Since the investigation, at an individual level, of lifetime sun exposure remains difficult the site distribution of different types of skin cancer can be an important source of aetiological clues. The present report deals with 1,149 cases of cutaneous malignant melanoma (CMM), 7,685 of basal-cell carcinoma (BCC) and 3,049 of squamous-cell carcinoma (SCC) reported between 1976 and 1992 to the Vaud Cancer Registry, in Switzerland. Site- and type-specific age-standardized (on the world population) incidence rates per 100,000 population and per 100,000 unit surface were computed, together with relative age-standardized incidence rates (i.e., rates per 100,000 surface unit in each anatomical site relative to rates for the body as a whole). The highest rates per unit surface were seen for both genders in the face, thus indicating same role of cumulative sun exposure in all skin-cancer types. Relative to the incidence in the whole body, the excess on the face was, however, more than 20-fold for BCC and SCC, but only 4-fold for CMM. The relative incidence in males was very much higher for SCC than for CMM and BCC in the neck, ears and scalp, a heavily sun-exposed area in men but not in women. Conversely, a substantial lack of SCC was seen in the trunk. In conclusion, site distribution of different skin-cancer types suggests that short-duration UV-light exposure is sufficient to increase CMM risk substantially, but has little influence on SCC risk. With the increase of exposure, however, SCC rises more steeply than BCC. Age-related behaviour (i.e., another indirect indicator of duration of exposure to UV light) is consistent with the anatomical distribution of skin cancer.

The association between intake of N-nitrosodimethylamine (NDMA), the most commonly occurring of the volatile nitrosamines derived from foods, and gastric cancer risk has been investigated using data from a case-control study conducted in Northern Italy between 1985 and 1993, including 746 incident cases of gastric cancer and 2,053 controls admitted to hospital for acute, non-neoplastic and non-digestive tract diseases, not related to long-term modifications of diet. Information was collected on frequency of consumption of 29 food items, including selected sources of NDMA. Compared with subjects in the lowest tertile of NDMA intake, the odds ratios (ORs) were 1.1 in the intermediate and 1.6 in the highest tertile of intake. These estimates were not appreciably modified after allowance for total energy intake, other major dietary and non-dietary correlates of gastric cancer, and estimated intake of nitrite and nitrate: the multivariate OR for the highest NDMA intake tertile was 1.4 (95% CI 1.1-1.7). The association was consistent across strata of sex and age, but somewhat stronger in males and in subjects below age 60 (OR in the highest tertile, 1.8). Limitations of exposure assessment and absence of information on other N-nitrosamines preclude, however, any definite assessment of the possible role of exogenous N-nitrosamines in gastric carcinogenesis.

Current smoking seems to reduce the risk of myomas.

In a survey about euthanasia, 1,600 critical care nurses were randomly assigned to receive either three complete, anonymous mailings of the questionnaire or, with each mailing, a coded postcard to be returned separately from the questionnaire to reduce subsequent mailings to previous responders. The response rate in these two groups was 76.5% [95% confidence interval (CI) = 73.6-79.4%] and 69% (95% CI = 65.7-72.4%), respectively. The two strategies yielded similar responses, and costs were much lower for the postcard group. Using coded postcards to be returned separately from completed instruments appears to lower the response rate to anonymous mail surveys, but it also lowers cost and may not introduce additional bias.

The two main determinants of oral and oesophageal cancer in Europe are alcohol and tobacco, and the two cancer sites show several similarities in their descriptive epidemiology. This study compares mortality from cancers of the oral cavity and oesophagus in European countries to evaluate similarities and differences. From official death certification numbers and population estimates, we obtained age-standardized rates for all ages and truncated (35-64 years). In most countries, rates for men tended to increase between 1955-59 and 1990-92 for both sites, although the increases were more marked for oral cancer. In the UK and Ireland, however, oral cancer decreased and oesophageal cancer increased, while in Finland and Iceland mortality for both sites decreased. The most striking increases were in Hungary, where the truncated rate in most recent calendar periods reached the highest levels in Europe. In France, rates for both cancers were extremely high: oral cancer increased from 1955-59 to the early 1980s, but started to decline afterwards. Mortality rates were much lower for women than men, and the correlation between the two sites was less marked. An age, period and cohort model, applied to the rates for men in selected European countries, suggested strong cohort effects for both cancers, generally more marked for oral cancer, with substantial increases in the cohorts born after 1920. The mortality rates of cancers of the oral cavity and oesophagus show several analogies, as expected from their relation to tobacco and alcohol; but some discrepancies suggest that other, less well-identified, factors may also influence their rates and trends in Europe.

The relationship between the risk of biliary tract cancers and menstrual and reproductive factors has been studied in a case-control study conducted in Milan, northern Italy, between January 1984 and February 1993 on 31 incident, histologically confirmed cases and 377 controls in hospital for acute, non-neoplastic, non-gynaecological, non-hormone-related conditions. Odds ratios (ORs) together with their corresponding 95% confidence intervals (CIs) and the significance of the linear trends in risk were estimated by unconditional multiple logistic regression, after adjustment for age and cholelithiasis. Menopause was associated with a decreased risk of biliary tract cancers (OR 0.2), while late menopause and the use of hormone replacement therapy tended to increase the risk (ORs 1.8 and 2.2 respectively). Age at menarche and regular menstrual cycles were not associated. A trend in risk was found with parity, while total abortions and age at first and last birth were not related. Thus, the protective effect of early menopause and the apparent association of multiple full-term pregnancies suggest a role of female hormones in the aetiology of biliary tract cancers.