The onset of decline in ischemic heart disease in Italy. C La Vecchia, E Negri, and A DecarliCopyRight https://doi.org/10.2105/AJPH.80.4.502 Published Online: October 07, 2011

The relationship between family history of breast, ovarian and endometrial cancer and risk of breast cancer was analysed using data from a case-control study of breast cancer conducted in the greater Milan area, Northern Italy. The cases studied were 3415 women (median age 52 years, range 23-74) who had histologically confirmed breast cancer diagnosed within the year preceding the interview. The controls were 2916 women (median age 54 years; range 21-74) in hospital for a spectrum of acute illnesses excluding gynaecological, hormonal or neoplastic conditions. A total of 375 cases (11.0%) and 128 controls (4.4%) reported a history of breast cancer in first degree relatives. Compared with women with no family history of breast cancer, the RR was 2.7 (95% confidence interval [CI] : 2.2-3.3) in those with one first degree relative affected and 2.8 (95% CI : 1.3-5.7) in those with two or more affected relatives. In comparison with women without family history of ovarian cancer the RR of breast cancer was 1.4 (95% CI : 0.9-2.3) for those reporting one or more first degree relatives with ovarian cancer. However, the multivariate estimate for family history of ovarian cancer, including a term for familial breast cancer, decreased to 0.8 (95% CI : 0.5-1.4). The risk of breast cancer was similar in women reporting a family history of breast cancer (RR = 2.2) and in those reporting a family history of both breast and ovarian cancer (RR = 2.5), in comparison with women reporting no family history of breast and/or ovarian cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Using data from a case-control study conducted between 1984 and 1992 in the provinces of Milan and Pordenone, northern Italy, on 439 cases of oral and pharyngeal cancers and 2106 hospital controls, we computed the population attributable risk for oropharyngeal cancer in relation to tobacco, alcohol, and a measure of low beta-carotene intake. Two different models were used for estimating relative risks, one assuming that the three factors act multiplicatively on the relative risk and the second estimating separately each combination of alcohol and tobacco and assuming a multiplicative model only for beta-carotene. The estimated attributable risks were similar for the two models considered. For both models and both sexes, the single factor with the highest attributable risk was smoking, which accounted for 81-87% of oral cancers in males and for 42-47% in females. Alcohol explained about 60% of male cases, but only 15% of female ones, and low beta-carotene accounted for 24% of total cases (25% of males, 17% of females). Together the three factors were responsible for 91-94% of oropharyngeal cancers in males, 51-57% in females, and 85-88% in both sexes combined. The present knowledge of major identified risk factors could, in principle, reduce the burden of the disease in Italy from 2400 to about 200 deaths per year for males and from 500 to 230 for females, thus explaining the difference in incidence and mortality between the two sexes.

Increases in cutaneous malignant melanoma (CMM) incidence and mortality rates have occurred in the last decades in virtually all white populations, more markedly in those which permanently (immigrants) or temporarily (tourists/vacationers) reside in very sunny areas distant from their original living environment. The strong relationship between sex and site of CMM in these upward trends (ie trunk in males, lower limbs and, more recently, trunk as well in females) points to intense intermittent ultraviolet light exposure as the cause of the CMM epidemic. In Europe the highest rates of melanoma are seen in Denmark, The Netherlands, the United Kingdom, Ireland and Germany, where many individuals have light complexion with tendency to burn. Increases of 2 to 7% per year in mortality rates appeared earlier in these countries, but were subsequently seen also in relatively low-risk areas such as southern European countries. The interpretation of data from case-control studies is, however, hampered by the difficulties in quantifying retrospectively CMM risk correlates (ie host factors, sun exposure, clothing habits, sunburns etc) in various periods during the life span.

The relationship of stature with the prevalence of 18 chronic diseases or groups of diseases was analysed using data from the 1983 Italian National Health Survey, based on a sample of 63,859 individuals aged 20 or over randomly selected within strata of geographical area, size of the place of residence and of the household in order to be representative of the Italian population. Rate ratios (RR) were computed using multiple logistic regression, including terms for sex, age, geographical area, education and smoking. For 15 out of 18 diseases or groups of diseases the RR was below unity in the highest quartiles of height, and the inverse trends with stature were significant for 11 (diabetes, RR 0.90 for highest vs lowest quartile; heart disease, RR 0.92; chronic bronchitis and emphysema, RR 0.84; bronchial asthma, RR 0.70; anaemias, RR 0.70; liver cirrhosis, RR 0.62; urolithiasis, RR 0.76; renal insufficiency, RR 0.71; arthritis, RR 0.89; psychiatric and neurological disorders, RR 0.82). None of the diseases considered showed significant direct trends with height, but hypertension (RR 1.09 for the highest vs lowest quartile), haemorrhoids or varices (RR 1.09) and cancers (RR 1.22) tended to be elevated in the highest quartile of height. The generalised inverse relationship between height and prevalence of chronic disease suggests that poorer nutrition in childhood and adolescence is an unfavourable indicator for the subsequent occurrence of several diseases. Major exceptions were hypertension and varices, two conditions highly dependent on the pattern of health care utilization, and cancer.

In Italy the peak rate of peptic ulcer mortality was observed in the early 1970s, with a delay of around two decades in comparison with northern Europe and the USA. This can be related to the later process of industrialization in Italy, with the consequent changes in lifestyle habits, and to a later pattern of rise and decline of cigarette smoking. A likely explanation of the falls in mortality on a period of death basis over the last decade is the introduction of new drugs (histamine-2 receptor antagonists) for the treatment of peptic ulcer, with a reduction of complications of the disease and related mortality. This decline in mortality from peptic ulcer corresponds to the avoidance of over 1500 deaths per year in the whole of Italy.

An overview is given of recent patterns of trends in cancer mortality in various age groups in Italy and, for comparative purposes, in other European countries. Important changes in mortality for several major cancer sites have been observed over the last two decades, such as the declines in gastric cancer or the increases in lung cancer mortality. These are difficult to understand and justify from an epidemiological and public health viewpoint, since the main cause of lung cancer (cigarette smoking) has long been known, while the determinants of stomach cancer are still largely undefined. Changes were minor, and inconsistent across countries, for other major cancers, such as intestines or breast. Furthermore, trends were systematically more favourable in young adults (and, to a less extent middle age), as compared to the elderly. The decline in young adults reflects more favourable exposure to risk factors (eg declined smoking prevalence, better diet), but also improvements in diagnostic and therapeutic procedures for some cancers. Due caution is required in any extrapolation, particularly since the distribution of the most common types of cancer changes in subsequent age groups. These favourable trends in young adults offer, none the less, important (and positive) indications as to the likely future trends when the same generations will reach middle and older age.

The cohort trend suggests that long term improvements in socioeconomic and general health conditions may be important factors in the diminishing stillbirth rates, as well as short term advances in obstetric care. Alternatively the cohort effect could be attributed, at least in part, to an age-period interaction, since the downward trends were more pronounced in younger women.