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Holocaust Survivors at Higher Long-Term Cancer Risk

The deprivation they faced is probably to blame, researchers say

FRIDAY, June 30, 2006 (HealthDay News) -- A new study finds that rates of cancer and cancer-related death are especially high among survivors of the Holocaust in Israel.

An Israeli research team found that Holocaust survivors who emigrated from Europe to Israel following World War II are at higher risk for cancer compared to European Jews who moved there before the war began.

Much of the difference can be attributed to cancers found among the youngest Holocaust survivors. Specifically, male and female immigrants born in Europe between 1940 and 1945 faced the highest odds of developing breast or colorectal cancers, the researchers found.

While the findings may have implications for survivors of mass atrocities in general, they are of immediate concern to the 238,600 Holocaust survivors still living in Israel, said study co-author Dr. Micha Barchana.

"The bad news is that Holocaust survivors are at a higher risk to get cancer, but the good news is that we can do something [about it]," he said. "We are focusing on the practical implementation of the research results: the need for survivors to participate in early-detection programs that are offered in Israel as well as in most modern countries, due to the finding that classifies them as a high-risk population," he explained.

Barchana serves as the director of the National Cancer Registry in the Israeli Health Ministry and is also a senior lecturer in the school of public health at the University of Haifa in Israel.

He and his colleagues presented their research earlier this year at the International Agency for Research on Cancer, held in Lyon, France. The work was funded by the Israel Cancer Society.

Barchana's team reviewed records from the Israeli government's Central Bureau of Statistics to first draft a list of all Jewish immigrants to Israel born in Europe between 1920 and 1945.

They then turned to the Israeli Health Ministry's National Cancer Registry to compile cancer incidence and death rates among these immigrants.

The researchers found that those immigrants born between 1920 and 1945 who came to Israel between the end World War II and 1989 were at significantly higher risk for cancer than immigrants born between 1920 and 1939 who migrated to Israel before the onset of World War II.

Barchana said his team does not know how many of the post-war European immigrants suffered through the experience of Nazi concentration camps or wartime Jewish ghettos. However, he said his team assumed that many or most did, and that, in any case, "all the Jews in Europe at war time had gone through severe food deprivation and other stresses."

Higher cancer risks seemed to linger for decades for this group, the researchers found. Male Holocaust survivors experienced a 14 percent higher cancer incidence rate than pre-war immigrants and were 2.4 times more likely to get cancer than their pre-war compatriots.

Female Holocaust survivors had a 21 percent higher rate of cancer than pre-war immigrants and were 2.3 times more likely to have a cancer diagnosis than pre-war immigrants.

Breaking down cancer incidence by specific diseases, the authors found that Holocaust survivors were at a significantly higher risk for lung cancer, Kaposi's sarcoma (a rare form of skin malignancy), and prostate cancer.

Heightened risks for certain other cancers stood out. For example, male Holocaust survivors were nine times more likely to be diagnosed with cancer of the large intestine than pre-war immigrants. Female Holocaust survivors faced more than double the risk for cancer of the large intestine and a 50 percent higher risk of developing breast cancer, the study found.

In addition, Barchana's team found that the younger the Holocaust survivor was during the war, the greater their risk for getting cancer. In fact, most of the increase in risk among Holocaust survivors was borne by those who were 14 years of age or younger during World War II.

Barchana said that finding has been shown in other studies involving survivors of terrible events. "Research on A-bomb survivors in Japan clearly shows that women that were at a young age are at higher risk of developing cancer later in life," he said. Similar data is emerging among those affected by the Chernobyl nuclear plant accident, Barchana added.

Patients who had survived the Holocaust also had a tougher battle to fight off the disease once it was diagnosed, the researchers found. According to Barchana, that may be due to the fact that "Holocaust survivors are being diagnosed at later stages compared to the control group."

Five-year cancer survival rates were 5 percent to 13 percent lower among Holocaust survivors compared to other immigrants, regardless of sex or age.

According to the researchers, the findings suggest that severe deprivation, from whatever cause, may weaken the body's long-term defenses against cancer. Inmates in the Nazi concentration camps suffered prolonged exposure to extreme poverty, food deprivation, over-crowding, harsh weather, physical abuse and mental stress.

The authors called for Holocaust survivors and their families to be increasingly vigilant about cancer detection, particularly for breast and colorectal cancers, and to avail themselves of the free screenings for such diseases that are currently available in Israel.

On a wider note, Barchana emphasized the role that food deprivation probably plays as a contributing factor to increased cancer risk.

"There has been some (prior) data on the possible role of malnutrition in breast cancer etiology," he remarked. "This work completes this knowledge, and this aspect of the study should be further investigated," Barchana said.

Dr. Michael Thun, vice president of epidemiology and surveillance research with the American Cancer Society in Atlanta, said the study was interesting and, in some ways, surprising.

"When one compares these results to studies of the Dutch Famine of 1944 to 1945, what they had found was that there was an increase in breast cancer risk, but they did not find the same increase in other cancers," Thun noted. "So, in this study, it was surprising to me that there was an increase in risk in colorectal cancer and a range of different cancers," he said.

"But in the case of the Holocaust, people had so many terrible things happen that it's even more complex and dreadful than just the famine resulting from war," added Thun. "So, I agree with the authors' conclusions that closer screening of these people is warranted to detect cancers early," he said.

More information

For advice on cancer screening, visit the American Cancer Society.

SOURCES: Micha Barchana, M.D., director, National Cancer Registry, Israeli Health Ministry, and senior lecturer, school of public health, University of Haifa, Israel; Michael Thun, M.D., vice president, epidemiology and surveillance research, American Cancer Society, Atlanta.; presented February, 2006 at the International Agency for Research on Cancer, Lyon, France.
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