Despite of important efforts made in the recent time, little progress has been made to better characterise high-risk PC populations and to identify genomics-based markers for its early diagnosis. PC rates continue to rise, and this disease is becoming a real public health problem in the Westernised world. International and multidisciplinary strategies to identify new markers and properly validate the promising ones are urgently needed to implement cost-efficient primary and secondary prevention interventions in PC.

The most recent scientific evidence supports the consumption of cow's milk and dairy products as part of a balanced diet. However, these days, the public and practicing physicans are exposed to a stream of inconsistent (and often misleading) information regarding the relationship between cow's milk intake and health in the lay press and in the media. The purpose of this article, in this context, is to facilitate doctor-patient communication on this topic, providing physicians with a series of structured answers to frequently asked patient questions. The answers range from milk and milk-derived products' nutritional function across the life span, to their relationship with diseases such as osteoporosis and cancer, to lactose intolerance and milk allergy, and have been prepared by a panel of experts from the Italian medical and nutritional scientific community. When consumed according to appropriate national guidelines, milk and its derivatives contribute essential micro- and macronutrients to the diet, especially in infancy and childhood where bone mass growth is in a critical phase. Furthermore, preliminary evidence suggests potentially protective effects of milk against overweight, obesity, diabetes, and cardiovascular disease, while no clear data suggest a significant association between milk intake and cancer. Overall, current scientific literature suggests that an appropriate consumption of milk and its derivatives, according to available nutritional guidelines, may be beneficial across all age groups, with the exception of specific medical conditions such as lactose intolerance or milk protein allergy. Key teaching points: Milk and its derivatives contribute essential micro and macronutrients to the diet, when consumed according to appropriate national guidelines, especially in infancy and childhood where bone mass growth is in a critical phase. Preliminary evidence suggests potentially protective effects of milk against overweight, obesity, diabetes and cardiovascular disease No clear data are available about the association between milk intake and cancer. Current scientific literature suggests that an appropriate consumption of milk and its derivatives may be beneficial at all ages, with the exception of specific medical conditions such as lactose intolerance or milk protein allergy.

This study shows evidence of a positive association between diabetes and colorectal cancer, mainly proximal colon cancer. Moreover, it indicates a negative association between colorectal cancer and metformin use and a positive association for insulin use.

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1608 Background: A decrease in cancer mortality has been reported in the United States, Europe and other developed regions of the world during the last two decades. Whether similar trends apply to less-developed countries – and globally – is unclear. Methods: We aimed at describing the global patterns of cancer mortality by conducting a systematic analysis of the WHO mortality database for countries for which high- or intermediate-quality data on death certifications are available for a period of at least 10 years (typically 2003-2012). We included 60 countries in the analysis, and calculated age-specific and age-adjusted mortality rates. Results: A decrease in overall cancer mortality of approximately 1% per year was present in both developed and less-developed regions, and in both genders. For cancers of the esophagus, stomach, larynx and thyroid, the average decrease in global mortality rate was greater than 2% per year. Individual cancers which showed an increase in mortality rates on a global scale are limited to pancreas and brain (both genders), lung (women), melanoma and kidney (men) and endometrium. Conclusions: Reasons for the decrease in cancer mortality in less-developed countries may include decrease in cancer incidence, shift in the stage distribution, shift in the proportional contribution of individual cancers, and improved therapy. The increase in the number of cancer deaths, globally and in less-developed countries, is primarily driven by changes in the demographic structure of the population, but the risk of the individual of dying from cancer appears to decrease in all countries with reliable data. Cancers with increasing mortality rates should be given priority for research.

Recent studies have reported germline <i>CDH1</i> mutations in cases of lobular breast cancer (LBC) not associated with the classical hereditary diffuse gastric cancer syndrome. A multidisciplinary workgroup discussed genetic susceptibility, pathophysiology and clinical management of hereditary LBC (HLBC). The team has established the clinical criteria for <i>CDH1</i> screening and results' interpretation, and created consensus guidelines regarding genetic counselling, breast surveillance and imaging techniques, clinicopathological findings, psychological and decisional support, as well as prophylactic surgery and plastic reconstruction. Based on a review of current evidence for the identification of HLBC cases/families, <i>CDH1</i> genetic testing is recommended in patients fulfilling the following criteria: (A) bilateral LBC with or without family history of LBC, with age at onset <50 years, and (B) unilateral LBC with family history of LBC, with age at onset <45 years. In <i>CDH1</i> asymptomatic mutant carriers, breast surveillance with clinical examination, yearly mammography, contrast-enhanced breast MRI and breast ultrasonography (US) with 6-month interval between the US and the MRI should be implemented as a first approach. In selected cases with personal history, family history of LBC and <i>CDH1</i> mutations, prophylactic mastectomy could be discussed with an integrative group of clinical experts. Psychodecisional support also plays a pivotal role in the management of individuals with or without <i>CDH1</i> germline alterations. Ultimately, the definition of a specific protocol for <i>CDH1</i> genetic screening and ongoing coordinated management of patients with HLBC is crucial for the effective surveillance and early detection of LBC.

While thyroid cancer incidence has globally increased over the last few decades, mortality has been steadily declining. This is essentially due to increased diagnosis of papillary thyroid cancer, due to the widespread use of ultrasound scan. Thyroid cancer is one of the few neoplasms more common in women than in men. Familial and genetic factors account for 5% to 15% of papillary or follicular neoplasms, and the association is even stronger for medullary carcinomas. Thyroid cancer risk is strongly related to benign thyroid diseases, particularly nodules and adenomas and goiter. The other major recognized risk factor is ionizing radiation, in particular iodine 131. Aspects of diet related to thyroid cancer risk include iodine deficiency—particularly for follicular thyroid cancer. However, fish and cruciferous vegetables are not consistently related to thyroid cancer risk. Tobacco and alcohol do not materially influence thyroid cancer risk, whereas overweight/obesity and adult height might increase risk.

To investigate the relative risk of cancer development in rheumatoid arthritis (RA) patients in Greece after taking into consideration treatment modalities. The present analysis used data on the medical history of 26 331 participants in the Greek arm of the European Prospective Investigation into Cancer and Nutrition that were collected at enrollment and thereafter during active follow-up. A history of RA and of drug treatment for the disease, as reported at baseline examination, was linked to cases of cancer reported during follow-up. A total of 91 (9.9%) patients with RA developed a cancer compared with 1542 (6.1%) patients without RA. The overall hazard ratios of all cancers increased 25% [95% confidence interval (CI): 1-54] among participants with prevalent RA, and almost all the site-specific incident cancer sites considered had rate ratios above unity. In terms of the contribution of RA medication, the hazard ratios of patients treated with salicylates was close to unity (1.07, 95% CI: 0.69-1.65), whereas those who were not treated with salicylates had a 31% (95% CI: 3-67) increased risk for cancer incidence compared with those without RA at baseline. RA patients have excess cancer risk because of either underlying complex disease pathways or treatment agents targeting immune function. Administration of salicylates appears to reduce the risk of developing malignancies.

To facilitate regionally specific liver cancer prevention and control, this study estimates the fraction of hepatocellular carcinoma (HCC) cases attributable to five major liver cancer risk factors by geographic region. Prevalence estimates of major HCC risk factors, including chronic infection with hepatitis B and hepatitis C, alcohol drinking, tobacco smoking, obesity, and diabetes, were extracted for each country from the literature, along with recent incidence and risk estimate data, to calculate regionally specific population attributable fractions. Overall, 44% of HCC cases worldwide were attributable to chronic hepatitis B infection, with the majority of cases occurring in Asia. Hepatitis C was responsible for 21% of cases. Lifestyle risk factors such as alcohol drinking and obesity were responsible for a larger percentage of cases in North America and Western, Central, and Eastern Europe. In addition, strong sex disparities were observed when looking at lifestyle risk factors, particularly tobacco smoking, in Asia and Africa. Prominent risk factors for HCC vary depending on the region. Our findings provide useful data for developing regionally specific guidelines for liver cancer prevention and control worldwide.

These results indicate that a pro-inflammatory diet, as indicated by higher DII score, was associated with increased risk of gastric cancer.

Background: Factors linked to glucose metabolism play an impor-tant role in the development of cancers, and both glycemic index (GI) and glycemic load (GL) have been investigated as potential etiologic factors. Objective: A meta-analysis was performed to explore the associa-tion between GI and GL and cancer risk from published studies. Design: A comprehensive, systematic bibliographic search of the medical literature was conducted to identify relevant studies. Case-control and cohort studies published before October 2007 that re-ported cancer risk estimates for GI and GL were included. Pooled relative risks (RRs) were estimated for breast, colorectal, endome-trial, and pancreatic cancer. Results: Thirty-nine studies were included in the meta-analysis. The interquantile ranges of GL were significantly wider in case-control studies, most of which were conducted in European countries, than in cohort studies. Cohort studies that presented lower ranges of GL also reported lower risk estimates. Overall, both GL and GI were significantly associated with a greater risk of colorectal (summary RR 1.26; 95 % CI: 1.11, 1.44 and RR 1.18; 95 % CI: 1.05, 1.34, respectively) and endometrial (RR 1.36; 95 % CI: 1.14, 1.62 and RR 1.22; 95 % CI: 1.01, 1.49) cancer than of breast and pancreatic cancer. There was, however, a significant between-study heteroge-neity for colorectal cancer (P 0.0001). The association between GL and breast cancer disappeared when publication bias was taken into account. No association was found for pancreatic cancer. Conclusion: This comprehensive meta-analysis of GI and GL and cancer risk suggested an overall direct association with colorectal and endometrial cancer. Am J Clin Nutr 2008;87:1793–801.