Overweight and obesity are associated with several important diseases, including diabetes, cardio- and cerebrovascular diseases, digestive disorders and cancer. We decided, therefore, to present estimates of the prevalence of overweight and obesity in the general Italian population. The prevalence of overweight and obesity in Italy was evaluated using data from the 1990-91 Italian National Health Survey. 25,818 households were surveyed, representing the whole Italian population. A sample of 24,602 males and 26,090 females aged 15 or over was randomly selected, within strata of geographical area, size of municipality and size of household, in order to be fully representative. Quetelet's index was considered as a measure of body mass index, on the basis of self reported height and weight, and was a priori divided into four levels: underweight (< 20 kgm-2), normal weight (20 to 24.9 kgm-2), overweight (25 to 29.9 kgm-2), and obese (> or = 30 kgm-2). In the overall national sample, 11.0% of subjects were underweight (4.4% males, 12.2% females), 50.8% normal weight (49.4% males, 52.2% females), 31.6% overweight (39.2% males, 24.5% females), and 6.5% obese (7.0% males, 6.1% females). The prevalence of overweight and obesity was higher in middle age and in the South of the country, and was directly related to history of diabetes, hypertension, heart diseases, gallbladder disease and chronic respiratory disorders. These data quantify the importance of overweight and obesity as a public health issue in the general Italian population.

The relationship between lifelong menstrual pattern and the risk of breast cancer has been analyzed using data from a large case-control study conducted since 1983 in the greater Milan area including 3,037 cases, aged 74 years or less, with histologically confirmed breast cancer and 2,569 control subjects admitted for acute nongynecological, nonneoplastic nonhormone-related conditions to the same network of hospitals where cases had been identified. Compared with women reporting lifelong regular cycles, those reporting irregularities were at significantly reduced risk of breast cancer, relative risk estimate being 0.6, with 95% confidence interval (CI) ranging from 0.5 to 0.8. This protection was restricted to women reporting totally irregular menstrual cycles; compared to women reporting menstrual cycles lasting 25 days or less, the estimated relative risks were 1.0 and 1.2 in those reporting cycles lasting 26-30 days or 31 days or more, respectively, but 0.6 (95% CI 0.5-0.8) for those reporting totally irregular cycles. The effect of irregular menstrual cycles was similar in different strata of age and main risk factors for breast cancer.

Our results do not support an association between calcium and the risk of prostate cancer. However, the present study cannot address the effect of calcium in the ranges where an increased risk of prostate cancer has been noted previously, and with specific reference to advanced disease.

Editor—A Danish study of 156 subjects with upper digestive tract cancers showed that wine drinkers may be at a lower risk than drinkers with a similar intake of beer or spirits.1 Wine is the most common alcoholic beverage in Italy, accounting for over 80% of alcohol intake.2 We investigated the separate and combined effect of wine drinking in a large dataset.3 Data were collected between 1984 and 1993 in Greater Milan and the province of Pordenone, Northern Italy, on 547 histologically confirmed incident cases of cancer of the oral cavity and pharynx (466 men, 81 women; age 22-74 (median 57)) and 412 cases of cancer of the oesophagus (345 men, 67 women; age 26-74 (median 60)). Controls were 2375 subjects (1797 men, 578 women; age 25-74 (median 56)) admitted to the same network of hospitals with acute non-neoplastic conditions unrelated to alcohol or tobacco consumption. Of these, 570 were admitted for trauma, 593 for non-traumatic orthopaedic conditions, 475 for acute surgical diseases, 428 for eye diseases, and 309 for miscellaneous other illnesses. Trained interviewers questioned cases and controls, using a structured questionnaire; questions on the days per week that each type of alcoholic beverage (wine, beer, and spirits) was consumed and the average number of drinks per day were included. The table gives the distribution of cases of oral and pharyngeal and oesophageal cancer and of the comparison group according to consumption of various alcoholic beverages. When non-drinkers and moderate drinkers (<3 drinks a day) were used as the comparison group, the odds ratios of oral and pharyngeal cancer were 4.95 for very heavy (⩾10 drinks per day) wine drinkers and 4.13 for very heavy wine, beer, and spirit drinkers. Corresponding findings for oesophageal cancer were 7.53 and 5.52. The odds ratios for beer or spirit drinkers only were 0.9 (95% confidence interval 0.3 to 2.4) for cancers of the oral cavity (7 cases, 47 controls) and 1.5 (0.6 to 3.9) for oesophageal cancer (7 cases, 47 controls). These results were consistent across separate diagnostic conditions in controls. This pattern of risk according to type of alcoholic beverage is different from that reported in the Danish study.1 Taken together, these data lead us to conclude that ethanol is the main component of alcoholic beverages that determines the risk of cancer and that the most frequently consumed beverage in each area tends to be the one with the highest risk.4,5 Wine consumption is clearly strongly related to cancers of the upper digestive tract in individuals and populations with heavy consumption.

We analyzed the role of reproductive factors on the risk of endometrial cancer using data from a case-control study conducted in Italy. Cases were 752 women with histologically confirmed endometrial cancer < 75 years of age. Controls were 2,606 patients < 75 years of age admitted for acute, non-gynecological non-hormone-related, non-neoplastic conditions to the same network of hospitals where cases had been identified. In comparison with nulliparae, the risk of endometrial cancer tended to be lower in parous women, and the estimated multivariate odds ratios (ORs) were 0.9, 0.8 and 0.7, respectively, for women reporting 1, 2 and 3 or more births (chi(2)(1) trend and 10.21). In comparison with women reporting no induced abortion, the ORs of endometrial cancer were 0.6 in women reporting 1 and 0.4 in those reporting 2 or more induced abortions. When considering parous women only, in comparison with women reporting their last birth 20 years before or longer, the ORs of endometrial cancer were 0.6 in those reporting their last birth 10-19 years before and 0.3 in those reporting their last birth < 10 years before. Our results confirm and further quantify a protective role of pregnancy on the risk of endometrial cancer and provide insights on the time-risk relationship between pregnancy and cancer of corpus uteri.

The authors describe the incidence of new primary cancers among 4,639 cases of squamous cell skin cancer (SCC) diagnosed between 1974 and 1994 in the cancer registries of the Swiss cantons of Vaud and Neuchâtel (total person-years at risk = 23,152). Overall, 729 metachronous cancers were observed versus 527.6 expected, corresponding to a standardized incidence ratio (SIR) of 1.4 (95% confidence interval (CI) 1.3-1.5). After exclusion of skin cancers, however, 384 second primary neoplasms were observed versus 397.2 expected (SIR = 1.0). Excesses were observed for cancers of the lip (SIR = 3.1) and lung (SIR = 1.3), for basal cell (SIR = 4.3) and melanomatous skin cancers (SIR = 3.3), and non-Hodgkin's lymphomas (SIR = 1.7). Rates were elevated for cancers of the salivary glands (SIR = 4.3) and for Hodgkin's disease (SIR = 2.7), and, below age 65 years, for cancers of the lung (SIR = 1.6), breast (SIR = 1.5), and prostate (SIR = 1.8), for Hodgkin's disease (SIR = 15.8), as well as for all neoplasms except skin (SIR = 1.2; 95% CI 1.0-1.5). The cumulative risk of basal cell skin cancer reached 17% after 15 years. The authors believe that the excesses for basal cell carcinomas and melanomas of the skin following SCC, and possibly of lymphomas, were likely attributable to common phenotypic characteristics and exposure to UV radiation. The elevated rates of lung cancer are suggestive for a role of tobacco as a cause of squamous cell skin cancer.

Although the role of selection bias should be carefully evaluated, the present data suggest that uterine fibroids should not be considered a contra-indication for oral contraceptive use.

To understand possible correlates of the systematically higher gastric-cancer rates in males than in females, we investigated the role of menstrual, reproductive and hormonal factors in females, using data from a case-control study conducted in Northern Italy. Cases were 229 post-menopausal women with incident, histologically confirmed gastric cancer, and controls were 614 post-menopausal women in hospital for acute, non-neoplastic, non-digestive-tract conditions. After allowance for age, education, family history, and selected dietary correlates of stomach cancer, a reduced gastric-cancer risk was observed in women with later menopause (odds ratio, OR = 0.6, p value for trend < 0.05), and longer duration of fertile life (OR = 0.7, but the trend in risk was not significant). The risk of gastric cancer was elevated in multiparous women (OR = 1.7 for 3 and 1.9 for > or = 4 births as compared to nulliparae). No association was observed with age at menarche, age at first birth, and with number of spontaneous or induced abortions. Ever-users of oral contraceptives had a non-significant increased risk (OR = 1.3), and users of oestrogen-replacement treatment a non-significant reduced risk (OR = 0.5). Although the association with each factor was moderate, and the interpretation of these findings is not straightforward, these results are compatible with the hypothesis that some role is played by (endogenous and exogenous) female hormones in the process of gastric carcinogenesis.

Risk factors for colon cancer have essentially been considered in terms of relative risks. From a public health viewpoint, however, their impact depends not only on the strength of the association, but also on the distribution of exposures in the population. Thus we used data from a case-control study conducted in Italy between 1992 and 1996 to estimate the population-attributable risks (PARs) for colon cancer in relation to educational level, physical activity, energy and vegetable intake, eating frequency, and family history of colorectal cancer. Cases were 1,225 incident, histologically confirmed colon cancer patients admitted to the major teaching and general hospitals in six Italian areas; controls were 4,154 subjects with no history of cancer, admitted to hospitals in the same catchment areas for acute, nonneoplastic diseases. By use of the distribution of the risk factors in the cases and the multivariate relative risk estimates, PARs were computed, i.e., the proportion of colon cancer that would have been avoided if all subjects were moved to the lowest exposure level. The PARs were 12% for high education, 14% for low physical activity, 14% for high energy intake, 22% for low vegetable intake, 7% for high eating frequency, and 8% for a family history of colorectal cancer. These factors together accounted for 56% of colon cancer cases. PARs were similar across age strata. Men had higher PARs for education, physical activity, and their combination, but lower PARs for energy, eating frequency, vegetable intake, and their combination than women. The percentage of colon cancers attributable to all factors considered together was 50% in men and 67% in women. Even if the PAR estimates were based on several arbitrary assumptions on the exposure distribution for various risk factors, available knowledge could, in principle, explain > 50% of cases in this Italian population, thus indicating and quantifying the theoretical scope for prevention.

Trends in age-standardised death-certification rates for skin cancer [mainly cutaneous malignant melanoma (CMM)] over the period 1955–1995 were considered for 22 developed countries (18 from Europe, Canada, the United States, Australia and New Zealand) on the basis of the World Health Organization database. Between 1955 and 1984, mortality from CMM has been rising in both young adults (20 to 44 years) and middle aged population (45 to 64 years) in most European countries, North America and Australia. Between 1985 and 1995, CMM mortality rates were still rising in several countries for middle-aged males, though, to a lesser extent, they were more favourable in middle-aged women and declined in young adults in most countries, particularly in northern Europe. Int. J. Cancer 81:62–66, 1999. © 1999 Wiley-Liss, Inc.