Showing posts with label health. Show all posts
Showing posts with label health. Show all posts

Because epidemiological research into the causes of cancer takes so long and may leave crucial questions unanswered, the more direct method of laboratory experimentation is undertaken when possible - as it generally is before the introduction of a newly synthesized chemical into foods or drugs. The two types of techniques often go hand in hand. Some compounds such as soot and certain dyes are known from the findings of epidemiologists to be dangerous. Laboratory tests can identify the components of such compounds that are to blame - benzopyrene in soot, beta-naphthylamine in dyes - and such tests can also provide indisputable proof that a suspected substance or activity does cause cancer.

When materials suspected as carcinogen are being tested, scientists cannot risk a human life; laboratory experiments must be done only on animals. During the 1960s, as epidemiological evidence on the risks of smoking began to pour in, generations of mice at the Imperial Cancer Research Fund in London panted out their lives in smoke-filled enclosures and showed evidence of lung cancer. At a Veterans Administration laboratory in New Jersey in 1970, cigarette smoke was pumped directly into dog's lungs, through openings cut in their throats and generated cancerous growths. And in a bizarre experiment of the early 1980s, baboons at the Southwest Research Foundation in San Antonio, Texas, were taught to smoke cigarettes themselves in the continuing quest for hard experimental evidence.

All such trials somewhat resemble a prospective study, in which a scientist selects a group of subjects and follows their course of health or illness. But there is one critical difference. In the laboratory - but not in everyday life - the scientist can be sure that his subjects differ only in the amounts of carcinogen they are exposed to. What they eat, how they exercise or sleep, the very air they breathe - all can be rigidly controlled. Hereditary differences between animals can be reduced or eliminated; among laboratory mice for example. Scientific breeding has produced strains in which all the individuals are genetically identical. Thus, if a scientist exposes one group of mice to a suspected carcinogen, leaving a second group unexposed, and the first group develops cancer while the second does not, he has proved that the substance causes cancer -  at least in mice. To move beyond this test, he might repeat it with other animal subjects - rabbits perhaps, or dogs or monkeys maybe. If a substance induces cancer in several different kinds of mammals, it probably is a carcinogen for most mammals, including human beings.

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In the course of studying epidemiology, the epidemiologists have developed two main branches of their science, one essentially retrospective and the other prospective. Retrospective epidemiologists follow Pott's method, but at a much higher level of thoroughness and sophistication. Having identified a group especially high in a specific cancer or in cancers generally, they probe the lives both of the victims and of those who have escaped the disease. They analyze medical records and personal histories, and the personnel and health records kept by employers. Survivors are questioned on every conceivable detail of their working and living habits, and the investigators search through death certificates to identify earlier cases

In one typical retrospective project - conducted in 1981 - a team of researchers led by Dr.Brian MacMahon of the Harvard School Of Public Health studied 369 victims of pancreatic cancer and 644 subjects who were free of that cancer. The epidemiologists asked all the subjects about their use of tobacco, alcohol, tea and coffee, in an attempt to  discover whether any of these factors increase the risk of developing the disease. One important connection emerged: pancreas cancer patients were more likely to be coffee drinkers than were the controls. Neither alcohol nor tea increased the risk; cigarette smoking increased it only slightly. What was more, the more coffee a person drank, the greater the risk. Those who drank one or two cups a day were twice twice as likely to develop pancreas cancer as those who drank no coffee at all. Those who drank five or more cups tripled their risk. Obviously, the effects of such a study can be vital to cancer prevention. In the United States, more than half of the population over the age of 10 drinks coffee every day, and Dr.MacMahon estimated that more than half of all pancreas cancer could be linked to coffee drinking. 

Unlike Dr.Macmahon - who worked backward from existing records - prospective epidemiologists follow large numbers of people into the future. These people are not necessarily ill when the project starts. The epidemiologists simply records their medical histories and their life styles in great detail, then waits to see what happens to them. The waiting is expensive; hundreds or even thousands of technicians may keep close track of the subjects for decades. But the findings - based upon identical - exhaustively detailed observation of many people over a long period, are especially valuable.

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In the modern world, no branch of the human family tree is known to be free of cancer, though rumors to the contrary keep popping up. In 1977 for example, the United Nations Educational, Scientific and Cultural Organization reported that the people of Pakistan's remote Hunza Valley showed no signs of the disease. The UN report was proved wrong; the Hunzas have insignificantly fewer cases of cancer than other populations of similar size, environment and occupation. Farmers in the uplands of Soviet Georgia - near the black sea - have long been an even richer source of health myth. They were once said to be not only cancer-free, but even immune to the aging process; tales abounded of people still active at the age of 125. But the accounts of fantastic longevity turned out to be based on provincial chauvinism and bad record-keeping. And the Soviet government, after an intensive study of the Georgians, reported in 1980 that they suffer as much breast, lung and cervical cancer as other Soviet peoples; in fact, only the incidence of stomach and esophageal cancer proved substantially lower than the average.

The facts about the Soviet Georgians illustrate an important truth about cancer. Although the affliction is universal, there are strange variations in its incidence, as a whole and by type. World Health Organization statistics showed that in 1974 and 1975 Scotland had a higher cancer death rate than any other country in the world - more than five and a half times higher than that of Thailand, the country with the fewest cases. Variations among types of cancer were even wider. Japan and Norway had much the same total cancer death rates, but the Japanese suffered three times more stomach cancer than the Norwegians; on the other hand, the death rate from breast cancer among Norwegian women was nearly four times higher than among the women of Japan.

Scientists can explain some of the variations in cancer incidence, including the appalling rate of stomach cancer in Japan. They are virtually certain that the Japanese diet, high in smoked and salted foods and in known carcinogen called bracken fern, is a major cause of that cancer. Elsewhere, specific cancers have been attributed to specific foods and other agents. But anomalies and mysteries remain. No one yet knows, for example why the cancer death rate is highest in Scotland. And no one knows why the breast cancer death rate is higher in Norway than in Japan, though some scientists have suggested that differences in childbearing or breast feeding customs may be the key.

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