NCT02837809 - Retrospectively registered July 1, 2016 - Enrolment of first participant September 2005.

The possible role of dietary fiber in the etiology of head neck cancers (HNCs) is unclear. We used individual-level pooled data from ten case-control studies (5959 cases and 12,248 controls) participating in the International Head and Neck Cancer Epidemiology (INHANCE) consortium, to examine the association between fiber intake and cancer of the oral cavity/pharynx and larynx. Odds Ratios (ORs) and their 95% Confidence Intervals (CIs) were estimated using unconditional multiple logistic regression applied to quintile categories of non-alcohol energy-adjusted fiber intake and adjusted for tobacco and alcohol use and other known or putative confounders. Fiber intake was inversely associated with oral and pharyngeal cancer combined (OR for 5th vs. 1st quintile category = 0.49, 95% CI: 0.40-0.59; p for trend <0.001) and with laryngeal cancer (OR = 0.66, 95% CI: 0.54-0.82, p for trend <0.001). There was, however, appreciable heterogeneity of the estimated effect across studies for oral and pharyngeal cancer combined. Nonetheless, inverse associations were consistently observed for the subsites of oral and pharyngeal cancers and within most strata of the considered covariates, for both cancer sites. Our findings from a multicenter large-scale pooled analysis suggest that, although in the presence of between-study heterogeneity, a greater intake of fiber may lower HNC risk.

The current study strengthens the hypothesis that small airway dysfunction might be a feature of SSc-related lung involvement, providing the first data on its significant impact on respiratory-related quality of life. A full assessment of lung function in SSc patients should include impulse oscillometry as a complementary technique, due to potential clinical and therapeutic implications.

Tea is second only to water among the most widely consumed beverages in the world. Several animal and in vitro studies indicated a protective role of polyphenolic antioxidants of tea on carcinogenesis.

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: The issue of the alleged contamination of talc from Val Chisone was extensively discussed in previous reports on the mortality of the cohort of talc miners and millers,1,2 and we did not address it at length in our new report,3 but the letter by Dr. Finkelstein raises again the hypothesis of contamination and requires a detailed response. This hypothesis was raised in the past, mainly in the framework of litigation, without any published supporting data. Conversely, there is strong evidence that talc from Val Chisone is not contaminated by tremolite or other asbestos fibers. In a 1972 study, Lighfoot et al4 reported the results of the analysis of 57 samples from Val Chisone mine: in none of the talc samples, there was asbestos contamination. Tremolite and anthophyllite were present (sometimes in nonfibrous form) in a few specimens of the foot wall rocks. In particular, they analyzed nine samples of “old powders and shipments” (final products), which were all free of any fibrous contamination. These results were quoted in the first mortality study of the cohort of miners and millers, published in 1976.1 Supporting evidence was provided by a 1982 paper by other authors,5 in which results based on X-ray diffraction and infrared reflection spectrometry showed no contamination by tremolite or other amphiboles. Furthermore, in a 1983 report, Pooley6 stated: “White Pinerolo Talc – this powder was found to be the most pure talc observed. The only impurity was a very small quantity of the mineral chlorite. Electron microscopic examination of this powder did not reveal any fibrous mineral particulates. Grey Pinerolo Talc – the major mineral observed in this sample by X-ray diffraction was chlorite and talc was present at the 25–30% level; a small quantity of dolomite was also observed. Again electrom microscope examination of this sample did not reveal any fibrous mineral particulate.” The results of the first analysis by Lighfoot et al4 were quoted by Gordon et al,7 who mistakenly interpreted the presence of tremolite in some samples of the footwall rocks as evidence of contamination of the talc ore and the final product used to produce the cosmetic talc. It is noteworthy the fact that this last paper includes a coauthor named Fitzgerald, that is, the name of the person quoted by Dr. Finkelestein as a source of unpublished analysis of one sample of talc from Val Chisone. The paper by Gordon et al7 was criticized by Lee and Van Orden8: these authors identified several methodological errors in the study by Gordon et al,7 and a severe amount of misinterpretation of literature. We think that the issue of contamination of Val Chisone talc by tremolite or other asbestos fibers should be finally put to rest. The data of our cohort confirm, with a follow-up extended to a maximum of 66 years,3 our previous observation that occupational exposure to Val Chisone talc is not associated with an increased risk of mesothelioma.1,2 In the new study, we observed no deaths from mesothelioma, and could exclude a two-fold excess risk. Dr. Finkelstein's calculation of the statistical power of our study is purely speculative, given the lack of support to the hypothesis of 4% asbestos exposure (or any other value different from zero) compared with Québec miners.

PRISMA 2009 Checklist. (DOC 63 kb)

We thank the authors of the letters to the editor [1.Brentisci C. Gangemi M. Migliore E. et al.Letter on ‘Validation of the diagnosis of mesothelioma and BAP1 protein expression in a cohort of asbestos textile workers from Northern Italy.Ann Oncol. 2018; 29: 2395-2396Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar, 2.Consonni D. Mensi C. Comment on the paper ‘Boffetta et al. Validation of the diagnosis of mesothelioma and BAP1 protein expression in a cohort of asbestos textile workers from Northern Italy. Ann Oncol 2018; 29(2): 484–489.Ann Oncol. 2019; 30: 340-341Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar] for giving us the opportunity to clarify some details of our study [3.Boffetta P. Righi L. Ciocan C. et al.Validation of the diagnosis of mesothelioma and BAP1 protein expression in a cohort of asbestos textile workers from Northern Italy.Ann Oncol. 2018; 29: 484-489Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar]. The study included a total of 127 members of a cohort of Italian asbestos textile workers with a diagnosis of mesothelioma on the death certificate. Among them, 76 were matched through record linkage to the regional Mesothelioma Registry. It is plausible that most of the 51 individuals who were not matched did not qualify for inclusion in the Registry. Among the 35 matched individuals, whose diagnosis was confirmed during our review process, 29 were listed as confirmed cases in the regional Mesothelioma Registry, leading to an estimate of 83% sensitivity. Among the 10 matched individuals whose diagnosis either was not confirmed by pathology review, or was based on death certificate only, four were listed as confirmed cases in the Registry (specificity 60%; our original estimate of 41% specificity included additional cases without histologic verification in our analysis, but we think the new estimate is more appropriate). The comparison between our validation effort and the data of the regional Mesothelioma Registry, however, is subject to uncertainty because of the diagnostic criteria used in the Italian mesothelioma registration system [4.Marinaccio A. Binazzi A. Bonafede M. et al.Il Registro Nazionale dei Mesoteliomi. Sesto Rapporto. Inail, Rome2018Google Scholar]. This system includes, in addition to three subcategories of ‘confirmed’ cases with defined immunohistochemical, imaging or pathological criteria, a fourth option for cases ‘confirmed, not elsewhere specified’, whose diagnostic criteria are unclear. This subcategory comprised as much as 31% of all ‘confirmed’ cases in the latest national report of the Mesothelioma Registries [2.Consonni D. Mensi C. Comment on the paper ‘Boffetta et al. Validation of the diagnosis of mesothelioma and BAP1 protein expression in a cohort of asbestos textile workers from Northern Italy. Ann Oncol 2018; 29(2): 484–489.Ann Oncol. 2019; 30: 340-341Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar], which includes the regional registry we used for our comparison, while only 57% of ‘confirmed’ cases in the same national Registries satisfied the immunohistochemical criteria recommended by international panels [5.Husain A.N. Colby T.V. Ordóñez N.G. et al.Guidelines for pathologic diagnosis of malignant mesothelioma: 2017 update of the consensus statement from the International Mesothelioma Interest Group.Arch Pathol Lab Med. 2018; 142: 89-108Crossref PubMed Scopus (303) Google Scholar], and used in our study [3.Boffetta P. Righi L. Ciocan C. et al.Validation of the diagnosis of mesothelioma and BAP1 protein expression in a cohort of asbestos textile workers from Northern Italy.Ann Oncol. 2018; 29: 484-489Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar]. We inadvertently did not mention in the original publication [3.Boffetta P. Righi L. Ciocan C. et al.Validation of the diagnosis of mesothelioma and BAP1 protein expression in a cohort of asbestos textile workers from Northern Italy.Ann Oncol. 2018; 29: 484-489Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar] potential conflicts unrelated to the submitted work. This has now been corrected. None declared.

The methods traditionally used to identify a posteriori dietary patterns are principal components, factor and cluster analysis. The aim of our study is to assess the relationship between dietary patterns derived with latent class analysis (LCA) and oral/pharyngeal cancer risk (OPC), highlighting the strengths of this method compared to traditional ones. We analyzed data from an Italian multicentric case-control study on OPC including 946 cases and 2,492 hospital controls. Dietary patterns were derived using LCA on 25 food groups. A multiple logistic regression model was used to derive odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for OPC according to the dietary patterns identified. We identified four dietary patterns. The first one was characterized by a high intake of leafy and fruiting vegetable and fruits (Prudent pattern), the second one showed a high intake of red meat and low intake of selected fruits and vegetables (Western pattern). The last two patterns showed a combination-type of diet. We labeled "Lower consumers-combination pattern" the cluster that showed a low intake of the majority of foods, and "Higher consumers-combination pattern" the one characterized by a high intake of various foods. Compared to the "Prudent pattern", the "Western" and the "Lower consumers-combination" ones were positively related to the risk of OPC (OR = 2.56, 95% CI: 1.90-3.45 and OR = 2.23, 95% CI: 1.64-3.02). No difference in risk emerged for the "Higher consumers-combination pattern" (OR = 1.28, 95% CI: 0.92-1.77).

Literature search strategy. Description of data: exact search strategy applied for analyses. (DOCX 14 kb)