Japanese Journal of Clinical Oncology

News from Japan

Low-dose Birth Control Pills in Japan

On September 2, 1999, low-dose oral contraceptives, known as `the pill', appeared in pharmacies and clinics for the first time in Japan. It took almost 9 years for these drugs to be approved for sale by the Ministry of Health and Welfare. With a doctor's prescription, women can get 11 types of contraceptive pills made by 10 pharmaceutical companies, although purchase is not covered by health insurance. Pills with high and medium dosages have long been approved for treatment of menstrual disorders and an estimated 200,000 women in Japan have been using them for contraceptive purposes. Approval of the low-dose pill, whose purpose is exclusively birth control, and which is now commonly used in many countries, was delayed in Japan because of concerns over the pill's side effects and spread of AIDS. Thrombosis is a well-known side effect of these drugs. Since the first approval of oral contraceptives in the USA in 1960, they are now used at varying dosages by 90 million women worldwide. More information on these drugs is necessary among Japanese women. Many Japanese women are estimated still not to be well informed about the contraceptive pills.

H. Asamura

Report of the Sixth Annual Meeting of the Japan Society for Cancer Prevention

The sixth annual meeting of the Japan Society for Cancer Prevention (JSCP) was held at the National Cancer Center in Tokyo on July 16 and 17, 1999. Dr Tadao Kakizoe, Director of the National Cancer Center Hospital, was the President of this meeting and was asked by Dr Charles W. Boone and Dr Frank Meyskens to report the activities of JSCP to the Newsletter of the International Society of Cancer Chemoprevention (ISCaC). The historical background of JSCP together with the highlights of this year's meeting are presented.

Cancer research in Japan covers all related fields from molecular biology to epidemiology, with a strong tradition in chemical carcinogenesis and carcinogens since the first success of Dr Katsusaburo Yamagiwa who induced skin cancer in the ear of rabbits by repeated painting of tar in 1915. Since then, a large number of experiments have been conducted with animals using many carcinogens to induce a full variety of cancers. However, research on primary cancer prevention has been very limited because in Japan, secondary cancer prevention, i.e. cancer screening or early detection and early treatment, has been a main strategy supported by the government after the emphasis of its policy had shifted from the nationwide antituberculosis program during and post-World War II. The importance of primary cancer prevention has been gradually recognized among scientists, however, because the necessity for smoking cessation, for example, has been clearly demonstrated. Moreover, the number of elderly people is sharply increasing and cancer has been the leading cause of death among the Japanese since 1981.

The first symposium on primary cancer prevention was organized in Sapporo in 1990 by Dr Hiroshi Kobayashi, who was the President of the 49th Annual Meeting of the Japanese Cancer Association. The Japanese Cancer Association, mainly composed of scientists covering every aspect of cancer research, had approximately 13^000 members at that time. Since then, a group of scientists including Dr Takashi Sugimura, Dr Haruo Sugano, Dr Hiroshi Kobayashi, Dr Nobuyuki Ito, Dr Masaaki Terada, Dr Suketami Tominaga and Dr Tadao Kakizoe started seriously to discuss organizing a society for primary cancer prevention. Thus, the first meeting of the Japan Society for Cancer Prevention (JSCP) was held in Sapporo in 1994 under the presidency of Dr Hiroshi Kobayashi. The membership of JSCP was gradually expanded from 106 at the first meeting to 324 as of July 1999. The second meeting was organized in Tokyo by Dr Kaoru Abe in 1995, the third in Nagoya by Dr Nobuyuki Ito in 1996, the fourth in Kobe by Dr Hoyoku Nishino in 1997 and the fifth in Sendai by Dr Minro Watanabe in 1998.

Coming back to this year's meeting, 170 members attended. The meeting was composed of one symposium, one panel discussion, 14 oral presentations and 46 poster presentations. The symposium was entitled `Success and dissatisfaction of cancer prevention in animals, success and difficulties of cancer prevention in humans'. This is because the main activities of JSCP were traditionally to inhibit cancer in animals, whereas what was really anticipated is the prevention of cancers in humans. In fact, according to Dr Suketami Tominaga, one of the presenters, the number of epidemiological and intervention studies in humans in Japan in 1998 was very limited compared with that in the USA, as indicated below.

	Animal	Epidemiology and intervention
Japan	243	19
USA	449	337

There are many difficulties in conducting large-scale human trials to prove the efficacy of certain chemopreventive procedures in Japan, such as the source of funding, obtaining informed consent, lack of infrastructure for a large-scale trial and so forth. Nevertheless, the activities of JSCP must be maintained in with a good balance between basic research on animals, cells and genes from the mechanistic standpoint and epidemiological and clinical studies in humans. This subject was hotly discussed among the participants.

For the panel discussion, `Eradication of Helicobacter Pylori: Its Expectation and Uncertainty' was chosen. Pros and cons of eradication of H.P. were discussed because this autumn, the Ministry of Health and Welfare of Japan will approve the use of combinations of proton pump inhibitors and antibiotics as a procedure to treat patients with refractory gastric or duodenal ulcers with positive H.P. infection by the health insurance system. This would dramatically change the environment of H.P. research in Japan. At present, a nationwide clinical trial is ongoing to prove the relationship between H.P. infection and progress of atrophic gastritis and ultimately to gastric cancer with the support of the Second Term Comprehensive 10-Year Strategy for Cancer Control by the Ministry of Health and Welfare, Japan. This study is confronted with difficulties in enrolling subjects because of randomization. Subjects who are allocated to a control group actually wish the H.P. to be eradicated and refuse to participate in the study. The government's approval to treat refractory ulcers by combination drug therapy may add further difficulties to recruiting subjects for this study. At the same time, there is a new observation that H.P. infection is a kind of symbiosis for humans and eradication of H.P. causes regurgitant esophagitis which might increase the risk of esophageal adenocarcinoma. This finding provoked another discussion of whether H.P. should be eradicated. Again arguments on this issue were very hot among the participants.

JSCP is composed of a heterogeneous group of people such as scientists interested in carcinogenesis in animals, cell biologists, epidemiologists, nutritionists, food and agricultural scientists, clinicians and others. This year's meeting seemed to be a great success as a step forward to a common purpose to prevent cancers in humans by merging various scientific efforts.

JSCP has also confirmed close cooperation with another group, the Japan Society for Cancer Epidemiology (JSCE). In fact, the seventh annual meeting will be held jointly by JSCP and JSCE under presidencies by Drs Shoji Fukushima and Kenjo Morimoto at Awajishima, an island near Osaka, in July 2000.

JSCP publishes Newsletters quarterly and it may be a good opportunity for both ISCaC and JSCP to communicate with each other by inviting articles mutually.

T. Kakizoe

Cancer Statistics Digest Prostate Cancer Incidence in Japan Age-specific incidence rates for prostate cancer are shown in the accompanying graphs. They are gradually increasing for all age groups. W. Ajiki and S. Yamamot Source: The Research Group for Population-based Cancer Registration in Japan, 1998

Viewing the News from Abroad

Maternal Thyroid Deficiency Causes Developmental Problems for the Child

In the August 19th issue of The New England Journal of Medicine, Vol. 341, No.8, Dr James E. Haddow and his colleagues reported significant implications for all pregnant women who have undetected, untreated hypothyroidism.

Dr Haddow's research term retrospectively tested serum samples for evidence of hypothyroidism in a group of 25^216 pregnant women who delivered babies between 1987 and 1990. From these samples, they identified 62 women who had been hypothyroid during pregnancy. Their children, who were aged 7-9 years at the time of the study, were examined for possible neurological or psychological effects of hypothyroidism in utero. A battery of tests for attention, language, reading and visual-motor performance were administered and the results were compared with those of a carefully matched control group of children whose mothers were not hypothyroid during pregnancy.

The children of the mothers who had been hypothyroid during pregnancy performed less well in all tests. Their mean IQ was reduced by four points compared with the control group. Larger IQ differences were seen in children born to a subset of mothers who never received any thyroid hormone treatment, where the mean IQ decreased by seven points. Among this group, 19% of the offspring had IQ less than 85 as opposed to 5% of children in the control group. This report confirms the findings of several earlier, smaller studies and it suggests that undiagnosed, untreated thyroid hormone deficiency during pregnancy adversely affects brain development (N Engl J Med 1999;341:549-55).

Dr Larry Jameson, the President of the Endocrine Society, believes this study has important implications for the management of thyroid disease before and during pregnancy and issued a press release and policy statements, which included the following recommendations:

A cost-effective strategy for screening pregnant women for hypothyroidism before or early during pregnancy. Women with a personal or family history of thyroid disease or symptoms suggestive of hypothyroidism should be screened using the TSH test, when they are planning pregnancy or as soon as possible after conception. Women who are found to be hypothyroid during pregnancy should begin thyroid hormone replacement, as thyroid hormone requirements increase by about 25-50% during pregnancy.

An End to Outpatient Chemotherapy? Medicare Takes Aim at Reimbursement

Hospitals in the United States are bracing themselves for a potential 5.7% decrease in Medicare reimbursement for outpatient procedures including chemotherapy. The Health Care Financing Administration is proposing the cutbacks as part of the `Prospective Payment System for Hospital Outpatient Services'.

The new payment system ( News, JNCI, August 4) would go into effect next year and the HCFA hopes it will hold down Medicare expenditure by 2002 in compliance with the 1997 Balanced Budget Act. Between 1996 and 2007, health care spending in the United States is expected to swell from $1 trillion to $2.1 trillion.

At issue is the way in which the payment system would group chemotherapeutic drugs and procedures into ambulatory payment classifications for reimbursement, rather than basing reimbursement on the cost of individual outpatient procedures. Cancer treatment drugs are classified in the new method under four ambulatory payment classifications, while chemotherapy administration is divided into three categories. By bundling services and procedures, HCFA did not include an ambulatory classification exclusively for supportive care drugs.

Lee E. Mortenson, Executive Director of the Association of Community Cancer Centers, Rickville, indicated problems in this proposal. Cancer hospitals may face a 30-50% hit on chemotherapy, supportive care drugs and chemotherapy administration. The proposed classifications have not caught up with the recent developement of new indications since 1996 and some drugs are not recognized by HCFA. There would be a disincentive for clinicians to prescribe these costlier drugs to their Medicare patients, despite the drug's promise.

Deborah Williams, Associate Director in the Policy Office of the American Hospital Association, stated, `We have serious concerns about the proposal's effect on cancer hospitals. Entire coding and structure needs to be revised completely'.

ASCO recommended that HCFA either keep the current payment system or use `the physician office payment system`, for all chemotherapy-related drugs, including supportive care drugs. Under ths system, Medicare pays physicians 80% of the cost and the pysicians in turn bill the patient for the remaining 20%.

US Rep. Gene Green introduced a Bill still awaiting discussion on the House floor that would `exclude cancer treatment services from the prospective payment system for hospital outpatient department services under the Medicare program'. (JNCI 1999;91:1444-5).

Compiled and edited by H. Ohkura

American Cancer Society (http://www.cancer.org/) The American Cancer Society (ACS) is the largest nationwide, community-based voluntary health organization in the United States, having about 3400 branches all over the country. When you search the Society's homepage on the Internet, you will find that even some of those branch offices have their own homepages. Since the Society sets its prime mission as the fight against cancer through its programs in research, patient services, prevention, detection and treatment and advocacy until total eradication of cancer, the Society's homepage intends to provide a variety of information targeting mainly cancer patients and ordinary people. Its Cancer Information service covers a wide range of information, including the latest strategies for prevention and early detection, new diagnostic techniques and the latest treatment options. In addition, the homepage carries other important information for patients living with cancer, such as `Issues about Faith', `Job Rehabilitation', `Marriage Problems' and `Pain Control'. Another interesting feature of the homepage is a section on `Alternative and Complementary Methods'. Although the Internet has become a miracle tool for obtaining information today, not all the information provided through the Internet is truly reliable and useful. A cancer patient who is desperate for a cure may believe false information written by promoters of useless treatments. Through its homepage, the ACS tries to explain to people how to use an alternative or complementary cancer treatment safely and where they can learn more about those methods. Obviously, some complementary methods can be safely used along with standard treatment to help relieve symptoms or side effects or to ease pain. The list of reputable websites for those methods seems to be useful even for clinicians. The ACS publishes four medical and clinical journals, of which CA and Cancer are peer-reviewed journals for clinical oncologists. All the text of CA, including articles, news and announcements of the Society, can be viewed at its homepage (http://www.ca-journal.org/). For Cancer (http://www.canceronline.wiley.com/), access to the full text is reserved for paid subscribers only. M. Noda Homepages are being re-designing or modified very frequently, and therefore, please note that comments in this section are based on the contents of the homepage at the time of writing.

Announcements

Chemotherapy Foundation Symposium XVII Innovative Cancer Therapy for Tomorrow

Date: November 3-6, 1999
Location: Sheraton Hotel, New York City, USA
Sonsors: The Page and 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, 1 Gustave Levy Place, New York, NY 10029, USA
Tel: +1 212 241 6772; Fax: +1 212 996 5787
E-mail: j_silverman{at}smtplink.msmm.edu
http://info.neoplastics.mssm.edu

Tumor Prevention and Genetics 2000

(1st International Conference and 5th Annual Meeting of the International Society of Cancer Chemoprevention)
Date: February 17-19, 2000
Location: Universtiy of St. Gallen, St. Gallen, Switzerland
Further information: Conference Secretariat, TUP 2000, Mrs Beatrice Nair, c/o Center for Tumor Detection and Prevention (ZeTuP), Rorschacherstrasse 150, Postfach, CH-9006 St. Gallen, Switzerland
Tel: +41 71 243 0032; Fax: +41 71 245 6805
E-mail: eso-d{at}sg.zetup.ch
http://www.zetup.ch

ISH 2000 28th World Congress of the International Society of Hematology

Date: August 26-30, 2000
Location: Metro Toronto Convention Center, Toronto, Canada
Hosted by the Canadian Society of Hematology
Abstract deadline: February 29, 2000
Early registration: March 31, 2000
Further information: ISH 2000 Secretariat, 275 Bay Street, Ottawa, Canada, K1R 5Z5
Tel: +1 613 238 9998; Fax: +1 613 236 2727
E-mail: ish2000{at}intertask.net
ish2000@intertask.net

Erratum

In the News section of the May issue, in the article "Grant in Aid for Cancer Research" from the Foundation for Promotion of Cancer Research, the title of Hiroshi Kiriu was "Assistant Professor" instead of "Professor" of the Department of Radiology, Hiroshima University School of Medicine.

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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