Publications

The risk of asbestosis death strongly declines in the decades after cessation of the exposure.

Data from the Vaud Cancer Registry, Switzerland, were used to analyse incidence and mortality from cancer in teenagers (aged 10 to 19 years) over the period 1974-1992. A total of 113 males and 87 females were registered. Of these, 23% were lymphomas, 16% leukaemias, about 15% central nervous system neoplasms, 10% germ cell tumours and bone neoplasms and 8% soft tissue sarcomas. The overall incidence rate (age-adjusted, world standard population) for all cancers combined was 167 per million boys and 128 per million girls. In both sexes, there was some indication of rising trends over time, to reach 196 per million males and 141 per million females in 1986-1992. The only types of cancer showing consistent upward trends in both sexes were lymphomas. A total of 53 cancer deaths were certified, due to leukaemias in about 40% of cases in both sexes and to lymphomas and brain tumours in 15%-20%. The overall mortality rate at age 10-19 years (age-standardised, world standard) was 47 per million boys and 31 per million girls, and no trend in mortality was observed over time. The 2 main findings of our analysis are (i) the absence of major trends in cancer incidence in adolescents, with the sole exception of a possible increasing incidence of lymphomas, and (ii) the lack of appreciable trends in mortality, in view of the declines in cancer mortality observed in children and young adults over the same calendar period.

The relation between calcium intake, estimated from frequency of use of 29 food items, and colorectal cancer risk was analyzed using data from a case-control study conducted in Northern Italy. The study was conducted on 558 cases of colon cancer, 352 cases of rectal cancer, and 1,032 controls admitted to the hospital for acute, nonneoplastic, nondigestive tract disorders (39% with traumas, 17% nontraumatic orthopedic diseases, 25% acute surgical conditions, 19% other miscellaneous disorders). There was no appreciable trend in risk of colon or rectal cancer in relation to measures of calcium intake. The multivariate relative risk (adjusted for age, sex, education, area of residence, and consumption of selected indicator foods) for highest versus lowest quintile was 1.1 for colon and 1.0 for rectum. Likewise, there was no appreciable difference between cases and controls with reference to frequency of consumption of the two major calcium-containing foods (milk and cheese), with relative risk for the highest level of intake between 0.9 and 1.2. This study indicates that little or no protection on large bowel cancer risk is provided by dairy products or calcium intake in a range of 0.5-1.5 g per day.

Government tobacco control policies are positively related to the individual-level tobacco policy of having an in-home smoking ban.

Using data from a case-control study conducted between 1985 and 1992 in northern Italy on 828 cases of colon cancer, 498 cases of rectal cancer and 2,024 controls in hospital for acute, non-neoplastic, non-digestive tract disorders, we estimated the percent population attributable risk (PAR) for colorectal cancer in relation to beta-carotene, vitamin C (as markers of a diet rich in fruit and vegetables), red meat and seasoning fat intake, daily meal frequency and family history of the disease. On the basis of multivariate odds ratios, adjusted for total calorie intake, a low intake of beta-carotene accounted for 39% of all the cases and a low intake of vitamin C for 14%. These two micronutrients together explained 43% of all colorectal cancer cases in this population. A high frequency of intake of red meat consumption explained 17% of all cases, and a high score of seasoning fats 4%. A higher daily meal frequency was responsible for 13% of the cases, and these 5 dietary factors together explained 63% of colorectal cancer cases in this population. Family history of colorectal cancer accounted for 4% of all cases. These estimates were similar for colon and rectal cancers separately, in males and females, and in younger and elderly subjects, except for seasoning fats and family history, whose PARs were apparently greater for colon cancer and at younger age. Thus, even though available dietary data were limited in several aspects, and the PAR estimates were based on somewhat arbitrary assumptions regarding the exposure distribution, about two-thirds of all colorectal cancers in this population could be explained in terms of a few risk factors or risk indicators considered. This would correspond to the avoidance of a large proportion of the over 18,000 deaths from colorectal cancer registered per year in the whole of Italy.

<div>Abstract<p><b>Purpose:</b> Renal cell carcinoma (RCC) has the potential for cure with surgery when diagnosed at an early stage. Kidney injury molecule-1 (KIM-1) has been shown to be elevated in the plasma of RCC patients. We aimed to test whether plasma KIM-1 could represent a means of detecting RCC prior to clinical diagnosis.</p><p><b>Experimental Design:</b> KIM-1 concentrations were measured in prediagnostic plasma from 190 RCC cases and 190 controls nested within a population-based prospective cohort study. Cases had entered the cohort up to 5 years before diagnosis, and controls were matched on cases for date of birth, date at blood donation, sex, and country. We applied conditional logistic regression and flexible parametric survival models to evaluate the association between plasma KIM-1 concentrations and RCC risk and survival.</p><p><b>Results:</b> The incidence rate ratio (IRR) of RCC for a doubling in KIM-1 concentration was 1.71 [95% confidence interval (CI), 1.44–2.03, <i>P</i> = 4.1 × 10<sup>−23</sup>], corresponding to an IRR of 63.3 (95% CI, 16.2–246.9) comparing the 80th to the 20th percentiles of the KIM-1 distribution in this sample. Compared with a risk model including known risk factors of RCC (age, sex, country, body mass index, and tobacco smoking status), a risk model additionally including KIM-1 substantially improved discrimination between cases and controls (area under the receiver-operating characteristic curve of 0.8 compared with 0.7). High plasma KIM-1 concentrations were also associated with poorer survival (<i>P</i> = 0.0053).</p><p><b>Conclusions:</b> Plasma KIM-1 concentrations could predict RCC incidence up to 5 years prior to diagnosis and were associated with poorer survival. <i>Clin Cancer Res; 24(22); 5594–601. ©2018 AACR</i>.</p></div>

Third generation oral contraceptives (OC), containing the progestins desogestrel and gestodene, were introduced in the 1980s in a attempt to lower the risk of cardiovascular side effects. However, the observation that desogestrel and gestodene in combined OC were related to a 50 to 100% greater risk of venous thromboembolism (VTE) suggested that the issue is more complex than originally thought.1–3 At the end of 2001, the Committee for Proprietary Medicinal Products (CPMP) of the European Agency for the Evaluation of Medicinal Products (EMEA)4 released a Public Assessment Report providing comparative evaluation of relative and absolute risk of VTE for third generation OC. Changes were also proposed for the Summaries of Product Characteristics (SPC), in particular for OC containing 20 μg or more of ethinylestradiol and desogestrel or gestodene, and a ‘Dear Doctor’ letter was sent by several National Regulatory Agencies. The summary message was that there was no urgency to modify the pattern of OC prescription for current OC users, but OC containing levonorgestrel (i.e. second generation OC) should be preferred to third generation ones when an OC is used by a woman for the first time. This procedure allowed the avoidance of a further ‘pill scare’ throughout Europe. In terms of risk/benefit assessment, an open issue was however related to other vascular effects, and mainly to the risk of myocardial infarction or stroke. There are now five published studies considering the risk of acute myocardial infarction (AMI) in users of second and third generation OC. One of these5 compared the AMI risk of current users of third versus second generation OC: the relative risk (RR) was about 0.7, but was based on only five cases reporting current use of second generation and two cases reporting current use of third generation OC, and the results were far from significant. The main results of four other studies giving the RRs of users of second and third generation OC versus non-users are given in table 1, together with the number of exposed cases. The first report6,7 was of an international (Transnational) case-control study from 16 centers in Austria, France, Germany and the United Kingdom, including 182 cases and 635 controls. Of these, 28 were current users of second generation OC (RRs 3.0) and seven of third generation (RR=0.9). The second report was from the WHO Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception,8 and included 368 cases and 941 controls recruited in 21 centers from Africa, Asia, Europe and Latin America. Of these, 13 were current users of second generation OC (RR 1.6) and 3 of third generation ones (RR=1.0). The third report was from the MICA study, including 448 incident cases of myocardial infarction and 1,728 controls from interviews and general practice records in England, Scotland and Wales.9 Of these, 20 cases were current users of second generation OC (RR=1.1), and 20 of third generation OC (RR=2.0). The fourth study10 was a national, populationbased case-control study from the Netherlands, including 248 AMI cases and 925 controls. Fifty-nine of the cases were current users of second generation OC (RR=2.5), and 20 of third generation OC (RR=1.3). Overall, in the four studies considered there were 120 cases of current users of second generation OC, and 50 of third generation OC. The pooled RR of AMI was 2.3 (95% confidence interval, CI, 1.8 to 2.8) for current users of second generation OC, and 1.5 (95% CI: 1.1–2.3) for current users of third generation OC. These pooled estimates, however, should be considered only indicative,11 since the results of the four studies were significantly heterogeneous. This is not surprising, since the populations studied were different, as were the methods used and the allowances for possible confounding factors. There are, in conclusion, limited data to compare the risk of AMI in current users of third versus second generation OC, but these suggest that the RR may be lower for third generation ones. This observation could be compatible with a more favourable lipid profile of third generation OC, which are associated with a slight increase in high density liproprotein cholesterol.1,12,13 Given the small number of cases, and the heterogeneity of the results across studies and populations, any comparative assessment of absolute risk with reference to the excess risk of VTE and the potentially reduced risk of EUROPEAN JOURNAL OF PUBLIC HEALTH 2002; 12: 81–82