The relationship between spontaneous and induced abortions and breast cancer risk was analyzed using data from a case-control study conducted between June 1991 and February 1994 in 6 Italian centers on 2,569 histologically confirmed incident breast cancer cases and 2,588 controls admitted to hospital for a wide range of acute, non-neoplastic, non-hormone-related diseases. One or more abortions were reported by 31% of cases and 32% of controls, corresponding to a multivariate odds ratio (OR) of 1.0 (95% confidence interval [CI], 0.8–1.1). No trend in risk was observed with increasing number of total abortions or spontaneous and induced abortions separately. No significant relationship was found between the risk of breast cancer and history of spontaneous or induced or total abortions in separate strata of age at diagnosis, number of children, time of abortion in relation to first birth and family history of breast cancer. When abortion was the outcome of the first pregnancy, the OR was 1.2 for spontaneous and 1.3 for induced abortion, in relation to women with birth as outcome of the first pregnancy, and 1.0 and 1.1, respectively, when the reference category was nulligravidae. Thus, our results indicate a lack of association between induced and spontaneous abortions and breast cancer risk. © 1996 Wiley-Liss, Inc.

To assess how the risk of cancer of the colon and rectum relates to place of birth and socio-economic status, we analysed data from an Italian case-control study. Data included 1225 cases with a recent diagnosis of cancer of the colon (ages 19-74 years), 728 cases of cancer of the rectum (ages 23-74 years) and 4154 controls (ages 19-74 years), frequency-matched with cases by age and catchment area and admitted to hospitals for a wide spectrum of acute non-neoplastic conditions. Compared with residents born in the north of Italy, migrants from the centre and south had an odds ratio (OR) of 0.7 (95% CI 0.5-0.9) for colon cancer and OR of 0.9 (95% CI 0.7-1.2) for cancer of the rectum. The inverse association of migration with colon cancer was stronger among women (OR 0.5, 95% CI 0.4-0.8) than among men (OR 0.8, 95% CI 0.6-1.1), and was independent of education and occupation. Among migrants, the direct association between education and colon cancer risk was less clear than among non-migrants. In conclusion, place of origin played an independent role in colon cancer aetiology. Results on rectal cancer were less clear, although in the same direction. Among migrants, those less susceptible to behavioural changes (e.g. women) retained most of the benefit associated with their place of origin.

The relationship between oral contraceptives (OC), menopausal hormone replacement treatment (HRT) and breast cancer risk was analysed in a case-control study conducted in the Swiss canton of Vaud on 230 cases below the age of 75, linked with the Vaud cancer registry, and 507 controls in hospital for a wide spectrum of acute, non-neoplastic, non-hormone-related diseases. A total of 77 (37.4%) cases and 134 (31.6%) of controls below the age of 70 had ever used OC, corresponding to a multivariate odds ratio (OR) of 1.5, of borderline significance. The risk was related to duration of use, but this might be partly due to a recency effect. In fact, with reference to time since last OC use, the OR was above unity for up to 14 years, but declined to 1.0 for women who had stopped OC use for > or = 15 years. With reference to HRT, ever users were 64 (27.8%) of cases and 113 (23.3%) of controls, yielding a multivariate OR of 1.3. Also, for HRT the association was stronger for shorter time since last use; the OR was 1.5 for women who had stopped for < 10 years, but declined to 0.8 for those who had stopped for 10 years or longer. The association with HRT was stronger for women aged > or = 65. Thus, the present study confirms that breast cancer risk is moderately related to OC and HRT. The association, however, is essentially restricted to the 10-15 years after stopping use. This pattern of risk is consistent with a late-stage effect of steroid hormone preparations on the process of breast carcinogenesis, and has relevant implications for any risk/benefit assessment and public health evaluation.

The result that, on average, in Europe smoking consumption decreases 5-7% for a 10% increase in the real price of cigarettes strongly supports an inverse association between price and cigarette smoking.

In this Italian population dietary iron intake was inversely related to AMI risk. This inverse association may depend on other nutrients present in the major sources of iron in the Italian diet.

aMario Negri Institute for Pharmacological Research and bInstitute of Medical Statistics, University of Milan, Milano, Italy Correspondence to Prof Carlo La Vecchia, Istituto di Ricerche Farmacologiche 'Mario Negri', via Eritrea 62, 20157 Milan, Italy Tel: +3902 3901 4527; e-mail: [email protected]

A Bayesian hierarchical model was used to study the spatial variation in mortality risk from lung and pleural cancer in both sexes, and breast and soft tissue sarcoma (STS) in women in Piedmont (north-west Italy, average population 4 349 411) from 1980 to 2000. Of these four neoplasms, two are common (lung and breast) and two rare (pleura and STS); two have well recognized risk factors (lung and pleura) while the other two (breast and STS) have no single strong risk factor. Data were analysed at a small-area level (1206 municipalities, population 39 to 989 663), using both standardized mortality ratios and Bayesian-estimated mortality risks. The Bayesian model allowed for both heterogeneity (through spatially independent random effects) and clustering (through spatially correlated random effects) and, by borrowing information from neighbouring areas, provided stable estimates for areas with sparse data. The aim was to reduce the noise in the disease maps to highlight the true underlying mortality distribution. Lung cancer in men showed strong spatial structure with a marked east-west gradient, but no appreciable urban-rural differences. In contrast, high mortality areas for female lung cancer were observed around conurbations. Female breast cancer and STS appeared to be spread uniformly across the region. Pleural cancer mortality clusters were evident around areas with major asbestos manufacturers, or natural asbestiform fibre pollution. Maps of Bayesian-estimated mortality risk provided appreciably clearer pictures of risk distribution than did maps of the standardized mortality ratio.

The relation between selected indicator foods, alcohol and coffee intake, and the risk of pancreatic cancer was evaluated in a case-control study conducted between 1983 and 1992 in northern Italy on 362 patients with histologically confirmed, incident cancers of the pancreas, and 1,552 controls in hospital for acute, non-neoplastic diseases. Odds ratios (ORs) for subsequent tertiles of intake were computed after allowance for sociodemographic factors and tobacco smoking. Pancreatic cancer risk was directly associated with consumption of meat (OR for the highest frequency tertile = 1.43), liver (OR = 1.43) and ham and sausages (OR = 1.64), and inversely with consumption of fresh fruit (OR = 0.59), fish (OR = 0.65) and olive oil (OR = 0.58). No appreciable association was found with coffee (OR = 1.21) and alcohol consumption (OR = 1.20). A summary score was derived by summing the six related food items; compared to the lowest level, the OR was 2.7 for the highest quintile, and the population attributable risk was 36% (95% confidence interval, 15-57%), indicating the scope of diet for the prevention of this common neoplasm in the Italian population.

Our findings show that correlates of sociocultural level and place of origin exert an influence on breast cancer risk which is not accounted for completely by known risk factors (i.e. reproductive and menstrual characteristics and recent dietary habits). Such influence may thus occur early in life.

Pipe smoking has been related to the risk of cancers of the upper digestive and respiratory tract, but quantification of the risk for exclusive pipe smokers is still limited. To analyse the association between exclusive pipe smoking and cancers of the upper digestive tract, we used data from a series of case–control studies conducted in Italy and Switzerland between 1984 and 1999. After excluding cigarette and cigar smokers, 41 male oral and pharyngeal cancer cases, 52 male oesophageal cancer cases and 1,032 male controls were included in the present analysis. Odds ratios (OR) of cancers were estimated by the mean of unconditional multivariate logistic regression, including terms for age, study centre, education, body mass index, and alcohol drinking. Compared to never smokers, exclusive pipe smokers had an OR of 8.7 [95% confidence intervals (CI): 4.0–18.9] of all upper digestive tract cancers. The OR was 12.6 for oral and pharyngeal and 7.2 for oesophageal cancer. Pipe smokers who were also heavy alcohol drinkers had an OR of 38.8 (95% CI: 13.6–110.9) as compared to never smokers and light drinkers. Thus, pipe smoking and heavy alcohol drinking appears to interact at least on a multiplicative model. ' 2007 Wiley-Liss, Inc.

The possible relationship between fibre intake and breast cancer risk has been considered in several studies, but the issue is still unsettled. Epidemiological data are compatible with moderate protection from fibre-rich foods against the risk of breast cancer, but also with an absence of association. The apparently inconsistent results may be due to chance or bias, to different approaches to data analysis and interpretation, but may also reflect heterogeneity in the dietary sources of fibres (cereals or vegetables and fruit) in various populations, and different correlates of fibre intake.