The relationship between menopause and non-fatal acute myocardial infarction (AMI) was considered by analysing data from a case-control study conducted in Italy between 1983 and 1992. Cases were 429 women, below age 75 years, with a first episode of non-fatal AMI, admitted to 30 coronary care units; controls were 863 women admitted to the same network of hospitals for acute diseases other than cardiovascular, neoplastic, or hormone-related. Postmenopausal women were not at higher risk of AMI than pre/perimenopausal women, after adjustment for age and other selected covariates [multivariate odds ratio (OR) 0.99]. With reference to age at menopause, compared with women reporting menopause when <45 years, the multivariate OR were 1.54 for those aged 45-49 at menopause, 1.36 for those aged 50-52 years, and 0.97 for those aged >/=53, in the absence of any trend in risk. No meaningful relationship emerged with time since menopause (OR 0.85 for <10 years since menopause). The results were similar in women aged <60 and >/=60 years at AMI. Although the present study does not support a substantial relationship between menopause and non-fatal AMI, the overall epidemiological evidence is compatible with a moderate association.

Most epidemiological data suggest a protective role for fruits and vegetables in the prevention of several common epithelial cancers, including digestive and major non-digestive neoplasms. The relation between frequency of consumption of vegetables and fruit and cancer and myocardial infarction risk was analysed using data from a series of case-control studies conducted in Italy. For digestive tract cancer, population attributable risks for low intake of vegetables and fruit ranged between 15 and 40%. A selected number of antioxidants showed a significant inverse relation with breast and colorectal cancer risk, although the main components responsible for the favourable effect of a diet rich in vegetables and fruit remain undefined. Fish tends to be another favourable indicator of reduced cancer risk. In contrast, subjects reporting frequent red meat intake showed a relative risk consistently above unity for several common neoplasms. Whole grain food intake was consistently related to reduced risk of several types of cancer, particularly of the upper digestive tract neoplasms. Epidemiological evidence of the relation between fiber and colorectal cancer indicated a possible protections. In contrast, refined grain intake was associated to increased risk of different types of cancer, pointing to a potential role of insulin-like growth factor 1 (IGF-1). A low risk diet for cardiovascular disease includes high consumption of fish, vegetables and fruit, and hence rich in ascorbic acid and other antioxidants, thus sharing several aspects with a favourable diet for cancer.

Small amounts of n-3 PUFAs may be inversely related to AMI risk in this low-risk population.

In several studies from northern Europe, north America and Australia, melanocytic nevi are correlated with pigmentary traits and with intense sun exposure in a way similar to malignant melanoma. However, it is unclear if these data can be extrapolated to populations in other geographic locations and with different prevalent phenotypes. Our study was conducted among schoolchildren aged 13-14 years in 16 Italian cities. The parents of 3,127 children of a total of 3,160 (99%) consented to our study. A structured questionnaire was used to collect information about sun exposure and lifetime history of sunburns. Children were also examined by trained dermatologists to assess pigmentary traits and to make a count of melanocytic nevi. The median nevus density was higher among boys than girls. Areas that are usually chronically exposed to the sun exhibited a higher density of nevi compared to intermittently and rarely exposed areas. A higher density of nevi was found in children with lighter skin, blond hair and blue eyes. Red-haired children had a remarkably lower nevus density compared to the other color categories. The density of nevi increased with an increased number of reported episodes of sunburns. The results concerning nevi >/=6 mm in diameter paralleled those obtained for the total nevus density. However, at variance with total nevus density, a significant relation was also observed between larger nevi and freckling. Our study confirms that, in Italian schoolchildren, there is a relation between pigmentary traits, history of sunburns and the density of melanocytic nevi. Melanocytic nevi and malignant melanoma share a similar risk factor profile.

Mortality rates for colorectal cancer in many developed countries have declined in women more than in men. Possible explanations of the sex differentials in colorectal cancer mainly, but not only, refer to different exposure to exogenous hormones. This paper aims to review the available epidemiological evidence on this issue. Seven cohort studies reported information on HRT use and colorectal cancer risk, with relative risks (RRs) around or below unity, and significant inverse association was found in two of them. Of 12 case-control studies, five reported significant risk reductions among ever-users of HRT, while two investigations showed moderate, non-significant inverse associations and none showed a significant increased risk. Two recent meta-analysis showed a 20% reduction in the risk of colon cancer among current users. Overall, the studies reviewed support the existence of an inverse association between colorectal cancer and HRT. Although these epidemiological observations are consistent, surveillance bias may account for part of the association.

Abstract In a cohort mortality study, a few basic rules must be respected for risk estimation including: (1) the definition of the criteria of entry in the cohort; (2) the time period of observation; (3) the outcome, which must be the same for observed and expected events [Breslow and Day, 1987; MacMahon and Trichopoulos, 1996]. In their letter to the Editor referring to our article "Mortality Among Workers in the Geothermal Power Plants at Larderello, Italy" [Pira et al., 1999], Merler et al. appear to ignore these basic principles, since they extend the observation period from 1990 to 1998 for observed but not for expected events and do not distinguish between incidence and mortality. Consequently, their relative risk estimates are simply not interpretable. Anyway, an update of the follow‐up to the end of 2000 has already been planned.

The risk of breast cancer is moderately elevated in current and recent hormone replacement therapy users, with an approximate 2.3% excess risk per year of use. Some excess risk has also been reported for ovarian cancer in long-term users. Unopposed oestrogens are strongly related to endometrial cancer risk, but cyclic progestogen addition appears to reduce this side effect, possibly further increasing the risk of breast cancer. There is a moderate inverse association between colorectal cancer and hormone replacement therapy. Most potential favourable and adverse effects of hormone replacement therapy on cancer risk are restricted to current users. Selective oestrogen receptor modulators may offer advantages in reducing breast cancer risk. Regular aspirin use and high levels of physical activity induce a moderate reduction of risk for colorectal, and possibly for breast, ovarian and endometrial cancer. Overweight and obesity are strongly related to gallbladder, endometrial and breast cancer, and appear to be also related to colorectal, renal, pancreatic and ovarian cancer.

Naldi, L1; Gallus, S2; Imbem, G L1; Cainelli, T1; Negn, E2; Vecchia, C La2,3 on behalf of the Italian Group Author Information

To 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.