Epidemiological studies based on cervical cytopathology have aroused widespread interest since it was realized that they could be a useful tool for measuring the effectiveness of screening programs and defining practical measures for the prevention of invasive neoplasms and deaths. In the present article, published evidence from screening programs, cohort investigations and case-control studies is reviewed, and possibilities for further analyses and applications are discussed. In particular, when estimates of the relative protections conveyed by Pap smear from various case-control studies conducted on different populations and using different criteria of selection were pooled, a surprisingly close concordance emerged, with overall risk estimates of invasive cervical cancer of 0.42 for women reporting one smear, and of 0.20 for two or more smears in the past. This protection appeared to be long-lasting in a considerable proportion of cases, since the major determinant of invasive cancer risk was the number of previous smears rather than the interval since last smear, and a noticeable residual effect was evident even more than 10 years after the last smear. Besides providing a measure of the effectiveness of cytological screening and helping define the optimal frequency of screening using the limited resources available, case-control studies should permit accurate estimates of the sensitivity of the test and quantify the probability of transition and the duration of various stages of the neoplastic process, i.e., permit a better understanding of the natural history of the disease.

Trends in death certification rates from the five major alcohol related causes of death in Italy (cancers of the mouth or pharynx, oesophagus, larynx, liver and cirrhosis of the liver) were analysed over a period (1955-79) in which per capita alcohol consumption almost trebled. Age standardised mortality from liver cirrhosis almost doubled in males and increased over 70% in females. In males, mortality from cancers of the upper digestive or respiratory tract showed increases of between 27% and 44%, and liver cancer increased by over 100%. In the late 1970s, the four alcohol related cancer sites accounted for about 12% of all cancer deaths in males and 4.5% in females. Mortality from liver cirrhosis alone accounted for 4.8% of all deaths in males (9.2% of manpower years lost) and 2.3% in females (6.3% manpower years lost) in females. These figures were even higher in selected areas of north eastern Italy, where alcohol consumption is greater. In absolute terms, the upward trends observed correspond to about 10,000 excess deaths per year in the late 1970s compared with rates observed two decades earlier and are thus second only to the increase in tobacco related causes of death over the same calendar period.

e12061 Background: Analysis of associations between insulin and cancer risk using Prescription Databases and Cancer Registers is complicated and should only be undertaken with extreme caution and employing advanced statistical and epidemiological methodologies. Methods: Interaction between methodologists, diabetologists and oncologists is also critical. Failure to do so can result in unfortunate events with potential societal implications as could have happened following the recent publication of a flawed database analysis of the association between a long-acting insulin analogue and an increased risk of cancer. Such reports cause unnecessary confusion and concern among patients and their physicians. Results: Prescription Databases were not established with such analyses in mind, and cannot identify many critical limitations such as changes in insulin type during study observation (“switchers”). Notably, those who use more than one type of insulin simultaneously pose specific problems but restriction of the analysis to users of only one type of insulin during the study period is inappropriate and likely to introduce bias. There are outstanding issues surrounding how to deal with the entire issue of “dose” which requires further exploration by the biostatistical community (reliability of doses captured, defining doses at baseline or/and differences in dose exposure). Conclusions: It is possible to obtain clear information from Prescription Databases if (and only if) the study is designed adequately, key data are available including multiple confounders (age, body weight, diabetes duration glucose control, socioeconomic status, etc.) and the biostatistical analyses are predefined. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Novo Nordisk, sanofi-aventis Novo Nordisk, sanofi-aventis sanofi-aventis

Trends in cancer mortality remained favorable for most major cancer sites, mainly in men for tobacco-related cancers. Due to the classification changes brought about by the change of ICD and the stricter age standardization, the present mortality rates should only be compared to previous ones with due caution.

RiassuntoIn questo rapporto vengono presentati e brevemente commentati i dati di certificazione di morte per tumori in Italia nel 1981 (tassi standardizzati per età ed età specifici, numeri assoluti di certificazioni e percentuali delle singole neoplasie rispetto al totale delle morti per tumore), sulla base dei dati di certificazione di morte pubblicati dall'Istituto Centrale di Statistica (ISTAT). Sebbene il numero complessivo di morti per tumore sia ultimamente salito avvicinandosi ai 125.000, ed in entrambi i sessi i tassi globali standardizzati per età siano ancora leggermente aumentati rispetto al 1980 (da 239,93 a 242,12/100.000 maschi e da 155,33 a 156,04/100.000 femmine), un'apprezzabile diminuzione si è osservata nei tassi troncati dai 35 ai 64 anni, soprattutto nei maschi (da 281,93 a 271,76). Questa diminuzione è stata la più cospicua dal 1955 in poi, ed è principalmente attribuibile al livellamento della mortalità nella mezza età per il tumore del polmone e le altre neoplasie legate al tabacco, unitamente alla continua diminuzione della mortalità per carcinoma gastrico. La mortalità per carcinoma del polmone, tuttavia, ha continuato ad aumentare nei maschi più anziani (oltre i 75 anni). Le morti per carcinoma del polmone rappresentavano da sole il 28,5% dell'insieme delle morti per tumore nei maschi (il 37% nella quinta decade di età), seguite dallo stomaco (12,4%), dall'intestino (9,8%), dalla prostata (6,6%) e dalla vescica (4,9%). Nelle femmine, modesti aumenti si sono registrati per le neoplasie del polmone e della mammella nelle diverse classi di età, e, come peraltro nei maschi, della cute nella giovane e mezza età, mentre sono continuate le diminuzioni per i tumori gastrici e dell'utero (collo). Nel 1981, le sole neoplasie mammarie rappresentavano il 17,5% di tutte le morti per tumore nelle donne italiane, seguiti da intestino (14,1%), stomaco (12,3%) e polmone (6,1%) mentre l'insieme delle neoplasie uterine raggiungevano l'8%. Gli aumenti in entrambi i sessi della mortalità certificata per tumori cerebrali, mieloma, leucemie e linfomi, e della prostata nei maschi, parallelamente alla diminuzione del numero di certificazioni di morte attribuite ad « altri e non specificati » siti di origine, piuttosto che riflettere effettivi cambiamenti nella mortalità per tumori, costituiscono verosimilmente degli indicatori indiretti di miglioramenti nell'attendibilità della certificazione.

The present study shows an inverse association between dietary intake of vitamins E and prostate cancer incidence. This finding is likely to reflect the influence of diet itself since supplementation or food fortification with vitamins is rare in the Italian population.

The relation between smoking habits and selected chronic diseases was evaluated from the data of the 1983 Italian National Health Survey, based on 72,284 people aged 15 or over randomly selected within strata of geographical area, size of place of residence and of the household in order to be representative of the whole Italian population. The prevalence of all the 19 diseases or groups of diseases considered was elevated among ex-smokers, thus suggesting that the presence of any chronic condition stimulates cessation of smoking. The excess prevalence among ex-smokers was particularly large for myocardial infarction and other heart diseases. Four groups of diseases were positively related with current as well as with past cigarette smoking. These were chronic bronchitis, emphysema of the lung or respiratory insufficiency, gastroduodenal ulcer and varicose veins or haemorrhoids. For all these groups of diseases the relative risks were higher in heavy cigarette smokers. Compared with never smokers, the point estimates for subjects smoking 15 cigarettes per day or more were 2.6 for chronic bronchitis, 1.7 for emphysema of the lung, 2.1 for gastroduodenal ulcer and 1.6 for varicose veins or haemorrhoids. For bronchitis, ulcer and varicose veins or haemorrhoids the relative risks tended to be higher in younger and middle age groups. From these data, it was estimated that in the whole of Italy a total of about 900,000 prevalent cases of chronic bronchitis, 270,000 of emphysema, 610,000 gastroduodenal ulcers and 380,000 varicose veins or haemorrhoids could be associated with cigarette smoking.(ABSTRACT TRUNCATED AT 250 WORDS)

p 1411), recalling feelings of "too little, too late" at the King's Cross Station tragedy. This inadequacy is shared by many doctors when they are called to cope with incidents away from the bright lights and comfortable surroundings of the surgery or hospital. The British Association for Immediate Care (BASICS) was formed in an attempt to improve prehospital care for victims of road accidents and other disasters. It provides a forum and training for doctors interested in immediate care. In recognition of this need, par- ticularly for general practitioners, the Royal College of Surgeons of Edinburgh has agreed to establish a diploma in prehospital care. BASICS doctors trained in the use of breathing apparatus were present at King's Cross but because of the inevitable delay in appreciating the size of the incident they were called some time later. They provided on site care and a site medical officer and subsequently searched the station with fire crews and helped certify and identify the dead. They too shared the feeling of grief but perhaps less the inadequacy. New members are always wel- come. At present there are only 2000 doctors in 70 immediate care schemes covering about one third ofthe United Kingdom.