Publications

Overweight and obesity prevalence and determinants in Italy: an update to 2010

A quick guide to cancer epidemiology

This short and essential book [1] is addressed essentially to medical and public health students, and to anyone interested in a summary up to date presentation of cancer epidemiology and prevention. It is subdivided into four major sections, that include principles of primary and secondary cancer prevention, the current global burden of neoplasms,...

Mediterranean diet and risk of endometrial cancer: a pooled analysis of three italian case-control studies

Our study provides evidence for a beneficial role of the Mediterranean diet on endometrial cancer risk, suggesting a favourable effect of a combination of foods rich in antioxidants, fibres, phytochemicals, and unsaturated fatty acids.

Alcohol drinking outside meals and cancers of the upper aero‐digestive tract

In our integrated series of case-control studies conducted in Italy and Switzerland (324 oral, 397 pharyngeal, 271 oesophageal, 506 laryngeal cancers and 3,263 controls), individuals who also drank alcoholic beverages outside meals showed an increased risk compared to those who drank at meals only. At any alcohol intake level, subjects also drinking between meals showed a more elevated risk of developing an upper aero-digestive tract cancer than subjects drinking only at meals. After adjustment for potential covariates, and, after allowance for the number of daily drinks to adjust for different alcohol-intake levels, the odds ratios for subjects reporting drinking outside meals were 1.5 (95% confidence interval [CI]: 1.0-2.2) for oral, 1.8 (95% CI: 1.3-2.5) for pharyngeal, 1.7 (95% CI: 1.2-2.5) for oesophageal and 1.2 (95% CI: 0.9-1.7) for laryngeal cancers. Our findings show that drinking pattern with respect to food consumption may influence alcohol carcinogenesis in the upper digestive and respiratory tract. An "alcohol washing effect" by chewing and swallowing is suggested.

Incidence of colorectal cancer following adenomatous polyps of the large intestine

Abstract An association between adenomatous polyps of the large bowel and colorectal cancer has been reported, in the absence, however, of population‐based estimates of risk. Subjects with histologically confirmed first diagnosis of large‐bowel polyps notified to the population‐based Cancer Registry of the Swiss Canton of Vaud (about 600,000 inhabitants) during the calendar period 1979‐1990 were actively followed up to the end of 1990 for the subsequent occurrence of malignant neoplasms. Among 2,496 individuals with intestinal polyps, followed for a total of 10,310 person‐years at risk (6,201 among males and 4,109 among females), 150 malignant neoplasms were registered versus 152 expected. Thus, the standardized incidence ratio (SIR) for all cancers combined was 0.99. A significant excess was observed for colorectal cancer, with 35 cases observed (19 males, 16 females) versus 17.0 expected (SIR = 2.1; 95% CI: 1.5–3.0). There was also an excess, although not significant, for small‐bowel cancer (2 cases observed vs. 0.4 expected; SIR = 5.4). In none of the other cancer sites was SIR significantly or appreciably elevated: in subjects with colorectal polyps the SIR was 1.6 for stomach, 1.0 for lung, 0.9 for breast and 1.2 for prostate. The SIR of colorectal cancer was 3.1 in the first year since polyp registration, and declined thereafter to 1.8, in the absence, however, of any further trend with time since diagnosis. The cumulative risk of colorectal cancer in subjects with colorectal polyps was 2% at 5 years and 3% at 10 years. The quantitative estimates of this study are of interest for their population‐based nature, and are potentially useful for defining and targeting screening colonoscopy programmes.

European cancer mortality predictions for the year 2019 with focus on breast cancer

Bergamo and Covid-19: How the Dark Can Turn to Light

The novel coronavirus, SARS-CoV-2, continues to spread rapidly. Here we discuss the dramatic situation created by COVID-19 in Italy, particularly in the province of Bergamo (the most severely affected in the first wave), as an example of how, in the face of an unprecedented tragedy, acting (albeit belatedly)-including imposing a very strict lockdown-can largely resolve the situation within approximately 2 months. The measures taken here ensured that Bergamo hospital, which was confronted with rapidly rising numbers of severely ill COVID-19 patients requiring hospitalization, was able to meet the initial challenges of the pandemic. We also report that local organization and, more important, the large natural immunity against SARS-CoV-2 of the Bergamo population developed during the first wave of the epidemic, can explain the limited number of new COVID-19 cases during the more recent second wave compared to the numbers in other areas of Lombardy. Furthermore, we highlight the importance of coordinating the easing of containment measures to avoid what is currently observed in other countries, especially in the United States, Latin American and India, where this approach has not been adopted, and a dramatic resurgence of COVID-19 cases and an increase in the number of hospitalisations and deaths have been reported.

Response: Re: False-Positive Results in Cancer Epidemiology: A Plea for Epistemological Modesty

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Leisure-time physical activity and gastric cancer risk: A pooled study within the Stomach cancer Pooling (StoP) Project

No association was found between leisure time PA and GC, apart from a slight suggestion of decreased risk below age 55 and in control population-based studies. These results may reflect specific characteristics of GC at a younger age, or the presence of a cohort effect mediating and interacting with socioeconomic determinants of GC The different distribution of PA levels among hospitalized controls could have led to an underestimated effect of PA on GC risk.

Adult height and risk of gastric cancer: a pooled analysis within the stomach cancer pooling project

Fried foods, olive oil and colorectal cancer

Breast and Female Genital Tract Neoplasms in Overweight Women

Family history and the risk of oral and pharyngeal cancer

Scanty data are available on familial risk in oral and pharyngeal cancer. The relationship between oral and pharyngeal cancer and family history of cancer in first-degree relatives was investigated using data from a multicentric case-control study conducted in Italy and Switzerland between 1992 and 2005 on 956 cases aged less than 79 years, with histologically confirmed incident oral and pharyngeal cancer, and 2362 controls admitted to hospital for acute, nonneoplastic conditions. Logistic regression models conditioned on sex, age, study centre, and including terms for education, tobacco smoking, alcohol drinking, and number of siblings were used to estimate the odds ratios (OR) of oral and pharyngeal cancer. The multivariate ORs were similar for a family history of oral and pharyngeal cancer (2.6, 95% confidence interval, CI, 1.5-4.5) and laryngeal cancer (3.8, 95% CI, 2.0-7.2). The OR was 3.1 (95% CI, 2.0-4.8) for oral and pharyngeal cancer and laryngeal cancer combined. The OR was 7.1 (95% CI, 1.3-37.2) for subjects with 2 or more first-degree relatives with oral and pharyngeal/laryngeal cancers. Significant increases in risk were also observed for a family history of melanoma (OR = 5.8; 95% CI, 1.3-26.4) and lung cancer (OR = 1.4; 95% CI, 1.0-2.0). Compared to subjects without family history, nonsmokers, and non or moderate drinkers, the OR was 42.6 for current smokers, heavy drinkers with family history. History of oral and pharyngeal cancer and laryngeal cancer is a strong determinant of oral and pharyngeal cancer risk, independent from tobacco and alcohol.

Coffee consumption and the risk of breast cancer.

On the basis of clinical observations that some women with fibrocystic breast disease experienced resolution of the disease on eliminating methylxanthines from their diet, it has been suggested that coffee intake might be related to breast carcinogenesis. The relationship between coffee (mostly expresso and mocha), decaffeinated coffee and tea intake and breast cancer risk was therefore considered, combining data from two case-control studies, conducted in Italy between 1983 and 1994. Cases were 5,984 women, below age 75, with histologically confirmed breast cancer, and controls were 5,504 women admitted to hospital for a wide spectrum of acute, non-neoplastic, non-hormone-related diseases. The odds ratios (ORs) were estimated from multiple logistic regression equations including terms for study/centre, age, education, body mass index, smoking status, total alcohol intake, age at menarche and menopause, parity and age at first birth, use of oral contraceptives, use of hormone replacement therapy, history of benign breast disease and family history of breast cancer. No relationship was observed between coffee intake and the risk of breast cancer. The multivariate ORs were 1.17 (1.03-1.33), 1.17 (1.04-1.33), 1.21 (1.06-1.37) and 0.96 (0.83-1.11) for women drinking < 2, 2, > 2 to < 4 and > or = 4 cups/day compared to non-drinkers. Decaffeinated coffee was consumed only by 6-7% of cases and controls and the corresponding OR was 0.84 (0.72-0.98). Tea consumption was also low and not associated with the risk of breast cancer (OR 0.94, 95% CI 0.85-1.03). No significant heterogeneity was found for coffee intake across strata of age at diagnosis, education, body mass index, smoking status, total alcohol intake, age at menarche and menopause, parity, age at first birth, ever use of oral contraceptives, hormone replacement therapy, history of benign breast disease and family history of breast cancer. Thus, this study, based on a large data set, allows us to exclude the hypothesis that coffee intake is related to breast cancer risk in this Italian population.

Faculty Opinions recommendation of Translocation-capture sequencing reveals the extent and nature of chromosomal rearrangements in B lymphocytes.

Chromosomal rearrangements, including translocations, require formation and joining of DNA double strand breaks (DSBs). These events disrupt the integrity of the genome and are frequently involved in producing leukemias, lymphomas and sarcomas. Despite the importance of these events, current understanding of their genesis is limited. To examine the origins of chromosomal rearrangements we developed Translocation Capture Sequencing (TC-Seq), a method to document chromosomal rearrangements genome-wide, in primary cells. We examined over 180,000 rearrangements obtained from 400 million B lymphocytes, revealing that proximity between DSBs, transcriptional activity and chromosome territories are key determinants of genome rearrangement. Specifically, rearrangements tend to occur in cis and to transcribed genes. Finally, we find that activation-induced cytidine deaminase (AID) induces the rearrangement of many genes found as translocation partners in mature B cell lymphoma.Copyright © 2011 Elsevier Inc. All rights reserved. PMID: 21962510 Funding information This work was supported by: NIGMS NIH HHS, United States Grant ID: T32 GM007739 NIAID NIH HHS, United States Grant ID: R37 AI037526 NIAID NIH HHS, United States Grant ID: AI037526 Howard Hughes Medical Institute, United States NIAID NIH HHS, United States Grant ID: R01 AI037526-17 Intramural NIH HHS, United States NIGMS NIH HHS, United States Grant ID: GM07739 NIAID NIH HHS, United States Grant ID: R01 AI037526 More Less keyboard_arrow_down

Author's reply to thyroid cancer: An epidemic of disease or an epidemic of diagnosis?

We thank Drs. Franceschi and Vaccarella1 for their interest in our work, and for the additional comments and insights they provided on the recent apparent epidemic of early papillary thyroid cancers.2 The choice of the scales in figures of trends in rates in different countries remains arbitrary. The use of different scales for various countries optimizes the within-country information, whereas the use of a single scale for all countries optimizes the between-country comparison; however, it makes difficult to investigate country-specific trends, in particular for those with low rates. A key observation by Drs. Franceschi and Vaccarella is that the rise in female thyroid cancer incidence over the last two decades has been largely heterogeneous across selected high-income countries providing data, and that there are at least three countries (Denmark, UK and Japan) where the rise has been modest in absolute terms—though not in relative ones—as indicated in Figure 5. Such a moderate rise has already been observed in selected well-surveilled populations.3 Drs. Franceschi and Vaccarella attributed the relatively modest absolute rise in thyroid cancer incidence in Denmark, UK and Japan to different organization in their health systems and in their utilization of innovative diagnostic practices, although the quantification of the role of these factors remains elusive. We agree with Drs. Franceschi and Vaccarella that overdiagnosis of thyroid cancer can have serious long-term consequences, and that more conservative approaches to the management of low-risk thyroid cancers are required. We also agree that the implementation of randomized clinical trials on such management would assist in providing evidence-based indications. The authors thank Mrs I. Garimoldi for editorial assistance.

Conclusions

Relation between goiter and autoimmune thyroid disease, and gastric cancer

In a Chinese cohort of 29,584 adults (participants to the Linxian General Population Nutrition Intervention Trial) followed from 1986 to 2001 and including 1,440 cases of gastric cancer, 1,949 of esophageal cancer and 425 subjects (59 among cases) who reported history of goiter, Abnet et al.1 found goiter associated with an increased risk of gastric noncardia adenocarcinoma. The hazard ratio (HR) was 2.04 (95% confidence interval, CI, 1.01–4.11). The HR were 1.45 (95% CI, 0.91–2.30) for gastric cardia adenocarcinoma and 1.37 (95% CI, 0.97–1.94) for esophageal squamous cell carcinoma. Iodine is concentrated by the gastric mucosa, where it may act as an antioxidant, thus, iodine deficiency, and hence goiter, may be associated with an increased risk of gastric cancer.2 Only a few studies investigated this issue. A study from Turkey3 reported that 49% of 61 gastric cancer cases versus 20% of 55 controls had history of goiter, and cases also reported more frequently thyroid autoimmune disease than controls. Another Turkish study of 19 cases found a lower iodine concentration in gastric cancer tissue than in surrounding normal tissue.4 An Iranian study5 showed that gastric cancer patients excreted more iodine than controls. To investigate the relation between thyroid diseases and gastric cancer risk in a developed country, we analyzed data from a hospital-based case-control study conducted between 1985 and 1997 in the Greater Milan area.6 Briefly, this included 769 incident, histologically confirmed cases of stomach cancer (469 men and 300 women; median age 61 years, range 19–79 years). The controls were 2,081 subjects (1,220 men, 861 women, median age 55 years, range 19–79 years) admitted to the same hospital network as cases for acute conditions other than neoplastic or digestive tract diseases and unrelated to long-term diet modification (46% traumas, 20% other orthopaedic conditions, 19% acute surgical, 15% other miscellaneous disorders). Less than 4% of identified cases and controls refused to be interviewed. Cases and controls were interviewed during their hospital stay using a standard questionnaire, including information on sociodemographic characteristics, anthropometric measures and information on smoking, alcohol, frequency of consumption of 29 food items and a problem-oriented medical history, including 16 diseases or conditions. Among these, there were thyroid diseases, which were subsequently classified as goiter, nodules/adenoma, hyperthyroidism and other or unidentified benign thyroid diseases. Odds ratios (OR) and the corresponding 95% CI were estimated using unconditional multiple logistic regression models, including terms for age, sex and education. Table I gives the distribution of cases and controls according to various thyroid conditions. The frequency of all of these ranged between 0.4% and 1.2%. No relation was found between history of various benign thyroid diseases and gastric cancer risk. The OR was 0.70 (95% CI, 0.19–2.65) for history of goiter, 0.61 (95% CI, 0.23–1.64) for thyroid nodules/adenomas, 1.10 (95% CI, 0.47–2.57) for hyperthyroidism, and 0.71 (95% CI, 0.32–1.57) for other or not specified benign thyroid diseases. In this study, we were not able to distinguish between various subsites of gastric cancer, but the incidence of gastric cardia cancers between 1985 and 1992 in Italy was only around 10% of total gastric cancers.7 Thus, our results refer mainly to noncardia gastric cancers. Among the advantages of the study, there is the relatively large dataset, the practically complete participation of cases and controls approached, and the reliability of information on medical history (r = 0.85 for thyroid conditions8). The study power, however, is limited by the small proportion of cases and controls with history of goiter and thyroid conditions. At the time of study conduction, gastric cancer was common in Italy, and was still the third cause of cancer death after lung and colorectal cancer.9 Furthermore iodized salt is not routinely used by the Italian population and mild iodine deficiency is not rare in the country.10 Still, goiter and other thyroid diseases do not appear to be a relevant cause of gastric cancer in Italy. Yours sincerely, The authors thank Ms. I Garimoldi for editorial assistance. Marta Rossi, Eva Negri, Roberto Foschi, Silvia Franceschi, Carlo La Vecchia.