Adherence to the Mediterranean diet is a favourable indicator of the risk of several common epithelial cancers in Italy. A score summarising the major characteristics of the Mediterranean diet was related to a priori defined reduced risks of several digestive tract neoplasms by over 50%.

Long-term health risks in patients with WHO group 2 anovulation demand their general health be monitored, even after their reproductive needs have been fulfilled. Metabolic and cardiovascular risk prevention in women with PCOS should start as early as possible. It is not easy to analyse the possible role of PCOS, independent of obesity, metabolic syndrome, insulin resistance and diabetes, on long-term health.

A restriction of the legislation, increasing to 18 years the minimum age for purchasing tobacco, would limit access to tobacco products by minors, only if adopted together with systematic and effective enforcement measures.

To the Editor: Rates of spontaneous abortion increased in Italy from 6.3/100 pregnancies in 1980 to 7.6 in 1991. The increase was generally constant during the period and was similar across subsequent age strata, with the exception of teenagers and of women age 50 or more. 1 We have now updated trends in rates of spontaneous abortion to 1995, using data published annually by the Italian National Institute of Statistics (ISTAT). 2,3 In Italy, spontaneous abortion is defined by law as a termination of pregnancy 180 days or less after the last menstrual period. The spontaneous abortion rate has been calculated using the number of spontaneous abortions (SA) as numerator and the total number of pregnancies (ie, the simple sum of spontaneous and induced abortions (IA) plus births (LB)) as denominator. Rates according to maternal age have been also analyzed using direct standardization for maternal age, taking the Italian population of 1982 as reference. 4 Because spontaneous abortion and induced abortion are competing risks, we have also analyzed the data using the statistic: SA/(SA+LB+IA/2). 5 Overall, age-adjusted rates of spontaneous abortion increased from 7.3 in 1992 to 8.3/100 pregnancies in 1995 with 95% confidence intervals of 7.2–7.5 and 8.2–8.4, respectively (Table 1).Similar trends also emerged after considering the competitive role of induced abortion. The increase in the rate of spontaneous abortion was larger in very young (<15 year, from 21.2 to 31.1/100 pregnancies, in 1992 and 1995, respectively) and older (≥50 years from 36.8 to 40.4/100 pregnancies) women, but we also found some increased risk in the intermediate age groups (Table 2).These trends in spontaneous abortions can be explained by improved diagnosis, following a wider availability of transvaginal ultrasounds, but this explanation cannot account for the different trends in various strata of age. It is also likely that the criteria for definition at certification of spontaneous abortion have changed in clinical practice over the last few years. We have not considered ectopic pregnancies, but this omission should not have introduced any marked bias. Table 1: Trends of Crude and Standardized for Age Rate of Spontaneous Abortion in Italy, 1982, 1990–1995Table 2: Trends of Spontaneous Abortion (Rates per 100 Pregnancies) According to Maternal Age (Italy, Selected Years)An increased frequency of abortion has been observed in pregnancies after assisted reproduction 6 and also after amniocentesis performed in the first trimester of pregnancy. 7 These effects could explain the increased rates of spontaneous abortion in women 35 years of age or older, but not in younger women. Whereas the rate of pregnancy (ie, the number of SA plus IA and births on number of women) for very young girls (<15 years) remained stable from 1981 to 1995, spontaneous and induced abortions had an inverse trend. 8 This pattern could be explained by a greater attention on sex education of teenagers in the 1990s, with a rise of wanted pregnancies and a simultaneous diminution of IA. These trends could have affected the rate of SA, resulting in an increase of the proportion of IA that could potentially end in SA. Cristina Rozzi Luigi Benassi Fabio Parazzini Liliane Chatenoud Carlo La Vecchia Guido Benzi

accurately distinguish them before the determination of therapy (i.e., liver transplantation). Our data show that the application of the American Association for the Study of Liver Diseases guidelines prevents a false-positive diagnosis of ICC in cirrhosis. Small ICC may display an early enhancement (partial or total) in the arterial phase. This is similar to the HCC pattern, but because we have not observed washout in delayed phases, this finding is confirmed to be specific for HCC 2,3 and critical for nodule diagnosis.

Laryngeal cancer is the neoplasm with the largest male to female sex ratio in most populations. Thus, inadequate data are available on women. We analyzed several risk factors in the combined dataset from two case-control studies conducted between 1986 and 2000 in northern Italy and Switzerland. Cases were 68 women under age 79 years, with incident, histologically confirmed cancer of the larynx. Controls were 340 women, admitted to the same network of hospitals as cases, for acute, nonmalignant conditions, unrelated to tobacco and alcohol consumption. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated by logistic regression models, conditioned by age, study center and year of interview, and including terms for education, body mass index, tobacco, alcohol drinking, and nonalcohol energy intake. Laryngeal cancer was strongly associated with cigarette smoking (OR = 435.7, 95% CI: 38.2-4964.4 for smokers of >/=25 cigarettes/day) and alcohol drinking (OR = 4.3, 95% CI: 0.8-24.1 for >/=5 drinks/day). An inverse relation was found for vegetables (OR = 0.3, 95% CI: 0.1-0.9 for the highest level of consumption), fruit (OR = 0.5, 95% CI: 0.2-1.3), and olive oil (OR = 0.3, 95% CI: 0.1-0.9). Reproductive and hormonal factors were not consistently associated to laryngeal cancer risk. This investigation, based on a uniquely large number of laryngeal cancers in women, provides definite evidence that cigarette smoking is the prominent risk factor for laryngeal cancer in women, accounting for 78% of cases in this population. Alcohol and selected dietary aspects account for approximately 30% of cases, whereas menstrual and hormonal factors do not appear to have a consistent role in laryngeal carcinogenesis.

This review focuses on selected aspects of the relation between alcohol consumption and cancer risk. Heavy alcohol consumption (i.e., ≥4 drinks/day) is significantly associated with an increased risk of about 5-fold for oral and pharyngeal cancer and esophageal squamous cell carcinoma, 2.5-fold for laryngeal cancer, 50% for colorectal and breast cancers, and 30% for pancreatic cancer. These estimates are based on a large number of epidemiological studies and are generally consistent across strata of several covariates. The evidence suggests that at low doses of alcohol consumption (i.e., ≤1 drink/day) the risk is also increased by about 20% for oral and pharyngeal cancer and 30% for esophageal squamous cell carcinoma. Thus, for these sites there is little evidence of a threshold effect. While consumption of fewer than 3 alcoholic drinks/wk is not associated with an increased risk of breast cancer, an intake of 3 to 6 drinks/wk might already yield a (small) increase in risk. On the other hand, intakes up to 1 drink/day are not associated to the risk of laryngeal, colorectal, and pancreatic cancer. The positive association between alcohol consumption and the risk of head and neck cancers is independent from tobacco exposure.

This study provides little support for the hypothesis that menstrual, reproductive, or hormonal factors are related to the development of pancreatic cancer.

CHD and CVD mortality steadily declined in Europe, except in Russia, whose rates were 10 to 15-fold higher than those of France, Italy or Sweden. Hungary and Poland, and also Scotland, where CHD trends were less favourable than in other western European countries, also emerge as priorities for preventive interventions.