The separate effect of alcohol and tobacco on laryngeal cancer was analysed in two case-control studies from Italy and Switzerland, comprising 40 non-smoking and 68 non-drinking cases, and 160 non-smoking and 161 non-drinking controls. The multivariate odds ratio was 2.46 for heavy drinkers non-smokers, and 9.38 for current smokers non-drinkers.
Understanding and perceiving risks is a major issue for any health education and preventive intervention (Zeckhauser and Viscusi, 1990; Hertz-Picciotto, 1995). However, comparing risk assessment and risk perception is subject to substantial error (Trichopoulos, 1996; La Vecchia et al., 1999). To address these issues using a systematic and quantitative approach, we have conducted a survey on belief, perception and behaviour of cancer risk in the general population of 5 European countries: Belgium, France, Italy, Portugal and Spain. The study sample was selected from telephone lists in strata of geographic area; over 95% of European households have a telephone. During September 1998, a total of 65,000 households (13,000/country) were sent an anonymous questionnaire (pre-tested in a pilot phase), requesting a reply by subjects aged 16 or over (20 or over in France). A total of 5,579 valid questionnaires was obtained (3,202 females and 2,377 males). No reminder was sent. Only basic demographic information was available from non-responders. The sample of respondents over-represented women, younger age groups and subjects with higher education. Consequently, direct standardisation was used to correct for these factors. The questionnaire included a general section on perception of risk of death and of selected diseases, such as cardiovascular disease, accidents, infectious diseases and cancer. Information was specifically collected on perception of risk and related behaviour for 16 major recognised or potential risk factors for cancer (La Vecchia et al., 1999). For each factor (e.g., “avoiding smoking”), 3 replies were included in the questionnaire for belief (yes, no, I do not know) and 2 for behaviour adoption (yes, no). Table I gives the percent population perceiving (belief) or adopting (behaviour) selected measures to reduce cancer risk, ranked according to belief on the overall data set. Avoiding smoking ranked first according to belief (96.8%) but third (after reducing alcohol and limiting exposure to sunshine) according to behaviour. The second rank according to belief, before alcohol, was limiting exposure to sunshine (92.2%). The fourth and fifth ranks were limiting exposure to UV radiation and avoiding consumption of pesticide-treated vegetables and fruit (74.4%), and a surprisingly high score was given to extremely low-frequency electromagnetic fields (65.3%). A smaller relevance was given to selected nutritional and dietary factors, such as avoiding overweight (59.1%) or excessive calorie intake (51.6%), which was believed to be as important as avoiding genetically modified foods (51.2%). Other measures with no documented impact of cancer risk also showed appreciable proportions of belief, including avoiding using cellular phones (39.6%), avoiding microwaved foods (34.3%) and using food supplements (29.4%). These were also the factors with generally larger between-country variation (e.g., between 57.8% in Italy and 26.3% in France for cellular phones), in the absence, however, of any single and consistent pattern (La Vecchia et al., 1999). With reference to behaviour adopted, 64.1% of respondents reported limiting alcohol drinking, 61.5% limiting exposure to sunshine and 60.9% avoiding smoking. Most other items ranged between 30% and 45%. Between-country variation was, if anything, larger for several behaviours than for beliefs. The sample was large enough to provide reliable estimates for most factors considered but over-sampled women, younger age groups and more educated subjects. These potential sources of bias were corrected by direct standardisation, but some residual bias is possible. A non-quantifiable bias, moreover, may have been introduced by the low response rate, which is inherent in the study design. In conclusion, tobacco and alcohol, the 2 major determinants of cancer on a population level in Europe, were perceived to be major risk factors (Sutton, 1998; Doll, 1999), though consequent behaviours were adopted by only about 60% of the population. Sunshine exposure is a well-defined but quantitatively smaller cancer risk factor on a population level, but was perceived to be a risk factor by most subjects (English et al., 1997). Other sources of non-ionizing radiation, such as electromagnetic fields, whose role in cancer occurrence, if any, remains largely undefined (Poole and Trichopoulos, 1991; Trichopoulos, 1996; Doll, 1999), appeared to be grossly over-estimated. Most nutritional and dietary factors ranked relatively low as risk factors for cancer, including some of the best established ones (i.e., overweight), whereas the role of food colouring, other food additives or pesticides was largely over-estimated (Ames et al., 1995), thus confirming the uncertainties and difficulties in the process of cancer risk communication and perception (Fischhoff, 1999; Gerrard et al., 1999). Yours sincerely, Carlo La Vecchia* , Marco Anelli , Ettore Zuccato*, Roberto Fanelli*, Guy Sermeus§, Natalia Milazzo
Mortality from testicular cancer has been declining in the USA since the 1970's and in western Europe since the late 1970's, and the rates in the late 1990's were about 70% lower than in the 1970's. In Eastern Europe, however, some decline was observed only since the late 1980's and was substantially smaller (only approximately 20%). Consequently, a few hundred avoidable deaths from a curable neoplasm, mainly of young adults, are still registered in Eastern Europe. This underlines the urgency of implementation of available and effective therapeutic schemes for testicular cancer in Eastern Europe.
To the Editor: Tarone et al1 describe and quantify a decrease in U.S. prostate cancer mortality in white men since 1992, with rates in 1997 below those of 1986, ie, the year when prostate specific antigen (PSA) testing was approved. In light of different incidence and mortality trends for prostate cancer worldwide, 2 we examined trends in the European Union (EU). Official death certification numbers for the 15 member states of the EU were derived from the World Health Organization (WHO) database for the calendar period between 1970 and 1996. 3 Three different revisions of the International Classification of Diseases (ICD) were used. Classifications of prostate cancer deaths were thus re-coded, for the whole calendar period considered and all countries, according to the ninth Revision (ICD-9). 4 Estimates of the resident population, based on official censuses, were obtained from the same WHO database. From the matrices of certified deaths and resident populations, we computed age-specific rates for each 5-year age group and calendar period. For age-standardization we used the world standard population. Overall age-standardized prostate cancer mortality peaked in 1992 (15.6/100,000), and declined subsequently reaching 15.4/100,000 in 1996. Figure 1 gives trends in age-standardized death certification rates from prostate cancer for EU men age 50 and over. In all age groups below age 80, prostate cancer mortality leveled off around 1992. FIGURE 1: Age-standardized mortality from prostate cancer per 100,000 men (world standard) in the European Union, 1970–1996.PSA testing was introduced—on a population level—in western Europe a few years later than in the United States (ie, around 1989–1990). Although no reliable data on prevalence of use and indication in the whole EU over the last few years is available in the absence of organized screening, the proportion of men aged 60 or over who had undergone PSA screening is probably much lower than what it is in several areas of the United States. 5–10 Fabio Levi Franca Lucchini Eva Negri Carlo La Vecchia
Read moreTo the Editor: Dr Rodriguez and colleagues1 found a direct association between the use of hormone replacement therapy (HRT) and the risk of ovarian cancer. Data from other cohort and case-control studies, however, are less consistent.2
Read moreThe relationship between a history of hypertension and the quality of its control in routine clinical practice and the risk of acute myocardial infarction was examined in a multicenter, case-control study conducted in Argentina between November 1991 and August 1994, within the framework of the FRICAS study. The cases were 939 patients with acute myocardial infarction and without a history of ischemic heart disease. The controls were 949 subjects identified in the same centers as the cases and admitted with a wide spectrum of acute disorders unrelated to known or suspected risk factors for acute myocardial infarction. The odds ratios and the 95% confidence intervals were derived from multiple logistic regression equations, including terms for age, gender, education, social status, exercise, smoking status, cholesterolemia, history of diabetes, body mass index, and family history of myocardial infarction. The quality of hypertension control was assessed with the most recent blood pressure reading reported by the subjects. Seventy-two percent of hypertensive cases and 62.6% of hypertensive controls had a history of antihypertensive therapy by self-report, when admitted to the medical center. The adjusted odds ratio for acute myocardial infarction due to hypertension was 2.58 (95% confidence interval, 2.08-3.19). The odds ratio was 2.42 (95% confidence interval, 1.88-3.11) when hypertensives reported that their greatest systolic value was below 200 mm Hg (moderate status) and 4.12 (95% confidence interval, 2.87-5.89) when it was above 200 mm Hg (severe status). When the highest diastolic blood pressure value was below 120 mm Hg (moderate status), the risk increased to 2.48 (95% confidence intervals, 1.90-3.24) and to 4.12 (95% confidence interval, 2.83-5.99) when it was above 120 mm Hg (severe status). If the most recent systolic blood pressure was less-than-or-equal140 mm Hg, the odds ratio was 2.59 (95% confidence interval, 1.96-3.41), and it was 3.42 (95% confidence interval, 2.40-4.87) when the value was >140 mm Hg. If the most recent diastolic blood pressure was less-than-or-equal90 mm Hg, the risk increased more than two fold (odds ratio=2.48; 95% confidence interval, 1.91-3.22), and if it was >90 mm Hg, it increased nearly four-fold (odds ratio=3.72; 95% confidence interval, 2.33-5.96). In smokers, the odds ratio was 2.28 in the absence of hypertension and increased to 7.51 when hypertension was present. In this Argentine population, hypertension is a strong and independent risk factor for acute myocardial infarction. In routine clinical practice, the control of blood pressure to levels below 140/90 seems to be required in order to reduce part (but not all) of the risk of acute myocardial infarction in hypertensive patients. (c) 2001 by CHF, Inc.
Read moreTo better understand the nutritional etiology of squamous cell esophageal cancer, we conducted a case-control study in 3 areas of northern Italy. A total of 304 incident, histologically confirmed cases of squamous cell carcinoma of the esophagus (275 men, 29 women) and 743 hospital controls (593 men, 150 women) with acute, non-neoplastic conditions, not related to smoking, alcohol consumption or long-term diet modification, were interviewed during 1992 to 1997. The validated food-frequency questionnaire included 78 questions on food items or recipes, which were then categorized into 19 main food groups, and 10 questions on fat intake pattern. After allowance for age, sex, education, area of residence, tobacco smoking, alcohol drinking and non-alcohol energy, a significant increased risk emerged for high consumption of soups (OR=2.1 for the highest vs. lowest quintile), whereas inverse associations with esophageal cancer risk were observed for pasta and rice (OR=0.7), poultry (OR=0.4), raw vegetables (OR=0.3), citrus fruit (OR=0.4) and other fruit (OR=0.5). The associations with dietary habits were consistent in different strata of tobacco smoking and alcohol drinking. Among added lipids, olive oil intake showed a significant reduction of esophageal cancer risk, even after allowance for total vegetable consumption (OR=0.4), while butter consumption was directly associated with this risk (OR=2.2). Our results thus provide further support to the evidence that raw vegetables and citrus fruit are inversely related to the risk of squamous cell esophageal cancer and suggest that olive oil may also reduce this risk. Int. J. Cancer 87:289–294, 2000. © 2000 Wiley-Liss, Inc.
Read moreA strong, dose-dependent association exists between alcohol consumption and risk of cancer of the oral cavity and pharynx. The impact on risk of temporal aspects of drinking habits has been inadequately evaluated. Our case-control study included 754 individuals with incident cancer of the oral cavity and pharynx (median age 57) and 1,775 controls (median age 57) in the hospital for acute, non-neoplastic diseases who were interviewed in 2 Italian areas and in the Swiss Canton of Vaud between 1992 and 1997. The questionnaire included lifetime drinking and smoking habits. No influence of age at starting or duration of alcohol drinking was found. Risk increased substantially with the increase of weekly alcoholic drinks [Odds Ratios (OR) for >/= 91 drinks/week vs. never drinkers = 11.6]. Risk in former compared with current drinkers was 1.9-fold elevated. However, among individuals who had also stopped smoking, former drinkers showed lower ORs than current drinkers. The persistence of risk elevation several years after drinking cessation suggests that the role of alcohol is complex and it probably affects more than one stage of oral carcinogenesis. It remains to be clarified which impact prevention-driven drinking cessation may have on the excess of cancer of the oral cavity and pharynx due to elevated alcohol intake.
Read more1Cancer Epidemiology Unit and Cancer Registries of Vaud and Neuchâtel Institut universitaire de médecine sociale et préventive, CHUV-Falaises 1 1011 Lausanne, Switzerland 2Laboratory of Epidemiology Istituto di Ricerche Farmacologiche ‘Mario Negri’ Via Eritrea 62, 20157 Milano, Italy 3Istituto di Statistica Medica e Biometria Università degli Studi di Milano Via Venezian 1, 20133 Milano, Italy Fax: (+41) 21 3230 303 E-mail: [email protected]
Read moreTo evaluate the strength of the evidence provided by the epidemiological literature on the association between alcohol consumption and the risk of 18 neoplasms, we performed a search of the epidemiological literature from 1966 to 2000 using several bibliographic databases. Meta-regression models were fitted considering linear and non-linear effects of alcohol intake. The effects of characteristics of the studies, of selected covariates (tobacco) and of the gender of individuals included in the studies, were also investigated as putative sources of heterogeneity of the estimates. A total of 235 studies including over 117 000 cases were considered. Strong trends in risk were observed for cancers of the oral cavity and pharynx, oesophagus and larynx. Less strong direct relations were observed for cancers of the stomach, colon and rectum, liver, breast and ovary. For all these diseases, significant increased risks were found also for ethanol intake of 25g per day. No significant nor consistent relation was observed for cancers of the pancreas, lung, prostate or bladder. Allowance for tobacco appreciably modified the relations with laryngeal, lung and bladder cancers, but not those with oral, oesophageal or colorectal cancers. This meta-analysis showed no evidence of a threshold effect for most alcohol-related neoplasms. The inference is limited by absence of distinction between lifelong abstainers and former drinkers in several studies, and the possible selective inclusion of relevant sites only in cohort studies. © 2001 Cancer Research Campaign http://www.bjcancer.com
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