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Further research is needed to replicate our findings and to explore potential underlying mechanisms.

A substantial delay in the decline of mortality from testicular cancer has been reported over the last few years. In the European Union (EU) testicular cancer rates at age 20 to 44 have fallen by 2 thirds between 1975–1979 and 1995–1997, from 1.5 to 0.5/100,000 men. However, in eastern European countries providing comparable data over time (i.e, Bulgaria, Czech Republic, Hungary, Poland, Romania and Slovakia), rates have only moderately declined and were still 1.3/100,000 men age 20 to 44 in 1995–1997. This corresponded to a few hundred excess avoidable deaths per year.1 Consequently, it is important to further monitor trends in testicular cancer mortality in the last few years. As in previous reports, we obtained official death certification figures from the WHO database, and recoded them according to the Ninth Revision of the International Classification of Diseases.2 We obtained estimates of the resident population from the same WHO database. Age-standardized rates were based on the world standard population. Figure 1 shows updated trends in mortality from testicular cancer in 4 broad geographic areas. In eastern Europe, a 16% fall in males was observed between 1995–1997 and 1998–1999, from 1.30 to 1.09/100,000. The fall was 14% in the EU, from 0.51 to 0.44/100,000. In contrast, a plateau was observed in the USA and Japan, with rates in the late 1990s of 0.47/100,000 and 0.38/100,000, respectively. Overall age-standardized rates in 1995–1997 and 1998–1999 were 0.31 and 0.27/100,000 in the EU, 0.75 and 0.65/100,000 in eastern Europe, 0.21 and 0.24/100,000 in the USA and 0.14 and 0.18/100,000 in Japan. Trends in age-adjusted (world population) death certification rates from testicular cancer in men aged 20–44 years. Eastern European countries represented are Bulgaria, Czech Republic, Hungary, Poland, Romania and Slovakia. There are 2 main messages in this updated analysis of trends in testicular cancer mortality. First, the levelling of the falls in rates over the last few years in the USA and Japan are confirmed by the most recent data, and testicular cancer mortality seems to have reached a plateau. Some fall is still observed in the EU, whose rates of 0.44/100,000, however, have now approached the low levels of the USA and Japan. Second, the fall registered since the early 1990s3 is persisting in eastern Europe, whose rates remain twice that of the EU and comparable to that registered in the EU in the early 1980s. In absolute terms, this corresponds to over 100 excess deaths in young men per year in the 6 countries considered. Testicular cancer, particularly seminomas and teratomas of young men, is a largely curable disease if adequate treatment is adopted.4 Thus, despite favorable trends over the last decade, there remains a substantial scope for improving testicular cancer management and treatment in eastern Europe. Fabio Levi*, Franca Lucchini*, Peter Boyle , Eva Negri , Carlo La Vecchia1* ?, * Cancer Epidemiology Unit and Cancer Registries of Vaud and Neuchâtel, Institut universitaire de médecine sociale et préventive, Lausanne, Switzerland, Division of Epidemiology and Biostatistics, European Institute of Oncology, Milano, Italy, Laboratory of Epidemiology, Istituto di Ricerche Farmacologiche ‘Mario Negri’, Milano, Italy, ? Istituto di Statistica Medica e Biometria, Università degli Studi di Milano, Milano, Italy.

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Aims and background Substantial upward trends for skin cancer mortality have been observed in most European countries in the last two decades. The distinction, however, between cutaneous malignant melanoma (CMM) and non-melanomatous skin cancers on the basis of death certification is unreliable Methods In order to assess the trends of CMM, analysis of the specific code for CMM (International Classification of Disease VIII and IX:172) was coupled with analysis of total skin cancer mortality rates, standardized on the 1981 Italian Census population, at all ages and in selected age groups (15-44, 45-64 and 65-84 years). The analyses were carried out for the whole of Italy and for Friuli-Venezia Giulia (FVG), a region in North-East Italy with a high proportion of fair-complexioned individuals, elevated frequency of sunbathing, and especially good diagnostic standards. Results In 1985-89 skin cancer mortality rates in men at all ages, as compared to 1970-74, were 33% higher in Italy and 46% higher in FVG. In women, there was a rise of 22% in Italy and 94% in FVG. More marked upward trends were observed in young and middle aged adults, especially among women in FVG (over 300% increase). In absolute terms, approximately 3000 more Italians died from skin cancers in 1985-89 as compared to 1970-74, about half of them prematurely (i.e., < 65 years). CMM was mentioned in death certifications for skin cancer increasingly often in all age groups, particularly in FVG. Conclusions The analysis of mortality trends from skin cancer is consistent with a substantial rise of CMM-related deaths. The sensitivity of death certification with respect to CMM diagnosis is also increasing, especially in FVG. A public health strategy with the aim of reducing intermittent intense exposure to ultraviolet light, especially in children, is urgent in Italy as CMM represents one of the few causes of premature death with unfavorable trends.

N-nitroso compounds are carcinogens that can be ingested directly or synthesized from nitrites and nitrates. The possible role of N-nitroso compounds in the induction of upper aerodigestive tract tumours was considered in a case-control study conducted in the Valle d'Aosta, an Italian region with a high incidence of these neoplasms. Nitrate, nitrite, labile and stable N-nitroso compounds were analysed in the saliva of 36 patients with cancers of the upper aerodigestive tract and 23 healthy individuals. After allowing for tobacco, salivary nitrate, nitrite and N-nitroso compounds were not associated with an increased risk of upper aerodigestive tract cancers. The odds ratio for continuous units of total N-nitros compounds was 0.99 (95% confidence interval 0.9-1.1). Thus, salivary nitrate, nitrite and N-nitroso compounds might not be suitable markers for the assessment of the risk of cancer of the upper aerodigestive tract, although a role for N-nitroso compounds cannot be excluded.

European Mediterranean populations have a high life expectancy. Several aspects of their diet are considered favorable on health. We considered the role of various aspects of the Mediterranean diet on cancer risk in a series of Italian case-control studies including about 10,000 cases of cancer at 13 different sites and over 17,000 controls. For most epithelial cancers, the risk decreased with increasing vegetable consumption. Allium vegetables were also favorably related to cancer risk. Fruit intake was inversely associated with digestive tract and laryngeal cancers. For digestive tract cancers, the population attributable risks for low intake of vegetables and fruit ranged between 15% and 40%. Olive oil and unsaturated fats, which are typical aspects of the Mediterranean diet, were inversely related to the risk of several cancers, particularly of the upper aerodigestive tract. Whole grain food (and hence possibly fiber) intake was also related to reduced risk of various cancers. In contrast, refined grains and, consequently, glycemic load and index were associated to increased risks. Several micronutrients and food components (including folate, flavonoids, and carotenoids) showed inverse relations with cancer risk, but the main component(s) responsible for the favorable effect of a diet rich in vegetables and fruit remain undefined.

In our large pooled analysis, leanness was associated with increased HNC risk regardless of smoking and drinking status, although reverse causality cannot be excluded. The reduced risk among overweight or obese people may indicate body size is a modifier of the risk associated with smoking and drinking. Further clarification may be provided by analyses of prospective cohort and mechanistic studies.

The report by Kyle et al.1 updates trends in multiple myeloma incidence in Olmsted County, Minnesota, and indicates that the incidence of multiple myeloma has remained stable over the 56-year period considered (1945–2001). Likewise, in Malmö, Sweden, the incidence of multiple myeloma remained stable between 1950 and 1979.2 However, in several other cancer registration areas, trends in the incidence of multiple myeloma have been rising over the last few decades. Furthermore, mortality from myeloma has tended to rise steadily over the last few decades in the United States and across Europe. In the European Union, age-standardized (world standard) mortality from myeloma increased for men from 0.9 per 100,000 in 1960 to 2.2 per 100,000 in 2000 and from 0.7 per 100,000 to 1.5 per 100,000 for women.3 However, the upward trends were larger in the elderly4 and were not observed in several countries that originally had high mortality rates, such as Sweden, Denmark, the Netherlands, and Norway.3 The Swiss canton of Vaud is another population that can contribute toward addressing the issue of trends in multiple myeloma, because it long has been covered with optimal and uniform surveillance for lymphohemopoietic conditions.5 We analyzed trends in myeloma incidence over the period from 1978 to 1987 and found no appreciable change in rates.5 Here, we update incidence rates in the Vaud population to the year 2001. The Vaud cancer registry includes information concerning incident cases of malignant neoplasms occurring in the resident population of the Canton (≈ 640,000 inhabitants in 2000). The current series includes 674 patients who were diagnosed with multiple myeloma (341 males and 333 females) from 1978 to 2001. For men, the overall, age-standardized rates (world standard) were 3.6 per 100,000 in 1978–1982 (95% confidence interval [CI], 2.7–4.5 per 100,000) and 2.4 per 100,000 (95%CI, 1.7–3.1 per 100,000) in 1998–2001. The corresponding rates for women were 1.9 per 100,000 (95%CI, 1.3–2.4 per 100,000) and 2.1 per 100,000 (95%CI, 1.5–2.7 per 100,000). Among the population aged ≥ 65 years, multiple myeloma incidence rates for men were 27.7 per 100,000 in 1978–1982 and 18.8 per 100,000 in 1998–2001. For women, the corresponding rates were 15.4 per 100,000 and 18.0 per 100,000. The current data, together with those from Olmsted County,1 provide conclusive evidence that the incidence of multiple myeloma in well surveilled populations from different areas of the world has been constant for several decades. Therefore, the apparent upward trends in incidence in several other populations and the rises in mortality rates from most countries are artifactual and attributable to improved diagnosis and certification of the disease.1-3