The NCI is also about to launch a large, randomized study to see if screening for prostate cancer in men aged 60-74 years is effective in decreasing mortality from prostate cancer. This is part of a large trial designed to test the efficacy of screening for prostate, lung, and colorectal cancers in men; and ovarian, lung and colorectal cancers in women. Investigators will pay careful attention to ensure that the study population is balanced with regard to inclusion of members of minority groups. The screening tests to be used to detect prostate cancer are rectal examination and a blood test for prostate specific antigen. As part of that study, there are plans to elucidate some of the causes of prostate cancer. Epidemiologic information which may uncover risk factors will be collected on each study subject. This will include information on smoking habits, life style, and diet. Of note, a recent study has suggested that cigarette smoking is a risk factor for prostate cancer. There is controversy over whether dietary factors play a role in prostate cancer. We plan to expand upon these observations and explore other possibilities in a prospective manner as part of our study. Studies continue to examine the descriptive characteristics of prostate cancer in the United States, with emphasis on geographic patterns, time trends, and racial/ethnic disparities. In the new nonwhite atlas, a landmark finding is the recent emergence of high-rate areas for prostate cancer among black men in the South Atlantic states. In a collaborative multicenter case-control study of prostate cancer in Atlanta, Detroit, and several communities in New Jersey, a variety of risk factors are being investigated, with special emphasis on the determinants of the higher rates in blacks than whites. Analyses are underway of interview data on lifestyle, diet, medical, and occupational history. Laboratory assays will be carried out on blood specimens to clarify the influence of dietary and hormonal factors. The role of diet is also being evaluated in the follow-up study of men in the first National Health and Nutrition Examination Survey (NHANES), which was recently extended through 1988 to permit further prospective investigation of the cohort. Initial analyses found serum vitamin A to be protective, with subjects in the lowest quartile having 2.2 times the risk of prostate cancer than those in the highest quartile. In collaboration with the University of Minnesota, dietary and other information are being analyzed in relation to prostate cancer risk in a Lutheran Brotherhood cohort of nearly 18,000 males who responded to a questionnaire in 1966-1967. Recent analyses of the cohort suggest that cigarette smoking and smokeless tobacco may be risk factors for prostate cancer. A role for smoking in prostate cancer risk is suggested also by recent findings from the Dorn cohort study, using data from a 26-year extended follow-up of 250,000 U.S. veterans. Extramural grants support a number of epidemiologic studies of prostate cancer. The role of nutrition is being explored in several of these, with emphasis on clarifying the role of dietary fat and micronutrients. In a multicenter case-control study being coordinated at Stanford University, risk factors for prostate cancer are being evaluated among blacks, whites, and Asians in Los Angeles, San Francisco, Hawaii, Vancouver, and Toronto. A second grant at Stanford is focusing on the influence of physical activity and diet in cancer of the prostate. A grant activity at the Kuakini Medical Center is assessing prediagnostic serum hormone levels, diet, and body mass in the origins of prostate cancer among migrant Japanese in Hawaii. At the University of Southern California, grant-supported activities are examining the role of androgenic hormones in prostate cancer, with data suggesting that excess risk among blacks may be due to higher levels of certain testosterone metabolites. This past year, the NCI epidemiology group organized a session on the etiology of prostate cancer which was part of a workshop held under the auspices of the Organ Systems Program. Special attention was given to factors that may account for the excess risk among black men, and plans for future research were developed. Another workshop, which involved intramural and extramural scientists, was held on the subject of cancer epidemiology in minority groups. As a result, a Request for Applications (RFA) was issued to encourage research in this area, including multidisciplinary studies on the etiology of prostate cancer. CANCER-RELATED INTERNATIONAL ACTIVITIES Question. Dr. Broder, last year, this Committee included language in the Committee Report expressing our interest in international collaboration in cancer research. Could you please summarize for me the efforts you currently have underway to promote international scientific exchange, particularly in the areas of research training, joint research projects and prevention. Answer. The National Cancer Institute places high priority on international collaboration. Cross-national research provides unique opportunities to advance the frontiers of cancer research. This commitment to international cooperation will continue, as NCI pursues promising new areas for collaborative investigations with foreign scientists and institutions and increases its efforts to disseminate cancer information worldwide. The unique opportunities provided by international collaboration are determined either by the special knowledge, skill, or ability of an individual foreign scientist or by the availability of special populations or nutritional or environmental exposure to carcinogenic agents in a foreign country. Such is the case of the high incidence of esophageal cancer in Linxian Province in China; the high incidence of stomach cancer in China, Chile, Costa Rica, Italy, and Hungary; the high incidence of pediatric AIDS in Romanian orphanages; the Chernobyl disaster; and the enormous levels of polycyclic aromatic hydrocarbons and other contaminants found in the air, soil, and water in Silesia in Poland. Extramural Cooperation During FY 1990, the National Cancer Institute funded approximately 80 foreign grants and contracts. A variety of studies were supported, such as a community-intervention smokingcessation trial involving 22 communities in the United States and Canada and a nutrition study in China to evaluate the effect of multivitamin and mineral supplements on the incidence of esophageal cancer. Other international cooperation included a U.S.-Germany effort to develop an HPV mucosotropic vaccine and U.S.-Soviet efforts in charged particle therapy and anti-sense oligonucleotide synthesis. Workshops and Scientist Exchanges The Office of International Affairs (OIA), NCI, catalyzes collaborative research between U.S. and foreign scientists by cosponsoring international workshops and scientist exchanges. Twenty-one workshops and 112 short term (six months or less) scientist exchanges were supported by NCI during the year. Thirteen long term (one to three years) exchanges came to U.S. laboratories from the European Organization for Research and Treatment of Cancer (EORTC) and from the Japanese Foundation for Cancer Research (JFCR). In addition, an extensive program whereby foreign scientists are at NCI under the NIH Visiting Program administered by the Fogarty International Center (FIC). The number of scientific exchanges involving nationals from Eastern Europe, the Middle East, South East Asia, and Latin America has expanded during the last year. During FY 1991, NCI has increased the funding for the participation of East European cancer researchers--who up to now have had little or no opportunity to interact with their Western counterparts--in international workshops on cancer prevention and AIDS research. NCI scientists are participating in epidemiological studies on the effects of the Chernobyl reactor disaster on affected populations of the Ukraine and Byelorussia. In addition, a cooperative effort is underway among NCI and three Latin American countries (Argentina, Brazil, and Chile) to pursue molecular epidemiology studies on childhood cancers. Workshop on Biodiversity The National Cancer Institute co-sponsored a Workshop on Drug Development, Biological Diversity and Economic Growth, an international collaboration in cancer research. The workshop was held on March 13 and 14, 1991. Other co-sponsors were the U.S. Agency for International Development, the National Science Foundation and the Fogarty International Center. Participants included representatives from the sponsoring organizations, nations collaborating in the international drug development effort, and the pharmaceutical industry. The objective of the workshop was to encourage developing countries, especially those in tropical areas, to conserve their vast diversity of biological species, so that the potential of discovering new pharmaceutical agents from natural products will not be lost. 1991. Key topics discussed or presented at the workshop included: a. Activity of the NCI Developmental Therapeutics Program in the discovery of anticancer and anti-AIDS agents in natural products, including contracts for collections around the world and the development of a Letter of Intent to facilitate these efforts and to protect the interests of the countries involved; b. The different problems and needs of the countries with c. The need for developmental funds. It can be 10 to 15 years before the collaborating country would receive any royalty return from a new drug. Compensation, therefore, would be in a form of immediate importance to a developing country. For example, Merck, Inc. is providing a free drug to one country for the treatment of endemic river blindness; d. Areas were identified for initiation or expansion of programs to further the overall objectives of international collaboration. These are improvement of the infrastructure within the countries involved; development of inventories of native species; training targeted to the needs of the specific country; assistance with the primary societal needs (education, health) of the individual country; and preservation of traditional pharmacology. Another workshop on this subject is scheduled for April 5, Clinical Trials NCI facilitates international cooperation in clinical trials by involving American industry, which contributes pharmaceuticals for such trials at no cost to the U.S. Government or foreign collaborators. Examples of this type of cooperation are three clinical trials, conducted in parallel in U.S. and Soviet cancer institutes, for the treatment of colon, colorectal, and breast cancers. NCI supports clinical and epidemiological studies in Egypt on adult lymphocytic leukemia (ALL) and non-Hodgkin's lymphomas (NHL). NCI and three cancer centers in India also cooperate on treatment protocols for ALL and NHL. Romanian scientists have requested cooperation from NCI's Pediatric Oncology Branch to develop clinical protocols for the treatment of pediatric AIDS patients. NCI with the Fogarty Center have committed themselves to fund a pilot project to determine the feasibility of a US-Romania collaborative effort in this direction. Cancer Information Dissemination Projects One field where we feel significant progress has been made with foreign countries is in the area of information dissemination. We have supported dissemination of published cancer research to Latin America through the Pan American Health Organization (PAHO) and technology transfer through short-term exchanges through the International Union Against Cancer (UICC) in Geneva, Switzerland. During FY 1990, with the assistance of NCI's International Cancer Information Center (ICIC), three projects were set up to demonstrate the use of compact disk read-only-memory (CD-ROM) technology in the dissemination of cancer information at cancer centers in Budapest, Moscow, and Warsaw. This technology provides access to the 'latest published cancer research literature and treatment information, through NCI's databases CANCERLIT and the Physician's Data Query (PDQ). To help with information dissemination, NCI provides a free subscription for a limited time to these two databases on compact disc and if required a compact disc player. The host institute provides the necessary computer hardware. Two additional demonstration projects became operational in early FY 1991 in the former East Berlin and in Bratislava. Those in Ahmedabad, Ankara, Belgrade, Bombay, Harare, Instanbul, Kampala, Kiev, Managua, Manila, Panama City and USSR-Academy of Sciences are expected to be operational before the end of the year. Seven Latin American cancer-information dissemination centers (in Argentina, Brazil, Chile, Costa Rica, Mexico, Peru, and Venezuela), will receive CD-ROM capabilities through the PAHO contract. Additional Latin American and Caribbean sites are under consideration. The new technology will provide all these sites with bimonthly updates of newly published research results relating to cancer prevention, diagnosis, and treatment. In FY-1990 ICIC began to provide no-cost subscriptions to the Journal of the National Cancer Institute and other NCI publications to over 200 cancer center and medical school libraries in developing countries. The availability of this information is expected to accelerate the development of national or regional cancer control programs around the world. We expect that the availability of solid scientific information will lead to anti-smoking campaigns and nutrition intervention programs, aimed at reducing cancer incidence and to programs in early detection, at least in Eastern Europe and Latin America. Cancer Institute directors in Bulgaria, Czechoslovakia, the former German Democratic Republic, Hungary, Poland, Romania, USSR, and Yugoslavia have received information about NCI's interest in the development of national cancer control plans, anti-smoking campaigns, nutrition intervention programs aimed at reducing cancer incidence, and programs in early detection. They are expected to request NCI advice for the projects of the highest priority in their respective countries. |