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This study presents a new model of screening for colorectal cancer. Persons aged 50 or over in a city of 160,000 inhabitants were encouraged by a newspaper campaign to act on signs of fecal blood and to come forward for examination. A quantitative immunological human hemoglobin (Hb)-specific test method was employed, and, as a simple discriminatory help to minimize perianal contamination, a constringent local ointment was used. The group of fecal bleeders was examined by colonoscopy. Altogether, 1638 persons came forward to request screening. Of these, 168 were submitted for colonoscopy, and, among those 18 colorectal cancers (11% of colonoscopies) were found. Of the cancers a significant part 28% were early cases (Dukes' A). In addition 28 adenomas were detected. The results show that there exists in the population a group of neglected fecal bleeders. Increasing the population's awareness of this symptom as a possible sign of colorectal cancer combined with prompt and proper medical investigations would lead to the detection of early cases of colorectal cancers.

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The effect of one single dose of N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) on the antigenic structures of gastric juice glycoproteins, was studied in dogs. Antisera to glycoproteins of the fetal alimentary canal were raised. Histologic mucosal specimens and glycoprotein fractions of gastric juice which were taken from four dogs during a 15.5-month period after MNNG administration, were examined immunohistologically and by immunodiffusion for the appearance of fetal-like antigens. Fetal-like structures appeared in a stepwise manner in both the acid and neutral glycoprotein fractions of the gastric juice, and showed gradual crossreactivity between macromolecules obtained from gastric juice samples obtained during the observation period. Eight immunizations carried out using physicochemically different glycoprotein fractions of fetal canine alimentary canal mucosa, produced a similar response, thus indicating that the same antigenic structures are incorporated into all mucus glycoproteins, even though they do differ physicochemically. It is suggested that this "omnipotential" incorporation picture could also be found after exposure to MNNG and is, by its nature, typically fetal.

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A clinicopathological analysis is presented of gastric cancer cases detected in a mass screening trial in Finland, using the oncofetal antigen, fetal sulfoglycoprotein antigen, as a marker. The survey covered a population of 53,020 between the ages of 40 and 70, the percentage of participation being 74.8%. Of these participants, 3,508 subjects (8.8%) were found to be fetal sulfoglycoprotein antigen secretors, and among them 36 gastric cancers, one gastric carcinoid, and 10 tubular adenomas were detected. Both main histological types of gastric cancer, intestinal and diffuse, were represented. There were 15 early cancers. In addition, there were three widely spread superficial cancers. Because of early diagnosis, the prognostic view for these cases is clearly better than that found in the clinic by conventional means, curative resection being carried out in 28 cases (78%).

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A purification procedure for a gastric cancer-associated glycoprotein FSA is described. This substance was considered to be sulphated but is now found to derive its charge from carboxylic groups and has been renamed foetal sialoglycoprotein. The chemical composition is similar to blood group substances with differences which may reflect its origin from gastric cancer. The molecular size differs from that of the carcinoembryonic antigen. The calculation of the yield based on dry weight measurements is not possible until a radioimmunoassay technique becomes available and development of such an assay is now in progress in our laboratory.

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Discrimination between histologically confirmed benign and malignant gastric ulcerations was studied, using an oncofetal antigen (FSA) as the parameter of malignant transformation. In chronic gastric ulcer FSA could be found in 54.2% as compared with 20.0% in duodenal ulcer patients. 91.1% of gastric cancers were FSA positive. A current epidemiological study on a non-selected population gives 8.8% FSA secretors. The study supports the earlier conception that chronic gastric ulcer must be considered a precursor of cancer, and indicates the need, especially in cases showing FSA secretion, for active surgical therapy or a long-term follow-up with endoscopic biopsies.

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The immunological status of seven patients with disseminated melanoma during BCG scarification was followed. As parameters, the total peripheral blood leukocyte and lymphocyte counts, serum immunoglobulin levels, natural ABO blood group antibodies, lymphocyte responses in vitro to PHA and PPD, and skin reactivity against PPD and candidin were followed during a period of 2--36 months. The EAC-rosette-forming cells increased and the E-rosette-forming cells decreased during prolonged BCG therapy. The skin reactions and lymphocyte responses showed in most patients conversion from negative to positive or augmentation at the start of the therapy. Later on, however, the values in most patients dropped before disseminated disease became clinically apparent. In the only surviving patient the values first increased, remained high, and after 100 weeks treatment decreased. After 140 weeks' treatment immunological parameters are similar to pre-treatment levels. The possibility that prolonged intensive BCG treatment might eventually suppress the immune system, and thus result in an enhanced risk of dissemination of the disease, is discussed.

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Sulphopolysaccharides, isolated from gastric juice of patients with pernicious anemia or gastric cancer, have been characterized immunologically using corresponding rabbit immunosera. Gastric juice sulphopolysaccharides differ from their normal form in the following conditions: a) when there is intestinal type metaplastic tissue in the gastric epithelium; b) in the presence of gastric cancer. Efforts to differentiate between these types by the absorption technique using rabbit immunosera were successful, and it was possible to demonstrate an antigenic determinant in sulphopolysaccharides from cancerous gastric juice not present in controls with benign intestinal type heterotopia as in pernicious anemia.

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