Publications

Attributable risks for kidney cancer in northern Italy.

The percent population attributable risk (AR) for kidney cancer was estimated in relation to smoking habits, beta-carotene intake, history of cystitis and family history of kidney cancer, using data from a case-control study conducted between 1985 and 1989 in Milan, northern Italy. The data comprised 133 histologically confirmed cases of incident kidney cancer and 392 controls, admitted to hospital for a wide range of acute, non-neoplastic, non-smoking-related diseases. On the basis of multivariate odds ratios (ORs), smoking habits accounted for about 26% of cases, a low beta-carotene intake for 18%, a history of cystitis for 7%, and a family history of kidney cancer in first-degree relatives for 3% of cases. Ever smoking and low beta-carotene intake combined explained 38% of all kidney cancers, and the combination of these two factors plus a history of cystitis and a family history of kidney cancer explained 45% of the incidence of the disease. Thus, even if available, dietary information was limited and the AR estimates were based on somewhat arbitrary assumptions. A considerable proportion of kidney cancers could be avoided simply by eliminating smoking and increasing consumption of fruit and vegetables in this Italian population. This would mean that about 1,500 kidney cancer deaths every year in the whole of Italy could be avoided.

Pancreatic cancer: Overview of descriptive epidemiology

Pancreatic cancer mortality rates have been increasing in high-income countries between the 1950s and the 1980s, and have leveled off or declined thereafter, particularly in men. To provide a global overview of recent pancreatic cancer mortality, we analyzed official death of the world certification data derived from the World Health Organization for 35 European countries and 19 other countries over the period 1980-2007. In 2007, the highest mortality rates from pancreatic cancer were in the Baltic countries, and some central/eastern and northern European countries (over 9.5/100 000 men and 6/100 000 women), whereas the lowest ones were in Latin America and Hong Kong (below 5/100 000 men and 3/100 000 women). Japan, the USA, Russia and the European Union (EU), as well as the largest countries in the EU, had rates around 7-9/100 000 men and 5-6/100 000 women. In the early 2000s, rates have been approximately stable in many European countries, as in the USA, Japan, and Australia. In Nordic countries and the UK, where declines in rates have been observed between the 1980s and the 1990s, mortality from pancreatic cancer has tended to rise over most recent calendar years. Some persisting rises were still found in men from a few countries of southern and central/eastern Europe (with low rates in the past), as well as in the EU overall, and in women from European and Asian countries. Recent trends were generally more favorable in young adults (30-49 yr), suggesting that overall trends are likely to improve in the near future.

Relation of dietary glycemic load with ischemic and hemorrhagic stroke: a cohort study in Greece and a meta-analysis

Tea consumption and gastric cancer: a pooled analysis from the Stomach cancer Pooling (StoP) Project consortium

RE: Risk of prostate, breast and colorectal cancer after skin cancer diagnosis

We thank Dr. Grant for his interest in our work.1 We cannot make inference on latitude of exposure, specifically, on latitudes south of about 40°. The subjects diagnosed with skin cancer are most likely, than those without skin cancer, to have been heavily exposed to sun in this Swiss population. Exposure may have occurred in the country with mountainous areas, where sun irradiation is stronger than at sea level,2, 3 or abroad. With reference to smoking, according to the Monograph 83 of the International Agency for Research on Cancer,4 there is evidence suggesting the lack of carcinogenicity of tobacco smoking for female breast cancer. There is clear evidence for the risk of neither prostate cancer nor skin cancer. There is some evidence from prospective cohort and case-control studies that the risk of colorectal cancer is increased among tobacco smokers. However, it is not possible to conclude that the association between tobacco smoking and colorectal cancer is causal (abstracted from reference4, pp. 1183–86). It is, therefore, unlikely that smoking has introduced any major bias, confounding, or modifying effect in the results of our study. The evidence from population-based cohort studies like ours1, 5-7 is open to criticism, but is in any case more valid than that of correlation (ecologic) ones often quoted by Dr. Grant in support of his views. Dr. Soerjomataram and Dr. de Vries suggest to provide additional information to address the issue of surveillance bias and stratified or sub-group analysis in our study.1 Although we caution toward inference based on subgroups, we are glad to provide the information requested, when available. With reference to potential surveillance bias, the number of male skin cancer cases in Vaud and Neuchatel, Switzerland were 15,246 when compared with 13,541 in the Dutch study, and that of population years at risk was 109,176. There is no reason to suppose that inclusion—rather than exclusion—of early prostate cancer introduces selection bias. In the mid 1990's, about 10% of men aged 65 or over may have undergone prostate-specific antigen (PSA) testing in Vaud and Neuchatel,8 and this proportion has risen over more recent years, in the absence, however, of any organised screening programme. The standardised incidence ratio (SIR) of prostate cancer was 1.18 (95% confidence interval (CI): 0.93–1.47) in the first, 1.24 (95% CI: 0.97–1.57) in the second, 1.16 (95% CI: 0.88–1.49) in the third year after diagnosis of skin cancer, and 1.13 (95% CI: 1.02–1.25) in subsequent years. Corresponding values were 1.34, 1.06, 0.89, 1.08 for colorectal, and 1.07, 1.20, 1.09, 1.06 for breast cancer. This weighs against the hypothesis of an early reduction in risk, which levels off with time, due to potentially reduced sunshine exposure after skin cancer diagnosis. With reference to strata of sex, the SIR of colorectal cancer were 1.06 (95% CI: 0.94–1.19) in men, and 1.14 (95% CI: 1.00–1.30) in women. The estimates were not significantly heterogeneous across sexes. We have information on stage and grade of prostate cancer only for recent years; thus numbers of subsequent cancers are inadequate now for any inference. Thus, none of the additional or subgroup analyses indicated by Dr. Soerjomataram and Dr. de Vries modify our conclusion that incidence of colorectal, breast, and prostate cancers is not reduced in patients diagnosed with skin cancer. We agree with Dr. Soerjomataram and Dr. de Vries that collaborative studies would help clarify the issue, and provide acceptable statistical power for subgroup analyses. Dr. Robert Tarone, from the International Epidemiology Institute, Rockville, MD, USA, kindly pointed to us that the expected rates in Table I were smaller than those in Table II.1 The correct Table I is, therefore, enclosed below. The first paragraph of the results section consequently reads as follows: “Table 1 gives the numbers of observed and expected cancers of the prostate, breast, and colorectum following basal and squamous cell skin cancers, skin melanomas, and all skin cancers combined. Overall, 680 prostate cancers were observed vs. 593.4 expected (SIR = 1.15; 95% CI: 1.06–1.24), 440 breast cancers were observed vs. 402.3 expected (SIR = 1.09; 95% CI: 0.99–1.20), and 535 colorectal cancers were observed vs. 488.0 expected (SIR = 1.10; 95% CI: 1.01–1.19). We, also, considered the risk of prostate, breast, and colorectal cancers in separate strata of age at diagnosis, location (head and neck vs. other), and time since skin cancer diagnosis, but found no indication of reduced risk in any of the strata considered, most SIRs for prostate, breast, and colorectal cancers being around or slightly above unity. The SIRs of colorectal cancer were 1.06 (95% CI: 0.94–1.19) for men, based on 292 observed vs. 275.4 expected, and 1.14 (95% CI: 1.00–1.30) for women, based on 243 vs. 212.6 expected.” These changes do not modify the inference and conclusions of our work. We apologize, nonetheless, the readers for the correction, and again thank Dr. Tarone for his careful reading and valuable help. Yours sincerely, Fabio Levi, Lalao Randimbison, Van-Cong Te, Manuela Maspoli Conconi, Carlo La Vecchia

Reproductive and hormonal factors and ovarian cancer

A meta-analysis of alcohol drinking and oral and pharyngeal cancers. Part 2: Results by subsites

Cancer mortality in Italy: Temporal trends and geographical distribution

S40. Aspirin and cancer risk: a quantitative review

Invasive cervical cancer in young women

Between 1970 and 1979, 103 women below 35 years of age with invasive cervical cancer were treated at the First Obstetrics and Gynaecology Clinic of the University of Milan. Nine patients were pregnant or less than 3 months postpartum. Estimated 10-year disease-free survival, determined by the life-table method, was 100% in stage IA (37 patients), 79% in stage IB (45 patients), 67% in stage II (15 patients), 0% in stages III (5 patients) and IV (1 patient). Prognosis was also strongly associated with lymph-node involvement, 10-year actuarial survival decreasing from 93% in lymph-node-negative to 44% in lymph-node-positive patients (P less than 0.001). The prognostic relevance of the clinical stage decreased after adjustment for lymph-node involvement, but the statistical significance of lymph-node involvement was unaffected when stage was allowed for. In the present series, the estimated 10-year disease-free survival was 80% in patients treated by radical hysterectomy compared with 62% in the group treated by total hysterectomy (stage IB to IV patients only); this difference, however, was not statistically significant when the data were adjusted for clinical stage (P = 0.10). None of the 20 patients with recurrent disease could be managed successfully.

Efficacy of lung cancer screening appears to increase with prolonged intervention: results from the MILD trial and a meta-analysis

No excess mortality among working-age Italians during the Omicron wave of Covid-19

Over the periods preceding the Omicron wave, Covid-19 caused around 12,800 excess deaths among individuals of working age, accounting for over 10% excess death. This excess was no longer observed during the Omicron wave.

Excess mortality in Italy in 2020 by sex and age groups accounting for demographic changes and temporal trends in mortality

After considering demographic changes and temporal improvement in mortality the excess deaths in 2020 still remains above 90,000 deaths. More important, considering these factors, the excess at ages <80 years is revised upwards, while the excess at older ages is revised downwards.

Processed Meat and Risk of Renal Cell and Bladder Cancers

We assessed the association of processed meat intake with the risk of renal cell carcinoma (RCC) and bladder cancer. We used data from two Italian hospital-based case-control studies, including 1,115 RCC cases and 2,582 controls, and 1,417 bladder cancer cases and 1,732 controls. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) with unconditional logistic regression models, adjusted for major confounders. The median consumption of processed meat in cases and controls was around 2 portions/week (50 g/portion). The ORs for a daily 10 g increment of processed meat was 0.89 (95% CI 0.84-0.94) for RCC and 1.00 (95% CI 0.94-1.06) for bladder cancer. The OR for the highest vs. the lowest consumption was 0.80 (95% CI 0.66-0.96) for RCC and 0.98 (95% CI 0.80-1.21) for bladder cancer. The ORs were consistent in strata of various covariates. For bladder cancer, however, a significant 23% excess risk was found in women (95% CI 1.03-1.47) for a daily increase of 10 g, significantly heterogeneous from the risk recorded in men (OR 0.96, 95% CI 0.90-1.02). The inconsistent results between men and women and the absence of association in both sexes combined indicate that the apparent association between processed meat and bladder cancer in women is unlikely to be causal.

Epidemiological data on cervical carcinoma relevant to cytopathology.

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.

Pattern of Cervical Screening Utilization in Italy

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.

Combined estrogen-progestogen contraceptives