<h3>To the Editor.</h3> —For decades, there has been a widespread social acceptance of cigarette smoking in Italy. The Ministry of Health (or any other governmental body) did not make or support any serious campaign to inform the public about the risks and damages of smoking, even when these were clear on a scientific level and most other Western countries took measures to control smoking.<sup>1</sup>Thus, any manufacturer operating in the Italian market was allowed to sell cigarettes without information or warning labels,<sup>2</sup>and the Italian Parliament imposed some warning only in 1991—more than two decades after the United States, Canada, and most other Western countries.<sup>3</sup> Mr Mario Stalteri was a pack-a-day smoker for 40 years, mostly of cigarettes produced by the state-owned manufacturer. In 1991, he died of lung cancer at 64 years of age, 4 years after stopping smoking. Following US developments in the topic of
The relationship between dietary factors and the risk of breast cancer was investigated in a case-control study conducted in the Canton of Vaud, Switzerland as a pilot phase for a larger cooperative study within the SEARCH Programme of the International Agency for Research on Cancer (Lyon, France). A total of 107 incident, histologically confirmed cases of breast cancer and 318 controls admitted to hospital for acute, nonhormone-related, gynecological, metabolic, or neoplastic disorders were interviewed. Significant direct trends in risk were observed with total energy intake [relative risk (RR) for highest vs. lowest intake tertile = 1.9] and, after allowance for energy intake, with frequency of consumption of various types of meat (RR = 2.1 for the highest tertile), cheese (RR = 2.7), and alcohol (RR = 2.1). Significant protections, on the order of 40-60% reductions for the highest vs. lowest consumption tertile, were conferred by total green vegetable consumption, selected types of vegetables and fruits (cucumbers, onions, pears), and a summary index of beta-carotene intake (RR = 0.4 for highest consumption tertile). Thus the present study confirmed the existence of an unfavorable dietary pattern for breast cancer risk (characterized by high-calorie, selected sources of animal fat and alcohol intake). Moreover, a significant protection could be gained by consuming a diet rich in vegetables and perhaps fruits.
We found a moderate inverse association between allium vegetable intake and the risk of squamous cell carcinoma of the UADT in case-control studies. The relation was unclear in cohort studies and for adenocarcinoma of the esophagus.
Epidemiological studies based on cervical cytopathology have aroused widespread interest since it was realized that they could be a useful tool for measuring the effectiveness of screening programs and defining practical measures for the prevention of invasive neoplasms and deaths. In the present article, published evidence from screening programs, cohort investigations and case-control studies is reviewed, and possibilities for further analyses and applications are discussed. In particular, when estimates of the relative protections conveyed by Pap smear from various case-control studies conducted on different populations and using different criteria of selection were pooled, a surprisingly close concordance emerged, with overall risk estimates of invasive cervical cancer of 0.42 for women reporting one smear, and of 0.20 for two or more smears in the past. This protection appeared to be long-lasting in a considerable proportion of cases, since the major determinant of invasive cancer risk was the number of previous smears rather than the interval since last smear, and a noticeable residual effect was evident even more than 10 years after the last smear. Besides providing a measure of the effectiveness of cytological screening and helping define the optimal frequency of screening using the limited resources available, case-control studies should permit accurate estimates of the sensitivity of the test and quantify the probability of transition and the duration of various stages of the neoplastic process, i.e., permit a better understanding of the natural history of the disease.
The pattern of cervical screening utilization in Italy was analyzed using data from the 1986-1987 National Health Survey on the basis of a sample of 27,455 women aged 20 to 79 randomly selected within strata of municipality of residence and age in order to be representative of the whole Italian population. Overall, about 17% of women aged 20 to 79 were screened per year, for a total of 3.5 to 4 million cervical smears per year. The highest frequency was reported in younger middle age, about one in four women being screened per year in the age groups 30 to 49, and there was a substantial decline above age 50. Cervical smear rates were higher in Northern areas (22%), where mortality from cervical cancer is lower, than in the Centre (16%) and South (11%) of the country. Further, there was a strong positive social class gradient in the utilization of cervical screening, in relation to both education and occupation. In spite of the absence of any organised mass screening program, cervical screening is a relatively common procedure among Italian women. However, this study provides further quantitative evidence of a markedly irrational utilization of non-organized cervical screening, which tends to end up selectively used by the groups in which cervical cancer is less common.
The role of menstrual and reproductive factors, family history, and body weight in the epidemiology of breast cancer has been reassessed in a meta-analysis of three large case-control studies of breast cancer from several Italian regions, for a total data set of 4,072 cases and 4,099 controls. Multiple logistic regression equations were used to obtain relative risks adjusted for study, center, age, and various combinations of risk factors considered. Relative to women with menarche at age 15 or over, those with earlier menarche had a 20-30% higher breast cancer risk. However, there was no tendency for the risk to increase with lower age at menarche, and the association with menarche was stronger at younger age. The risk of breast cancer was directly related to age at menopause (relative risk (RR) = 0.7 for less than 45 years vs. greater than or equal to 50 years), age at first live birth (RR = 1.8 for greater than or equal to 28 years vs. less than 22 years), and family history of breast cancer in first-degree relatives (RR = 2.0). The effect of these factors was similar in various age strata. After allowance for age at first live birth, the risk of breast cancer did not differ among women with one to four live births, but it was significantly below unity (RR = 0.6) for those with five or more live births. Furthermore, there was a clear modifying effect of age at diagnosis on parity-related risk, since parous women had elevated breast cancer risk below age 35 and reduced risk above age 40.(ABSTRACT TRUNCATED AT 250 WORDS)
Trends in death certification rates from the five major alcohol related causes of death in Italy (cancers of the mouth or pharynx, oesophagus, larynx, liver and cirrhosis of the liver) were analysed over a period (1955-79) in which per capita alcohol consumption almost trebled. Age standardised mortality from liver cirrhosis almost doubled in males and increased over 70% in females. In males, mortality from cancers of the upper digestive or respiratory tract showed increases of between 27% and 44%, and liver cancer increased by over 100%. In the late 1970s, the four alcohol related cancer sites accounted for about 12% of all cancer deaths in males and 4.5% in females. Mortality from liver cirrhosis alone accounted for 4.8% of all deaths in males (9.2% of manpower years lost) and 2.3% in females (6.3% manpower years lost) in females. These figures were even higher in selected areas of north eastern Italy, where alcohol consumption is greater. In absolute terms, the upward trends observed correspond to about 10,000 excess deaths per year in the late 1970s compared with rates observed two decades earlier and are thus second only to the increase in tobacco related causes of death over the same calendar period.
