Ni^roes are of particulnr
A cauKtenv n-htisonship beiuvcu atrophy »tten« in this *egartt
and dcrclopjnem of rattrrr has been eon*
EpUlcwtalngit mnwhialiaHs: JJfcc mlier
sfderuci hr wrveral invc*dgsrtors.."'*,*T* Atrophy CADCCMS, (he ni«Jo(;\ of earner «f the |>rc««ir
can be inslured hy itittanunatiuH. imiifriona) s jjiuhahly uittJiifactoiiat In nature. Wc
4ehVieiice£. ami Ixat i>rht*j»jb_;j Whitt q>i- slioiild fon^'drr tlic po^ibih'ir ibai while IUK*
deimologk eWdnue do ire havt- \mhum% to facto* m*r J«ur.»M* an u«1m'h*:i?'s rivfc fi?r
fli& icbtknuhifii; OJIC kad fnvu ilu* I'lim-d jMtHfsK" cancer, anuihif mat fkMiea^e Si. Jf
$WC> if the jeiMtn-iy h^h hi^ncnti. ut {..m- iw»j orinoicnj>tit»4nj> h«Uin<-xiM in ihevtmictr of tfur jH<j\i;tii* auMttlug Nc*yi««s.
individual, lht^i if is di&ktfh IM V\J]UJM* ift<The p^r-vihJHn ikif lepmiril U>IH% of J»I*I upiiftrann- «4 'Jih f.Kim. A*, JH *vjio|-lf. Uf
orthea tmd uitu*\M\ pacHCsaitr*- t.o* tuntiib ws-TvoiiMf iiis-l «ISna«y CJI IM*».JA«V a j-f-wN
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risk tor prostaticre«K«rWK! IUIM account a for iijmenrj 10 be related to IIMS lower rate of pre*.
ihe diffetetiro in Incidence of dinfcal prostatic lane rancer* among immigrant* from Eastern
cancer among the American mid Japanese K«ro]iti.Nnih'c.borj»J«wsn|jpMftoh»v*CTnict
populations, Japanese himdKrants to the U*S., sindtor iff IIKHC of other C&urasbns bum In
nna the warUwitte distribution of clinical the Umttnt Suites,
3- $nm* chttx have *ttgg£»tcd that prostatic
prostatic etawtt hi gene-rat. Now lei Us *up*
JXBG that prostatitis fnTeascs one's risk for nuicer ix slightly more common amc«iig marprostatic cancer nud thus account* for the ried I hail single ntcu. The promt study
higher raiet among die Negroes. fallowing showed no differences in term* of eitftcr mari»
this train of thought, a population with a cat status or fertility,
high fat Intake mid a high venereal disease
$. No differences were shown for edttea*
rule should Imvo n high rate «f jgMiiaffr can- tlonal lcvul between iho cancer and control
ccr. Supposing 11a add :t (Uivd factor- -sexual gtoitjK.
activity. The present study did not ibou* ;i dif5. Tobacco and akohol habits ol prostatic
Cerettce in hictdcnrc of prostatic ranccr rcU- canrcr patients wcie aimilnr to tltusis of the
ttve to marital slants, bi*l data from Dcwnmk control patients.
Indicate thai single men have a slightly lower
6. Surgical ami medical hntorics of \troxittrfdence rate Car cancer of the pioiiatc liuin utic cancer patients reveal UP IUIIIMKII disease
married men. American Undies indicate lint |xtlteriis compared with those of the controls,
single- men have a slightly lower rale in the frtiriher data should he obtained on pm&taii*
older age groups, but not in the overall rates, i Is More lis |>0K]bic effect on prostatic cancer
If wc lake these published data at face value, can be evaluated,
W9 may conclude? that tcxnal activity sliglidy
7. Mo difterenrct wow found m respect to
enhances one's risk for prostatic earner, assunv circumcision, weight, height, blood group, and
ing that ou the arcntgc $cxua! activity is hairdistribiiliion between die cancer awl congreater amung marked tlian tSngto men. l^ir- irol gtxmiis,
ther data on prostatic ranosr among prietti
S. The main epidemiologic lead to which
might be of value hi Uiis regard. Ilonrcvcr, so ihkstudy could not fo:uribnie Is the rarity of
fari there have been no reports indicatm^ any ilinical prostatic cancer in Ja]>au nnd its indifference :n incidcitee rates for clinical pros- cv«iie among jajMiu-se Emmigraiils in the VS.
utic cancer for ceUbace incUrlduals.
Our inability to determine major ?n virnnmenSome of (he C)>ictcn)iologic problcnts relate (at factors may lie n const^unicc of the posssto obtaining reliable information on certain I«Kiy thai proiiaiic cancer is honuoue-rclated
factors such as junnuntttis, frequency nnd then like cancers of die breast, nvniry, nnd ciulnmcapy of gouonhea, and sexual activity, In for- trium. and that fr.cior.t ih-i hifliK'iite ihejc
mation which is notoriously ttlfiicuh to obtain, hormones are most diflkult to dcierminc by
Another problem Is die *ntcrrc3a(ionilJp of interview icdiuKjiH'*. i*sfx*rKilty ainoujr "tale*,
variables. For example wc found the parity
9L It is a logical working hypothesis ihat
factor to be foBiicnctd by hospital status. Act- hormonal factors a flea the development of
trillion }X3iicics of U.S. Veterans* Adninisira- cancer of the |irasiaie and that any tenor that
tion hospitals, for example, brinjf about a attta* hoirmnial sccrctttiu. rctmthm. and in
jpreatcr ndmisskm of child lew mid single nrei paiticuhur the seiiMiivity of the target organ
titan in other hospitals.
sniti/or cells inniK-iKes the frequency of this
cancer.
HL J'*uc«ic MtKiiri. mif^U jirolitably COIKCIIirate on obtaining; nliabk* data on lepeatctl
K Historical information was obtained on iiifrclKHK. nml J « I H « tin** of vcuortal di5cnse.
S00 peiiienu with> clinical cancer of ibo paos- proMaitiisaiHlii'siKil.-iriiviir.
11. V.Uu idatkn of UK* ciioUgy of caurer «t
tMea»d46®p#lk imwitlto»t clfnicalcvklcna'
of rostatk* disease. |I(n|ittal jeeords were re* the [MtiitaU- vilt T :v<Jv*- t'if clime tmmtfoik
viewed <»i anotiVr 3&U proM:uk i^xci pa- of t'|MtU-juioUj^i\n. p:i;lK)Io^iUs nuiiittoital
tieoti. "litefiiicI?)>Rs.wiic* rraliiairil in Hm* hiothc-misK aud Mi^nid ilv-HiiM\ and should
whh the Krtal rplilrmM^o;*^ pattern *»I |»ov rnwtTilian* ««i ihr a|>pairiM tlilittrtirfs in the
iiKHltiirt *A CIIUHJI pioMaiit <smfrr anwng
laijc rancci.
2. The b**c Hnktowr iaic «4 |»«i-.»3iir /aui
i n lamii,. jn»i%li n§»» in thu t'mii«i ?*ta***
TI8CM30794
558
CAKCHR
^i/^wi 197 J
U Adim*o*, L FJ Scram chulcstem] coturtttraftoa*
of vxthu effcnfc *mipi lit |ia*aff, j . / t a r . 71tf7-w,
J^nAftw* C. j , i u < n t card**!* of t & ]>ro«a(e.
w,a*
NVf Vflrk a i y . 19II-GO. A tc^tw ti Incltletic^ niorul*
ftr, luoiwbilHy, **1 uirvJic**hK Ntv Yoric fime
U<t>t.of IIrtl*M«*.
H yfacJioHaMmiMrtv, IV- » d YiHtMncett, A. t ^
Cant-r of the iw»itta> A dinfral itiidr of 131 tttffentt*
' • AW M OfrcitWctifcw u d prMlatfe ttllar. /fefil
AJi<i, £ « W . WM9NK& IOCS.
£5^ rqilnrr, j . fl^ TIK; InltuMiar of nulrallon on
•i IHron, K« and AtigxUu A.: totWeiwe of occult ad* jjxxjlancom UuiHXiRcncUt hi ih* 5yi»aHfcoWcit)Ittltt*
eiiocaretoom* of life uN»t»fe /fofe JSafA. W:VS7-W3,
ISM],
5>0. ^ k - v , I* K, aw! ^aalMm, IX F.t RrorplioJcpJcal
8. Jtmiritc*
J. II* aad Griffin, J. Pi hfoxl-Kroiijii Jn and l)kHlM.-'mkal I*«HM of Vim* AV-td) iroiufcmtwl
1
fcSJ&P am! sniHfcmM protellc Itypcuiophy. £**<*!
fi^. Kan':), I* iU T.srem ratciiAuui «f ilm »m*iitf.
A. JlltlfaooX. R, B.. Tlomim 2. $ , Ubuiminlra, J„
»tl(I Ifiuila&iIcH KJ Hie nriii:iry rwnrtlou of tl.rfeM. —*—f Aimritr ami hypfii>)etfia It% lite prottete
Q)c)M?H3VW»<:jGitU ami l?'fJ$iho£VcarrkttU£raJ<fK In- l»wpcr. / . iMfA, W*tf.tiS:6! 7-^r, i W I.
nortmd Jai*i)cjc and BrirtA women, / , /Stofctr. f»{401«
20. Cftynor* R. S*^ ?!t>r Fratf fas FroftaiakivlH, KM>
1
fAaen«<»vA. SOfiCQS-OfiS, IAS J.
3d CWJIO». K. fU dKliMtna irf itirjwcatate .a Jews
1 Burnt, £.*. Prostatic eUlrMdkn In Kfegrees. / . ami flixiimdrttf Ccmlli'^ >>n'r. J, urn. Stt:H27-A^
*7>W, <M;lfr4tt, Hlfc
8. Hiinowr, lf.t RtlM^gtal lenitltfout Jnrfncr<t toy
31. GfoM7, C. >fj Ciitlwjlj am! «TtfiK*ni of the
oefH*ftctiIc ccwippuixU fn the coaguhilng tfatid anil firoslKte gin nd. / . Ur*h &t 291-1W, 13iil.
rotwtc «f the IttVUS*. ^»U/r. / . Cmwr 25H£XV^!£, i» JS. Oir.liaui. A Itvln. ^r. mid I llinifcfd, A. U U
(
955.
Jhf* mrliiMniMnifc tlhirik'nkxt << oiKtr of >arf*in.
0. Oriffemla Tainor UrflUliyl Cincw rcfttttiatfoit
ami siiTlwl fn California, mi. 223-S5A. $t?tc oX O U - sties in Jlnffalo, *\',V^ IDfA-^S. Ctnrcr I3:ltt)-I91.1MD.
M. Otitm. S. A., fiovld, T . C t u t d Ajnk't$im, W. A*
toilE Dent. of Public Health, i « » .
10. ——« 1 nc^nce ol caflttr In Al»me4n CTounir, U.: I'lotKiit-c cfTtxt of cnttjjjc« a«alnil ^y»iilar ilaftiCalifornia, Uti9-19Gf. SaHftmfc. P-pi, of Jtealth, 1^77. aeo to ilte tciUt CMI«4 l>y ratlnuvn. /^nv. .Vcv. £w*.
11. CfanMcscn* J«: SWMCBJ studies fn ftoafcifolAgf /&/. ^frd. | IJUjJWl^OS, I9rf>.
ci rnuUtmui ncnpjawiis, I, Review inrf jr«iiift«. Wcte
SI. IliitrtiKMrl, t\\: Cancer uioriaVlY nniiifi llie ff»ifcfA. JJ/£wWoJ:irtii(/. Jiij.p). 1741315-31** !£»&.
«lRH-born l » thtt l.'itfird Slater i . AW. dnecr Jmh
IX. CknimcKit, Jt,an* MicUfn, A.: Tft* wrfal *li*iri- &k37-m, 1£WK
hutlojt of canter in Copenhagen, IDtt-JiJT. jt/r//. / .
55. IhcnjzclAV.. «ml KurHt-jra, M^ MudfO of JIJMuc«[? inljniinj. I, Meiialfiy front cfiiifrr and ocftcr J&13. Coflcr, K. ».: ItacfaJ uvftlcjice of piojutti.:; jn raicsauionff JajQiics* fn llie Unhudiiak-*./. AV/« Off*
Ilk-walL/* Waf. WltH-Hf. 1917.
N . CaaJt.C !U Arotnnarfionof fiiiRlc and lauZflpl*
*0. Ifmimmidj R. Gj SniofcfDfi in scLiiSon to Ute
death mici of OIK1 MUHMI men ami MOWTII. Mif. O n 15. IJoJL K./aiid IKH. A. n.t UoruJiir fn relation to rrr/itir. .iMJ/o^r. l!^IW-lwff )ftM.
wnotrijjr: ten year? <ob<»vaif0ii o£ Btillsh doctor* JW/,
W f A / . J(5»&!3W-Mia 1951,
16, Darn, H. R, «»d folk* S. 1.: MorMdilv /irons
ft. Ifctlcr, A^ 7tnl -ViJulu), A. A.! lMdoctfM studies
o n » r In the United MaU.^. U.S. rttbfic UfAliIi Kcrvfm
M#iM>£r. No. Mi, Goit. Fritting Ofi<p, W'afhlti^Kiti,
W. IkiUf, \V. ) \ : *IIK cfftTU of MIlKb'nt diprojxi»xl« anil «K«b\l MiJWmoi on iiuKynjit }Htt\tatlc lisJ7. Duffield, T . J«, mid Jatftb?on, |>, It: fiaiicrr i»K»r- ute. VVuui. / I w n . /»5i- CcMttctrht Afjv. Ji;|£»5-ftKi,
r*Ulr MK1 MBHU! iUluv. An a»alj*I« of dcallw iKrlb. 1911.
ulocf to OMttr *t*c*l£lhe vhhtt tta\MfiMitnt vf f<3?w
4a JloUttt, II.: Owtalum iftvlcofoty. /.#IMW 2:57.
Vorfc Chv *f»irtot IKJ3-J1. / . Wat. Cnnitr Inst.
0:103-112.1W5.
41. Ilomirt^, H. S-. mid JJmocJioK&i. !_: IflilncUmi
IS. )>bnrtfr/& \ y , F.? )»m*iit <anccr In lite wl. .Y«i. •f itf««taic inmcxs Jn mice, ili/f. Jt C*n«r J;KMS?,
C»KA*rJii*JlAF«H«gr. U;361-3W. i903.
1917.
IP. Duunbtf, W. F-. Curlts M. R-. and Sc^-iHf, A.:
4S. HUJKIHJ, C.^nw] I I K I J - ^ C V.: 5l^It>t Ati p i w
MiMbyJclKtlaniUtvtM: jrj«rj»«w rt4l ntHliHWKt of tbe lat i«rt* rtmir- I- The <Iittt of /^nacllni. untA&m mid
BMMiat* with ifcelcfcil n w a s w n aiul follm* »^ rhc rat a(iitii)fi0i iii|rrtloii wt «rrum jrfiu'^niii^ts la tmtaiivrv 14 tcHKMnl lo the -»njm? ra*riijanMi. Camrr )Us. JlJttic CMKinaina AI the pi*a»aft-\ GntrtT lln. ]£$3-2*)7,
Mum
r
H,t An smi>|>iT Hiutyof J.iirm i;in^oicir raiiffr, Cttuzi
0:&3I-MI, l k
SI. K^mltrtju I I . : Cittf*? fe Ort*»«vitrm. hwUfiicc
nn<l tairt, IWi-fG. CMni^ibiii Cte»iv IffiM. «f Ifotixfr,
IVAS.
3». Kflttb-. E. T.. 7m! Sliw*. A. P.: ^nnbiiwcMfi ff 1M«r cm<fpHiK» til Ihr pi>^ 3 |r in « MMMIL^V (Slacani
-<3. |fi*el»«. C ami -V«il, ^V. AV- s.laloal atfJma»
Ircimnf hi fdusfatie rjM.tr. Cllll>ic4ffralnwf Wkf «»*iwar csKsHion of 17 ^i««*«»iif* stud r*ttoge». ^JIIM.
Surf. iryrfWi-IOlI. 1 9 a
44. jhnni. If- L. MiW^, K. \ r « HUT. tl. F, |r^ and
Sfarltrv. M*. A|^ J"he I ' A?r IKM1«U* uf pi«i«Mk uie
«T. Rruih J5 \ i » \ -.jrr »ulk«I runfmi. JAMA
43. lAnifhiui. I U ) a Ifa&at? j»M-fc»*t;pK- proi-rftV
sx. r n t Y 9 r » . ii»w*\, r. ! i . o i i w f u . K ic. M«4
^tJlil^T^M^>**^?6•'a^^fi*WAW<M'J'J'^•~JaL•^^Y'^ ^
f^^ ^1|
1 l ^ ' I if A If |*»%« »*W<lwtt^|Wtfc|»lfr>aMW •*—•^<<S*1WH. '.» *.»*H*«* *•«.
».
tf
Wat
GAKCSA or w r . VHOSTATR
4ft, X*5M%, i t A.i The Uetn itady of smvklng awl
mortally- among 1IA. vetetaiw Kcjtaf ou cifthi and
KtfW York I31Y, 1TJ31-M, J. Mil. Oiwtr iawl. Wl^WKft. Ntw Yor% Blood Cwucr. ]*vnotKil *«*»itnlrt.
•If* Ka]d«ik» 6 . W* «*td O'Gamwr, V* I « |fc$ T t e fiu
3<K Qjpw?, K<4 CottUUuO&wal tlihUM MI tun«n of
<Me«e or OKriivmxa of thefewrtatttn lewt and On- HistetmwKkI. OIMIK mt<*s«rciii*fiU4 «f cutuinutHMU
48. K*nth«, K.l *Utdy at laical carritwoa of the
piosjfttc tn i!ie jn»a»«c luue4 «it nrciomy maJfrali.
t;
40* Kliw, H.i ]3J»UVD*H1, K^ atkl UUmfrlti, A* >U
Some ctwcfiratorfcaj aspect* «f cntttr of ttt« nndate.
J. Giro*. toh> Wttl T-453» l&tffc
D*. KI^llHc M. H„ and Waurhrtiw. J. A. 1U Cadwtum and jxovniic cutlnoma. /-ra«r h?30-?3l. 1M7.
fil. LaneM, MA Occult <aitlnouta in clinkilly Iwatai
liTpcTirtmliy of Itic m*»l&ltt A itttitoloalcal and tliuiad study. J.. I/rtrf.ttfciat-SH;,192*.
fie. lanaster. It. OA Tke mortality in Autudb
torn canters yccuttar (a itw rods, jifa?, J. Ai»f.
2HM4. 195!. *
53. Laiifenrt, T. K. and TaiwmhuuM, M.: Pcrional
unmunlcaikm. 1970.
frl. J-Uvwg, IJ Atropky ami ittgcntfatlon In tl«
.tUoKiMtU *f prostatic eardrum*. .Htf* Path. Wkto*
af.&*ta\ JJtJM-SfiO, IOCS.
55, Uoyd, a W„ ,i»*d YNUIaHK. U. II.: Kmtocrtnc
ttongoaattotlaicd wlili y*tntw<*cltv}t+iftof HmUvcr.
yf«n-..M/*<M:ar.--}JQ, 1018.
56. J.Ulf, R. 15,; Tfcc tmrnui «CWIIL-U« of ifcc in
fc&atftgic rajiablw i icvteir of llw liciaiu)«, and a
•tiHty of tht nonual cUsliihMSatt or rlac in Hie » i , ou.
a n ! join. 7. MJiuf. ffyj. ICI77-KI7.1!)%
67. MftrnuAton, ) . t Uwflmda. l» J* jr., Mym, 5.
M v GfctMa, 11., Stem, fc, sad llopfelm. C. JC: Urf
UMT cxrailoti of iKiitml 17-lncwcji Wt ami ]>txjiiau*
dlol Ziy lulicnu wltli niotuitc caiwr *sid Uenrtn prui*
S
j
•a Urinary cx<r*tton of ciirouc, r u n d M »«d <itrfol by patltnts vrlib hrwlallc rticcr .ind Iwtkx i>roaUlIcUytxrl^plO'./^/rcl.DJ^W-COS.lWS.
M. Mat<(rtll. V. K.: Teaixx* or Urolo-v, Mrf cd.
h t v Voik, Hoct>cr Uedkal DMJIOI^ llarncr It Kow,
r:
do. Mn\tr, J.: Vt*A InWis and Mulrfifotial Kami N
Aiiiwkaii K^rou. iVi^rrf. JLfo). KtA-IIO-A-ll^
CI. MtK«l, J. SU M«rpl»ojict»eUi at proMittcoTdOOW3. CaitrtT JS-.IGM-IOCB, IPCS.
« . Mocttcl, C C H Pocfccriy. M. 31.. and najyxjimnt.
A* f 1» MuH*irfe }rtliwi»ry w»liy*3iit tim^buni. I. F,.liadtirttott and l>rocnuiton of <bta. 0 » « r 14SSI-S£t7v
190U
em* In jMtiwis w»0i p«yitei1c C9;«HMMI»» aud l«i»ljy*
|>r»stMie It^Krpb^a. {/;&£.;;$*. 9: H-HS, IWXJ.
fit. Mo*ie. K. A.: MavubotaK? d muH |M«mtk »rfi& M^fr-. R. A., and McStMwtitt, M. II.: Pi«d»c•Urn of imnoti t4 lit* iM'tmaUf •*! tlK itlih.' ml with
lA-betM]*})*!*. Amcr. 1. CiMTfT»L7St-7-<lr MWL
fifi. Motoie*Hi, rC and KidriU**. M^ Oiwird tn
iHrttni <su*^
I»T
unitul
I4JIH»,
Att* uwu > ^ !ct«7:-fi«. mt.
9U
ft
ConMtiiUluiial HtidEei ON lumws o( iho
\iniMitfc. 1). Oil Icilr MHcint and odivr fcnitncx. Art*
Urrt.Jap. 151507-Slu, ISff.
•Jt. Onla. X4 latent <ar(1wt% of l&ft puMiacc
awniig Itw J.-»|>:uic«s Ada Urn* InL UtHCr. l):K^-9S?t
l»U
tt. P#r*»-TimaYo. R.: Mcctaitfim of niswr, An 1«ln**urlinn to J^Miolofty. l>liihi!clj*)k« aim IJHKSOTH W.
Jl. 5a»ndcr» 0 > 4 IDGH pp. Hf-HT.
H . J'tfl. tt„ Sclmjilia. It. H., »nd R3$»/o»l, I!.;
Male Uroctiihal 'JVklK>mD»tii-Jj. J. Xtount $**** llcip.
ir.r.afoi9MKid.t9io.
75. lU\hli, A., Mid TUvfdt. R. Az Vt6pk#vtto of
can«r nf ihr uio>uic. pen?*, and crrviv uf firtwrtci*
slon.-Ycir Yah J. Mcti.iumO' 1^0.1^116. tt^hicr CICIKUII l»wcmilal Slmplttncal, England ami Walff, K)31,1'l. Ifa. OniiimiimUil Mi«iMUf.
lxinaon.lltr M^c-iiy-j.MMioi.aiT OJTHTC, 1W&? l - — - t Drfctntt^ kumdeaitnia VVjUjid and
AV»lc«. 1951. V:. 7, OxuiHiiloniil inoitatHv. toAdnts»
lUr M^titft SiaUmiry OifeC. 1M4.
tS. Ridi< A. R.; Ou die frmuMcy tit nrctik rarrj*
Itnma of iTic plWUie. i , i'rof. M-215 -S?5. I0JS.
/ft. Rldunl'on, 1. M^ l*i«iiul!c cm HIT and toctat
clan. nnV. / . He*. A«. /XftL ] 0; M6-142, IOCS.
B»- RO1JST»»,J.: l*ci«r»ul<aiu\minIcaliOP> JW*,
&1. RofuAji. M. O.: Clnlvoilj and inouatk nwplanus. CrrUrr/o 21 <Ji> J53-1SI, >0«.
S?. Sctn wrier, II, AJ Cadmltim at a faciei in JiypcrumiMt. j . C/ITOJI. vii, iston-aso, i»$.
89. Sc^J, M.j and Kurltiara. 3d4 OlKcr mortality ?<*
*flectcd »hci Jn N wimlrif. Xo. 4, 10G^: Dcm. of
]*ubtlc llcaKh, TolioVu L'tilvtiKty School d Mcrfirliie,
Gondii. Japan. lUfife.
H. Xddmai'! II.: Con«r rfcnih mtct Ly iltejtiwl t&t
far leHt^w( nfd (OdfHKWiomic jaoww m Xcw York
City. Jint'Iwr. Ucs. 'xtet-VW,
197B,
$S. SlMTtcv. n . A . and l:l5rhtr, St R.t CiirlnOrtia of
itie ttrajtale m (btr abK'nce of teukutnr liuur. / . Urol,
W. SIKVTUOIH-, II., ynd TVmittilwuiw, A.; TfK efTcct
of llic [HUjiortlim of dlcttty Cat on %he »al« of frirmaliott of nununviry ctunkniia |tl udce. durrr An. l*t
X7. Sintomri^ $. CL: Knforrliic c h a i n s %riili picrttiitc
4ardii»Ma. frncvr HI:3I3 S>X. 1^7.
88, Si.is/cvr'Vl,, J.4ai*l II.-MMt»H. \r.: Camrr MMriaJity
amoiix ilie I*c0itli-lxtni hi Hie l^miol States. / . A'«/.
&tv*rtmh y*V*A-~&r*. 19(5.
RSL 5fellilt/k K.; 5>tnrs'sHuMdlty f i w iwapUyin In
ruacl** p«]ait.Umn p<lH|K. IM*U 01*fit4tC «f Iw&cl MIui«tiy nf lUMttlt, Dtrkwi afCtHMtfc Dltrauf and lUhab«il:.UnH, I3i»?.
9*. Sirtw, n , Jlnpthi^ C rM >VHnrr. J. M., and
MaiiimtainH. ]« llMnmiM-eui«4&*u m«rt»w ill breast
1961.
•Jl. S«klii. A.: V( W dm Kt«-b. dc% TUkTr iaolic^
f**>ltt*- \A*r% tHf Ittt|»ltta^i«kl i it tirt lUMhicii'lni
llauflttrtjlhtt uud Hk.i ilir* l'|Mi^wl*Mth; «V^ TliSt**tuwl Uru^h>hLM4r>r^ .I^-fc. JLiw. {%ir. S'c*l*i OW.
l"»li^4 M^h-\.
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V^y^y^^t^A, m J a ^ L ^
CUKCSB* August
XtKtomtotg) twteti
otethy, ml «Fft*gph$c exaction
4
« ^ . u O ^ W : \\,..V. Jii.. « ^ » i .
1371
i 't rfWl I i t t » t X . t
\W. i »
Iranian aiU esmtno proMtfa Afe£ GrtftT Jitif, Jftufxr.
flfc WilU: Kpftfem, Vi<»1ftnt.K ^ , WW*.
JW, Wil'JflwwUJiHwm, 13, & , snA SlitjiuMfci, j ^
cumt
rwcMtiicc l» Eft* Cbttitnou.
te. U^hHt, A, C ? KfrnlKlL A. IV, Fiiuh. U€lnta«ifcc^ X. W* and netintfrt, IV. IU SWuc driaynl effau
of MM*-U©inh taJUiiont lit i»tc& Cmnnr J:M. 2*1-60.
1*00.
£& t S ^ rVpatihinit of rittlili, E*ItKaiton, and VM*
fSKV l*itUH<; JlcaJiU SwvJrv; Vflut MtfffUfcs ol fkc
tfttftei)&»t«ul«$»Y*f. if. Van A. JUonalilfS& VcT*JlKt« J, J.; Oatxo- and ummarifw fu ihr
91. WJiimwiA IV. X- Ji1^ CDMmntt- «Kt ?inc In ifct-
DUR.
OF 'I
OK M«i>*l an<* uwpbtfft; i>ttm*i<-. TH Kmlc^rtiv.ux
F*di>w »n(l«iwicftis llwHiMtor Jlahmx, Ulltv. aT<:i)i<
Off* I'lrtt, IMJ7; |»|>.3MI.
101. Wfiitclvk'j'n. W., ] r , ami Knutor, S,: I'miwiic
CftKceR n&wfofitTito lo stuimKlnt iun If dilate alrittilue f « i . / T / w . A / W l / i t t M f e l J 3 M » 190a
10*. \Wml«*> j . WV MIHV l h u \ L. I , O M u i f * of
in* frtotfafoe An altfttjaK Of ||Mi f3«t ftAftlrrf at ihv
VHi-nm* Atl'iihtlMinifoiv JlOJjufal. Tfcttl&ege* Afctfiattia.
IIW-WOOVJ. Jtticr. £ * M & *w. MzU\ i-\ IDO, ;$G5,
103. Winder, K. I - , l i m i t I... aixl ttifeattai,*. T.:
f > m Jaiftijis of Ink-nut IMWI«,utter <J*MII jaies. Ourct*r
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