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CANCER DETECTION AND PREVENTION Address all editorial correspondence, including manu- scripts, to Herbert F.. Nieburgs, M.D., I)epartment of Pathology, Mt. Sinai School of Medicine, New York, New York 10029. Address all subscription orders, with payment, to Marcel I)ekker Journals, P. O. Box 11305, Church Street Station, New York, New York 10249. Address all change of address notices for the member- ship listing to The lnternational Study Group for the Detection and Prevention of Cancer, Mt. Sinai School of Medicine, New York, New York 10029. Address other inquiries to the office of the Publisher: Marcel Dekker, Inc., 270 Madison Avenue, New York, New York 10016. The subscription rate for Volume 3 (1980), containing two numbers, is $35.00 prepaid. The special discounted rate for individual professionals and students is $17.50 per volume. To secure this special rate, your order must be prepaid by personal check. Add $3.70 per volume for postage outside the United States. Copyright © 1980 by Marcel Dekker, Inc. All rights reserved. Neither this work nor any part may be repro- duced or transmitted in any form or by any means, electronic or mechanical, including photocopying, micro- filming, and recording, or by any information storage and retrieval system without permission in writing from the publisher. Printed in the United States of America. Contributions to this journal are published free of charge.

The International Society for Preventive Oncology, Inc. - EDITOR-IN-CHIEF Herbert E. Nieburgs Department of Pathology, Jl1t. Sinai School of Medicine of the City University of New York, New York 10029 ASSISTANT EDITOR S. A. Kay EDITORIAL BOARD Richard R. Bates Henry Colcher M. M. Copeland E. Cuyler Hammond Ronald B. Iierberman Kingsley K. Kay Paul M. Newberne A. J. Phillips (Canada) Franco Rilke (Italy) Jeffrey Schlom Albert Segaloff Leon M. Shabad (USSR) Philip Strax Lorenzo Tomatis (IARC) Victor E. Valli (Canada) Umberto Veronesi (Italy) MARCEL DEKKER, INC., New York and Basel

3 London, F,ngland July 26 - 31, 1980 Sponsors: The Royal Society of Medicine The International Society for Preventive Oncology, Inc. (ISPO) Co-sponsor: The Page & William Black Post-Graduate School of Medicine of the Mount Sinai School of Medicine of the City University of New York, Neu York, New York, U.S.A. President of the Symposium: The Lord Smith of Marlow Vice Presidents: Sir Richard Doll Mrs. Albert D. Lasker Symposium Advisors: N. Berlin (U.I.A.) The Earl of L4alsbury The Lord Pdrritt P. Strax (U.S.A.) The Lord iuckerman G. Zubrod (U.S.A.) 0 PROGRAM COMMITTEE Chairman: H.F.. Nieburgs (U.S.A.) G. Bennette (U.K.) R.L.. Clark (U.S.A.) H. Colcher (U.S.A.) M.M. Copeland (U.S.A.) %A'. Davis (IARC) R. Flamant (France) J.F. Fraumeni (U.S.A.) S.A. Geller (U.S.A.) R.M. Hicks (U.K.) J. Husband (U.K.) Members: P1.1. L.innett (U.K.) Pt. Moore (U.K.) B.C. Morson (U.K.) G. NeHell (U.S.A.) G.T. O'Conor (U.S.A.) F. Rauscher (U.S.A.) D. Schmahl (Germany) R.A. Se1lNood (U.K.) L.H. Sobin (N'HO) V.E.O. Valli (Canada) U. Veronesi (Italy) U.K. LIAISON COMMITTEE Chairman: J. I. Burn, Royal Society of Medicine Members: K. BagshaH•e, Cancer Research Campaign L.M. Franks, Imperial Cancer Research Fund R. HeNitt, Royal Society of Medicine R.M. Hicks, Middlesex Hospital V.R. McCready, Royal Marsden Hospital M. Moore, British Association of Cancer Research P.A.B. Raffle, Royal Society of Medicine R.H'. Raven, The Marie Curie Memorial Foundation R.N. Thomson, Royal Society of Medicine I

This is a special issue of C'ancer Detection and Prerentlon. Volume 3, Number 1, 1980

INTERNATIONAL SCIENTIFIC ADVISORY COMMITTEE Chairman: R.W. Raven, FRCS. Members: S. Ahmad (Libya) O. Bjarnason (Iceland) D. Burkitt (UK) E. Caceres (Peru) A. Canonico (Argentina) 0. Capella (Spain) R.L. Clark (USA) J. Clemmesen (Denmark) H.N. Cooper (Liberia) P. Correa (USA) O. Costachel (Romania) D. Crowther (UK) S.F. al-Damluji (Iraq) J.A. Dickerson (UK) S. Eckhardt (Hungary) T. Elicano, Jr. (Philippines) C. Escalante (El Salvador) G. Friedell (USA) J. Sampaio Goes (Brasil) R.A. Good (USA) R.B. Gorbon (Turkey) V. Griffiths (Malta) K.E. Halnan (UK) I.W.F. Hanham (UK) T. Hirayama (Japan) Ho-Kei Ma(Hong Kong) H. Holzner (Austria) H. Kasdorf (Uruguay) N.M. Kazi (Abu Dhabi) R.A. Kolthoum (Dubai) W.S. Lowry (N. Ireland) J.P. Mach (Switzerland) H.E. Maisin (Belgium) I. Martinez (Puerto Rico) D. Metcalf (Australia) P. Morgado Mieves (Venezuela) A.B. Miller (Canada) G. Milton (Australia) A. Mojtabi (Iran) J.F. Murray (South Africa) H. Mustin (Mauritius) E. Nanson (New Zealand) A. Munro Neville (UK) F. Nkrumah (Ghana) T. Norin (Kenya) N. Mourali (Tunisia) M. O'Halloran (Ireland) Y. Omar (Kuwait) K. Oota (Japan) F. Prochnow (Hungary) K. Qassab (Iraq) A. Rahim (Bangladesh) F. Rilke (Italy) A. Riyami (Sultanate of Oman) F.J.C. Roe (UK) M. Garcia-Sainz (Mexico) P.A. Salem (Lebanon) F. Samarrae (Iraq) 1.. Santi (Italy) W. Schlipkoter (W. Germany) I.J. Selikoff (USA) K. Shanmugaratnan (Singapore) H. Skeete (Barbados) J. Svoboda (Czechoslovakia) H.J. Tagnon (Belgium) S. Tanneberger (G.D.R.) 0. de The (France) N. Trainin (Israel) N.N. Trapeschnikoff (USSR) M. Tubiana (France) V.E.O. Valli (Canada) D. van Bekkum (Netherlands) M. van Rysselberghe (Chile) A.O. Williams (Nigeria) M. Woodruff (UK) H. Wrba (Austria) H. Yaqin (Pakistan) iv

CANCER DETECTION AND PREVENTION, 3(1), v (1980) II)IIdR'S NOQ'E This special issue of the jounial is devoted to the scientific program of The Fourth International Synposium on Prevention and Detection of Cancer, in London, July 26-31, 1980. The abstracts of the papers presented in the Conferences, Panels, Syng)osia, Poster Sessions, Workshops and Courses, are arranged according to subject mtter. A total of 548 abstracts provide extensive overview and reference material of current progress in primary and secondary prevention. Included topics range frcm etiologic factors and control measures to biologic mani- festations, detection of occult carcincma in individuals at high risk, social issues in cancer control, mass screening, detection and diagnosis in specific sites, immuioprevention, and a new look at cancer. For those attending the Symposium, daily sessions are in numerical sequence; presentations listed by session are cross-indexed with abstract numbers; the abstracts are cross-referenced with session numbexs. The program schedule avoids conflicts and provides a sequence of sessions on similar topics throughout the Symposium. I am greatly indebted to members of the Program Ccnmittee for their choice of topics and speakers and to contributing authors for their enthu- siastic response to the call for abstracts. I am particularly grateful to Doctors Steven Geller, Franco Rilke, Philip Strax and Ted Valli for their help in reviewing and arranging the abstracts in the order in which they are presented in this volume. Last but not least, the production of this volume would not have been possible without the oooperation of Mr. Maroel Dekker and the outstanding editorial assistance of Ms. Suzanne Kay, Ms. Iris Accordino and Ms. Hannah Scherer. I very much hope that the reader will enjoy the use of this volume as much as the few of us who prepared it. H.E. Nieburgs, M.D. Editor-in-Chief V ~ 0 0 a r J N ,3D r

Around Wembley Complex By Bus 83,92 Et 182 come to Wembley Arena 18 comes to the Triangte. 5 mins walk Other usefut buses are: 297 (alight at Wembtey park Stn) 245 (alight at Bridge Road) Wembley Conference Centre (Wembley Grand Hall) Wembley Complex BR Station

CONTINUING MEDICAL EDUCATION CREDIT HOURS As an organization accredited for continuing medical education, The Page and William Black Post- Graduate School of Medicine of the Mount Sinai School of Medicine (CUNY) certifies that this conti- nuing medical education offering meets the criteria for 30%: credit hours in Category I of the Physicians' Recognition Award of the American Medical Association, provided it is used and completed as designed. You will be entitled to additional credit hours, awarded on an hour for hour basis, for atten- dance at Courses and Workshops. PROGRAM ACTIVITIES Meeting Site: Wembley Conference Centre, London Inaugural Ceremony: Saturday, July 26 at 6:00 pm, Grosvenor House Park Lane Closing Ceremony: Wednesday, July 30 at 5:00 pm, Grand Hall Scientific Sessions: July 27: 10:00 am to 6:30 pm July 28: 9:00 am to 6:30 pm July 29: 9:00 am to 6:30 pm July 30: 9:00 am to 5:00 pm Courses &. Workshops: July 30: 2:00 pm to 5:00 pm July31:9:00amto5:00pm August 1: 9:00 am to 5:00 pm Roundtable Luncheon July 27, 28, 29, 30 Discussions: 1:00 pm to 2:30 pm Films, Scientific Exhibits and Poster Presentations: Daily. Transportation: Buses will depart on a regular schedule between Symposium Hotels and Wembley Conference Centre. Official Language: English.

THE SYMPOSIUM TIMETABLE AVON 3 SEVERN I SEVERN 2 SUNDAY 1. OCCUPATIONAL 2. BIOLOGICAL 3. MASS 4. HEAD & NECK 6. NUTRITION 10:00 CARCINOGENESIS MARKERS SCREENING CANCER Symposium -11:30 Conference Panel Symposium I 'Panel 11:30 I ! I 5. HEAD 8 NECK ' -13:00 + j + CANCE R + *Symposium 15:00 7. CARCINOGENIC 8. BIOLOGICAL 9. MASS 11. BREAST 12. CANCER OF -16:45 FACTORS MARKERS SCREENING CANCER UPPER GASTRO- Conference Symposium *Symposium fl Panel INTESTINAL I ' TRACT 17:00 I I 10. CANCER PREV. I Panel -18:30 111 iii DEV. COUNTRIE S + 'Panel MONDAY 13. GENETIC AND 14. BIOLOGICAL 15. STRESS 16. BREAST: PROG- 18. GASTRO- 9:00 ENVIRONMENTAL MARKERS Symposium NOSTIC FACTORS ENTEROLOGY -10:45 INTERACTIONS Symposium *Symposium *Symposium Conference 11:00 ~ 17. BREAST: 19. PANCREATIC -12:45 ~ HORMONES CANCER *Symposium 'Panel 14:00 20. DIET AND 21. SYSTEMIC MA- 22. SQUAMOUS 24. BREAST: BIOL- 26. LYMPHOMAS AND -15:45 CANCER NIFESTATIONS LESIONS, FEMALE OGIC MARKERS LEUKEMIA Conference Symposium GEN, TR. 'Panel *Symposium *Symposium 16:00 I ~ 23. IMAGING 25. BREAST: MASS 27. LYMPHOMAS AND -17:45 1 'Panel SCREENING LEUKEMIA *Symposium •Panel UESDAY 28. DETECTION OF 29. CARCINOGENIC 30. SOCIAL 31. BREAST: 32. GENITO-URINARY 9:00 PRECLINICAL FACTORS RESEARCH AND IMAGING TRACT CANCER -10.45 CANCER Symposium PUBLIC Symposium 'Pane/I Conference EDUCATION Panel 11:00 ~ 33. GENITO-URINARY -12.45 1 TRACT CANCER •Panel 11 14:00 34. PROMISING 35. EXPERIMENTAL 36. EDUCATION 37. IMMUNOLOGY 38. COLO-RECTAL -15:45 TECHNIQUES CARCINOGENESIS AND AND VIROLOGY CANCER OF DETECTION RELEVANT TO REGISTRIES Symposium •Panel Conference CLINICAL Symposium 16:00 ONCOLOGY I + 39. COLO-RECTAL: -17.-00 ~ Panel 1 i ETIOLOGY & DIAG. •Symposium WNSDAY 40. A NEW LOOK 41. OCCUPATIONAL 42. CERVIX: RISK 44. PREVENTION 46. COLO-RECTAL: 9:00 AT CANCER CARCINOGENESIS FACTORS, HIS- OF METASTASIS SCREENING AND -10:45 Conference Symposium TOLOGY *Symposium MANAGEMENT 'Symposium Symposium 11:00 ~ 43. CERVIX: 45. RESPIRATORY J -72.-45 J SCREENING TRACT CANCER *Symposium 'Panel 14:00 47. SOCIAL 48. CARCINO- 49. FEMALE 50. RESPIRATORY 51. IMMUNO- -17:00 ISSUES & CAN- GENESIS GENITAL TRACT CANCER PREVENTION CER CONTROL Symposium - TRACT CANCER Symposium Symposium Conference Symposium 17:00 CLOSING CEREMONIES POSTER SESSIONS: 52-61, Sunday, Monday 62-68, Tuesday, Wednesday

PODIUM (SESSIaV N0,) POSTER ORG{WI7ATION OF ABSTRACTS ABSTRACT CTORS & CONTROL MEASURES # OGIC F ETIOL A 7 29 Carcinogenic factors 1 - 17 1 41 54 occupational carcinogenesis 18 - 40 48 53 Carcinogenesis 41 - 58 6 20 62 Nutrition 59 - 78 13 Genetic & envirorunental interactions 79 - 83 37 55 Imrnmlogy & virology 84 -101 15 Stress 102-111 35 fxperimental carcinogenesis relevant to clinical oncology 112-117 10 61 Problems of detection & prevention of cancer in developing countries 118-126 BIOLOGIC MANIFESTATIONS; DETECTION OF OCCULT CARCINOh{A IN INDIVIDUALS AT RISK 2 8 14 24 64 Biological markers 127-162 21 63 Systemic manifestations 163-179 28 Detection of pre-clinical cancer 180-184 23 31 34 65 Prcmising techniques of detection SOCIAL ISSUES IN CANCER CONTROL 185-199 47 Social issues in cancer control 200-205 30 52 Social research & public education 206-219 36 Education & registries 220-234 3 9 MASS SCREENING SITES 235-252 4 5 58 Head & neck 253-270 45 50 Respiratory tract 271-288 12 Upper gastrointestinal tract 289-296 18 59 Gastroenterology 297-307 19 Pancreas 308-314 38 39 46 Colo-rectal 315-344 32 33 Genito-urinary tract 345-360 22 42 43 49 60 Female genital tract 361-402 11 16 17 24 25 31 67 Breast 403-477 26 27 68 Lymp}rlnas & leukemias 478-497 66 Skin 498-502 51 56 INMUNOPREVENTION 503-514 44 57 PREVENTION & DETECTION OF METASTASIS 515-525 40 A NEW LOOK AT CANCER 526-531 SCIENTIFIC EXHIBITS & FILMS 532-541 ADDENDA 542-out ix

s FILMS .A1LY 27-30, 13:00-14:00, SEVERN 1 JULY 27 14:00 THE REIDT!'EGRATICN OF PARAPLEGIC 545 Pesquisa de Oncologia, Sao Paulo, Brasil PEOPLE IN Cw'AJNITY TEfft(XJGIi THE FORNMCN OF CMCnW-HIJICIANS, AN IMPORTANT AND NDL-ESSARY ACPIVITy IN MFLSS SCREENING PROCRAM FOR CANCER DETECTICN AND PREyf~~TPION GOES, J.S. Jr. GOES, J.C.S. Instituto Brasileiro de Controle do Cancer, Fundacao Centro de JULY 28 MINIAZURE PAN-EDIDO-MICROSCOpE AND ITS CLINICAL USE 13: 00 PART I: COIPObaCR06CpPY FOR EARLY DETDCPICN C&' DYSPIASIA AND CANCER 538 OF THE CERVIX OHKAWA, K. SASAKI, S. OHKAWA, R. Dept. of Obstetrics & Gynecology, Nippon Medical School, Tokyo, Japan 13:30 PART II: HYSTERCMICR06COPE AND Li1PARCr'IICROSCOPE FOR EARLY DETEC- 539 TICN OF CANCER OF ENDCIVTRItAv1 AND OVARY OHKAWA, K. OHKAWA, R. Dept. of Obstetrics & Gynecology, Nippon Medical School, Tokyo, Japan JULY 29 13:00 BREAST SELF EXANLINATION 540 SCIENTIFIC EXHIBITS JULY 27-30, CONCOURSE E-1 INIgtNATIQQAL CLASSIFICATION OF 532 DISEASES FOR ONG'OUJGY (ICD-O), hL3RID HEALTH ORGANIZATION (YN0) PERCY, C. YOUNG, J.L. Jr. National Cancer Institute, Bethesda MD, U.S.A. E-2 THE USE OF 35nm SLIDES IN MEDICAL 533 AND SCIENTIFIC PRESENrATIONS MCDOWELL, L.B. Dept. of Medical Illustration, Memorial Sloan-Kettering Cancer Center, New York NY, U.S.A. E-3 ORIGINAL MEPHOD T0 AUTO-EVALUATE 534 TOBAC00 RISKS SORS, Ch. DURANTEAU, R. DAUTZENBERG, B. C.H.U. Pitie-Salpetriere, Paris, France E-4 PREVENPION OF PERIOPERATIVE MICROMOWTATIC Et`HANCE24EJT 535 IN FAJMAN BREAST CANCER PAPAIOANNOU, A.N. Hellenic Breast Cooperative Group, Athens, Greece E-5 THER-1AI, BIOIAGY C&` BREAST DISEASE: 536 "HIGI= RISK Tg1RKE.'R FOR BREAST CANCER?" HOBBINS, W. WEISS, J. KING, B. REEVES, W.H. Madison Breast Foundation, Madison WI, U.S.A. 13:30 THE HIDDEN CHALLENGE: WHAT YOU NEED TO IQQ(Xa AH" TESTING FOR E-6 CUR CLINICAL STAGE CLASSIFICATION COIARELTAL CANCII2 HARDCASTLE, J.D. NEUMAYR, Pr. AND CURE-RATE OF GESTATIONAL 537 CHORIOCARCINCM University of Erlangen, Erlangen, Germany, FR; University of Vienna, Vienna, Austria JULY 30 ITO, H. SEKINE, KOMURO, MIURA, SEKINO, OHSONE, T. N. S. S. S. 13:00 ON THE TREA4MENT OF MALIGi1ANP 541 HOBBS, P. HARAN, D. Dept. of Epidemiology & Social Research, University Hospital of South Manchester, Manchester, U.K. TM0RS WITH AN EX'II2ACP FRCY2 HUMN 7LJBERCUIE BACILLI (S.S.M.) MARUYAMA, C. HIRAI, T. FUJITA, K. GOTO, If . NAKAZI, K. ARAI, Y. IWAKI, H. SUGAMATA, M. IIDA, K. Nippon Medical School, Tokyo, Japan Dept. of Obstetrics & Gynecology, Jikei University School of Medi- cine, Tokyo, Japan 11

WORKSHOPS AND COURSES SCHEDULE AND DESCRIPTIONS

TIP1ETABLE OF COURSES AfJD WORKSHOPS ; NUMBER JULY 30, 1y:30-U:30 1 ROIE OF THE HEALTH CARE PROFESSIONAL IN CANM CONTROL 6 DL'lIX,TION AND PREUENPICN OF CUTANEOUS CANCERS; EIdPNASIS ON MELANObg1 11 APPLICATICNS OF NUCIEAR MEDICINE TO CANCIIt CONTROL 16 TONAf2D AN INYAINODIACNOSIS OF CANCEI2 JULY 31, 9:00-12:00 2 IDUCATIOJ OF THE CENffiRAL PUBLIC: IDENTIFYING PROSI,F3MiS & PRIO2ITIF5 12 RADIATION HAZARDS 17 NIIIRITICN AND CANCER 21 PRIDISPOSITICN M AND DE=`PION OF CHILDHOOD CANCER 25 CELL NIORPHOLOGY IN THE BIOLOGY AND DIACNOSIS OF 4L1M0RS 28 PREVF3f1ZGiv OF METASTASIS JULY 31, 14:0a-17:00 3 IDUC.ATICN CP THE GENERAL PUBLIC: PLANNING EDUCATIONAL PROGRAWES 7/8 ORAL PRE-IIDOPLASIA 13 SCREENING FOR BREAST CANCER 18 GASTRIC AND COLON CYTOIAGY 22 CANCER REIATID SYNDRCMES 26 COMPUTE9 TCMOGRAPHY IN THE DEPII;'PION OF CANCER 29 LABORATORY HAZARDS IN HANDLING CARCIf10GIIJS AUGUST 1, 9:00-12:00 4 OCCUPATIONAL CANCERS: IDFNTIFICATICN & INVESTIGATICN OF INDUSTRIAL CARCINOCE?dS 9 CYTOUJGY OF THE RFSPIRATORY TRACT 14 HORMCNES AND RISK C&' CANCER 19 PREVFNPI(N AND DEJPDCTION OF COIARDCTAL CANCER 23 GEAGRAPHIC PATHOLflGY AND CANCER RDGISTRIES 30 M[TtACENESIS STUDIES AND CANCER CONTROL Al!GUST L 14:00-11:00 5 OCGUPATIONAL CANCERS: ME'THODS OF PRKVENPION AND CONTROL 10 SMOKING PROGRAbLS: IDUCATION AND INPPRVENII'I0N 15 FINE NEEI)LE ASPIRATION C]'TOLOGY 20 EARLY DBTE)CPION OF PANCREATIC AND PERI P.NIPULLARY CANCER 24 PSYCHOSOCIAL PATPERNS IN HIGH RISK GRfJUPS 31 BACTERIA IN RIIATICN TO CANCER CONTROL xiii

Xiv COURSES AND WORKSHOPS 1~ ROLE OF THE FItALTH CARE PROFESSIONALS IN CANCER CONTROL July 30, 14:30-17:30, at The Royal Society of Medicine Director: R. TIFFANY (Royal Marsden Hospital) 2. EDUCATION OF THE GENERAL PUBLIC: IDENTIFYING PROBLEMS AND PRIORITIES July 31, 9:00-12:00, at The Royal Society of Medicine Director: R.L. DAVISON (Manchester Regional Comnittee for Cancer Education) This workshop will look analytically at public education in the detection and prevention of cancers. Two main areas will be discussed: a) Epidemiological and Medical. What health problens have priority? Will cancer prevention attract sufficient funds? What are the rela- tive incidences of cancers? Which are preventable? Can public educa- tion help? Are services adequate to meet the demand education might create? Does this impose limits on the extent of the educational programie? b) Educational. What do we want people to do? Why do they not do this now? What barriers to canmmicaticn are there? (Geographical, educational, psychological, cultural, etc.) How might these be over- eane? What are our educational priorities? 3. EDUCATION OF THE GENERAL PUBLIC: PLANNING EDUCATIONAL PROGRAPMES July 31, 14:00-17:00, at The Royal Society of Medicine Director: R.L. DAVISON (Manchester Regional Carmittee for Cancer Education) This workshop will build on the foundation of Workshop 2, with the aim of setting up guidelines for the planning of educational programries. Though it is clear that cultural and other differences do not permit the setting up of a universal planning formula for public education, scme educational pronciples do have wide application. Among questions to be examined and discussed will be those of suiting educational content and method to the problem: barriers to learning : schools education : mass media versus per- sonal educational methods : measurement and evaluation. 4. OCCUPATIONAL CANCERS: IDENTIFICATION & INVESTIGATION OF INDUSTRIAL CARCINOGENS August 1, 9:00-12:00, at The Royal Society of Medicine Director: R. NUJRRAY (Consultant in Industrial Medicine) 5. OCCUPATIONAL CANCERS: METHODS OF PREVENTION AND CONTROL August 1, 14:00-17:00, at The Royal Society of Medicine Director: R. MURRAY (Consultant in Industrial Medicine) 6. DETECTION AND PREVENTION OF CUTANEOUS CANCERS; EMPHASIS ON MELANCMA July 30, 14:30-17:30, at The Royal Society of Medicine Director: J. EVF.F2ALL (Royal Marsden Hospital) 7-8. ORAL PRE-NEOPLASIA July 32, 14:00-17:00, at Eastman Dental Hospital, Gray's inn Road Director: M. HARRIS (Eastman Dental Hospital) 4bpics to be discussed: 1) The clinical diagnosis of oral malignancy; 2) The management of oral pre malignant lesions; 3) Oral sub-noacous fibro- sis and oral malignancy; 4) Blood antigens, oral epithelial cells and early malignancy; 5) The histo-che;nistry of oral malignancy; 6) Cariputer aided diagnosis and prognosis in oral pre-cancerous lesions. 9. CYTOLOGY OF THE RESPIRATORY TRACT (see Fsbstract 546) August 1, 9:00-12:00, at The Royal Free Hospital Director: M.L. IZASIELI. (Sabbatsberg Hospital, Stockholm, Sweden)

COURSES Ah'D WORKSHOPS xv 10, SMOKING PROGRAMS: EDUCATION AND INTERVENTION August 1, 14:00-17:00, at The Royal Society of Medicine Director: G. CUST (Health Education Council) ]1, APPLICATIONS OF NUCLEAR MEDICINE TO CANCER CONTROL July 30, 14:30-17:30, at The Royal Society of Medicine Director: V.R. MOCREADY (Royal Marsden Hospital) Th.is course will outline various aspects of nuclear medicine in the role of onoology. First the various types of imaging eciuipnent and their limitations will be discussed. The various radiopharmaceuticals will be detailed indic- ating their adv4ntages and disadvantages. 7fie specific applications of radioisotope imaging techniques will be discussed to shaa how they can modify treatment. The course will end with a panel discussion giving the audience a chance to discuss the role of nuclear medicine in onoology. 12. RADIATION HAZARDS July 31, 9:00-12:00, at The Royal Society of Medicine Director: S. RAE Invited Speaker: H. SMITH (National Radiological Pro- tection Board, Harwell, Didcot) Dr. Snith will review the biological effects of exposure to ionising radia- tion with enphasis of the effects on man. The basis and validity of the risk coefficients for cancer induction, published by the International Can- mission on Radiological Protection will be assessed. This will be followed by a discussion of Dr. Smith's subject matter. Dr. Rae will describe the principles of the systen of radiological protection for workers and the public recatmended by the ICRP. The reoamiendations and their implementation will then be discussed by the wnrkshop. 13. SCREENING FOR BREAST CANCER July 31, 14:00-17:00, at The Women's Unit, B.U.P.A. Medical Center Director: P. IAST (B.U.P.A. Medical Center) 14, HORMONES AND RISK OF CANCER August 1, 9:00-12:00, at The Imperial Cancer Research Fund, Lincoln's Inn Fields. Director: R.D. BULBRUOK (Imperial Cancer Research Fund) It is hoped that the following topics will be covered in free discussion: 1) Results of endocrine measurements in case-control studies for breast, endcmetrial and ovarian cancer; 2) Endocrine status in high risk groups; 3) Effects on risk of administered hormones and drugs affecting endocrine function; 4) Effects of diet on endocrine function and relation to risk; 5) Camparison of endocrine function in various races. The workshop will explore the possibility that the majority of presently known risk factors all act via the endocrine system. ]S, FINE NEEDLE ASPIRATION CYTOLOGY August 1, 14:00-17:00, at The Royal Free Aospital Directors: A. MEISEIS (Hopital du Saint-Sacrenent, Quebec, Canada) H.E. NIEBURG.S (Mt. Sinai School of Medicine, New York NY, U.S.A.) The sampling of accessible ttarors by fine needle aspiration is an office procedure easy to perform, practically painle^s for the patient and therefore requiri.ng minimal or no anesthesia, which permits in rrost cases to establish an accurate diagnosis before surgery or other appropriate treatment. 4his workshop will illustrate the sampling techniques and will oanprise a Kodachrcme denonstration of the criteria most useful in diagnosis and a large collection of microscopic slides to be examined by participants, including sairples fran the breast, lung, thyroid, prostate, soft tissue tumors and lymph nodes. In most cases, fine needle aspiration snears will be correlated

Xvi COURSES AND WORKSHOPS with the corresponding tissue samples. A discussion will follow on the future of this technique which may replace tissue biopsy in certain specific areas. 16. TOWARD AN IMMODIAGNOSIS OF CANCER (see Abstract 547) July 30, 14:30-17:30, at The Royal Society of Medicine Director: R.J. ABLa] (Cook County Hospital, Chicago IL, U.S.A.) 17. NUTRITION AND CANCER July 31, 9:00-12:00, at The Royal Society of Medicine Director: F.J.C. ROE As much as 50% of human cancer is determined by what and hcxa much people eat and drink. In this course, experienced epideniologists and experiment- alists will review the role of nutritia•tial factors as determinants of cancer risk. The emphasis of the course will be on the role of nutritional factors as distinct fran that of carcinogens in food. Individual speakers will dis- cuss the effects of overnutrition on cancer incidence, the influence on cancer risk generally, of inorganic dietary camponents, of dietary oarposi- tion, of Vitamin A and related retinoids, of other vitamins, and of alcohol, and the relation between liver damage, cirrhosis and risk of liver cancer. 18. GASTRIC AND COLON CYTOLOGY July 31, 14:00-17:00, at The Royal Free Hospital Director: O.A.N. HUSAIN (Regional Cytology Center, St. Stephen's Hosital) The workshop will consist of short tutorial talks and slide seninars follow- ed by ample workshop time to circulate cytology and histology slides on case studies. Both gastric and colonic cases will be stXkm as well as oesophageal and pancreatic cancer brush and aspirate specinens. Case studies will be demonstrated on the television monitors detailing the diagnostic criteria and interpretational and correlating features between the cytological and histological specimens. 19, PREVENTION AND DETECTION OF COLORECTAL CANCER August 1, 9:00-12:00, at The Royal Society of Medicine Director: B.C. MORSCN (Dept. of Pathology, St. Mark's Hospital) The object of this workshop is to present the latest views on the aetiology, pathogenesis, detection and treatment of eolorectal cancer as seen by the medical staff of St. Mark's Hospital which has a special experience of this disease. It is intended to present a series of short papers on the follaa- ing topics with ample time for discussion. 9:00 Dr. Michael Hill, AE'PIOIAGY; 9:45 Dr. B.C. Morson, PRECANCEROUS CXIrIDIT- ICNS AND LESIONS; 10:45 Dr. C.B. Williams, ROIE OF COLON06COPY IN EARLY DE'TfX,TICN; 11:30 Mr. R.J. Nicholls, CLINICAL STAGING OF REOPAL CANCER. 20. EARLY DETECTION OF PANCREATIC AND PERI-AMPULARY CANCER August 1, 14:00-17:00, at Hammersm.ith Hospital Director: I.S. BEt3.TAl4Iri (HaRmersmi.th Hospital) 21. PREDISPOSITION TO AND DETECTION OF CHILDHOOD CANCER July 31, 9:00-12:00, at The Royal Society of Medicine Director: A.T. P¢'.AbOwS (Children's Hospital of Philadelphia, Philadelphia PA, U.S.A.) Cancer in children is rare and unlike adults children have limited exposure to occupational, dietary, and other environme,ntal agents. A knda1edge of host factors that increase cancer susceptibility could be useful, therefore, in detection and early diagnosis. History, physical examinations, and chren»scmal analysis are all useful. History detects those with a prior malignant neoplasm, those with siblings

COURSES AT.'D WORKSHOPS xvii or parents with multiple.primaries in paired or different organs or with cancer at earlier than expected ages. Careful es:amination can detect indi- viduals with hemihypertrophy, aniridia, the Beckwith-[siedemarui Syndrome, or stigmata or neurofibranatosis and other phaamatoses. Those with Bloan's syndrome, Fanconi's anemia, Da,m's syndrane, and ataxia telangiectasia have the diagnosis confirmod by chrarroscmal studies. These children can be fol- lo,aed for neoplasia. In addition, three human neoplasms are now )o'icxn to be associated with specific constitutional chrorbsanal locations. our expectation is that new molecular and cytogenetic techniques will allow us to identify the chrcmo- sanal locations of other neoplasms and to characterize the genes. The study of cancer in children, therefore, holds great pranise for the characterizn- tion of genetic states that increase susceptibility to environrrental car- cinogens and predispose to cancer. This Imaaledge will prove useful for the detection of cancer in all ages. 22. CANCER RELATED SYNDROMES July 31, 14:00-17:00, at The Royal Society of Hedicine Director: R.C. COQ^qF,S (Ludwig Institute for Cancer Research) This course will concentrate on the following topics: (a) Clinical syrxlrcmes, in particular hypercalcaemia and the possible role of calcium-regulating- honnones in their aetiology. The cancer-associated parathyroid horrrone, calcitonin, QAF arid prostaglandinds will be discussed together with the evidence for their roles in the disturbances of calcium metabolisn associa- ted with cancer. (b) Mr. M.L. ELI~SON will outline the findings concerning ectopic houmnes, ectopic hormone receptors and their roles in modifying cell behavior in vitro. (cZ Dr. J. RATCLI fE will outline his rctient find- ings concerning the release and adsorption of peptide honrrones and what implications this may have, with particular relevance to adrenooorticotrophic horrrone. In addition, there will be brief presentations of the most recent results . of studies on turrour-associated-hypothalam.ic- releasing factors; of studies concerned with a reoently-described animal model of human cachexia and the progress made in characterising the biochesnical abnormalities associated wzth this syndreme; and of recent studies oancerned with the che:.tistry of cancer-associated-calcitonin. 23. GEOGRAPHIC PATHOLOGY AND CANCER REGISTRIES August 1, 9:00-12:00, at The Royal Society of,A:edicine Directors: M.S.R. HUIT (St. Ttomas's Hospital Medical Sehoo1) M.R. AIDERSON (Royal Marsden Hospital) This course is designed for those individuals, particularly from developing countries, who have not had much experience in the management of cancer registries or in geographical studies in canoer research. The airs and cbjectives of popul.ation and hospital based registries will be discussed and practical exan-ples will be given of the value of epidaniological studies in the African continent. 24, PSYCHOSOCIAL PATTERNS IN HIGH RISK GROUPS August 1, 14:00-17:00, at The Royal Society of Medicine Director: S. GREER (Faith Courtauld Unit, The Rayne Institute) Research papers will be presented on the above th,_-e and it is hoped to generate discussion on methoc3ologieal issues involved and Mays of solving the formidable research problerns in this area.

xviii COURSES AND WORKSHOPS 25. CELL MORPHOLOGY IN THE BIOLOGY AND DIAGNOSIS OF TlM0RS July 31, 9:00-12:00, at The Royal Free Hospital Director: H.E. NIEBURC',S (Mt. Sinai School of Medicine, New York NY, U.S.A.) Nuclear and cyt,oplasnic changes in exfoliated cells and in those reaaved by brushing and aspiration will be daronstrated by correlation with identical cells in the site of their tissue origin, and with nuclear structures in mitotic phases. The morphology and biologic role of cellular changes in the develolnmt of histopathologic patterns will be shoan in a spectnan of histologic alterations. A unified cyto- and histologic diagnostic classif- ication of cellular changes will be demnstrated, and the microscopic workshop will be conducted with ariphasis on the utilization of criteria for cytologic diagnoses in terms of histopathologic alteration. The nnrphogene- sis of cellular changes in the tunor and host and their microscopic identification will be reviewed. Participants will have the opportunity to examine a large number of specimens with usual and unusual as well as equi- vocal cellular changes in benign diseases and malignant neoplasns. Microscopic findings will be discussed by camparative projection of corresponding cytologic and histologic preparations. 26. COMPUTED TOMOGRAPHY IN THE DETECTION OF CANCER July 31, 14:00-17:00, at The Royal Society of Medicine Director: J.S. NACDCNALD (Fmyal Marsden Hospital) The aim of diagnostic radiology in the detection of cancer has always been to detect primary tumours and metastases when these lesions are small. Canputed tccmgraphy is the roost sensitive and efficient means yet devised of using diagnostic X-rays with obvious applications in the detection of cancer. The object of this workshop is to examine in depth the role of the General Purpose C.T. Scanner in the primary diagnosis of tiarours and in the assessment of how far these tunours have spread. 28. PREVENTION OF METASTASIS July 31, 9:00-12:00, at The imperial Cancer Research Fund, Lincoln's Inn Fields Directors: K. HELIFAAIN (Cancer Chemqtherapy Dept., Imperial Cancer Research Fund); S.A. DOCLES (Chester Beatty Institute, Sutton) Prevention of metastasis by changes in the host or tumour or their inter- relationship will be described. Manipulation of these relationships by means of drugs has been stu3ied and will be demonstratsd. Prevention may be an important aspect of treatment, but stimulation of metastasis is also possible and the balance between these two possibilities will be discussed. The influence of such diverse substances as the antioaagulants, fibrinolytics and miscellaneous anticancer drugs will be dealt with. Newer drugs that are highly immn7osuppressant will also be discussed. Their influenee on metastases developnent will be examined in detail. All of these factors will be examined as they have been revealed from experimPntal animals, since clinical trials on the possibility of prevention of metastasis present considerable difficulties. 29. LABORATORY HAZARDS IN HANDLING CARCINOGENS July 31, 14:00-17:00, at The Royal society of Medicine Director: S. Vf3dITT (Institute of Cancer Research) 3O. MUTAGENESIS STUDIES AND CANCER CONTROL August 1, 9:00-12:00, at The Royal Society of Medicine Director: B.A. BRIbGES (M~ Cell Mutation Unit, University of Sussex, Faimex, Brighton) Mutagenesis studies can be used to detect carcinogens, to study their mode of action and to identify individuals who may have been exposed to carcirxr- gens. They do not give a omnplete picture, however, and their limitations a

_ COURSES AND WORKSHOPS xix as well as their uses will be discussed. Mutagenicity will be discussed yrithin the context of occupational cancer, of iatrogenic effects of inedicines, and of the detection of carcinogens in the wider environment. Particular attention will be given to the psoralens which are photo-activated carcino- gens fourxl naturally, used clinically in the treatment of psoriasis and vitiligo, and present in a number of sun-tan preparations. jj., BACTERIA IN RELATION TO CANCER CONTROL August 1, 14:00-17:30, at The Royal Society of Medicine Directors: M.J. HILL and W.R. BRUCE (Central Public Health Laboratory, Colindale) This course will smmarise our current )axxaledge of the role of bacteria in the causation of intestinal cancer. There will be a series of presentations on various aspects of the subject. 14:00 Dr. W.R. Bruce, MUPACENS PRESENT IN H[MAN FAECES; 14:30 Dr. R. Bilton, BILE ACID MtTDA(ENS FORMED BY GUT BACTERIA; 15:00 Dr. M. Thmpson, ADENO^.}iRCINONA SFQLJENCE AND BA~,`lERIA IN CODD.- RDCPAL CANCER 16:00 Dr. M.J. Hill, N-NI7R060 COMPOUND FORN%TION AND ITS RoLE IN HUNAN CANCER 16:30 Dr. W. Rudell, ETIOIAGY OF GASTRIC CANCER IN GASIRIC ACHIARHYDRIA 17:00 Dr. M. Stewart, COLON CANCER IN PATIE3NiS WITH URETEFD6ICMID- ANASTAM06IS 1 { 9

PODIUI SESSIONS 1, JULY 27, 10:00-13:00, MAIN HALL pCCUPATIONAL. CARCINOGENESIS CHAIRMAN: R. DOLL (U.K.) CO-CHAIRMAN: D. SCHMAHL (Germany FR) SECRETARY: J.F. FRAUMENI, Jr. (U.S.A.) 10:00 INP1tODUClCA2Y RFI4FIRK.S CF C}AiPMAN 10: 05 ENVIROWESTP AND CANCF3t 10:00 ItJlROOUCTCRY FE24VRKS CF CHAIRNlAN 10:05 7UMOR MARI~Ft.S IN B20NCHOGfIdIC HIGGINSON, J. 18 Internationa2 Agency for Research on Cancer, Lyon, France CAYC-INCMA 127 COOMBES, R.C. Ludwig Institute for Cancer R h (L d ) R l M d 10:25 DISCUSSION esearc on on , oya ars en Hospital, Sutton, U.K. 10:40 OOQJPATIGtAL CANCERS 10:20 DISCUSSION FURST, A. Institute of Chemical Biology, University of San Francisco, San Francisco CA, U.S.A. 10: 30 7UMOR MARKEiS CF BREAST HOLLINSHEAD, A.C. 128 Dept. of Medicine, The George W hi t U i i di 11:00 DISCUSSION as ng on n vers ty Me cal Center, Washington DC, U.S.A. 11:15 EPIDIIvIICQAGIC IDESllIFICATICN CF CARCINOGQZS 10:45 DISCUSSION 20 ARMSTRONG, B.K. 10:55 7UMOR M~ER.S IN T122ATCFFi NH and MRC Research Unit in Epi- demiology 6 Preventive Medicine, KOHN, J. 129 Royal Marsden Hospital and Ludwig University of Western Australia, Nedlands WA, Australia Institute for Cancer Research, Sutton, U.K. 11:35 DISCUSSION 2. JULY 27, 10:00-13:00, AVON 1/2 BIOLOGICAL MARKERS: PART ONE CHAIRMAN: J.V. KLAVINS (U.S.A.) CO-CHAIRMAN: A. MUNRO NEVILLE (U.K.) SECRETARY: M.N. CAUCHI (Australia) 11:10 DISCUSSION 11: 50 METHCOS CF C.ARCINOCENICITY 11:20 7UMOR I,~ C&' THE CYNfRAL TSSIZNG 1EZVWS SYSTFM 21 MOHR, U. 130 BIRKMAYER, G.D. Abt. fur experimentelle Pathologie, Dept. of Cell Biology, University Medizinische Hochschule Hannover, of Munich, Munich, Germany FR Hannover, Germany FR 12: I0 12:25 22 DISCUSSION 11:35 DISCUSSION 11:45 MORPHCIIAGICAL 7UMOR NMWS NIEBURGS, H.E. Dept. of Pathology, Mt. Sinai School of Medicine of CUNY, New York NY, U.S.A. P3mBSIEMS C&' OOCxTPATIQNAL CARCINCY- CEMSIS IN DEUE3APING COU[fPRIFS TABA, A.H. World Health Organization Eastern Mediterranean Regional Office, Geneva, Switzerland 12:45 DISCUSSION 131 12:00 DISCUSSION 132 12:10 SE(1RCH FOR UNIVERSAL 4[IMOfft 2~ KLAVINS, J.V. Dept. of Pathology, Catholic Medical Center, Jamaica NY, U.S.A. 12:25 DISCUSSION ~

PODIIM SESSIONS 3, JULY 27, 10:00-13:00, AVON 3 N14SS SCREENING: PART ONE CHAIRMAN: A.B. MILLER (Canada) CO-CHAIRMAN: J. VAN ROY (Belgium) SECRETARY: R.N. DENNEY (Hawaii) 10:00 WPRODUCPORY REt191RKS OF CHF1TFdrA,N 10:05 THE DSPACP OF CANCER SCRFENIING ON 235 MDRBIDITY AND MfJRTALI'i'St. I. Problems in effect evaluation XABBEMA, J.D.F. OORTMARSSEN, G.J. van JONG, G.A. de LUBBE, J.Th.N. MAAS, P.J. van der Dept. of Public Health and Social Medicine, Erasmus University, Rotterdam, Netherlands 10:15 THE IMPACT OF CANCER SCREQdING ON MORBIDITY AND N3JRTAIII'Y. 236 II. Numierical experimentation through a arnputer progratmie LUBBE, J.Th.N. NABBEMA, J.D.F. OORTMARSSEN, G.J. van JONG, G.A. de MAAS, P.J. van der Dept. of Public Health and Social Medicine, Erasmus University, Rotterdam, Netherlands 20:55 DISCUSSION 11:15 240 9CRE3:NING OF BREAST CANCER AIII3 HEALTB ED[K'.ATION IN CO~MIIMTION WI'Ifl lCps. CANCER SCRMJING RASANEN, 0. AURANEN, A. GRONROOS, M. The Turku Multipurpose House of the Finnish Cancer Society, Turku, Finland 11:25 SOCIAL AND PSYCHOIAGICAL FAMRS 241 IN ACCEPTANCE OF BREAST SCREENING BY M-SYJGRAPHY HOBBS, P. Dept. of Epidemiology and Social Research, University Hospital of South Manchester, Withington, Manchester, U.K. 11:35 FCUR DIJ•MIQIIS OF PUBLIC 242 ATfINDE 70 CANCER DENT, 0. GOULSTON, K. The Australian National University, Canberra; Concord Repatriation General Hospital, Sydneyt Australia 11:45 DISCUSSION 12:05 THE VAIIJE OF Ng1SS SCREENING FOR 243 THE EARLY DbTFCTION CE' BREFLST CANCER VUJICIC, N. NOLA P 10:25 DOUBLING TIMS, IF.AD TIME BIAS AND LFNGPH BIAS , . JUZBASIC, S. BESENSKI, N. 237 SPRATT, J.S. Dept. of Surgery, University of Louisville, Louisville KY, U.S.A. KOSANOVIC, S. Central institute for Tumors and Allied Diseases, 2dgreb, Yugoslavia 10:35 7HE IMPAf.'P OF CANCER 9CREQIING ON 12:15 EARLY DEIECTION OF BREAST CANCER NDRBIDITY AND MORTALITY IN MA,SS SCREENING. RESULT OF 14 238 III. The case of cervical cancex screening in The Netherlands OORTMARSSEN, G.J. van JONG, G.A. de LUBBE, J.Th.N. MAAS, P.J. van der HABBEMA, J.D.F. Dept. of Public Health and Social Medicine, Erasmus University, Rotterdam, Netherlands 244 YF.ARS ACTIVITY MAISIN, R. BONTE, J. COLLIN, Cl. MOLTER, Fr. VAN ROY, J. RAMIOUL, H. FROIDMONT, C. WAROCQUIER, J. • Centre des Tumeurs Universitaires de Louvain. Leuven, Liege, Anvers, 10:45 OiT1)COMES OF A COORDINATfD, Brussels, et Provinciaux de CQrT'A7NITY BASED CANCER C:ODfIROL Verviers, Namur et Mons, Belgium 239 PROGRAM BRENNAN, N.J. 12:25 DISCUSSION SWANSON, G.M. Michigan Cancer Foundation, ~ Detroit MI U.S.A O , . O

POD1lH SESSIONS 4, JULY 27, 10:00-11:30. SE1ERiV 1 HEAD MQ) NECK CANCER: PART ONE 5, JULY 27, 11:30-13:30, SEVERN 1 HEAD AND NECK CANCER : PART TYJ() CHAIRMAN: D.J. JUSSAWALLA (India) CO-CHAIRMAN: N.J. SHAW (U.K.) SECRETARY: R.B. HELLQUIST (Sweden) CHAIRMAN: R.C. HICKBY (U.S.A.) CO-CHAIRMAN: M. HARRIS (U.K.) SECRETARY: F.S. MENTA (India) 10:00 INPRODUClORY RDPRKS OF CHAiRNIIiN 11:30 THE RE:LIABILITY OF IgA ANTIBODY 10:05 EPIOLOGIC FAC'1nRS IN HEAD AND 255 TO EPSTEIN-BARR VIRU.S (FW) CAPSID ANTIGEN AS A TEST FOR DIAQk7SIS OF AID K CARCINOPA 2530 BRUGERE, J. I3A.SOPHARYNCEAL CAfCINaM1 (NPC) LEVINE, P.H. Read and Neck Dept., Institut Curie, Paris, France The American NPC Study Group. National Cancer Institute, Beth- d i 10:15 IA'AAJNOLOGl' OF HEAD AAII) AIDCR CANCER: es a MD; Mayo Cl nic, Rochester MN; M.D. Anderson Hospital, 2535 RELATICN TO ETICQAGY, PATHOGINESIS, PROPHYIJXIS AND TF~'.AZMENTP Houston TX; Center for Disease Control, Anchorage AX; Massachus- CHRETIEN, P. Surgery Branch, National Cancer Institute, Bethesda MD, U.S.A. setts Eye & Ear infirmary, Boston MA; Armed Forces Institute of Pathology, Washington DCj Duke University, Durham NC; U.S.A. 25 TFIYNIIDINE KINRSE AS AN ONvOFEaAL 0 : 1 ANTIGEN 11:40 IIM06COPIC AWANCES IN EARLY 254° BALIS, M.E. Laboratory of Cell Metabolism, Sloan-Kettering Institute, New York NY, U.S.A. 256 CANCER DEPECPION IN Rl3E HEAD AfID IEC!C STEINER, W. JAUMANN, M.P. t hi f O l 10:35 DISCUSSION . o Dep tor no aryngology, University of Erlangen, Erlangen, Germany FR 10:50 NEW APPImACHFS IN RADIOifERAPATPIC ?.~ENT 11:50 SCINTIGRAPHIC EXAbIINATIONS OF 5 254 LAWRENCE, G.A. 4UMRS IN THE NAXILLOFACIAL Dept. of Radiation Therapy, 257 RDGICIN Louis A. Weiss Memorial Hospital, Chicago IL, U.S.A. WICKENRAUSER, J. HOHENBERG, G. C l i 11:00 NEW APPRDACHES IN CF6;.M7!}ERhPEUTIC entra Inst tute of X-Ray Diag- nostics, University of Vienna; 254Y 11AN~P University Clinic for Radiotherapy PRICE, L.A. Head and Neck Unit al Marsden Ro and Radiobiology; Vienna, Austria , y Hospital, London, U.K. 12:00 MICROIARYNOOSOOPIC DIAC3406IS OF 11:10 SURGICAL REIiABILITATION KAVARANA, N.M. Plastic and Reconstructive Surgery Service, Tata Memorial Hospital, Bombay, India 11:20 DISCUSSION 258 PRESALICNANf LESIONS CP THE IAFa= OLOFSSON, J. LUNDGREN, J. HELLpUIST, R.B. Depts of Otolaryngology and Path- ology I, Linkoping University Hospital, Linkoping, Sweden 12:10 SC7ME FXPFRiFN,'E WIZN IN VIVO 259 STAITiBJG OF EARLY IARYNGEAI. CANCER IN JAKARTA, IAIDCINESIA KURNIAWAN, A.N. HANDIKIN, L.S. Depts of Anatomic Pathology and Otorhinolaryngology, School of Medicine, University of Indonesia, Jakarta, Indonesia

PODIIM SESSIONS 5. JULY 27, 11:30-13:30, SEVERN 1 6. JULY 27, 10:00-13:00, SEVERN 2 FiEAD AND NECK CANCER: PART TWO (CONT`D) NUTRITION CHAIRMAN: T. SUGIMURA (Japan) 12:20 LARYNCFAL FNFOLIATIVE CXTaIAGY CO-CHAIRMAN: W.K. LUTZ (Switzerland) 260 LUNDGREN, J. SECRETARY: L.N. KOLONEL (Hawaii) OLOFSSON, J. HELLQUIST, H.B. STRANDH, J. Depts of Otolaryngology, Pathology I and Clinical Cytology, Linkoping University Hospital, Linkoping, Sweden 12:30 PHCQUME'IRIC SIUDIE.S ON NUCLFAR 261 DNF1 CODfl'f3dl' AND AREA IN DIFFFRE2IT IARXNC2:'AL EPII4ELIA HELLQUIST, H.B. OLOFSSON, J. LUNDGREN, J. Depts of Otolaryngology and Path- ology I, Linkoping University Hospital, Linkoping, Sweden 10:00 INTfmDUCPORY R11QJKS Ot' (HAIRNFiN 10:05 DIEfARY NPJDUTATION IN CANCEIi PREVENTION WITf'1 ~~ TO 64 S0C1AL AND CULTURAL F'OOD HABI7`S RANDERIA, J.D. Cancer Research Institute, Univer- sity of Durban-Westville, Durban, Republic of South Africa 10:15 FOFMTION OF NAIPACENS IN HEAT 12:40 DETfJCTION OF TH>%)ID NEOPIA.SMS BY 262 CYIC)IAGIC MEZHOD: RESULTS OF FIVE YEARS STUDY C6' 2,938 ASPIRATION BIOPSIES STAVRIC, C. XARANFIIBKI, B. KALAMARAS, A. ZOGRAFSKI, G. Institute of Radiotherapy and Oncology, Skopje, Yugoslavia 65 PROCF.SSID FOOD PARIZA, M.W. ASHOOR, S.H. Dept. of Food Microbiology and Toxicology, Food Research Insti- tute, University of Wisconsin, Madison WI, U.S.A. 10:25 EPIDII,IIOUJGY OF CANCER AMONG ACI'IVE CALIFOFNIA MURM7NS 66 ENSTROM, J.E. School of Public Health, Univer- sity of California, Los Angeles CA, U.S.A. 10 35 D SCUSSI 12: 50 CANCER 6CREININS FOR NBJLLTIPLE : I ON E2IDOCRIt1E ADtTNOMATOSIS SYDIDFKME 10:50 THE EIFECPS OF VITAMIN A DERIV- 263 (MFA II) ATIVES ON NORt4NL AND t1EJOPIASTIC HICKEY, R.C. 67 HIASAN CELIS CULTUFM IN VITRO SAMAAN, N.A. HILL, C.S. Jr. The University of Texas System Cancer Center, M.D. Anderson Hospital and Tumor Institute, Houston TX, U.S.A. WILSON, L. DOWDLE, F. Dept. of Clinical Science and Immunology, University of Cape Town, Cape Town, Republic of South Africa 13:00 J-131 UP2AKE, BIOIAGICAL BSfIAVIOR 11: 00 CONML OF TiMJR (ROW1H BY 264 AND RF7CURRFTlC3; FFM INIEiVAI, CF DIFFF•RFI7PIATID TFYROID CANCER 68 DIEPARY PYRIDOCIINE RESTRICTION OR TRF.ATNEW WITH ANPIVI'IANRN KOKOSCNKA, R. AIGINGER, P. KRISCH, K. Depts of Surgery I, Medicine II and Pathology, University of Vienna Medical School, Vienna, Austria ACENiS TRYFIATES, G.P. Dept. of Biochemistry, West Virginia University School of Medicine, Morgantown WV, U.S.A. H J M 13:10 TREATRMENP C&' IFS7KOPL?11QA NTITH 11:10 AR FI L EFFE7CTS OF CARRAGEEW FFID TO ANIhpAIS "TIGA.SCN" 69 WATT, J. 265 KOCH. H.F. MARCUS, R. Clinic of Maxillofacial & Plastic Surgery, University of Dusseldorf, Dusseldorf, Germany FR Dept. of Pathology, University of Liverpool; Clatterbridge Hospital, Bebington, Merseyside, U.K.

PODILTI SESSIONS 6. JULY 27, 10:00-13:00, SEVERN 2 NUTRITION (CONT'D) 7. JULY 27, 15:Oa-18:30, MAIN FIALL CARCINOGENIC FACTORS 11:20 DISCUSSION 11:35 DIET MC)DIFICATION OF PIA-W CHAIRMAN: A. BROWN (U.S.A.) CO-CHAIRMAN: S.L. JOHANNSON (Sweden) SECRETARY: N. HARAN GHERA (Israel) 70 HORNZ7NE5 IN ECDEFQ,Y MEN WI4H pR06TATIC CANCER 15:00 INTRODUC7LlRY gIIMARKS OF CHAIRt'JAN HILL, P. GARBAC2EWSKI, L. 15:05 GENETIC PRIDISPOSITICN TO CANCER WALKER, A.R.P.* WYNDER, E.L. American Health Foundation, New York NY, U.S.A.; *Medical Research Institute Johannesbur Re ublic KNUDSON, A.G. Jr. 1 The Institute for Cancer Research, The Fox Chase Cancer Center, Philadelphia PA, U.S.A. , g, p of South Africa 11:45 CUMJIATIVE F.F4IX`f OF BtTfL-NUf, 15:25 DISCUSSION 15:40 NAJLTIPLE FACIC)R ETIOIAGY 1 72 PIPE'RAZIAIE AND SAOC}iARIIN ON CAUSATION OF E?Q'E:RIIENIAh CANCEt PAI, S.R. SHIRKE, A.J. S V GOTHOSKAR 2 FRAUMENI, J.F. Jr. Environmental Epidemiology Branch, National Cancer Institute, Bethesda MD, U.S.A. . . , Biology Division, Cancer Research institute, Bombay, India 16:00 DISCUSSION 16:15 IAW DOSE CARCINOCENE5IS 11:55 EPiECP OF BETEL [XfID CHF.WING ON NITRITE IEVEIS IN SALIVA HICKS, P.M. 3 School of Pathology, Middlesex 73 SNIVAPURKAR, N.M. D'SOU2A, A.V. BHIDE, S.V. Carcinogenesis Division, Cancer Research Institute, Bombay, India Hospital Medical School, London, U.K. 16:35 DISCUSSION AND TEA BREAK 17 20 IATICGE IC C : N ARCIINOCENFSIS 12:05 DISCUSSION SCHMANL, D. 4 Institute of Toxicology and 12:20 N[lPRITIONAL ASSESSMESTP AND SUPPORT Chemotherapy, German Cancer IN ONOOLOGSf Research Center, Heidelberg, 74 MULLEN, J.L. Germany FR SMALE, B.F. BU2BY, G.P. ROSATO, E.F. 17:40 DISCUSSION Dept. of Surgery, University of Pennsylvania School of Medicine, Philadelphia PA, U.S.A. 12:30 PRESERVATION OF THE NIIIRITIONAL 75 INi'FiCRI't'Y OF THE CANCER PATIFNP: IEVERSAL OF CANCEt CACHEXIA BY HYDRAZIIQE SUIFATE GOLD, J. Syracuse Cancer Research Institute, Syracuse NY, U.S.A. 17:55 RISK ASSESSNkIdIS LEE, P. Independent Consultant, London, U.K. 18:15 DISCUSSION 12:40 DISCUSSION

PODIIM SESSIONS 8. JULY 27, 15:OU-18:30, AVON 1/2 BIOLOGICAL MARKERS: PART TWO CHAIRMAN: P.P.G. FRANCHIMONT (Belgium) CO-CHAIRMAN: A. ALVSRYD (Sweden) SECRETARY: P. OEHR (Germany FR) 16 :10 TlE RFLEVANCE OF SECRETORY IqA ES`i'IIMATION IN THE SERA OF 138 PATIfNiS WI4H GYNEOOLOGICAL CANCER CAUCHI, M.N. LIM, D. Section of Hematology and Immun- ology, Royal Women's Hospital, Melbourne, Australia 15 00 INIRODUCILIRY RE!4ARKS OF C1iAIRNF N : a 15:05 CHOLESTEROL AND CHOIES'I'FROL-a- EPOXIDE IN HLS+AN BREAST SECRRF.TIONS 16:20 DISCUSSION AND TEA BREAK 17:00 M7PTITORING TUN1aUR CROW141 IN 133 PETRAKIS, N.L. PATIt1dI'S WITH MEIANONFl BY GRUENKE, L.D. 139 DEPDLTION OF NELANONA ANPICENS CRAIG, J.C. Dept. of Epidemiology and Inter- national Health, University of California, San Francisco CA, U.S.A. IN SERA AND IAA ASSAYS HERSEY, P. MURRAY, E. MCCARTHY, W.N. Kanematsu Memorial Institute and Melanoma Unit, Sydney Hospital, 15:15 PRESIIVCE OP EPO}DCHOLP51ERpLS IN Sydney, Australia THE AGING H[Ag1N PRJSTATE G[AAID AS 134 A RISK FACTOR IN CANCER 17:10 EFT'EC'IS OF AGE AND SMDKING CN SCHAFFNER, C.P. LEVELS OF SERIM PROIEINS ALTERII) BRILL, D.R. 140 IN CANCER PATIb3JIS SINGAL, Waksman A.K. Institute of Microbiology, WEISS, J.F. CHRETIEN, P.B. Rutgers-The State University, New Brunswick NJ, U.S.A. EDWARDS, B.K. BEVERIDGE, R.A. ASKI M 15:25 SEIdRM B-PROSTATIC P}4)TEIlV AND . B ES, A. WOLF, G.T. PATHOIL)GY OF THE PRL)STATE 135 ROCHMAN, H. WU, W. Dept. of Pathology, University of Chicago, Chicago IL, U.S.A. National Cancer Institute and Armed Forces Radiobiology Re- search Institute, Bethesda MD, U.S.A. 17:20 AN EVAIx1ATION OF CEA-S FOR 15:35 DISCUSSION CANCER DIAC3JD6IS 141 REYNOSO, G. 15:50 FEPAL TYPE ANTIGENS IN GYDIDOOL- Wilson Memorial Hospital, John- OCiICAL CANCER 136 CAUCHI M N son City NY, U.S.A. , . . LIM, D. 17:30 SCREENING FOR LIVER M~SES BARTON, J. ' f IbaM COIARFCI71L CANCER WI4H KOH, H. 142 CARCDM'1BRYONIC ANTIGEN AND Section of Hematology and Immun- ALICAL~NE PP06PHATPSE ology, Royal Women's Hospital, Melbourne, Australia 16:00 CA1CIN0&SfBFdtONIC ANPICE4 LEVELS AS TARTTER, SLATER, GELERNT, AUFSES, P.I. G. I. A.H. r. AN AID IN THE DIFFEREJfIAL DIAC3d0- Dept. of Surgery, Mt. Sinai 137 SIS OF AEiDOrffNO-PET;VIC ~AhIC2NANCIES PARENTE, J.T. School of Medicine, New York NY, U.S.A. GRESTON, M.T. Dept. of Obstetrics 6 Gynecology, 17:40 SYSTFS4aTIC SEA%Ii FOR PIdX[.IDIICAL Bronx-Lebanon Hospital Center; CANCE2 NYIRKEEtS IN SIRIM: TFM 143 Albert Einstein College of Medicine JAttIIS PRQ7DCT Bronx NY, U.S.A. JELLUM, E.

PppIllrl SESSIONS 8. JULY 27, 15:00 18:30, AVON 1/2 BIpLpGICqL MqRKERS: PART TMlb (COrrT'D) 143 ORJASETER, H. DENNEY, R.N. Cancer Center of Hawaii, Honolulu, HARVEI, S. L RSE Hawaii, U.S.A. . N, THEODO PIHL, A. 15:55 VAIdIE, AIMS AND RESUi.TS OF THE The Norwegian Cancer Society, Oslo, Norway 250 IARGt:ST 0[lI'PATIFNP CLINIC FOR 4S"RS IN ITALY 17:50 DISCUSSION AZZARELLI, A. DI PIETRO, S. Istituto Nazionale per 1o Studio e la Cura dei Tumori, Milan, Italy 15:25 DISCUSSION 10. JULY 27, 17:00-18:30, AVON 3 15:35 THE P06SIBIISTIFS CF PIAbIIdING PROBLEMS OF CANCER DETECTION AND PREVENTION IN DEVELOPING COlRJ1RIES HFALTH EDUCATION PR3GRAMS BASED CN 248 RFSULTS OF INVF.S'lZGATING PUBLIC BEHAVIOR AND ATPI4UDES 70WMW CANCER MIJALKOVIC, O. NESKOVIC, B. CHAIRMAN: A.0. WILLIAMS (Nigeria) CO-CHAIRMAN: D. BURKITT (U.K.) SECRETARY: J.B. GIBSON (Hong Kong) Institutw of Oncology and Radiology Belgrade, Yugoslavia 17:00 INPf4DUCMRY RFhFiRKS OF CWIIFQ~%N 15:45 EFEE=IVENESS OF THE CONATiNITY- BASLU CO[1ffiAL PROGRAMS OF THE 249 NATIO[F1L CANCER INSTIT=o THE IAWIIIIIAN CASE 16:05 DISCUSSION 16:15 OOCUPATICNAL CANC ER - IIID06COPIC AND ROIIJlC~E?JDIbGIC PF1SS SCREEIING CHAIRMAN: G.M. SWANSON (U.S.A.) 251 CF THE UPPER AERD-DIGESTIVE TRACT CO-CHAIRMAN: J.D.F. RABBEMA (Netherlands) SECRETARY: O. DENT (Australia) STEINER, W. JAUMANN, M.P. Dept. of Otorhinolaryngology, 15:00 INPRODUCPORY FOQRKS OF CNAiRW University of Erlangen, Erlangen, Germany FR 15:05 CANCER DEPDCIION AS A PART OF 16:25 A SiUDY OF NEGATIVE CASES IN THE GENERAL PRACTICE MSS SURVEY OF GASTRIC CANCER 246 VAN ROY, J. 252 MATAYOSHI, J. PEETERS, G. Free University of Brussels, V.U.B. Gezondheidscentrum, Brussels, Belgium DOI, H. YAMAWAKI, K. KATO, T. HIROTA, K. 15:15 FEED BACK OUTML OF SCREEIUNG Dept. of Radiology, Gifu Univer- sity School of Medicine, Gifu RFSULTS IN NORD- AND SUDWUFrITFM- City, Japan 247 BERG 6A:ST GERNFINY; E)PERgIJCE IN , 1.5 MILLION TESTS FOR CANCER DEPDL'P'ION SCHRAGE, R. • 16:35 DISCUSSION Universitats-Frauenklinik, Tubingen Germany FR 9. JULY 27, 15:00-16:45, AWN 3 MASS SCREENING, PART TWO

10. JULY ?J, 17:00~18:30, AVOtJ 3 PODIIH SESSIONS 11. JULY 27, 15:00-18:30, SEVERN 1 PROBLEMS OF CANCER DETECTION AND BREAST CANCERt OVERVIEYd ~ ]ON IN DEVELOPING COUtJTRIES 7:05 MODFL FOR CANaR PREVLITI'1ON AND CHAIRMAN: CO-CHAIRMAN: SECRETARY: U. VERONESI (Italy) A.I. HOLLEB (U.S.A.) J. CHA1lBERLAIN (U.K.) 1l8 DEI'ExTION PROGRAM GOES, J.S. Jr. 15:00 INrFODIX.'4ORY RfTRtRKS OF CFAIICI21N GOES, J.C.S. Fundacao "Centro de Peguisa de Oncologia," Instituto Brasileiro de Controle do Cancer, Sao Paulo, Brasil 15:05 EPIDfMIOIDGY OF BREAST CANCER BERRINO, F. Istituto Nazionale per lo Studio e la Cura del Tumori, Milan, Italy 17:15 14EDICAL WMOiE? UPILISATION FOR ~'15:25 CANCER DEI'FI'I'ION AT T N[JIRITIONAL EFFIC'!S IN BRFASP CANM 119 ID SCREES ING PROCRknC. Eleven year expexience 403 NEWBERNE, P.M. VAIDYA, S.G. Goa Cancer Society, Gosalia Memorial Hospital and Research Institute, Panaji, Goa, India Dept. of Nutrition and Food Science, Massachusetts Institute of Technology, Cambridge MA, U.S.A. 17:25 77-IE CRAB CLUB P%k7DCT 120 15:45 PRATINI DE M.ORAES, L. 16:00 The Women's League Against Cancer, Porto Alegre RS, Brasil 404 DISCUSSION CHEMJPRbVFNPId7 OF tRshYVARY CANCER WI74i RET'INOIAS MOON, R.C. I I T Research Institute, 17:35 DISCUSSION Chicago IL, U.S.A. 17:45 MA?IQvANP TIDJPIA.4MS IN It1FA'ICY 16:20 GENETIC FACIORS IN BFCFAST CANCER AtD GiIID iO00 IN THE SOyIALIST CLETON, F. 121 PF.JpIE' S LZBYAN ARAB JA*WHIInCA WASSEF, S.A. Dept. of Pathology, Tripoli Central Nederlands Kankerinstitut, Antoni Van Leeuwenhoek Hospital, Amsterdam Netherlands Hospital, Tripoli, The Socialist People's Libyan Jamahirya 16:40 BIOIAGICAL Afl1RfCP..RS MUNRO NEVILLE A 17:55 CF_VCE72 PREVENTION IN E?LSf APRICA , . Haddow Laboratories, Ludwig HL•TT, M.R. Institute for Cancer Research, 122 Geographical Pathology Unit, St. Th ' H it di l h Sutton, U.K. omas s osp al Me ca Sc ool, London, U.K. 17:00 DISCUSSION 18: 05 AL7I1aA2IONS IN TFM 1'R.('PA13OLLShI Atd[1 17:15 IANG TEFQd FESULTS Of' H.I.P. MASS 123 TOXICITY OF D ~MINE DURTNG THIIA*>ITE DEFICIfNC'Y: PRE- 405 SCFMTSNG PRJGRAM FOR BREAST CANCER VAIfIJCE OF THE DEFICIFNP STATE IN THFLT POP[A.A77ON RUCHIRAWAT, M. MAHATTANATRAKUL, W. KOOL KI T STRAX, P. Health Insurance Plan of New York Cityj Guttman Institute, New York NY, U.S.A. T , D. I SINRACHATAI:ANT, Y. Dept. of Pharmacology, Faculty of 17:35 A RANIDC1*IISID BREAST CA*Y`~t SCREENING S4UD1' IN Sw'ra:N Science, Y•ahidol University, Bangkok, Thailand 406 TABAR, L. Mammography Dept., FaIun Central Hospital, Falun, Sweden 18:15 DISCUSSION

NS y 1. pODIl1M SESSIONS 11, JULY 27, 15:0(}-18:30, SEVERN 1 BREAST CANCER: OVERVIEW (CONT'D) 17:55 RISK-BINEFIT IN MAS.S SCWIIING 407 PFDGRAMMES MILLER, A.B. Epidemiology Unit, National Cancer Institute of Canada, Toronto Ont., Canada 18:15 DISCUSSION 12. JULY 27, 15:W-18:30, SEVERN 2 UPPER GASTROINTESTINAL TRACT CANCER CHAIRMAN: H. ICHIKAWA (Japan) CO-CHAIRMAN: K. HEINKEL (Germany FR) SECRETARY: A.F. BASKIND (South Africa) 16:20 293 FARLY DETECTION OF GASTTRIC CANCER BASID ON PA'I[OUDGICAL AND ENZ]T9- OIAGICAL SZUDIES SUGAR, J. Research Institute of Oncopathology National Oncological Institute, Budapest, Hungary 16:35 DISCUSSION AND TEA BREAK 17:00 DIAGNOSIS OF FARLY C-N47RIC CANCER KURIHARA, M. Dept. of internal Medicine, School of Medicine, Juntendo University, Tokyo, Japan 17:15 DISCUSSION 17:20 FTIDOSCOPIC DIAGNOSIS OF CANCER 294 OF THE UPPER GrtSTROINTESTINAL 3RACf NAKAZAk71, S. 2nd Dept. of Internal Medicine, Nagoya University School of Medicine, Nagoya, Japan 15:00 INTWDUCZURY RIIMYiRKS OF CHAIId-m 17:35 DISCUSSION 15:05 EARLY GASTRIC CANCIIt AND EXPERI- 17:40 RFCENf ACNANCES IN ENDOSCOPY IN NENPAL ASPDCIS Z[M DIAGNOSIS OF UPPER GASlRO- 289 KURIHARA, M. 295 DMESTINAL DISEASES Dept. of internal Medicine, School of Medicine, Juntendo University, Tokyo, Japan 15:15 DISCUSSION 15:20 DEiDCTION OF EARLY ESOPEAGEAL CANCEt 29D YAMADA, A. Tokyo Women's Tokyo, Japan 15:35 DISCUSSION Medical College, 15:40 Fd)CENP PROGESS IN X-RAY DIAGNOSIS CE' UPPER GFiS`i'fbOINPFSTINAL CANCER COLCHER, H. Division of Gastroenterology, The Medical Center, The University of Alabama, Birmingham AL, U.S.A. 17:55 DISCUSSION 18:00 EFFECT OF NIA.SS SCR1]ENING FOR 296 GASTRIC CANCER: TEE NFt.SS SURVEY FOR STOhYCH CANCER AT HOKQsIDO PRi2BCiURE IN JAPAN YOSNIDA, Y. Cancer Detection Center, Anti-Cancer Association, City, Japan 8okkaido Sapporo KREEL, L. 18:15 Clinical Research Centre, North- wick Park Hospital, Harrow, U.K. 15:55 DISCUSSION 16:00 292 EARLY DEIELTION OF GASTRIC DISEASES WIZi-1 X-RAY VERNAZA, J.L. de Hospital Santo Tomas, Panama, Republic of Panama 16:15 DISCUSSION DISCUSSION 18:25 FINAL CCrifgSTIS ICHIKARB, H. National Cancer Center Hospital, Tokyo, Japan

PODIUM SESSIONS 13. JULY 28, 9:04-12:45, MAIN HAIl 14. JULY 28, 9:00-12:45, AVON 1/2 GENETIC AND ENVIRONMENTAL INTERACTIONS BIOLOGICAL MARKERS: PART THREE CHAIRMAN: CO-CHAIRMAN: SECRETARY: N.P. NAPALKOV C.M. FENOGLIO O.A.N. HUSAIN (U.S.S.R.) (U.S.A.) (U.K.) CHAIRMAN: CO-CHAIRMAN: SECRETARY: R.J. ABLIN (U.S.A.) Y. MURAYAMA (Japan) M. STROUN (Israel) 9:00 INPRODUCIbRY RET'121RK4 OF CFUIIRN9IN 9:05 GENMC AND FNVIRO[Z2lPAL FACT03iS 9:00 WPRODUCTORY RII4ARKS OF CHAI13f9iN 9:05 H(R4AN KAPPA-CASEIN AS A 4SRMOR IN HCAAN CAfCINOCENESIS 79 MILLER, R.W. Clinical Epidemiology Branch, National Cancer institute, Bethesda MD, U.S.A. 144 NFiRKER: PURIFICATION AND PROPE1rPIES WEIR, H. MACKINLAY, A.G. NASH, A.R. G.A. SARFATY 9:25 DISCUSSION , School of Biochemistry, Univer- of New South Walesj and sit 9:40 CANCER PREDISPOSITION AND GQN 4:PIC MARKERS y Special Unit, New South Wales Cancer Council, Prince of Wales KNUDSON, A.G. Jr. Hospital; Sydney, Australia The Institute for Cancer Research, The Fox Chase Cancer Center, 9:15 NEW SER[M DDAi BIDIDING PROTE.IIN Philadelphia PA, U.S.A. 145 (64DP) FTITH A MOIDK.ULAR WEIGFIT 000: SCi4E PROPER'PIES AND OF 64 10:00 DISCUSSION AND COFFEE BREAK 10:45 RADIATION lIIi7.A1tD6: CENEPIC AND , ITS ASSAY SYSTa9 KATSUNUMA T.1 TSUDA, M.i EPIDFrIIOIAGIC EVIDENCE AND CONPf2C)L 81 MEAgURES HOWE, G.R. Epidemiology Unit, National Cancer Institute of Canada, Toronto Ont., Canada MITOMI, T.2 NAKASAKI, 11.2 TAJIMA, T.2 KOBAYASHI, K.3 SHINODA, H.4 1Dept. of Biochemistry; 2Dept. of Surgery; 3Dept. of Obstetrics 11:05 DISCUSSION 11:20 VIRUSES AND CANCER 82 BLAUDIN DE THE, G. U.E.R. Faculte de Medecine Alexis Carrel, Lyon, France and Gynecology; School of Medi- cine, Tokai University, Isehara; 4Kyorin Pharmaceutical Company, Tokyo; Japan 9:25 BICCfEMICAL AARIdERS IN COIL7N RLM0RIGEIIgSIS: REPINOIC ACID AND 11:40 DISCUSSION 146 DIHYDR7PESTO6TERONE - BIbIDING PROTEINS 11:55 DES - RELATED H[MAN TRANSPLh~ CARCINOGENESIS SANI, B.P. BANERJEE, C.K. 83 HERBST, A.L. Dept. of.Obstetrics & Gynecology, University of Chicago, Chicago IL, U.S.A. BROCKMAN, R.W. Kettering-Meyer Laboratory, Southern Research Institute, Birmingham AL, U.S.A. 12:15 DISCUSSION 9:35 DISCUSSION J W 0 O*

PODIUM SESSICNS 9:0a-12:45, AVON 1/2 JULY 28 14 11:30 PERCHffARIC ACID SoLUBLE SERUNI , , BIOLAGICAL MARKERS: PART TF~2EE (COKT'D) 9:50 1-70DIFIED NUCLFJ06IDES Ct' THE URINE AS DIAl310S'IZC NWERS FOR CANCER 148 AND FOR MODTITaRING TFERAPY 152 Q.YCOPROTEIN: AN IPIDEX F)R WIDR CELL BURDEN IN THE FARLY DIAC,NO- SISOF CANCER MEDAK, H. HAKIM, A.A. Depts of Oral Diagnosis and Surgery, University of Illinois BOREK, F. GEHRKE, C.W. at The Medical Center, Chicago IL, U.S.A. WAALKES, T.P. A M C Cancer Research Center, 11:40 SERUM GLYCOPROTEIN IE\1E[S AS Lakewood CO; University of Missou- ri, Columbia M0; The Johns Hopkins 153 DIFMSlPIATING AID BE4F1EE3J PRITg1RY AND SECpbIIYiRX CAtJCEROUS University, Baltimore MD; U.S.A. 10:00 RADIOrrnFr.rPn OWII'I4INE AS A M7a:?j(ER OF CANCER 149 WEBBER, M.M. GR7V7I'H KHUTETA, K.P. BHARGAVA, K.N. RASTOGI, K.K. Sawai Man Singh Medical College, BUFFKIN, D.C. Jaipur, India SCHWABE, A.D. JUILLARD, G.J.F. 11:50 IACALISATION OF NlkLIGNANf TUMORS BENNETT, L.R. VERMA, R.C. Dept. of Radiological Sciences, Center for Health Sciences, Univer- sity of California at Los Angeles, Los Angeles CA, U.S.A. 10:10 DISCUSSION AND COFFEE BREAK 11:00 DETFXTION OF CANCER BY SITATLTf1tIDOUS USE CF CEA AND TENNAC.E3d. COMPARISON 150 OF BdISI 4UMOR MARKEEtS 154 BY MEANS OF TISSUE POLYPEPTIDE ANTIGEN (TPA) AND CANCER ENIBRYO- NAL ANTIGEN (CEA) IN VENOUS BIAOD SAMPLING ALVERYD, A. LJUNGDAHL, I. LILJEQVIST, L. ENGSTROM, P. HARDSTEDT, C. Surgical Clinic and Dept. of Radiology, Huddinge Hospital, Huddinge, Sweden OEHR, P. Chirurgische Universitatsklinik, 12:00 SERUM FERRTTIN IN THE DIFif3N06IS Bonn-Venusberg, Germany FR 147 AND PROQ106IS CP KEI:fFi0AWICM1 HANN, H.L. 11:10 TEINbMSSEE ANi`ICEN -- CLINICAL APPLICATION 151 POTTER, T.P. Jr. LASATER, H.A. JORDAN, T.A. JORDAN, J.D. EVANS, A.E. Institute for Cancer Research, Fox Chase; Children's Hospital of Philadelphia, Philadelphia PA; U.S.A. JOHNS1bN, R.K. OISHI, N. Memorial Hospital, Johnson City TN; University of Tennessee, Knoxville TN; JCL Clinical Research, Knox- ville TN; Cancer Center of Hawaii, Honolulu HI; U.S.A. 11:20 DISCUSSION 12:10 DISCUSSION r

PODIllr9 SESSIONS 15. JULY 28, 9:00-12:45, AVON 3 10:30 DISCUSSION AND COFFEE BREAK STRESS AND CANCER 11:15 A CCF>PARATIVE STUDY CF DEVFMP- ME7JIR1L HISNRY IN MEN WITH CHAIRMAN: V. RILEY (U.S.A.) 108 TESTICUTAR CEW-CIIL CANC ER CO-CHAIRMAN: SECRETARY: T. G. MORRIS (U.K.) BENNETTE (U.K.) AND ACUPE IEpfOEMrA GORZYNSKI, G. HOLLAND, J. LEBOVITS, A. 9:00 INI'R3DI1CPpRX RFTSARKS CF CHAI1d+II1N 9:10 A '41'PE C' FOR CANCER? IfJW TRAIT VUGRIN, D. Memorial Sloan-Kettering Cancer Center, New York NY, U.S.A. 102 AbUCCEI'Y IN THE PA'INaCENESIS CF' BREAST CANCER 11:25 SIMTLAT'ION OF ANXIEFY STRESS BY MORRIS, T. GREER, H.S. 109 NANRAh OR SYNTHETIC ADREPFiL CORTICOID6 AND RHEIR INFUTIIJCE Faith Courtauld Unit for Human Studies in Cancer, King's College Hospital Medical School, London, U.K. ON NE7OPIASIA RILEY, V. FITZMAURICE, N.A. SPACKMAN, D.H. h i 9:20 PSYCHo-SOCIAL FACibRS AND BFtFAST Pac fic Nort west Research Foundation; and Fred Hutchinson 103 CANCER CRAMER, I. Cancer Research Center, Seattle WA, U.S.A. SCHERG H , . Institut fur Sozial - und Arbeits- i i i l i i 11:35 DISCUSSION med z n, Un vers taet He de berg, Heidelberg, Germany FR 11:55 BIOCHET'SICAd. AND CEId1TLAR PARA- N~ 'IZ;ELS AS90CIATID WITH ANXIEPY 9:30 PREDICTION C1F BREAST CANCER . SI'RFSS IN MICE 104 WIRSCHING, M. HOFFMANN, F. SPACKMAN, D.H. SANTISABIN, G. FITZMAURICE, M.A. RILEY, V. WEBER, G. WIRSCHING, B. STESLIN, H. Psychosomatische Klinik, Univer- sitaet Heidelberg, Heidelberg, Germany FR 2:05 Pacific Northwest Research Found- ation; Fred Hutchinson Cancer Research Center; Seattle Univer- sity; Seattle WA, U. S. A. CANCER, AN 1XPRES,SION OF 9:40 DISCUSSION 111 II DTIONAL RF.AC.`PIONS? SCHON, M. 10:00 LgE STRM AND IASS AS A PRE- Private Practice, New York NY, U.S.A. 105 CIPITA'FING FAC1OR FOR PULMONFM CARCIIJCMA HORNE, R.L. Carrier Foundation, Belle Mead NJ; and The University of Pennsylvania; U.S.A. 10:10 PSYCH060CIAL FFCI'OFLS OF CHTIl1FIOOD 106 AND PUiM71Z1RX AAL.IQNINC,'Y PICARD, R.S. Veterans Administration Medical Center, Shreveport LA, U.S.A. 10:20 LIFE STRESS AAII) ONSET GF 107 POLYCY741AFSUA VERA BALTRUSCN, H.J.F. STANGEL, W. Dept. of Clinical Immunology and Blood Transfusion, Hannover Medical School, Hannover, Germany FR 12:15 DISCUSSION 16. JULY 28, 9:00-ll:00, SEIiERN 1 BREAST CANCER DETECTION: METHODS AND ASSESSMENf OF BENEFITS CHAIRMAN: R.C. MOON (U.S.A.) CO-CHAIRMAN: P. LAHIRI (India) SECRETARY: P. JURET (France) 9: 00 DfiTDCPIOtN OF FARLY BRFASP CANCER 408 PATEROK, F.M. Universitats-frauenklinik, Erlangen, Germany FR

NS p0DIU9 SESSIONS 16. JULY 28, 9:00-ll:00, SEVERN 1 BREAST CANCER ~C~,M~.TFIDDS AI~ ASSES D)SNFNT OF R 9:10 BIEEDING BREA.ST AS AN FARLY SIIN 409 3N NON PALPABLE CANCE] GOES, J.S. Jr. GOES, J.C.S. Fundacao "Centro de Pesquisa de oncologia," Instituto Brasileiro de Controle do Cancer, Sao Paulo, Brasil 9:20 FbLLpW-UP STWY OF ATYPICAL IDII'RA- DUCTAL PAPILT.ARY LESIONS 410 ENOMOTO, K. ABE, O. Dept. of Surgery, School of Medi- cine, Keio University, Tokyo, Japan APPRDACH AIANE OR IN COMBINATION WITH CYTOIAGICAL, RADIOIAGICAL AND THERMOGRAPHIC TDDIIQUES IN EARLY Db'PDCPION OF BREAST CANCER AS A PART OF A FIFTEEN YEAR Ni?1SS SCF41N- ING PFOGRANAffi FOR THE FIIMALE POPU- 9:30 RIIATIVE EFFICIIIJCY OF THE CLINICAL 416 411 IATION IN NORTIMq BEZGIUM BONTE, J. WERELLEN, W. DECLERCK, A. IDE, P. BAERT, A. k7NANTS, P. ARTOOS, C. ESTINFITE THE BENEFITS OF SCRfENIING YOUNGEI2 WC1MEN FOR BREAST CANCER K.U. Leuven, Louvain; Belgium 10:50 DISCUSSION Centra voor Vroegtijdige Kankerop- sporing Antwerpen, Brugge, Leuven, 9:40 USE OF A IyF1THFMATICAL NX)DEL T.7 412 SHWARTZ, M. Health Care Management Program, Boston University, Boston MA, U.S.A. 9:50 DISCUSSION 10:00 A'T ASSESSMENT OF THE RELIABIIITY 413 CLF SING[,E FINE NEEDLE ASPIRATION CYTOIAGY IN THE PRDOPERATIVE DIACr- NOSIS OF CARCINCtYi CF THE BREAST 10:10 A'S4LYSIS OF PAIHOIAGIC DISCRIDIIIV- 414 A\lfS OF BREAST CANCERS DEPkx'I4D ON SCRI:EIJING BY MAJ41JQRAPHY AId) PHYSICAL FJO1NffNATION FEIG, S.A. SCHWARTZ, G.F. NERLINGER, R. Thomas Jefferson University Hospital, Philadelphia PA, U.S.A. 10:20 THE ANALYSIS OF LYNPHOPIASM9- 415 CYY7IRIC INFILTRATION OF BREAST CANCER STROMA AND THE RFACI'IVITY OF AXIIZARl' LYMPH NODES JOCOVIC, N. BUGARSKI, M. VLAJIC, M. JOVANOVIC, R. Institute of Oncology and Radiology, Belgrade, Yugoslavia 10:30 HISTOIAGIC SCREENING IN EARLY ' BREAST CANCER 70 SELflCP APPfbOP- RIATE THERAPY NEALON, T.F. Jr. NKONGHO, A. GROSSI, C.E. GILLOOLEY, J. St. Vincent's Hospital and Medical Center, New York NY, U.S.A. 10:40 SIIF)L'PIVE SUBCZTPANECUS hF',STUMtiXfit 417 FOR THE TREATMESTP OF PRFS'P1ISCNANf DISEASE OF THE BREAST COURY, O.H. Breast Diagnostic and Treatment Center, South Miami Hospital, Miami FL, U.S.A. 17. JULY 28, 11:04-13:00, SEVERN 1 BREAST: NORNpNAL. FACTORS CHAIRMAN: R.A. SELLWOOD (U.K.) CO-CHAIRMAN: B. VON MATTHIESSEN (FRG) SECRETARY: Y. ARIYOSHI (Japan) 11:00 ACE AT TENkPCHE AND SEX CF THE VAN ZYL, J.A. 427 STREET, B. Breast Clinic, Tygerberg Hospital, Bellville, Republic of South frica FIRST CHIID AS PROGNOSTIC FACTORS IN H[M BREAST CANC.ER JURET, P. COUETTE, J.E. DELOZIER, T. LEPLAT, G.

PODIUI SESSIONS 17. JULY 28, 11:00-13:00, SEVERN 1 BRFAST: HORMONAL FACTORS (CObfT'D) 427 BLANC, L. MANDARD, A.M. VERNHES, J.C. Centre Francois Baclesse, Caen, France 11:10 BARRIFR CIXTPRACEPTION AND BREkST 428 CANCER GJORGOV, A.N. Dept. of Obstetrics & Gynecology, University of Pennsylvania Hospit- al, Philadelphia PA, U.S.A. 11:20 RISK FACI0RS IN bFL*fF3RY CANCEt: 429 TSH AND PROLACPIN SERIRd LESIE[S IN FIBROCYSTIC DISEASE OF TFE BREAST TARQUINI, B. BENVENUTI, M. BAZZANI, M. LEGNAIOLI, M. CHERICI, R. CAGNONI, M. • Dept. of Medicine, University of Florence, Florence, Italy 11: 30 INCRFASID ANIDFa79SIIC ACTIVITY AS 430 A RISK FACTOR FOR BREAST CANCER SECRETO, G. Hormonal Research Laboratory, National Cancer Institute, Milan, Italy 11:40 BfNI(N BREA.ST DISEASE: ESTRIOL 431 PROPOR'.I`IONS AND FAMILY HISTORY C&' BREAST CANCE2 VAKIL, D.V. MORGAN, R.W. ELINSON, L. Dept. of Preventive Medicine and Biostatistics, University of Toronto, Toronto Ont., Canada 11:50 DISCUSSION 12:00 A CASE 00NIIIZOL STUDY OF BREAST CANCER IN SINGIE JAPANESE hL7FgN 432 TAKATANI, 0. WAKABAYASHI, Y. National Defence Medical College, Tokorozawa, Japan 12:10 fSTISlGEN RDCII'TOR (ER) IN A 433 CIiDUP OF BRAZILIAN BREAST CANCEt PATIfNPS GOES, J.S. Jr. BRENTANI, N.M. Fundacao "Centro de Pesquisa de Oncologia;" Laboratorio de Oncol- ogia Experimental, Faculdade de Medicina, University of Sao Paulo; Sao Paulo SP, Brasil 12:20 DEPF7CTION OF GLUCOCORTICOID 434 Rf7CEP`DORS IN BREAST T%I7URS : CCtTARISON OF BIOClff3+fICAL AtII) CAL MOT410D5 PAPAMICNAZL, M. AGNANTIS, N. IOANNIDES, C. LEVENTAKOU, A. GARAS, J. SEKERIS, C. Hellenic Anticancer Institute, "Saint Savvas" Hospital; National Hellenic Research Foundation; Athens, Greece. 12:30 DFIiYD%DEPIANDRCSTL'X)[3E: A NEW 435 ANPI-'I[MR PRlJNY)'I'ER SCHWARTZ, A. HARD, G. PASHKO, L. ABOU-GHARBIA, M. SWERN, D. Fels Research Institute; Dept. of Chemistry, Temple University; Philadelphia PA, U.S.A. I2: 40 WOIE BODY HYPFFMIERhIIA (42°C) ; IbIDiKED GRCXRI4i STINYIIATION IN 436 pOF44ONE DEpENDERr EXPERIMENTAL 1_~ 4[t40URS IAHIRI, P. LAHIRI, T. Oncological Research Centre, Academy of MedicaI Sciences, MosCow, U.S.S.R. 12:50 DISCUSSION

r >IOhS pppltM SESSIONS 1CER 18, JULY 28, 9:00-]1:00, SEVERN 2 9:50 DISCUSSION Gq$T(tOEMEROLOGY 10:00 HISTOPATFiOIAGICAL STUDY OF IIgPES'!'INAL METAPIASIA IN de ro1- 3e CNAIRMAN: M. KURIHARA (Japan) CO-CHAIRMAN: J.L. DE VERNAZA (Panama) SECRETARY: M.P. JAUMANN (Germany FR) 302 P05P-WRTET! ST.WH,S OF AGED IbIDIVIDCg1IS NAKANO, G. NAKAMURA, T. ~u1o; I 9:00 EARLY CANCER DETECrION AM PREVfN- TION IN THE UPPER AERODICESTIVE Dept. of Surgery i, Cunma University, School of Medicine, Maebashi, Japan 297 TRACP STEINER, W. JAUMANN, M.P. 10:10 IS CEA A NARKE:R HELPFUL IN PREDICTING THE PREX`ANCERO[lS PESCN, H.-J. 303 STATES IN ITTIESTINAL NlEPAPLASIA I Depts of Otorhinolaryngology and Pathology, University of Erlangen, Erlangen, Germany FR OF (A.STRIC M[K)06A? LEE, P.K. MORI, T. 9:10 SCRF.ESIING FOR OESOPHAGPAL CANCER, NAKAO, T. HATADA, N. AETIOLOGICAL CLUES 298 BASKIND, A.F. MARUYAMA, H. KOSAKI, G. !al 1 KOORNHOF, J.N. NAMILTON, D.G. BERRY, A.V. Dept. of Surgery II, Osaka University Medical School, Osaka, Japan CROANGOLD, T. Dept. of Surgery; School of Path- ology; University of Witwatersrand, Johannesburg, Republic of South 299 Africa 9:20 T[iE 12fJLE OF OESOPHACa06CCPY IN DETFJCPION OF OESOPHACEAL T[M0RS ROTH, A. KOLARIC, K. Central Institute for Tumors and Allied Diseases, Zagreb, Yugoslavia 300 9:30 THE SIC3TIFICANCE OF EPI7IH[SAL DYSPIASIA IN THE UPPER AERC}- Depts of Pathology and Otorhino- laryngology, University of Erlangen, Erlangen, Germany FR DI(ESTIVE TRACT PESCB, R.-J. STEINER, W. 10:20 THICACETANIIDE-IAIDUCED HEAP'!C}- 304 CELSIIIAR CAICINCMA IN RAT DASGUPTA, A. CHATTERJEE, R. ROY CHOWDHURY, J. Chittaranjan National Cancer Research Centre, Calcutta, India 10:30 y-GUTl7WtLTRANSFERA.SE (GT) AND 305 Gf17PATHIONE IN SDQUF2TPIAL ANAId'- SIS OF CHE3MICAL CARCIINOGQ\IE5IS IN RAT LIVER FIALA, S. KETTERING, W.G. TROUT, E.C. FIALA, A.E. OSTRANDER, H. Cell Physiology Laboratory, Veterans Administration Medical Center, Martinsburg VA, U.S.A. 9:40 PR7GRESS IN HIST.?-CYIOPATHOIAGY 10:40 PRXI7CPIVE ROLE OF QUTATHIONE ~ FOR THE RECOC3IITION CE' EARLY AC9AIN.ST LIVER CARCINOGENESIS I 301 STAGES OF GASTRIC CARCIN7[Fi 306 IIMUCID BY AFLATOXITI Bl 4 RAVETTO, C. SANTAMARIA, L. Istituto di Patologia Generale NOVI, A.M. Dept. of Pathology, Dusseldorf University, Dusseldorf, Germany I "C. Golgi;" Centro per 1a Profi- lassi, Prevenzione, Diagnosi e Cura dei Tumori; Universita di Pavia, Pavia, Italy FR 10:50 DISCUSSION . O

PODIIH SESSIONS 19. JULY 28, 11:0(}-13:00, SEVERN 2 20. JULY 28, 14:00-17:30, M4IN HAIl PANCREATIC CANCER DIET AND CANCER CHAIRMAN: I.J. COHN, Jr. CO-CHAIRMAN: P.B. COTTON (U. SECRETARY: A.R. MOOSA (U.S (U.S.A.) K.) .A.) CHAIRMAN: D. BURKITT (U.K.) CO-CHAIRMAN: P. HILL (U.S.A.) SECRETARY: J.D. RANDEIRA (South Africa) 11:00 INPRCJDUCIIlRY RFNg1RKS OF CHAIRPAN 14:00 IPTPlUDUCIbFLY REMfl1RKS OF CIfAiRfg1N 11: 05 EPIDII-ffOIAGIC CIiARACIE2ISTICS AND 14:10 FA&4AN DIETARY C7RCINOGfNS 309 TRACE EIEMEtTIS IN PANCRFATIC CANCER IN GREDCE LUTZ, W.K. 59 Institute of Toxicology, ETH; TRICNOPOULOS, D Dept. of Hygiene and Epidemiology, i di U it f Ath M l University of Zurich, Schwerzen- bach, Switzerland n vers y o ens e ca School, Athens, Greece 14:30 DISCUSSION 11:20 ANINAL RL>rYXTR SZUDIES 14:45 FOOD ADDITIVES 310 ALTHOFF, J. Abt. fur experimentelle Pathologie, Medizinische Hochschule Hannover, Hannover, Germany FR 11:35 DISCUSSION 11:45 PANCREATIC SECRETIONS AS A C71)E 70 Ti-IE PRFSIIJCE OF PANCRFATIC CAtJCEIt 311 REBER, B.A. Dept. of Surgery, University Medical Center, University of Missouri, Columbia MO, U.S.A. 12: 00 4S)/4;)R MARl0W OF PANCREATIC CARCINCl6A 312 KLAVINS, J.V. Dept. of Pathology, Catholic Medical Center, Jamaica NY, U.S.A. 12:15 DISCUSSION 12:25 313 II]DOSCOPIC DIAGNJ6IS OF PANCREATIC CANC.'ER COTTON, P.B. Gastrointestinal Unit, Middlesex Hospital, London, U.K. 12:40 PERCUTANEOUS bIEEI)IE BIOPSIES HANKE, S. Ultrasound Laboratory, Gentoff Hospital, Hellerup, Copenhagen, Denmark 12:55 DISCUSSION ROE, F.J.C. Independent Consultant, London, U.K. 15:05 DISCUSSION 15:20 DEiECPION OF DIETAFdt CAFCINCX;EN: 61 EXPERIMENTAi. APPROACHFS SUGIMURA, T. National Cancer Center Research Institute, Tokyo, Japan 15:40 DISCUSSION 16:00 DIEPAIa P24CtMDV OF CARCIAXY- CENFSIS 62 CARROLL, K.K. Dept. of Biochemistry, University of Western Ontario, London Ont, Canada 16:20 DISCUSSION 16:40 63 DIEtAKY M=JTATION FOR CANCE2 PREUFNPION NEWBERNE, P.M. Dept. of Nutrition and Food Science, Massachusetts Institute of Technology, Cambridge MA, U.S.A. 17:00 DISCUSSION

ICYJS QLL frica) y71N pppI(M SESSIONS u, JULY 28, 14:00-ll:45, AVON 1/2 SYSTEMIC MANIFESTATIONS CHAIRMAN: H.E. NIEBURGS (U.S.A.) CO-CHAIRMAN: P. MAURICE (Switzerland) SECRETARI': M. MOORE (U.K.) 14:00 RERODUCPDRY RII4ARKS OF CHAIIMN PROTEIN (64DP) IN CANCER 14:05 00~11CAL TRAt3SFORMTION OF CULZSJRED 169 PATIENiS SKIN FIBfLDBI1SIS FFLD*1 HUhFiNS GQNE- MITOMI T 1 163 TICALLY PREDISPOSID TO CANCFR , . NAKASAKI H 1 en- RHIM, J.S. , . TAJIMA, T.1 ARNSTEIN, P. HUEBNER, R.J. National Cancer Institute; National KATSUNUMA, T.2 TSUDA, M.2 SHINODA, H.3 Institutes of Health; Bethesda MD, U.S.A. 1Dept. of Surgery; 2Dept. of Bio- Chemistry; School of Medicine, 1 Tokai University, Isehara; . 14:15 SCREENING FOR PATIENTS AT HI(H RISK OF CANCER 3Kyorin Pharmaceutical Company, Tokyo; Japan i 164 MACIEIRA-COELHO, A. DIATLOFF-ZITO, C. AZZARONE, B. Institut de Cancerologie et 15:55 ALRJOCYIE MATURATION IN SQUAAIOUS CELL CARCINO Fi OF THE BRONQiC1S 170 DENT, R.G. d'Immunogenetique, INSERM, Ville- juif, France COLE, P. Cadriothoracic Institute, Bromp- 14:25 H[R9IIV SKIN FIBIdOBIASTS FFa?M ton Hospital, London, U.K. 165 PATIENTS WIZN D*2,1ARY TUMOURS. DIF7ERIIJCES IN CTMWlSi PImPEFtI'IES AZZARONE, B. MACIEIRA-COELNO, A. Institut de Cancerologie et d'Immunogenetique, INSERM, Vi11e- juif, France 14:35 SKIN NIARKERS OF INPEfML CANCER EL ZAWAHRY, M. 166 Dept. of Dermatology, Kasr El Aini Faculty of Medicine, Cairo Univer- sity, Cairo, Egypt 14:45 MAL.IGNAN,'Y AS,SOCIATED (IA1KES 167 IIIDCICED IN VITRO IN HEALTHY LYMPFKY- ~ CYIES BY EXTRACZLUXAR DNA CF IFUmIIC LYMP1K)CYM ANKER, P.1 f ~ NIEBURGS, H.E.2 STROUN, M.3 ' MAURICE, P.A.1 lOnco-Hematology Division, Hopital ~ Cantonal, Geneva, Switzerland; 2xt. Sinai Medical Center, New York NY, U.S.A.; 3Dept. of Human Microbiology, Faculty of Medicine, Tel-Aviv, Israel 14:55 ANALYSIS OF CffCMTIN IN 168 tY1LIGNAPIC,'Y HUSAIN, O.A.N. MILLETT, J. Charing Cross Hospital, London, U.K. 15:05 DISCUSSION AND TEA BREAK 15:45 DIARJOSPIC VALUE OF A SF1iUM DNA 16:05 SYS=C C}tANGES IN BrJVINE 171 BIIDING IJMPHOhA JACOBS, R.M. VALLI, V.E.O. Dept. of Pathology, Ontario Veterinary College, Guelph Ont., Canada 16:15 SUSTAINED LYP4PHC)CY40PENIA: A 172 USEFFUL DIAQNOSZZC FEATURE CF' BIbONQiOG'EI•TIC CARCINCM MCMAHON, L:J. THOMSON, S.P. NUGENT, C.A. Veterans Research Service; Arizona Health Services Center; Tuscon AZ, U.S.A. 16:25 THE POLY-L-LYSIN-AOQI7PINATION 173 OF LYNIPHOCY7ES-TEST FOR CANCER DIAGJOSIS: SPDCIFICITY, SE~ZSI- TIVITY, PREDICTIVE VAIdJE SCHMOLL, E. SCNMOLL, H.-J. AX, W. Dept. of Hemato-Oncology, School, Hannover; Behring Marburg/Lahn; Germany FR Medical Company,

PODILM SESSIONS 21. JULY 28, 14:00-17:45, AVON 1/2 SYSTEMIC MANIFESTATIONS (CONT'D) 22. JULY 28, 14:00-16:00, AVON 3 S(dIUM'IOUS LESIONS OF THE FEK4LE GENITAL TRACT 16:35 LTTILIZATION OF IdTLTIPLE BI0NFIRKERS CHAIRMAN: C.M. FENOGLIO (U.S.A.) 174 IN AN INDEX FOR SURVEILLANCE CF SUBJECIS AT HIC~i CANCEt RISK CO-CHAIRMAN: SECRETARY: J. PENTTINEN A. SCHACHTER (Finland) (Israel) GUIRGIS, H.A. KUROSARI, T. Dept. of Community & Environmental 14:00 INPRODUCIORY RENIARKS OF C1iAIY4-Y1N Medicine, University of California, Irvine CA, U.S.A. IN TFT DES 26:45 DISCUSSION 381 HERBST, A. 17:00 WATER P%YhON IANGITUDINAL REIAX- Dept. of Obstetrics & Gynecology, University of Chicago, Chicago IL 175 ATION TIMES IN TISSUES OF THE C3H M31USE BEARING A RHABDCMII'OSAItIJONII U.S.A. I SIUDIES AS A F[R4CI`ION OF FRD9UP.NG'Y 14:20 C.TSNCER OF THE CERVIX: A SEXUALLY ESCAYNE, J.M.1 CANET, D.2 382 TRANSAIITTfD DISEASE? CORRELATIdN BEWEFSI PATHOIAGIC CERVICAL ROBERT, J.1 BRONDEAU, J.2 1Laboratoire de Biophysique, Facul- te de Medecine; 2Laboratoire de Chimie Theorique, Faculte de Scien- ces; Nancy, France CYlC)LOGY AND ASYMP1UMTIC AFD- GWII741L IWECPION IN WE DAHLBERG, B. Women's Clinic, University of Lund, Lund, Sweden I7:10 HISTOPATHOIAGICAL SUPPOIrl' FOR 176 14:05 SQ[B1M LFSIONS 14:35 383 P%IGEJY OCNDYIANA ACCUA IIMTA: A PRDCANCEF=S LESION? ROY, M. Division d'Oncologie, Universite Laval, Quebec P0, Canada 14:50 DISCUSSION 15:05 HSV-2 EXPRESSION IN IATfINC..'Y AND 384 CE3NIC.AT. 1iEOPLASIA FENOGLIO, C.M. Division of Surgical Pathology, College of Physicians & Surgeons, Columbia University, New York NY, U.S.A. OF SYSTEMIC EF ECI' OF CANCF It ON 177 F , SF.RLM AAII) TISSUES 15:20 PI3pLIFERATNE SQCOMOUS LESIONS CERTAINES, J. de GALLIER, J. 385 CF THE VULVA. ULTRASTRX-1URAL, IhKJNO[IISTOQHEMICAL, AND IN SITU BERNA RD, A.M. RIVET, P. BENOIST, L. Centre Anti-cancereux, CNR Pont- chaillou, Rennes, France HYBRIDIZATION SZUDIFS CRUM, C.P. Dept. of Gynecological Pathology, College of Physicians & Surgeons, Columbia University, New York NY, U.S.A. EIF.VATION OF PR7PON SPIN-IATTICE REIAXATION TIMES (Tl) IN KIISCWIM STATE RANADE, S.S.1 SHAH, S.1 TALWALKAR, G.V.2 KASTURI, S.R.3 1Cancer Research institute; 2Tata Memorial Hospital; 3Tata Institute of Fundamental Research; Bombay, India 17 : 20 T1UCT EAR DYkMIETIC RESONANCE S4S1DY 17:30 DISCUSSION r

PODIUM SESSIONS 22. JULY 28, 14:00-16:00, AVON 3 SQUAMOUS LES10 S OF TNE FE1~A1E GENITAL TRACT CONT~DI 15:35 H[AMAN PAPILLCXNAVIRUS (HPV) INFTX,`l- 386 ION OF THE CERVIX: THE ATYPICAL CO[IDYL(Y ATA MEISELS, A. Dept. of Laboratory Medicine, Pathology and Cytology Service, Hopital du Saint-Sacrement, Quebec Pp, Canada 15:50 DISCUSSION 23. JULY 28, 16:0(}-17:45, AVON 3 IMAGING TECHNIQUES CHAIRMAN: V.R. MCCREADY (U.K.) CO-CHAIRMAN: P.H. COX (Netherlands) SECRETARY: S. HANKE (Denmark) 23. JULY 28, 16:00-ll:45, AVON 3 l,MAGING TECFTIlOUES ICONT~D) 17.05 RE7CE31f DE1FSlJPI gNIS IN 7UMDR INAGING USING UUI'RASOUBID TECHNIQUES JOSEPH, A.E. Dept. of Nuclear Medicine and Ultrasound, St. George's Hospital, London, U.K. 17:20 DISCUSSION 24, JULY 28, 14:00-16:00, SEVERN 1 BREAST BIOLOGICAL M4RKERS CHAIRMAN: N.L. PETRAKIS (U.S.A.) CO-CHAIRMAN: G.A. SARFATY (Australia) SECRETARY: W. DE LOECKER (Belgium) 16:00 INIT0DUCTORY RES'1AF2iGS OF CHAIFdMAN 14:00 INPfbODUCIORY RIIMARKS OI:' CI-IAIfd,F1N 16:05 L7MIITATIONS OF COJRRIIJT IMFiGING 14:05 PRGIiI'EIN KIINALSES AND cAMP BINDING TECHNIQUES IN H[MYsN MW1ARC TtkORS PARKER, R. Dept. of Physics, Royal Marsden Hospital, Sutton, U.K. 442 EPPENBERGER, U. BIEDERMANN, K. AL.MENDRAL, A. D f G i l i 16:20 COtiPARIS011 OF ULTRASOUAID AND yneco ept. o ogy, Un vers ty Clinic, Basel, Switzerland OONIPt1IM 70MOGRAPHY IN INIIaGING THE UPPER ABDOMEN 14:15 PIRShA KAId.IKREIN ACT'IVITIES, 198 BRYAN, P.J. FSP AND C1 INH IEVIIB IN BREAST Dept. of Radiology, University 443 CANCER Hospitals of Cleveland, Cleveland OH, U.S.A. WERK, W. PLOGMEYER, P. A 16:35 DISCUSSION B RTSCH, W. Waldsanatorium, Neukirchen; Med. 16:50 RDC'ErTt DE.VFSAPDgNfS IN T[%M INYtGING USING RADIOISO'IOPE Enz. Research Group, Munich- Sauerlach; Germany FR TECHNIQUES 14:25 SERUM OOFrPISOL FRAL'IZONS IN ELL, P. BREAST CANCE.R AND PRDGtTANCY Dept. of Nuclear Medicine, 444 ARIYOSHI, Y. Middlesex Hospital, London, U.K. KUZUYA, K. Aichi Cancer Center Hospital, Nagoya, Japan

24, JULY 28, 14:Oa-16:00, SEVERN 1 BREAST BIOLOGICAL MARKERS (CONT'D) 14:35 445 OiF1RACPERIZATION OF GLYCbPR02'EI1ZS SY[114ESIZID BY KA'F1N BREAST SURGICAL SPECIMEIIS TOKES, Z.A. GENDLER, S.J. SILVERMAN, L.M. DERMER, G.B. Cancer Research Laboratories, University of Southern California Cancer Center, Los Angeles CA, U.S.A. 14:45 DISCUSSION 15:00 CLINICAL VAI1)E Cff' SFIBG F1OR BREAST 446 CANCER MURAYAMA, Y. UTSUNOMIYA, J. ASANO, K. 2nd Dept. of Surgery, Tokyo Medical and Dental University, Tokyo, Japan 15:10 A GCMPARATIVE S'NDY OF SIALYL 447 TRANSFTI2A.SE AND difM 4UMDR MARIT3tS IN BREAST CANCER PATIFSTI'S KREIENBERG, R. ROTHER, G. PREISS_-,2~ MELCHERT, F. Frauenklinik; Abt. fur Baematologie der Universitaet; Dept. of Gynecol- ogy & Obstetrics, University Hos- pital; Mainz, Germany FR 15:20 IhBORATaRY S7UDIES ON THE ROLE CF 448 CELILiIAR IMMTY AND GF?lEfICS IN THE ETIOIAGY OF RAPIDLY PF30GRESS- ING BREAST CANCER IN 4LJNISIA LEVINE, P.R. MOURALI, N. TABBANE, F. LOON, J. TERASAKI, P. BEKESI, J.G. National Cancer Institute, Bethesda MD, U.S.A.; Institut SaIah Azaiz, Tunis, Tunisia; University of California at Los Angeles, Los Angeles CA, U.S.A.; Mt. Sinai Hospital, New York NY, U.S.A. PODIUM SESSIONS 15:30 EARLY DEI'EJC'IZON CF BREAST CANCER 449 BY LFSJKOCYTE ADFEF04CE INHIBITICN ASSAYS SANNER, T. KOTLAR, H.Kr. EKER, P. BRENNHOVD, I. JORGENSEN, O. Norsk Hydro's Institute for Cancer Research; Norwegian Radium Hospital; Oslo, Norway 15:40 DISCUSSION 25. JULY 28, 16:00-18:00, SEVERN 1 BREAST MASS SCREENING CHAIRMAN: J.S. GOES, Jr. (Brazil) CO-CHAIRMAN: P. LAST (U.K.) SECRETARY: L. TABAR (Sweden) 16:00 MISSOURt'S ROLE IN BREAST CANCgi 450 DETDCTION RODES, N.D. FARRELL, C. BLACKWELL, C.W. Cancer Research Center, Columbia MO, U.S.A. 16:10 ADt.SS SCFdM~NING FOR BREAST CANCER: TSiE JEFFERSUd FXPFRgIJCE 451 SHABER, G.S. SCHWARTZ, G.F. PATCHEFSKY, A.S. FEIG, S.A. NERLINGER, R. Jefferson Medical College, Philadelphia PA, U.S.A. 2 6 r 20 T1ODE'.L PRCIGRANl FOR BREAST CANCER 452 OOIJPROL GOES, J.S. Jr. GOES, J.C.S. Fundacao "Centro de Pesguisa de Oncologia," Instituto Brasileiro de Controle do Cancer, Sao Paulo, Brasil 16:30 A PROGRAh1 TO ENJOURAGE EARLY DE- TFX.'lION CF BREAST CANCER BY GIVING 453 IRbRMATION 70 'iHE PUBLIC IN ORDER

PODIUM SESSIONS 25. JULY 28, 16:00-18:00, SEVERN 1 BREAST MASS SCREENING (CODIT'D) 26. JULY 28, 14:00-16:00, SEVERN 2 LYMPHOMAS AND LEUKEMIAS, PART ONE 53 TO HEIQiTEN A49LRE[ZFSS AND TO REDUCE FEAR KUSHNER, R. Breast Cancer Advisory Center, Kensington MD, U.S.A. CHA CO-CHA SECR 4 : 00 IRMAN: P. MAURICE (Switzerland) IRMAN: H. ZUR HAUSEN (Germany FR) ETARY: L. FIORE DONATE (Italy) rA9UN0IAGICAL DIAQJ06IS OE' M~NOUS IEUKEKIA 16:40 POPITiATION SCREErTING FOR BREAST 479 TAUB, R.N. 454 CANC .Ft USING SINCL1 VIEAJ Mi&P77GRA- PHY AND CLINICAL E}UiMIIqATIOyS BAKER, M.A. RONCARI, D.A.K. THOMAS, B.A. Guildford Breast Screening Project, Jarvis Screening Centre, Guildford, U.K. MOHANAKUMAR, T. Medical College of Virginia, Richmond VA, U.S.A.; Toronto Western Hospital, Toronto Ont., Canada 1 : S OF BR AST CANCER MASS SCREEt1ING AT UYRDt,"kfP 14:10 CELLUI,AR IMMUNODEFICIENCY IN 455 ROMBACH, J.J. RODG[QrT'S DISEASE: CIRC'UTATING Prevention Institute for Breast 480 L('1W NJOLELULAR YEICHP SER[&M FAC- 7:00 Cancer and Cervical Cancer Screen- ing, Utrecht, Netherlands FPIDEMOIAGICAL EUAIMTION OF TIE 7bRS IAII{IBITING PRCYiEIN SYNiHESIS MANKE, N.-G.1 DRINGS, P.1 LENHARD, V.2 456 POPUL,ATION-BASEID SCREENING PR7JDCP AT UIRDCIIT (D.O.M.-PIDTDCT) BY TILL, G.2 lonkologisches Zentrum Heidelberg- MF.ANS OF A CANCER REGISTRY COLLETTE, B.J.A. institute of Social Medicine, State University of Utrecht, Netherlands Mannheim, Krankenhaus Rohrbach d. LVA Baden, Heidelberg; 27nstitut fur Immunologie und Serologie, Universitaet Heidelberg, Heide2- bergt Germany FR 6 50 ROC - CURVE ANALYSI E 17:10 RFSULTS OF BREAST CANCER DETECPIQN (1966-1978) 457 VANDENBROUCKE-VANDERWIELEN, A. MAISIN, H. BOURDON, C. Centre des Tumeurs, Universite Catholique de Louvain, Louvain-en- Woluwe, Belgium 17:20 RFSULTS FRLM AN EhAI1IATION PFU7DCT 458 ON BREAST SELF'-EXAbIINATION FOR THE EARLY DETECTION OF BREAST CANCER GASTRIN, G. National Institute of Nursery, Helsinki, Finland 17:30 EVAIIJATION OF EARLY DEI'ECFION OF BREAST CANCER 459 CHAMBERLAIN, J. MOSS, S. WILSON, D.T. Institute of Cancer Research, Sutton, U.K. 17:40 DISCUSSION 14:20 CASEATING HODQCQI'S DISEASE: A 481 PREIJMINAM REPORT ATTAH, Ed.B. Ahmadu Bello University, Zaria, Nigeria 14:30 DISCUSSION 14:40 FINE S'!'fBJCIURAL CFIFINGF.S IN IEU- 482 KESIIC CELTIS EXPOSED TO LIGNP AND HEP%TaPORPHYRIN COPPOLA, A. RASILE, G. Dept. of Pathology, Downstate Medical Centert Dept. of Rehabil- itation Medicine, Long Island College Hospital; Brooklyn NY, U.S.A. 14:50 FIIJARESIIICE POIARIZATION STUDY OF 483 PERIPHERAL BIAOD CELLS OF LEUKEM- IC PATIFIlIS JASMIN, C. AUGERY, Y.

26. JULY 28, 14:Oa-16:00, SEVERN 2 ~S AND LEUKEMIAS: PART ONE C) 483 CALVO, F. ZOHAR, M. ROSENFELD, C. INBAR, M. Institut de Cancerologie et d'Immunogenetique, Villejuif, France 15:00 ITIDiK'PION OF FIBROSIS BY IFITfCi7•IIC IIZFII,TRATES 484 SHAMSUDDIN, A.K.M. SCHWARTZ, J.B. Dept. of Pathology, University of Maryland School of Medicine, Baltimore MD, U.S.A. I5:10 DISCUSSION 15:20 CF4)SS-RFSISTANC'E AND SfISSITIVITY 487 S'IUDIES OF ANTI NEOPiASTIC AGEfTIS IN ANI43RAC.'YCLIINE RFSISTAbTP SUBLINES OF WRYNE IEUKDIIAS CHITNIS, M.P. JOSHI, S.S. Chemotherapy Division, Cancer Re- search Institute, Tata Memorial Center, Bombay, India 15 : 30 IM4JNOP%1LIFERATIVE ShATi<, INPESTIN- 488 AL DISEASE - A POT'INIZALS,Y PREVfNPABLE DISEASE SALEM, P. NASSAR, V. ALAMI, S. JABBOURY, K. KHALYL, M. American University of Beirut, Beirut, Lebanon 15:40 GA.STRIC IYNIPHCMA, AND PFR]TVJEOLAR 489 PIASNA, CELS, CASTRITIS DUTZ, W. BOROCHOVITZ, D. Dept. of Pathology, Medical College of Virginia, Richmond VA; Pittsburg University Medical School, Pitts- burg PA7 U.S.A. 15:50 DISCUSSION PODIUM SESSIONS 21, JULY 28, 16:00-18:00, SEVERN 2 LYMPHONWS AND LEUKEMIAS: PART 7YJ0 CHAIRMAN:'F. RILKE (Italy) CO-CHAIRMAN: N. HARAN-GNERA (Israel) SECRETARY: R.N. TAUB (U.S.A.) 16:00 IATPRODUCTORY RfSp1RKS OF CHAIRMAN 16:05 VIRAL EPIOUOGY OF LYNIPHOP%)LI- 490 FERATIVE DISEASES ZUR HAUSEN, H. Institut fur Virologie, Zentrum fur Hygiene, Universitat Freiburg, Freiburg, Germnay FR 16:15 ANI2BODIFS 70 fI'STEIN-RARR VIRUS 491 IN VERY LA2£ RIIAPSING PATIENTS WIiH BURKITP'S LYMPHQFA NKRUMAH, F.K. BIGGAR, R.J. HENLE, W. University of Ghana Medical School, Accra, Ghana; National Cancer Institute, Bethesda MD, U.S.A.; Children's Hospita2, Philadelphia PA, U.S.A. 16:25 DISCUSSION 16:40 ZHE PRESENT STATE.OF 1MMJOIAGIC- 478 AL H~ IN MALIQNANP LSMPHON>A STUART, A.E. Dept. of Pathology, University of Newcastle-upon-Tyne, Newcastle- upon-Tyne, U.K. 16:50 B'PiLTGNANP LYMPHCMAS OF FOLLICUTAR CfSREA CIId. ORIGIN STANSFELD, A.G. Dept. of Pathology, St. Bartholo- mew's HospitaI, London, U.K. 17:00 DISCUSSION 17:10 faf`.'WII~,FSt4IC Ig,- ;--Ck'*:, LYSOZWF AND a 1 ANPI(HYMOTRYPSIN EXPRES.SION 486 IN DVINOBLAMC LYN>pjM STEIN, H. MASON, D.Y. Institute of Pathology, University of Kiel, Kiel, Germany FR; Dept. of Pathology, University of Oxford John Radcliffe Hospital, Oxford U.K. ()D

PODIUd SESSIONS 27. JULY 28, 16:Oa-18:00, SEVERN 2 ~yMPFiQME1S AND LEUKEMIAS: PART TVA 27:20 DE'IfJCPICN (P HAF?-PLT0IAGICAL AAID NCIJ-HAIIMA4LUUJGICAL CANCER BY BC[E BIOPSY BURKHARDT, R.12 FRISCH, B.3 BARTL, R.1 KETTNER, G.2 SCHLAG, R.2 HILL, W.2 IAbt. f. Knochenmarksdiagnostik, Med. Klinik Innenstadt d. Univ.t 2Abt. Raematomorphologie d. Ges. f. Strahlen- u. Umweltforschung mbH; Munich, Germany FR; 3Te1-Aviv Univ. Med. School, Tel-Aviv, Israel 28. JULY 29, 9:0U`12:45, MAIN HALL DETECTION OF PRE-CLINICAL CANCER (CONT D) 12:15 IDENPIFICATION AND SURVEILLANCE 183 OF HIQi RISK CRX)PS RIRAYAMA, T. Epidemiology Division, National Cancer Center Research Institute, Tokyo, Japan 11:35 DISCUSSION 11:50 DESICN AND EUAIITATION OF SCRFa1- 184 12:10 DISCUSSION 29. JULY 29, 9:OU`13:00, AVON 1/2 CARCINOGENIC FACTORS CHAIRMAN: CO-CHAIRMAN: SECRETARY: A. A. T. MUNRO NEVILLE (U.K.) GREENSTEIN (U.S.A.) TAKEMOTO (Japan) CHAIRMAN: CO-CHAIRMAN: SECRETARY: D. SCHMARL (Germany FR) J.A. DI PAOLO (U.S.A.) K.-W. STAHL (France) 9:00 INiRODUCTM REIMARK.S OF C}iAIRNLnN 9:05 4dM IS EARLY CANCER? MORSON, B.C. Dept. of Pathology, St. Mark's Hospital, London, U.K. BIOIAGICAL NARKERS IN PRE-CISNICAL CANCFdi FRANCNIMONT, P.P.G. Universite de Liege, Liege, Belgium 10:00 DISCUSSION 10:15 C.IIL, M7RPHOIAGIC ~41RiQ;1iS NIEBURGS, H.E. Dept. of Pathology, Mt. Sinai School of Medicine of CUNY, New York NY, U.S.A. 10:35 DISCUSSION AND COFFEE BREAK 6 9:05 I1IIlUCI'ION OF RF1NAL PELVIC 7[RMDRS BY ANAI,GESICS JOHANSSON, S.L. Dept. of Pathology II, Sahlgren's Hospital, Gothenburg, Sweden 9:15 7 ING PROGRAS BRENNAN, M.J. Michigan Cancer Foundation, Detroit MI, U.S.A. CANCt3t MDRTAI iTY LINKED WI74I AFtI'IFICIAL F7 UORIIATZON IN BIRN>IIX;-M, ENGLADID BURK, D. Dean Burk Foundation, Washington DC, U.S.A. 9:25 SIGNIFICANi` INCRFASE OF CELL TRANSFURhATION IN VITRO BY CITY SMJG EXPRACiS AND PAPCNAVIFdJS b1190 SEEMAYER, N.H. MANOJLOVIC, N. Medizinisches Institut fur Umwelt- hygiene, Universitat Dusseldorf, Dusseldorf, Germany FR 0

PODIU'I SESSIOTIS 29. JULY 29, 9:00-13:00, AVON 1/2 CARCINOGENIC FACTORS.(COMT'D) 9: 35 9 RD:XYMBINOGESIIC ALTIVITY CF FRESH CIGAYOTE SM71CL IN SACCHAROMYCES CEFtEVISIAE GAIROLA, C. GRIFFITH, R.B. Tobacco and Health Research insti- tute, University of Kentucky, Lexington KY, U.S.A. 9:45 DISCUSSION AND COFFEE BREAK 10:45 EFTECIS OF CHIARPRCMAZIIQE CN 10 DIMETHXINI TROSAMIINE DFTg.THYIASFS IN RATS PREPRFATID WIZH VARIOUS MIC%160NF1L E31ZYbiE IAIDUCFIIS MOSTAFA, M.H. RUCHIRAWAT, M. WEISBURGER, E.K. Medical Research institute, Alex- andria, Egyptj Laboratory of Car- cinogen Metabolism, National Cancer Institute, Bethesda MD, U.S.A. 10 : . 55 P310'IOCIddCINOGQNESIS BY 1~ 'THOXYPSC?- 11: 25 INHIBIfiIQI OF EPIDE.lihR1L G%J41IH 14 FACIOR BINDING BY PHORBOL ESTF•RS, SAfJMkRIN, AND CYCIIM LEE, L.S. General Electric Research and Development Center, Schenectady NY, U.S.A. 11:35 DISCUSSION 12:00 NE0d'IAS"PIC SDQUF.IItE OF REPEATED 15 INPRAPF.7tT4CR3F.AL 002 INSUFFIATIOIZS, A NIJRibItE MCIDEL FOR MULTIPLE LAPA%OSGOPIES? GOLDSMITH, A. RYAN, G. JOSEPH, A. National Cancer Cytology Center; Borrkhaven Hospital; Melville NY, U.S.A. I2:10 ONOOGIINIC 4IiANSfUFitATION SY[7DII5 16 RECEUANT TO CLINICAL ONOOIAGY BOREK, C. Radiological Research Laboratory, Dept. of Radiology, Columbia Uni- versity College of Physicians and Surgeons, New York NY, U.S.A. I RAI EN, 1+1Q1IRAI. RID AND PRXIAVItlE 12:20 EFF= OF LOtJIDAMINE CN 'IHE 11 SANTAMARIA, L. ENERGY MEPABOLISM OF RUMJR CELIS BIANCHI, A. 17 PAGGI, M.G. ARNABOLDI, A. DAFFARA, P. Istituto do Patologia Generale "C. Golgi," Centro Tumori; Istituto di Farmacologia lI, Universita di Pavia; Pavia, Italy FLORIDI, A. MARCANTE, M.L. DE MARTINO, C. BELLOCCI, M. CAPUTO, A. SILVESTRINI, B. Re ina Ele i tit t f C 11:05 TM EPIDERt41L PAPILDOMA AND CANM g na ns e ancer u or Research; F. Angelini Research 12 IN N>X)SE SKIN BURNS, F.J. Institute; Rome, Italy Institute of Environmental Medicine New York University, New York NY, U.S.A. 11:15 WE EE'fWr OF CARBAMDYLTERRAMETHYir 13 PYIdDLLINE-N-0XiDE ON YC-8 LYMPFKkMN CELS$ IN VITRO BATKIN, S. TABRAH, F.L. MISCONI, L.Y.* Cancer Center of Hawaii, University of Hawaii, Honolulu HI, U.S.A.j *Dept. of Chemistry, Swinburne College of Technology, Victoria, Australia 12:30 DISCUSSION

pxIum SESSIONS 30, ,NLY 29, 9:0013:00, AVON 3 SDCIAE RESEARCH AND PUBLIC EDUCATION CHAIRMAN: L•M' WsMSTROM (Sweden) C0_CffAIRmAAr: A.I. HOLLEB (U.S.A.) SECRETARY: E. WILKES (U.K.) 9:00 INIRmvIow RDmRKS OF CHAI"N 9:05 IIqF~ THE PUBLIC AEOVT CANCf3t RISKS: AN IDPORDINP ASPDCP OF 206 CANCER CONTROL MALONE, W.F. preventive Hedicine Branch, Nation- Cancer Institute, Bethesda MD, U.S.A. 9:25 OOALS AND PRIORITIIS IN PiJBLIC EDUCATION AaCxTf CANCER 207 HOBBS, P. Dept. of Epidemiology and Social Research, University Hospital of South Manchester, Manchester, U.K. 9:45 DISCUSSION 9:55 A OOUILSE IN CANCEt PRbUENPION FOR PRACTICING PHYSICIANS 208 LOVE, R.R. Wisconsin Clinical Cancer Center, Madison WI, U.S.A. 10:15 A CA'JCII2 EDUCATION NffTHODOIAGY FOR 209 OOURSES CHARLTON, A. Manchester Regional Committee for Cancer Education, Manchester, U.K. 10:35 DISCUSSION AND COFFEE BREAK 11:00 A DLTLTI DIIIENSIdNAL M3DEL FOR NCIN- 210 FEAR-ARC[1SING EDUCATION AB7CrP BRFAST SEIF-EXAhIMTION GASIRIN, G. National Institute of Nursery, Helsinki, Finland 11:20 DISCUSSION PREVfNI`IOy OF SMOIQNG IN ADCILES- CENPS: DEVE[APMES?T AN) LYAi1JATION OF A IAPGE-SCALE FOUR-YEAR (7TH '!FM 10M GRADES) SOCIAL PSYCtIOIr OGICAL STRATDGY EVANS, R.I. Social Psychology/BehavioraI Medi- cine Research & Graduate Training Group, University of Houston, Houston TX, U.S.A. 11:45 THE RDLE OF PUBLIC EDUCATION IN PImGRAM4ES FOR SNICIKING CESSATION 212 RAYSTROM, L.M. National Smoking and Health Assoc- iation, Stockholm, Sweden 12:05 DISCUSSION 12:15 EDUCIATIONAL MEANS OF ENC7GURAGING A NON-ShYJKiNG ORIENPED CLINM DAUBE, N. Dept. of Comnunity Medicine, University of Edinburgh, Edin- burgh, Scotland 12:35 DISCUSSION 31. JULY 29, 9:OU-13:00, SEVERN 1 BREAST IMAGING CHAIRMAN: J.J. ROMBACH (Netherlands) CO-CHAIRMAN: P. STRAX (U.S.A.) SECRETARY: B.A. THOMAS (U.K.) 9:00 IR17RDDUCRM RBMARKS OF CHAIRt-M 9:05 L(X4-DOSE-SDJGLEVIEW RADIOGRAPHY 462 OF THE FES'BiiE BREAST PATEROK, E.M. Universitats-Frauenklinik, Erlangen, Germany FR 9:15 NRV-PI7GRAPHIC PATTERn1S AS A RISK 63 4 INDICATOR FOR BREAST CANCER; A CASE OOKPFL?L S'IUDY IN SCREENED AND SEIF-REFERFW hOMEN ROSSELLI DEL TURCO, M, CIATTO, S. MEZZALIRA, L. CAMARGO, J.R. PETRACCO, A. Center For Social Diseases and Preventive Medicine, Florence, Italy 9:25 ULIUASONOGRAPHY, A PRONIISING 464 MEZ4iCD FOR DE7WCPION OF EARLY BRF.AST CANCER ' PLUYGERS, E. ROMBAUT, M. Breast Unit, Dept. of Oncology, Jolimont Hospital, Haine-Saint- Paul, Belgium 9:35 CLINICAL SIGNIFICANCE OF ULTRA- SCNOCRAPHY IN THE DIJ1(3d06IS AND 465 MAN~ENT OF PALPABLE BREAST

PODIlJT9 SESSIONS 31, JULY 29, 9:00-13:00, SEVERN 1 BREAST IMAGING (CONTV 465 MASSES ROSNER, D. Dept. of Breast Surgery, Roswell Park Memorial institute, Buffalo NY, U.S.A. 9:45 KVMOGRAPHY IN (X7N7UNCTION WITfi 466 ULTRASONOGRAPHY - IMPRCX7F11 BREAST CAFCIIJJP?A DIAGdOSIS LOGAN, W. Private Practice, Rochester NY, U.S.A. 55 DISCUSSION AND CO 9 R K : FFEE B EA 11:10 CANCER DEPDClZON S4UDIES USING 471 A 4.7 GIGAHERTZ RADICMETER SHAEFFER, J.1 EL-MARDI, A.M.1 CARR, X.L.2 lEastern Virginia Medical School, Norfolk VA; 2Microwave Associates Inc., Burlington MA; U.S.A. 11:20 DISCUSSION 1I:45 472 A PI6LIID2CRY APPRAISAL OF DIAP1UtNOGRAPHY IN DISFASES CE' THE BRFAS'P ISARD, H.J. Division of Radiology, Albert Einstein Medical Center, Phila- delphia PA, U.S.A. 10:30 PREISNIIHIW TESTS ON CANCER DE,TE7C- 11:55 N~APHY AND DIAPHANOQtAPHY IN THE DEPDCPION OF BREAST CANCER TION BY MICROWAVE USiHT41C~APHX 467 ROBERT, J. EDRICN, J. MAMOUNI, A. ESCANYE, J.M. ITTY, C. 473 WALLBERG, R. ALVERYD, A. STEGE, R. BERGVALL, U. SUNDELIN, P. Surgical Clinic; Depts of Radiol- Laboratoire de Biophysique, Faculte B de Medecine, Nancy, France ogy and Pathologyp Huddinge Hospital, Huddinge, Sweden 10:40 RADIOIMYJNOINDIGING OF M~Y 12:05 BREAST CANCER DEfECTION UlZLIZING 4UMJRS WI'i41 (ELirTYPE SPECIFIC BIOSTFRDONIETRIC ANALYSIS 468 ANTIBODIES 474 LOUGHRY, C.W. CERIANI, R.L.1 PETERSON, J.A.1 WILBANKS, T.1 MILLER, S.2 KAUFMAN. L.3 ORTENDANL, D.3 1Children's Hospital Medical Cen- 2:15 HERRON, R. LIEBELT, R. PROIETTI-ORLANDI, F. Akron City Hospital, Akron OH, U.S.A. AC1JANlYGES AtID LIMITATIQVS CF ter, Oakland CA; 2Dept. of Radiol- ogy, University of California, San 475 PHYSICAL E:XFIMINATION AND N1WID- GRAPHY IN BREAST CANCER SCRg~3JIIJG Francisco, CAj 3Radiologic Imaging Laboratory, South San Francisco CA; U.S.A. 10:50 SZUDY OF PHYSIOIqGY OF BRFA.ST BY CHOIFSTERiC ANALYSIS PFdOFILE 469 ROBBINS, W.B. FEIG, S.A. SCHWARTZ, G.F. PATCHEFSKY, A.S. SHABER, G.S. NERLINGER, R. Thomas Jefferson University Hospital, Philadelphia PA, U.S.A. Wisconsin Breast Cancer Detection Foundation, Madison WI, U.S.A. 12:25 UPIYITE CN DIACNU6IS CF BREAST 11:00 CRITICAL EVAL[TATION OF NX)RPHOIAGIC DIAGtdOSIS TDCHNIQUFS IN HVI90IpGY 470 COLLARD, M. BRASSEUR, P. Centre de Mammolo i M t it 476 CANCER MATALLANA, R.H. Dept. of Radiology, University of Wisconsin Hospitals and Clinics, Madison WI, U.S.A. g e, a ern e Reine Astrid, Charleroi, Belgium 12:35 DISCUSSION

GENITO-URINARY TRACT CANCER: PART ONE CHAIRMAN: G.H. FRIEDELL (U.S.A.) CO-CHAIRMAN: J.C. GINGELL (U.K.) SECRETARY: P. AIGINGER (Austria) 9:00 INPFiC)DUC,`PDRY RIIdARKS CF (2iAI3d.1AN 9:05 CYibCENEI'ICS Ct' BLADDER CARCINOMA: 345 A KEY '10 PROQdC6IS IN NQN-INVASIVE AND IN SUBt•i1006AL INVASIVE CARCIINCHF{ FAIqR, F.H. WARD, R.M. BREZLER, M. Lymph and Cancer Research Labora- tory, Akron City Hospital, Akron OH, U.S.A. 9:I5 URINAFtY a-NAPIPIHYL ACEi'ATE FSPEIIt- ASES: A PREILMIINAAKY SCREENING TEST FQR BLADDER CANCER EL-SEWEDY, S.M. SOFFAR, A.M. MOSTAFA, M.N. EL-BORNO, F.A. ARAFA, A. EL-ZOGHBY, S.M. Dept. of Applied Medical Chemistry, Medical Research Institute: Dept. of Biochemistry, Faculty of Medi- cine, Tanta University; Dept. of Urology, Faculty of Medicine, Alexandria University; Alexandria, Egypt 9:25 ROLE OF N-ACEPXLTRANSFIRASE PF1EJO- 347 TYPE IN AUt,AN SUSCEPTIBILITY 70 BLADDER CAfCINOCENIC ARYiANIINES WOLF, H. LOWER, G.M. BRYAN, G.T. Dept. of Urology, Hvidovre Univer- sity Hospital, Hvidovre, Denmark; Dept. of Human Oncology, University of Wisconsin Center for Health Sciences, Madison WI, U.S.A. 9:35 DISCUSSION COHEN, S.M. JACOBS, J.B. Dept. of Pathology, St. Vincent's Hospital, Worcester MA, U.S.A. 10:00 PROCIJOSTIC INlPO17TANCE C&' SPECIFIC 349 IN OOCUPATIODFIL BLADDER CANCER KUMAR, S. Pediatric Oncology Laboratory, Christie Hospital and Holt Radium Institute, Manchester, U.K. 10:10 DISCUSSION 10:20 CARCIIJiXMA CF 71-IE PR064ATE - A 350 REVIE,W OF HISPDICGICALLY BFTIIGN AND CYiC)IAGICALLY NFiLI(3,F1Nf P1476TATE GINGELL, J.C. SWIFT, A. SLADE, N. Dept. of Urology, Southmead Hospital, Bristol, U.K. 10:30 DISCUSSION 33. JULY 29, 11:OU-13:00, SEVERN 2 GENITO-URINARY TRACT CANCER: PART TWO CHAIRMAN: I. ELSEBAI (Egypt) CO-CHAIRMAN: L.M. FRANKS (U.K.) SECRETARY: H. WOLF (Denmark) 11:00 INlRODUChORY RFI"iz1RK.S DF CHAIId"g1N 11:05 RACIAL DIFF72ZENICES IN SURVIVAL 351 ANALYSIS dF PATIFNPS WPIH PRDSTATIC CANCER STEVENS, C.W. CARTER, W.H. WAMPLER, G.L. RAZRA, T.A. Virginia Coarnonwealth Universityj Medical College of Virginiaj Richmond VA, U.S.A. 11:15 4[MOR ASSOCIATED IMrIR1ITY IN P1Yl6TATIC CANCER: SUPPRESSION BY HCAg1N SFMIIAL PIASNFI ABLIN, R.J. BUSH, I.M. BHATTI, R.A.

PODIU4 SESSIONS 33. JULY 29, ll:OU 13:00, SEIIERN 2 12:15 FFFF)L'P OF SONIE PHYSIOIAGIC AND GENITQ-URINARY TRACT CANCER: PART TWO (CONT D) PA7HOIAGIC FACI'ORS ON THE ACTIVITY 358 OF URINARY a-NAPHTHYL A'PATE ESTERASES IN BIIRARZIAL $IADDER Cook County Hospital; Hektoen CANCEt EL-SEhTDY, S.M. SOFFAR, A.M. Institute for Medical Research; ARAFA, A. Chicago IL, U.S.A. EL-BORNO, F.A. 11:25 NpWIA4lAiY EF'F37CTS OF AMY(UPILIB7 EL-ZOGHBY, S.M. Dept. of Applied Medical Chemistry, ON 4LMR-W6T DIRDCPID IM4JSIITY Medical Research Institute, Alex- 353 IN PR06TATIC CANCER andria University; Dept. of Bio- BHATTI, R.A. chemistry, Faculty of Medicine, ABLIN, R.J. Tanta Universtiy; Dept. of Urology, NAGUBADI, S.R. Faculty of Medicine, Alexandria GUINAN, P.D. University; Alexandria, Egypt Cook County Hospital; Hektoen Institute for Medical Research; 12:25 CONIROL OF PATIFNTS WITH UROM- Chicago IL, U.S.A. LIAL CANCER BY 8 HR URINARX 359 E?QrRF.TION OF S AhIINOISOBVTYRIC 11:35 FINE NEEDLE ASPIRATION CYlOIAGY ACID AND PSFIJDOUR.IDIAIE OF THE PROSTA'IE GIAND NYHOLM, K.K. 354 CHAUHAN, P.M. SJOLIN, K.-E. GABRIEL, J. SAHU, B. PATRICK, C. GARNES, H. Columbia University Harlem Hospi- tal, New York NY, U.S.A. IVERSEN, J. PALM, L. Institute of Pathology, Sundby Hospital, Copenhagen; Dept. of Surgery, Division of Urology, Roskilde County Hospital, Roskilde; Denmark 11:45 EPIDET4IOIAGY OF CANCf3t OF ZHE 355 TFBM IN R<1QQ,ADID COUNPY JAFFREY, I.S. Palisades Oncology Associates, Pomona NY, U.S.A. 11:55 PRb17tTMON AND EARLY DETFCfION 356 OF TFSTICUIAR CANCF:R IN CRYPT- OFQrHIDS BATATA, M.A. CHU, F.C.H. Memorial Sloan-Kettering Cancer Center, New York NY, U.S.A. 12:05 >vALUATIOfI OF VARIOUS DIN3NOS'fIC 12:35 SI[JDY OF 250 CASES OF CARCIINCNA 360 CF IJRIIARY BLADDIIt: A PRII.IMIN4RY RkRORT RIZVI, S.H.A. Dept. of Urology, Dow Medical College and Civil Hospital, Karachi, Pakistan 12:45 DISCUSSION 34, JULY 29, 14:00--17:45, MAIN HALL 357 MEIIiCDS FOR THE EARLY DEIELTION OF META3TASES IN TESTICUTAR 7[1NI)R PROMISING TECFQdIQUES OF DETECTION AIGINGER, P. KUHBOCK, J. KOLBE, H. SPONA, J. CHAIRMAN: CO-CHAIRMAN: SECRETARY: R.W. RAVEN (U.K.) H. ICHIKAWA (Japan) J.M.S. PREWITT (U.S.A.) 2nd Dept. of Medicine; Ist Dept. of Gynecology E Obstetrics; L. 14:00 INPiODUCTORY REMARKS OF CHAIF41M Boltzmann Institute of Clinical Endocrinology and Nuclear Medicine 14:05 NEW APPRDACFES IN CYTOIAGIC University of Vienna, Vienna, DIAf3"IS Austria 185 MEISEIS, A.

PODIU'1 SESSIONS 34, JULY 29, 14:00-17:45, MAIN NAIl 35. JULY 29, 14:00-ll:45, AVON 11'1 I p{Z~TSIDNG TECFPIIQUES OF DETECTION Dept. of Laboratory Medicine, Pathology and Cytology Service, Hopita2 du Saint-Sacrement, Quebec PQ, Canada 14:25 DISCUSSION 14:40 AWANC£S IN ITIDO9L`OPY 186 TAKEMOTO, T. Dept. of Medicine, Yamaguchi Uni- versity School of Medicine, Ube, Japan 15:00 DISCUSSION 15:15 CCMPLTi'ERI2ID TONIJGRAPHY 187 HUSBAND, J.E. EMI Scanning Unit, Royal Marsden Hospital and Institute of Cancer Research, London, U.K. 15:35 DISCUSSION AND TEA BREAK 16:00 BRF.AST IT4IGING: PAST, PRFSFNP AND 188 FSTlURE STRAX, P. Guttman Institute, New York NY, U.S.A. EXPERIMENTAL CARCINOGENESIS RELEVANT TO CLINICAL ONCOLOGY CHAIRMAN: L:O. LAJTHA (U.K.) CO-CHAIRMAN: B.K. ARMSTRONG (Australia) SECRETARY: C. BOREK (U.S.A.) 14:00 INPROD[K,TORi' RII4V*~.S CP CHIiIRMAN 14:05 113 C1EMIICAL CARCIIJOGEIVS: STRICIURE/ACPIVITY RECIiTIONSxIPS BROOKES, P. Institute of Cancer Research, Chalfont-St. Gi1es, U.K. 14:25 DISCUSSION 14:35 ON NIDCIFNISMLS QF C1ffSIICAL 114 CARCINOCEffSIS O'CONNOR, P.J. Paterson Laboratories, Christie Hospital and Ho1t Radium Institute, Manchester, U.K. 14:55 DISCUSSION 15:05 ASSAY ME'PFKlD6 FOR CAFCINOGFSIS 115 PURCHASE, I.F.H. Central Toxicology Laboratory, ICI Limited, Macclesfield, U.K. 16:20 DISCUSSION 16:35 ULTRASOUAID 15:25 DISCUSSION AND TEA BREAK 16:00 iHE RF)GUIATION Cff' CELL 4RANSFOFQy}- 189 COSGROVE, D. Dept. of Nuclear Medicine, Royal 116 ATION INDUCfD BY CHEMICAL AND PHYSICAL CAftCINOGQIS IN SYRIAN Marsden Hospital, Sutton, U.K. 1AKSTER CELIS DI PAOLO J A 16:55 DISCUSSION , . . Laboratory of Biology, National h i 17:10 DIAGd06TIC NMETFK)DS IN TIUCLFAR Cancer Inst esda MD, tute, Bet U.S.A. MEDICINE 190 COX, P.H. Dept. of Nuclear Medicine, Rotterdamsch Radio-Therapeutisch Instituut, Rotterdam, Netherlands 16:20 DISCUSSION 16:30 DEPIIIDFNP AND AUNMICX)S PHASFS DURTM IIIJKEMOCEIWSIS NARAN-GHERA, N. Dept. of Chemical Immunology, The Weizmann Institute of Science, Rehovot, Israel 17:30 DISCUSSION 117 16:50 DISCUSSION

PODIlM SESSIONS 36. JULY 29, 14:00-17:45, AVCJN 3 EDUCATION AND REGISTRIES CHAIRMAN: M. KLEIN (Israel) CO-CHAIRMAN: P. HOBBS (U.K.) SECRETARY: R.I. EVANS (U.S.A.) 14:00 7NPRDDUCIC)RY R0-1hRKS OF (HAIRMAN 14:05 NIIi PREVIIdfION RESEARCH 220 KALBERER, J.T. Jr. National Institutes of Health, Bethesda MD, U.S.A. 14:15 EFFECTIVE TEACHING OF CANCER PREVEDTPION 221 CRAVATS, M. York College, The City:University of New York, Jamaica NY, U.S.A. 14:25 HOPE VERSUS FEAR - ACTION VF3tSUS 222 INACPION: THE BALANCE OF INVFST- MENP IN PRCMOTING CANCFR SCRF..F3IIIJG P1OCRANLS INGALL, J.R.F. HARSEN, J. Michigan Cancer Foundation, Detroit MI, U.S.A. 14:35 PSYCHOIAGICAL ASPDL'IS (lr ASBFSTOS- 223 REIATED MESO2HES,IOFSA AND HIN0kIIDDGE OF HICII RISK FC)R CANCFR LEBOVITS, A.H.1 CHAHINIAN, P.1 GORZYNSKI, J.G.2 HOLLAND, J.C.2 1Dept. of Neoplastic Diseases, Mt. Sinai School of Medicines 2Memorial Sloan-Kettering Cancer Center; New York NY, U.S.A. INPRA-I4ATIONkL MIGRATION ALDRICH, T.E. NEALEY, J.E. Comprehensive Cancer Center for the State of Florida, University of Miami School of Medicine, Miami FL, U.S.A. 15:20 A CQIIDE TO IMPIFSgIdP A CANtER 226 P1iQG2AM IN A COMM1nIITY HOSPITAL USING THE CRITMtiA OF TFE AbE2.ICAN COLLFJGE Cff' SU14GE0[1S GRIFFITHS, E.K. Mease Hospital and Clinic, Dunedin FL, U.S.A. 15:30 TSE NEED FOR INPE~2N1TI0NAL OOLLABOdiATION TO AOCELERATE Tf1E 227 DISSEhnaTION OF CANCm RFSFIiFr_H RFS(JLTS BOSCOTT, R.J. University of Queensland Medical School Library, Brisbane, Australia 15:40 DISCUSSION 16:00 CANCER RISK, AGE AT DIACN06IS, 228 AG6 AT DEATH AS FlPM0NS 0F SEASON OF BIIiTEi JANSSON, B. MALAHY, M.A. University of Texas System Cancer Center, M.D. Anderson Hospital & Tumor Institute, Houston TX, U.S.A. 16:10 CHIIDHOOD T[&IORS IN THE 229 1E'IHFItiAAIDS HAYES, R.B. VAN NOORD, P. Study Center of Social Oncology, Rotterdam, Netherlands 16:20 CANCER IN F70RILlA: INFTIJF3JCE.' SOF 230 14:45 DISCUSSION 16:30 TFESIDS IN CANCER MOIrPAI1TY AMJNG 15: 00 THE DFSIQI, IMPIFSIENTATIDN AND THE CHINESE IN 1TTE UNITED STATES, EVAIUATION CF AN EfTI)CPIVE PUBLIC 231 1959-1972 224 CANCER EDUCATION PA_IGRAM KING, H. HANSEN, J.A.B. Cancer Center, Arizona Health Sciences Center, Tuscon AZ, U.S.A. LOCKE, F.B. National Cancer Institute, Bethesda MD; Georgetown Univer- sity, Washington DC; U.S.A. 15:10 225 DISCUSSION TAYLOR, P. 17:00 DESCRIPTIVE AWERS IN THE EPI- The Center for Attitudinal Healing, DE!yIIOIAGY OF CUPAPIDWS MELANOMA Tiburon CA, U.S.A. 232 VAN DER ESCH, E.P. PEER AND SEIF-HFALING WITH CHILDRIId bd-IO HAVE CATASTIdJPHIC II?NESG 16:40 JAMPOLSKY, G.G.

pODIUM SESSIONS 36. JULY 29, 14: (10-17:45, AVON 3 EU(',ATION AND REGISTRIES (COPIT'D) 14:25 CEL1,[TIAR IPMJNI PY IN UJARIAN Antoni Van Leeuwenhoek Ziekenhuis, CANCER Netherlands Cancer Institute, 86 SIMM, S. 17:10 Amsterdam, Netherlands AN ANALYSIS CF TRIINDS IN MC>RTA,LITY MARXOWSKA, J. TOMASZKIEWICZ, T. Oncology Hospital, Academy of 233 F%YM NAL.I(INANP NIQAiJCNA CF THE SKIN IN AUSTRAL7A Medicine, Poznan, Poland HOLMAN, C.D.J 14:35 FTFDCP OF D[U1 EXCRtiTEa BY STIIMIAr JAMES, I.R. GATTEY, P.R. 87 ATED T CELLS IN THE TRANSFER Cg' IIZFORN121TION TO B LYMPHOCYTfS 7:20 ARMSTRONG, B.K. NH and MRC Research Unit in Epi- demiology and Preventive Medicine, University of Western Australia, Nedlands WA, Australia USE OF ACPIVE PATIfSTP FOLLpW-UP IN DURING AN IM41NE RESP0IISE MAURICE, P.A.' JACHERTZ, D.2 STROUN, M.3 CORNILLE-BROGGER, R.~ LEDERREY, C.1 HENRI, J.1 234 CANCER FOR DESIQJING EPIDEMIIOIpGIC ST(3DIES ANKER, P.1 lOnco-Hematology Division, Hopital SMITN, E.M. THARP, R.F. BEAN, J. Dept. of Preventive Medicine and Iowa State Cancer Registry, Uni- Cantonal, Geneva, Switzerlandt 2Hygien Institut, Bern, Switzer- Iandi 3Dept. of Human Microbiology, Faculty of Medicine, Tel-Aviv, Israel versity of Iowa, Iowa City IA, U.S.A. 17,30 DISCUSSION 37, JULY 29, 14:04-17:45, SEVERN 1 IM'IJNOLOGY AND VIROLOGY Dept. of Laboratory Medicine, Medical University of South Carolina, Charleston SC, U.S.A. 14:45 DISCUSSION 15:00 SUPERpDCIDS (02) ASSAY-M0IJOCYTE 89 ADHERENCE TEST EOR DETk7CTION C&' CIId, NSEDIATID IMAIIIiITY IN CANCM PATIFldI'S YAGAWA, K. KAKU, M. MANABE, B. YASUMOTO, K. Kyushu Cancer Center Research Institute, Fukuoka, Japan 15:I0 SF34JIiaGICAL DEIEC'l7:ON OF ANPIBODY RESPCRdSES Ta HUMAN CER1TICAL CA,R- 90 CINCMA CEId.S 14:00 INPRODUCIqRY RE29RRS OF CIU1.TRt41N 14:05 LYMPHOCY'1£.S ROBF.`ITE WITH ANPI(EN WINTERS, W.D. WOLNIK, L.K. WIENKOTTER, R.M. S'PIMUTATION IN GYBADOOIAGIC CANCERS 84 MARXOWSKA, J. SORIERO, 0. University of Texas Health Science SIMM, S. Oncology Hospital, Academy of Medicine, Poznan, Poland Center, San Antonio TX, U.S.A.; University of Marburg, Marburg, Germany FR CHAIRMAN: P. ANXER (Switzerland) CO-CHAIRMAN: W. WINTERS (U.S.A. SECRETARY: F.K. NKRUMAH (Ghana) 14:15 E ROSETPE INHIBITION BY ANPILYMPHO- 15:20 IMMRNOLOGIC TEST REAC'I'IONS IN CYTE SERtE IN NDOPLASIA FC1Rf ffiM RISK GICUPS OF UPkRINE 85 LA VIA, M.F. 91 CERVIX CANCER

37. JULY 29, 14:00-17:45, SEVERN 1 IMINOLAGY AND VIROL.06Y. (CONT'D) 91 CNARKVIANI, T.L. Oncology Dept., State Doctors Training Institute, Tbilisi, U.S.S.R. 15:30 DISCUSSION AND TEA BREAK I6:00 SOhATIC CELL HYBRIDS PRODCiCING 92 MCNOCIL~~ ANfIDODIFS SPF)rIFIC 70 FIBRONOMU CARNEMOLLA, B. ZARDI, L. SIRI, A. SANTI, L. ACCOLLA, R.S. Istituto Scientifico per 1o Studio e la Cura dei Tumori, Genoa, Italy; Ludwig institute for Cancer ' Research, Lausanne, Switzerland 16:10 ANTI-MLI(NIN ANTIBODY AS CANCE2 93 SCREaI, AND MALIININ AS PCr1'ENI'IAL VAOCINE BOGOCH, S. BOGOCH, E.S. Boston University School of Medi- cine, Boston MA, U.S.A. 16:20 TEClfiTICAt, ASPFMS APID CLINICAL 94 RESULTS OF TfiE CELLULAR IIECPRC?- PHOREPIC MBILITY TEST FOR EARLY CANCE32 DIAl3NJSIS KREIENBERG, R. STELDERN, D. von LEMMEL, E.-M. Dept. of Gynecology & Obstetrics, University Hospital, xainz, Germany FR 16:30 DISCUSSION 16:50 TEE2NIINAL DEO%YNUGLOEfIDYLTRANSFER-- 95 ASE IN PURIFIED MOLOtWy NIIIRINE IIxIMMA VIRUS, BAIB/C S+ Ir AND H[DAN UR1tg+RY BIADDII2 CAWIINYMA CELIS ARIDA, E.N. Laboratory of Viruses and Tissue Cultures, National Research Center, Dokki, Cairo, Egypt PODIM SESSIONS 17:00 CCHPIFS~ DM CIDPIES OF 96 II;TJfaX[A AND SF1R3l5~h VIRUS FM OOKI7LIN SEQUFS)CES OF DEOXYCYTIDYir ATE AND DDOXYGUPINYIA'IE PHILLIPS, L.A. KANG, M.S. PARK, J.J. Laboratory of Viral Carcinogenesis, National Cancer Institute, Nation- al Institutes of Health, Bethesda MD, U.S.A. I7:10 IM4-INOIAGICAL RESPO[ZSE IN CHICKENS FI2CM DIFTT74Sll (ENETTC 9 7 LIKES TO %R7S SAF0Ot1k VIRUS BOWER, R.K. GYLES, N.R. Dept. of Botany and Bacteriology, University of Arkansas, Fayette- ville AR, U.S.A. 17:20 PERSPFX'1'IVES ArID I,IIMI'I'S OF AN 98 ItR1lNOF3JZYD%TIC ASSAY (FI.ISA) FOR HERPES SIMPIEX VIRUS (H" 4SMJR AS.SOCIA'I'ID AtdPICIN (TAA) TARRO, G. D'ALESSANDRO, G. MASCOLO, A. BOSSA, L. MATURO, S. FLAMINO, G. ESPOSITO, C. D.E.P.A. Research Center; 1st Dept. of Oncologic Virology; University of Naples, Naples, Italy 17:30 DISCUSSION 38. JULY 29, 14:(1U-16:00, SEVERN 2 COL1rRECTAL CANCER: OVERVIEW CRAIRMAN: N.M. COPELAND (U.S.A.) CO-CHAIRMAN: D.J. JUSSAWALLA (India) SECRETARY: P. HERMANEK (Germany FR) I4:00 INPFKJD[ICPORY RII-FiIIICS OF CIIAIRNFN

IONS PpDIlfM SESSIONS JULY 29, 14:04-16:00, SEVERN 2 25:20 TISSUE CARCINOEMffiTd(C[JIC ANTICEN 38, (CFA), DYSPIASIA AND DORATION OF OVERVIEW (CONT'D) CER 320 DISEASE IN UhCIRATIVE COLITIS : COLD-RECTAL CAN ' (UC) AtID CR7F¢d S (CD) COLITIS PANVELIWALLA, D. 14:05 SBQUDMAL ANALYSIS OF COIANIC GREENSTEIN, A. CARcIIJOGFTNESIS OF 1,2-DIME143YIr HEINMANN, T. 315 IIYDRAZ II1E TRBATID RATS : KATZ, L.B. FFATVRES OF THE GELLER, S. prdEZIDpPIASTIC LESIONS PERTSEMLIDES, D. LAUMONIER, R. SMITH, H. TAYOT, J. AUFSES, A.H. Jr. DELAPIERRE, F. Mt. Sinai Medical Center, New Research Institute of Pathology, f Ex erimental Cancer lo t York NY, U.S.A. p gy, . o o Dep Centre Henri Becquerel, Rouen, 15:30 SCREINING FOR COIARDCPAL CANCER France BY TESTING STOOIS FOR OOCULT 321 BIAC)D 14:25 CQg'IRy1TION OF A 2-STEP MEC'FANISM GNAUCK, R. IN RAT COIIrRD2TAL CARCINOGE3N4~~IS Deutsches Klinik fur Diagnostik, 316 MASKENS, A.P. Wiesbaden, Germany FR Cancer Research Unit Clini ue , q Saint-MicheI, Brussels, Belgium 15:40 DISCUSSION 14:25 PRIIALICINANP CFIUMS IN H[2W COIONIC NAK70. h ADJACETTP TO AND 317 RM= FROId CARCIN(tpLS SHAMSUDDIN, A.K.M. 39. JULY 29, 16:0(}-18:00, SEVERN 2 TRUMP, B.F. Dept. of Pathology, University of Maryland School of Medicine COLO-RECTAL CANCER: ETIOLOGY & DIAGNOSIS , Baltimore MD, U.S.A. 14:35 DISCUSSION 14:50 DISPARY FACIORS IN RIIATION TO CHAIRMAN: CO-CHAIRMAN: SECRETARY: J. S. K. CNRISTODOULOPOULOS (Greece GELLER (U.S.A.) KANAZAWA (Japan) THE EPIOIAGY OF COI0-RDCTAL CANC:ER 16:00 AN EPIDE2IIOIAGIC SIUDY OF COIA- 318 HOWE, G.R. RY7CPAL CANCER AND DRIIIKING FW'fR MILLER, A.B. 322 SCX7FCE JAIN, N. COOX, G. Epidemiology Unit, National Cancer Institute of Canada, Toronto Ont., Canada GOTTLIEB, N.S. CARR, J. MORRIS, D. Tulane University, New Orleans LA, U.S.A. 15:00 IARGE BJWEL CANCER: ITS METABOLIC EPIDfrIIOIDGY AND PRE.VENFICtd REDDY, B.S. American Health Foundation, Valhalla NY, U.S.A. 16:10 A PRCSPDCiZVE STUDY OF THE 323 RELATICNSHIP C&' FAEJCAL BILE ACIDS, NEUPfiAi, STF.ROIDS AND NUCLFAR DE2IYDROGEZATING CLASPRIDIA WiTH THE DEVIIOPMEdP OF CANCER OF TW IARGE BOMh (CSB) HAINES, A.P.1

PODI(M SESSIONS 39. JULY 29, 16:00-180, SE1-M 2 Q0L0-RECTAL CANCER: ETIOLOGY & DIAGNOSIS ICMNT 'D) 323 NEADE, T.W.1 THOMPSON, S.' HILL, M.2 WILLIAMS, Sir Robert2 1MRC Epidemiology 6 Medical Care Unit, Northwick Park Hospital, Harrow; 2Public Health Laboratory Service, London; U.K. 16:20 DIFFF.RFSICES IN EFtBCIS OF DIETARY BRANS BfFORE AND AFTER 4[H1R 324 R41TIATION BY 1,2-DIMETHYIHYDgAZINE 17:20 VATIUE AND RFASCNS FOR %JilfINE RDCISIWIDC)SCOPY 328 MEIER ZU EISSEN, J. MEIER ZU EISSEN, P. PADMOS, M. WEDELL, J. VAN CALKER, H. Dept. of Surgery; Institute of Pathology; Academical Teaching Hospital, Herford, Germany FR 17:30 DIAf3dOSIS AND TRFAZTgNP QF PARIa' C11NCER OF THE RFX`ILM 329 EKIC M J , . Surgical Service, Clinical Hospital Zemun, Belgrade, Yugoslavia (C1Ng1) IN RATS 17:40 THE PATHOIQGIST'S RESPCNSIBILITY BARNES, D.S. IN DIAQI06IS OF EARI.Y OOIARD'TAI, CLAPP, N.K. 330 cAremom Roberts Wesleyan College, Rochester NY; Biology Division, Oak Ridge National Laboratory, Oak Ridge TN; U.S.A. HERMANEK, P. Dept. of Surgical Pathology, University of Erlangen, Erlangen, Germany FR 16:30 DISCUSSION 17:50 DISCUSSION 16:40 DETFJCTION OF THE CAN=-DERIVM (EA IN fI)CES: A PRELIrIITVIM FEPORT 325 MORI, T. FUJIMOTO, N. KURIYAMA, H. INAJI, H. OKUDA, H. KOSAKI, G. Dept. of Surgery II, Osaka Univer- sity Medical School, Osaka, Japan 16:50 PLA..SMA PR(mFASE AND INHIB.ITOdt ACTIVI'PY IDEN!'IFIES PATZENfS WIN 326 A PRDrAN.-OWS COPIDITICN LYKO, H.C. HARTMANN, J.X. Dept. of Biological Sciences, Florida Atlantic University, Boca Raton FL, U.S.A. 17:00 A COOPERATIVE S4VDY CN THE DEPDCPIdN OF 0DIlJ-RDCI7iL CANCER 327 AND POLYPS IN PRANCE MARTIN, F. POYNARD, T. The Cooperative Group on Detection and Prevention of Colorectal Tumours, Laboratory of Immunology, Faculty of Medicine, Dijon, France 40, JULY 30, 9:00-]3:00, MAIN HAl.1.. A NEW LOOK AT CANCER CHAIRMAN: M.J. BRENNAN (U.S.A.) CO-CHAIRMAN: T. HIRAYAMA (Japan) SECRETARY: A.B. MILLER (Canada) 9:00 INPF2CJDUCIqRY RES9URKS OF CHAIRMAN 9:05 CANCBt: A IACAL OR SYSTEMIC DISEASE? 526 VALLI, V.E.O. Dept. of Pathology, Ontario Veterinary College, Guelph Ont., Canada 9:25 DISCUSSION 9:45 VZTAhSIIN C AND ANTICAFCINOGE3gSIS PAULING, L. 527 Linus Pauling Institute of Science & Medicine, Menlo Park CA, U.S.A. 17:10 DISCUSSION 10:05 DISCUSSION

t R ropl W SESS I ONS 40, ,LLY 30, 9:00-13:00, M4I N HAIl A MX LOOK AT CANCER (CONT'D) ~OrJS ~'I~~~~ gOLLINSHEAD, A.C. ~SS Dept, of Medicine, George Washing- ton University Medica2 Center, N,shington DC, U.S.A. JOe4'1 DISCUSSrON . lIr00 CHPCVWOUJGY AND CANaR RALBERG, F. •1! University of Minnesota, Minneapo- lis MN, U.S.A. j Jr20 DISCUSSION Jl,40 SL'RFS.S AND CANCFR S10 RILEY, V. Dept. of MicrobioIogy, Pacific Northwest Research In:•titute, Seattle WA, U.S.A. J2r00 DISCUSSION I2:20 RFSISTANC'6 TO C94CER: FAL'!5 AND SPDLZJIA4ZON S>> ALEXANDER, P. Division of Tumour Irmnunology, Institute of Cancer Research, Sutton, U.K. ]2:40 DISCUSSION 41, JULY 30, 9:00-13:00, AVON 1/'2 OCCUPATIONAL CARCINOGENESIS CHAIRMAN: B.K. ARMSTRONG (Australia) CO-CHAIRMAN: R. MURRAY (U.K.) SECRETARY: G.G. CALDWELL (U.S.A.) 9:00 CANGI;R INCIDEN:E AND MpRTALITY IN 23 RECATION TU OCCUPATION IN 700,000 122'WRS OF 4IiE CANADIAN IABOR FOFiC'.E HOWE, G.R. MILLER, A.B. Epidemiology Unit, National Cancer Institute of Canada, University of Toronto, Toronto Ont., Canada 9:10 P06SIBI£ ME74i0DS OF CAFCIIJI'~- 24 GINICITY TESTING OF SLMSTMMs USED AT THE PIACE OF PARK STEINHOFF, D. Institute of Toxicology, Bayer AG, Bochum, Germany FR 9:20 FARLY DEIflC"FION OF AIDpPIh,qM AND PREX'ANCEROUS C}O;NGES IN hAF21QNG 25 %10t&N RAPHAEL, M. Occupational Physician, Mosman, Australia 9:30 DISCUSSION 9: 45 CANCti32 DY)FrIAL ITY IN qf0;EE ACADf?rIIC 26 CGHORIS: CHETIISTS, ARQtITDCI'S AtID PSIIdING IINCINEM/W47ULURGISTS OLIN, G.R. AHLBOM, A. ALVARSSON, B. UNANDER, B. Preventive Occupational Medicine Unit, Royal Institute of Tech- nology, Stockholm, Sweden 9:55 CARCINOGQdIC RISK IN OIL TANKERS VALERIO, F. 27 RAFFETTO, G. PUNTONI, R. VERCELLI, M. Istituto di Oncologia, Universita di Genova, Genova, Italy 10:05 CANCER INCIDENCE ANIItJG fERFO- CFROIIM ArID FEFtF0SILICODI WMFMRS 28 LANGARD, S.1 ANDERSEN, Aa.2 GYLSETH, B.3 1Dept. of Occupational Medicine, Telemark Sentralsjukehus, Pors- grunn; 2Cancer Registry of Norway, Oslo; 37nstitute of Occupational Health, Oslo; Norway 10:15 DISCUSSION AND COFFEE BREAK 10:45 HIS2OPA4HOUpGICAL CHANGES CF THE 29 NASAL M1006A IN NICKEL WORKM BOYSEN, N. SOLBERG, L.A. HOGETVEIT, A.C. REITH, A. Norsk Hydro's Institute for Cancer Research, Norwegian Radium Hospit- al, Oslo; Falconbridge Nikkelverk A/S, Kristiansand, Norway I M I

POD1lM SESSIONS 41, JULY 30, 9:00-13:00, AVCINN I/Z 2 3 PAI"IONAL EXPOSURE TO OOC : 0 1 U 11:05 SHIPBUIIDINCrASSOCIA'IED Z1ESOTHE- N-NITROSAMDIES LIONF+ IN C0.AS"TAL VIRGINIA 37 SPIEGELHALDER, B. 31 TAGNON, I. PREUSSMANN, P. BLOT, W.J. DAY,'N.E. MORRIS, L.E. PEACE, B.B. FRAUMENI J F Jr Institut fur Toxicologie und Chemotherapie, Deutsches Krebs- forschungszentrum, Heidelberg, Germany FR , . . . Environmental Epidemiology Branch, National Cancer Institute, Bethes- da MD, U.S.A. I2:40 DISCUSSION 12:10 OOC1PATIONAT. NASAL CARCIIJOGEIQE- SIS AM7NG DfNfISTS? OCCUPATIONAL CARCINOGENESIS (COPIT'D) 10:55 INIERACI'IdN OF NICKEL WITS-I DNA AND CHROMATIN FRCM H[lMAN CELT S 35 GLAZEBROOK, G.A. Dept. of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada 30 ~ UGOLINI, D. 12:20 F1FAL'IH FYT'DCTS OF AN AQCIDEN'I7iL ZARDI, L. DIVINCI, A. 36 FJP06URE TO DIMEItMTE AtID ITS DERIVATIVFS RIALDI, G. SANTI, L. Istituto Scientifico per 10 Studio e la Cura dei Tumorit Istituto di Chimica Industriale, Universita di Genova; Genova, Italy MATOS, E.L. LARRIPA, I. Oncology Institute "Angel H. Roffo," National Academy of Medicine, Buenos Aires, Argentina 12:15 SIC:N RFACTIVITY 'i0 SK-SD, PPD APII) Montreal PQ; Canada 9:10 OBS1ElRICAL TRA(M AS A RISK ' r 362 I1:50 CARCIIJOGQdICITY OF SIJBSTIZLTIED FAC M OF LTIERINE CM IX CAfCINl7~R ILIC, S. BEN= DIAMINfS PAVLOVIC, S. 34 SONTAG, J.M. RISTIC, B. National Bethesda Cancer Institute, MD, U.S.A. KARABASEVIC, M. MIRCETIC, M. 12:00 DISCUSSION STEFANOVIC, D. OPRIC, M. PSA IN ASBESTOS WC)FOQW LANGE, A. SMOLIK, R. GARNCAREK, D. CHMIELARCZYK, W. CIECNANOWSKI, G. Dept. of OccupationaI Diseases, Institute of Internal Diseases, Medical School, Wroclaw, Poland 42. JULY 30, 9:00-ll:00, AVON 3 UTERINE CERVIX: RISK FACTORS & HISTOLOGY CHAIRMAN: N.W. CHOI (I.A.R.C.) CO-CHAIRMAN: G. GEIRSSON (Iceland) SECRETARY: C.P. CRUM (U.S.A.) TSE SSI E I g 9:00 BI t T.UFNCE OF ORAL PO 11:25 DISCUSSION 361 CC6T!'RFICEPTIVES ON 4fiE Il+]CIDENt,~ OF Z4E IN/ASIVE CARCINCX-R, CAR- 11: 40 BIOC3D34ICAL AND It,~LOGICAL CIN24A IN SITU AND DYSPLASIA OF Si)RVEIII.RNCE OF A GR'JUP CF VINYL 33 C2II:URIDE hORKEFS THE CERVIX KOVACIC, J. PAGE, M. DELORME, F. AUDETTE, M. Dept. of Biochemistry, Universite Laval, Quebec PQ; Dept. of Path- ology, Universite de Montreal, KOZUN, M. ANDOLSEK, L. Dept. of Obstetrics & Gynecology, Clinical Center, Ljubljana, Yugoslavia 32

pODIU1 SESSIONS tQ, JULY 30, 9:00-ll:00, AVON 3 UTERINE CERVIX: RISK FACTORS & HISTOLOGY (CONT'D) Institute of Oncology, Kladovo, Yugoslavia 9:20 PREt.IIMI]AM RESULTS OF A PROSPDC- 363 SUCHANEK, A. DOMORASKOVA, E. Dept. of Gynecology, Faculty of Medical Hygiene, Charles Univer- sity; Dept. of Experimental Virology, Institute of Sera and Vaccines; Prague, Czechoslovakia TIVE S'lUDY ON CERVICAL CANCER KANKA, J. VONKA, V. KUTINOVA, L. HAVRANKOVA, A. VACHAL. M. SUBRT, I. JELINEK, J. 9:30 EFFDCP OF AGE W THE DURATION OF CARCINOMA IN SITU AND INVASIVE 364 CERVICAL CANCER PENTTINEN, J. Dept. of Public Health, University of Tampere, Tampere, Finland 9:40 DISCUSSION 9:50 RISK (FOiJPS IN EARLY DEPEC'FION OF 365 UiERINE CERVIX CANCER CHARKVIANI, L.I. CHITIASHVILI, R. Oncology Research Center, Ministry of Health of Georgian S.S.R., TbiIisi, U.S.S.R. 10:00 CY'lOCHffS'IICAL DESCRIPTION C&' 366 CERVICAL NDILICWrY ROY CHOWDHURY, J. LAHIRI, T. Chittaranjan National Cancer Research Centre, Calcutta, India 10:10 DIA(3dO6IS OF CERVICAL CANCE~t BY 367 ME4HYLFM BLUE BAATTACHARYA, N. PAUL, U. DAS, D.P. CHAUDURI, N. BANERJEE, S.K. Dept. of Obstetrics & Gynecology, 10:20 DISCUSSION 10:30 OONk3INATION OF CY1C)IAGY AND 368 COIFOSCOPY IN DIAGA106IS CF CERVICAL INPRWITFffLTAT. NDOPIASIA (CIN) HARAHAPt R.E. Neoplasm Subdivision, Dept. of Obstetrics & Gynecology, School of Medicine, University of Indo- nesia, Jakarta, Indonesia 10:40 HISTOLOGICAL AND STERDDIAGICAL 369 ANALYSIS OF MICROINVASIVE CAR- CINCNFi OF TFE ilPF:F2I'NE CERVIX ERZEN, N. RAINER, S. KALISNIK, M. Dept. of Gynecology, Clinical Center, Ljubljana, Yugoslavia 10:50 DISCUSSION 43, JULY 30, 11:00-13:00, AVON 3 UTERINE CERVIX: MASS SCREENING CHAIRMAN: G. WIED (U.S.A.) CO-CHAIRMAN: S. SJOSTEDT (Sweden) SECRETARY: A. ORTNER (Austria) 11:00 PARPICIPATION IN A SCREINIIJG 373 PROGRAM FUR TF)E DEPDCPION OF CERVICAL CANCER •JANSEN, J:H. KREMERS, W. Study Center of Social Oncology, Rotterdam; Dept. of Sociology, State University of Utrecht, Utrecht; Netherlands 11:10 RDCfTTf RFSULTS OF CERVIX CRNCE~t 374 SCREQIING PROGRAMS IN TAE CEFI-M DIIMOCRATIC REPUBLIC EBELING, K. NEUMANN, H.-G. NEUSER, D. BERNDT, H. HEROLD, H.-J. Academy of Sciences of the German Democratic Republic, Central Institute of Cancer Research, Berlin, Germany DR S S K M Hospital, Calcutta, India

POD1U°1 SESSIONS 43, JULY 30, 11:OU-13:00, AVON 3 12:30 BioPEPR: AN AUICJNIATEI) PRESCFTE1- ING SYS'IISI FOR CERVICAL ShEARS UTERINE CERVIX: MASS SCREENING (CONT'D) 380 ZAHNISER, D.J. 11: 20 EFFI>rC'T OF N41.SS SCREFWIIJG FaR CERVICAL CANC.'ER IN FINLAND 375 9AKAMA, M. OUD, P.S. RAAIJMAKERS, M.C.T. VOOYS, G.P. VAN DE WALLE, R.T. Physics Laboratory; Institute of Finnish Cancer Registry, Helsinki, Finland Pathology; University of Nijmegen, Nijmegen, Netherlands 11:30 DISCUSSION 11:40 SCREENING FOR CANCER OF THE UPERIIZE CERVIX IN ICFSArD 1965-1979 AND THE 376 EI'FDGT ON INCIDE3NCE AND MC1FtTALITSt JOHANNESSON, G. GEIRSSON, G. DAY, N.E. TULINIUS, H. The Cancer Detection Clinic, Icelandic Cancer Society, Reykjavik Iceland 11:50 SCREENING CP CERVICAL CANCER IN 377 ISRAII.I POPUTATION: A PI1frP S2t)DY OF 12,163 h[)rD;N SCHACHTER, A. NERI, A. EDELSTEIN, 2. OVADIA, Y. Gynecological Cytology and Colpo- scopy Unit "Marie Cohen;" Dept. of Obstetrics 6 Gynecology; Beilinson Medical Center, Petah-Tiqva, Israe2 12:00 DISCUSSION 12:10 FRDQUIIJC,'Y (F PAP Shg:AR SCREF3QING 12:40 DISCUSSION 44. JULY 30, 9:00-11:00, SEVERN 1 PREVENTION & DETECTION OF METASTASIS CHAIRMAN: I.J. BURN (U.K.) CO-CHAIRMAN: A.F. MONTORO (Brazil) SECRETARY: R. WYBURN-MASON (U.K.) 9:00 515 9:10 516 AND PREVFNIY+BII,ITY OF INVASIVE 9:20 378 CANCE3t OF THE CERTIX - A OOEIOnP ANALYSIS 517 CHOI, N.W. NELSON, N.A. International Agency for Research on Cancer, Lyon, France; Manitoba Cancer Foundation, Winnipeg Man., Canada 12:20 HISTCE=CAL TYPES ARID CIIVICAL 379 STAGES OF CERVICAL CANCER IN ICELAND BEPbRE AND AFTER 2M ONSET OF N1zs.SS SCRF.F2dING GEIRSSON, G. JOHANNESSON, G. TULINIUS, H. The Icelandic Cancer Society, Reykjavik, Iceland 9:30 518 THE VAIITE OF' Fad0W-UP CHEST X-RAYS IN PATIFNiS WITH CANCER CAHAN, W.G. Memorial Sloan-Kettering Cancer Center, New York NY, U.S.A. SFd2IAL QUANPITATIVE BONE SCAN- NING IN BREAST CANCER PARBHOO, S.P. ALANI, H. AGNEW, J.E. STOLL, B.A. Royal Free Hospital, London, U.K. OCNIRCIQ, OF' THE PRIIKIRY 4SMR AND ITS INFi,UIIJCE ON THE SUBSE- QUFNP INCIDENCE OF ME'PASTASES DISCHE, S. ANDERSON, P. Marie Curie Research Wing, Regional Radiotherapy Center, Mount Vernon Hospital, Northwood, U. K. PREVFNl7ON AND DE4IX,`fION C&' A RELAPSE OF GYNAfl00IlJGICAL CANCFM KALPAKTSOGLOU, P.K. KONDYLI, A.P. IOANNIDOU, G.B. CHRYSSIKOPOULOS, E. COMNINOS, A. CHIOTI, A.S. Immunobiology Research Center,

PODIUrI SESSIONS 44, JULY 30, 9:00-11:00, SEVERN 1 PREVEMT! ON & DETECTION OF METASTASIS ~CONT'DI "Marika Eliadi" Maternity Hospital, Athens, Greece 9:40 519 PROBIFMS ON PREVFNfION CP METAS'I'A- SES IN NON-SfrffNCNMClUS TESTICULJilt T[MRS BY AU7i1VANP CHES10TfIEFtAPY KUHBOCK, J. AIGINGER, P. POTZI. P. 2nd Dept. of Medicine, University of Vienna, Vienna, Austria 9:50 DISCUSSION 10:00 T[-fE ROLE OF LYtV11ADEIZDCICIHII IN 520 CURATIVE SUIbGEFCi' FC1R GASTRIC CANCER JEKIC, M. Surgical Service, Clinical Hospit- al Zemun, Belgrade, Yugoslavia 10:10 ISOIATED LIMB PERFUSION FOR 521 NFILIC?N1AfP MESANQNA CF THE LCXqER LIMB ROSIN, R.D. WESTBURY, G. Dept. of Clinical Oncology, West- minster Hospital, London, U.K. 10:20 T[VOR FIBRIN AS AN ANTIDISSII IIN- ATIVE FACTOR 522 BALITSKY, K.P. SOPOTSINSKAYA, E.B. Institute for Oncology Problems, Academy of Sciences of Ukrainian S.S.R., Kiev, U.S.S.R. 10:30 ANPI'IiHOR ACTIVITY OF BENZAIDEHYDE 523 PARTICULARLY WI'ffl RDGARD 70 BENZAIDEHYDE DERi\TATIVE KOCHI, M. MOCHIZUKI, K. Ichijokai Hospital, Ichikawa, Chiba, Japan 10:40 SIGJIFICANCE OF CIhCUTATING CANCER 524 CEZIS IN CANCEt DETECTION SONG, J. SAMS, J. Dept. of Pathology, Mercy Hospital Medical Center, Des Moines IA, USA 45. JULY 30, 11:00-13:00, SEI/ERN 1 RESPIRATORY TRACT CANCER: PART ONE CHAIRMAN: H. SPENCER (U.K.) CO-CHAIRMAN: C. MOURIQUAND (France) SECRETARY: A.M. STEWARD (Australia) 11:00 THE DEVF.LOfN1QNP OF LUNG CANCER 271 SPENCER, H. Dept. of Morbid Anatomy, St. Thomas's Hospital Medical School, London, U.K. 11:20 DISCUSSION 0 11:30 DIAG406IS CF I17NG W4C1RS 272 SEAL, R.M.E. Dept. of Pathology, Llandough Hospital, Nr. Penarth, Cardiff, U.K. 11:50 DISCUSSION 12:00 THE DIAGNOSIS OF ASBES'IOS RELATED 273 CANCER CORRIN, B. Cardiothoracic Institute, Brompton Hospital, London, 12:20 DISCUSSION U.K. 12:30 TUAfOR NFJOCETS IN THE IdJNG: TIiEIR 274 I1fi9.3NOPEROXIAA.SE IACALISATION HEYDERMAN, E. Dept. of Morbid Anatomy, St. Thomas's Hospital MedicaI School, London, U.K. 12:50 DISCUSSION 46. JULY 30, 9:%-12:45, SEVERN 2 COLO-RECTAL MASS SCREENING & MANAGEMENT CHAIRMAN: A.P. MASKENS (Belgium) CO-CHAIRMAN: A.P. HAINES (U.K.) SECRETARY: M.S. GOTTLIEB (U.S.A.) 10:50 DISCUSSION 9:00 INPIMC'i'ORY REhF{RKS OF CHAIFdW

PODIIH SESSIONS 46, JULY 30, 9:00-12:45, SEVERN 2 CALD-RECTAL MASS SCREENING & M4NAGEMENT (CONT'D) 9:05 SCREENING FOR COIA-1OCPAL 4iMRS: 11:00 PRE-0PERATIVE RADICrI4EPAPY FOR 336 CANCER OF THE RDCM REIS NETO, J.A. QUILICI, F.A. Dept. of Surgery, Pontificia Universidade Catolica de Campinas, Campinas SP, Brasil C7UR 3-YFARS' FXPERIENCE 331 RIBET, A. 11:10 ZFA TRPAZNIFNI' SCHEMES IN COLON ESCOURROU, J. FREXINOS, J. 337 CARCINOhA: A CQhIPARISON OF 5-FU AND 5-FUPIAS AG71n/ANP HYDROLYTIC DELPU, J. Clinique des Maladies de 1'Appareil Digestif, C.H.U. de Rangueil, Toulouse, France ENZYMES WERK, W. WISCHERATH, H. Medical Enzyme Research Institute, Munich-Sauerlach, Germany FR 15 COIANIC EPI7M LA1. AIDDPIASIA AM3NG 9 : . TFE AGED JAPANESE IN JAPAN AND 11:20 N(xJ-SPECIFIC ACTIVE IMMi1N(7IIOvRAPY 332 THEIR RAiCKGFL3i1rID6 FOR CANCER OF THE RDCILM AND COIAN KANAZAWA, K. 338 REIS NETO, J.A. Dept. of Surgery, University of Tsukuba, School of Medicine, Ibaraki, Japan QUILICI, F.A. Dept. of Surgery, Pontificia Universidade Catolica de Campinas, Campinas SP, Brasil 9:25 CONIPARATIVE STUDY OF FND06CXaPIC .333 FINDINGS, HISIOIAGY OF PREOPE.'RATI1lE BIOPSIES AND S'URGICAL SPDCIMENS IN PATIENTS WI48 REChOSI(37QID CARCINONFI CHRISTODOULOPOUTAS, J. DELIDES, G. GEORGOULIS, B. Metaxas Memorial Cancer Center, Piraeus, Greece 9:35 DISCUSSION 9:45 PRECPERATIVE IACAL ASSESSMNi OF' 334 RF7CPAL CARCINCr41: DIGITAL FJCAPIirI- ATION AND OONPUiEtI ZED TOMOGftAPHY CONIPARED NICHOLLS, R.J. DIXON, A.K. YORK MASON, A. KELSEY FRY, I. MORSON, B.C. St. Mark's Nospital, London, U.K. 9:55 SYSTFIMATIC AND PLURiFAG'IORIAL DIACIN06TIC APPROAC1 IN COLO-RDCI7iL 335 7tj/jOU1;S D'JIOORE, P.L. PEYS, P.H. RADEMAKERS, F.E. Dept. of Gastroenterology, Univer- sity of Antwerp, Antwerp, Belgium 11:30 FFF9;,`f OF TPN CN ZUN13R Gtd7WPH AAID 339 SURVIVAL IN ADVANCED OGIAN CANCER NIXON, D.W. MOFFITT, S. LAWSON, D.H. ANSLEY, J. LYNN, M. KUTNER, M. HEYSMFIELD, S. RUDMAN, D. Depts of Medicine, Surgery and Biometry, Emory University School of Medicine, Atlanta GA, U.S.A. 11:40 DISCUSSION 12:00 340 EPID0.400PY IN ASYMP`ibNFiTICS PRLVIOUSLY SUDSITIED 70 ANl'gtIOR RESDCIZON OF COIA-RDClAL CANCER ASTE, B. PUGLIESE, V. NICOLO, G. SANTI, L. Istituto di Oncologia, Universita di Genova, Genova, Italy 12:10 SPdNTANE0US COLC)S'1CMY CANCER: 341 A MaDFd, FOR COLC-REC191L CAACINO- GENESIS WINKLER, R. OTTO, S.F. PFEIFFER, M. DORNER, A.

PODIIIM SESSIONS 46, JULY 30, 9:00-12:45, SEI/ERN 2 15:20 DISCUSSION COLO-RECTAL MASS SCREENING & M4NAGEMENT 15:35 bVAL[ATION OF ANPI-SMJKING (Carr'D) 203 CAMPAIC3dS: IMPLICATIONS FUR ZHE Furm Chirurgische Klinik; Pathologisches Institut; Universitaet Hamburg, Hamburg, Germany FR MILLER, A.B. Epidemiology Unit, National Cancer Snstitute of Canada, University of Toronto, Toronto Ont., Canada 12:20 . . 342 IN TEE GTISMIN'PESTINAL TRACP AND SUBSE []I2TP IM4M STINAJJIATING 15:50 DISCUSSION Q THERAPY Wi'IH A STREPIOCOO~L 16:05 T4iE ImIB OF THE PRIh1AFnt HEALTH VA(JCIIQE CARE TEAM IN CANCER COfTiROL OENR, P. 204 WILKES, E. HAUBECK, H. KUNATH, U. Chirurgische Universitaetsklinik, Bonn, Germany FR Dept. of Community Medicine, Sheffield University, Sheffield, U. K. 12:30 DISCUSSION 47, JULY 30, 14:OU-17:00, MAIN IkL SOCIAL ISSUES IN CANCER CONTROL CHAIRMAN: G. FUELGRAFF (Germany FR) CO-CHAIRMAN: M.M. COPELAND (U.S.A.) SECRETARY: J.S. GOES Jr. (Brazil) 14:00 INPf0DTJCP0R1' RFZ-~ OF CHAIRW 16:20 DISCUSSION 16:35 fl•~1CPIVIIgSS OF CANCER CObTIROL PROGRANS WIED, G. International Academy of Cytol- ogy, University of Chicago, Chicago IL, U.S.A. 16:50 DISCUSSION 48, JULY 30, 14:0L)-17:00, AVON 1/2 CARCINOGENESIS 14:05 PUBLIC HEALTH AND POLITICAL INSPLICATIONS OF PRE'VENPICN AND DETE7CTICN OF CANCER CHAIRMAN: CO-CHAIRMAN: SECRETARY: R.M. HICKS {U.K.) L. SANTI (Italy) M. EMURA (Germany FR) GORI, G. Franklin Institute, Silver Spring MD, U.S.A. 14:00 CANCER IN NUCLEAR TEST PARTICI- 14:20 DISCUSSION 14:35 COST BENEFIT ASSESSMENT Ot' CANCER DE.Tf7CPION 201 HOLLEB, A.I. The American Cancer Societ Inc 41 PANTS: A PRII,IMINARY RSPORT CALDWELL, G.G. Cancer Branch, Chronic Diseases Division, Bureau of Epidemiology, Center for Disease Control, Atlanta GA, U.S.A. ., y, New York NY, U.S.A. 14:10 BREAST CANCER MORTALITY FOLIAWIING 14:50 DISCUSSION 42 Fi.WFOGODPIC IRRADIATION IN A COHOR'P OF ZSIBERCULIOSIS PATIENTS 15:05 I1FORMING TFE PUBLIC AND THE PROFT:SSION VERONESI, U. Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy HOWE, G.R. MILLER, A.B. SHERMAN, G.J. Epidemiology Unit, National Can- cer Institute of Canada, Univer- sity of Toronto, Toronto, Canada TION OF RFJCURREIdP CANCER `IEX EARLY DF

PODItlr9 SESSIONS . 48, JULY 30, 14:OU-U:00, AWN 1!1 15:25 ' 48 CARCINOGENESIS (CONT D) 14:20 WH~M GLAND CARCINOCISff'SIS IN 43 RATS FCIISAWING IRIUtDIATION AND HOFd4ClNE ADMINISTRATION VAN ZWIETEN, M.J.1 HOLLANDER, C.F.1 BROERSE, J.J.2 VAN BEKKUM, D.W.2 llnstitute for Experimental Geront- ology; 2Radiobiological Institute; T N 0, Rijswijk, Netherlands 14:30 DISCUSSION 14:40 SEOORID MLICNANT NUOPIASMS (SM) IN CHIIDRFN IDFNTIPY "HIGH RISK" 44 GP40UPS MEADOWS, A.T. The Late Effects Study Group (LESG) Children's Hospital of Philadel- phia, Philadelphia PA, U.S.A. 14:50 CRYOST2ITIC CM-~`Y AND SFX,'CtID- AF{Y MLSQ+ANCIES 45 GERHARTZ, H. GERHARTZ, D. Dept. of Hematology and Oncology, Klinikum Westend, Free University of Berlin, Berlin, Germany FR 25:00 DISCUSSION 15:05 EVAIIIA'FIOtd OF MIEPIC RISK AAID DNA 46 DANAGE EFFBCPS ITIDUCED BY NMPJ, NCNA AM NIRROCHIr0RMFTTZENES CESARONE, C.F. BOLOGNESI, C. SANTI, L. Institute of Oncology, University of Genoa, Genoa, Italy 15:15 ON Ziffi CARCINDGF3JICITY OF THE 47 N-NITRO6Ah1INE5 FORt-M DURING NITfbOSATION OF SPERDffDINE IN SYRIAN ODIDEN HAMSTERS LAVOIE, E. RIVENSON, A. BEDENKO, V. OHMORI, T. HOFFMANN, D. American Health Foundation, Naylor Dana Institute for Disease Preven- tion, Valhalla NY, U.S.A. A ISGF1'f AND EIIICl'RON MICI4OSOOPIC S4UDY OF LIVER AND II1NG 4LMR.S IId)[1vED BY A SINGIE IAW DOSE OF DIE'IIiYINITROSAP>alE (DEN) IN NIICE RIJHSINCHANI, K. ABRAHAMS, C. KRAKOWER, C. ShERDLOW, M. RAO, K.V.N. Michael Reese Hospital; Univer- sity of Chicago; Chicago IL, U.S.A. 15:35 DISCUSSION 15:45 SENSITIVITY OF SYRIAN ODIDFN 49 HAri5Tk32 FEPAL II1NG CELiS TD BENZO(A)PYA[M IN VITRO EMURA, M. RICHTER-REICHHELM, H.-B. SCHNEIDER, P. MOHR, U. Abt. fur experimentelle Path- ologie, Medizinische Hochschule Hannover, Hannover, Germany FR 15:55 PREVIITPION OF CANCER DE<IEWPMEdf 50 hTIfl SE^IISYNTEtESIZED ACID POI,Y- SApQiARIDE (ZGDS) IN ARTIFICIAL SKIN CANCER IrIDUCED BY N-ME'I4iYir N' -NITRD-N-NI'I'R'JSOQFiNIDINE (rTLNG) IN MOUSE FUKUSHI, K.1 OHKAWA, K.2 KATO, S.2 KAk71DA, A.2 SAGAWA, Y.2 1Dept. of Pathology; 2Dept. of Obstetrics & Gynecology; Nippon Medical School, Tokyo, Japan 16: 05 MfBRANIE ACTIVE CCMC(1NDS AS 51 ANPI-SCE-IDIDUCEFS: IN VIVO AND IN VITRO RESULTS WITH N-ME'IHYL, N-BII'IROSOLTREA "YJ) STAHL, K.-W.1 CHENG, S.-J.2 BAYER, U.2 CHOUROULINKOV, 7.2 llnstitut de Cancerologie et d'Irmnunogenetique, INSERM; 27nstitut de Recherches Scien- tifiques sur le Cancer, CNRS; Villejuif, France 16:15 DISCUSSION I

PODILT'I SESSIONS 48, JULY 30, 14:00-11:00, AVON 1/2 14:15 STUDY OF' PRIOR BIOPSIES OF CARCINOGENESIS (CONVD) E NfE R AL CANCER PATIENIS 388 AND CODTII2DIS ORTNER, A. MIKUZ, G. 16:25 A NEW CAFCIIJOCESI ASSAY USING HCkD1N JERABEK, R. CFLIS ON A SOLID SUPPORT Universitaets-Frauenklinik; AUDETTE, M. Pathologisch-Anatomisches PAGE, M. Institut der Universitaet Dept. of Biochemistry, Faculty of Innsbruck, Innsbruck, Austria Medicine, Universite Lava1; Research Center, Hotel Dieu 14:25 1HE DIAQJ06IS OF ETIDCWI'RIAL Nospital; Quebec PQ, Canada ABNORMAi.ITIFS BY A SIMPIE C'Y'it?- 389 LOGIC OFFICE PROCEDURE 16:35 TRANSFORNATION OF UNUSUALLY STABLE SCHACHTER, A.1 DIPLOID CELi.S AND F.ltTRAPOIATION BECKERMAN, A.2 53 FCR PR7NSIIOR AND CARCINOCEMSIS EDEISTEIN, 2.1 TFST BAHARY, C.2 NATANAKA, M. 1Gynecological Cytologic & Col- National Cancer Institute, poscopy Unit "Marie Cohen;" Bethesda MD, U.S.A. 3Dept~ of Obstetrics 6 Gynecol- ogy; Beilinson Medical Center, 16:45 A SYS`!EM FOR SIMULTANEOUS ASSAY Tel Aviv University Sackler OF 47tANSFOR!MATION AND I`f1iATI0N School of Medicine, Tel Aviv, 112 ITIDUCED BY CtRSIICAL ANII) PHYSICAL Israel CAFCINOGEtZS KAKUNAGA, T. 14:35 MINIATUF~E PAN-FMD--MICR06CqPE CROW, J.D. (COIBChIICRO6COPE, HYS4ER01MIICIY.?- AUGL, C. 390 SOOPE, IAPARCriffCFtCl6C0PE) FOR National Cancer Institute, EARLY DEPt7CPION C&' CANCER Bethesda MD, U.S.A. OHKAWA, K. K 16:55 DISCUSSION AWA, R. OH Dept. of Obstetrics & Gynecology, Nippon Medical School, Tokyo, Japan 14:45 DISCUSSION 15:05 OONSTITUfI014AL FA{•TORS AND 49, JULY 30, 14:04-17:00, AVON 3 391 IIIDCV2TRiAL CARCINOhYI RISTIC, B. ILIC S FEMALE GENITAL TRACT CANCER , . PAVLOVIC, S. MIRCETIC M CHAIRMAN: A. CANONICO (Argentina) CO-CHAIRMAN: J. JORDAN (U.K.) SECRETARY: B. RISTIC (Yugoslavia) . , KARABASEVIC, M. OPRIC, M. STEFANOVIC, D. Institute of Oncology, Kladovo, Yugoslavia 14:00 INPfmDUC,`!ORY F"1ARKS OF CHAITAAN 14:05 DEIAYS IN DIAQd06IS AND STAGE CF 387 I5:15 IMPAIRED GL[IOOISE METAF30LISM Ata) CHld3GESS OF THE liELATED HORMOtMS DISEASE IN GYNECOLOGIC CANCF.R 392 IN ENDOMETRIAL CANCER FRUCHTER, R.G. BOYCE, J. SUNY Downstate Medical Center, Brooklyn NY, U.S.A. KUZUYA, K. ARIYOSHI, Y. Aichi Cancer Center Hospital, Nagoya, Japan

PODII1'1 SESSIONS 49. JULY 30, 14:00-17:00, AWN 3 FFT9AI..E GENITAL TRACT CANCER (CqNT'D) 50. JULY 30, 14:00-17:00, SEVERN 1 RESPIRATORY TRACT CANCER: PART TNC) 15:25 DISCUSSION AND TEA BREAK 16:00 RESUL4`S OF RE7GIStIa' AtII) FC))Li0+-UP CHAIRMAN: W.G. CANAN (U.S.A.) CO-CHAIRMAN: M. NASIELL (Sweden) SECRETARY: Ch. SORS (France) 393 SYSTFM C1f' HY[ATIDIF'ORNI MDLE KATOH, T. 14:00 SDQIIAR CtiANGES IN ItiNG CANMR ENDON, N. KOBAYASHI, 0. 275 EPIOIAGY: OC7GiTPATION, PIFIJRAL PIAQm, AND SmKIIQG, 1964-1979 TAKAMIZAWA, H. Chiba University School of Medi- cine, Chiba, Japan NILLERDAL, G. Institute of Pulmonary Medicine, University Hospital, Uppsala, Sweden 16:10 INZYMISTl7CHMCAL SRUDY C1N THE 394 GEMTIONAL CHORIOCARCINOM MIURA, S. SEKINE, T. KOMURO, N. SEKINO, S. OHSONE, S. ITO, H. Dept. of Obstetrics 6 Gynecology, The Jikei University School of Medicine. Tokyo, Japan 14:10 CARCINCt'!AS OF THE IxJNG: AN oOQJPA- 276 TIONAL DISTRIBUPION IN M GE2ERAL POPULAZ'ION OF THE RHMEALPES AREA MOURIQUAND, J. MOURIQUAND, C. MERMET, M.A. DUTET, M.L. Laboratoire de Cytologie, Centre Hospitalier Regional, Grenoble, France 16:20 DIACI405'PIC VATIJE (&' TOPICAL 14:20 LUNG CANCIR DETEX.`!'ION S4UDY IN 5-FIAOFYJURACIL IN PREINVASIVE CZECHOSIOVAKIA (PFELIMIIFM REPORT) 395 WI,VAR CAFCIN lI IIl BIANO, G. DONAHUE, V.C. Sidney Farber Cancer Institute; Boston Hospital for Women; Boston MA U S A 277 KUBIK, A. POLAK, J. Institute of Tuberculosis and Respiratory Diseases, Prague, Czechoslovakia , . . . 16:30 IATE FFFI7CPS OF RADIATION THERAPY OF TEE UPERINE CERVIX 14:30 DISCUSSION 14:40 NA7[JRAL HISIbRY OF Ix1NG CANCER: 396 ZIPPIN, C. OCYvfPi= SIhATLATION FXPIAIIIS DATA LUM, D. 278 CF'NEW YORK EARLY LUNG CANCER KOHN, H.I. DE7PECTION P%)GRAM BAILAR, J.C. III University of California, San Fran- cisco CA; Shields Warren Radiobio- logicaI Laboratory, Boston MA; National Cancer Institute, Bethesda MD; U.S.A. FLEHINGER, B.J. MELAMED, M.R. SMART, J.S. ZAMAN, M.B. TUCKER, E.R. MARTINI, N. IBM T.J. Watson Research Center, 16:40 DISCUSSION Yorktown Heights NY; Memorial Sloan-Kettering Cancer Center, New York NY; U.S.A.

pWIW SESSIONS go, ,LI.,Y 30, 14:OU-17:00, SEVERN 1 16:10 FIEa{IBIE FIBFR7PTIC BMJQK6C:py IN 24E DIAGTJO6IS Cf' iFE Pi,Tmz,,qy ANCFR: PART TWO 288 OCtdPLICA7ZCNS CE• L122HQSA SPIv TORY 7RACT C ~,~ D) CHUANG, M.T. GRIBETZ, A.R. J I f SO IAt.l.JNJIACICAL DIAGN066TIC PFYICFDURFS 3N UgpplR•f bIQIFRS WPPH L[7NG CANGk32 TEIRSTEIN, A.S. BERMAN, L.B. Pulmonary Medicine Div., Mt. S.nai 279 ANDRLIKOVA, J. Medical Center, New York hY, U.S.A. KUDRNA, K. STIPL, Z. 16: 20 CYZUUDGIC RFSPIRATCM CFgt'Js ^ SMID, A. 286 IN WORKERS FXP06ID 4p AIIZ POLdd1rION 5,00 PALEK, V. Research Dept., Health Institute of the Uranium Industry, Pribram, Czechoslovakia EXPUSM 70 BENZF3NE AND RADIATION: VETRANI, A. PALOMBINI, L. DEL BASSO DE CARO, M.L. MARINO, N. Cytology Laboratory, Institute 280 RISK OF I1JNG 7MOJRS IN SWISS MICE GOTNOSKAR, S.V. of Pathologic Anatony, II Fa_^u1_ ty of Medicine and Surgery, Cancer Research Institute, Bombay, India University of Naples, Naples, Italy 15:10 DISCUSSION 16:30 REIJABILITY OF PFROLTIP."BXJCRS 1 S: 20 SmDKING AI ID HISTOIAGY OF BIdONCiO- 287 NEEDLE ASPIRATION BIOPSY FOR DII1C3d06IS OF BRONCHO=C GSIIC CAWINOM CARCINOMA, 281 DONTAS, N. JAMIESON, W.R.E. RAPTIS, C. KAKAVAS, Chr. HICKEN, P. SUEN, K.C. Dept. of Thoracic Surgery, Greek Anti-Cancer Institute, Athens, Greece BURR, L.N. MUNRO, A.I. Vancouver General Hospital, Vancouver BC, Canada 15:30 D 282 PFOIEIN ANPIGE3d: ITS SEPARATION BY HI(1•I PRESSURE ISQUID CHIMIU- 16:40 DISCUSSION CPAPHY AND RELATION TO LONG CAFCINOGENESIS STEWARD, A.M. 51. JULY 30, 14:00-11:00, SE1iE:M 2 MISCONI, L.Y. Dept. of Surgery, University of Melbourne; De t of Chemistry Iff"OPREVEKTION p . , Swinburne College of Technology, Hawthorn, Victoria; Lung Cancer Research Center, Morwell, Victoria; Australia CHAIRMAN: E.M. GREENSPAS (U.S.A.) CO-CHAIRMAN: K. BAGSHAWE (U.K.) SECRETARY: P.K. KALPAKTSOGLOU (Greec,-) 15:40 DISCUSSION AND TEA BREAK 14:00 IS PRF.VIO(IS HEALED RW A pAC'x 16:00 PFYJCI)06lZC FACIORSr IN I1M CANCER 503 IN IfJNG Tf RM CODTPRdL OR CU,ctE CF SOLID CANCERS BY CHEM7TF.c"P',.,pr, 284 STOLOFF, I.L. KANOFSKY, P. GREENSPAN, E.M. COHEN, S.M. BROISSIER, K. Jefferson Medical College, Phila- delphia PA, U.S.A. Division of Oncology, Y.t. Sir.z: School of Medicine, Fev York F!, U.S.A. v w r ELAYED HYPERSIIJSITIVITY TOBACCO ..

PODIIM SESSIONS 51. JULY 30, 14:OU-17:00, SEVERN 2 IMIRVOPREYFNTION (COKT'D) 14:10 SCY3E P1iUSPECIS ON CANCER IMMUNC)- 504 PREVEN1ZON REFIECPID F'fYINf IANG TEFdM FOLLiOW-UP RESULTS IN ADJANCM CANCER TREATED 4TI'!4i S.S.M. (AN E?{1R)= FfOM 1UMAN T(7BERCULE BACILIS) FUJITA, K. HIRAI, T. MARUYAMA, C. The Research Institute of Vaccine Therapy for Tumors and Infectious Diseases, Nippon Medical School, Tokyo, Japan 14:20 OOMPIFXNP SYSTFIM OF CANCER 505 PATIFNIS AS RESISTANCE AGAINST CANCER OHKAWA, R. OHKAWA, K. Dept. of Obstetrics 6 Gynecology, Nippon Medical School, Tokyo, Japan 14:30 DISCUSSION 14:40 IN14RNOTkIERAPY AND IMMUNOPREVfNFION OF SOME EXPFRIMENTAL T(MORS WI'I41 506 LIVING S2CII:RIA LUPU, A. CORNECI. I. OncoIogical Institute, Bucharest, Romania 14: 50 INCREASE IN TUWR ITMUNOGEIJICITY UPON MEMBRANE IuGIDIFICATION 507 SKORNICK, Y. RARAN-GNERA, N. SRINIT2KY, M. The Weizmann Institute of Science, Rehovot, Israel 15:00 IAGIC RESTORATION OF 508 EARLY IM-7UNE DEFICIENCIES IN FXPERIMENPAL CANCER COSTACHEL, O. '1CITULESCU, I. Oncological Institute, Bucharest, Romania 15:10 DISCUSSION AND TEA BREAK 16:00 ABUIIf TFE P06SIBILITY OF PREUfNf- 509 ION OF CANCER DMEIAPNSEnIN P AND REGLiRRENCE BY ACTIVATION OF ALTEF4<WTIVE PATH4RY OF CXTh1PI,fhffNl' OHKAWA, R. OHKAWA, K. Dept. of Obstetrics 6 Gynecology, Nippon Medical School, Tokyo, Japan 16:10 M3DUTATION OF TEE IMhA7I1E RESPCkNSE: 510 POTENTIAL CANXR PREVFNI'ION DFd1GS Dept. of Chemo-hmnunotherapy; Laboratoire d'Irmnunopharmacologie des Tumeursj FRA-INSERM p46j ERA- CNRS 1/844; C.R.L.C. Montpellier, France SERROU, B. CUPISSOL, D. 16 : 20 IMMYINOI OGY AND IbT4JNOIAGICAL 511 AU7WANIS IN CANCEt RESEARCIi AADLEY, R.G. R.G. HadIey Research Foundation, Washington DC, U.S.A. 16:30 VISCERAL RF1E[M70ID LESI011S AS PREMALIGNANP CCNDITIONS: MODE OF 512 PRE VFNPION WYBURN MASON, R. Christ's College, Cambridge, U.K. 16:40 DISCUSSION

f a pOSTER SESSIONS JULY 27 CONCOURSE JULY 28 JULY 27 CONCOURSE JULY 28 13 : 00-13 : 30 10 : 3a-11: 00 13:00-13:30 10:30-11:00 16 : 45-17 :15 15 : 30-16 : 00 16 : 4r17 :15 15 : 30-16 : 0D 52. SOCIAL RESEARCH & PUBLIC EIXICATION 1. THE USE OF HYPNOLAGY TO CURB 7. {diAT THE PUBLIC IQUVE ABOUP CANCER: 213 6hYORIAIG RINGROSE, C.A.D. 218 A S'ILiDY OF 1,020 QUESTIONS IN I1Eb1S- PAPFRS . Hypnotherapy Institute, Edmonton, Alberta, Canada ANPI-3MDKIIJG CAMPAIQI IN GREEK OSTOJIC, M. Institute of Oncology & Radiology, Belgrade, Yugoslavia 9CTIOOL CHIIDRIIN 8. CANCER SCRE:ENING CAN BE A II'ARNING 283 DONTAS, N.S. EXPERIR4CE: DEI'1X,TION OF CANm B[7T Hellenic Cancer Society, Athens, 219 ALSO INF'0RMTION AAID IDUCATION CF 3. Greece DELAY OF HOSPITATi<ZATION ADID IACUS THE PUBLIC VAN PARIJS, L.G.1 VANDENBROUCKE-VAN DER WIELEN, A.2 214 OF CONIROL AMJNG SURGICAL CANCER PATIFNIS 1Centre d'Information pour I'Educa- tion a la Sante; 2Service de Depis- ~ *1 MIZUGUCNI, T. NAKAZATO, K. tage Precoce du Cancer, Universite de Louvain; Bruxelles, Belgium . 1 . National Cancer Center Hospital; Tokyo Metropolitan Institute of Gerontology; Tokyo, Japan PSYCI-IOTFffItAPY OF 1 WJOR ILLNESS 3. ARCINOGENESIS r 215 USING AUDIO CASSF,TI'ES FOR PLEASURE RFSPONSE EIFLER, 2. 9. EMJCT OF Ii'JW DOSFS OF IRRADIATION © . Private Practice, Frankfurt/Main, Germany FR THE IMPORTANCE IN CHFIIJGE CF 54 ON THE T CELL CYTOTOXIC RfSPCNSE TO TLMC)P. CROFTIH GERBER, M. DUBOIS, J.B. 216 BIIHl\7IOR OF TFM POPUTATION ABCXTT CANCER PIOCH, Y. SERROU, B. PAVLOVIC, P. Institute of Radiotherapy 6 Onco1- ogy, Faculty of Medicine, Univer- sity of Rijeka Clinical Hospital 0. INSERM FRA N46; CPL; Cliniques St. Eloi; MontpeIlier, France SCRSENING FOR RADIATION-IbIDtKED "Brothers Dr. Sobol," Rijeka, Yugoslavia 55 HFAD AND NIDCK TCtDRS DAAL, W.A.J. van 6. THE ROIE Ct' PHYSICIAN FxIE[IDYRS IN GOSLINGS, B.M. NERMANS, J. 217 TFE PRfVENPION, DEPE7CTION, AND RUITER, D.J. PATIENT RIIiABIISTATION C&' IIDCIPIAS- TIC DISFASE IN PRIIPIa' CARE SEITIIICS ROUSH, R.E. THOMSON, W.A. Baylor College of Medicine, Houston TX, U.S.A. SEPMEIJER, Chr. F. VINK, M. VLOTEN, W.A. van University Hospital, Leiden, Netherlands I ® c

53. 12. 57 13. 58 9{. 19. 38 15. 39 POSTER SESSIONS JULY 27 CONCOURSE JULY 28 JULY 27 CONC;OURSE JULY 28 13:00-13:30 10:30-11:00 13:00-13:30 10:30-11:00 -16:45-17:15 15:30-16:03 16:45-17:15 15:30-16:00 ENESIS 54 T ONAL CARCINOGENESIS QCCUPA ~n PRINFsRSt CtD30IJIC INPFRSTITIAL NEPHRCY- PAYHIFS (E3IDFtIIC BAiM IIEPHROPAItIY, PHUQwMTIN 1QEP[RDPA'IHY AND O'I4FMS) FOIdlJ4ED BY URINAFd' TRACP CANCER: A CCMP'ARAZ`IVE MDRPHOIAGICAL AND F?PER- . 6. ,D (CONT i Institute of Pharmacology, Centro di Medicina Sociale della Provin- cia, Firenze, Italy NA.SAL SINUS TMYJURS, WOOD FOTO6URS IMENPAI, S7UDY WITH SPECIAL REFERENCE TO ETIOhOGY AND PA4HOGt3NESIS 40 AND SMKRJG ELWOOD, J.M. MARKOVIC, B. Medical Centre, Gnjilane, Yugoslavia 4LMR GROh'Ifl INHIBITION BY C.ATCIZnNIN DELBRUCK, H.1 ANGHILERI, L.2 5. Cancer Control Agency of British Columbia, Vancouver BC, Canada ftdJOLOGY AND VIROLOGY IMedizinische Universitatsklinik, Homburg, Germany FR; 2Orsay, France 17. I.SO~C FOC'USING (IEF) CF A CANCER: CAUSATION, REOCIGNITION AND TRm1S43dT 99 SPF]CIFIC ANTICEJ Itd)UCE) BY HERPES SIMPIEX VIFOIS (HLSU) IN IINF`E7CiED HOLT, J.A.G. Centre for Radiotherapy & Oncology, Wembley WA, Australia CCUPATIONAL CARCINOGENESIS Ix1NG CANCER MORTAT,ITY IN FARiM~S EMPIUYED IN CIYCMTE PICMESTP FACTORIES. A M.iltiCnritric Central . CELiS FLAMINO, G. RANDAZZO, G. GARZILLO, A.M. D'ALESSANDRO, G. HASCOLO, A. CAPEZUTTO, G. GARGIULO, G. D.E.P.A. Research Center, Arzanoj Dept. of Organic Chemistry, Uni-r versity of Naples, NaplesJ Italy PURIFICATION AND CHARACIF,I2IZATION European Epidemiological Stuc9y FRENTZEL-BEYME, R. 100 OF TYPE 2}ERPES SIMPLEX VIRU,S ZUMX7R AS.SOCIATID ANTIGESI (HSV-TAA) Institut fur Dokumentation, Inform- ation u. Statistik, Abt. Epidemiolo- gie, Deutsches Krebsforschungszent- rum, Heidelberg, Germany FR IIRI2F+1bC M(JPAGR1S AND MCNOQXIGE3NASE ACTTVITY IN CHFSSICAL WbRIWS MAZZOLI,_ S. LODOVICI, M. BUTATTI, E. DOL1lRA, P. BACCETTI, S. TURCHI, A. FLAMINO, G. TARRO, G. PAPA, G. MARESCA, M. DONNARUMMA, M.P. BONITO OLIVA, G. FOSTER, W. D.E.P.A. Research Center, Arzano; Ist Dept. OncoIogic virology, Uni- versity of Naples, Naples, Italy

POSTER SESSIONS JULY 27 OONNCOURSE JULY 28 JULY 27 CONOOURSE JULY 28 13:00-13:30 10:3o-11:00 13:00-13:30 10:30-11:00 16:45-17:15 15:30-16:00 16:45-17:15 15:30-16:00 55. tcoD)~r 58- HEAD AM NECK CANCER 19. ACTIVITIFS RII.ATED 70 MAKqJJAN RKA 23. A SZLJDY OF CANCF72 CE' 1M HEAD 101 Til57C.1R VIRUSES IN PURIFIED PREPARA- TIOIIS OF IWZLTIIIZA VIFd1SES GRCF?N IN 266 AND Ik)CK HERITY, B. EMBRYONATED DOGS ARIDA, E.N. Laboratory of Viruses and Tissue Cultures, National Research Center, Dokki, Cairo, Egypt 4. MORIARITY, M. DALY, L. BOURKE, G.J. University College; St. Luke's Hospital; Dublin, Ireland 4NYTOID OOCUR,T CARCINCYMA: CiSNIOO- 267 PATk1OLl.lGICAL STUDIES AND OPfItAT1VE 1.~IJr 56. IM'IJNOPREVENTION DI MATTEO, G. 20. OXYGQN NAJLTISiEP Tl{I72APY AS A LUCCI, S. Surgical Clinic V, School of Medicine, University of Rome, 513 MEASURE FOR IMPROJING W1UNOUOGIC PARMEZ'ERS AND PREUf3QPION OF CANCER Rome, Italy IN hYSN 25. HOW M[K'H 70 RESECT IN CASE OF ARDENNE, M. von KRUGER, W. 268 DIFTERENfIATID THYILOID CAFCINOhg1 KOKOSCHKA, R. 1. Research Institute Manfred von Ardenne, Dresden, Germany DR HEAVY AROONIDES PREVFNf AAII) TREAT NIEDERLE, B. KRISCH, K. Dept. of Surgery I; Dept. of Pathology; University of Vienna, 514 CANCER IONESCO-PANTELIMON, D. Vienna, Austria Oncologica7 institute, Bucharest, 26. SCME OBSERJATIONS ON THE ULTRA- Romania 269 ST1Q)GZUftE OF BENIGN TI1MDUR5 OF T[IE PAFOTID CQAM 7. REVENTION OF METASTASES SZENDE, B. TIMAR, J. LAPIS, K. Institute of Pathology & Experi- 22. ANPI'1[AlOUR ACPIVITY AND METASTA.SIS- mental Cancer Research I, Semmel- weis Medica2 University, Budapest Hungary 52 5 PF2IUFSTfING EFFECT OF HIG'III,Y PURIFIED SQ[k1IENE 27. EVALUATION OF HIS7aAGIC CFlANG1;5 IKEKAWA, T.1 UMEJI, M.1 270 IN IARYNGAI. MK)0.SA IN MIGMNr GFtOt+llH MIZUNUMA, H.2 IKEKAWA, N.3 TANAKA, S.4 OHKUMA, T.4 1National Cancer Centre Research Institute; 2Tokyo Hospital of Japan Monopoly Corf.; 3xokyo Institute of Technology: Nokushin General Hos- pital; Tokyo, Japan KAMBIC, V. RADSEL, Z. GALE, N. E N T Dept., Institute of Path- ology, University of Medicine, Ljubljana, Yugoslavia

POSTER SESSIONS JULY 27 00NCOURSE ,X1LY 28 JULY 27 00(d00URSE JULY 28 13 : 00-13 : 30 10 : 30-11: 00 13 : 00-13 : 30 10 : 30-11: 00 16 : 45-17 :15 15 : 30-16 : 00 16 : 45-17 :15 15 : 30-16 : 00 59. GASTRIC, PANCREAS, COLON 60. FEMALE GENITAL TRACT: (CONT~D) UTERINE CERVIX, EtmOMETRIIM, OVARY 28. EPIDOSC,IOPIC BORDERL'INE PA'ITE32NS IN GASTRIC CANCER 33. E.VAIl1ATI0N OF MASS SCREF3TTNG FOR FARiy DE=ION OF CERVICAL CAIJCFit 307 PASCU, O. DRAGHICI, A. DUMITRASCU, D. 3rd Medical Clinic, Institute of Medicine & Pharmacy, Cluj-Napoca, Romania 245 NEUSER, D. BERNDT, H. EBELING, K. Zentrallabors im Pathologischen gnstitut des Stadt, Krankenhauses im Friedrichshain, Berlin, Germany FR 29. If1E DIAhT]06IS OF RFSFX,'I'Affil; PANCREATIC CANCFR 34. MRJIA7URE PAN-FTIDO-MCRLSCOPE AND 308 MOOSSA, A.R. ITS CLJNICAL USE FOR EARI,Y BOWIE, J. LU, C.T. Depts of Surgery and Radiology, University of Chicago, Chicago IL, U.S.A. 372 DEZ)C'PION OF CANGER OHKAWA, K. OHKAWA, R.• AOKI, T. Dept. of Obstetrics 6 Gynecology, Nippon Medical School, Tokyo, 30. EFFECT OF FAFICCAL STRE.AM GN EXPF12I- NlF31TAId.Y IAIDUCED CARCINOMAS Japan 344 SCURR, J.H. FILIPE, I. 35. ESTROCENS P%IDUCP- ION IN POSZ`NIESIOPAUSAL WOth?1 FTITH ELLIS, H. Westminster Medical School, London, U. K. 397 AND WI4Ha(lF EA1flOWTRIAL CANCER: CCt4PARISCN BElW0SI IN VITRO AND IN VIVO RESULTS JASONNI, V.M. LODI, S. PRETI, S. BONAVIA, M. 60, FEMALE GENITAL TRACT: UTERINE CERVIX, ENDOMETRIUM, OVARY LESI, G. BOLELLI, G. FLAMIGNI, C. 31. EARLY SEXUAL LIFE AS AN IIM,COtPIAL FACDDR FOR HIGH INCIDIIJCE CF Fisiopatologia della Riproduzione, Clinica Ostetrico-GinecoIogica, 370 CERSTICAL CAFCINOtA STEFANOVIC, D. ILIC, S. PAVLOVIC, S. 36. Bologna, Italy APPLICABILITY CF PISTOI£f ASPIRAT- ION, JET VASH AND VABRA CUREITACE KRABASEVIC, M. Oncological Institute, Belgrade, Yugoslavia 398 FOR ENDOMPIRIAL SCREFIJING IN P06T- NMETIOPAUSAL A.SYNIP'DOtWIC WOMEN VUOPALA, S. KAUPPILA, A. 32. FIRST RESULTS CF A 15-YFAR'FOiSA4d-UP OF HIGH RISK WCI4tN INQJUDE'D IN A MIKKONEN, M. STENBACK, F. 371 CERVICAL PREVEITPION PImCRAM REMOTTI, G.1 GARSIA, S.1 GALLUS, G.2 lObstetrical & Gynecological Clinic; 2Biometry & Medical Statistics Ins- titute, University of Milan; Italy KIVINEN, S. Dept. of Obstetrics & Gynecology; Dept. of Pathological Anatomy; University of Oulu, Oulu, Finland (T Q J W 41 P

:SI ONS ~ I PpSM SESSIONS JULY 27 CONCOURSE JULY 28 JULY 27 CONODUEiSE JULY 28 l 13:00-13:30 10:30-11:00 13 : 00-13 : 30 10 : 30-11: 00 ) 16 : 45-17 :15 15 : 30-16 : 00 16 : 45-11:15 15 : 30-16 : 00 sn Ises AND 'y. N ]i r 60. FUNF GENITAL TRACT: (CONT'D) 61. PROBLEMS OF CANCER DETECTION AND 37. UTERINE CERVIX, ENDOi^1ETRIn OVARY CyTY}-gISIt7I1JGICAL ORSfTW7TIONS OF 41. PREVENTION IN DEVELOPING COIRNTRIES A S'IU17Y ON CLINICAL ASPF7C.R5 (1F' 399 RIDpN1EIRIAL ADEIJOCWINCMg1 BEFORE AND AFTER TREF+II'g'NP WIT4i 6-14EiNYIr- 124 ORAL CANCER IN SRI IANKA, WARNAKULASURIYA, K.A.A.S. 17-HYDFbOXY ACETA4E PFOGES'1EWW VECCNIETTI, G. GERZELI, G. ZANO7O, L. NOVELLI, G. 2. Division of Ora1 Medicine, University Medical School, Peradeniya, Sri Lanka ESOPIiAGUS CANCERS IN Z[JR1Cr,Y BARNI, S. MARTINELLI, A. 125 AKOGUZ, H.K. Dept. of Surgery, Oncology Hospital Dept. of Obstetrics & Gynecology, University of Verona, Verona; Center for Study of Histochemistry, 43. of Ankara, Ankara, Turkey MF.RIF3JCE WI7H R1m KUmIT CNR, University of Pavia, Pavia; Italy 126 POPUI,ATION BASFD CANCER REGISlW: 1974-1978 38. EP71>13MIIOIAGIC SIUDY OF WARIAN OMAR, Y.T. Al-Sabah Hospital, Ministry of 400 CRNCER DE OLIVEIRA, C.F. Public Health, Kuwait AMARAL, N. 44. CANCER INCIDIIXE FOR CHIIDRFN FERREIRA, M. Servico de Ginecologia, Hospital da 544 UNDER 15 YfARS Cf' AGE IN IENGRAZI DURING 1977 39. Universidade, Coirnbra, Portugal OlAR7AN CYSTS ATID 14r1SSFS: DIARJ06IS ABUDEJAJA, A. MALHOTRA, S.L. AMAN ULLAH KHAN, M. 401 USING FINE NEEDLE ASPIRATION RAMZY, I. University of Garyounis, Benghazi, Libya 0. MARTINEZ, S. SCKANTZ, H.D. The University of Texas Health Science Center, San Antonio TX, U.S.A. PELVISOOPY, DDOCYTOSOOPY AND 402 ASPIRATION CY1C)IAGY IN OVARIAN NE7GPIASM SIMIC, S. HUTERER, D. BUKVIC, I. GMAZ, Z. SIMIC, O. K2inika za Ginekologiju i As*user- stvo, Sarajevo, Yugoslavia t

POSTER SESSIONS JULY 29 OONOOURSE JULY 30 10:30-11:00 15:30-16:00 AACKYARD CITRi1S AVAnABIISTY AAID U(AER INCIDENCE OF IA%M BOWL CANCER LYKO, B.C. HARTMANN, J.X. Dept. of Biological Sciences, Florida Atlantic University, Boca Raton FL, U.S.A. INFLUEJCE (E' DIFTAFCY SELIIdIUbl ON THE HEPATIC AND PUIM)NAitY ENZYMES IN POLYC~BIJROBIPFiENYIS (PCB) -fiREATED RATS CHOW, C.K. GAIROLdI, C. Dept. of Nutrition & Food Sciences, University of Kentucky, Lexington KY, U.S.A. DIET AND CANCER RISK IN HAWAII KOLONEL, L.N. HANKIN, J.H. CHU, S.Y. LEE, J. NOMURA, A.M. Cancer Center of Hawaii, University of Hawaii, Honolulu HI, U.S.A. TW "FfCT FC)OT" SIQI WITi REI%JPERI- TOt~'.AL BIDOPIASTIC DISEASE EVANS, R.J. Toronto General Hospitall Princess Margaret Hospital; Toronto Ont., Canada BIOPTIC DEPECI'ION AND EHARACTERIZA- TICRJ C&' CARCINQMA.T0I1S OSZDJDYSPIASIA BURKHARDT, R.12 FRISCH, B.3 BIENSACK, 7.2 KETTNER, G.2 SOMMERFELD, W.2 lAbt. f. Knochenrnarksdiagnostik, JULY 29 OONOOURSE JULY 30 10:30-11:00 15:30-16:00 63, SYSTEMI MANIFESTATIONS ~CONT~D~ Nedizinische Klinik Innenstadt der Universitaet; 2Abt. f. Haematomor- phologie der Ges.f.Strahlen- u. Umweltforschung mgH; Munich, • Germany FR; 3Tel-Aviv University Medical School, Tel-Aviv, Israel 64, B10LOGICAL MARKERS 6. 155 Center, Manila, Philippines GtIXMSE-6-PH06PHATE DII-IYDF4GENA.SE (G6PD) AC'PIVITY DURTIJG THE DEVPdAP- MESTP CF ORAL I ALI(NANCR EVANS, A.W. JOHNSON, N.W. BUTCHER, R.G. Midhurst Medical Research Insti- ture, Midhurst, Surrey; Dept. of Oral Pathology, London Hsopital Medical College, London; U.K. HCG AS A SPECIFIC MAMM FOR NUIC3N*JCSi NAVARRO, M.D. University of Santo Tomas Research 7. 156 8. 157 SEQIkSTfIAi, ESTIP'IIsMON OF ALCALINE PRaSPHATASE ISOENZYMES (API) IN BREAST CANCEt PATIEKIS HORNER, G. CAFFIER, H. Universitaets-Frauenklinik, Wurzburg, Germany FR 9. INCR'ASING CCNCEnTPRATION RIA 4'F5T 158 FOR PRIIXRY ADFIJOChICINCMA.S BARTORPLLI, A. BIANCARDI, C. OREFICE, S. MOR, C. ACCINNI, R. Istituto Ricerche Cardiovascolari, Universita di Milano, Milan, Italy U 0 0 b ~

pOSTER SESSIONS JULY 29 CONCOUfiSE 10:30-11:00 15:30-16:00 64. 10. 159 11. 160 12. 161 13. 162 65, 14. 191 JULY 30 JULY 29 (JONOOURSE JULY 30 10:30-11:00 15:30-16:00 ~IOC~ID~CAL MARKERS 65. CONT IqDI[JG TECFOVIQUES OF DETECTION BREAST CANCER ANPIGEN (S) : BCA ACCINNI, R. 15. PROBdES1S OF EARLY DIAQJ06IS OF FRITg1RY BONE nMRS BAILO, N. CAVALCA, V. FERRARA, R. BARTORELLI, A. Istituto di Ricerche Cardiovasco2- ari "G. Sisini," Milan, Universita di Milano, Milan, Italy 192 WICKENHAUSER, J.1 HOHENBERG, G.2 1Central Institute of X-Ray Diag- nostics, University of Vienna; 2University Clinic of Radiotherapy and Radiobiology; Vienna, Austria BIOIAGICAL NLz1RKER: A RNA VIFd7S 16. CHRXDSOM ANALYSIS IN BfNIIN AND NWLI(OM PLEURAL EMSIONS GRANDI, F. GRANDI, M. Centro Studi Ricerche e Terapia delle Neoplasie, Torino, Italy SPECIFIC REACTIVITY OF HI(HLY POLARIZED CEffMICAL SYSTFMS WPIH 193 FALOR, W.H. WARD, R.M. BREZLER, N. Lymph and Cancer Research Labora- tory, Akron City Hospital, Akron OS, U.S.A. NEOPIASlZC CELL MF34BRANE'S FOR POSSIBLE EARLY DETE7C'EION 17. THIN NEEDLE ASPIRATION CYIC)IAGY IN TEM DIAQdOSIS Ot' PALPABLE NYISSFS NABIH, I. National Research Center, Dokki, Cairo, Egypt OVERLAP OF CF.LIS IN VITRO AS A BIOIfJGICAL FFtRKEt OF PREINVA.SIVE ADID INVASIVE 1EAPIRSTIC LESIONS OF THB CERVIX ITiERI EBELING, K. 194 ARGANESE, T.J. CONTARDO, M. SALTZSTEIN, S.I. BARONE, R.B. PILCH, Y.H. School of Medicine, University of California at San Diego, San Diego CA, U.S.A. TANNEBERGER, St. SCHINDLER, Ch. 18. AUPDMATID CYTOIAGY SYSlTHLS: CRPPERIA FC)R INS'lRCR4ENP DFSIIN AND BILEK, K. Academy of Sciences of the German Democratic Republic, Central Insti- tute of Cancer Research, Berlin, Germany DR 195 SEErJCiZON PREWITT, J.M.S. Division of Computer Research and Technology, National Institutes of Health, Bethesda MD, U.S.A. PROMISING TECFNIQUES OF DETECTION 19. SE[f'-APPLIID, BREAST PATHOIAGY DEITJCPING SfS1SOR DhVICE: DESCRIPR- I2o7An-v2bRY-{EIS. PRL7PEASES AS AMP- LIFIERS Of C}ffMICAL PRCtD7ERS: A RAPID FUICIZOAAL SCRMIIIJG ASSAY F'OR Il$x7C1RS RANNEY, D.F. QUATTRONE, A.J. University of Texas Health Science Center, Dallas TX, U.S.A. 196 ION ANI) PREiill11NARY RESULTS KARPMAN, B.L. HAMILTON, B. University of California at Los Angeles, Los Angeles CA; George- town University School of Medicine, Washington DC, U.S.A.

PODIU4 SESSIONS JULY 29 C0NCAURSE JULY 30 JULY 29 OONOOURSE JULY 30 10:30-11:00 10:30-11:00 15:30-16:00 15:30-16:00 65, IISDNG TECFCJI(aUES OF DETECTION 66. SKIN (CONT'D) 20. Fl•-IXME FIBfItOPTIC BRON~,"'HOSOOPY IN THE DIAGNOSIS OF T'HE PUIMONARY 24. TF1E DF'PFTdiIIaTION OF C-19 STEROID METABOLITES IN URINE OF WqMETI WIYH 288 CONIPLICATIONS OF LYMPHClYA CHUANG, M.T. GRIBET2, A.R. TEIRSTEIN, A.S. BERMAN, L.B. Division of Pulmonary Medicine, Mt. Sinai Medical Center, New York NY, U.S.A. S00 NEVUSES AND NYILIQQANf MEIANOMA MICIC, J. MARKOVIC, Lj. IVANOVIC, S. KOVACEVIC, M. NIKOLIC, S. JOVANOVIC, S. PAVLICA, J. Interna Klinika A, Med. Fak „ 21. ANALYSIS OF THE PULMUIRY NEOPIAS- TIC LESIONS DIAGNOSID BY CT AND Belgrade, Yugoslavia 197 NCYP PERCEPTIBLE BY STANDARD RADIOIr OGICAL INV£S'TIG4TIONS 25. VISUAISZING AGGRESSION IN SKIN CANCII2: EMLTRON VERSUS LI(HfP COLLARD, M. BRASSEUR, P. SUKKARIEB, F. Universite Libre de Bruxellest Centre Hospitalier de Montignies le Tilleul, C.G.T.R., Montignies le Tilleul, Belgium 501 MICROSUOPY SPOOR, H.J. ERLANDSON, R.A. Dept. of Dermatology, Cornell Medical Center; Dept. of Pathology, Memorial Sloan-Kettering Cancer Centert New York NY, U.S.A. 26. A GENERAL DIFINI'TION CF. BIDDPLASM IIIIICH PR7JIDES A NIDCtU+NISM FOR 502 SPOfIPANIDOUS RDGRESSION OF INIZiA- 66. SKIN fPIDERML CAFCINOI Yl 22. MNLTCNFSNP M~A ARISING IN SNYiId. ROWLRTT, C. Imperial Cancer Research Fund, London, U.K. 498 CONCENITAI, IZE.VI BRIELE, H. CNAUDHURI, P.K. RONAN, S. 67, BREAST TRIPPON, M. DAS GUPTA, T.K. 27. DEPDCPION-FARLY DIAC3NOBIS OF Abraham Lincoln School of Medicine, University of Illinois Medical Cen- 542 BRFAST CANCEt MAVEC, P. 23. ter, Chicago IL, U.S.A. H11itCN1NP 1-~A IN IZEW MEDCIOO: LENART, I.F. Institute of Oncology, Ljubljana, Yugoslavia 499 A MODEL FOR ONE KIbID OF FNVIA7N- NEiTl73L PATHOIAGY STUDY . 28. TDCEwQUE FoR RFSFARCIi OF "BORDII2- KEY, C.R. BLACK, W.C. 418 LINE" EPI'I4ELIAL DYSPLASIAS OF THE BREAST WIGGINS, C.L. New Mexico Tumor Registry, Albuquerque NM, U.S.A. MIGNANI, E. GORI, R. Institute of Pathological Anatomy, General Hospital Valdinievole, Pescia, Italy

S 67. (co~~rrTD) CON00URSE JULY 30 10:30-11:00 15:34-16:00 JULY 29 OONOOURSE JULY 30 10:30-11:00 15:30-16:00 67. BREaST (corrr D) © 29. DIAQJOSIS OF SIMPIE AND PAPILIIUtY e la Cura dei Tumori, Genova, 419 CYSTS CE' THE BREAST SOFTIC, Dz. Italy GMAZ, Z. 35. THE DIAGN08'TIC RLXI!'IINES FOR DETt7CTL DIZDAREVIC, J. IDRIZBEGOVIC, S. 425 ION OF CANCER IN WtI4EN WITH A BREAST l4AS.S 0. Klinika za Ginekologiju i Akuser- stvo, Sarajevo, Yugoslavia T•gySl'ITIS AS ONE OF 74M RISK FACPORS CAPOFERRO, R. GULLESTADT, H.P. Nordland Central Hospital, Bodo, Norway 420 OF BREAST CANCER KUDLICKOVA, Z. 36. BREAST CANCER SUFNIVAL RATE IN SVEJDA, J. MALIR, A. 426 CUTIIJDIITY SURGICAL PRAC`I'ICE, SOVIH CESdPRAL OaNIDCPICUT, U.S.A. 1. Research Institute of Clinical and Experimental Oncology, Brno, Czechoslovakia AGS-RE[ATED DISTRIBUPION OF BENIGN ROACH, A.I.1 SHAPIRO, B.S.1 NABEL, M.I.2 ADESS, M.L.2 PARIKH, G.C.2 421 FIMINGS IN MAK40MAPHY AS RTCC- GIYJUNID FOR CANCER DEPECTICN 1Griffin Hospital, Derby CT; 2Quinnipiac College, Hamden CT; BENDER, M.G. GREUEL, H. University Women's Hospital, 37. U.S.A. CYSTIC DISEASE, FANIILY HISTW1 CF Dusseldorf, Germany FR 437 BREAST CANCER AND USE OF ORAL CON`I?ACEPTIVRS 32. EFFfJCF CF COIrFISOL GN 4RANSFE2 RNA VAKIL, D.V. 422 MEZNYLASE ACTIVITY IN 14W~PRX RLYrYxTRS ELINSON, L. MORGAN, R.W. LEYMAN, A.M. DE LOECKER, W. Afdeling Biochemie, Departement Humane Biologie, Faculteit Genees- kunde, Universiteit te Leuven, 8. Dept. of Preventive Medicine & Bio- statistics, University of Toronto, Toronto Ont., Canada TIiE VAiAE CF EXANIINING C-19 Louvain, Belgium 438 S1£ROIDS IN URINE CP WCMETd WITH DUCTAL BREAST CANCER 33. EARLY DETDCPION AND IDETlTIFICATION MICIC, J. 423 OF MV4,PRY GLAND NEClPLASMS MADICH, C.C. IVANOVIC, S. MARKOVIC, Lj. f i 4. State Doctors' Training Institute, Tbilisi, U.S.S.R. USE OF RISK FACTORS IN DESIQI OF A BRZAKOVIC, P. NIKOLIC, S. Interna Klinika A, Med. Fak, Belgrade, Yugoslavia I 424 SC3RMING PROMM FQR BREAST CANCER TOMA, S. 39. FSIDOCRIINE TRF11714ENi OF BREAST CAN- i ` i BRUZZI, P.A. PUNTONI, R. SERRA, G.E. SANTI, L. Istituto Scientifico per lo Studio 439 CER: BF2~.'FIT FAR RESP(NDE1iS - ADDITICNAL RISK FOR NClNRESPONDERS? AN IN VITRO STUDY MATTHIESSEN, H. v. KOLDOVSKY, U. FELDHAMMER, B. (71 0 0 4J r

POSTER SESSIONS JULY 29 CONCOURSE JULY 30 JULY 29 CONCOI!RSE JULY 30 10:3U-ll :00 1030-31:00 15:34-16:00 15:30-16:00 67. BREAS~ (COI~IT D) 67. BRONTEASj ~C D) Dept. of Gynecology & Obstetrics, University of Dusseldorf, Dussel- 44. BREAST 4CRpI2.S MISSED BY )aMWI- MOGRAPHY AND/OR CLINICAL F3ANLItWICN dorf, Germany FR 477 CAMBOURIS, T. ADAMI, E. 40. HL&!AN BREAST CANCER: I. SURGICAL TRFAT1-M AND OESTR0.':EN FJCCRETICN PONTIFEX, Gr. Dept. of Radiology, Aretaion Univer- 440 PATTERN RESPONSE CASTAGNETTA, L. sity Hospital, Athens, Greece DI BENEDETTO, F. PALISI F. 45. PACET'S CARCINCiMA OF THE BREAST: STUDY IN 17 PATIE[TPS WI1H EARLY OR , POLITO, L. TRAINA, A. 543 LATE LESICNS MONTORO, A.F. Hospital Osvaldo Breast Service FERTITTA, S. Biochemistry Institute, University of Palermo; Cancer Hospital Center "M. Ascoli," Policlinico; Palermo, Italy , Cruz, Sao Paulo, Brazil 41. H[MAN BREAST CANCER: II. SURGICAL TFIERTLPY, STEROID PATTERN RESPONSE R LYMPHOMAS AND LEUKEMIAS 441 AND PFOQd06IS CASTAGNETTA, L. D'AGOSTINO G. 46. REFiIICTIONS AHO[Tf OPPORIS.INITY OF RAPID CYTOIOGIC ANL? HISTOIL)GIC , GRANATA, O. PATERNO, F. TRAINA, A. FERTITTA, S. Biochemistry Institute, University 492 EXMMTIQI IN I71LTGUTP LYI4PHCNAS HALALAU, F. Dept. of Pathology, Victor Babes Institute, Bucharest, Romania of Palermo; Cancer Hospital Center "K. Ascoli;" Palermo Italy 47. HifC'I'ERIOCINS IN DIAQJ06IS OF MAI,ICr NANT LYMPHOL'YTEB ANALYZED BY FIl.7W , 493 CYTOh47IRt5C 42. TfIE DCQJCMIC CCt9SDQUIIJCES OF SCREf31ING FOR BREA.ST CANCFit FARKAS-NIMSLEY, H. MUSCLOW, C.E.* 460 CHAMBERLAIN, J. SIMPSON, P.R. GRAVELLE, H. Institute of Cancer Research, Sutton, Surrey, U.K. Depts of Microbiology & Parasitol- ogy and *Pathology, University of Toronto; •Dept. of Laboratories; Mt. Sinai Hospital; Toronto Ont., Canada 43. BREAST SCRFMNING BY BREAST SEIF- FXAMIIaTICN: AN EVAIIJATICfI OF 48. MECHANISM OF PENETRATION CF BACILLUS SP INI'O LStMPI]OCYTES CECd. 461 REAC7iING METHODS AAID_ N1A4ERtAIS HOBBS, P. HARAN, D. PENDLETON, L.L. Dept. of Epidemiology & Social Research, University Hospital of South Manchester, Withington, Manchester, U.K. 494 LINE L5178Y TOMAS-MARTIN, C. RAMOS, A.M. ESQUIVEL, C. Electronmicroscopy Laboratory, Dept. of Biology, Faculty of Sciences, U N A M, Mexico, Mexico

JNS pOSTER SESSIONS JULY 29 CONCOURSE JULY 30 10:30-11:00 15:30-16:00 68. LyMPHQMAS AND LEUKFTII AS (COPIT D) 3'IQ~] 49. }[ES'YILYTIC ANEMIA DUE TO FERfI7ITARY pyRUVATE KINASE DEFICIF2K.'Y DEI7EIAP- 4 9 5 M ACLnE LEIKfSiIA GOEBEL, K.M. ver- SCHNEIDER, J. Dept. of Medicine, University of Marburg, Marburg, Germany FR 496 51. 497 CHR[dIC L1TlPHOCY'PIC IZ;[JXE'II'A F'OIIfJWING 32-P TRFATMENP QF POLY- CYTH}3`IIA VERA CHONE, B. Klinikum der Universitaet Heidel- berg, Zentrum Radiologie, Abt. Strahlenbiologie, Heidelberg, Germany FR DERPAZCIGLYPHICS IN CHIIaN00D IEU- KAEMA AND LYMPHQMA ABDEL-SALAM, E. GAD EL-MAWLA, N. ABOU-GABAL, A. Dept. of Pediatrics; Cancer Insti- tute; Cairo University, Cairo, Egypt

I.IST OF ABSTRACTS M GENETIC PREDISPOSITION TO CANCER W1 KN UDSON, A.G., Jr. The Institute for Cancer Research, rhe Fox Chase Cancer Center, Philadelphia, PA 19111, U.S.A. The burden of cancer falls nonrandomly upon a population, the cause for this inequity being sometimes environmental, sometimes genetic, and some- times both. This last group is the one about which we have the most to learn. The few known examples in man include xeroderrna pigmentosum, which has taught us about mechanisms for the repair of damaged DNA, and Duncan's disease, which shows how close man is to lethal reaction to the common EB (p» virus. Animal studies suggest numerous sites for genetic-environmental interaction, notable being those genetically controlled reactions that activate or metabolize chemical carcinogens. psowledge of the target sites that are altered by mutagenic carcinogens pas been derived largely from studies of chromosomes in neoplasia. Some chromosomal aberrations are specific, as with the Philadelphia chromosome in chronic myelocytic leukemia. In some instances constitutional chromo- somal abnormality is associated with a specific tumor, as with the delet- ions found in some children with retinoblastoma and with Wilm's tumor. These same tumors are known in dominantly heritable forms and we look for further evidence that the same sites are affected in them as in the delet- ion cases. We also look for localization of other well known "cancer genes", such as those causing polyposis coli and neurofibromatosis. This has been achieved recently by genetic linkage analysis for one heritable form of breast cancer. The power of molecular and cytogenetic techniques is now turned upon this problem and we can look forward to greatly increased ability to identify persons genetically at risk of cancer, with all that implies for prevention and detection. /GENETICS/HOST SUSCEPTIBILITY/ o2 RtULTIPLE FACTOR ETIOLOGY. Fraumeni, J.F., Jr. National Cancer Institute, Bethesda, Maryland, U.S.A. Epidemiologic observations have contributed to the concept that carcinogenesis is a multi-stage process resulting from the joint effects of environmental influences and susceptibility states. This notion is (07) in keeping with recent case-control studies of various cancers in the United States, especially in areas where the cancer rates are elevated. A major challenge in cancer etiology is the delineation of multiple risk factors that interact with one another, and thus expand the opportunities for cancer prevention. /MULTIPLE RISK FACTORS/INTERACTIONS/ r

LIST OF ABSTRACTS 003 LOW DOSE CARCINOGENESIS. R.M. Hicks, School of Pathology, Middlesex Hospital Medical School, London, England. If the carcinomas attributable to cigarette smoking are excluded, human cancer does not usually develop as a consequence of exposure to high doses of carcinogens. Carcinogenesis is a multistage process in which the initiating cellular event may be caused by exposure to a very low dose of carcinogen which damages the genome of a few cells. This damage may remain latent and unexpressed for many years before it is (07) triggered into tumour growth by a sequence of cellular events caused by further exposure to low doses of the same or other carcinogens or other co-carcinogenic factors. Although some damage to the genome may be repaired, evidence suggests that the initiating damage can be permanent. Thus, although the number of cells affected and therefore the number of eventual cancers is related to the dose of the initiating carcinogen, as with radiation there is no threshold or safe dose below which no potential carcinogenic damage will be produced. There is little possibility of preventing all exposure to low doses of environ- mental carcinogens, and even after identification of a carcinogenic hazard there is frequently unwillingness on the part of individuals to change their life style in order to avoid exposure to any risk which is less than certain death. LOW-DOSE/INITIATION/NO SAFE DOSE W4 IATROGENIC CARCINOGENESIS. Schmahl, D., German Cancer Research Center, Institute of Toxicology and Chemotherapy, Heidelberg Recently some drugs have proved to be carcinogenic not only in animals but also in m3n. This applies predominantly to alkylating agents which are used as cytostatics in cancer treatment. The lecture will give a detailed description of the experimental and clinical results as well as a discussion of the problems of the so-called "adjuvant chemotherapy" (07) in cancer treatment. It will also be discussed which drugs and drug groups have to be regarded as carcinogenic and which drugs were regarded as carcinogenic but were found to be not. It will be mentioned that after surgical treatment, too, a predisposition.for cancer formation may be created. One exarrple for this is the carcinoma of the gastric sturrp after Billroth operations. Iatrogenic carcinogenesis is not very significant from the quantitative point of view. It is estimated that approximately 1 out of 10.000 cancers are induced by iatrogenic caroinogenesis. However, there are some high risk groups where about 20% of the patients develop cancer after medical treatrrent. . I /.

TS r LIST OF ABSTRACTS 005 RISK ASSESSMENTS (% INDUCTION OF RENAL PELVIC TUMORS BY ANALGESICS JOHA NSSON, S.L. Department of Pathology II, Sahlgren's Hospital, Gothenburg, Sweden An association between abuse of analgesics containing phenacetin, phen- azone, and caffeine and the development of renal pelvic tumors has been demonstrated in human patients. Eight groups of male Sprague-Dawley rats were treated with the following analgesics in the diet: Group 1/ 0.535% phenacetin, Group 2/ 0.535% phenazone, Group 3/ 0.102% caffeine, Group 4/ phenacetin, phenazone and caffeine in the above doses, Group 5/ phena= cetin and phenazone in the above doses, Group 6/ phenacetin and caffeine in the above doses, Group 7/ 0.535+% paracetamol, Group 8/ control rats. Each group contained 30 rats, which were treated up to 117 weeks. Renal pelvic tumors were detected in 13 rats. One tumor was found in Group 1, four in Group 2, four in Group 4, three in Group 5, and one in Group 6. Four tumors were squamous cell carcinomas, eight urothelial, and one mixed metastasizing squamous cell carcinoma and urothelial carcinoma. The results demonstrate phenazone to be a stronger urinary tract carcino- gen than phenacetin. /RENAL PELVIC TUMORS/RATS/PHENACETIN/PHENAZONE/CAFFEINE/PARACETAMOL/

LIST OF ABSTRACTS arj CANCER MORTALITY LIN1= WI241 AATIFICIAL FLUORIDA'I'ION IN BIMV9GHAM, IING[.ATID. BURK, D. Dean Burk Foundation, 4719 Forty-Fourth Street, Washington, DC 20016, U.S.A. Upon fluoridation of the Birmingham County Borough (CB) public water supply in October 1964, its '%, 1.1 million population showed one of the highest documented, abrupt, increases in cancer death rate ( L1CDR) of any large city in the world, far greater than occurred in e.g., the ti 600,000 population of nonfluoridated Manchester CB or the '~, 300,000 , (291 population of only-15-miles-away Coventry CB, over the 10-year epoch of 1964-1973 after fluoridation compared to the 10-year epoch 1955-1964 before fluoridation. The bCDRs, based on linear least square regression slopes (CDR x time), for the respective three cities and two epochs, were 38.4 - 4.9 = 33.5, 40.7 - 37.0 = 3.7, and 37.0 - 31.9 = 5.1 CD/ million population/year, corresponding to a differential CDR increase in Birmingham CB, compared to Manchester CB or Coventry CB, of 30 CD/million population/year, or an annual increase of about 1.2% of the mean, annual, 1964-1973, Birmingham CDR ( ti 2,500), which is larger than the 'v 0.25% per year average, standardized differential for the 10 largest fluorid- ated cities in the U.S.A. compared to 10 large nonfluoridated cities (Yiamouyiannia and Burk, Fluoride, 10:102-123, 1977). /FLUORIDATION/CANCER MORTALITY/BIRMINGHAM COUNTY BOROUGH/ ~ SIGNIFICANT INCREASE OF CELL TRANSFORMATION IN VITRO BY CITY SMOG EXTRACTS AND PAPOVAVIRUS SV 40 SEEMAYER, N.H., and N. MANOJLOVIC. Medizinisches Institut fur UmweIthygiene der Universitat Dusseldorf, Dusseldorf, Germany, F.R. Interaction of environmental carcinogens and viruses could be of great importance in human carcinogenesis. We analyzed the effect of city smog extracts and of polycyclic aromatic hydrocarbons on SV40-induced cell transformation in vitro. Samples of city smog from the heavily indus- [29] trialized Ruhr area (West Germany) were extracted by organic solvents and further fractionated. Logarithmically growing Syrian hamster kidney cell cultures were exposed for 18 hours to different concentrations of city smog extracts and their fractions. Thereafter, cells were infected with SV40 at a Moi of 500. In parallel experiments, hamster cells were exposed to different concentrations of Benzo(a)pyrene or Dibenz(a,h)- anthracene also followed by SV40 infection. . Using various fractions at different concentrations, we found a 2-10 fold increase in transformation frequency in comparison to the SV40 control. /CITY SMOG EXTRACT/CELL TRANSFORMATION/SV40-VIRUS/ (291 /291

LIST OF ABSTRACTS ~ RF)CQNIBIN0CENIC ACPIVITY OF FRESH CIGARETiE SMOKE IN SACCtARaMYCES CEREVISIAE. Gairola, C. & GrDfYith, R. B. University of Kentucky, Lexington, Ky. 40506, U.S.A. Experiroental studies of cigarette snoke (CS) have been tradition- ally carried out using its condensates. We describe here a procedure for direct testing of fresh CS in the yeast, Saccharcmyces cerevisiae enerat~ p-7 with gene conversion as the end point. Cigarette snoke generated by 2 second, 40 ml puff once per min was forced into an open end tube and passed through the exposure vessel within 58 seconds, exposing a oontinuously stirred stationary phase cell suspension to smoke, 1-58 second old. Under these conditions, whole snoke (WS) and gas phase frcm university of Kentucky Reference Cigarettes (2R1) and WS fran 2R1- filter tip cigarettes (2R1-F) showed a dose related response, requiring about 20, 75 and 45 puffs, respectively, to induce a 5-fold increase in mitotic gene conversion in yeast D-7. Filter tip which reduced the total particulate matter delivery of 2R1 by 25% resulted in a greater than 50% reduction in recambinogenic activity of Sti5 suggesting a selec- tive raroval of genetically active canponents by acetate filters. Our results indicate that (1) yeast-D provides a sensitive system for assaying fresh CS without external metabolic activation, (2) gas phase of CS possesses recanbinogenic activity, and (3) standard acetate filters may selectively trap genetically active axrponents of cigarette srrioke. FRESH CIGARETTE SNIfJKE, GAS PHASE, REOOMBINOGENICITY, BIOASSAY. 010 EFFECTS OF CHLORPROMAZINE ON DIMETHYLNITROSAMINE DEMETHYLASES IN RATS PRETREATED WITH VARIOUS MICROSOMAL ENZYME INDUCERS. M.H. Mostafa, M. Ruchirawat & E.K. Weisburger, Medical Research Institute, Alexandria, Egypt and Laboratory of Carcinogen Metabolism, National Cancer Institute, Bethesda, Md. 20205, USA. Chlorpromazine (CPZ), a neuroleptic drug, markedly enhanced the acti- vity of dimethylnitrosamine (DMN) demethylase I, but inhibited DMN-deme- thylase II, in vitro, in normal rats. In this study, the effects of the microsomal enzyme inducers on the oxidative-N-demethylation of DMN in (?9) the absence and presence of CPZ (4.8 x 10-4M) were investigated. Pre- treatment of rats with phenobarbital (PB), arochlor 1254, 3-methylcholan- threne (3-MC) and 6-napthoflavone (BNF) inhibited DMN-demethylase 1 acti- vity. However, in the presence of CPZ, the enzyme activity under these conditions was higher than the corresponding control values. DNA1 demethy- lase II responded differently. The activity was enhanced markedly in PB and arochlor pretreated rats, whereas it was only increased slightly by BNF, and unaffected by 3-MC pretreatments. The addition of CPZ greatly decreased the activity of this enzyme in all cases. Feeding rats with 1% indole for 8 days considerably increased the activities of both DMN de- methylases I and II. The presence of CPZ caused a slight further in- crease in the DMN-demethylase I activity but a marked decrease in DMN- demethylase II activity. This study supports the hypothesis that demethy lation of DMN involves at least two enzymes; each of which has different kinetics and responds to CPZ in a different manner./DMN DEMETHYLASE/

L'r LIST OF ABSTRACTS ou PHOTOCARCINOGENESIS BY MMEOXYPSORALEN, NEUTRAL RED AND PROFLAVINE. Santamaria, L. Bianchi, A., Arnaboldi A., Daffa- ra, P. Istituto di Patologia Generale 'C. Golgit, Centro Tu- mori; Istituto di Farmacologia II, University of Pavia, Pa- via, Italy. The photosensitizing effects of 8-methoxypsoralen (8-MOP), neutral red (NR) and proflavine (PF) on the skin of female Swiss albino mice, strain 955, were studied using fractio- (29) nated exposure to long ultraviolet light (UVA) and visible light (tungsten emission). The results (a) confirmed the 8-MOP photocarcinogenicity; (b) demonstrated for the first time that both NR and PF are photocarcinogens; further, (c) showed that UVA with 2.6% of fluence at 313 nm is a long term carcinogenic agent eventhoughtthe total dose of 313 nm component is one hundred times less than the minimal UV tumorigenic dose. The tumors were mammary adenocarcinomas, skin.appendages carcinomas, carcino-mixo-sarcomas, lymphomas and one thyroid adenocar- cinoma. /PHOTOCARCINOGENESISdIFMOXYPSORALEN NEUTRAL RED PROFLAVINE 012 THE EPIDERMAL PAPILLOMA AND CANCER IN MOUSE SKIN. F.J. Burns. NYU Institute of Environmental Medicine, New York, N.Y. 10016. An analysis is presented for evaluating the potency of initiators, promoters, and carcinogens based on the number of tumors that occur as a function of dose and time when compounds are applied topically in an appropriate solvent to mouse skin. A given compound was tested as an initiator (a single dose followed by prolonged promotion), as a whole carcinogen (multiple applications for a prolonged period of time) and (29) as a cocarcinogen (multiple applications for a prolonged period of time in combination with promotion). Compounds tested were 7,12 dimethylbenz(a)anthracene (DMBA), benzo(a)pyrene (B(a)P), 4-nitro- quinoline-l-oxide (4-NQO), and betapropriolactone (BPL). The results indicated that various types of papillomas were produced in proportion' to the dose applied of DMBA, B(a)P and BPL. Certain of these papil- lomas were nonregressible and progressed readily to carcinomas; others regressed and did not progress to cancer. Multiple doses of DMBA and B(a)P produced carcinomas without an antecedent papilloma stage. The latter cancers were produced in proportion to the 2nd or 3rd power of applied carcinogen dose and were accelerated strongly by concomitant action of a promoter. Certain nonregressible papillomas probably represent the first step in a two or three step progression to cancer, although cancers from papillomas occur in proportion to dose. /PAPILLOMA/MOUSE SKIN/CANCER/PROGRESSION/ O O b r (29) l29)

OF wg$T'RACTS - EFFECT OF CARBANiOYLTETRINtbTHYLPYROLLINE-N-NtIDE ON YC-8 q} B TRO tki b S T d h F L . a n, Ll*i~~,ip ~L~ ,~ yi . , a ra ., an ~ , . ersity of Hawaii 1236 * Cancer Center o* Hawaii, Univ , i, L .y, Ni~s Street, Honolulu, HI; Department of Chemistry, Swinburne ~ lco of Technology, Vic., Australia. nitraxyls have shown varying antitunoral effects and an addi- Sorac ule is now studied YC- 8 lym hama cells (2 x 106 l . p ec yl mo nitroa tjowl r a,lture tube) were grown in vitro in RPMI-1640 media supple- ;ith 10% fetal calf serum for ~ours at 370 in 10% 002 atmo- ~t~ y / ») ,,fiCre, 1'arious doses of 3-carbamoyl-2,2,S,S-tetramethylpyrroline-l- erimental c lture t b Th h f th e exp u es. e exposure o u e CW ~1 %rrc added to t cells to three different concentrations of the added compound 1)"Phoma KEUltcd in cellular growth changes. A marked decrease in cell growth W.1 in cell viability of the lymphema cells compared to the controls (Ccxitrols containing 0.6% of the ethanol solvent) followed the exposure to a concentration of 1.86 x 10-3M. A lesser inhibiI ing effect O;p.irrcd with a decreased concentration of 6.kx 10"hf of the nitroxide r,in label while a concentration of 6.5 x 10" t showed no difference tween ~~~,~cmalandlthe controlo ellas.nd ESR spectraet ken of the culture media ~.i %,-ashed cells fran the 1.86 x 10'3M group after I hour incubation of the cells with the nitroxide indicated that this compound was not Z,cz,rxt to the cells or serum proteins. 014 INHIBITION OF EPIDERMAL GROWTH FACTOR BINDING BY PHORBOL ESTERS, SACCHARIN, AND CYCLAMATE. Lee, L.S., General Electric Research and Development Center, tumor promoters 12-0-tetradecanoyl phorbol 13-acetate (TPA) and related diterpenes inhibit the binding of 1251-labeled enouse epidermal growth factor (EGF) to HeLa cells. The /!tJ potencies of phorbol esters in the inhibition of EGF binding correlated well with their effects as tumor promoters on tnouse skin (Science, 202:313, 1978). The inhibition of EGF binding by TPA was observed in cultures from a variety of species and cell types. We have now studied the effects of suspected promoters on the binding of EGF to several human cell cultures, and found HeLa cells to be most convenient and sensitive. The reportedly carcinogenic sweeteners, sac- charin and cyclamate, were observed to inhibit the binding of EGF to HeLa cells, with doses for 50% inhibition of 3 and 9 mg/ml respectively. These results suggest there may be a class of suspect human tum3r promoters that operate through interaction with the EGF receptor system. /TUMOR PROMOTERS/EGF/SACCHARIN/CYCLAMATE/ p,o. Box 8, Schenectady, New York 12301, USA. We have previously reported that the potent mouse skin

LIST OF ABSTRACTS 015 NDOPIASTIC SDQUFdAE QF RF.F'FATED INPRAPERI70iJF•AL_ 0~0~~-~ INSCk~'iATICTIS, A MJRII~ Ni~DEL FOR MJLTIPLE LAPARIJSCX)PIES? Goldsmith, A., Ryan, G. & Joseph, A. National Cancer Cytology Center, 150 Broad Hollow Road,Me1vi11e,N.Y.,11747.U.S.A.;Brookhaven Hospital,N.Y. Intraperitoneal insufflations of .v 4 ml of OO were given daily bo 3 groups of BALB/c mice for 11,20 and 32 oonsecuti& days respectively. In all these animals an early imrnmological response (proliferation of splenic T-cells) and the late clinical result (malignancies) showed no f291 dose response relationship. Pu2ironary,lymphoid and a wide spectnun of intra-abdominal malignancies were noted in long-term survivors of all groups. The pulmonary turor incidence is by far the highest. This occur- renoe of differing neoplasns suggests that the carcinogenic mechanisms involved differ from those causing lymphomas, which were the only malig- nant sequelae of autologous and syngeneic transplantations of various tissues in previous studies. These derronstrated in graft recipients the association of elevated CO tensions with high incidenoes of lynphana (60-70%). Of 4 tissues graited only bone marrow did not induce lyrrphana. This may implicate grafts' T-cells in post-transplantation lymphoma develoFment. LynQhana in graft recipients appeared to develop fran host lyriphoid tissue. But intraperitoneal insufflation of 00 may result in cellular changes by lowering intraoellular pH in primar? target tissues fram which malignancies arise. Cbuld this neoplastic outoome be a clue to a similar seguel in hum3ns after multiple laparosoopies? /WPRAPERITOI,1FAL CQ2 INSUFFTATIODTS/NIIMTIPLE LAPA%)SCOPIES/ 016 ONCOGENIC TRANSFORMATION STUDIES RELEVANT TO CLINICAL ONCOLOGY. Borek, Carmia Columbia Univ. College of P&S,N.Y Transformation in vitro is a powerful tool for comparing the oncogenic potential of various agents both environmental and those used in clinical oncology, and for seeking ways to minimize the carcinogenic effect. In recent years a great deal of data have been accumulated from our laboratory and others on the dose response relationship for transformation by x-rays as well as high LET radiation. In contrast (291 data available for transformation frequency by chemotherapeutic agents are not as well documented but are sufficient to establish that many of these agents are vastly more carcinogenic than x rays. In seeking compounds and suitable millieux which would reduce the oncogenic po- tential of agents used in therapy we find the following a) several retinoids inhibit radiation & chemically induced transformation and in a dose dependent manner, negate the potentiation of transformation by chemical promoters. b) In human skin cells which we can transform in vitro by radiation, estradiol as well as a protease inhibitor can potentiate the transforming effect of z ray when administered prior to the radiation. c) By modulating the thyroid level 1'n the cultures we can eradicate the neoplastic potential of x rays Such experiments conducted in isolated defined cell systems address basic mechanisms at a cellular and molecular level but also offer potential pragmatic use for radiotherapy and chemotherapy. ~

L1ST OF A.BSTRACTS W7 EFFECT OF hONIDAMINE ON THE ENERGY METABOLISM OF TUMOR CELLS paQgi M,G.,Floridi A.,Marcante M.L.,De Martino C.,Bellocci M., Caputo A•.Silvestrini B. R,gina Elena Institute for Cancer Research and F.Angelini itosearch Institute - Roma - Italy qhe action of Lonidamine on respiration,aerobic and anaerobic Plycolysis of several tumors and normal differentiated cells nas been investigated.Lonidamine reduces the oxygen consump- tion either in normal or neoplastic cells and the extent of inhibition is greater in the latter.A different behaviour bet- ween normal or neoplastic cells glycolysis has been found I,onidamine increases aerobic lactate production of the former but,on the contrary,inhibits that of neoplastic cells.It is coincevable that the decrease of the aerobic lactate produc- tion depends on the inhibition of mitochondrially-bound he- xokinase usually not present in normal differentiated cells These biochemical changes have been correlated to mitochon- drial structure and deep modifications have been observed. preliminary experiments on viability and growth of cancer cells have shown that Lonidamine affects both parameters. 018 ENVIRONMENT AND CANCER - OVERVIEW. Higginson, J., International Agency for Research on Cancer, 150, Cours Albert-Thomas, 69372 Lyon C6dex 2, France. The role of cancer and the environment will be discussed in relation to 1) tumours due to defined carcinogenic stimuli, and 2) tumours where the effect of the environment can be only indirectly inferred from circumstantial data. The proportion of tumours in each group in relation to predominant causes will be discussed. The signifi- cance of 'carcinogenic risk factors' as reflecting lifestyle and their possible implications in terms of hypotheses on multistage carcinogenesis will be reviewed, since cancer development may be modified by factors both prior to and after initiation. /ENVIRONMENT AND CANCER - OVERVIEW/ U 0 0 0

LIST OF ABSTRACTS 019 OCCUPATIONAL CANCERS [1] 020 EPIDEMIOLOGIC IDENTIFICATION OF CARCINOGENS. Armstrong, B.K., NH & MRC Research Unit in Epidemiology and Preventive Medicine University of W.A., Nedlands, Western Australia. Concern has been expressed at the increasing exposure of humans to synthetic chemicals, or naturally occurring chemicals to which there is unnatural exposure as a result of human activity. Suspicion that such exposure may be carcinogenic arises in several ways: Evidence of carcinogenicity or mutagenicity in experimental tests; reports of cases [1] of uncommon cancers associated with uncommon exposures; evidence of geographic or secular variation in cancer incidence occurring in parallel with changes in exposure; and analytic epidemiological studies of cancer in relation to the chemicals. Confirmation of suspicion of carcinogenicity depends on carefully conducted analytic epidemiological studies. Studies of occupational cancer have contributed greatly to this process. Many chemicals are widely dispersed at low levels in the general population and the hazards associated with them are difficult to study. Individuals involved in their manufacture, however, are often exposed to large amounts and may be studied easily. Follow-up of such people has contributed to study of the carcinogenicity of chemicals such as arsenic, asbestos, chromium compounds, soots, tars and mineral oils and vinyl chloride, to which there is widespread, low level exposure. Precise measurement of the hazards of low level exposure, however, remains a problem. /EPIDEMIOLOGY/CHEMICAL CARCINOGENESIS/OCCUPATIONAL CANCER7 4 W 01 W

CTS LIST OF ABSTRACTS !ii ~ METHODS OF CARCINOGENICITY TESTIN G: PRINCIPLES AND LIMITATIONS. p, Mohr, Abteilung fUr experimentelle Pathologie, Medizinische Hochschule Hannover, Karl-Wiechert-Allee 9, 3000 Hannover 61, West Germany. There are at present two main approaches to testing toxic and carcinogenic compounds. On the one hand, the so-called "short-term test" using micro-organisms, cells, producing tissues or vresultst on the biological a activity of relatively fast chemicals. On the other hand, although the "long-term test" using laboratory mammals is more time-consuming and costly, it provides data more appropriate for extrapolation to man. This report gives,an evaluation of different treatment methods and models. It pays special regard to the problems involved in the interpretation of findings from long-term studies, where the influence of factors such as dose-level, animal species and strain, aging and the biological behaviour of tumours is not fully understood. The need for achieving minimum standards of conformity is also discussed. /SHORT-TERM TESTS/LONG-TERM TESTS/ ~ PFmBI1MS OF OOCUPATIONAL CARCINOGDIESIS IN DEUFZAPING CGUNPRIF.s A.H. TABA. Director, WHO _Ea_stp_r;; Mediterranean Regional Office World Health Organization, Geneva, Switzerland. occupational cancer in developing countries is mostly due to exposure to carcinogenic agents in agriculture, the petroleum apd„other.,chemical in- dustries and the inhalation of asbestos dust. Skin cancer may be due to exposure to tars, pitches, oils, arsenic and sunlight. Lung cancer occurs in asbestos and per}iaps carpet workers while bladder cancer may be due to schistosomiasis infestation, or to exposure to BNA used in the production J1) of dyes, or 4-AB and benzidine used in the rubber industry: Inspite of the lack of adequate epidemiological studies and surveys about the nature and magnitude of occupational cancer in the developing world, one would expect that the problem would be the same as in industrialized countries, or even worse, if workers are exposed to the same carcinogenic agents. however, countries in the developing world should be in a better position to control occupational cancer, as they are beginning their industrial- ization process, if they would make use of the knowledge and experience gained in the industrialized world. Unfortunately, this is not the case because the personal protective measures which would decrease human ex- posure to occupational carcinogens require a certain level of general education which is often lacking and a change in the workers' traditional behavior. Furthermore, there are few developing countries which have legislation controlling the use of potential carcinogenic agents or are in a position to enforce it. The problem is enhanced by the trend of exporting dangerous industries from industrialized countries to the developing world. t i

LIST OF ABSTRACTS M3 CANCER INCIDENCE AND MORTALITY IN RELATION TO OCCUPATION IN 700,000 MEMBERS OF THE CANADIAN LABOUR FORCE. Howe, G.R., Miller, A.B. NCIC Epidemiology Unit, University of Toronto, Canada. The mortality and cancer incidence experience of a 10% sample of the Canadian labour force has been monitored by using computerized record linkage to the Canadian National, Mortality and Cancer Incidence Data Bases. Occupation and industry data are available for the sample for the years 1964-1971, and the data is being used both to generate [41] and test hypotheses concerning occupational exposures and increased risk of various cancers. It is planned to continue the monitoring process in future years, and as the number of cancer cases and deaths in a cohort accumulate, the data will provide an increasingly valuable utility for cancer researchers. /OCCUPATION/CANCER INCIDENCE AND MORTALITY/EPIDEMIOLOGY (24 POSSIBLE METHODS OF CARCINOGENICITY TESTING OF SUBSTANCES USED AT THE PLACE OF WORK. Steinhoff, D.Institute of Toxicology, Bayer AG, W.Germany Even in early stages of the development of new chemical substances the chemist should know as much as possible about their eventual carcinogenic properties. [41] In most cases an extensive carcinogenicity testing cannot be performed in that situation. However, sensitive and relatively inexpensive tests with subcutaneous, intra- tracheal, or intraperitoneal application to rodents give reliable results even with regard to the necessary quanti- fication of potency. In such tests the unkown substances (unknown with regard to carcinogenicity) can be handled more safely than in other tests. Results obtained with different test systems will be compared. /CARCINOGENICITY/TESTING/METHODS/POTENCY/ J U O+ ~

TRACTS IN ., a. of !nce iple :e hs ble y i LIST OF ABSTRACTS ~ EARLY DETEC''IC+N OF i~JDPIASMS AI~II) PRF]C10.NC~US CHANNC~S IN lX-~ WpRIQIdG %X14EN Margaret RAPHAEL, M.B., B.S., D.O.H. Occupational Physician, P.O.B. 24, Mosman, Australia 2088. rhis paper describes a service of routine physical checks on symptomless .,omen in a variety of occupations. The majority were done at their place of work and the remainder at the recently set up Women'8 Medical Centre. It covers 15 years and 10,000 women. The practical methods and difficul- ties are discussed. Few work centres have ideal facilities and practical Mays of adapting them are illustrated. The age range was 18-64, 86% being aged 20-49, so there were fewer women over 50 than in the general population. Neoplasms detected include carcinoma of the breast, colon, uterus, ovary, c,alignant melanoma, numerous early skin cancers, dysplasias and carcinoma- in-situ of the cervix. The pickup rate for abnormal Papanicolaou smears and for breast cancer was higher than average, so it seems that taking a check-up service to the busy women was of considerable value. Fringe benefits included the discovery of other health problems and a certain amount of counselling on sexual, marital and emotional problems. Breast self-examination was demonstrated and the practice of it encouraged, though success was limited. /EARLY DETECTION CANCER/WORKING WOMEN/ 026 CANCER MORTALITY IN THREE ACADEMIC COHORTS: CHEMISTS, ARCHITECTS AND MINING ENGINEERS/METALLURGISTS. Olin, G.R., Ahlbom, A., Alvarsson, B., Unander, B. Preventive Occupatio- nal Medicine Unit, Royal Institute of Technology, Stockholm, Sweden. The mortality among three cohorts of male academics who graduated during the years 1930 to 1959 and who were followed up until the end of 1977 was analyzed. The three cohorts consisted of 820 chemists, 657 architects and 584 mining engineers/metallugists. The total mortality t41) and the mortality pattern in each cohort was compared with general wor- king male population and in between the cohorts. The total S"iR for the mentioned three cohorts was 80, 67 and 71. The cancer SMR, however, differed between the three group: 132, 54 and 97. - The architects, with no obvious environmental exposure, had a low but proportional can- cer mortglity rate. When the cancer mortality among the chemists and the metallurgists was compared with this social class standardized group the RR:s were significantly elevated, 254 and 181. CANCER AMONG CHEMISTS, ARCHITECTS, METALLURGISTS

LIST OF ABSTRACTS (p7 CARCINOGENIC RISK IN OIL-TANKERS VALERIA, F., RAFFETTO, G., PUNTONI, R., VERCELLI, N. Istituto di Oncologia, Universita di Genova, Genova, Italy Measures of Polycyclic Aromatic Hydrocarbons (PAH) were carried out on particulates collected inside oil tankers during the use of oxyacetylene flames. High levels of Benzopyrene (8.3 + 7.2 mg/l000m3) and nitrogen oxides (from 2 to 20 ppm) were collected. The fraction of collected (41J smoke, soluble in cycloesane, was injected in peritoneum of Balb/C mice. (41 The frequency of Sister Chromatide Exchange (SCE) induced in marrow cells was evaluated. A significant and dose-related increase of SCE resulted, comparable to that induced by pure PAH. According to this result, the presence of other mutagenic substances together with Benzo- pyrene is hypothesized. Chemical and biochemical results confirmed epidemiological evidence of an increased risk of lung and bladder cancer in workers operating inside oil tankers. Authors propose the use of this coordinated approach for an effective primary cancer prevention in work places. /OIL TANKER/POLYCYCLIC AROMATIC HYDROCARBONS/SISTER CHROMATIDE EXCHANGE/ /LUNG CANCER/BLADDER CANCER/ 028 CANCER INCIDENCE AMONG FERROCHROMIUM AND FERROSILICON WORKERS. LangArd, S.x, Andersen, Aa.xx & Gylseth, B,xxx xDepartment of Occupational Medicine, Telemark Sentralsjukehus, Porsgrunn, Norway; xxCancer Registry of Norway; xxxInstitute of Occupational Health, Oslo. The cancer incidence in a male population involved in ferrochromium and ferrosilicon production has been studied. The study includes all retirees and present workers employed in the factory for more than 1 year from 1928 through 1977. The prime purpose of the study was to eva- luate the carcinogenic potencies of trivalent chromium. 976 persons were included in the investigation. The cancer incidence for all sites was found to be lower than expected when compared with the national figures. Seven out of 9 lung cancer cases had occurred in the.ferro- chromium sub-population, against an expected rate of 3.1 and 1.8 when using national and local expectance rates respectively as reference. Since hexavalent chromium compounds were demonstrated in the working atmosphere, it is concluded that the raised lung cancer incidence was partly due to exposure to chromates. The results demonstrate that a lower than expected cancer incidence in a working population does not justify the conclusion that no increased cancer risk is present. /CHROMIUM(III)/CHROMATES/CANCER INCIDENCE (411

~ HISTOPATHOLOGICAL CHANGES OF THE NASAL MUCOSA IN NICKEL WORKERS. A FOLLOW-UP STUDY. Boysen, M., Solberg, L.A., Hogetveit, A.C. & Reith, A. Norsk Hydros Institute for Cancer Research, The Norwegian Radium Hospital, Oslo, Norway.Falconbridge Nikkelverk A/S, Kristiansand, Norway. Workers employed in the nickel refining industry have a high risk, increasing with the duration of exposure, of developing cancer of the upper and the lower respiratory tract. Recent histopathological stud- ies at Falconbridge Nikkelverk A/S, Kristiansand, Norway, demonstrate that 12% of the process workers and 47% of retired nickel workers ex- hibit dysplasia of the nasal mucosa. These changes have been inter- preted as probable early precancerous lesions. These findings called for preventive measures and modifications in the refining process and an improvement of personal hygiene were there- fore introduced. Histopathological follow-up studies show that the num- ber of dysplasias have thereby been reduced by 50% compared to the pre- vious study. These findings correlate well with a significant reduc- tion in plasma nickel content. The authors believe that the reduction in dysplastic epithelial les- ions reflects the improved environmental conditions. Whether these findings will entail a reduction in the occurrence of cancer in the respiratory tract is for the future to show. NASAL MUCOSA, HISTOPATHOLOGY, DYSPLASIA, NICKEL 030 INIERACPION OF NICKEL WITB DNA ADID CF~ZCYMhTIN FFmM HUA'RsN CELLS UGOLINI, D., 2ARDI, L., DIVINCI, A., RIALDI, G., and SA NTI, L. Istituto Scientifico per lo studio e la cura dei tumori; e Istituto di Chimica Industriale de22'Universita, de»ova; Ita1y. Nickel has been shown to be a powerful carcinogen in animals and humans. Experimental studies on animals have shown the production of several malignant tumors and epidemiological studies conclusively demonstrate a high risk of cancer of the nasal cavity and lungs in workers in nickel refineries. Because relatively little is known about the molecular site attached by nickel ions within a cell, it is of some interest to consider reactions of nickel ions with molecules or complexes of molecules that have been isolated from the cell. We have studied the equilibrium con- stant of Ni65 with purified DNA and chromatin from human fibroblasts using the equilibrium dialysis technique. We observed that nickel binds to DNA with two different equilibrium constants possibly representing nickel-phosphate and nickel-base binding. On the other hand, nickel binds irreversibly to chromatin suggesting an.interesting mechanism for carcinogenicity of nickel.

LIST OF ABSTRACTS l411 (411 and asbestos exposure. 031 SHZPBVU,DZNG-ASSOCIATm MSODEsaMA IN 00AsTlL vIFrj1nnA TAGNON, I., BLOT, W.J., DAY, N.E., MORRIS, L.E., PEACE, B. B.,. and FRAUMENI, J. F., Jr. Environmental Epidemiology Branch, National Cancer Institute, Bethesda, MD 20205, U.S.A. A case-control study, undertaken to clarify reasons for a higher incid- ence of mesothelioma discovered among white males in coastal Tidewater, Virginia, linked the high rates to employment in area shipyards. The relative risk (RR) of inesothelioma was 18.1 for career shipyard workers who began employment before 1950 and were reported to handle asbestos (95% confidence limits = 8.1 - 48.4). The RR's were 16.4 for those who worked only temporarily, most during World War II, and were reportedly exposed to asbestos (95% confidence limits = 5.7 - 62.8), and 10.3% for career shipya'rd workers who began employment prior to 1950, and who were not reported to handle asbestos (95% confidence limits = 5.9-31.5). The risk of mesothelioma was inversely associated with the amount of cigarettes smoked, a trend that may be related to the powerful competing risks for fatal diseases due to the interactions of smoking /MESOTHELIOMA/SHIPYARD/RELATIVE RISKS/ASBESTOS/ 032 SKIN RF.ALTMTY TO SK-SD, PPD AND PHA IN ASBESTOS DJURKERS LANGE, A., SMOLIK, R., GARNCAREK, D., CHMIELARCZYK,W. CIECRA NOWSKI, G. Dept. of Occupational Diseases, Medical School, Wroc3aw, Poland. Skin reactivity to streptokinase (SK-SD), tuberculin (PPD) and phyto- hemagglutinin (PHA) was studied in 232 asbestos workers. Asbestosis is significantly correlated with the lack of skin reactivity to first strength of all three lymphocyte activators; however, the PHA and SK-SD tests show more sensitivity than PPD. A statistically significant cor- relation was found between the lack of reactivity to first strength SK-SD and presence of ANA; however, this is at least partly related to asbestosis. The simultaneous occurrence of ANA and a negative skin response to second strength of PHA is suggestive of asbestosis. The fate of workers lacking a response to recall antigens and PHA shows that this can be predictive of asbestosis and/or ANA. Up to the present time only one lung cancer was diagnosed and this case lacked the skin respon- ses. Skin testing can be of value in weecTing out workers more suscept- ible to the adverse effects of asbestos, and on a group basis abnormal skin responses appear before the workers reach an age of maximum risk to cancer. /SKIN REACTIVITY/ASBESTOS WORKERS/ 1 lI 14

LIgT OF ABSTRACTS BIOC'FtEMICAL AND I*21NC)IAGICAL S[JRVEILLANCE OF A CFOUP OF 033 VINYL CHIARIDE WDRKEIiS. PAGE, M. , DELORME, F., AUDETTE, I7. pept. of Biochemistry, Universite Laval, Quebec; and Dept. of Pathology, universite de Montreal, Montreal, Quebec, Canada. Vinyl chloride has been recognized as a potential carcinogen in the work- place. An increased risk of angiosarcoma has been observed among workers exposed to the monomer. Serum from 193 male subjects from the same industry were analysed. We found elevated levels of carcinoembryonic antigen (>4.3 ng/ml) in 19/193 (P<0.005), ferritin (>170 ng/ml) 18/185 (p<0.005), GGT in 44/185 (P<0.005), alkaline phosphatase in 14/185 (P<0.1). Levels of GOT, GPT, LDH were significantly different from a normal popul- ation. The total of 112 abnormal analyses obtained in this cohort of vorkers shows clearly its anomalous nature (P<0.005). We shall discuss the importance of these immunological and biochemical tests in a surveil- lance program. (Supported by the National Cancer Institute of Canada and Conseil de Recherches en Sante du Quebec.) /VINYL CHLORIDE/CEA/FERRITIN/SURVEILLANCE/WORKERS/ 034 CARCINOGENICITY OF SUBSTITllTED-BENZENE DIAMINES. Sontag, J. M. National Cancer Institute, Bethesda, MD. U.S.A. The substituted-benzene diamines (SBD) constitute an important class of chemicals. Sixty-three SBD are reported in commerce.,.having an estimated annual volume in excess of 700 million pounds. SBD are associated with the dyestuff industry, hair dye ingredients and polyurethane manufacture. General population exposure is likely in the millions for SBD in hair dyes. Workplace exposure may occur in the manufacture and application of dyes and in the production of polyurethanes. Ten SBD were studied for carcinogenicity in long-term rat and mice bio- assays. Four induced a statistically significant incidence of tumors in both species and one in mice only. Three others were associated with an increased, though not statistically significant, tumor frequency in treated animals. Two SBD were not associated with any notable tumor in- creases. Tumors induced in rats were mainly of_the..bhadder, liver and thyroid; and in the mouse of the liver and thyroid. Many mutagenicity (in bacteria and higher organisms), chromosome damage and cell transfor- mation studies have been done on eight of the SBD tested for'carcinogen- icity, including those that were negative in both species. All SBD were positive in short-term assays, even those found not to be carcinogenic. Despite the similarity among SBD studied for carcinogenicity, no correla- tions could be made between the observed results and chemical structure. Theee findings strongly indicate the need to reevaluate those SBD found not to be carcinogenic and to study those SBD not yet tested. /SUBSTITUTED-BENZENE DIAMINES/CARCINOGENICITY/HAIR DYES/

LIST OF ABSTRACTS 035 OCCUPATIONAL NASAL CARCINOGENESIS AMONG DENTISTS? Glazebrook, G.A., University of Alberta and Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada. 671 dentists were registered in Alberta for 1973. In that year two dentists presented at the Cross Cancer Institute with extensive anaplastic squamous cell carcinoma involving the nasal cavity and accessory sinuses, an incidence rate of 298 per 100,000. Owing to the Provincial Cancer Service the registration of malignant disease is (41) virtually complete and during 1973 the total Alberta registration of squamous carcinoma of the nasal cavity, accessory sinuses and naso- pharynx was 28 cases. Assuming that all 28 cases arose in males over 24 years of age, and knowing that the 1973 Alberta population included 432,000 males over the age of 24 years a maximum expected incidence rate of 6.5 per 100,000 would apply to this population group. This paper describes the two dentists referred to above, contrasts the incidence rates previously quoted, discusses the frequency of malignancy among dentists in general and most especially draws attention to the role of inhaled oil droplets produced by high speed air rotor dental drills as a possible occupational carcinogenic hazard in the dental profession. On reviewing the world medical literature no previous report of this hazard has yet been traced. There is no significant risk for dental patients. /CANCER/PARANASAL/OCCUPATION/OIL/DENTISTS/ 036 HEALTH EFFECTS OF AN ACCIDENTAL EXPOSURE TO DIMETHOATE AND ITS DERIVATES. Matos, E.L., Larripa, I.- Oncology Institute "Angel H.Roffo", National Academy of Medicine, Buenos Aires, Argentina.- Contradictory results have been found in experimental animals regarding dimethoate carcinogenesis. This phosphorate pesticide also proved to be mutagenic within diverse systems. In April 1979 an exo- termic reaction ocurred in B.A. in a cystern where dimethoate was (QI) formulated. Clinical analysis, performed on the 25 firemen who participated in the disaster immediately after the accident, gave normal results. The damaged reported respiratory tract and conjunctiva irritation (24%), itching (20%), digestive symptoms (24%) and neurological symptoms (24%). Not all the symptoms were concurrent and 24% of cases was asymptomatical. Also information was required concerning personal data, work and smoking history as well as health antecedents related to work. We also studied the peripheral blood lymphocytes chromosomes from the exposed by the SCE technique. Exchanges average for each case was achieved from the reading of 20 methaphases. Exposed people,s SCE average was significantly different from the control people,s one with a p 0.05. Two months after the accident 36% of cases reported sexual inhibition, dimethoate smell still persisted in the scalp and sweet of 28% of cases. The 36% left was aymptomatical. None of them reports any symptoms 8 months after the disaster. We will follow this cohort as far as the possible tumor's apparition is concerned.- DIMETHOATE ACCIDENTAL EXPOSITION/HUMAN. , r

tSTRACTS a ABSTRpCTS P LtiT O nrrrUPATIONAL EXPOSURE TO N-NITROSAMINES. Spiegel- I M ia!'f R_ & Preussmann. P. DeutceheG KrehSfnr- iada. ~ ~ zentrum, Heidelberg, Federal Republic of Germany. two ~chengs exposure to N-nitrosoamines exists in the fol-lo- potential eXp s: metal cuttin & rollin leather tan- area g g, ~lnQ working ubber manufacture, hydraulic fluids handling (esp. r the ~ n, in t~ines), chemical industry producing or using amines (in- ticides) In ord t er o el id i t th i uc a e e or g ine pes ing am.n f clud n of nitrosamines in these areas industrial i , o ~ d format ~ and chemicals as well as the air in various are ltl r er ded as I J~ ~u cts were analyzed. Usually the sources of the amine precursors .aill be known since they will be part of the manufacturing process. The nitrosating agent can be nitrite (metal cut- draulic fluids), NO (leather tanning chemical h , y 0 tin9• dustry) and transnitrosatfng agents like nitrosodiphenyl- :S ln anine, used in the rubber industry. The resulting data are compared for their contribution to the individual exposure le,els in different working places. First results on bio- logical monitoring are reported. Spiegelhalder, B. (1979), paper presented on 16th Dt. Kon- gress f. Arbeitsschutz & Arbeitsmedizin, D'usseldorf. l.aien, M.J. et al., Science 205, 1262-1264 (1979). /OCCUPATIONAL EXPOSURETNITROSAMINES/ i ~ LUNG CANCER MORTALITY IN WORKERS EMPLOYED IN CHROMATE PIGMENT FACTORIESI A multicentric Central European epidemio- logical study. R. Frentzel-Beyme, German Cancer Research Center. Heidelberg The risk of cancer of the respiratory tract after exposure to chromium has been pointed out and preventive measures were taken. In order to verify the suspicion of an increased cancer risk in workers exposed to lead chromate pigment dust, a study including 7 factories in 4 countries was designed. Due to difficulties in follow-up of causes of death in France and Italy, only 5 factories in The Netherlands and in the German Federal Republic were included for evaluation. Almost all the employees had been exposed to both lead and zinc chromate pigmentss the final nunber of 1,921 employees contributed 28,.512 person-years. A moderately but consistently Increased risk of lung cancer and other respiratory tract cancers was apparent for the workers of 4 out of 5 factories. In no instance did the observed deaths range below the expected nLanbers. even when classifying the workers by duration of e•nployment. The results are consistent with the hypothesis that exposure to chromate pigments may cause increased incidence of cancer of the respiratory tract. OCCUPATIONAL RISK/LEAD CHRDMATE PIGMENT/ZINC CHROMATE PIGMENT/ RESPIRATORY TRACT CANCER

LIST OF ABSTRACTS 039 uRUNAxY r1UrACEis ArID MNOOxIC;E~WE ACrrvrPY IN cMuCAL WORiOEFS. MAZZOLI, S. , LODOVICI, M. , BUTATTI, E. , DOLARA, P. , BACCETTI, S. , TURCHI, A. Institute of Pharmacology, Centro di Medicina Sociale de11a Provincia, Firenze, Italy. The levels of mutagens in the urine of controls and chemical workers were studied by desorption from XAD-2 resin and testing with Salmonella-micro- some plate test. The urine of chemical workers showed higher mutagenic activity compared with controls with Strain TA 100, with and without S-9. When TA 1538 was used, the differences between the two populations were less relevant, although a higher mutagenic activity was found among chemical workers in the presence of metabolic activation. After 20 days of leave from work, the levels of mutagenic activity fell to zero in 5 workers that were followed up. Inherently active mutagens were found in the urine of chemical workers and not in controls. The possibility that this difference might be explained by variations of the levels of mono- oxigenases in the population exposed to chemicals was tested by following D-Glucaric acid excretion, antipyrine half-life and y-GT in serum. /URINARY MUTAGENS/ENZYME INDUCTION/ NASAL SINUS TUMOURS, WOOD EXPOSURE, AND SMOKING. Elwood, J. Mark Cancer Control Agency of British Columbia, Vancouver, British Columbia, Canada. Furniture makers in England working With'hardwoods have an in- creased risk of nasal sinus tumours. In British Columbia forestry and associated industries, using mainly softwood, are the major industry. A case control study compared the 121 male patients with primary epithelial tumours of the nasal cavity and sinuses.seen at the main referral centre from 1939 to 1977 with comparison patients matched on age and year of diagnosis who had selected other tumours, excluding types known to be related to major occupational risks or to smoking. Of the cases, 23$ had a wood exposure occupation compared to 13$ of comparison patients: relative risk, RR = 2.3, P= 0.001. Smokers had a RR of 4.3 (P < 0.001) compared to non smokers. Each association persisted after control for the other, and for ethnic origin. The RR for both smoking and wood exposure, compared to neither, was 7.10. The use of two other comparison series of patients and of census data suggested that the comparison series used was unbiased in terms of occupational and smoking histories. The increased risk with wood exposure was not specific to any anatomical or pathological subgroup. /NASAL SINUS CANCER/OCCUPATION/SMOKING/W00DWORKERS/EPIDEMIOLOGY ~ 0 O $0 r LO

LIST OF ABSTRACTS ~ CANCER IN NUCLEAR TEST PARTICIPANTS: A PRELIMINARY REPORT, CA LDWELL, G.G. Cancer Branch, Chronic Diseases Division, Bureau of Epidemiology, Center for Disease Control, Atlanta, GA, U.S.A. During the summer of 1957, 25 nuclear tests were detonated in the Nevada desert as part of the United States Nuclear Test Program. In conjunction with these tests, 3,225 individuals participated in mock etomic war maneu- veTs. This study is a followup of those participants, to determine if they have experienced an increased incidence of cancer during the inter- vening twenty years. All individuals were identified through military and government records which listed name, serial numbers, unit designation and radiation exposure. We have contacted 70% of the participants by October, 1979, and obtained birth dates on 93% using the birth and death data known thus and using incidence rates from the Third National Cancer Survey, we calculate that 3.5 cases of leukemia were expected by chance alone. To date 8 cases have occurred, a significant difference. In addition, approximately 100 cases of all cancers were expected and 111 have been identified but not entirely confirmed, nevertheless, the total number of cancers is not significantly elevated. The importance of this study is that individuals theoretically exposed to low dose radiation during the nuclear test program, have exhibited an increased incidence of disease and consequently, further study must be done to determine whether this is due to coincidence or is a result of radiation exposure. /RADIATION/CARCINOGENESIS/NUCLEAR TEST PARTICIPANTS/ 0V BREAST CANCER MORTALITY FOLLOWING FLUOROSCOPIC IRRADIATION IN A COHORT OF TUBERCULOSIS PATIENTS. Howe, G.R,, Miller, A.B., Sherman, G.J. NCIC Epidemiology Unit, University of Toronto, Canada. The breast cancer mortality experience of 44,929 female tuberculo- sis patients has been ascertained using computerized record linkage techniques and the Canadian National Mortality Data Base. A substan- tial proportion of these women were subject to amounts of fluoroscopic irradiation up to several thousand rads. The data have been examined with respect to dose-response relationships, age at exposure and latent period, factors of particular relevance to breast cancer due to current interest in screening programmes using mammography. The data will provide the largest single body of evidence accumulated in man to date relating to radiation-induced cancer. /BREAST CANCER/RADIATION/EPIDEMIOLOGY

LIST OF ABSTRACTS Of+3 MAMMARY GLAND CARCINOGENESIS IN RATS FOLLOWING IRRADIATION AND HORMONE ADMINISTRATION. van Zwieten, M.J.1), Hollander, C.F.1), Broerse, J.J.2) and van Bekkum, D.W.2). Institute for Experimental Gerontology TNO1), and Radiobiological Institute TNO2), P.O. Box 5815, 2280 HV Rijswijk, The Netherlands. Retrospective epidemiological studies in women have supported the (48) premise that the human mammary gland is quite sensitive to radiation carcinogenesis. In order to assess risk estimates for low dose expo- sures, such as used in diagnostic radiology, studies on dose-effect relationships for mammary gland carcinogenesis in experimental animals are essential. Investigations in 3 rat strains irradiated with single doses of X-rays and mono-energetic neutrons at several energy levels, with and without the administration of 17-g-estradiol, have shown that considerable differences exist in susceptibility for tumor induction in the three strains. RBE values at the 30% prevalence level vary between 2 and 4 for 15 MeV neutrons and between 8 and 25 for 0.5 MeV neutrons. Malignant mammary tumors occurred more frequently in one of the strains than in the other 2, and estrogen treatment not only in- creased the proportion of rats with malignant tumors but also increased their absolute incidence. MAMMARY CARCINOGENESIS/RADIATION/HORMONES/RATS t 044 SECOND MALIGNANT NEOPLASMS (SMN) IN CHILDREN IDENTIFY "HIGH RISK" GROUPS. Meadows, A.T. for the Late Effects Study Group (LESG), Children's Hospital of Philadelphia, Philadelphia, PA 19104. The LESG has recorded 219 children from 13 pediatric oncology centers who developed more than one malignant tumor. There were 143 whose SMN occurred in irradiated fields, including leukemias;41 of them also had a known genetic disease. Thirty-one others with genetic disease developed SMN unrelated to radiation. In 45 children neither radiation nor a known genetic condition could account for the SMN; chemotherapy might [48] have been related to the SPN in 11 but some also had family histories or tissue-specific combinations of neoplasia which suggested that they too might be at increased risk because of genetic susceptibility. Examples of the former included having siblings with cancer. There were 13 pairs, including 2 members of 2 pairs in the study, both with SMN and known genetic disease. In the small group of 6 with more than 2 malignant tumors were 3 whose sibs also had cancer, reinforcing the designation of "high risk" in those with affected siblings. Certain combinations of tumor types were also recorded more often than expected, in siblings, and in those with more than 2 malignant diseases: brain tumors with leukemia or lymphoma, brain tumor with colorectal carcinoma, and Wilms' with brain tumor or soft tissue sarcoma. The drugs which might increase risk are alkylating agents, nitrosoureas and procarbazine as well as others, such as methotrexa e, which cause chronic organ dama e and stimulate repair and proli~eration. Examples will be presen~ed. Supported by USPHS Contract NO1 CP 91049. /SECOND NEOPLASMS/CHILDREN/HIGH RISK/ ~

LIST OF ABSTRACTS 1481 045 CYTOSTATIC CHEMOTHERAPY AND SECONDARY MALIGNANCIES. Gerhartz, H., Gerhartz, D.,Dpt. of Hematology and Oncology, Klinikum Westend, Free University Berlin, Germany. Secondary malignancies occur quite often during the course of malignant diseases of the hemopoetic system, but less frequent in advanced carcinomas. Among nearly 1000 pa- tients with chronic lymphocytic leukemia (CLL), Morbus Waldenstrtim (IM), multiple myeloma (MM), Morbus Hodgkin (LG) and high grade malignant lymphoma (lymphosarcoma, reticulo- sarcoma) the rate of secondary malignancies varied from 2.2 to 20%. In diseases combined with antibody-deficiency-syn- drome or paraproteins, e.g. CLL, IM and MM, usually 10 to 20% of all patients died due to second cancers. In all dis- eases chemotherapy, especially with alkylating agents, was given over a long-time period due to the relatively long life-expectancy of the patients (3 to 4 years in CLL, MM and IM), but no relation could be found between duration or amount of chemotherapy and frequency or kind of secondary cancers. The most frequent secondary malignancies were cancers of the gastro-intestinal tract and of the lung; acute leukemia only occured in IM, MM and LG. In advanced cancer patients secondary cancers are rare (less than 2%); acute leukemias only occured after intensive radiotherapy. 046 EVAiIJATION OF CENEPIC RISK AND DNA-DAr4;GE EFTW'IS IDIDUCED BY NMU, NiYMA AND NITFODWROBENZENES. CESARONE, C. F. , BOLOGNESI, C., and SANTI, L. Institute of Oncology, University of Genoa, Genoa, Italy. The alk~tline elution technique has been greatly improved by a new fluoro- metric method for DNA assay. The in vivo treatment with NMU (I) and NDMA (II) has induced increased breaks on DNA molecule. I and II were given at the doses of 100, 150, 200 mg/kg and 200 mg/kg respectively. 48) The results were confirmed evaluating the incorporation of tritiated thymidine into DNA during repair synthesis stimulated in mice spermatids by the treatment with I and II at doses of 50, 75 mg/kg and 2, 4 mg/kg respectively. These experiments evidenced also the ability of such nitroso-derivates to cause genetic damages at low exposure levels. More- over using alkaline elution, the damaging ability has been evaluated of mono-, di-, and trinitrochlorobenzene injected in scalar doses (1000, 180, 60 mg/kg). These derivates have shown a great affinity for lipid- rich tissues: brain, liver and kidney. The single-strand breaks induced seems to be increased as a function of the nitro-groups beared on the ring. These observations have led to suggest a relationship between ~ ~ chemical structure and the damaging properties on the DNA molecule. /DNA-DAMAGE NITROCHLOROBENZENES NITRODERIVATIVES/ r

LIST OF ABSTRACTS 047 ON THE CARCINOGENICITY OF THE N-NITROSAMINES FORMED DURING NITROSATION OF SPERMIDINE IN SYRIAN GOLDEN HAMSTERS. LaVoie, E., Rivenson, A., Bedenko, V., Ohmori , T. and Hoffmann D. American Health Foundation, Naylor Dana Institute, Valhalla, New York 10595 USA Several N-nitrosamines are formed during the nitrosation of the polyamines, spermidine and spermine. Since these polyamines may represent a source for the endogenous or f48) exogenous formation of N-nitrosamines, their major nitrosa- tion products were assayed for carcinogenicity in male Syrian golden hamsters. Administration of N-nitroso-3- butenyl(2-propenyl)amine, s.c. once a week for life at a dose of 300 mg/kg, induced neoplasms mostly in the upper respiratory tract (nasal cavity, larynx, trachea). Lung microlithiases (aveolar and bronchial) also developed in all of these animals. In contrast, N-nitroso-3-butenyl(3- hydroxypropyl) amine and N-nitroso-4-hydroxybutyl(2-pro- penyl)amine induced neoplasms, primarily in the digestive tract, including the nonglandular stomach, cecum, colon, and adrenal gland. These compounds are the only N-nitrosamines which are carcinogenic to the colon and can be formed from an endogenous substrate. This study was supported by National Cancer Institute Contract N01-CP-55666 and #nstitutional funds:. ~ A LIC~i'P AND EIECITiC7N MICR06COPIC SZIJDY OF LIVER AND IiJIVG 'lZMRS I2IDUCID BY A S1T]GIE IlyW DOSE OF DIEIHYLNITF0SAM= (DEN) IN MICE RIJNSINGHANI, K., ABRAHAMS, C., KRAKOWER, C., SWERDLOW, M., and RA O, K.V.N. Michael Reese Hospital and University of Chicago, Chicago, IL 60616, U.S.A. A long term study to investigate the effect of a single intragastric dose of DEN was undertaken in 15 day old male C57BLXC3H F1 mice. Group I was given 0.3 ug/gm b.w., group II 0.6 ug/gm b.w. and group III received ve- (48J hicle only and served as control. There were 30 mice in each group. Ani- mals were sacrificed at 10 week intervals and liver and lung tissue were examined by light and electronmicroscopy. Between 25-75 weeks, 13/15 ani- mals of group I and all 22 animals of group II showed gross liver tumors. The liver lesions were classified as hyperplastic nodules, liver cell adenomas and carcinomas. The incidence of these lesions was related to the duration of the observation period. Ultrastructurally the hyperplas- tic and adenomatous lesions showed dilated cisternae of the rER which contained electron dense crystalline material. No gross or microscopic liver lesions were observed in the controls. Lung lesions were not seen grossly in 13 control mice, however microscopy showed one adenoma at 52 weeks. Mice of group II developed a significant increase in number of lung adenomas (12/22) compared to mice of group I(3/15). Electronmicro- scopy of the lung adenomas showed many dense granules, some with dense cores and lamellated inclusion bodies. Our results indicate that DEN is effective even in a low single dose in inducing liver and lung tumors in mice. /DEN/LIVER/LUNG/TUMOR/MICE/ ~~

115T OF ABSTRACTS SENSITIVITY OF SYRIAN GOLDEN HAMSTER FETAL LUNG CELLS TO V+~ BENZO(A)PYRENE IN VITRO. Emura, M., Richter-Reichhelm, H.-B., schneider, P. & Mohr, U. Abt. f. exp. Path., Medizinische Hochschule ,tannover, FRG. ,rhe dose-response of Syrian golden hamster fetal lung (FSHL) cells to toxic and transforming effects of benzo(a)pyrene (BP) was studied 4,1th regard to influence of sex, cell batch and insulin in medium (FPN1)Trypsinised lung cells were cryo-preserved for every litter of fetuses (male or female, or a mixture of both) at the 15th prenatal day. After 2 passages in RPMI with 20% FBS, 6 cm plastic dishes were seeded w•ith 6 x 103 cells each. Colonies were counted electronically. Trans- ic=-m,ation was scored morphologically. Toxicity and transformation were not significantly influenced by cells of different sexes, but were by different batches. Insulin appeared concentration-dependent. The add- ition of 8 Vg/ml insulin, which significantly stimulated both attach- 6,ent and cloning efficiency, enhanced sensitivity to BP-transformation hut not to BP-toxicity. Good correlations were found for the linear dose-response between transformation frequencies and lor,-scaled BP doses. The dose-response to BP-toxicity covered a rather wide range of doses. Thus, with 8 ug/ml insulin and 20% FBS, linear dose-responses of FSHL cells to BP-transfoYmation appeared to occur at much lower BP doses (0.01 - 0.5 ug/ml) than without insulin. Supported by the Umweltbundesamt, Berlin (Contract No. 10401011), FRG. /SYRIAN GOLDEN HAMSTER FETAL LUNG CELLS/BP/DOSE-RESPONSE/INSULIN ~ PREVENTION OF CANCER-DEVELOPMENT WITH SEMISYNTHESIZED ACID POLYSACCHARIDE ~TGDS~ IN ARTIFICIAL SKIN CANCER INDUCED BY N-METHYL-N'-NITRO-N-NITROS GUAN DINE (MNNG) IN MOUSE. Fukushi,K.*; Ohkawa,K., Kato,S., Kawada,A. & Sagawa,Y. Depts.of *Patho- logy; Obsterics & Gynecology; Nippon Medical School, Tokyo, Japan. Squamous cell carcinoma only was induced in mouse skin, and by pre- t'reatment with semisynthesized acid polysaccharide (TGDS), cancer deve- lopment was markedly prevented. By comparing N-GROUP (0.4% MNNG solu- 1461 tion applied on dd/Y mouse abdominal skin, 3 times/wk. for 7 months) with TN-GROUP (MNNG applied as in N-GROUP after treatment twice/wk. for 2 months intra-peritoneal injection of 1% tragacanth gum degradation sulfation - TGDS - physiological salt solution (0.05% mg/g.bod.wt.)),-- cancer prevention: N-GROUP 7.7% < TN-GROUP 32.1%; size of cancer: N-GROUP av. 496mm3 >'TN-GROUP 205.4mm3; multiple appearance; N-GROUP 70.8% > TN-GROUP 31.3%; and inhibitory effect was strongly seen histo- logically in the induced cancer. The preventive effect of TGDS is due to hyperfunction of general RES which causes immuno-stimulation by fibrous encapsulation through proliferation of subcutaneous RES mem- brane and mast cells. TGDS can be used in human beings. The MNNG skin application method is characterized by the appearance of only squamous cell carcinoma with no complication of sarcoma. /PREVENTION OF CANCER-DEVELOPMENT/MNNG-SKIN CANCER/ SEMISYNTHESIZED ACID POLYSACCHARID (TGDS)/SUBCUTANEOUS RES MEMBRANE/HYPERFUNCTION OF RES/

LIST OF ABSTRACTS ~ MEMBRANE ACTIVE COMPOUNDS AS ANTI-SCE-INDUCERS: IN VIVO AND IN VITRO RESULTS WITH N-METHYL, N-NITROSOUREA (NMU). Stahl, K.-W*! Cheng, S.-J., Bayer, U. & Chouroulinkov I. +) Institut de Cancerologie et d'Immunogenbtique (U.50 INSERM) & Inst. de Recherches Scientifiques sur le Cancer (CNRS), F-94800 Villejuif, FRANCE In accordance with known chemical data, genotoxicity of NMU as measured by sister chromatid exchange (SCE) at 37o C in serum free culture medium was found to be short lired ( 6Cmin.). When V79 Chinese hamster cells 1481 were exposed to NMU (10 -5x10 M), the SN1 alkylating carcinogen induced SCEs in a non linear log dose dependent manner. Analogous results were obtained in vivo measuring SC_Ea in Chinese hamster bone marrow cells. The inhibition of NMU (5-9x10 M) induced SCEs found in the presence of membrane active compounds, heterobipolar molecules of a definite chain length (i.e. n-alkanols, cis-alkenoic acids), depended on their chemical nature and tkeir concentrations. For the most potent inhibitor, CREMOPHOR EL (inhibition rate: in vivo 37%, in vitro 28$),indirect ex- perimental evidence is presented suggesting that at least two mechanisms may be implicated in the decrease of intracellular bioavailability of NMU: a physical interaction with NMU and the induction of cytoplasmic membrane structure modifications. A supglement treatment with non toxic anti-SCE-inducers, such as CREMOPHOR EL could be of considerable clinical interest provided that decrease of genotoxicity will not be accompanied by a similar effect regarding the anti-tumour activity of N-a-klyl, N-nitrosoureas. 052 A NEW CARCINOGEN ASSAY USING HUMAN CELLS ON A SOLID SUPPORT. Audette, M, and Page, M. Department of Biochemistry, Faculty of Medicine, Universite Laval and Research Center, Hotel-Dieu Hospital, Quebec, Canada. The actual health hazard of carcinogens is difficult to evaluate because the multiplicity of new chemical products. The classical in Vivo screening procedures require a large number of animals, an impor- tant financial contribution and are time consuming. It is now known [48] that chemical or physical carcinogens may induce alterations in the structure of DNA. That is the base for the DNA repair assay for screening carcinogenic compounds. The Ames test which is commonly performed has the disadvantage of using a bacterial system. The eva- luation of DNA repair by measuring the unscheduled DNA synthesis is performed with human cells. We describe a DNA repair assay on cover= slips using liquid scintillation counting. We found wi.th this method that a single treatment with styrene oxide (10-7 - 10-"M) induced unscheduled DNA synthesis in human amnion cells. Results obtained with this new, rapid and economical assay are in good correlation with the ones obtained with other methods. (Supported by the National Cancer Institute of Canada and the Medical Research Council.) / CARCINOGEN / DNA REPAIR / HUMAN CELLS / STYRENE OXIDE/ V, O O ~ r PS 53

{,TST OF ABSTRACTS ~ TRANSFORMATION OF UNUSUALLY STABLE DIPOID CELLS AND EXPLOITABILITY FOR PROMOTOR AND CARCINOGENESIS TEST. K, Hatanaka, M.D., National Cancer Institute, Bethesda, Maryland 20205 U.S.A.. Indian muntiac ( muntiacus munt3ak ) cells with a dipoid chromosome number of 6 in female and 7 in male, have been transf60mmorphologicallyotransformedscellsawereuisolatedX About and cloned. The clonal isolates maintained the diploid number of chromosfmihewparentalycellss However~ithentransformantsm those o developed no anchorage independency by the regular soft agarose method. A human tumor line deficient of thymidine kinase colony formation)inathessoftsagaroseeculturelwith hypoxan- Raji- thineitransformantsmformedH colonies the the s agarose. TK-, the These permanently established transformed cells with stable,gigantic dipoid chromosomes,will be expoitable to test the aquisition of anchorage independency by promotors, chromosomal aberration and SCE by carcinogens. %SCE%{RRNSFf1nI!'.Tif1D%ANCHORAGE TEST%DIPLO~D~CELLALINE%TION 054 EFFECT OF LOW DOSES OF IRRADIATION ON THE T CELL CYTOTOXIC RESPONSE TO TUMOR GROWTH. Gerber M., Dubois J.B., Pioch Y., Serrou B. INSEF4+I FRA N°46,CPL,Cliniques St Eloi, Montpellier, France. Previous studies on localized radiotherapy of a solid tumor implan- ted in the rear limb of mice showed that the scatter on the spleen(20 rads)of the therpeutic dose was sufficient to significantly lower the T cytotoxic response, as evaluated by chromium release test.In 2 diffe- rent regimen,400 rads 3 times a week for 3 weeks and 700 rads 3 times over a week, given for the same splid tumor,opposite results were ob- served related to tumor growth on one hand and to cytotoxic response on the other hand. The first regimen was curative for 50% of the trea- ted animals and their cytotoic response was normal and could be reac- tivated up to 7 months after transplantation. On the contrary, the growth of the tumor of the mice treated by 700x3 over a week was com- parable to that of the control mice, and T cell cytotoxicity of their splenocytes was-abolished. We elicited a threshold dose of 12 to 15 rads from the dose-response studies of T cytotoxicity which lead us to assume that the depressive effect of 700 rads was due to the scatter(About 13 rads versus <10 rads for 500 rads) and participate in the poor response to the radiothera- peutic regimen. / LOW DOSES OF IRRADIATION/T CYTOTOXICITY/SOLID TU10R/

LIST OF ABSTRACTS Because a population of nearby 2,500 patients irradiated between 1932 055 SCREENING FOR RADIATION-INDUCED HEAD AND NECK TUMORS. Daal, W.A.J. van, Goslings, B.M., Hermans, J., Ruiter, D.J.•, Sepmeijer, Chr. F., Vink, M., Vloten, W.A. van. University Hospital Leiden, The Netherlands. PS 53 All the lesions found in EN including urinary tract cancer have been in- with Special Reference to Etiology and Pathogenesis. MAR KovrC, B. Medical Centre, Gnjilane, Yugoslavia. URINARt TRAC.`T CANCT;R. A CCanparative Nbrphological and ncperimental Study and 1963 at the University Hospital of Leiden for benign diseases as tuberculous lymphadenitis, hyperthyroidism and larynxpapillomas, was considered to be at risk for radiation induced cancers, in particular of the thyroid gland (UNSCEAR, 1977 United Nations, New York), an at random sample of 25 A of this population was examined. Most carcinomas were seen in the skin. Far less carcinomas of the thyroid were observed than expected according to the dose-effect relations of similar screening programs elsewhere (Maxon, H.R., e.o. 1977, Am. J. of Med. 63: 967-978). Only a few tumors were seen in the larynx, hypopharynx and salivary glands. Radiation-induced hyperparathyroidism was diagnosed in about 6 R of the examined patients. The costs and benefits of a screening of the whole population were analysed after examination of the sample group. /RADIATION-INDUCED HEAD AND NECK TUMORS/EXTERNAL IRRADIATION FOR BENIGN DISEASES/ SCREENING OF HIGH RISK GROUP / (% PRINg1RY CHMNIC INPEIiSTITIAL NEPFII;DPAT-lIES (EAIDEMIC BAIJCAN NEPHFLDPA4HY, PIIENACE`PIN NEPHROPA44iY AND OTE1F RS) FOLIAWID BY PS 53 of chemical analysis of phenacetin-affected human kidneys, the content of silicon and other microelements should be investigated. es from which they penetrate temporarily into drinking water. By means metals must be taken from magmatic rocks liable to microerosive process- experimental laboratory studies, the silicates containing blastomogenic where reports of these urinary tract diseases have originated. For the duced in laboratory animals in experiments using silicates containing blastomogenic metals. By chemical analysis of EN-affected human kidneys, a highly increased amount of silicon and other microelements have been ascertained. By associated action of phenacetin and quartz, all the lesions of phenacetin nephropathy have been experimentally induced in- cluding papillary necrosis. In the further experiments on phenacetin nephropathy and urinary tract cancer, environmental, geological and hydrological research should be performed in the regions of the countries /CHRONIC INTERSTITIAL NEPHROPATHIES/URINARY TRACT CANCER/ tr 0 0 s0 r 4 w m 0

LTST OF ABSTRACTS ~,cf q;k1DR (FOWlfl INHIBITION BY CAIirITO[JIN lT~~ DELBRUCK, H.1 and ANGHILERI, L.2 11. Medizinische Universitatsklinik, Homburg, Germany, F.R. 20rsay, France. Female Wlstar rats (b.w. 120-250 g) were injected s.c. in the inguinal region with 2 x 107 viable DS sarcoma tumor cells suspended in 0.2 ml of saline. T+'enty-four hours after inoculation the animals received sub- cutaneously 1 MRC U of salmon calcitonin (4700 MRC U/mg-Sandoz SA, Svitzerland). Calcitonin administration was repeated daily for 9 days. A11 the animals were killed 13 days after tumor cells inoculation. Tunor uptake of 14C(U)L-leucine, (5.6 - 3H) uridine and (6 - 3H) thymid- ;ne was studied in groups of tumor-bearing controls. Tumor growth in- hibition was observed only in young rats (b.w. 120-140 g). For a group of 23 tumor-bearing animals treated with calcitonin, the mean value of the tumor weight was 9.7 ± 1.7 while for 16 controls it was 14.6 ± 1.6 (p 0.01). The uptake by nucleic acids and protein precursors presented no significant differences between calcitonin-treated and control animals. Radiophosphate was incorporated to a higher extent (p 0.05), into the acidic phospholipid fraction of calcitonin-treated animals. The experiments performed with aged animals (b.w. 200-250 g) failed to show any significant difference of tumor growth or radioactive precursors. 0% CANCER : CAUSATION, RECOGNITION AND TREATMENT Holt, J.A.G., Centre for Radiotherapy & Oncology, 190 Cambridge Street, Wembley, West Australia 6014. Cancer is a defect in the linkage between aerobic and anaerobic glucose metabolic systems. Energy derived from aerobic glucose meta- bolism is used to control the energy which, derived from anaerobic glucose metabolism, is essential for mitosis. Any sublethal cellular injury, which releases the anaerobic glucose metabolic energy functions from control by the aerobic glucose metabolic pathways may cause cancer. Specific electrical differences in conductivity and dielectric constant between cancer, glucose oxidising normal and non-glucose oxidising normal cells permit 434 HHz electromagnetic radiation (VHF) to be used to (1) stimulate normal human growth and repair processes (2) distin- guish between apparently identical cancer and primitive cells (3) produce specific changes in reflection/absorption of VHF which identify cancer (4) alter the dynamics and morphology of human cancer (5) create non- specific thermal and specific non-thermal effects in cancer (6) increase radiosensitivity by 1 or 2 decades (7) design non toxic specific anti- cancer metabolic regimes (8) estimate Do and x values of human cancer (9) design effective therapy regimes for all types and stages of human cancer using combined x-ray therapy and VHF (10) formulate theories on cellular organisation and control (11) pinpoint sites of action of conventional cytotoxic drugs. DIAGNOSTIC & CANCERICIDAL EFFECTS OF 434 MHz RADIATION t; I

(20] LIST OF ABSTRACTS 059 HUMAN DIETARY CARCINOGENS. Lutz, W.K., Institute of Toxicology, ETH and University of Ziirich, CH-8603 Schwerzenbach, Switzerland. The following sources (with a selection of respective carcinogens) are discussed in connection with human dietary tumor incidence: Plants (pyrrolizidine alkaloids, safrole, cycasin); mushrooms (gyro- mitrin); microbial food contaminants (aflatoxins, sterigmatocystin); drinking water (asbestos, halogenated hydrocarbons, polynuclear aro- matic hydrocarbons); residues of the above mentioned in meat, milk, eggs; f ood processing and cooking (nitrosamines, amino acid pyroly- sates, aromatic hydrocarbons). Carcinogenic metals or salts of As, Be, Cd, Cr, Ni can also be found in the above-mentioned sources. The incidence of gastro-intestinal tumors is much higher than would be expected from exposure to the carcinogens so far known. Strongly synergistic or promotive events must therefore take place or additional, hitherto unknown carcinogens must be responsible. Only short-term assays will be able to deal with the great number of com- pounds to be evaluated, those tests being most urgently needed which also provide an estimate for promotive activities and the carcino- genic potency. As an example, it is shown that covalent binding of carcinogens to DNA in mammalian organs can be used for an assessment of (i), the carcinogenic potency of aflatoxin residues in meat, and (ii), the formation of dimethylnitrosamine in the rat from dimethyl- amine and nitrite. 060 FOOD ADDITIVES r 12

LTST OF ABSTRACTS DETECTION OF DIETARY CARCINOGEN: EXPERIMENTAL AP- ou PROACHES. Sugimura, T., Nagao, M. & Wakabayashi,K. National Cancer Center Research Institute, Tokyo, Japan. The microbial mutation test provides a practical way to detect carcinogens in food. Through its application, charred parts of broiled fish and meat were mutagenic with metabolic activation to Salmonella. Among compositions in fish and meat, only amino acids and proteins yielded potent mutagens upon pyrolysis. Amino-Y-carbolines and dipyrido- imidazolessed ntemivelfroTherypto- phan and glutamic acid PYrolYsates, resPect Y• specific mutagenic activity of some of these heterocyclic amines was found to be highter than that of aflatoxin B1. These new heterocyclic amines were organic-chemically syn- thesized and they showed carcinogenicity in vitro and in vyvo. The knowledge of properties of these chemicals made possible the determination of actual amount of these sub- stances in charred food. The above is an example of the process used to identify and prove experimentally the presence of carcinogens in food. Other examples of detec- tion of dietary mutagens will be given. New information on promoters in food will be introduced. /DETECTION CARCINOGEN FOOD/ ~ DIETARY PROMOTION OF CARCINOGENESIS Carroll, K.K., University of Western Ontario, London, Canada. The pioneering work of Berenblum and others has led to the concept that carcinogenesis can be divided into stages, commonly referred to as initiation and promotion. Initiation, resulting from interaction of a carcinogenic agent with a cell, is generally considered to occur rapidly and to be essentially irreversible. Subsequent proliferation of tumor cells during the promotional stage is thought to be significantly inf- /JOJ luenced by environmental factors, which may either stimulate or inhibit tumor growth. Environmental influences are also thought to be largely responsible for the marked geographical differences in cancer mortality observed in epidemiological studies. Diet has been implicated as a sig- nificant environmental variable because certain dietary constituents, such as fat, show a positive correlation with mortality from cancer at specific sites such as breast and colon. Similar correlations have been observed in experiments with animal models. The studies with animals have also provided evidence that the dietary effects are exerted mainly at the promotional stage of carcinogenesis. Since breast and colon cancers account for a large proportion of cancer deaths in many coun- tries, tumor promoting effects of diet may be an important factor in overall cancer mortality. /DIET/FAT/CANCER PROMOTION/BP.EAST/COLON/

LIST OF ABSTRACTS (63 DIETARY MODULATION FOR CANCER PREVENTION. Newberne, P.M. & Nauss, K.M. M.I.T. Cambridge, MA 02139. The relation of nutrition to cancer and to modulation of susceptibility of individuals to carcinogens has been ques- tioned a number of times during the past four decades. Only recently has interest been sufficient to spur significant, wide-ranging investigations. Data now available from epi- demiology and laboratory studies indicate that dietary in- (20) gredients are related to cancer; those most likely to affect cancer induction and its progress include protein (and some amino acids), fat, carbohydrate (fiber), vitamin A and ana- logues, and zinc; other nutrients have not been as exten- sively studied. Mechanisms whereby nutrients influence carcinogenesis are unclear; however, nutrients appear to affect metabolism, and many chemical carcinogens are either activated to the proximate carcinogen, or detoxified by the microsomal en- zyme systems, the latter modified by dietary nutrients. There are also some indications that nutrients may influence immunocompetence, and in this manner increase or decrease susceptibility to cancer induction. The complexity of diet and nutrition suggest multifactorial effects on susceptibil- ity to cancer. /DIET/NUTRITION/CANCER/EN2YMES/IMMUNITY ()64 DIETARY-MODULATION IN CANCER PREVENTION WITH REFERENCE TO SOCIAL AND CULTURAL FOOD HABITS. Randeria, J.D., Cancer Research Institute, University of Durban- Westville, Private Bag X54001, Durban, South Africa. Drastic control of oral intake of a variety of commonplace agents during pregnancy, lactation, childhood and adolescence is advocated for effective cancer control at adult ages. Well documented knowledge on hazardous environmental factors pertaining to harmful food habits [6] deserves attention. A cytopathological profile of oral submucous fibrosis interpreted in terms of nutritional modulations of the oral mucosa is exemplary. The sensitivity to carcinogenic initiators is great during growth period in and out of the womb. During the dynamic developmental stages criteria for safe levels of intakes on.aggregate body weight basis remain indefinite. Pleasure foods containing alcohol, tobacco, betel and related chews, drugs, fungal contaminants, nitro- satable ingredients, products of pyrolysis and harmful feed and food additives are cautioned against and evaluated in terms of risk:benefit. /EFFECTIVE CANCER CONTROL/

/E) LTSr OF ABSTRACTS FORMATION OF MUTAGENS IN HEAT-PROCESSED FOOD. Pariza, M.W. W~ 6 Ashoor, S.H. Dept. Food Microbiology and Toxicology, Food Reaearch Institute, U. Wisconsin, Madison, WI, 53706, U.S.A. We have previously reported that mutagens detected with the Ames tut are present in a variety of heat-processed meat, bakery, and cereal products (Fd. Cosmet. Toxicol. 17, 429, 1979) and are generated in ground beef patties during frying (Cancer Letters 7, 63, 1979). The ,,tagens have been partially purified and appear to be amines with aro- saic properties produced by reactions between reducing sugars and amino ,cids. In experiments designed to determine the origin of these muta- Cens we added, individually, twenty common amino acids to ground beef patties prior to frying at 191°C for 4 min. Only proline enhanced muta- `en formation (up to 8-fold) (Proline cognates except for esters were oegative). Chromatographic analysis showed that mutagens formed in un- treated and proline-treated ground beef are similar. Adding fructose (but not glucose) to untreated or proline-treated ground beef patties •1so increased mutagen formation. Conditions required for mutagen gen- tration in model systems (aqueous mixtures of amino acids and sugars) •re very different from those which exist in ground beef, and in beef low molecular weight factors not yet identified are involved in mutagen formation. Experiments on the possible carcinogenicity of the mutagens are in progress and will be discussed. /DIET, NUTRITION, CANCER/ l6l (66 EPIDEMIOLOGY OF CANCER AMONG ACTIVE CALIFORNIA MORMONS ENSTR OM, J.E. School of Public Health, University of California, Los Angeles, CA 90024, U.S.A. Based on 1960-75 data obtained mainly from Church records, California Mormons are an unusually low-risk population with respect to cancer and total mortality. In particular, the ratio of age-adjusted total death rates for religiously active California Mormon males compared with U.S. white males is 37% for ages 35 to 64 years and 48% for ages 35 years and above. Their standardized mortality ratio is 50% for all cancer, 65% for colorectal cancer, and 25% for lung cancer. In an attempt to understand these mortality data in terms of their lifestyle a prospect- ive study of active California Mormons was initiated in 1979. Some relevant findings from this survey and other sources are now available. Active Mormons indeed use essentially no tobacco, alcohol, coffee or tea, in accordance with their Church doctrine. They are average in height and weight and appear to have an average intake of calories, fat, and dietary cholesterol. They eat meat in moderation, but make extensive use of fruits, vegetables, and vitamin supplements. The implications of these and other findings, especially with regard to colorectal and lung cancer etiology, will be discussed. It appears that a full understand- ing of the Mormon lifestyle can yield valuable new information relevant to cancer prevention. /CANCER EPIDEMIOLOGY/MORMONS/

LIST OF ABSTRACTS 067 THE EFFECTS OF VITAMIN A DERIVATIVES ON NORMAL AND NEOPLASTIC HUMAN CELLS CULTURED IN VITRO. Wilson, Lynette & Dowdle, Eugene. University of Capetown, Cape Town, South Africa. The effects of Vitamin A derivatives on plasminogen activator (PA) synthesis by cultured human cells derived from normal and neoplastic tissues has been determined. PA was measured, as this enzyme has been correlated with expression of the malignant phenotype and can be [6] induced both by the tumor promoter phorbol myristate acetate and also by retinoic acid in cultured chick embryo fibroblasts. Retinoic acid consistently induced PA synthesis by human cells of inesenchymal origin, including fibroblasts from foreskin, lung, synovium, breast and thyroid and cells obtained from glioblastomas and uterine sarcomas. Adult skin fibroblasts were the only exception, and PA could not be induced by retinoic acid in these cells. Cells from epithelial origin could notbe induced to secrete PA by retinoic acid. Epithelial cells were obtained from normal esophagus, bladder, kidney, skin and malignant melanomas. Cells derived from normal or neoplastic tissues showed no consistent differences either in baseline rates of PA release or in the magnitude of. the retinoid effect. Retinoids may therefore influence cell behavior in vivo in tissue-specific ways that should be considered when admin- istering retinoids for the management of neoplastic or preneoplastic disorders. /VITAMIN A/ PLASMINOGEN ACTIVATOR (68 CONTROL OF TUMOR GROWTH BY DIETARY PYRIDOXINE RESTRICTION OR TREATMENT WITH ANTIVITAMIN AGENTS. Tryfiates, George P. Dept. of Biochem., W.Va. Univ., Sch. of Med., Morgantown, WV 26506. The effects of restricting dietary pyridoxine(PN) and treatment with antivitamin agents on tumor growth were studied. Buffalo female rats with transplantable Morris hepatomas were employed. These were fed a diet lacking PN or pair-fed the same diet with different PN levels. Ad lib fed animals were also treated with L-penicillamine (10 mg/100 g body wt) or B-chloro-D-alanine (16 mg/100 g) every other day for 9 days. The ie- [6] sults from six hepatoma lines showed that hepatoma growth was severely inhibited when the vitamin dose was limited. On the other hank, pair-fed or ad lib fed rats developed tumors up to 3x heavier. The effect of L- penicillamine(PLA) was tested using 15 ad lib fed controls bearing high- ly developed hepatomas #7777. Ten were treated with (PLA). Four of the untreated rats died within 3 days; the other lived for 8 days. In a si- milar test, eight animals with underdeveloped tumors were employed and five were treated with B-chloro-D-alanine. In this case, one of the con- trol rats lived for 8 days and two for 27 days. Three of the treated an- imals lived for 25 days, one for 29 and the other for 40 days. These re- sults show that tumor growth may be controlled by limiting PN availabil- ity or treating in vivo with vitamin inactivating agents. (Supported by awards from the WVU Medical Corp., School of Dentistry and a travel grant from the WVU Foundation. VITAMIN B6/ANTIVITAMIN AGENTS/TUMOR GROWTH I

RACTS PA) . 161 d n, id .n be ed )f. j LIST OF ABSTRACTS 069 HARMFUL EFFECTS OF CARRAGEENAN FED TO ANIMALS. Watt, J., & Marcus, R. Department of Pathology, University of Liverpool, and Clatterbridge Hospital, Bebington, Merseyside, England. Over the past 10 years, an increasing number of reports have appeared in the literature describing the harmful effects of degraded and undegraded carrageenan supplied to several animal species in their diet or drinking fluid. The harmful effects include foetal toxicity, teratogenicity, birth defects, pulmonary lesions, hepatomegaly, ulcerative disease of the large bowel with hyperplastic, metaplastic, and polypoidal mucosal changes, enhancement of neoplasia by carcinogens (Cancer Res. 1978, ~,.,8, 4427), and, more ominously, colo- rectal carcinom& (Cancer Lett. 1978, 4, 171). The use of degraded carrageenan as a drug or food additive has been restricted in the U.S. by the Food and Drugs Administration. Undegraded carrageenan is still widely used throughout the world as a food additive. Its harmful effects in animals are almost certainly associated with its degradation during passage through the gastro- intestinal tract. There is obviously a need for caution in the use of carrageenan or carrageenan-like products as food additives in our diet in view of their potential hazards. /CARRAGEENAN/FOOD ADDITIVE/POTENTIAL HAZARDS/CARCINOGENESIS/ 070 DIET MJDIFICATION or PLASMA HORMONES IN ELDERLY MEN WITH PROSTATIC CANCER Hill, P., Garbaczewski, L., *halker, A.R.P & Wynder, E.L. American Health Foundation, New York, U.S.A. &*Medical Res. Institute, Johannesburg, S.A. Rural Black South African men, 70+ 1.3 years of age with prostatic canoer (P.C.) and age matched healthy men and men with benign prostatic hyperplasia (BPH) were transferred from their customary vegetarian to a western diet for three weeks which was fed under controlled conditions described previously (Hill et al., Cancer Res. 39, 5101, 1979). Plasma and urinary hormone levels were determined prior to and after the dietary period. In men with P.C., a western diet decreased plasma testosterone (T), androstenedione (A) and dehydroepiandrosterone (DHEA) and increased estrone levels and tended to increase urinary androgens. LH, FSH and prolactin levels were unaltered. Higher levels of T, A, DHEA and lower estrone occurred in healthy versus men with P.C. In men with BPH, estrone levels increased but T, A and DHEA levels were un- altered. Diet also modified hormonal status in healthy men and men with BPH. Total urinary estrogen and androgen levels in healthy & men with BPH, unlike men with P.C., were decreased by the western diet. The benefits of the long term diet reduction of plasma androgens in patients require further investigation. /DIET/HORMONE/PROSTATIC CANCEF/

LIST OF ABSTRACTS 071 NUTRIENTS, ANTI-NUTRIENTS AND MELANOMA MACDONALD, Eleanor J., and KING, Stephen C., Jr. The University of Texas System Cancer Center, M.D. Anderson Hospital and Tumor Institute, Houston, TX 77030, U.S.A. Melanoma is considered in its systemic aspect as a manifestation of the average chemical composition of the patient's body. Anti-nutrient pro- perties of chemotherapeutic agents for melanoma are compared with a model in which the body's normal tissues compete with malignant cell masses for a nutrient broth on which both depend. Competition for minerals, vitamins, amino acids, lipids, hormones, neuro-transmitters, biogenic amines, and nucleotides is reviewed. Hypotheses are proposed for clinical manipulation of nutritional variables that might benefit melanotic patients and persons at risk of developing melanoma. /MELANOMA/NUTRIENTS/NEURO-TRANSMITTERS/ANTI-NUTRIENTS/MODEL/ 072 CUMUI2ITIVE EWEX,'T OF BETQrNl7I', PIPSRAZINE AND SAMiRIN CN CAUSATION OF E}PERIME.KrAL CIINC,ER. PAI, S.R., SHIRKE, A.J., and GOTBOSKAR, S.V. Biology Division, Cancer Research Institute, Bombay 400012, India. In India, children pick up from their elders a habit of chewing betel-nut either spiced or commercial preparations uoated with saccharin. Many of them carry helmenthic infection and are repeatedly exposed to piperazine preparations as an antidote. Betel-nut, piperazine and saccharin: all [6] three are suspected environmental carcinogens. Studies were therefore planned to find the cumulative effect of all three entities on C17 mice by long term feeding. Total of 119 inbred C17 mice of both sexes were grouped as:(1J control, 34; [2] on diet with 10% saccharin coated betel- nut, 32; (3J daily par os 0.2 ml aqueous solution of 0.1% dinitropiper- azine, 29; and [4j diet of (2j and intubation of [3], 24. The feeding was continued for 40 weeks and all mice given the standard diet and water ad lib, were observed till life span. The commonest neoplasm was found to be squamous cell carcinoma of the forestomach in mice of groups (3] and [4]. The sexual dimorphism observed will be discussed. /DINITROPIPERA2INE/SACCHARIN/BETEL-NUT/C17 MICE/STOMACH TUMOR/ I

LIST OF ABSTRACTS 073 YFFDCP OF BETEL QUID CHEWING CXJ NITRITE LEVEIS IN SALIVA SNIVAPURKAR, N.M., D'SOUZA, A.V., and BHIDE, S.V. Carcinoqenesis Division, Cancer Research Institute, Bombay 400012, India A preliminary study on nitrite levels in saliva and the effect of chew- ing betel quid with or without tobacco on the nitrite content in saliva of volunteers was carried out. Zero time sample of saliva was collected one hour after lunch. Immediately the donors were offered betel quid and saliva was collected every hour up to three hours. It was observed that salivary nitrite increased one hour after betel quid chewing. Sub- sequent studies showed that betel quid alone increased nitrite in saliva substantially but the same was not observed in the case of betel quid with tobacco. It was further observed that saliva of tobacco chewers contains a significantly higher amount of thiocyanate which acts as a catalyst in nitrosamine formation as compared to non-chewers. Work on estimation of secondary amines and nitrosamines in saliva of chewers and non-chewers is in progress. Relevance of these findings to oral cancer will be discussed. /BETEL QUID/SALIVARY NITRITE/ORAL CANCER/ 074 NUTRITIONAL ASSESSMENT AND SUPPORT IN ONCOLOGY. Mullen, J.L., Smale, B.F., Buzby, G.P., Rosato, E.F. Department of Surgery, University of Pennsylvania School of Medicine. To determine if preoperative nutritional assessment can identify high risk patients, and if preoperative TPN can decrease M&M in this high- risk group, 159 cancer patients underwent preoperative, multiparameter nutritional assessment and clinical course monitoring: (6) Risk (%) - 158 - 16.6 (ALB) - 0.78 (TSF) - 0.2 (TFN) - 5.8 (DH) (ALB-Albumin, TSF-Triceps skinfold, TFN-transferrin, DH-delayed hypersensitivity reactivity) ACTUAL OUTCOME (% of patients/group) Predicted n Complications Major Sepsis Death Risk No-TPN TPN No-TPN TPN No-TPN TPN No-TPN TPN Low (<40%) 52 15 8 13 0 7 0 0 High (>40%) 53 39 66 31 43 15 40 15 p<(x2) - - 0.005 NS 0.005 NS 0.005 NS p'< (high risk: TPN vs. NoTPN) 0.001 0.005 0.025 Substantial malnutrition correlates with subsequent M&M. This index of nutritional status accurately and prospectively identifies a subset of cancer surgery patients at increased risk of operative M&M. In this high-risk group, preoperative TPN reduces operative morbidity (p < 0.001) and mortality (p < 0.025). /NUTRITIONAL ASSESSMENT & SUPPORT - CANCER SURGERY/ (A G O ~ r J w OD 0

LIST OF ABSTRACTS (6] 075 PRESERVATION OF THE NUTRITIONAL INTEGRITY OF THE CANCER PATIENT: REVERSAL OF CANCER CACHEXIA BY HYDRAZINE SULFATE. Gold, J. Syracuse Cancer Research Institute, Syracuse, New York, USA. In 1968 Gold indicated cancer cachexia to be the result of a systemic interplay between tumor glycolysis and host gluconeogenesis--amenable to therapeutic intervention at the hos hoenol ruvate carboxykinase level of gluconeogenesis. Use of hydrazine su ate HS as a non-competitive inhibitor of this enzyme in both animal and human studies, has resulted in a reported reversal of weight loss, negative nitrogen balance and tumor growth itself. The present study reports the actual weight re- sponse in a series of 59 evaluable late-stage cancer patients, in whom HS was used either as a sole agent or added to already pre-existing therapy to which the patients had become refractory. 79.7% of these patients responded with "indicated appetite improvement" (IAI), express- ed either by protocol code or direct quantitation. In those patients receiving HS alone the IAI was 86.1%; in those in whom HS was added to pre-existing therapy the IAI was 69.6%. Of those cases expressed in direct quantitation the average weight gain for patients receiving HS alone was 8.2 lbs., whereas the average weight gain for those with pre- existing therapy was only 0.6 lbs. (p = 0.02). The results corroborate the use of HS as a specific chemotherapy for cancer cachexia and suggest a differential beneficial action in those patients not compromised by ineffective concurrent therapy. /HYDRAZINE SULFATE AND CANCER CACHEXIA/ 076 BACKYARD CITRUS AVAILABILITY AND LOWER INCIDENCE OF LARGE BOWEL CANCER. Lyko, B.C. and J.X. Hartmann. Dept. of Biological Sciences, Florida Atlantic University. Although the population of the United States is considered at high risk for developing large bowel cancer, the Southeast as well as sou- thern California, Arizona and Florida residents are interesting excep- tions. The incidence of large bowel cancer is two-,fold lower in these 62 regions, in spite of many residents having previously lived in the high- pS er risk northeastern and mid-western states. Previous studies of diet- ary practices (meat consumption and dietary fiber) has not shown differ- ences which can account for.the low risk regions. Our hypothesis is that citrus fruit consumption is the prime factor which can account for these low risk regions. A survey of 90,000 homes in southeastern Florida shows that 60,000 homes have a total of 274,000 backyard citrus trees. Hence, 2/3 of the families in this region have an average of 3 citrus trees per household. Data will be presented on the U.S. national pattern of citrus consumption in contrasting incidence regions. Epidccmiology/Citrus: Cancer From the Florida Atlantic University Large Bowel Cancer Study. J W ~ 0

077 INFLUENCE OF DIETARY SELENIUM ON THE HEPATIC AND PULMONARY ENZYMES IN POLYCHLOROBIPHENYLS (PCB)-TREATED RATS. Chow, C.K. & Gairola, C. University of Kentucky, Lexington, Ky. 40506, U.S.A. Effect of dietary selenium on the levels of aryl hydrocarbon hydroxylase (AHH), GSH and related enzymes in the livers and lungs of PCB- treated rats was investigated. Male rats maintained for 19 weeks on a low selenium diet with or without 2 ppm selenium supplementation were injected i.p. with either 500mg PCB (Aroclor 1254)/Kg body weight or 62 placebo five days prior to sacrifice. As expected, PCB-treatment elevated Ps AHH levels in the liver and lung in both groups of animals. In addition to AHH (527%), PCB-treatment also caused a significant increase in hepatic levels of GSH (52%), GSH peroxidase (66%), GSH reductase (81%), G-6-P de- hydrogenase (167%), and GSH-S-transferase (52%) in rats on low selenium diet. The non-selenium dependent form was found to be mainly responsible for the increase of hepatic GSH peroxidase upon PCB treatment. Only the activities of AHH (221%) GSH-S-transferase (42%) and G-6-P dehydrogenase (98%) were significantly higher in the livers of PCB-treated rats fed the selenium supplemented diet. In contrast, except for AHH activity (155%) the lung GSH and related enzymes were not significantly affected by PCB in any of the two groups. Dietary selenium supplementation alone resulted in significant increase of AHH activity in the liver, but not in the lung. These results suggest that dietary selenium depletion renders the rats more sensitive to PCB effects. (supported in part by Kircher fund). /DIETARY SELENIUM/POLYCHLOROHIPHENYLS/ 078 DIET AND CANCER RISK IN HAWAII. Kolonel, L.N., Hankin, J.H., Chu, S.Y., Lee, J. and Nomura, A.M., Cancer Center of Hawaii, University of Hawaii, Honolulu; U.S.A. Striking differences in the incidence of cancers of the gastroin- testinal tract, breast, and prostate are seen in comparisons of the five main ethnic groups in Hawaii (Caucasians, Japanese, Chinese, Fili- pinos and Hawaiians). In an effort to explain these observations, we have recently collected detailed dietary information from a representa- 62 tive sample of nearly 5,000 persons in Hawaii. Quantitative estimates Ps of usual intake were obtained from personal interviews using a validated diet history method. Ethnic-specific correlations of dietary components (nutrients as well as specific foods) with the cancer incidence rates have been made in order to identify factors that could explain the observed ethnic variation in cancer rates. Early findings show positive correlations of dietary fat intake with cancers of the prostate and female breast but not with colon cancer. Stomach cancer patterns can be explained by the joint intakes of processed meats (containing nitrite additive) and vitamin C. These and other results will be presented. -- - -- ----- - ----- - ---- - - - Our findings support the general hypothesis that dietary components contribute to the risk for cancers of selected sites. Because the correlations we found are between adult dietary practices and cancer, these data suggest that dietary factors may act as promoting agents in carcinogenesis. /DIET AND CANCER/ETHNICITY/HAWAII/

LIST OF ABSTRACTS 079 GENETIC AND ENVIRONMENTAL FACTORS IN HUMAN CARCINOGENESIS. Miller, R.W. National Cancer Institute, Bethesda, MD, U.S.A. New understanding of cancer biology can come from study of clinical syndromes for w,h,i_r_h no a_ni_mal_ models are known. In this way inter- actions between the environment and heredity have been identified, for elucidation by laboratory_research. Examples include defective DNA repair defects in xeroderma pigmentosum after ultraviolet exposure; its [13] gamma ray counterpart ataxia-telangiectasia; Purtilo's X-linked disorder with susceptibility of B-cell lymphocytes to EBV-related diseases; and partial deletion of chromosome 11 (llp-) and 13 (13q-) usually, but not always, associated with Wilms' tumor and retino- blastoma, respectively. Also regional near-absence of certain cancers suggest negative interactions, as an explanation perhaps for the rarity of neuroblastoma in Central Africa. Human evidence reveals that interactions may involve the host, chemicals, physical agents, viruses and other biological agents, and unknown factors. /CARCINOGENESIS/ENVIRONMENT/HOST SUSCEPTIBILITY/INTERACTIONS/ Q$Q CANCER PREDISPOSITION AND GENETIC MARKERS [131 I rp ,

081 RADIATION HAZARDS: GENETIC AND EPIDEMIOLOGIC EVIDENCE AND CONTROL MEASURES. Howe, G.R., Sherman, G.J. NCIC Epidemiology Unit, University of Toronto, Canada. A brief review is made of induced currently available genetic and epidemiologic data on the potential hazards of radiation carcino- genesis. Particular emphasis is placed upon evidence concerning the nature of the dose response relationship, and the implications of this for possible control measures. The need for, and methodological problems associated with future research in this area are also discussed. 082 VIRUSES AND CANCER : ARE UNFAVORABLE GENETIC-ENVIRONMENTAL INTERACTIONS PREVENTABLE ? Dr. Guy de Thg, CNRS, Faculty of Medicine Alekis Carrel, Lyon, France and IRSC, Villejuif, France. That some viral infections should now be regarded as part of the oncogenic hazards present in our environment is examplified by both the Hepatitis B virus (HBV) and Epstein-Barr virus (EBV) stories. Both viruses do not represent the "necessary and sufficient factors" leading to malignancies but early primary EBV infection or HBV chronic carrier state act as critical risk factors for Burkitt's lymphoma and hepato carcinoma development. t. Their effect results from complex interactions between genetic and life style factors and such an approach to biological carcinogenesis fits with the-multistep hypothesis proposed for chemical carcinogenesis. But the most challenging aspect of studying the role of viruses in human carcinogenesis is to assess the feasibility of antiviral intervention as a possible preventive measure, which would also bring .the ultimate proof of causality. The examples of Burkitt's lymphoma nasopharyngeal carcinoma and liver carcinoma will be discussed along these lines. EBV - BURKITT'S LYMPHOMA - NASOPHARYNGEAL CARCINOMA - PREVENTION

083 DES-RELATED HUMAN TRANSPLACENTAL CARCINOGENESIS HERBST, A.L., SCULLY, R.E., and COLE, P. The University of Chicago, Chicago, IL; Harvard School of Medicine, Boston, MA; The University of Alabama, Birmingham, AL, U.S.A. Four hundred cases of clear cell adenocarcinoma of the vagina and cervix were accessioned by 12/31/79 into a special Registry designed to study these tumors in females born since 1940. Approximately two-thirds of the investigated cases have been associated with intrauterine exposure to (13) diethylstilbestrol (DES). The incidence of these tumors in the U.S. corresponds to estimated usage for pregnancy support. The risk of clear cell adenocarcinoma development among exposed women up to the age of 24 years is estimated to be 0.14 to 1.4 per thousand. Risk appears to be increased.in young women exposed to DES early in intrauterine life in comparison to those exposed later. The carcinomas are rare before the age of 14 years and an irregular peak in the age-incidence curve appears between 17 and 21 years followed by a decline. The overall actuarial 5-year survival rate is 78% and the survival is better for women 19 years of age and over than for younger patients. This results in part from a higher frequency of the more favorable tubulo-cystic histologic pattern of tumor occurring in the older age group. Oral contraceptive (O.C.) users appeared to have an improved survival which in part seems to be related to more intense medical surveillance among this group. A direct effect of the pill was not demonstrated. (M Ll'NIPHOCY'IES ROSETPE W'ITH ANTIGEN STIMULATION IN GYNAECOIAGIC CANCERS. MARKOWSKA, J., SIMM, S., TOMASZKIEWICZ, T. Oncology Hospital, Academy of Medicine, Poznan, Poland. In 57 ovarian cancer cases, no correlation was found between E-Rosette tests and seven tests for delayed skin reactions: Pollens, PHA, PPD, SK-SD, Trichophyton, Candida, and DNCB. Nevertheless, statistical correlation was established in 26 cases while T-tests were sensitized by addition of cancer antigen. This sum applied for local or dissemin- (371 ated disease. The sensitized T-tests positively correlated with the sum of delayed skin reactions: PHA, PPD, DNCB, etc. We believe that the a.m. tests are more sensitive for appreciation of cancer progress and immunity deprivement. /T-ROSETTES/DELAYED SKIN REACTION/OVARIAN CANCER/ (371

hIST OF ABSTRACTS ~5 E rosette inhibition b antil hoc te serum in neo lasia. M. F. a Via, Medica University o Sout Caro ina, Charleston, SC 29403, U.S.A. T lymphocytes form E rosettes with sheep erythrocytes (SRBC) and the rosettes are categorized by their differing reactivity with SRBC into active (E~) and late (E1), the sum of the two being total rosettes. We have shown that Ea are the most sensitive and El the least sensitive to antilymphocyte serum (ALS) inhibition of rosetting. Total E rosettes 1)71 ALSminhibitionwtitereatileastytenfoldshigherathanoTalymphocytesvfrom25% normal women even though they contain less Ea than normal. These results, together with further study of ALS inhibition, make it likely that inhibition results from membrane changes preceding or induced by the dysplastic or the early malignant process. We have also followed a number of patients with dysplastic and malignant oral lesions and measured the 25% ALS inhibition titer for up to four years. The rise and fall of this correlate with disease progression or regression. It appears that this test affords a sensitive indicator of early malignancy and correlates well with its course. Current studies are directed to an identification of the functional property of the lymphocytes which can be inhibited more easily from rosetting by ALS treatment. (Supported by a grant from the Scientific Committee of the Smokeless ~ a Tobacco Council). M6 CELLULAR IMMUNITY IN OVARIAN CANCER SIMM, S., MARKOWSKA, J., and TOMASZKIEWICZ, T. Oncoloqy Hospital, Academy of Medicine, Poznan, Poland. In 27 cases of ovarian cancer, T-Rosettes test was performed according to WHO standards or modified by addition of specific antigen or auto- logous patient's serum. The test was positive in 50.2% and 34% without and with modification in localized, and in 58.6% and 43.4% in dissemin- ated disease. The autologous serum reacts similarly and has also fj)) unblocking properties. Such tests are appropriate for detection of sensitized T lymphocytes as well as the presence of neoplastic antigen. They may be promising in early detection of recurrence as well as actual progress of the process. /T-ROSETTES/OVARIAN CANCER/MODIFIED BY ANTIGEN ADDITION/

LIST OF ABSTRACTS (371 087 EFFECT OF DNA EXCRETED BY STIMULATED T CELLS IN THE TRANSFER OF INFORMATION TO B LYMPHOCYTES DURING AN IMMUNE RESPONSE. Maurice, P.A.*, Jachertz, D.**, Stroun, M.***, Cornille-Brogger, R.*, Lederrey, C.*, Henri, J.*, & Anker, P.*. *Oncohematology, HBpital cantonal, Geneva, Switzerland. **Hygien Institut, Bern, Switzerland. ***Human Microbiology, Faculty of Medicine, Tel-Aviv, Israel. Antigen stimulated blood lymphocytes in culture release a DNA containing complex which is not the product of dying cells. Lymphocytes obtained from several donors carrying different allotypes were separated into"B" and "T" subsets, and cultured in presence or in absence of U.V. inacti- vated Herpes Simplex Virus (HSV). B or T cell suspensions alone did not produce any antiherpetic activity whereas B lymphocyte cultured in presence of supernatant collected from HSV stimulated T cells synthesi- zed an antiherpetic antibody with some allotypic markers of the T cell donor. Similar results were obtained with B cells cultured in presence of DNA extracted from the supernatant of HSV stimulated T cells, at concentrations ranging from 0.002 yg/m1 to 0.2 yg/ml. These data suggest that informational DNA migrates from T to B lymphocytes in the course of an immune response. Preliminary experiments performed with tumor associated antigens confirm the data obtained with HSV. ~ THE EEFECPS OF «,TER SOLUB,IE FRACPIdN OF CICAREiTE TAR CtJ LYMPHOBLASI'OCE1JESIS AND PHAC)OCY'IC)SIS. LI, M. C. & WA TERS , D. J.L.P. Memorial Veterans Administration Hospital, Loma Linda, CA, U.S.A. The correlation between cigarette smoking and human cancer of the upper respiratory and upper alimentary tracts has been established epidemio- logically. Present effort deals with the direct effect on normal human cells in tissue culture. Cigarette tar obtained from a smoking apparatus was mixed with tissue culture medium RPMI 1640. Lymphocytes and phago- l371 cytes were isolated from the heparinized venous blood of 4 normal young adults by Ficoll-Hypaque separation. Lymphocytes were cultured with phytohemagglutinin and incubated in a CO2 enriched environment at 370C; several Concentrations of cigarette tar were used. Tritiated thymidine was added to the cultures at 48, 72, 96 and 120 hours after incubation. The lymphoblastogenic activity was measured in a liquid scintillation counter (Beckman LS8000). The phagocytic activity was measured contin- uously for 60 minutes according to the principle of chemiluminescense using opsonized zymosan suggested by Jederberg. Marked diminution of thymidine uptake by lymphocytes and marked increase of chemilumescense by phagocytes were observed when compared with controls. It is concluded that substances contained in the water soluble fraction of cigarette tar exhibited marked influence on the mononuclear cells of the immunological system. /CIGARETTE TAR/LYMPHOBLASTOGENESIS/PHAGOCYTOSIS/

LIST OF ABSTRACTS ~ SUPEROXIDE ( O2 ) ASSAY-MONOCYTE ADHERENCE TEST FOR DETECTION OF CELL-MEDIATED IMMUNITY IN CANCER PATIENTS. Yagawa, K., Kaku, M., Manabe, H. & Yasumoto, K. };yushu Cancer Center Research Institute, Fukuoka, Japan. peripheral mononuclear cells from patients with lung cancer were incubated with 3 M-KCl extract of lung tumors or normal lung tissues in a glass microcell for spectro- photometric analysis. Instead of visual cell counting, the cells adherent to the bottom of the microcell were stimu- lated with cytochalasin E and wheat germ agglutinin, and the amount of 02 generated from the adherent monocytes was assayed. Of 23 patients with tumor 16 reacted to the lung tumor extract ( 9 adherence inhibition and 7 adherence stimulation ). Of 12 patients without tumor after surgical treatment 3 showed positive adherence stimulation. Of 35 control donors only one reacted to the tumor extract. The reliability of this test was ascertained by tumor bearing animals. Peritoneal cells from strain-2 guinea pigs inocu- lated with line-10 hepatoma were incubated with the hepat- oma extract. Although the adherence inhibition by the extract was detected at 2 weeks, the adherence stimulation appeared after 3 weeks of tumor inoculation. /SUPEROXIDE ASSAY MONOCYTE ADHERENCE TEST/ ~ SEROLOGICAL DETECTION OF ANTIBODY RESPONSES TO HUMAN CERVICAL CARCINOMA CELLS. Winters, W.D., Wolnik, L.K., Wienkotter, R.M. and Soriero, O. University of Texas Health Science Center, San Antonio, Texas, U.S.A. and University of Marburg, Germany. Levels of antibodies reactive in radioimmunoassay (RIA) and immuno- fluorescence (IF) tests against antigens from early passage cultures of human cervical carcinoma cells were significantly higher in sera of 53 of 60 patients with untreated gynecological and other malignant 37) tumors than in sera from 60 normal donors. In contrast, no marked differences in antibody levels were observed by RIA in sera from either cancer patients or normal donors against normal cells. Indirect IF tests revealed that carcinoma patient sera with high RIA levels also had strongest nuclear membrane fluorescence reactions with cervical cancer cells, but not with normal tissue cells. All normal and cancer cells failed to react in IF with reference sera specific for human adenoviruses and herpesviruses. Similar levels of virus-specific antibodies were detected by RIA in normal and cancer patient sera. Results of these serological tests demonstrated.that patients with tumors had serum antibodies reactive with cervical cancer cell, but not normal cell, associated antigens. These studies suggest that combination tests, such as IF and RIA, may have advantages over single immunodiagnostic tests for the detection of human carcinoma antibodies. Supported in part by Prof. Schmidtmann Foundation, Marburg. /CARCINOMA ANTIGEN-ANTIBODY/RADIOI!lMUNOASSAY/IMMUNOFLUORESCENCE/

LIST OF ABSTRACTS 091 IMMUNOIAGIC TEST RFACTIONS IN FC)RNIING RISK CROUPS FOR UI'ERIAIE CERVIX CANCER. CRARXVIANI, T.L. Doctors Training Institute, Tbilisi, Georgia, U.S.S.R. The cellular immunity state was studied in cases of background and pre- cancerous diseases, preinvasive and invasive cancer of uterine cervix (207) and in controls (38) with the aim to form high risk groups of cervical canqer, and to perform their thorough examination (cytology, (37j colposcopy, qolpomicroscopy). Test reactions both in vivo (skin-allergy delayed sensitivity reactions on PPD, DNC1B, tumoral and embryonal anti- gen) and in vitro (reactions of spontaneous rosette formation and blast transformation of FHA) were carried out. The cellular immunity is subject to dynamic suppression; however, regular immune deficiency of the body develops with invasive carcinomas. There- fore, immunologic test reactions can provide an efficient means to form high risk groups for cervical cancer. /UTERINE CERVIX CANCER/RISK GROUPS/IMMUNITY/ (37) (T SONATIC CELL HYBRIDS PFbOD()CING MbNOQQNP.L ANTIBODIES SPEX;IFIC TO 1UMAN FIBROIU)C.'TIN. CARNEMOLLA, B., ZARDI, L., SIRI, A., SANTI, L., ACCOLLA, R.S. Istituto Scientifico per lo studio e la cura dei tumort, Genova, Italy; Ludwig Institute for Cancer Research, Lausanne, Switzerland. A correlation between an increase in tumorigenicity and a decrease in the percentage of cells expressing cell surface fibronectin has been suggested for several cell lines although recent evidence suggests that this decrease may actually indicate the probability of such cells to metastasize. We have produced somatic cell hybrids between mouse plasmo- cytoma cells deficient in hypoxanthine phosphoribosyltransferase (P3x63 Ag8) and spleen cells derived from mice immunized with purified human plasma fibronectin. Here we report the properties of monoclonal anti- fibronectin antibodies released by eight different clones. The avail- ability of hybrids producing large amounts of monoclonal antibodies against different determinants of this antigen will allow a better ~, characterization of the molecule and therefore a more careful comparison ~ between plasma and cellular fibronectin as well as fibronectin secreted •~ by normal and transformed cells. ~ /MONOCLONAL ANTIBODIES TO FIBRONECTIN/ ~:

LIST OF ABSTRACTS 093 ANTI-MALIGNIN ANTIBODY AS CANCER SCREEN, AND MALIGNIN AS POTENTIAL VACCINE gogoch, S. and Bogoch, E.S. Boston U. School of Medicine, Boston, USA. The family of cancer cell polypeptide markers called Recognins, first prepared from malignant glial tumor cells grown in vivo and in vitro (Malignin: Nat. Cancer Inst. Monogr. 1977, 46, 133), then fro 1 hp oma and mammary cancer cells (Recognins L and M: Neurochem. Res. 1979, 4, 465) appear to be widely distributed (Lancet 1979, 1, 987). The elevated antibody has been quantitatively determined in the serum of human cancer patients with an accuracy of approx. 90°b in a seven- hospital blind study (Neurology 1979, ?9, 58+). Subsequent ongoing population survey studies support this finding. The false positive rate may be less than 5%. The test has been positive as long as 18 months before the appearance of clinical signs or symptoms of cancer. The purified antibody (MTAG), in double-layer immunofluorescence, in- creased the accuracy of PAP smear and other microscopic detection of cancer from 77% without, to 94 with MTAG, in a controlled study. Since Recognin L is derived from Epstein-Barr virus-positive lymphoma cells, it represents the first pure small molecular weight antigen of this type of defined composition. It and the other Re- cognins are being tested for their potential as anti-cancer vaccines. /RECOGNIN/MALIGNIN/ANTIBODVSCREEN/VACCINE/IMMUNOPRF,'VENTION/ 094 =]NICAL ASPF7CPS AND CLINICAL RESULTS OF T'i-IE CEILUTAR ELDCTfOPHORETIC MOBILITY TEST FOR EARLY CANCE2 DLAGNDSIS: KREI.ENBERG, R., V. STELDERN, D., and LEMMEL,'E.-M. Dept. of Gynecology and Obstetrics, University Hospital, 6500 Mainz, Germany, F.R. For ten years dysfunction of the immune system was thought to be respon- sible for the development of human tumors. The methods used at present are the migration-inhibition- and the leukocyte-adherence-tests. One /37) alternative method to those methods above could be the electrophoretic mobility test. The aim of our experiments is to demonstrate that it is also possible to differentiate malignant from benign tumors in gyneco- logic disorders. About 165 lymphocytc donors were examined with the electrophoretic mobility test system using the conventional cytophero- meter. 78.4% of patients with confirmed malignant tumors-showed positive test results using this method. 21.6+% were false-negative. 78.0% of patients with benign tumors showed negative test results. 22.0% in this group were false positive. Only 2.4% of the healthy controls were false positive. On the whole, 83.1% test results were correct; 16.9% were false. The conventional cytopherometer chamber shows a variety of tech- nical problems like electroosmosis, focus uncertainty and convective motion. First experimental Yesults obtained with a new method on the basis of laser doppler spectroscopy and an analytic version of free-flow electrophoresis will be discussed.

LIST OF ABSTRACTS 095 TERMINAL DDOXYNUCLDO'T'YDL4'f2At3SFL~tA.SE IN PURIFIm MOIA[QE'Y MURINE IEUKEMIA VIRUS, BAIB/C S+ Ir AND H[JMAN URIN1RY $IADDER CARCIt1LMA CELIS. ARIDA, E.N. National Research Center, Dokki, Cairo, Egypt. Highly purified preparations of Moloney murine leukemia virus (MLV-Virgo Reagents NIH/USA, 3T3, Lot 589-16-7) contained a DNA polymerase which is not template directed. This terminal deoxynucleotidyl transferase (TdT) catalyzed DNA synthesis in presence of thymidine-containing substrate [37] and initiator with the production of a single stranded DNA. TdT is located in the viral core and its activity depended upon the presence of detergents, reducing agents, preformed initiator and divalent cations. The optimal conditions for TdT activity were quite different from those needed for RNA dependent DNA polymerase (RT) and allowed the functional distinction of the two enzymes. TdT was also isolated and purified from Balb/c S+L- (from NIH/USA) and T-24 human urinary bladder carcinoma cells (from Wenner-Gren Institute, Stockholm, Sweden) by oligonucleotide affin- ity-chromatography. TdT contained no detectable DNA dependent DNA poly- merase, - merase, RT or endonuclease activities. In all three cases, the reaction optima, effect of salt concentrations and various inhibitory factors (including antisera against murine, feline and primate type C viruses) were investigated. The molecular weight and subunits were revealed by gel electrophoresis. /TdT/MLV/ Balb/c S+ L- / T-24 CELLS/ 0% COMPLEMENTARY DNA COPIES OF LEUKEMIA AND SARCOMA VIRUS RNA CONTAIN SEQUENCES OF DEOXYCYTIDYLATE AND DEOXYGUANYLATE. Phillips, L.A., Kang, M.S., & Park, J.J. Laboratory of Viral Carcinogenesis, NCI, NIH, Bethesda, Maryland 20205. These studies were performed to determine whether the poly(A), poly(C), and poly(G) sequences in the RNA of retro- viruses are transcribed to poly(dT), poly(dG), and poly(dC) sequences respectively in cDNA copies of retrovirus RNA and [37) whether these like sequences were present or absent in the DNA of mammalian and human cells. Viral cDNA copies were synthesized either in an endogenous reaction with virions or in vitro from viral RNA. Poly(dC) and poly(dG) sequences, but not poly(dA) and poly(dT) sequences, were detected in viral cDNA copies. Single-stranded DNA from nonmalignant cells, retrovirus infected and transformed cells, and chem- ically transformed cells of human and mammalian origins was examined for the presence or absence of these homopoly- deoxyribonucleotide sequences. The results suggest the possibility of establishing an experimental basis for a molecular approach to the preven- tion and treatment of some hur}an cancers. CES/AOMOLECULARPAP ROACHYTONCANCOER/dC) AND POLY(dG) SEQUEN- . [371 (371 y r A

,LTST OF ABSTRACTS IMMUNOLOGICAL RESPONSE IN CHICKENS FROM DIFFERENT GENETIC 097 LINES TO ROUS SARCOMA VIRUS. gower, Raymond K. and N. Roy Gyles, University of Arkansas at Fayeiteville, Fayetteville, ARK, U.S.A. Chickens of a Progression and Tumor Regression Line received a single injection of F.ous sarcoma virus (RSV), via the wing-web. On day 0 and on days 10, 15 and 20, after injecting virus, the chickens were bled. Serums obtained were tested for the presence of antibodies that neutralize RSV by inoculating serum-virus mixtures and virus elone, on the chorioallantoic membranes of chick embryos and counting tumors that developed. The data obtained revealed that: (1.) In chickens of the Progression Line; 3 died, 1 regressed and 1 had a persistent tumor; In chickens of the Regression Line; 5 regressed their tumors and 1 had a progressive tumor; (2.) Chickens of both Lines, that showed no detectable antibody specific for RSV died with massive tumors: (3.) Chickens of either Line, that showed a delayed antibody response tended to have persistent tumors; (4.) Chickens of both Lines that showed an early response in antibody for RSV regressed their tumors and; (5.) there was evidence of a serum factor potentiating tumor-induction by RSV. / CHICKEN / TUMOR / ROUSVIRUS / ANTIBODY / ~ PERSPECTIVES ArID I,'IIMITS OF AN IA'A'ARdOENZYMATIC A.SSAY (ELISA) FOR HERPES SIMPLEX VIRUS (HSV) T[1N1OR ASSOCIATED ANTIGQi (TAA). TARRO, G., D'ALESSANDRO, G., MASCOLO, A., BOSSA, L., MATURO,S. FLAMINO, G., and ESPOSITO, C. D.E.P.A. Research Center; and Dept. I oncologic Virology, University of Naples, Naples, Italy. An ELISA has been developed to detect specific antibodies for HSV-TAA in sera of patients with head, neck and urogenital tract carcinomas (Cancer, 45, 1980). Further studies have shown that 64/800 controls (8.12%), i.e. healthy people, are positive against 312/425 patients with herpes assoc- iated tumors (73.41%). People with herpes recurrentis show 18% positiv- ity, precancerous lesions 44% and other cancers 6%. Immunodepression, chemo- and radio- therapy play an inhibitory role on the ELISA positivity for TAA. Radical surgery of the HSV-TAA positive cancers results in lack of specific antibody whereas relapse or metastasis of the tumor yields positive results. The reproducibility of the test is very good and the standard error is low (1.0655). The conclusions allow us to foresee the use of this ELISA for early detection of the HSV-TAA antibodies in cer- tain human carcinomas. /ELISA/HSV-TAA/

LIST OF ABSTRACTS (~ ISOELECTRIC FOCUSING (IEF) OF A SPECIFIC ANTIGEN INDUCED BY HERPES SIMPLEX VIRUS (HSV) IN INFECTED CELLS. Flamino, G., Randazzo, G., Garzillo, A.M., D'Alessandro, G., Mascolo, A., Capezzuto, C., Gargiulo, G. DEPA Research Center; and Dept. of Organic Chemistry, University of Naples, Naples, Italy. The antigen extracted from Guinea Pig (GP) kidney cells infected with 55 HSV type 2, E-304 Strain, and harvested three hours after infection was PS detected by hyperimmune GP serum. 70% of antigenic activity recovered in the ultracentrifuged supernate was loaded on a 1-50% (W/V) sucrose gradient in a 1% ampholite pH 3-10 column: After 72 hours, 1.5 ml fractions were collected and showed antigenic activity in an immuno- enzymatic assay at 4.21 to 4.60 pH values. The active material was further purified by ion exchange and affinity chromatography, and was run in parallel with matched control on an analytical polyacrylamide slab gel IEF. After destaining, a band was observed at about pH 4.32 not present in the control and identical to HSV-tumor associated antigen for physical, chemical and immunological characterization. /ISOELECTRIC FOCUSING/HSV-TAA/ 100 PURIFICATION AND CHARACTERIZATION OF TYPE 2 HERPES SIMPLEX VIRUS TUMOUR ASSOCIATED ANTIGEN (HSV-TAA). Flamino, G., Tarro, G., Papa, G., Maresca, M., Donnarumma, N.P., Bonito Oliva, G., and Foster, W. DEPA Research Center, via Squillace 59/60, Arzano 80022, Naples, Italy and I Oncologic Virology University of Naples, Naples, Italy. Guinea pig (GP) kidney cells were infected with HSV type 2 ~-304 strain in growth medium with 35S-methionine. Cells 55 were harvested at 1, 2 and 3 hours after infection in cold PS PBS and extraction buffer was added containing 20 mM Tris- HC1 at pH 8.0, 80 mM NaC1, 20 mM EDTA, 1.0 mM dithiothreitol and 1.0 mM phenylmethyl sulfonilfluoride. The Protein A Antibody Adsorbent (PAA) was used for isolating HSV-TAA. The immunoprecipitate obtained from infected and mock-infected cells was eluted with an electrophoresis buffer. After 7.5% SDS-polyacrylamide gel electrophoresis, autoradiography was performed showing a labelled band at a molecular weight of about 60,000 daltons, as determined by some marker proteins, with peak at three hours. /ANTIGEN PURIFICATION/ HERPES SIMPLEX VIRUS-TUMOUR ASSOCI- ATED ANTIGEN/

115) I,IST OF ABSTRACTS ACTIVITIFS RELATID TO b(AM,AfAL,tAN RIC4 TUuJOR VIRIJSFB IN PURIFIID 101 pREPARATIONS OF INnITII47A VIRUSES GROR5N IN EMBRYONATEO EGCS. )IRTDA, E•N• National Research Center, Dokki, Cairo, Egypt. It was possible to detect activities related to some mammalian type C viruses in influenza/A/Dunedin/4/73(H3N2), influenza/A/Victoria/3/75(X- 47)(H3N2) and influenza/A/New Jersey/76(Hsw1N1). The materials used vere either viral concentrates prepared from formalin treated virus oontaining alantoic fluid by isopycnic banding in a 0-60% sucrose grad- ient or purified viral preparations without exposure to formalin. These activities include: 11) Presence of internal core proteins immunologic- slly related to some mammalian type C viruses gag antigens. No reaction Fas seen with antisera against avian myeloblastosis virus or Schmidt- Ruppin Rous sarcoma virus (from NIH/NCI/USA). [2] Presence of biologic- ally active RNA in the virions coding for some mammalian type C viruses core proteins besides the major influenza proteins. This RNA contained polyadenylic acid (PolyA) stretches which were characterized by gel electrophoresis and sedimentation analysis. Poly(A) was never reported before in influenza virion RNA but exists in type C viruses. (3] Pres- ence of RNA directed DNA polymerase (RT) immunologically related to certain tumorigenic primate type C viruses RT. Pure RT was isolated on poly(C) agarose by affinity chromatography giving one band on polyacryl- amide gels with molecular weight of 70,000. /INFLUENZA VIRUSES/RNA TUMOR VIRUSES/REVERSE TRANSCRIPTASE/ 1(p A 'TYPE C' FOR CANCER? LOW TRAIT ANXIETY IN THE PATHOGENESIS OF BREAST CANCER. MORRIS, T., and GREER, H.S. Faith Courtauld Unit for Human studies in Cancer, King's College Hospital Medical School, London, U.K. Previous work by Greer, H.S. and Morris, T. (1975) J. Psychosom. Res., 19:147, described an association between the diagnosis of breast cancer and a lifelong tendency to suppression of anger. A detailed study of this phenomenon has been carried out in 71 patients prior to breast biopsy using semi-structured interviews, the Eysenck Personality Quest- ionnaire (EPQ) and the Spielberger State-Trait Anxiety Inventory (STAI). Mean EPQ'N' score in 43 benign disease patients was 12.6 ±.896 compared with 9.6 ±.967 in 21 cancer patients (p<.05). STAI 'Trait' anxiety score mean in cancer patients was 37.9 ± 1.82 compared with a mean of 4.25 ± 1.66 in the benign disease patients (p<.10). The mean Delta score in the cancer patients was however significantly (p<.Ol) higher (10.0 compared with 4.9). Taped transcripts of interviews with 49 patients independently rated by 3 raters, showed a significant differ- ence (p<.01) in mean expression of anger rating between 32 benign disease patients (mean 4.3 ±.254) and 17 cancer patients (mean 3.2 ± e I a .308). Taken together, these results accord with previous observations of cancer patients as emotionally contained individuals, particularly in the face of stress, by Kissen, D.M. (1963) Br. J. Med. Psychol., 36: 27, and Magarey, C.J., Todd, P.B., and Blizard, P.J. Med., 11:229./LOW TRAIT ANXIETY/BREAST CANCER/ (1977) Soc. Sci i ~ O O r J ~ 0 w F F 0 0 0 0 U

103 PSYCHOSOCIAL FACTORS AND BREAST CANCER CRAMER, I. , and SCHERG, H. Institut fur Sozial- und Arbeitsmedizin der Universitaet Heidelberg, Heidelberg, Germany, F.R. A given psychosocial risk profile was to be re-examined for breast can- in discriminating between this study's newly detected cancer cases and controls. It's use as a screening instrument for breast cancer is at least questionable. /BREAST CANCER/CASE CONTROL STUDY/PSYCHOSOCIAL FACTORS/QUESTIONNAIRE/ Results show this questionnaire's inadequacy to measure factors relevant included scales describing anger outlet, life events and adverse child- hood. Comparison of the means showed no difference in any of the above dimensions. However, by separating cases and controls into two age groups (< 50 and > 50), a significantly lower mean score for anger out- let was found for the younger case group as compared to the younger control group. factor analysis resulting in six factors. Other psychosocial dimensions (15J matched to 100 cancer cases and compared on several psychological and psychosocial dimensions. Psychological dimensions were determined by to the knowledge of diagnosis. Afterwards, 100 non cancer controls were ed to 2,879 women participating in an early detection program of breast cancer in a hospital during the years 1977-1978, was administered prior cer screening. The modified Bahnson psychosocial questionnaire present- and STESLIN, fl. Psychosomatische Klinik, Universitat Heidelberg, D-6900 Heidelberg, Germany, F.R. Fifty-six women admitted for breast biopsy were interviewed one day be- WIRSCBING, M., SOFFMANN, F., WEBER, G., WIRSCBING, B., 104 PREDICTION OF BREAST CANCER fore the operation. The correct diagnosis was predicted by an independ- ent rater reviewing the audiotapes for 17 of 18 women who had cancer (15) (94.4%). The interviewers, themselves failed to identify two out of 18 euphoric attitudes and forced autonomy). This pattern is found in all breast cancer patients but also in about 1/3 of the control population. Conclusions are drawn for the patient's management in therapy and re- habilitation. A possible influence of the identified psychological factors on the manifestation and course of the illness is discussed. al outlet, less involvement in the interview, health neglecting behavior, variables (high altruism, harmonization, rationalizations, poor emotion- cancer patients (11.2%). A benign node was predicted correctly by the interviewer in 27 out of 38 cases (70.2%) and by the independent rater in 25 cases (67.6%). The results are statistically significant for the rater with a p<0.00000 and for the interviewer p=0.00014. The predict- ion is based on a psychological syndrome comprising 8 of 10 examined 11

LIST OF ABSTRACTS LIFE STRESS AND LOSS AS A PRECIPITATING FACTOR FOR PULMONARY 105 CARCINOMA. Horne, R.L., Carrier Foundation, Belle Mead, N.J. and the University of Pennsylvania, U.S.A. Since 1701, investigations have linked severe emotional stress or loss with subsequent development of cancer. This study investigated re- cent stress and significant losses e.g., loss of job or death of spouse, parent or sibling in 110 patients with undiagnosed subacute or chronic pulmonary x-ray lesions. The prevalence and significance of 33 losses was determined. Patients were assigned a score on a 1-5 scale which measures both the occurrence of significant loss and the length of time between any loss and the patient's admission to the hospital. Of the 44 patients with malignancy, 28 (6b%) scored 4 or 5 on the scale compared to only 16 (24%) of the 66 patients with benign disease (t = 4.02, P<.0001). In the 5 years prior to admission, a significant loss oc- curred in 30 patients (68%) with malignant disease and in 22 (33%) with- out cancer (X2 = 12.9, p<.0003). A X2 analysis revealed job loss was y,uch more likely to be associated with a malignancy if there had been previous Job stability. Other variables including smoking history and age were also investigated. A multiple regression analysis indicated both the Recent Significant Loss Scale and the Smoking Scale contrib- uted something unique in the prediction of the diagnosis. Thus, the data suggests there are psychosocial risk factors for lung cancer which could be utilized in programs to prevent or detect the illness. /PSYCHOSOCIAL RISK FACTORS/LOSSES/LUNG CANCER/ 106 PSYCHOSOCIAL FACTORS OF CHILDHOOD AND PULMONARY MALIGNANCY PICARD, R.S. Staff Physician, Veterans Administration Medical Center, Shreveport, LA 71130, U.S.A. Previous investigations have correlated loss with the subsequent development of hopelessness followed by the inception of overt malig- nancy. It is postulated that certain childhood experiences make cert- ain individuals more sensitive to the consequences of a significant loss. Using a structured questionnaire containing 75 items regarding childhood and smoking, alcoholic patients (N-118) were compared with lung cancer patients (N-78). Items were submitted to a SPSS cross tab analysis. Following this multiple regression analyses were performed on randomized halves. The responses of the remaining half were investi- gated for validity of items in the derived optimal discriminant func- tion. Corrected for age, lung cancer patients could be discriminated from the alcoholics at the .01 level. Significant factors discrimi- nating the malignancy group from the alcoholics were more mothers work- ing, more parents smoking, greater age-difference from next younger sibling and next older brother, fewer relatives nearby, less rebel- liousness and less left by self during childhood. Packyears, inhaling, smoking in bed provided no significant discriminant separation. The author concludes that in two groups where tobacco consumption is similar, there is a statistical association between specific child- hood psychosocial factors that discriminate adults prone either to alcoholism or lung malignancy. MALIGNANCY, ALCOHOLISM/CHILDHOOD PSYCHOSOCIAL FACTORS

LIST OF ABSTRACTS 107 LIFE STRESS AND ONSET OF POLYCYTHAEMIA VERA BALTRUSCH, H.J.F., and STANGEL, W. Dept. of Clinical Immunology and Blood Transfusion, Hannover Medical School, D-3000 Hannover, Germany, F.R. Polycythaemia vera (p.v.) is a rare myeloproliferative disease with widely unknown etiology and epidemiology. This is the first report on an interdisciplinary, controlled study. A consecutive series of [15] 23 patients with p.v. were studied by structured interview schedule. They also completed a number of psychological tests (Family Attitudes Questionnaire, Habits of Nervous Tension, Rorschach, Thematic Apper- ception Test). 21/23 patients manifested their disease while unsuccess- fully coping with major psychological stresses such as loss of a prom- inent family member. Moreover, poor social adjustment with regard to marital, sexual and interpersonal relationships was found. Six of 23 patients grew up in incomplete families or broken homes. The Family Attitudes Questionnaire revealed a significant lack of closeness towards parents, as demonstrated in other neoplastic diseases. These findings are discussed in the light of current stress and psychosomatic cancer research. /STRESS-PSYCHOSOCIAL/POLYCYTHAEMIA VERA/ 1~ A COMPARATIVE STUDY OF DEVELOPMENTAL HISTORY IN MEN WITH TESTICULAR GERM-CELL CANCER AND ACUTE LEUKEMIA GORZYNSKI, G., HOLLAND, J., LEBOVITS, A., and VUGRIN, D. Memorial Sloan-Kettering Cancer Center, New York, NY 10021, U.S.A. Twenty-five men with testicular germ-cell tumors were compared by developmental history and past and present psychologic adjustment to 25 men with acute leukemia. The mean age was 30 years for cancer (151 group and 26 years for leukemia group. Current and Past Psychpathology Scales (18 scales of prior and 8 of present adjustment) were rated dur- ing a semistructured interview. Following differences were found in developmental history: onset of puberty was 12.4 years for leukemics and 15.1 years for.the cancer group (p<0.001), cryptorchidism 20% of cancer patients and 4% of leukemia, 36% opiate drug abuse in cancer , patients and 24+% of leukemia patients, psychiatric disturbance prior to illness in 32% of cancer group and 12% of the leukemia group. Major psychiatric illness was diagnosed in 20% of testicular cancer group and 4% of leukemia group. Findings of delayed puberty and psychiatric dis- turbance in men with germ-cell testicular tumors as compared to leukem- ics suggest a possible impairment of hypothalamic-pituitaty-gonadal axis. The etiology of this impairment is discussed (genetic factors, prenatal endocrine milieu, abnormal LH receptors, and abnormal interaction between dopaminergic system, LH and endorphins). /TESTICULAR GERM CELL CANCER/DE{/EIAPMENTAL HISTORY/ ~ O 0 ~ ~ (151 9

LIST OF ABSTRACTS SIMULATION OF ANXIETY STRESS BY NATURAL OR SYNTHETIC ADRENAL 109 CORTICOIDS AND THEIR INFLUENCE ON NEOPLASIA. Vernon Riley, H,A. Fitzmaurice, and Darrel H. Spackman. Pacific Northwest Research Foundation; & Fred Hutchinson Cancer Research Center, Seattle WA 98104. The earliest and most conspicuous biochemical feature of anxiety stress in the mouse and other mammals is a rapid elevation of plasma corticosterone or cortisol. Thus the role of stress in affecting var- ious pathological processes, including cancer, is logically related to the physiological consequences of these elevated stress-related hormon, es, In mammals undergoing anxiety stress, the elevation of endogenous corticoids is produced through well-known neurohormonal pathways invol- ving the central nervous system, the pituitary, and the adrenal cortex. It is useful, from the experimental standpoint, to by-pass these endog- enous pathways in order to determine the direct effects of adrenal cort- icoids on critical organs and cell populations that determine immunocom- petence and other physiological states, since these relate to either en- hanced or impaired abilities of the host to cope with pathological chal- lenges. Direct administration of natural or synthetic adrenal cortico- ids produces adverse effects on lymphocytes, thymus, and other tissues, that are indistinguishable from those produced by the imposition of conj trolled stress. Thus the enhancement of neoplastic processes, and esca- pe from host control, can be demonstrated by either the induction of psychosocial stress, or the injection of corticoids at stressed levels. /STRESS/PSYCHOSOCIAL/NEOPLASIA/LYt4'HOCYTES/THYMUS/ADRENAL CORTICOIDS/ 110 IIvTEL117CIUAL LEVEL IN HODGl{IN AND NON-HODCKIN LI'biPHU'IAS. COMAZZI, A.M., and TABIADON, C. Clinica Psichiatrica dell'Universita, Ospedale Policlinico; e Servizio Oncologia Medica, Ospedale S. Carlo Borromeo, Milan, Italy. Authors, in their own clinical experience, observed a different intellectual degree in patients suffering from Hodgkin's lSmrphana compared to those affected by non-Hodgkin lymphomas. They have there- fore investigated those patients divided into twu groups (Hodgkin and (15) non-Hodgkin) through Wechsler-Bellevue intellectual scale. Tbe results of such investigation will be examined in the present paper. /HODGKIN NON-HODCa{IN MTHOMAS/INTII1,LCIUAL LEVEh/

LIST OF ABSTRACTS (15] 198J ]u CANCER, AN EXPRESSION OF FMOTIOPIAL REACTIONS ? MARTHA SCHON,PH.D.,PRIVATE PRACTICE,NEW YORK,N.Y. (Formerly of Kemorial Sloan Kettering Cancer Center,New York,N.Y., USA ) Previous psychological research on cancer implied that cancer is related to repression of emotions, or may be an alternative to suicide or to psychosis. The present research indicates that negative environmental factors may result in " Wear and Tear" of the patients' psyche and phy- sique,and may be contributory to the development of the disease. This study is based on a small, but well studied number of patients in intensive psychotherapy. Results in- dicate 1) cancer patients often lead lives, destructive to them physically as well as emotionally, due to negative en- vironmental influences, past or present.2) Reversal of the- se negative situations may contribute to the arrest of the disease process.3) Cancer itself can be the agent to stop the destructive life style.4) Psychotherapy helps the pa- tientsto reorganize their lives, leading to a more normal and rewarding existence.5) Resolution of emotional conflict may increase possibly the life expectancy of the cancer patient. /Cancer/E<notions/Psychotherapy/Possible improved Prognosis D2 A SYSTEM FOR SIMULTANEOUS ASSAY OF TRANSFORMATION AND MUTA- TION INDUCED BY CHEMICAL AND PHYSICAL CARCINOGENS. T. Kakunaga, J.D., Crow, C. Augl, National Cancer Institute, Bethesda, Maryland 20205, U.S.A. It has been known that various experimental conditions affect the frequency of transformation and mutation induced by chemical and physical carcinogens in mammalian cells and it resulted in the large variations in the results between laboratories and researchers. In order to assay comparative potency of the mutagenic and transforming action of environmental carcinogens, it would be useful to develop a system for simultaneous assay of transformation and mutation in mam- malian cells. Normal human diploid fibroblasts and suhclones of BALR/3T3 mouse cell lines were chosen as target cells because of their availability as a target cell for chemical-induced transformation in culture (T. Kakunaga, Int. J. Cancer 12: 463 (1973) & Proc. Natl. Acad. Sci. U.S.A. 75: 1334 (1978), and their differences in the species and in the characteristics as a non-established diploid cell vs an established aneuploid cell line. Ouabain-resistance was used as a marker of muta- tion. Many experimental conditions were carefully examined and deter- mined. So that a near optimal assay system was established.

LIST OF ABSTRACTS Chinese hamster cells. The nature of the DNA lesions leading to these mutations is under investigations. induced per lethal event) at various genetic loci of V79 a high mutagenic efficiency (i.e. number of mutations most potent carcinogenic metabolites are those which have systems. with the polycyclic aromatic hydrocarbons the to base-pair transition mutations in several genetic gens the important DNA lesions appear to be those leading produce more than one type of DNA modification some of which may be of more significance than others in the initiation of tumours. In the case of methylating carcino- CHEMICAL CHEMICAL CARCINOGENS: STRUCTURE/ACTIVITY RELATIONSHIPS Brookes, P. Institute of Cancer Research, Chalfont St. Giles, Bucks HP8 4SP, England. It is now widely accepted that virtually all chemical carcinogens react with the DNA of the cells in the tissues in which tumours are induced. In many cases this reaction requires prior metabolic conversion of the carcinogen to a chemically reactive derivative. However many carcinogens 114 gens. the repair. of certain adducts from DNA will be considered in relation to the tissue specificity of tumour induction by these alkylating carcino- acteristics of the reaction patterns formed and tissue differences in between species. The amounts of reaction in target tissues, the char- which vary markedly from tissue to tissue either, in the same animal or, informational macromolecules and in DNA may elicit repair reactions RNA and in DNA may lead to-changes in the stability of these important characteristically different amounts. Individually, their presence in ted by reference to the reactions of the alkylating carcinogens, includ- ing the N-nitroso compounds. Interaction of these agents with nucleic acids leads to the formation of a number of adducts which occur in by measuring the amount of reaction with DNA and this.will be illustra- the body. The differing amounts of reaction•that occur can be assessed the extent to which the carcinogen can react in different tissues of cells, the presence of appropriate enzymes for metabolism may determine active metabolite before they can interact with the constituents of /CHEMICAL CARCINOGENS/MUTAGENS/DNA REACTION/ .ON MECHANISMS OF CHEMICAL CARCINOGENESIS O'Connor, P.J. Paterson Laboratories, Christie Hospital and Holt Radium Institute, Manchester M20 9BX, U.K. As many chemical carcinogens require activation to a chemically re- [ALKYLATING CARCINOGENS/DNA REACTION/DNA REPAIR/TARGET TISSUES]

. LIST OF ABSTRACTS llj ASSAY METHODS FOR CARCINOGENS. Purchase, I.F.H., ICI Limited, Central Toxicology Laboratory, Macclesfield, U.K. The key to the prevention of chemically induced cancer is the detection of those chemicals which have carcinogenic potential. Current opinion favours the results of whole-life carcinogenicity assays in experimental animals as definitive evidence of the presence or absence of carcinogenicity of a chemical. These studies have a [35] number of draw-backs, both logistic (they are expensive and time- consuming) and scientific (expense has prevented rigorous assessment of reproduceability). More recently short-term assays for carcinogens have been developed, based on a variety of end-points (particularly mutation), which have as main advantages their low cost and short time scale. Extensive validation of these tests has shown that they detect a high proportion of carcinogens. They are now being used as screening tests in the selection of compounds for development and as part of the initial regulatory screening of industrial chemicals for toxicity. Once this first step in the evaluation of risk associated with exposure to a chemical is accomplished, control measures appropriate to the level of risk can be instituted. /ASSAY METHODS FOR CARCINOGENS/ 116 THE REGULATION OF CELL TRANSFORMATION INDUCED BY CHEMICAL AND PHYSICAL CARCINOGENS IN SYRIAN HAMSTER CELLS. DiPaolo, J.A., Doni ger, J., Evans, C.E. and Popescu; N.C. Nat. Cancer Inst., MD USA. Potentially carcinogenic agents including benzo(a)pyrene (BP), vinyl chloride, arsenic, asbestos and ultraviolet irradiation (UV) induce dose related transformation; the transformed cells produce tumors when inject- ed into animals. Noncarcinogens do not cause transformation. The UV action spectra for transformation and production of DNA lesions coincide, [35] strongly indicating that DNA is the primary target for carcinogenesis. The transformation frequencies are greater than the mutation frequencies induced by chemicals in different species, and the chromosomal changes observed are independent of the etiological agent. Transformation can be enhanced or inhibited by sequential treatment with different agents. Sy- nergism occurs when X-ray or an alkylating agent precedes chemical car- cinogen or UV; with asbestos and BP cotreatment; and when caffeine fol- lows a carcinogen. Neither excision nor post-replication repair are re- sponsible for the enhancement by X-ray and UV, while caffeine effects post-UV DNA replication. The neoplastic state is associated with sus- ceptibility to lymphotoxin which can also inhibit transformation by a chemical carcinogen or UV. The neoplastic process can also be inhibited by cortisone or dexamethasone. Thus, it is possible to determine which agents have a potential for producing cancer as well as the nature of the cell-insult interaction. /TRANSFORMATION ENHANCEMENT/INHIBITION/LYMPHOTOXIN/DNA REPAIR/

LIST OF ABSTRACTS IV DEPENDENT AND AUTONOMOUS PHASES DURING LEUKEMOGENESIS. Haran-Ghera, N., Department of Chemical Immunology, The heizmann Institute of Science, Rehovot, Israel. The different phases observed during murine T cell leukemogenesis involve the initial transformation of stem cells or committed pre T cells to dependent preleukemic cells (their proliferation controlled by host factors) or to autonomous transformed leukemic cells (non respons- ive to host factors). The qualitative differences observed between preleukemic and leukemic cells imply that the transformed cells undergo sequential changes during the long latent period. Leukemogenic agents inducing a low overt leukemia incidence induce "dependent" preleukemic cells in almost each treated mouse. Thus, the "dependent" preleukemic phase may be arrested at this stage, thereby contributing to leukemo- genesis resistance (affected by the immunizing capacity of preleukemic cells); alternatively, sustained proliferation of "dependent" preleu- kemic cells, afforded by host factors, may result in the emergence of an "autonomous" clone. It is suggested that during the long latent period the proliferation of immunogenic preleukemic cells is controlled and a host-tumor cell balance is maintained. At this stage host immunity may have a significant role. The presence of various cofactors (not necessarily leukemogenic by themselves) may be required for tran- sition from the dependent preleukemic state to autonomy thereby establishing an autonomous clone preceeding overt leukemia development. 118 14ODEL FOR CANCER PREVENTION AND D,ETFCT;ON PROGRAM Goes Jr., J.S.; Goes, J.C.S.; Functag ao 'Centro t!e Pes quisa de Oncologia", Instituto Brasileiro de Controle do Cancer. Sao Paulo - S.P. - Brasil. Cancer is a serious problem for every country, mainly for Bra sil because of its great expansion and population,difficulties of transportation and lack of human and msterial resouroes. The early detection and prevention is the first step for the oontrol of the disease. To be feasible the program must be easy to be carried out and have a low cost which is possible only if se veral areas are covered at the same time.We started with oervix and breast cancer, then the skin and oral cancer, and now we are doing the rectosigmoid cancer detection, performing hemo- cult test, in patients over 50 years,and rectosigmoidoscopic examination and radiography when necessar . Training and utilizing of non medical personnel is important to multiply doctors' task. Program's administrative structure has centr- alized coordination and decentralized execution. Specialized sanitary education will inform the public about the importance of prevention and detection. Program must be carried out permanently; temporary campaigns are ineffective. Register of patients is essencial for the continuous evaluation of act- ivies and follow up of cases. During the rogram,327.529 pa- tients without symp toms were examined, be performed 350.~00 cytologic examinations and 62.000 speciali breast examinations. /MODEL CANCER PREVENTION DETECTION PROGRAM/

LIST OF ABSTRACTS 119 MEDICAL MANPOWER UTILISATION FOR CANCER DETECTION AND SCREENING PROGRAMME: Eleven Year Experience. Dr. Sharad G. VAIDYA. Goa Cancer Society, Gosalia Memorial Hospital and Research Institute, Panaji, Goa, India. CANCER DETECTION. A mass screening process can be divided into three phases: [1] motivation for doctors and community interaction; [2] per- formance of mass check-ups; and (3) hospital and laboratory investigation. Family physicians were motivated to donate six hours a month for prevent- (10] ive check-ups, ten days a year. Four groups of thirty doctors thus donated fifty Sundays for five years; 36,000 medical hours were used too check-up 72,000 persons. With pre-arrangement an9 community participa- tion and an eight year effort, 3,125 persons (1,605 males and 1,520 females) were checked in 12 villages. High risk groups were identified and precancerous lesions investigated; thus, 23 cases of cancer and 2% leukoplakia were detected.• The results were analysed for head and neck, and cervix and breast cancers which constituted about 70% of cancer cases. The preventive check-ups allow the opportunity and time to discuss prob- lems of health rather than disease. It is a good form of direct education and motivation to abandon unhealthy and precancerous habits, and inculcate yearly check-ups. The cost of this scheme does not ordinarily exceed US $0.50 per person. The author favors the view that this method of Med/hr utilisation is best suited for doctor/population interaction and low cost detection of cancer. /MEDICAL MANPOWER UTILISATION/CANCER DETECTION PROGRAh4ME/ 120 THE CRAB CLUB PROJECT: Lygia Pratini de Moraes, The Women's League Against Cancer. Rua Sarmento Leite 187, Porto Alegre, Rio Grande do Sul, Brasil. Main Objectives : to spread Knowledge about cancer and its prevention, thus creating a new attitude towards the illness, stimulate hu- man solidarity and raise funds to build a children's ward. Project Basis was elaborated upon Health and Educational Programme covering 150.000 youngsters from 14 to 18 years (10] old. Due to success obtained, it was extended to children from 7 to 14. First step: Contact between the League's board (10 members) the State Secretariat of Education and private schools. Fifty schools with 50.000 students joined in. Second step: lectures, audio visuals, printed information distributed by the members of the League. Third step: Club was activated under the care.of a teacher responsible for information and collecting annual fees. Members are entitled to discounts in stores and f ree tickets to soccer games. Evaluation by League through forms distributed by the teachas Many schools asked to join the programme favouring cancer prevention through teaching of habits and ectitudes. /PREVENTION OF CANCER/ MASS EDUCATION/ A CHANGE OF VIEW/ (1

LIST OF ABSTRACTS ~ MALIGNANT NDClPLASbiS IN INFANCY AtO CHIIDHCXD IN Tf{E SOCIALIST PFX7PLE'S LIBYAN ARAB JAMAHIRYA. S.A. Wassef, HB, BCH, PhD, and FRCPath (Eng.), professor of Pathology, Head of The Pathology Dept., Tripoli Central Hospital, Tripoli, The Socialist People's Libyan Jamhirya There is no population-based cancer statistics in Libya. The present study is based on pathological material as a source of information on cancer pattern. The study is composed of two parts. The first part cov- ers years 1968-1972 during which 7,585 biopsies were performed. 996 of the latter proved to be malignant, i.e., 13.13%, with 56.22% occurring in males and 43.77% in females. Paediatric malignant neoplasms were reported in 48 cases, i.e., 0.63% of total biopsies and 4.82% of total malignancies. Twenty-nine cases occurred in males, i.e., 60.42% of paediatric malignant neoplasms, 2.91% of total malignancies and 5.18% of total malignancies in males. Nineteen cases occurred in females, i.e., 39.58% of paediatric malignant neoplasms, 1.91% of total malignancies and 4.36$ of total malignancies in females. The highest incidence of malignant neoplasms occurred in lymph nodes followed by bone, eye, etc. The second part of the study covers the years 1973-1977 during which 20,863 biopsies were performed. 1,940 proved to be malignant, i.e., 9.3%, with 54.02% occurring in males and 45.98% in females. Paediatric malig- nant neoplasms were reported in 176 cases, i.e., 9.07% of total malig- nancies. The highest incidence of malignant neoplasms occurred in lymph nodes, followed by bone, skin, eye, connective tissue, brain, etc. (10) ]~ CANCER PREVENTION IN EAST AFRICA. Hutt, M.S.R„ Geographical Pathology Unit, St.Thomas's Hospital Medical School, London, England. The pattern of cancer in East Africa is different in many respects from that seen in Europe or the U.S. Tumours of the stomach, large boael, lung, kidney, prostate, testis and endometrium are less common in East Africa and tumours of the liver, penis, cervix, Kaposi's sarcoma and Burkitt's lymphoma are more common The aetiolog+cal factors for the latter group lie in the rural environment and sociocultural pattern of life of East Africans. Prevention requires firstly an attempt to deal mith the knoan aetiological factors for the common tumours in the area and secondly effective measures to minimise the adverse carcinogenic effects of the aestern aay of life and the industrialised aorld

LIST OF ABSTRACTS ~ ALTERATIONS IN THE METABOLISM AND TOXICITY OF DIMETHYLNITROSA- MINE DURING THIAMINE DEFICIENCY: PREVALENCE OF THE DEFICIENT STATE IN RHAI POPULATION. M. Ruchirawat, W. Mahattanatrakul, D. Kittikool and Y. Sinrachatanant. Mahidol University, Bangkok, Thailand Dimethylnitrosamine (DMN) =s a food and environmental carcinogen which requires metabolic activation for its carcinogenic action. This investi- gation has been undertaken to study the possible effects of thiamine deficiency on DMN metabolism and toxicity since the deficiency is still a major public health problem in many developing countries, especially (10] in South East Asia. In Thailand, thiamine deficiency is prevalent in the North-East region where there is a high risk of exposure to nitrosamines through regular consumption of raw fermented fish. In rats, thiamine deficiency caused a marked increase in the rate of disappearance of DMN from the serum. The activity of DMN demethylase IF responsible for the conversion of DMN to formaldehyde at low substrate concentration, was not altered by the deficiency and supplementation of thiamine produced no change. The activity of DMN-demethylase II, operated at high substrate concentration, on the other hand, was enhanced; however, the conversion of DMN to CO2 , in vitro, was unaffected. Moreover, acute toxicity of DMN assessed by the LDdoses and serum transaminase levels was also enhanced. These findings suggest that thiamine deficiency modifies the metabolism which may lead to changes in toxicity and carcinogenicity of DMN. __/DMN METABOLISM/THIAMINE DEFICIENCY/ 61 PS 124 A STUDY ON CLINICAL ASPECTS OF ORAL CANCER IN SRI LANKA. WARNAKULASURIYA, K.A.A.S. Division of Oral Medicine, University Dental School, Peradeniya, Sri Lanka. 269 patients (mean age of 59 years) with oral squamous cell carcinoma were investigated for affected site, associated lesions, aetiology and delay in treatment. For recording, the oral cavity was divided into 10 sites. Smoking and betel chewing habits were analysed. In the 269 patients, 454 sites were affected in the following order of frequency: [1] buccal mucosa; [2] retromolar; [31 sulcus; (4] alveolus; [5] commisure; [6] tongue. Gingiva was the least common site for occur- rence of a malignancy, despite sepsis in the mouth, in this population. in only 10% of the cases the lesions were less than 2 cm. in diameter. Atrophy of the mucosa, homogeneous and speckled leukoplakia, angular chelitis and glossitis were coexisting. Seventy-seven percent showed regional lymphadenopathy. Out of 269, 256 were betel chewers, 174 smoked and 155 engaged in both habits. In 68 of the betel chewers analysed in detail, 18 kept the quid in the mouth overnight, and in 27 the site affected corresponded to where the quid was placed, usually. The average delay in patients reaching the institute was estimated as 15.7 months after appearance of initial symptoms. /ORAL CANCER/

i I 61 FS 61 PS LIST OF ABSTRACTS 125 ESOPHAGUS CANCERS IN TURKEY. Dr.med. Bamit Korkut AKOGUZ chief of Surgery, Oncology Hospital, Ankara, Turkey. over an eleven year period from 1967 to 1978, 348 esophageal cancer cases were identified out of 20,635 patients who had malignant tumors; this represents approximately 1.69% of the total. This particular type occupied the 13th rank in our frequency distribution tables. No remark- able correlation has been observed between the incidence of illness and dwelling areas; patients coming from rural areas (48.5%) and city dwell- ers (51.5%) showed only a slight difference. The breakdown of the cases according to sex was highly remarkable: 107 women vs. 241 men. As far as the incidence according to age is concern- ed, the mode group was 51 to 60 years; 18 years of age, the youngest and 75 years of age, the oldest. All the patients were Whites. No significant relationship has been detected according to geographical distribution and dietary habits. /ESOPHAGEAL CANCER/TURKEY/348 CASES/ 126 EXPERIENCE WITH THE KUWAIT POPULATION BASED CANCER REGISTRY, 1974 - 1978. Y.T. OMAR, F.R.C.R. Al-Sabah Hospital, Ministry of Public Health, Kuwait, Arabian Gulf. Abstract was received after going to press.

LIST OF ABSTRACTS U7 TUMOUR MARKERS IN BRONCHOGENIC CARCINOMA. Coombes, R.C. Ludwig Institute for Cancer Research (London Branch), Royal Marsden Hospital, Sutton, Surrey SM2 5PX, U.K. The precise roles of surgery, radiotherapy and chemotherapy in the management of bronchogenic carcinoma are still unclear and this is partly because of a lack of a satisfactory tumour marker. Studies from our Institute have been directed at examining the place of peptide hormones as tumour index-substances and we have inves- (2j tigated the nature of tumour-associated-hypercalcaemia, cachexia, Cushing's syndrome and hypercalcitoninaemia in the search for a tumour marker in this disease. Our investigations indicate (a) that parathyroid hormone is rarely if ever the cause of cancer-associated-hypercalcaemia (b) calcitonin is elevated in a proportion of patients, and is a potential tumour marker in this cancer and the circulating forms of calcitonin are often immun- ologically and chromatographically distinct from calcitonin monomer, (c) carcinoembryonic antigen may be a useful marker in some cases and occasionally a rise antedates the recurrence of disease (d) human placental proteins are of little value as markers in these neoplasms using current reagents. /BRONCHOGENIC CARCINOMA/PEPTIDE HORMONES/TUMOUR PRODUCTS/ 128 TUMOR MARKERS OF BREAST AOLLINSHEAD, Ariel C. Department of Medicine, The George Washington University Medical Center, Washington, DC 20037, U.S.A. The 15,000 dalton protein from human breast gross cystic disease fluid (Haagensen and Wells), CEA (Myers, et al.) and Ferritin (McCulloch and Dent) markers may be useful in monitoring recurrence or metastatic dis- ease. Kappa casein serum levels vary from 7% positive in the benign breast diseases to 27% positive in metastatic cancer, and the range of serum levels is variable (Searle and Bagshawe). Results with LMI (Black (2] at al.; McCoy et al.; Dean et al.; and Oldham) and LAI (Yonemoto et al.) assays vary, depending upon the antigens used, and the sensitivity of the tests. Delayed cutaneous recall hypersensitivity reaction to Thompson- Friedenreich (T) antigen are seen in 90% of ductal breast carcinomas, 60% of lobular breast carcinomas as well as in adenocarcinomas of other organs (Springer, et al.). Other studies of tumor markers of breast will be re- viewed. Our own•studies have centered upon those tumor-associated antigens and tissue-associated antigens which induce cell-mediated immune responses, relationship to putative viral proteins associated with breast fluids or tissues, and the effects upon TAA and other breast tissue antigens by chemotherapeutic agents and candidate drugs such as 3-deazaguanine and trifluorothymidine. A breast cancer cell line which expresses TAA is use- ful for antigen isolation, and further purification by 2-dimensional chromatographic techniques using isotachophoresis; antibody can be obtain- ed using affinity chromatography with hyperimmune antisera from immunized ~ patients. O O r o,

LIST OF ABSTRACTS 129 TUMOUR MARKERS IN TERATOMA: Kohn, J., Raghavan, D., Royal Marsden Hospital and Ludwig Institute for Cancer Research, Sutton, Surrey, England. The role of tumour markers in germ cell tumours lies primarily in monitoring the course of disease and the response to treatment. Frequent sampling for marker levels is essential (twice weekly) in the post-operative period and following therapeutic procedures. The rate of change j2) of serum marker levels, kinetics of AFP in particular, are relevant to the progress and prognosis of the disease - valuable lead time can be obtained. A prolonged, apparent half-life (AHL) of AFP in excess of six days always appears to correlate with persistent disease but normal AHL may occur if non-marker producing cells are present. Discord- ance between AFP and HCG occurs in up to Wlo of patients with advanced disease. In stage one referral practice, the absence of HCG in circulation after orchidectomy does not necessarily mean absence of HCG producing tumour. A correlation study between presence and level of tumour markers and final outcome is now being completed and will be discussed. At the Royal Marsden Hospital immuno- peroxidase technique is part of the routine diapostic workup and it's value and application will be discussed. L7)0 TUMOR MARKERS OF THE CENTRAL NERVOUS SYSTEM. Birkmayer,G.D. Department of Cell Biology, University of Munich, FRG. For serological diagnosis of human tumors,two presupposi- tions have to be fullfilled:(a)The distinct cancer has to express specific antigens,as tumor markers,and (b) the patient has to produce antibodies against these markers in orddr to allow their detection. Gliomas are among those (2) human malignancies known to elicit an immune response. By a variety of methods in which viable tumor cells have been used, immunity directed partly against tumor specific anti- gens and partly against glia-cell specific antigens could be demonstrated in glioma patients. An isolated tumor anti- gen would provide a more convenient tool in this respect. We have approached this problem,therefore,by identifying and isolating tumor-associated components from glioma tissue Immunological identical antigens could be detected in all human gliomas tested so far by a rabbit antiserum. Electro- phoretic analysis revealed at least 2 tumor specific poly- peptides with an estimated molecular weight of 55,000 and 10,000 dalton. Using these soluble tumor-associated com- ponents as antigen source cross-reacting antibodies could be detected in 79% of the glioma patients' sera. /GLIOMA-ANTIGENS/ BRAIN TUMORS/ IMMUNDIAGNOSIS/

LIST OF ABSTRACTS 131 MORPFpLOGICAL W'IOR MARKERS NIEBURGS, N.E. Department of Pathology, Mt. Sinai School of Medicine of The City University of New York, New York NY 10029, U.S.A. Morphologic tumor markers were first described as systemic malignancy associated cellular changes (MAC) in 1959. Essentially, the cellular markers were identified by the presence of abnormal nuclear alterations in well differentiated cells. The nuclear markers occur as a result of (2) mitotic arrests in the early and late prophase and remain unchanged throughout cell differentiation. In contrast, nuclear alterations in malignant tumor cells, though comparable to mitotic phases and to structures of nuclear markers, are associated with lack of different- iation and with the probability of cellular commitment to division. Experimental induction of nuclear tumor markers in vivo by low dose carcinogenesis, and in vitro by leukemic lymphocyte DNA, and presence of lymphocyte tumor markers in normal individuals with a family history of neoplasms, points to a possible role of this nuclear alteration in the biology of cancer. 332 SEARCH FOR UNIVERSAL TUMOR MARKERS. Klavins, J.V., Department of Pathology, Catholic Medical Center, Jamaica, N. Y., U.S.A. Universal tumor specific markers are: 1) CTA - a basic protein in plasma membranes (Caspary and Dickinson), 2) "B-Protein" in sera of cancer patients (Bucovaz et al), 3) A unique polysaccharide moiety of a membrane glycoprotein in various mice tumor cells (Sidebottom). Non specific universal tumor associated markers: 1) Plasminogen activator (Rifkin et al), 2) EDC1- a glycoprotein from urine of cancer (2) patients (Rudman et al). Universal oncofetal markers: 1) CEA (Gold et al), 2) AFP (Abelev et al), 3) B S-glycoprotein (Takahashi et al), 4) Regan Isoenzyme (Fishman), 5) T-globulin (Tal), 6) Oncofetal antigen in mice (Stonehill and Bendich), 7) Cell surface antigen (Avis et al), 8) TPA - a tissue polypeptide-(BjtSrklund), 9) A soluble antigen - BOFA (Fritsche and Mach), 10) a2H globulin (Buffet and Rimbaut), 11) A membrane antigen OFA (Irie et al), 12) C3DP and MAD-2-DNA - binding proteins (Parsons et al), 13) 3-M KC1 extracts of human embryos (Zoller et al), 14) In our laboratories we have demonstrated an antigen in an aqueous extract of human embryos and another in (NH,,)2S0,, fraction -(0-25X) of an aqueous extract of pancreatic carcinoma. These antigens cross reacted with various carcinomas derived from all three germinal layers. /SEARCH/UNIVERSAL TUMOR MARKERS/ (8) (8)

LIST OF ABSTRACTS CHOLESTEROL AND CHOLESTEROL-a-EPOXIDE IN HUMAN BREAST 133 SECRETIONS. Petrakis, N.L., Gruenke, L.D. & Craig, J.C. University of California, San Francisco, California, U.S.A. Cholesterol and cholesterol-a-epoxide levels were determined in nipple aspirates of breast fluid from nonpregnant women, employing GLC end mass spectrometric techniques. Cholesterol levels were found to be plevated above plasma levels averaging 1995 mgm % and showing progres- SiVe increases in mean cholesterol levels with advancing age, averaging 187 mgm %, 1957 mgm % and 3553 mgm % in women of age groups 20-29, 30- 39 and 40-49 years, respectively. Cholesterol-a-epoxide (CAE) was detected in a significant number of women with high levels of breast f)uid cholesterol. CAE has been reported by others to have transform- ing activity for embryo hamster cells and to be carcinogenic in animals. These findings further support our hypothesis and observation (Petrakis, f;,l, et al., Cancer Res. 40: 188, 1980) that the human breast secretes rnutagenic and cancer promoting substances. /CHOLESTEROL/CHOLESTEROL-a-EPOXIDE/HUMAN BREAST FLUID/BREAST CANCER 134 PRESENCE OF EPOXYCHOLESTEROLS IN THE AGING HUMAN PROSTATE GLAND AS A RISK FACTOR IN CANCER Schaffner, C. P. , Brill, D. R. & Singal, A. K. Wa ksman Institute of lsicrobiology, Rutgers-The State University, New Brunswick NJ, USA Cholesterol-5a, 6a -epoxide (a -CE) is a suspected potent carcinogen that has been shown to transform hamster embryo cells (Kelsey, M.I. & Pienta, R. J. /1979/ Canc. Let. 6:143). This metabolite, as well as the 0 isomer (0 -CE) and cholesterol, was isolated from human pros- tate tissues. We used thin-layer and gas chromatography and mass spectrornetry to detect, measure, and identify the compounds. Sam- ples from 49 prostate glands removed at autopsy were from patients 17 to 85 years old. Both a-CE and ft -CE were found in substantial concentrations only in glands older than 42 years. Both compounds are apparently associated with the gradual accumulation of cholesterol in the aging but normal gland, more in benign prostatic hyperplasia, and still more in prostatic carcinoma. The formation and role of a-CE in the prostate gland and its secretions should be considered in determining the etiology of prostatic carcinoma, and, further, in sex- ually related carcinomas in the female consort. /EPOXYCHOLESTEROLS/PROSTATE/ CARCINOMA/

LIST OF ABSTRACTS 135 SERUM B-PROSTATIC PROTEIN AND PATHOLOGY OF THE PROSTATE. .Rochman, H. & Wu, W. Pathology Department, University of Chicago, Chicago, U.S.A. S-prostatic protein, (6-pp) is a normal constituent of prostatic fluid. It was purified by column chromatography employing Sephadex G-150. S-pp is devoid of activities for a number of enzymes including acid and alkaline phosphatases and the transminases. To evaluate its clinical applicability for prostatic pathology an RIA for B-pp was ~gl established and the levels in the peripheral circulation measured. The concentration of B-pp in unexamined male blood donors, (n, 30), aged 22.7 ± 2.93 yr. (mean ± SD) was 10.7 ± 9.67 ng per ml. The serum B-pp of middle aged and elderly patients (n, 35) aged 58.7 3 10.99 yr. with various cancers and inflammatory conditions in the presence of a clini- cally normal prostate was 16.2 3 13.4 ng per ml. The pre-operative levels of serum S-pp in 18 patients (69.9 ± 11.27 yr.) with symptoms and signs of BPH sufficient to require surgical intervention was 32.7 ± 25.7 ng per ml. The B-pp levels for 14 patients w:th cancer of the prostate aged 67.9 ± 8.39 yr. was 61.2 ± 47.55 ng per ml (pre-operative level). The results on coded sera from 18 patients obtained f rom the National Prostatic Cancer Project, Roswell Park were as follows: 11 ' were elevated for serum B-pp and 6 for serum acid phosphatase. The results suggest that the serum s-pp concentration is a sensitive marker for BPH and cancer of the prostate. /S-PROSTATIC PROTEIN/PROSTATIC CANCER/ 181 136 FETAL TYPE ANTIGENS IN GYNECOLOGICAL CANCER. Cauchi, M.N., Lim, D., Barton, J., and Koh, H. Section of Haematology and Immunology, Royal Women's Hospital, Melbourne, Australia. The value of serial estimation of a number of oncofetal antigens in patients with gynecological cancer was investigated. The incidence of elevated CEA in patients with gynecological cancer was as follows: Ca ovary 30%, Ca endometrium 27%, Ca endocervix 78%, and Ca ecto- cervix 34%. The very high levels of CEA in cancer of the endocervix (usually > 50 ng/ml) may serve to distinguish it from cancer of the . ectocervix and endometrium, where CEA values are usually < 10 ng/ml. Fetal hemoglobin is another fetal type antigen found elevated in 65% of patients with Ca ovary, 69% of patients with Ca endometrium, and 22% of patients with Ca of the cervix. Beta 2 microglobulin is a small molecular weight antigen found in high concentration in fetal serum. High levels of 62m were detected in up to 47% of patients with gynecological cancer. The value of these paremeters in the diagnosis and follow-up of patients with gynecological tumors will be discussed. FETAL ANTIGENS/GYNECOLOGICAL CANCER. 0

CTS e LIST OF ABSTRACTS LV CARCINOEMBRYONIC ANTIGEN LEVELS AS AN AID IN THE bIFFERENTIAL DIAGNOSIS OF ABDOMINO-PELVIC MALIGNANCIES Parente, J.T. and Greston, W.M. Department of Obstetrics and Gynecology The Bronx-Lebanon Hospital Center and Albert Einstein College of Medicine, Bronx, New York, U.S.A. The differential diagnosis of abdomino-pelvic tumors can be difficult. The inability to differentiate colorectal carcinoma from ovarian carci- noma, in particular, may result in inadequate surgical procedures and unnecessary complications. In this study, elevated pretreatment levels of carcinoembryonic antigen (CEA) were used as an aid in distinguishing between extragenital and gynecologic tumors in 76 women. Levels below 10 ng/ml suggested gynecologic malignancy or benign disease; levels above 20 ng/ml indicated extragenital carcinoma. In addition to other diagnostic studies, pretreatment CEA values may enable the physician to anticipate the specificity of the tumor and the scope of the surgical problem more precisely and, thus, be better able to prepare the patient for optimum treatment. CARCINOEMBRYONIC ANTIGEN/ABDOMINO-PELVIC MALIGNANCIES i I i I i ~ THE RELEVANCE OF SECRETORY IgA ESTIMATION IN THE SERA OF ~ ~ PATIENTS WITH GYNECOLOGICAL CANCER. ~ Cauchi, M.N., and Lim, D. Section of Haematology and Immunology, Royal Women's Hospital, Melbourne, Australia. + Secretory component of IgA (SIgA) was isolated by DEAE Sephacel anion exchange chromatography and Sephadex G200, radioiodinated, and a radioimmunoassay procedure developed. The standard inhibition curve vns linear to 10 nQ/ml_ The levels of S7nA In the aPrum of nnrmal ~ /B) persons was 1.9 ± 0.1 ug/ml (mean ± SE), while in lactating women the level w$8 5.5 ± 0.5. In cancer of the ovary, endometrium, and cervix, the levels of SIgA were 3.1 ± 0.3, 2.2 ± 0.5 and 2.8 ± 0.4 ug/ml •0 respectively. A significantly increased level of SIgA was found in 13/24 (54%) of patients with cancer of the ovary and in 5/15 (33%) of 4~ patients with cancer of the cervix. Further studies are in progress to establish levels of SIgA following surgery and chemotherapy. SECRETORY IgA/GYNECOLOGICAL CANCER

LIST OF ABSTRACTS 139 MONITORING TUMOUR GROWTH IN PATIENTS WITH MELANOMA BY DETECTION OF MELANOMA ANTIGENS IN SERA BY LDA ASSAYS Hersey, P., Murray, Elaine, McCarthy, W.H. Kanematsu Memorial Institute & Melanoma Unit, Sydney Hospital, Sydney, Australia. We have previously described the appearance of factors in the sera of melanoma patients which neutralize antibody detectable in leukocyte dependent antibody (LDA) assays against melanoma cells. These factors were shown to be small m.w. glycoproteins which were similar to cell (8) surface antigens identified in melanoma cell membrane extracts. Small m.w. fractions were obtained from acidified sera by gel and membrane chromatography and tested for their ability to inhibit a panel of melanoma and non-melanoma antisera in LDA 51Cr release cytotoxic assays. Patients were grouped according to the stage of their disease and patients with non-melanomatous carcinoma were included as controls. The results indicated (1) that small m.w. antigens could be detected in approximately 60% of patients overall. The highest rate of detection was in patients with primary melanoma and lowest in patients with stage II & III melanoma. (2) The variation in levels of these antigens appeared to closely parallel tumour growth in melanoma patients and had predictive value in detecting recurrences. (3) The high false negative detection rate suggests the assays would be of little value in excluding melanoma. Conversely, the number of false positive results appeared low so that these assays may be of value to monitor the response of patients to therapy. 140 EFFECTS OF AGE AND SMOKING ON LEVELS OF SERUM PROTEINS ALTERED IN CANCER PATIENTS. Weiss J.F., Chretien, P.B., Edwards, B.K., Beveridge, R.A., Baskies, A.M. & Wolf, G.T. National Cancer Inst. & Armed Forces Radiobiology Research Inst., Bethesda, MD, USA. In patients with solid malignancies, serum levels of acute-phase proteins (APP) [al-acid glycoprotein (AGp), al-antitrypsin (ATr), haptoglobin (Hp)] are increased while other serum proteins [albumin (Alb), prealbumin (PA), a2HS- glycoprotein (HS)] are depressed. Levels of these serum proteins are altered in (8) patients with head and neck squamous carcinomas, and levels of APP and HS correlate with tumor stage and immune reactivity. The effects of smoking (a factor associated with the developm ent of head and neck cancer) and age on the levels of these proteins were determined. Groups studied were 140 nonsmoking and 132 smoking normal volunteers. AGp increased while Alb decreased with age in both groups. Hp levels increased with age in smokers. AGp, Hp, and Alb levels were also related to the extent of smoking (pack-years). In a comparison of age- and sex-matched smokers and nonsmokers, ATr was significantly elevated in smokers (p <0.001). In a previous study of patients with head and neck cancer, we found that mean levels of Hp and AGp were elevated, and HS, PA, and Alb were depressed compared to smokers. Because of the immunosuppressive proper- ties of APP and the direct correlation of HS and PA with cellular immunity, these changes in serum proteins may be related etiologically to the association between age, smoking, and head and neck cancer and other malignancies. Studies of these serum proteins may be important in the. assessment of patient status. /SERUM PROTEINS/AGE/SMOKING/HEAD AND NECK CANCER/ I

LtST OF ABSTRACTS AN EVALUATION OF CEA-S FOR CANCER DIAGNOSIS. Reynoso, G, M. D. 141 Wilson Memorial Hospital, Johnson City, NY; State University of Ne„r York, Upstate Medical Center, Clinical Campus at Binghamton. CEA-5 has been described as an isomeric form of CEA which may be more ufeful for cancer diagnosis than conventional CEA. We have compared the sensitivity and specificity of the CEA-S assay with classical CEA in 482 patients admitted with signs and symptoms suggestive of cancer. The diagnosis was based on standard clinical, radiological and labora- III tory data plus histological confirmation when appropriate. All nega- tive patients have been followed for up to 19 months. In 184 patients . positive diagnosis of cancer was established and in 298 it was not. lrhen all cases are considered, the sensitivity of CEA-S for the diag- nosis of cancer is .6739 and the specificity is .5436. When only colo- r ectal cancer is considered, the corresponding figures are: specificity ,6667, sensitivity .5812. The classical CEA assay on the same population yave the following results: all cases: specificity .7337, sensitivity 5101, colorectal cancer: specificity .7011, sensitivity .5299. The differences are not significant. The CEA-S assay offers no additional sensitivity or specificity for the diagnosis of cancer under the clinical conditions and type of population studied by us. CEA/CEA-S/CANCER DIAGNOSIS/CANCER ANTIGENS 1Q SCREENING FOR LIVER METASTASES FROM COLORECTAL CANCER WITH CARCINOEMBRYONIC ANTIGEN AND ALKALINE PHOSPAATASE Tartter, P.I., Slater, G., Gelernt, I., and Aufses, A.H.,Jr. Department of Surgery, Mount Sinai School of Medicine, New York, N.Y. The presence of liver metastases influences the therapy and prognosis of patients with colorectal cancer. A sensitive and economical method of screening for liver metastases was developed using serum alkaline phosphatase and carcinoembryonic antigen. The upper limit of normal for alkaline phosphatase and carcinoembryonic antigen did not represent the optimal level for use in predicting liver metastases. Optimal reliability was found when alkaline phosphatase was greater than 135 IU or carcinoembryonic antigen was greater than 10 ng/ml. This screening test was applied retrospectively to 190 unselected patients who had undergone laparotomy for colorectal cancer. Sensitivity was 88%: 23 of 26 patients with liver metastases fulfilled either criterion. Liver scanning alone detected metastases in only 69% of 35 patients with liver metastases among a group of 179 patients with colorectal cancer who underwent preoperative liver scanning during the same interval. Although liver scintilation scan is the best single noninvasive test for the detection of liver metastases from colorectal cancer, the combination of alkaline phosphatase and carcinoembryonic antigen can be used economically to screen for liver metastases and to determine which patients should undergo a liver scan. LIVER METASTASES/COLORECTAL CANCER/ALKALINE PHOSPHATASE/CEA

LIST OF ABSTRACTS 181 143 SYSTMATIC SEARCH FOR PRE-CLINICAL CANCER D1ARKERS IN SERUM: THE JANUS PRQIECT. Jellum, E., Orjaseter, H., Harvei, S. Theodorsen, L. & Pihl, A. The Norwegian Cancer Society, Huitfeld'tsgt. 49, Oslo 2, Norway. Since 1973 serum specimens from 17,000 blood donors have been collec- ted at intervals, often once a year, and stored at -250. From another group of 30,000 people living in 3 communities of Norway about 60,000 blood samples have been obtained. During the first 5 year period, 416 of the blood donors have developed different types of cancer. Deep frozen serum samples withdrawn 1-5 years prior to clinical recognition of the disease are thus available. In collaboration with 10 different laboratories in Europe and USA more than 1,000 serum constituents are analyzed in a search for early pre-clinical biochemical changes in the sera. The analyses involve high resolution two-dimensional electrophoresis (proteins), high resolution gas chromatography - mass spectrometry (low molecular weight metabo- lites), high performance liquid chromatography (nucleosides and bases) and neutron activation (trace metals). Leukocyte adherance test is carried out and new enzymatic markers like galactosyltransferase isoen- zyme II, ectopic (polypeptide) hormones, and specific antibodies are included in the systematic search for pre-clinical cancer indicators. Preliminary results will be reported. /BIOLOGICAL CANCER bfARKERS/PRE-CANCER SERA/JANUS/ 144 HUMAN KAPPA-CASEIN AS A TUMOUR MARKER: PURIFICATION & PROPERTIES Weir, H., Mackinlay, A.G., Nash, A.R., & Sarfaty, G.A., School of Bio- chemistry, University of N.S.W., & Special Unit,N.S.W. Cancer Council, Prince of Wales Hospital, Sydney, Australia. There are conflicting reports of the value of human K-casein as a tumour marker in malignant disease, particularly breast cancer. The use of published methods for human K-casein purification lead, in our hands, [19] to a K-casein heavily contaminated with at least S-casein and degradation products of both 6-casein and K-casein. Antibodies to this product cross-react extensively with S-casein which has been reported to have little value as a tumour marker. Using ion-exchange and affinity chromatography a glycoprotein has been isolated from human milk which appears to be free of S-casein or other proteins, as judged by end-group analysis and gel electrophoresis. There is a charge heterogeneity which may be due to differential sialic acid content (c.f. bovine K-casein). In common with bovine K-casein the protein has a pyro-glutamyl amino terminus and is cleaved, although slowly, by bovine chymosin. Antisera raised to it do not cross-react with human S-casein. The protein is therefore assumed to be K-casein and antisera to it have been used to establish and RIA method to test, retrospectively, its value as a tumour marker. K-CASEIN/S-CASEIN/TUMOUR MARKER

ly5 NEW SERUM DNA BINDING PROTEIN(64DP) WITH A MOLECULAR WEIGHT OF 64,000: SOME PROPERTIES AND ITS ASSAY SYSTEM: Tsunehiko Katsunuma, Michio Tsuda,*Toshio Mitomi,*Hisao Nakasaki,*Tomoo Tajima, ••Kazuo Kobayashi,&***Hirotaka Shinoda. Department of Biochemistry,* Department of Surgery,**Department of Obstetrias & Gynecology, School of Medicine, Tokai University, Isehara, 259-11, Japan. &***Kyorin Pharma- ceutical, Co., LTD., Tokyo, 101-91, Japan. one of the human serum DNA binding proteins,C3DP, was previously desc- ribed in association with malignant diseases. We have isolated an ano- ther malignancy-associated human serum DNA binding protein(64DP), which is a monomeric protein with a molecular weight of 64,000. Its homogene- ity was examined with polyacryl amide gel electrophoresis with or with- out SDs and with sedimentation equilibrium studies. Its isoelectric point was pH 4.5-4.7 and about 9% and 7% of hexose and sialic acid were contained respectively. Immunochemical studies have revealed that the 64DP protein has been found to be different from C3DP, CEA or a-FP. we have also developed a quantitative assay system of serum 64DP level, by using single immunodiffusion system with anti-64DP serum. It was possible to measure serum 64DP level between 100 and 1,000 Vg/ml of serum using this method. /64,000 DNA BINDING PROTEIN(64DP)/ASSAY SYSTEM OF 64DP/ 146 BIOCHEMICAL T'.ARKERS IN COLON TUMORIGENESIS: RETINOIC ACID- AND DIHYDROTESTOSTERONE - BINDING PROTEINS. B. P. Sani, C. K. Banerjee and R. W. Brockman. Kettering-Meyer Laboratory, Southern Research Institute, 2000 Ninth Avenue South, Birmingham, AL 35205. USA. Retinoic acid-binding protein (RABP), which is distinctly present in embryonic colon and lung, is below the limits of detection in adult mouse colon and lung. The binding protein is present in murine colon and lung tumors as well as in lungs of animals bearing subcutaneously implanted tumors. None of the three normal human colon extracts analyzed for RABP or for a dihydrotestosterone-binding protein (DHTBP) contained any detectable amounts of either of the binding protein. Of the 32 human colon, cecum and rectal tumors analyzed, 80% contained RABP and 90% contained DHTBP. About 20% of the human colon segments isolated from patients suspected for colon tumors contained RABP in detectable amounts, whereas 80% revealed nondetectable to marginally detectable amounts. RABP of human colon tumor exhibited the same ligand specificity, thiol functions in ligand-binding, and sedimentation coefficient as RABP of chick embryo skin but differed in isoelectric pH. Appearance of RABP and DHTBP in tumors may prove to be significant biological markers. (Supported by Grant CA 22924.)

LIST OF ABSTRACTS 147 SERUM FERRITIN IN THE DIAGNOSIS AND PROGNOSIS OF NEURO- BLASTOMA, Hann, H.L & Evans, A.E.,Institute for Cancer Re- search, Fox Chase and the Children's Hospital of Philadelphia,PA USA Elevated serum ferritin levels without corresponding Increase in tissue iron storage have been observed in patients with cancer, eg Hodgkin's disease and leukemia. To determine whether such an eleva- tion also occurred in neuroblastoma (NBL) patients, serum ferritin levels were measured in 58 children by counter-electrophoresis (CEP) [29) using antibody to human placental ferritin. Increased ferritin levels in serum, positive by CEP (>400 ng/ml), were found in NBL patients and not in those with Wilms' tumor or normal children. A positive test correlated well with active disease and was significantly different from the results of patients in remission (p < 0.001). An exception was found in 6 patients with Stage IVS NBL undergoing spontaneous re- gression, all of whom were negative. Primary tumors and NBL cells from cell lines contained ferritin. Supernatant fluids from NBL cell lines in culture were also positive for ferritin whereas culture medium it- self and supernatant from a human fibroblast cell line were both negative. Elevated ferritin in serum of NBL patients is probably de- rived from the tumor. The authors conclude that serum ferritin levels can be useful In the diagnosis, prognosis and therapy of neuroblastoma. /SERUM FERRITIN LEVELS/NEUROBLASTOMA/ 1(18 MODIFIED NUCLEOSIDES OF THE URINE AS DIAGNOSTIC MARKERS FOR CANCER AND FOR MONITORING THERAPY. Borek, E., Gehrke, C.W., and Waalkes, T.P. AMC Cancer Research Center, Lakewood, CO, USA; Univer- sity of Missouri, Columbia, MO, USA; and The Johns Hopkins University, Baltimore, MD, USA. All tumor tissues contain aberrantly high tRNA methylase activity and unique, tumor-specific isoaccepting tRNAs (Borek, E. and Kerr, S.J. [I4) Advances in Cancer Research 16,.163, 1972). Cancer patients and animal models excrete in their urine elevated levels of breakdown products of tRNA (Mandel, L.R., Srinivasan, P.R., and Borek, E. Nature 209, 586, 1966). Highly sensitive methods,for the quantitation of some of these products have been developed (Gehrke, C.W., Kuo, K., Davis, G.E., Suits, R.D., Waalkes, T.P. and Borek, E. J. Chrom. 150, 455, 1978). In a recent study, it was found that one or more of seven tRNA breakdown products are elevated two standard deviations relative to creatinine content in 26 out of 26 cancer patients with 12 different malignancies (Speer, J., Gehrke, C.W., Kuo, K.C., Waalkes, T.P. and Borek, E. Cancer 44, 156, 1979). The level of excretion products returns to normal after e7fective chemotherapy or surgery and remains normal while the patient remains in remission. However, the marker levels rise if the patient goes into relapse. I

Ll57 OF ABSTRACTS RADIOLABELLED ORNITHINE AS A MARKER OF CANCER. M.M. Webber, ~~ D.C. Buffkin, A.D. Schwabe, G. J.F. Juillard, L.R. Bennett, and R.C. Verma. UCLA School of Medicine, Los Angeles, CA. Drnithine metabolism appears to be closely associated with growth. Metabolism of L-(1-C-14) ornithine monohydrochloride was studied in pdtient~he'efficacy proven of iutilizinfolabellednorn thineoasncancer marker. ~ssess utilizing radi Followin9 i•v• injection of 8 uCi C-14 ornithine, decarboxylation of o n,ithine was monitored for a 2.5 hour period utilizing the vibrating reed electrometerionization chamber model of Tolbert, as modified by py Davidson and Schwabe. Thirteen normal subjects ranged from 7.3-33.3% of administered dose being recovered, displaying a mean of 14.6% and a S•D. of ±6.48%. Ten patients, tested before initiation of therapy, ranged from 18.2-32.1%, displayed a mean of 23.02% with a S.D. of +4.52t. g,nplication of the t-test indicates a confidence level of 99.5% that a significant difference exists between means. Sensitivity of this test is t00-~, while specificity is 92.3&. Re-testing of two normal volunteers showed little or no change in ornithine metabolism over a 2-5 month period. Results from testing three cancer patients before and after therapy correlate well with the clinical response. In normal individuals ornithine metabolism proceeds slowly. In patients with neoplasia, however, higher utilization suggests that altered ornithine metabolism may be a sensitive test for malignancy. /ORNITHINE/CARBON-14/RADIOLABELLED/CANCER/ 150 DE'i'ECTION OF CANCER BY SIMITIli'ANEOUS USE OF CEA AND TENNAGEN.COMPARISON OF BOTH TUMOR MARKERS. Oehr,P. Chirurgische Universitatsklinik,Bonn,F.R.G. Blood samples from 300 patients with defined carcinoma were measured quantitatively for their content of CEA and Tennagen.To measure CEA the enzymatic immunoassay (a double antibody solid phase method) was used.The Tenna- gen test is a two point hemagglutination inhibition method. Comparison of the markers showed that both are glycopro- teins and that the Tennagen preparation(Oxford Lancer) does not crossreact with ~he CEA preparation (Abbott). CEA is heat stabile at 70 C for 'IOmin while Tennagen is not.We found cases in which CEA was negative and Tennagen positive,or in which Tennagen was negative and CEA positive, with an equal frequency.We also found cases where both were positive or both were negative.These results indicate that'the markers are immunologically different and appear independently in the same tumor.Independence of the markers can be shown as well in monitoring chemoimmuno- therapy.That is why both CEA and Tennagen should be applied for detection of cancer and postoperative follow-up TUMOR-MARKER / COMPARISON / CEA / TENNAGEN

LIST OF ABSTRACTS 151 TENNESSEE ANTIGEN--CLINICAL APPLICATION. Potter, T.P., Jr.; Lasater, H.A.; Jordan, T.A.; Jordan, J.D.; Johnston, R.K. and Oishi, N. Memorial Hospital, Johnson City, TN; University of Tennessee, Knoxville, TN; JCL Clinical Research, Knoxville, TN; and Cancer Center of Hawaii, Honolulu, Hawaii. The immunologic properties and immunoassay of Tennessee Antigen has been reported. The tumor associated glycoprotein; MW 100,000; is chem- ically and immunochemically different from CEA. The present work de- [14) scribes the clinical value of Tennessee Antigen. Serum Levels were mea- sured using the hemagglutination-inhibition method(Lancer TennaGen Assay) in 5,788 individuals by 20 investigators. The Assay was elevated (>5.5 u/ml) in 748 of 729 patients with histopathologically confirmed cancer, 83.6% of 225 colorectal carcinoma cases,94.5% of 18 cases.of early stages (Dukes'A) and 81.4% of 204 cases of other entodermal carcinomas (stomach, pancreas, liver and lung). Elevated levels were measured in 29.5% of 763 active benign gastrointestinal and lung diseases and 17% of 1,870 general medical patients. 1,251 healthy subjects showed 92.4% to have normal le- vels with no bias between smokers and non-smokers.Levels correlated well with the clinical state of 266 patients followed at the Cancer Center of Hawaii. 88% of 526 patients with active disease had elevated levels. 82% of 338 patients in remission had levels of <_ 5.5 u/ml. Sensitivity and usefulness of the Lancer TennaGen Assay as an aid in diagnosis and man- agement of carcinoma patients has been documented. TENNESSEE ANTIGEN/ TennaGen/ DIAGNOSIS/ MANAGEMENT 152 PERCHLORIC ACID SOLUBLE SERUM GLYCOPROTEIN AN INDEX FOR TUMOR CELL BURDEN IN THE EARLY DIAGNOSIS OF CANCER. Medak, H. 8 A. A. Hakim. Departments of Oral Diagnosis and Surgery.Universi- ty of Illinois at the Medical Center. Chicago. Illinois. U.S.A. Several in-vitro cultured neoplastic cells, particularly human mamma- ry carcinoma and malignant melanoma cells shed or secrete glycoproteins which are tumor specific(Hakim, Neoplasma 24, 81, 1977 6 Exp. Cell Biol. 47, 332,1979). These compounds contain N-acetylneuraminic acid(NANA) and [14) they differ from the bulk of serum proteins and glycoproteins by being ~ soluble in perchloric acid. The present studies report on the correlation between perchloric acid soluble serum proteins(PA-P) and N-acetylneurami- nic acid(PA-NANA) and tumor cell burden. Graded number of R3230 AdCa cells were implanted into separate groups of rats(20/group). At 0, 24, 48, 72 and 196 hrs and at 6, 9, 12, 15 and 21 days after tumor cell implantation, blood was examined for PA-P and PA-NANA and spleen lymphocytes (SP) for cellular immunity.Animals which received 100 R3230 AdCa cells/animal showed progressive increase in PA-P and PA-NANA 48 hrs after implanting the tumor cells. The PA-P and PA-NANA levels were time dependent and in- creased with the number of implanted tumor cells. Maximum levels were found in sera from blood drawn 196 hrs or later periods from animals which received 1000 tumor cells/rat or higher. At 72 hrs or longer after tumor cell implantation, SL from animals which received 300 or more R3230 AdCa cells showed immunological responsiveness to the tumor cell surface glycoproteins.In conclusion PA-NANA level is an index of tumor cell bur- den. / Acid Soluble Serum Glycoprotein/Early Diagnosis of Cancer/ 0 0 0 a J r N ~ .1 q~_

SERL%f GLYCOPROrIEIN LEVELS AS DIFIIIdPIATING PIATING AID BM'FEN 153 PRIMARY AND SF]OOAIDARY CANCEROU;S GRatifii KHUTETA, K.P., BBARGAVA, K.N., and RASTOGI, K.K. Sawai Man Singh Medical College, Jaipur, India. There has been considerable interest in recent years about the diagnostic and prognostic importance of glycoproteins in clinical cancer. Sialic acid, fucose, and hexose was estimated in 10 normal healthy subjects and 58 cases of cancer (histopathologically confirmed) affecting various parts of the body. Elevated fucose levels were noted in patients having cancer located at primary site with little or no change in the levels of sialic acid and hexose, which showed significanly higher levels in cases having clinically demonstrable metastases (in liver and lymph nodes, etc.) /GLYCOPROTEINS IN CANCER/PRIMARY/SECONDARY/ 154 IACALISATION OF MALIC3NANT TU4OURS BY NSFANS OF TISSUE POLYPEP- TIDE ANTIG'EN (TPA) AND CA.NCER EMBRYONAL ANTIGGF3N (CEA) IN VIIdGOS BIAOD SAMPLING. Alveryd, A., Ljungdahl, I., Liljeqvist, L., Engstrcm, P. & Hardstedt, C. Surgical Clinic and Department of Radiology, Huddinge Hospital, Sweden. Tissue polypeptide antigen (TPA) and cancer embryonal antigen (CFA) are well correlated to cancer. TPA as CFA can be quantitated in blood by (19J radioinmunoassay. TPA can be demonstrated in tissue sections by inmuno- histology. Several procedures for localisation of malignant tumours are in clinical use. Datorized tomagraphy has been an outstanding method for exact localization of several kind of tumours. Venous catheterisation with collecting of blood sarrples from diffe- rent parts of the human body and estimation of TPA and CEA give possi- bility indicating a malignant tumour. In ooanbination with dator tomr graphy the exact localization of the tumour can be determined. Since 1978 venous catheterisation and level diagnostic with TPA and CEA has been performed at Huddinge hospital in over 25 cases of malig- nant tumours. The results show that this method can be very useful in detection of malignant tumours in the thyroid, lungs, gastro-intestinal organs and kidneys.

LIST OF ABSTRACTS 155 GLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD) ACTIVITY DURING THE DEVELOPMENT OF ORAL MALIGNANCY. A.W.Evans, N.W.Johnson and R.G.Butcher, Midhurst Medical Research Institute, Midhurst, Surrey and Dept. Oral Pathology, London Hospital Medical College, London, Fngland. G6PD is a key enzyme in the pentose phosphate pathway, providing NADPH for biosynthesis and ribose for synthesis of RNA & DNA.Its activity is likely to increase in the development of neoplasia and this may pre- cede morphological evidence of malignancy. The activity of G6PD has 64 been quantified in tissue sections from an animal model in which carcino- PS genesis was induced chemically and from benign, potentially malignant & Inalignant lesions in human oral mucosa. In the hamster cheek pouch, at ~east 8 weeks treatment with the carcinogen dimethylbenzanthracene was necessary before definitive histological evidence of carcinoma appeared, yet the enzymic activity had doubled after only 2 weeks and after 4 wedcs some cells showed a five fold increase. Control tissue rendered hyper- plastic with turpentine showed no such change. In human cheek mucosa, activity was highest in dysplastic tissue; activities in carcinomas of the cheek were similar to those in normal tissues. The number of cells per unit volume of tissue decreases with the development of malignancy. Results expressed as activity per cell indicated the dysplastic group to be significantly different from normal control (pG0.005) and benign hyperkeratotic lesions (pG0.05). Such an approach appears to be of value in the early diagnosis of oral carcinoma and longitudinal studies in man are now required. GLUCOSE-6-PHOSPHATE DEiiYDROGENASE/ORAL MALIGNANCY. 64 PS 156 HCG AS A SPECIFIC MARI~'.R HUR MAIdG'UWCY. _7avarro, .danuel P. University of Santo Tbmas P.esearch Center, :1anila, Philippines. Since our first report in 1963 on the irmunologrical test for trophoUlastic HCG in urine, mary other investigators have found this honnone in the blood or urine of patients with awic?e variety of nti.liEpant t"r-.. Our study in over 3,00!) cases of proven m.aligmarr- cy has indeed shaan that this gl,vco-protein honnone is associated with cancer. Iriiiunological tests 1•rere positive in carcinorias, sarca,,as and leukerdas. The lii!dtation of this test is that it does not pin-point the site of the malijnancy. For those cases which had lar titers of NCG, there was need to concentrate the iiCG extracted fYwi the urine by as inuch as a hundredth fold. r'he levels of HCG is c,irectly proporticnal to the nurober of live siali[-7iant tumor cells. Clinical iuprovement of the patients acnieved.with the therapy is rrdrrortd in the dirainution of t'ie level of 'r`.CG. 7 lbe autbor feels that 31CG is a specific mas4:er in malip;-ancy, the i:wa.molo,-;ical test being positive even before the tm or is detected clinically. Hy serial NCG detenninations, it may reflect the onset of the remission. /HCG/SPECIFIC/.'tiARIM/MAIIG3dANCY/P4OiTI'hOR 1MPRMDM/ 61 P 64 PS

SEQUENTIAL ESTIMATION OF ALCALINE PHOSPHATASE ISOEN- 157 ZYMES (API) IN BREAST CANCER PATIENTS. Fiorner, G. & Caffier, H. Universitats-Frauenklinik Wurzburg, Germany. The usefulness of sequential serum API determinations for early detection of metastases and in the follow-up of metastatic breast cancer during chemo- therapy was studied. Till now 60 patients entered the study, the observation time was 6-12 months, serum samples were collected every 1-3 months. The different serum API were separated by acrylamide gel electrophoresis and their quantities in regard to the total AP activity calculated by planimetric methods following densitometry. A strong correlation exists between the specific bone and liver isoenzyme activity and the clinical, radiographic or scintigraphic state of the metastatic desease. Furthermore changes of these isoenzyme activities parallel the clinical course during chemotherapy and appear to antedate clinical signs for remission or progression. At normal total AP activity a percentual increase of bone or liver isoenzyme seems to indicate a beginning metastasis. Quantitative API determinations are a useful, more specific and reliable parameter for the detection and follow-up of at least bone and liver metastases in mammary cancer than the estimation of the total AP activity. / ALCALINE PHOSPHATASE ISOENZYMES / BREAST CANCER / 158 INCREASING CONCENTRATION RIA TEST FOR PRIMARY ADE- NOCARCINOMAS. A.Bartorelli, C.Biancardi,S.Orefice,C.Mor, R. Accinni. I stituto Ricerche Cardiovascolari,Univ.di Milano, Milano, Italy The hypothesis of the cross-reaction among CEA-like antigens was exploited in two directions: the attempt to isolate antigens from primary tumours (A.Bar- torelli,Current Trends in Tumor lmmunology(1979),233): and the development of a RIA technique with the following characteristics.Increasing plasma concen tration (from 0.01 to 0.8m1) are assayed with the 125CEA-anti CEA and125CEA anti BCA systems (A.Bartorelli...(1979) Compendium of Assays for Immunodia- gnosis of Human Cancer 1, 17/391) . The inhibition curves of the binding capacity, thus obtained, are recorded on a card , where the baseline curve inferred from the mean (plus the standard de- viations) of hundred of patients, not suffering from malignant tumours and health y donors is drawn.Primary adenocarcinomas, negative at low concentrations, become positive(56%) at higher concentrations, while the presence of inetastases of these adenocarcinomas causes more positive curves (86%) at the lower con- centrations. The false positives are around 10% for cirrhoses,3% for the other non malignant pathology.This technique requires no standard curves. RIA / CEA / BCA / PRIMARY ADENOCARCINOMAS.

LIST OF ABSTRACTS 159 BREAST CANCER ANTIGEN(S):BCA. R.Accinni,M.Bailo,V.Caval- ca, R. Ferrara, A. Bartorelli. 1. R. C. "G. Sisini", Milano, I taly In previous studies(A.Bartorelli,R.Accinni (1979),Current Trends in Tumor lmmunology,233)the differences between CEA and BCA,and the absence of the latter in normal and control displastic tissues were demonstrated.Subsequently, BCA was further purified,in analytical amounts,employing purification steps yielding a significant amount of specific activity: KC1 extraction,(NH~)2SO4 pr_e cipitation, ion exchange chromatography,G 200 gel filtration,Con A chromatogra phy,4 B Sepharose bioabsorption.The last purification step yielded a high spe- cific activity antigen(1600U/pg).After labeling,the labeled antigen lost its im- munological activity.This might have been possibly accounted for by a BCA de- polimerization yielding inactive structures during labeling due to its low concen- tration.On the other hand,it was impossible to concentrate the antigen due to the formation of aggregates. Using CEA as an experimental model, serial concentra- tions of the latter were labeled(1jug/ml to I mg/ml)the first peak usually active at the standard labeling concentration(lmg/ml) lost its activity and decreased in concentration,while the second inactive peak,which in standard conditions, is practically non existent,increased in concentration.Following these results a preparative puritication was attempted, discarding some steps less significant in comparison with the previous analitical procedure. CEA/ BCA/ BIOABSORPTION / RADIOLABELING 160 BIOLOGICAL MARKER: A RNA VIRUS GRANDI, F. , and GRANDI, M. Centro Studi Ricerche e Terapia delle Neoplasie, Torino, Italy. A complement fixation reaction with RNA extract from Virus 0 of aphtous fever as an antigenic model was used for diagnostic screening of cancer patients. A factor (B globuline) that permits in healthy individuals the complement fixation reaction with AgRNA was absent in the neoplastic patients' serum. The addition of ram erythrocytes to the RNA-human serum produced a non haemolytical reaction in healthy individuals and a haemolytical reaction in cancer patients. A more accurate evaluation of the intensity of haemolysis was possible by adding normal human serum, in gradually increasing quantity, to the serum of cancer pateints. The more normal serum was needed to prevent haemolysis, the greater the cer- tainty that cancer was present. Our study of 300 patients revealed that the use of the reaction was more valuable for prognostic indication than for diagnosis. Cancer progression was consistently accompanied by an increase of haemolysis whereas a favorable prognosis and effects of therapy were associated with a decrease in haemolysis.

LIST OF ABSTRACTS 161 64 pS SPECIFIC REACTIVITY OF HIQiLY POLARIZ® CMfICAL S15T7~]~fS WITFi IMPL4SI'IC CELL I+1EMRANES FOR POSSIBLF. EARLY DEMCPION Nab3.h , I. National Research Centre -Dokki- Cairo -MPT. There is some evidence indicating that the membranes of tumour cells differ in their chemical and physical nature f rom those of normal cells . Cells of kidney and liver tumours carry hioher ne,-Htive electrical charges than their homologous normal cells as found by Ambrose ,E.J. James, A.Iv;. and Lowick , J.H. (1959)-Nature , 177,576. Such changes had sug?ested the synthesis of a new group of chemical compounds represented by both isoreers ,1,2-cyclohexeno,4- (5-diethylaminoethyamino)-thiaxanthor.e and 1-(R-diethyl- aminoethylamitro)-3,'+- c,yclohexenothiaxar.thone. ~lhese posses high tendency for electronic polarization resulting in high dipole coments . Both compounds showed to be readily uptaken upon their application in vivo or in vitro to mammary carcinoma and glioma .-ihis-f;iled to occur with normal cells. These reactions may provide a clue for possible differentiation and a tool for early detectior. of neoplasm formation . POLARIZiD CHEi.:ICAL SYST'EtviS /CELL h4EI•/;BRKNE/ DF.rECTION 162 OVERLAP OF CELLS IN VITRO AS A BIOLOGICAL MARKER OF PREINVASIVE AND INVASIVE NEOPLASTIC LESIONS OF THE CERVIX UTERI. Ebeling,l:., Tanneberger, St., Schindler, Ch. & Bilek,K.. Academy of Sciences of the German Democratic Republic, Central Institute of Cancer Research, GDR. The overlap behaviour of in vitro cultivated cells of human normal tissues (cervical epithelium and endometri- 64 um), eMbryonal ti ssue, dyspla sia, caa in situ, invasive ps cervical carcinoma and ovarian carcinoma was examined. The overlap index of cells from normal tissue was signifi- cantly lower than that of all other cells examined (pc 0,001), while no significant differences existed between overlap indices of cervical carcinoma cells and ovarian carcinoma cells (p> 0,05). No significant differences were obtained between embryonal cells and cancer cells. The significant differences of overlap index between cells cultivated from nor mal cervical epit helium and from intraepithelial atypias and carcinomas of the cervix uteri, and the non-significant differences between intra- epithelial atypias and cez•vical carcinomas, are considered as an expression of the same biological deviation in pre- invasive and invasive lesions of the cervix uteri. /OVERLAP CELLS/LESIONS CERVIX UTERI/

LIST OF ABSTRACTS 163 CHEMICAL TRANSFORMATION OF CULTURED SKIN FIBROBLASTS FROM HUMANS GENETICALLY PREDISPOSED TO CANCER. Rhim, J.S., Arnstein, P. & Huebner, R.J. National Cancer Institute, National Institutes of Health, Bethesda, Maryland U.S.A. Adenomatosis of the colon and rectum (ACR) is an inherited form of cancer. Assuming that phenotypic expressions that appear in cell strains reflect its biological abnormalities, the study of cultured skin fibroblasts derived from individuals with an inherited form of [21) cancer such as ACR provides a unique study for analysis of the onco- genic process. Growth disorders and increased susceptibility to tumor promoters and to transformation by an oncogenic RNA tumor virus have been demonstrated in these skin fibroblasts. We found that human skin fibroblasts (PF) derived from ACR individuals were sensitive to a chem- ical carcinogen. Cells treated only with various levels of N-methyl- -N'-nitro-N-nitrosoguanidine (MNNG) underwent morphological alteration. The morphologically altered cells formed large cell aggregates when suspended in liquid growth medium above an agar base and grew to high saturation densities but did not form colonies in soft agar. Trans- formed cells were resistant to rechallenge of MNNG (1 ug/ml) and showed prolonged life span compared to those untreated cells. However, no tumors were produced when cells were inoculated subcutaneously into nude mice. Data suggest that neoplastic transformation of these skin cells by chemical carcinogens is a multi-phase process. /CHEMICAL TRANSFORMATION/ACR HUMAN SKIN FIBROBLASTS/ 164 SCREENING FOR PATIENTS AT HIGH RISK OF CANCER Macieira-Coelho, A., Diatloff-Zito, C. and Azzarone, B. Institut de Canc6rologie et d'Immunog6netique, INSERM U 50, 94800 Villejuif, France. When fibroblasts from different species were tested con- cerning their sensitivity to low dose rate ionizing radia- tion, establishment was accelerated in those fibroblast populations (Nature 261:586, 1976) that spontaneously yield [21] permanent cell lines. The same experiments were made with human fibroblasts to see if there would be a different res- ponse between cells from normal donors and at high risk of cancer, and from neoplastic patients. Cells were irradiated several times with 100 rad (0.27 rad/min) at each passage until the end of their lifespan in vitro. The lifespan of irradiated human embryonic fibroblasts was identical to that of the controls but the lifespan of normal adult fibroblasts was shortened. However, with human adult fibroblasts derived from an inherited disease known to be at high risk of cancer and from one cancer patient, radiation increased the popula- tion doubling potential. The data are of potential value for attempts to distinguish between donors genetically prone to cancer. RADIATION/FIBROBLASTS/CELL CULTURE/DOUBLING POTENTIAL/CANCER RISK/

LIST OF ABSTRACTS 165 HUMAN SKIN FIBROBLASTS FROM PATIENTS WITH MAMMARY TUMOURS. DIFFERENCES IN GROWTH PROPERTIES. Azzarone, B. & Macieira-Coelho, A. Institut de Canc6rologie et d'Immunog6n6tique, INSERM U 50, 94800 Villejuif, France. The growth properties of thoracic skin fibroblasts derived from patients with breast cancers were compared to those of fibroblastic cultures derived from patients with benign lesions or operated for non neoplastic diseases. The parameters we measured included: comparison between growth fraction and cell density,survival curves in non permissive conditions for normal cells (serial transfers at different inocula), growth in low serum-concentration, anchorage dependence and lifespan. We are now reporting data showing that fibroblastic cultures from patients with mammary carci- nomas respond in an abnormal way to the biological parame- ters for which they have been tested. Skin fibroblasts from patients with benign lesions or from "normal donors" show some but not all these abnormal properties, suggesting different degrees towards malignancy. Results could lead to the detection of high risk cancer patients. / CANCER PATIENTS / SKIN FIBROBLASTS / GROWTH KINETICS / ANCHORAGE DEPENDENCE / 166 SKIN MARKERS OF INTERNAL CANCER 14. El Zawahry, P.S.D. Professor of Dermatology Cairo University, Egypt. On many occasions the skin shows certain lesions that indicate the presence of visceral carcinoma. Some of the manifestations are diagnostic,others may give a clue to the diagnosis, while a third group [21) indicates only the far possibility. The author is impressed with the Association that exists between the skin and internal malignancy. Some of them may be an early sign. The illustration shows the skin lesions Assoc- iated with cancer in general and in the Arabian territory in particular.skin markers/ visceral cancer.

LIST OF ABSTRACTS 167 MALIGNANCY ASSOCIATED CHANGES INDUCED IN VITRO IN HEALTHY LYMPHOCYTES BY EXTRACELLULA,R DNA OF LEU}CEMIC LYMPHOCYTES. Anker, P.*, Nieburgs, H.E.**, Stroun, M.***, Maurice, P.A.* *Oncohematology, Hopital Cantonal, Geneva, Switzerland. **Mount Sinai Hospital, New York,USA. ***Human Microbiology, Fac.Med., Tel-Aviv,Israel Cancer patients have malignancy associated changes (MAC) in cells of apparently benign tissues adjacent to and distant from malignant tumors. We now studied whether these nuclear markers (MAC) occur as a result of [21] a humoral factor released by the tumor. Normal human lymphocytes were cultured in the presence of either normal (N) or malignant (M) lympho- cyte supernatant, extracellular nucleoprotein or DNA extracted from the supernatant. Presence of MAC was determined by computerized measurements and confirmed by microscopic observation of coded slides. Cultures N failed to produce the nuclear structure of MAC whereas cultures M led to formation of A:AC in normal lymphocytes. Blind studies were made of 34 coded slides; 5 were correctly interpreted as positive for MAC; 9 false negative diagnoses were related to cultures with low concentrations of leukemic lymphocyte extracts; 20 were correctly diagnosed as negative for MAC. Lymphocyte nuclear changes were most prominent when cultured in the presence of Con A. MAC may be caused by a humoral factor that con- sists of DNA released from malignant cells and, in cancer patients, an oncogenic message may be transmitted to cells of apparently normal tissues. 168 ANALYSIS OF CHROMATIN IN MALIGNANCY. O.A.N. Husain & Jacqueline Millett, Charing Cross Hospital, Fulham Palace Road, London W 6, England. The feulgin reaction normally performed at 60°C does not permit a full study of the D.N.A. and associated proteins, and prolonged hydrolysis may itself cleave the D.N.A. backbone which then dissolves in the acid. By slowing down the reaction at room temperature and [21] arresting the hydrolysis at set intervals one can study the different moities of D.N.A. By use of the M 85 Vickers Integrating Microdensit- ometer measuring the D.N.A. of 20 nuclei per slide we have demonstrated two peaks in the hydrolysis curves, one maximal at 20 minutes and one at 60 minutes. The malignant nuclei, however, have an earlier peak at 5 minutes, presumably due to a highly labile component, and this feature exists to a lesser extent in the surrounding non-malignant cell nuclei. The significance of this finding in both identifying malignant change 9nd as an autometable procedure will be presented.

169 DIAGNOSTIC VALUE OF A SERUM DNA BINDING PROTEIN(64DP) IN CANCER PATIENTS: Toshio Mitomi, Hisao Nakasaki, Tomoo Tajima, *Tsunehiko Katsunuma,*Michio Tsuda &**Hirotaka Shinoda. Department of Surgery.*Department of Biochemistry, School of Medicine, Tokai Univer- sity, Isehara, Japan. &**Kyorin Pharmaceutical, Co.,LTD.,Tokyo, Japan. We have isolated a human serum DNA-binding protein, which has been found to be a monometric protein with a molecular weight of 64,000. The present study evaluated the diagnostic value of this previously unexplored serum DNA-binding protein(=64DP) in cancer patients. Using the column method(DEAE,DNA-cellulose, SDS electrophoresis), total of 207 quantitative determinations of serum 64DP level were made in healthy controls, non-cancer and various cancer patients. In healthy controls 64DP levels ranged from 10 to 119ug/ml with the mean value of 44 ± 24. The untreated cancer patients showed distinctly high levels regardless of the type and the site of malignancy which included cancers of the stomach, colon, esophagus, breast and lung. It was of particular interest to note that the preoperative values in patients with 30 stomach cancer were uniformly elevated in all stages including 9 cases with T1 of TNM system(209 + 67). There were two T1 lesions also in the esophageal cancer group with similarly elevated values. The results obtained have led us to believe that the serum 64DP deter- mination may be of most use in the diagnosis of a wide variety of malig- nant neoplasms. /64,000 DNA BINDING PROTEIN(64DP)/DIAGNOSTIC DATA OF 64DP/ 170 MONOCYTE MATURATION IN SQUAMOUS CELL CARCINOMA OF THE BRONCHUS. Dent, R. G. and Cole, P. Cardiothoracic Institute, Brompton Hospital, Fulham Road, London, SW3 6HP, England. The maturation of monocytes into macrophages in vitro has been studied in a total of 40 patients with squamous ceTl- carcinoma of the bronchus, 60 normal controls and 33 patients with chronic obstructive airways disease (COAD). Groups of patients with terminal non-malignant disease and relatives of patients with cancer were also studied. The assay was based on that described by Currie and Hedley, Br. J. Cancer, (1977), 36, 1. The mean maturation of monocytes maturing into macro- phages in 50% autologous serum was 22.8% in patients with limited cancer, 14.2% in those with extensive disease and 38.0% in patients with COAD. Relatives had normal maturation but patients with terminal non-malignant disease had depressed values (mean 19.2%). In patients with low maturation (<30.1%), 19 of 30 died at a mean of 5.6 months and a further four developed new metastases. In contrast, only two of 10 patients with normal maturation died, at eight and 11 months and no new metastatic growth was demonstrated during a mean follow-up of 8.5 months. The depressed maturation was largely corrected by culturing patients' monocytes in normal serum pool; conversely the maturation of normal monocytes was depressed in serum from cancer patients. /MONOCYTE MATURATION/BRONCHIAL CARCINOMA/

LIST OF ABSTRACTS (21] lll SYSTEMIC CHANGES IN BOVINE LYMPHOMA. Jacobs, R.M. and Valli, V.E.O. Department of Pathology, Ontario Veterinary College, Guelph, Ontario, Canada. The enzootic form of bovine leukosis is believed to result from in- fection with an RNA virus. Cattle with occult tumor have malignancy associated changes in neutrophils, whereas cattle with viral infection without tumor have normal appearing neutrophils. Cellular antigens derived from tumors of cattle with lymphoma were used in tests to de- tect occult tumor by delayed, cutaneous hypersensitivity reaction and in blastogenesis tests with peripheral blood lymphocytes in 122 normal cows and in 13 cows with enzootic lymphoma all of which were advanced cases. Two-thirds of animals with advanced tumor had cutaneous anergy to recall antigens and did not respond to tumor antigen. In blasto- genesis tests, 9 of the 13 cattle with lymphoma reacted specifically to tumor antigen as did 5 of the 122 apparently normal cattle. Cows with lymphoma had increased concentrations of alpha 2 globulin, which were significantly different from normal animals and animals with inflam- matory disease. Beta 2 globulins in cattle with lymphoma were signi- ficantly decreased as were all immunoglobulin classes except IgA with the greatest decrease occurring in IgM. Serum from cattle with lym- phoma contained a heat-stable, noncytotoxic, high molecular weight substance which inhibited blastogenesis of lymphocytes from normal cattle and this inhibition correlated closely with skin anergy. BOVINE LYMPHOMA, TUMOR ANTIGEN, DELAYED HYPERSENSITIVITY, BLASTOGENESIS 172 SUSTAINED LYMPHOCYTOPENIA: A USEFUL DIAGNOSTIC FEATURE OF BRONCHOGENIC CARCINOMA. McMahon, L.J., Thomson, S.P., and Nugent, C.A. Veterans Research Service and Arizona Health Sciences Center, Tucson, Arizona, U.S.A. Patients with bronchogenic carcinoma have decreased peripheral blood lymphocytes compared to patients with benign lesions. Because lympho- cyte numbers co-vary with the total white count, absolute lymphocyto- penia can be used to distinquish benign from malignant lesions only if (21] considered relative to total white count. With a precise assay and with consideration of the normal lymphocyte circadian rhythm, relative lymphocytopenia persistent for 3 weeks correctly characterized 54 of 59 chest x-ray lesion patients (27 of 27 benign lesions > 28.4%, 27 of 32 carcinomas < 28.4%). Benign and malignant lesions as small as 1.0 cm were correctly identified. The lymphocytopenia correlated with in- creased plasma cortisol (r=-.85, p<.02) and is congruous with the 95% of bronchogenic carcinoma known to produce ACTH (Gewirtz, et al., J Clin Invest, 1974, 53:102). Lymphocytopenia may be an easily measured index of ACTH as a tumor marker with amplification (1 pm ACTH -+ 4 x 104 pm cortisol production) and modulation (cortisol "spike" causes sus- tained lymphocytopenia). . F k /LYMPHOCYTOPENIA/BRONCHOGENIC CARCINOMA/CORTISOL/ACTH/

If r - "I", LIST OF ABSTRACTS ~ The Poly-L-Lyein-A~;rlutination of Lymphocytes-Test for Can- cer diagnosis: Specifity, sensitivity, predictive value. Schnoll, E., Schmoll, H.-J., W.Ax., Medical School, Hannover, Dptm. Hemato-0ncolopy; Behring Company, t4arburg/Lahn, West Germany. The agglutination of lymphocytes by a low molecular weipht Poly-L- Lysin (PLL) is a known phenomen. Lymphocytes of tumor patients are iden- tified to agglutinate with a PLL of 3 000 molecular weight in a factor 1,5 less concentration of PLL in contrast to lymphocytes of non-tumor- bearing patients. A total population of 399 patients has been investiga- ted: 193 patients with histologically proven tumors (group I), 106 pa- tients with documented not malignant diseases (group II), 52 patients without any apparent disease (normal blood donor) (Froup III), and 48 patients of an early cancer detection programme (group IV). Y'ith 45 false negative test in proup I the sensitivity calculated with 77 f.. The specifity is calculated by group II with 79 %, by group III with 92' and by group IV with 88 %. Calculated on the basis of all proven pa- tients without malignancies with and without other diseases the speci- fity is 85 %. 4'ith a predictive value of 5 q this test ist worthful more for clinical use than for early cancer screening programmes. e 9 (211 174 UTILIZATION OF MULTIPLE BIOMARKERS IN AN INDEX FOR SUR- VEILLANCE OF SUBJECTS AT HIGH CANCER RISK. Hoda A. Guirgis, Ph.D. and Tom Kurosaki, University of California, Irvine, CA., U.S.A. The purpose of this report is to describe a model which utilizes multiple biological markers to identify individuals at high cancer risk. The markers tested include immunological (TbcB lymphocytes, suppressor and helper T cells, IgG, IgA, IgM, PHA-mitogen activation, CEA, AFP and HCG); cytological (sister chromatid exchange) and biochemical (AHH activity in lymphocytes). The above biomarkers were quantitated in subjects at high cancer risk, normal individuals and in cancer patients. It is recognized that a single biomarker possesses neither the sensitivity nor the specificity to distinguish between cancer prone subjects and those at low cancer risk and to evaluate the response of cancer patients to treatment. As a result, we have utilized Fisher's method for combining results from multiple tests to derive an index of suspectibility. The probability, P of obtaining a more extreme standardized value were obtained (taking into Wnsideration the direction of immynodefficiency). An index was then calculated for each individual as follows: I=2.E~ In P. where k=number of variables measured. This quantity was tested for signiricancJ based upon the chi-square distribution with 2k degrees of freedom. This procedure was applied in 3 types of malig- nancies; lung cancer, malignant melanoma, and lymphoma. The predictive value was found to be significant and it was possible to discriminate between biomarkers as to their value in relation to the type of tumor studied. Supported by Council for Tobacco Research 1132, MR2./BIOMARKERS CANCER RISK/ I t

LIST OF ABSTRACTS 175 WATER PROTON LONGITUDINAL RELAXATION TIMES IN TISSUES OF THE C3H M3USE BEARING A RHABDOMYOSARCOME STUDIED AS ATINCTION OF FREQUENCY J.M.ESCANYE+, D.CANET++,J.ROBERT+, J.BRONDEAU++ Due to progress in NMR imaging techniques which open the feasibility of detecting cancer by water proton relaxation times, it is essential to elucidate the origin of the increase of this parameter when going from normal to tumoral tissues. Water proton longitudinal relaxation times were measured in vitro between 7 and 90 MHz for skin, muscle, spleen, [21] liver, kidney, brain and tumour of the C3H mouse bearing a rhabdomyosar- coma. The variations of T1 versus frequency have been interpreted accor- ding to a two site model ("bound"and"free"water). The systematic diffe- rence observed between the tumour and the other tissues is maximum an,und 10 MHz, indicating the optimum frequency at which such measurements should be preferable. Furthermore, it is hereby confirmed that the "bound" compartment is smaller or, preferably, that the magnitude of the water-protein interaction is smaller, in the tumoral tissues. KEYWORDS : NMR/ Relaxation times/Water/Tumour +Laboratoire de Biophysique-Facult6 de Medecine-18,rue lionnois-NANCY-F ++Laboratoire de Chimie theorique-Faculte des Sciences-C.O.140- 54037 NANCY CEDEX 176 HIS'IOPATHOUJGICAL SUPPORT FOR ELEVATION OF PHO'ADN SPIN-LATPICE RELAXATION TITIFS (Tl) IN MALIGNANT STATE S.S.Ranade, Smita Shah, G.V.Talwalkar+ and S.R.Kasturi* Cancer Research Institute, Tata Memorial Hospital+ And the T ata Institute of Fundamental Research, Bombay (I2rDIA). Characterization of normal and malignant tissues using [211 pulsed nuclear magnetic resonance spectrometry# has been based on the observed enhancement of proton spin-lattice relaxation times (T 1) of tissue water protons in the latter, compared with the normal tissues. This effect has been attributed to increase in the 'free' water content in the cell compartments following the loss of structure in malig. nant cells. In many normel (uninvolved) samples we fre- quently encountered high T1 values compared with other normal samples, all of them being taken from grossly uninvolved regions of the gastro-intestinal tract. A concomitant histopathological study of such areas revealed presence of malignant cells. In samples of colon and rectum malignancy associated changes were observed. This f inding supports the contention that elevated T 1 value is characteristic of malignant state. /RELAXAT ION T IME T 1 VALUE MALIGNANT CELIS/

1~ NUCLEAR MAGNETIC RESONANCE STUDY OF SYSTEMIC EFFECT OF CANCER ON SERUM AND TISSUES. de Certaines J., Gallier J., Bernard A.M, Rivet P., Benoist L. Centre Anti-cancereux, CHR Pontchaillou, Rennes, FRANCE. T1 and T2 proton NMR relaxation times differences between tumoral and reference tissues have often previously been described since the early work of Damadian (1971). Less numerous are works on systemic effect detected by NMR, early described by Frey (1972) on tissues and more recently by different goups on serum of cancer patients. On experimental Lewis Lung Carcinoma we have obtained a very significant increase in T1 but less in T2 (with Bruker SXP 100 at 90 MHz and 23°C) on spleen, liver, kidney and muscle during the tumoral growth. The intra and peritumoral NMR differentiation is clearly shown and may be correlated with necrosis or reactional tissues. Systemic effect on serum has been studied (Bruker P20 at 20 MHz and 23°C) on 200 healthy human donors and 300 patients with cancerous diseases at different stages : increase in T1 and modification of distribution of T2 values have been statistically established. Biological significance of these systemic effects are discussed. P::!R / SYSTEMIC EFFECT / SERUM / TISSUES 178 THE "HOT FOOT" SIr,N WITH RETROPERITONFAT. r1Fnn_r,.AsmIr_ DISEASE Evans, R.J. Toronto General Hospital & Princess Margaret Hospital Toronto Tumours growing within or arounj nerves commonly produce vague pains and sensory complaints such as burning, stinging, numbness, etc. Primary or metastatic neoplastic disease in the retroperitoneal space may displace viscera and other tissues and create symptoms remote from the tissue of origin [63] 1ong before its presence is suspected. 75 adults with mali- fps) gnant disease were referred, and found on routine clinical examination to have a hotter than normal foot. Investigations revealed retroperitoneal metastatic disease. 53 females (70%) had previously treated carcinoma of cervix, and 47 (65%) had had their primary disease treated within the preceding 3 years. Thermography of the legs regealed varying peripheral temperature gradients of up to +10 C, and neurological def- icits were present in 38 patients (45%). 11 other adults with a "hot foot" have been investigated and in 4, no explanation was established. Lower extremity pain associated with malignant disease is not uncommon. The clinical findino of a hot foot should alert the physician to the possible presence of retroperitoneal disease. 46 of 57 (80%) patients followed, succumbed within one year, and we conclude that the signs of autonomous tumour sympathectomy are of grave prognostic significance.

63 PS [28J LIST OF ABSTRACTS 179 B1OP1'IC DE1'ECf1ON AND c:HARAC1ER1ZAi'1ON OF CARCINOMAI'OUS OS fEODYSPLA S1A Burkh-_.'t, R.• )• • ), Frisch, B. +), Biensack, T. I.ettner, G. Sommerfeld, W.• • ) • ) Abt,f.Knochenmarksdiagnostik, Med.Klinik ]nnensladt d.Univ., Abt,Hamatomorphologie der Ges- f. Strahlen- u. Umweltforschung mbH, Munich, Germany, +) Tel-Aviv Univ. Med. School, 1'el-Aviv, Israel. Carcinomatous osteodysplasia (COD) is an abnormal condition primarily affecting the trabecular bone, which can be attributed to the direct or indirect influence of carcinomatous growth by morpholo- gical or biochemical evidence. COD was studied in semithin undecalcified sections of 838 iliac crest biopsies of unselected patients with different types of carcinoma in various clinical stages. The inci- dence of COD was 312/342 = 91°'~o in the biopsies which contained metastases (42°Jo of 838) and 83/486 = 17% in the negative biopsies (58% of 838). The incidence of COD in the cases with tumour generali- zation in the positive group was 265/283 = 93°Jn, against 79;v (47/59) in the positive cases without generalization. The proportions of COD in the negative group were 20°Jo respectively 19% for the cases with and without generalization. The incidence of inetastases was 63L'p respectively 20% among the biopsies in cases with and without generalization. In occult primaries the total rate of positive biopsies was 88°'p (114/139) and of COD 89% (100/112). A schematic view of COD is proposed, indicating the sclerotic or lytic tendency as well as the remodelling activity. In all of the groups, sclerotic osteo- blastic remodelling was more frequently observed than lytic destruction - most frequently in the prostatic, intestinal and mammary carcinoma cases. Lytic changes predominate among the occult and bronchogenic primaries. These results can be interpreted primarily as the consequences of a paraneo- plastic hormonal induction in accordance with the histological tumour type. 180 WHAT IS EARLY CANCFR? B.C. Morson, St Mark's Hospital, City Road, London, DC1V 2PS, England. The best clinical definition of early cancer, among many which have been published, is that stage of the disease which is essentially curable by current techniques. But, the stage of the disease can be defined by both clinical and histopathological criteria. Thus, "early" is a word which may be used differently by clinical and histopathological methods and also varies at different primary sites. The word "cancer" is a generic term with a strong clinical connotation which also needs to be defined in terms of early disease both clinically and pathologically. The problems associated with defining early cancer will be illustrated by comparing the pathology of early gastric cancer and early colorectal cancer. The issues are essentially problems of nomenclature and classification which must be resolved by international agreement so that clinical research workers, pathologists and epidemiologists can more readily compare the results of their work. CANCER EARLY HISTOPATHOLOGY

BIOLOGICAL MARKERS IN PRECLINICAL CANCER 18l FRANCNIMONT, P., and ZANGERLE, P.F. Universite de Liege, Tour de Pathologie, 4000 Liege J, Belgium Some tumor markers may be used as preclinical state of cancerous diseases. CEA could predict precancerous state in asymptomatic population and in smoking population. HCG is an index of initial disease in trophoblastic tumors. Both HCG and AFP have a potential value in tumors of germ cell origin. The Gross Cystic Disease Fluid Protein (G.C.D.F.P.) extracted from breast gross cyst fluid is found in two breast diseases : a benign, with high risk of malignant transformation : the Gross Cystic Disease Fluid and the breast cancer. This double association is a serious argu- ment for the usefulness of this protein as preclinical breast cancer marker. 182 CELL MORPFpLOGIC MARKERS NIEBURGS, N.E. Department of Pathology, Mt. Sinai Schoo2 of Medicine of The City University of New York, New York NY 10029, U.S.A. Morphologic markers may be observed in cells of the buccal mucosa, bron- chial epithelium, esophagus, stomach, liver, skin, bone marrow, and in blood lymphocytes of patients with a variety of tumors in different sites. The presence of cellular markers is unrelated to tumor site except for particular markers that occur in bronchial specimens in the presence of lung tumors. Persistence of markers following effective cancer therapy precludes their role for the diagnosis of tumor recur- rence. Microscopic identification of cellular markers in histologic, cytologic and hematologic specimens, their biologic implications, and role in the detection and diagnosis of tumors will be discussed.

LIST OF ABSTRACTS 183 IDENTIFICATION & SURVEILLANCE OF HIGH RISK GROUPS. Hirayama, T. National Cancer Center Research Institute, Tokyo, Japan. Series of carefully conducted case-control studies and cohort studies identified key factors enhancing cancer risk. Cigarette smoking was found by far the most impor- tant life style risk factor, attributable risk for cancer of all sites being 34.5%, 33.7% and 31.8% in US, UK and [2e) Japan respectively. The highest risk attributable to ciga- rette smoking was noted for cancer of larynx(93.3%) fol- lowed by buccal cavity and pharynx(73.3%), lung(69.4%) and esophagus(44.3%) in Japan. Alcohol drinking was observed to enhance the risk of upper digestive tract when combined with cigarette smoking. Daily meat intake was noted to enhance the risk for pancreatic cancer and breast cancer. Certain nutritional deficiencies, such as inadequate intake of vitamin A, were also noted to be related to selected cancers. Factors related to reproductive history were also found to alter the risk(e.g. singleness and breast cancer). Influences of other risk factors such as occupation and other socioeconomic variables are also under study. Ethnic groups at high risk, including migrants, are also being studied by cancer registries and or vital statistics. /HIGH RISK GROUPS/COHORT STUDIES/CIGARETTE SMOKING/ 184 DESIGN AND EVALUATION OF SCREENING PROGRAMS Brennan, M.J. and Shwartz, M. The Michigan Cancer Foundation and the Comprehensive Cancer Center of Metropolitan Detroit, Detroit, Michigan. The principal variables open to management control in the opera- tion of public health cancer surveillance systems are (1) testing methodology, (2) personnel selection, (3) frequency of examination, and (4) population sub-group selection. Self-surveillance education [28) should be included as an intrinsic element of the service to provide for optimization of early diagnosis probabilities during inter- examination intervals. Productivity optimization schedules for public health level breast and cervical screening systems have developed from disease process models and systems analyses and will be presented. /BREAST - CERVICAL CANCER SCREENING VARIABLES/ P .4 11 I

tIST OF ABSTRACTS 185 NEW APPROACHES IN CYTOLOGIC DIAGNOSIS. Meisels, A. H6pital du Saint-Sacrement, Quebec, Canada. pevelopements in recent years to improve cytodiagnosis have been numerous and often of great impact. One of the most important techniques becoming universally accepted is fine needle aspiration cytology which is a painless and DKurate procedure used particularly for preoperative diagnosis of neoplasia of the breast, prostate, lung, thyroid and other accessible tumors. The development of fiberoptic endoscopes has stimulated the obten- tion of cytologic material by washings and brushings, particularly of bronchi and stomach and more recently of ureter and renal pelvis. Application to cytology of immunoperoxydase techniques permit identification of many components and micro-organisms. Electron microscopy can now be done on single cells lifted from smears to demonstrate virus or specific cellular structures. Finally there is a large body of research focusing on eventual automation of routine gynecologic specimens obtained for population screening programs. ADVANCE OF ENDOSCOPY. Takemoto,T. & Okita,K. Dept.of Medicine, 186 Yamaguchi University School of Medicine, Ube, Japan. It is generally known that endoscopy in gastroenterology has progressed since the development of gastrocamera in 1950 and of gastrofiberscope which was introduced by Dr.Hirschowitz in 1957. Now, the advance of endoscopy made the Japanese endoscopists possible to establish the concept of early gastric cancer. Furthermore, endoscopy has been applied not only for the diagnostic procedure in gastroenterol- !uU ogy, but for the therapeutic method which is called therapeutic endoscopy. In this presentation, we put on the stress at the advance of recent endoscopy in Japan. (1) Diagnosis of esophageal cancer: dye - endoscopy using lugor is much useful for its diagnosis, in additiori to - usual endoscopic observation. (2) Diagnosis of gastric cancer: mainly, diagnosis of minute gastric cancer(less 5mm in diameter) by using dye endoscopy with methylene blue or indigocarmine, and also magnifying endoscopy. (3) Diagnosis of colon cancer: polypoid lesion should be biopsied or polypectomized through endoscopy, because of its possible malignancy. (4) Diagnosis of biliary tract disorders: endoscopic retro- rade cholangio-pancreatography is commonly used for its diagnosis. ?5) Diagnosis of hepatoma: laparosco y is applied for the diagnosis of minute hepatome(less 4cm in diameter~ which is absolutely available for its radical operation. In this symposium, we discuss the present and future of endoscopy in gastroenterology from the view point of cancer detection in early. t

LIST OF ABSTRACTS A7 COMPUTERIZED TOMOGRAPHY. Husband, J.E. Royal Marsden Hospital & Institute of Cancer Resef.r:t. London. Co-izte,;, Tomography (CT) is an important imaging technique for thc detection of cancer because tumours can be demczs:rated in almost every anatomical site. The major limia:ions of the system are the inability to detect small lesicn_ in sites where there is insufficient contrast (34j betseem the tumour and surrounding normal tissue and the lack c: tissue specificity. However within these constrs:nts CT can provide unique information. It thus providcs a valuable tool for primary diagnosis particularly in theN areas where tumours can be difficult to demonstrate eg. tte brain, mediastinum and retroperitoneum. CT has a usef;:: role in staging because metastatic spread to lymph nodes, :he lungs, bone, liver and brain can be shown. The value c' CT in clinical practice depends on the sensitivity of the technique compared with conventional methods of incestiZation and the effect that the information provided will Lsve on patient management, its role thus varies accerding to tumour type and area of body examined. In this paper s: attempt will be made to provide an overview of the accuracy and use of CT in the detection of cancer at the present time. ~ BREAST IMAGING: PAST, PRESENT AND FUTURE. Philip Strax, M.D., Guttman Institute, New York City. 26s.nmoaraphy has become the most accurate method for breast imaging. It ca: c:fferentiate a benign from a malignant process and it can ide::ti',va lesion before it becomes palpable. Nonpalpable cancers, with s L:gh degree of no nodal.involvement lead to increased survival and re!::ztion in mortality and have emphasized the importance of the xre,r eisninstion, particularly in mass screening. (34) ^_'~-- is--is concept is pointed up by the persisting one-third reduction in a+or:atity in the screening program for breast cancer detection of the Eeslth Insurance Plan (HIP) in New York City. Also, at the Gutt- m.^ Lstitute in New York City as well as at 28 other federally funded progrFas for screening for breast cancer substantial numbers of early breas: rancers have been found, with a high percentage of no axillary nod&i_ izvolvement. Tae radiation dose used has been reduced by the use of film-screen coc:`is:icas to under 5% of 1 rad to the mid breast at the same time thE; t?l-a qsality has been greatly improved. rt_-er methods of breast imaging include: 1. Thermography, a ph,vsirlrgical determinant, useful in conjunction with palpation and 2. Ultrasound, which holds promise as an additional saEtamirs3 imaging method. 3. Diaphanography, an improved version of t^a nation and 4. Mammoscan, an electronic device for ~ 0 O ~ J F C+

t,IST OF ABSTRACTS ULTRASOUND IN THE EARLY DETECTION OF TUMOURS 189 Cosgrove, D.O., Royal Marsden Hospital, Sutton, Surrey, U.R. High sensitivity is the prerequisite for screening for cancer. Current technology can detect 1 cm lesions and this has been encouragingly evaluated in Japan for breast tumours. Kandling tomograms in a routine application is burdensome but attemPts to use transmission imaging or mechanical Screening of results are hopeful. The lack of toxicity is a powerful incentive for the application of ultrasound. High specificity is required for the differential diagnosis of presenting masses. The complexity of inter- action between ultrasound and tissue raises the expectation that characteristic patterns can be recognised. Computer methods are being developed which should improve on the moderate success of visual interpretation. ULTRASONIC/TUMOUR/DIAGNOSIS 190 DIAGNOSTIC METHODS IN NUCLEAR MEDICINE. Cox, P.H., Dept. of Nuclear Medicine, Rotterdamsch Radio- Therapeutisch Instituut, Groene HillediJk 331 3075 EA Rotterdam, The Netherlands. In vivo nuclear medical techniques have an established role in the detection of both primary malignancy and metastatic disease. The reagents used may be classified as tumour localising or organ specific whilst the imaging techniques used may be static or dynamic. The latter makes it possible to evaluate organ function, tumour viability and response to therapy. The relative merits of a number of reagents will be discussed within this frame work and related to other diagnostic techniques. A number of potential areas of future development will be outlined.

LIST OF ABSTRACTS 191 INFLAMMATORY-CELL PROTEASES AS AMPLIFIERS OF CHF.MICAL PROMOTERS: A RAPID FUNCTIONAL SCREENING ASSAY FOR INDUCERS Ranney, D.F., and Quattrone, A.J. Department of Pathology, University of Texas Health Science Center, Dallas, Texas 75235, USA Chemical promoters that enhance DNA synthesis may act on target cells both directly and indirectly by modulating the release of growth- enhancing products from local inflammatory cells. Involvement of this indirect amplifier mechanism was tested by inducing day-3 inflammatory 65 exudates in Lewis rats with i.p. and i.t. thioglycollate (TG), an in- PS complete activator of macrophages. In experimental groups, phorbol myristate acetate (PMA) or asbestos (A) was coinjected on days 0-3. Peritoneal exucate cells (PEC) and lung alveolar macrophages (LAM) were harvested, washed, and cultured in serum-free medium. PEC super- natants increased the 20-hr uptake of 3H-thymidine by autologous L2 lung epithelial cells as follows: TG, 10 ± 9%; TG + PMA,50 ± 8%; PMA, 72 ± 8o;and A, 52 t 11%. Similar results were obtained using in vitro induction, LAM supernatants, and WI-38 human lung fibroblasts as targets. Mithramycin flow cytoflurometry confirmed these in- creases in DNA synthesis. The growth enhancers were nondialyzable and inactivated by protease inhibitors. This study provides a rapid, sensitive, biologically relevant screening assay for agents that induce the release of amplifier proteases. (Supported by CA 26031.) /PROMOTERS/ASBESTOS/PHORBOL MYRISTATE ACETATE/PROTEASES/ 192 PROBLEMS ON EARLY DIAGNOSIS OF PRIMARY BONE TUMORS Wickenhauser, J., Central Institute of X-Ray- Diagnostics, University of Vienna; Hohenberg, G., University Clinic of Radiotherapy and Radiobiology, Vienna. An analysis of 94 consecutive patients with primary bone tumours was performed to determine the influence of early 65 diagnosis on the management of these patients. A long time- ps intervall before specific diagnostic measures were unter- taken was noted in many patients of our study. The reasons for the delay of treatment were partially ascribable to the patients, who ignored to consult a physician in spite of symptoms. In the other hand, physicians often did not take appropriate diagnostics measures. In 63 of all patients diagnostic'X-ray examinations were initially not done. In 11 cases diagnostic X-ray examinations were misinter- preted. Twenty patients delayed their treatment by ignoring symptoms and by consulting a doctor too late.

6S pS LIST OF ABSTRACTS CHROMOSOME ANALYSIS IN BENIGN AND MALIGNANT PLEURAL 193 EFFUSIONS. Falor, W.H., Ward, R.M. and Brezler, M. Lymph and Cancer Research Laboratory, Akron City Hospital, Akron, OH 44309, U.S.A. Cytogenetic changes, namely morphologic and numerical chromosomal abnormalities (aneuploidy), characterize malignant cells. To assay the utility of chromosomal analysis in pleural effusions histologic and direct examination by cytogenetic analysis were performed on the fluid from 60 patients with proven intrapleural lesions: 27 benign and 33 y,alignant. A fluid was considered cytogenetically positive if three of 30 metaphases were hyperdiploid and/or contained a marker chromosome. All 27 benign effusions were diagnosed correctly by the histopathologist, however, two were misclassified as positive by chromosomal analysis. Of the 33 malignant effusions, 30 (91%) were diagnosed correctly by chromo- somal analysis compared to 21 (64%) by cytology. The two lymphomas were only diagnosed by chromosomal analysis. Positive diagnosis in the malignancies was not changed by combining cytologic with chromosomal results. /CHROMOSOME ANALYSIS/BENIGN/MALIGNANT EFFUSIONS/ 194 THIN NEEDLE ASPIRATION CYTOLOGY IN THE DIAGNOSIS OF PALPABLE MASSES: T.J.Arganese, M.Contardo, S.I.Saltzstein, R.B.Barone, and Y.H.Pilch, University of California, San Diego, School of Medicine, San Diego, CA., U.S.A. Aspiration cytologies of palpable masses were reviewed. Cytologic diag- noses, either "cancer", "suspicious", "benign" or "inadequate specimen", were compared with the final diagnoses. One hundred thirty-four speci- mens from 122 patients were evaluated; 8 specimens were considered in- adequate and 41 were interpreted as benign. The remaining 94 lesions proved to be malignant, including 63 adenocarcinomas, 6 melanomas, 21 epidermoid carcinomas, 1 sarcoma and 2 lymphomas were distributed as follows: breast-49, extremities-4, head and neck-6, trunk-21 and nodes- 44. Eliminating inadequate specimens, aspiration cytology was diagnos- tic in 87.5% (91/104) of cases, with a sensitivity of 62.1% (54/93). Of the 54 patients with positive cytology, 100% proved to have cancer. Of those with suspicious cytology 91% (20/22) had malignancies. Of the negatives only 26% (13/50) proved to be cancer. Considering only those patients proven to have cancer, 62.1% (54/87) had positive cytology, 23% (20/87) had suspicious cytology, and only 14.9% (13/87) had false negative cytology. Thin needle aspiration cytology is a reliable pro- cedure for establishing the diagnosis of cancer. A suspicious cytology must be considered ominous and biopsy is mandatory. A negative cytology does not exclude malignancy and suspicious lesions must be biopsied. /THIN NEEDLE ASPIRATION CYTOLOGY/ , I

LIST OF ABSTRACTS 195 AUTOMATED CYTOLOGY SYSTEMS: CRITERIA FOR INSTRUMENT DESIGN AND SELECTION Prewitt, J. M. S. Division of Computer Research and Tech- nology, National Institutes of Health, Bethesda, Md., U.S.A. Automated computer-based systems for cell classification and enumeration are now a reality, and screening and diag- nostic systems will follow. Presently, human •'expert" per- formance constitutes'the reference standard for automation. Prudent instrument selection can obviously benefit from knowledge of human and machine evaluation criteria and actu- al performance. However, a system will not necessarily perform well under evaluation criteria which are different from the design criteria. Satisfactory criteria should address effectiveness and efficacy, i.e., validity and cost-utility. Traditional measures of association, error rates and confusion matrices are inadequate and illusory. Theoretical and empirical relative operating characteristic curves (ROC), constrained optimization, and kappa, an index of fortuitous success, provide more meaningful evaluation tools and can easily be understood by the clinician. The fortuity index is parti- cularly important in assessing screening systems for dis- eases of low prevalence. Actual systems have been studied. /AUTOMATED CYTOLOGY/DECISION-MAKING/SYSTEM EVALUATION/ 196 SELF-APPLIED, BREAST PATHOLOGY DETECTING SENSOR DEVICE: DESCRIPTION AND PRELIMINARY RESULTS. Karpman, Harold L., M.D., and Hamilton, Betty, PhD., University of California at Los Angeles School and Georgetown University School of Medicine. The results of preliminary studies with a new chemical breast cancer screening indicator (BCSI) in patients with proven breast pathology will be described. The indicator consists of chemical heat sensors placed in wafer-thin pliant material which is capable of assuming the contours of the breast when held against the breast by a brassiere. The heat sensors measured gradations of temperatures from 31.6 to 36.6 degrees centigrade by changing colors and were arranged in such a way that a bar graph was made for each of three areas of the breast. Data obtained from the BCSI studies were correlated with findings on physical examination, mammography, thermography and biopsy. Preliminary results will be presented. /BREAST CANCER SCREENING/

LIST OF ABSTRACTS 197 ANALYSIS OF THE PULMONARY NEOPLASTIC LESIONS DIAGNOSED BY CT AND NOT PERCEPTIBLE BY STANDARD RADIOLOGICAL INVESTIGATIONS M. COLLARD, P. BRASSEUR et F. SUKKARIEH Universite Libre de Bruxelles Centre hospitalier de Montignies le Tilleul C.G.T.R. - B-6110 MONTIGNIES LE TILLEUL. The authors study twelve observations of primitive pulmonary tumors clearly diagnosed by CT. For anatomic reasons, these lesions were either poorly 65 or not perceptible by classical radiology. FS The authors describe the thoracic regions where the scanner proves useful in the investigation of neoplastic lesions suspected clinically or af ter cytological examinations of the sputum. The authors also emphazise the value of the scanner in the determination of the operability of the lesion. This is effected through the recognition or exclusion of homo or hetero lateral metastasis or of unsuspected extensions of the tumor. 1231 198 COMPARISON OF ULTRASOUND AND COMPUTED TOMOGRAPHY IN IMAGING THE UPPER ABDOMEN. Patrick J. Bryan, M.D.* Both ultrasonography and computed tomography (CT) provide a similar cross-sectional depiction of anatomy. They rely on different physical principles to produce these images. Ultrasonography depends on reflect- ion of sound at interfaces between tissues of differing acoustical impedance. CT on the other hand provides a cross-sectional map of radiographic densities. Ultrasound is not transmitted by gas and is very poorly transmitted by bone. It is also attenuated to a large degree by excessive fat. For this reason depiction of anatomy in the upper abdomen can be hindered by the presence of abundant bowel gas, by interposing ribs and spine, and by excessive obesity. CT is not hindered by any of these factors and in fact produces the best images when there is a mod- erate to a large amount of abdominal fat present. In very thin people CT provides relatively poor images and in these situations ultrasound is superior. CT also does not distinguish between different tissues which happen to have equal radiographic densities whereas these may be clearly distinguishable by ultrasound. A study was done to compare visualization of upper abdominal anatomy with ultrasound and CT in patients of varying body habitus. Results of this study will be presented. * Department of Radiology, University Hospitals of Cleveland, Cleveland, D11 44106, U.S.A.

LIST OF ABSTRACTS (23J 199 RECENT DEVELOPMENTS IN TUMOR IMAGING USING ULTRASOUND TECFNIQUES JOSEPB, A.E. Dept. of Nuclear Medicine and Ultrasound, St. George's Hospital, London, U.K. 2W PUBLIC HEALTH AND POLITICAL IMPLICATIONS OF PREVENTION AND DETECTION OF CANCER. (97]

901 COST BENEFIT ASSESSMENT OF CANCER DETECTION. Holleb, A. I., New York & Eddy, D. M, California. Many insights can be gained from studying the economics of cancer prevention and detection. However, the final answers are not deter- rnined by an analyst. The choice of an early detection protocol is a personal judgment that can be made only by individual patients and physicians. There is no "correct" answer or "optimal" screening frequency. Economic analysis provides estimates of outcomes - the health benefits, the risks and costs of different protocols. The final choices depend on how one values those outcomes. It all becomes a question of personal values, and what is best for one person Is not necessarily best for another. The analyst must cooperate with physicians and patients to help build a common understanding of the consequences of different options and help design the best protocol to fit personal needs. /COST BENEFIT ASSESSMENT/CANCER DETEC TION/ ~ INFORMING THE PUBLIC AND THE PROFESSION VERONESI, U. Director, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.

LIST OF ABSTRACTS 203 EVALUATION OF ANTI-SMOKING CAMPAIGNS: IMPLICATIONS FOR THE FUTURE. Miller, A.B., NCIC Epidemiology Unit, University of Toronto, Canada. The data available from surveys in Canada relating to prevalence of smoking in the community by age and sex has been examined in relation to changes in mortality from smoking associated cancers. For lung cancer in men at younger ages there is an indication that reduction in cigarette smoking is having an impact. Mortality from bladder cancer [471 in males has also recently fallen. Though changes in type of cigarette consumed may also influence the rates for smoking associated cancers, this is difficult to confirm and is confounded with a number of different factors. Nevertheless, some improvements may be expected on this basis. Expectations for dramatic improvements in smoking associ- ated cancer rates were based on over optimistic expectations for benefit, a failure to understand interaction with other carcinogens and a failure to appreciate the necessity to change habits early in life for a full impact. A further generation may need to pass before a substantial impact in rates of smoking associated cancers can be expected in the Western world and several generations before we are able to overcome the expected epidemic of such cancers in developing cour.tri es. /SMOKING AND DISEASE/PREVENTION/LUNG NEOPLASMS 20(1 Ti-IE ROLE CF THE PRIMARY HEALTH CARE TF.AM IN CAWM CCOIIRCH. E. Wilkes, Dept, of Community Medicine, Sheffield University, Sheffield. The doctor-patient relationship may be of crucial importancein }he early detection of important disease. Major symptoms can be reported late if personal fears, family difficulties or a poor level of confidence encourage delay. Social background, sexual activity and personal habits (including patterns of consultation and smoking or [47] alcohol usage) can help the family physician evaluate early symptoms. Basic clinical competence and time to maintain suitable standards are required before a major educational role can lead to prevention or earlier diagnosis. The increasing use of well-women clinics or routine screening of the over-75's are of interest and importance, but are not likely to vie in importance with the supportive or symptom-control duties needed by the advanced case. F~ ~1

LIST OF ABSTRACTS 0 EFFECTIVENESS OF CANCER CONTROL PROGRAMS ~ INFORMING THE PUBLIC ABOUT CANCER RISKS: AN IMPORTANT ASPECT OF CANCER CONTROL. Malone, W.F. Preventive Medicine Branch, National Cancer Institute, Bethesda, Maryland, U.S.A. Informing various members of society about cancer risks is an impor- tant component for health promotion and disease prevention activities. Not only does the exercise of the right to know differ, but the flow of information to various segments of society differs considerably. Tech- niques applicable to one segment of society may not be applicable to !30) another. Progress on developing and communicating information about risks will be discussed, including the contents of informational re- source documents concerned with exposures to carcinogens. Several re- cent experiences involving different population groups and varying circumstances will be reviewed. An example will include- a aiscuss'!ou of the experiences associated with informing workers about occupational risks. Among the topics for discussion are: How risk and benefit tradeoffs can be made more comprehensible to the public; how uncer- tainties surrounding scientific evidence can be meaningfully conveyed; and how people use risk information provided them in making personal decisions. While there has been a strengthening in the number and scope of carcinogen regulations, there is a need for a comparable strengthening of access to personal preventive health materials and cancer risk information for the future. CANCER CONTROL/CANCER RISKS/HEALTH EDUCATION

207 GOALS AND PRIORITIES IN PUBLIC EDUCATION ABOUT CANCER. P. Hobbs, Department of Epidemiology and Social Research, University Hospital of South Manchester, England. A model of cancer education treatment at [30] an early stage mammography, proctoscopy etc. cervical screening changing life-style prevention avoiding known carcinogens (i) industrial (ii) cigarette smoking (iii) life-style, e.g. diet We have developed from a fairly simplistic approach to cancer educa- tion to an appreciation of the value of evaluative and behavioural studies related to our work. Some of the answers we already have and current questions we are pursuing are discussed in relation to the content and approach of education programmes. Some new questions are posed. 208 A COURSE IN CANCER PREVENTION FOR PRACTICING PHYSICIANS. Love, R.R. Wisconsin Clinical Cancer Center, Madison, Wis. Comprehensive medical education in cancer prevention must advance knowledge and skills, notably in the psychosocial sciences, which have direct application in clinical practice. This 24-hour classroom course for physicians-in-training is based on the precept that alterable factors in cancer causation are consequences of physician and/or pa- tient behaviors; the educational goal is therefore to effect behavior (30) change in both-groups. -Introductory course sessions address critical concepts in cancer causation in relation to multifactorial and multi- step etiologies; rates and risks; induction periods, and to basic prin- ciples of biological and behavioral cancer prevention. In sections on smoking, diet, drugs, occupation, radiation, and genetics, 1) the con- cepts of the mechanisms that control disease are described, 2) the techniques for operationalizing these concepts are identified, and 3) the clinical skills needed to apply these techniques are taught inter- actively. Concluding presentations promote the systematic integration of pre- ventive skills, strategies and services into an acute care practice. Theory and rationale for course content, details of the curriculum, and the potential impact of such an educational program will be discussed. reduction of patient delay: 1attitudes and behaviour breast self screening:, -examination, CANCER PREVENTION COURSE/PRACTICING PHYSICIANS

tACTS LIST OF ABSTRACTS i (301 209 A CANCER EDUCATION METHODOLOGY FOR TEACHER-TRAINING COURSES Chariton, A. Manchester Regional Committee for Cancer Education, Kinnaird Road, Manchester, England. The fear of cancer which can prevent people from accepting screening might be greatly reduced if children were to be taught the facts about cancer in schools. But to feel confident to do this, teachefs must first learn about it themselves. The aim was to investigate the possibility of incorporating cancer education into teacher training programmes in a way that would be of use to both tutors and students. Short questionnaires, completed by 672 students and 160 tutors in 14 teacher-training establishments in England, provided information on their knowledge and opinions about cancer and cancer education. On the whole the students expressed a gloomier view of cancer than their tutors did e.g. 41% of the students and 16% of the tutors thought that cancers cause the most deaths in this country. However, 91% of the students expressed willingness to teach about cancer in schools, and 67% of the tutors would use cancer education materials in teaching their students. At least 40% of the students said that no health education was included in their course. Groups of students and tutors assessed the value of QUEST, our multi- disciplinary cancer education resources pack for teachers, to teaching methodology and academic subject classes. It scored best as a content of methodology courses. /CANCCR EDUCATION/TEACHER-TRAINING/ 210 A MULTI-DIMNESIONAL MODEL FOR NON-FEAR-AROUSING EDUCATION ABOUT BREAST SELF-EXAMINATION (BSE). G. GA S TRIN, M.D. National Institute of Nursery, Helsinki, Finland. Almost all breast cancers are found by women themselves, but by co- incidence only. Interval cancer cases occur in those few screening programs in the world. According to interviews conventional health education in this field is fear-arousing. A new health education (30) program, aimed at_being non-fear-arousing was tested with 56,177 women enrolled in the project. Women got motivational information in person-to-person situations, regular breast self-examination was check- ed up and women who detected symptoms themselves were linked to a named specialist. Previous to the project, 0-2% performed BSE 12 times a year. During the project, 68.4% performed BSE. The women answered in questionnaires that they felt a new sort of security. The project was set up to be correlated with the numbers of new self-detected cases in comparison to previous years, the number of local cases and five-year mortality rates. The number of cases found was twice that expected; more local cases; younger women than normal. Five-year mortality rates decreased. The new model can now be introduced world-wide through different medicare channels. Key-persons for information and follow-up material are tested in the project. Material is prepared in English.

LIST OF ABSTRACTS 2U PREVENTION OF SMOKING IN ADOLESCENTS:DEVELOPMENT b EVALUATION OF A LARGE-SCALE FOUR-YEAR (7th THRU lOth GRADES)SOCIAL PSYCO- LOGICAL STRATEGY. Evans, Richard I., Rozelle,R., Dill,C., Guthrie,T., Henderson,A., Hi11,P., Maxwell,S., Raines,2i. A social psychological smoking deterrence strategy was developed which consists of utilizing persuasive communications in the form of film mes sages and posters in which (1)immediate physiological consequences of cigarette smoking are demonstrated; (2)information is communicated identifying the social pressures on adolescents to smoke which emanate from peers, parental models and media advertisement; (3)detailed tech- niques for coping with these social pressures are role-played by stu- dents of approximately the same age as the target audience. The inves- tigation which follow6d a population (N=2351) of 7th graders through the 10th grade was conducted in physical education classes in the Hous- ton Independent School District. A modified time series design which involved full treatment, repeated testing only, and control groups was implemented. A novel nicotine-in-saliva measure was used to increase the validity of self-reports of smoking. Individuals were classified as having gained or not having gained knowledge from the pretest to the posttest. A MANOVA revealed significant disordinal interaction of treat ment and knowledge for both behavior and intention. The full treatment condition resulted in the lowest smoking behavior and intention to smoke of all conditions for those students who exhibited a knowledge gain. SOCIAL PSYCHOLOGICAL SMOKING PREVENTION STRATEGIES/ADOLESCENTS 212 THE ROLE OF PUBLIC EDUCATION IN PROGRAMMES FOR SMOKING CESSATION Ramstrom, L.M. National Smoking and Health Association, Stockholm, Sweden The concept "Smoking Cessation" should be defined as the entire process by which a smoker develops, step by.step, a motivation to stop smoking, takes action to get off cigarettes and, finally, stays off. In this multistep process the initial steps will be encouraged by all-educational type intervention while the later steps would benefit from additional intervention by therapy of pharmacological and/or other type. This multifaceted background implies, that "traditional" educational efforts concentrating upon certain medical facts being disseminated by mass com- munication do not meet the multitude of needs that arise from the diffe- rent steps of the cessation process. The total educational activities therefore have to be substantially expanded both in terms of content and ways of communication. This situation calls for involvment of a broad variety of professionals who can contribute to the execution of diffe- rent kinds of programmes that should be adapted to and launched in diffe- rent environments. /PUBLIC EDUCATION/SMOKING CESSATION/

LIST OF ABSTRACTS 213 THE USE OF HYPNOLOGY TO CURB SMOKING C.A.D. RINGROSE, M.D., F.R.C.S.(C) Aypnotherapy Institute, Edmonton, Alberta, Canada. Despite evidence of serious morbidity and mortality due to smoking,this self-destructive habit remains common. Learning self hypnosis can increase the feeling of respect for the mind and body as a precious, nonrenewable resource and provide an alternative feeling of well-being to that perceived when inhaling carbon monoxide, tar and nicotine. Initially, the subject is educated about the harmful effects of smoking and the trance state explained. After induction of hypnosis, smoking hazards are visualized and membership in the smoking "cult" terminated. The urge to smoke is transferred to a benign alternative, - like a warm feeling in a finger. Age regression is used to recapture attitudes to smoking before the habit started. The origin of the habit is re-created and than removed from the life style just like one can remove pages from a filing cabinet if unwanted. Future success is fantasized. The smoking ritual is replaced by writinp down the 14 advantages of not smoking whenever the urge occurs. Cassette tapes reiterate the suRaes- tions after the 3 visit program. The success rate was 86% in 50 subjects and was sustained using the tapes. Some of the 14% initially unsuccessful were later motivated to quit. These results have been consistently duplicated in a solo or group situation in motivated subjects. 50% of the successful subjects quit after the first 1/2 hour session. /SELF HYPNOSIS CAN CURB SMOKING/ uL{ DELAY OF HOSPITALIZATION AND LOCUS OF CONTROL AMONG THE SURGICAL CANCER PATIENTS. Mizuguchi, T. & Nakazato, K. National Cancer Center Hospital $ Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan. Psychological delay factors of hospitalization among the cancer patients were investigated. Subjects were 100 surgi- cal patients admitted into National Cancer center Hospital. They were divided into four.groups: extremely internal, internal, external, and extremely external. Also, State- Trait Anxiety Inventory, Mausley Personality Inventory, and Witkin's Embedded Figure Test (a test of perceptual style) were administered. Internal group showed greatest delay of hospitalization from the time when they had been notified of their cancer either directly or indirectly, whereas extreme- ly internal or extremely external showed least delay. How- ever,.other factors such as extroversion, neuroticism, per- ceptual style, or levels of state anxiety did not seem to contribute to the greatest delay among the internal group. Relationships between delay of hospitalization and psychol- ogical factors were further discussed. With respect to delay of hospitalization, locus of cont- rol seems to be the most significant variable among those investigated in present study. /DELAY OF HOSPITALIZATION/LOCUS OF CONTROL/ ,

LIST OF ABSTRACTS 215 PSYCHOTHERAPY OF MAJOR ILLNESS USING AUDIO CASSETTES FOR PLEASURE RESPONSE. Dr.med. Z. EIFLER. Finkenhofstrasse 27, D-6 Frankfurt/Main, Germany, F.R. The benefits of a patient's emotional well-feeling are recorded through- out the history of medicine. Our therapy consists of patients listening to audio cassettes. This presents a very pleasant type of therapy because it induces introverted pleasure that is comparable to light 52 hypnosis in an awake state. The patient may listen to various cassettes Ps daily for periods of 20 to 30 minutes, ranging from months to even years. This procedure is suitable in canbination with any other needed treat- ment. The usefulness of this method ranges from prevention to severe cases of hospitalized patients, and may replace psychotherapy of patients with malignant neoplasns. /PSl'CBCQHFMP1' OF MAJOR ILiMSS/AUDIO CASSEITFS/ 216 THE IMPORTANCE IN CHANGE OF BEHAVIOR OF THE POPULATION ABOUT CANCER. PAVLOVIC, P. institute for Radiotherapy and Oncology, Faculty of Medicine, University of Rijeka and Clinical Hospital "Brothers Dr. Sobol," Rijeka 51000, Yugoslavia. At the present time, we report better results in early detection and treatment of cancer in the northern coastal region of Yugoslavia. The reasons for this progress are partly due to the cancer education and 52 screening programs which are held in some of our cocnrnmities; however, ps more inportant facts to be discussed include the significant change of behavior and attitudes of people towards cancer as related to improved economic, social, cultural and health conditions. /CI-IANGING BEHAVIOR ABOUr CANCER/ r A O

LIST OF ABSTRACTS 52 pS 29 THE ROLE OF PHYSICIAN EXTENDERS IN THE PREVENTION, DETECTION, AND PATIENT REHABILITATION OF NEOPLASTIC DISEASE IN PRIMARY CARE SETTINGS. Roush, R.E., Thomson, W.A., Baylor College of Medicine, Houston, Texas. The physician extender (PE) concept in the United States has markedly increased the range of physician-services to patients in a cost-effective manner. The authors' experience at Baylor College of Medicine as well as other individuals (Mendenhall & Repicky, 1978) have clearly indicated that PE's employed in primary care settings provide a great proportion of care in the areas of prevention and patient education. Thus, PE's are the logical health care providers to which increased emphasis on the control of cancer must be delegated by physicians. The poster presents a schema for conceptualizing the general princi- pals of prevention specifically applied to cancer by illustrating: 1. the primary, secondary, and tertiary levels of prevention; 2. the multidimen- sional matrix emphasizing aspects of cancer prevention; and 3. a tripar- tite model classifying the levels of prevention by PE's activities that lead to prescription for prevention. The value of the Baylor model is that a simplified matrix is formed which permits an observable role relationship between the physician and the extender in the prevention, detection, and rehabilitation of neo- plastic disorders. Additionally, the models have applicability to all aspects of medical education in that they can be used to generate in- structional objectives for specific teaching units on prevention of cancer. Physician Extenders/Cancer Control/Patient Education 218 WHAT THE PUBLIC KNOWS ABOUT CANCER. A STUDY OF 1,020 QUESTIONS IN NEWSPAPERS. OSTOJIC, N., x.D.,Sc.D. institute of Oncology and Radiology, Belgrade, Yugoslavia. Over a 10 year period, newspapers received 1,020 questions concerning cancer diagnosis and therapy. The requests for information were classi- fied as follows: 1/ cancer therapy, where treatment had already been initiated (3%); 2/ cancer diagnosis, abere the patient at time of first 52 consultation and before therapy, had received insufficient explanation ps fran his physician (97%). The greatest number of questions concerned skin lesions (81%) and were asked by patients aho were not satisfied with the physician's explanation about the need to operate. Taelve per cent of the questions concerned breast cancer. The renaining seven per cent included questions about dysplasias, various other lesions and detection and prevention of cancer. Questions about therapy were posed by patients who believed that their physician aould not adequately answer their queries. The author believes that this analysis is useful to the physician who should provide information to the patient at the time of first consultation.

LIST OF ABSTRACTS 219 CANCER SCREENING CAN BE A LEARNING EXPERIENCE: DETECTION OF CANCER BUT ALSO INFORMATION AND EDUCATION OF THE PUBLIC. VAN PARIJS, L.G.1, and VANDENBROUCKE- VAN DER WIELEN, A.2 1Centre d'Information pour 2'Education a 1a Sante, Bruxelles, Belgique; 2Service de Depistage Precoce du Cancer, Universite de Louvain, Bruxelles, Belgique. The purpose of this study is two-fold. First, to develop uays and means of motivating persons at risk to participate in a cancer screening pro- 52 gramne. Secondly, to provide specific learning experiences during the Ps cancer examinations with respect to a selected nunber of prevalent ques- tions patients may have about cancer or about the cancer screening test. The study is being conducted in a medical center of a semi-urban city. Its purpose is to evaluate the differential impact of planned education- al inputs on patients in this center compared to a control population of a similar medical center where cancer screening occurs. Specific evalu- ation will be carried out with respect to knowledge and attitudes of patients about cancer and cancer screening. /PUBLIC INFUW77ON ANII) EDUCATION/CANCEt SCREENING/ ~ NIH PREVENTION RESEARCH Kalberer, J.T., Jr., Ph.D. National Institutes of Health, Bethesda, Maryland, USA. A survey reveals that, overall, the NIH spent approximately $352.4 million in fiscal year 1978 to support projects related to primary pre- vention (i.e., intervention before the biologic onset of a disease). The largest contributors to this total were the National Cancer Insti- tute ($109 million), the National Institute of Child Health and Human [36] Development ($70 million), and the National Heart, Lung, and Blood Institute ($58 million). When the size of each Institute's total research budget is considered, however, the National Institute of Environmental Health Sciences (74%) and the Child Health Institute (48%) are by far the most prevention-oriented. The science supported by NIH prevention funds runs the gamut from developing improved methods for-predicting carcinogenicity, muta- genicity, and teratogenicity and instituting smoking cessation research, education, and information programs (both sponsored by the NCI) to community-based multiple risk factor intervention demonstration programs (instituted by the NHLBI). Secondary prevention activities at the NIH may include basic research related to diagnosis and development of diagnostic methods, as well as actual diagnostic intervention (such as screening programs for the detection of disease). PREVENTION RESEARCH/NATIONAL INSTITUTES OF HEALTH/ 4 F P N

2?1 EFFECTIVE TEACHING OF CANCER PREVENTION CRA VA TS, H. York College of The City University of New York, ,7amaica, NY 11451, U.S.A. One important way to reduce the incidence of cancer is through prevent- ion. The earlier one starts to practice proper living habits the better; therefore, the task of teaching about cancer prevention should fall on the teacher of young pupils. Yet, these teachers are generally not well ,trained in health education and cancer prevention. To accomplish the task of training elementary school teachers to be able to teach cancer prevention, an institute supported by the American Cancer Society was established at York College. Physicians, scientists and educators conducted an intensive course. Methods of instruction were analyzed and a number of effective motivational teaching devices were demonstrated. The elementary school teachers were then charged with responsibility of training their colleagues in cancer prevention. The evaluation of the institute was very favorable and could serve as a model. /EFFECTIVE TEACHING OF CANCER PREVENTION/ ~ HOPE VERSUS FEAR - ACTION VERSUS INACTION: THE BALANCE OF INVESTMENT IN PROMOTING CANCER SCREENING PROGRAMS. Ingall, John R.F., Harsen, Joy. Michigan Cancer Foundation, 110 E. Warren, Detroit, Michigan, U.S.A. The inducement of behavioral change by the individual and society at large is the mission of health education efforts. When fear of cancer is utilized as the major means to increase the number of screenees, it has been shown to have the opposite effect on participation. The need [36J to target groups "at risk" carries with it an economic and theoretical justification. The "at risk" target populations for screening are be- yond the years where the inducement to behavioral change can be dra- matically influenced and displace established habits. Hope lies, by definition, in the future. This paper presents exper- ience in detection and early diagnosis conducted under the Cancer Con- trol Program of Metropolitan Detroit, and examines the potential of preventive measures that may be introduced before attaining the age of risk (i.e., during the formative school years , and the health educa- tion needs for teachers and family. /CANCER SCREENING/HEALTH EDUCATION/INVESTNENT/

LIST OF ABSTRACTS 223 PSYCHOLOGICAL ASPECTS OF ASBESTOS-RELATED MESOTHELIOMA AND KNOWLEDGE OF HIGH RISK FOR CANCER. Lebovits, A.H., Chahinian, P.,Dept. of Neoplastic Diseases, Mt. Sinai School of Medicine. Gorzynski, J.G., Holland, J.C.,Memorial Sloan-Kettering Cancer Center, New York, New York. 10 patients were assessed within a year of the diagnosis of meso- thelioma regarding the impact on them of their known high risk of cancer due to asbestos exposure. Mean age was 59 years. 7 of 9 patients (36] stated they were aware of the dangers of asbestos prior to diagnosis. The reported primary reactions to high risk had been lack of concern and denial of risk. Many minimized their exposure as "not sufficient", or had dismissed the information as "just another scare". Not a single patient reported increased visits to a physician or restriction of smoking. 4 of 5 cigarette smokers continued to smoke. A "why me" re- action of being unlucky was common. Patients denied anger towards the asbestos industry despite the clear environmental exposure. Guilt was absent. These preliminary findings of non-concern among people exposed to a carcinogenic substance suggest the need for'better information and education of high risk individuals and intervention. !36] 224 THE DESIGN, IMPLEMENTATION AND EVALUATION OF AN EFFECTIVE PUBLIC CANCER EDUCATION PROGRAM. Hansen, J.A.B., Cancer Center, Arizona Health Sciences Center, Tucson, Arizona, U.S.A. The Cancer Center Division of the Arizona Health Sciences Center has presented 3 highly successful public education forums. These individual forums are part of an ongoing series of outreach programs entitled, "Cancer's Impact on You!". Subjects covered have included breast cancer, malignant melanoma, and radiation hazards. Aggressive community publi- city began with the design of a powerful logo to be used on all posters, flyers, and television spots. Heavy media coverage was assured by per- sonal contacts. Panelists were chosen with great carel professional ex- pertise and method of delivery were factors considered. Rigorous re- hearsals were conducted to assure presentations suitable for the level of a lay audience. At the forums packets were distributed containing educational materials from the National Cancer Institute and the Ameri- can Cancer Society. Included in the packets were evaluation forms for the audience to fill out at the conclusion of the forum. Given overflow audiences at the forums, and extensive media coverage reaching hundreds of thousands, the forum series is exceedingly successful and cost effec- tiqe. On a scale of 4 being excellent, the audiences' overall rating of the forums has been as follows: Overall Rating Attend Future Forums? Breast Cancer 3.545 98.3% Yes Melanoma 3.714 99.5% Yes Radiation Hazards /EFFECTIVE PUBLIC CANCER EDUCATION/ 3.193 95.3% Yes

LIST OF ABSTRACTS (361 25 PEER AND SELF HEALING WITH CHILDREN WHO HAVE CATASTROPHIC ILLNESS Jampolsky, Gerald G., M.D., Taylor, Patricia The Center for Attitudinal Healing, Tiburon, CA. 94920 USA A new program has been developed where children who have various forms of cancer, etc., are learninq to help themselves by helping each other. A national telephone network has also been set up. The Center is an educational model that is a supplement to the medical model. At the Center, health is defined as inner peace, and healinq is defined as letting go of fear. The children have written a book, There Is A Rainbow Behind Ever Dark Cloud, which is published by Celest a Arts, Mi lbrae, CA. US . The book is made up of their words and cartoons that describe what they have gone through and gives advice to other children. Concepts such as "This instant is the only time there is" and "To give is to receive" and "Forgiveness is the key to haopiness" and "The mind can change all things that hurt" are stressed. The use of letting go of fear.techniques through active imagination and mental imagery is stressed. FORGIVENESS/I!4AGERY/FEAR/PEACE/TELEPHONE ~ A GUIDE TO IMPLEMENT A CANCER PROGRAM IN A COMMUNITY HOSPITAL USING THE CRITERIA OF THE AMERICAN COLLEGE OF SURGEONS. Griffiths, E.K.,M.D.,F.A.C.P.,Mease Hosp./Clinic,Dunedin, Fla., U.S.A. Implementation was based on a community need for a Cancer Program where there is a high incidence of cancer. Methods included developing a schematic designed to show involvement of the hospital medical staff and ancillary personnel, administration, and volunteers for presentation at time of conception of program. Educational programs consisting of a (36) Tumor Board, Speakers Bureau, and programs for the general public as well as specific cancer patient group needs were developed stressing prevent= ion and detection as well as diagnosis and treatment. Results to date, 1978 and 1979, from this 300 bed hospital reveal an average of 800 cancer patients per year entered in the Registry from a total of 9,885 inpat- ients and 197,818 outpatients in 1978, and 9,608 inpatients and 208,683 outpatients in 1979. It is to be concluded that this is a worthwhile endeavor for accomplishing a more complete concept of total cancer patient care along with a positive response from physicians and ancillary as well as voluntary personnel to the educational program through a cohesiveness of groups involved toward reaching not only the goal of receiving recognition by the American College of Surgeons, but also attempting to establish the identity necessary for a community hospital to function as a "Cancer Center" for the patient population it serves. Cooperation amongst the hosp. staff, administration, ancillary personnel and volunteers, was paramount in assuring a successful program.

LIST OF ABSTRACTS 227 THE NEED FOR INTERNATIONAL COLLABORATION TO ACCELERATE THE DISSEMINATION OF CANCER RESEARCH RESULTS. R.J. Boscott University of Queensland Medical School Library, Australia, 4006. The dissemination of new cancer information by publishing in journals is inappropriate in view of the huge expenditure on cancer research. The several months out-of-date, and often superceded, information in the journals is retrieved efficiently from the appropriate data banks using highly sophisticated technology. It is socially important and (36) economically justifiable that the medical profession and the public benefits as quickly as possible from new discoveries on the prevention, detection and treatment of cancer. An international collaborative effort is needed to organise a rapid exchange of abstracts of new cancer research papers in an acceptable electronically transmissable microform, and that are retrievable by computer. The exchanged abstracts would be followed rapidly by the edited full papers in a similar microform.' Because of the huge output of cancer and related bionedical research papers, there is a great need for highly trained cancer literature specialists to filter the computer printouts for the research workers and the media journalists. There is a need for a faster reviewing of important areas of cancer research and for more scientifically trained medical librarians to contribute to these needs. The journal - as we know it - must be displaced! /CANCER RESEARCH/INFORMATION DISSEMINATION AND RETRIEVAL/MEDICAL LIBRARIANS/ ~ CANCER RISK, AGE AT DIAGNOSIS, AGE AT DEATH AS FUNCTIONS OF SEASON OF BIRTH. JANSSON, B., and MA LA BY, M.A. M.D. Anderson Hospital and Tumor Institute, Houston, TX 77030, U.S.A. The availability of vitamins, trace ele?nents, etc. in the diet and e.g. viruses in the general environment vary seasonally over the year. Both in humans and in animals the serum concentration of selenitan decreases during pregnancy to return to normal levels almst imnediately after (36) delivery. Is there a relationship between season of birth and the risk for cancer? This question has been studied using data for almost 180,000 cancer patients included for the Third National Cancer Survey. Statistic~ ally significant results have been found, e.g. patients with cancer in different organs have different month of birth distributions, the season of birth influences the age at diagnosis and the life span of the cancer patient. bfethodologicel difficulties with these types of studies are discussed. The results are compared to similar findings regarding other diseases or life span in general. /BIRTH-SEASON/CANCEIt-RATES/AGE AT DIA(WT3IS/

LIST OF ARSTRACTS ~ CHILDHOOD TUMORS IN THE NETHERLANDS HAYES, R.B., and VAN NOORD, P. Study Center of Social Oncology, Rotterdam, The Netherlands. (361 (36J A study of the extent of and factors associated with childhood tumors, in The Netherlands, is presented. The distribution of malignant tumors in childhood is described with respect to certain demographic variables, including age, sex, urban-rural and social class characteristics. Attention is given to selected sites, particularly tumors of the brain and central nervous system. The data source is a registry of initial hospitalizations, which covers approximately 90% of all hospitalizations in The Netherlands. As this data source has not previously been used for such purposes, particular attention is given to the accuracy of reporting. ~ CANCER IN FLORIDA: INFLUENCES OF INTRA-NATIONAL MIGRATION, Aldrich, T.E., and Healey, J.E. Comprehensive Cancer Center for the State of Florida, University of Miami School of Medicine, Miami, Florida, United States. Cancer Mortality statistics suggest an increased occurance of lung cancer in Florida, particularly in certain counties of the state (e.g. northeast, southeast, west central), Mason, T.J., McKay, F.W., Hoover, R. Blot, W.J. and Fraumeni, F.J.Jr., Atlas of Cancer Mortality for U.S. Counties: 1950-69. DHEW Pub. No. 75-780, 1975. This same data suggests a lower-than-the-nation occurance of digestive malignancies. This is curious as the intra-national migratory pattern would suggest a high digestive cancer risk among Florida's large retirement community (prim- arily from the high digestive cancer mortality areas of the northeast and mid-western U.S.). Data from 22 tumor registries in Florida is presented(40% of the expected cases ), as weak approximation of incidence in Florida. The patterns of proportional site distributions within geographic areas of the state support the suggestions of the mortality data. The tumor registry data further suggest that the digestive malignancy negative difference is too great to be accounted for by shifts to the positive of other sites (e.g. lung, breast,prostate). This data provides a provac- ative indication of an intra-national migratory effect: one reducing risk from digestive malignancies. /INTRA-NATIONAL MIGRATION/

LIST OF ABSTRACTS 231 TRENDS IN CANCER MORTALITY AMONG THE CHINESE IN THE UNITED STATES, 1959-1972. King, H. & Locke, F.B. National Cancer Institute, Bethesda, Maryland & Georgetown University, Washington, D.C., U.S.A. The study examines changes in cancer mortality among U.S. Chinese from 1959-1962 to 1968-1972, with emphasis on nativity differences. The measuring index, standardized mortality ratio (SMR), is adjusted to the age-specific death rates of U.S. whites. The mortality experience of (36) Taiwanese is taken to represent homeland risk level by which site- specific displacement among U.S. Chinese is ascertained. The two terms, idai & erdai, are suggested for foreign and native (U.S.) born Chinese, respectively. For overall cancer mortality, no substantial reduction was observed since 1960, except for erdai males, with an SMR 50% below that for white males and one third for male Taiwanese. Several site-specific displace- ments of interest were noted, such as an apparent successive decline (but remaining high) in nasopharyngeal mortality among erdai, a continu- ing elevation of colonic cancer risk among idai males, the perpetually high, although declining lung cancer mortality among females, and the absence of a rise in cancers of female breast, corpus uteri, ovary, and prostate to the white level. The transitional experience is interpreted in terms of host and environmental factors, indicating the needs for pro- longed observation and/or comprehensive studies. /CHINESE/CANCER MORTALITY/ 232 (36] DESCRIPTIVE MARKERS IN THE EPIDEMIOLOGY OF CUTANEOUS MELANOMA. VAN DER ESCH, E.P. Antoni van Leeuwenhoek Ziekenhufs Netherlands Cancer Institute, Amsterdam, The Netherlands. Contrasting incidences of cutaneous melanoma have been studied for geographically different areas. Sex ratios, age and anatomical site frequencies correspond in part with low and high incidence rates of various ethnic groups. Additional data and calculations (from Perspectives in the Pathology of Cutaneous JNe2a- noma, by van der Esch, E.P., and Stukonis, M.K. - submitted) are pre- sented using also the Cumulative Cancer Incidence Risk. It is suggested that the (basic) low incidence is determined by endogenous factors, while the (superimposed) high incidence arises as a result of an envir- onmental cause. An outline for a comprehensive approach using descrip- tive and analytical methods will be given. /EPIDEMIOLOGY/MALIGNANT MELANOMA/CARCINOGENESIS/

AN ANALYSIS OF TRENDS IN MORTALITY FROM MALIGNANT 233 MELANOMA OF THE SKIN IN AUSTRALIA. HOLMAN, C.D.J., ,7AMES, I.R., GATTEY, P.A., and ARMSTRONG, B.K. NH and MRC Research Unit in Epidemiology and Preventive Medicine, University of western Australia, Nedlands, Western Australia 6009, Australia. Australian mortality rates from cutaneous malignant melanoma in succes- sive periods from 1950-1977 have been examined with respect to geograph- ic variation and trend with time and birth cohort. The age standardized rates rose from 1.6/100,000 in males and 1.2/100,000 in females (1950-54) to 4.2/100,000 and 2.5/100,000 in 1975-1977. Mortality rates were highest in Queensland in the north of Australia and progressively diminished from the north to south of the country. Multivariate analysis designed to separate calendar year, birth cohort and age variation in mortality rates showed that virtually all the secular trend in rates could be explained by increases in successive birth cohorts, beginning at least as early as 1865 but stabilising with the cohort born around 1925. Control for the birth cohort and age factors revealed a slight doM'nward trend in mortality by calendar year as might be expected from improvements in treatment. It is suggested that the cohort-based increase in mortality resulted from lifestyle changes occurring with successive generations. Its stabilisation with the cohort of 1925 suggests that the secular trend toward increasing total mortality from melanoma will also stabilise in the near future. /14ELANOMA/MORTALITY/COHORT/ANALYSIS/ 234 USE OF ACTIVE PATIENT FOLLOW-UP IN CANCER FOR DESIGNING EPI- DEMIOLOGIC STUDIES. Smith, E.M., Tharp, R.F., Bean, J. Department of Preventive Medicine, and Iowa State Cancer Registry, University of Iowa, Iowa city, Iowa. Because of the high costs and complexities of epidemiologic research in determining carcinogenic risk, it is important to utilize all aggre- gate data available to suggest preliminary hypotheses. The 10 popula- tion-based Surveillance, Epidemiology and End Results (SEER) cancer reg- (j6Jistries in the U.S. can serve just such a purpose. Follow-up using death certificates and writing patients' physicians have been the major sources of SEER cancer survival information. Since 1979 an active follow-up has been instituted in.Iowa whereby the Cancer Registry writes directly to patients or their families to determine not only survival, but also relevant information not uniformly available through physician or hospital records: e.g., occupation, education, and water supply at time of diagnosis. In two studies to be discussed, these data are being used as measures of lifestyle and environmental exposures comparing 1) actual patient socioeconomic status to Standard Metropolitan Statistical Area indirect measures of SES for statistical error; and, 2) incidence/survival for site-specific cancers between socioeconomically richer vs poorer rural farm areas for differences in carcinogenic exposure, defining more per- tinent etiologic and health behavior parameters in a proposed case-con- tol study. /CANCER REGISTRIES/SURVIVAL ANALYSIS/

LIST OF ABSTRACTS (31 (31 235 THE IMPACT OF CANCER SCREENING ON MORBIDITY AND MORTALITY. I. Problems in effect evaluation. Habbema, J.D.F., Oortmarssen, G.J. van, Jong, G.A. de, Lubbe J.Th.N., Maas, P.J. van der. Dept. of Public Health and So- cial Medicine, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR ROTTERDAM. The series of three papers reflectsthe activities of the research group "decision making for mass screening". Estima- ting the effects of cancer screening on morbidity and morta- lity remains difficult. Even with randomized controlled stu- dies controversy arises as soon as these results have to be extrapolated to other situations. Some kind of quantitative theory or model seems to be required in order to make these extrapolations in a scientifically controllable way. These models have to incorporate assumptions concerning natural history, epidemiology, quality of the screening test, impro- vement in prognosis, attendance etc. Existing models for effect estimation are reviewed. One of them is simulation of entire populations by generating individual life histories and changes in these life histories as a result of screening. We intend to apply this approach first to cervical cancer, both for the dutch situation and, in a joint study with IARC for other countries. Later on, we hppe to study breast-/ colo-rectal-/lung and other cancers. 36 THE IMPACT OF CANCER SCREENING ON MORBIDITY AND MOR- TALITY. II. Numerical experimentation through a com- puterprogramme. Lubbe, J.Th.N., Habbema, J.D.F., Oortmarssen G.J. van, Jong, G.A. de, Maas, P.J. van der. Dept. of Public Health and Social Medicine, Erasmus University Rotterdam, Netherlands. The computerprogramme for evaluation of screening is based on Monte Carlo simulation and consists of two main parts: in part one, individual life histories are generated -with an appropriate number of them developing the type of cancer un- der study- and a second part in which early detection is si- mulated for a specified mass screening program. In the second part the life histories can be changed as a result of early detection. The input of the programme consists of parameters descri- bing the natural history of the disease and the screening process. According to these parameters, a large number of li- fehistories will be generated, together constituting a birth cohort or population. For this population, incidence and pre- valence figures are aggregated from the individual histories for each disease stage.For each individualt the effect of screening is determined by comparing the life history before and after screening. The effect of mass screening is computed by aggregating the individually obtained effects.

LIST OF ABSTRACTS „~ DOUBLING TIMES, LEAD TIME BIAS AND LENGTH BIAS. Spratt, JS, LJ~ Department of Surgery, University of Louisville, Louisville, KY, USA. Data compiled since 1961 on the actual doubling times, DT(act), of human cancers at many sites have repeatedly shown an extreme natural variance, usually lognormal. This variance contributes to extreme variance in the optimum intervals between screening exams, lead time and length bias and the frequency of cancers surfacing between screens. This variance can be used to estimate the optimum intervals between screens. The DT(act) determine the variance in the "cancer control window." The c.c.w. is that segment of time in the life history of a cancer elapsing between the attainment of a threshold size for detection and a size at which a cancer disseminates beyond the region of origin. The c.c.w. cannot exceed 14 net doublings and the median is probably not greater thdn 9 doublings. A table will be provided relating DT(act) to the net number of doublings in the c.c.w. demonstrating how a year between screens will exceed the c.c.w. for most acute cancers. These considerations can then be cross referenced to the observed lognormal frequency distributions of the DT(act) of many common human cancers measured in vivo to estimate the percent of cancers that might be detected effectively with various screening intervals. Data from the University of Louisville Breast Cancer Detection Demonstration Project will be used as a model. 238 THE IMPACT OF CANCER SCREENING ON MORBIDITY AND MORTALITY. III. The case of cervical cancer scree- ning in the Netherlands. Oortmarssen, G.J. van, Jong, G.A. de, Lubbe, J.Th.N., Maas, P.J. van der, Habbema, J.D.F., Dept. of Public Health and Social Medicine, Erasmus University Rotterdam, Netherlands. When the computerprogramme is applied to cervical cancer screening, age-specific input parameters have to be supplied for aspects of the disease process: hysterectomy, incidence of dysplasia, duration and possible regression of dysplasia and carcinoma in situ, duration of invasive stages and sur- vival according to stage. Then,the output of part one of the programme, consisting of age-specific incidence and preva- lence of c.i.s. and of invasive cancer and mortality figures, should be comparable with present epidemiological data. In this way, the programme can be used to test the validity of various theories concerning the natural history of cervical cancer. In the mass-screening part of the programme, input is nee- ded on elements of the screening process: specificity and sensitivity of the Pap smear, consequences of a possible fal- se positive Pap test, and the ages and corresponding atten- dance rates of the screening policy. Both dutch data and da- ta from other countries will be used in preparing the input.

LIST OF ABSTRACTS (3j (3J 239 OUTCOMES OF A COORDINATED, COMMUNITY BASED CANCER CONTROL PROGRAM. BRENNAN, M.J., and SWANSON, G.M. Michigan Cancer Foundation, Detroit, MI 48201, U.S.A. The Metropolitan Detroit Cancer Control Program has operated a coor- dinated mass media/small group health education reinforced, community- wide breast cancer surveillance program for the past three years. Four alternative health education/examination sequences and three types of service setting were employed. More than 40,000 women participated in the small group health education/screening programs. Survey results in- dicate that an additional 200,000 women were reached by the media por- tion of the program. Productivity of these methods varies from 10% to 80% who have nurse instruction for self-surveillance and a screening examination, Preliminary results show that an annual case-finding rate of 16/1000 examinees can be sustained through optimal use of coordinated informa- tion/health education/examination sequences for groups of 5,000 examinees per year. A 10-15% improvement in Stage 1(localized) presentation over current community rates for conventional access to the health care system has been observed in the screened population. Estimates indicate that minimum operational costs for this alternate diagnostic system may achieve substantial morbidity and mortality savings at acceptable cost/benefit rations. /COMMUNITY-BASED BREAST CANCER CONTROL/ 240 SCREENING OF BREAST CANCER AND HEALTH EDUCATION IN COMBINATION WITH CERVICAL CANCER SCREENING Rasanen,Osmo, Auranen,Aa=re and GTtinroos,Matti The Turku Multipurpose House of the Finhish Cancer Society, Finland The mass screening of breast cancer, population-based and free of charge, is carried out in Turku since January 1977. All women 35- 60 years of age are invited to this voluntary and multiphasic cancer screening by one personal, letter once in five years, Screenin methods consist of an interview and physical examination inspection and palpation) by a specially educated nurse. Single- view, reduced dose mammography ecc. to B.Lundgren, completes the screening of women with big or scarry breasts. Health education comprises of personal instruction supported by a videotape "How to examine Your breasts", teaching model "Betsi", brochures and a diary. The results after two years (TABLE) show, that this screening is readily accepted (participation rate about 84 %) and overall costs (7 US doll./screenee) are reasonable. This kind of screening is applicable to periodic common population screening of cancer. No OF WOMEN INVITED,EXAMINED AND BIOPSIEDy CASES OF INVASIVE CANCER Age Invited Examined % Biopsied % Invasive cancer % 35-40 3885 3303 85.0 33 1.0 - - 45-60 8043 6734 83,7 79 1.2 17 0.25 11928 . , .

SOCIAL AND PSYCHOLOGICAL FACTORS IN ACCEPTANCE OF 241 BREAST SCREENING BY MAMMOGRAPHY. Patricia Hobbs, Department of Epidemiology and Social Research, University Hospital of South Manchester, Manchester M20 9QL, England. The Manchester Breast Screening Feasibility Study team (George et al., 1976, British Medical Journal ) included a social scientist. Studies of the effect on response to a doctor's invitation to screening of confidence in the value of early treatment for cancer and of previous screening behaviour have been reported (Hobbs et al., 1980, Journal of Epidemiology and Community Aealth). The role of symptoms in determining self-selection and self-referral was also studied (Hobbs et al., 1980, Clinical Oncology ) . This paper uses data from interviews with random samples of acceptors and rejectors of invitations to consider the immediate reaction to the letter and the effect of temporal and peer group influences on subsequent action. Data from the personality scores (Eysenck Personality Inventory) of a series of screened women, invited and self- referred, are presented and compared with those of rejectors of invitations. BREAST SCREENING: SOCIAL/PSYCHOLOGICAL FACTORS 242 FOUR DIMENSIONS OF PUBLIC ATTITUDE TO CANCER. Dent, 0. & Goulston, K., The Australian National University, Canberra & Concord Repatriation General Hospital, Sydney, Australia. The success of screening programmes for cancer (Ca) will depend greatly on public attitudes if sufficiently high levels of participation are to be attained. This is true for both mass screening and for regular surveillance of a specific group at risk of developing Ca. The aim of this study was to identify major independent dimensions of public attitude to Ca through factor analysis of responses to interview questions using a representative population sample. Data were collected by survey of a 0.37% random sample comprising 500 persons aged -18 in Canberra in October 1978. Respondents answered 34 questions on awareness of Ca and up to 24 questions on their experience of Ca in relatives and acquaintances. Subjects with Ca were excluded. Principal components factor analysis showed four relatively indepen- dent attitude dimensions which can be represented as ANXIETY or FEAR about Ca, DENIAL of the threat of Ca, FATALISM about Ca prevention, and FATALISM about cure or control of Ca. Item analysis and inter-scale correlations confirmed the internal coherence and relative independence of these dimensions, except that the latter two showed a moderate positive correlation. It is suggested that Ca education and promotion of screening should deal separately yet concurrently with these four attitudes to achieve best effect. /PUBLIC ATTITUDE TO CANCER/ATTITUDE SURVEY/

LIST OF ABSTRACTS "IT, VALUE C7 MSS SCREf;PZ":GS FOR TF-T T_•:AMY DE"'F.C'^I0t'. OF BRFAS?' CA1~ CER Vuji6i6, ::., iola, P., Jv^ba"sic, S., Bes"enski, N., Kosanovib, S. Central Institute for 7umors and Allied Diseases, Zagreb, Ilica 1q7, Yugoslavia An analysis of our breast cancer patients showed that over E9,; came for a check-up because they palpated a lump and that over six nonths passed from the time of palpation to the initial clinical visit in about 6o:5. 1•etastasis had spread to the axil]ary lymph nodes in over 700. Early diagnosis is essential for obtainir.F better treatment results and mass screening is of major importance for making the early diagnosis. A mass screening prof-ran has been underway since 197o in our Institute. During this period, 31.616 women, the majorty ranging in ape from 30 to 55 years, have been examined. Xammography was per- formed in those (267o or F.4;.5) with pathologic findings. Following the clinical and mammographic, or one of these examinations, aspiration biopsy was performed. In cases with a niFple discharge, the secretion was cytologically examined several times. Aspiration biopsy was selec- ted for 116 women and exfolliative cytology in 322. Results obtained with this type of eiass screening program have been good. In addition to periodically discovering other pathological conditions of the breast, an early diagnosis o?' breast cancer can be made in a number of patients who can then begin treatment early. 244 EARLY DETECTION OF BREAST CANCER IN MASS SCREENING. RESULTS OF 14 YEARS ACTIVITY'. MAISIN, R., BONTE, J., COLLIN, Cl., MOLTER, Fr., VAN ROY, J., RAMIOUL, B., FROID- MONT, C., and WAROCQUIER, J. Centre des Tumeurs Universitaires de Louvain, Leuven, Liege, Anvers, Brussel, et Provinciaux de Verviers, Namur et Mons, Belgium. The study collects the results of all the early detection centers (with the exception of two) subsidized by the Belgian Ministry of Public Health. The authors analyse their results (1,000 breast cancers) with respect to frequency, kind of clinical examination, and qualification of the doctor performing the examination. Results reflect the influence of early de- tection estimated as a function of the stage found, and the extent of the treatment performed (more or less nutilating). They give the per- centage of the total population of Belgian wornen over 30 years of age who were examined and the percentage of all breast cancers diagnosed that were detected in early stages. In their conclusion, the authors emphasize the importance of clinical examinations in the early detection of breast cancer and the role that the general practioner should play in- an effective program of detection.

LIST OF ABSTRACTS EVALUATION OF MASS SCREENING FOR EARLY DETECTION 245 OF CERVICAL CANCER. NEUSER, D., BERNDT, A., and 'rBELING, K. Zentrallabors im Pathologischen Institut des Stadt, j~rankenhauses im Friedrichshain, Berlin 1017, GERMANY, D.R. p.S the situation with respect to cervix carcinoma in Berlin has hardly ged, we have initiated a prograrrme for early detection of cervical ~r and its preceding stages, beginning in 1973. All wornen from the Fj 3~S of Using 65 l National Central Cancer ologi ly examined every tati g Reg' ry, we are investigating ~ t,}~ relationship of carcinoma in situ to invasive carcincama, and morbid- it~, and mortality before, during and after screening. We have especially tried to clarify the influence of false negatives on the success of the W_reening programme• (9J /qCg~ING/CY'UIDGP/CFRVICAL CANGE2./ 246 CANCER DETECTION AS A PART OF GENERAL PRACTICE : Van Roy J., Peeters G., Free University of Brussels, V.U.B. Gezondheids- centrum - Brussels (Belgium). For 15 years, cancer detection has been organized in Belgium by specia- lized centres which are subsidized by the Health Department. In prac- tice, these examinations concern mainly women older than 35 years who are examined clinically and by means of a Papanicolaou smear. 85% of the detected cancers are gynaecological tumors (including the mammary gland). Nevertheless, these groups of cancers only represent 24% of the national cancer morbidity. This shows us that the actual cancer detection gives no solution for the greater part of the tumors. Cancer detection has proved its educational value. The public as well as the general practioners are now familiar with its principles. Provided that the necessary arrangements are fulfilled as to the standardization, quality control and registration, family doctors can assume an important role. The authors start from the vision that the detection should be integrated in general practice and that specialized institutions should contribute to its expansion in general practice (continuing medical education and logistic support). University detection centres should be specialized in perfection and evaluation of new detection-technics. /CANCER DETECTION METHODOLOGY/GENERAL PRACTICE/

LIST OF ABSTRACTS Z47 FEED BACK CONTROL OF SCREENING RESULTS IN NORD- AND SUDWURTTEMBERG, WEST GERMANY - EXPEREINCE IN 1.5 MILLION TEST FOR CANCER DETECTION. SCHRAGE, R. Universitats- Frauenklinik, Tubingen, Germany, F.R. Today, the greatest problem in screening for cancer detection is the !91 feed back control of the screening results. The experience of 1.5 million tests in the screening program of Nord- and Sudwurtteroberg, 1975-1979 are reported. The primary sites of cancer detection in screening tests, and the frequency of abnormal findings are: breast (0.04%); uterus (Pap. test: 0.35%); other genital organs (0.02%); rectum (0.U1%); urinary tract (haematurie positive: 0.04%); skin (0.07%). The practioners are required to document the results of cancer detection, including the results of histologic studies. In ccmparing the screening results of different practioners, there was wide variation in documentation: histologic con- firmation was obtained in 0.8-9.3%, not confirmed in 27-82%, and not obtained in 15-70%. Reasons for these results are: too high rate of false-positive screening tests, long intervals between screening test and histologic examination, and inexact recording. The possibilities for better documentation to improve feed back control of screening results are discussed. /SCREINING PROGRAhS/FEED BACK CONTROL OF RE6'ULTS/ 24$ THE POSSIBILITIES OF PLANNING HEALTH EDUCATION PROGRAMS BASED ON RESULTS OF INVESTIGATING PUBLIC BEHAVIOR AND ATTITUDES TOWARDS CANCER. MIJALKOVIC, 0., and NESKOVIC, B. Institute of Oncology and Radiology, Belgrade, Yugoslavia. In the present day of advances in oncology, there are sites in which cancer can be cured if detected at an early stage. Ilowever, the strategy in organizing health care.has not been sufficiently developed, especial- ly in the organization of public health education about cancer. To de- !g1 termine the existing situation, we are gathering information on public behavior towards cancer in the Republic of Serbia using the UICC Model Questionnaire for a Public Health Survey on Cancer Control in a sample group of 1,600-2,000 men and women. Through this approach, we are going to determine solutions for planning and implementing health education programs in order to influence and improve the behavior of the healthy individual towards cancer, which should lead to early detection, early treatment and to less expensive health care. J r a a

LIST OF ABSTRACTS t 6 r [91 191 249 EFFECTIVENESS OF THE COMMIINITY-SASED CONTROL PROGRAMS OF THE NATIONAL CANCER INSTITUTE -- THE HAWAIIAN CASE. Oenney, R. N., Cancer Center of Hawaii, Honolulu, Hawaii, U.S.A. Test of the hypothesis that a statewide coordinated approach to cancer control results in long-run reduction of morbidity/mortality and better outcomes for detected cases than the fragmented approach prevailing before institution of the program. Summary of first three years and projection of final two years of federal funding for pro- grams in prevention, detection, treatment and rehabilitation/continuing care. Use of the statewide population-based Tumor Registry, health surveillance of a random sample of the population by the Department of Health and Cancer Center resources in epidemiology and record linkage for development of intermediate effectiveness measures. Examples of measures used in professional education involving technology transfer, public education in health maintenance, breast screening and team care for the non-medical needs of cases requiring rehabilitation/continuing care. Projected programs in risk reduction and control of ionizing radiation involving the public and private sectors with associated effectiveness measures to be applied. Development of methods to test the coordination hypothesis. Plans for institutionalizing successful elements of the control program after termination of federal funding, including cooperative efforts with statewide programs in gerontology and reduction of occupational risk. EFFECTIVENESS OF COORDINATED STATEWIDE CONTROL PROGRAMS 250 VALUE, AIMS AND RESULTS OF THE LARGEST OUTPATIENT CLINIC FOR TUMORS IN ITALY. Azzarelli, A., and• Di Pi etro, S. Istituto Nazionale Tumori, Milano, Italy. In the Outpatient Clinic of the NCI of Milan, Italy, during the past year 110,952 physical examinations were performed, including 20,072 patients seen for the first time, and 4,445 surgical operations were done under local anesthesia: 1,401, for breast lesions, 1,075, for skin tumors including melanoma and 1,969 for miscellaneous tumors. 7,458 patients were hospitalized for more extensive surgery. Our efforts are to achieve an effective control and treatment of precancerous lesions, identification and follow up of high risk groups, oarl y wie+.. .,vu nn+.,lnn _ ..f some iani;cr j, and a r 1oll__VW . up after major surgery to prevent and cure possible relapses and metastases. Breast lesions are of leading interest: any suspicious lump is detected by physical examination, mammography and needle biopsy in the same morning; 715 breast cancers, most in Stage I or II, were so detected. Data on 1,850 needle biopsies are available: 612 for carcinomas with 65% of cyto- histologic concordance. /BREAST CANCER DETECTION/OUTPATIENT SERVICE/

LIST OF ABSTRACTS 251 OCQJPATICt1AL CANCER - EIID0600PIC AND IOFNlGENOLAGIC MASS 9CRFENING OF THE UPPER AIIRa-DIGPSTIVE TRACP Steiner, W., M. P. JauTann. Department of Otorhinolatyngology, Univer- sity Erlangen, W-Germany. The Erlangen model attexVt to establish cancer prevention in the mouth, pharynx and larynx in almost 7.000 persons (Steiner 1976), showed that mass screening is both technically feasible and - with a 3$ success rate for precanoerous conditions and 0,3 % for malignant tumours - also efficient and sensible. At the beginning of 1978, an endoscopic mass screening project (suppor- (9) ted by the Federal Ministry for Youth, Fasni.ly and Health) was initiated, in an attenpt to differentiate occupational fran private risk factors (in particular cigarette smoking) in persons exposed to heat, dust, chenical fumes and irritant gases at their place of work. With this in- vestigation it was hoped to be able better to define groups at risk of contracting cancer of the upper aero-cligestive tract. The prelimi.naiy results obtained with same 6.000 persons working in a variety of different industrial branches, indicate that the regular in- halation of cigarette snoke represents the main risk factor for the fre- quent occurrence of chronic inflarnnatory conditions and precancetrous stages in the oral cavity and larynx. Oceupational exposure as a oo-fac- tor clearly plays only a seoondary role. OOOUPATIONAL CANCEE;/ MASS SCREINING/FIIDCSCOPY/PPIXINCEROUS OONDITIONS/UPPER AE%J-DIGaTIVE TRACT !91 252 A STUDY OF FALSE NEGATIVE CASES IN THE MASS SURVEY OF GASTRIC CANCER. MATAYOSRI, J., DOI, R., YAMAWAKI, Y., KATO, T., AIROTA, K. Department of Radiology, Gifu University School of Medicine, Gifu City, Japan. In 1974 and 1975, 12,650 persons in Gifu City and vicinity participated in a mass screening survey for gastric cancer (6 different exposures of indirect radiograph). TWenty-nine cancers were detected. There were some false negative cases that were not detected in the survey. In 1977, all examinees were sent a questionnaire and five cancers were found additionally. The false negative rate then became 14.7p. Among these cases, three were classified as Bornnann IV (diffuse carcinoma), one as Borrmann II, and one as IIa type early gastric cancer. In the retrospec- tive review of the X-ray filrrts of these cases, we recognized some rigid- ity and irregularity of the gastric wall in the cases of Borrnarm IV and there was no detectable abnormality at all in the other two cases. In order to diminish these false negative cases in the ma.ss survey, we should give more attention to the rigidity of the gastric wall and the difficulty of expansion of the gastric ltmren. On the other hand, we emphasize that the double check system at the point of reading is* important to avoid misinterpretation; and in the technical area, we must try to get more detailed contrast pictures with the patient in various postions. /GASTRIC CANCIIt/Z;tASS SURVEY FOR GAS'lRIC CANCFIt/FALSE NEGATIVE/

r 253~, ETIOLOGIC FACTORS IN HEAD AND NECK CARCINOHA BRUGERE J, POINT D, THANH P & BATAINI P. Institut Curie 26 rue d'Ulm 75231 Paris 05 FRANCE. The present results of a prospective survey on going since 1975 show the almost exclusive prevalence of exogenous factors (tobacco and alcohol) in men with ecc of oral cavity, oropharynz, larynx & bypopbarynx. Men (1738) represent 90% of the whole. Less than 6% of men have smoked from 0 to less than 100 000 cigarettes, their average consumption is about 27 g a day and about 360 000 cig.The daily consumption is higher when cancer appears under 50yr. Only 7% of men drunk less than 40 g of alcohol a day t the average con- sumption is over 80 g for 81% of nin, except for patients with glottic carcinoma (52%). In women (196) exogenous factors are not observed at the same rate t 42% did not smoke, only 47,4 have smo- ked more than 100 000 cig. 46$ drunk less than 40 g of alcohol a day and 40% drunk over 80g. Occupational factors are observed rou- ghly at the same rate whatever the location t their role in sober patients does not a~pear_significantl_y. Patients_ are__particula_rl_y numerous in the social classes 4&5, in which are usually encoun- tered heavy smokers and drinkers, whatever be the occupation. Inezistence of any etiologic factors is very rare in men (< 1~d) whereas it is suprisingly frequent in women (> 25%). HEAD AND NECK CARCINOMA, TOBACCO, ALCOHOL, OCCUPATIONAL FACTORS 253S IMMUNOLOGY OF HEAD AND NECK CANCER: RELATION TO ETIOLOGY, PATHOGENESIS, PROPHYLAXIS AND TREATMENT. Chretien, P.B., National Cancer Institute, Bethesda, Md., U.S.A. and Wolf, G.T., Dept. of Otolaryngology, Univ. of Michigan, Ann Arbor, Mi., U.S.A. Patients with head and neck squamous carcinomas (HNSCa) are immunologi- cally unique in that compared to patients with tumors of other histolo- gic types, 1)they have marked depression of cellular immunity that is also present in cured patients, 2)sera from both untreated and cured (4] patients is immunosuppressive-in in vitro assays of cellular immunity and 3)both untreated and cured patients have a high incidence of anti- bodies to Herpes simplex virus non-virion antigen (HSV-NVA) and IgA anti-Herpes simplex virus-induced antigen (HSVIA). The suppressed cell- ular immunity associated with heavy tobacco consumption which is asso- ciated with_a_high risk for developm_e_n_t_o_f HpTSCa is also assoc.iated with a higher incidence of IgA anti-HSVIA than found in non-smokers. HSV-specific blocking antibody activity of this IgA may be critical for malignant transformation of mucosal cells by HSV. Expression of HSV- NVA follows, leading to production of anti-HSV-NVA antibodies. The quantitation of IgA anti-HSVIA and antibodies to HSV-NVA may be useful screens for subjects at high risk for developing HNSCa. HSV-NVA vacc- ines may be useful for immunoprophylaxis against HNSCa among these sub- jects and for adjuvant treatment of patients with these cancers. /HEAD AND NECK CANCER/IMMUNE DEFECTS/IgA/HSV NON-VIRION ANTIGEN/ i

LIST OF ABSTRACTS ~r a THYMIDINE KINASE AS AN ONCOFETAL ANTIGEN. Balis, M.E., Brigati, D.J. and Salser, J.S. Laboratory of Cell Metabolism Sloan-Kettering Institute, New York, New York and Department of Labora- tory of Medicine, Yale University School of Medicine, New Haven, Ct. The presence of variants of the enzyme thymidine kinase has been evaluated as a potential oncofetal developmental antigen in a retrospec- tive analysis of malignant head and neck tumors using antibodies di- rected against the highly purified term placental thymidine kinase. This [4) antiserum had been preselected for crossreactivity with kinases of extra- placental origin by immunodiffusion assays. Indirect immunofluorescence and immunoperoxidase analysis of frozen sections and routinely processed formalin fixed paraffin embedded tissue sections has revealed a consistently heterogeneous phenotypic expression of this enzyme marker in malignant cells derived from the same tumor. The prognostic value of this marker will be discussed in a retrospective review of patients with head and neck cancers. /THYMIDINE KINASE/ONCOFETAL ANTIGEN/PROGNOSTIC t1ARKER 2548 NEW APPRQ4CHES IN RADIOTFIERAPEUTIC MANAGEMENT OF HEAD AND NECK CANCER, LAWRENCE, G.A., RENN, R.A., GARCES, R.M. Dept. of Radiation Therapy, Evanston Hospital, Evanston IL 60201, U.S.A. Radiation biologists have ascribed radioresistance of tizriors to 2 basic factors: 1. Presence of hypoxic cells; 2. Repair of sublethal and poten- tially lethal damage. Head and neck cancer lends itself ideally to testing and evaluating of new therapeutic modalities. These twibrs are easily [4) accessible to inspection, palpation, measurement and biopsy. They fail frcm local recurrence rather than distant metastasis. Hence, the effect of therapy on recurrences and survival should be apparent by 2 years. Being superficial, these tumors can also be heated or adequately exposed to mod- erate energy radiation. Based on these radiobiological principles, new therapeutic nadalities have been developed and are naa in various phases of clinical applicaticns. These include heavy particle radiation, hypoxic - -- - cell radiosensitisers, hyperthenrii.a-and hyperfractionation. Heavy particle radiation due to high linear energy transfer (LE'P) have radiobiological and/ or physical depth dose advantage. The most widely used particles are Fast Neutrons. Preliminary experience with Protons, Pi mesons and Heavy ions is encouraging. The oxygen enhanosnent ratio for fast neutrons is 1.6 to 1.8. The hypoxic cell sensitisers are electron affinic drugs whose mechanism of action is similar to oxygen. Currently tested drugs belong to the nitroimi- dazole group of which the most widely used are metranidazole (Flagyl) and misonidazole (Ro-07-0582). These have a cytntoxic and radiosensitising action on hypoxic cells pro3ucing an enhancenent ratio of 1.4 to 1.7 for clinically acoeptable blood levels of the drug. Thexe are several phase II and III studies naa in progress. Hyperthermia has interesting theoretical bases for applicatice. These include a greater cytotexic and radiosensit- ising action on hypoxic and tunor oells than on normal cells. Thermal en- hanosoent ratios (TER) at the same tempcxature (43°C) are about 2 for normal tissue and 4 for tunors. Thus, in vitro studies suggest an irrprovement in the therapeutic ratio. The clinical application, results and future pros- pects of these modalities will be presented and discussed. Lit 0 0 0 r J r m O

LIST OF ABSTRACTS [41 254Y PROSPECTS FOR INCREASED SURVIVAL IN SQUAMOUS CELL HEAD AND NECK CANCER. PRICE, L.A. Head & Neck Unit, Royal Marsden Hospital, London, U.K. One hundred and fifty-five patients with advanced squamous cell carcinoma of the head and neck received combination chemotherapy consisting of vincristine 2 mg i.v. stat. at time zero, bleomycin 60 mg i.v. infusion from 12-18 hours, methotrexate 100 mg i.v. stat. at 12, 15 and 18 hours, hydrocortisone 500 mg i.v. stat. at 12 and 18 hours, and 5-fluorouracil 500 mg i.v. stat at 18 hours. A folinic acid "rescue" was started at 26 hours using calcium leucovorin 15 mg i.m. 6 hourly x 4. Treatment cycles were repeated every 2-4 weeks. Patients were divided into two groups: Group 1 - new patients receiving chemotherapy before planned radiation or surgery, and Group 2 - patients with recurrent, previously treated disease for which chemotherapy was the only option. Side effects were minimal. No significant myelosuppression occurred in any patient when the protocol was observed. Overall responses in assessable patients were: Group 1 - 57 of 76 (75%), and Group 2 - 20 of 40 (50$). Prior radiation significantly reduced response (p=0.012). Crude survival at 4~ years in Group 1 patients was 40% against an expected 20%. There was no significant increase in survival in Group 2. This protocol is currently being used as adjuvant treatment before surgery and/or radiotherapy. This kinetically based approach has several major advantages for patients. They A;pend only one night in hospital every 3 weeks and since myelosuppression is minimal there is no need for intensive supportive therapy. The application of this approach provides safer cancer chemotherapy for other "solid" tumours. 25(}d SURGICAL REFABIISTATION: HFAD AND NECK CANMR ICAVARANA, N.M. Plastic and Reconstructive Surgery,Service, Tata Memorial Hospital, Bombay, India !Q1

LIST OF ABSTRACTS 255 The Reliability of IgA Antibody to Epstein-Barr Virus (EBV) Capsid Antigen as a Test for the Diagnosis of Nasopharyngeal Carcinoma (NPC). The American NPC Study Group. National Cancer Institute, Bethesda, Md., Mayo Clinic, Rochester, Minn., M.D. Anderson Hospital, Houston, Tx., Center for Disease Control, Anchorage, Alaska, Massachusetts Eye & Ear Infirmary, Boston, Ma., Armed Forces Institute of Pathology, Washington, D.C., and Duke University, Durham, N.C. !5) Since NPC patients were first reported to have elevated levels of IgA antibody to EBV in their sera (Henle & Henle, 1976), workers in a number of countries have studied the possibility that this assay could be used in the diagnosis and monitoring of patients with this disease. In the United States a collaborative project involvingseven centers has been established to investigate the potential value of IgA antibody to EBV VCA as a clinical tool. In this report we will summarize the results obtained from 112 NPC patients and 158 controls with other malignancies involving the head and neck. For the NPC patients, 69/112 (62%) had IgA VCA antibody titers > 1:10. The geometric mean titer (GMT) was 1:9. In the cancer control group 8/158 (5%) had IgA VCA antibody titers >_ 1:10. The GMT for this group was 1:1.2. IgA antibody titers were elevated more frequently in patients with non- keratinizing or poorly differentiated types of NPC than for the well- differentiated squamous cell carcinomas. IgA antibodies to EBV VCA appears to be of value in the early detection and diagnosis of NPC. (5) 256 IINID09YDPIC ADVANCFS IN FA2I,Y CANCER DEPE7C7"I0N IN TFE HFAD AND NRCiC Steiner, W., M. P. Jaumann. Deparhnent of Otorhinolaryngology, Univer- sity Erlangen, W-Germany In our opinion, the decisive advance in the endoscap~y of the head and neck region over the last decades, was the developrent of the von Stuck- rad zocm endo,Rcope (magnification laryngosoope%piptaryngosoope) (1975). Using this 90 Wo1f optical system, which provides magnification of up to 5 times, the pharynx and larynx can be inspected directly and reliab- ly without the need for any auxilliary instruments. Daring the oourse of various research projects we have carried, out mpre than 30.000 such endosoopic examinations since 1975. Fbr routine exami- nations, this instxnument is an excellent replacement for the mirror. Both cytological and biopsy material can be reliably obtained from the conscious patient. Simple photographic, film and video documentation permits the recording of findings and follow-up examinations. This new method is capable of revolutionizing early cancer detection, diagnostic clarification and post-therapeutic follow-up in the pharynx and larynx. + Supported by the Deutsche Fbrschungsgemeinschaft (SFB 118) and Dandes- ministerium fiir Jugend, Familie und Gesundheit IIdDOSCOPY/90o OPTICS/E~'.AD AND HEXK/FARL,Y DEII•7GTI0N/ MSS SCRETNING

'S [5) [5J LIST OF ABSTRACTS 257 SCINPIGRAPHIC EXFINIINIATIONS OF 7[ANORS IN ?•IH; M}QLiAFACIAL REGION. WICKENNAUSER, J. and BDAENBERG, G. * Central Institute of X-Ray Diagnostics, University of Vienna, Vienna, Austria; *University Clinic for Radiotherapy and Radiobiology, Vienna, Austria. The close connection of the bone of the maxillofacial region with the adjacent soft parts results in a rapid affection of the latter in the event of malignant tumors. This fact gives rise to the following three problems: namely, the problem as to an affection of the skeleton, the extent thereof as well as a delimitation in particular from the base of the skull. This paper is to deal with the infiltrating extraosseous tumors only. The type and agressivity of the tumor and the reparative capacity of the skeleton are of decisive importance for the skeleton reaction to be observed and thus for the scintigraphic results. Both pre- and post- therapeutic examinations have been made. In the first group, the main question was the operability, which is not the case in general with affections of the base of the skull. In the second group, it turned out that, independent of preceding treatment (operation, radiotherapy, chemo- therapy) a judgement is particularly difficult respectively only possible when controlling the course of the process. The above problems are to be discusses by means of several cases. 258 MICROLARYNGOSCOPIC DIAGNOSIS OF PREMALIGNANT LESIONS OF THE LARYNX. Olofsson, J., Lundgren, J. & Hellquist, H.B. Departments of Otolaryngo- logy and Pathology I, Linkbping University Hospital, Linkt9ping, Sweden. While it is true that a correct diagnosis of dysplasia, carcinoma in situ and invasive squamous cell carcinoma can be established only by means of histological examination the microlaryngoscopic technique has increased the accuracy in the laryngoscopic diagnosis and has facilita- ted endolaryngeal surgery. Most premalignant lesions in the larynx are found on the free margin of the anterior two thirds of the vocal cords, and if localized they are then amenable to minor measures such as stripping of the vocal cord. It must, however, be stressed that patients treated for a severe dys- plasia or a carcinoma in situ should have the same careful follow-up as patients treated for an invasive carcinoma. Exfoliative cytology can be of diagnostic value when the lesions are diffuse. Vital stain such as toluidine blue certainly does not offer an alternative to the histological examination of a clinically suspect area but may serve as a complementary diagnostic aid in microlaryngo- scopy (Lundgren et al.(1979) Arch.Otolaryngol 105:169). The problems involved in the microlaryngoscopic diagnosis of pre- malignant lesions will be discussed and a 10 year material is presented. /LARYNX/PREMALIGNANT LESIONS/MICROLARYNGOSCOPY/

LIST OF ABSTRACTS 259 30I:E S:<P;SaI:;1dC~ ':1ITFi IP; 9IVC' 3T:1TP'Ii„ C: .'3_1 tLY L•aZYN:,?,;I, CAi}C ~,'t IN JaY.13Ta, IPiDGNS3Iy. }:urniawan, A.N. R- Handikin, L.S. Ue;.L-rtment of Anat•omic r=.k- tho].ogy & Department of Otorhinol_irynSolo;y, 3chool of i:e- dicine, University of Indonesia, Jakarta, Indonesia. I,aryn-eal cancer, clinically as weI1 as pashol.o-ically, usually does not pose a difficult. problem in dial-nosis. The problem lies in the clinical di::3nosis of early laryngeal cancer. :?e besan to study and develop the in vivo stainin,- technique for laryngeal lesions in our clinic, using tolui- din blue, an acidophilic metachromatic dye. This preliminary study comprised $ cases of laryngeal lesions, 5 of them were carcinoma. Among these latter cases, besides carcinoma, we were able to detect dysplasia in 2 ca- ses, ca.in situ in 1 case and false positive area in 1 case. Non-carcinoma cases consisted of dysplasia, dysplasia in post-radiation for carcinoma and ca.in situ. In 2 cases of carcinoma, tumor margin was accurately defined by positive staining area. This experience suggests that in vivo staining may be a useful method for early detection of laryngeal cancer used as an adjunct to microlaryn-oscopy. /Itd VIVC STaINING/LAftXNG :AL CANCER/ 260 LARYNGEAL EXFOLIATIVE CYTOLOGY Lundgren, J., Olofsson, J., Hellquist, H.B., Strandh, J. Departments of Otolaryngology, Pathology I and Clinical Cytology, Lin- koping University Hospital, Linktiping, Sweden. In a prospective study, 1973 to 1979, comprising 380 microlaryngo- scopic examinations the reliability of exfoliative cytology was eval- uated by comparison to the histology. In 166 of 201 lesions with histologically moderate and severe dys- plasia, carcinoma in situ and invasive carcinoma the cytologic smears were classed as Pap III, IV and V. The sensitivity (positive smear/ positive biopsy) of the cytologic method in detection of "premalignant" and malignant lesions was 83 per cent. In 147 of 179 histologically benign lesions the cytologic smears were classed as Pap I and II. The specificity (negative smear/negative biopsy) was thus 82 per cent. In at least one case the cytologic exam- ination disclosed true malignancy that had been overlooked at biopsy. Exfoliative cytology may be of decisive diagnostic value in diffuse laryngeal lesions where representative biopsies may be difficult to obtain. The exfoliative cytologic method seems less sensitive after radiotherapy and in the presence of moderate dysplasia. A negative smear, however, does not rule out the possibility of malignancy. /LARYNX/EXFOLIATIVE CYTOLOGY/

261 PHOTOMETRIC STUDIES ON NUCLEAR DNA CONTENT AND AREA IN DIFFERENT LARYNGEAL EPITHELIA. Hellquist, H.B., Olofsson, J. b Lundgren, J., Departments of Otolaryngology and Pathology I, Linkoping University Hospital, Linkoping, Sweden. Laryngeal keratosis, hyperplasia, moderate and severe dysplasia (CIS), and invasive carcinoma have been investigated in Feulgen stained slides. The results show markedely increased values for carcinoma and severe dys- plasia and the histograms display rather characteristic patterns, quite different from normal laryngeal epithelium. There is no sign of malignan- cy in keratotic or hyperplastic epithelia when looking at nuclear DNA content and area. There is a slight increase in the values for hyper- plastic epithelium but these do not reach the tetraploid values which is in accordance with previously published results (Hellquist et al,(1979), J•Laryngo1.93:1037). Four of eight patients with moderate dysplasialater developed severe dysplasia. However, only one of these had photometric values exceeding the normal. The results suggest that epithelia with keratosis and moderate dysplasia do not differ from morphologically normal laryngeal epithelium concerning nuclear DNA content and area. Squamous cell hyperplasia, however, show slightly increased values, but in no way reaching the values of pre- malignant lesions as severe dysplasia which have quite different photo- metric pattern resembling that of established malignancy. The group of patients with severe dysplasia will be further analyzed. /LARYNGEAL PREMALIGNANT LESIONS/PHOTOMETRY/DNA/ 262 DETCTION OF THYROID NEOPLASMS BY CYTOLOGIC METHOD: RESULTS OF FIVE-YEARS STUDY OF 2938 ASPIRATION BI- OPSIES.StavriE G.,Karanfilski B.,Kalamaras A.,Zografski G. Institute of Radiotherapy & Oncology, Skopje, Yugoslavia. 2938 patients with "cold" thyroid nodules (22 of them with clinically manifest thyroid Ca) were examined by aspi- ration biopsies between 1975-79. Cytologic analysis disclo- sed two groups of patients:.2836.cases with benign thyroid lesions and 80 with malignant ones. Surgery was performed on 64 patients of the first and 57 of the second groups: subsequent pathohistologic examinations of the surgical specimens were used to evaluate the cytologic findings.Thus, 7 false negative results were discovered in the first, and 5 false positive regults in the second group. The obtained results shota that systematic application of aspiration biop- sies on every "cold" nodule enables detection of clinically non-suspected, localized and differentiated thyroid tumors and, actually, represents secondary prevention of thyroid neoplasia. /THYROID-NEOPLASMS DETECTION/ASPIRATION BIOPSY/

LIST OF ABSTRACTS 263 CANCER SCREENING FOR MULTIPLE ENDOCRINE ADENOMATOSIS SYNDROME (MEA II). Hickey, R. C.,Samaan,N.A.,& Hill, C.S.,Jr., The University of Texas System Cancer Center M. D.Anderson Hospital and Tumor Institute, Houston, Texas One hundred forty medullary thyroid carcinoma patients,both in the sporadic and familial groups, are registered here. Five kindreds ex- hibited the MEA II syndrome (medullary thyroid carcinoma,pheochromocy- toma, and parathyroid tumor.) Early identification in family members often before clinical evidence of disease was based on measurement of serum calcium;immunoreactive cal- citonin (ICT), at basal and after penta astrin stimulation; and 24/hour urinary catecholamines and metabolites ~VMA and metanephrine). Investigations and follow-up on thirty-five patients with MEA II for the last 10 years showed that patients detected early with localized disease had a better prognosis than those detected later, often with metastatic spread. All patients screened with elevated urinary cate- cholamines and metabolites in the urine had bilateral pheochromocytomas and either therapeutic or prophylactic surgery. Management of these patients with alpha and beta blockers prevented fatal complications. Screening and early detection of the MEA II syndrome components offers the best cancer prognosis and potential amelioration of other sequelae. 264 J-131 UPTAKE, BIOLOGICAL BEHAVIOR AND RECURRENCE FREE INTERVAL OF DIFFERENTIATED THYROID CANCER. KOKOSCHKA, R., AIGINGER, P., and KRISCH, K. Dept. of Surgery II Dept. of Medicine, Dept. of Pathology, University of Vienna Medical School, Vienna. Austria. Well-differentiated carcinoma of the thyroid gland shows different bio- logical behavior. Experience has demonstrated the difference in rate of growth and subsequent recurrence even in identically differentiated tumors. [5J This report deals with in vivo J-131 uptake, tumor staging and recurrence free interval in 21 thyroid carcinomas of well-differentiated type (11 papillary, 10 follicular). Carcinomas staged T2NOMO have a significant- ly higher uptake rate (30.7%) than tumors staged T3N1M0 (11.1%) and tumors staged T4N1M0 (7.2%). The J-131 uptake is correlated with the recurrence free interval. Patients with an uptake of 30.7% are recurrence free up to 24 months, whereas patients with a rate of 7.2% experienced recurrence within 1-5 months. The authors favor the view that measurement of in vivo J-131 uptake might help to decide postoperative treatment for well-differentiated thyroid carcinoma more easily. /THYROID CARCINOMA/J-131 UPTAKE/RECURRENCE FREE INTERVAL/ 4 r ~ a

LIST OF ABSTRACTS [5] 265 1REAIMENT OF LEUKOPLAKIA WITH "TIGASON" KOCH, H.F. Clinic of maxillofacial and Plastic Surgery of the Face, University of Dusseldorf, Dusseldorf, Germany, F.R. Treatment of precancerous leukoplakia is difficult particularly in multifocal and advanced oral lesions. Since 1970, we have tested the therapeutic effect of different derivatives of retinoic acid. The study includes 75 cases of various types of leukoplakia with minimal to moder- ate epithelial dysplasia. More than 60% of the cases treated showed positive early results. In follow-up from 1 to 9 years, about 45% of cases showed complete or partial remission. The rest showed relapses or even progression. In these cases, positive effects were achieved with 1 to 4 repeated courses of therapy. Under the derivatives of all-trans- retinoic acid, the aromatic retinoid "TIGASON" seems to be most effective in treatment, while undesirable side effects are minimal. . /LEUKOPLAKIA/RETINOIC ACID/ " TIGASON"/ 266 A STUDY OF CANCER OF THE HEAD AND NECK. Herity, B., Moriarty, M., Daly, L., and Bourke, G.J. University College, and St. Luke's Hospital, Dublin, Ireland. A retrospective case-control study of aetiological factors in cancer of the head and neck was undertaken during 1976 and 1977. A presenting sample of 200 patients attending St. Luke's Hospital, Dublin for the treatment of head and neck cancers was compared with a 58 presenting sample of controls attending the same hospital for the PS treatment of non-smoki,ng-related cancers and non-malignant conditions during the same period. Controls were matched for sex and age to within three years of cases. A precoded questionnaire was administered to obtain details of sex, age, occupation, education, tobacco and alcohol consumption, and dental care, and clinical data were also recorded. Significant associations with smoking and alcohol consumption were found, which were dose-related; in particular heavy cigarette smoking was positively associated with cancer of the larynx, and heavy alcohol consumption with cancer of the tongue. This study adds to a growing body of evidence confirming clinical impressions of a positive association between excessive tobacco and alcohol consumption and the development of cancers of the upper respiratory and gastro-intestinal tracts. HEAD AND NECK CANCER/ALCOHOL/TOBACCO

LIST OF ABSTRACTS 267 THYROID OCCULT CARCINOMA :CLINICOPATHOLOGICAL STUDIES AND OPERATIVE MANAGEMENT Di Matteo G., Lucci S. - Surgical Clinic V, School of Medicine,University of Rome,Italy The authors present their experience about nonpalpable thyroid cancers first discovered because of metastatic 58 lesions, the so-called "occult" carcinomas,observed over a ps period of 9 years by the same surgical team. During the period of 1970 through 1979 about 2300 patients were opera- ted at our Institution because of thyroid diseases; a total of 246 thyroid cancers were treated : 12 patients were found to have "occult" lesions. The authors discuss latent and occult thyroid cancers, analyse their clinico-pathological and biologic characteristics,indicate Total Thyroidectomy plus.bilateral modified neck dissection as the most adequate therapy to treat such particular entities. /OCCULT THYROID CANCER / TOTAL THYROIDECTOMY/ 268 HOW MUCH TO RESECT IN THE CASE OF DIFFERENTIATED THYROID CARCINOMA. KOKOSCNKA, R., NIEDERLE, B. and KRISCH, K. Department of Surgery Ij and Department of pathology, University of Vienna, Vienna, Austria. Radical surgery in the case of differentiated thyroid cancer has vanished because of the efficiency of postoperative treatment and follow-up. Lob- ectomy usually is performed, The authors reason for thyroidectoW 58 coinbined with lymph node excision even if no lyrrphatic involvanent is ps evident, are as follows: In case of papillary carcinoma, local lymphatic spread may be occult and not detectable by frozen section examination. lhyroidectomy makes postoperative J-131 treatment more effective, as well as whole-body scanning and J-131 retention in outpatients follow-up. Seventeen patients (age 53, T1-4NOMO) out of 77 operated on by modified neck dissection because of papillary cancer under went this treatment after resection or lobecto!ry. It was necessary after 3 years. Four patients died, 13 patients are without recurrence for 4 years (2-8). Sixty patients (age 43) T2-4N1a10 underwent modified neck dissection with the result of no recurrence after six years (2-17). The authors favor the view that thyroidectomy and local lynpb node excis- ion can reduce further operations. /THYROID CANCEIt/1HYROIDECIOMY AND NOCE EXCISION/

'S 58 PS LIST OF ABSTRACTS 269 SOME OBSERVATIONS ON THE ULTRASTRUCTURE OF BENIGN TUMORS OF THE PAROTID GLAND. SZENDE, B., TIMAR, J., and LAPIS, K. Institute of Pathology and Experimental Cancer Research, Semmeiweis Medica2 University, Budapest, Hungary. The ultrastructural features of Warthin's tumour, basal cell adenoma, pleomorph adenoma and benign lymphoepithelial lesion will be discussed. The epithelial cells of Warthin's tumour are very much like normal ductal cells, but frequently show an oncocytal transformation. The lymphoid cells of this tumour are resting lymphocytes. The basal cell adenoma consists mainly of undifferentiated basal cells, but a differentiation toward myoepithel and flattened epithelium can also be observed. The main features of the lymphoepithelial lesion are the proliferation of abnormally differentiated regenerating epithelial cells and a defensive lymphoid reaction. The malignant transformation of the pleomorph adenoma may originate from the proliferation of one type of cell building up this tumour. /PAROTID GLAND/BENIGN TUMOURS/ULTRASTRUCTURE/ 58 PS 270 EVALUATION OF HISTOLOGIC CHANGES IN LARYNGEAL MUCOSA IN PREMALIGNANT GROWTH. KambM, V., Radgel, Z., Gale, N. University of Medicine - ENT Department, Institut of Pathology, Ljubljana, Yugoslavia The histological picture which should be taken as characteristic of the tendency of the malignant degeneration of the tissue enables an objective assessment of the treatment for precanceroses. It is well known that histologic picture and biological properties of the hyperplastic aberration on the laryngeal mucosa do not correlate. Changes labelled as "precancerosis" do not occur only on the epithelium but appear also on the stroma, therefore, "precancerosis" is an ectomesodermal complex which has to be considered in evaluation. The authors recommend a histologic classification which would enable a more objective evaluation of hyperplastic changes on the laryngeal mucosa. They are of the opinion that the term "precancerosis" is not appropriate and that it should be supplemented by a more appropriate one. Their conception of the histologic patterns in risk epithelium is presented. The present stage of our knowledge of laryngeal carcinoma as well as future prospects and possibilities of therapy force us to evaluate risk epithelium very accurately and treat it accordingly. /RISK EPITHELIUM/HISTOLOGIC CLASSIFICATION/ I I !

LIST OF ABSTRACTS 271 THE DEVELOPMENT OF LUNG CANCER. Spencer, H. St. Thomas's Hospital Medical School, London SEI 7EH, England. (45) Lung cancer now one of the most common forms of cancer in males in most developed countries still carries a very poor prognosis once diagnosed. One main reason is that lung cancer is usually only detected during the last quarter of its total lifespan. Premalignant changes leading to lung cancer are those common to most forms of cancer- chronic reparative hyperplasia leading to neoplastic change, bronchial dysplasia leading to carcinoma in situ proceeding to invasive cancer. The aetiology of these changes and their bearing-on the delay in early diagnosis and subsequent course of the disease will be described. /PREMALIGNANT STATES/LUNG CANCER/LATE DETECTION/SPREAD/ 272 . DIAGNOSIS OF LING TUv10RS SEAL, R.M.E. Department of Pathology, Llandough Hospita2, Nr. Penarth, Cardiff, Glamorgan., England. [45) Occupational lung cancers other than those related to asbes- tos exposure will be briefly discussed. The histological classification of lung tumors will be discussed and the histopathology of bronchial biopsy correl- ated with the cytology. The place of cytology in the diag- nosis of the individual case and its possible use in selected high risk groups will be discussed.

THE DIAGNOSIS OF ASBESTOS RELATED CANCER. Corrin, B. Cardiothoracic Institute, Brompton Hospital, London, SW3 6HP, England. This paper will review 1) the pathological features of malignant mesothelioma and its distinction from other growths, in particular metastatic adenocarcinoma 2) the distinction of asbestosis from other forms of diffuse pulmonary fibrosis, which is important in Britain because industrial compensation for lung cancer is payable to asbestos workers only if the tumour has complicated asbestosis. The value of lung asbestos fibre counts in recognising an occupational as opposed to other environ- mental exposure will be considered in relation to both mesothelioma and diffuse interstitial fibrosis of the lung. /ASBESTOS/MtiSOTHELIOMA/ASBESTOSIS/CARCINOMA LUNG/ 274 TUMOUR MARKERS IN LUNG CANCER: THEIR IMMUNOPEROXIDASE LOCALISATION. Heyderman, Eadie, Department of Morbid Anatomy, St. Thomas's Hospital Medical School, London SEI 7EH, England. Lung tumours may be associated with a variety of ectopic tumour products. Some of these are hormones and are associated with ectopic syndromes; others such as carcinoembryonic antigen (CEA) and calcitonin have no demonstrable biological effect and are detected by biochemical assay. Oat cell carcinomas tend to be associated with production of ACTH, ADH, CEA and calcitonin; adenocarcinomas with CEA and calcitonin; squamous cell carcinomas with parathyroid hormone and giant cell tumours with placental protein production. Secretion of ACTH may be accompanied by any of the g lipotrophin moieties such as MSH and endorphins, and some tumours produce hormone releasing factors. Many of these materials may be demonstrated in tissue sections of the tumour using the immunoperoxidase technique. This is suitable for routinely fixed and paraffin embedded material so that retrospective studies are possible. By employing serial sections, the distribution and segregation of multiple tumour markers can be shown in the same tumour sample. The localisation.of various tumour markers is of potential value in elucidating the biology of lung cancer and should lead to more precise pathological classification on the basis of functional as well as morphological criteria. /TUMOUR MARKERS/IMMUNOPEROXIDASE/LUNG CARCINOMA/

LIST OF ABSTRACTS 275 SECULAR CHATTGES 11! LUNG CANCER ETIOLOGYs OCClTP,1TI0", PLEURAL PLAQUES, AND SbSOKI1IG, 1964 TO 1979. • Hillerdal,G. Institute of Pulmor.ary Medicine, University Hbspital, Uppsala, Sweden. All patients with pulmonary carcinoma WHO I-TV seen during a 16-year-period at the Clinic were studied retrospectively. In most cases smoking history, occupations, and chest X-rays were available. Occupations with probable exposure to asbestos were considered to [50] be work in the building industry, dock yards, automobile industry, etc. X-rays were scrutinized for pleural plaques. Only typical bilateral changes without any signs of old pleurisy were accepted. There were 889 male cases. Only 3,9 % of these were never-smokers, with no significant changes between the WHO types, and with no change with time. The frequency of pleural plaques increased from 2,0% 1964-67 to 14,1% 1976-79. This rise is parallell to the rise in the general population but is at any time period 4 to 5 times higher than expected. "Asbestos occupations" were 18% in the first period and 29 in the last. Female cases rrere 197. In 1964-67, 75% were non-smokers, and in 1976-79 43,2%. Fspecir.lly among the young patients an increase of the percentage of idHO I and II was seen.It is conclud^d that co-carcinoPens like asbestos are more important today, possibly because cigarettes today contain less tar. /LUNG CAP?C.^R/ SD!OKING/ ASBESTOS/ PLEURAL PLAQUES/ 276 CARCINOMAS OF THE LUNG : AN OCCUPATIONAL DISTRIBUTION IN THE GENERAL POPULATION OF THE RHONE-ALPES AREA. Mouriquand J., Mouriquand C., Mermet M.A., & Dutet M.L. Laboratoire de Cytologie, Centre Hospitalier R6gional, BP 217 X- 38043 GRENOBLE CEDEX - FRANCE 815 cases of bronchial carcinomas (611 epidermoid and 204 small cell carcinomas), were correlated with professional categories. Occupational data were obtained from hospital admission records. (50) There was no difference in the professional distribution of small cell and epidermoid carcinomas. 49% of the patients belonged to 4 occu- pational groups which appear at risk. 18% metal workers, 13% construc- tion workers, 11% farmers and 7% truck drivers. 48% of the cases occur in metal workers, construction workers and truck drivers before the age of 50. Only in the farmer group does the percentage of lung cancer increase with age. These observations are correlated with 3 control groups : the occu- pational distribution - a) in the general population of the Rhone-A1pes area as obtained by the census of 1975 - b) in 584 non cancerous pa- tients admitted in the chest disease department - c) in hospital admis- sion records of the surgical department. Statistical evaluations of these data will be given. CANCER - LUNG - EPIDEMIOLOGY - OCCUPATIONAL DISEASES. r _j X~ ,o N

LIST OF ABSTRACTS (50I 2n -LUNG CANCER DETECTION STUDY IN CZECHOSLOVAKIA (PRELIMINARY REPORT). Kubik,A., Po1gk,J. Research Inst.of Tuberc.and Respiratory Die.,Prague,Czechoslovakia. A prospective experimental study of lung cancer detect- ion organized by the Research Institute of Tuberculosis and Respiratory Diseases, Prague, is in progress sinoe the year 1976. The objective of the study is to ascertain whether periodic screening of high-risk groups is able to reduce lung cancer mortality in the population under study. 6365 men aged 40-64 years having smoked not less than 150,000 cigarettes were enrolled in the study, and divided randomly into two subgroups. In the experimental subgroup periodic screening is being performed at eixmonthly inter- va].s, consisting of chest photofluorography, cytologic sputum investigations and completion of a questionnaire. The control subgroup ~s investigated at the beginning and the end of the 3-yea'r period of the astudy, employing the same methods. During the initial screening of the series of 6365 men 18 cases of lung cancer were found (283 per 100,000); pulmonary resection was done in 6 of them. The preliminary experiences confirmed the feasibility of the screening procedures in the collaborating Chest Clinics, %LUNGhCANCERcDETECTION%PHOTOFLUOROGWHY/SPUiTUM. CYTOLOGY/ v8 NATURAL HISTORY OF LUNG CANCER: COMPUTER SIMULATION EXPLAINS DATA OF NEW YORK EARLY LUNG CANCER DETECTION PROGRAM. Flehinger, B.J., Melamed, M.R., Smart, J.S., Zaman, M.B., Tucker, E. R., and Martini, N. IBM T.J. Watson Research Center, Yorktown Heights, NY and Memorial Sloan-Kettering Cancer Center, New York, NY. A computer simulator of a periodic screening program for the early detection of lung cancer has been developed. It (50) is based upon the assumption that the natural history of each type of cancer may be represented by a sequence of stages proceeding from incidence to cure or death. Successive stages, with random sojourn times, are characterized by increasing probabilities of detection and decreasing probabilities of cure. Data about prevalence, incidence, and survival obtained by the National Lung Program in New York through annual screening of 10,000 heavy-smoking men over age 45 were matched to the outputs of the simulator. Thus, the natural histories of bronchogenic adeno, epidermoid, and oat-cell carcinoma were characterized and the possibility of successful early detection and cure for each was explored. CREENING /LUNG CANCER/SCOMPUTER SI6_LATION%LY DETECTION/

LIST OF ABSTRACTS 279 IL2:iUNOLOGICAh DIAGNOSTIC P,tOCEDUi2ES IN URANIUM J:iI1TERS :`1TTH LUNG CANCER. Andrlikova,J., Kudrna,K., kip1,Z., Niid,A., & Palek,V. Health Institute of Uranium Industry, Research Department, Yribram, Czechoslovakia. The uranium miners are representinLr.- one of the "high risk sroups" ae related to the lung cancer. In our case the iiuaunolo~;ical aspects of ionizin;; radiations must be (50) accounted into consideration. Uranium miners with proved lun;; cancer and controls h ave been investigated using :;e- -riun irununo(;lobulin levels, lymphocyte blastic transforma- tion af ter stii7ulation -by PHA and rosette f orniinb cells test. The irmiunoglobulin levels do not appear to be of reliable value for diagnosis of early stages of lung can- cer. IgG levels in patients depend on their clinical sta- te. Iij;iune state of patients bearing neoplasia with res- pect to cellular irnmunity is distinctly affected when con- siderinS the lymphocyte blastic transformation and rosette forminn cells tests. The interferrence of changes as a re- sult of ionizing radiations with nalignant process in the uranium miners is discussed. /It,II'iNNOLOGY/LUNG CANCER DETECTION/U'iiAI1IUI,I MINERS/ 280 EXPOSURE TO BENZENE AND RADIATION - RISK OF LUNG TliMOURS IN SWISS MICE. Gothoskar, S.V., Cancer Research Institute, Bombay 400 012, India. Fractionated doses of radiations as well as exposure to' Benzene are suspected leukamogenic agents in human popula- tion. Recent literature suggests the possibility of risk• of other cancer types associated with radiation. In the (50) pilot experiment, total number of 100 Swiss mice of both the sexes were divided into following 4 groups: 1) un- treated control mice, 2) mice exposed to X-irradiation in 4 doses of 100'rads each at weekly interval, 3) mice receiv- ing cutaneous application of AR grade benzene thrice a week for 6 months and 4) mice without cutaneous application exposed to inhale the vapours:of benzene, being housed with the mice of group 3. Autopsies performed on weak and mori- bund animals (ages 9 to 18 months), showed prevalence of lung tumours in male mice exposed to benzene by both the routes and also to radiation. The control groups were free ot any lesion. Radiation exposed female mice developed leukaemia originating in thymus. The above results will be discussed in the light of epidemiological reports. / BENZENE/RADIATION/MICE/LUNG TUMOUR/LEUKEMIA /.

281 SMOKING AND HISTOLOGY OF BRONCHOGENIC CARCINOMA ASSOC.PROF. N.DONTAS, C.RAPTIS, CHR.KAKAVAS. From the THORACIC SURGICAL DEPARTKENT OF THE GREEK ANTICANCER INSTITUTE, ATHENS 603, GREECE. smoking is the most important aetiological factor of bronchogenic carcinoma. Many studies have analysed carcinogenicity of tobacco components and their effect upon relationship between dose and type of tumour. Present communication evaluates 2.000 cases of broncho- genic carcinoma and corresponding influence of smoking upon their histological type. Number of cigarettes per day, age at which smoking began and total number of years an individual has smoked regularly were assessed. Squamous cell carcinoma and undifferentiated type were influenced from smoking by 87 %, while adenocarcinoma and small type tumours had an effect only by 55 %. /BRONCHOGENIC CARCINOMA/SMOKING/HISTOLOGY/ DELAYED HYPERSENSITIVITY TOBACCO PROTEIN ANTIGEN: ITS SEPARATION BY HIGH PRESSURE LIQUID CHROMATOGRAPHY AND RELATION TO LUNG CARCINOGENESIS. Steward, A.M., and Misconi. L.Y. Department of Surgery, University of Melbourne: Department of Chemistry, Swinburne College-of Tethnology, Hawthorn, Victoria; Luhg Cancer Research Centre, Morwell, Victoria. The consumption of cigarette tobacco has statistically correlated with the incidence of deaths from lung cancer. The pathological .mechanisms involved however are unclear. Tobacco-derived proteins have shown several immunological properties: one is the production of delayed hypersensitivity skin responses in lung cancer patients (Steward, A.M. (1973). Clin. Res. 21:983). The present study has separated cigarette tobacco proteins by high pressure liquid chromatog- raphy (HPLC) using the Waters Protein Separation System. The chromatog- ram showed 9 defineable protein peaks at 280nm. Molecular weights ranged from 2,000 to 80,000 daltons. The main biological (skin test) activity was in the peaks merging at the 80,000 mark. U.K. Life Tables show diminishing deaths from pulmonary Tb have been balanced by increasing lung cancer deaths. The present findings suggested that the pathogenesis of Pulmonary Tb and lung cancer are interrelated: the former being a tissue response to mycobacterial protein, and lung cancer-a response to the sensitizing stimulus of tobacco protein. /TOBACCO PROTEIN ANTIGEN/9 PROTEIN PEAKS/PATIENT SENSITIZATION

LIST OF ABSTRACTS 283 ANTI-SMOKING CAMPAIGN IN GREEK SCHOOLCHILDREN. ASSOC.PROF. N.S.DONTAS, GENERAL SECRETARY, HELLENIC CANCER SOCIETY, 6 GEORGE STREET, ATHENS,GREECE. 52 PS Antismoking campaign in high schools is an essential deed in organising prevention of pro-cancerous habit, In a previous oommunication it was reported ( N.DONTAS, Facts on smoking behaviour in Greek schoolchildren, 4th World Conference on Smoking and Health, Stockholm 1979 ) that girls are more apt to smoking than boys in a ratio of 54.1/45.9. A further analysis suggests that 70 % of this habit is done for mimic and boredom of young female generation, and also that strict family conditions reduce, or postpone an early start. Criteria propose that campaign should be done a) early in high school, b) by medical staff, and c) by rbund table discussions with doctors, psychologists and children. /SMOKING CAMPAIGN/BEHAVIOUR/HIGH SCHOOLS/ 2814 PROGNOSTIC FACTORS IN LUNG CANCER STOLOFF, I.L., KANOFSKY, P., and BROISSIER, K. Jefferson Medical College, Philadelphia, PA 19107, U.S.A. A study of 273 patients with proved'primary lung cancer observed five years or more was undertaken to determine the prognostic factors from among a group of ten recorded at the time of diagnosis. Bronchoscopic location of the tumor, histologic type and resectability were the major survival determinants and were independent of each other. Survival im- (50J proved the more distal the tumor even after adjusting for cell type and resectability. The biological significance of the findings and their implications in improving the current staging method will be discussed. /PROGNOSIS/LUNG CANCER/BRONCHOSCOPIC IACATION/

yIST OF ABSTRACTS 285 SEQUENTIAL CHANGES IN SPUTUM CYTOLOGY IN A HIGH CANCER RISK POPULATION. Madison, R, Mittman, C, Zelman, R, Teplitz, R. City of Hope Medical Center, Duarte, California, USA. In some workers exposed to specific occupational carcinogens sputum cytology undergoes progressive pre-malignant changes prior to the development of lung cancer. To better delineate this sequence we are studying a cohort of approximately 4000 steel workers employed on coke ovens at 12 different locations throughout the United States. Standardized methods are used to evaluate metaplastic and malignant changes. In addition, inflammation is quantitated by evaluation of the presence and features of various cells such as leukocytes and histiocytes. Regular metaplasia was present in approximately 11% of workers studied. Inflammatory and metapiastic changes were common In smokers but were seen, as well, more frequently in non-smoking than in workers not exposed to coke oven emissions. The type and duration of exposure at work influenced the frequency of observed changes. Inflammatory cells appeared soon after the beginning of the work expo- sure. With long exposure, regular metaplasia tended to develop and inflammatory cells were seen less frequently. Our longitudinal obser- vations cover only a brief period. They suggest that this approach permits assessment of the influence of various environmental and constitutional factors on the tracheobronchial tree as reflected In exfoliated cells. /sputum cytology/coke oven workers/ 286 CYTOLOGIC RESPIRATORY CHANGES IN WORKERS EXPOSED TO AIR POLLUTION AND CIGARETTE SMOKING. Vetrani,A., Palombini,L., Del Basso De Caro,hf.l.., Marino, M. cytology Laboratory,Institute of Pathologic.Anatomy, II Fa- culty of Medicine and Surgery,University of Nanles, Italy. A random soutum specimens from 420/2500 sweepers of Naples city (369 male smokers-. at least 10 daily filter cigarettes /50)trounht a minimum of ten years- and 51 male non smokers,con- trol) have been investigated. In the smokers groun 220 cases(59,6%) as non specific ch- ronic inflammatory disease, 54 cases(14,61~) as regular squa- mous metaplasia, and 13(3,5%) as atypical squamous metapla- sia are reported. One case(0;3ro) of presumed carcinoma in situ has been identified. In the control qroup, 18 cases(35,3t) tion specific chronic inflammatory processes with occasional re.qulaP squamous me- tanlasia was the only founded pathology. According to their results the AA. believe that air pollu- tion may enhance on the respiratory tract the smoking ef- fect or viceversa. LUNG CANCER/ENVIRONMENT

LIST OF ABSTRACTS 287 RELIABILITY OF PERCUTANEOUS NEEDLE ASPIRATION BIOPSY FOR DIAGNOSIS OF BRONCHOGENIC CARCINOMA Jamieson, W.R.E., Hicken, P., Suen, K.C., Burr, L.H., Munro, A.I., Vancouver General Hospital, Vancouver, B.C., Canada. Preoperative diagnosis, and typing of pulmonary lesions is influential In patient management. Percutaneous needle aspiration biopsy of lung lesions has a high predictive value. Between August 1978 and January 1980, 50 patients were investigated for pulmonary lesions by the above technique. The majority of patients were presented for the evaluation following nondiagnostic bronchoscopy (50] and/or mediastinoscopy. The cytological diagnoses were as follows: malignant lesions - primary bronchogenic carcinoma (32), carcinold (1), sarcoma (1) and metastatic carcinoma (3); non-malignant lesions - inflammatory lesions (11), benign tumors (2). Thirty of the 50 patients came to surgery - 22 with confirmation of malignancy, and 8, of non-malignant lesions. The cases were all true positives or true negatives. Twenty patients were not presented to surgery - 16 with diagnosis of malignancy, latter confirmed by clinical evaluation; 3, of inflammatory disease; and one, inadequate specimen. The procedures were performed under fluoroscopy (PH) utilizing a Chiba 23 gauge needle. The cytological examination was performed at time of biopsy, often multiple biopsies were required (KCS). The complication rate of pneumothoraces was 46% (23), but only 8% (4) required Intercostal tube decompression. The specificity, sensitivity and predictive value in this series is 100%. BRONCHOGENIC CARCINOMA, ASPIRATION BIOPSY, CYTOLOGY L7 ~ FLEXIBLE FIBEROPTIC BRONCHOSCOPY IN THE DIAGNOSIS OF THE PULMONARY COMPLICATIONS OF LYMPHOMA CHUANG, M.T., GRIBETZ, A.R., TEIRSTEIN, A.S., BERMAN, L.B. Division of Pulmonary Medicine, Department of Medicine, Mount Sinai Medical Center, New York, NY 20029,.U.S..A. Patients with known Hodgkins and non-Hodgkins lyrrphorna often present with pulmonary abnortnalities which require pranpt diagnosis. The usual radiographic, sputum, blood and serologic techniques tnay fail to be of 65 diagnostic value. Since February, 1972, we have performed flexible rs fiberoptic bronchoscopy on 35 such patients with Hodgkins and 29 with non-Hodgkins lymphana. In 15 of the 64 patients, biopsy specimens re- vealed lymphoma, six pneumocystic carinii infection, twa aspergillus infection, and in three others cryptococcus, herpes simplex and squamous cell carcinoma, respectively. In all, a specific diagnosis was obtained with the flexible bronchoscope in 26 patients (40.6%). In the remaining 38 patients, the bronchoscopy specimens failed to yield a precise diag- nosis and further procedures were required or the patient was treated empirically. Flexible fiberoptic bronchoscopy is a relatively risk-free diagnostic procedure which is recomnended as a valuable initial invasive study in the diagnosis of the various pulmonary canplications of lymphoma. }a

LIST OF ABSTRACTS t121 /121 289 EARLY GASTRIC CANCER AND EXPERIMENTAL ASPECTS. Minoru Kurihara, Tadashi Yarita & Hikoo Shirakabe, Dept• of Internal Medicine, School of Medicine, Juntendo University, Tokyo, Japan. 369 cases with 423 lesions of early gastric cancer have been detected by the combined use of x-rays, gastroscopy and biopsy in the past 11 years in our department. Diagnos- tic accuracy has been raised year by year, but difficulties arise in the detection of minute cancers. 54 out of the 423 lesions of early gastric cancer were less than 10mm in dia- meter. 29 of them between 5 and 10mm in diameter ( 7 eleva- ted and 22 depressed type ) could be diagnosed preoperative -ly, but the remaining 25 lesions less than 5mm in diameter were hardly identified even in the resected specimens. Early findings and growing process of gastric cancer have been studied in experimental dog gastric cancer. With our methods of gastric cancer production in dogs ( 2.Krebs- forsh,90:241-252,1977 ), it was confirmed by x-rays and gastroscopy that a tiny erosion with a histological proof of cancer began to appear around one year after the start of ENNG administration and it grew up to advanced cancer during the follow-up. /EARLY GASTRIC CANCER/MINUTE CANCER/EXPERIMENTAL DOG GASTRIC CANCER/ 290 DETECTION OF EARLY ESOPHAGEAL CANCER YAMADA, Akiyoshi. Institute of Gastroenterology, Tokyo Women's Medical College, Tokyo, Japan. According to the Japanese Society for Esophageal. Diseases, we define superficial esophageal carcinoma as having its infiltration limited with- in the submucosal layer, among which the one without lymph node metastasis is called "early carcinoma." In our hospital, we have experienced 43 cases of superficial carcinoma including 28 cases of early carcinoma. Five-year survival rate of early carcinoma is 64%. On the other hand, that of superficial carcinoma with lymph node metastasis is only 20%. Thus, five year survival rate of the latter is not superior to that of all carcinoma cases. Six out of 12 cases of early carcinoma with vascul- ar invasion died of recurrence of carcinoma. From X-Ray findings, we divided superficial carcinoma into five types, i.e., superficial flat, superficial depressed, superficial elevated, tumorous elevated and tumorous. This paper will present X-Ray findings characteristic of these types and will discues the correlation between X-Ray findings and lymph node metastasis and/or vascular invasion. /EARLY ESOPHAGEAL CANCER/SUPERFICIAL CANCER/X-RAY FINDINGS/

LIST OF ABSTRACTS 291 RIJCETP PROGRESS IN X-RAY DIAQN06IS CF UPPER CA.STRfJINTESTINAL TRACI'. lfftEEL, Louis. Department of Radiology, Clinical Research Centre, Northwick Park Hospital, Harrow, U.K. lj21 ~ FARLY GASTRIC CANCER AND ITS FXPFRIMFNTAL ASPECTS. Vernaza, J.L., M.D., Hospital Santo Tomas, Panama. With the development of the double contrast technique, a macroscopic descriptive classification, and a profound knowledge of histopathology, the concepts off early gastric cancer (E.G.C.) were defined in 1962, in Japan. This under- standing lead the way for its early detection and since then a 5 year survival rate of 95-100%, with adequate surgery, f121 has been demonstrated. E.G.C. can appear as elevated, superficial, or depressed lesions. Follow up observations of malignant ulcers reported in the literature,reveal a sig- nificant healing process that can mislead its malignant nature. As a conclusion, all gastric ulcers should be biopsied. Nakamura's histological evaluation of minute E.G.C. revealed a high prevalence for signet ring cell car- cinoma in the fundic gland area, where linitis plastica usually occurs, suggesting its possible histogenesis. Also, experimental gastric cancer has been induced in dogs, using N-Nitroso compounds. Further research on these aspects are in process in Japan. A brief comment on the state of F.G.C. in Panama will be discussed. /EARLY GASTRIC CANCER/EXPFRIMFNTAL GASTRIC CANCFR/ /EARLY DETECTION/ J 0 0 0

LIST OF ABSTRACTS 293 EARLY DETECTION OF GASTRIC CANCER BASED ON PATHOLO- GICAL AND ENZYMOLOGICAL STUDIES. Sugar, J., Szentirmay, Z. and Kralovanszky, J. National Oncological Institute, Research Institute of Oncopathology, Budapest, Hungary. Atypical glandular proliferation processes (dysplasias) of human gastric mucosa have been studied. By the use of Feulgen's cytophotometry and a new mathematical test 1121 developed by us the same type of aneuploid (hypo- and hyperdiploid) DNA content could be demonstrated as in cancers. In addition to aneuploidy, the presence of ectopically synthetized alkaline phosphatase isoenzyme in the surgical specimens could be proved that had been identified so far only in placental and tumour tissues. With these methods dysplasias representing a transition to early cancer can be selected. 294 CANCER OF THE UPPER GASTROINTESTINAL TRACT ENDSCO- PIC DIAGNOSIS. S. Nakazawa,M.D. Nagoya Univ. Japan. Endoscopical diagnosis of early gastric cancer and duodenal malignancies will be discussed based on the studies of 255 and 69 cases of each. Minute gastric cancerk5mm in diamet- er) can be divided into elevated, flat and depressed types. Tiny stellate erosion surrounded by minimal mucosal elevati- on was characteristic endoscopical feature of depressed ty- (12] pe lesions, while reddening or patchy discoloration of the mucosa were significant findings in flat type lesions. It is to be noted that nearly half(46.6%) of early gastric ca- ncers were asymptomatic and detected by mass survey. Duodenal malignancies include carcinoma of the papilla(.50 cases), extrapapillary carcinoma(12 cases) and sarcoma( 7 cases). Duodenal carcinoma tended to present with differe- nt gross appearances depending on its location; namely, ulcerated platelike lesions in the duodenal cap, stenotic lesion of varying degrees in the descending limb and irreg- ular tumor growth accompanied by erosion or ulceration in the papillary region. While differentiation between carci- noma and sarcoma was rarely a problem, it was not necessari- ly easy to differentiate the carcinoma of papilla from those of biliary or pancreatic duct origin. / EARLY GASTRIC CANCER / DUODENAL CANCER /

LIST OF ABSTRACTS 295 RECENT ADVANCES IN ENDOSCOPY IN TFE DIAGNOSIS OF UPPER GASTROINTESTINAL DISEASES COLCHER, H. Division of Gastroenterology, The Medical Center, University of Alabama, Birmingham AL 35294, U.S.A. [12I 2% TID; MA.SS SURVr."Y FOR STCMACH CANCER AT flOIQSAIDO PRFTEX'NRE IN JAPAN. YOSHIDA, Yuji and TAMURA, Koichi. Cancer Detection Center, Hokkaido Anti-Cancer Association, Hokkaido, Japan. We have carried out a gastric mass survey for 17 years, since 1973, and think that it is very effective in reducing the death rate for stcniach cancer. Here, we report the met}nd, results and evaluation of effective- ness. In discussing the effects of the mass survey, we will repart on (12) the data for the 9-year period, 1970-1978: 1,050,680 exaninees were screen- ed and 1,371 cancers were detected. The detection rate was 0.15% in total, 0.20% in males, 0.10% in females. Histological studies revealed cancers infiltrating to the rmacosa and sukmuoosa (called early gastric cancer) in 466 cases (42.8%); advanced cancers were fonmd in 623 cases (57.2%). As for the survival rate of patients with stcmach cancer, the 5-year survival rate was 95.4% in early cancer, 51.3% in advanced cancer. FYcm the facts stated above, it may be oonclude8 that the gastric mass survey is effect- ive in reducing the death rate for stamach cancer.

LIST OF ABSTRACTS 297 EARLY CANCER DE't'ECPION AND PRF'MUI0N IN THE UPPER AERD- DIGESI'IVE TRAL`P Steiner, W., M. P. Jatunarul, H. -J. Pesch. Departrient of C+t,orhinolaryngo- lpgy ani Pathology, University Erlangen, W-Gennany pp until quite recently, the tumaurs of the upper aero-digestive tract received little attention, since their mortality is low. According to figures issued by the American Cancer Society (1976), however, the inci- 116] dence of cancer in the rmuth, pharynx and larynx is higher than that of cancer of the stanach or cervix. The methodological requirements for the early detection of cancer in the upger aero-digestive tract have been met. Fndosoopes providedpith a g0 optical system make it possible to carry out a reliable inspection of the conscious patient, 3n vtxxn cancer may be suspected. This sirple, rapid and stress-free examination has been eaployed by us since 1975, in over 30.000 persons investigated during various research projects. Sus- picicus proliferations can be clarified using cytology and biopsy, re- liably and inexpensively. In the case of early-stage lesions, functional therapy resulting in a cure, can be achieved in more than 90 %. Thus the situation for cancer prevention and early cancer detection is rrore favourable than in any other organ system. EARLY DF4TJC4'ION/UPPER AEFLO-DI(ESTIVE TRACT/FNDOSOOPY/MASS SMONMG 2~ SCREENING FOR OESOPHAGEAL CANCER, AETIOLOGICAL CLUES. A.F. Baskind, J.H. Koornhof, D.C. Hamilton, A.V. Berry, T. Crowngold. Department of Surgery and School of Pathology, University of the Witwatersrand, Johannesburg, South Africa. A prograeaoe of screening for oesophageal cancer using an inflatable ab- rasive brush has been conducted amongst a very high risk black popula- tion group of Southern Africans. A 32 incidence of unsuspected oesopha- geal cancer of which 22 is ca-in-situ, microinvasive cancer or very (18] early invasive cancer was found amongst a randomly selected population without oesophageal symptoms. Using groups of these patients with a stepwise gradually increasing severity of oesophageal premalignancy to malignancy we have established their maximal acid output (MAO) and collected upper gastro-intestinal secretions for mutagenic studies (Ames Test). Normal Atypia Dysnlasia Ca-in-situ Invasive Ca No. of cases 10 8 5 3 5 MAO, mEq/hr, z(SEM) 14 (4) 12 (3) 3 (1) 2 (1) 2 (1) Mutagens (Incidence) 0/10 0/8 3/5 3/3 2/5 We have therefore shown a clear relationship between hypochlorhydria,the presence of mutagens in the contents of the upper gastrointestinal tract and dysplasia, Ca-in-situ or malignancy of the oesophagus (p<0.05). These results support a hypothesis that hypochlorhydria permits the prolifer- ation of mutagen producing bacteria in the upper gastrointestinal tract, which form a carcinogen that causes premalignant and malignant changes. /OESOPHAGEAL CANCER/SCREENING/HYPOCHLORHYDRIA/MUTAGENS/

LIST OF ABSTRACTS 1281 299 THE ROLE OF OESOPHAGOSCOPY IN DETECTION OF OESO- PHAGEAL TUMORS. A. Roth and K. Kolaric, Central Institute for Tumors and Allied Diseases, Zagreb, Yugoslavia. During the period from March 1973 to August 1979 at the Central Institute for Tumors and Allied Diseases in Zagreb oesophagoscopy was performed in 160 patients with oesophageal tumors. A hundred and fifty one patients (128 males and 23 females) were retrospectively evaluated. The mean age of the whole group was 60.8 years (males 60.5; females 62.4). The authors present the analyses of pathohistologic types of tu- mors and correlate them with cytological findings. Seventy nine precent of patients (120/151) had squamous cell carcinoma. In 51 patients his- tologic findings were compared with cytology and in six patients only cytological examinations were positive. Furthermore, the localizations of tumors in oesophagus were analysed and in more than 50 percent of patients (82/151) tumor was localized in the middle third of oesophagus. Almost in all cases disease was advanced and inoperable. Smoking and alcoholism were also analysed as potential etiological factors. The au- thors consider that oesophagoscopy could be valuable method in early detection of oesophageal carcinoma in high risk group of population (men over 60 years, heavy smokers and alcoholics). 3ffl_ THE SIGNIFICANCE OF EPPI'FLEZ.IAY, DYSPLASIA IN THE UPPER AEFm- DIGESTIVE TRACT ' Pesch, H.-J., W. Steiner. Departrrent of Pathology and Otorhinolaryngo- logy, University Erlangen, W-Germany Acconding to Vd-10 (1978), dysplasias are txnor-like lesions. They repre- sent precancerous stages. Their frequency in the upper aero-digestive tract uas analysed on the basis of more than 10.000 cases, of which the (18) specimens wexe sent in for histological work-up. Dysplasias are found nast frequently in the oral cavity and in the larynx. Acmng the laryngeal dysplasias, 80 % are located in the glottis, the rest in the region of the supraglottis, the distribution being ana- logous to that of carcincma in situ and the T1 carcin4nas (Pesch/Stei- ner (Verh. Dtsch. Ges. Path. 63 (1979) 105)). The subglottis and trachea are not involved, and dysplasias were hardly ever seen in the hypophazynx. On account of their tendency to keratini- ze, they could easy be recognized by visual inspection or zoan endo- soopy in combination with cytology and biopsy. At that stage treatnent could preserve function. These facts argkasize the importanoe of carry- ing aut cancer prevention measures of this organ-system in high-risk groups (smkers older than 30). P ~RS ITI~OuN ~ SPL~A.rSI~~/U~PPE~R -DI~C~STIVEB 1TRACP/CYTQIAGY/ HISICEAG'Y ~ 0 0 r .I tr 0 a

LIST OF ABSTRACTS 301 PROGRESS IN HISTO-CYTOPATHOLOGY FOR THE RECOGNITION OF EARLY STAGES OF GASTRIC CARCINOMA. RAVETTO, C., and SANTAMARIA, L. Istituto di Patologia Generale „C. Golgi"; Centro per la Profilassi, Prevenzione, Diagnosi e Cura del Tumori; Universita di Pavia, Pavia, Italy. The recent progress in detecting point, minute and small gastric cancers is discussed along with the improved experience in identifying cytolog- [187 ically various degrees of atypical cells. Perspectives are presented in an effort to extend the studies of gastric "atypic" lesions both histologically and cytologically with respect to the problem of identify- ing conclusively the carcinoma in situ of gastric mucosa. /EARLY STAGES GASTRIC CARCINOMA/RDOOGNITION/ 3M [28] HISTOPATHOLOGICAL STUDY OF INTESTINAL METAPLASIA IN POST-MORTEM STOMACHS OF AGED INDIVIDUALS Genichi NAKANO, M.D., and Takuji NAKAMURA, M.D. Department of Surgery I, Gunma University, School of Medicine, Maebashi, Japan. The purpose of this investigation is to study the histopathology of intestinal metaplasia (I.M.) of the stomach from various stand points. Four hundred and twenty-two post-mortem stomachs were obtained from aged individuals which were well fixed without prior autolysis because formal- in solution was induced into the stomach as soon after death as possible. In this study, many of the stomachs were examined entirely from cardia to pylorus. Results: [1J The I.M. was classified into 6 types according to the pattern of distribution. [2] Tieo spreading forms of the I.M. were observed: the one, where the I.M. occurred at prepyloric area spreading to cardia; the other was the fusion of two metaplastic processes occur- ring at cardia and prepyloric region separately. [3] The I.M. occurred primarily at cardia in 7.8% of all cases. The intensity of I.M. at cardia was slightly greater than at prepyloric antrum. [Q] Correlation was observed between the intensity of the I.M. and the grade of atrophic change of mucosa. [5] Ninety percent in all gastric cancers in this ser- ies were histopathologically well differentiated adenocarcinomas, and were surrounded with the mucosa with high I.M. /INTESTINAL METAPLASIA/POST-MORTEM STOMACH/THE AGED/

LIST OF ABSTRACTS 303 IS CEA A MARKER HELPFUL IN PREDICTING THE PRE- CANCEROUS STATES IN INTESTINAL METAPLASIA OF GASTRIC MUCOSA ? Lee, P.K., Mori, T., Nakao, T. , Hatada, N., Maruyama, H. & Kosaki, G. Dept. of Surgery II., Osaka Univ. Medical School, Osaka 553, Japan. Immunohistological studies of CEA on surgical specimens of 150 cases of gastric cancer showed that in 93 cases of CEA(+), 71 cases (76%) were found accompanying with intestinal metaplasia (IM) in which CEA was simultaneously detected. [18] In contrast, in 57 cases of CEA (-) , IM was found acoanpanying in only 12 cases (21%) where no CEA was detected. In referring to gastrointestinal epithelia of 20 fetuses of 8-24 weeks gestation immunohistologically, staining pattern of CEA in fetus of 9 weeks gestation was found closely resembled to that of CEA(+) gastric cancer, whereas in fetus of 24 weeks, the pattern was almost looked like that in CEA(+) IM, lead- ing to presume that CEA(+) IM is under-developed when com- paring with CEA(-) IM and seemed to be closer in relating to the development of gastric cancer. Enzymological as well as electron microscopical studies on these CEA(+) and CEA(-) IM were unable to characterize the differences between them. /CEA/INTESTINAL METAPLASIA/GASTRIC CANCER/FETAL TISSUES/ 3N THIOACETAMIDE-INDUCED HEPATOCELLULAR CARCINOMA IN RAT. DASGUPTA, A., CHATTERJEF, R., and ROY CNOWDBUR Y, J. Chittaranjan National Cancer Research Center, Calcutta 700026, India. Status of thioacetamide as hepatocarcinogen is not conclusive. Male albino Wister rats 120g. body weight were fed a diet containing 0.04% of the carcinogen which produced giant nucleoli of hepatocytes, chol- angiofibrosis and hyperplastic hepatic nodules in the earlier part. (18) Hepatocellular carcinara was induced in four rats at the intervals of 300, 360, 450 and 495 days of thioacetamide feeding with lung metastasis in two cases. Succinate dehydrogenase and glucose--G-phosphatase were localized in the hepatocyte nucleoli which are quite new apart fran their usual cytoplasmic counterpart. In malignant hepatocytes, glucose- -6-phosphatase activity was lost canpletely but succinate dehydrogenase was present in fair amount. Usefulness of present data as a diagnostic marker is being explored. /THIOACETAMIDE/FEPATWARCINOGIIQ/

LIST OF ABSTRACTS 305 Y-GLUTAMYLTRANSFERASE (GT) AND GLUTATHIONE IN SEQUENTIAL ANALYSIS OF CHEMICAL CARCINOGENESIS IN RAT LIVER. Fiala, S., Kettering, W. G., Trout, E.C., Fiala, A.E., & Ostrander, H., Veterans Administration Medical Center, Martinsburg, W. Va. 25401. GT (E.C. 2.3.2.2) is a marker of chemical hepatocarcinogenesis in the rat (Fiala et al., J. Natl. Cancer Inst. 48, 1393, 1972; Kalengayi et al., ibid. 55, 579, 1975). A single dose of Iomg/l00g of 3'-Me-DAB or DAB, metabolized in 24 hrs, consumed GSH in 1:1 ratio. Depletion of GSH due to the conjugation with the azodye into an acid-labile complex, induced an increased rate of GSH synthesis and a short-lived GT (TI/2 <20 hr). After all azodye was metabolized, [GSH) reached a max. and GT with a longer T1/2 (>24 hr) was induced. Disulfiram and pyrazole (PZ) inhibited the increase of constitutive, azodye-independent CT but allowed the increase of adaptive, azodye-dependent and relatively short lived GT. Continued supply of the carcinogen produced transition of adaptive CT into constitutive type. GT(+) biliary duct cells were suc- ceeded by the appearance of GT(+) "centaurus-like" hepatocytes that re- sembled those in fetal and neonatal liver. Few C-L cells occur in nor- mal adult liver but their number increases after the "critical" stage in neoplastic nodules. Clusters of C-L hepatocytes delineate GT(+) ca- naliculi. CT in C-L cells is of fetal type, contains high amount of neuraminic acid and is long-lived, whereas most CT in biliary duct cells disappears after carcinogen was removed. Supported by VA Dept. of Research and by Grant CA-14084 from NCI, USPHS. 306 PROTECTIVE ROLE OF GLUTATIIIONE AGAINST LIVER CARCINOGENESIS INDUCED BY AFLATOXIN B.Novi,A.M. Department of Pathology,D'usseldorf University1D'usseldorf, Federal Republic of Germany. It is now widely accepted that antioxidans have an inhibitory effect on induction of chemical carcinogenesis. In this paper,I report evidence that reduced glutathione (GHS) has a protective effect on chemical carcinogenesis ~18) even when administered at the late stage of tumor progression.Wistar Il,female rats were given an 8-week AFBI- carcinogenic regimen that yields hepatocellular Earcinomas in 100% of animals after 1 year (Wogan,G.N.& Newberne,P.M. Cancer Res.27,2370,196?).16 months later when rats started dying of liver tumor,50% (21) of the animals was additionally treated with GEiS (100mg/rat/day).While all rats treated with AFB1 only had died by 20 months after discontinuation of the carcinogen,82% of rats additionally treated with GHS were still alive 4 months later when the experiment was terminated.The gross appearance of GHS- livers showed no tumor changes.However,their lobes had partially or totally coaleshed.These results indicate a regression of tumor growth by GHS administration in vivo. /chemotherapy/chemical carcinogenesis/antioxidans/

LIST OF ABSTRACTS 307 ENDOSCOPIC BORDERLINE PATTERNS IN GASTRIC CANCER PASCU, O., DRAGHICI, A., DUMITRASCU, D. III Medical Clinic, Institute of Medicine and Pharmacy, Cluj-Napoca, Romania. Twb hundred and ninety cases of gastric carcinoma diagnosed in the last two years (representing 11% of endoscopic examinations) have been studied and classified as folloks: 74 ulcerated, 72 infiltrating-diffuse, 90 fungoid, 56 developed on gastric stump (mostly infiltrating). False negative biopsy results have been recorded in 17% of the cases (grade II 59 and III dysplasias; necrotic tissue; normal). The endoscopic picture PS was mostly characteristic and sufficient. In four radiologically and endoscopically benign ulcers, only biopsy revealed the carcinoma. Infil- trating-diffuse carcinoma had to be separated from erosive gastritis very frequently (139 cases in two years) and from circumscribed fibrosis and lymphcma.s (4 cases). Numerous, deep biopsies enabled the diagnosis. All ulcers must be verified by biopsy. Whenever the endoscopic appear- ance is abnormal, numerous biopsies should be performed. Proliferative forms, especially early type I and benign polyps were differentiated by biopsies or endoscopic polypectomy. Hypertrophic scars of ulcers required repeated endoscopies with biopsies. 308 THE DIAGNOSIS OF RESECTABLE PANCREATIC CANCER. Moossa, A.R., Blackstone, M.O., Bowie, J., Lu, C.T. Departments of Surgery and Radiology, University of Chicago, Chicago, Illinois, USA Numerous reports have advocated various diagnostic modalities without mentioning whether potentially curable tumors can be diagnosed by the particular tests. We report a prospective evaluation of six techniques and examine their comparative sensitivity for resectable (R) as opposed to unresectable (U) pancreatic cancer. 192 patients underwent ultra- 59 sonography (US), computed tomography (CT), endoscopic cholangiopancrea- Ps tography (ERCP), 'sSe-methionine scan (PS), arteriography (PA) and duo- denal/pancreatic juice cytology (CYT). Seventy-three patients had ductal adenocarcinoma of the pancreas. Twenty eight (38%) were resectable (mean diameter 3.35 cm). Forty five (62%) were unresectable (mean dia- meter 7.6 cm) and 21 (46%) were associated with hepatic metastases. The results show definite trends. US, ERCP, and CYT are better for R than U tumors probably because R lesions are usually situated in the head and are often of the discrete as opposed to diffuse infiltrating type. CT is better for U than R tumors because it relies on contour distortion or glandular enlargement. PA has similar diagnostic sensitivity for both U and R tumors. PS is confirmed to be valueless. We conclude that US, ERCP and CYT are the best tests for diagnosing pancreatic cancer at all stages. The key to early diagnosis appears to be early suspicion and access to competent diagnostic programs. - DIAGNOSIS OF RESECTABLE PANCREATIC CANCER ~ 0 0 0 r J 0 0 o'

LIST OF ABSTRACTS f191 3~ EPIDEMIOLOGIC CHARACTERISTICS AND TRACE ELEMENTS IN PANCREATIC CANCER IN GREECE. Manousos,O,Tricliopoulos,D.,Koutselinis,A, Papadimitriou,Ch.,Trichopoulou,A. & Zavitsanos,X. Department of Hygiene and Epidemiology,University of Athens,Medical School,Athens, Greece. Epidemiologic characteristics and trace elements (Cu,Zn,Mg) were studied in a sample of 50 patients with pancreatic cancer (32 males and 18 females) admitted at various hospitals of Athens between June 1976 and December 1977, and 100 age and sex matched hospital controls with diagnoses other than cancer and disorders of liver or pancreas. Trace elements were determined by the Perkin-Elmer model 306 atomic absorption spectrophotometer and were expressed in ug/10oml (Cu and Zn) or in mg/ 100m1 (Mg). The main findings are as follows: 1. Moderate and heavy smokers have significantly hipher risk compared to those who smoke little or not al all (relative risk 1.6). 2. There is a significant but not causal association between cancer of the pancreas and diabetes melitus (relative risk 2.3). 3. Subjects with chololithiasis appear to have a substantially higher probability of developing pancreatic cancer (relative risk 4.2). 4. No significant associations were found between cancer of the pancreas and several other bio-social factors. 5. There was a statistically significant increase of serum coptper in pa- tients sufferinp from pancreatic cancer (171±6 in men and 165 7 in women) in comparison with non cancer hospital controls (137±4 in men) and (137±6 in women). No significant differences were found with respect to Zn and Mg. PANCREATIC CANCER/SERUM-COPPER/SMO.CING/CHOLOLITNIASIS 310 ANIMAL TUMOUR STUDIES J. Althoff, Abteilung f(ir experimentelle Pathologie, Medizinische Hochschule Hannover, Karl-Wiechert-Allee 9, 3000 Hannover 61, West Germany. Epidemiological investigations on the etiology and pathogenesis of human pancreatic cancer indicate that there are environmental factors involved in the origin and develop- 119) ment of this neoplastic disease. Efforts in experimental cancer research have been undertaken to obtain suitable animal models for the study of cells of origin, tumour development and biological behaviour. Whereas initial sytematic experimentation in scme strains of'animal led to the induction of neoplasms with acinar cell differentiation, the examination of different compounds in other species resulted in tumours of duct cell type which resembled those seen most frequently in human pancreatic cancer. Those models showing high rates of pancreatic neoplasms after relatively short treatment periods appear to be appropriate for studies on modifying factors and therapeutics. To what extent such findings can be extrapolated to the human situation is as yet unknown. /PANCREATIC TUMOURS IN ANIMALS/CHEMICAL INDUCTION

LIST OF ABSTRACTS 311 PANC~iF.ATIC SDCRETICKdS AS A Cd,UE TO T'M PRESENCE OF PANCRFATIC CAN:ER. R EBER, H.A. Associate Professor of Surgery, Univ- ersity of Missouri Medical Center, and Chief, Surgical Service, Veterans Administration Hospital, Columbia, MO 65212, U.S.A. Pancreatic secretion is abnormal in at least 90% of patients with either pancreatic cancer or pancreatitis. The functional abnormalities in pan- creatic cancer are characterized by a depression in the secretion of fluid, NCO3 and pancreatic enzymes. They can be detected by standard (I9] direct tests of pancreatic function, employing either secretin or CCK- like hormonal stimulation. At this time, there is no clear evidence of the superiority of either stimulus, although animal studies suggest that abnormalities of enzyme secretion may occur earlier than those of electro- lyte secretion. Abnormalities of pancreatic function do offer clues to the presence of pancreatic disease, and function tests are good to screen those in whom pancreatic disease is suspected. There is no evidence that function tests can discriminate reliably between patients with pancreatic cancer and those with pancreatitis. Although there are reasons to suspect that pancreatic function may be abnormal early in the evolution of pan- creatic cancer, it is unlikely that the testing of function will provide •a means for earlier diagnosis. This is beacuse there are no identifiable high risk groups to study and it is not practical to perform pancreatic function tests on broad segments of the population. 312 TUMOR MARKERS OF PANCREATIC CARCINOMA. Klavins, J.V., Department of Pathology, Catholic Medical Center, Jamaica, N. Y., U.S.A. Evaluating tumor markers for pancreatic carcinoma, Wood and Moosa (Br.J. Surg. 64:718, 1977) reported that pancreatic oncofetal antigen (POA, Banwo et al, Lancet 1:643, 1974) was more valuable and AFP less valuable when compared with CEA. POA is a glycoprotein with MW between 800,000 and 900,000 daltons (Gelder et al, Cancer 42:1635, 1978). It (19J is present predominantly in sera of patients with pancreatic carcinoma, also with other cancers and in some healthy individuals. PCAA recently reported by Chu (Int. Conf. Ca Pancreas, New Orleans, 3/10/80) probably is similar to POA. A specific pancreatic tumor marker might be a polycytidylic acid specific serum ribonuclease isoenzyme with a pI of 4.72 (Renner et al, Gastroenterol. 74:1142, 1978). In our laboratories, using immunoperoxidase microscopy, we demonstrated an antigen in the cells of pancreatic and other carcinomas as well as in fetal colon. This antigen (CAPI) was present in ammonium sulfate fraction (0-25%) from an aqueous extract of a pancreatic carcinoma. Using micro- complement fixation method, the sera of patients with pancreatic carcinoma reacted with an antiserum to CAPI (aCAPI) in a dilution of 1:16,000. Sera from patients with other carcinomas and from some healthy individuals reacted at lower dilutions of aCAPI. /TUMOR MARKERS/PANCREATIC CARCINOMA/

LIST OF ABSTRACTS 313 ENDOSCOPIC DIAGNOSIS OF PANCREATIC CANCER P. B. Cotton, Gastrointestinal Unit, The Middlesex Hospital London. Duodenoscopy is the simplest and most accurate diagnostic method for peri-ampullary tumours; visual and radiographic diagnosis can be confirmed by forceps biopsy and brushing cytology. The same fibrescope also permits palliation of malignant obstructive jaundice In some patients, using sphincterotomy and endoscopically placed prostheses. The sensitivity of duodenoscopic pancreatography in the diagnosis of pancreatic cancer depends on the user, but can and should exceed 900'o; pancreatograms reported as normal occur In less than 2% of patients with cancer. Tumours of the head and neck are accessible to brushing cytology and forceps biopsy; those in the body and tail can be confirmed by pure juice cytology (accuracy only 60°Jo). Pancreatography can demonstrate the position of a tumour, but not Its size or resectability. Following prospective trials of different diagnostic techniques, we use ultrasound and duodenoscopic pancreatography as our main. diagnostic combination in patients suspected of pancreatitis and pancreatic cancer; CT. scanning has proved disappointing. Cotton, P. B. Progress Report ERCP. Gut, 1977, 316-341. Cotton, P. B, et al. Grey-scale ultrasonography and endoscopic pancreatography in pancreatic diagnosis. Radiology 1980;134, 453. 314 PERCUTANEOUS NEEDLE BIOPSIES Joren HANKE, M.D. Ultrasound Laboratory, Gentoff Nospital, Xellerup, Copenhagen, Denmark.

LIST OF ABSTRACTS 315 SEQUENTIAL ANALYSIS OF COLONIC CARCINOGENESIS OF 1,2-DIMETHYLHYDRAZINE TREATED RATS: ULTRASTRUCTURAL FEA,TURES OF THE PRENEOPLASTIC LESIONS. Laumonier, R., TAY OT J and Delapierre F. Research Institute of Pathology - Depart- ment of Experimental Cancerology, Center Henri Becquerel - 76 038 Rouen Cedex - France. 100 female Wistar rats were given weekly subcutaneous in- jections of 1,2-dimethylhydrazine (15 mg. per kg.) for pe- riods of 1 up to 28 weeks. Discrete changes were observed as (38J early as 2 weeks after commencement of treatment. In goblet cells the secretory granules were droplets of mucin or small chains of various sizes and locations. The absorptive cells had microvilli of various heights with a rare coat and nu- clei abnormalities. The intermediate cells and the electron- dense bodies are a prominent feature. The lamina propria shows precocious vascular abnormalities, an unequal collagen and a discontinuous basal lamina. This latter steps we con- sider as the beginning of neoplasia and all prior changes as preneoplasia. /U LTRASTRUCTURE DURING COLON CARCINOGENESIS/ 316 CONFIRMATION OF A TWO-STEP MECHANISM IN RAT COLORECTAL CARCINOGENESIS. MASKENS, A.P. Cancer Research Unit, Clinique Saint-Michel, 1040 Brussels, Belgium. A prospective experiment has been designed to test our hypothesis that experimental colorectal carcinogenesis proceeds as a two-step mechanism. Male BD IX rats were given weekly s.c. injections of 1,2-dimethylhydraz- ine (DMH) at various dose levels (1,4,8 or 16 injections), and serially sacrificed up to 85 weeks after initiation of the treatments. Analyses [38] were then performed on the relationship between dose, time and tumor yield. One hundred and fifty-three rats were available for analysis, with a total yield of 494 adenocarcinomas (adcas). In animals given a short exposure to DMH (1 to 8 weeks), the number of adcas per animal increased linearly with time, at a rate proportional to the total amount of DMH, with new carcinomas being continuously produced as long as one year after interruption of the treatments. In animals given a prolonged exposure to DMH (16 weeks), the number of adcas per rat increased as the 2nd power of time. Those data, together with our previous observation that no benign polyp-cancer sequence is present in this material, con- firms the two-step hypothesis. The latter implies that DMH induces a permanent transmissible alteration within some cells which thereafter will be at risk for a second alteration capable of initiating cancer growth. /DIMETHYLHYDRAZINE/COIAN AND RECTUM/CARCINOGENESIS/TWO-STEP/ Supported in part by a grant from the "Fondation Cancerologique-Saint- Xiche2.°

I LIST OF ABSTRACTS 317 PREMALIGNANT CHANGES IN HUMAN COLONIC MUCOSA ADJA- CENT TO AND REMOTE FROM CARCINOMAS. Shamsuddin, A.K.M. 6 Trump, B.F. Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, U.S.A. The histogenesis of colonic carcinoma has been studied in vivo using aZoxymethane (AOM) in F-344 rats and in vitro single exposure of 2.5pg/ml N- methyl-N'-nitro-N-nitrosoguanidine (MNNG on rat colonic explants maintained in culture for over 3 months. Early after carcinogen treatment both in vivo and in vi o, the colonic crypts show dilatation, distortion, hypercellularity and shift from normally occurring sulphomucin to predominant sialomucin. These changes (presumably premalignant) precede malignant transformation. Studies of the colon epithelia from 15 humans with colonic carcinoma consistently demons- trated identical morphological and histochemical changes in mucosa adjacent to and remote from carcinofias in all of the 15 patients. Colonic epithelia obtained irnmediately after death from 15 otherwise healthy individuals serving as control showed none of these changes. These data along with the observation of multifocal in situ and "microinvasive" carcinoma in non-polypoid flat mucosa of colon in one patient suggest a "field effect" by carcinogens on colonic epithelia rausing multifocal c.h,anges- (r,r esumed preneopiastic) in the entire mucosa. We have demonstrated that besides arising from the polyps, colonic carcinomas may also arise de novo from flat mucosa. The histochemical changes observed in remote mucosa may lead to the development of a rapid and inexpensive screening test for early detection of colonic carcinomas during routine office visits. /COLONIC CARCINOMA/DE NOVO HISTOGENESIS/RAPID SCREENING TEST/ 318 DIETARY FACTORS IN RELATION TO THE ETIOLOGY OF COLORECTAL CANCER Howe, G.R., Miller, A.B., Jain, M., Cook, G. NCIC Epidemiology Unit, University of Toronto, Canada. A case control study of 542 cases of colorectal cancer, 542 neighbour- hood controls and 535 hospital controls has been conducted in two areas of Canada. The consumption of 13 nutrients has been estimated individually for all study members using an extensive diet history questionnaire. Highly significant dose-response relationships are observed between saturated fat intake and increased risk of both colon and rectum cancer for both sexes. In contrast no increase in risk was observed for intake of any level of polyunsaturated fat. The data are thus supportive of the hypothesis that dietary saturated fats may be of considerable etiologic significance in cancers of the large bowel. /DIET/BOWEL CANCER/SATURATED FAT/EPIDEMIOLOGY

LIST OF ABSTRACTS 319 LARGE BOWEL CANCER: ITS METABOLIC EPIDEMIOLOGY AND PREVENTION Bandaru S. Reddy, American Health Foundation, Valhalla, NY,USA Epidemiologic studies indicate that high intake of fat and lack of dietary fiber are associated in the incidence of colon cancer. High in- take of fat increases the concentration of colonic secondary bile acids (BA) and the activity of gut microflora, whereas certain dietary fibers dilute BA and alter their metabolism in the colon. The BA exert a pro- moting activity in the colon. We have compared the dietary pattern and (38] fecal constituents of 5 populations with varied risk for colon cancer: high-risk New York population (Group 1); inherited high-risk cancer families (Group 2); moderate-risk Seventh-Day Adventists (Group 3); low- risk populations in Finland (Group 4) and in Japan (Group 5). Groups 1 and 2 consumed diets high in fat and low in fiber whereas Group 4 con- sumed diets high in fat and fiber. The fat intake was very low in Group 5 and moderately low in Group 3 and the fiber intake was moderately high in Group 3 compared to Groups 1 and 2. The fecal bulk was high in Groups 3 and 4. Colon cancer-prone members of Group 2 excreted high levels of cholesterol which suggests that the analysis of stools for cholesterol is useful in screening cancer families for latent disease. The con- centration of fecal BA, mutagens, comutagens, S-glucuronidase, 7a-de- hydroxylase and 7a-hydroxysteroid dehydrogenase were lower in Groups 3, 4 and 5 than in Group 1. Our animal studies also indicate that high-fat diet increases and high-fiber diet inhibits colon cancer incidence. /COLON CANCER/DIETARY PATTERN/FECAL CONSTITUENTS/ [381 320 rISSUE CARCINOEMBRYONIC ANTIGEN (CEA), DYSPLASIA AND DURATION OF DISEASE IN ULCERATIVE (UC) AND CROHN'S (CD) COLITIS. D. Panveliwalla, A. Greenstein, T. Heimann, L.B. Katz, S. Geller, D. Pertsemlides, H. Smith and A.H. Aufses, Jr. The Mount Sinai Hospital, New York, N.Y., U.S.A. CEA content, dysplasia and duration of disease were studied in 13 patients with ulcerative colitis, 16 with Crohn's disease, and 18 colo- rectal cancer (CRC) patients. Surgical specimens were frozen to - 700C and CEA assayed by the Hanzen Z-gel method. CRC tissues were sampled at the resection margin away from malignancy. Dysplasia was read blind. Results were expressed in ng of CEA per gram of tissue dry-veight.-Mean CEA values (m), SD and degree of significance are shown below. I CD Non/ Diseased II CD Diseased III UC Mild/ No Dysplasia IV UC Severe Dysplasia V CRC Non/ Cancer n 7 9 8 5 18 m 0.41+0.19 0.64+0.29 0.77+0.18 1.21+0.28 0.88+0.24 p I-II<0.05 I-III<0.01 I-IV<0.01 III-IV<0.01 I-V<0.01 Conclusions: High CEA correlated well with severe dysplasia (p<0.02), and duration of disease (p<0.025) in UC. Mild/no dysplasia in UC, diseased tissue from CD, and non malignant tissue from CRC patient show- ed significantly higher CEA levels than non diseased Crohn's tissue. High tissue CEA combined with histological dysplasia and long duration of disease are better predictors of malignancy in UC. CEA/ULCERATIVE COLITIS/CROHN'S COLITIS/DYSPLASIA/DISEASE DURATION

LIST OF ABSTRACTS 321 SCREENING FOR COLORECTAL CANCER BY TESTING STOOLS FOR OCCULT BLOOD. Gnauck,R. Deutsche Klinik fur Diagnostik,Wiesbaden,Germany. Testing stool for occult blood in a prescribed way,using Haemoccult has proven to be effective in finding cases of colorectal neoplasms earlier,i.e. before clinical signs and symptoms develope. Haemoccult is used in our clinic continuously since 1972 on now over 2o.ooo ambulatory patients.About 2-3% had a posit- ive test.85 colorectal cancers and 15o precancerous large polyps were found in this group.2/3 of all lesions were lo- cated above the reach of the rigid rectosigmoidoscope,i/5 of these patients being younger than 5o years. Similar data have been reported by Winawer and other inves- tigators in the USA and Europe and are emerging from the National Health Program in Germany,which uses Haemoccult since 1977 for persons above age 45. Screening with Haemoccult therefor can be described as an effective,simple,generally available,convenient and inex- pensive procedure for earlier diagnosis of colorectal can- cer,i.e. secondary prevention.The long term benefit from annual screening upon morbidity and mortality of this com- mon type of cancer remains to be evaluated. 322 AN EPIDEMIOLOGIC STUDY OF COLO-RECTAL CANCER AND DRINKING WATER SOURCE. Gottlieb, M.S., Carr, J. 6 Morris, D. Tulane University, New Orleans, Louisiana, United States. A case-control mortality study was conducted In 20 parishes (counties) of South Louisiana to determine what relationship drinking Mississippi River water might have on mortality from colon or rectal cancer. Rectal and colon cancer deaths (692 and 1167) from 1969 to 1975 were matched to non-cancer deaths by age at death (+5 years), year 1391 of death, sex and race within parish clusters consisting of parishes similar in urban-industrial characteristics but differing in water source. Colon cancer did not relate significantly to any water variable but rectal cancer associated strongly with surface, or Mississippi River, water. The odds ratio for rectal cancer between those who were born and died on surface water to those who were born and died on ground water was 2.07 with 95$ C.I.:(1.49-2.88). A multi-dimensional contingency table analysis found the association between rectal cancer and surface water significant at the .0001 level and not dependent on age, race, sex or year of death. The risk for men was slightly higher than for women, but both sexes showed an increased risk. Chlorination also associated with rectal cancer significantly. Among those who lived along the river, the risk increased inversely as the distance from the mouth, with greater risk.downstream from the many industries which line the river. /COLO-RECTAL CANCER/DRINKING WATER/CASE-CONTROL STUDY/

LIST OF ABSTRACTS 323 A PROSPECTIVE STUDY OF THE RELATIONSHIP OF FAECAL BILE ACIDS, NEUTRAL STEROIDS AND NUCLEAR DEHYDRO- GENATING CLUSTRIDIA WITH THE DEVELOPMENT OF CANCER OF THE LARGE BOWEL (CLB). Haines, A.P., Meade, T.W. & Thompson,S. MRC Epidemiology & Medical Care Unit, Northwick Park Hospital, Harrow, England. Hill, M. & Williams, Sir Robert Public Health Laboratory Service, London, England. It has been suggested that cancer of the large bowel (CLB) is caused by the formation of co-carcinogens from (39) bile acids in the intestine through the action of nuclear dehydrogenating clostridia. In order to test this hypo- thesis, we have collected faecal samples from about 7,000 men and women aged 45-74 in general practices in three areas of the U.K. The samples were freeze dried and stored deep frozen. The stool samples of all participants who develop CLB are analysed for bile acid concentration, neutral steroid concentration, cholesterol and nuclear dehydrogenating clostridia. The results from each index case are compared with those from three age sex matched participants who have not developed CLB. It is estimated that about 60 new cases of CLB will occur in the study pop- ulation during a follow up period of ten years. /LARGE BOWEL CANCER/BILE ACIDS/ INTESTINAL BACTERIA/ 324 DIFFERENCES IN EFFECTS OF DIETARY BRANS BEFORE AND AFTER TUMOR INITIATION BY 1,2-DIMETHYLHYDRAZINE (DMH) IN RATS. Barnes, D.S. & Clapp, N.K., Roberts Wesleyan College, Rochester, NY 14624 & Biology Division, Oak Ridge National Laboratory;ti0ak Ridge, TN 37830, U.S.A. To determine the effects of wheat bran given before and after intes- tinal tumor initiation, 4 week old Fisher-344 rats were placed on 20% bran synthetic diets for life. They received 2 sc DMH injections (ti150 (39j mg/kg BW) at 8 and 10 wks of age. Groups included: DMH control(C), wheat bran(W), and two groups, delayed wheat I(DWI) and delayed wheat II(DWII) were given the control (no bran) diet and then, at 4 and 18 weeks re- spectively after the second DMN dose, the wheat bran diet. Rats were killed 9 mos after the first DMN dose. Likewise to determine the effects of various dietary brans, three other groups corn(CO), rice(R), and soybean(S), received 20% bran at age 4 wks and same DMH dose. Survival values were: C 65%, DWII 79%, S 83%, CO 86%, DWI 87%, R 91%, and W 95%. Large intestine tumor incidences were: C 93%, DWII and S 84%, CO 100%, DWI 62%, R 86%, and•W 75X. All DMH groups had ti2 tumors/tumor-pos rat except CO (4). Duodenal tumors occurred near the common bile duct with 50% incidences in C and CO, 74% in DWII and 38-47% with other diets. Apparently wheat bran may decrease and corn bran increase the promotion (expression) state of colon tumorigenesis; wheat bran may be of greatest value when eaten before or soon after tumor initiation but has little effect if eaten long after. /DIETARY BRAN/COLON CANCER/1,2-DIMETHYLHYDRAZINE/RAT/ * Operated by Union Carbide Corp. with the U.S. Department of Energy. W O O r J N .• ot

LTST OF ABSTRACTS ~5 DETECTION OF THE CANCER-DERIVED CEA IN FECES. A PRELIMINARY STUDY. Mori, T., Fujimoto,N., Kuriyama, H., Inaji, H., Okuda, H. & Kosaki, G. Dept. of Surgery II., psaka Univ. Medical School, Osaka 553, Japan, Various reports revealed that determination of plasma CEA by conventional CEA-RIA kits is not useful for diagnosis of early gastrointestinal cancer, implying that a new assay bystem for detecting CEA in feces is necessary. In fraction- ating I.OM perchloric acid-soluble extracts of normal adult feces/meconium by chromatographies, NCA, NCA-2 and IMA (intestinal mucus antigen) were found abundantly present and were found all CEA-positive when conventional CEA-RIA kits were used, but completely non-reactive with specific anti- CEA antiserum raised in guinea pigs (Mori, T., Scand. J. Immunol., 8, 439, 1978). Using the specifiq antiserum, a new RIA system for cancer-derived CEA determination was develcoped. In preliminary, dose-dependent inhibition effect by applying samples from colorectal cancer was observed whereas inhibition effect was negligible when samples from normal feces/mzoonium were applied, suggesting that development of a RIA system for measuring the cancer-derived CEA in feces is indeed feasible. CANCER-DERIVED CEA/FECES/RIA/DIAGNOSIS OF COLORECTAL CANCER PLASMA PROTEASE AND INHIBITOR ACTIVITY IDENTIFIES 326 PATIENTS WITH A PRECANCEROUS CONDITION. LYKO, N.C. , and HARTMANN, .7.X. Department of Biological Sciences, Florida Atlantic University, Boca Raton, FL 33431, U.S.A. A 100 fold increase in plasma protease activity (p<0.001) was found in 9 of 12 individuals with heritable adenomatosis of the colon and rectum (ACR). The three patients lacking increased protease activity showed 400% more plasmin inhibitor activity compared to controls. The 9 ACR patients were identified out of 75 coded samples which included normal controls, asymptomatic at risk and medically treated (total colectomy, ileostomy) ACR individuals. These 9 protease positive plasma samples caused a transformation associated morphology in normal human colon cells in culture. We shall present evidence that: 1) ACR patients with clinical precancer can be identified and 2) Protease and protease in- hibitors are directly implicated in the development of cancer in ACR. Florida Atlantic University Large Bowel Cancer Study. /PROTEASE/PRECANCER DETECTION/FAMILIAL POLYPOSIS/ J cn 0- -4

LIST OF ABSTRACTS 327 A COOPERATIVE STUDY ON THE DETECTION OF COLORECTAL CANCERS AND POLYPS IN FRANCE. Martin, F., Poynard, T. and the Coope- rative Group on Detection and Prevention of Colorectal Tumours. Labora- tory of Immunology. Facult46 de Mddecine, 21033 Dijon, France. Polyps and cancers of the large bowel have been searched for in a population of 1369 in- and out-patients, aged from 45 to 70 years, in 8 universitary departments of Gastroenterology or Abdominal Surgery (Toulouse, Dijon, Paris, Marseille and Strasbourg). An air contrast (39] barium enema and proctosigmoidoscopy were mandatory, whereas total colo- scopy was only performed in the case of detected tumours. A questionary including 233 data about age, sex, family and personal history anRd symptoms was filled up for each patient. In 252 patients, 444 lesions have been discovered, including 245 ade- nomatous or villous polyps, 8 transformed polyps and 30 carcinomas.Three out of 4 lesions were located in rectum or sigmoid. Cancer or adenoma- tous or villous polyp was found in 13% of the patients. The prevalence of these lesions was increased in patients with rectorrhage (19%) or a personal history of surgery for colorectal cancer or polyp (23%). In the patients without rectorrhage or history of intestinal tumour, prevalence was 9.7%. It was significantly increased in males and patients more than 50. Efficiency of proctosigmoidoscopy and air contrast barium enema was compared in 909 patients. Sensitivity and specificity were respectively 35% and 99% for endoscopy, 96% and 94% for radiology. /COIARECTAL CANCER/ POLYPS/DETECTION 328 VALUE AND REASONS FOR ROUTINE RECTOS1GM01DOSCOPY MEIER ZU EISSEN, J., MEIER ZU EISSEN, P., PADMOS, X., WEDELL, J., and VAN CALKER, H. Department of Surgery, and Ir.sti- tute of Pathology, Academic Teaching Hospital, Herford, Germany. Routine rectosigmoidoscopy was undertaken in 1,800 patients under surgical.treatment for disease in other parts of the body. Pathological changes were found in 154 patients (8.6%). There were 17 patients with infiltrating carcinomas and 7 patients with carcinoids. [39] The tubular and tubulovillous adenomas were removed with an electric loop or haemoclip, the villous adenomas by transanal submucous excision. The results indicate that routine recto-sigmoidoscopy is of value. /ROUTINE RECTOSIGMOIDOSCOPY/POLYPS/

LIST OF ABSTRACTS f391 329 DIAGNOSIS AND TREATMENT OF EARLY CANCER OF THE RECTl1M JEKIC, M. Surgical Service, Clinical Hospital, 2emun-Belgrade, yugoslavia. in the last ten years, our department has had four cases of early cancer of the rectum: three females and one male. Patients ranged in age from 48 to 80 years. Complaints on admission were melana, bloody stool and diarrhoea experienced for a duration of three months or less. The tumor measured less than 2 cm in diameter satisfying the definition of early cancer of the rectum. The most frequent site of early cancer of the rectum is the ampulla region. Thus, the tumor was easily palpable by digital examination and the diagnosis was determined by proctoscopic examination and biopsy. Tumor enucleation is enough to cure the mucosal cancer but the treatment for early cancer of the rectum where the can- cerous infiltration involves the submucosal layer shall be further discussed. . 3M THE PATHOLOGIST'S RESPONSIBILITY IN DIAGNOSIS OF EARLY COLO- RECTAL CARCINOMA. HERMANEK, P. Department of Surgical Pathology, University of Erlangen, Erlangen 8520, Germany, F.R. With increasing frequency early stages of colorectal carcinoma are dia- gnosed in endoscopic polypectomy specimens. The pathologist has to give three statements: 1. histological classification including grading of carcinoma, 2. is there lymphatic invasion demonstrable histologically in the submucosa zone ? 3. is local excision by polypectomy complete or (391 not ? It is very important to be familiar with the histological feature of the socalled pseudocarcinomatous invasion or pseudoinvasion. Endo- scopical removed polyps must be exactly orientated for embedding and sectioning. The most important unsolved histological problem is how to process the polyps histologically. It has become fashionable to talk about serial or step sections but the distance between the steps is usually kept a secret. The preliminary results of our study on serial sections of sessile adenomas demonstrate that not infrequent- ly only a relative small number of sections will show the resection line and within this number different results may be found. It seems that steps of 24o ym are desirable. Further experiences with serial sections of colorectal adenomas are necessary for standardization of the histological technique. COLORECTAL POLYPS / EARLY COLORECTAL CARCINOMA

LIST OF ABSTRACTS ~~ SCREENING OF COLORECTAL TUMORS. OUR 3 YEARS' EXPERIENCE. Ribet, A., Escourrou, J., Frexinos, J., Delpu, J. Clinique des Maladies de l'Appareil Digestif, C.H.U. de Rangueil, 31054 Toulouse cedex, France. Authors report their experience after 3 years of systematic colo- rectal tumors screening in 706 subjects aged between 40 & 70 years. All subjects were submitted to rectoscopy (R) and air filled barium enema (AFBE). Total frequency of screened tumors : 16 %. Study of (46] topographic repartition of tumors show that 82 % can be found in the recto-sigmoid area. 2 sub-groups were individualized in this popula- tion. In sub-group A, 125 subjects were submitted to R, AFBE & flexible pansigmoidoscopy. Percentage of screened tumors is 19.2 !. Sensibility rate of radiology for exploration of the recto-sigmoid area as compared with flexible pansigmoidoscopy is rather low : 0.41. In sub-group B, 200 subjects were submitted to hemoccult, R, AFBE, & coloscopy, when needed. Comparative study of these different investi- gations means show the Very low rate of sensibility of hemoccult : 0.17 Besides, percentage of screened colorectal tumors is significantly higher p 0.01 in subjects with personnal or family anteceder.ts of polyp or carcinoma 22 % than in the remaining population 13 ~. Authors point out interest of flexible pansigmoidoscopy for systematic screening of colorectal tumors in subjects over 40. 332 COLONIC EPITHELIAL NEOPLASIA AMONG THE AGED JAPANESE IN JAPAN AND THEIR BACKGROUNDS. Kanazawa, K. Department of Surgery, University of Tsukuba, School of Medicine, Ibaraki, Japan. About 1,600 colons of Japanese older than 60 years,conse- cutively autopsied at the Tokyo lletropolitan Geriatric Hospi- tal, were examined for the existence of coloniv tumours. .The incidence of adenoma was approximately 50 % as high as 146) in the western countries with increased risk of colon cancer. But, about 75 % of them were less than 5 mm in size, and only 4$ of them were larger than 10 mm. Seventy nine colorectal carcinomas were found in 76 cases„ the incidence being equal to the data from U. S. A., and the S/C+A ratio proposed by Correa & Haenszel was 1.0. Japanese tended to have more preclinical cancers than the Occidental. The incidence of the metaplastic/hyperplastic polyp was extremely low among the aged Japanese. Thus, Japanese in Japan have quite a same rate of initiating colonic neoplasia, but less promoting factors. No characteristic features of the intestinal flora were observed except the increased number of Veillonellae among those who were carryinq colorectal carcinoma. Findings of intestinal flora and bile acids will be reported. /COLONIC TUMOURS IN JAPAN/INTESTINAL FLORA/BILE ACIDS/ & 0 0 b 41 0

LIST OF ABSTRACTS ~ COMPARATIVE STUDY OF ENDOSCOPIC FINDINGS: HISTOLOGY OF PREOPERATIVE BIOPSIES AND SURGICAL SPECIMENS IN pATIENTS WITH RECTOSIGMOID CARCINOMA. CHRISTODOULOPOULOS,J., DELIDES, G., and GEORGOULIS, B. Metaxas Memorial Cancer Hospital, piraeus, Greece We have compared endoscopic findings, histology of preoperative biopsies and surgical specimens in 200 cases of recto-sigmoid carcinoma and have found a high number of false negative biopsies. A second biopsy was often necessary to confirm the malignancy that had been observed endo- scopically. Variations in the grade of malignancy of biopsies and operative specimens were also noted. We will discuss: 1/ the incidence of agreement between endoscopy and biopsy; 2/ the histologic variations observed; and 3/ possible solutions for the avoidance of these discrep- ancies. 334 PREOPERATIVE LOCAL ASSESSMENT OF RECTAL CARCINOMA: DIGITAL EXAMINATION AND COMPUTERISED TOMOGRAPHY COMPARED. NICHOLLS, R.J., DIXON, A.K., YORK MASON, A., KELSEY FRY, I., and MORSON, B.C. St. Mark's Hospital, London, U.K. The preoperative assessment of patients with rectal carcinoma can deter- mine operability, the type of operation to be used and whether local radiotherapy should be added to surgery. it is the only means of stag- ing cases entering trials of preoperative radiotherapy. The choice of treatment depends largely on the local extent of the tumour. In this study, the accuracy of digital examination was compared to computerised tomography (CT) in assessing 1) the local spread of the primary tumour, 2) the presence of lymph node metastases. Thirty-five patients with carcinoma of the rectum (0-12 cm from the anal verge) were examined by three clinicians and by CT of the pelvis. The assess- ment was judged correct if it agreed with the pathologist's findings in the resected specimen. The clinical accuracy in detecting penetration of the rectal wall was over 90% and the degree of extra-rectal spread was correctly assessed in about 75% of cases. Specificity in detecting involved nodes was 80% but sensitivity was only 35%. CT was only use- ful in assessing extensive tumours. /RECTAL CANCER/PREOPERATIVE ASSESSMENT/CT/ 1 i I 3

335 SY3PFMATIC AND PLURIFACTORIAL DIAGNOSTIC APPROACH IN COIA- REX,"PAL MOURS.D'Hoore P.L.,Peys P.H.and Rademakers F.E. Department of Gastroenterology,University of Antwerp,Antwerp,Belgium. Since the previous Symposium(1976) a plurifactorial diagnostic pro- cedure for ambulatory detection of colorectal tumours was personally performed by the author.The technical part of the examination inclu- ded:he.~test,hematology,serology,proctosiBraidoscopy,fiberoptic si®rq- coloscopy and double contrast radiology.The diagnosis of about 150 1961 tumours (carcinoma=C 1/3,adencina=A 2/3) led to the following conside- rations:i/decreased serum Fe (80%) seems to be a sensitive parameter of blood loss in the C group,in comparison with open or occult blood loss (66%),in the A group the percentages being resp.21 and 48;2/the use of the fiberoptic signocoloscope in addition to the rigid procto- scope augnented the diagnostic yield in the C group from 50 to 70 %, in the A group from 45 to 80%;3/the double contrast radiology succee- ded in ima.girig the carcinomas and adenomas in nearly 100 %;4/ the high recurrence rate in the A group stresses the need for periodic follow-up examination of the'high risk'group;5/ since diagnosis in the C group was nearly always promptly possible,the adoption of a systema- tic diagnostic approach may result in reduction of delay in symptoma- tic patients trough protection against the risk of unaware errors.The same attitude leads to the detection and treatment of otherwise un- suspected adenomas and thus to prevention of cancer. /S7ST'EAATIC PLURIFACTORIAL DIAGNOSIS / COUJRECTAL ?UMOURS/ 336 PRE-OPERATIVE RADIOTHERAPY FOR CANCER OF THE RECTUM Reis Neto, J.A. & Quilici,F.A. Department of Surgery, Pon - tificia Universidade Catolica de Campinas The 30 patients analysed were divided into two groups CROUP A: PATIFNPS SUBNII"tTED TO A RC7PAL DOSIS OF 4000 r for four oon- [46) secutive weeks and then to Chesrotherapy for another week and finally operated on. The dhemotherapic agents used Frexe: 5-fluorouracil ( lOmg /Kg/day ) for four days and Mitomycin C ( 4moq/Kg/day ) just cne day. GROUP B: PPT]aII5 THAT RECCEIVED 5000 r for five consecutive weeks and were operated on after this radiotreatment. The results obtained as to tur.bral involution, to intra-operative difficulties and to post-operative oornplications were oa!paratively studied between the two groups. As to turoral invulutl.on the results were similar in both groups, but as far as intra and post operative oorrplications are ooncerned,the first group has shown better results.

LIST OF ABSTRACTS ~ TWO TREATMENT SCHEMES IN COLON CARCINOMA: A COMPARISON OF 5-FU AND 5-FUPLUS ADJUVANT RYDROLYTIC ENZYMES. WERK, W., and WISCHERATA, H. Medical Enzyme Research Institute, Munich-Sauerlach, Germany, P.R. A randomized study was undertaken comparing 5-FU and 5-FU in combination with an adjuvant therapy of hydrolytic enzymes in the treatment of colon carcinoma patients. Clinical parameters were observed, and cellular immunity was evaluated. The study began in 1975 and continues for the longest period possible for each patient. Laboratory parameters used for cellular immunity evaluation include al-antitrypsin, C3, C4, the rosette forming test with SRBC and the migration inhibition assay. Both a higher remission rate and prolonged survival time is seen in patients treated with adjuvant hydrolytic enzymes. T-lymphocyte function is in- creased, and colon carcinoma immune complexes are more easily attacked. An adjuvant therapy of hydrolytic enzymes seems to support maintenance of the endogenous immune system in the presence of S-FU in the treatment of colon carcinoma. /COLON CARCINOMA/5-FU/HYDROLYTIC ENZYMES/ 3M NON-SPECIFIC ACTIVE IMMUNOTHERAPY FOR CANCER OF THE RECTUM AND COLON . Reis Neto, J.A. & Quilici, F.A.Dept of Surgery, Pontificia Universidade Catolica de Campinas . 110 patients with cancer of the oolon or rectum were treated by non- specific.active imrnmotherany with B.C.G.. Zhis was administered intra- (a6) cutaneously, 2.106 bacillus, once a week, for a period that varied frnm 12 to 18 weeks. 4he patient having negative DNCB received the vacina for a longer period. The administration was interrupted when local or general hipersensibility appeare3. The results in patients having Dukes B and C 1 turiours seeaG to be favorable, changing the prior immmolocric tests . The patients with negative DNCB and Dukes C 2 tumurs had negative respcai.ses to the therapeutic essay . All patients were treated 30 days after surgery and reevaluated three rxmths after the treatment finished .

LIST OF ABSTRACTS ~9 EFFECT OF TPN ON TUMOR GROWTH AND SURVIVAL IN ADVANCED COLON CANCER. Nixon, D.W., Moffitt, S., Lawson, D.H., Ansley, J., Lynn, M., Kutner, M., Heysmfield, S. & Rudman, D. Departments of Medi- cine, Surgery & Biometry, Emory University School of Medicine, Atlanta, Georgia, U.S.A. Because undernutrition is common in cancer, nutritional support is being increasingly recommended in management. To determine if central intravenous hyperalimentation (HA) would affect tumor growth and survi- val in advanced colon cancer, 45 chemotherapy patients were randomized l461 to receive 3 weeks of HA or ad lib feeding (control). We performed serial carcinoembryonic antigen assays, determined size change of ac- cessible lesions (by direct measurement or radiographic means) and re- corded survival durations. Although no clinical or biochemical evidence of tumor growth enhancement during HA was found (median CEA values de- clined in both groups), median survival in the HA group was statistical- ly inferior (79 days HA, 308 days control; P = 0.03). When patients with liver metastases alone (on radioisotope scan) were compared, sur- vival remained less (79 vs 171 days) in the HA group but statistical significance was lost (P = 0.10). Further study is indicated to deter- mine the reasons for decreased survival in the HA group. /HYPERALIMENTATION/COLON CANCER/CEA/ 340 G.,Santi L. - Istituto di Oncologia, UniversitA di Genova, RESECTION OF COLORECTAL CANCER. Aste H., Pugliese V., Nico13 ENTOSCOPY IN ASYrlPTCh1ATICS PREVIOUSLY SWfITTID 70 ANTERIOR Italy. In the attempt to evaluate the role of colonoscopy as a part of a follow-up program after anterior resection for colorectal cancer, we considered S8 asymptomatic subjects previously resected. Eighty-two were the colonoscopies performed (6 months - 3 years after surgery). (461 Several types of lesions were observed and biopsied; endoscopy poly- pectomy was carried out when suitable. In 6 patients endoscopy disclo- sed recurrent anastomotic cancer and in 1 a cancer probably synchro- nous to the primary neoplasia. In 19 patients polyps were detected, 13 of which were endoscopically removed. Two of them proved to be tubular adenomas with ca in situ and invasive cancer in another. Since total colonoscopy is usually unfeasible before resection of a stenosing cancer, the authors emphasize that an endoscopic surveil- lance of this high risk group can show both metachronous polyps or capcers not seldom disregarded at the time of anterior resection. COLON CANCER IOLLCRV-UP/ COIANOSCOPY/ - ~ 0 0 ~ r -J 0 N r

LIST OF ABSTRACTS 341 SPONTANEOUS COLOSTOMY CANCER - A MODEL FOR COLO- RECTAL CARCINOGENESIS. Winkler,R.,Otto,H.F., Pfeiffer,M.&Dorner,A., Chirurgische Klinik and Pathologi- sches Institut der UniversitHt, Hamburg, W-Germany. Colostomies were known to have a higher risk to develop cancer if exposed to carcinogens acting on the colon. In male Wistar rats we have shown that colostomies theirselves lead to "spontaneous" cancer ( Winkler et al. (1977) Langen- becks Arch.Chir. 343,229 ). They originate in the oral mouth of the stoma as well as in parts of the colon although excluded from fecal passage if only opened widely and im- planted in the body wall. In the main they are poorly diffe- rentiated, stroma-rich adeno-carcinomas. t;orphogenesis can be described as an "inflammatory mode". 240 carcinomas were examined under various conditions. Cancer developement is promoted by feeding a high fat diet, but merely uneffected by low residual diet. Aletachronously induced cancer grew more rapidly. Cancer once performed and excluded from fecal passage showed no or much reduced proliferation activity. Analogies in human pathology shall be presented. COLORECTAL CANCER - IATROGENIC CARCINOGENESIS - COLOSTOMY CARCINOMA - CANCER DEVELOPEhENT - EXPERIIENTAL COLORECTAL CANCER . EARLY DETECTION OF RECURRENT CANCER IN THE GASTRO- INTESTINAL TRACT AND SUBSEQUENT If'IIKUNE STIMULATING THERAPY WITH A STREPTOCOCCAL VACCINE Oehr, P., Haubeck, H., Kunath, U. Chirurgische Universi- tatsklinik, Bonn F.R.G. Gastrointestinal carcinoma patients, who had preoperativly elevated CEA-levels were controlled postoperatively for recurrence twice a week. Recurrence was monitored by CEA- (461 increase. If further surgical treatment was not possible, patients were treated subsequently with a vaccine of Streptococcus pyogenes A,III. The effect of immunotherapy was determined in vivo ( x-ray, serial CEA clinical chemistry, clinical status ) and in vitro t lymphocyte cul- tures, determinations of lymphocyte subpopulations ). Results: partial remission in 50% of the patients; few side effects; immune stimulation in vivo and in vitro. Our results indicate immunotherapy with this streptococcal vaccine would be a helpful approach in treating patients with small tumor load. CEA-MONITORING / IMNNOTHERAPY / STREPT0C0CCAL VACCINE

LIST OF ABSTRACTS 343 THIRD GENERATION LIVER SCANS - WHAT IS THEIR VALUE IN PATIENTS WITH COLORECTAL CANCER. RUBIN, R.J., GROFF, W., SALVATI, E.P., and PISENSTAT, T. New Jersey College of Medicine and Dentistry at Mahlenberg Aospita2, Plainfield, NJ, U.S.A. Three hundred consecutive patients with proven colon or rectal carcin- omas were studied with current scintigraphic image scanning using Technetium colloidal Sulfur. False positive and false negative results are reviewed and the correlation between normal and elevated alkaline phosphatase levels are made with the findings on liver scan. The sen- sitivity and specificity of the newer imaging techniques reaffirm the value of liver scans in detecting hepatic metastases from colorectal carcinomas where liver function tests fail. /LIVER SCAN/CARCINOMA COLORECTUM/ 344 EFFECT OF FAECAL STREAM ON EXPERIMENTALLY INDUCED RAT CARCINOMAS. Scurr J.H. Filipe I. & Ellisq H. Westminster Medical Schooi , Lonaon, Engiand. Colonic cc-,rcinomas were induced in rats who had under- gone surgery to the colon to produce areas of decreased and increased faecal exposure. The rats were sacrificed at 2 59 weekly intervals and studied histologically and histo- Ps chemically. Interesting changes in the distribution of lesions were seen, the lesions tending to occur more proximally and in areas surrounding anastomoses than those in rats who had not been operated on. A change in the normally predominating sulphated mucins to sialomucins in areas surrounding early change was also noted. The authors conclude that changes in faecal stream in the presence of an anastomosis enhance tumour formation, ut 0 0 r J ~ N o~

LIST OF ABSTRACTS ~5 CYTOGENETICS OF BLADDER CARCINOMA: A KEY TO PROG- NOSIS IN NON-INVASIVE AND IN SUBMUCOSAL INVASIVE CARCINOMA. Falor, W.H., Ward, R.M., and Brezler, M. Lymph and Cancer Research Laboratory, Akron City Hospital, Akron, Ohio 44309, U.S.A. Direct cytogenetic analysis in 65 early carcinomas of the bladder followed up to 11 years has demonstrated that chromosomal change - specifically the appearance of a marker j3?1 chromosome - (a) in non-invasive carcinoma precedes histo- logic evidence of onset of invasiveness, and (b) in submucos- al invasive carcinoma is an index of malignant potential mandating radical therapy if cure is to be achieved. Based on the prognostic importance of the marker chromosome in early tumors a classification of bladder carcinoma is propos- ed combining (a) cytogenetic analysis with (b) cytopathology and (c) depth of tumor invasion. /CYTOGENETICS/EARLY BLADDER CARCINOMA/ 346 URINARY o(-NAPHTHYL ACETATE ESTERASESt A PRELIMINARY SCREENING TEST FOR BLADDER CANCER. E1-Sewedy,S.M.,Soffar,A.M.,Mostafa,M.H.,El-Borno,F.A.,Arafa, A.,and El-Zoghby, S.M. Dep. Applied Med. Che., Med.Res. Ins. Alex. Univ., Dep. Biochemistry, Fac.lded., Tanta Univ.& Dep. of Urology, Fac. Med., Alex. Univ., Alexandria, Egypt. The urinary activities of o(-naphthyl acetate esterases are measured for groups of bilharzial and non-bilharzial pat- ients with benign urologic diseases and for others with (37J bladder cancer. All these patients show elevation in the urinary enzyme activity over that given by healthy controls. Bilharzial and non-bilharzial bladder cancer patients exhi- bit significant increase in urinary enzyme activities as compared with corresponding groups with benign urologic dis- eases. A level of 50 Units of enzyme activity is taken as a limit to discriminate between bladder cancer patients and• those patients with benign urologic diseases. The specifity and sensitivity of this urinary test exceeds 90 % with low falsely positive and negative results. The data of the pre- sent study recommended the use of urinary*naphthyl acetate esterases activities as a preliminary screening test for bilharzial and non-bilharzial bladder cancer patients. /BLADDER CANCER/ q!NAPHTHYL ACETATE ESTERASES/

[321 1321 LIST OF ABSTRACTS ~ ROLE OF N-ACETYLTRANSFERASE PHENOTYPE IN HUMAN SUSCEPTIBILITY TO BLADDER CARCINOGENIC ARYLAMINES. Wolf, H., Lower, G.M. & Bryan, G.T. Department of Urology, Hvidovre University Hospital, 2650 Hvidovre, Denmark and Department of Human Oncology, University of Wisconsin Center for Health Sciences, Madison, Wisconsin 53792, USA. N-acetyltransferase activity is species specific and in animal experiments a determinant of the susceptibility of each species to arylamine bladder carcinogens. The effect of N-acetylation is that of inactivation. In human subjects N-acetyltransferase is also genetically determined so that two N-acetyltransferase phenotypes exist, a rapid and a slow acetylator phenotype. N-acetyltransferase phenotype was determined in 71 bladder cancer patients and 74 control subjects from Copenhagen. The distribution of the slow acetylator phenotype among the bladder cancer patients was 65% in contrast to 51% among the control subjects indicating that the N-acetyltransferase phenotype also in man may be a determinant of the susceptibility of each individual to arylamine carcinogens. In addition, this finding indicates that carcinogenic arylamines also play a role in bladder carcinogenesis in Copenhagen. Such studies may identify risk groups in an exposed population. /N-ACETYLTRANSFERASE PHENOTYPE/BLADDER CANCER/ARYLAMINES/ 3l~$ SCANNING ELECTRON MICROSCOPIC (SEM) EVALUATION OF URINARY CYTOLOGIC MATERIAL IN THE DETECTION OF URINARY BLADDER CANCER. Friedell, G.H., Cohen, S.M., Jacobs, J.B. Department of Pathology, St. Vincent Hospital, Worcester, MA 01604, U.S.A. We have been evaluating the usefulness of SEM examination of cyto- logic specimens in the detection and clinical management of urinary bladder cancer. Methodology for the collection of well-preserved cells in high yield was developed based on rapidly mixing the specimen with glutaraldehyde and then centrifuging the cells onto a poly-L-lysine coated coverslip. Pleomorphic microvilli (PMV) were present on the surface of all 50 biopsy specimens of bladder carcinoma examined. In addition, they have been present on exfoliated cells in preparations of urine and/or bladder washings from 44 of 45 cases of transitional cell carcinoma, including 14 cases in which light microscopic cytologic exam- ination was negative or suspicious. Follow-up SEM studies on patients with superficial bladder carcinomas removed by transurethral resection revealed PMV on exfoliated cells from all patients who developed re- currence, including 5 cases in which PMV were detected before the re- currence was visible on cystoscopy. PMV have not been found in cyto- logic samples from patients with normal bladders, with bacterial cysti- tis or with cyclophosphamide induced hemorrhagic cystitis. Workers exposed to bladder carcinogens on the job have also been followed with SEM studies, as have patients receiving radiation therapy for bladder cancer. L-_

349 PROGNOSTIC IMPORTANCE OF SPECIFIC IMMUNOREACTIVITY IN OCCUPATIONAL BLADDER CANCER. Kumar, S. Paediatric Oncology Laboratory, Christie Hospital and Holt Radium Institute, Manchester, England. Sixty-eight workers with a history of exposure to a bladder carcino- gen were followed up to see whether changes in lymphocyte immuno- reactivity to a bladder-cancer-cell target were predictive of the development of neoplasia of the urothelium. A twofold or greater in- crease in reactivity was strongly associated with the development of abnormal urinary cytology suggestive or indicative of malignant change. Changes in immunoreactivity to a non-bladder-cancer-cell target did not have this association. The findings support the possibility that changes in lymphocyte immunoreactivity may be used to predict the onset of bladder cancer in people exposed to bladder carcinogens. 350 CARCINOMA OF THE PROSTATE - A REVIEW OF HISTOLOGICALLY BENIGN AND CYTOLOGICALLY MALIGNANT PROSTATE. Gingell, J.C., Swift, A., Slade, N. Department of Urology, Southmead Hospital, Bristol, Eng. Over the past decade all patients presenting to the Department of Urology at Southmead Hospital with prostatism and retention of urine have had transrectal fine-needle aspiration (Franzen) of the prostate if on rectal examination there has been a suspicion of malignancy. A [32] small but significant group of patients have been detected with unequivocal carcinoma of the prostate on cytological grounds but in whom subsequent histology of the resected prostate has shown benign hyperplasia only. Some of these patients have had bilateral orchiectomy or aestrogen therapy while others have had specific anti- cancer therapy deferred. All of these patients have been regularly reassessed and the findings will be discussed. PROSTATE CANCER/FINE-NEEDLE ASPIRATION

LIST OF ABSTRACTS 351 Racial Differences in Survival Analysis of Patients With Prostatic Cancer Stevens, C.W., Carter, W.H., Wampler, G.L., and Hazra, T.A. Virginia Commonwealth University, Medical College of Virginia, Richmond, Virginia, U.S.A. (33J The prostate gland is the fourth most frequent site of primary neoplasm In the adult U.S. male population. The incidence rate for non-whites is higher than that of whites (68.6 compared to 45.2 per 100, 000) . The mortality rate among non-whites (26.9 per 100, 000) is considerably hig her than that of w hite (15.1 per 100,000 patients). In the Medical College of Virginia Tumor Registry there are records of 638 patients of which 200 were white and 438 were black. Life tables which provided nonparametric estimates of the survival functions were constructed for both groups. Using the nonparametric estimates of the hazard, a best fitting parametric model was selected using the procedure proposed by Gehan and Siggiqui. A summary of this analysis and a comparison of the various models explored will be discussed in the presentation. RACIAL DIFFERENCES/SURVIVAL ANALYSIS/PROSTATE CANCER/ TUMOR REGISTRY (33J 352 TUMOUR-ASSOCIATED IMMUNITY IN PROSTATIC CANCER: SUPPRESSION BY HUMAN SEMINAL PLASMA. Ablin, R.J., Bush, I.M. & Bhatti, R.A. Cook County Hospital and the Hektoen Institute for Medical Research, Chicago, IL. The immunosuppressive properties of the hormonal and/or secretory mi- lieu or tumour-elaborated factors of the prostate have been hypothesized as contributory to the natural history of prostatic cancer (PCa). The effect of normal human seminal plasma (HuSP1) on immunity to tumour-as- sociated antigens and the 'arming' of normal peripheral blood leukocytes (PBL) by cytophilic antibody (CA) in the sera of PCa patients (pts.) have been evaluated. Significant (p<0.01) suppression of immunity to malignant prostate ranging from 16-80% of the level of reactivity obtain- ed with unincubated pts. PBL was observed in 22(88%) of 25 pts. follow- ing pre-incubation of their PBL with HuSP1. Similarly, pre-incubation of PBL from 8 normal adults with HuSP1 prior to 'arming' with PCa pts. sera, resulted in significant suppression of 'arming' by CA ranging from 10-60% of their level of reactivity obtained with unincubated and 'arm- ed' PBL and malignant prostate. It is hypothesized on the basis of col- lation of studies demonstrating experimental PCa from sensitization by spermatozoa and the relationship of PCa to repression of sexual activity that SP1 may play a significant role in the natural history of PCa. IMMUNITY/SUPPRESSION/SEMINAL PLASMA/PROSTATIC CANCER

MODULATORY EFFECTS OF AMYGDALIN ON TUMOR-HOST DIRECTED IMMU- 353 NITY IN PROSTATIC CANCER. Bhatti, R.A., Ablin, R.J., Nagubadi, S.R. and Guinan, P.D. Cook County Hosp. and Hektoen Inst. for Med. Res., Chicago, Illinois 60612. To evaluate the in vitro effects of amygdalin on tumour associated immunity(TAI) of patients with adenocarcinoma of the prostate(CaP), leu- kocytes from 56 patients with a confirmed histological diagnosis of CaP were reacted with 3M KCI-(NH4)2504 extract of allogeneic malignant pro- state alone and Tn combination with amygdalin(Sigma Chemical Co., St. Louis Mo.) in the leukoc te adherence inhibition test. No. Patients $Non-adherence + S.E. o CaP Patients P Leukoc tes Obtained With: CaP Ca + Am da n 56 19.9 + 2.0 32. + 2. <0.001 The data obtained tends to indicate that leukocytes from 44 patients 7$ exhibited greater Immunoreactivity to tumour-associated antigen(TAA) of CaP in the presence of amygdalin as compared to reactivity obtained with TAA of CaP alone. The difference in reactivity was statistically signifi- cant. The possibility that this increased reactivity, as Judged by the $non-adherent cells, was due to cytotoxic effects of amygdalin.was ruled out by trypan-blue dye exclusion and by reacting the leukocytes with amygdalin alone, in which case the %non-adherent cells obtained was very low(as in control). Studies are underway to see whether this increased cellular response was a reflection of an increase in TAI. 394 Fine Needle Aspiration Cytology of The Prostate Gland Chauhan, P.M. Gabriel, J., Sahu, B., Patrick, C.,Garnes, H. Columbia University/Harlem Hospital Center, New York, N.Y. Prostatic Carcinoma can be diagnosed by various methods such as Transuretheral Resection, Perineal Cup Biopsy, Transrectal Puncture and more recently by Fine Needle as- piration Cytologic examination. A prospective study of fine needle aspiration cytology with correlated core Bi- opsy is being performed at Columbia University, Harlem Hospital Center. The correlation between light micro- scopic findings of Biopsy specimen and cytological evalu- ation by fine needle aspiration was 85%. The procedure is relatively simple, painless with insignificant complica- tions. The authors think that fine needle aspiration can be performed as an outpatient or office procedure for the early diagnosis of Carcinoma of the prostate. /FINE NEEDLE ASPIRATION CYTOLO(?Y/PROSTATIC CARCINOriA/ J 0 W V

LIST OF ABSTRACTS 355 EPIDEMIOLOGY OF CANCER OF THE TESTES IN ROCKLAND COUNTY. Jaffrey, I.S., Palisades Oncology Assoc., Pomona, New York,USA From 1972-1977 the number of cases of carcinoma of the testes in Rockland County approximated the expected number of cases based on population. A unexpected increase in the number of patients presenting with carcinoma of the testes between 1978 and 1979 prompted this study. Between 1978 and 1979 twenty cases were newly diagnosed in Rockland County. Their ages ranged from 2 to 45. There were 9 stage I, 7 stage II and 4 stage III. All patients were born -between 1933 and 1976. [33] Geographically they represented six New York State counties, 4 states and one foreign country. 5 patients had embryonal, 2 had seminoma, 2 teratoma, 6 mixed embroynal and 1 seminoma with teratoma. Interviews with the maternal parent and medical record review showed no history of Diethylstilbesterol (DES) exposure in utero for nine patients. No DES information was available for the remaining patients. Eight patients were born with testicular or other congential defects. These included two, severly retarded patients, one with hypospadias and the second with a malformation of the cranial vault and jawt two patients had undescended testicles. One patient had gynecomastia, one had "acromegalic facies", one had an anomaly of the left kidney. From 1975-1978 thirty one cases of malignant neoplasm of the testes were diagnosed. Based upon available population figures, the observed number exceeds the expected number of cases by a factor of 1.9. /EPIDEMIOIAGY/CANCER-TESTES/ROCKLAND COUNTY 3~'j PREVENTION AND EARLY DETECTION OF TESTICULAR CANCER IN CRYPTORCHIDS. Batata, M.A. and Chu, F.C.H. Memorial Sloan-Kettering Cancer Center, New York, N.Y. 10021 Of 1152 testicular cancer patients seen at MSKCC from 1949 to 1976, 137 patients were historically or currently cryptorchids with pure seminomas (56) or germinal carcinomas [33] (81) found in the abdomen in 14, in the groin in 24, and in the scrotum in 99 patients. Of the latter patients, 86 had ipsilateral correction of the cryptorchid state spontaneous- ly (23) or by orchiopexy (54) or hormonal therapy (9), and 13 had ipsilateral normally descended testes with contra- lateral historical (7) or current (6) cryptorchidism. Cryptorchid state was corrected at ages 4-42 years and the cancer detected at ages 15-60 years, with a median interval of 20 years in-between. Unilateral cryptorchidism, especia- lly in postpubertal patients, should be treated by orchiec- tomy instead of orchiopexy, preventing ipsilateral tumor- igenesis. Cryptorchid testes which descended late spontane- ously or by hormonal therapy in prepubertal patients should be carefully observed, especially after the 20 year latent period, for early detection of cancer. Cryptorchidism, Testis Cancer, Orchiopexy. cT 0 0 r ~ V• w N

LIST OF ABSTRACTS (33] (33) 3~ EVALUATION OF VARIOUS DIAGNOSTIC METHODS FOR THE EARLY DETEC- TION OF METASTASES IN TESTICULAR TUMORS. Aiginger','P~, KUh- bbck, J., Kolbe, H., Spona, J, 2nd Med.Dep., Ist.Dep.Gyn.&Ob., L.Boltzmann Inst.Clin.Endocrin.Nucl.Med.,Univ.of Vienna, Austria. In the last 3 years 71 patients with testicular tumors were control- led. At the time of orchiectomy metastases were present in 45 patients, in 5 patients relapses occured later. 27/45vtumor recurrences were smal- ler than 2cm. The following methods were employed to detect relapses as early as possible: S-HCG, AFP, estradiol (E ), testosterone (T) evalu- ations by RIA-technique, CT-scanning (CT), Vray/chest, urography (uro.),, isotope scanning (nucl.scan). The frequency of positive results is listed in table 1(%) a-HCG AFP E T/E2 CT X-ray uro nucl.scan group I( 2cm) 56 48 63 67 41 41 11 26 group II( 2cm) 72 72 72 78 72 78 67 26 These results indicate that by employing E2 and T evaluations besides the well known tumor markers R-HCG and AFP it becomes possible to detect tumor relapses in testicular tumors at an ea_.rly-stage,--Po;itivity-6`r T:u=-- ,rror snar°kers preceded all other methods in abdominal tumor relapses, where as X-ray/chest preceded tumor marker positivity in some cases of solita- ry pulmonary metastases. Bone metastases could be localized best by isotope scanning and computer tomography. EARLY DETECTION OF RELAPSES/ TUMOR MARKER/ R-HCG/ AFP/ HORMONES/ CT 3~ EFFECT OF SOME PHYSIOLOGIC AND PATHOLOGIC FACTORS ON THE ACTIVITY OF URINARY a(-NAPHTHYL ACETATE ESTERASES IN BILHARZIAL BLADDER CANCER. El-Sewedy, S.M., Soffar, A.M.,Arafa,A., El-Borno,F.A.and El- Zoghby, S.M. Dep. Applied Med. Chem., Med. Res. Inst., Alex Univ.i Dep. Biochemistry, Fac. Med., Tanta Univ., and Dep. Urology, Fac. Med., Alex. Univ., Alexandria, Egypt. A simple biochemical method for measuring the activity of urinary O(tnaphthyl acetate esterases for bilharzial bladder cancer patients is discribed. The method depends on measur- ing the colour produced from the interaction of released o<-naphthol and Fast Garnet GBC at 555nm. The urinary enzy- me activities for bilharzial and non-bilharzial bladder ca- cer patients were measured in four urine sampless early mor- ning, overnight, diurnal and 24-hour urine. The correlation between the urinary oC-naphthyl acetate esterases activities for these patients and the presence of haematuria,pyuria, creatinine concentration and urinary bacterial infection is discussed. The physiologic changes related to age and smok- irig have been studied as possible factors affecting enzyme activities. The interfering eff ects of some commonly used drugs on the urinary *naphthyl acetate esterases activit- ies are discussed. /URINARY o(-NAPHTHYL ACETATE ESTERASESIMETHOD OF ASSAY/

LIST OF ABSTRACTS OONPiilJL OF PATIFN!'S WITH UR7PE~.IAL CANC'.FI2 BY 8 HR URINARY 359 FXCRE'pION OF S-AbffIqOISOB[P!'YRIC ACID AAID PSfUDOURIDIIQE Nyholm, K.K., Sj6lin, K.-E., Iversen, J. & Palm, L., Inst. of Pathology, Sundby Hospital, Copenhagen, and Dept. of Surgery, Division of Urology, Fmskilde County I-bspital, Roskilde, Denmark. B-aminoisobutyric acid (SAIB) and pseudouridine (iy) in 8 hr urinary samples were determined by gas chrerratography and high performance liquid chromatography, respectively. The values were related to urinary [33] creatinine. The ~/BAIB ratio was calculated in 52 patients suspected of primary or recurrent urothelial cancer and 23 controls. R'he choice of this ratio was based on earlier results which indicated an increase in urinary * and a decrease in urinary SAIB in patients with progressive invasive urothelial cancer (K. Nyholm et al., Biomedicine, 1975:22:509 and 1976:25:85). The results were conpared with the results from the controls, the presence of cancer determined by conventional clinical and pathological methods, and the invasive or non-invasive type of the can- cer. The ratio was significantly higher (>5) in patients with cancer than in the controls (p<0.01). In invasive cancer the ratio was >5, in nan-invasive cancer <5 (p<0.0005) (X2-test). We find the urinary ~P/gAIB ratio valuable in the clinical rronitoring of patients with urothelial cancer and the present study continues to confirm this. /CIRINARY B-AMINOISOBUTYRIC ACID/URINARY PSEUDOURIDINE/U0Tj,IAL CANCER/ 360 STUDY OF 250 CASES OF CARCINOMA OF URINARY BLADDER: A PRELIMINARY REPORT. Rizvi, S.H.A. Department of Urology, Dow Medical College & Civil Hospital, Karachi-Pakistan. Carcinoma of urinary bladder remains a problem of considerable importance. With emphasis on investigation [33)of haematuria, including radiological and endoscopic screening, increasing number of patients with bladder tumours are being discovered. The treatment remains a challenge, more so in this part, because the disease is far advanced at the time of presentation, rendering radical treatment impossible and in others treatment does not bring the disease under control. 250 cases have been followed up for age and sex variation, clinical presentation, radiological picture and endoscopic appearence, site and histology of growth and the results of treatment is presented. /STUDY OF CARCINOMA OF BLADDER/ U 0 0 ~0 Js .I 0 W a

LIST OF ABSTRACTS (42J (42] 361 THE POSSIBLE INFLUENCE OF ORAL CONTRACEPTIVES ON THE INCIDENCE OF THE INVASIVE CARCINOMA, CARCINOMA IN SITU AND DYSPLASIA OF THE CERVIX Kovacic,J., Koiuh,M., Andolsek,L. Clinical Center, Department of Obstetrics and Gynecology, Slajmerjeva 3, Ljubljana, Jugoslavija. In order to find out the possible influence on the incidence of cervical invasive carcinoma, carcinoma in situ and severe dysplasia a prospecti- ve study in two groups of oral contraceptive users and in one control gro- up of nonusers was carried out. From the recruitment period 1970-1972 till the end of the study in 1976, 5562 not prior users with 20189 women years, 5906 prior users with 28498 women years and 15665 nonusers with 65637 women years were followed. In the not prior users 3 cases of inva- sive carcinoma (0,148/1000wy), 19 cases of carcinoma in situ (0,891/ 1000wy) and 16 cases of severe dysplasia (0, 792/1 000wy) were found, the coresponding findings in prior-users group were 3(0,105/1000wy), 19 (0,666/1000wy) and 23 (0,807/1000wy) and in the control group 1(0,015/ 1000wy), 48 (0,731/1000wy) and 46 (0,700/1000wy). The life-table ana- lyses using the Mantel-Haenzsel procedure to adjust for years of follow- up and individual risk factors was used, followed by analysis with simul- taneously adjustment for the principal risk factor. /CERVICAL CARCINOMA / ORAL CONTRACEPTION/ 362 OBSTETRICAL TRAUMA AS A RISK FACTOR OF UTERINE CERVIX CARCINOMA Sibin Ilid,S.Pavlovid,B.Risti6,M.Karabagevid,M.Mir6etiE, D.Stefanovi6,M.Opri6. Institute of Oncology,Kladovo, Yugoslavia. Mechanical trauma was observed as a relative risk factor in developing of cervical carcinoma. Authors inquired patients with vaginal delivery and those delivered by Sectio Cesarea and found that incidence of cer- vical carcinoma was higher at women with vaginal delivery. Authors tried to explain these differences by more fre- quent histological and anatomical lesions of exo- and endo- cervix during delivery. Squamous cell epithelial hyperplasia and metaplasia,par- ticularly of reserve cells,developed for a time,as well as atypia of different degree with more or less proliferative potential. These changes were the most frequent at the squamocellu-• larjunction.It should be supposed that Sectio Cesarea had prophylactic role and considered that the less delivering trauma of squamous epithel the less was relative risk fac- tor,i.e.if delivery was,performed unskilled the more was possibility of developing proliferative process.

LIST OF ABSTRACTS 363 PRELIMINARY RESULTS OF A PROSPECTIVE STUDY ON , THE CERVICAL CANCER.Kanka, J., Vonka, V., Kutinovd,L , Havrdnkovd, A., V dchal, M.,gubrt, I., Jelinek, J., Suchcinek, A.,Domo- rdskova,E.Dep.of Gynecology,Faculty of Medical Hygiene, Charles UniversityfDep.of Experimental Virology,lnstitute of Sera and Vacc- ines; Prague, Czechoslovakia. - To determine the risk associated with previous herpes simplex type 2 infection a prospective study on 10,619 women aged 25-45 years has been initiated in Prague in 1976.At the enrollement colposcopy & cytology were performed,blood sample was taken,& data regarding socio-economical status & sexaal & reprod- uction-associated attributes were obtained in each woman.At the enrol- lement 10 cases of invasive ca,41 of ca 0 & 55 of dysplasia were detect- ed.In the subsequent follow-up 4 more cases of invas.ca,19 of ca 0 & 22 of dysplasia were revealed thus far.Of these 45 women completely negative findings had been originally made in 15 subjects,unclear find- ings in 20 and suspicious findings in 10 subjects.ln the first analysis the epidemiological characters of the women with invasive ca & ca 0 have been compared with those possessed by the completely negative women.The results obtained will be discussed.In addition,serological findings in the patients and matched control' subjects will be presen- ted. /CA CERVICIS - EPIDEMIOLOGY-VIROLOGY-DETECTION/ 364 EFFECT OF AGE ON THE DURATION OF CARCINOMA IN SITU AND INVASIVE CERVICAL CANCER. Penttinen, J. Department of public health, university of Tampere, Tampere, Finland. There has been practiced an organized mass screening programme in Finland since the beginning of 1960's. Every woman between the ages of 30 and 55 years in screened every fifth year. In the paper the duration of carcinoma in situ-stage is estimated in women aged between 35 and 53 years and the duration of invasive cervical carcinoma is estimated in wo- men aged between 35 and 74 years. The results indicate, that the duration of carcinoma in situ-stage decreased af- ter age of 40 years. The duration was 7.2 years in women aged 42 years and 3.9 in women aged 51 years. According to these results, a screening interval shorter than five years could be recommended for women aged over 50. The duration of invasive cervical carcinoma decreased evenly from 11.5 years in females aged 35 years to 8.7 years in females aged 74 years. The decrease may be accounted for the decrease in the expectation of life by age. /DURATION OF CERVICAL CANCER/

LIST OF ABSTRACTS (421 RISK ,~'s.ROUPS I?l ?s!t??LY' DFT?.^.'_^IO!`? 0:~ UT'~'_RP''L' 365 C~t'JIX C9NCER Oharkviani Z.T.,Chitiaahvili R.A., Oncology Research Centre,Ministry of Health of Georgian SSR,Tbilisi,USSR Complex use of modern mPans of diagnostics (cytology, colposcopy,colpo:nicroscopy)is required for identification of uterine cervix cancer at its preinvasive and early in- vasive stages.In Georgia the rate of occurrence of cervi- cal cancer is 16-17 per 100,000,at most.A thorough _exRmin- ation of a great :aass of population aimed at revealin ; the relatively negligible number of cases is practically impos sible and too expensive.our epi'.e~niologic studies showed , 18 high risk lActors(af;e,puberty and senilit,y,sexua:l life, ;enerative function,bloor' group,etc. )for the develotiment of cervical cancer.Special questionnaires are filled in for all women over 30. Risk v;roups are formed if 4 or raore risk factors(14-15,', of the interrop,Ated)occur,^hese women undergo thorough examinations in their reaional disnensR- ries once a year.Experimental stud,y of the proposed meth- od has proved its safety and high efficiency in prevention a.nd early detection of uterine cervix cancer. /UT-PRI?TE CERJI: CANCLR/RISK GROUPS/ CYT0C*'E!.!IC:1L ~ZCRIPfIGN OF CF721•IC;a• ',:,,LIGi2.J~CY. Roy Clun;dhiu.•y,J. & L;;fiiri, T. Chitt:ran,f an X:rtioawl C,.ncer Rese.rch C~nt.re, Calcutt2, Indi~. The c,vtochenicnl evidences of •lifferentiatirni closely p,rallels cyte- morpholonical evi(lences of differentiation in the str::tified epithelium of cervix and ti-.e same is reflected in the r,ells exfolijted. Cytochemi- cal localization of m-:cromolecules and a series of enzymes were made in the erfoliated cells of cervi;: in normalcy ond ri--liqnuncy under pre- and pnst-:aenop~usal conditions. The r!;:ta. reveals tnat the distribution 142) pattern of the mucromolecules vury under :,ivide spectrum in the process of differenti::t.ion ond dedifferentiation. The cerbohydrate moiety - , glyco~,jen :ind ;:cid nueopolysaccii;xide cre sensitive imlicators of malig- nant changes us well as reveal hornone dependence. Sudanophilic lipid granu)es exhibit c!ifferential response of fine ;;nd coc:rse ryr;~nules vitP: respect to influence of oestrogen and proC-esterone respectively but strikingly indic3tes selective increase of fine nrunules in malignancy. ::,nong the enzynes,ivhile succinate dehydrogenase and vlkaline phosph - tase is increased in malinnant condition, the other phos,^.hatase prcups like acid rljosph3t;:se,adenosine triphosphr.tase and 4ilucose-5-phospha- t;ise are loa•rer than that of normal condition.The result is discussed in terms of cytochemical lesion of 7alignnncv as ; diagnostic criteria nerhaps even at its prenalign.nt condition: /CYTlx11E1.;IC°.L UrSCRIPT7kYN/C'r7tVIC.•I. ;;i,LIGR,tvCY/

LIST OF ABSTRACTS 367 vl~Gtic,: IS vF C.~.;iVICI+.L C:;1•:Ci:fi 13'1 T:::TliYL :Y4.~ fiUE, h~Iia.:c; i.h }32i~.'PY~+C}fi.i~Y.~,U.PAUI ,D.P.Di,C,1T.C2i~.UDRU1.1, S.K.IiAT:EnJLr:,D3PT CF Oi^T & GYN,SSr_'. HC`SPITAL,CALCUT'Pti,TxliIA Tadayoshi Qt al reported the diaprostie ahility of inethy lene blue for gastric cancer(Asian 1•:ed Jr,Vel 36 patients of prossly unhea?thvi cervie,refd to cancPr cliric for hioosy,vere considered as sulh;ects for GtuAv.?Ieth ylene blue 5mg%ml were sprayed over tlae cervix total)y >?y an atomiTer,after it's proper vi4ualisation.Patients rPexamined [42) =fter onehour end residua.l stairs r.oted A.nd Rraded As follo- kG.(:-rade 1-deeply and uniforrroly st3ir.ec?,Grade II--natchy de- ep stein,Grade TII-poor stain,Grade TV-nc stFin. I?esults: ?10 of Cases Grading c,c Ca Ac?eno .^.A Chronic Cervicites t 'TCn n°o?)1rBtic lnsio" F cases I 3 6 x 1^ cases II 9 ~ 6 cases III 6 10 cctses IV 1* 0 Conclusion:This u_~sion:TY.is affinity st-aninP is a simple F: effective for screeninf ofthc hi r1: ri e1- cases from Gynae OPD. Ormde I <i II sufg.e&-ts m-:lit?nPncy.FnlQe(Positiv~ $~3A nerative ?.7j(. * Sq cell Ca with Prernancy ?4 weel!s ~ COYMINATION OF CYTOLOGY AND COLPOSCOPY IN DIAGNOSIS OF CER- VICAL IN.TRAEPITHELIAL NEOPLASIA (CIN). Harahap, R. E., Neoplasm*sub Division, Dept. of Obstetrics and Qmeco- logy, School of Medicine, Univercity of Indonesia, Jakarta, Indonesia. TWo hundred and eighty cases of erythroplakia were examined cyto- logically and colposcopically. On cases with abnormal colposcopical findings spot biopsies were performed to get specimen for histological examination. Very mild and mild dysplasiawere regarded as CIN I, mode- [42] rate one as CIN•II, and severe dysplasia + carcinoma in situ (CIS) as CIN III. Cytological result was normal on 76 cases, inflammation on 162 cases and abnormal on 42 cases. Out of 76 normal cytological re-4 tults, there were 41 abnormal colposcopical findings which resulted 20 CINs (26.3%): 15 CIN I, 4 CIN II, and 1 CIN III. Out of 162 inflammato- ry cytological results there were 108 abnormal colposcopical findings which resulted 52 CINs (32.1%) : 36 CIN I, 13 CIN II, and 3 CIPI III. Cryosurgery on 72 CINs resulted good result on 97.2% with follow-up period 6 - 12 months. As a conclusion, normal and inflammatory results of cytology didInt garantee that the cervix is free of dysplasia; in other words oolposcopy should be used routinely to detect CIN. /COLPOSCOPY AND CYTOLOGY/CIN DETECTION/

LIST OF ABSTRACTS (427 369 HISTOLOGICAL AND STEREOLOGICAL ANALYSIS OF MICRO- INVASIVE CARCINOMA OF THE UTERINE CERVIX. Erzen, M., Rainer, S., Kalisnik, M. Clinical Center - Department of Gynecology, Ljubljana, Yugoslavia. Fourteen cases of microinvasive carcinoma of the uterine cervix were stereologically analysed. Stereological analysis was made by Zeiss's light microscope and by Weibel's multipurpose test system. Histological characteristics of the tumours, cell type, the pattern of invasion within the stroma and the presence of capillary-like space invasion were compared with the quantitative results obtained by stereological analysis: absolute volume, absolute surface and factor of deformity, meaning how many times the specific surface density of the tumour is greater than the ideal spherical specific surface density. High significant correlation was established between the pattern of in- vasion within the stroma, the presence of capillary-like space invasion and stereological findings. Increasing values of absolute surface and factor of deformity In carcinomas with confluent type of invasion could mean higher malignancy morphologically performed by capillary space invasion. /STEREOLOGICAL ANALYSIS / MICROINVASIVE CARCINOMA/ 37o EARLY SEXUAL LIFE AS AN INFLUENTIAL FACTOR FOR HIGH INCIDENCE OF CERVICAL CARCINOMA. D.Stefanovi6,S.Ilid,S.Pavlovid,M.Kraba:;evid. Onkologki institut geoqrad Yu osla Our investigation was on the causal c`~nnecUSn between sexual life in adolescence and the high incidence of cervical carcinoma in the Eastern part of the Republic of Serbia.. The autors'opinion is that the adolescence cervix is bio- logicaly immature for sexual activity.The metaplastic cervical epithelium,which very often occurs in adolescen- 6o ce is prerequisite for atypical proliferations. ps The investigated material was 4000 women.The metaplas- tic epithelium was found in 808 virgo intacta (teenagers) an all women who had their first pregnancy.A few cases were found in the reproductive an postmenopause period of life.In women who had an sexual experience of 3-5 years and more partners,65% had an Atypical Transformation Zone on the cervix,while in married teenagers who had only one partner this precentage was half smaller.In pregnant tee- nagers we found TZ in 36% while the ATZ was present in only 3% of them. The autors conclude that metaplastic epithel in adoles- cence is the primary risk factor for the high incidence rate of cervical carcinoma in the Eastern part of Serbia.

LIST OF ABSTRACTS 371 FIRST RESULTS OF A 15 YEARS FOLLOW-UP OF HIGH RISK WOIIEN IN"LUDID IN A CERVICAL PREVENTION PROGRAM. • Remotti°,G., Garsia°,S., & Gallus °O,G. ° Obstetrical and Gynaecological Clinic University of Milan 0o Biometry and Medical Statistics Institute, University of Milan, Italy 709 women selected for cervical pathology have been visited in the years 1964-1965 at the "Centro Diagnostico" of the Obstetrical Clinic 60 of the University of Milan and checked after 15 years. Ps 556 had to be treated as out-patients in order to bring the cervix nd to a normal condition (401:ectropions, 115:1st grade dysplasia,39:2 grade dysplasia, and 1:3T'd grade dyplasia). The control has been done by a gynaecological visit in 213 cases and by questionnaire in the remaining 343 cases. No treated patient developed cervical cancer. This seems to suggest that periodical screenings are not necessary within the limits of the observed period , when the cervical pathology has been properly cured. An exception to this statement could be given by vaginal deliveries with consequent cervical lesions. /CERVICAL CANCER PR~.'VFNTION/ 3n MINIATURE PAN-ENDO-MICROSCOPE AND ITS CLINICAL USE FOR EARLY DETECTION OF CANCER. KIMIYASU OHKAWA, RYOKI OHKAWA. T. AOKI Department of Obst. Gynec., Nippon Medical School•1-1-5 Sendagi-cho Bunkyo-ku TOKYO JAPAN Object of study : The early detection of cancer of cervix, endometrium and ovary is most important. We have tried 6 years ago to detect cancer of cervix of uterus , uterin cavity and abdominal cavity with miniature 60 PAN-ENDO-MICROSCOPE. This endomicroscope is improved by Ohkawa. PS Method used : Two types of endomicroscope are available, one with the lenses on the tip and other on the side, depending on the side to be observed, Living cells are spray-stained in situ with Cresyl violet acetate and Thionin solution. These instruments are 8 mm in diameter and 40 cm in length. Results obtained : 125 cases of dysplasia, 150 cases of cancer of cervix of uterus, 20 cases of intracervical cancer, 10 cases of endo- metriumcancer and 30 cases of cancer of ovary were examined by these instruments. The stain distingishes normal from abnormal cells in two or three seconds, allowing immediate preliminary diagnosis. Comfirmatly hystological tests are then done on positive tissue salple. Conclusion : This methods not only facilitate the endoscopic diter- mination of the extent of the carcinomatos spread, but also represents the useful means of early diagnosis of malignant grows. /EARLY DETECTION OF CANCER/ ENDOMICROSCOPE/

LIST OF ABSTRACTS 373 PARTICIPATION IN A SCREENING PROGRAM FOR THE DETECTION OF CERVICAL CANCER, Jansen,J.H. and Kremers,W, Study Center of Social Oncology, Rotterdam and Department of Sociology State University of Utrecht, The Netherlands. Factors associated with (non-)participation in a community based screening program were studied. 1,403 women, a complete sample of selected age groups from 13 selected neighbourhoods of a large city, were interviewed; six months prior to being called for the screening. 1083 (77%) were interviewed. The interview included demographic variables as well as questions concerned with social participation, health knowledge, and the variables constituting the Health Belief Model (HBM). Of the entire sample: 61% participated in the screening, 22% were 'protected' (recent PAPsmear, uterus removed, etc.), 14% did not participate without giving a reason, and 3% had moved from the area. The variables of the HBM correlated only moderately with partici- pation in the screening program. Results indicate that non-partici- pation can be seen as a form of social non-participation; whereas health knowledge and a general interest in health matters facilitate participation. Policy implications of the study results are suggested. /SCREENING/CERVICAL CANCER/ RECENT Rf;SULTS OF CERVIX CANCER SCREENING PROGRAMS 374 IN THE GERMAN DEP4OCRATIC REPUBLIC. Ebeling,K., Neumann,Ii.-G., Neuser,D.$ Berndt,H. & Herold, H.,J. Academy of Sciences of the German Democratic Repu- blic, Central Institute of Cancer Research, GDR. In three districts of the GDR cytological mass scree- ning were established many years previously and in 1976 a mass screening program was decided for the whole courH- try. The recent result s in the districts with screening programs are - a markedly increase of the morbidity rate of ca in situ, followed by a clear decrease - a temporary increase of morbidity rate of invasive cer- vical cancer (screening eftect!), followed by a conti- nuous decrease of incidence beginning after the second screening period - an increase of earlier stages connected with a simul- taneous decrease of stages III and IV - a decrease of side-effects of treatment (treatment of earlier stages. It is obvious that screening effects are clearer in districts with long-term established screening pro grams. /CERVIX CANCER SCREENING IN GDR/

LIST OF ABSTRACTS 375 EFFECT OF MASS SCREENINGS FOR CERVICAL CANCER IN FINLAND. Hakama, M. Finnish Cancer Registry, Liisankatu 21 B, 00170 Helsinki 17, Finland. In Finland there is a nationwide mass screening programme for cervical cancer according to which females are invited to attend every five year between ages 30 and 55. Both inci- dence and mortality rates have decreased during the pro- gramme and an estimate of 50 % reduction due to screening [431 was arrived at in the incidence assuming the system to be continued, whereas it is likely that similar reduction in the mortality was not solely due to screening but the reduc- tion in risk was accounted for by other factors related to environment or medical care as well. On the other hand, it was estimated that one in three preinvasive cases subjected to operative treatment would have progressed into invasive cancer even in absence of any intervention. /MASS SCREENING/CERVICAL CANCER/ ~6 SCREENING FOR CANCER OP THE UTERINE CERVIX IN ICELAND 1965- ." 1979 AND THE EFFECT ON INCIDENCE AND MORTALITY. G. Johannesson, G. Geirsson, N.E. Day and H. Tulinius. The Cancer Detection Clinic of the Icelandic Cancer Society, Reykjavik, Iceland. An organized mass-screening for early detection of cervical cancer has been in operation in Iceland for 15 years. During the first five years, from 1965-1969, this screening was confined to Reykjavik and the surrounding districts and aimed at women in the age-group 25-60 [431 years. But from 1969 the screening was extended to include the whole country and the upper age limit was moved to 70 years. The mean number of femdles in these age-groups is about 50 thousand. In the end of 1979, 80% of these women had been screened at least once and in the end of 1977, 65% at least twice. The incidence of cervical cancer was during the first 5 years of screening, 1965-1969, 24,8 per 105 females per year and dropped to 17,7 the_following five years. During the last five years period 1975=1979 the annual incidence of cervical cancer was 8,9 cases per 105 or a reduction by 64% compaired with the first five years period. During this 15 years period of screening there has been a decrease in the total ~ t~lity from cervical cancer - from 13.1 deaths per 105 females per ye3~6 /19b~o annual mortality of 3.4 per 105 females in the last five years period 1975-1979, a reduction by 74%.

(431 (431 LIST OF ABSTRACTS Y7 SCREENING OF CERVICAL CANCER IN ISRAELI POPULATION: A PILOT STUDY OF 12,163 WOMEN. A. Schachter, M.D., A. Neri, M.D., Z. Edelstein, M.D., Y. Ovadia, M.D. Gynecological Cytology and Col- poscopy Unit: "Marie Cohen" and Department of Obstetrics and Gynecology, Beilinson Medical Center, Petah-Tiqva, Israel. Cervical cancer continues to be one of the most frequent cancers of gynecological oncology. Since this cancer has been considered to occur only rarely among Jewish women, a preliminary study was conducted on 12,163 Jewish women in Israel (including 8,560 kibbutz women) who were referred, at their own request, to the Cytology and Colposcopy Unit of Beilinson Medical Center out-patient clinics from January 1977 to Jan- uary 1980. The screening population was divided according to epidemi- ological aspects as well as ethnic background and the results have been submitted for statistical analysis. The cytological findings of our study controlled by colposcopic and histopathological examinations of directed cervical biopsies challenge the validity of the so-called "immunity" of Jewish women against this type of cancer. 378 FRDQUPNCY OF PAP SMEAR SCREE'NING Ata) PRFVfNPABILITY OF INVASIVE CANCER OF THE CERVIX - A COHORT ANALYSIS. Choi, N.W.. & Nelson, N.A. International Agency for Research on Cancer and Manitoba Cancer Foundation, Lyon, France. Percentages of women in Manitoba in 1972 participating in a province- wide pap smear screening progran during 1963-72 were estimated by age cohort. 85% of women age <45 in 1963 participated (94% age 15-19). A detailed exarnination of repeat screens for 270,000 strictly negative women indicate low frequency scheduling (only 40% with rmre than 2 screens). Sccie squairous cell invasive cervical cancer cases under age 35 - 37% strictly negative and 23% with scme atypical findings; 30% of cases age 35-59 - 15% strictly negative and 15% with atypias) were reported. Similarly additional invasive cancer cases were observed during 1973-75 among the previously screened (65% of cases under age 40 - 29% negative and 36% positive). Using person years at risk, the differences in risk between high frequency, low frequency and unscreened women were statistically significant. (p < 0.05). Sane of the available pap smear slides were reread to investigate false negatives. Sane unprevented young cases appear due to low frequency screening while for older women due to "not screened". /PAP SMFAFj/FREQUINCY/INVASIVE CERVICAL CANCER

LIST OF ABSTRACTS 379 HISTOLOGICAL TYPES AND CLINICAL STAGES OF CERVICAL CANCER IN ICELAND BEFORE AND AFTER THE ONSET OF MASS SCREENING. Geirsson, G., J6hannesson, G. and Tulinius H. The Icelandic Cancer Society, Reykjavik, Iceland. The histological material from cervical cancer diagnosed in Iceland during the period 1955-1974 was reviewed and retyped in accor- dance with the WHO classification of tumoUrs. Out of the total of three [43] hundred and fourteen malignant epithelial tumours, 86.0 per cent were squamous cell cancers, (subtypes: 6% microcarcinomas, 30% keratinizing, 45% non-keratinizing and 5% small cell carcinomas), 9.0 per cent adeno- squamous carcinoma, 3.5 per cent adenocarcinoma and 1.5 per cent undiff- erentiated carcinoma. A comparison between histological types of cervical cancer in the ten years prior to mass screening and those found in the ensuing ten years reveals a distinct increase in the number of microcarcinomas and the same trend is reflected in the lower clinical staging of the patients in the latter period. The changing pattern of histological types and clinical staging is discussed in the perspective of the patients'screening history which is available in every case. CERVICAL CANCER/ WHO-CLASSIFICATION OF TUMOURS/ CANCER DETECTION/ CLINICAL STAGING, [43] 'i8o BioPEPR: AN AUTOMATED PRESCREENING SYSTEM FOR CERVICAL SMEARS DJ Zahniser, PS Oud, MCT Raaijmakers, GP Vooys and RT Van de Walle The Physics Laboratory and the Institute of Pathology, University of Nijmegen, The Netherlands BioPEPR is a cathode ray tube scanning device that has been devel- oped for the prescreening of cervical smears. Cervical samples are collected in suspension, syringed, counted and spread across a micro- scope slide. Thionine-Feulgen with Congo Red is used as the staining procedure. Fields of 6 X 8 mm are scanned at one micron resolution, using an intermediate photographic step. Morphologic parameters of the cells are measured, as called for by a hierarchical decision strategy. Analysis speed is currently 2-U minutes per smear. A field test of BioPEPR is being undertaken in cooperation with a local population soreening program. To date approximately 4000 smears have been analyzed by the BioPEPR system. The results show a missed positive rate on the order of a few percent (no missed positives were more severe than a slight dysplasia), and a false alarm rate of about 23%. A further analysis of the age distribution of the false alarm rate shows that a large proportion came from woman above the age of 50; the false alarm rate is about 18% for woman under the age of 50. This presentation wi1l briefly review the smear preparation and staining techniques, the hardware and the software of the BioPEPR sys- tem, and will give the first results from the field test. /CERVICAL SMEARS/AUTOMATED PRESCREENING/IMAGE ANALYSIS/ 0 0 O r

LIST OF ABSTRACTS 381 SQUAMOUS CELL LESIONS IN THE DES PROGENY Arthur HERBST, M.D. University of Chicago, Chicago, IL 60612, U.S.A. There is considerable controversy regarding the histological classifica- tion and biologic behavior of vaginal and squamous cell abnormalities in women who have been exposed in utero to Diethylstilbesterol (DES). The report of frequencies of vaginal and cervical dysplasias detected by cytology and/or biopsy in the DES-exposed female progeny has ranged from 1221 0 to 18%. There are multiple factors which have been offered to explain the discrepancies in the frequency of intraepithelial squamous neoplasia - - in the series that have been reported: Current data from case control studies do not indicate an increased risk of intraepithelial neoplasia among DES-exposed females. The basis of these controversies will be discussed. [22) M2 CANCER OF THE CERVIX: A SEXUALLY TRANSMITTED DIS- EASE ? CORRELATION BETWEEN PATHOLOGIC CERVICAL CYTOLOGY AND ASYMPTOMATIC UROGENITAL INFECTION IN MALE. Dahlberg,B.Womens' Clinic,Univ.of Lund,Malmo and Lindblom, P.,Uro1.Malmo,Sweden. Group A: 200 partners of women with two or more consecutive pathologic cervical cytologic findings were examined by method of Dahlberg,B.(1976),Urology,vol 3:6:563, with cyto- logic smears and bacteriologic cultures taken from prosta- tic fluid and semen.Method of contraception = other than condome. All men were asymptomatic but 100 % had positive bacteriologic cultures of various pathogenic strains.Only 1% had pathologic cytologic findings. Group B: Controls.50 women with negative cervical cytologic findings the last five years.Their partners(50) were exami- ned as male group A.No pathogenic strains were found. Contraceptive method as.in A = other than condome. Group C: Controls. 200 women who had negative cervical cyto - logic findings the last five years.Method of contraception= condome. Repeated exposure of the cervix to male partner's asymptoma- tic urogenital infection may lead to precancerous or cancer- ous changes. MALE ASYMPTOMATIC INFECTION / CERVICAL CANCER.

LIST OF ABSTRACTS 383 CONDYLOMA ACCUMINATA: A PRECANCEROUS LESION? Michel ROY, M.D., FRCS(C). Division d'Oncologie, Universite Laval; Gynecology Oncology, Hotel-Dieu de Quebec, Quebec, P.Q., Canada. Condyloma accuminata has always been considered a benign sexually trans- mitted disease, responding more or less to conservative management. Very little research has been done on the nature of the virus and its possible oncogenic potential. Recent articles by Meisels et al., have lead us to review our clinic [22] material. Thirty-six cases of vulvar intraepithelial neoplasia (VIN) were reviewed. More than 50% were found to coexist with a previous or present neoplasia of the genital tract. Forty-two percent had concomit- tant vulvar condyloma accuminata confirmed by histo-pathology. One thousand patients referred for cytology compatible with condyloma accuminata were colposcopically examined and biopsied. Twenty-two percent were found to have cervical intraepithelial neoplasia (CIN) with confirm- ed condyloma of the cervix or the vagina. Further studies are in progress regarding the reason for the coexistence of condyloma and intraepithelial neoplasia. 3$4 HSV-2 EXPRESSION IN LATENCY AND CERVICAL NEOPLASIA FENOGLIO, C.M., GALLOWAY, D.A.*, CRUM, C.P., LEVINE, R.U., RICHART, R.M., and MCDOUGALL, J.K.* College of Physicians and Surgeons, Columbia University, New York, NY 10032; *Fred Hutchinson Cancer Research Center, Seattle, WA 98104, U.S.A. Herpes simplex viruses (HSV) are infectious, producing diseases which range from persistent and recurring skin lesions to fatal encephalitis. They can remain in a latent state for long periods of time, from which [22] reactivation of infection can occur. They can also alter normal mam- malian cells to malignant phenotypes. We have examined tissues derived from sympathetic ganglia and cervix for evidence of herpes genetic material using the in situ hybridization technique to detect virus- specific RNA, with whole herpes virus DNA or subgenomic viral DNA fragments as probes. We have also localized herpes-specific antigens utilizing the immunoperoxidase technique. The cervical tissue included benign, intraepithelial, and invasive squamous lesions. We have been able to demonstrate the presence of HSV RNA within ganglion cells and within preinvasive squamous cell lesions of the cervix using whole virus probes and certain subgenomic probes. Parallel results have been ob- tained in the antigen localization studies. The relationship of these results to latent states and to the progression of cervical intraepith- elial neoplasia through invasive carcinoma will be discussed. ON

'70r, PROLIFERATIVE SQUAMOUS LESIONS OF THE VULVA. ULTRASTRUCTURAL, I6SbfUNOHISTOCHEAJICAL, AND IN-SITU HyBRIDIZATION STUDIES. CRUM C.P.1, FU, Y.S.2, SHAH, x.3, MCDOUGALL, J.4, GALLOWAY, D.4, PURIFOY, D.S, POWELL, K.S, LEVINE, R.U.1, RICHART, R.M.1, and FENOGLIO, C.M.1 )College of Physicians 6 Surgeons, Columbia University, New York, NY; 2Case Western Researve University, Cleveland, OH; 3Johns Hopkins Univer- sity, School of Medicine, Baltimore, MD; 4Fred Nutchinson Cancer Research Center, Seattle, WA; 5Dept. of Microbiology, University of Leeds, U.K. Vulvar intraepithelial neoplasia (VIN) is a disease which is increasing in incidence, particularly in young patients. This increased incidence and prevalence has been linked to sexual contact and viral factors by vir- tue of an association with herpes simplex virus infections, condyloma accuminata, and cervical intraepithelial neoplasia. The present study was undertaken to evaluate the relationship of HSV-2; cytomegalovirus (CMV), and papovavirus to vulvar intraepithelial neoplasia using DNA microspectro- photometry, electron microscopy, immunoperoxidase, and in situ hybridiz- ation techniques. The results confirm the presence of papova virus and HSV-2 antigens in lesions which fulfill the conventional light microscope criteria for VIN. The co-existence of HSV-2 and papova virus is also observed in a small percentage of lesions. However, the relationship of this finding to the etiology of vulvar intraepithelial neoplasia is unclear. . 386 HUMAN PAPILLOMAVIRUS (HPV) INFECTION OF THE CERVIX: THE ATYPICAL CONDYLOMATA. A. Meisels, C. Morin, M. Casas-C. M. Roy, M. Fortier, K. Shah. Correlative studies of cytology, colposcopy and histology of intra- epithelial lesions of the cervix have shown that about two-thirds are consistent with HPV infection. Electron microscopy and immunoperoxydase techniques have confirmed the presence of HPV in these lesions. In a small number of condylomatous lesions of the cervix, nuclear atypia are prominent and may lead to an erroneous cytologic diagnosis of cancer. In a period of 2 years, 162 patients presented with atypical condylomata. Follow-up was available in 110 patients, of which 10 developed more advanced disease ( 1 moderate dysplasia, 5 moderate to severe dysplasia, and 4 carcinoma in situ) in the following two years. HPV was demonstrated in the original atypical condylomata but not in the more advanced lesions. The possible -oncogenic role of HPV on the cervix is further emphasized by our results. Atypical condylomata may represent an early stage of carcinogenesis, with demonstrable virus, while the more advanced lesions may be considered as a cellular response to the viral DNA integrated in the cell genome.

LIST OF ABSTRACTS 387 DELAYS IN DIAGNOSIS AND STAGE OF DISEASE IN GYNECOLOGIC CANCER. Fruchter,R.G. and Boyce,J. Downstate DSedical Center, Brooklyn, N.Y.,USA. Patient delayl and doctor delay' in diagnosis were correlated with clinical and surgical stage in 332 symptomatic patients with gynecologic cancer. In carcinoma of the endometrium, there was a strong positive association between patient delay and surgical stage(N=48,p < 0.01),but only a weak association with clinical stage(N=61,pC0.05). In carcinoma of the cervix, there was a strong positive association between patient [49) delay and surgical stage(N=89,p < 0.0001) but a weaker association with clinical stage(N=120,p<0.02). There was no association between patient delay and clinical or surgical stage in carcinoma of the vulva(N=65) or carcinoma of the ovary(N=86). There was no significant association between doctor delay and clinical or surgical stage at any site. A positive association between delay in diagnosis and stage is found in cancers where there is also an association between stage distribution and race or socioeconomic status. The findings will be discussed in the context of the secondary prevention of cancer of the endometrium. l.Patient delay-interval from first symptom to first medical visit 2.Doctor delay- interval from first medical visit to histologic diagnosis DELAYS IN DIAGNOSIS/ SURGICAL STAGE/ G1'NECOIAGIC CANCER j$$ STUDY OF PRIOR BIOPSIES OF ENDOMETRIAL CANCER PATIENTS AND CONTROLS. Ortner,A.,Mikuz,G.,JerabekR„ UniversitBts-Frauenklinik u. Patholoqisch-AnatomischesInsti- (49] tut der UniversitMt Innsbruck, Austria. 36 prior biopsies of 31 patients were available for re- classification of the endometrial chanqes in 21 patients who later developed endometrial cancer and in 10 patients who did not develope endometrial cancer. The examination was done without knowledge of the patients follow uo and with special attention to architectural and cellular endometrial changes. There was a trend for the histnl.ogical diagnoses to be more severe in the reexamination. The severe hyper- plastic changes were found in a 1-6 year interval before endometrial cancer was diagnosed. The endometrial chanqes encompassed normal to glandular cystic hyperolasia with fo- cal adenomatous hyperplasia in the controls; in the group who developed endometrial cancer all the specimes exceDt one were described as hyperplastic chanqes ranging from glandu- lar cystic hyperplasia to grade I endometrial carcinoma.The authors feel that "atypical architectural" hyoerplasia alone does not have the same precancerous pontential as "atynical architectural" and "atypical cellular" hyperplasia. /PRECANCEROUS LESIONS OF THE ENDOMETRIUM/

LIST OF ABSTRACTS (49) 389 THE DIAGNOSIS OF ENDOMETRIAL ABNORMALITIES BY A SIMPLE CYTO- LOGIC OFFICE PROCEDURE. A* Schachter, M.D., A. Beckerman, M.D.; Z. Edelstein, M.D., C. Bahary, M.D. , Gynecological Cytologic f, Col- poscopy Unit "Marie Cohen", Department of Obstetrics and Gynecology, Beilinson Medical Center, Tel Aviv University Sackler School of Medicine, Israel. The search for simple and reliable procedures for the early detection of genital cancer continues. For the diagnosis of endometrial carcinoma, dilatation and curettage is required. Such a procedure is impractical for screening purposes. We therefore tried five different procedures for collecting endometrial cells for cytologic evaluation. We investigated 299 women by one of the following methods: Gravlee jet-wash, IUD (Lippes loop), the French balayette, the Ayre brush and the Nieburgs endometrial cannula. Endometrial carcinoma was detected in 12 cases and was confirmed by endometrial biopsy. There were no false negatives. In 42 cases referred with the diagnosis of endometrial carcinoma, the cyto- logic results were accurate in 16 (38.1%) patients by cervico vaginal smear and 30 (71.5%) patients by endometrial brush. The Gravlee jet-wash and the IUD techniques proved more suitable for women in the premeno- pausal period, while the 3 types of endometrial brushes were found prac- tical for the postmenopausal women. The advantages of each method are discussed. It is concluded that cytology will probably play a role, in the future, for the early detection of endometrial cancer. The litera- ture is briefly mentioned. 390 MINIATURE PAN-ENDO-MICROSCOPE (COLPOMICROSCOPE, HYSTEROMICRO- SCOPE,LAPAROMICROSCOPE) FOR EARLY DETECTION OF CANCER. KIMIYASU OHKAWA, RYOKI OHKAWA , Department of Obst. & Gynec. Nippon Medical School. 1-1-5 Sendagi Bunkyo-ku Tokyo Japan Object of study: The early detection of cancer of cervix endometrium and ovary is most important. We have tried 6 year's ago to diagnose by endomicroscope cancer of uterus and of abdominal cavity.And Endomicro- scope is improved by Ohkawa. [49] Methods used :'Pao types cf endomicroscope are available, one with the lenses on the tip and the other on the side, depending on the side to be observed. Living cells are spray -stained in situ with Cresyl violet acetate and Thionin solution. These instrument are 8 mm in diameter and 40 cm in length. Results obtained : 125 cases of dysplasia and 150 cases of cancer of cervix of uterus, 20 cases of intracervical cancer, 10 cases of endo- metrial cancer and 30 cases of cancer of ovary were examined by this endomicroscope. The stain distingishes normal from abnormal cells in two or three seconds,allowing immediate preliminary diagnosis. Comfirmatly hystological tests are then done on positive tissue sample. Conclusion : This methods not only facilitate the endoscopic diter- mination of the extent of carcinomatos spread, but also represents the useful means of early diagnosis of malignant grows. / ENDOMICROSCOPE / EARLY DETECTION OF CANCER /

LIST OF ABSTRACTS 391 CONSTITUTIONAL FACTORS AND ENDOMETRIAL CARCINOMA Branimir Ristid,S.Ilid,S.PavloviE,M.Mir6etid,M.Karabagevid, M.Opri6,D.Stefanovid. Institute of Oncology,Kladovo, Yugoslavia. Endometrial carcinoma is an exceedingly complex disease with undoubtedly heterogeneous etiology. Obesity appears to be the most constant risk factor. Other constitutional factors include hypertension,nullipari- (49) ty,late natural menopause and diabetes melitus. During a period of five year (1974-79) authors identi- fied one hundred patients with endometrial carcinoma and with history available to evaluate certain constitutional factors. Obesity as the most common factor was found in 70%. Hypertensia was present in 65% and diabetes melitus in 41%. 1 In this series 35% exhibited the triad of obesity,hy- pertension and diabetes. Nulliparity was present in 36% and late natural meno- pause in 52%. [49) 392 IMPAIRED GLUCOSE METABOLISM AND CHANGES OF THE RELATED HORMONES IN ENDOMETRIAL CANCER. Kuzuya, K. & Ariyoshi, Y. Aichi Cancer Center Hospital, Nagoya, Japan. It has been well known that the incidence of impaired glucose tolerance is high in cases of endometrial cancer. In this study glucose metabolism in patients with endo- metrial cancer was investigated by glucose tolerance test and changes of the related hormones to glucose metabolism were observed. The relationship between impaired glucose metabolism and histological type of endometrial cancer, namely, well, moderately and poorly differentiated adeno- carcinoma, was also studied. Oral glucose tolerance test of 32 cases revealed diabetic pattern for 18 cases (56.3%) and borderline pattern for 12 cases (37.5%). The changes of IRI, GH and glucagon level in glucose tolerance test showed similar-pattern to those of adult type diabetes. Serum cortisol level in endometrial cancer was slightly higher than that in normal women. Percentage of unbound cortisol which is thought to be physiologically active increased significantly and percentage of transcortin-bound cortisol decreased. Diabetic cases were frequently observed in the cases of well differentiated adenocarcinoma. /DIABETES/RELATED HORMONES/ENDOMETRIAL CANCER/ 0

LIST OF ABSTRACTS (49J 393 RESULTS OF REGISTRY AND FOLLOW-UP SYSTEM OF HYDATIDIFORM MOLE. Katoh, T., Endoh, N., Kobayashi, 0. and Takamizawa, H. Chiba University School of Medicine, Chiba, Japan The prognosis of the patients with choriocarcinoma has been poor yet. The about half of patients diagnosed as choriocarcinoma were developed after hydatidiform mole (H. mole). For the purpose of the early detection and early treatment of malignant sequela after H. mole, the registry and follow-up system of H. mole were administered. During undoubtedl death of choriocarcinoma developed after H. mole will be extirpated to 25.0%. From now, by means of the thorough follow-up system, the system to 17.9% after that. And the mortality has decreased from 81.8% 55.0% in the period before the administration of registry and follow-up mole as antecedent pregnancy in choriocarcinoma, it has decreased from carcinoma has obtained remissions. According to the incidence of H. with unclassified group. All patients except only one case with chorio- 4 cases with_choriocarcinoma, 36 cases with invasive mole and 64 cases ation of H. mole. The total treated patients were 104 cases (10.1%), IU/L at 5 wks, 1,000 IU/L at 8 wks and 100 IU/L at 12 wks after evacu- for malignant sequelas when their U-hCG remained the levels of 10,000 5 years, from 1974 to 1979, 1031 cases with H. mole occured in Chiba Pref. were registered. They were followed up by measuring with urinary hCG and basal body temparature mainly. They were diagnosed and treated HYDATIDIFORM MOLE/ANTECEDENT PREGNANCY/CHORIOCARCINOMA 394 ENZYMOHISTOCHEMICAL STUDY ON THE GESTATIONAL CHORIOCARCINOMA. (497 The genesis of the gestational choriocarcinoma is very School of Medicine, Tokyo, Japan. Ito, H. Dept. of Obstet. $ Gynec. The JIKEI University Miura, S., Sekine, T., Komurot N., Sekino, S., Ohsone, S.and often proceded by hydatidiform mole and on account of this , hydatidiform mole, destructive mole and choriocarcinoma tic different from those of any other chorionic.tissues. deviation and therefore to possess particular characteris- chemical viewpoint and is assumed to have specific enzymic hydatidiform mole or destructive mole from enzymohisto- localization, choriocarcinoma is hardly comparable with Through the comparative study about those activity and phosphatase, acid phosphatase, and lactate dehydrogenase. ization of alkaline phosphatase, heat-stable alkaline histochemically in the aspect of the activity and local- neoplasma, various chorionic tissues were examined enzymo- sequent lesions. In view of enzymic deviation of malignant are viewed by some to constitute a spectrum disease or /ENZYME/HISTOCHEMISTRY/GESTATIONAL CHORIOCARCINOMA/

LIST OF ABSTRACTS 395 DIAGNOSTIC VALUE OF TOPICAL 5-FLUOROURACIL IN PREINVASIVE VULVAR CARCINOMA. Biano, G., and Donahue, V.C., Sidney Farber Cancer Institute and Boston Hospital for Women, Boston, MA, USA. Preinvasive carcinoma of the vulva is a multifocal disease that affects younger women. Total vulvectomy may have a 40% recurrence rate. Local resection is acceptable, but subclinical disease may be missed if only simple inspection is used. Toluidine blue staining and colposcopy are inadequate to find all the foci of preinvasive disease. We have used topical 5-FU (0.1 to 1.0%) both to delineate subclinical (491 disease and to treat extensive fields of disease, especially involving the clitoris or buttocks. Erythema, edema and discomfort are noted as the cream is applied twice daily over 2 to 4 weeks. Subclinical lesions are brought to the level of clinical recognition by the reaction to 5-FU. In 8 cases, there was an 80% correlation between clinically reacting foci and the histologic diagnosis of preinvasive cancer in 30 biopsies. The remaining 20% revealed nonspecific inflammation. Repeated applica- tions of 5-FU to the endpoint of ulceration may be used as therapy; the destruction by necrosis is apparently as effective as excisional biopsy. Another course of treatment may be given at 6 months, routinely or in case of clinical suspicion. As surveillance for recurrent preinvasive carcinoma and as a means of early diagnosis of locally recurrent invasive cancer, 5-FU may be an increasingly important tool for the clinician. /VULVAR CARCINOMA, DIAGNOSIS & TREATMENT/TOPICAL 5-FLUOROURACIL/ 3% LATE EFFECTS OF RADIATION THERAPY FOR CANCER OF THE UTERINE CERVIX. Zippin,C., Lum,D., Kohn,H.I. & Bailar,J.C.III. Univer- sity of California, San Francisco; Shields Warren Radiological Laboratory Boston, Mass.; National Cancer Institute, Bethesda, Md., USA. This report presents follow-up information on 497 women diagnosed with cancer of the uterine cervix in Connecticut and California between 1932 and 1951 who received only radiation as their initial course of therapy. The primary objectives were to record diagnosis of subsequent (491 malignancies, to construct life tables, and to tabulate causes of death in relation to level of radiologic exposure. Patients entered into the study were all treated before age 55 and all were five year survivors following treatment in order to eliminate early deaths due to cancer. The present report is based on approximately 8850 person years of observation. Three radiologic dosage groups (high, medium, low) were formed, with 93, 244, and 160 patients, respectively. For stage I cases patients in the high dosage group had somewhat poorer overall survival than the low and medium dosage groups beyond approximately 23 years following diagnosis. No clear survival pattern in relation to dose appeared for those with regional involvement (stages II and III). No excess deaths above expected were attributed to leukemia or lymphoma. The most frequent cancers coded as underlying cause of death beyond five years after initial treatment were uterine cancer followed in order by cancers of the large bowel, ovary, lung and breast. /LATE EFFECTS RADIATION UTERINE CANCER/

LIST OF A.BSTRACTS 397 EXTRAGLANDULAR ESTROGENS PRODUCTION IN POST-MENOPAUSAL WOMEN WITH ANL WITHOUT ENDOMETRIAL CANCER: COMPARISON BETWEEN "IN VITRO" AND "IN VIVO" RESULTS. Jasonni,V.M., Lodi,S., Preti, S.,Bonavia, M., Lesi,G., Bolelli,G. S Flamigni,C. Fisiopatologia della Riproduzione, Clinica Ostetrico-Ginecologica, Bologna, ITALY. Forty-five "in vitro" incubations of adipose tissue of normal young women (n.3), post-menopausal obese (n.3) and non obese (n.3) women with and without endometrial hyperplasia and post-menopausal obese (n.1) women with endometrial cancer, were performed with different techniques; the plasma levels of J54-dione,T,DHT,DHEAS,E1,E2 and the urinary levels of E1S and the "in vivo" conversion and production rate of A:-dioneS-dione and El were also determined in the same women. No significant difference between the case with cancer (0.09%) and the cases without (0.07% - 0.012%) was found in the "in vitro" aromatase activity of adipose tissue and between obese and non obese women. Different techniques, however, lead to different results. The comparison between the "in vitro " and the "in vivo" results seems to suggest that the aromatase activity of adipose tissue does not play a prevalent role in post-menopausal estrogens production. Investigations of the role played by the liver have been started in our departement. /POST-MENOPAUSAL ESTROGENS PRODUCTION/CANCER OF ENDOMETRIUM/ 398 APPLICABILITY OF PISTOLET ASPIRATION, JET WASH AND VABRA CURETTAGE FOR ENDOMETRIAL SCREENING IN POST- MENOPAUSAL ASYMPTOMATIC WOMEN. Vuopala, S., Kauppila, A., Mikkonen, M., Stenb8ck, F. & Kivinen, S. Department of Obstetrics and Gynecology, and Pathological Anatomy, Uni- versity of Oulu, Finland. There is an urgent need for early detection of malignant and prema- lignant enc3ometxial lesions. Because pistolet aspiration, jet wash and vabra curettage have been proved to be reliable in the diagnosis of en- dr,metrial carcinoma, we have evaluated the applicability of these tech- nics for endanetrial screening in 362 asymptcxnatic postrrielxypausal wcmen Jet wash oould be perfoimed in 56.9 %, pistolet aspiration in 84.3 % and vabra curettage in 81.3 % of the women. The specimen was too scan- ty for cytological examination in 3.9 % of the jet wash sam, les and in less than 1$ of the samples aspirated by the pistolet. The tissue ob- tained by vabra curettage was insufficient for histological examination in 5.1 % of the cases. No significant oomplications oocurred except 1 hysteric reaction after the procedures. We reocnmend pistolet aspiration as an endanetrial screening method, because it was more often applicable and caused less frequently pains than the other methods. This is due to the fact that the cannula used in pistolet aspiration is thinner (2 mm) than that in jet wash (4.6 mm) or in vabra curettage (3 mm). /IICOME;PR.IAL SCREENING IN POb`IT04OPAUSAL Wl7NIEN/

LIST OF ABSTRACTS 399 CYTO-HISTOLOGICAL OBSERVATIONS OF ENDOMETRIAL ADENO CARCINOMA BEFORE AND AFTER TREATMENT WITH 6-METHYL- 17-HYDROXY ACETATE PROGESTERONE . Vecchietti,G, Gerzeli,G.;Zanoio,L.,Novelli,G.,Barni,S.;Marti- ne11i,A.,Department of Obstetrics & Gynecology University of Verona (Italy) and Center for study of hystochemistry of CNR University of Pavia (Italy). The present investigation deals with the histochemi cal and structural changes encountered in 17 cases of adeno carcinoma of human endometrium before and after treatment wi_ th 6-Methyl-17-hydroxy acetate progesterone (MAP) administe- red in large doses via parenteral and oral routes. Histologi- cal,cytogenetic,histospectrophotometric,ultrastructural fin- dings were obtained. Hydrolisis and•denaturation of DNA were studied for investigating the chemical-phisical state of tu- mors. After treatment a regularisation of histological stru- ctures, a nlepression of mitosis, a constant decrease in poly- ploid complement of neoplastic nuclei, a regular organization of the chromatin are observed.These tumors can be treated and should be treated with strong doses of MAP. /ADENOCARCINOMA/DNA/MAP/ L}00 EFIDEP`IOLOGIC STUDY OF C:TAFIAN CANC::R DE Oliveira,C.F., Amaral,N. & Ferreira 1'. Serviqo de Ginecologia,IIospital rla IIniversidade,Coimbra,Fortugal Some factors mentioned as predisposing for ovarian cancer such as the age,marital state,sexual activity,obFtetrica7 antecedents, general antecedents of turooral pathology,weight,blood pressure, glycemia and menstrual history,are analysed in two groups of pati- ents.The first group included lP patients with ovarian primitive malignant tumours of epithelial type and the second included 228 patients with ovaries normal to the histopathological exemination (control group).The statistical analysis lead to conclude : the patients with ovarian cancer are older than the controls;there are a great number of nullipars among the cancer patients;the dysne- r.orrhoea is lesG frequent and the menopause is more frequent among patients with ovarian cancer than in the control group. In another study we selected 36 patients with ovarian cancer compared with 36 controls and in this case we matched the two groups to eliminate age influence.In this study the statistical analysis shows that only the dysmenorrhoea is less frequent in the cancer group than in the control group and the patients of that g--oup had the menopause earlier than the patients with normal ovaries. EPIDrI'ICLOGY / OVARIAN CAtICER

0 LIST OF ABSTRACTS 401 OVARIAN CYSTS AND MASSES: DIAGNOSIS USING FINE NEEDLE ASPIRATION. Ramzy, I., Martinez, S. and Schantz, H.D. The University of Texas Health Science Center, San Antonio, TX U.S.A. The early diagnosis of ovarian tumors is hindered by the inaccessi- bility of the ovary by non-invasive techniques. The increasing popular- ity of fine needle biopsy f, laporoscopy, created a demand for using these techniques to diagnose ovarian masses. One hundred ovarian masses were aspirated prior to, during or after 60 laparotomy and laparoscopy. The cases included non-neoplastic cysts, PS benign and malignant neoplasms of celomic epithelium, germ cells, sex cord and mesenchyme, papillary mesothelioma and others. The nuclear and cytoplasmic features of the aspirated cells, the background material and the presence of other structures such as hair, psammoma bodies and hyaline bodies made it possible to classify most tumors regarding their behavior as well as their specific type. Malig- nant neoplasms in general produced more cellular specimens than benign tumors. It was difficult to differentiate between some types of sex cord/mesenchyme neoplasms. Aspiration cytology, which can be performed through a laparoscope, transvaginally, transrectally or transabdominally is a safe, non- invasive and relatively reliable technique. It should be utilized more in evaluating ovarian masses, when it is desirable to preserve ovarian function in young patients or to minimize surgical trauma to the elderly high-risk patients. /OVARIAN MASSES/ASPIRATION CYTOLOGY/ 4W 60 PS Transparent wall,smooth epithel and significant for retention cysts. No is a sign of clinical malignancy. In this way a number of unnecessary sure diagnosis may be estabilish. PELVISCOPY,ENDOCYSTOSCOPY AND ASPIRATION CYTOLOGY IN OVARIAL NLOPLASHIAS. Simic,S., Huterer,D., Bukvic,I., Gmaz,Z., Simic,0. Klinika za ginekologiju i aku"serstvo Sarajevo, Jugoslavija. Laparatomy is necessery in every case of ovarial tumour biger then 5 cm.Laparatomy was made in 131 cases of ovarial tumours in one year. It means 14 ovarial carcinomas and 117 benign cystic neoplasas.We are not satisfied with this postulate.0ur treatment of ovarial tumours is as follows: 1.Pelviscopy with detailed vi- sualistion of tumour. 2.Aplication of fetoscop in tumour and aspi ration of content for cytologic analyse.Instilation of physiologi cal saline solution.Detailed visualisation of cysts cavity. delicate bloodvassels are transparent wall of papillary laparatomys decrease and OVARIAL NEOPLASMAS,PELVISCOPY,ENDOCYSTOSCOPY.

LIST OF ABSTRACTS 403 NUTRITIONAL EFFECTS IN BREAST CANCER. Newberne, P.M. & Rogers, A.E. M.I.T. Cambridge, MA 02139 While there is no convincing direct evidence of an in- fluence of specific dietary factors on breast cancer in wo- men, the overall geographic correlation between risk of breast cancer and food consumption patterns suggests a posi- tive link. Epidemiologic studies have correlated breast cancer rates with fat consumption. Increased dietary fat, (111 through intestinal microflora production of estrogens, might expose breast tissue to chronic, excessive stimulation and increase cancer risk. Laboratory animal studies have shown that dietary fat affects response to DMBA carcinogenesis. Studies in our own laboratory have shown that 20% corn oil or lard increased DMBA mammary tumorigenesis, compared to rats fed 5% fat; 20% corn oil accelerated sexual maturation, but 20% lard did not. In contrast, diets high in beef fat (30%) depressed tumor induction by DMBA. The mechanisms of tumorigenesis under such circumstances are unknown. MAMMARY CANCER/FAT/HORMONES t04 CHEMOPREVENTION OF MAMMARY CANCER WITH RETINOIDS. Moon, R. C. IIT Research Institute, Chicago, IL 60616, U.S.A. The retinoids (vitamin A and its synthetic analogs) are not only potent agents for the control of cell differentiation in several epithelial tissues but have also been shown to directly affect preneo- plastic cell differentiation in organ culture. In experimental animals, a deficiency of dietary retinoids enhanced susceptibility to chemical carcinogenesis. The natural retinoids fed at high dietary levels have some ability to prevent chemical carcinogenesis in epithelial tissues of the bronchi, trachea, stomach, uterus and skin of experimental animals (121 and the synthetic retinoids have been particularly useful for prevention of experimental bladder and breast cancer. The importance of the reti- noids for chemoprevention of cancer has received further support with the finding that retinoids can suppress the in vitro expression of malignant phenotypes irrespective of whether it is caused by chemical carcinogens, radiation or viral transforming factors. Furthermore, retinoids have also been found to be potent inhibitors of tumor-promoting effects of the phorbol esters. Additionally, it appears that the retinoids may se- lectively inhibit hormone independent mammary tumors and that this effect may be mediated by cellular retinoid acid binding proteins (RABP) in a manner similar to that of the steroid hormones. Although the retinoids suppress mammary carcinogenesis, an even greater suppression may be obtained when retinoid treatment is combined with ovariectomy or with the use of a prolactin inhibitor. /MAMMARY CANCER/PREVENTION/RETINOIDS/

LIST OF ABSTRACTS 405 LONG TERM RESULTS OF H.I.P. MASS SCREENING PROGRAM FOR BREAST CANCER. Philip Strax, Health Insurance Plan, New York City. The mass screening program for breast cancer of the Health Insu-• rance Plan of Greater New York, involving palpation and mammography has resulted in a 25% reduction in breast cancer mortality. In this ran- domized trial women aged 40 to 64 years were allocated either to a study group offered an initial screening examination and 3 annual repeat screenings, or to a control group. Each group had about 30,000 women. (12) Screening was completed in 1970, follow-up for mortality continues. 1. In 12 years of follow-up there has been a persistence of breast cancer mortality reduction among women whose cancers were detected within 5 years of entry into the study. 2. The benefit is clearest for women over 50 at time of entry. Lower mortality is observed at ages under 50 but this appears concen- trated among cases diagnosed after the women were past age 50. Reser- vations exist about benefit for the younger age group, 3. Case fatality rates continue to show an especially large re- duction in risk of death among cases that were detected through mammo- graphy alone. 4. Improvement in mammography's ability to detect early breast cancers among women under 50 as indicated by experience in The Breast Cancer Detection Demonstration Projects conducted by the American Cancer Society and the National Cancer Institute, encourages new studies to determine whether screening benefits this age group. L{~'j A RANDOMISED BREAST CANCER SCREENING STUDY IN SWEDEN. Tabar,L., Gad,A., Akerlund,E. Falun Central Hospital, 79132 Falun, Sweden There is no need to prove that mammography diagnoses breast carcinoma with high accuracy, it is well acceptable for the patient, is simple to perform and is not expensive. However, can mammography, as a screening method reduce the mortality caused by breast cancer or improve life quality of breast cancer patients? In order to answer this important ques- tion a randomised controlled trial of a sufficiently large population using-mammography as a single screening-procedure is mandatory. Such a study is in progress in two of Sweden's 24 counties, namely Kopparberg and tistergotland, on the initiative of the Swedish National Board of Health and Welfare. The main goal of this study is to evaluate the effect of screening mammography on the mortality rate and life quality of breast cancer patients. Screening started in Kopparberg in Oct 1977 and in tister- gotland in May 1978. The total study population includes 160 000 women above 39 years of age-without upper age limit, out of which 90 000 were invited to be screened; the control group included 70 000 women, age matched. This report describes the planning, organisation and the method as well as the preliminary results of the first two and a half years in Kopparberg county.

LIST OF ABSTRACTS !}07 RISK-BENEFIT IN MASS SCREENING PROGRAMMES Miller, A.B., NCIC Epidemiology Unit, University of Toronto Canada There has been considerable controversy over the risk versus benefit equation for mammography breast cancer screening. Technological im- provement has resulted in a reduction in the dosage necessary to achieve good images to 1/40th of that necessary two decades ago and 1/5th of that judged optimal three years ago. Our calculations, based on the (12J linear dose-response model, suggest that if 25,000 women aged 40 to 49 were to receive mammog-aphy annually, a maximum of three induced breast cancers after a latent period of 15 years could be expected. The benefits of breast cancer screening have so far only been measured in the Health Insurance Plan study in New York. This indicated a 40% reduction in mortality at 5 years in women aged 50 or more but no reduction in mortality in younger women. Hence, the necessity for clarifying the degree of benefit in younger women before breast cancer screening programmes can be introduced in women under the age of 50. Other aspects of risk and benefit should be taken into consideration including on the risk side induction of anxiety, unnecessary surgery, false reassurance and on the benefit side reduced morbidity as well as reduced mortality. . /BREAST NEOPLASMS/SCREENING/MAMMOGRAPHY/RADIATION/ La$ DETECTION OF EARLY BREAST CANCER / PATEROK E. M. UNIV.-FRAUENKLINIK 852 ERLANGEN BAVARIA WEST-GERMANY Radiographic Examination of the female breast is our only reliable means of detecting cancer prior to signs and symptoms. Early diagnosis means detection of preclinical cancer - finding the cancer before it would be detected in the normal course of events. Mammography acts as a thoroughly investigated yardstick to gauge the value of other procedures - such as ultrasound, xeroradiography, istope scanning and thermography.At (26] present all these techniques have not had the extensive proven applicat- ion of mammography.But only 5-10% of malignant tumors are found on ac- count of apparative investigations.A mass on mammogram which is not typical for cancer should be punctured. Whenever possible the radiolo - gist should do a pneumocystography. Microcalcifications my be associa- ted with breast malignancy. We made more than 45o excisions for grouped microcalcifications:14,4'd carcinoma, 9% lobular and ductal carcinoma in situ. In this cases we had no clinical recognition.Pathological dis- charge from the nipple indicates galactography. This method enables the localization of the milk duct segment with inhomogenous fillings. We excised 511 milk ducts: 8% carcinoma, 12%intraductal proliferations and carcinoma in situ. Mammography has forced radiologist, surgeon and pathologist to work closely together to detect breast cancer at an earlier stage, to institute more comprehensive treatment and to effect a lowering of the mortality from breast cancer. v1 0 0 ~ r J tn ~ ~

LIST OF ABSTRACTS (4(9 BLEEDING BREAST AS AN EARLY SIGN IN NOT PALPABLE CANCERS Goes Jr., J.S ;GoVs, J.C.S.; Fundac o"Centro de Pes quisa de Onco~ogia , Instituto Brasileiro de Controhe do Cancer. Sao Paulo - S.P. - Brasil. Nipple discharge is an early sign in not palpable cancers of the breast and thefore very importantin breastcancer detection and prevention. In a selected group of 182 patients the type of discharge was yellow in 24, green in 6, brown in 13,serous in 5 and bloody in 134. Cytology is essential 'to show the presence of red blood cells in the non-characteristic- discharges [16] and also to show the presence of malignant neoplastic cells. Histopathological examination has shown:intraductalpapilloaes 74; intraductal papillomatosis 37; intraductal papillomas transformed into a carcinoma 6; Dysplasia (adenosis) 32; car cinoma (early stage) 25; granuloma (foreign bodies)4; fibroa denoma 1; hyalinized polyp 1; ectasia 8. Ductography, followiny the intraductal injection of acqueous iodine contrast, permits the examination of the duct system, together with the identi fication and localization of negative images characteristic of intraductal polyps. It is also possible to distinguish the image of papilloma, non -papillcma- like polyps and intraductal pa pillomatosis. Incipient intraductal carcinoma may also be re- cognized by the sudden blockage (stop)which it provokes within the lumen of the duct. Ductography made possibl.e theperformance of directed biopsy, preventing unnecessary mutilation in the benign cases, many of which occur in young patients. ,. /BLEEDING BREAST AS AN EARLY SIGN/ 410 FOLLOW-UP STUDY OF ATYPICAL INTRADUCTAL PAPILLALY LESIONS. Enomoto, k. & Abe, O. Keio University, Tokyo, Japan. Three quator of the patients with non-palpable breast cancer (To) were diagnosed by a bloody or serious nipple discharge. In such cases, contrastmammography and micro- dochectomy are rather useful for detection of the early breast cancer than cytology. However, we have sometimes [16]trouble in the clinicAl differential diagnosis between atypical intraductal papillary lesions and intraductal carcinoma. Follow-up study of the 105 patients with micro- ddchectomy revealed that 13 cases had reoperation including seven cases of the breast cancer (7%) and that the most high risk of the cancer was in patients with multiple intraductal papillary lesions (38%), the next was in those with multi- ple nodules in same duct (15$)(F>(0.01). Accordingly, we must carefully follow-up those patients who have multiple or broad cellular type of the intrductal papillary lesion every three months by three years after microdochectomy. MICRODOCHECTOMY/ATYPICAL INTRADUCTAL PAPILLARY LESIONS I

LIST OF ABSTRACTS 4ll RELATIVE EFFICIENCY OF THE CLINICAL APPROACH ALONE OR IN COM- BINATION WITH CYTOLOGICAL, RADIOLOGICAL AND THERMOGRAPHIC TECHNIQUES IN EARLY DETECTION OF BREAST CANCER AS A PART OF A FIFTEEN YEAR MASS SCREENING PROGRAMME FOR THE FEMALE POPULATION IN NORTHERN BELGIUM. Bonte, J., Verellen, W., Declerck, A., Ide, P., Baert, A., Wynants, P. & Artoos, C. Centra voor Vroegtijdige Kankeropsporing Antwerpen - Brugge - Leuven, K.U.Leuven, Louvain,.Belgium. About 500.000 women aged between 25 and 80 years routinely underwent a general clinical examination completed with a gynaecological examina- [16] tion and the taking of a cervicovaginal smear. Simultaneously several screening trials were set up in the same female population in order to evidence the most efficient policy for early detection of breast cancer. In different prospective studies the following screening procedures were compared : clinical examination or mammography or thermography alone, various combination modalities of these techniques, complementary fine needle aspiration cytology. The efficiency in early cancer detection for the whole screening programme could be expressed by the number of detected cancers (4,5 %,). With special regard to breast tumours, the detection efficiency obtained by clinical examination alone amounts to 10 %a suspicious cases and to 1%o confirmed cancers; these results are enhanced by mammography to respectively 20 %o and 4%o. Fine needle aspiration cytology further improves breast cancer detection efficiency. /EARLY BREAST CANCER DETECTION / MAMMOGRAPHY / CYTOLOGY/ 412 USE OF A MATHEMATICAL MODEL 'PD ESTIMA7E THE BENEFITS OF SCREENING YOUNGER WOMEN FOR BREAST CANCER. Shwartz, M. Health Care Management Program, Boston University, Boston, Massachu- setts, USA. It is first shown that this model overcomes several objections to the use of models raised by the Beahrs committee. Specifically, the model replicates mortality data reported by HIP, particularly the finding that there is no benefit from screening women under age 50; the model replicates the difference between stage and mortality in clini- (16] cal and screen detected cases reported by HIP; and the model takes into account the self-selection of women in the BCDDP. The model is then used for the following: (1) based on the detec- tion rate in younger women in the BCDDP, it is shown that the screen- ing modality in current use appears as reliable in women under age 50 as over age S0; (2) the magnitude of lead time and length bias in the BCDDP is estimated; (3) the extent to which yearly screening would detect disease that would not otherwise surface is estimated; and (4) the long-term benefits to younger women of different screening strategies with mammography and physical examination are estimated. /BREAST CANCER SCREENING/

LIST OF ABSTRACTS (16) Q]3 AN ASSESSMENT OF THE RELIABILITY OF.SINGLE FINE NEEDLE ASPIRATION CYTOLOGY IN THE PRE- OPERATIVE DIAGNOSIS OF CARCINOMA OF THE BREAST. Van Zyl, J.A., Street, B. Breast Clinic, Tygerberg Hospital, Bellville, Republic of South Africa. A firm preoperative diagnosis of breast cancer will alleviate the uncertainty and anxiety of patients undergoing surgical treatment for clinically operable breast carcinoma. To determine whether fine needle aspiration cytological examina- tion could contribute towards obtaining these objectives, a study was undertaken on 100 consecutive cases of operable breast carcinoma as judged on clinical and radiological criteria. The simplicity of the procedure allows it to be repeated but for this assessment only one aspiration was performed. In 80 instances a positive diagnosis of carcinoma was made and intra-operative frozen section examination was not performed on these patients. In the remaining 20 instances the cytological appearances were equivocal in 6 and in 14 the material was pronounced unsuitable for examination. In 19 of these patients mammography had not demonstrated the tumour, emphasising the danger of using this form of examination except in conjunction with fullclinical and cutological evaluation. From these results we conclude that in 80% of patients, with a single aspiration, a positive preoperative diagnosis of breast carcinoma is possible, achieving the advantages set out in the first paragraphs. :{iy ANALYSIS OF PATHOLOGIC DISCRIMINANTS OF BREAST CANCERS DETECTED ON SCREENING BY MAMMOGRAPHY AND PHYSICAL EXAMINATION. Feig, S.A., Schwartz, G.F., and Nerlinger, R. Zfianas Jefferson University Hospital, Philadelphia, U.S.A. One hundred-eighty-three breast cancers detecte8 on screening by manmography an3 physical examination were analyzed by means of multiple prognostic factors such as histologic type, lesion size, (16) proportion of infiltrating to in situ growth, lymphatic vessel invasion, axillary lymph node metastasis, histologic grade, percent tubule formation, and several definitions of minimal cancer. Because of their early stage, most cancexs apparent only on mxmrbgraphy and not on physical examination should be associated with favorable long term survival. These cancers had histologic features indicating significant potential for metastatic spread which wt7uld have occured had they not been detected at an early stage by mantmgraphy. Although decreased breast cancer mortality can be proven only through a randomized clinical trial, this study strongly suggests that manmographic screening of asymptanatic wcxnen, both above and below 50 years of age, can substantially reduce breast cancer mortality. / MANMJGRAPHY / BRl AST CANCER SCREIINIING / ©

i LIST OF ABSTRACTS 415 THE ANALYSIS OF LYMPHOPLASMACYTARIC INFII1P1tATI0W 0F aBEAST CANCER STROMA AND THE REACTIVITY OF AXILLARY LYMPH NODES - JocoviG, N., Bugarski, M., Vlaji6, M., Jovanovid R. - INstitute of Oncology and Radiology, Belgrade Yugoslavia The authors analysed 250 cases of brast cancer which were not previously treated. Frozen section was performed during surgery and afterwards the parafine preparation of the ampu- tated breast and lymph nodes was thoroughly examined. When (26) analysing the lymphoplasmacitary infiltration of the tumor stroma in relation to the occurence of inetastases in the regional lymph nodes, the authors noticed some indications for favorable effects of lymphoplasmacitary infiltration on the prognosis since there were more cases without metasta- ses In the axillary lymph nodes. The regional lymph nodes had different histornorphological changes such as folicular hyperplasia, sinus-histiocytosis, "sarcoid-like" reactions and others, which may represent the immunologic activity - of the organism. 416 HISTOLOGIC SCREENING IN EARLY BREAST CANCER TO SE- LECT APPROPRIATE THERAPY. Nealon, T.F.,Jr., Nkongho A., Grossi, C.E., Gillooley, Jr. St. Vincent's Hospital and Medical Center of New York, New York, N.Y. 10011 Since 20 to 40• of early breast cancer patients (T1, T2, NOMO) have a recurrance in 10 years this project attempted to identify those patients in whom disease was likely to re- cur. Poor prognosis was associated with four histologic (16) characteristics: poor cytologic differentiation; lymphatic permeation; blood vessel permeation; invasion of tumor into surrounding tissue. This was applied to over 400 cancers of the breast T1, T2, NOM0 followed 3 to 10 years. Among patients with no histologic characteristics there was 5% failure at 10 years. In the group with more than one high risk histologic factor there was a 50% failure rate. in low risk group choices of therapy ranging from segmental mastectomy to radical mastectomy gave similar good results. Patients with high risk factors did better when treated with radical surgery and radiotherapy. Screening factors permit proper choice of therapy, with less surgery in.low risk group. HISTOLOGIC FACTORS/BREAST CANCER SCREENING

4].] RECONSTRUCTIVE SURGERY FOLLOWING MASTECTOMY FOR BREAST CANCER COURY, Oswald H.,M.D.,So. Miami Hosp. So. Miami, Fla. U.S.A. Reconstructive procedures for mastectomy have in the past involved multiple procedures such as flaps, tubes, splitting the opposite breast, moving pieces of buttocks and more recently Bostwick has advocated the myocutaneous transfer of the latissimus dorsi muscle. For the most part women have rejected this approach because of the added scar- ring, length of time, multiple procedures and cost. A much simpler procedure is described utilizing many of the basic techniques of Snyderman and Guthrie with the use of the Ashley or Natural Y Prosthesis and more recently the Coury Custom Prosthesis. Selection of patients, prostheses and techniques will be described along with advantages, disad- vantages and complications encountered with the older types of protheses. Summary of the data of 200 reconstructed breasts will be presented along with slides. RECONSTRUCTION/ASHLEY/COURY IMPLANTS/BREAST 418 TECHNIQUE FOR RESEARCH OF "BORDERLINE" EPITHELIAL DYSPLASIAS OF THE BREAST. HIGNANI, E., and GORI, it, Institute of Pathological Anatomy, General Hospital of valdinievo2e, Pescia, Italy. Epithelial dysplasias of the breast are found in the ducts in 15% of the cases and in the lobules in 5$. In situ and 'micro-carcinoma' type lesions are rare because of the difficulty of finding these lesions by gross examination. A method has been developed which permits a more precise investigation of the surgical specimen. We have x-rayed 3nm sections and have oornpared the radiograph with matching histologic sections. This technique permits docunentation in most cases of those histopathologic alterations which can be interpreted as early (border- line) malignant change. Interpretation and biological significance will be discussed.

LIST OF ABSTRACTS 419 DIAGNOSIS OF SIMPLE AND PAPILLARY CYSTS OF THE BREAST SOFTIC, Dz., GNAZ, Z., DIZDAREVIC, J., IDRIZBEGOVIC,S. RZinika za Ginekologiju i Akuserstvo, Sarajevo, Jugoslavia Simple and papillary cysts of the manmary gland are frequent pathologic findings in wornen in their fourth decade of life. In 1,280 instances of benign changes, there were 126 cysts (10%). Cystic tunburs must be localized by palpation and the cyst punctured with a needle and corrplete- 67 ly evacuated. With the needle in place, marnmgraphy is performed. PS Following this, through the same needle, a quantity of air is injected into the cyst and another radiograph made. Finally, the air is withdrawn fran the cavity and the cyst is allowed to totally collapse. The first rranmogram defines the nature of the parenchyma around the cyst; the second provides data about the tissue of the cyst wall. Simple cysts, after collapse of the cavity, did not recur during tav years follow-up of 112 cases. No further therapy was applied. Cysts that contain papil- lary structures visible after air insufflation nust be removed surgically and histologically analyzed regardless of the results of cytology of their contents. Four of these tumours which were not surgically rerraved recur- red 2-8 weeks after aspiration of contents. L120 MASTITIS AS ONE OF RISK FACTORS OF BREAST CANCER. Kudlibkov6, Z., tvejda, J., Dlalif, A. Researoh Institute of Clinical and Experimental Oncology, Brno, Czechoslovakia. Beside many others risk factors as nonparity, parity after 30, parenohymal breast patterns, the pased mastitis plays an important role in our country. Zhis faotor was followed in the group of breast cancer patients and in the 67 group of normal po~ iation. From 251 breast cancer pa- PS tients there were 41 (14m) with the history of mastitis. In the group of 1200 women of the norma] population the history of mastitis was reported in 5,6%. The fact that the women who suffered from mastitis oane to the first examination mostly at the clinical stage IIIa and IIIb (T was measured on the mammography) seems to be very se- rious. None of 40 patients with the clinioal stage I had history of mastitis. In the group of the clinical stage II 14 patients from 117 suffered from mastitis. In the clini- cal stage III about 25% of patients reported mastitis. Nearly 100e of breast canoer patients with the history of mastitls was suffering from this disorder during their nursering. The history of mastitis is easy to detection and it aocomplishes the estimation of a high risk group. /BREAST CANCER/RISK FACTOR/DiASTITIS/ ~ 0 0 r -4 0 P r

LIST OF ABSTRACTS 67 PS (oi AGE-RELATED DISTRIBUTION OF BENIGN FINDINGS IN MAMMOGRAPHY AS BACKGROUND FOR CANCER-DETECTION. Bender, H.G., H. Greuel, University Women's Hospital DUsseldorf, F.R. Germany Detection of an occult breast cancer by mammographie is a relatively infrequent event if compared to the by far dominating benign findings in screening programs. We analyzed l4ooo mammographies related to the dif- ferent age groups and found that there 'is an age-related shift in the distribution of benign diagnosis. We conclude from our findings: 1. There is an individual structural change within the mammary gland from maturity to the final senile stage. 2. Fibrocystic disease represents one of the transient or persistent forms within this development and not a pathologic finding per se. 3. tlammographic diagnosis is not altered by cyclic hormonal changes. 4. The higher detection rate of occult breast cancers in the age group above 4o years is due to two factors: a) The increasing breast-cancer incidence, b) the decreasing frequency of diagnosis with high structural density and in cempensation the prevalence of findings with lower density facilitating the detection of small cancerous lesions. MAMMOGRAPHY/BREAST CANCER DETECTION/BENIGN MAFtMOGRAPHIC FINDINGS 422 EFFECT OF CORTISOL ON TRANSFER RNA METHYLASE ACTI- VITY IN MAMMARY TUMOURS.. Leyman, A.M. & De Loecker, W., Afdeling Biochemie, Departement.Humane Biologie, Facul- teit Geneeskunde, Universiteit te Leuven, B-3000 LOUVAIN, Belgium. ~ Steroid hormones are known to affect the activity of transfer RNA methylases in different tissues. As the tRNA methylases reach particularly high levels in tumour tissue, 7 the effects of cortisol on the behaviour of these transfe- rases are examined. Experimental mammary carcinomas are induced in female Sprague-Dawley rats by treatment with 7,2-dimethylbenz(a)anthracene. In vitro as well as in vivo application of cortisol significantly inhibit the transfe- rase activity by up to 50% (P<0.001). Analogous inhibitions are obtained when hepatoma and rhabdomyosarcoma tissue of rats as well as human breast cancers are compared. This inhibitory effect of cortisol is closely related to and possibly controls the inhibition on protein synthesis. These transferases taking part in the expression of the hormone message seem differently affected depending on the tissue examined. /MAMMARY CARCINOMA/CORTISOL EFFECT%tRNA METHYLASE/

LIST OF ABSTRACTS 67 PS L123 '^ARLY DiT:;.^.mION Ar:D ID'FidTIFI.^.1TIOTi OF iaA'7:.A'3Y GIAT:P "FOPIAS::S C.C.'Tadich, State Doctors' Training Institute, Tbilisi, USSR Higiz risk groups of women were formed by way of onco- logic-epidemiologic testing and policlinical examination. Subsequent clinical examinations includec3 pAlpation (with 95% coincidence of preliminary and final diagnosis), thermography, mammography (87.Y coincidence), cytologic analysis of the papilla discharge and of aspiration TnAte- rial ( 93 .% coincidence ). In cmse of an inpqlpable mpmunft- ry tumours detected by thermograph,y and mn.nmo.Qraphy, the affected section was subject to sectorel resection, fol- lowed by macroscopic study (90~'- coincidence), quick cyto- logic (98.V, coincidence) ancd morphological (;q.5')cnin- cidence) tests. Close cooperation of epidemiologists, clinicists, rA- diologists and morphologists eppeRrs to be n reliable means to successful detection of precursory pathology and early stages of mammary gland cancer, / :;AI-DJARY GLA?rD CA1dCER/HIGH RISK GROUPS/ l.12l{ USE OF RISK FACTORS IN ZIM DESIGN OF A SCREENING PROGRAAI FbR BREAST CANCETt TOMA, S., BRUZZI, P.A., PUNTONI, R., SERRA, G.E., and SANTI, L. Istituto Scientifico per lo studio e la cura dei tumori, Genova, ItaIy. Mass screening programs for breast cancer, which have been shown to be useful in reducing mortality, present economical and practical feasibility problems. Several studies indicated the presence of specific risk factors for this disease; we evaluated the distribution of some of these in a 67 sample of 122 breast cancer patients and 2,124 cancer-free women diagnosed PS in our Institute during the years 1978-1979. The distribution was signif- icantly different in the two groups, with relative risks similar to those reported from other authors. The use of these risk factors showed a good discriminant ability between cases and non-cases, and enabled us to identify subgroups which included the majority of cases. as a subgroup including 25% of non-cases and 75% of cases. Authors suggest that differ- ent screening procedures at different intervals should be applied to subgroups at different level of risk. /BREAST CANCER SCREENING/

LIST OF ABSTRACTS 4`L5 THE DIAGNOSTIC ROUTINES FOR DETECTION OF CANCER IN WOMEN WITH A BREAST MASS. Capoferro, R. & Gullestad, H.P., Nordland Central Hospital, Bodo, Norway The diagnostic routines for detection of cancer in women with a breast mass vere investigated. The pi!rpose was to study the ef- fect of the introduction of aspiration cytology and of a more accurate clinical assessment as routine method. The number of hospitalized patients with benign breast diseases and the number of frozen section examinations on breast tissue dropped dramatically. The diagnostic accuracy improved and radical mastectomies for benign diseases, which occasionally occurred before the introduction of the new routines, have not occurred so far. The hospital expenses per detected cancer dropped. The new routines re- sulted also in a better comfort for the patient. BREAST CANCER DETECTION BREAST CANCER SURVIVAL RATE IN COMMUNITY SURGICAL PRACTICE SOUTH CENTRAL CONNECTICUT, U.S.A. Roach A.I. & Shapiro B.S., Griffin Hospital, Derby, Connecticut, Nabel M.I., Adess M.L. & Parikh G.C., Quinnipiac College, Hamden, Connecticut. A retrospective epidemiological study was done in the Lower Naugatuck Valley of South Central Connecticut on 233 breast cancer patients. The objective of the study was to compare the results of a private surgical practice in a homogenous population of 5 towns, serv- 67 ed by an acute care 300 bed hospital with published statistics. Sub- PS jects were checked for age, menstrual status and nodal involvement at the time of diagnosis. 97.2% of the subjects with negative nodes at the time of surgery survived 10 years. 10 year survival had been noted by 81.5% who had 3 or less and 94% of those who had more than 3 positive nodes at the time of surgery. No significance was found in relat-ion to age and menstrual status at the time of diagnosis, using analysis of variance of 95% confidence level. These findings are in accordance with U.S. and State of Connecticut data. Overall rates were found to be significantly different. Changing trends of diagnos- tic and therapeutic measures and a follow-up care by a community sur- gical group have shown a longer disease free period and better quality of life. /BREAST CANCER SURVIVAL/COMMUNITY SURGICAL PRACTICE FOLLOW-UP/

LIST OF ABSTRACTS (17J 1171 L127 AGE AT MENARCHE AND SEX OF THE FIRST CHILD AS PRONOSTIC FACTORS IN HUMAN BREAST CANCER. P. Juret, J.E. Couette, T. Delozier,G.Leplat,I,.Blanc,A.M,Mandard, J.C. Vernhes - Centre FranQois Baclesse, route de Lion-sur-mer, 14021 Caen Cedex, France. In preliminary papers (Europ. J. Cancer 12, 701, 1976 and the Lancet 8061, 415, 1978) it was reported that, in our series, early age at menarche and a female first child appeared as unfavorable prognostic factors after mastectomy for potentially curable breast cancer. Yet these findings were barely significant. They are confirmed in a larger number of patients and the differences are here statistically significant. Thie influence of early inenarche and a female first child as unfavorable pronostic factors is correlated with a more important metastatic in- volvement of the axillary nodes : this correlation is statistically signi- f icant. LQH BARRIER CONTRACEPTION AND BREAST CANCER. Gjorgov, A.N. University of Pennsylvania, Ob.Gyn., Philadelphia, Pa. 19104. A retrospective study was conducted in order to test the hypothesis that a reduced exposure to human seminal factors in the•reproductive lives of women is a risk factor in the development df breast cancer (b.c.). The study population came from the Hospital of the University, and consists of 153 mastectomy patients and 168 matched controls, mar- ried and ever-married white women, 35-62 years of age: The results showed that women who were exposed to barrier contracep- tive methods (condom, withdrawal, long-term abstinence, celibacy, and male infertility) had a b.c. risk that is 4.6-5.2 times (P<0.005) the risk of women who used non-barrier methods (diaphragm, pill, rhythm, IUD, creams, tubal ligation). The male-infertility risk of 1.53 was not statistically significant. The effects of the age at first birth, pari- ty, and other factors, had non-causal associations with the disease.The carcinogenic effect of condom use was operative within 5-year exposure in marriage, with a cumulative effect. The barrier contraceptive espo- sure is viewed in the study as an 'inverse' environmental factor, that is, an absence, elimination, or reduction of the protective factors in the human biological balance. By elisdinating barrier contraceptive methods, specifically the condom, the preventive rate of the incidence of breast cancer in married women in the United States is estimated to be as high as 50 percent. BREAST CANCER/BARRIER CONTRACEPTION/CONDOM/SEMEN FACTORS/PREVENTION

LIST OF ABSTRACTS 429 RISK FACTORS IN MAMMARY CANCER: TSH AND PROLACTIN SERUtd LEVELS IN FIBROCYSTIC DISEASE OF THE BREAST. Tarquini, B., Benvenuti, M., Bazzani, M., Legnaioli, M., Cherici, R. & Cagnoni, M. Department of Medicine, Univer- sity of Florence, Florence, Italy. The human breast cancer seems to be a process involving several risk factors. There are, inter alia, pre or subcli- [171 nical hypothyroidism, fibrocystic disease of the breast(FM) and probably hyperprolactinemia. From this viewpoint a con- siderable interest arises in the relationship betiveen FM, hyperprolactinemia and thyroid function, especially consi- dering the possibility of risk combination. With such aims prolactin and TSH (as preclinical hypothyroidism index)were chronobiologically investigated in serum samples obtained at 4-hourly intervals throughout a 24-h span from 23 heal- thy women and from 25 women with FM (hystologically veri- fied). These results suggest that circadian mesor-hyperpro- lactinemia is a feature associated with FM and a modest im- pairment of thyroid function in these patients. /BREAST CANCER/CIRCADIAN RHYTHM/RISK FACTORS/ l27j ~ INCREASED ANDROGENIC ACTIVITY AS A RISK FACTOR FOR BREAST CANCER. Secreto, G., Hormonal Research Laboratory, National Cancer Institute, Milan, Italy. 5 patients who developed breast cancer between the ages of 27 and 55 years had been singled out 17-69 months before as being at risk because they had one or more of the following items in their history: previous mammary disease, use of contraceptives, use of psychoactive drugs and familiality and presented above-normal androgen levels (Testosterone, Androstanediol, Etiocholanolone and Androsterone). In addition, the endometrium was found hyperplastic in the 3 cases in which the examination was done. On this evi- dence it would seem that high androgenic activity plus endometrial hyperplasia are factors making for the risk of developing breast cancer in patients with the "right" history. /INCREASED ANDROGENS/BREAST CANCER RISK/

LIST OF ABSTRACTS (171 431 BENIGN BREAST DISEASE: ESTRIOL PROPORTIONS AND FAMILY HISTORY OF BREAST CANCER. Vakil, D.V., Morgan, R.W. & Elinson, L. University of Toronto, Toronto, Canada. Urine samples were analyzed for estrone (E1), estradiol (E2), and estriol (E3) to test the hypothesis that women diagnosed with benign breast disease (high risk for breast cancer?) will have lower estriol proportions (E3/E1 + E2 + E3) than a comparison control group. Cystic cases compared to controls weighed less (p<.05), had a lower Quetelet's Index (p<.01), and had a higher proportion of relatives with a history of any breast disease and of breast cancer (p < 01). Fibroadenoma cases also weighed less than the control group (p <.05), and had more relatives with a family history•of breast disease (p<.05). Mean estriol proportions (EP) were similar for cases and controls, before and after stratification by family history of breast disease and parity. Age at interview was positively correlated with EP (p=.053). We conclude that if women with benign breast disease are at high risk of breast cancer, that risk is not mediated by the Estriol Proportion. /BREAST DISEASE/ESTROGENS/GENETICS/CANCER/ 432 A CASE CONTROL STUDY OF BREAST CANCER IN SINGLE JAPANESE WOMEN. Takatani, 0., Wakabayashi, Y. National Defence Medical College, Japan. During Oct.'75 to Oct.'k-7, 3622 female Japanese cases who were admitted on main clinical cancer centers were interviewed for case-control study of breast cancer. 487 cases were primary breast cancer cases, and control group l171was extracted from benign diseases or other cancer cases. Above two groups separated each other into single women or married women, and compared with various epidemiological factors. Among single women the mammary cancer risk showed identical tendency in many factors with married women,such as mean age of menarche, mean age of natural menopause,mean hight, mean weight, nutritive condition, breast size, favorite foods and family history. But in factors related menstrual status,•single women showed some different tendency with married women. Single breast cancer cases comparing single control showed rather low rate in the cases with short period of menstrual cycle, and showed high frequency in abnormal menstruation or menstrual pain and also showed high rate in little amount of menstrual flow. Married breast cancer cases and control showed not•any differences in same factors./BREAST CANCER/SINGLE WOMEN/ % i

LIST OF ABSTRACTS [171 I{jj ESTROGEN RECEPTOR (ER) IN A GROUP OF BRAZILIAN BREAST CANCER PATIENTS. Goes Jr.,J.S.; Brentani, M.M. Fundagao"Cent.ro dePesqui sa de Onoologia" and jaboratorio de Onoologia Experimental da Faculdade de Medicina da USP - Sao Paulo,S.P., Brasil ER was determined in 132 mammary primary carcinomas (86 posmenopausic and 46 premenopausic women)by a dextran-coated charcoal method and by polyacrylamide gel electrophoresis ( PAGE ) . The concentration of ER was calculated from the data on binding of 1nM of (3H) estradiol, both in the absence and presence of 20mmo1 of diethylstilbestrol (DES) and was ex- pressed in fmol/mg of cytosol protein. Cytosol was additionally incubated with 0,5,2 and 5nM of (3H) estradiol and the complex dissociation constant obtained from a four point Scatchard plot. Specimens were stated positive when they contained at least 6fMo1 of estrogen-specific receptor per miligram of cytosol protein. PAGE of ER positive cytosol exhibited a peak absent from benign and ER-negative tumors. which is eliminated by excess DES but not dihydrotestostero- ne. The frequency of ER+ in posmenopausic women was 61% and in premenopausic women was 53%. The mean receptor value was 22,2f7,8 in premenopausal women and 89,4±91,9 in posmeno- pausic women. BREAST CANCER / ESTROGEN RECEPTOR DETECTION OF GLUCOCORTICOID RECEPTORS IN BREAST TUMOURS : COMPARISON OF BIOCHEMICAL AND IMMUNOCYTOCHEMICAL METHODS. Papamichail, M., Agnantis, N., Ioannides, C., Leventakou, A.,Garas,J., & Sekeris, C. - Hellenic Anticancer Institute "Saint Savvas" Hospital & National Hellenic Research Foundation, Athens, Greece. Seventy five breast tumours were assayed for the presence of gluco- corticoid receptors by the biochemical technique (Dextran-coated char- coal) and the immunoperoxidase method, using a specific antibody against cytoplasmic receptor isolated from rat thymocytes. The results obtai- [171 ned by the biochemical method demonstrated no strict correlation be- tween the degree of binding of 3H-dexamethasone and malignancy, on the basis of histological findings. In contrast the immunoperoxidase r•w- thod was in full agreement with the histological type of the tumour. Thus nearly all malignant breast tumours were positive by the immuno- ;~ peroxidase method, whereas the benign tumours were mostly negative. In addition intermediate situations such as hyperplasias were also positi- ve. These findings demonstrate that the immunoperoxidase technique, apart for its usefulness for the detection of glucocorticoid receptors, could be used as an early biological marker in evaluating pre-malignant situations of the mammary gland. /GLUCOCORTICOID RECEPTORS/BREAST TUMOURS/

LIST OF ABSTRACTS 435 DEHYDROEPIANDROSTERONE: A NEW ANTI-TUMOR PROMOTER. Arthur Schwartz, Gordon Hard, Laura Pashko, Magid Abou-Gharbia, and Daniel Swern. Fels Research Institute and Department of Chem- istry, Temple Univereity, Philadelphia,PA 19140 DehydroepiacLaru.terone (DHEA) sulfate is a major adrenal secretory product in men and women, yet its biological role is unknown. According to the prospective study of Bulbrook et al., women with subnormal excret- ory rates of androsterone and etiocholanolone (metabolites of DHEA and DHEA-sulfate) are predisoposed to develop breast cancer. DHEA is a po- tent non-competitive inhibitor of mammalian glucose-6-phosphate dehydro- [17] genase (G6PD). Yen et al. have reported that treatment of Avy/A mice with DHEA (450 mg/kg p.o. or 10 mg/kg ip., thrice weekly) prevented the development of obesity without suppressing appetite, presumably by in- hibiting lipogenesis as a result of inhibition of G6PD. We have reported previously that long-term treatment of C3H-A/A and C3H-A°Y/A female mice with DHEA markedly inhibits spontaneous breast cancer development. A single injection of DHEA (10 mg/kg i,/p.) into ICR mice immediately be- fore the topical application of the potent tumor promoter, TPA, prevents the enhancement in the rate of epidermal DNA synthesis normally seen. A similar anti-tumor promoting effect was observed with synthetic DHEA- sulfatide, which, according to Oertel, is the form of the steroid found in human plasma. We are also examining the effects of TPA and DHEA on the rates of DNA synthesis in several chemically and spontaneously trans- formed cell lines. LL36 WHOLE 000Y HYPERTHERP'~IA(42oc)-INDUCED GROWTH STIMULATION IN HORMONE DEPENDENT EXPERIMENTAL MAf•.VARY TUMOURS, Lehiri P. and Lahiri T, Oncological Research Centre,Academy of Pledical Sciences. Moscow, U.S.S.R. Hyperthermia is a potential anticancer modality al- though the stress-endocrine aspects are not well investigated Hormone dependent mammary tumours(adenocarcinoma) induced byoDr~BA Were grouped for a) acute Whole body h perthermia 42 c(WBH) exposure 15 min. daily for 6 weeks. b) Pituitary l171 stalk section-to induce prolactin elevation. c) Control. Results showed marked enhancement of tumours over con- trols with simultaneous increase of prolactin synthesis(by EM studies) in both groups. The incr ease tumour in the stalk sectioned group confirmed the prolactin dependency of the tumours. In the heat exposed groups the tumour enhancement is possibly due to the growth stimulatory effects of prolac- tin which is also elevated by UBH acting as a stressor. We concludesbesides other factors hormone dependency of tumours an important factor that should be considered in devising thermal therapy of tumours. HYPERTHERMI A/STRESS/TUMOUR ENHANCEMENT/ v, 0 0 r J J N

LIST OF ABSTRACTS 67 PS 67 PS L~j] CYSTIC DISEASE, FAMILY HISTORY OF BREAST CANCER AND USE OF ORAL CONTRACEPTIVES. Vakil, D.V., Elinson, L., & Morgan, R.W.,University of Toronto, Toronto, Canada. Epidemiologic studies show a lower frequency of fibrocystic breast disease among users of oral contraceptives than among women who have never used them. Family history of breast cancer appears to be more common among benign breast disease patients than among their controls. To determine the use of oral contraceptives and the presence of family history of breast cancer information was obtained from 211 cystic cases and their matched controls from Metropolitan Tornto area. Cystic cases compared to controls had a higher proportion of women with a family history of breast cancer (21% vs 15X). For both a positive and negative family history of breast cancer as well for all women combined, the mean duration of oral contraceptive use was lower for cystic than for controls. The odds ratio for oral contraceptive use according to family history of breast cancer for cystic disease and controls was 0.42 and 0.81 respectively. The possibility that a women is more protected against benign breast disease by using oral contraceptives if she has a family history of breast cancer deserves more attention in future investigations on the long-term effects of birth control pills. BREAST DISEASE/ORAL CONTRACEPTIVES/GENETICS/CANCER 435 THE VALUE OF EXAMINING C-19 STEROIDS IN URINE OF WOMEN WITH DUCTAL BREAST CANCER. MICIC, J., IVANOVIC, S., MARKOVIC, Lj., BRZAKOVIC, P., and NI KOLIC, S. Interna Klinika A, Med. Fak., 11000 Belgrade, Yugoslavia. In 24 hour urine, the authors examined the levels of C-19 steroids: Androsterone (A), Dehydroepiandrosterone (DHA), Etiocholanolone (E) using. the method of thin layer chromatography (TLC) and 17-KS (method Zimnerman) for 73 patients with ductal breast cancer. There were 37 women with axil- lary metastases while the others were free of inetastases. In patients with ductal breast cancer withou metastases, a decrease of E was found and the correlation A:E was in hortrbnal disbalance (r=0.295). In patients with axillary metastases the relation was A:E, which was in a great stoch- astic dependence (r=0.821). DHA was lower in both groups. 17-KS in patients without meatstases are lower (p< 0.001) According to the results it was found possible to detect ductal breast cancer based on hormonal analysis and to approximately detemtine the prognosis.

LIST OF ABSTRACTS 439 ENDOCRINE TRE-'-.^1M1::NT OF BREAST CANCER: BENEFIT FOR RESPONDERS - ADDITIONAL RISK FOR NONRESPONDERS? (A in-vitro study) v.Mattlnyessen, H., Koldovsky, U., Feldhammer, B. Dept. of Gynecology ar,d Obstetrics, University of DUsseldorf, FRG Tumor regression occurs in about one third of breast can- cer patients with endocrine therapy. The group of nonre- sponders consists of receptor-positive as well as receptor 67 negative tumors. Little is known about the clinical course ps of so called nonresponding patients. Some of them - possib ly the receptor-positives - might be stimulated by addi- tive hormonal treatment. This apprehension is supported by our experimental data: Using short-term-incubation the incorporation of tritiated thymidine in cells of 46 breast cancers was measured under the influence of inedroxypro esterone acetate (MPA), estra- diol (E ) and testolactone3~T), Compared to control values stimulaiion/inhibition of H-thymidine uptake was found by MPA in 32,4/21,6io, by E2 in 23,9/17,4% and by T in 19,3/ 25, 8c0 of the tumors. From these data it seems important to study the possibili- ty of accelerated tumor growth caused by hormonal therapy. Key words: Breast cancer, endocrine treatment, risk 440 HUMAN BREAST CANCER: I - SURGICAL TREATMENT AND OESTROGEN EXCRETION PATTERN RESPONSE by L. Castagnetta, F. Di Benedetto, F. Palisi, L. Polito, A. Traina and S. Fertitta. Biochemistry Institute of Palermo University and Cancer Hospital Centre "M. Ascoli" - Policlinico- Palermo Italy. In a series of 42 breast cancer patients, from the third year of postmenopausal age (PM) oestrogen excretion patterns were studied by gas-liquid-chromatography-mass-spe- ctrometry (GLC-MS). The studies were conducted by evaluating three points of referen- ce: 72 hours before mastectomy (t, ), 72-96 hours after mastectomy (t2) and 12-15 67 days after surgery. Particular attention was paid to the ratios (R) between various oe- ps strogen metabolites, with reference not only to classical oestrogens (E~+EZ+E3) but also to those defined as unusual, as well as to ratios between oestrogens and androgens, valuated as 17 oxo-steroids, and between oestrogens and progestins. Steroid excretion levels were also compared with E2, T and P plasmatic rates. Two different control groups were used: one of 12 women with PM benign breast tumours, the other of PM women with various types of surgery, excluding breast surgery. The preliminary results indicate that: a) corticosurrenal response is not of the same intensity in all cases (t2); b) these data often appear independent of both age and PM age; c) there would seem to be a different response at t3, tending to divide the series studied into two groups; that in which oestrogen excretion patterns tend to normalize at t3, and that in which they remain abnormal; d) the unusual oestrogen metabolites fraction appears to have a significant correlation with 17oxo-steroid excretion levels. This could imply that unusual oestrogen metabolites levels are somehow dependent on peripheral aromatiza- tion process and so could imply the need for precise medical therapy for PM breast cancer patients chosen in this way. OESTROGENS / BREAST CANCER / SURGERY

LIST OF ABSTRACTS 67 PS 441 HUMAN BREAST CANCER: II SURGICAL THERAPY, STEROID PATTERN RESPONSE AND PROGNOSIS by L. Castagnetta, G. D'agostino O. Granata, F. Paternb, A. Traina and S. Fertitta. Biochemistry Institute of Palermo Uni- versity and Cancer Hospital Centre "M. Ascoli" Palermo Italy. As has been observed, some postmenopausal (PM) breast cancer patients, treated with radical surgery and without subsequent adjuvant therapy, have shown good clinical response, as regards both the free interval and the survival time. It is also known that ca- ses with PM age of less than 5 yrs have a significantly different prognosis than those with PM age over 9 yrs, in terms of both free interval and survival time. Our previous studies made it possible for us to identify two main steroid excretion pattern groups in PM breast cancer. In particular, significant differences have been found in the two groups as regards E3 R and pattern indexes (i.e. the ratio of classical oestrogens to oestrogen metabolites de- fined as unusual). The aims of this study were, to attempt to define steroid pattern modi- fications following breast cancer surgery: a) to endeavour to ascertain the existence of different steroid pattern responses in the two patient groups (the cases with PM age less than 5 yrs and those with PM age over 9 yrs); b) to attempt to correlate these steroid re- sponses with clinical response, in terms of free interval and survival rates. The prelimina- ry results suggest significant differences between the two groups, if we refer to certain selected parameters, such as E3 R or pattern indexes. They also indicate that some of the- se parameters are dependent on PM age, while others appear not to be. The implications of these findings will be discussed, and the preliminary results concerning clinical respon- se will be presented. STEROID PATTERNS/BREAST CANCER/ SURGERY PROTEIN KINASES AND cAMP BINDING IN HUMAN MAMMARY TUMORS Eppenberger, U., Biedermann, K. and Almendral, A. 1241 Dept. of Gynecology, University Clinic, 4031 Basel, Switzerland. Human mammary carcinomas exhibited a relative decrease of type II cAMP-dependent protein kinase as compared to mammary dysplasias. Type II protein kinase is implied in the control of the cell proliferation. Two significantly different groups with high and low cAMP-binding affinities (high 5 pmoles, low 5 pmoles) were found in the carcinoma tissues. A new therapy with DBcAMP is suggested in carcinoma patients with high levels of cAMP binding resulting in an improved prognosis rate of the endocrine therapy (60 %). Low specific activity levels ( 200) of cAMP-dependent protein kinase within the carcinoma group (n = 51) caused a significantly higher rate of metastatic disease raising the possibility to use this enzyme as a biological marker for the prediction of metastasis. No inverse correlationship could be found between cAMP binding and steroid hormone receptors (estrogen and progesterone) in human mammary carcinomas. (This research is supported by the Swiss Cancer League - No. FOR.125.AK.78(2).) /pROTEIN KINASES/cAMP BINDING/HUMAN MAMM.TUMORS /

r LIST OF ABSTRACTS 443 PLASMA KALLIKREIN ACTIVITIES, FSP and C1 INH LE- vels IN BREAST CANCER Werk,W.,Piogmeyer, P., Bartsch, W., Waldsanatorium 3579 Neu- kirchen and Med. Enz. Research Group, Munich-Sauerlach, FRG, The purpose of this study was to observe the effect of plas- ma kallikrein activity, FSP-and C1INH levels in 100 mammary carcinoma patients after radical surgery and to compare the results with healthy persons,Mean values for kallikrein ac- (24) tivities in the samples from the patients were lower than those from the healthy people. Mean C1INH concentrations were significantly higher in the cancer patients than in healthy volunteers. FSP levels increased in carcinoma pati- ents. It is tempting to speculate therefore that the low levels of plasma kallikrein observed in the mammary cancer patients are at least partly due to activation of the kalli- krein-kininsystem.It seems to be possible, that changes in plasma levels of C1INH and FSP would interfere with kalli- krein production and activity, /KALLIKREIN/C1jESTERASE INHIBITOR/FIBRINOGEN SPLITTING PRODUCTS/ ft (24) L9A SERUM CORTISOL FRACTIONS IN BREAST CANCER AND PREGNANCY. Ariyoshi, Y. & Kuzuya, K. Aichi Cancer Center Hospital, Nagoya, Japan. Cortisol ( F ) in the blood exists in three main forms such as transcortin-bound, albumin-bound and protein- unbound forms. Only unbound fraction is generally thought to be physiologically active. In order to determine these three fractions a modified equilibrium dialysis was de- vised. Total F concentration and three fractions were measured in 29 normal women, 46 patients with breast cancer and 29 pregnant women. No significant difference of total F concentration between normal women and patients with breast cancer was observed. Total F level in the blood increased significantly with the course of pregnancy. Percentages of transcortin-bound and albumin-bound F in breast cancer were not different from those in normal women. But percentage of unbound F in breast cancer increa- sed significantly comparing with that in normal women. In pregnancy percentage of transcortin-bound F increased remarkably and percentage of unbound F decreased. The authors favor the view that high level of unbound F in breast cancer may be associated with a risk factor. /CORTISOL FRACTIONS/BREAST CANCER/PREGNANCY/

LIST OF ABSTRACTS 445 CHARACTERIZATION OF GLYCOPROTEINS SYNTHESIZED BY HUMAN BREAST SURGICAL SPECIMENS. Tokes, Z. A., Gendler, S.J., Silverman, L.M., Dermer, G.B. USC Cancer Center, Los Angeles, CA, USA. Earlier we hypothesized that under pathological conditions, like neoplasia, significant changes in gp synthesis and release should be observed due to altered topographic relationship of epithelial cells within the glandular architecture, (J. Supramolec. Struct. (1977) 7: 515-530). Thus, the appearance of these gp in serum could be diagnostically significant. Short-term organ cultures were performed on surgical specimens of human breast adenocarcinoma and benign [24] hyperplasia. Gp synthesis and release were monitored by the incorporation of 3H-glucosamine into macromolecules. At least 5 major groups of labelled gp, released into the supernatant, have been identified by two-dimensional gel electrophoresis followed by fluorography. Three of the five major components migrated to positions where normal serum gp are found. Using cross-immuno- electrophoresis with rabbit anti-normal human antisera, three radioactive com- ponents were precipitated. Specific antisera against a1 acid gp and a1- antichymotrypsin in combination with Staph A-protein precipiTated 1.5 to 9% and 3 to 8% of the total labelled mixture, respectively. Indirect immunoperoxidase staining of surgical specimens revealed positive staining of epithelial cells which indicates the site of origin of these gp. These observations support the suggestion that gp synthesized by epithelial cells could enter the serum. Their presence in the serum in slightly altered immunogenic forms or elevated levels may be indicatory of altered glandular architecture. (NIH-CA 24645) (GLYCO- PROTEINS, BREAST CANCER, ANTI-CHYMOTRYPSIN, al-ACID GP) ~ CLINICAL VALUE OF SHBG FOR BREAST CANCER. Y. Murayama, J. Lttsunomiya & K. Asano Tokyo Medical & Dental University 2nd Dept. of Sur- gery, Tokyo, Japan, A clinical value of SHBG (Sex Hormone Binding Globulin) titer was studied in breast cancer. Our study showed that SHBG had two scientific merits for treatment of breast can- cer. The first scientific merit was that the relation bet- ween SHBG titer and prognosis of breast cancer was recog- 124] nized. In eighteen patients with Stage IIIa disease (UICC TNM classification), we examined the relation between SHBG titer before radical mastectomy and disease-free interval. Patients with a high titer of SHBG had a disease-free inter- val of 19 months (±5 months: standard deviation) compared with 10±6 months for patients with low SHBG levels. The difference was significant (p<.0.01). The second scientific merit of SHBG titer was that SHBG was a reliable indicator of hormone dependence in human breast cancer. In 72 patients with advanced breast cancer, SHBG titer before therapy was examined to determine the efficacy of hormone therapy. Our result showed that only 5 out of 46 patients with low SHBG titers responded to hormone therapy (response rate: 11%), on the other hand, 24 out of 26 patients with high SHBG ti- ters resffbnded to hormone therapy (resoonse rate: 92%). /SHBG/BREAST CANCER/

LIST OF ABSTRACTS L147 A OQITARATIVE STUDY OF SIALYL ZRANSrERASE AAID OTiiER 4LMR MIUM63 IN BREAST CANCER PATIESTIS KREIENBERG, R., ROTHER, G., PREISS, J., and MELCAERT, F. FrauenkIinik und Abt. fur Hamatologie der Universitat Mainz, Dept. of Gynecology and Obstetrics, University Hospital, 6500 Mainz, Germany, F.R. The present study was undertaken to determine the following: 1. Usefulness of sialyl transferase and other currently avail- able tumor markers in preoperative diagnosis of breast cancer; 2. Changes of serum levels of these markers in patients after operative treatment. (241 In 55 patients with breast cancer, the following markers were determined pre- and postoperative: Sialyl transferase, alpha-l-antitrypsin, alpha- 2-macroglobulin, alpha-2-HS-Glycoprotein, carcino-embryonic antigen, SP-1-glycoprotein and alpha-feto protein. The different markers were determined simultaneously. The validity of each single marker in com- parison to the others was analysed by statistical methods. RESULTS 1. For the purpose of preoperative diagnosis of breast carci- noma, only sialyl transferase gives satisfying results. In 58.2% of all cases with proven malignancies, serum values were elevated. 2. All the other investigated tumor markers were raised in less that one third of our cases. 3. AFP and SP-1 were not detectable in all our sera; presum- ably our method for the determination of SP-1 was not as sensitive as necessary. 4. Sialyl transferase can be helpful in monitoring breast cancer patients postoperatively. 448 Laboratory Studies on the Role of Cellular Immunity and Gene- tics in the Etiology of Rapidly Progressing Breast Cancer in Tunisia. P.H. Levine, N. Mourali, F. Tabbane, J. Loon, P. Terasaki and J.G. Bekesi. National Cancer Institute, Bethesda, Md., Institut Salah Azaiz, Tunis, Tunisia, UCLA, Los Angeles, Ca., and Mt. Sinai Hospital, New York, N.Y. It has been suggested that poussee evolutive (PEV) or rapidly progres- sing breast cancer (RPBC) represents a failure in the host immune system to control the proliferation of breast cancer cells. To evaluate this (241 possibility we have performed in vivo and in vitro assays of cellular immunity in Tunisian patients wiffFireast cancer. Studies of delayed hypersensitivity using dinitrochlorobenzene, microbial antigens and ex- tracts from breast tumors indicated that RPBC patients had a normal immune response to non-tumor-associated antigens and a heightened skin test response to tumor-associated antigens. In vitro studies also indi- cated that RPBC patients had a more vigorous immunoTogic response to a variety of antigens than breast cancer patients without evidence of rapid progression. In three independent series, an increased frequency of blood group A was found in RPBC patients, suggesting a genetic pre- disposition to this form of breast cancer. However HL-A typing for A, B and DRW antigens revealed no specific RPBC-associated HL-A antigen. Our studies clearly demonstrate that RPBC or PEV is not a reflection of immunodeficiency. ' /BREAST CANCER/CELLULAR IMMUNITY/GENETICS/

LIST OF ABSTRACTS [291 L(L(9 EARLY DETECTION OF BREAST CANCER BY LEUKOCYTE ADHERENCE INHIBITION ASSAYS Sanner, T., Kotlar, H.Kr., Eker, P., Brennhovd, I., and Jorgensen, O. Norsk Hydro's Institute for Cancer Research and the Norwegian Radium Hospital, Oslo, Norway: Leukocyte adherence inhibition (LAI) assays are based on the finding that leukocytes from sensitized persons show a reduced adherence to glass compared to leukocytes from non- sensitized persons when mixed in vitro with the relevant antigen. In the present study, LAI measurements have been performed on 167 untreated patients with breast cancer and 297 women with benign breast diseases. Approximately 75% of the patients with breast cancer in stage I gave a LAI response while only 51% of the patients in stage III and IV responded. Interestingly, 21% of the patients with benign breast diseases showed reactions in the LAI assay. The patients with benign breast diseases were divided into 3 groups on the basis of risk factors. About 15% of the women were assigned to the high risk group. 50% of these showed a LAI response. Of the women without any known risk factors (52%) only 10% showed a positive index. This work is supported by the Norwegian Cancer Society. /CELLULAR IMMUNITY/BREAST CANCER/BENIGN BREAST DISEASES/ 450 MISSOURI'S ROLE IN BREAST CANCER DETECTION. Rodes, N.D., Farrell, C., and Blackwell, C. W. Cancer Research Center, Columbia, Missouri, U.S.A. In 5 years, the experience of the National Breast Cancer Detection Demonstration Project at the Cancer Research Center, sponsored jointly by the American Cancer Society and the National Cancer Institute, has included 10,166 participants and more that 50,000 sets of examinations. Certain trends are now apparent and suggestions may be made concerning [251 the screening of asymptomatic women. The primary purpose of the pro- ject is to demonstrate that breast cancer can be detected at an early potentially curable stage. It is being achieved predominantly by mammography. Of the occult cancers detected by mammography, 87% are free of axillary metastases. Forty percent of these cancers are > lcm or intraductal. It is reasonable to believe that patients identified with minimum breast cancer have a greatly improved prog- nosis when contrasted to the usual clinical situation of a palpable tumor. Screening/Detection/Mammography/Survival

LIST OF ABSTRACTS (25) 451 MASS SCREENING FOR BREAST CANCER: TFE JEFFERSON EXPERIENCE SHABER, G.S., SCHWARTZ, G.F., PATCHEFSKY, A.S., FEIG, S.A., NERLINGER, R. Jefferson Medical College, Philadelphia PA, U.S.A. Between 1973 and 1978, 17, 543 asymptomatic women between 45 and 65 underwent 35,367 examinations, including mammography, thermography, and clinical examination. Follow-up was by biopsy or aspiration when indi- cated by clinical or Xray findings, or be rescreening in six months or two years, depending upon the initial findings. Biopsy or aspiration was recommended in 7% of examinees. Of this group, one-fourth had successful cyst aspiration; 896 biopsies were recommended. 664 biopsy specimens were reviewed. Invasive or in situ ductal or lobular carcin- oma was found in 183 biopsies, or 10.4/1000 women screened, an inci- dence four times that expected. Of the cancers, only 50.5% were palpa- ble, so that almost half were detected by mammography only. 21.7% of the cancers were not visualized on the mammograms, noted only on clini- cal exam. Of the entire group of cancers, 22% were non-invasive and 13% were tubular cancers, i.e. 35% of the cancers were biologically non-aggressive. Of the invasive cancers for which axillary dissection was part of the therapy, 60% showed no evidence of node metastases. Subsequent to the initial examination, 64 interval cancers were detected in this population, an incidence of 3.6/1000 women. The over- all experience of this center supports the adoption of mass screening using clinical exam and mammography for women over 45. Thermography did not prove efficacious. BREAST/SCREENING/EARLY DETECTION MODEL PROGRAM FOR BREAST CANCER CONTROL Goes Jr., J.S.; Goes J.C.S.; Fundagao"Centro de Pes- quisa de Oncologia", Instituto Brasileiro de Controle do Cancer, Sao Paulo - S.P. - Brasil: In Brazil, the main problem to establish a program for cancer control is the areat number of inhabitants, the great expan sion and the lack of human and material resources. Our goal was to establish a low cost and easy to be carried outprogram. [25] Patients are examined in attendance stations(65 at the moment) by non medical personnel (Level I). They are specially trained Nurse Attendants and the examination results have alreadybeen tested showing great accuity. Nurses also teach patients how to perform the-self examination at home. Patients selected by this screening are reexamined by a specialized doctor for a final diagnosis (Level II). If necessary mammography, ducto- graphy, thermography, and biopsy are done (Level III). The pilot program carried out a screening of 55.000 women over 20 years, without symptoms. The incidence rate was 1:216 inpatients aRed over 45 and 1:1315 in patients between ages 35 to 45. From January to November 1979, 61.173 examinations were performed, being detected 41 positive cases. /MODEL PROGRAM FOR BREAST CANCER CONTROL/ '

LIST OF ABSTRACTS (25J 453 A PROGRAM TO ENCOURAGE EARLY DETECTION OF BREAST CANCER BY GIVING INFORMATION TO THE PUBLIC IN ORDER TO HEIGHTEN AWARE- NESS AND TO REDUCE FEAR. Kushner, R., Breast Cancer Advisory Center, Kensington, Md. 20795, USA. Although various public and private agencies in the U.S. offer many information and emotional support systems to women after they have been treated for breast cancer, little or no attention has been paid to pre- treatment counseling or education about available therapeutic options. As a result of being unaware of the high cure rates possible when the disease is diagnosed and treated early or of available procedures to preserve the breast, women delay seeking professional help. In addition, there are often long periods of anxiety between detection of a symptom and any definitive treatment that may be needed. This waiting period may last for weeks or even months, but Its psychological trauma can be reduced or eliminated by an information-giving support system that as- sists women rior to any surgery. Knowing such aid Is available through groups like the Breast Cancer Advisory Center will encourage women to obtain diagnoses and treatment earlier. Since September, 1975, the BCAC has helped more than 10,000 women and their families. This discussion will attempt to show that such programs should be available to women everywhere. At the present time, there is little help for women between the times they are taught breast self-examination and, after surgery, post-mastectomy exercises. The Breast Cancer Advisory Center fills this gap /BREAST-CANCER/EDUCATION/INFORMATION/EARLY-DETECTION/ - 454 POPULATION SCREENING FOR BREAST CANCER USING SINGLE VIEW MAMMOGRAPH~ AND CLINICAL FDCAMINATION Thomas, B.A., Guildford Breast Screening Project, Jarvis Screening Centre, Stoughton Road, Guildford, Surrey, England. Guildford is one of tw0 centres carrying out a population screen- ing programme as part of the British Breast Cahcer Screening Trials. All women aged 45 - 64 registered with Practitioners in the South West Surrey Health District are being invited to attend for clinical (25j examination of the breasts and single view mammography. Results are presented covering the first 15,000 women invited of whom two-thirds attended. New cases of breast cancer were detected in 5/1000 women screened and the staging of these is indicated. The review and further investigation of the 8% of women with an initially suspected abnormality is discussed, as is the place of fine needle aspiration biopsy. Less than 1% of women had an excision biopsy for a benign lesion. The results are compared with those obtained from a pilot study using single view mammography alone as a screening technique, on women from threP adia„n,eI:+ practi.^.ess i'utside ine study dietY'ict. Some financial estimates for the screening techniques are given. /BREAST CANCER SCREENING/SINGLE VIEW MAMMOGRAPHYfFINE NEEDLE BIOPSY/ .,.

LIST OF ABSTRACTS 455 ROC - CURVE ANALYSIS OF BREAST CANCER MASS SCREENING AT UTRECHT. Rombach, J.J. Preventicon Institute for Breast Cancer and Cervical Cancer Screening, Utrecht, The Netherlands. The concept of Receiver Operating Characteristics in medical diagnosis illustrates the fact that the sensitivity of a diagnostic procedure varies with changes in the decision threshold, while the specificity changes inevitably in the opposite direction. This interdependency of sensitivity and specificity of diagnostic tests is visualized by ROC - curves. The population-based Utrecht female breast cancer mass screening project, using physical examination and (Xero-)mammography, is submitted to ROC - analysis. The sensitivity and specificity belonging to various diagnostic levels fit into a ROC - curve. In mass screening ROC-curves can be used for selecting detection modalities, for differentiating the initial diagnosis decision from subsequent additional procedures, for deciding on appropriate operating points and/or additional procedures, for making hospital capacity and cost estimations. / BREAST CANCER SCREENING / ROC - ANALYSIS / 456 EPIDEMIOLOGICAL EVALUATION OF THE POPULATION-BASED SCREENING PROJECT AT UTRECHT (D.O.M.-PROJECT) BY MEANS OF A CANCER REGISTRY. Collette, Bertine J.A. Institute of Social Medicine, State University of Utrecht, the Netherlands. Abstract: A screening project in a well-defined population birth cohort 1911-1925 can be evaluated by assessing: 1. mortality: The CBS (Central Statistical Office) annually produces ab- solute figures of deaths from breast cancer as well as population figur- es. Thus mortality rates can be computed. 2. morbidity: For the assessment of morbidity a cancer registry has been set up. Data are available for the period 1974-1979 at the moment. Rates can be computed with the population data of the CBS. 3. lethality (case fatality): Follow-up of the registered cancers can give information about lethality. A synopsis is given of the preliminary results. - Regarding mortality it will be shown that the impact of the program on mortality in the total population of Utrecht will be limited even if mortality among screened women could significantly be diminished. - Regarding morbidity the effect on breast cancer is shown and an anal- ysis is presented of the various categories of women with breast can- cer which are due to screening and not due to screening, a comparison has been made of tumor size and the presence of metastases. - Regarding lethality very few data will be given in view of the short period of follow-up since the initiation of the study.

LIST OF ABSTRACTS [25J 45] RESULTS OF BREAST CANCER DETECTION (1966-1978) A. Vandenbroucke-Vanderwielen, H. Maisin, C. Bourdon, Centre des Tumeurs UCL, Louvain-en-Woluwg, Belgium. The authors presents the results of systematic breast examinations executed on 36.500 women for the detection of cancer. They studies the incidence of this cancer on different group of ages, the technics of examinations, the re-examinations rhythm and there interest, the grade of the detected tumors, the task of self examination, the risk factors and the follow-up. /BREAST CANCER/HIGH RISK FACTORS/ BREAST SELF EXAMINATION/FOLLOW-UP. 458 P,ESULTS FImM AN LUAIZATICV PRO7ECP ON BRF.AST SIIF-F.}Q4Affi3ATICDI FOR 17 TE EARLY DEIT]C'I'ICN OF BREAST CANCER. Gastrin, G., National Institute of Nursery, P.O.Box 21, 00571 Helsinki 57, Finland. I A new type of health education program, including persoarto-person information to women by medical informants, follovrup of participating women's behaviour with special material and linking to name8 breast cancer specialized physicians for those wrxnen, who detect synptans of [251 breast cancer themselves, has been tested in a group of 56 177 women similar to that of normal population. Only 1.3 per cent of the women enrolled needed a physician during a 12 month's pexiod. Out of those wan°n, who needed a physician, every 8:th was a new self-detected breast cancer patient.'There were detected ab. twice the cases expected, they represented younger age groups, and rrore local stages, than in normal popul.ation. The five year mortality rates decreased with about 30 per cent. No fear.was noticed. The costs per new detected case was ab. one tenth -of the costs in screenings. Questionnaires used shawec7 that women were satisfied in being taken care of. The method has already in different countries been part of public health care at places of work, in wanen's organizations, in student health care. The aim is to reach all women in the world. A manuscript of a book is available 1980. /FARLY DETDCPION OF BRERST (',ANCEFZ/ I

LIST OF ABSTRACTS 459 EVALUATION OF EARLY DETECTION OF BREAST CANCER. Chamberlain, Jocelyn, Moss, Susan & Wilson, D.T. Institute of Cancer Research, Sutton, Surrey, England. A large-scale trial of methods of early detection of breast cancer is in progress in Gt. Britain. Its aim is to compare mortality.from breast can- cer over a period of years among populations of women aged 45-64 offered different services for early detection of this cancer. Quantitative esti- mates will be made of benefit, in terms of lives saved, and cost, in terms of unnecessary surgery, radiation hazard and use of health re- sources. Two populations, each of 25,000 women, are invited for annual screening by clinical examination and mammography, 2 more populations of the same size are invited for BSE teaching sessions and 4 comparison pop- ulations, totalling 120,000 women, are offered no additional services beyond conventional diagnostic facilities. All breast histology, benign and malignant, occurring in all these women is recorded and findings, management and follow-up of all breast cancers noted. Changes in the population will be traced and deaths from all causes recorded. Factors influencing compliance with early detection programmes are being inves- tigated and the sensitivity and specificity of different modalities of detection measured. Mortality in screening, self-examination and compa- rison populations will be compared and other issues related to evaluation of cancer screening, such as lead time, natural history of borderline neoplasia and delineation of high-risk women, are being explored. /SCREENING EVALUATION/BREAST CANCER/SELF-EXAMINATION/ !6() THE ECONOMIC CONSEQUENCES OF SCREENING FOR BREAST CANCER. Chamberlain, Jocelyn, Simpson, P.R. & Gravelle, H. Institute of Cancer Research, Sutton, Surrey, England. Based on an experimental clinic, financial costs of health care result- ing from a screening policy were compared with those of conventional symptomatic diagnosis of breast cancer. Estimates were made of costs of different screening modalities and costs of investigation and treatment of women referred from screening. Sensitivity and specificity were mea- sured and, from these, the probability and cost implications of true or false positive and negative results were used to derive a total cost per woman screened. The incidence of benign and malignant brease disease under a conventional policy and the average cost of their care were es- timated. Subtracting this cost from the screening policy cost, the extra cost of screening was €9 per woman for clinical examination alone, €10 for mammography alone and €18 for both. From this a cost per cancer de- tected was -derived and, using survival data, the 'cost-effectiveness' per discounted year of life was estimated to be €1500 and €1900 for single and dual modality screening respectively. Costing methods were accurate but some of the epidemiological assumptions are crude and a controlled trial is needed. The study emphasized the crucial influence of test specificity on 'cost-effect' and of test sensitivity and obser- ver variability on 'cost-effectiveness'. /SCREENING ECONOMICS/BREAST CANCER/ U 0 0 r `v ~

LIST OF ABSTRACTS 461 BREAST SCREENING BY BREAST SELF-EXAMINATION: AN EVALUATION OF TEACHING METHODS AND MATERIALS Patricia Hobbs, Dave Haran and Laura L. Pendleton, Department of Epidemiology and Social Research, University Hospital of South Manchester, Kinnaird Road, Withington, Manchester M20 9QL, England The feasibility of breast self-examination (BSE) as population screening for the early detection of cancer is largely dependent on its acceptability to a majority of women. The methods and materials used in Ps teaching BSE may be crucial to its acceptability (Hobbs, 1973, Eealth 67 Education JournaZ). Two teaching methods are currently under evaluation. A base-line survey of women's opinions on breast problems, cancer and BSE, in two experimental and one control districts, showed that current awareness of BSE is positively related to previous use of other preventive health measures. A slight association between feeling most worried about breast cancer and high awareness of BSE may be counter- balanced by the statistically significant trend for more aware women to hold a more optimistic view of outcome of breast cancer. Detailed discussion of these points will be accompanied by data from pre-teaching and immediate post-teaching questionnaires. BREAST SELF-EXAMINATION/TEACHING EVALUATION/OPINION SURVEY Note: The synchronised sound/slide teaching material will be made available at the conference. [31) I{62 LOW-DOSE-SINGLE-VIEW RADIOGRAPHY OF THE FEMALE BREAST PATEROK E.M. UNIV.-FRAUENKLINIK ERLANGEN BAVARIA WEST-GERMANY Induction of breast cancer by repeated exposure to ionizing radiation is a serious concern of mammographers. A woman might undergo at least 2o studies during her lifetime. Using rare-earth film-screen-systems for image detectors in mammography surface dose is 1/lo to 1/15 when compared to industrial film, for example Kodak Medical Definix. Phantom measurements and measurements with patients to determine the radiation dose to the breast have been done. We examined amputated, different- sized breasts with various techniques. Low-dose film mammography can provide diagnostic information with minimal radiation hazard. A further reduction of exposure is possible when single view radiogra- phy of the mammary gland, described in 1976, is performed. The combi- nation of low-dose and single-view mammography can be used for the following applications: 1. First examination of young women. 2. Interim follow-up observation of patients who received conventional mammography in two standard projections. 3. Surveillance of the contralateral breast of cancer patients. 4. Pneumocystography, Galactography. 5. Screening of large groups of well woman. The author will report his experiences and discuss the efficiency of the low-dose-single-view technique as a method of early detection of breast cancer.

LIST OF ABSTRACTS (31J (31J 463 MAMMOGRAPHIC PATTERNS AS A RISK INDICATOR FOR BREAST CANCER; A CASE-CONTROL STUDY IN SCREENED AND SELF-REFERRED WOMEN. Rosselli Del Turco M., Ciatto S., Mezzalira L., Camargo J.R.,Petracco A. Center for Social Diseases and Preventive Medicine, Florence, Italy. The purpose of the present- study is to define the role of the mammogra- phic pattern as a risk factor for breast cancer in a series of breast cancer diagnosed in the course of a mass screening. Two case-control studies were performed:study 1(279 breast cancers,aged 40-49, vs.279 controls matched by age, date of examination and place of residence, in self-referred women), showed a higher relative risk for P2 and DY groups though evidently lower than in previous reports(DY/Nl:2,2; P2/NI:2,I).Study II considered a female population aged over 40, siste- matically invited and screened; 57 cancer cases were compared to 114 controls matched by age, date of examination and place of residence.No significance of the mammographic patterns was evidenced and a low fre- quency of P2 and DY cases was observed The frequency of subjective symptoms (high in self-referred and low in screened women) seemed to be directly correlated with P2 and DY patterns.For this reason we did not e x clude the symptomatic cases from the control group of our case-con- trol studies. No significant role of Wolfe's mammographic patterns as risk factor was observed in our experience;expecially in screened women a selection of high risk group m the basis of the mammographic pattern is not possible . MAMMOGRAPHIC PATTERN/CASE-CONTROL STUDY/. 464 ULTRASCNOGRAPHY, A PROMISING METHOD FOR DETECTION OF EARLY BREAST CANCER Pluygers, E. & Rombaut, M. Breast Unit, Oncology Depart- ment, Jolimont Hospital, 7161 Haine-Saint-Paul, Belgium. The aim of this study is to assess the value of ultraso- nography (US) in detecting early breast cancer, as compared to other techniques. Specialized equipment has been used (SINMED 16 echomammograph), allowing manual contact scanning and automatic immersion scanning in both A and B modes. Over 10.000 examinations have been performed and 285 cancer cases recognized; among these, 64 were "early" ('12 TO and 52 TI). Histologic control, thermography and X-ray mammo- graphy (XRM) have been obtained in every case. Out of 12 TO cases, accurate diagnosis was obtained by US in 7 cases, by XRM in 4 cases and by the association US+XRM in 8 cases. For the 52 T1 cases, diagnosis was made by US in 43 cases, by XRM in 42 and by the association in 48. Overall figures for the 285 cancer cases wera as follows : accurate diagnosis by US : 257/285 = 90.1%; by XRM : 235/ 285 = 82.4%. The conclusion is reached that US is at least as accurate as XRM in the diagnosis of early breast cancer, including infraclinical cancer. /EARLY BREAST CANCER/ ULTRASONOGRAPHY/ MAFSMOGRAPHY/

LIST OF ABSTRACTS CLINICAL SIGNIFICANCE OF ULTRASONOGRAPHY IN TRE DIAGNOSIS AND 465 MANAGEMENT OF PALPABLE BREAST MASSES. Dutzu Rosner, Roswell Park Memorial Institute, Buffalo, New York, U.S.A. In a previous study of 209 patients with breast disease we defined the clinical application of ultrasonography in breast disease. (D. Rosner, et al. First. Congress Ultrasonic Examination of the Breast. Abstr. 28, 1979). In the present ongoing study 86 patients with palpable breast masses, clinically requiring surgical biopsy, were sonographic examined in order to provide additional diagnostic information for therapeutic de- cision. In the presence of palpable mass, sonographic scanning was supe- rior to palpation or mammography in discriminating a cyst from a solid tumor. All 30 patients with solid masses, 5 fibroadenomas and 25 carci- nomas underwent surgical biopsy. Cancers were correctly diagnosed in 20 of 25 (80%) by initial sonography vs. 22 of 25 (88%) by mammography. Mi- crocalcifications identified in 11 patients by mammography were not de- tectable by ultrasound limiting its use in screening or early diagnosis. In patients with fibrocystic masses and solitary cysts ultrasound permit- ted a more accurate detailed description of the lesions (92%) than mam- mography (62%) and was capable of detecting nonpalpable cystic lesions as small as 0.2 cm. in diameter. Of the 36 patients with fibrocystic masses, 22 are being followed clinically and 14 underwent excisional bi- opsy. All 14 patients with solitary cysts had needle aspiration. The superiority of ultrasound diagnosis of cystic masses had the potential of sparing unnecessary, costly and often emotionally-stressful biopsies. /ULTR4SONOGRAPHY/BREAST DISEASE/ 466 MAMMOGRAPHY IN CONJUNCTION WITH ULTRASONOGRAPHY-IMPROVED BREAST CARCINOMA DIAGNOSIS Logan, Wende W. 1351 Mt. Hope Avenue, Rochester, New York USA The author has employed screen-film mammography in her office since 1976, at an average glandular breast dose of 200 millirads per each two-view study of each breast. She also performed B-Mode ultrasonography of dom- inant palpable densities, utilizing a slightly modified Bronson B-Mode Ophthalmic Scanner. 1600 patients (mostly symptomatic patients, not screening)were evaluated between July 1978-July 1979. 60 carcinomas were diagnosed via mammography only. In addition, localized ultrasonography was performed on 250 patients with dominant palpable densities occurring in dense glandular tissue. Most of the time, cysts were diagnosed, but whenever cysts could not be diagnosed, additional coned down magnified views of the palpable dominant densities were performed. In this way, 10 additional carcinomas were discovered. Many of these lesions were smooth- ly outlined and clinically thought to represent cysts. In addition to the additional carcinomas detected, ultrasonography resulted in many canceled biopsies. Only 98 biopsies had to be recommended for the 70 pathological- ly confirmed carcinomas(three biopsies for each two carcinomas). At this time(Jan.1980), only one carcinoma was missed after a one year followup of the first 800 patients. Therefore, ultrasonography i.n conjunction with technically good screen-film mammography resulted in few false positives (30%),and minimal false negatives(3%).

LIST OF ABSTRACTS [311 [31J 467 PRELIMINARY TESTS ON CANCER DETECTION BY MICROWAVE THERMOGRA- PHY - J.ROBERT,J.EDRICH,A.MAMOUNI,J.M.ESCANYE,C.I'ITY-Lab. de Biophysique-Facult46 B de M6decine-18,rue lionnois-NANCY-54000 The greater penetration depth of microwaves (MW) in tissues makes it superior over IR to detecting thermally active, deep seated tu- mors by measuring their direct emission of MW. 120 patients bearing le- sions of different kind and situation have been examined with remot sen- sing, focussed MW thermography (68,30 and 11 GHz) in a raster scan fas- h3on, and also with a skin-contact sensor at 9 GHz. MW thermography for superficial lesions(thyroid or superficial bones and articulations) does not show much superiority over IR thermography . On the opposite it clearly detects the deep lesions invisible to IR (cancer in posterior pole of the eye, of deep skeletal pieces and of the brain or yields sharper results (mammary tumors). Low frequencies (9,11 GHz) seems to gi- ve clearer results than higher ones (30 and 68 GHz). Detection is less easy in water-rich tissues for example at level of intra-abdominal or- gans. Our preliminary tests appears to indicate the ability of MW to the detection, prognosis and survey of some deep seated cancers. 468 RADIOIt•LSUNOIMAGING OF MAMMARY TUMORS WTTH CELL-TYPE SPECIFIC ANTIBODIES. Ceriani, R.L.*, Peterson, J.A.*, Wilbanks, T.-, Miller, S..t, Kaufman, L.4 & Ortendahl, DA *Children's Hospital Medical Center, Oakland, California, tDepartment of Radiology, University of California, San Francisco, California and 4Radiologic Imaging Labora- tory, 400 Grandview Dr., South San Francisco, California, U.S.A. Successful imaging of mammary tumors is described using Fab fragments of antibodies against cell-type specific surface antigens (MME-antigens) of mouse mammary epithelial cells. Fab fragments were used since their clearance from circulation was more rapid than whole gamma globulin. Seventy uCi of 1311-labeled anti-MME (Fab) were injected into mice car- rying simulated mammary or non-mammary tumor metastases. After 23 hours the mice were administered 500 yCi 99mTc-pertechnetate and then at 24 hours images obtained on a High Purity Germanium camera. Clear localization of mammary tumors was seen, while other tumors, such as a melanoma and lung carcinoma were not detected, thus.demonstrating the localization specificity of these cell-type specific antibodies. Nor- malization of the 131, image to the distribution of 99mTc-pertechne- tate in the same mouse allowed compensation for differences in extracel- lular and intravascular spaces. Print-outs of numerical values per ima- ging element permitted calculation of localization ratios, showing a 4 to 6 fold specific accummulation of 131, in the mammary tumor. This work is supported by NCI Grant Nos. CA19455 & CA20286 of the NIH. /MOUSE MAN.N.ARY EPITHELIAL ANTIGENS/GERMANIUM IMAGING CAMERA/ ~.

LIST OF ABSTRACTS 469 STUDY OF PHYSIOLOGY OF BREAST BY CHOLESTERIC ANALYSIS PROFILE Hobbins, William B., M.D., F.I.C.S., F.A.T.S. President Wisconsin Breast Cancer Detection Foundation, Inc. Thermobiological studies of the breast have been undertaken by Lawson, Gautherie, and many thermal engineers. The physiology of the breast is clearly reflected by infared monitoring of the surface of the breast. T. Love has stated that thermography is the best mea- surementof breast blood flow. Cholesteric plate analysis is the most accurate, reproducible, and inexpensive method to record this phenomena. In the natural states of pregnancy, lactation, and hormone im- balances the thermobiology is distinct and accurate. When disturbed states caused by pain (local or distant in origin) or reparative growth (mastopathy) or neoplasia (benign or malignant) are observed by cholesteric plate analysis, these various states can be differen- tiated accurately. Thus it is also possible to divide these various states into sub groups as evidenced by thermal biology. This paper will present thermal evidence of physiological and pathological entities. The various reactions of hormone manipula- tion (BCP) and the significance of host thermal reaction to the pathological conditions of mastopathy (progesterone deficiency rel- tive) and neoplasia (benign and malignant) will be confirmed. /PHYSIOLOGY, THERMAL-BIOLOGY, CHOLESTERIC PLATE ANALYSIS/ 470 CRITICAL EVALUATION PF MORPHOLOGIC DIAGNOSIS TECHNIQUES IN MAMMOLOGY M. COLLARD et P. BRASSEUR Universite Libre de Bruxelles Centre de Mammologie - Maternite Reine Astrid B - 6000-CHARLEROI 3000 cases were selected from 17000 observations combining mammography, thermography, end echography. The respective value of the 3 techniques are compared when correlated with the pathological findings. The authors study the interest of real time echography and B.Scan. Echography is useful in cases.of glandular hyperplasia. Real_tinie echography allows an easy and fast study whereas B.Scan, less easy to perform, gives a higher power of resolution. Finally the authors describe the rare mammological discrepancies between the results obtained by these techniques and by cytological puncture.

LIST OF ABSTRACTS (311 CANCER DETECTION STUDIES USING A 4.7 GIGAHERTZ 471 RADIOMETER. Shaeffer, J., EI-Mahdi, A.M., Eastern Virginia Medical School, Norfolk, VA & Carr, K.L., Microwave Associates, Inc., Burlington, MA, U.S.A. Our laboratory has begun to evaluate the cancer detection capabilities of a microwave thermographic unit which employs a 4.7 GHz radiometer. The technique is payive and noninvasive. The temperature sensitivity of the unit is less than 0.1 C. Malignant tumors are often a full degree Celsius warmer than normal tissues. Microwave thermography can provide information related to subsurface temperatures, whereas infrared thermography is limited to surface temperatures. Results of microwave thermographic examinations in 18 patients with biopsy-proven cancers at various anatomic sites will be presented. Positive results were obtained in 9 of 10 women with breast carcinoma and 2 of 2 patients with Hodgkin's disease. Negative results were obtained in patients with more deeply-seated tumors. Results using the VX2 carcinoma in rabbits have demonstrated the feasibility of using heat to enhance microwave thermographic tumor detection. Microwave thermography' is a promising new method of noninvasive cancer detection. /MICROWAVE THERMOGRAPHY/CANCER DETECTION/ .[311 472 A PRELIMINARY APPRAISAL OF DIAPHANOGRAPHY IN DISEASES OF THE BREAST. Isard, H. J. Albert Einstein Medical Center, Phila- delphia, PA, U.S.A. Transillumination of the breast is a non-invasive innocuous procedure that is being tested as an imaging technique.for evaluation of breast disease, differentiating benign from malignant lesions, and as a pos- sible screening modality. A new prototype unit permits the observer to photographically document the visual findings in color on infrared film for detailed review and interpretation. The average normal breast when transilluminated in a darkened room has a reddish-yellow color that is reproduced with remarkable fidelity on the infrared film. Absorption of the light beam is dependent upon the size of the breast and the composi- tion of its tissues. Differences of color, shading and blood vessel calibre are criteria for the recognition of various breast lesions. The recorded images must be of optimum quality which requires technical skill that is attained with experience. The diaphanographic findings in approximately 200 women have been compared with the interpretations based upon mammography and thermography. To date the level of accuracy reported by some investigators (Di Maggio et al, Italy; Ohlsson et al, Sweden; Wallberg and Alveryd, Sweden) has not been achieved in our se- ries of histologically proven malignant and benign lesions. Diaphanog- raphy can be useful as a complementary technique in examination of the breast, but its potential as a single screening test appears limited. DIAPHANOGRAPHY / IMAGING / BREAST / CANCER / TRANSILLUMINATION

I LIST OF ABSTRACTS 4~ MANPfOGRAPHY AND DIAPHANOG}iF1PHY IN Tk1E DEi'DCTICN OF BREAST CANGER. Wallberg, H., Alveryd, A., Stege, R., Bergvall, U. & Sundelin, P. Surgical Clinic and Department of Radiology and Pathology, Huddinge Hospital, Sweden. Mamnography is a wellknown method in the detection of breast cancer. With modern techniques with low dose of radiation there is no risk for inducing cancer even after repeated examinations. All cases of breast cancer, however, can not be detected by marmiography. A new method to detect breast cancer with transillumination of the breasts called dia- phanography has been introduced in Sweden during the last years. Over 3.000 wcxnen have been examined at Huddinge hospital with this method. In patients with breast cancer the results of examinations with rnamno-- graphy, diaphanography and cytologic examination have been compared. Oornbination of the three methods evidently gives the best chance to detect a breast cancer. iow differentiated cancer tuRaurs seem to be very severe to detect both with marrrnography and diaphanography. (L74 BREAST CANCER DETECTION UTILIZING BIOSTEREOMETRIC ANALYSIS. Loughry, C. W., Herron, R., Liebelt, R., & Proietti-Orlandi, F Akron City Hospital, Akron, Ohio, U.S.A. The main purpose of this research was to further investigate spatial anomalies of the breast surface and the incidence of malignant breast tumors in women. The work was predicated on the need to explore new, innocuous methods for breast cancer screening and the results of a double-blind pilot study on 12 subjects In which the presence of a malig, nant tumor was correctly identified and located (by quadrant) in eight (31] of ten cases with known lesions as small as 1.8cm In diameter, using a biostereometric procedure. Biostereometrics is defined as "the spatial and spatiotemporal anal- ysis of biological form and function based on principles of analytic ge- ometry". A stereometric source, in this case stereophotography, was used to determine the spatial features of.the breast. The three dimen- sional breast geometry is defined by serial contours, which are analyzed individually to reveal departures from a smooth curve, or in combination, to obtain the breast volume distortion between planar cm sections. We will describe an automatic mathematical technique for identifying spatial parameters of the breast surface which may be correlated with the incidence of malignant breast tumors and discuss the implications of this research for breast cancer screening and development for a new form of plethysmography for studying breast pathophysiology. /BREAST TUMORS/SURFACE GEOMETRY/PLETHYSMOGRAPHY/ I

LIST OF ABSTRACTS 1311 (31] ADVANTAGES AND LIMITATIONS OF PHYSICAL 475 EXAMINATION AND MAMMOGRAPHY IN BREAST CANCER SCREENING. Feig, S.A., Schhwartz, G.F., Patchefsky, A.S., Shaber, G.S., and Nerlinger, R. Thcnas Jefferson University Hospital, Philadelphia U.S.A. For any given patient, there may be inherent limitations to the accuracy of physical examination ard/or manmography in breast cancer detection. Both xeran3nmQgraphy and physical examination were pe.r- formed on each of 17,000 self-selected wornen and over 200 breast cancers were detected. Physical examination was less effective for large breasts, deeply situated lesions, fatty breasts, and older warien. it was more accurate than m3mrography for small breasts, retroareolar lesions, and cancers with axillary 1ymph node involve- ment. Ccmpared to physical examination, mamrography was most effec- tive in detecting carcimnas associated with negative axillary nodes, minimal cancers, and cancers detected on the basis of nwmnographic microcalcifications. Nevertheless, for each category, many cancers would have been undetected if either mamnography or physical examination had been omitted as-a screening modality. This was especially true for women with dense, dysplastic breasts. M~APHY / BREAST CANCER SCREFNING/ 476 UPDATE ON DIAGNOSIS OF BREAST CANCER Raul H. Matallana, M.D., Department of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Avenue, Madison, Wisconsin 53792 U.S.A. A retrospective study is being conducted to evaluate the sensitivity of the current methods now being utilized for breast cancer detection. The information obtained from 100 patients who had simultaneous physical examination, mammography and breast ultrasound was individually analyzed in order to determine each mode's effectiveness in diagnosis. Contrary to some recent publications, our preliminary findings indicate the enhanced diagnostic accuracy when combining all three methods of evaluation rather than the singular clinical examination. /BREAST CANCER/DETECTION/METHODS/

LIST OF ABSTRACTS 477 BREAST TUKlRS MISSE1) BY XEYCfdAbAM:1APHY ANII7ICR CLINICAL FXAMINATICN CAMBOURIS, Theo, ADAMI, E., and PONTIFEX, Gr. Department of Radiology, Aretaion University Hospita2, Athens, Greece fPs) (671 l271 Xeranammography has been particularly effective in detecting early breast cancer mbere chance for cure is expected to be greatest. This method is more effective for large breasts, fatty breasts and in wrxnen of old age. Cbnversely, clinical examination is more effective for small breasts, dense breasts and retroareolar lesions. An analysis of our false negative findings is attenpted in our breast material of the Breast Clinic of the Aretaion Hospital, Department of Radiology, of Athens University. 478 THF F?tESEN'P STATUS OF IMMLn10LOGICAL MARKFJ3S IP7 MALIGNANT LYMPHOMA. Stuart, A.E. Department of Pathology, University of Newcastle upon Tyne, England. Advances in ?cnowledge about malignant lymphoma have been rapid in the last decade. These are largely due to the application of morphologv, cytochemistzy and immunology to the study of neoplastic lymphocytes. The icmntmoloqr of lymphomas stems directly from fundamental work on norniall cells and their ability to express surface receptors, imcnanoglobulins and differentiation antigens. Differentiation antigens are at the forefront of cell biology and it is likely that they will be of practical value in assessing cell maturity and cell lineage. t•Lrker studies have been helpful in identifying the origin of tumours and may possibly be useful as prognostic aids. The early promise that immunological markers would provide a working classification of lymphomas has not been sustained and the reasons are varied. _ However, 'marker studies have focused attention on that part of the differentiation process where the oncogenic stimulus is expressed. PRT~`SWT STATUS IMP2UNOLOGICAL MA.TiKE.+2S/MALIGNANT LYWHOMA

LIST OF ABSTRACTS (26J l261 479 IMMUNOLOGICAL DIAGNOSIS OF MYELOGENOUS LEUKEMIA. Taub, R.N., Baker, M.A., Roncari, D.A.K., Mohanakumar, T. Medical College of Virginia, Richmond, Virginia and Toronto Western Hospital, Toronto, Canada. It is now recognized that leukemia-associated antigens may be detected on human myeloblasts by means of specific hetero or alloantisera. We have partially purified and characterized a distinctive glycoprotein (AMLSGA) shed from human myeloblasts in in vitro short-term culture. Antisera raised to this material have proven useful for early diagnosis of relapse in patients with acute myeloblastic leukemia. Primate antisera raised to this material have shown that (1) antigens may be present on the surfaces of these cells, which are leukemia'specific, yet are distinct from la-like antigens; (2) the sera may be used in a sensitive coprecipitation radio- immunoassay to detect leukemia-associated antigen in the serum of patients; (3) sera may be used for direct immunofluorescence testing of human bone marrow samples from patients in remission with acute myeloblastic leukemia to determine earlier relapse. Efforts to further purify this material and tt~o prepare monospecific hybridoma_antlsgra are currently under way. /LEUKEMIA-ASSOCIATED ANTIGENS/EARLY DIAGNOSIS/RELAPSE/ CELLULAR IMMUNODEFICIENCY IN HODGKIN'S DISEASE: CIFr Leo CULATING LOW MOLECULAR-WEIGHT SERUM FACTORS INHIBIT- ING PROTEIN SYNTHESIS. Manke, H.-G., Drings, P., Lenhard, V~, and Till, G! Onkolo- gisches Zentrum Heidelberg-Mannheim, Krankenhaus Rohrbach d. LVA Baden, Heidelberg, and ) Institut ftir Immunologie und Serologie der Universit8t Heidelberg, Germany. E-Rosette formation of peripheral human T-lymphocytes de- pends on expression of a glykoprotein (Owen & Fanger) in the cell membrane. Inhibition of protein synthesis, of the nuc- leo-cytoplasmic mRNA-transfer and of mRNA synthesis (by al- pha-amanitin) depletes the cells from the E-receptor prot- ein within 15, 90 min, and 8 - 10 hours respectively. The lymphocytes of 20 patients with Hodgkin's disease hJ a low E-rosette forming capacity (32 + 8 i; compared to 61 + 81 of a control group). The lymphocytes of 15 patients are inducible by thymic peptides to form E-rosettes, those of 5 patients cannot be induced. The sera and serum fractions of 9 patients of both groups induce in normal peripheral human lymphocytes an inhibition of E-rosette formation within 60 min. Blockage by serum fractions (all above 5000 dalton) is not induced by PG E(molecular weight below 400 dalton), but has a time courie comparable with inhibition of protein synthesis, and induction of cAMP-dependent protein kinases. E-rosette formation/Hodgkin§ disease/serum factors -

LIST OF ABSTRACTS 481 CASEATING HODGKIN'S DISEASE: A PRELIMINARY REPORT ATTAH, Ed. B. Department of Pathology, Ahmadu Bello Univer- sity, University Hospital, Zaria, Nigeria. A study of 89 consecutive cases of histologically confirmed Hodgkin's disease in lymph nodes reveals caseous necrosis in 15 (16.98), associ- ated with discrete noncaseating sarcoid like epitheloid granulomas in 6(6.7$). in many, caseation was extensive, almost destroying the lymph [26) node, making diagnosis difficult most prominently in patients in the third decade - nine out of 28 patients (32.1%). Caseation occurred in all histological types and there was no significant difference between the caseating and noncaseating groups in sex and age distribution. These was no evidence of tuberculosis or other granuloma producing disease in these patients. While subscribing to the opinion that epi- theloid granulomas in Hodgkin's disease probably represent an immunologic reaction, the author suggests that caseation as seen in these African patients probably represnets an intense expression of such reaction. This is the first report of caseation in Hodgkin's disease as far as the author knows. It is suggested that pathologists be aware of it and search carefully for Hodgkin's disease so as to avoid a presumptive diagnosis of tuberculosis. /CASEATING HODGKIN'S DISEASE/ i /~ Fine structural changes in leukemic cells exposed to light and hematoporphyrin. Coppola, A., and Rasile, G. Dept. of Pathology Downstate Medical Center and Rbhabilitation Medicine, Long Island College Hospital, Brooklyn. Hematoporphyrin (hmp), has been used to localize and delineate neoplasms. When activated by light it:kills tumor cells in vivo and in vitro. The present investfgation was conducted in vitro to determine the sequential ultrastruc- tural changes leading to necrosis of peripheral blood cells. Buffy coats from patients with various types of leukemias were suspended in Ringer's solution and washed. Cells were then suspended in tissue culture medium containing .1 ml of a solution of 10'2M hmp. The cells were exposed for 250 ftc of white light. After 30 minutes the flasks containing the irradiated cells were returned to the dark at 370C. Samples of cells were taken for fine structural analysis at various intervals. It was determined that the first toxic effects occurred in the cytoplasm, within 20 minutes, followed by nuclear changes by 1 hour. The cytoplasmic changes included focal areas of decreased density, dilatation of mitochondria and margination of granules along the plasma membranes. This preliminary study indicates that the hmp exerts its toxic effect primarily on the cytoplasm. v ~ b ~

LIST OF ABSTRACTS 483 FLUORESCENCE POL4RILA"TO" S7lJDY OF PEP,IPHERAL BLOOD CELLS OF LFUJDQC PATIENTS. C. Jasmin, Y. Augery, F. Calvo, M. Zohar, C. Rosenfeld & M. Inbar. Insti- tut of Cancerology & Imminogenetics, Villejuif, French. Fluorescence polarization of cells labeled with the fluorescent probe 1,6 diphenyl hexatriene (DPH) has been used to study the cell membrane. We have studied with the aid of a microviscosimeter Elscint MV-1 mononucleated cells isolated with a Ficoll hypaque gradient from peri- pheral blood of patients with acute lymphoid leukemias (ALL) and lympho- sarcomas (LS) and labeled with DPH. In l`.LL patients in complete her:ato- logical remission the finding of a low value of FP (below 3.44 poises) in apparently morphologically norral mononucleated cells was significa- tly associated with a shorter dunation of remission and survival than in the group of patients with FP value of rrononucleated blood cells always superior to 3.44 poises. In LS patients, leukemia lymphoblasts with a normal FP value were associated with a poor prognosis. These result show that the measurement of FP of DPH labeled cells rreys consti- tute a new method of detection of abnormal cells with a norrral morPholo- gy and a new prognosis factor in malignant hemopathies. Study of subpopulations of blood cells labeled with DPH in leukemic patients separated with a fluorescence activated cell sorter (FACS) are in pro- gress. LI$(I INDUCTION OF FIBROSIS BY LEUKEMIC INFILTRATES. Shamsuddin, A.K.M. & Schwartz, J.B. Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland U.S.A. Compared to other leukemias, chronic lymphocytic leukemia (CLL) is considered to be a relatively benign disease and asymptom atic patients are not aggressively treated. Based on our recent observation of a death due to severe endocardial fibroelastosis associated with leukemic infiltrate (LI) in a CLL patient (Applefeld et al, Cancer-In press), we have studied multiple organs obtained at autopsy of 47 patients with CLL, to evaluate the extent and effects of LL After excluding the known causes of fibrosis, LI was associated with marked fibrosis in liver, kidney, pancreas and heart in 43%, 89%, 60%, 44%, of cases respectively. In the liver there was bridging infiltrate, bridging fibrosis, pseudolobule formation and advanced cirrhosis. The morphology in various organs were similar to chronic inflammation. Fibrosis was not observed in areas free of LI and the severity of fibrosis seem ed to be directly proportional to the duration of CLL. It is hoped that this report will stimulate further research in this field and treatment plans be re-evaluated. If our observation is substantiated by other studies, effective therapy of asymptomatic CLL patients could further extend their longitivity. /FIBROSIS/CHRONIC LYMPHOCYTIC LEUKEMIA/ .:

[271 [271 LIST OF ABSTRACTS L}$5 DETECI']ON OF HAEMAfOLOGICAL AND NON-HAEMATOLOGICAL CANCER BY BONE BIOPSY. Burkhardt, R. • r•), Frisch. B. +). Barti, R. •). Kettner, G. Schlag, R. Hill. W!•) •)Abt,f.Knochenmarksdiagnostik, Med.Klinik Innenstadt d.Univ., Abt.}lgmatomorphologie der Ges.f.Strahlen- u.Umweltforschung rr,bH. Munich, Germany, .) Tel-Aviv Univ. Med.School, lel-Aviv, Israel. Material: Trepine and needle biopsies from the anterior iliac crest of 2471 patients with haematologi- cal (A) and 517 patients with non-haematological neoplasias (B). Light microscopic evaluation of 3~u serial sections embedded in methacrylate without decalcification with 5 different stains. Results: Confirmation of the clinical diagnosis in S6°,b of (A) resp. 21% of (B); no confirmation in 3% (A) resp. 44% (B). In 14% of (A) and 35% of (B) the positive biopsy was the only diagnostic result. AccoL ding to the bioptic significance the groups follow each other in this sequence: myeloproliferative syn- drome, multiple myeloma, non-Hodgkin-lymphoma, acute leukaemia, non-haematological neo- plasias, Hodgkin's disease. According to the percentage of primary bioptic diagnoses: non-haematolo- gical neoplasias, non-Hodgkin-lymphoma, acute leukaemia, myeloproliferative syndrome, multiple myeloma. Hodgkin's disease. Especially in the myelofibrosis, malignant lymphoma. Hodgkin's, myeloma, and metastatic cancer groups, mesenchymal, vascular, and osseous changes with a prospec- tive pathogenetic and prognostic significance have been observed. Conclusions: Adequate iliac crest biopsies offer a remarkable chance of the detection of various neo- plasias including the early stages. The positive diagnostic result depends mainly of the size and pre- paration of the specimen, and the stage of disease and its relationship with the marrow tissue, In addition the biopsy lends an almost ideal model for the study of the accompanying stromal changes along with the progress of disease and the influence of therapy. L& CYTOPLASbtIC Ig, J CHAIN, LYSOZYM.E AND at-ANTICHY- b•iOTRYPSIN EXPRESSION IN IZ1-TUNOBLASTIC LYMPHOMA. Stein,H. & N:ason,D.Y. Institute of Pathology University of Kiel, Plest Germany and Department of Pathology, University of Oxford, John Radcliffe Hospital, Oxford, UK. There is no general agreement on the incidence of so- called large cell lymphomas that are actually derived from macrophages and those derived from lymphoid cells. There- fore we investigated 50 cases of large cell lymphomas for the presence of markers characteristic of lymphoid cells (CIg, j chain) and characteristic of cells of the phagocy- tic cell series (lysozyme = LZ, and ai-antichymotrypsin = al -ACT). The antigen assays were performed in trypsinized paraffin sections by means of the PAP method. Interpreta- tion of CIg staining reactions was frequently complicated by the presence of exogenous Ig. However, Ig of presumed endogenous origin was demonstrable in more than half of the cases. J chain was not demonstrable in thT majority oT lymphomas. In many cases a large number of LZ and al-ACT cells was observed. These cells containing LZ+ and/or al-ACT could not be identified as tumor cells, but were instead reactive macrophages. /Ib9lFUNOBLASTIC LYh+YHOMA/ CIg/ J CHAIN/LYSOZYME/ al -ANTICHYI;OTRYPSIN/

LIST OF ABSTRACTS (26j 487 CROSS-RESISTANCE AND SE2ISITIVITY STUDIES OF ANTI I,20YL^,3TIC AOENPS IN ANIffftACYCLINF RESISTANP SUBLIN'r:S OF MURINi: IEUKEMIAS. Chitnis, hl.P. and Joshi, S.S. Cherrotherapy Division, Cancer Research Inst., Tata hiemorial Centre, Parel, Bombay 400012, India. We have earlier reported (Johnson, Chitnis et al., Cancer Treat. Rep. 62:1535-1547, 1c,78) about the development of anthracycline resistance in P388 lymphocytic leukemia (P388/ADR). We report here our studies on the development and drug responses on L1210 lymphoid leukemia resistant to Adriamycin. Tumour cells were exposed to adriarycin in vivo to induce resistance in L1210. Therapeutic response of drugs was deterrcdned to understand cross-resistance or sensitivity. Anticancer agents Bouvardin, Vincristine, Actinomycin D and Metho- trexate were used. Studies on membrane proteins and glycoproteins were analysed with the use of polyacrylamide gel electrophoresis. Our observations indicates that pattern of cross resistance and sensitivity are retained in both these resistant sublines. Preliminary studies on membrane proteins and glycoproteins suggest the presence of an e•r.tra high molecular weight protein in P388/ADR cells. /P368/L1210 IEU}4TIIC Cr". ,LS/ADRIAMYCIN/RFSISTANCE/ 488 It3MUNOPROLIFERATIVE SMALL INTESTINAL DISEASE - A POTENTIALLY PREVENTABLE DISEASE. Salem,P.; Nassar,V. Alami,S.; Jabboury,K.; and Khalyl, M. : American University of Beirut , Beirut , Lebanon . Thirty five cases of "Mediterrariean Abdominal Lymphoma" better known as Immunoproliferative Small Intestinal Disease (IPSID), are reported. IPSID is shown in this study to be a distinct disease entity characterized by chronic diarrhea [26) and diffuse involvement of small bowel mucosa and/or mesen- teric lymph nodes by a lymphoplasmacytic cellular infiltrate The disease is also frequently associated with a paraprotein consisting of a portion of the alpha heavy chain of IgA (AHCP) in the serum, intestinal fluid or involved tissues. AHCP was fpund in the serum or intestinal fluid in 11 patie- nts. A new histopathological classification and a new stag- ing system are proposed. The role of laparotomv in staging is emphasized..A pre-malignant phase (stage 0) which is clinically indistinguishable from the malignant one is des- cribed .3 cases were considered in stage 0. In contrast to the malignant phase which is associated with a very poor diagnosis, the pre-malignant phase is totally reversible with antibiotic therapy only.Accordinglv early detection of IPSID while still in stage 0 can not be overemphasized . /IMMUNOPROLIFERATIVE SMALL INTESTINAL DISEASE / '

(26J LIST OF ABSTRACTS 489 GASTRIC LY[rPHOP"iA AND P7-RIFCV30LAR PLASMA CELL GASTRITIS. Dutz W. and Rorochovitz D. Dept. of Pathology, I'!edical College of Virginia, Richmond Va. and Pittsburgh University Medical School, Pitrsburgh Penn. USA. 60 cases of gastric lymphoma were staged into:I Gastric only;II Gastric and occasional individual reginal nodes; III gastric and massive regional hodes;IV generalized lymph- oma. The lymphor,a was typed according to Rappaport. The gastric lymphoma in all primary cases was accompanied by a diffuse plasma cell infiltration of the perifoveolar region with a sharp demarcation from the secretory glandular port- ion. Immunoperoxydase studies showed polyclonicity of the gastritis for If;A,M,G,k,1.Practically all primary lymphomas originated at the lesser curvature. Stage IV cases were con- sidered to be secondary, unless a primary origin from the stomach could be proven by operation and histology with follow up. None of the secondary cases was accompanied by plasma cell gastritis. 'rle consider the plasma cell gastritis therefore as nrecursor of gastric lymphoma, since it was not associated with any other condition in a cor,troltserids of 200 random gastric lesions selected on autopsy and surg- ery. The prognosis of gastric lymphoma depends on stage with a median survival of 5yrs. for stage 1, regardless of type. M:F ratio is 2:1.The lymphoma is aataimfiune•cor,aitior_ed. 490 VIRAL ETIOLOGY OF LYMPHOPROLIFERATIVE DISEASES Harald zur Hausen, Institut ft9r Virologie, Zentrum fur Hygiene, Universit9t Freiburg, Hermann-Herder-Str. 11, 78 Freiburg, West Germany. The Epstein-Barr virus has been identified as the causa- tive agent of infectious mononucleosis. Its involvement in two malignant diseases, Burkitt's lymphoma and nasopharyn- geal carcinoma, will be discussed in detail. The virus also induces an apparently X-linked lymphoproliferative disease in genetically predisposed individuals. Recently a B-lympho- tropic papovavirus has been isolated and characterized from Epstein-Barr virus transformed African Green monkey lympho- blasts. Thus far, this agent grows exclusively in trans= formed B-lymphoblasts and apparently "supertransforms" some of these cells. Antibodies directed against capsid antigens_ of this virus are also found in about 20% of human sera from adults. The possible relationship of this virus in- fection to lymphoproliferative diseases of man will be discussed. n

LIST OF ABSTRACTS !27). lpS) (68J 491 ANTIBODIES TO EPSTEIN-BARR VIRUS IN VERY LATE RELAPSING PATIENTS j•,ITH BURKITT'S LYMPHORA. Nkrumah, F.K., Biggar, R.J., Henle, W. University of Ghana Dledical Schopl, Accra, Ghana; National Cancer Institute, Bethesda, U.S.A.; and Children's Hospital, Philadelphia, U.S.A. Fourteen of 112 patients with Burkitt's lymphoma in remission for a minimum period of 12 months following chemotherapy have subsequently relapsed. Risk of these very late relapses increased with more advanced tumors at initial presentation and with the occurence of an ealier relapse during the first year. Serial antibodies titers to Epstein-Barr virus capsid antigen (VCA), early antigens (EA-R and EA-D), and the virus nuclear antigen(EBNA) were determined on sera throughout the course of illness and follow up on the 14 very late relapsing patients as well as a control group of non relapsing long term survivors. Patients with VLR maintained higher anti EA-R or D titers during remission compared with non relapsing patients. There were no consistent antibody titer changes to any EBV antigen preceed- ing relapse or at the time of overt relapse. BURKITT' S LYMPHOMA EBV SEROLOGY 492 REFLECZ'LONS ABOUT OPPORTUNITY OF RAPID CYTOLOGIC AND HISTOLOGIC EXAMINATION IN MALIGNANT LYMPHOMAS. Halalau, F. Victor Babes Institute, Bucharest, Romania. Exfoliative cytology and frozen sections are very important methods for early detect&on of neoplastic le- sions.For this reason,some pathologists applied needle biopsy, touch impressions and frozen sections for rapid diagnosisof nalignant ?-~r:mlia-.a:as.0ur experience shows that in this case all three methods mentioned are dangerous fqr patients,beoause yoti,ir percentege,of mistakes is too high. Like.J.J.Butler,R.F.Dorfman,W.St.C.Symmers and others we consider that single indicated method for a correct diagno sis of malignant lymphomas is the lymph node biopsy etnbed- ded in paraffin wax which offer,to pathologist satisfeoto ry sections and time to reflect. / LYIJ!PHONIAS/LYMPH NODE BIOPSY/ TECHNICAL METHODS/ ~ 0 0 r J a 0 0

PS 68 PS 68 LIST OF ABSTRACTS 493 BACTERIOCINS IN DIAGNOSIS OF MALIGNANT LYMPHOCYTES ANALYZED BY FLOW CYTOMETRY. Farkas-Himsley, Hannah & Musclow, C.E.* Department of Microbiology and Parasitology & Department of Pathology* University of Toronto, Toronto, and Department of Lab- oratories*, Mt. Sinai Hospital, Toronto, Canada. Bacteriocin from Pseudomonas ~aelu_ yi~_nosa, pyocin 1-4, was shown to interact prefer- ent lly with malignant cells. Consequently, bacteriocins were studied for their ability to detect malignant lymphocytes in human peripheral blood. Flow cytometry was employed, providing results within 24- 48 hrs, accompanied by computerized histograms. The differential analysis for a few patients with chronic lymphocytic leukemia (CLL) and an equal number of normal peripheral bloods, will be presented. /BACTERIOCIN-PYOCIN/DETECTION OF CLL/MALIGNANCY/ FLOW CYTOMETRY/. MECHANISM OF PENETRATION OF BACILLUS 5P.* INTO LYMPHOCYTES 494 CELL LINE L5178Y. Tom3s-Martin, C., Ramos, A.M. & Esquivel, C. Electronmicroscopy Lab.,Biology Department, Faculty of Sciencies, UNAM. Mexico 20, D.F. An ultrastructural study in vivo of the action of Bacillus sp. on a murine lymphoma cell line L5178Y in mice of an endogamic Balb/c strain was made. The bacterial suspension was inoculated intraperitoneally in mice with advanced lymphoma. Samples were taken at 3 and 14 minutes and were processed for transmission electron microscopy. An interaction between bacteria and lymphocytes was observed: the compact bacteria in the proximity of the lymphocyte change their struc- ture to filamentous. The mechanism of penetration of the lymphocyte by the bacteria begins with an approximation of the bacteria to the micro- villi of the lymphocyte and, afterwards, to the plasma membrane. A fu- sion"between the bacterial cell wall and the.plasma membrane of the lymphocyte takes place and the bacterial filaments penetrate the lympho- cyte cytoplasm. Some intracytoplasmic bacteria are observed and also bacterial filaments free in the cytoplasm. The penetration of Bacillus sp. into the lymphocyte and the further enzime secretion is thought to be the cause of the tumor regression. *Patent pending. BACILLUS SP. PENETRATION/MURINE LYMPHOMA

LIST OF ABSTRACTS 495 HEMOLYTIC ANEMIA DUE TO HEREDITARY PYRUVATE KINASE DEFICIENCY DEVELOPING ACUTE LEUKEMIA. Goebel, K. M. & Schneider, J. Department of Medicine, University of Marburg, Marburg, W. Germany. Recent investigations have demonstrated a coincidence betweenpan- cytopenia, hemolytic anemia(HA)and red cell(RBC)enzymopathies re- presenting a preleukemic state developing myelofibrosis. The case of a young woman with pancytopenia, HA and acute monocytic leukemia is described in detail. The underlying cause for RBC destruction was found to be a pyruvate kinase enzyme instability. Further investigation into three generations of her family(n=12)disclosed a hereditary PK instability of RBC. This was proven by performing biochemical stu- dies to elucidate mutants representing a structural defective enzyme Since conversions of pancytopenia with acquired RBC enzyme defi- ciencies into leukemia have been described, our observation empha- sizes that hereditary RBC enzymopathies might also be associated with adult acute leukemia. /PANCYTOPENIA/HEMOLYSIS/ACUTE MONOCYTIC LEUKEMIA/ CHRONIC LYMPHOCYTIC LEUKEMIA FOLLOWING 32-P 496 TREATMENT OF POLYCYTHEMIA VERA Chone, B.: Klinikum der Universitat Heidelberg, Zentrum Radiologie, Abteilung Strahlenbiologie, VoBstr. 3. BRD Based on hematological follow- up studies of 121 patients with P.v. we observed 3 cases of myelofibrosis, 1 of acute and 1 of chronic granulocytic leucemia, the last one 20 years after the first course of 32-P-therapy, having re - ceived a total dose of 62 mCi. Following the case of a female who developed in age of 64 years the usual symptomatology of P.v. After confirming the diagnosis by laboratory criteria and bone marrow aspiration fractionated 32-P-therapy was induced and repeated four times, given intravenously over a five year period (total dose: 22 mCi). 12 months after the last administration she developed the clinical signs of a CLL with enlargement of multiple lymphnodes, associated with rising of leucocytes up to 100.000, continuously. The immunologic surface was detec- ted as B-cell type. Complete remission occured by chemo - therapy, lasting two years. The diagnosis could be proved by autopsy. The development of CLL as possible sequela of pre- treatment with 32-P seems us to be most remarkable. POLYCYTHEMIA VERA/32-P-THERAPY/ CLL I

LIST OF ABSTRACTS 497 DIE1qZ)OGI,YPHICS IN CHILDHOOD LExTKF1IIM AM LiT'1PFKM Abdel-Salam, E., Gad E1-Riawla,N., and Abou-Gabal Pediatric Department & Cancer Institute,Cairo Univers3ty• Cairo Egypt. The study of dermatoglyphic pattern was carried on children with leukaernia and lymphoma as well as normal con- trols. The "atd" angle was increased in the lymphoma group. A higher frequency of whorls was present in al:nost all dig- 6s its in leukeemic children and ulnar loops in the lymphoma Ps group. The axial triradius of the palm was more distal in the lymphoma group as well as a significant increase in the hypothenar whorls and thenar radial loops. Analysis of tot- al ridge count absolute ridge count,index of complexity and patters of different areas of the palm, sole and toes revealed no significant diiference from controls. The results point to the importance of dermatoglyphic analysis in screeninig susceptible individuals for leukaem- ia and lymphoma. /DERIATOGLXPHICS CHILDHOOD LEUKAEI`IA LY1.'.PH02;A/ 498 b1ALIQVANI` ai'~ ARISING IN StiLALL 00NGINITAL NEVI. Briele, H., Chaudhuri, P.K., Ronan, S., Trippon, LZ., & Das Gupta, T.K. Abraham Lincoln School of Medicine, University of Illinois, Chicago. The malignant potential of large bathing trunk nevi is reasonably es- tablished but the frequency of inelanomaa arising in small congenital nevi is unknown. Recently we have shown that there are estrogen receptors in congenital nevi. The possible role of this finding in the developmental biology of melanoma pranpted a retrospective review of our melanoma pa- ps tient population regarding the epidemiologic incidence of melanoma a-. 66 rising in small congenital nevi. Cbnsecutive review of the charts of 294 melanoroa patients treated at the University of Illinois showed that 52/294 (17.6%) of the patients charts gave a history of pre-existing pigmented lesion from birth or for at least 20 years. The accuracy could only be substantiated in 5 (1.7%) patients. In these 5, the mela- noma arose in small (0.3-2.5 cm) congenital nevi as substantiated by the parents. The patients were from 18-37 years of age; 2 male, 3 female. Twn_were located on the trunk, 3 on the lower extremity. Four were superficial spreading melanoma and 1 was a malignant cellular blue nevus. We concluded that the incidence of inelanrnm arising in sma.ll congenital nevi is small and similar to findings by Kopf et al. We advise recmval of all melanocytic nevi in newborns and estimate that 175-700 lesions would have to be remved to prevent 1 melanoma depending upon the ac- curacy of clinical diagnosis of "pigmented" lesions in newborns. /S".SALL OONGINITAL IZEVI/MALICNANT MM,ANOhSA 

LIST OF ABSTRACTS MALIGNANT MELANOMA IN NEW MEXICO: A MODEL FOR ONE KIND OF EN- y99 VIRONMENTAL PATHOLOGY STUDY. Key, C.R., Black, W.C., Wiggins, C.L. New Mexico Tumor Registry, Albuquerque, New Mexico,U.S.A. Through the cooperation of pathologists and other New Mexico physici- ans, the New Mexico Tumor Registry (NMTR) data base contains information on 474 cases of malignant melanoma representing virtually all cases oc- curring in the New Mexico population in 9 years (1969-1977). Standard- ized incidence ratios, comparing New Mexico's tricultural populations to the Third National Cancer Survey (TNCS), are low for New Mexico Hispanics (males 26.1, females 38.6) and New Mexico Indians (males 21.7, females 15.9), but high for New Mexico's fair-skinned "Anglos" (males 182.6, fe- males 197.7). New Mexico's high levels of a natural environmental vari- able, i.e.,annual ultraviolet (UV)integral, have been documented by ob- servatories of the National Oceanic and Atmospheric Administration since January, 1974. Comparisons with TNCS and other studies indicate support for the hypothesis that sun exposure increases the risk of melanoma in fair-skinned people. /MALIGNANT MELANOMA/NEW MEXICO/ Im THE DETERMINATION OF C-19 STEROID METABOLITES IN URINE r OF WOMEN WITH SKIN NEVUSES AND MALIGNANT MELANOMA Micic, J., Markovic, Lj., Ivanovi6, S., Kovacevic, M., Nikoli6, S., Jovanovi6, S. I Pavlica, J. The determination of C-19 steroid metabolites as an additional me- thod was used when the diagnosis of malignant melanoma was reached. We determined the levels of: Androsterone, Dehydroepiandrosterone and Etiocholanolone as well as 17-Ketosteroides. Out of 43 women, 28 had malignant melanoma without distant meta- stases and 15 women had nevuses. Patients who were in their reproducti- ve stage were treated 7th, 14th and 21st days of their menstrual cicle. With nevuses when Investigating the corelation coefficient between 17-Ks and DHA in the 7th.day of the menstrual cicle and between 17-Ks and Androsterone -in the 21th day we faund a high stochastic depedance (pt0.01). Patients with malignant melanoma in the 7th day have a high stocha- stical dependance, that is, no hormonal disbalance in all relation, while in the 21th day of the cicle they have a high stochastical dependance in the relation 17-Ks and A(pG 0.01) and the relation 17-Ks and DHA has a complete absenc of stochastical dependance. ~ 0 0 r -4 O% 0 r

LIST OF ABSTRACTS 501 VISUALIZING AGGRESSION IN SKIN CANICER: ELECTRON VERSUS LIGHT :•IICROSCOPY. Spoor, P.J. and Erlandson, R.A. Cornell 1:edical Center (Dermatoloe~y), t:emorial Sloan-Kettering Cancer Center (Patholory) New York, New York. Conventional histopathology separates skin cancer into basal and squamous cell carcinomas plus intraepidermal ananlasia, intraepithelial carcinoma and keratoacanthoma. Visualization of the signs of alzr_ression in particular lesions has not been achieved throueh light microscopy. A-hressive differences, narticularly among basal cell car- cinomas do exist. These may he nredicted clinically if one cnnsiOers the cancer induc`ion cause, namely nevoid, chemi- cal, sunltoh* or ionizin- . radia`ion. Ultrastructural stud- ies of a^.r~ressive skin carcinomas showed more extensive loss of -olari*-y, Qrea•er numhers of pleomorphic and dyskeratotic rells, more nuclear aty-Nia, more basal lamina discontin- uit.ies, a c~rearer reAuc'ion in tonofilaments and desmosomes, increased num>,ers of mitotic cells and much larger and more irrec?ular nuclei than more banal varieties. /SKIN CANCER AGGRESSION/rII CROSCOPY/ ~ A GENERAL DEFINITION OF NEOPLASM WHICH PROVIDES A MECHANISM FOR SPONTANEOUS REGRESSION OF INTRA-EPIDERMAL CARCINOMA Rowlatt, C. Imperial Cancer Research Fund, London WC2A 3PX, England Surveys suggest that intra-epidermal carcinoma does not always pro- gress to an invasive form. A general rigorous definition of neoplasm allows analysis of cellular behavioural characters in tumours. A neoplasm is a mass of tissue which is generated by cells capable of division, which have acquired either permanent expressible heritable change or stable epigenetic change so that the same or other cells no longer respond to one or more tissue organising stimuli, chemical or physical, intracellular or extracellular, in the organism in which it occurs. In any organ there are many cell and tissue organising mechanisms, and failures in particular mechanisms cause the characteristic structuras of--tumours. In stratified squamous epithelium one normal constraint is the limitation of division to a basal zone. Permanent loss of•ability to react to this constraint, by whatever mechanism, will permit cells to divide in superficial layers, an important criterion in the diagnosis of intra-epidermal carcinoma. However this cellular defect carries the corollary that normal adjacent cells, which must divide in the basal zone, may repopulate the affected area. In tTiese cases the defective cells would be shed during normal maturation. DEFINITION OF NEOPLASM/REGRESSION/INTRA-EPIDERMAL CARCINOMA

LIST OF ABSTRACTS .(5j) 15],J ~ IS PREVIOUS HEALED TBC A FACTOR IN LONG TERM CONTROL OR CURE OF SOLID CANCERS BY CHEMOTHERAPY? E.M. Greenspan, S.M. Cohen, Mount Sinai School of Medicine, New York, N.Y., U.S.A. High incidence of healed tuberculosis and old Ghon Foci were observed among longterm "cured" survivors of advanced ovary, breast and GI cancer treated with combination chemotherapy. Among >300 Stage III-IV ovarian carcinomas treated from 1951-1974 there were 8 survivors apparently cured >6-14 years. Two had extensive TBC as young adults (pulmonary 1, spinal 1); two had typical Chon Foci and 4 had negative skin tests and findings. Twenty eight cases of unusual survival after high risk breast cancer were classified as either a) complete regression of advanced met- astases >4 years, b) partial response with stable metastatic disease >5 years or c) recurrence free interval >5 years (Stage IIN>3+ or III). There were 8 with extensive TBC, 7 with Ghon Foci, 5 with +Tuberculin tests but no x-ray evidence of TBC and 8 with negative findings. In over 75 advanced GI cancers the only advanced Stage III pancreas cancer in remission for >4.years had extensive old TBC. The only Duke's D >5 year survival had TBC and 1 of 2 complete regressions >4 years of recur- rent colonic cancer had extensive TBC. Any predictive value as a favor- able prognostic factor requires controlled prospective data to obtain a reliable denominator in failed cases. Differences in indolent patterns of breast cancer in Eueope contrasted to the United States could be due to exposure to tuberculosis. /HEALED TBC/SURVIVAL POSTCHEMOTHERAPY/SOLID TUMORS/ ~ SOME PROSPECTS ON CANCER IMMUNOPREVENTION REFLECTED FROM LONG TERM FOLLOW-UP RESULTS IN ADVANCED CANCER TREATED WITH S.S.M.(AN EXTRACT FROM HUMAN TUBERCLE BACILLI) K.Fujita,M.D.,T.Hirai,M.D. and C.Maruyama,M.D., The Resear- ch Institute of Vaccine Therapy for Tumors and Infectious Diseases, Nippon Medical School, Tokyo, Japan Since 1964, more than 114000 cases of advanced cancer in various organs have been introduced to the immunotherapy by their physicians, mostly after conventional treatments have been exhausted. Among 16445 patients under this therapy in Sept. 1979, there were 1041 cases for more than 3 years and 369 cases for more than 5 years under this continuous medi- cation, resulting in apparent improvements of objective and subjective clinical symptoms and marked prolongation of the survival time or retarding the tumor growth and metastasis. Kawamura et al and Sugamata reported respectively that the preliminary inoculation of S.S.M. in animals transplant- ed tumors revealed some effects against the metastatic inci- dences. As S.S.M. has no adverse side effect at all, it can be applied as an immunopreventive trial against cancer. /SOME PROSPECTS ON IMMUNOPREVENTION WITH S.S.M./

LIST OF ABSTRACTS 1511 1511 505 ABOUT THE POSSIBILITY OF PREVENTION OF CANCER DEVELOPMENT AND RECCURENCE BY ACTIVATION OF ALTERNATIVE PATHWAY OF COMPLEMENT. Ryoki Ohkawa, Kimiyasu Ohkawa Department of Obst. & Gynec. Nippon Medical SCHool 1-1-5 Sendagi-cho Bunkyo-ku Tokyo Japan' Object of Study: In almost all cancer patients the delayed hypersensi- tivity is suppressed. It is important to activate the alternative pathway of complement by several drugs, as the results many chemical mediator are produced and cellular immune responce iis enhanced. Method used: Hemolytic activity of complement ( alternative and classical pathway ) , C3, C4 and C3-activator were measured. Cancer patients were treated bt several drugs(acid polysaccharides, B.C.G., OK 432 etc)that activate the alternative pathway. Results obtained: 145 cases of cacer of uterus and ovary with elevated activity of complement and 25 cases with suppressed activity of complement were treated by acid polysaccharides, B.C.G. and OK- 432 that activate the complement. After treatment in cases of good prognosis activity of complement and skintest enhanced markedly. In cases of poor prognosis activation of complement and skintest did not occured. Conclusion: Activation of complement is effective for prevention of cancer development. / PREVENTION/ COMPLEMENT ACTIVATION/ ALTERNATIVE PATHWAY/ IbiPINNOTHERAPY AND If~RaUNOPREVENTION OF SOME ~ . EXPERIMENTAL TUMORS "ITH LIVING BACTERIA. A.Lupu,I.Corneci,Oncological Institute,Bucharest,Rumania The effect of the intratumoral inoculation of the micro- bial flora izolated from 25 tumors (24 non-differentiated RJL secreting carcinor.ras and a B-III adenocarcinoma) during spontaneous healing in the 1,7istar rats strain, was investi- gated. RJL carcinoma is resistant to the cytostatics. The bacteria izolated belonged to the Enterobacteriaceae family and were more often associated (2or3). The result of the i- noculation of this f lora in RJL aseptically transplanted tumors was their lysis within 24-72 hours. Both pure and mixed microbial cultures isere inoculated.The tumoricide ef - fect was prompter in the latter.Similar results and even better ones were obtained after i.t.inoculation with lysate from the tumors.The izolated bacteria proved to be weak pa- thogens f or the normal and tumor hosts and very sensitive to some antibiotics.Microbial distruction of the tumor, as well as the late surgical intervention determine usualy,a resistance to the regrafting.The same microbial flora ino- culated s.c.to the rats before, concomitatly or after the RJL tumor grafts,didn't assure the prevention or distroyng of the grafts. RAT TUMOHS ENTEROBACTERIACEAE IMMTH.-IfOiUNOPREVP,NTION

LIST OF ABSTRACTS [51] 507 INCREASE IN TUMOR IMUNOGENICITY UPON MEMBRANE RIGIDIFICATION. Skornick, Y., Haran-Ghera, N. [, Shinitzky, M. The Weizmann Institute of Science, Rehovot, Israel. We have recently demonstrated that rigidification of tumor cell membranes, by incorporation of cholesterol or cholesteryl hemisuccinate (CHS), significantly increased their immunogenicity, as tested in immunization-survival experiments in mice (Proc.Natl.Acad.Sci.USA 76, 5313, 1979). In line with this finding, we have screened skin tests in cancer patients with autologous tumor cells enriched with cholesterol or CHS. A very marked response was observed with CHS-treated cells in over 80% of the cases, whereas untreated cells did not elicit any obvious response. Immunotherapy, based on this approach, is currently being examined in tumor-bearing mice and will, hopefully, provide the basis for clinical use. JIDMUNOTHERAPY/TUMOR ANTI GENS/CHOLESTEROL/CHOLESTERYL HEMI- SUCCINATE/ 508 IMd[UNOYHARh1ACOL0GIC RESTORATION OF EARLY Isd;dUNh DEFICIENCIES IN EXPERIMENTAL CANCER Prof.O.Cestd.chel,Irina Xijuleseu,Oneol.gie Institute, Bucharest,RemaRia By specifically restoring T and B lymphocytes'fuxe- tions with iaon toxic substances (thisiminediphosphate,thia- mine analogs,aminoacids'esters ase) an efficient treatment (30-50 complete regressions,better than py any cytoatk- 1511 tics) was realized in Ehrlieh as ites (1O7cells inoo.) ia ALR mice,L 1210(105cells) in DBA~mice,Lewie cajoinoma(GxlO6 cells)in C57BL/G mice, Gu6rin and Walker (5x10 cells) in Wistar rats,with normal b bod picture. By the same treatment a complete restsation of bone marrow blast cells chromosomal aberrations was otitain~~ in Wistar rats after LD 100~/10 days of Thio-TEPA or Co, as well as 90~ over 30 days (definitive) survivals,if the treatment begins 24 hours after cytostatics or irradiation with normal blood picture after 14 days. The restoration of chromosomal injuries of the immuno- reactive cellularity is superior to its non specific des- truction by cytostatics or irradiation in cancer trest- ment. IL]iSUNOPHARMACOLOGIC NON TOXIC TREATMENT CANCER ~ 0 0 r ~ o0 m

151J 1511 LIST OF ABSTRACTS ~ COMPLEMENT SYSTEM OF CANCER PATIENTS AS RESISTANCE AGAINST CANCER. RYOKI OHKAWA, KIMIYASU OHKAWA Department of Obst.& Gynec. Nippon Medical School, 1-1-5 Sendagi-cho Bunkyo-ku TOKYO JAPAN Object of study; In almost all cancer patients the delayed hypersensi- tivity is suppressed. We studied as primtive defence system about activity of complement. Method used; Hemolytic activity of complement( classical pathway=CH50 alternative pathway= A1.CH50) was measured. And C3, C4 and C3-activator were measured by radial immunodifusion. Skin tests of cellular immunuty were examined by 10 Antigen. Results obtained; In 125 cases of cancer of uterus and 35 cases of cancer of ovary with good prognosis the classical pathway and alter- native pathway enhanced. C3,C4 and C3-activator very much increased. And number of positive skin tests came up to more than 50 $. In 30 cases of advanced cancer of uterus and ovary activity of comple- ments(CH 50, Al.CH-50 ) enhanced but number of positive skintest came down. These cases showed the long clinical course. In 20 cases of advanced cancer of uterus and ovary-both suppressed activity of comple- ment and suppressed skintest of cellular immunity were shown. These cases showed short clinical course. Conclusion: Bnhanced activity of Complementsystem shows the resistance against cancer and shows the compensation to the suppression of cellular immunity. / RESISTANCE/ COMPLEMENT / MODULATION OF THE IMMUNE RESPONSE. POTENTIAL CANCER PREVEN- 510 TING DRUGS. - B. Serrou and D. Cupissol. Department of Chemo~ Immunotherapy and Laboratoire d'Immunopharmacologie des Tumeurs FRA- INSERM N° 46 - ERA-CNRS N° 844, C.R.L.C., B.P. 5054, 34 033 MONTPELLIER, France. Immunodepression in the cancer patient is an established fact. Fur- thermore, cancer therapy is less effective in the immunodepressed patient We have evaluated the immunorestorative potential of new drugs such as thymosin, bestatin and retinoic acid derivatives. Lymphocyte in vitro treatment and in vivo treatment of solid tumors bearing patients with these drugs yields a significant immunorestorative effect as judged by delayed hypersensitivity skin tests and the auto-rosette cell assay (T cell subset). Furthermore some of these drugs (e.g. thymosin) were able to significantly decrease in vitro suppressor cell activity which con- firms our previous in vivo thymosin animal studies. Taken as a whole, these results demonstrate the possibility of modulating and restoring immune--function in the immunodepressed cancer patient. The use of these drugs as cancer prevention agents deserves close scruting beginning with confirmation of previous preliminary results. V Oi 0 b

LIST OF ABSTRACTS 1513 511 IhM7N0UJGY AND IMKlIQOIAGICAL AA7UVANIS IN CANCER RESE'AiC[-I Henry G. HADLEY, M.D., Research Foundation, Inc., Washington, DC 20032, U.S.A. Immune substances were studied which influence the onset or course of cancer by their presence or absence. Attention was focused on a bacteria resembling myxophyceae, with 100,000 serological procedures performed. Thirty years of delayed-type hypersensitivity tests, on 25,000 individ- uals, indicate that the results resemble those of leprosy, being the reverse of those in tbC. Following the records of deaths in this group, from the Vital Statistics Bureau, Department of Health, Washington, DC, no changes were noted in the first five years since this time is required for cancer to develop. Immunity is not permanent. However, the individ- uals receiving the test, excluding the first five years, live up to three years longer than those of the same age of the District of Columbia pop- ulation. Further proof of validity is that treatment, after cancer develops, does not slow death. The patient having cancer, after having a skin test, lives longer not because of the vaccine itself, but because after the temporary immunity has disappeared cancer develops at an older age. /BACTERIAL IMMUNITY/MYXOPHYCEAE/HYPERSENSITIVITY/ 512 VISCERAL RHEUMATOID L.wSIONS AS PR ' WALIGNANT CONDITIONS. MODE OF PREVENTION. Wyburn-Mason, R., Christ's College, Cambridge, England. Recently it has been shown that RA is due to infection with one of the universally distributed pathogenic species of free-living amoebae of the genus, Naegleria. In this disease the causative organism can be recovered from every tissue of the body, many of which exhibit so- called auto-immune lesions, in which the histological changes are the I5jj same as in the joint capsules, but any body tissue may/show them even in the absence of joint lesions. In vitro the organism can be killed by a series of substances having in common only their anti- amoebic activity. These include the 5-nitroimidazoles. When administ- ered to cases of active RA, joint inflammation ceases, either perman- ently or for a variable time according to whether reinfection with a pathogenic strain of the organism occurs. These observations apply equally to the visceral lesions of the disease, many of which are premalignant and can often be cured by these drugs. By a regular dose of antiamoebic drugs at 3-6 monthly intervals, their recurrence and so the development of cancer can be prevented. These lesions are considered in detail. AN''EBA/A."T,BI ASI S/ARTHRI TI S, RHEUMATOI D/NEOPLASF,S/PR ECAN CbMOUS CONDITIONS

LIST OF ABSTRACTS 513 OXYGEN MULTISTEP THERAPY AS A MEASURE FOR IMPROVING IMMUNOLOGIC PARAMETERS AND PREVENTION OF CANCER IN MAN. Ardenne, M. von & Kruger, W. Research Institute Manfred von Ardenne, 8051 Dresden, G. D. R. As was shown previously by others, the arterial oxygen partial pressure (p02) will decrease with progressing age in man. The diminished oxygen supply of tissues, hitherto considered to be irreversible, is one of the reasons for age-dependent complaints, immunodeficiency, and increased IPS) cancer incidence. By means of the Oxygen Multistep Therapy [56J (02MT) the p02 is reelevated up to values characteristic for the iuvenile. The regimen includes administration of drugs supporting cellular oxygen utilization, inhalation of oxygen-enriched air, and improvement of blood supply of tissues. The p02 elevation is permanent for months or years after treatment, which covers only 36 hr within 3 weeks. In a large number of patients of different age and health state this treatment activated also the immune system: an increase of leukocytes, lymphocytes, and rosette-forming cells was found in the peripheral blood. The regular application of the 02MT might play an impor- ,tant role in the prevention of cancer. /OXYGEN MULTISTEP THERAPY/IMMUNE STATE/CANCER PREVENTION/ IPS1 [56J HEAVY ARGONIDES PREVENT AND TREAT CANCEH: 514 D .I0NESCU-PANTELIbi0N,BUCUKESTI,HOt„ANIA, Knowing that the cancer manifests a exaggerated cataboli- sm,I try to find and I discover that the heavy argonides (Ar.,Kr.,Xe.,Rn.) have anticatabolic properties.L.Pauling (1961) and other have showed,about these inert gasesrthat they form crystaline hydrates,clatratep,like of the ice. Measuring the argon concentration in the blood of the can- cerous persones;I find that it is inversely proportional to the malignity degree.Experinentally I find that the atmospheric air,enriched with argon,ceases and stops of growth and multiplication any gern.The well-developed tu- mours,in usual conditions,have cmpletely stagnatedlwit- hout,to become necrotics;when they have been kept in en- riched air with argon.Injecting 10 cm.cubic argon at a period of 5-10 days,peritumorally,intratunourally,in the cerebrospixal fluid,in the mammary glands,etc.,it was observed encouraging modificationa.The diacovery was regis- tered as invextiox,at OSIM,Bucharest,nr.100169,under the title:,,THE METHOD FOR THE TREATEMENT OF THE CONSOMPTIVE DISEASES". -4 o, .,. .,.

LIST OF ABSTRACTS 515 THE VALUE OF FOLLOW-UP CHEST X-RAYS IN PATIENTS WITH CANCER Cahan,W.G., Memorial Sloan-Kettering Cancer Center, N.Y.C.,USA For their lifetime, cancer patients should be periodically examined. This should include chest x-rays (PA & lateral),NOT fluoroscopy, at reg- ular intervals. Unfortunately, these basic radiologic studies are often omitted and taken only when pulmonary symptoms appear. The reasons for neglect are:a) lack of conviction by physicians as to its value;b)physi- cians'forgetfulness; c)cost to patient; d)patient resistance to "unnec- j44] essary" exposure. These conditions are more than balanced by the poten- tial hazards of omitting these studies.By so doing,pulmonary metastases or a new primary lung cancer which,at first,are asymptomatic, can eniarg4 insidiously before symptoms appear. The earlier either condition is de- tected, the better the chance for benefit. At MSKCC, over 200 solitary metastases and over 1000 primary lung cancers associated with primary cancers elsewhere have been found. When these two conditions were detec- ted early enough to be resectable,overall survival was a respectable 25- 35%.Periodic chest x-rays are mandatory in those who have 1)known cancer capable of inetastasizing and/or;2)history of heavy smoking;3)most parti- cularly in cancers notoriously associated with primary lung cancer,e.g., bladder,cervix,oropharynx & larynx. Suggested Intervals for Maximum Yields: 1) everv 6 months*for first 3 years after treatment of known primary, then annually;2) every 6 months for heavy smokers over 50. *shorter intervals in m(4anomas and osteosarcomas for first 2 years. VALUE CHEST X-RAYS IN CANCER 516 SERIAL QUANTITATIVE BONE SCANNING IN BREAST CANCER. Parbhoo, S.P., Alani, H., Agnew, J.E., & Stoll, B.A. Royal Free Hospital, Pond Street, London NW3 2QG. Serial quantitative bone scanning has been advocated for assessing the alteration of inetastases during the natural course or following treat- ment. Because its clinical usefulness has yet to be established we have studied 39 patients with breast cancer over 2 years. Our aims were to determine by means of profiling the spine and using a region of interest [44) (ROI) technique (1) the reproducibility and (2) the significance of variation of uptake. Sixteen patients without bone secondaries ("normal") and 23 patients with secondaries were serially examined using 99m- Technetium-M.D.P. and a ganmia camera interfaced with a computer. Analysis of the data in-patients-who hadvore-than 3 scans showed a spine}profile - - fluctuation above minimum of 35 = 10.4 in the 11normalyl-and-1-36 --37%- in the ab_~ormal groups. The bone to bone ratio using the ROI technique was 1.05 + 0.2 in the ~~normall' group and the metastasis to bone ratio was 1.73 - 0:29 in the abnormal group. While a longer term study might incidate the value of spine profiles the ROI technique is clearly more accurate. We have seen the development of secondary deposits shown by an increased ratio and healing (progressive fall in ratio after initial increase) following endocrine manipulation or local radiotherapy. These encouraging results suggest that the ROI technique may be used to detect early response to treatment. SERIAL BONE SCANNING / BREAST CANCER.

I441 1441 LIST OF ABSTRACTS 517 CONTROL OF THE PRIMARY TUMOUR AND ITS INFLUENCE ON THE SUBSEQUENT INCIDENCE OF METASTASES. Dische, S. and Anderson, P. Marie Curie Research Wing, Regional Radiotherapy Centre, Mount Vernon Hospital, Northwood, HA6 2RN, England. Clinical experience has led to the view that metastases are occultly present at time of treatment of the primary tumour in the considerable majority of those patients who later show metastases clinically. During the past decade much attention has been given to the problem of occult metastasis and it is commonly considered that the treatment of the primary has little influence upon the Incidence of distant metastases. In our studies of patients with carcinoma of the uterine cervix and bladder treated by radiotherapy those patients presenting the best local response when assessed soon after treatment have the lowest incidence of subsequent local recurrence. Survival is improved and in addition they have the lowest incid- ence of distant metastases. An association between radio-responsiveness and a low tendency to metastasis is possible but it seems most probable that early and effective control of the primary tumour at least at these two sites leads to a diminished Incidence of metastasis. Effective treatment leading to an early and complete zontrol of the primary tumour Is important in oncology. /PRIMARY TUMOUR CONTROL/IIdCIDENCE METASTASES 518 PREVENTION AND DETECTION OF A RELAPSE OF GYNAECOLOGICAi.. CANCER. - Kalpaktsoglou, P.K., Kondyli, A.P., Ioannidou, G.B., Chryssikopoulos, E., Comninos, A., Chioti, A.S. - Immunobiology Research Center, "Marika Eliadi" Maternity Hospital, Athens, Greece. The present study is an effort to emphasize the necessity of changes which should be made in the scheme of imm uno chemotherapy (I.C.Th.) we apply in order to eliminate as much as possible a relapse of the disease and to point out the laboratory findings which might help to the detect ion of an impending relapse. Our material consists of cases with gynae- cological cancer stage IIb and III. Our results support the view that it might be possible to reduce the relapse of the disease by keeping the patient under continuous I.C.Th. for over three years, by applying the intensive chemotherapy (endoxan 200 mg i.v./day for 10 days) during the first two sessions of the second year, and - in severe cases - by con- tinuing the intensive chemotherapy for over one year. Our immunological findings, i.e. hyperglobulinaemia A, permanently low percentage of ro- settes forming cells, high percentage of agglomerated mononuclear cells, low reactivity of neutrophils to LPS and negative skin reactivity to tuberculine favor our view for the prognosis of an impending relapse of the disease.

1441 1443 LIST OF ABSTRACTS 519 PROBLEMS ON PREVENTION OF METASTASES IN NON-SEMINO- MATOUS TESTICULAR TUMORS BY ADJUVANT CHEMOTHERAPY. Kiihbbck,J., Aiginger,P. and Ptitzi,P. II.Medical Department, University of Vienna, Vienna, Austria. The fate of patients with testicular tumors has changed impressive since metastatic disease may be cured by chemo- therapy, while the role of adjuvant chemotherapy still re- mains in discussion. Of 20 patients (14 embryonal, 1 tera- to-, 3 mixed ce11, 2 choriocarcinoma: stage N, N, N2) treated with mithramycin (27,5 mcg/kg/10 daysp foilowing orchiectomy and lymphadenectomy all patients are tumor free including 5 patients with recurrence after initial mithramy- cin but CR following vinblastine- blegmycin +/- cis-platinum (0,4 mg/kg - 30 mg/1-5 days - 20 mg/m /5 days). In a further series of 20 patients (No, N -N , M) treatment with vinbla- stine- bleomycin +/- cis-plalinAm (i cycles/year) resulted in CR (15 pat.) or in PR (5 pat. starting in N, N or M). These results indicate: 1) The efficacy of ~iithfamyciA in adjuvant chemotherapy (15/20 patients being tumor free 30 months after orchiectomy). 2) The superior role of vinblast- ine- bleomycin +/- cis-platinum combination for adjuvant chemotherapy (15/15 pat.) as well as for palliative treat- ment (5/10 pat.CR-5/10 pat.PR) without serious complications /PREVENTION OF METASTASES/MITHRAMYCIN/VELBE- BLEO- CIS-DDP/ 520 mVE ROLE OF LYP;PHADENECTOI-iY Its CURATIVE SURGERY MR GASTRIC CAfiCER.Jeki6,N.Surgical Service of the Clinical Hospital Zemun-Belgrade,Yugoslevia. A total od 530 cases of gastric cancer treated by curative surgery was an0lyzed with regard to lymph node metesteses and survivQl rate.During this period,curetive resections made up 75,9% of all resections(530/698)for ga- stric cancer,and the 5-year survival rate was 50.60(268/530 A tmtal of 15,739 regional lymph nodes(an average of 30 per specimen)removed at surgery were examined histologically "for metastases,and 16% were found to be positive.The almost complete removal of at least the primary and secondary lytn- ph node groups draining a gai;tric neoplasm is an essential part of the curative surgical treatment of gastric cancer.

1441 1441 LIST OF ABSTRACTS 521 ISOLATED LIMB PERFUSION FOR MALIGNANT MELANOMA OF THE LOWER LIMB. Rosin, R.D. and Westbury, G. Department of Clinical Oncology, Westminster Hospital, London, England. A retrospective study has been made of patients with malignant melanoma of the lower limb over the period January 1962-December 1979. 188 limb perfusions were carried out during this 18 year period mainly for patients with clinical Stage IIa and IIb. All patients had histologically proven disease and depth staging was reviewed whenever possible. Perfusion was carried out via the external iliac vessels except in cases where the disease was confined to the limb below the knee when perfusion was prolonged via the superficial femoral vessels in Hunter's Canal. There were few complications and more than 50% had no trouble, compared to a high incidence of complications following radical lymphadenectomy. Tumour response was measured in terms of reduction in cross-sectional diameter in nodules within eight weeks of perfusion; < 52 showed no detectable regression. Although initial failure of control was unusual, 20% showed subsequent local recurrence within two years. Repeated perfusion was possible in 5% of cases. The results confirm regression of established disease and, when combined with excision of residual tumour, prolonged local control. MALIGNANT MELANOMA/LIMB PERFUSION/LOCAL CONTROL TUMOR FIBRIN AS AN APITIDISSFSJ!DATIVr: r'ACTOR: 522 Balitsky, K.P., Sopotsi3:s'<ezrY, E.B. Institute for Oncolo gy Problems, Ukr.SSR Acad. of Sci., Kiev, USSR. Fibrin destruction induced in intercellular space of rat Gudrin carcinoma or rabbit Brotim Pierce carcinoma by injections of fibrinolysin solution into several points of tumor in the concentration lysing fibrin but not caus- ing side-effects on the other tumoral structures increas- ed (60%) the number of animals with iuetastases. M:cperi- ments on DUBA-induced rat femur rhabdomiosarcoma prelimi- nary subjected to scanning high intensity ultrasound to intensify the development of inetastases showed tlr,4.t '_ ib- rin adsorbtion induced by intratumoral injections of coa- gulant substances completely inhibited metastatic proces- ses. A complete inhibition of metastatic processes was also observed after intratestS.cular transplantation of Brovtm Pierce carcinoma, tumor cells being 3noculated toge- ther with coagulant substances (thrombin, fibrinogen). The data obtained allow to con sider tumor exstravaseular fib- rin as an antidisseminative factor inhibiting the in itial stage of the metastatic processes, /TUY1OR EXTRAVASCUI,AR VIBRTe+/ 11 J o~ .+ t^ ; (

LIST OF ABSTRACTS 144J 1441 523 ANTITUMOR ACTIVITY OF BENZALDEHYDE, PAR'"ICULAFLv WITH REGARD TO BENZALDEHYDE DERIVATIVE. Mutsuyuki Kochi and Ko Mochizuki. Ichijokai Hospital, Ichikawa, Chiba, Japan. Antitumor activity of benzaldehyde against some of the transplanted tumors of mice and clinical experiments with [3-cyclodextrin benzaldehyde inclusion compound (CDBA) were reported earlier. Our further investigation has indicated that benzaldehyde inhibited the spontaneous phenotynic and chromosomal conversion of embryonic cells of mice. Through treatment with CDBA, squamous cell carcinoma of C3H/HE male mice induced by injection of 20-methylcholan- threne converted into conglomeration of pearls (the well known product of differentiation) which consisted of extremely differentiated keratinized squamous cells. Similar phenomena were seen in the treatment with CDBA or 4,6-benzylidene-a-D-glucose (BG) against squamous cell carcinoma of human being. Toxicity of BG in both animals and human being is very slight. Several cases of extensive colon carcinoma combined with peritonitis carcinomatosa and liver metastasis responded markedly by intraperitoneal or intravenous injection of BG. SIGNIFICANCE OF CIRCULATING CANCER CELLS IN CANCER DETECTION 524 Song, J., & Sams, J., Department of Pathology, Mercy Hospital Medical Center, Des Moines, Iowa U.S.A. Multiple blood samples obtained from the antecubital vein of 318 patients with breast cancer, carcinomas of lung, gastrointestinal tract, stomach, bladder, thyroid, ovaries, tubes, parotid gland, skin, pancreas, pharanx, leukemia, lymphomas, brain tumors, testicular tumors and sar- comas were studied for circulating cancer cells to determine: (1) the feasibility of routine application of one stage filtration method for circulating cancer cells in cancer detection; (2) the validity of cyto- logical findings in staging diseases advanced; and (3) the possible value to measure the effectiveness of cancer immunochemotherapy. Each specimen, consisting of 10 ml. of heparinized blood, was poured onto a nucleopore membrane filter, followed by an application of 100 ml. of isotonic saline solution for clear filtration. The filters were stained by conventional Papanicolaou method and examined by light microscopy. Twenty-five healthy individuals serving as control were also studied. Reasonable clinical and cytological correlation could be made in less than 15% of the patients studied. Results of 15 year follow-ups and cytological criteria for circulating benign cells and cancer cells will be presented in detail. /CIRCULATING CANCER CELLS/CANCER DETECTION/ I r

525 ANTITUMOUR ACTIVITY AND METASTASIS-PREVENTING EFFECT OF HIGHLY PURIFIED SQUALENE, Ikekawa, T., Umeji, M., National Cancer Centre Research Institute, Japan, Mizunuma, H., Tokyo Hospital of Japan Monopoly Corporation, Ikekawa, N., Tokyo Institute of Technology, Tanaka, S., Ohkuma, T., Hokushin General Hos- pital, Japan. We used various assay systems to test the antitumour activity of squalene, highly purified (99.8%) from shark liver oil, and found it to exhibit a preventive effect against lung metastasis in mice. Squalene was administered p.o. for 15 days before and after inoculation of Lewis lung carcinoma into the leg of mice. On the 17th day after inoculation, the leg was amputated and squalene-treated mice showed a significant increase in life span. Squalene, administered i.p. for 10 days before and after cryosurgery of established solid sarcoma 180, also enhanced "cryoimmunity". S-180 ascites was inoculated i.p. on the 7th day after surgery, and survival of the squalene-treated group was remarkably prolonged. We also report on the antitumour effects of other newly synthesized squalene derivatives. /SQUALENE/METASTASIS-PREVENTING EFFECT/ 526 CANCER: A LOCAL OR SYSTEMIC DISEASE? VALLI, V.E.O. Department of Pathology, Ontario Veterinary College, Guelph, Ontario, Canada When a malignancy occurs, is this the primary event or have there been prior changes in the host which have made it incompetent to control neoplastic cells. Systemic changes are known to accompany cancer and nuclear malignancy associated changes (MAC) in particular have been shown to precede the appearance of tumor in man. MAC also occurs in animals, and dogs, which share mans' environment and can be considered to develop environmentally induced cancer, have nuclear changes in buccal cells in a variety of tumors. Similarly, cattle which develop lymphoma as a result of RNA viral infections have nuclear changes in neutrophils. Significantly, only a small percentage of cattle with viral infections develop lymphoma and only those which develop cancer have MAC. What are the changes which occur in man and animals and why are the majority of individuals, which suffer similar exposure and assault, protected? One of the most compelling arguments for systemic control of cancer is the apparent frequency of patients for whom surgery was believed curative and followed by many years without symptoms with recurrence and rapid progression following bereavement. We need a large scale prospective study in a high risk area to define the systemic changes which precede cancer development. The profile would need to be broad and include diet, environment, psychosocial, immunologic, and bio- chemical parameters. An understanding and acceptance of cancer as a systemic disease would aid prevention, detection and therapy. /MALIGNANCY ASSOCIATED CHANGES/HEALTH PROFILE/

LIST OF ABSTRACTS 1401 1401 527 VITAMIN C AND ANTICARCINOGENESIS. Pauling, Linus, Cameron, Ewan. Linus Pauling Institute of Science and Medicine, 2700 Sand Hill Road, Menlo Park, California. There is epidemiological and clinical evidence that vitamin C (ascorbic acid, sodium ascorbate) has both prophylactic and therapeutic value against cancer. Its prophylactic effect probably results from several mechanisms, including potentiation of the immune system and other natural protective systems. In addition, it is likely that it results in part from the general property of the substance in serving as a detoxifying agent, effective against carcinogens as well as other substances. Its effectiveness is such that it may be a valuable supplement to the accepted methods of preventing and treating cancer. 52$ A NEW LOOK AT CANCER --- IP4dUNOPREVENTION. Hollinshead, Ariel C., Dept. of Medicine, The George Washington Univ. Medical Center, Washington, D.C. 20037, U.S.A. Different forms of cancer, and single forms of cancer may have multi- ple causes, and there are intricate inter-relationships between genetic and environmental causes. It may be possible to protect an individual or a segment of the populace at high risk if one could identify suscep- tibilities to certain malignancies, and if coordinated efforts and a coordinated strategy at the international level were to include a combi- nation of approaches. This is an appropriate forum for a dialogue with regard to the role immunoprevention might play as a candidate for inclu- sion in multimodality measures for prevention of cancer. This dialogue will include a consideration of the evidence for premalignant or precur- sor changes, in normal tissues, as a result of environmental or genetic influences; evidence for premalignant change in the relationship to ge- netic factors or short and long term exposure to carcinogens; evidence for efficacy of immunopreventive measures in model systems; evidence for malignant change as a part of the various alterations which take place in an appropriately selected animal model tumor system; and, the selec- tion of one form of human cancer for a detailed analysis of the hard science and clinical evidence with regard to effective vaccination. Lastly, we will outline a cautious two-step approach in the evaluation of immunoprevention as a useful single procedure, prior to inclusion in a multimodality program. 0% 0 O ~ r

140J [40j LIST OF ABSTRACTS 529 CHRONOBIOLOGY AND CANCER. Halberg, F. University of Minnesota, Minneapolis, Minnesota, USA First-order chronopsies consist of questionnaires and measurements made by family members and continued by the child, with automatic meas- urements for rhythm assessment (e.g., the collection of breast surface temperatures and if need be, as second- and third-order chronopsies, the check upon single or serial hormonal determinations for the interpreta- tion of single values--in the light of time-specified peer-group and ind- ividual chronodesms--and of time series characteristics). Correlations thus have been found between the epidemiologically assessed risk of de- veloping breast cancer and the circannual amplitudes of TSH and prolactin as well as the circannual mesor of LH. Correlations have also been indi- cated between breast cancer risk and the circadian prolactin mesor in winter and in spring, and the circadian prolactin amplitude in winter, but not in other seasons. Season dependent correlations between breast cancer risk and circadian characteristics also were found for estrone and estriol. TSH showed a circannual rhythm for men with low risk of de- veloping prostatic cancer (but not for patients with prostatic cancer). A circannual prolactin rhythm was seen in prostatic cancer but not in low risk subjects. An assessed rhythm spectrum quantifies health positively, revealing chronoepidemiologic differences in specifiable stages of rhy- thms with multiple frequencies--for cost-effective chronoprevention whenever rhythm alteration is a harbinger of cancer. CHRONOBIOLOGY/PLASMA HORMONES/BREAST CANCER/PROSTATIC CANCER/CHRONOPSY 530 STRESS AND CANCER. Vernon Riley. Pacific Northwest Research Foundation, & Fred Hutchinson Cancer Research Center, Seattle, Washington, 98104, U.S.A. Anxiety stress produces increased levels of adrenal corticoids through well-known neuroendocrine pathways involving the cerebral cortex, the hypothalamus, the pituitary, and the adrenal cortex. A direct conse- quence of stress-induced plasma corticoid elevation is injury to impor- tant elements of the immunological apparatus, which may leave the sub- ject vulnerable to the action of latent oncogenic viruses, newly trans- formed cancer cells, or other incipient pathological processes normally held in check by an intact immunological apparatus. The physiological and biochemical details of these processes are being studied using ro- dent models, with the expectation that biological principles which apply to mice may be relevant in some respects to humans. Our attention is directed to an examination of the adverse influences that elevated con- centrations of circulating adrenal corticoids have upon the thymus and thymus-dependent T cells, inasmuch as they constitute a major defense system against various neoplastic processes, including those involving viruses and transformed malignant cells. In order to establish the pathological influences of alterations in adrenal corticoid levels, we have compared the biochemical and cellular effects resulting from emot- ional stress with those that occur following the administration of nat- ural or synthetic corticoids. Both anxiety stress and administered cor- ticoids produce similar biological effects in mice.

LIST OF ABSTRACTS [40J El 531 RESISTANCE TO CANCER. FACTS AND SPECULATIONS Peter Alexander. Division of Tumour Immunology, Institute of Cancer Research, Sutton, Surrey. There is no question that many experimentally-induced neoplasms invoke in the histocompatible host in which they grow an immune reaction directed against neo-antigens characteristic of the malignant trans- formation. There is, however, as yet no unambiguous evidence that such an immunologically specific host reaction against neo-antigens occurs in any human malignancy. The relative uneffectiveness of immunotherapy when applied to metastasizing human tumours suggests that tumours of this category are probably not immunogenic. Even if there is no immunologically specific host reaction, there is evidence that phagocytic cells are selectively toxic to malignant as opposed to normal cells; this selective toxicity may be an important element in the tumour-host reaction when there is no specific immune reaction. 532 INTERNATIONAL CLASSIFICATION OF DISEASES FOR ONCOLOGY (ICD-0), WORLD HEALTH ORGANIZATION (WHO), Percy, C. & Young, J.L., Jr., National Cancer Institute, Bethesda, Maryland, United States. This is a scientific exhibit of a manual for coding all neoplasms by topography, morphology, behavior; i.e., malignant, benign, etc. and grading or differentiation of tumors. The manual is an extension of Chapter II, Neoplasms of the WHO's International Classification of Diseases, Ninth Revision and provides users with a more detailed code for morphologic entities. The exhibit shows each part of the classification of tumors: a numeric index for topography and morphology and an alphabetic index, an introduction telling how to use the manual and its relation to other codes; past and present. Samples of conversions to these other classifications will be available. The morphology section for ICD-O was based on the histologic terms for neoplasms listed in WHO's Inter- national Histological.Classification of Tumors series ("Blue Books"). Foreign language editions of ICD-O will be available. Tabulations of data using ICD-O for site and histology from large population-based registries in the U.S.A. will be shown. The objective is to promote ICD-O as an international code for neoplasms, to coordinate research and information in cancer. /ICD-0 - CODE MANUAL SITE TYPE/ Ll ~ 0 0 t0 r J A N 0 !

LIST OF ABSTRACTS ~j THE USE OF 35mm SLIDES Itv MEDICAL aD SCIH\TIFIC PRESENTATIOIv S. McDowell, L.B., Dept. of Medioal Illustration, Memorial- Sloan-Kettering Cancer Center, Ivew York, USA. The use of 35mm slides in medical and scientific meetings is an accepted and routine practice. Speakers have come to depend on them as 'visual-aids' to emphasize and organize E2 information so that information will be more available for the audience to use productively during the presentation. It is the common experience of us all that too many of these slides have little educational va7ue for the audience. Vis- uals do belong to the audience and proper use of them can smooth and strengthen a presentation. This is particularly Important at larger meetings, where time is an imnortant constraint. The purpose of this proferred paper is to dem- onstrate and compare slides which work for speaker and slides which work for the audience. Legibility is only the first criteria to be considered. N•ore or as imnortent is for a speaker to know when a slide should be used and how to appropriately limit its content or modify it so the informa- tion can b6 quickly interpreted and smoothly integrated with Information that preceded it and the information that is to follow. 534 JRIGINAL METHOD TO AUTO-EVALUATE TOBACCO RISKS SORS Ch., BURANTEAU R. and DAUTZPNBERG B. - C.H.U. PITIE-SALPETRIERE 75651 PARIS CbDEX 13 - FRANCE Stah.ting bn.om the expen.i.enee ob a pukmonahy un.i,t, a aets- tu.i,ton pnogn.am has been .imptemen.ted on a eompuzeh•, aZZowing aCmoax any .Endivi.duu.C to pn.i,va,te.Cy evatuate h.i,a own A.i,akh. In the beg.i.nnf.ng, tobacco eonsump.ti,on •i.e eva.e.ua,ted thkoughou.t- Gi.~e, eone-i.deh.i.ng sepana.tety e.i.ganette, c.i.gan and pipe. E3 Then b.impte dnawi,ng6 aZCOw beven.a.P ohgana to be eeteeted (methe i, e. , hean,t, •Cungb, an,tel~i.ea, ete...). The pati.en.t is abte to move aCong the ohganb he uante = h-i.e own a.i.ek6 concenning ,i.t ane di,apCayed. Sevehae .i,n6ohuna.t,Lve page,d hetp xo gain dci.entisie hnowQ.edge on .the phye.i.opa•tho.2ogy o6 the ee.beeted ongan. The ayatem .i,e on,i.ginat aa .i,t neede onty to touch the ach.een wi #h aj.i.ngeA, to have dncuui.nge on the eaceen and to get a pn.i.va•te undews.#and.i.ng ob h,i.d poten,ti,aR pnob.2ema, beeause the pczLi.en.t ia atone to d.ia.Cogue w.ixh the maeh.i.ne. Sevena.et methoda how to etop emofiing aee eugge6xed, ad weLQ ad the.uc main a.im = w,i,P.C. The ayaxem he,Ppd to get mozi.vated. TOBACCO/COMPUTbR/bVUCATION.

LIST OF ABSTRACTS 535 PREVENPION OF PERIOPERATIVE MICRCVE'PASTATIC FIHANCIIMENP IN HUMAN BREAST CANCER. Hellenic Breast Cooperative Group. Athens,Greece. Tumor-prcmoting factors operative during mastectony,may facilitate the developnent of inetastases frun ttanor cells disseminated during ope- rative manipulations. The sa<ne factors are also likely to strengthen already existing micranetastases. These detrimental events can be pre- vented if instead of surgery,systenic therapy is used as the initial E4 step in the management of these patients. Preoperative chemotheraFy may acheive this because a) Reduces to a miniminn cells in the primary tumor capable of forming metastases,so that their subsequent operative disse- mination beocmes inconsequential.b)Micrametastatic tumor burden is attacked when it is trully minimal for each patient and before it graws as a result of postoperative im-nunosuppression. c)If operation is timed during the post-che-notherapy rebound of iinnunity sane of the imminosuppresive effects of surgery may be counteracted. d)The sensiti- vity of the tumor to the agents used can be quickly estimated by measuring changes in the primary tumor size after chemotherapy,so that an ineffective systanic treatment may be abandoned and a new one is instituted. A sizeable body of experimental and clinical evidence supporting the value of this proposal,is introduced. The initial results fran our prospective collaborative studies in stage iI and III patients are presented._ 536 T[iERNF1L BIOIAGY OF BREAST DISEASE: "HICHEST RISK D'ARKER FOR BREAST CANCER?". Hcbbins, W., Weiss, J., King, B., Reeves, W., Madison Breast Foundation, Madison, Wisconsin Results af 200+ biopsies reveal a high degree of correlation between abnormal thermal patterns and pathologically proven breast cancers. A sumary of preliminary studies demonstrating that thermal biology can be used to select additional patients at a higher risk for breast can- cer, than selected by conventional history risks factors and clinical E5 examinations. Current screening methods fo