CHAPTER 15
Buccal-Cavity & Pharynx Cancers, Males: Relation with Medical Radiation
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* Part 1. Introduction
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Buccal-Cavity and Pharynx Cancers include cancers of the lip, tongue, unspecified parts of the
buccal cavity, and the pharynx (see Chapter 4, Part 5, Number 5). The MortRates in Table 15-A
clearly present a "small numbers problem." The problem is so severe for the females --- as indicated
by their lower national MortRate in Table 15-B --- that we did not analyse the female data.
. Part 2. How the Dose-Response Develops, 1921-1940
6
-
Part 2a.
Pacific
New England
West North Central
Mid-Atlantic
East North Central
Mountain
West South Central
East South Central
South Atlantic
* -
Part 2b.
Pacific
New England
West North Central
Mid-Atlantic
East North Central
Mountain
West South Central
East South Central
South Atlantic
0 - Part 2c.
Pacific
New England
West North Central
Mid-Atlantic
East North Central
Mountain
West South Central
East South Central
South Atlantic
..........................
•- Part 2d.
Pacific
New England
West North Central
Mid-Atlantic
East North Central
Mountain
West South Central
East South Central
South Atlantic
1940
1921
PhysPop MortRate
5.3
165.11
6.4
142.24
4.6
140.93
6.9
137.29
4.8
136.06
2.8
135.38
4.0
125.15
3.3
119.76
4.3
110.32
Buccal + Pharynx Ca, Males
Regression Output:
-0.3152
Constant
1.2889
Std Err of Y Est
0.1884
R Squared
9
No. of Observations
7
Degrees of Freedom
1940
1923
PhysPop MortRate
5.3
163.06
6.4
137.39
4.6
138.31
6.9
138.92
4.8
131.82
2.8
130.51
4.0
119.16
3.3
113.16
4.3
106.79
Buccal + Pharynx Ca, Males
Regression Output:
-0.6198
Constant
1.2327
Std Err of Y Est
0.2577
R Squared
9
No. of Observations
7
Degrees of Freedom
X Coefficient(s)
Std Err of Coef.
Coefficient / S.E.
X Coefficient(s)
Std Err of Coef.
Coefficient / S.E.
S....
0.0373
0.0293
1.2746
0.0407
0.0261
1.5589
,............................................
Buccal + Pharynx Ca, Males
1940
1925
Regression Output:
PhysPop MortRate
-0.7436
Constant
5.3
161.67
1.1670
Std Err of Y Est
6.4
138.31
0.3346
4.6
R Squared
133.92
9
No. of Observations
6.9
134.36
7
Degrees of Freedom
4.8
127.54
2.8
122.30
0.0430
X Coefficient(s)
4.0
112.83
0.0229
Std Err of Coef.
3.3
107.22
1.8763
Coefficient / S.E.
4.3
103.61
1...................................................C.........................................
Buccal + Pharynx Ca, Males
1927
1940
PhysPop
157.83
137.50
131.54
138.40
126.18
118.75
108.25
102.07
102.13
Regression Output:
MortRate
5.3
6.4
4.6
6.9
4.8
2.8
4.0
3.3
4.3
Constant
Std Err of Y Est
R Squared
No. of Observations
Degrees of Freedom
X Coefficient(s)
Std Err of Coef.
Coefficient / S.E.
- 169
-
-1.2380
1.0624
0.4486
9
7
0.0477
0.0200
2.3862
a'.a.
*
-Io
- Part 2e.
Pacific
New England
West North Central
Mid-Atlantic
East North Central
Mountain
West South Central
East South Central
South Atlantic
.
.. -ii.
,
.......
-
t
rI
u,
.. i......
Part 2g.
1929
1940
PhysPop MortRate
156.64
5.3
138.46
6.4
128.72
4.6
138.49
6.9
126.51
4.8
118.68
2.8
105.60
4.0
99.41
3.3
100.86
4.3
- Part 2h.
Pacific
New England
West North Central
Mid-Atlantic
East North Central
Mountain
West South Central
East South Central
South Atlantic
,...
.... i ....
.°........
0 - Part 2i.
Pacific
New England
West North Central
Mid-Atlantic
East North Central
Mountain
West South Central
East South Central
South Atlantic
e ar
X Coefficient(s)
Std Err of Coef.
Coefficient / S.E.
......
.° .....
°. .....
....
........
1931
1940
PhysPop MortRate
159.97
5.3
142.35
6.4
126.50
4.6
140.82
6.9
128.59
4.8
118.89
2.8
105.95
4.0
96.73
3.3
99.59
4.3
°°
1936
1940
PhysPop MortRate
158.44
5.3
150.18
6.4
126.14
4.6
155.05
6.9
130.42
4.8
119.80
2.8
103.52
4.0
89.94
3.3
99.16
4.3
.....
........
.. °.........
..........
1938
1940
PhysPop MortRate
157.62
5.3
154.08
6.4
124.95
4.6
160.69
6.9
131.98
4.8
119.88
2.8
102.79
4.0
88.21
3.3
99.26
4.3
0.0472
0.0190
2.4891
159.72
161.55
123.14
169.76
133.36
. .....
..
..
. . . ..
..
. . .
. ..
.
.
Buccal
+ Pharynx Ca, Males
Regression Output:
Constant
-0.7783
Std Err of Y Est
1.0182
R Squared
0.4935
No. of Observations
9
Degrees of Freedom
7
S.............
°........
............
X Coefficient(s)
Std Err of Coef.
Coefficient / S.E.
.....
...................
............
........
.
°.........
......
0.0430
0.0131
3.2784
.. .........
S..
......
Buccal + Pharynx Ca, Males
Regression Output:
Constant
-0.5979
Std Err of Y Est
0.8714
R Squared
0.6290
No. of Observations
9
Degrees of Freedom
7
X Coefficient(s)
Std Err of Coef.
Coefficient / S.E.
....
........
°................
...
0.0422
0.0122
3.4453
,.................
5.3
6.4
4.6
6.9
4.8
- 170 -
.°.......
Buccal + Pharynx Ca, Males
Regression Output:
Constant
-0.4713
Std Err of Y Est
0.8197
R Squared
0.6718
No. of Observations
9
Degrees of Freedom
7
X Coefficient(s)
Std Err of Coef.
Coefficient / S.E.
0.0409
0.0108
3.7853
al +iPhRegression
ar nx C Output:
i ...........
Constant
Std Err of Y Est
R Squared
No. of Observations
Degrees of Freedom
.
0.0441
0.0169
2.6115
Buccal + Pharynx Ca, Males
Regression Output:
Constant
-0.6732
Std Err of Y Est
0.8985
R Squared
0.6056
No. of Observations
9
Degrees of Freedom
7
............
9/40 ... ...............
PhysPop MortRate
Pacific
New England
West North Central
Mid-Atlantic
East North Central
.
X Coefficient(s)
Std Err of Coef.
Coefficient / S.E.
1934
1940
PhysPop MortRate
160.09
5.3
148.60
6.4
125.96
4.6
149.62
6.9
129.36
4.8
117.16
2.8
104.68
4.0
92.00
3.3
98.41
4.3
. . . . . . . . . . . . . . . . . . .. . ....
Johln W.
Buccal + Pharynx Ca, Males
Regression Output:
Constant
-1.1282
Std Err of Y Est
1.0421
R Squared
0.4695
No. of Observations
9
Degrees of Freedom
7
... ,..
Pacific
New England
West North Central
Mid-Atlantic
East North Central
Mountain
West South Central
East South Central
South Atlantic
*
ielau m UI
01Clancer and, IsnclmIC Heart Disease
...
Pacific
New England
West North Central
Mid-Atlantic
East North Central
Mountain
West South Central
East South Central
South Atlantic
*
u.
............
0 - Part 2f
..
In
-0.2081
0.7525
0.7234
9
7
..
Uofman
Chap. 15
Radiation (Medical) in the Pathogenesis of Cancer and Ischemic Heart Disease
Mountain
West South Central
East South Central
South Atlantic
119.89
103.94
85.83
100.74
2.8
4.0
3.3
4.3
X Coefficient(s)
Std Err of Coef.
Coefficient / S.E.
John W. Gofman
0.0382
0.0089
4.2782
Box I of Chap. is
Summary: Regression Outputs, Buccal Cav. & Pharynx Cancers, Males.
Below are the summary-results from regressing the 1940 cancer MortRates
upon the ten sets
of PhysPops (1921-1940), as presented in Parts 2a-2j of this chapter.
Part
PhysPop
2a
2b
2c
2d
2e
2f
2g
2h
2i
2j --- >
1921
1923
1925
1927
1929
1931
1934
1936
1938
1940 Max
R-squared
0.1884
0.2577
0.3346
0.4486
0.4695
0.4935
0.6056
0.6290
0.6718
0.7234
Constant
X-Coef
-0.32
-0.62
-0.74
-1.24
-1.13
-0.78
-0.67
-0.60
-0.47
-0.21
0.0373
0.0407
0.0430
0.0477
0.0472
0.0441
0.0430
0.0422
0.0409
0.0382
Std Err
0.0293
0.0261
0.0229
0.0200
0.0190
0.0169
0.0131
0.0122
0.0108
0.0089
X-Coef/SE
1.2746
1.5589
1.8763
2.3862
2.4891
2.6115
3.2784
3.4453
3.7853
4.2782
Box 2 of Chap. 15
Input-Datafor Figure 15-A. Buccal Cay. & Pharyn Cancers. Males.
Part 2j, Best-Fit Equation: Calc. MortRate = (0.0382
*
PhysPop) + (-0.21)
Census Divisions
1940
Observed
PhysPops
1940
Observed
MortRates
Best-Fit
Calc.
MortRates
Pacific
New England
West No. Central
Mid-Atlantic
East No. Central
Mountain
West So. Central
East So. Central
South Atlantic
159.72
161.55
123.14
169.76
133.36
119.89
103.94
85.83
100.74
5.3
6.4
4.6
6.9
4.8
2.8
4.0
3.3
4.3
5.891
5.961
4.494
6.275
4.884
4.370
3.761
3.069
3.638
Additional PhysPops
--- not "observed" --down to zero PhysPop
(zero medical radiation).
For each, we calculate
a best-fit MortRate.
These additional x,y pairs
are also part of the
best-fit line (Chap 5, Part 5e).
70.00
60.00
50.00
40.00
30.00
20.00
10.00
0
-
171
2.464
2.082
1.700
1.318
0.936
0.554
0.172
-0.210
-
Box 3 of Chap. 15
Presumptive Fractionof CancerMortRate Attributable to Medical Radiation.
Please see text in Chapter 6, Parts 4 and 6.
Buccal-Cavity + Pharynx Cancers. MALES.
5.1 National MortRate
"* MALE National MortRate (MR) 1940, from Table 15-B
Constant
-0.2081
2j
Part
"* Constant, from regression,
# Frac. Causation
%
104.1
"* Fractional Causation, Best Est. = (Natl MR - Constant) / Natl MR
22, Part 3.
Chapter
See
100%.
>
values
# The Upper-Limit is 100%. Negative Constants produce
. .. . .
.....................................................................................................................
please.
4b,
Part
6,
Chapter
in
text
See
90% Confidence-Limits (C.L.) on Fractional Causation.
0.0382 X-Coef., Best Est.
0.0089 Standard Error
X-Coefficient, from Part 2j
Standard Error (SE) of X-Coefficient, from Part 2j
0.0528 New X-Coefficient
Upper 90% C.L. on X-Coef. = (Coef) + (1.645 * SE) =
New Constant
-1.8771
=
PhysPop)
Natl
1940
*
X-Coef
New Constant = (Natl MR) - (New
# New Frac. Caus'n.
136.8%
=
MR
Nati
/
Constant)
New
MR
(Natl
=
High-Limit
Frac. Causation,
22, Part 3.
Chapter
See
# The Upper-Limit is 100%. Negative Constants produce values > 100%.
Lower 90% C.L. on X-Coef. = (Coef) - (1.645 * SE) =
New Constant = (Natl MR) - (New X-Coef * 1940 Natl PhysPop) =
Frac. Causation, Low-Limit = (Natl MR - New Constant) / Natl MR =
0.0236 New X-Coefficient
1.9892 New Constant
61.0% New Frac. Caus'n.
Box 4 of Chap. 15
Error-Check on Our Own Work: Buccal-Cav. & Pharynx Cancers, Males.
Please see text in Chapter 6, Part 5.
B, the
Below, Columns A, C, and E come directly from the regression input in Part 2j. Column
3.
Chapter
in
3-B
Table
from
comes
Division,
Census
fraction of the whole 1940 population in each
product
the
is
entry
Column-F
Each
C-entry).
times
(B-entry
of
product
Each Column-D entry is the
of (B-entry times E-entry). PhysPops and MortRates are each "per 100,000."
132.04
The Weighted-Avg. Nat'l PhysPop, 1940, is the sum of Column-D entries =
The Weighted-Avg. Nat'l Male MortRate, 1940, is sum of Col.F entries =
The Nat'l Male MortRate is also (X-Coef * Nat'l PhysPop) + Constant =
Comparison: The Nat'l Male MortRate, 1940, in Table 15-B =
(A)
Census
Division
Pacific
New England
West No. Central
Mid-Atlantic
East No. Central
Mountain
West So. Central
East So. Central
South Atlantic
Sums
(B)
Pop'n
Fraction
0.0739
0.0641
0.1027
0.2092
0.2022
0.0315
0.0992
0.0819
0.1354
1.0000
(C)
PhysPop
1940
159.72
161.55
123.14
169.76
133.36
119.89
103.94
85.83
100.74
- 172 -
(D)
Weighted
PhysPop
11.80
10.36
12.65
35.51
26.97
3.78
10.31
7.03
13.64
132.04
5.03
4.84
5.10
(F)
(E)
MortRate Weighted
1940 MortRate
5.3
6.4
4.6
6.9
4.8
2.8
4.0
3.3
4.3
0.39
0.41
0.47
1.44
0.97
0.09
0.40
0.27
0.58
5.03
BuccPhaMrnyx Cancers:Males.
Figure 15-A.
1940 Buccal/Pharynx Mortality-Rates versus
1940 PhysPop Values for the 9 Census Divisions, USA.
Dose-Response Relationship
to
PhysPopis a surrogatefor accumulated dose from medical irradiation.
-T
9
8 _
7 _
0
6 _
I
5
Q
4
0
3
0
0
00
2
R-Squared = 0.7234
X-Coef/SE = 4.2782
National MortRate 1940
per 100,000 males.
I
=
5.1
0
I
-1
0
20
40
I
I
60
80
I
I
I
100
120
140
I
160
I
180
I
I
200
Physicians per 100,000 Population
Calc CA Mort/100K
0 Observed CA Mort/l00K
On the X-axis, PhysPop values = Physicians per 100,000 Population in
the Nine Census Divisions of the USA Population, Year 1940. This variable is
a surrogate for accumulated radiation dose --- the more physicians per 100,000
people, the more radiation procedures are done per 100,000 people.
On the Y-axis, Buccal/Pharnyx Mortality-Rate per 100,000 males = the
reported rates in USA Vital Statistics for the Nine Census Divisions, Year 1940.
Shown above is the strongest relationship between these two
variables (Part 2j). The nine datapoints (boxy symbols) were collected long
ago for other purposes, and are free from potential bias with respect to this
dose-response study. Fractional causation is (Natl MortRate minus the
Y-intercept) / (Nat] MortRate).
FractionalCausationof Buccal/Phatynx CancerMortalty-Rate in Males
by Medical Radiation = -u100 % from Best Estimate (Box 3).
61 % at Lower 90% Conf Limit (Box 3). "- 100 % at Upper 90 % Conf Limit (Box 3).
- 173
-
Table 15-A.
Buccal-Cav. & Pharynx CancerMortRates by Census Divisions: Males.
Rates are annual deaths per 100,000 male population, USA, age-adjusted to the 1940
reference year. There are no exclusions by color or "race." Sources are stated in Table
15-B, and described in Chap. 4, Part 2. The Nine Census-Division MortRates are
population-weighted (Chap. 4, Part 2b). The averages below them are not.
Census Division
Pacific
New England
West North Central
Mid-Atlantic
East North Central
Mountain
West South Central
East South Central
South Atlantic
Average, ALL
Average, High-5
Average, Low-4
Ratio, Hi5/Lo4
1940
1950
1960
1970
1980
1990
5.3
6.4
4.6
6.9
4.8
2.8
4.0
3.3
4.3
4.7
6.5
4.5
5.9
4.9
3.2
4.3
4.2
4.7
4.6
6.6
4.0
5.4
4.9
2.6
3.9
4.2
4.5
4.4
6.2
3.8
5.3
4.8
2.8
4.1
4.3
4.8
4.2
5.7
3.5
5.1
4.6
2.9
4.2
4.4
5.0
-
4.7
5.6
3.6
1.56
4.8
5.3
4.1
1.29
4.5
5.1
3.8
1.34
4.5
4.9
4.0
1.23
4.4
4.6
4.1
1.12
-
-
--
Table 15-B.
Buccal-Cavity & Pharynx CancerMortality Rates, USA National
Rates are age-adjusted to the 1940 reference year. Both sexes: Deaths per
100,000 population (males + females). Males: Deaths per 100,000 male
population. Females: Deaths per 100,000 female population. No exclusions by
color or "race."
Both Sexes
Male
1940
1950
1960
1970
1979-81
1989-91
* - 1940,
neoplasm of
e - 1970:
- 1980:
- 1990:
*
*
3.1
3.0
3.0
5.1
5.0
4.7
4.65
4.6
--
2.9
......
Female
1.1
1.2
1.3
1.4
1.5
1950, 1960: All rates come from Grove 1968, Table 67, p.679, "Malignant
buccal cavity and pharynx (140-148)," ICD/7.
All rates are interpolations (Chap. 4, Parts 2b, 2c).
All rates (ICD/9, 140-149) come from the reference NatCtrHS 1980.
No data obtained. Please see Chap. 4, Part 2c.
-
174
-