Publications

In Costa Rica, like elsewhere, inducing smokers to stop is a public health priority.

A survey was conducted through a web link on the students and staff of the Università degli Studi di Milano, Italy in the period 14-30 April 2020. It was anonymous at the source and included history of COVID-19-related questions (fever, headache, cold, cough, anosmia, gastrointestinal complaints and separately fever over 38.5°C) in the previous three weeks, and similar information on cohabitants. A total of 14 374 subjects were included. Overall, from 24 March to 30 April, 3138 subjects (21.8%) reported COVID-19-like symptoms, and 219 (1.5%) fever above 38.5°C; 217 subjects performed at least one swab. Of these, 46 were positive (21.3% of those performed, 0.3% of the total). The frequency of any symptom was similar in women and men, but fever above 38.5°C was lower in women (multivariate odds ratio (OR) = 0.65, 95% confidence interval, CI, 0.49-0.85). There was a strong association between symptoms in the respondent and in cohabitants: 64% of subjects with symptoms reported at least one cohabitant with symptoms, compared to 14% of asymptomatic subjects (OR = 11.4, 95% CI, 10.4-12.6). The lower risk of serious symptoms in women, and the strong intra-nucleus of cohabitation contagiousness are an indication that at least part of the symptoms was caused by a new pathogen - SARS-CoV-2. These data, therefore, suggest that the number of persons affected by COVID-19 was much greater in northern Italy than the number of recorded cases. This has implications for the prevention, management and mortality of other serious diseases, including cancer.

Helicobacter pylori infection is acquired predominantly during childhood. Childcare promotes interpersonal contact and may be an important determinant of infection. The aim was to quantify the association between childcare attendance and H. pylori infection in childhood or adolescence. PubMed was searched up to July 2012 to identify eligible studies. The DerSimonian and Laird method was used to compute summary odds ratio (OR) estimates and 95% confidence intervals (CIs); heterogeneity was quantified with the I statistic and explained through stratified analyses and metaregression. Sixteen studies compared participants attending childcare with those not exposed. The summary OR was 1.12 (95% CI: 0.82-1.52, I=77.4%). Summary estimates were similar for crude and adjusted estimates, and higher when the infection was evaluated in children of 3 years or younger (OR=2.00, 95% CI: 0.94-4.29, I=55.0%). Studies based on the detection of stool antigens yielded higher estimates (OR=2.65, 95% CI: 1.24-5.66, I=36.4%). Those conducted in settings with a high prevalence of H. pylori infection yielded stronger associations (OR=1.44, 95% CI: 0.94-2.20, I=74.3%). In multivariate metaregression, there was no significant association with any of these variables; taking them into account contributed to a reduction of I to 67%. The role of childcare as a risk factor for H. pylori infection is confirmed by our results, especially in settings with a high prevalence of infection. However, the association was moderate, and the effect of the type of childcare setting or the duration or the intensity of exposure was seldom addressed, leaving considerable scope for improving our understanding of how this modifiable exposure contributes towards H. pylori infection.

The proportions of gastric cancer cases attributable (or attributable risks, AR) to consumption of traditional foods (i.e., pasta, rice and maize), low intake of beta-carotene and vitamin C, short duration of use of an electric refrigerator, low educational level, and family history of gastric cancer were computed using data from a case-control study conducted in Northern Italy. Between 1985 and June 1993 a total of 746 incident, histologically confirmed gastric cancer cases and 2,053 controls admitted to the same network of hospitals for acute, nonneoplastic, non-digestive-tract diseases, unrelated to long-term modifications of diet, were interviewed. The ARs were 48% for low intake of beta-carotene, 40% for high consumption of traditional foods, and 16% for low intake of vitamin C. Overall, these 3 dietary factors explained 73% of the gastric cancer cases in the population. Five percent of all cases were attributable to less than 30 years' use of an electric refrigerator, 15% to low educational level, and 5% to family history of gastric cancer. In individuals over age 60, a greater proportion of cases was attributable to traditional foods, low education and late adoption of electric refrigeration (58% vs. 32% aged under 60), suggesting that correlates of lower social class, influenced lifestyle, and dietary habits more markedly in earlier than in more recent generations. According to our estimates, over 3 quarters of the gastric cancer cases in this area are explainable in terms of the risk factors considered. Increased consumption of vitamin C and beta-carotene, and reduced consumption of traditional foods, would help to avoid over 10,000 out of 14,000 stomach-cancer deaths in Italy every year. Consequently, stomach cancer, which is still the third leading cause of cancer death in Italy, would represent only about 2% of all cancer deaths.

We investigated the influence of anthropometric measures at diagnosis and at different ages on prostate cancer risk using an Italian multicentre case-control study conducted between 1991 and 2002 of 1294 histologically confirmed cases and 1451 controls admitted to the same network of hospitals for acute non-neoplastic conditions. Height, weight, body mass index (BMI), waist-to-hip ratio, lean body mass 1 year before diagnosis/interview were not significantly associated with risk. However, a positive association with high BMI at age 30 years was found (odds ratio=1.2 for BMI> or =24.7 vs <22.7) and: for less differentiated prostate cancer, with BMI 1 year before diagnosis/interview. This study supports possible relationships between high body mass in young adulthood, and a tendency to high weight throughout adult life, and the risk of prostate cancer.

Istituto di Ricerche Farmacologiche “Mario Negri”, via Eritrea 62, 20157 Milano and Istituto di Statistica Medica e Biometria, Università degli Studi di Milano, via Venezian 1, 20133 Milano, Italy Correspondence to Carlo La Vecchia Tel: +39 02 39014 527; e-mail: [email protected]

Progress in cancer epidemiology and prevention has been a key determinant of the fall in cancer mortality in Europe. Using mortality and population figures from the WHO and Eurostat databases, we estimated the number of averted cancer deaths in the EU27 over the period 1989-2021, for both sexes, for all cancers, and nine major cancer sites. We also computed the avoided deaths for all cancers in five major European countries and the UK. We estimated a total of 4 958 000 (3 339 000 men and 1 619 000 women) avoided deaths for all neoplasms over the period 1989-2021 and 348 000 (246 000 men and 102 000 women) in 2021 alone in the EU27. For both sexes, we estimated 1 679 000 avoided deaths for stomach cancer, 747 000 for colorectum, 227 000 for bladder, 102 000 for leukemias. Avoided deaths for lung cancer accounted for 1 156 000 in men, while no reduction was estimated for women. For breast and uterine cancer, avoided deaths were about 300 000, for ovary 105 000 and for prostate 352 000. In the UK, a total of 1 061 000 (721 000 men and 340 000 women) deaths was avoided. Elimination of tobacco may avoid a further 20% of cancer mortality by 2050. Control of alcohol, overweight and obesity, and occupational and environmental carcinogens may avoid an additional 10% of cancer deaths. A similar reduction may be due to optimal adoption of cervical, colorectal, breast, and probably, lung and prostate cancer screening. Thus, primary and secondary cancer prevention can avoid an additional third of cancer deaths in Europe up to 2050.