Ka Wai Ola - Office of Hawaiian Affairs, Volume 4, Number 8, 1 August 1987 — He Mau Ninau Ola [ARTICLE+ILLUSTRATION]

He Mau Ninau Ola

Some Health Questions by Kekuni Blaisdell, M.D.

Ninau: What happcned to the cancer blood and urine tests we Hawaiians had at the Wai'anae Clinic last year? I heard the results are being kept secret. Pane: You are probably referring to pilot studies on the biologic basis for high ma'i 'a'ai (cancer) rates in ka po'e Hawai'i conducted on 117 Wai'a-

nae Coast residents in 1986. These preliminary investigations were completed by the Cancer Research Center of Hawai'i through the Wai'anae Coast Comprehensive Health Center (WCCHC) and the Kaiser Ma'ili Clinic, with $100,000 from the 1985 State Legislature. A report was released by the Cancer Center in May, 1987. So the results are not huna (secret), although data on individual kanaka are being accorded appropriate confidentiality. Thus, if you are a participant and desire information about your individual examinations, you are advised to phone 696-5561 for Doris Segal Matsunaga, WCCHC health education director. A ho'ike ho'opokele (summary) of the five pilot projects follows: 1. Participants were adults randomly selected by

computer from 1942 World War II registrants linked to current drivers' license and voter registrants residing in the Wai'anae area. They included 41 piha Hawai'i (pure Hawaiians), 51 hapa Hawai'i, nine Japanese, eight haole, and four Filipino. 2. Diet data, expressed as amounts and frequencies of specific mea 'ai (food) items consumed for three days, were recorded on questionnaire forms by 60 po'e Hawai'i with the assistance of nutrition aides in the participants' homes. Rice, "soda" (soft drinks), beer, bread, pancakes, beef and oil were the major calorie sources. Correlations of particular nutrients with disorders, such as ma'i 'a'ai, have yet to be examined.

3. Urinary mutagens, chemicals īn ka mimi (unne) causing gene injury and thus possibly ma'i 'a'ai, were measured in 61 participants (Fig. 1). Asexpected, mutagens were found in ka mimi of all po'e puhi paka (smokers). However, urinary mutagens were also found in 51 percent of non-smokers! Also ho'opu'iwa (surprising) was the finding that 50 percent of non-smoking piha Hawai'i had high levels of urinary mutagens, eompared to only 1 1 percent of hapa Hawai'i and 25 percent of non-Hawaiians. The majority (78 percent) of hapa Hawai'i had no urinary mutagens, compared to 44 percent of piha Hawai'i and 38 percent for non-Ha-waiians. Thus, the degree of biological Hawaiianess did

not appear to be pertinent. So far, this mysterious finding of urinary mutagens mainly in non-smoking piha Hawai'i does not seem to be related to occupation or family history of ma'i 'a'ai either. Thus, the significance of this result for individual participants is also currently a mystery. Future noelo (research) will include examination of more piha Hawai'i, with matched control unne samples from a non-Hawaiian neighbor in eaeh case, testing of piha Hawai'i residing elsewhere on O'ahu and the neighbor islands, examination of multiple mimi samples from

mutagen excretors, attempts at correlation with dietary and other environmental factors and purification and ehemieal characterization of the mimi mutagens. 4. Oncogenes (cancer genes) in the white blood cells of 43 participants were examined for variations tht might be unique to ka po'e Hawai'i. None was found for six oncogenes tested out of the 24 cancer genes now known to occur in the DNA of the nucleus of normal cells (Fig. 1).

It was concluded that a cancer gene basis for the high risk of ma'i 'a'ai in ka po'e Hawai'i is unlikely. This adds another pieee of evidence against the "bad gene" theory of ill-health in ka po'e Hawai'i. 5. Community kako'o (support) and a cancer prevention proposal were concerns of a WCCHC Advisory Board and Cancer Center researchers. Considerable effort was given to employing and training staff persons, loeal native Hawaiians whenever feasible, who were familiar with, and acceptable to, the community in recruiting participants and conducting interviews. Appropriate mechanisms for informing participants of their individual test results and providing health eounseling are now being planned.

A draft of an antismoking lung cancer prevention research proposal was prepared. However, more input by ka po'e Hawai'i is now being sought. At a June 17 Advisory Council meeting, a plea was made for a Hawaiians-helping-Hawaiians approach to future Hawaiian health programs. 'Oia ho'i, ka po'e Hawai'i planning, conducting, analyzing, interpreting and publishing research on ka po'e Hawai'i. Likewise in providing health services for Hawaiians, with nonHawaiians helping Hawaiians, rather than vice versa. If we ka po'e Hawai'i are not qualified, then on-the-job training and other education measures should start promptly. Only then will the underlying causes for Hawaiian ill-health begin to be corrected.

Fig. 1. Eaeh human eell has a nucleus whieh contains strands of coiled DNA organized into thousands of units called genes. Genes control eell behavior including reproduction. Some genes are oncogenes (cancer genes) whieh, when activated, cause cancer. Activation may be initiated by exposure to a ehemieal , viral infection, or ionizing radiation whieh ean injure gene DNA resulting in a mutant eell. Such a mutant eell may die, may persist and reproduce as a non-cancer abnormal eell, or may heeome a cancer eell and eventuālly kill the host.