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A community based study of prostatic symptoms in Singapore.

PURPOSE: We describe the prevalence of prostatic symptoms, bother and related quality of life, as well as health seeking behavior in men 40 years old or older in Singapore. MATERIALS AND METHODS: A community based cross-sectional study was conducted in men 40 years old or older in Queenstown, Singapore. The International Prostate Symptom Score for benign prostatic hyperplasia was used to score symptom severity objectively. Results obtained were compared to those from United States, Scottish and Japanese populations. RESULTS: The prevalence of moderate to severe symptomatology was 10% after age adjustment to match the 1990 Singapore population. The most prevalent symptoms were frequency (22.5% of cases) and nocturia (21.5%) with consistently lower prevalence for bother (6.9% for frequency and nocturia). The prevalence of prostatic symptoms was approximately 3 or more times less than in the Scottish, United States and Japanese populations, while the prevalence of bother was approximately 10 times less. For symptomatic individuals there was poor correlation between symptom severity and bother scores. Bother scores correlated better with quality of life scores (r = 0.50) and were more closely associated with health seeking behavior (p = 0.03) than symptom severity scores (r = 0.39, p = 0.07). CONCLUSIONS: The prevalence of prostatic symptoms, severity and bothersomeness were all relatively low in Singapore. Bother was not analogous to symptom severity and should be considered independently in clinical decision making.

Adult↗

Occupational chromate allergy in Singapore: a study of 87 patients and a review from 1983 to 1995.

BACKGROUND: The prevalence of chromate allergy among all patients tested at the Contact and Occupational Dermatoses Clinic at the National Skin Centre in Singapore had fallen progressively from 1983 to 1989. Chromate has also become a less common occupational allergen because of the decline in the number of cases of allergic contact dermatitis from cement. OBJECTIVE: The aim of this report was to study and update the epidemiology of occupational chromate allergy among workers seen in a tertiary dermatology referral centre in Singapore from 1990 to 1995 and to review the changing trends of occupational chromate allergy in our local setting since 1983. The occurrence of concomitant contact allergens among was also studied. METHODS: All patients diagnosed to have occupational allergic contact dermatitis together with positive reactions to chromate, at the Joint Occupational Dermatosis Clinic at the National Skin Centre in Singapore, between January 1990 to December 1995, were included. Causes of chromate allergy and frequency of occurrence of concomitant contact allergens among construction and nonconstruction workers were compared. RESULTS: Eight hundred and fifty workers were seen during the 6-year-study period. Six hundred and thirty three (74.5%) were diagnosed to have occupational contact dermatitis, of which 257 (40.6%) had allergic contact dermatitis. Eighty-seven (33.8%) of these workers had positive reaction to chromate on patch testing. Ninety-five percent of these workers were men with a mean age of 33.4 years. The construction industry contributed 59% of the workers with chromate allergy. Cement (61%) remained the most common source of chromate allergy in our workers, and chromate from sources other than cement (39%) accounted for the rest. Of workers allergic to chromate from cement, 96% (51 of 53) came from the construction industry. Sixty percent of the workers with chromate allergy had concomitant contact allergens and the coexistence of two or more allergens was significantly more common among nonconstruction workers (53%) than construction workers (22%). The three most common concomitant contact allergens were cobalt (28%), rubber chemicals (21%) and nickel (18%). Nonconstruction workers had significantly higher rates of nickel allergy (36% v 6%) than construction workers (P < .03). Simultaneous reactivity to cobalt and nickel was also significantly more common among nonconstruction workers (22%) than construction workers (6%) (P < .03). CONCLUSION: Chromate has progressively become a less common occupational allergen at the National Skin Centre in Singapore from 1983 to 1989, because of a progressive fall in the number of cases of allergic contact dermatitis from cement. However, our study showed that occupational chromate allergy had now increased from 1990 to 1995, because of an increase in chromate allergy from sources other than cement. Chromate allergy from cement is declining, although still frequent, and sources other than cement are increasing in recent years. Concomitant nickel allergy, as well as simultaneous nickel and cobalt allergies, were more common among nonconstruction workers than construction workers.

Adult↗

Registration of new blindness in Singapore for 1985-1995.

Data on causes of blindness in Singapore from blind registration have been gathered yearly since 1950, when blind registration in Singapore was first started. The blind register is maintained by the Singapore Association of the Visually Handicapped (SAVH), based on reports from practising ophthalmologists in the government institutions. Ophthalmologists in the private sector (who also attend to the bulk of patients coming from overseas) do not register their blind patients. During the past four decades (from 1950 till 1990), analyses of our causes of blindness have been published by various local authors, quoting data from the blind register at the SAVH. These reports showed that our pattern of blindness reflected predictably the trend already observed in the developed countries, viz a shift from infections to congenital and age-related causes. This trend is in keeping with the impact of affluence on the economic and social environment, resulting in better health services and the prevention of avoidable diseases. Updated but hitherto unpublished new blind registrations in Singapore for 1985-1995 confirm the now established trend. As of now (in 1995), retinal diseases is the ranking cause (57.6%), followed by congenital and developmental disorders (14.7%), optic atrophy (9.3%), glaucoma (8.6%) and minor causes (1%).

Aging↗

The incidence of IDDM in Singapore children.

OBJECTIVE: To determine the incidence of insulin dependent diabetes mellitus (IDDM) in children 0-12 years of age in Singapore, which has a population of 2.9 million. METHODS: The primary source was a 2-year phone and mail survey of doctors in the government and government restructured hospitals and the private sector. The secondary source was the membership records of the Diabetes Society of Singapore. RESULTS: Using the capture-recapture method, ascertainment was assessed to be 92.2% complete. The age standardised incidence rate was 2.46 per 100,000 children 0-12 years old, for the period 1992-1994 (95% confidence interval: 2.16-2.75). The data seemed to indicate a rising incidence of IDDM in this population, being 1.4/100,000 in 1992, 2.4/100,000 in 1993 and 3.8/100,000 in 1994. The male: female ratio is 1:1.85. There was seasonal variation with fewer cases from July to October and more from November to May. Five percent of patients had a first degree relative with IDDM. Malays appeared to have a lower incidence (1.23/100,000) compared to the Chinese (2.25/100,000) and the Indians (5.78/100,000). CONCLUSIONS: The incidence of IDDM in Singapore children is similar to that reported for Hong Kong and Japan, but higher than that for Shanghai. The female preponderance is similar to that seen in other Asian population. The data suggests a rising incidence of IDDM in Singapore and differences in incidence between the Malays, Chinese and Indians, but further observations are needed.

Child↗

Diabetes mortality in Singapore, 1991--a preliminary study.

OBJECTIVES: The study was undertaken to estimate the contribution of diabetes mellitus to total mortality in Singapore and to study the mortality experience among known diabetics in Singapore by sex, age-group and ethnic group. METHODS: Death certificates of all persons who died in Singapore between 1 January 1991 and 31 August 1991 (n = 9,197) were reviewed. Records which mentioned diabetes mellitus as an underlying or contributory cause of death were selected as being a diabetic case (n = 1,010). RESULTS: If all diabetes related deaths were considered, diabetes mellitus would account for 9.3% of all deaths in Singapore in 1991, i.e. four times higher than the figure of 2.3% in the official statistics. Ischaemic heart disease was the leading cause of death in all age-groups. Renal failure was a major cause of death before the age of 55 while cerebrovascular disease and respiratory tract infections were important causes of death after the age of 64. Renal failure was the leading cause of death among Chinese diabetics below the age of 65. Ischaemic heart disease was the main cause of death among Indian and Malay diabetics. As compared to the general population, Chinese diabetics were more likely to die from renal failure while Indian and Malay diabetics were more likely to die from ischaemic heart disease.

Adult↗

Eye growth changes in myopic children in Singapore.

AIMS: To assess the longitudinal changes in biometric parameters and associated factors in young myopic children aged 7--9 years followed prospectively in Singapore. METHODS: Children aged 7--9 years from three Singapore schools were invited to participate in the SCORM (Singapore Cohort study Of the Risk factors for Myopia) study. Yearly eye examinations involving biometry measures were performed in the schools. Only myopic children (n=543) with 3 year follow up data were included in this analysis. RESULTS: The 3 year increases in axial length, anterior chamber depth, lens thickness, vitreous chamber depth, and corneal curvature were 0.89 mm, -0.02 mm, -0.01 mm, 0.92 mm, and 0.01 mm, respectively. Children who were younger, female, and who had a parental history of myopia were more likely to have greater increases in axial length. After adjustment for school, age, sex, race, parental myopia and reading in books per week, the age (p<0.001), sex (p=0.012), and parental myopia (p=0.027) remained significantly associated with the 3 year change in axial length. Reading in books per week, however, was not associated with axial length change. Children with faster rates of progression of myopia had greater increases in axial length (Pearson correlation coefficient (r)=-0.69) and vitreous chamber depth (r=-0.83). CONCLUSIONS: The 3 year change in axial length of Singapore children aged 7--9 years at baseline was high and greater in younger children, females, and children with a parental history of myopia. Myopia progression was driven largely by vitreous chamber depth increase.

Anterior Chamber↗

The use of Chinese herbal medicines and their correlates in Chinese older adults: the Singapore Chinese Longitudinal Aging Study.

BACKGROUND: There are very few studies of the use of Chinese herbal medicine and their psychosocial and health-related determinants in older adults. OBJECTIVES: To determine the prevalence of use of Chinese herbal medicine in community-living Chinese older adults in Singapore and its associations with socio-economic status, social support, health behaviour, health and functional status. DESIGN: Cross-sectional analyses of baseline data from a longitudinal cohort study of old adults (Singapore Chinese Longitudinal Aging Study). SETTING: Community of Toa Payoh in Singapore (total population 22800 out of 3 million). PARTICIPANTS: community residents comprising 2010 Chinese older adults aged 65 years and above. MEASUREMENTS: participants completed a questionnaire on Chinese herbal medicine use and other information on psychosocial and health-related variables. RESULTS: The use of Chinese herbal medicine over the past year was reported by 25.3% of the subjects, among whom 52% reported concurrent use of Western prescription medications. Significant factors that were strongly and independently associated with Chinese herbal medicine use were limited to extensive social support (OR = 2.66-5.56), current smoking (OR = 1.35), regular taiqi (OR = 1.94), arthritis (OR = 2.36), cancer (OR = 3.15), hypnotic use (OR = 2.08), IADL disability (OR = 1.72) and poor treatment compliance (OR = 2.35). CONCLUSION: Positive and negative psychosocial and health-related factors determine the use of Chinese herbal medicine use in Chinese older adults, consistent with the dual-pattern use of Chinese herbal medicine as health supplement and complementary/alternative medicine.

Age Factors↗

DENGUE-TYPE VIRUSES ISOLATED IN SINGAPORE.

A dengue-like illness with marked haemorrhagic manifestations appeared in Singapore in 1960. Its similarity in many respects to the haemorrhagic fevers of Thailand and the Philippines led to its being described as "Singapore haemorrhagic fever".This paper describes the isolation and identification of dengue-type viruses from patients in Singapore between 1960 and 1962. In addition to the conventional complement-fixation and neutralization tests, a new test, called the "sensitized erythrocyte agglutination test", was employed; this test method is described.Altogether 21 dengue-type viruses were isolated, including dengue types 1, 2 and 4. Chikungunya virus, prominent in the Thailand disease, was not detected.The author suggests that study of the epidemiology of haemorrhagic fevers in South-East Asia would cast further light on the transmission of arboviruses.

Arboviruses↗

Racial difference in the incidence of retinal detachment in Singapore.

OBJECTIVE: To determine the incidence of retinal detachment (RD) operations in a multiracial Southeast Asian population. DESIGN: Population-based incidence study using a universal medical savings database in Singapore. METHODS: Information on all RD operations performed for rhegmatogenous RD (International Classification of Diseases, Ninth Revision, Clinical Modification code 361.0) between 1993 and 1996 was retrieved and analyzed from a population-wide, government-administered medical savings database. Exudative, tractional, and unoperated-on rhegmatogenous RD are excluded. The 1990 Singapore population census was used to allow an estimation of age-, sex-, and race-specific annual incidence of RD. RESULTS: Between 1993 and 1996, 1126 RD operations were performed on Singapore residents. The average annual incidence of RD operations was 10.5 per 100,000 population (95% confidence interval [CI], 10.2-10.9). The annual incidence was highest for Chinese (age-adjusted incidence, 11.6 per 100,000), followed by Malays (7.0 per 100,000), and lowest for Indians (3.9 per 100,000). The age-adjusted relative risk of RD operation for Chinese compared with Indians was 3.0 (95% CI, 2.9-3.1). Males were twice as likely as females to require RD surgery (age-adjusted relative risk, 2.0; 95% CI, 1.7-2.4). Chinese men 40 years and older had a 30.9 times higher risk (95% CI, 9.9-96.1) than Indian females younger than 40 years. CONCLUSION: The incidence of RD is strongly associated with male sex and ethnic origin.

Adolescent↗

Near-work activity, night-lights, and myopia in the Singapore-China study.

OBJECTIVE: To investigate the relationship among near-work activity, night-lights, and myopia in schoolchildren in Singapore and Xiamen, China. METHODS: The refractive error and ocular dimensions of 957 Chinese schoolchildren aged 7 to 9 years in Singapore and Xiamen, China, were determined using cycloplegic autorefraction and A-scan ultrasound biometry. Information on near-work activity (number of books read per week, reading in hours per day) and night-light use before age 2 years was obtained. RESULTS: The prevalence rate of myopia was 36.7% (95% confidence interval [CI], 33.0%-40.3%) in Singapore and 18.5% (95% CI, 14.0%-23.1%) in Xiamen, China. The crude odds ratio (OR) of higher myopia (at least -3.0 diopters) for children who read more than 2 books per week was 3.50 (95% CI, 2.15-5.70). In a multivariate logistic regression model, the OR of higher myopia for children who read more was 2.81 (95% CI, 1.69-4.69), adjusted for age, night-light use, parental myopia, and country, whereas there was no association between night-light use before age 2 years and higher myopia (OR, 1.54; 95% CI, 0.92-2.58), after controlling for age, books read per week, parental myopia, and country. MAIN OUTCOME MEASURES: The ORs of higher myopia for children who read more and children who are exposed to night-lights before age 2 years. CONCLUSIONS: Reading (number of books per week) may be associated with higher myopia in Chinese schoolchildren. However, night-light use does not seem to be related to higher myopia.

Child↗

An outbreak of Fusarium keratitis associated with contact lens wear in Singapore.

CONTEXT: Fungal keratitis is a potentially blinding condition that is rarely seen with contact lens wear. OBJECTIVE: To describe a nationwide outbreak of fungal keratitis caused by Fusarium species among contact lens wearers in Singapore. DESIGN, SETTING, AND PATIENTS: Nationwide, hospital-based case series. All cases of fungal keratitis among contact lens wearers in all ophthalmology departments in Singapore were reviewed along with the charts of all contact lens wearers with culture-proven fungal keratitis from March 2005 through May 2006. A standardized telephone interview was conducted to obtain additional clinical information. MAIN OUTCOME MEASURE: Diagnosis of Fusarium keratitis associated with contact lens wear. RESULTS: During the study period, 66 patients (68 affected eyes) were diagnosed with Fusarium keratitis associated with contact lens wear; the estimated annual national incidence is 2.35 cases per 10,000 contact lens wearers (95% confidence interval, 0.62-7.22). Patients ranged in age from 13 to 44 years (mean [SD], 27.1 [8.4] years), of which 32 (48.5%) were men. The vast majority (65 patients; 98.5%) wore soft, disposable contact lenses; 62 patients (93.9%) reported using 1 brand of contact lens cleaning solution (ReNu, Bausch & Lomb, Rochester, NY), including 42 patients (63.6%) who recalled using ReNu with MoistureLoc. Most patients (81.8%) reported poor contact lens hygiene practices, including overnight use of daily wear contact lenses (19.7%), and use of contact lenses past the replacement date (43.9%). The final best-corrected visual acuity ranged from 20/20 to 20/80. Five patients (5 eyes; 7.4%) required emergency therapeutic or tectonic corneal transplantation. CONCLUSIONS: A new and evolving epidemic of Fusarium keratitis associated with contact lens wear was found in Singapore. Physicians and eye care practitioners worldwide need to be aware of the likelihood of similar outbreaks emerging among contact lens wearers.

Adolescent↗

Non-Hodgkin's lymphoma in an Asian population: 1968-1992 time trends and ethnic differences in Singapore.

BACKGROUND: Non-Hodgkin's lymphoma has increased in incidence in many countries, particularly in the West. Advances in diagnostic methods and the understanding of the disease over time pose a challenge to the interpretation of these trends. The aim of this study was to determine if the disease has increased in Singapore, a newly industrialized Asian country, and to examine the possible factors that may account for any observed changes. METHODS: Data from the population-based Singapore Cancer Registry for the period 1968 to 1992 were reviewed to determine time trends based on sex and ethnic group. The Poisson regression model was fitted to the cross-tabulated data to obtain the adjusted incidence density ratios. RESULTS: A total of 1988 cases of non-Hodgkin's lymphoma were included in the analysis. There was an overall increase in incidence among both Chinese and Malaysians. However, the rate of increase was greater in females (age-standardized rate from 1.8 per 100,000 in 1968-1972 to 4.5 per 100,000 in 1988-1992) than in males (3.2 per 100,000 to 5.9 per 100,000 in the same time periods). Between ethnic groups, Malay females were at higher overall risk compared with their Chinese counterparts (incidence density ratio 1.32; 95% confidence interval, 1.08-1.61). Although a substantial proportion of patients diagnosed with Hodgkin's disease between 1968 and 1972 were reclassified on review, using present criteria, as having non-Hodgkin's lymphoma, it is unlikely that this, and other recent changes in histologic interpretation, could have accounted for an increase of this magnitude. CONCLUSIONS: Non-Hodgkin's lymphoma has increased in incidence among the Chinese and Malay populations in Singapore. The pattern of increase differs from that of the common cancer sites, and suggests the need to look for environmental and genetic factors that have not yet been elucidated.

China↗

Colorectal carcinoma among ethnic Chinese in Singapore: trends in incidence rate by anatomic subsite from 1968 to 1992.

BACKGROUND: Recent epidemiologic studies have suggested that the anatomic distribution of colorectal carcinoma may have undergone a distal to proximal shift over several decades, which has been attributed variously to environmental and genetic factors as well as preventive intervention. METHODS: Trends in subsite distribution and the incidence rate of colorectal carcinoma among Chinese in Singapore between 1968 and 1992 were explored using data from the Singapore Cancer Registry (n = 10,489). Age-standardized incidence rates were computed and compared further using age-period-cohort models by subsite and gender. RESULTS: The proportion of lesions in the distal colon was found to have increased from 23.2% to 24.4% whereas that for the proximal colon and rectum were fairly consistent over the past 25 years. Our results also showed that age-standardized rates have doubled in proximal lesions (2-3% annually) and more than doubled in distal lesions (3-4% annually) whereas rates in rectal carcinoma have shown a slight increase or stability over time. The patterns of change in all subsite tumors could be attributed to a significant birth cohort effect. CONCLUSIONS: The results of the current study suggest that incidence rates have increased rapidly with no distal to proximal shift observed among ethnic Chinese in Singapore over the past 25 years. The pattern of change differs from findings reported in high incidence countries such as the U. S. and parts of Europe, suggesting that the preventive intervention and early diagnostic capabilities that may have played an important role in these countries have had less effect in Asia. The rapid overall increase in the incidence rate of colon carcinoma supports the role of dietary and other environmental factors as possible risk factors.

Adult↗

Prevalence of pharmacogenomically implicated prescriptions in multi-ethnic populations in Singapore.

AIM: To assess the potential impact of implementing pre-emptive pharmacogenomic (PGx) testing in Singapore, focusing on prevalence and genetic actionability of PGx prescriptions. METHODS: Electronic Health Records from 2014 to 2021 were obtained from the National University Hospital (NUH), a tertiary medical centre serving approximately 6% of Singapore's population, which were filtered for pharmacogenomically implicated medicines (CPIC Level A or A/B), defined as PGx medications. Coupling this with published data of whole-genome sequencing of 9051 Singaporeans, we estimated the proportion of patients whose prescriptions might have been modified based on pre-emptive PGx at population level. RESULTS: From 2014 to 2021, a total of 1&#xa0;157&#x2009;359 unique patients were seen at NUH, with 38.1% to 43.0% of patients with prescriptions receiving at least one PGx medication annually, exhibiting minimal variance over year of prescription, sex or race/ethnicity. The most frequently prescribed PGx medications were omeprazole, statins and tramadol, while the most implicated pharmacogenes were CYP2C19, CYP2D6 and SLCO1B1. The age-dependent increase in PGx medication exposure varied significantly by sex, with males prescribed these medications earlier in life than females. Similarly, Indians and Malays were more likely to be prescribed these medicines at a younger age than Chinese. Based on frequency of PGx variants in Singaporeans, we estimate that 18.4% of patients could have their prescriptions modified from pre-emptive PGx testing. DISCUSSION: Pharmacogenomically implicated medication prescriptions are common in Singapore and are particularly prevalent in elderly populations. Strategic investments in infrastructure and policy development will be pivotal to the successful integration of pre-emptive PGx into clinical practice.

Asian genomes↗

From genes to therapeutics: educating the government and the public on biomedical sciences-a Singapore experience.

Singapore has a highly developed economy and has been recognized to have one of the best business environments in Asia. Her success is based largely on focused developments of key industries in traded services and manufacturing sectors. The challenge for Singapore is to utilize her small human resource to transform the present economy to a more knowledge-intensive economy. Singapore has recently embarked on the ambitious goal of developing Biomedical Sciences as an industry. Educating the government and the public on various aspects of this new industry was identified as one of the essential steps towards this goal. The challenge was to inspire non-biologists to embrace the life sciences. This review describes how a series of workshops were developed to address the needs and the challenges of educating the public and the government.

Biological Science Disciplines↗

Prevalence of cognitive impairment amongst Singapore's elderly Chinese: a community-based study using the ECAQ and the IQCODE.

OBJECTIVES: This study examined the prevalence of cognitive impairment in the elderly Chinese living in the Queenstown district of Singapore using two locally-validated cognitive screening instruments: the Elderly Cognitive Assessment Questionnaire (ECAQ), and the Informant Questionnaire on the Cognitive Decline of the Elderly (IQCODE). METHODS: 234 elderly Chinese subjects were randomly selected from the Queenstown district and administered the ECAQ, while their principal relatives were administered the IQCODE. The screening instruments' respective cut-off scores to identify cognitive impairment indicative of dementia were based on local validation work. RESULTS: The prevalence of cognitive impairment was computed based on the percentage of failed scores on the two screening instruments. We found the prevalence of cognitive impairment to be 7.7% by ECAQ (95% Confidence Intervals (CI): 4.6%-10.1%) and 13.2% by IQCODE (95% CI: 9.4%-17.7%). A similar study in 1990 using ECAQ on elderly Chinese from the Henderson district in Singapore showed a cognitive impairment prevalence of 4%. This ECAQ-based variation between the two studies, likely indicates a true difference in prevalence rates between the two communities. On the other hand, the different ECAQ and IQCODE prevalence rates within our Queenstown study probably reflect spectrum bias, with IQCODE detecting earlier stages of dementia than ECAQ. CONCLUSION: We have found the prevalence of cognitive impairment amongst Singapore's elderly to be higher than previously reported. These findings imply that current resources may be inadequate for the effective care and management of the cognitively-impaired elderly in our aging community.

Aged↗

Population-based survival analysis of colorectal cancer patients in Singapore, 1968-1992.

Since the 1980s, colorectal cancer incidence in Singapore has ranked second to lung in males and females. We describe a population-based analysis of survival of colorectal cancer patients diagnosed from 1968 to 1992 in Singapore. Data of colorectal cancer patients diagnosed during 1968-1992 were retrieved from the Singapore Cancer Registry. Patients were passively followed up for death to the end of 1997. The final dataset consisted of 10,114 subjects. Observed and relative survival rates were calculated by stage (localized, regional metastases and distant metastases), age, ethnicity and calendar period for both genders. Over the study period, a significant progress in survival of colorectal cancer patients was observed. For localized cancer of the colon, the 5-year age-standardized relative survival (ASRS) increased from 36% in 1968-1972 to 66% in 1988-1992 for males and from 32 to 71% for females. For localized rectal cancer, the 5-year ASRS improved from 25 to 66% for males and from 23 to 66% in females. Similarly, improvement was observed in colorectal cancer patients with regional metastases, but not in those with distant metastases. Calendar year period and clinical stage of disease were identified as major significant prognostic factors of survival for colorectal cancer. The substantially improved colorectal cancer survival rates reflected the interplay of cancer control activities in various areas, such as health promotion, early diagnosis and treatment. Our study shows a unique changing pattern of survival experience for colorectal patients from a country undergoing rapid economic development.

Aged↗

Incidence rates of specific histological types of lung cancer in Singapore Chinese dialect groups, and their aetiological significance.

Significant differences in the incidence levels of lung cancer have been observed among major Chinese dialect groups or communities (Kokkien, Teochew and Cantonese) in Singapore. Among males, the incidence rate is highest in the Hokkiens (age-standardized incidence rate per 100,000 persons per year in Hokkien 67.8, Teochew 55.3, Cantonese 54.0) and among females, it is highest in the Cantonese (Hokkien 12.4, Teochew 12.8, Cantonese 27.2). The present investigation was undertaken to determine the incidence rates of each of the main histological types of lung cancer in the Chinese population and to determine whether there are any correlations between histological patterns and the dialect group differentials that may be of aetiological significance. During the period 1968-1972, a total of 1,747 cases of lung cancer (1,285 males and 462 females) were reported to the Singapore Cancer Registry. It proved possible to type the neoplasms histologically in 476 males (37.0%) and 154 females (33.3%). Age-standardized rates by histological type were computed on the assumption that those histologically typed were a representative sample of all lung cancers. This study shows that Hokkien males have a significantly higher incidence rate of epidermoid carcinoma than the other dialect groups (Hokkien 36.1, Teochew 21.1, Cantonese 17.3). The Cantonese females have significantly higher incidence rates of both epidermoid carcinoma (Hokkien 3.7, Teochew 2.3, Cantonese 5.9) and adenocarcinoma (Hokkien 4.6, Teochew 3.6, Cantonese 11.9). Various sources of bias in studied of this type were examined; it is concluded that the differences in the histologic-specific incidence rates of lung cancer among the various Chinese dialect groups in Singapore are real and not artefactual. The significance of these findings in relation to possible aetiological factors is discussed.

Adenocarcinoma↗