To obtain quantitative information on the risk of invasive cancers following a diagnosis of basal cell carcinoma (BCC) of the skin, patients with incident BCC cases listed in the cancer registries of the Swiss cantons of Vaud and Neuchâtel between 1974 and 1994 were actively followed up through December 31, 1994, for the occurrence of subsequent invasive neoplasms. Among 11,878 persons with incident BCC who were followed for a total of 76,510 person-years at risk, 1,543 metachronous cancers were observed versus 1,397.9 expected, corresponding to a standardized incidence ratio (SIR) of 1.1 (95% confidence interval (CI) 1.0-1.2). However, after exclusion of skin cancers (mostly squamous cell carcinoma and melanoma), 975 second primary cancers were observed versus 1,059 expected (SIR = 0.9, 95% CI 0.8-1.0). Significant excesses were registered for cancer of the lip (SIR = 2.2), for squamous cell skin cancer (SIR = 4.5) and melanoma of the skin (SIR = 2.5), and for non-Hodgkin's lymphoma (SIR = 1.9). The SIRs were also above unity, though not significantly, for cancers of the salivary glands (SIR = 2.8) and the small intestine (SIR = 2.1) and for soft-tissue sarcomas (SIR = 1.7). The SIR for lung cancer was 0.9. The SIRs for salivary gland and skin cancer were appreciably greater below age 70 years. For most sites, particularly for squamous cell cancer and melanoma of the skin, the SIRs remained elevated 5 or more years after BCC diagnosis. The cumulative incidence of squamous cell skin cancer was 13% at 19 years; this stresses the importance of carefully monitoring skin lesions among persons previously diagnosed with BCC.

Smoking trends and patterns in Italy were evaluated using data from the 1986-87 Italian National Health Survey, based on a sample of 30,096 males and 32,176 females aged 15 or over, randomly selected within strata of geographical areas and sizes of the place of residence and of the household in order to be representative of the whole Italian population: 40.8 % of Italian males and 17.3 % of females described themselves as current smokers (overall estimated prevalence, 28.6 %). In comparison with previous survey-based data, self-reported smoking prevalence in males has been steadily decreasing over the last three decades, whereas rates in females have been increasing up to the early 1980s, and have shown a levelling off only in more recent years. The apparent declines in self-reported smoking, however, were not reflected in official sales figures. In fact, in the mid 1980s, there were simultaneously the lowest overall prevalence of the last three decades and the highest sales figures ever reported. The inter-sex differences in smoking prevalence were smaller at younger ages. Education, but not occupation as a measure of social class, was inversely related to smoking prevalence in males. Furthermore, rates for males were lower in the northern (and richer) part of the country. The pattern was totally different in females, since smoking prevalence was higher in more educated women, of higher social class, living in North Italy. This suggests that, in the absence of adequate measures, smoking prevalence is likely to rise among Italian women in the near future. Continued monitoring of smoking patterns gives important information with which to identify the most likely future patterns in smoking and smoking-related diseases, besides providing data for targeting intervention programs.

In a case-control study to evaluate risk factors for endometrial cancer, obesity, history of various diseases, reproductive and menstrual characteristics, marital status, education, and lifetime use of female hormones were examined in 173 histologically proven endometrial cancers and 347 controls. Obesity, non-contraceptive oestrogen use, late menopause, low parity and history of uterine fibromyomas were associated with an increased risk of endometrial cancer. The relative risks of obesity and oestrogen use seem to fit well for an additive model. Histological differentiation was positively correlated both to oestrogen use and to level of overweight, supporting the hypothesis of a specific role of oestrogens in endometrial cancer.

The association between oral contraceptive (OC) use and the risk of uterine fibroids was analyzed in a case-control study conducted between 1986-1990. The subjects were 390 patients under 55 years of age with histologically confirmed fibroids and 1136 controls in hospitals for a spectrum of acute conditions (other than gynecologic, hormonal, or neoplastic) apparently unrelated to OC use. A total of 78 cases (20%) and 200 controls (18%) reported OC use. Compared with never-users, the multivariate relative risk for ever-users was 1.1 (95% confidence interval [CI] 0.8-1.5). No direct relationship emerged with duration of use, the estimated relative risk being 1.3 (95% CI 0.9-2.0) in users of OCs for less than 3 years and 0.8 (95% CI 0.5-1.3) in users for 3 years or more. The risk of fibroids was apparently (though not significantly) greater with longer recency of use: The estimated relative risks were 0.9 and 1.5, respectively, in women reporting last OC use less than 10 years before and 10 or more years before diagnosis of the disease. No relationship emerged with latency of use. There was no noteworthy interaction regarding risk of fibroids between OC use and potential covariates. These findings suggest that fibroids are unrelated to the use of OCs.

Over the last two decades, mortality rates for colorectal cancer in many developed countries have declined in women but not in men. A role of exogenous female hormones (i.e. oral contraceptives and hormone replacement therapy (HRT) in such different trends is possible. Seven cohort studies reported information on HRT use and colorectal cancer risk, for a total of over 2,400 cases. Most studies showed relative risks (RRs) around or below unity. A significant inverse association was found in two cohort investigations, including the largest one dealing with fatal colon cancer. Of 12 case-control studies, for a total of over 5,000 cases, five reported 20-40% significant risk reductions among ever-users of HRT. Two additional investigations showed moderate, non-significant inverse associations. Studies showing an inverse association between HRT use and colorectal cancer were among the largest and best controlled ones. The apparent protection tended to be stronger among recent users. Differences in RRs by duration of HRT use and anatomic subsite were not consistent, but the protective effect seemed stronger in most recent publications. Available studies support the possibility of an inverse association between colorectal cancer and HRT, but prevention and surveillance bias cannot be ruled out.

The relationship between selected dietary factors and the risk of bladder cancer was investigated in a case-control study conducted in northern Italy. The study included 163 cases and 181 controls who were hospitalized for acute, nonneoplastic or urinary tract diseases. The frequency of consumption of green vegetables and carrots was lower in the cases; thus, the estimated relative risks for the upper vs. the lower tertiles were 0.6 for green vegetables and 0.5 for carrots. Significant inverse trends in risk emerged with estimated carotenoid (as well as retinoid) intake. The apparent protection conveyed by vitamin A was stronger in current smokers. The risk of bladder cancer was not related to scores of fat and measures of alcohol consumption; the risk was elevated in coffee drinkers (although there was no tendency to rise with higher consumption), but it was reduced in tea drinkers. These findings were not explainable in terms of selection, information, or confounding bias. Thus, although available information is too uncertain for any precise definition of specific (micro)nutrients related to bladder cancer risk, the confirmation that several aspects of a less-affluent diet adversely affect the risk is still of interest in terms of a better understanding of bladder carcinogenesis.

The relationship between induced abortions and subsequent risk of ectopic pregnancy has been analysed using data from a case-control study conducted in Milan, Italy. The cases were 158 women with a diagnosis of ectopic pregnancy confirmed by laparoscopy or laparotomy, admitted to a network of university and general hospitals. Two control groups were selected. The first one (obstetric controls) included 243 women who gave birth at term (more than 37 weeks gestation) to healthy infants at the same hospitals where the cases had been identified. The second control group (non-obstetric controls) was a random sample of 158 women of comparable age interviewed in the same calendar period, admitted to hospital for a broad spectrum of acute, non-gynaecological or obstetric conditions. A total of 35 out of 158 cases (22%) reported one or more previous induced abortions; the corresponding figures were 29 out of 243 (12%) obstetric controls and 29 out of 158 (18%) non-obstetric ones. The risk of ectopic pregnancy was higher in women reporting induced abortions: the estimated multivariate relative risks (relative risk) for any induced abortions were 2.9 [95%, confidence interval (CI) 1.6-5.3] in comparison with obstetric controls and 2.5 (95% CI 1.2-5.0) in comparison with women admitted to hospital for other conditions. The risk increased with number of induced abortions, being, compared to women with no induced abortion, 13.1 (95% CI 3.2-54.5) and 3.8 (95% CI 1.1-12.7) in women reporting two or more induced abortions when the comparison groups were respectively obstetric and non-obstetric controls. This study shows an increased risk of ectopic pregnancy after induced abortion.(ABSTRACT TRUNCATED AT 250 WORDS)

The relationship between use of non-contraceptive oestrogens and risk of breast cancer was investigated using data from a hospital-based case-control study from Northern Italy. This study covered 1,108 patients with histologically confirmed breast cancers and 1,281 control subjects with a large spectrum of acute conditions unrelated to any of the known or suspected risk factors for breast cancer. Compared with "never-users", the age-adjusted relative risk for "ever-users" was 1.93 (95% confidence interval = 1.35-2.75). The risk increased with duration of use (relative risk = 2.08 for over 2 years), but was unrelated to time elapsed since first or last use. Allowance for a large number of identified potential confounding factors, including indicators of socio-economic status and the major determinants of breast cancer risk, failed to account for the observed association (multivariate relative risk = 1.84 for ever use and 2.04 for greater than 2 year use). Possible explanations for these findings and for their apparent discrepancy with some American data are discussed in terms of different baseline incidence of breast cancer in the two populations, and hence of potential baseline differences in availability of endogenous serum oestrogens. Nonetheless, the results of this study should be interpreted cautiously and viewed as a further contribution to a topic still open to debate.

Journal Article Maternal Mortality in Various Italian Regions Get access FABIO PARAZZINI, FABIO PARAZZINI Istituto di Richerche Farmacologiche Mario Negrivia Eritrea 62,20157, Milan, Italy. Search for other works by this author on: Oxford Academic PubMed Google Scholar EVA NEGRI, EVA NEGRI Istituto di Richerche Farmacologiche Mario Negrivia Eritrea 62,20157, Milan, Italy. Search for other works by this author on: Oxford Academic PubMed Google Scholar GUERRINO MEZZANOTTE, GUERRINO MEZZANOTTE Istituto di Richerche Farmacologiche Mario Negrivia Eritrea 62,20157, Milan, Italy. Search for other works by this author on: Oxford Academic PubMed Google Scholar CARLO LA VECCHIA CARLO LA VECCHIA Istituto di Richerche Farmacologiche Mario Negrivia Eritrea 62,20157, Milan, Italy. Search for other works by this author on: Oxford Academic PubMed Google Scholar International Journal of Epidemiology, Volume 18, Issue 2, June 1989, Pages 466–467, https://doi.org/10.1093/ije/18.2.466 Published: 01 June 1989

Journal Article Education and prevalence of smoking in ltalian men and women Get access CARLO LA VECCHIA, CARLO LA VECCHIA Mario Negri InstituteRome, Italy Search for other works by this author on: Oxford Academic PubMed Google Scholar ADRIANO DECARLI, ADRIANO DECARLI Mario Negri InstituteRome, Italy Search for other works by this author on: Oxford Academic PubMed Google Scholar ROMANO PAGANO ROMANO PAGANO Mario Negri InstituteRome, Italy Search for other works by this author on: Oxford Academic PubMed Google Scholar International Journal of Epidemiology, Volume 15, Issue 2, June 1986, Page 279, https://doi.org/10.1093/ije/15.2.279 Published: 01 June 1986

We report the relation between hip fracture and intake of calcium and dairy products in postmenopausal women age 45 years or over. We conducted a case-control study in northern Italy. We interviewed a total of 241 cases of hip fracture and 719 controls in hospital for acute, nonneoplastic, nontraumatic, nondigestive, non-hormone-related diseases during their hospital stay. We derived odds ratios (OR) and their 95% confidence intervals (CI), according to intake of calcium, milk, and cheese from multiple logistic regression equations, including terms for age, education, body mass index, smoking status, alcohol drinking, and estrogen replacement therapy. Cutoff points for extreme quintiles of calcium intake were 443 and 1,026 mg per day. Compared with the lowest quintile of calcium intake, the multivariate ORs were 1.2 (95% CI = 0.7-2.0), 1.1 (95% CI = 0.6-1.7), 1.1 (95% CI = 0.6-1.7), and 1.2 (95% CI = 0.8-2.0) for subsequent quintiles of intake. Similarly, there was no appreciable association with milk (compared with less than 7 drinks per week, ORs were 1.2 and 1.0, respectively, for 7 and more than 7 drinks per week) or cheese intake (compared with less than 4 portions per week, ORs were 1.2 for 4-6 portions and 1.0 for more than 6 portions per week). OR estimates for calcium intake (tertiles) were consistent across strata of age, education, smoking status, and alcohol drinking. Thus, within the range of variation of intake of the main sources of calcium in this population, there was little association between hip fractures in women and intake of calcium, milk, and cheese.