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Breast cancer death certification rates in Italy showed a consistent geographic variation, with approximately a 2-fold ratio between the highest rates registered in Northern (and richer) regions, and the lowest ones in the South. This variation in breast cancer mortality was positively and strongly correlated with mean age at first birth (r = +0.73). This positive correlation could not be totally explained by several other economic or dietary variables considered, though some of them substantially reduced the strength of the association. Breast cancer mortality rates were found to be positively correlated with milk, meat and sugar consumption, and negatively with pasta, thus confirming previous studies on national or international scales. These correlation coefficients, however, were considerably reduced after controlling for mean age at first birth. Further, when allowance was made for economic variables and age at first birth, only the correlation coefficients for milk and cheese remained significantly positive. Thus, the evidence from this study suggests that the Italian geographical correlations between breast cancer mortality and dietary variables may be largely explained in terms of reproductive factors, though there may be some effect of dietary variables on breast cancer risk as well.
Oncogenic human papillomavirus is the key determinant of cervical cancer, but other risk factors interact with it to define individual risk. Among these, there is oral contraceptive (OC) use. A quantitative review of the link between OCs and cervical cancer was performed. Long-term (>5 year) current or recent OC use has been related to an about two-fold excess risk of cervical cancer. Such an excess risk, however, levels off after stopping use, and approaches unity 10 or more years after stopping. The public health implications of OC use for cervical cancer are limited. In any case, such implications are greater in middle-income and low-income countries, as well as in central and eastern Europe and Latin America, where cervical cancer screening and control remain inadequate.
To investigate possible correlates of the systematically higher pancreatic cancer rates in males than in females, the role of menstrual, reproductive and hormonal factors in females have been assessed using data from a case-control study conducted in Northern Italy. Cases were 133 women with histologically confirmed incident cancer of the pancreas, and controls were 377 women in hospital for acute, non-neoplastic, non-digestive-tract disorders. After allowance for age, education, area of residence and smoking habit, an increased risk of pancreatic cancer was observed in women with early menarche (< or = 13 years) (OR = 1.9; 95% CI: 1.0-3.6), but no significant association was observed with age at menopause or length of fertile life. Parous women were at reduced risk as compared to nulliparous women (OR = 0.7), although the trend in risk with number of births was not significant. No association with spontaneous or induced abortions was observed. Pancreatic cancer risk was inversely related to early age at first birth (first birth < 25 versus nulliparae: OR = 0.5; 95% CI: 0.3-0.9; p-value for trend < 0.01) and to age at last birth (last birth < 25 versus nulliparae: OR = 0.3; 95% CI: 0.1-0.8; p-value for trend < 0.05). Ever-users of estrogen replacement therapy showed a non-significantly increased risk (OR = 2.2). Although no clear pattern of association is evident, the present results are in agreement with previous epidemiological observations and experimental research indicating that hormonal (menstrual and reproductive) factors could explain part of the male-to-female differential in incidence and mortality from pancreatic cancer.
The relationship between alcohol drinking and gastric cancer risk was analyzed using data from a case-control study conducted in Northern Italy between 1985 and 1993 on 746 cases of histologically confirmed incident stomach cancer and 2,053 controls in hospital for acute nonneoplastic nondigestive tract diseases. Wine was the most frequently consumed alcoholic beverage, accounting for approximately 90% of all alcohol consumption. Compared with those who never drank wine, the odds ratios (OR) were 1.1 [95% confidence interval (CI) 0.9-1.3] for fewer than four drinks per day, 1.3 (95% CI 1.0-1.7) for four to fewer than six drinks per day, 1.6 (95% CI 1.1-2.4) for six to fewer than eight drinks per day, and 1.4 (95% CI 1.0-2.0) for eight or more drinks per day. No association was observed with beer or spirits. For total alcohol consumption, 25% of cases and 30% of controls never drank alcohol, and the multivariate OR for those who drank versus those who did not drink was 1.1 (95% CI 0.9-1.4). After allowance for smoking, education, family history of stomach cancer, selected micronutrient intake, and nonalcohol calorie intake, the ORs were 1.1 (95% CI 0.9-1.4) for fewer than six drinks per day, 1.0 (95% CI 0.4-1.4) for six to fewer than eight drinks per day, and 1.3 (95% CI 0.9-1.9) for eight or more drinks per day, and the trend in risk was not significant. No interaction was observed between alcohol drinking and sex, family history, and smoking, but the association with alcohol drinking was appreciably stronger in the elderly and in less-educated individuals. Thus this large data set was able to exclude a strong and consistent association between alcohol (mainly wine) drinking and stomach cancer risk. A nonsignificant association was observed in those who drank very heavily, but the absence of a dose-risk relationship suggests that even such a moderate association may reflect inadequate allowance for covariates or the presence of other risk factors (possibly related to diet and social class) among the heaviest drinkers.
