The importance of the major risk factors for endometrial cancer in women of different ages was evaluated with the use of data from a hospital-based case-control study conducted in Milan, Italy, on 283 women with endometrial cancer and 566 age-matched controls. Current weight was related strongly to the risk of endometrial cancer both in younger (premenopausal) and in older women (with risk estimates for the heaviest categories of 20.3 and 7.7, respectively), thus confirming that obesity is the major cause of endometrial cancer in Northern Italy. Endometrial cancer risk appeared to be approximately proportional to the second power of body mass index. Early menarche and nulliparity were associated with an increased risk of endometrial cancer in premenopausal women, the point estimate for nulliparity rising to 35.1 (with lower confidence limit of 10.2) after adjustment for marital status. However, no association with these factors was evident in postmenopausal women. Combination oral contraceptives were used by 2 cases and 19 controls only [relative risk (RR) = 0.2, with 95% confidence interval = 0.1-0.8]. The use of noncontraceptive estrogens was associated with an elevated risk, which was greater in perimenopausal women (RR = 5.1 for greater than 2 yr of use), and decreased progressively with increasing time after menopause. Late menopause was also related to endometrial cancer. However, the risk estimates for late menopause apparently were more elevated in older women (greater than or equal to 65 yr) than in perimenopausal women. Most of the risk factors identified (excluding late menopause) apparently act on one of the later stages of the process of carcinogenesis, because the excess risk drops after cessation of exposure.
The relationship between self-reported height and cancer risk was investigated in an integrated series of case-control studies including 273 cases of cancer of the oesophagus, 474 of the stomach, 558 of the colon, 352 of the rectum, 227 of the liver, 267 of the pancreas, 110 of the larynx, 2,388 of the breast, 545 of the cervix uteri, 563 of the endometrium, 688 of the ovary, 80 of the prostate, 263 of the bladder, 105 of the kidney, 43 Hodgkin's disease, 152 non-Hodgkin's lymphomas, 109 multiple myelomas, and a total of 5,574 controls admitted to hospital for acute, non-neoplastic conditions. No significant positive trend in risk was observed for any of the cancer sites considered, and some suggestion of elevated risks for the upper quintile of height was observed only for prostate (relative risk, RR = 1.4), kidney (RR = 2.7) and colon (RR = 1.2) in males (but not in females). For breast cancer, all the RRs for subsequent quintiles of height were close to unity. Four neoplasms showed significant inverse trends with height: oesophagus (RR = 0.7 for highest vs. lowest quintile), cervix (RR = 0.4), endometrium (RR = 0.7) and ovary (RR = 0.6). For oesophagus and cervix the trends could be explained, at least in part, in terms of social class correlates (multivariate RR 0.8 and 0.5, respectively), while for endometrium they could possibly be related to an inverse correlation between height and body mass (multivariate RR 0.9). Thus, our study did not support the hypothesis that nutrition in childhood and adolescence (which in this population is a determinant of adult height) is directly related to the subsequent risk of cancer at several major cancer sites. A number of inverse associations emerged, which may be either spurious and incidental, or suggest that poorer nutrition early in life may be an unfavourable indicator of the subsequent risk of selected neoplasms.
Information from published case-control studies on benign breast disease was pooled using standard statistical methods to obtain single, overall risk estimates. This analysis showed that higher socio-economic status (pooled relative risk, RR = 1.24, 95% confidence interval, CI = 1.13-1.37), later menopause (pooled RR = 1.87, 95%, CI = 1.67-2.11) and late age at first birth (pooled RR = 1.30, 95%, CI = 1.13-1.50) were associated with an increased risk of benign breast disease, whereas an apparent protection was given by greater body mass index (pooled RR = 0.58, 95%, CI = 0.50-0.67) and the use of oral contraceptives (pooled RR = 0.75, 95%, CI = 0.67-0.83). The role of these factors did not appear to be materially different in the various histopathologic categories considered, although available information allowed only a general distinction between breast dysplasia (fibrocystic disease) and benign tumors, chiefly fibroadenoma. In conclusion, the general evidence from published studies indicates that benign breast lumps appear to share a number of important risk factors with breast cancer.
The relation between dietary factors and the risk of colorectal cancer was investigated in a case-control study conducted in Northern Italy on 339 cases of colon cancer, 236 cases of rectal cancer and 778 controls admitted to hospital for acute, non-neoplastic or digestive disorders. Consistent positive associations were observed with more frequent consumption of starchy foods (pasta or rice) (relative risk, RR = 3.0 for colon and 1.8 for rectum for highest vs. lowest tertile) and beef/veal meats (RR = 2.1 for colon, 2.3 for rectum), whereas reduced relative risks were observed in subjects reporting more frequent green vegetable consumption (RR = 0.5 for highest vs. lowest tertile), a few specific vegetable or fruit items, and coffee (RR = 0.6 for highest vs. lowest tertile). Various fats in seasonings were positively, but inconsistently, related to intestinal cancer risk, whereas no association was evident with measures of whole grain foods or alcohol intake. For both intestinal sites, a 4- to 5-fold difference in risk was evident between the extreme quintiles of a simple score obtained by algebraic sum of the 4 major groups of foods. These findings could not be explained in terms of confounding by socio-economic status or other major potential distorting factors, are in agreement with the results from previous studies of colo-rectal cancer in Southern Europe, and are consistent with various aspects of the descriptive epidemiology of intestinal cancer in Italy.
Read moreThe relation between socio-demographic factors, general lifestyle habits, smoking-related variables and rates for stopping cigarette smoking was evaluated using data from the 1983 Italian National Health Survey, on the basis of a sample of 19,472 males (15,473 current and 3,999 ex-smokers) and 7,371 females (6,707 current and 664 ex-smokers), representative of the whole Italian population of smokers. Overall rates for stopping (20.5% for males and 9.0% for females) were substantially lower than those observed over comparable calendar periods in other western countries. Besides age, and after allowance for it, stopping smoking was positively associated with higher education and socio-economic status, greater body mass index and the presence of smoking-related symptoms or diseases. Further, a strong inverse association was observed with coffee consumption, and a direct one with physical leisure activity. There was an U-shaped relation between average number of cigarettes per day and stopping smoking, since rates were lower for intermediate (15 to 24 cigarettes per day) smokers, and elevated both for light and heavy smokers, probably reflecting a lower degree of addiction and a greater prevalence of smoking-related disorders, respectively. The effect of most factors was independent, and these associations with quitting rate ratios were still evident after simultaneous allowance by means of multiple logistic regression. The existence of smoking related diseases or symptoms was the most frequent reason for quitting (50.7%); 30.3% reported to have stopped because of knowledge of the health consequences of smoking, 1.3% for economic reasons and 17.6% for other or undefined reasons.(ABSTRACT TRUNCATED AT 250 WORDS)
Read moreAn analysis of the mortality of a cohort of 6629 workers employed from 1906 to 1981 in a rubber tyre factory in northern Italy (978 deaths and over 133,000 man-years at risk) showed that the all cause mortality ratio was slightly lower than expected (0.91). Overall cancer mortality was close to expected (275 v 259.4) but there were significant excess rates for two cancer sites: pleura (9 observed v 0.8 expected, which may be due to the use of fibre containing talc) and bladder (16 observed v 8.8 expected). Death rates were not raised for other sites previously associated with employment in the rubber industry, such as cancers of the lung and brain, leukaemias, or lymphomas. The substantially reduced relative risk of pleural cancer among workers first employed after 1940 (RR = 0.05 compared with before 1940) probably reflected improvements in working conditions over more recent periods. For cancer of the bladder, the relative risk was also lower for workers first engaged after 1940. Thus no appreciable risk for any disease was apparent for workers employed over the past four decades. Analysis for each of the 27 job categories showed a substantial excess for cancer of the pleura in the mechanical maintenance workers (4 observed v 0.17 expected); an excess of cancer of the lung (21 v 13.48) was also present in this job category.
Read moreWe conducted a study on 165 women with thyroid cancer and 214 hospital controls in order to investigate the role of reproductive and hormonal factors in the aetiology of thyroid cancer. Late age at menarche (Relative risk (RR) for menarche at greater than or equal to 14 vs less than or equal to 11 = 2.8), menstrual irregularity (RR = 1.7), late age at first birth (RR for first birth at greater than or equal to 28 vs less than or equal to 21 = 2.4) and at last birth (RR for last birth greater than or equal to 30 vs less than 30 = 2.2) significantly increased the risk of the development of thyroid cancer both in premenopausal and postmenopausal women. Parity was, in the present study rather inconsistently related to disease status whereas voluntary abortions and miscarriages were completely unrelated. A non significant increasing risk was observed with age at menopause older than 50, and with the use of oral contraceptives in premenopausal women. The mechanism of action of female hormones on the thyroid gland remains largely obscure, but the observation that age at first and, perhaps, subsequent pregnancies may be relevant points to an interplay of reproductive factors (and, possibly, their hormonal correlates) more complex than previously suggested.
Read moreRiassuntoIn questo rapporto viene presentato l'insicme dei dati di certificazione di morte per tumori in Italia net 1980 (tassi standardizzati per età ed età specifici, numeri assoluti e percentuali rispctto al totale delle morti per tuinore), sulla base dei dati di certificazione di morte pubblicati dall'Istituto Centrale di Statistica (ISTAT). Rispetto al 1979, la mortalità globale per tumori è aumentata nei maschi da 236,31 a 239,93/100.000 in tutte le età e da 275,82 a 281,93/ 100.000 tra i 35 ed i 64 anni. Tuttavia, gli incrementi per il solo cancro del polmone (da 66,09 a 69,43 in tutte le età e da 91,91 a 97,20 dai 35 ai 64 anni) possono da soli spiegare gran parte degli aumenti complessivi, ed in tutti i diversi altri tumori si sono registrate soltanto moderate variazioni. Di conseguen-za, la proporzione di tutte le morti per tumore do-vute al solo cancro del polmone è aumentata dal 27,8 al 28,6 %. Le seguenti principali cause di morte per tumore nei maschi erano Io stomaco (12,6 %), l'intestino (10,6 %) e la prostata (6,4 %). Nelle feminine, non si sono registrati aumenti consistent per il tumore del polmone o le altre neoplasie legate al tabacco. Pertanto, la mortalità globale per tumori è rimasta costante in tutte le età (155,33 nei 1980 rispetto a 155,66 nei 1979), ed in leggera diminuzione nella mezza età (158,83 nei 1980 rispetto a 161,82 nei 1979). Il cancro della mammella era la principale causa di morte per tumore (17,2 %), seguito da quelli dell'intestino (14,2 %), dello stomaco (12,2 %) e del polmone (6,0 %). Le maggiori diminuzioni si sono osservate per il cancro del (collo) dell'utero, mentre le variazioni apparivano minori per tutti gli altri tumori, con la sola eccezione del tumore della cute (melanoma) in giovane età, i cui tassi sono rimasli in costante aumento in entrambi i sessi.
Read moreData from a hospital-based case-control study of oesophageal cancer conducted in Northern Italy were used to analyse the risk associated with alcohol in non-smokers and with tobacco in non-drinkers. Out of a total of 250 cases (198 males, 52 females) and 1,089 controls (800 males, 289 females), there were 38 cases and 404 controls who described themselves as lifelong non-smokers. Among these persons, the relative risk was not different for teetotallers and moderate drinkers (less than 4 drinks per day), but increased markedly for higher levels of alcohol consumption. The point estimates were 2.1 for 4 to 8 and 3.6 for over 8 drinks per day, and the trend in risk was statistically significant. Likewise, among 30 cases and 189 controls who were non-drinkers, the point estimates were 2.0, 3.9 and 6.2 for smokers of less than 15, 15-24 and greater than or equal to 25 cigarettes per day, with, again, a statistically significant trend. This study supplies further evidence that both alcohol and tobacco are strongly related to the risk of oesophageal cancer, even in the absence of exposure to the other risk factor. This confirms previous indications from a study in Calvados, France and also provides statistically significant epidemiological evidence of an independent role of exposure to tobacco alone in the aetiology of oesophageal cancer. The relative risks associated with exposure to either of the 2 factors among subjects not exposed to the other were readily comparable to the estimates adjusted for the other factor in the overall data-set, thus further confirming the independent effect of alcohol and tobacco on oesophageal carcinogenesis.
Read moreThe files of the Childhood Cancer Research Group ( CCRG ) and of the Oxford Survey of Childhood Cancers ( OSCC ) were scrutinized for all malignant genital neoplasms other than ovarian tumor registered in England, Scotland, and Wales in the period 1962 to 1978. After a review of the records and of the available pathologic reports, a total of 55 cases were confirmed, indicating an average incidence of about 0.5 cases per million female children per year, with no obvious trend over the study period. These included 9 (16.4%) cases originating from the vulva, 28 (50.9%) from the vagina, 3 (5.5%) from the cervix, 12 (21.8%) from the corpus uteri, and also 3 (5.5%) cancers of unspecified pelvic sites. A total of 45 (81.8%) cases were sarcomas, most frequently of the botryoid type, 7 (11.7%) were carcinomas, and 3 (5.5%) were germ cell neoplasms. Fifteen cases (27.3%) occurred in children younger than 1 year of age, and incidence showed a declining trend over age. Long-term survival was more common in tumors of the external genitalia, vagina, or cervix, and significantly better in carcinomas (100%) than in germ cell neoplasms (67%), or sarcomas (34%). A significant improvement in survival was noted over the period of time considered (5-year survival rates were 23% in the cases diagnosed in the 1960s, but 52% for those diagnosed in the 1970s), suggesting that a more rational integrated therapeutic approach may appreciably improve the prognosis of these rare neoplasms.
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