We compared the effect of 26 types or groups of vegetables and fruit on the risk of cancer using data from two case-control studies that included 1,225 cases of cancer of the colon, 728 cases of cancer of the rectum, 2,569 cases of cancer of the breast, and 5,155 hospital controls interviewed between 1991 and 1996 in six Italian areas. Most vegetables were inversely associated with cancer of the colon and rectum, whereas only carrots and raw vegetables lowered breast cancer risk. High fruit intake was associated only with a reduction of rectal cancer. Different contents of sugar, fiber, carotenoids, and folic acid in fruits vs vegetables plus the concurrent consumption of oil with vegetables may partly explain these findings.
This study indicates that IIP is less than 7% in Europe and suggests that the supply of illicit tobacco, rather than its price, is a key factor contributing to tax evasion.
To offer quantitative evidence on the association between pancreatitis and pancreatic cancer, we analyzed data from a hospital-based case-control study conducted in northern Italy between 1983 and 1992, including a total of 362 incident cases of histologically confirmed pancreatic cancer and 1,408 controls admitted to hospital for acute, nonneoplastic, nondigestive tract disorders. Information was obtained using a structured questionnaire on sociodemographic characteristics and lifestyle habits (including tobacco and alcohol consumption) and a problem-oriented medical history, which included history of pancreatitis and age at its first diagnosis. Pancreatitis was reported by 24 (6.6%) cases and 18 (1.3%) controls, yielding an age- and sex-adjusted relative risk (RR) of 5.7 (95% confidence interval, 2.9-11.4). The risk of pancreatic cancer was appreciably higher 5 or more years after diagnosis of pancreatitis (RR = 6.9) than in the first 4 years (RR = 2.1), and in subjects below age 60 (RR = 8.3) than in elderly ones (RR = 2.6), but similar in males and females. The time-risk relationship is strongly indicative of a real relationship between pancreatitis and pancreatic cancer. After allowing for tobacco and alcohol, besides area of residence and education, the association between pancreatitis and pancreatic cancer appeared to be partly explained by such covariates (RR = 3.9); however, this may represent some degree of overadjustment if, for instance, alcohol is causally linked to pancreatitis, which, in turn, is causally related to pancreatic cancer. In terms of population attributable risk, pancreatitis would explain approximately 5% of pancreatic cancer cases.
Istituto di Ricerche Farmacologiche Mario Negri. Via Eritrea 62. 20157 Milano. Italy; Institute of Social and Preventive Medicine, University of Lausanne. Switzerland.
Abstract Background In 2019, the EAT-Lancet Commission proposed a diet promoting plant-based foods, while reducing red meat and added sugars, aiming to improve health outcomes for both humans and the environment. Within the StoP Project, a global consortium of epidemiologic studies on gastric cancer (GC), we investigated the association between adherence to the EAT-Lancet Diet and the risk of GC. Methods We included four Southern European studies (two from Italy, one from Portugal and Spain) with available Food Frequency Questionnaire data and total energy intake (TEI). Adherence to the EAT-Lancet Diet was evaluated using four different indices: EAT-Lancet Index (EATL), Planetary Health Diet Indexes (PHDI) developed by Cacau and Bui, and World Index for Sustainability and Health (WISH). A two-stage approach was applied: study-specific odds ratios (ORs) for GC per 1-SD increase in score were estimated using multiple logistic regression models adjusted for confounders (age, sex, BMI, socioeconomic status, smoking, alcohol and TEI), and pooled using random-effects meta-analysis. Heterogeneity assessed with I². Results Among 6031 individuals (2271 cases, 3760 controls), 63.4% of cases and 54.2% of controls were male, with a mean age of 65.0 ± 11.1 and 60.2 ± 12.3 years, and BMI of 25.3 ± 4.1 of 26.3 ± 4.3 kg/m², respectively. Low socioeconomic status was 78.9% and 57.4%, never smokers 43.7% and 47.2%, and intermediate alcohol consumers 54.4% and 44.7%, respectively. Higher adherence to EAT-Lancet Diet was associated with lower GC risk across all indices: EATL (OR = 0.92; 95% CI: 0.85-0.99; I² = 0.0%), PHDI by Cacau (OR = 0.87; 95% CI: 0.81-0.94; I² = 0.0%), PHDI by Bui (OR = 0.81; 95% CI: 0.72-0.91; I² = 40.6%), and WISH (OR = 0.86; 95% CI: 0.79-0.93; I² = 0.0%). Conclusions Adherence to plant-based, sustainable dietary patterns may protect from GC. These results highlight the potential role of dietary changes in cancer prevention, particularly in reducing the burden of GC. Key messages • Sustainable dietary patterns are associated with a lower risk of gastric cancer in Southern Europe. • Diets rich in plant-based foods and low in red meat and added sugars may reduce the risk of gastric cancer.
The role of the major identified risk factors for breast cancer was assessed using data from a hospital-based case-control study conducted in Northern Italy on 1108 women with histologically confirmed breast cancer and 1281 control subjects with a spectrum of acute conditions unrelated to any of the established or potential risk factors for breast disease. With reference to nulliparous women, the risk of breast cancer was below unity for those who first gave birth below age 25, and above unity for those with later first full-term pregnancy. However, in each stratum of age at first birth, the point estimate was below unity for women with five or more births. The relative risk for greater than or equal to 5 births compared with 1 or 2 was 0.6 (95% confidence interval = 0.4-0.9) when allowance was made for age at first birth. Likewise, there was a significant and independent effect of age at last birth which was evident in various strata of parity and age at first birth. The overall relative risk for last birth at 30 years or over compared with under 30 was 1.4 (95% confidence interval = 1.1-1.8). There was little relation of breast cancer risk with abortions or miscarriages. Breast cancer cases reported earlier menarche and later menopause; further, lifelong irregularities in menstrual pattern were less common among the cases (relative risk = 0.6, 95% confidence interval = 0.5-0.8). The risk estimates were elevated in women with positive history of benign breast disease, family history of breast cancer and greater body mass index.(ABSTRACT TRUNCATED AT 250 WORDS)
Observational studies and randomized clinical trials that have looked at the effect of hormone replacement therapy (HRT) on the risk of colorectal cancer are reviewed. Nine cohort studies in this area have included a total of over 2700 cases of colorectal cancer. Most of these studies found a relative risk (RR) of around or below unity. Of 15 case–control studies, with a total of over 7300 cases, six reported a 20–40% risk reduction among women who had ever used HRT. With reference to randomized clinical trials, in the Women's Health Initiative (WHI) study, after seven years of follow-up, 45 cases of colorectal cancer were observed in the combined HRT group versus 67 in the placebo group, corresponding to a RR of 0.63. A combined reanalysis of data from both the WHI and the Heart and Estrogen Progestin Replacement Study (HERS) included 56 cases in the com bined HRT group and 83 cases in the placebo group (pooled RR = 0.64). However, in the WHI study cancers diagnosed in the HRT group were more advanced and there were more positive lymph nodes. Furthermore, among women in the WHI who had had a hysterectomy, there was no difference at the eight-year follow-up in the incidence of colorectal cancer between those in the estrogen-only arm of the trial ( n = 61) and those in the control group ( n = 68).
