Previous studies have reported that Mediterranean diet is inversely related to the risk of several neoplasms; however, limited epidemiological data are available for bladder cancer. Thus, we examined the association between Mediterranean diet and this neoplasm in an Italian multicentric case-control study consisting of 690 bladder cancer cases and 665 controls. We assessed the adherence to the Mediterranean diet via a Mediterranean Diet Score (MDS), which represents the major characteristics of the Mediterranean diet and ranges from 0 to 9 (from minimal to maximal adherence, respectively). We derived odds ratios (ORs) of bladder cancer according to the MDS score from multiple logistic regression models, allowing for major confounding factors. The ORs of bladder cancer were 0.72 (95% confidence interval, CI, 0.54⁻0.98) for MDS of 4⁻5 and 0.66 (95% CI, 0.47⁻0.93) for MDS of 6⁻9 (<i>p</i> for trend = 0.02) compared to MDS = 0⁻3. Results were similar in strata of sex, age, and education, while the risk appeared somewhat lower in never-smokers and patients with pT1⁻pT4 bladder carcinomas. Among individual components of the MDS, we observed inverse associations for greater consumption of legumes, vegetables, and fish. In our study, which was carried out on an Italian population, the higher adherence to the Mediterranean diet was related to a lower risk of bladder cancer.

The Mediterranean diet has been related to a reduced risk of several common cancers but its role on breast cancer has not been quantified yet. We investigated the association between adherence to the Mediterranean diet and breast cancer risk by means of a hospital-based case-control study conducted in Italy and Switzerland. 3034 breast cancer cases and 3392 controls admitted to the same network of hospitals for acute, non-neoplastic and non-gynaecologic diseases were studied. Adherence to the Mediterranean diet was quantitatively measured through a Mediterranean Diet Score (MDS), summarizing the major characteristics of the Mediterranean dietary pattern and ranging from 0 (lowest adherence) to 9 (highest adherence). We estimated the odds ratios (ORs) of breast cancer for the MDS using multiple logistic regression models, adjusting for several covariates. Compared to a MDS of 0-3, the ORs for breast cancer were 0.86 (95% confidence interval, CI, 0.76-0.98) for a MDS of 4-5 and 0.82 (95% CI, 0.71-0.95) for a MDS of 6-9 (<i>p</i> for trend = 0.008). The exclusion of the ethanol component from the MDS did not materially modify the ORs (e.g., OR = 0.81, 95% CI, 0.70-0.95, for MDS ≥ 6). Results were similar in pre- and post-menopausal women. Adherence to the Mediterranean diet was associated with a reduced breast cancer risk.

We did not find clear evidence of an association between detailed estimates of lifetime total THM exposure and colorectal cancer in our large case-control study population. Negative associations with chloroform concentrations and ingestion suggest differences among specific THMs, but these findings should be confirmed in other study populations. Citation: Villanueva CM, Gracia-Lavedan E, Bosetti C, Righi E, Molina AJ, Martín V, Boldo E, Aragonés N, Perez-Gomez B, Pollan M, Gomez Acebo I, Altzibar JM, Jiménez Zabala A, Ardanaz E, Peiró R, Tardón A, Chirlaque MD, Tavani A, Polesel J, Serraino D, Pisa F, Castaño-Vinyals G, Espinosa A, Espejo-Herrera N, Palau M, Moreno V, La Vecchia C, Aggazzotti G, Nieuwenhuijsen MJ, Kogevinas M. 2017. Colorectal cancer and long-term exposure to trihalomethanes in drinking water: a multicenter case---control study in Spain and Italy. Environ Health Perspect 125:56-65; http://dx.doi.org/10.1289/EHP155.

We assessed the association of processed meat intake with the risk of renal cell carcinoma (RCC) and bladder cancer. We used data from two Italian hospital-based case-control studies, including 1,115 RCC cases and 2,582 controls, and 1,417 bladder cancer cases and 1,732 controls. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) with unconditional logistic regression models, adjusted for major confounders. The median consumption of processed meat in cases and controls was around 2 portions/week (50 g/portion). The ORs for a daily 10 g increment of processed meat was 0.89 (95% CI 0.84-0.94) for RCC and 1.00 (95% CI 0.94-1.06) for bladder cancer. The OR for the highest vs. the lowest consumption was 0.80 (95% CI 0.66-0.96) for RCC and 0.98 (95% CI 0.80-1.21) for bladder cancer. The ORs were consistent in strata of various covariates. For bladder cancer, however, a significant 23% excess risk was found in women (95% CI 1.03-1.47) for a daily increase of 10 g, significantly heterogeneous from the risk recorded in men (OR 0.96, 95% CI 0.90-1.02). The inconsistent results between men and women and the absence of association in both sexes combined indicate that the apparent association between processed meat and bladder cancer in women is unlikely to be causal.

Findings on the association between alcohol consumption and bladder cancer are inconsistent. We investigated that association in the European Prospective Investigation into Cancer and Nutrition cohort. We included 476,160 individuals mostly aged 35-70 years, enrolled in ten countries and followed for 13.9 years on average. Hazard ratios (HR) for developing urothelial cell carcinoma (UCC; 1,802 incident cases) were calculated using Cox proportional hazards models. Alcohol consumption at baseline and over the life course was analyzed, as well as different types of beverages (beer, wine, spirits). Baseline alcohol intake was associated with a statistically nonsignificant increased risk of UCC (HR 1.03; 95% confidence interval (CI) 1.00-1.06 for each additional 12 g/day). HR in smokers was 1.04 (95% CI 1.01-1.07). Men reporting high baseline intakes of alcohol (>96 g/day) had an increased risk of UCC (HR 1.57; 95% CI 1.03-2.40) compared to those reporting moderate intakes (<6 g/day), but no dose-response relationship emerged. In men, an increased risk of aggressive forms of UCC was observed even at lower doses (>6 to 24 g/day). Average lifelong alcohol intake was not associated with the risk of UCC, however intakes of spirits > 24 g/day were associated with an increased risk of UCC in men (1.38; 95% CI 1.01-1.91) and smokers (1.39; 95% CI 1.01-1.92), compared to moderate intakes. We found no association between alcohol and UCC in women and never smokers. In conclusion, we observed some associations between alcohol and UCC in men and in smokers, possibly because of residual confounding by tobacco smoking.

Epidemiological and toxicological evidence suggests that PFOA and PFOS elicit a decrease in BrthW both in humans and rodents. However, the effective animal extrapolated serum concentrations are 10²-10³ times higher than those in humans. Thus, there is no quantitative toxicological evidence to support the epidemiological association, thus reducing the biological plausibility of a causal relationship.

We predicted continuing falls in mortality rates from major cancer sites in the EU and its major countries to 2018. Exceptions are pancreatic cancer and lung cancer in women. Improved treatment and-above age 50 years-organized screening may account for recent favourable colorectal cancer trends.

Limited information is available on risk of peritoneal mesothelioma after asbestos exposure, and in general on the risk of cancer after cessation of asbestos exposure. We updated to 2013 the follow-up of a cohort of 1083 female and 894 male textile workers with heavy asbestos exposure (up to 100 fb/mL), often for short periods. A total of 1019 deaths were observed, corresponding to a standardized mortality ratio (SMR) of 1.68 (95% confidence interval [CI]: 1.57-1.78). SMRs were 29.1 (95% CI: 21.5-38.6) for peritoneal cancer, 2.96 (95% CI: 2.50-3.49) for lung cancer, 33.7 (95% CI: 25.7-43.4) for pleural cancer, and 3.03 (95% CI: 1.69-4.99) for ovarian cancer. For pleural and peritoneal cancer, there was no consistent pattern of risk in relation to time since last exposure, whereas for lung cancer there was an indication of a decline in risk after 25 years since last exposure. The findings of this unique cohort provide novel data for peritoneal cancer, indicating that - as for pleural cancer - the excess risk does not decline up to several decades after cessation of exposure.

Indication for the use of trastuzumab was given in Italy in 2000 for the treatment of HER-2 metastatic breast cancer and in&#13;\n2006 for early stage breast cancer. Information on trastuzumab use and on its possible variation with age in Italy is however limited. Using&#13;\nhealth care administrative databases, we evaluated the prevalence of the use of trastuzumab, and the probability for administration&#13;\nsince the first hospitalization for breast cancer in various age groups, in two series of Italian women diagnosed with breast cancer in the&#13;\nLombardy region (2004-2009) and in the Palermo district. The rate between trastuzumb users and patients with a hospitalization for&#13;\nbreast cancer increased from 2.9% in 2004 up to 17.2% in 2009 in Lombardy. Patients aged &lt;65 years were more frequent users (9.6%)&#13;\ncompared to those aged 75 years (1.3%). Similarly, in the Palermo district the proportion of users increased from 10.6% in 2006 to&#13;\n28.5% in 2008, with subjects aged &lt;65 years more frequently using trastuzumab (19.1%), than subjects aged 75 years (6.2%). The rate&#13;\nratio between younger and older patients decreased over time in both settings (from 15 in 2004 to 10.2 in 2006, and 5.2 in 2009 in&#13;\nLombardy, and from 4.0 in 2006 to 2.3 in 2009 in Palermo district). The proportion of breast cancer patients using trastuzumab increased&#13;\nover time both in Lombardy and in Palermo District, though geographical differences persisted. Younger breast cancers patients were&#13;\nmore likely to receive a trastuzumab treatment than elderly ones.

Readers are invited to submit letters for publication in this department. Submit letters online at http://joem.edmgr.com. Choose “Submit New Manuscript.” A signed copyright assignment and financial disclosure form must be submitted with the letter. Form available at http://www.joem.org under Author and Reviewer information. Reply: We thank Dr. Mirabelli for his letter about a patient with pleural mesothelioma who was identified in the Regional Mesothelioma Registry, and allegedly was employed as talc miner and belonged to the cohort whose analysis of mortality during 1946 to 2013 we recently reported in the Journal.1 Dr. Mirabelli was courteous enough to share the personal data of this patient; we double-checked this information against the roster of the cohort and we were not able to identify him. The number of observed deaths from pleural mesothelioma in our cohort remains therefore zero. We can offer three possible explanations for the discrepancy between the data in our cohort and those in the Mesothelioma Registry. First, this patient might have been employed in graphite production, since a graphite plant, including a mine, was operated in the same alpine valley by the same company that owned the talc mine. We have some records of the workers employed in graphite production, and could not identify the patient. However, contrary to the talc, the graphite records might not be complete and we are not fully confident that this patient had not been employed there. Second, the patient might have been employed by a subcontractor involved in maintenance operations at the talc site; however, we have no data to test this hypothesis. Third, the information on employment available in the Mesothelioma Registry, which was provided by a next-of-kin, might be wrong. Dr. Mirabelli's statement on the possible contamination of talc by asbestos is contradicted by the available evidence, as we have recently discussed in detail.2 Exposure to asbestos in maintenance jobs is a hypothesis without supporting evidence. This example stresses the need for a cautious interpretation of the information collected retrospectively—often from next-of-kin, as in this case—on occupational history and circumstances of exposure within the frame of surveillance systems, such as a Mesothelioma Registry.3 While such data might have some value in identifying general patterns and trends at the population level, their validity for assessing exposures of individual patients may be suboptimal.