Two Nutrition Intervention Trials in Linxian, China were designed to investigate the effect of nutritional supplementation on esophageal cancer, gastric cancer, and other causes of death. These trials showed a beneficial effect of a multivitamin-mineral supplement on stroke death and on the prevalence of hypertension. Men who took this supplement had a 60% reduction in rates of stroke death. We are designing a study to investigate the relationship of this finding to treatment by measuring baseline levels of homocysteine and the B-vitamins. Similar studies are in progress to investigate whether pre-intervention serum levels of antioxidant vitamins, serum markers of fungal food contamination, and serum markers of bacterial or viral infection are associated with risk of subsequent esophageal or stomach cancer. This year, we also reassessed the current health status of all living trial participants to see whether the early beneficial effects found on esophageal cancer, gastric cancer, and the precursors of esophageal cancer have persisted. We have initiated a new trial of 3,400 subjects in Shandong, China. This trial is designed to test whether any of three interventions that are thought to be of potential benefit in preventing gastric cancer will retard progression of precancerous gastric lesions. We developed statistical methods for evaluating community-wide interventions and applied them to analyze the COMMIT study, a study which tested the effectiveness of various community-wide interventions to promote cessation of cigarette smoking. Though the interventions did increase quit rates among light-to-moderate smokers, the quit rates among heavy smokers were not affected. We collaborated on several studies to assess the long-term effects of treatment for cancer. Long-term survivors of Ewing's sarcoma were less likely to marry, to have children, and to be employed than sibling controls. Female survivors of acute lymphoblastic leukemia in childhood began menstruating within the normal age range in most (92%) cases. Cyclophosphamide treatment for non-Hodgkin's lymphoma was associated with a strong, dose-dependent increase in the risk of bladder cancer.
