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Long-term prediction of gastric cancer mortality in Korea.
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Jin Gwack, Yunhee Choi, Hai Rim Shin, Yun Chul Hong, Keun Young Yoo
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Korean J Epidemiol. 2005;27(1):163-172.
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This study was carried out to predict the mortality rate for gastric cancer up to 2020 in Korea with forecasting model.METHODS The trends of the age-adjusted mortality rate was calculated from 1983 to 2003 using the mortality data of the past 20 years in Korea, and projected up to the year of 2020 with log-linear models for each gender. The number of deaths from gastric cancer was calculated from the predicted mortality rate.RESULTS Age-adjusted mortality rates for gastric cancer per 100,000 persons were 32.13 in 1983, 23.95 in 1990, and 15.99 in 2003 for women, and 70.37, 58.74, 41.04 for men, respectively. The expected age-adjusted mortality rates for gastric cancer were 16.50 in 2005, 14.27 in 2010, and 10.66 in 2020 for women, and 39.14, 33.83, 25.28 for men, respectively. In contrast to this decreasing trend, it is predicted that mortality rates for those aged 75 or over would increase steadily. The predicted number of deaths from gastric cancer was 6,519 for women and 13,743 for men in 2020.CONCLUSIONS This study suggests that gastric cancer mortality rate would decrease continuously except for some aged groups. The declining trends in gastric cancer mortality are regarded as a result of lifestyle changes, improvements in screening methods and treatments. Strategies for aged groups should be developed in order to control increasing mortality rates.
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Mortality Trends in Colorectal Cancer and Breast Cancer in Korea: Birth Cohort Effects?.
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Jae Kwan Jun, Yeon Ju Kim, Jin Gwack, Yunhee Choi, Yun Chul Hong, Keun Young Yoo
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Korean J Epidemiol. 2005;27(1):154-162.
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Cancer has been the leading cause of deaths since 1980s in Korea. Among them, colorectal cancer and breast cancer shows steadily increasing pattern, being the fourth and the fifth common site of cancer death in Korea, respectively. This analysis aimed to evaluate potential contribution of birth cohort effects to the recent increases in mortality of colorectal cancer and breast cancer since 1983 in Korea.METHODS Mortality statistics on deaths of both cancers for the past 20 years of 1983~2002 were obtained from the National Statistical Office. The age-standardized mortality rates were calculated based on the census population of 1992 as a standard.RESULTS Age-standardized mortality rate for colorectal cancer increased 4.7-fold in men and 3.6-fold in women, whereas 2.1-fold increase in breast cancer mortality during 1983~2002. Age-specific mortality rates for colorectal cancer were steadily increasing by age before 1991 in both genders. However, the mortality rates showed an exponentially increasing pattern for the age group of 70 and over during 1993~2001, which was more prominent in female.
The birth cohort curves showed that there were 2- to 3-fold increases in the mortality rates of people who were born in 1931 for colorectal cancer compared to those of people who were born in 1921. Differences in mortality for breast cancer by birth cohort were 1.7-fold among age group of 45~49 and 50~54 between 1936 and 1946.CONCLUSIONS This analysis suggests that recent increases in mortality of colorectal cancer and breast cancer could potentially be due to birth cohort effects, i.e. rapid changes in life-style in younger generation. The quantitative approach using age-period-cohort model should be pursued.
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Cancer Epidemiology and Prevention.
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Keun Young Yoo, Hai Rim Shin
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Korean J Epidemiol. 2003;25(1):1-15.
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Cancer is one of the main cause of death worldwide. There are about 10 million new cases every year, and more than 6 million persons will die of the disease in a year. Many factors are responsible for the recent increase in cancer.
Changing lifestyles, in particular as regards tobacco smoking, alcohol drinking and diet, also play a crucial part. Several different types of scientific studies contribute to identifying the causes of human cancer. IARC's prestigious series of Monographs on the Evaluation of Carcinogenic Risks to Humans publishes authoritative reports on the risks posed by potentially carcinogenic agents and exposures. Most cancers are thought to be caused by factors related to lifestyle and environment. In particular, tobacco, chronic infections and diet are involved in a substantial number of new cancers. Tobacco is responsible for about 15% of all cancers throughout the world. Chronic infections with viruses, bacteria and parasites are responsible for 16% of all cancers. It has been hypothesized that 30% of all cancers could be prevented by appropriate diet and physical activity. Other known causes of cancer, such as occupational, genetic, and reproductive factors, plays a lesser role in the global burden of cancer. Many types of cancer seem to be cluster in families, occurring more often in close relatives of affected individuals. The risks that a person inheriting a defect in a person inheriting a defect in a cancer susceptibility gene will develop a certain type of cancer must be estimated, and the role of environmental factors in modifying these risks must be ascertains. Researches into the causes of cancer has revealed how many of the most common cancers can be prevented. Detection of many forms of the disease at an early stage can greatly improve the prospects for effective treatment, reducing deaths and enhancing quality of life.
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The Association between Helicobacter pylori Infection and Gastric Adenocarcinoma: a Review of the Literature.
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So Young Oh, Aesun Shin, Seung Sik Hwang, Keun Young Yoo
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Korean J Epidemiol. 2002;24(2):93-106.
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Stomach cancer is a major cancer in the world as well as in Korea. Helicobacter pylori infection was suggested causing atropic gastritis, but there has been a debate on the association with the gastric adenocarcinoma.
We reviewed recent literatures and meta-analyses on the association between Helicobacter pylori infection and the development of gastric adenocarcinoma.
PESULTS: The animal experiments suggested that Helicobacter pylori is a causative agent of gastric adenocarcinoma.
Meta-analyses on the relationship between Helicobacter pylori infection and gastric adenocarcinoma showed increased risk in infected person, but the strength of association was varied with study design, characteristics of study participants and the nature of tumors.CONCLUSIONS Recent study results suggested that Helicobacter pylori is a necessary causative agent for development of gastric adenocarcinoma. Assessment of the association between Helicobacter pylori infection and other factors related with gastric cancer risks and the effects of the eradication therapy of Helicobacter pylori infection on the prevention of gastvic cancer need further evaluation.
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Correlation Study on Clinical Laboratory Findings with Occupational Exposure to Low Dose Ionizing Radiation in Nuclear Workers in Korea.
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Young Khi Lim, Keun Young Yoo
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Korean J Epidemiol. 2001;23(2):8-18.
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Even though atomic energy and radioisotope had been made for a peaceful purpose, some of the public do't feel safe possibly due to potential exposure to ionizing radiation. While health effects of high level radiation are almost deterministic, the stochastic effects of the 'low-dose radiation' have not come to a correct conclusion.
This correlation study was conducted to assess the health effect due to potential exposure th low-dose radiation in the nuclear power plants workers in Korea.METHODS The study subjects was selected among the nuclear workers. Among those who attend the epidemiologic survey for screening of any malignancies done by the study group of Seoul National University Hospital during 1992-1993, 1) those who had undertaken both the physical examination with clinical laboratory tests and the direct interview with questionnaire, 2) male workers, and 3) those with record on radiation dosimetry as well as employment records in the company. Correlation analysis with Pearson's correlation coefficients and quantitative analysis with normal ranges of various tests were done by the PC-SAS for window.RESULTS Total cumulative radiation doses was relatively low, ranging 1 mSv at the lowest to 391 mSv at the highest.
Moreover, mostly 68.7% of the subjects was within lower limit of total cumulative doses under 10 mSv. Among the clinical laboratory test, statistical significant correlation was see in hemoglobin(HGB), creatinine(CRE), and carcinoembryonic antigen(CEA).CONCLUSION This study concluded that health effect of occupational exposure to low-dose ionizing radiation is minimal or, if any, extremely lower than expected in the nuclear power plants workers in Korea. Major limitation of this study is that the healthy worker effect could not excluded. A large-scale prospective epidemiologic study on the relationship between radiation exposure and health hazard is needed to draw a more valid conclusion.
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Is Breast Cancer Incidence Rate Further Increasing in Korea?.
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Keun Young Yoo, Hai Rin Shin, Sue Kyung Park, Ha Chung Yoon, Ae Sun Shin, Dae Hee Kang, Dong Young Noh, Kuk Jin Choe
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Korean J Epidemiol. 2001;23(2):1-7.
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Breast cancer ranks second to stomach cancer as a primary cancer site. An increasing trend in mortality and morbidity of breast cancet has been shown since 1980s. Studies on migrant populations, in which higher incidences were shown than population in their motherlands, indicated the importance of environmental factors on breast cancer development. Older age, family history of breast cancer, early menarche, late menopause, late full-term pregnancy, never-having had a breast-fed child, and postmenopausal obesity were idenrified as risk factors in Korea. These are not different from risk factors detected in western countries. Nevertheless, a ^-shape age-specific incidences surve is shown in Korea shose incidence is relatively low.
In western countries, where incidence rates are high, the incidences increase with age in a straight line. This difference may be explained by the "Estrogen-Augmented-:rogesterone Hypothesis" that is relevant to sex hormones. In fact, a nuch lower estradiol levels was reported in Korean women compared to those in American. On the other hand, genetic polymorphism is expected for future research on breast cancer etiology. Only preventive strategies based on epidemiology of breast cancer in Korea may effective to counter this malignancy in Korean women.
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Glutathione S-transferase(GST) M1 and T1 Genetic Polymorphism in Benign Breast Disorders of Korean Women.
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Sue Kyung Park, Mina Ha, Sook Un Kim, Daehee Kang, Keun Young Yoo
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Korean J Epidemiol. 2000;22(1):52-58.
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A hospital-based case-control study was conducted to evaluate the role of glutathione-S-transferase(GST)M1 and GSTT1 genetic polymorphism for developing benign breast disorders(fibrocystic diseases and fibroadenoma) in Korea.
MATERIALS AND METHODS: Histologically confirmed incident cases of benign breast disorder(n=56) were selected from inpatients at the Department of General Surgery, Seoul National University Hospital since 1994. Women with free of self-reporting past history of any malignancies were regarded as controls who were selected from the inpatients at the same department at three hospitals during 1994 to 1998(n=180). Information on life-styles including reproductive factors were obtained by direct interview using questionnaire. Age and menopausal status were matched and 51 cases and 102 controls were finally selected. Odds ratio and 95% confidence interval were estimated by multiple logistic regression after adjusting for age, education, body mass index, smoking history, drinking history, menstrual regularity, age at menarch, age at first pregnancy, frequency of fullterm pregnancy, breast feeding history, duration of breast feeding, and family history of breast cancer.RESULTS GSTM1-null type showed no significance related to the risk of benign breast disorder(adjusted OR=0.8, 95% CI=0.38-1.83) and GSTT1-null type was also not significant(adjusted OR=1.4, 95% CI=0.63-3.29). Increasing tendency of disease risk by the number of GSTs null type was not observed (ptrend>0.1) after adjusting for all other variables.DISCUSSIONS Further investigation with larger sample size should be needed to provide more concrete information on the role of GST genetic polymorphism in benign breast cancer and a lots of studies relation in normal level of GST genetic polymorphism in general population should be performed.
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A Case-Control Study on Risk Factors of Benign Breast Disorders in Korea.
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Sue Kyung Park, Keun Young Yoo, Daehee Kang, Sook Un Kim, Sang Yun Lee, Hyung June Im, Hee Jun Kang, Dong Young Noh, Kuk Jin Choe
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Korean J Epidemiol. 2000;22(1):11-19.
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A hospital-based case-control study was conducted to figure out the risk factors for benign breast disorders in Korea.
MATERIALS AND METHODS: Histologically confirmed incident cases of benign breast disorders(n=54) were selected from inpatients with life-style information at the Department of General Surgery, Seoul National University Hospital during 1994 to 1997. Women with free of self-reporting past history of any malignancies were regarded as controls who were selected from the inpatients at the same department of the same hospital(n=180). Information on life-styles including reproductive factors were obtained by direct interview using questionnaire. Adjusted odds ratios and 95% confidence intervals were estimated by multivariate logistic regression model with matching variables.RESULTS Overall, higher educational level, family history of breast cancer, alcohol drinking, and older age at first fullterm pregnancy related to the risk of benign breast disorders. For premenopausal women, older age, higher educational level, and family history of breast cancer increased the risk of benign breast disorders. For postmenopausal women, alcohol drinking, older age at first fullterm pregnancy, and more frequent experiences of fullterm pregnancy increased the risk. Elder age in postmenopausal women and the experience of breast feeding had, however, protective effect against benign breast disorders.CONCLUSIONS Although the risk factors for benign breast disease may differ from those for breast cancer, these findings are consistent with the hypothesis of excessive circulating estrogen. The present data indicate some risk factors of benign breast disorders are confirmed as risk factors for breast cancer though a substantial agreement between the risk factors for (pathologically confirmed) benign and malignant breast disease.
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Current Status of Multicenter Cancer Cohort Study with Biological Materials Bank in Korea.
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Keun Young Yoo, Hai Rim Shin, Song Hun Chang, Jung Myung Choi, Chang Yup Kim, Kun Sei Lee, Won Jin Lee, Dae Hee Kang, Bu Ok Lee, Duck Hee Lee, Sue Kyung Park, Joo Hon Sung, Yeong Su Ju, Dae Sung Kim, Jong Won Kang, Soo Hun Cho
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Korean J Epidemiol. 1998;20(2):275-278.
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This cohort study is a collaborative effort of 8 institutions. The goal is to establish a large scale cohort that can be followed for 10 or more years to assess the relationship between life-styles and cancer occurrence, and to evaluate the role of environmental exposures in the development of six major sites of cancers(stomach, liver, lung, colorectum, uterine cervix and female breast) in the rural population. Since 1993, 11,304 men and women aged over 35 living in four areas have been recruited. The number of target population is 30,000 persons, which is expected to be successfully recruited until 1999. Each subject has completed a detailed questionnaire on general life-styles, reproductive factors, and agricultural chemical exposures through the interview. Anthropometric measurements with body fat composition and the routine clinical laboratories were examined. For the cancer-free cohort, physical examination by the physicians and serologic tests for hepatitis markers, some tumor markers, and lipid profile have been done, but not all. In order to provide an opportunity to incorporate barious biomarkers of exposure and effect as well as genetic susceptibility, a biologic tissue bank has been established from blood and urine sample(plasma, WBC buffy-coat, RBC clots, and urine supernatant) stored at-70degrees C.
Re-examination of changes in exposere to risk factors will be done periodically. Disease occurrence will be ascertained by the active(mainly through diagnosis by physicians) and the passive surveillance(through both death certificate and screening of medical utilization records).
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Prediction of future breast cancer mortality in Korea.
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Sue Kyung Park, Young Khi Lim, Keun Young Yoo
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Korean J Epidemiol. 1998;20(2):267-274.
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A recent increase in the number of deaths and mortality rates of breast cancer occurred in Korean women. The increases shows a indirect increase in incidence of breast cancer. The number of deaths from breast cancer and the mortality rate in the future would be of use in the perspectives of breast cancer control and management in Korea. This study is to forecast cancer deaths and age-adjusted death rates in the future(2000-2015 year) by fitting modelling, assuming present trends continue. The number and mortality rate of breast cancer were fitted and estimated by simple linear regression mode. Estimated crude death rates for breast cancer per 100,000 persons were 5 person in 2000, 5.99 person in 2005, 6.98 person in 2010, and 7.79 person en 1015. The observed age-adjusted death rates per 100,000 persons were 1.08 person in 1980, 2.03 person in 1985, 2.49 person in 1990, and 3.29 person in 1995 and the estimated age-adjusted death rates per 100,000 persons were 4.01 person in 2000, 4.72 person in 2005, 5.42 person in 2010, and 6.14 person in 2015. Future estimated increase rate of the number of death is 2 times as many as the estimated rate in population-increase. Particularly noteworthy was an increasing tendency of the age-specific death rate with the ages in death, as like a mortality pattern of breast cancer in western females. These findings suggest that cohort effect might significantly contribute to the increase of the number and mortality of breast cancer in Korean women.
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Reproductive Factors Related to Serum Estrogen, Progesterone, and Sex Hormone Binding Globulin in Postmenopausal Women in Korea.
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Chul Hwan Kim, Sue Kyung Park, Heon Kim, Mi Na Ha, Hai Rim Shin, Bu Ok Lee, Dae Sung Kim, Dae Hee Kang, Keun Young Yoo
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Korean J Epidemiol. 1998;20(1):70-81.
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The etiology of breast cancer is not yet clear. Several epidemiologic studies have supported the concepts that endogenous female sex hormones, i.e., estrogen and progesterone, may play a central role in the development of breast cancer. Female reproductive factors such as menstruation, pregnancy, and breast feeding are well-known risk factors of breast cancer. There have been many suggestions that all these factors are midiated by female sex hormeones. However, only a few studies have evaluated the relationship between the reproductive factors and endogenous female sex hormones. This study was designed to evaluate the relationship between the reproductive factors and endogenous female sex hormones in Korean women. We analyzed the relationship between reproductive factors and female sex hormones in 153 premenopausal women 153 postmenopausal women who participated in a community health promotion program in Haman County, Korea. The questionnaires about reproductive factors were completed by personal interview. Serum level of total estradiol(E2), progesterone(:g), and sex hormone binding globulin(SHBG) were measured by radioimmunoassay. There was no significant correlation between age at menarche and E2 in both premenopausal and postmenopausal groups. In postmenopausal subjects, E2 level increased significantly with the age at menopause increasing(r=0.25, p=0.009), adjusting for the potential confounding effect of both age and body mass index. There was a positive correlation between E2 and the intervals between age at menarche and age at menopause(r=0.25, p=0.009). Moreover, the serum level of SHBG was significantly correlated with total months of breast feeding(r=0.19, p=0.048), as well as with age at first fullterm pregnancy(r=-0.24, p=0.01). However, Pg was correlated with none of reproductive factors in both groups.
This study observed that female reproductive factors, e.g., age at menopause, breast feeding, age at first fullterm pregnancy, were correlated with serum female hormones, particularly E2 and SHBG. The results provide an evidence that the relationship between the reproductive factors and breast cancer risk may be mediated, at least in part, through serum female hormones, especially estradiol in Korean women.
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Cigarette Smoking, Alcohol Consumption, and Breast Cancer in Korea.
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Dae Hee Kang, Keun Young Yoo, Sue Kyung Park, Hye Won Koo, Jun Suk Suh, Young Chul Kim, Dong Young Noh, Kuk Jin Choe
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Korean J Epidemiol. 1998;20(1):60-69.
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A hospital-based case-control study was conducted to assess the relationship between cigarette smoking, alcohol consumption, and the risk of bgreast cancer in Korea.
Histologically confirmed incident cases of breast cancer(n=146) were selected from the inpatients at the Department of Surgery, Seoul National University Hospital and Borame Hospital during 1994 to 1997. Women ithout self-reported past history of any malignandies were regarded as controls and selected at the same hospitals during the same period(n-153). Information on life-styles including cigarette smoking, alcohol drinking, and reproductive history were obtained by direct interview using standardixed questionnaire. Each case was matched with one control by 5-year age category(n=146). Adjusted odds ratios and 90% confidence intervals were estimated by unconditional linear logistic regression model. For smokers, age at first smoking was significantly associated with the breat cancer risk(adjusted OR=14.1, 90% CI=1.24-364.2). Particularly noteworthy was an increasing tendency of the breast cancer risk with the duration of alcohol consumtion in years aong alcohol drinkers(ptrend<0.1). These findings suggest that cigarette smoking at an earlier age and alcohol intake might contribute to the risk factor of breast cancer in Korean women. Further investigation on the association between genetic polymorphism of xenobiotic metabolism enxymes of environmental carcinogens and breast cancer should be needed.
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A stochastic analysis on the force of infection by hepatitis B virus in Korea.
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Keun Young Yoo, Moo Song Lee, Youngjo Lee, Bo Youl Choi, Heon Kim, Yong Sik Kim
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Korean J Epidemiol. 1992;14(2):128-137.
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Hepatitis B virus infection is still one of the major health problems in Korea, because of its high prevalence and its deleterious sequellae to liver cirrhosis and hepatocellular carcinoma. However, little is known about incidence (force of infection) of the viral infection. Investigation on the natural history of the virus, such as age-dependency of occurrence, is thus necessary to establish the efficient measures of prevention and management. This study was done to estimate the incidence of hepatitis B virus infection, as well as to assess the prevalent age group of the infection through a stochastic analysis using mathematical models. Data on positivity of hep¬atitis B virus markers (HBsAg, anti-HBs，anti-HBc) were obtained from two different population； a typical rural population in Kyunggi province (n=741) and a health insurance beneficiaries in the Seoul City (n=726). As results, force of infection by the virus was decreasing until the age group around 20, and afterwards remained stationary. The annual incidence of the infection was 15 per 100 persons at birth, 5 per 100 persons at the age, of 10, and about 3 per 100 persons after the age of 20. Proportion of antigen positivity among persons infected by the virus was also decreasing with age increasing. These results suggest that new infection of hepatitis B virus mostly occurs early in life in Korea, resulting in subsequent high prevalence of the infection.
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Estimation bias arising from unmached analysis of 1-to-2 matched triplets in case-control study.
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Keun Young Yoo, Seok Jin Kang
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Korean J Epidemiol. 1991;13(1):80-86.
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A bias may arise, when unmatched analysis is done to get an asymptotic maximum likelihood estimate from an 1-to-2 matched data set in a case-control study. Quantification of the bias showed that it could be in either direction of underestimation or overestimation of matched odds ratio. It depends on four different components : matched odds ratio, ratio of exposure/unexposure among cases, difference of the concordants among the case-exposures, and difference of the concordants among the case-unexposures. The direction of the bias was discussed in a simple univariate setting with actual examoles. It suggests that results of this study can be applied to the analysis of matched data in order to predict potential estimation bias in the analytic stage.
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A review of test for trend : score tests and likelihood ratio tests using linear logistic model and log-linear model with computer programs
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Keun Young Yoo
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Korean J Epidemiol. 1990;12(2):115-130.
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Evidence of a dose-response effect is fundamental in making a causal interpretation of an association in epidemiological research. The analysis method known as tests for trend includes score test methods used in traditional analysis, as well as logistic models, which have been widely used since they were proposed in the 1960s, and the likelihood ratio for testing a hypothesis using a log-linear model.
Although the score test method using Pearson statistics involves relatively simple calculations, it becomes complicated when adjusting for multiple variables and becomes practically impossible for the qualitative analysis of continuous variables. However, more powerful and diverse dose-response effect analyses are possible if linear models are used. In fact, it is possible to adjust for the effects of multiple variables simultaneously, test for the qualitative associations of a specific variable, and investigate and adjust for the effect of variables that show a proxy effect or interactions with that specific variable in testing the linear trend. Moreover, using such models has the advantage of eliminating randomly selected exposure levels, which can give rise to statistical bias and inconsistency.
In this review, we present the theoretical background of conventional score test methods and their application in assessing dose-response relationships, the theoretical aspects and methods of interpreting the results of trend analysis using logistic models, and practical procedures with examples using log-linear models for trend analysis. Programs for SAS and the GLIM statistical package are also included to assist in the application of these methods.
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Use of a SAS program for conditional maximum likelihood estimate in linear logistic model to fit pair matched data
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Keun Young Yoo
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Korean J Epidemiol. 1990;12(1):93-99.
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For the most valid estimation of matched odds ratios in the analysis of pair-matched data, the method of choice is the conditional maximum likelihood method. Many alternative methods have been suggested, but in most cases, they lead to biased estimations in comparison to the conditional maximum likelihood method. Despite developments in statistical software such as GLIM, EGRET, and EPILOG for conditional likelihood estimation, the applicability of the SAS program remains limited, although it is one of the most common and popular statistical computer programs. According to the modification suggested by Holdford, since the conditional probability of selection in pair-matched case-control studies approximately takes the form of a linear logistic model, a conditional likelihood estimate can be estimated using standard statistical software. In this study, the author introduces a simple SAS program using PROC LIFEREG, which is commonly used for survival function analysis, to estimate matched odds ratios.
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A review study on epidemiology of viral hepatitis
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Keun Young Yoo
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Korean J Epidemiol. 1982;4(1):11-34.
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Correlation study on foods/nutrients intake and the mortality and the morbidity of carcers of stomach and colorectum in Korea.
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Myong Kyun Cynn, Dong Hyun Kim, Keun Young Yoo
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Korean J Epidemiol. ;15(2):119-131.
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Chronological correlation analysis studies with 10 to 12 years lag period between various foods/nutrients intakes and mortalities of gastro-intestinal cancers such as stomach cancer, colorectal cancer in Korea were performed to investigate the effect of dietary factors on carcinogenesis.
Information on the foods/nutrients intake from 1969 to 1988 were obtained from National Nutritional Survey Report published annually by Ministry of Health and Social Affairs. Data on the death due to stomach and colorectal cancers between 1981 and 1990 were gathered from Annual report on the cause of death statistics, National Stati Stical Office and Data on the morbidity from Medical insurance statistical yearbook, Korea Medical Insurance Corporation.
Since 1969, the intakes of total energy and cereals which is a major supplier of carbohydrate have gradually decreased, whereas, those of total protein, protein from animal sources, lipid have remarkably increased in recent years. While the mortality from stomach cancer has increased upto 1984, and then decreased steadily for male and female, that of coloncancer has increased continuously during this period. The mortality of male stomach cancer has correlated only with niacin among various nutrients. There appears to be no good, correlating food group or nutrient found whth mortalities
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