INTERDISCIPLINARY PROGRAM AND COORDINATION AREA

SUMMARY OF ACTIVITIES

The Interdisciplinary Program continues to stimulate ideas through its workshops by focusing on areas in which the two countries differ greatly - in disease frequency or in their approaches to research. Binational differences on the frequencies of lymphocytic diseases, first discussed in March 1981, has been a recurrent topic at meetings ever since, and we hope the idea will spread to the U.S.-China Program. In China studies can be made to determine if the lymphoproliferative disease rates are more like those in Japan than those in the United States. In particular, the occurrence in China of diseases unique to Japan or with unusually high or low rates there, will be of great interest (e.g., Takatsuki’s disease = unique; nodular lymphoma = low rate, subacute necrotizing lymphadenitis in young women of Hokkaido = high rate). During the year an extended summary of the second U.S.-Japan workshop on this project was published by Kadin, M et al: Human Pathology 14:745-772, 1983.
Our recent workshops involved pathologists and led to another main theme for the Interdisciplinary Program, namely, the role of pathologists in cancer epidemiology. A series of meetings is beginning to develop concerning this subject.
In another workshop we have considered again the importance of biostatistics in cancer studies, toward which the two countries have markedly dissimilar approaches.
In consequence of the workshops, the exchange of scientists has concentrated on the questions raised about the frequencies of lymphoproliferative diseases and on their viral etiology. A notable sequel to a workshop on biostatistics in 1978 was that it introduced opportunities for research in Japan to the Director of the Biometry and Risk Assessment Program of NIEHS. In consequence he spent nine months in research there and has just begun another 2-year appointment at the Radiation Effects Research Foundation in Japan.
Seminars and Workshops:
Two workshops were held during the year. The first, in Hiroshima on March 1-2, 1984, concerned Statistical Methods in Cancer Epidemiology. The Radiation Effects Research Foundation (RERF) served as the host and a substantial number of its staff participated. In addition, four participants came from the United States and eight from elsewhere in Japan. The co-organizers were Takeshi Hirayama, M. D., from the National Cancer Hospital Research Institute in Tokyo, and William J. Blot, Ph. D., from the National Cancer Institute in Bethesda. As shown in the summary of the meeting by Dr. Hirayama, the subjects covered were cluster analysis, descriptive studies, and cohort and case-control studies. The meeting concluded with a powerful statement by Dr. I. Shigematsu, Director of RERF, on the need for enhanced biostatistical interest and capability in Japan for cancer research.
Dr. Breslow stated that the methods of RERF in its cohort analyses were up-to-date. Apart from the meeting we learned that a great stimulus to biostatistics in Japan may come from computer centers at leading medical institutions. The first, to be at Tokyo University, will be directed by Dr. Furukawa, an internist skilled in computer technology. The example he sets is likely to spread elsewhere in Japan. The proceedings of the meeting will be published as a monograph by RERF.
The workshop on the Role of Pathologists in Cancer Epidemiology was held in San Francisco on March 10-11, 1984, just before the annual meeting of academic pathologists (International Academy of Pathology, U.S. and Canadian Division). Four of the seven Japanese participants stayed on for that meeting.
The U.S.-Japan workshop was organized by Drs. Haruo Sugano and Robert W. Miller, the coordinators for the Interdisciplinary Program. Each side compiled a volume of abstracts and relevant reprints from its participants. This simple device provided information useful for future reference and to clarify (and shorten) the formal presentations.
Among the items of special interest:

1. Dr. Urano’s report concerning the annual volume on national autopsy registration (a summary of the findings of each autopsy) led Dr. Stemmerman of Honolulu to offer similar data from autopsies of Japanese-Americans at Kuakini Hospital.
   
2. Several speakers, Dr. John Berg in particular, emphasized and illustrated the importance of subtypes in epidemiology.
   
3. The concept of “demographic distances” between clusters of subtypes was introduced. The clusters are defined by numerical taxonomy.
   
4. The concept of basic (inherent) vs. variable (environmental) components in organ-specific carcinogenesis.
   
5. Dr. Purtilo described the analagous reciprocal relationship between certain lymphoproliferative and autoimmune diseases in males vs. females and in the U.S. whites vs. Japanese. It seemed that the best opportunity for extending these observations is in Hawaii, where medical care and diagnostic facilities are similar for the various ethnic groups living there.
   
6. Subtypes of kidney tumors defined by Dr. J. Bruce Beckwith of the University of Washington led to two newly identified renal tumors that respond poorly to treatment for Wilms’ tumor, and a difference between the histology when Wilms’ tumor is bilateral (hereditary type) or occurs with aniridia as contrasted with Wilms’ tumor that is unilateral (non-hereditary type) or is associated with congenital hemihypertrophy. In the latter, renal dysplasia, when found, is perilobular, whereas in the hereditary group it is intralobular as well as perilobular. These observations indicate that review of the histology in treatment failures may reveal previously unrecognized entities which can be effectively treated by other means.