Incidence of adenocarcinoma of the oesophagus and gastric cardia is increasing in most developed countries and strongly associated with obesity and male gender. An underlying increase in the prevalence of gastro-oesophageal reflux has generally been postulated. We suggest that the increase in frequency of reflux and the 2 associated forms of cancer can be explained by growing abdominal pressure brought about by increasing central obesity, most common among men, and sedentary lifestyle, including car use. Abdominal pressure is further accentuated mainly in men by the shift in Western male dressing towards the general use of belts.

The relation between diet and risk of oral and pharyngeal cancer was analysed in a case-control study conducted in North-East Italy between 1996 and 1999. Cases were 132 patients (including 33 women), with incident, histologically confirmed cancer of the oral cavity or pharynx, and controls were 148 subjects (including 45 women) admitted to hospitals for acute conditions unrelated to smoking or alcohol drinking. After allowance for tobacco, alcohol and several other potential confounding factors, significant inverse association with the risk of oral and pharyngeal cancer was found for consumption of total green vegetables (OR 0.37) and total fruit (OR 0.34) with significant trends in risk Compared with alcohol drinkers of < 20 drinks/week and eating > 13 portions/week of total green vegetables, the OR for drinkers of > or = 20 drinks/week and eating < 7 portions/week of green vegetables was 15.44. Our study provides further support to the beneficial effect of high intake of vegetables and fruit, particularly in heavy smokers and alcohol drinkers.

1Istituto di Ricerche Farmacologiche “Mario Negri” Via Eritrea 62 20157 Milano, Italy 2Istituto di Statistica Medica e Biometria Università di Milano Via Venezian 1 20133 Milano, Italy Correspondence to: C La Vecchia Fax: (+39-02-33200231/39001916)

We investigated the role of fried foods on oral-pharyngeal and oesophageal cancers, using data from two case-control studies conducted in Italy and Switzerland between 1992 and 1999, one with a total of 749 (634 men) cases of oral/pharyngeal cancer and 1772 (1252 men) controls, the other with 395 (351 men) cases of oesophageal cancer and 1066 (875 men) controls. Controls were admitted for acute, non-neoplastic conditions, unrelated to alcohol and smoking consumption. After allowance for sex, age, centre, education, body mass index, tobacco smoking, alcohol drinking and nonalcohol energy intake, the multivariate odds ratios (ORs) for an increment of one portion per week of total fried foods were 1.11 (95% confidence interval (CI): 1.05-1.17) for oral-pharyngeal and 1.16 (95% CI: 1.08-1.26) for oesophageal cancer. The ORs were consistent across strata of gender (OR in men only were 1.10 and 1.16, respectively), age, alcohol, tobacco consumption and body mass index.

In order to evaluate the short-term effects (3 weeks) on selected coronary heart disease (CHD) risk factors, 90 obese in-patients (body mass index, BMI, > or = 35 kg/m2 received a same low-calorie diet (1200-1800 kcal/day), nutritional education and psychological counselling, and were randomly assigned to either a non-specific, high-volume, low-intensity exercise training program (NET), or to an individualised, low-volume and high-intensity exercise training program (IET), for 5 days/week for 3 weeks. NET and IET programs lead to a significant reduction in blood glucose (6.2 and 7.7% respectively), total cholesterol (17.3%, 12.3%), HDL-cholesterol (13.7%, 15.2%), systolic (8.9%, 5.3%) and diastolic resting blood pressure (10.6%, 3.3%). Total CHD scores were also significantly improved (38.1%, 33.1%). The changes occurred with a relatively moderate decrease in body weight (4.2%, 4.4%) and with still elevated BMI values (41.6 kg/m2). Although IET, compared to NET program, induced smaller reductions of blood pressure, it requires 30% daily training period and may possibly enhance long-term patient compliance.

The incidence of most epithelial cancers rises with a power of age. However, second breast cancers have a high constant incidence independent of age. The skin is one of the few other sites allowing examination of age incidence curves of second neoplasms of the same organ. We considered the risk of second primary cutaneous malignant melanoma (CMM) in a population-based series of 3,439 first CMM registered and followed-up between 1974 and 2003 in the Swiss Cantons of Vaud and Neuchâtel (about 786,000 inhabitants). A total of 43 cases of second CMM were observed vs. 9.3 expected, corresponding to a standardized incidence ratio (SIR) of 4.6. The SIR was 8.5 under age 50, 5.7 at age 50-59 and 3.5 at age 60 or over. At 20 years, the cumulative risk of second CMM was 5%. Age-specific incidence rates of second primary CMM did not vary across age groups 30-39 through 80+, ranging between 1 and 2.5 per 1,000 person-years. Thus, the risk of CMM is substantially increased in subjects diagnosed with a CMM, and the relative risk is greater at younger age and declines with advancing age. The high constant incidence curve of second CMM is compatible with the occurrence of a single mutational event in a population of susceptible individuals.

Although several studies have been conducted, the relation between diet and prostate cancer remains unclear. The role of a wide range of foods on the risk of prostate cancer has thus been analyzed in a case-control study conducted in Italy between 1991 and 2002. Cases were 1,294 patients below age 75 years with incident, histologically confirmed carcinoma of the prostate; controls were 1,451 subjects below age 75 years admitted to the same hospitals as cases for a wide spectrum of acute, non-neoplastic conditions. Multivariate odds ratios (ORs) were obtained after allowance for major potential confounding factors, including calorie intake. Among the 19 food groups considered, 4 showed some significant association with prostate cancer risk. A significant trend of increasing risk with more frequent consumption was found for milk and dairy products (OR = 1.2 for highest vs. lowest quintile, p = 0.03) as well as bread (OR = 1.4, p = 0.01), whereas inverse associations were observed for soups (OR = 0.8, p = 0.02) and cooked vegetables (OR = 0.7, p = 0.01). This uniquely large study on prostate cancer and diet in a southern European population confirms that no strong association exists between any specific foods and prostate cancer, apart from an increased risk for milk and dairy products and a possible protective effect of vegetables.

We analyzed the association between history of cancer in first-degree relatives and the risk of squamous cell carcinoma of the esophagus (SCCE) using data from three case-control studies conducted in Italy and Switzerland on 805 incident, histologically confirmed SCCE, and 3,461 hospital controls. The alcohol- and tobacco-adjusted odds ratio (OR) for a family history of esophageal cancer was 3.2 [95% confidence interval (CI), 1.7-6.2], and the OR was higher when the affected relative was a brother or was diagnosed at age <55 years. Compared to subjects without family history of esophageal cancer, non-current smokers, drinking <49 drinks per week, the OR was 2.9 (95% CI, 1.1-7.5) for family history alone, 15.5 (95% CI, 11.7-20.5) for current smokers drinking > or = 49 drinks per week without family history of esophageal cancer, and 107.0 (95% CI, 13.0-880.2) for current smokers drinking > or = 49 drinks per week who also had a family history of esophageal cancer. The risk of SCCE was also increased in subjects with a family history of cancer of the oral cavity/pharynx (OR, 3.7; 95% CI, 1.5-9.0) and stomach (OR, 2.0; 95% CI, 1.1-3.6), but not of other cancers, nor for a family history of any cancer (OR, 1.0; 95% CI, 0.8-1.4). These data show that, as for many other epithelial cancers, the risk of SCCE is increased in subjects with a family history of the disease, and that--in Western countries--avoidance of alcohol and tobacco is also the best way to prevent SCCE in subjects with a family history of the disease.