Data from a multicentric case-control study on breast cancer conducted in Italy were used to analyze the relationship of occupational and leisure-time physical activity with breast cancer risk. Cases were 2569 histologically confirmed incident breast cancer cases, and controls were 2588 patients admitted to the same network of hospitals of cases for acute, nonneoplastic, nonhormone related diseases. After allowance for major identified potential confounding factors (including an estimate of total calorie intake), the odds ratios (ORs) were 0.70, 0.71, 0.64, and 0.54 in subsequent levels of physical activity at work at ages 30-39, compared to the lowest level. The association was similar for occupational physical activity at ages 15-19 and still apparent at ages 50-59, with risk estimates of 0.86, 0.85, 0.85, and 0.62. The ORs for the highest versus the lowest category of leisure-time physical activity were also below unity (ORs for the highest level of leisure-time physical activity at ages 15-19, 0.95; at ages 30-39, 0.76; and at ages 50-59, 0.66). The protection of physical activity was apparently stronger below age 60 at diagnosis and was consistent across the strata of selected covariates, although the protection was somewhat greater for more educated women.

The relationship between fertility treatment and breast cancer was investigated in a multicentric case-control study conducted in Italy on 2569 women with incident, histologically confirmed breast cancer and 2588 control women admitted to hospitals for acute, non-neoplastic, non-hormonal or gynaecological conditions, unrelated to fertility problems. The odds ratio of breast cancer was 1.08 (95% confidence interval 0.8-1.5) in those reporting fertility treatment compared with those who did not receive fertility treatment. Similarly, the odds ratio was 0.60 for women with tubal occlusion, 0.99 for those reporting hormonal imbalances and 1.32 for other/unspecified reasons. There was no consistent pattern of risk according to age at treatment and time since treatment. Women reporting fertility treatment with drug use had an odds ratio of 1.43, while those who did not report drug therapy had an odds ratio of 0.85. None of these odds ratio estimates was significant. Likewise, there was no heterogeneity among strata of parity, menopausal status, education and family history of breast cancer. Thus, our study, while providing reassuring evidence on the relationship between fertility treatment and breast cancer risk, cannot exclude the possibility that the use of specific drugs may be related to breast carcinogenesis.

A large amount of evidence indicates that BMC reduce the risk of gonorrhoea and HIV transmission, but the results are--at least in quantitative terms--less consistent for other diseases. Implications for individual choices and public health approaches should relate to frequency of exposure and severity of the disease too.

Recent trends in mortality from lung cancer and other tobacco-related neoplasms in Europe are reviewed. During the last decade, overall lung cancer mortality in males showed no systematic pattern in northern and central Europe, but some modest decline started at younger ages in several countries. In southern Europe, lung cancer mortality started from lower values, but is still rising, and only in Italy is some flattening of rates at relatively high levels becoming apparent in middle age (35 to 64 years). The average change in lung cancer rates in southern Europe over the last decade for males was +24% at all ages and +22% in middle age. The upward trends were even more substantial in eastern European countries (+32% in middle age), which now have the highest lung cancer rates in young and middle-aged males. Over the last few decades, female lung cancer rates have risen in all European countries, but only in Denmark and Britain are overall rates now over 20/100,000. There is therefore still ample scope for urgent intervention aimed at controlling a major tobacco-related lung cancer epidemic among European women in the near future. Substantial rises have been observed for cancer of the oral cavity and pharynx in most European countries, and for cancers of the esophagus, larynx, and (to a lesser extent) of the bladder in eastern Europe. Thus, southern and mainly eastern Europe are becoming priority areas for a campaign for giving up smoking since the prevalence of tobacco smoking in the young is higher and high-tar dark-tobacco cigarettes are still common.

Data from a case-control study on the upper digestive and respiratory tract cancers were analyzed to investigate the relationship with anthropometric measures. The data set included 538 oropharyngeal, 410 esophageal, and 388 laryngeal cancer cases and 2,102 controls in hospital for acute nonneoplastic diseases, unrelated to tobacco or alcohol use, recruited in the same catchment areas as the cases. Lower body weight appeared to be an indicator of oropharyngeal and esophageal cancer and, more moderately, of laryngeal cancer. The multivariate odds ratio (OR) for oropharyngeal cancer was 5.0 for subjects in the lowest compared with the highest quartile of weight. The corresponding ORs were 6.2 for esophageal and 2.2 for laryngeal cancer. When quartiles of body mass index (BMI) were considered, the ORs in the lowest quartile were 4.0 for oropharyngeal, 6.3 for esophageal, and 2.4 for laryngeal cancer. Subjects in the lowest quartile of height had ORs of 2.0 for oropharyngeal, 1.6 for esophageal, and 1.4 for laryngeal cancer. When all the upper digestive and respiratory tract neoplasms were considered together, the OR for subjects with lower BMI who were also current smokers compared with never-smokers with higher BMI was 11.4. The OR was 5.0 for those consuming six or more drinks/day and with low BMI. Although the nature of the association needs to be clarified, these data suggest that leanness may be involved in the process of upper digestive and respiratory tract carcinogenesis.

Analysis trends in incidence rates avoids some weaknesses of AIDS statistics based on absolute numbers, and should become one of the standard tools for AIDS surveillance.

Biliary tract cancers are rare neoplasms including gallbladder cancer (the commonest), extrahepatic biliary tract cancer and cancer of the ampulla of Vater. Descriptive epidemiology of biliary tract cancers as a whole has two peculiarities: incidence and mortality rates are higher for women than men, and in some specific populations. Mortality rates are highest among New Mexico American Indian women, in Chile and Japan, lowest in Great Britain and Greece. Mortality trends vary widely: the largest increases have been observed in Japan, Hong-Kong and Spain and the largest decreases in the Anglo-Saxon populations. Our knowledge of biliary tract cancer etiology is limited. Defined risks include genetic factors (family history of biliary tract cancers, ethnicity), history of gallbladder disease, and cholelithiasis. Risk factors reported in some studies, on which, however, information is not consistent and which need further study, include overweight, some menstrual and reproductive factors (multiparity, young age at first birth, late menopause), low education, cigarette smoking, selected bacterial infections, some intestinal diseases and diabetes.

Trends in age-specific and age-standardized mortality from 10 major cancer sites and total cancer mortality in the USSR were analyzed for the period 1965-1990, on the basis of the World Health Organization mortality database. Gastric cancer mortality declined substantially. Still, these rates were among the highest registered in the world, and in 1990 stomach cancer accounted for over 85,000 deaths, being the second cause of cancer death (and the first one until 1980); further, there was some indication of a levelling of the declines in gastric-cancer rates for both sexes over most recent calendar years. Likewise, uterine-cancer mortality declined between 1965 and 1985, but there was no further decline over the last 5 years. Upward trends were registered for cancers of the intestine, of the breast and of the prostate. Mortality from these neoplasms, however, was still comparatively low by worldwide standards. Leukaemia rates were stable in both sexes. Substantial rises were observed for cancers of the oral cavity and pharynx, larynx and, chiefly, lung. Even more unfavourable was lung-cancer mortality in young and middle-aged males, since the truncated rate of 121/100,000 in 1990 was higher than the values reached by countries like England and Wales or Finland even at the top of their epidemic in the 1960s, and trends in the USSR were still upwards. Thus, total cancer mortality was 176/100,000 males in 1965, declined to 170 in 1970, but increased thereafter, particularly over the last decade, to reach 203/100,000, i.e., one of the highest rates on a worldwide scale. Among females, the overall cancer mortality rate declined between 1965 and 1975, but rose thereafter to a value intermediate on a worldwide scale. These recent unfavourable trends of cancer mortality in the USSR indicate that, in the absence of adequate intervention, particularly on the tobacco-related cancer epidemic, overall cancer mortality will continue to rise in the foreseeable future.