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Japanese Journal of Clinical Oncology Pages 54-69

Cancer Incidence in Japan, 1985-89: Re-estimation Based on Data from Eight Population-based Cancer Registries
Introduction
Materials and Methods
   Moving Average Process
   Reporting Standards
   Arithmetic Mean of Incidence Rates from Eight Registries
   Correction Coefficients Based on Cancer Mortality in Japan
Results
   Registration Reliability and Correction Coefficients of Re-estimated Incidence
   Cancer Incidence in Japan
Discussion
   Validity of the Correction in the Estimation Process
   Re-estimation Evaluation on Completeness of Reporting
   Discontinuity at the Juncture of 1980-84 and 1985-89
   Reliable 15-Year Re-estimates
   Observation of Recent Changes in Incidence Rates
Acknowledgments
References

Cancer Incidence in Japan, 1985-89: Re-estimation Based on Data from Eight Population-based Cancer Registries

Cancer Incidence in Japan, 1985-89: Re-estimation Based on Data from Eight Population-based Cancer Registries

The Research Group for Population-based Cancer Registration in Japan*

The Research Group for Population-based Cancer Registration in Japan has been conducting a cooperative study to estimate cancer incidence in Japan since 1975. Estimated incidence data calculated annually were accumulated in 1996 for 18 years. The Group has separately provided another re-calculated incidence estimate series which were prepared for 1975-79, 1980-84 and 1985-89. The former two results, each of five years were previously published elsewhere. These recalculated estimate series made more reliable observations of time trends in incidence feasible by using the same eligible registries' data throughout each 5-year period. This report presents results of the latter 5 years between 1985 and 1989; age-specific, crude and age-standardized incidence rates, as well as the number of incidence according to site and gender, under the cooperation of eight eligible population-based cancer registries in Japan: Miyagi, Yamagata, Kanagawa, Fukui, Osaka, Tottori, Hiroshima City and Nagasaki City. Incidence in Japan was estimated at 187 200 and 150 700 for all cancer sites among males and among females, respectively, in 1985 and 216 700 and 166 900, respectively, in 1989. The leading site was the stomach among both males and females from 1985 to 1989. Among males the second leading site was the lung, followed by the liver, colon and rectum. Among females, it was the breast, followed by the colon, uterus and lung in 1989. The proportion of the cases registered by a death certificate only for all sites was 14.0-15.7 and 13.7 -15.3% and the ratio of incidence to mortality was 1.69-1.73 and 1.95-2.01 among males and females, respectively, during the period.

Key words: cancer incidence - incidence estimates - estimation methods - cancer registry - Japan

Introduction

Monitoring cancer incidence and cancer trends for the entire country is essential in order to provide and assess programs of cancer prevention and control in Japan.

The Research Group for Population-based Cancer Registration in Japan has been providing and publishing national estimates of cancer incidence and incidence rates since the Research Group was first organized in 1975 (1,2). A series of annual estimates were conducted according to site, gender and age-group based on qualified data from eligible registries whose reporting rate satisfied a set of standards. The results have been reported in this journal (3-6).

Generally, completeness of reporting was constant or improved in most registries. However, from time to time, some registries failed to maintain satisfactory reporting rates. On the other hand, other registries successfully improved their reporting rates to satisfactory standards. This variance caused a change in the member of eligible registries, resulting in inconsistencies being introduced into the annual trends of incidence estimates. To avoid this, it was suggested that estimates be calculated for at least 5 years, based on the data from the same eligible registries.

Apart from this, a considerable number of delayed cancer reports were subsequently submitted to all relevant registries from their reporting hospitals after each annual estimate was conducted. It was concluded that if a recalculation of incidence using the total cancer reports including those which were delayed was to be conducted in registries after a few years, estimates obtained using these data would more closely reflect true incidence.

For these two reasons, re-estimations were conducted for 1975-79 and 1980-84 which provided another estimate series. The results have been presented elsewhere (2).

All member registries of the Research Group agreed to recalculate their annual cancer incidence from 1984 to 1990 by including all their delayed cancer reports in order to conduct a re-estimation of incidence in Japan for each year between 1985 and 1989.

Materials and Methods

Moving Average Process

According to the standard methods defined in the `Guidelines for Population-based Cancer Registries in Japan, Third Revision' (7) published by the Research Group, all member registries re-calculated their annual cancer incidence in 1993 according to site, gender and 5-year age-group between 1984 and 1990 and sent their data to the Secretariat of the Research Group, the Osaka Cancer Registry (OCR). Annual average incidence rates were computed at the OCR for each three years 1984-86, 1985-87, 1986-88, 1987-89 and 1988-90 by a moving average process according to site, gender and 5-year age-group for each registry region. The Research Group has used this moving average data to obtain a set of stable age-specific incidence rates for each cancer site, even from small population registries.

Reporting Standards

To select qualified data, a set of standards was set up by the Research Group: (1) the proportion of cases registered with death certificate only (DCO) [le]30% and (2) the ratio of cancer incidence to cancer deaths in the vital statistics [ge]1.4, for all cancer sites in males and females combined (8).

The data from the following eight eligible registries, whose every 3-year moving average data satisfied the standards through the period, were used for the re-estimation of annual incidence in Japan between 1985 and 1989: Miyagi, Yamagata, Kanagawa, Fukui, Osaka, Tottori, Hiroshima City and Nagasaki City. The Kanagawa Cancer Registry alone presented data from a representative area with a population of one million in order to provide a satisfactory reporting rate.

The characteristics of the eight eligible registries are shown in Table 1. The population covered by the eight registries was 16 241 600, corresponding to 13% of the total population of Japan in 1989. The proportion of DCO and the ratio of incidence to deaths which present completeness of reporting are shown together with the proportions of the histologically verified cases to incidence as well as those to reported cases for all cancer sites. The highest completeness of reporting was provided by the Fukui Registry and the highest accuracy of diagnosis was provided by the Hiroshima City Registry.

In comparing these registries with the eligible registries of the 1980-84 re-estimation, the Chiba Cancer Registry was excluded because of a decrease in completeness of reporting. The Saga Cancer Registry failed to complete a calculation for incidence in 1990 before the closing date and was excluded. The registries of Kanagawa, Fukui and Tottori were newly included as they satisfied the expected reporting standards.

Arithmetic Mean of Incidence Rates from Eight Registries

In estimating cancer incidence in Japan, in order to avoid a bias caused by the size of the registry population, an arithmetic mean of incidence rates of all the eligible registries (by site, gender and 5-year age-group) was used, instead of dividing the total incidence by the total population of the eight registries. These rates were regarded as uncorrected estimates of incidence rates in Japan.

Table 1. Size of population, incidence, deaths and reliability for all sites according to registry, 1989
Registry Population Number of Completeness of reporting Accuracy of diagnosis
    Incidence Deaths DCO/I (%) I/D HV/I(%) HV/R(%)
Miyagi 2234106 7201 3765 8.6 1.91 75.6 82.7
Yamagata 1259044 4608 2732 17.1 1.69 64.5 77.8
Kanagawa 1066085 2542 1539 26.8 1.65 49.0 66.9
Fukui 822395 2796 1540 1.7 1.82 73.7 75.0
Osaka 8721232 24222 15005 22.0 1.61 66.5 85.3
Tottori 615782 2311 1316 24.9 1.76 53.1 70.7
Hiroshima City 1077388 3511 1628 7.9 2.16 83.5 90.6
Nagasaki City 445556 1639 893 7.3 1.84 81.0 87.4
Total (average ) 16241588 48830 28418 14.5 1.81 68.4 79.6
DCO/I, proportion of cases with information of the death certificate only to incident cases; I/D, ratio of incidence to deaths; HV/I, proportion of histologically verified cases to incident cases; HV/R, proportion of histologically verified cases to reported cases.

Table 2. Reliability and correction coefficients of estimated incidence in Japan for all sites according to gender and year
    Gender 1985 1986 1987 1988 1989
Reliability DCO/I (%) Male 15.7 14.8 14.4 14.0 15.0
    Female 15.3 14.6 14.0 13.7 14.3
  I/D Male 1.69 1.72 1.72 1.73 1.70
    Female 1.90 1.93 1.96 1.92 1.90
  HV/I (%) Male 65.8 67.1 67.9 68.1 66.9
    Female 68.6 69.7 70.6 70.4 69.7
Correction   Male 0.97 0.96 0.97 0.96 0.97
coefficients   Female 0.98 0.97 0.98 0.98 0.97

Correction Coefficients Based on Cancer Mortality in Japan

On the assumption that survival rates for cancer patients from all eligible registries do not differ much from those for cancer patients in Japan according to gender and site, the following correction was applied during the final stage of the estimate to minimize any possible bias caused by the selection of too few eligible registries.

Cancer mortality in Japan was estimated by using the exact methods employed for the estimation of incidence, by taking mortality data from the vital statistics (8) of the same eight eligible registries. Correction coefficients were then computed according to site and gender by using the observed cancer deaths in Japan in the vital statistics divided by the number of estimated deaths in Japan.

The estimated uncorrected cancer incidence according to site, gender and 5-year age-group were multiplied by the correction coefficients prepared according to site and gender to obtain corrected estimates. These corrected figures were then multiplied by the corresponding Japanese population to obtain the incidence figures for Japan. Age-standardized rates were calculated for two standard populations: the world population (9) and the Japanese model population in 1985 (10).


Figure 1 Proportional site distribution based on incident cases in Japan in 1989. Proportions of incident cases by site are illustrated in pie chart form for 10 major sites.

Results

Registration Reliability and Correction Coefficients of Re-estimated Incidence

Indices presenting registration reliability and correction coefficients for the re-estimated incidence are shown in Table 2 for all sites combined for each year in the 1985-89 period.

The proportion of DCO for all sites combined improved yearly from 15.7 to 14.0 among males and from 15.3 to 13.7 among females from 1985 to 1988 and then rose slightly in 1989. This decline in reporting rate in 1989 was caused by the last year data for the average of the three years 1988-90 in which not all of the delayed cancer reports could be included owing to a shortage of time until re-calculation. The proportion by site and gender is shown in Appendix 1 for 1985, 1987 and 1989. Although the figures for 1986 and 1988 are omitted from the Appendix owing to space limitations, those for each site were almost constant during the period. It was consequently concluded that no consideration was necessary regarding changes in the proportion of DCO in the observation of incidence trends.

The ratio of incidence to deaths is shown for all sites combined in Table 2 and according to site and gender in Appendix 2. The ratio for all sites ranged from 1.69 to 1.73 among males and from 1.90 to 1.96 among females. This ratio is regarded here as another index which can be used to indicate the completeness of reporting. However, it is also an index which indicates the survival rates of patients. The index was generally larger for sites with a more favorable survival rate and smaller for sites with an unfavorable survival rate.

The proportion of histologically verified cases to incidence indicating the diagnostic accuracy of registry data was 66-68% in males and 69-71% in females, for all sites combined, as shown in Table 2. The proportion is usually lower than that with respect to the reported cases, reflecting the size of the DCO proportion. The proportions by site and gender are shown in Appendix 3.

During the 1985-89 observation period, DCO (%) had been increasing and ratio of I/D and HV/I (%) had been decreasing in the female `lip, oral cavity and pharynx' and female multiple myeloma, as observed in Appendices 1-3. This was caused by an increasing DCO (%) in the former site in three eligible registries and in four registries for the latter. The reason why the completeness of these sites had been decreasing in these registries is unclear. As both were among the most minor sites of the 25 sites appearing in the Appendices, late reporting might have accidentally had a great influence on these sites. The cancer reporting collection process for these two sites should be examined for these registries.

The correction coefficients for all sites combined are shown in the last two rows of Table 2 and were 0.96-0.97 for males and 0.97-0.98 for females during the 1985-89 period. No differences were observed between genders in these years. Correction coefficients according to site and gender are shown in Appendix 4 for 1985, 1987 and 1989. These coefficients were between 0.85 and 1.15 in most cancer sites. One situated outside the range 0.80-1.20 has been seen only in a few incidence sites for some years, e.g. thyroid in males and larynx, skin and corpus in females.

Cancer Incidence in Japan

The incidence and age-standardized incidence rates in 1985 and 1989 for the five leading sites are shown according to gender in Table 3. Incident cases for all sites combined increased from 187 200 in 1985 to 216 700 in 1989 (1.16-fold) in males and from 150 700 to 166 900 (1.11-fold) in females. The leading site was the stomach both among males and females from 1985 to 1989. Among males the second leading site in the same period was the lung, followed by the liver, colon and rectum. Among females, the second leading site was the breast, followed by the uterus, colon and lung from 1985 to 1988; however, in 1989, the number of incidence in the colon and uterus was reversed.

Age-standardized rates (Table 3) for all sites combined rose from 254.4 in 1985 to 261.0 in 1989 (1.03-fold) among males and declined slightly from 167.0 to 165.5 (0.99-fold) among females. Among males, between 1985 and 1989 the rate decreased only for the stomach and increased considerably for the colon, rectum, liver, lung, etc. Among females, the rate decreased for the stomach and uterus. Increases were smaller among females than males even for sites where the incidence rate had increased.

Proportional site distributions based on age-standardized rates (world population) in 1989 are shown in pie chart form according to gender in Fig. 1.

Table 3. Trends in incidence (thousands) and age-standardized incidence rates in Japan according to gender and site
Gender   Year Rank in 1989
        1 2 3 4 5
      All sites Stomach Lung Liver Colon Rectum
Male Incidence 1985 187.2 60.5 26.1 17.8 12.4 10.0
  (thousands) 1989 216.7 65.7 30.3 21.0 18.3 13.1
    (1989/1985) (1.16) (1.09) (1.16) (1.18) (1.48) (1.31)
  ASIR 1985 254.4 81.7 34.8 24.2 16.5 13.6
    1989 261.0 78.8 35.6 25.4 21.8 15.8
    (1989/1985) (1.03) (0.96) (1.02) (1.05) (1.32) (1.16)
      All sites Stomach Breast Colon Uterus Lung
Female Incidence 1985 150.7 34.9 20.8 11.2 13.3 10.1
  (thousands) 1989 166.9 35.2 24.4 16.3 12.3 11.4
    (1989/1985) (1.11) (1.01) (1.17) (1.46) (0.92) (1.13)
  ASIR 1985 167.0 37.5 25.3 11.7 15.8 10.1
    1989 165.5 33.2 27.5 14.9 13.2 9.8
    (1989/1985) (0.99) (0.89) (1.09) (1.27) (0.84) (0.97)
ASIR: age-standardized incidence rate to world population, per 100 000 population.

The incidence, crude rates (per 100 000 population), age-standardized rates to the world population and to the Japanese model population in 1985 are shown according to gender and site in Appendices 5-8 for 1985, 1987 and 1989.

Time trends in age-standardized rates (world population) in all sites combined and the leading seven sites are shown in Fig. 2 for each year between 1975 and 1989, obtained from the first to third re-estimation series (2) on semi-logarithmic graph paper. Incidence rates for all sites combined increased until 1987 and then leveled off among males, whereas the rates rose slowly until 1987 and then showed a declining trend among females. The rates for stomach cancer showed a decreasing trend in both genders. The uterine cancer rate also continued to decline in females. Incidence rates for colon, rectum, liver, gallbladder, pancreas, lung and breast cancer rose between 1980 and 1985. However, in recent years the rate increase has slowed for cancers of the liver, gallbladder, pancreas and lung.


Figure 2 Time trends in age-standardized incidence rates in Japan by gender and site from 1975 to 1989. The standard population is the world population. Estimates from re-estimation series I: calculated based on data from five registries (Miyagi, Yamagata, Osaka, Hiroshima City and Nagasaki City). Estimates from re-estimation series II: calculated based on data from the above five registries plus Chiba and Saga Cancer Registries. Estimates from re-estimation series III: see text.

Appendices 9-11 show 5-year age-specific incidence rates according to site and gender for 1985, 1987 and 1989. When compared with age-specific incidence rates in 1985, the rate for each age-group younger than 30-34 in 1989 showed decreases of 17 and 8% on average among males and females, respectively, for all sites combined. Conversely, the age-specific rate for the age-group over 85 showed increases of 18 and 12% among males and females, respectively, in the same period. For age-groups between 35 and 84 there was only a 3% increase and 2% decrease among males and females, respectively, although the trends showed a considerable variation between age-groups.

Discussion

Validity of the Correction in the Estimation Process

Our correction regarding cancer mortality in Japan conducted in the final estimation process, was based on the assumption that survival rates were almost equal for the cancer patients from all the eligible registries and those for the entire country. Regrettably, this assumption cannot be proven at present, because survival rates have been published for only three registries (11-13), and not for the other eligible registries or the country as a whole.

Re-estimation Evaluation on Completeness of Reporting

Incidence and age-standardized rates obtained by the annual estimates are shown in the top row of Table 4 and those obtained by re-estimation are shown in the bottom row for 1985, 1987 and 1989. Indices of registration reliability for each estimate are also shown in the same Table.

Table 4. Comparison between results of annual estimation and re-estimation according to gender and year: incidence, ASIR and the reliability for all sites
      Male Female
      1985 1987 1989 1985 1987 1989
Incidence Incidence Annual es. 178.0 193.4 212.0 138.4 147.7 158.8
  (thousands) Re-es. 188.0 204.5 216.7 146.6 157.6 162.5
  ASIR Annual es. 242.3 247.8 255.4 152.8 153.3 156.0
    Re-es. 254.4 261.4 261.0 161.7 163.8 159.9
Reliability DCO (%) Annual es. 12.9 17.0 17.6 12.6 15.9 16.5
    Re-es. 15.7 14.4 15.0 15.3 14.0 14.3
  I/D Annual es. 1.61 1.62 1.67 1.85 1.89 1.86
    Re-es. 1.69 1.72 1.70 1.90 1.96 1.90
  HV/I (%) Annual es. 68.8 64.5 64.3 72.0 68.0 67.4
    Re-es. 65.8 67.9 66.9 68.6 70.6 69.7
Re-es., re-estimate; Annual es., estimate obtained by annual estimation.

Table 5. Comparison of DCO % for all sites for both genders for 1984-86 at annual estimation and at re-estimation according to registry
Registry DCO (%) for all sites at
  Annual estimation Re-estimation
Miyagi 9.5 8.9
Yamagata 17.7 15.0
Fukui 9.1 6.9
Osaka 21.1 19.2
Hiroshima City 10.7 7.4
Saga 12.5 -
Nagasaki City 8.6 5.4
(Subtotal) (12.7) (10.5)
Kanagawa - 29.7
Tottori - 30.5
Total - 15.5
Note: DCO in Tottori was 30.5% for incidence in 1984-86, which was slightly over the standard. However, as the value was 27.9, 26.3, 24.5 and 24.9% for 1985-87, 1986-88, 1987-89 and 1988-90, respectively, the Tottori Cancer Registry was accepted as a qualified registry for the estimation of incidence in Japan for 1985-89.

The reliability of the data was improved in both quality and quantity in the re-estimation when compared with the annual estimation. In the re-estimation, the proportion of DCO decreased from 16-17 to 13-15%, the ratio of incidence to mortality increased from 1.6-1.8 to 1.7-1.9 and the proportion of verified histologically cases rose 2-5%. The annual number of incident cases increased 8000-12 000 and age-standardized rates rose 9-16 (per 100 000 population) per year in both males and females in the re-estimation.

The proportion of DCO in 1985 was lower in annual estimates than in re-estimates (Table 4), which did not conform to usual trends. Since most of the five registries selected for an annual estimate in 1985 achieved high completeness, the average DCO was 12.7% for both genders, as shown in Table 5 and the completeness improved at the time of the re-estimate even for these registries. However, two additonal registries. whose completeness had not satisfied the standards at the time of annual estimate but barely satisfied it at the time of re-estimation, were included as eligible registries for re-estimation. This resulted in reducing the total completeness in re-estimates to 15.5% (Table 5). The HV/I (%) in 1985 in Table 4 was higher for annual estimate than for re-estimates. This was due to the same reason.

Discontinuity at the Juncture of 1980-84 and 1985-89

Discontinuities were observed in several cancer sites at the temporal juncture of the two re-estimation series: one for 1980-84 and the other for 1985-89. Possible causes are as follows: 1) eligible registries differed between two re-estimations 2) there was a longer time-lag until re-estimation for the first year of each 5-year period and a shorter time-lag for the last year. This could have caused incidence data to be characterized by a higher reporting rate including enough delayed cancer reports for the first year and incidence data with a relatively lower reporting rate for the last year of each 5-year period. 3) The Fukui Cancer Registry was included in the eligible registries in the re-estimation for 1985-89. This Registry started in 1984. Information obtained from medical institutes at the beginning of registration inevitably suffers from an over-reporting of prevalent cases, making it difficult to distinguish true incident cases (14). The above three factors may have caused a higher rate of incidence in the first year of the re-estimation series for 1985-1989.

The names of the eligible registries and the re-estimates reliability for the first and the second re-estimation series are shown in the left and the right sides of Table 6, respectively. Reliability data are shown for all sites and for both genders according to year of incidence.

Table 6. Eligible registries for the first and second re-estimation series and time trends in estimated incidence reliability in Japan for all sites according to year for both sexes, 1975-84
    Series
    I II
    1975 1976 1977 1978 1979 1980 1981 1982 1983 1984
Registry   Miyagi, Yamagata, Osaka, Hiroshima City, Nagasaki City Miyagi, Yamagata, Osaka, Hiroshima City, Nagasaki City, Chiba*, Saga
Reliability DCO (%) 17.1 16.5 14.7 13.4 13.0 18.1 15.5 14.8 14.5 15.0
  I/D 1.58 1.56 1.57 1.58 1.60 1.57 1.60 1.63 1.65 1.64
  HV/I (%) 60.3 62.3 65.6 67.7 68.8 63.2 66.1 67.7 68.2 68.3
*Specific district only.

Reliable 15-Year Re-estimates

Although the incidence data for 1985-89 have some problems as mentioned above, the results of the I-IIIrd re-estimation series provided final estimates of cancer incidence in Japan for 15 years from 1975 to 1989 which virtually achieved internationally acceptable completeness (9). These incidence estimates could be utilized both in cancer epidemiology and in programming and assessing cancer control programs. The Research Group has published future cancer incidence predictions for Japan until 2010 by extrapolations based on these 15 years of incidence estimates; they will be utilized to examine cancer problems in Japan from various aspects in the future (15).

Observation of Recent Changes in Incidence Rates

When time trends in cancer incidence were observed for the 15 years from 1975 to 1989, an increasing rate for sites whose incidence had been increasing seemed to change towards the end of the period. These changes should be confirmed to determine whether or not these are true trends or just a delay in increase for some reason which will be followed by an increasing trend in incidence. Time trends in mortality rates should be observed carefully in relation to this incidence observation.

Acknowledgments

The authors acknowledge participation in the study of all member registries of the Research Group for Population-based Cancer Registration in Japan from 1986 to 1993: Miyagi, Chiba, Kanagawa, Fukui, Aichi, Hyogo, Tottori, Kochi, Saga, Nagasaki, Hiroshima City and Nagasaki City. The authors also thank Mrs T. Kitagawa, Mr H. Matsumoto, Mr S. Kosono and Mr K. Kawai for their assistance in facilitating the computer work required for this report.

This study was supported by a Grant-in Aid for cancer research from the Ministry of Health and Welfare (62-5 and 5-3).

References

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4. Research Group for Population-based Cancer Registration in Japan. Cancer incidence and incidence rates in Japan in 1986: estimates based on data from nine cancer registries. Jpn J Clin Oncol 1991;21:318-23. MEDLINE Abstract

5. Research Group for Population-based Cancer Registration in Japan. Cancer incidence and incidence rates in Japan in 1987: Estimates based on data from nine cancer registries. Jpn J Clin Oncol 1992;22:437-42. MEDLINE Abstract

6. Research Group for Population-based Cancer Registration in Japan. Cancer incidence and incidence rates in Japan in 1988: Estimates based on data from nine cancer registries. Jpn J Clin Oncol 1994;24:299-304. MEDLINE Abstract

7. Fujimoto I (editor). Guidelines for Population-based Cancer Registries in Japan, 3rd revision. Osaka: Research Group for Population-based Cancer Registration in Japan, 1986 (in Japanese).

8. Statistics and Information Department, Minister's Secretariat, Ministry of Health and Welfare. Vital Statistics 1985-89, 1987-91 in Japan, vol 3. Tokyo: Kosei Tokei Kyokai, 1987-91 (in Japanese).

9. Parkin DM, Muir CS. Comparability and quality of data. In: Parkin DM, Muir CS, Whelan SL, Gao YT, Ferlay I, and Powell J, editors. Cancer Incidence in Five Continents, vol VI. Lyon: IARC, 1992;45-173.

10. Statistics and Information Department, Minister's Secretariat, Ministry of Health and Welfare. Age-Adjusted Death Rates by Prefecture, Special Report on Vital Statistics 1990. Tokyo: Kosei Tokei Kyokai, 1992;9 (in Japanese).

11. Hanai A, Tsukuma H, Hiyama T, Fujimoto I. Cancer survival in Osaka. Gann Monogr Cancer Res 1994;41:159-65.

12. Kakisaki M, Osatuma T, Kunii K, Sato S, Matsuda T, Matuzawa J,et al.Ten-year survivals for cancer patients in Yamagata. Yamagata Cancer Registry Report 42. Yamagata Byo-I-Shi 1994;28:222-31 (in Japanese).

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Appendix 1. Trends in Proportions(%) of Cases Registered by Death Certificate Only to Incidence, According to Sex and Primary Site - 1985, 1987, 1989 -
    Male Female
Primary site ICD-9 1985 1987 1989 1985 1987 1989
All sites (incl. in situ) 140-208, 233 15.7 14.4 15.0 15.0 13.7 14.0
All sites 140-208 15.7 14.4 15.0 15.3 14.0 14.3
Lip, oral cavity & pharynx 140-149 7.0 9.8 8.5 6.9 7.7 10.3
Esophagus 150 15.5 11.9 13.4 19.9 15.4 17.4
Stomach 151 12.9 10.7 10.7 15.6 13.1 12.7
Colon 153 13.7 11.6 10.3 15.9 13.6 12.1
Rectum 154 10.9 9.4 7.9 13.5 12.1 9.4
Liver 155 24.3 22.6 24.7 30.8 27.8 29.0
Gallbladder 156 23.1 20.7 23.2 25.0 22.5 23.4
Pancreas 157 24.1 25.0 25.8 27.6 26.7 27.4
Larynx 161 6.4 6.1 4.0 12.8 15.7 12.1
Lung 162 18.8 18.7 21.0 21.0 20.2 24.2
Skin 172-173 6.0 3.8 2.4 8.1 4.5 4.6
Breast (incl. in situ) 174-175,2330 - - - 5.1 4.0 4.5
Uterus (incl. in situ) 179-182, 2331 - - - 7.2 7.4 6.6
Uterus 179-182 - - - 8.6 8.8 8.0
Cervix 180 - - - 3.1 4.1 3.7
Corpus 182 - - - 3.9 3.5 4.3
Ovary 183 - - - 15.6 14.9 16.2
Prostate 185 15.5 14.7 14.8 - - -
Bladder 188 9.6 8.7 10.2 12.1 14.1 18.0
Kidney 189 14.6 12.5 13.6 15.5 14.7 18.3
Brain and nervous system 191-192 17.1 15.9 19.4 18.4 19.6 19.0
Thyroid 193 6.8 4.7 4.4 5.4 3.6 5.0
Malignant lymphoma 200-202 12.9 13.1 15.3 15.9 15.1 16.6
Multiple myeloma 203 26.2 22.5 25.7 22.9 24.6 28.2
Haematopoietic tissue 204-208 18.6 19.3 23.1 20.8 21.0 22.3

Appendix 2. Trends in Ratios of Incidence to Death According to Sex and Primary Site - 1985, 1987, 1989 -
    Male Female
Primary site ICD-9 1985 1987 1989 1985 1987 1989
All sites (incl. in situ) 140-208, 233 1.69 1.72 1.70 1.96 2.01 1.95
All sites 140-208 1.69 1.72 1.70 1.90 1.96 1.90
Lip, oral cavity & pharynx 140-149 2.32 2.03 2.25 3.14 2.92 2.42
Esophagus 150 1.32 1.37 1.31 1.46 1.54 1.33
Stomach 151 2.01 2.11 2.17 1.86 1.97 1.96
Colon 153 2.24 2.43 2.51 1.97 2.24 2.21
Rectum 154 2.15 2.28 2.45 2.04 2.18 2.39
Liver 155 1.29 1.29 1.23 1.22 1.32 1.23
Gallbladder 156 1.19 1.22 1.17 1.23 1.25 1.19
Pancreas 157 1.13 1.05 1.06 1.10 1.11 1.05
Larynx 161 3.72 3.45 3.42 3.44 3.46 2.58
Lung 162 1.25 1.24 1.17 1.31 1.30 1.19
Skin 172-173 6.43 5.89 6.16 5.77 6.90 8.35
Breast (incl. in situ) 174-175, 2330 - - - 4.22 4.38 4.24
Uterus (incl. in situ) 179-182, 2331 - - - 3.54 3.45 3.54
Uterus 179-182 - - - 2.78 2.65 2.66
Cervix 180 - - - 5.50 4.73 4.31
Corpus 182 - - - 6.13 4.91 5.25
Ovary 183 - - - 1.73 1.63 1.50
Prostate 185 2.33 2.34 2.26 - - -
Bladder 188 3.41 3.39 3.63 2.37 2.48 2.32
Kidney 189 2.25 2.34 2.08 1.78 2.15 2.03
Brain and nervous system 191-192 3.51 3.18 2.89 3.70 4.03 3.55
Thyroid 193 4.17 4.91 5.06 7.55 9.51 8.71
Malignant lymphoma 200-202 1.52 1.63 1.57 1.54 1.72 1.61
Multiple myeloma 203 1.41 1.51 1.31 1.59 1.54 1.19
Haematopoietic tissue 204-208 1.11 1.14 1.11 1.15 1.12 1.12
ICD-9: International Classification of Diseases, 9th Revision

Appendix 3. Trends in the Proportion (%) of Histologically Verified Cases to Incidence According to Sex and Primary Site - 1985, 1987, 1989 -
    Male Female
Primary site ICD-9 1985 1987 1989 1985 1987 1989
All sites (incl. in situ) 140-208, 233 65.8 67.9 66.9 69.1 71.2 70.2
All sites 140-208 65.8 67.9 66.9 68.6 70.6 69.7
Lip, oral cavity & pharynx 140-149 83.9 83.5 84.9 85.3 84.4 81.5
Esophagus 150 73.6 78.5 76.2 69.5 71.8 66.2
Stomach 151 78.6 82.5 81.6 75.5 79.6 79.8
Colon 153 73.8 78.0 77.8 69.3 74.8 75.0
Rectum 154 77.7 81.2 81.6 74.7 80.0 80.5
Liver 155 26.1 26.5 26.4 21.6 22.6 23.3
Gallbladder 156 42.3 47.3 41.8 42.8 44.0 42.9
Pancreas 157 38.5 36.7 34.6 31.8 27.9 28.9
Larynx 161 84.0 88.3 87.5 72.4 63.8 72.8
Lung 162 52.2 53.1 51.4 48.4 49.7 46.7
Skin 172-173 87.6 92.5 91.9 88.0 90.5 87.0
Breast (incl. in situ) 174-175, 2330 - - - 87.8 89.6 87.1
Uterus (incl. in situ) 179-182, 2331 - - - 81.9 84.9 84.2
Uterus 179-182 - - - 80.2 82.6 81.6
Cervix 180 - - - 87.0 89.0 87.2
Corpus 182 - - - 87.9 88.5 86.6
Ovary 183 - - - 66.7 67.8 65.5
Prostate 185 71.1 72.7 72.1 - - -
Bladder 188 77.6 78.9 80.2 69.2 72.3 73.3
Kidney 189 65.7 69.1 66.7 57.6 63.0 60.9
Brain and nervous system 191-192 69.2 71.0 65.8 67.9 67.5 65.4
Thyroid 193 81.3 86.4 86.6 86.7 89.5 86.2
Malignant lymphoma 200-202 81.2 80.2 77.2 79.1 77.6 76.3
Multiple myeloma 203 61.3 59.6 62.6 59.5 58.9 55.1
Haematopoietic tissue 204-208 62.8 64.9 62.0 64.0 63.0 63.1

Appendix 4. Trends in Correction Coefficients According to Sex and Primary Site - 1985, 1987, 1989 -
    Male Female
Primary site ICD-9 1985 1987 1989 1985 1987 1989
All sites (incl. in situ) 140-208, 233 0.97 0.97 0.97 0.98 0.98 0.97
All sites 140-208 0.97 0.97 0.97 0.98 0.98 0.97
Lip, oral cavity & pharynx 140-149 0.91 0.86 0.95 1.13 1.06 0.99
Esophagus 150 1.05 1.05 1.01 1.02 0.96 0.93
Stomach 151 0.99 1.00 1.01 1.00 1.00 0.96
Colon 153 0.94 0.99 0.95 0.95 0.95 0.99
Rectum 154 1.03 1.00 1.01 0.93 0.99 1.07
Liver 155 0.91 0.90 0.91 0.96 0.99 0.92
Gallbladder 156 0.99 1.00 1.01 1.01 1.02 1.00
Pancreas 157 0.99 0.96 0.95 1.01 0.96 0.98
Larynx 161 1.05 0.91 1.03 1.40 1.24 1.14
Lung 162 0.97 0.97 0.98 0.94 0.97 0.96
Skin 172-173 1.14 0.98 0.93 0.85 1.04 1.13
Breast (incl. in situ) 174-175, 2330 - - - 1.01 1.03 1.00
Uterus (incl. in situ) 179-182, 2331 - - - 0.99 0.95 1.04
Uterus 179-182 - - - 0.99 0.95 1.04
Cervix 180 - - - 1.01 0.98 1.02
Corpus 182 - - - 1.01 0.79 1.00
Ovary 183 - - - 1.02 1.00 0.95
Prostate 185 1.01 1.02 1.05 - - -
Bladder 188 0.92 0.90 0.96 0.97 0.89 0.87
Kidney 189 0.97 0.91 0.83 0.83 0.91 0.85
Brain and nervous system 191-192 0.98 0.86 0.86 0.96 1.13 1.02
Thyroid 193 1.02 1.12 1.14 0.96 1.11 0.98
Malignant lymphoma 200-202 0.95 0.99 0.90 0.94 1.04 0.92
Multiple myeloma 203 0.96 1.07 0.97 1.04 1.07 0.95
Haematopoietic tissue 204-208 0.85 0.96 1.01 0.92 0.97 0.99

Appendix 5. Trends in the Number of Incidence in Japan According to Sex and Primary Site - 1985, 1987, 1989 -
    Male Female
Primary site ICD-9 1985 1987 1989 1985 1987 1989
All sites (incl. in situ) 140-208, 233 187,200 204,550 216,730 150,860 161,960 166,920
All sites 140-208 187,200 204,550 216,720 146,590 157,590 162,470
Lip, oral cavity & pharynx 140-149 3,390 3,330 3,950 1,970 1,900 1,670
Esophagus 150 6,680 7,620 7,580 1,680 1,730 1,650
Stomach 151 60,540 63,900 65,720 34,940 35,620 35,170
Colon 153 12,360 15,710 18,260 11,230 14,000 16,300
Rectum 154 9,960 11,130 13,090 6,730 7,600 8,760
Liver 155 17,840 20,080 21,040 6,310 7,360 7,410
Gallbladder 156 4,700 5,510 5,890 6,770 7,720 7,840
Pancreas 157 6,730 7,200 7,720 4,930 5,770 6,050
Larynx 161 2,780 2,510 2,570 300 300 230
Lung 162 26,140 28,590 30,280 10,150 11,140 11,400
Skin 172-173 2,360 2,030 2,110 1,800 2,330 2,480
Breast (incl. in situ) 174-175, 2330 - - - 20,750 22,900 24,350
Uterus (incl. in situ) 179-182, 2331 - - - 17,380 15,900 16,390
Uterus 179-182 - - - 13, 640 12,210 12,320
Cervix 180 - - - 9,690 8,470 7,810
Corpus 182 - - - 2,610 2,390 3,170
Ovary 183 - - - 4,620 4,980 4,890
Prostate 185 6,160 6,940 7,740 - - -
Bladder 188 5,810 6,160 7,260 2,070 2,000 2,180
Kidney 189 3,390 3,900 3,810 1,340 1,840 1,870
Brain and nervous system 191-192 2,050 1,840 1,730 1,730 1,890 1,760
Thyroid 193 1,120 1,350 1,360 4,130 5,570 5,310
Malignant lymphoma 200-202 4,090 4,730 4,650 2,600 3,260 3,110
Multiple myeloma 203 1,210 1,380 1,270 1,220 1,380 1,180
Haematopoietic tissue 204-208 3,310 3,810 3,780 2,520 2,590 2,660

Appendix 6. Trends in Crude Incidence rates (per 100,000 Population) in Japan According to Sex and Primary Site - 1985, 1987, 1989 -
    Male Female
Primary site ICD-9 1985 1987 1989 1985 1987 1989
All sites (incl. in situ) 140-208, 233 321.2 348.3 367.4 249.1 264.9 271.7
All sites 140-208 321.2 348.3 367.4 242.5 257.9 264.6
Lip, oral cavity & pharynx 140-149 5.7 5.5 6.6 3.2 3.0 2.7
Esophagus 150 11.4 12.9 12.8 2.8 2.8 2.7
Stomach 151 105.5 110.3 113.1 58.8 59.5 58.5
Colon 153 20.9 26.4 30.5 18.7 22.9 26.6
Rectum 154 17.2 19.0 22.2 11.2 12.5 14.4
Liver 155 29.6 33.0 34.7 10.4 11.9 11.9
Gallbladder 156 8.2 9.6 10.2 11.5 12.9 13.2
Pancreas 157 11.7 12.5 13.3 8.4 9.5 10.0
Larynx 161 4.8 4.3 4.4 0.5 0.5 0.4
Lung 162 45.0 48.8 51.7 16.7 18.1 18.5
Skin 172-173 4.0 3.4 3.4 2.9 3.8 4.0
Breast (incl. in situ) 174-175, 2330 - - - 33.5 36.5 38.6
Uterus (incl. in situ) 179-182, 2331 - - - 28.2 25.6 26.3
Uterus 179-182 - - - 22.2 19.8 19.8
Cervix 180 - - - 15.7 13.6 12.5
Corpus 182 - - - 4.3 3.9 5.1
Ovary 183 - - - 7.5 8.0 7.8
Prostate 185 10.5 11.8 13.1 - - -
Bladder 188 9.8 10.4 12.1 3.4 3.2 3.5
Kidney 189 5.7 6.6 6.3 2.2 3.0 3.0
Brain and nervous system 191-192 3.5 3.1 2.9 2.9 3.1 2.9
Thyroid 193 1.9 2.3 2.2 6.7 9.1 8.5
Malignant lymphoma 200-202 6.9 8.1 7.8 4.3 5.3 5.0
Multiple myeloma 203 2.1 2.4 2.2 2.0 2.3 2.0
Haematopoietic tissue 204-208 5.6 6.4 6.3 4.1 4.2 4.3

Appendix 7. Trends in Age-Standardized Incidence Rates in Japan based on the World Population (per 100,000 Population) According to Sex and Primary Site - 1985, 1987, 1989 -
    Male Female
Primary site ICD-9 1985 1987 1989 1985 1987 1989
All sites (incl. in situ) 140-208, 233 254.4 261.4 261.0 167.0 169.4 165.5
All sites 140-208 254.4 261.4 261.0 161.7 163.8 159.9
Lip, oral cavity & pharynx 140-149 4.6 4.4 4.8 2.2 2.0 1.7
Esophagus 150 9.1 9.6 9.0 1.6 1.6 1.4
Stomach 151 81.7 81.1 78.8 37.5 35.7 33.2
Colon 153 16.5 20.0 21.8 11.7 13.7 14.9
Rectum 154 13.6 14.2 15.8 7.2 7.8 8.5
Liver 155 24.2 25.7 25.4 6.4 7.0 6.7
Gallbladder 156 6.4 6.8 6.8 6.7 7.0 6.6
Pancreas 157 9.1 9.1 9.1 4.9 5.2 5.1
Larynx 161 3.8 3.2 3.1 0.3 0.3 0.2
Lung 162 34.8 35.7 35.6 10.1 10.4 9.8
Skin 172-173 3.2 2.5 2.5 1.8 2.2 2.2
Breast (incl. in situ) 174-175, 2330 - - - 25.3 26.9 27.5
Uterus (incl. in situ) 179-182, 2331 - - - 20.6 18.1 18.3
Uterus 179-182 - - - 15.8 13.4 13.2
Cervix 180 - - - 11.3 9.4 8.4
Corpus 182 - - - 3.1 2.7 3.5
Ovary 183 - - - 5.6 5.8 5.5
Prostate 185 7.9 8.4 8.8 - - -
Bladder 188 7.8 7.7 8.5 2.0 1.8 1.8
Kidney 189 4.7 5.1 4.7 1.5 1.9 1.7
Brain and nervous system 191-192 3.2 2.7 2.4 2.4 2.5 2.4
Thyroid 193 1.5 1.8 1.7 5.1 6.5 6.0
Malignant lymphoma 200-202 5.7 6.3 5.9 2.9 3.4 3.1
Multiple myeloma 203 1.6 1.7 1.5 1.2 1.3 1.0
Haematopoietic tissue 204-208 5.2 5.7 5.4 3.6 3.5 3.5

Appendix 8. Trends in Age-Standardized Incidence Rates in Japan based on the Japense 1985 Model Population (per 100,000 Population) According to Sex and Primary Site - 1985, 1987, 1989 -
    Male Female
Primary site ICD-9 1985 1987 1989 1985 1987 1989
All sites (incl. in situ) 140-208, 233 355.6 365.2 365.4 226.1 229.5 224.0
All sites 140-208 355.6 365.2 365.4 219.5 222.5 217.0
Lip, oral cavity & pharynx 140-149 6.3 5.8 6.5 3.0 2.7 2.3
Esophagus 150 12.8 13.5 12.6 2.4 2.3 2.0
Stomach 151 144.2 113.4 110.3 51.9 49.7 46.1
Colon 153 23.6 28.1 30.6 16.5 19.2 21.0
Rectum 154 18.9 19.8 21.9 10.0 10.7 11.6
Liver 155 32.9 34.8 34.5 9.2 10.0 9.5
Gallbladder 156 9.3 10.1 10.2 9.7 10.3 9.7
Pancreas 157 13.0 13.0 13.2 7.1 7.7 7.5
Larynx 161 5.3 4.5 4.3 0.4 0.4 0.3
Lung 162 51.0 52.2 52.1 14.7 15.1 14.3
Skin 172-173 4.5 3.7 3.6 2.6 3.1 3.1
Breast (incl. in situ) 174-175, 2330 - - - 32.6 34.7 35.5
Uterus (incl. in situ) 179-182, 2331 - - - 27.0 23.7 23.8
Uterus 179-182 - - - 20.9 17.8 17.3
Cervix 180 - - - 14.9 12.5 11.1
Corpus 182 - - - 4.0 3.5 4.5
Ovary 183 - - - 7.2 7.4 7.0
Prostate 185 12.6 13.3 13.7 - - -
Bladder 188 11.3 11.2 12.4 2.9 2.6 2.7
Kidney 189 6.4 7.0 6.4 2.0 2.6 2.4
Brain and nervous system 191-192 3.6 3.1 2.9 2.7 2.8 2.6
Thyroid 193 2.0 2.3 2.2 6.4 8.4 7.7
Malignant lymphoma 200-202 7.5 8.3 7.8 3.9 4.6 4.2
Multiple myeloma 203 2.4 2.6 2.2 1.8 1.9 1.4
Haematopoietic tissue 204-208 6.0 6.6 6.3 4.0 3.9 3.8

Appendix 9. Age-specific Incidence Rates (per 100,000 Population) (Corrected Estimates) in Japan According to Sex and Primary Site, 1985 140-208, 233140-208, 233174-175, 2330179-182, 2331
Age Group
Primary site ICD-9 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+
Male
All sites (incl. in situ) 42.1 18.5 9.6 9.2 13.0 12.8 22.6 39.7 70.4 114.0 210.6 423.0 709.0 989.6 1,367.8 1,935.3 2,411.8 2,692.5 2,676.6
All sites 140-208 18.5 9.6 9.2 13.0 12.8 22.6 39.7 70.4 114.0 210.6 423.0 709.0 989.6 1,367.8 1,935.5 2,411.8 2,692.5 2,676.6
Lip, oral cavity & pharynx 140-149 0.1 0.1 0.0 0.2 0.6 0.4 1.5 2.6 2.9 5.3 9.2 13.2 16.7 24.1 30.7 38.0 40.9 29.0
Esophagus 150 0.0 0.0 0.0 0.2 0.0 0.0 0.0 0.3 1.8 6.9 14.9 27.1 47.4 57.3 70.8 87.4 86.6 73.0
Stomach 151 0.0 0.0 0.0 0.7 0.7 5.2 13.0 26.8 50.9 77.2 154.2 246.6 324.7 445.7 607.8 703.8 763.5 781.1
Colon 153 0.0 0.0 0.1 0.2 0.8 0.8 2.4 6.0 6.5 14.7 28.4 45.9 61.3 85.7 133.7 168.8 194.1 211.1
Rectum 154 0.2 0.0 0.0 0.2 0.4 0.5 1.9 3.1 6.1 15.3 24.1 40.9 58.1 76.8 87.7 117.2 137.1 144.7
Liver 155 0.3 0.1 0.1 0.2 0.5 0.8 1.1 4.3 8.5 22.3 68.3 107.1 110.2 123.0 144.8 143.7 169.6 156.0
Gallbladder 156 0.0 0.0 0.0 0.2 0.1 0.0 0.4 0.6 2.3 4.4 6.2 12.0 22.1 43.3 55.8 73.2 96.5 113.5
Pancreas 157 0.0 0.0 0.0 0.0 0.0 0.2 0.9 1.9 3.7 6.9 11.5 24.0 36.2 58.1 76.4 93.8 109.7 100.9
Larynx 161 0.0 0.0 0.0 0.0 0.0 0.0 0.2 0.2 0.9 2.8 8.1 10.2 20.8 25.3 30.9 30.5 31.3 18.1
Lung 162 0.0 0.0 0.0 0.0 0.3 0.3 1.8 4.2 6.8 14.3 36.0 79.4 137.8 222.4 344.0 461.2 476.8 399.7
Skin 172-173 0.0 0.1 0.2 0.2 0.0 0.7 0.7 0.7 2.1 2.5 5.4 7.6 10.5 15.4 26.0 24.9 41.6 65.9
Prostate 185 0.0 0.0 0.0 0.2 0.0 0.0 0.1 0.0 0.3 0.3 1.9 6.2 17.6 38.4 96.9 160.5 195.6 241.2
Bladder 188 0.0 0.0 0.0 0.1 0.1 0.5 1.1 2.4 2.3 5.1 7.4 17.1 34.8 41.7 68.6 89.5 108.7 121.3
Kidney 189 1.6 0.1 0.0 0.1 0.0 0.3 0.5 1.5 1.6 4.5 8.7 11.6 20.7 27.4 33.5 38.4 46.1 40.8
Brain and nervous system 191-192 2.1 2.7 2.3 2.4 1.4 1.3 2.1 2.9 2.9 3.5 3.6 7.2 6.6 7.6 7.3 11.6 9.3 12.6
Thyroid 193 0.0 0.0 0.1 0.0 0.4 1.3 1.5 1.1 1.7 3.2 3.6 4.2 5.5 3.9 5.8 9.4 5.7 5.4
Malignant lymphoma 200-202 1.4 1.4 1.7 1.4 1.4 1.0 2.3 3.6 3.7 5.7 9.6 14.4 17.4 23.3 33.0 44.7 47.4 43.0
Multiple myeloma 203 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.2 0.5 1.6 2.3 3.4 6.7 6.5 16.7 18.7 21.5 29.5
Haemato-poietic tissue 204-208 5.8 3.2 2.5 2.2 1.4 4.1 2.6 3.1 3.4 5.1 6.6 7.9 10.5 17.3 22.7 25.4 22.8 25.4
Female
All sites (incl. in situ) 42.1 14.8 7.8 7.9 8.2 13.6 31.7 72.4 128.5 206.5 258.8 324.8 416.2 547.9 690.5 946.4 1,155.9 1,389.9 1,390.1
All sites 140-208 14.8 7.8 7.9 8.2 12.9 28.7 63.5 112.0 188.2 242.7 315.8 407.8 542.1 683.6 941.5 1,153.3 1,388.0 1,387.1
Lip, oral cavity & pharynx 140-149 0.1 0.0 0.1 0.2 0.2 0.3 1.7 1.4 1.5 3.1 5.7 6.2 8.4 10.8 10.1 15.3 13.0 15.1
Esophagus 150 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.7 0.4 2.0 3.6 5.4 10.8 12.2 23.0 26.8 32.8
Stomach 151 0.0 0.0 0.0 0.1 1.5 6.8 15.0 27.4 38.6 52.5 68.5 91.3 123.3 172.8 255.2 289.5 352.3 382.0
Colon 153 0.0 0.0 0.0 0.0 0.1 0.6 1.5 4.1 8.2 13.3 23.1 27.6 50.0 57.7 82.2 106.9 135.7 129.8
Rectum 154 0.0 0.0 0.0 0.0 0.2 0.3 1.3 1.6 7.5 12.1 12.7 17.8 27.1 32.7 51.4 56.3 75.6 69.1
Liver 155 0.1 0.1 0.0 0.1 0.0 0.1 0.4 0.6 1.8 4.5 8.5 17.6 29.4 39.6 48.1 66.4 85.2 80.4
Gallbladder 156 0.0 0.0 0.0 0.0 0.3 0.1 0.6 0.6 2.4 4.0 8.0 16.6 25.1 37.0 58.0 87.7 98.0 97.2
Pancreas 157 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.3 1.5 3.1 6.9 10.4 20.6 27.3 41.2 56.7 75.0 75.8
Larynx 161 0.0 0.0 0.0 0.0 0.0 0.1 0.1 0.1 0.0 0.1 0.3 1.1 1.0 2.2 1.7 4.2 3.1 4.8
Lung 162 0.0 0.0 0.0 0.0 0.0 0.3 1.2 3.0 6.4 9.4 12.7 22.6 34.8 56.9 93.0 115.7 144.9 116.1
Skin 172-173 0.0 0.1 0.3 0.3 0.1 0.7 0.4 0.8 1.4 1.2 2.8 4.1 5.4 7.3 11.6 14.7 30.8 46.7
Breast (incl. in situ) 42.1 0.0 0.2 0.0 0.1 0.8 4.9 16.7 35.7 59.8 76.9 72.2 69.5 72.0 64.7 62.4 58.4 47.3 42.1
Uterus (incl. in situ) 42.1 0.0 0.0 0.1 0.0 1.0 6.4 18.5 31.7 46.0 42.5 48.8 60.1 59.7 62.6 64.4 72.7 66.9 56.6
Ovary 183 0.0 0.9 0.8 1.6 1.9 1.6 3.7 5.0 8.5 13.6 14.8 15.7 15.5 15.8 17.9 17.9 23.5 22.4
Bladder 188 0.0 0.0 0.0 0.2 0.4 0.0 0.6 0.2 0.9 0.4 2.4 2.3 7.6 9.3 16.8 29.3 35.6 42.0
Kidney 189 0.6 0.1 0.0 0.0 0.4 0.3 0.2 0.3 0.8 1.3 1.9 4.5 6.5 6.7 10.9 12.7 11.0 10.1
Brain and nervous system 191-192 2.7 1.3 1.7 0.7 1.8 1.0 2.0 2.7 1.5 2.2 3.0 3.2 5.3 6.8 8.4 9.1 8.3 3.7
Thyroid 193 0.0 0.0 0.2 0.6 1.4 4.4 3.8 6.8 10.7 8.4 12.5 13.0 12.2 14.6 17.0 14.6 13.7 18.5
Malignant lymphoma 200-202 0.7 0.6 0.5 0.5 0.8 0.4 0.8 1.0 1.9 2.9 4.0 7.5 9.1 14.4 19.8 25.9 24.0 19.2
Multiple myeloma 203 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.6 0.8 2.1 3.7 4.5 7.0 12.7 9.8 16.5 17.0
Haemato- poietic tissue 204-208 4.9 3.4 1.9 1.5 0.9 1.7 2.3 2.5 3.3 3.9 4.5 6.5 7.2 7.5 9.8 12.8 13.8 10.8

Appendix 10. Age-specific Incidence Rates (per 100,000 Population) (Corrected Estimates) in Japan According to Sex and Primary Site , 1987
Age Group
Primary Site ICD-9 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+
Male
All sites (incl. in situ) 140-208, 233 18.9 8.6 9.5 9.9 12.3 20.9 36.3 70.1 113.3 205.7 412.5 747.5 1,065.4 1,394.6 2,003.3 2,471.8 2,683.5 2,913.1
All Sites 140-208 18.9 8.6 9.5 9.9 12.3 20.9 36.3 70.1 113.3 205.7 412.5 747.5 1,065.5 1,394.6 2,003.3 2,471.8 2,583.5 2,913.1
Lip, Oral Cavity & Pharynx 140-149 0.2 0.1 0.1 0.3 0.9 0.9 0.7 2.0 3.7 6.2 8.9 13.0 16.4 23.4 29.1 24.9 29.0 25.8
Esophagus 150 0.0 0.0 0.0 0.0 0.1 0.1 0.0 0.5 2.0 6.1 16.2 33.4 49.0 55.4 79.4 94.7 84.9 77.1
Stomach 151 0.0 0.0 0.0 1.2 0.8 3.7 11.7 26.0 46.7 77.8 142.2 247.2 337.6 442.8 604.4 723.9 746.6 761.3
Colon 153 0.0 0.0 0.3 0.0 0.4 0.5 2.6 5.7 7.8 16.2 36.3 56.1 82.6 111.1 149.9 196.3 175.1 285.3
Rectum 154 0.2 0.0 0.0 0.0 0.5 0.4 1.4 3.8 8.4 15.2 25.0 46.0 59.3 74.2 99.9 114.9 145.1 160.3
Liver 155 0.2 0.0 0.1 0.0 0.3 0.6 1.2 4.9 9.0 20.3 63.5 121.1 129.2 135.7 151.9 151.7 151.7 171.2
Gallbladder 156 0.0 0.0 0.0 0.0 0.1 0.0 0.3 0.7 1.4 3.7 6.0 13.2 25.2 40.7 66.8 97.4 102.9 116.1
Pancreas 157 0.0 0.2 0.0 0.0 0.2 0.2 0.5 1.7 3.1 6.5 10.9 20.9 39.2 53.8 80.8 97.7 117.1 115.3
Larynx 161 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.4 0.5 1.3 4.3 12.0 19.1 20.1 26.1 26.2 28.6 21.0
Lung 162 0.0 0.0 0.0 0.0 0.2 0.3 1.3 3.4 8.1 13.7 35.3 82.7 148.2 216.3 355.7 449.5 514.7 462.0
Skin 172-173 0.0 0.2 0.1 0.1 0.2 0.1 0.1 0.7 0.7 2.5 4.0 7.2 9.1 10.4 16.4 27.0 46.8 43.1
Prostate 185 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.3 0.3 2.3 5.1 20.6 40.4 98.6 158.4 193.4 300.3
Bladder 188 0.0 0.0 0.0 0.1 0.1 0.4 0.8 1.5 3.0 4.5 8.1 20.2 29.7 43.8 64.9 90.6 111.9 127.6
Kidney 189 1.5 0.1 0.0 0.0 0.2 0.5 0.6 1.8 1.9 4.6 8.8 13.4 19.4 29.4 43.1 41.9 47.2 36.5
Brain and nervous system 191-192 2.2 2.2 1.6 1.5 1.0 0.9 2.4 3.1 1.6 2.9 5.2 4.4 5.1 6.5 7.7 11.9 11.4 8.7
Thyroid 193 0.0 0.0 0.3 0.0 0.8 1.0 1.1 1.8 2.4 2.5 4.7 5.3 5.9 4.4 5.8 9.6 9.9 7.7
Malignant lymphoma 200-202 1.2 1.3 1.8 1.3 1.3 1.7 1.8 3.3 3.2 5.8 10.2 13.6 24.6 28.8 37.4 50.4 52.3 49.1
Multiple myeloma 203 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.2 0.2 1.2 1.3 2.4 6.2 10.1 22.4 19.6 27.7 30.5
Haemato-poietic tissue 204-208 6.0 3.4 2.9 2.6 1.6 3.2 2.9 4.4 4.2 5.6 7.0 8.9 12.4 17.9 25.1 30.7 21.9 28.0
Female
All sites (incl. in situ) 140-208, 233 16.3 5.8 6.5 8.6 13.1 30.6 68.7 137.4 197.9 262.5 324.9 409.2 547.1 697.7 990.9 1,180.5 1,359.8 1,497.8
All Sites 140-208 16.3 5.8 6.5 8.5 12.7 27.9 58.9 118.7 176.4 246.2 316.7 402.7 540.4 692.6 985.2 1,177.7 1,357.4 1,496.6
Lip, Oral Cavity & Pharynx 140-149 0.2 0.0 0.0 0.2 0.2 1.0 1.6 1.3 1.0 3.1 4.3 3.2 8.2 8.8 11.7 13.0 15.4 19.2
Esophagus 150 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.2 0.3 1.0 2.9 3.1 6.3 9.9 11.7 20.0 22.7 28.7
Stomach 151 0.0 0.0 0.0 0.2 1.7 5.9 11.3 25.9 34.7 48.5 61.5 84.0 123.3 166.2 254.6 300.0 331.7 370.9
Colon 153 0.0 0.0 0.0 0.3 0.3 1.1 1.5 5.3 9.1 17.1 23.9 33.3 55.3 65.3 98.2 129.0 141.9 167.6
Rectum 154 0.0 0.0 0.0 0.1 0.4 0.3 1.4 2.1 6.6 12.4 18.3 22.4 31.3 34.7 50.6 57.3 63.6 69.6
Liver 155 0.4 0.0 0.0 0.1 0.0 0.0 0.2 0.7 1.7 3.4 8.8 19.6 31.6 48.5 58.7 68.9 86.7 75.2
Gallbladder 156 0.0 0.0 0.0 0.0 0.1 0.1 0.7 1.5 1.5 4.5 8.7 15.2 26.8 34.6 37.2 87.4 109.8 110.7
Pancreas 157 0.0 0.0 0.0 0.1 0.2 0.0 0.6 0.6 1.5 2.8 6.6 11.9 17.3 29.7 51.1 66.9 76.5 87.0
Larynx 161 0.0 0.0 0.0 0.0 0.0 0.2 0.1 0.0 0.0 0.2 0.0 1.2 1.2 2.1 2.9 2.0 2.4 3.1
Lung 162 0.0 0.0 0.0 0.0 0.0 0.8 0.8 2.6 5.5 8.4 13.7 25.4 35.4 60.1 89.2 121.4 138.6 139.2
Skin 172-173 0.0 0.2 0.1 0.5 0.1 0.7 0.9 1.2 1.9 1.8 2.3 5.1 5.3 7.6 15.3 19.2 28.4 68.5
Breast (incl. in Situ) 174-175, 2330 0.0 0.0 0.0 0.1 0.8 4.0 17.1 42.7 64.0 86.5 74.2 65.7 75.1 68.0 72.3 58.0 54.4 52.5
Uterus (incl. in Situ) 179-182, 2331 0.0 0.0 0.0 0.1 1.0 5.8 16.3 33.1 39.9 36.2 43.0 48.9 47.3 53.3 55.5 60.1 66.7 72.5
Ovary 183 0.0 0.3 1.1 1.0 1.9 2.2 4.5 5.1 8.7 12.9 16.0 16.9 17.5 15.9 19.4 18.9 20.3 20.6
Bladder 188 0.0 0.0 0.0 0.4 0.1 0.0 0.1 0.2 0.4 1.0 1.6 3.0 5.2 9.9 15.5 23.6 32.8 40.9
Kidney 189 0.4 0.0 0.0 0.0 0.3 0.1 0.4 0.6 0.8 1.9 2.9 5.7 7.6 8.9 13.9 16.7 17.8 13.6
Brain and nervous system 191-192 3.1 1.1 2.0 0.8 1.8 1.2 1.1 1.9 1.1 2.0 4.1 3.4 5.9 6.8 11.5 8.8 11.6 4.5
Thyroid 193 0.1 0.0 0.0 0.4 1.8 2.6 6.4 9.1 14.1 11.7 19.0 16.9 16.4 17.6 21.3 18.9 22.4 19.8
Malignant lymphoma 200-202 0.6 0.2 0.6 1.2 0.2 0.7 1.2 1.8 2.3 4.1 4.8 9.3 10.7 13.4 23.1 30.8 29.6 25.4
Multiple myeloma 203 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.3 1.0 2.0 2.7 4.9 8.7 10.7 13.8 20.8 14.1
Haemato- poietic tissue 204-208 5.0 2.5 1.6 1.4 1.2 2.7 2.1 2.3 3.0 3.3 4.7 5.9 5.1 8.1 14.4 13.6 12.2 16.2

Appendix 11. Age-specific Incidence Rates (per 100,000 Population) (Corrected Estimates) in Japan According to Sex and Primary Site , 1989
Age Group
Primary Site ICD-9 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+
Male
All Sites (incl. in Situ) 140-208, 233 16.4 8.4 7.6 10.2 12.6 16.8 32.4 67.5 118.7 210.5 384.7 709.5 1,084.6 1,441.4 1,926.9 2,470.0 2,828.8 3,149.7
All Sites 140-208 16.4 8.4 7.6 10.2 12.6 16.8 32.4 67.5 118.7 210.5 384.7 709.5 1,084.6 1,441.4 1,926.9 2,470.0 2,828.8 3,149.7
Lip, Oral Cavity & Pharynx 140-149 0.5 0.1 0.0 0.3 0.7 1.0 0.8 1.9 3.5 5.7 10.4 16.7 18.5 25.7 26.5 33.5 36.4 29.0
Esophagus 150 0.0 0.0 0.0 0.0 0.0 0.1 0.1 0.6 1.5 6.7 14.8 31.6 47.2 54.3 65.7 87.1 84.0 69.8
Stomach 151 0.1 0.0 0.0 0.9 1.8 2.8 9.17 25.1 44.4 78.8 136.5 217.9 332.6 432.0 604.6 699.6 753.2 785.9
Colon 153 0.0 0.0 0.5 0.0 0.6 0.9 1.9 5.4 10.6 19.3 40.9 62.4 95.5 122.2 147.2 199.2 225.6 249.2
Rectum 154 0.0 0.0 0.0 0.0 0.0 0.5 0.7 2.7 9.0 17.7 29.0 49.2 69.6 87.7 117.8 111.8 145.7 170.7
Liver 155 0.4 0.0 0.2 0.0 0.0 0.1 1.9 3.5 11.2 17.8 48.0 115.4 144.2 144.2 144.5 152.8 171.8 190.9
Gallbladder 156 0.0 0.0 0.0 0.0 0.1 0.0 0.4 1.0 1.4 2.9 6.7 13.0 23.4 42.1 62.0 95.4 115.6 129.6
Pancreas 157 0.0 0.3 0.0 0.0 0.2 0.0 0.3 1.1 1.8 7.9 10.2 21.9 34.8 57.8 75.0 107.3 127.9 123.9
Larynx 161 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.3 0.6 2.1 3.0 11.7 14.9 24.2 23.6 26.1 26.8 31.3
Lung 162 0.0 0.0 0.0 0.0 0.0 0.1 1.2 3.7 6.9 15.9 31.0 72.1 143.6 231.3 341.6 451.3 540.0 571.3
Skin 172-173 0.1 0.1 0.2 0.0 0.1 0.4 0.5 1.0 1.5 2.0 2.9 5.6 8.5 10.7 17.4 27.0 43.2 52.4
Prostate 185 0.3 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.2 0.5 1.2 5.7 24.5 44.9 91.7 170.0 205.8 302.8
Bladder 188 0.0 0.0 0.0 0.0 0.1 0.3 0.6 2.9 3.16 5.2 9.12 20.1 32.2 50.1 66.9 103.5 120.8 161.3
Kidney 189 0.5 0.2 0.0 0.0 0.2 0.2 0.3 1.0 2.1 4.8 7.7 11.9 20.6 30.2 32.5 38.3 42.5 38.8
Brain and nervous system 191-192 1.8 1.8 1.0 1.2 1.4 0.8 1.5 1.9 1.8 2.5 3.9 3.9 5.6 6.5 10.5 12.6 15.8 6.5
Thyroid 193 0.0 0.2 0.3 0.1 0.3 0.2 0.9 1.5 4.3 1.9 3.8 5.0 5.8 4.7 5.8 9.1 9.2 8.7
Malignant lymphoma 200-202 0.8 1.3 0.9 1.1 1.4 2.1 2.3 3.2 4.4 5.2 7.5 13.6 21.0 27.2 27.7 47.4 52.7 76.0
Multiple myeloma 203 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.2 0.8 1.6 0.9 4.5 5.2 7.1 14.2 15.4 25.6 25.2
Haemato-poietic tissue 204-208 4.9 2.7 2.8 2.9 1.5 2.1 3.0 4.5 5.1 4.5 5.9 10.4 13.1 11.5 20.1 34.2 20.9 45.8
Female
All Sites (incl. in Situ) 140-208, 233 15.5 5.9 6.1 8.7 13.0 30.1 64.7 128.4 201.5 267.0 310.0 395.5 534.6 703.1 913.5 1,139.6 1,355.8 1,560.0
All Sites 140-208 15.5 5.9 6.1 8.6 12.3 26.4 52.7 112.5 178.5 252.1 302.1 390.1 527.2 697.1 908.1 1,135.3 1,354.9 1,557.8
Lip, Oral Cavity & Pharynx 140-149 0.2 0.0 0.0 0.2 0.2 0.8 1.0 1.6 0.8 2.7 3.2 3.5 5.6 6.2 11.2 9.2 17.6 15.9
Esophagus 150 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.3 0.4 1.1 2.5 2.3 5.0 7.4 11.7 17.6 20.6 28.5
Stomach 151 0.2 0.0 0.1 0.2 1.0 4.1 9.2 21.6 32.2 43.6 56.5 81.4 117.1 163.6 213.8 277.8 321.3 365.2
Colon 153 0.0 0.0 0.0 0.4 0.4 0.7 1.7 5.1 9.4 18.2 26.2 40.2 58.1 80.8 97.2 132.2 171.9 189.6
Rectum 154 0.0 0.0 0.0 0.1 0.1 0.1 1.2 4.0 7.0 13.2 16.7 27.8 35.0 45.0 52.1 60.0 54.7 79.0
Liver 155 0.1 0.1 0.0 0.1 0.6 0.1 0.5 0.7 1.6 3.9 7.6 18.1 30.5 45.9 58.3 62.3 68.6 81.3
Gallbladder 156 0.1 0.0 0.0 0.0 0.1 0.0 0.8 1.3 1.6 4.0 7.9 12.4 24.1 33.1 60.6 84.4 108.9 130.3
Pancreas 157 0.0 0.0 0.0 0.0 0.3 0.0 0.3 1.1 1.4 3.3 7.4 9.2 15.7 30.0 47.8 62.5 78.9 95.5
Larynx 161 0.0 0.0 0.0 0.0 0.0 0.1 0.1 0.0 0.2 0.2 0.3 0.6 0.2 1.1 2.4 1.1 3.0 4.0
Lung 162 0.2 0.0 0.1 0.0 0.0 0.7 0.5 2.7 4.3 7.6 13.5 22.3 30.5 58.5 83.4 117.6 145.1 145.4
Skin 172-173 0.0 0.5 0.3 0.5 0.1 0.7 0.3 0.6 1.8 2.5 4.3 4.3 4.4 7.8 15.0 25.0 21.1 60.5
Breast (incl. in Situ) 174-175, 2330 0.0 0.0 0.0 0.1 0.5 4.8 16.0 40.2 69.5 87.3 72.4 71.3 76.6 76.3 68.5 66.7 59.9 45.6
Uterus (incl. in Situ) 179-182, 2331 0.0 0.0 0.0 0.2 1.5 7.8 18.9 31.2 44.4 39.5 43.7 41.4 50.8 47.9 54.7 54.4 56.6 72.4
Ovary 183 0.1 0.6 0.5 1.0 1.8 2.5 3.6 4.4 8.7 13.5 13.4 16.1 14.2 14.7 17.5 18.3 22.1 24.4
Bladder 188 0.0 0.0 0.0 0.1 0.1 0.0 0.3 0.3 0.8 1.1 1.4 3.5 5.7 10.6 16.4 19.6 34.1 41.8
Kidney 189 0.3 0.0 0.0 0.0 0.0 0.2 0.3 0.4 0.9 2.2 2.0 4.8 7.7 7.4 13.0 15.0 22.0 20.2
Brain and nervous system 191-192 3.5 1.1 1.7 1.3 1.2 1.0 1.4 1.3 1.0 2.1 3.3 2.6 4.2 6.9 10.1 8.5 7.0 11.2
Thyroid 193 0.1 0.1 0.1 0.5 2.5 2.5 5.8 8.3 11.5 13.1 16.6 15.1 17.5 16.1 16.0 18.4 17.5 13.4
Malignant lymphoma 200-202 0.2 0.6 0.4 1.2 0.3 1.2 1.4 2.4 2.5 4.4 4.0 6.3 9.8 11.5 21.6 22.8 27.1 29.3
Multiple myeloma 203 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.1 0.1 0.3 1.1 1.9 4.4 6.8 6.6 13.6 20.2 13.7
Haemato-poietic tissue 204-208 5.6 1.6 2.3 1.4 1.6 1.7 1.5 2.4 2.4 2.8 5.0 4.8 5.8 7.7 12.3 15.4 20.2 16.8

Received March 21, 1997; accepted August 7, 1997
*This report was prepared by Aya Hanai and Isaburo Fujimoto, Japanese Association of Cancer Registries, Osaka and Akira Oshima, Department of Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
For reprints and all correspondence: Aya Hanai, Japanese Association of Cancer Registries, c/o Osaka Medical Center for Cancer and Cardiovascular Diseases, 3-3 Nakamichi 1-chome, Higashinari-ku, Osaka 537, Japan
Abbreviations: DCO/I (%) or DCO (%), proportion of cases registered with information on the death certificate only to incident cases; I/D, ratio of incidence to deaths; HV/I (%), proportion of histologically verified cases to incident cases; HV/R (%), proportion of histologically verified cases to reported cases; ASIR, age-standardized incidence rate to world population

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