| Japanese Journal of Clinical Oncology | Pages |
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News from Japan
No Donors for Transplant: Half a Year Passed since Organ Transplant Law Validated
Half a year has passed since the organ transplant law took effect in October 1997. This law was intended to promote the transplantation of the heart, lung, liver, kidney, pancreas, small intestine and eye at the brain death stage. However, despite the increase in patients who require the organs, there has been no transplantation from the donors at brain death stage.
Several issues are highlighted: the Ministry of Health and Welfare restricts the 96 medical centers which are qualified to make a diagnosis of brain death. These medical centers cover only 30% of patients who are potentially donors for transplantation. Some of the transplant surgeons are strongly demanding the increase of numbers in the qualified emergency medical centers. Another issue is the difficulty in obtaining the permission according to the new law. Japanese transplant law is the strictest in the world: donors must give their written permission for their organs to be used when they are declared brain-dead, as well as written acceptance to undergo the survey for being brain-dead. A further prerequisite is that the donors' families must agree to the transplant and that the donors are restricted to those older than 15 years. For these reasons, the Ministry of Health and Welfare has delivered 4.5 million `donor cards' indicating the written permission. However, it is questionable whether these cards are prevailing among the people and actually functioning.
For the promotion of transplantation, it is necessary to revise the present system for a better and practical one.
UK-Japan Workshop on Gastrointestinal Cancer was Held Towards Improved Understanding Between East and West
This one day workshop was held at the International Lecture Hall, Tokyo, on 24th April 1998, with the support of the British Council, Tokyo and the Foundation for Promotion of Cancer Research, Japan. The Organising Committee assembled an International panel of workers renowned in the field of management of Gastrointestinal Cancer to discuss a number of key issues. Other guests included discussants from Australia, the US, Singapore and China in addition to the UK and Japan, ensuring lively discussion of all topics covered. The workshop formed part of the Festival UK 98 and arose from the exchange programme between the UK and the National Cancer Center, Tokyo.
Invited speakers presented data in the areas of cancer epidemiology and screening, the detection of early cancers, comparison of surgical techniques in Britain and Japan in the treatment of rectal and gastric cardia cancer and the role and rationale of multimodal therapy in the management of gastrointestinal cancer. Particular emphasis was placed on the safety of surgical resection and the need to maintain low levels of morbidity and mortality and new techniques in the preservation of autonomic function after rectal cancer surgery. Endoscopic techniques of mucosal resection and dye-spraying were demonstrated, techniques that we in Britain are only now beginning to recognise as an area where we are far behind our Japanese colleagues. From the medical oncology viewpoint, close collaboration between surgical and medical colleagues was emphasised and the need to adopt a multidisciplinary approach to management of gastrointestinal cancer and to evaluate new therapies by collaborative randomised controlled trials.
Throughout the workshop, the theme of co-operation was emphasised and there was general agreement that quality control and standardisation of classification systems was a prerequisite for the future comparison of results between East and West.
In addition, this workshop served as a forum to further cement the close links between Japan and the UK, and Dr Kauro Abe, President of the NCCH and Professor Tony Axon, Leeds, representing the British Clinical Oncology Group signed an agreement to secure the UK-Japan Exchange program for a second term of 3 years, to facilitate exchange of research workers and clinicians between NCCH and British Institutions. This agreement has already supported the exchange of 7 surgeons and 5 endoscopists between NCC hospitals and British centres over its first 3 year term, funded generously by the Foundation for Promotion of Cancer Research and the British Council. This program is now secure into the millenium and will guarantee close co-operation and collaborative research over the next 3 years.
This workshop proved a great success and has generated a number of ideas which will be investigated by workers in Japan and Britain and will be reported on at further UK-Japan Workshops.
GV Miller, MD FRCS
Lecturer in Surgery
University of Leeds, Leeds, UK
Awards
Mutation Research Award 1997 to Dr Minako Nagao
Dr Minako Nagao, a long-standing collaborator of Dr Takashi Sugimura in the National Cancer Center Research Institute (Tokyo) received the Mutation Research Award for Excellence in Scientific Achievement for 1997.
Dr Nagao made the seminal discovery that cooking of proteinaceous foods under normal cooking conditions induces mutagenesis. She has been the major contributor to the discovery of mutagen formation during the cooking of meat and fish, and to the characterization of these mutagens as heterocyclic amines (HCAs).
She also described the mutational fingerprints in tumors induced by HCAs. A remarkable finding was that of a unique mutation induced by PhIP (2-amino-1-methyl-6-phenylimidazopyridine), one of the most abundant HCAs, in the Apc gene of rat colon tumors. Studies on Big Blue transgenic mice revealed a unique fingerprint for each HCA.
Thus, Dr Nagao contributed greatly to HCA studies and highlighted the importance of HCAs as possible causative agents of human cancers due to continuous daily exposure.
She also contributed significantly to other areas of environmental mutagenesis such as genomic instability caused by the protein phosphatase inhibitor.
She was nominated by the Environmental Mutagen Society of Japan as a candidate for the 1997 Mutation Research Award for Excellence in Scientific Achievement and was selected as a winner by the Award Committee of Editors and Executive Managing Editors of the journal Mutation Research published by Elsevier Science for her contributions described above. The award presentation and lecture will be held at the International Meeting for Human Population Monitoring in Thailand in December this year.
One scientist who has made a significant, recent contribution to the science of mutation research has been awarded every year since 1996. In 1996, Professor Philip C. Hanawalt was a winner of the award for his famous studies on DNA repair.
This spring, Dr Nagao retired from the position of Chief of the Carcinogenesis Division, National Cancer Center Research Institute and became a professor at the Tokyo University of Agriculture. She is expected to continue and extend her contributions to the field of environmental carcinogenesis.
Setsuo Hirohashi, MD
Deputy Director
National Cancer Center Research Institute, Tokyo
Viewing the News from Abroad
`Big Smoke' of the Cigar Causes Cancer and Heart Disease
The April issue of JNCI dealt with cigar smoking, which is increasingly attracting concern in the medical community (JNCI 1998;90:562-4). Cigars have been regarded as a safe alternative to cigarettes, while people can be relaxed by smoking and enjoy the rich flavors and blend of taste. The National Cancer Institute released a monograph entitled `Cigars: Health Effects and Trends' in early April. According to the new data, daily cigar smoking causes cancers of the lip, tongue, mouth, throat, larynx, esophagus and lung, as well as chronic obstructive pulmonary disease and coronary heart disease. The increase of interest in cigar smoking is due to the two facts: cigar consumption has dramatically increased by 50% since 1993, and the `presence' cigars have acquired in todays culture. The new report showed that smoke from cigars contains the same toxins, irritants and carcinogens.
According to the monograph, the risk for oral cancers in cigar smokers is more than 10 times greater than non-smokers. They are also at increased risk from heart and lung disease such as coronary heart disease and chronic obstructive pulmonary disease: even regular smokers who inhale slightly still have twice the risk. Compared to cigarette smokers, however, cigar smokers were reported to have lower overall risks for cancer of the larynx and heart and lung disease. This fact is attributed to the differences in inhalation pattern.
The present problem concerning cigar smoking is that most of the current increase appears to be amongst young adult males and teenagers who smoke occasionally (less than once per day). Large state-wide studies in California showed that the greatest rate of increase was seen in occasional cigar use among younger males age 18-24 (from 4.2% to 12.4%, nearly a 200% increase). It seems increasingly important to realize that the cigars are not a safe alternative to cigarettes and may be addictive. (JNCI 1998;90:562-4.)
`Photodynamic Therapy' for Early Lung Cancers
Photodynamic therapy (PDT) is being used to treat lung cancer which is diagnosed at an early stage. PDT is a new treatment that uses lasers and a light-activated drug (Photofrin) to destroy tumors. Photofrin (porfimer sodium) is injected intravenously, and concentrates in tumor cells. The drug is then activated by laser light delivered through a bronchoscope, producing a toxic form of oxygen. Tumor cells are necrotized and finally removed.
In January, the US Food and Drug Administration approved the use of Photofrin in PDT for microinvasive lung cancer, which is not feasible for surgery or radiotherapy. Photofrin is already approved in the US for palliative treatment of cancers, but this is the first approval for potentially curative use. It was previously approved for early stage lung cancer treatment in Japan and Germany. The merit of this new therapy is the minimal damage to normal tissue compared with the conventional surgery or radiotherapy. Therefore, even patients who have objective risks for surgery or radiotherapy might have an option for cure. The most serious side effect of Photofrin is photosensitivity of the skin. The efficacy of PDT is being assessed in north America, Europe and Japan. Dr Harubumi Kato, Tokyo Medical College, stated that `PDT is an effective alternative to surgical resection'. His earlier study found that PDT is more cost-effective than surgery for early stage lung cancer. This new approach awaits further large-scale clinical trials. (JNCI 1998;90:417-8.)
Exposures and Habits Early in Life May Influence Breast Cancer Risk
Recent research has recognized several factors for breast cancer in the early period of life, even though breast cancer strikes most often over the age of 50. Suggested factors include the season of birth, age at maximum height, and other aspects of life and growth before the age of 20. Furthermore, even factors before and around the time of birth may be important. For example, mothers who had toxemia during pregnancy had a `markedly' reduced risk of breast cancer, while those who had neonatal jaundice or who were born before 33 weeks of gestation had an excess risk. They were related to the differences in estrogen exposure in the uterus. For similar reasons, twins, who are exposed to higher estrogen levels due to the two placentas, had a higher breast cancer risk. Since women born in spring and summer had higher levels of estradiol than those born in other seasons, time of birth may be related to the risk. Some studies suggest that heavier babies have higher risk as well. Events during the teen years may be related to breast tumor risk. Women who reached their maximum height when they were 18 years or older had lower risk for breast cancer compared those who did when 13 years or younger.
This data is based on retrospective studies, and, as is always the rule in the epidemiology, that prospective studies draw more accurate conclusions than retrospective ones. Therefore, they are presently only a suggestion, and there is not enough evidence confirming the right conclusion. (JNCI 1998;90:187-8.)
Compiled and edited by
Hisao Asamura, M.D.
Division of Thoracic Surgery
National Cancer Center Hospital Tokyo
Announcements
The 61st Annual Course `Principles of Colon and Rectal Surgery'
Date: September 17-19, 1998
Location: University of Minnesota, Minneapolis campus
Further information: Continuing Medical Education, University of Minnesota
107 Radisson Hotel Metrodome
615 Washington Avenue S.E.
Minneapolis, Minnesota 55414
Tel: +1-612-626-7600; toll free +1-800-776-8636
Fax: +1-612-626-7766
WWW site at http://www.cee.umn.edu:80/cme/
The 56th Annual Meeting of the Japanese Cancer Association
Location: Pacifico Yokohama, Yokohama, Japan
Date: September 30-October 2, 1998
Chairperson: Kaoru Abe
Contact: c/o National Cancer Center, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104, Japan
Fax: (03) 3542-8702
E-mail: jca98{at}ncc.go.jp
WWW site at http://www.info.ncc.go.jp/meetings/jca98/
Chemotherapy Foundation Symposium XV Innovative Cancer Therapy for Tomorrow
Date: November 11-13, 1998
Location: Sheraton Hotel, New York City, USA
Sponsors: The Page & William Black Post-Graduate School of the Mount Sinai School of Medicine
Chairperson: Ezra M. Greenspan, Clinical Professor of Medicine (Oncology) at the Mount Sinai School of Medicine
Further information: Jaclyn Silverman, Conference Coordinator
Division of Neoplastic Diseases
Box 1178, Mount Sinai School of Medicine
One Gustave Levy Place, New York, NY 10029
Tel: +1-212-241-6772
Fax: +1-212-996-5787
E-mail: J_silverman{at}smtplink.msmm.edu
| To include information of upcoming cancer-related events in the News Section, please send details, including the title, date, place, organization, contact name, address (fax number and e-mail address if any) to the news department of the editorial office of JJCO who also welcome suggestions for news stories. Items in this section are selected for publication and edited by the editorial office at their discretion. |
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