Publications

La présente étude prend en compte les données et les tendances relatives à la mortalité par cancer du tractus digestif dans 35 pays européens. Elle confirme la poursuite du long déclin de la mortalité par cancer gastrique avec cependant une persistance de taux élevés en Europe de l’est (et au Portugal). Elle indique aussi que l’évolution des cancers colorectaux est devenue relativement favorable dans plusieurs pays européens depuis le milieu des années 80, principalement pour la femme. Après une période de hausse, depuis le début des années 90, les cancers de la cavité buccale, du pharynx et de l’œsophage se sont stabilisés chez l’homme à des âges de plus en plus jeunes. En revanche, l’évolution des cancers hépatiques est extrêmement difficile à interpréter et la mortalité par cancer pancréatique reste en hausse dans plusieurs, bien que pas tous, pays européens. Remerciements: Ce travail a été soutenu par la Ligue Suisse contre le cancer, la Fondation Suisse de Recherche sur le Cancer et l’Association Italienne de Recherche sur le Cancer.

Risk factors for complete and partial hydatidiform mole were analyzed in a case-control study conducted in the greater Milan area on 139 complete moles, 49 partial moles, and 410 obstetric control subjects. Patients tended to be more frequently nulliparous than controls, and the risk of complete mole and partial mole decreased with number of births, although the trend in risk was significant only for partial mole (chi 2(1) trend, P = .05). The risk for both histopathologic subgroups was greater in women reporting spontaneous miscarriages. Compared with women with no previous miscarriage, the estimated odds ratios (as estimators of relative risks) were 3.1 and 1.9, respectively, for complete mole and partial mole for two or more miscarriages. Infertility problems or difficulty in conception were associated with an odds ratio of 2.4 (95% confidence interval 1.3-4.3) and 3.2 (95% confidence interval 1.4-7.0), respectively, for complete mole and partial mole. No association emerged between mole and induced abortions and age at first pregnancy. A personal history of gestational trophoblastic disease increased the risk of both complete mole and partial mole: The odds ratios were 12.0 (95% confidence interval 3.0-38.9) and 18.1 (95% confidence interval 5.0-64.7), respectively. Similarly, a family history of gestational trophoblastic disease was more frequently reported in complete mole cases (five of 128) than in controls (one of 395) (odds ratio 16.0, 95% confidence interval 3.2-80.3). When the mating frequencies by patient/husband blood groups were considered, a nonsignificant increased risk was evident for women with group A married to men of group O in both histopathologic subgroups (odds ratio 1.5 compared with all other combinations).(ABSTRACT TRUNCATED AT 250 WORDS)

Trends in death certification rates from peptic ulcer between 1955 and 1989 have been analysed for 24 European countries on the basis of age-specific and age-standardized rates, and a log-linear model to estimate the effects of age, cohort of birth and period of death. For males, in all Western countries there were substantial declines in mortality. In the late 1950s, the range of variation of the world standardized rates was between 4/100 000 in France and 17.8 in Portugal. In the late 1980s, only Ireland had a rate over 5/100 000, and values for most Western countries ranged between 2 and 4/100 000. The average fall in rates over the last three decades was 56%. Of this, a high proportion (45%) was registered between 1975 and 1984. In Eastern Europe, no systematic change was observed until the early 1970s, but over the last 15 years peptic ulcer mortality declined by an average of 20%. In 1985–1989 the lowest rate was 4.5/100 000 in Bulgaria, and for all other countries peptic ulcer mortality ranged between 5 and 7.2/100 000. Peptic ulcer mortality was substantially lower in females, and showed no appreciable modification in Western Europe, and several increases in Eastern Europe until the mid 1970s. Thereafter, mortality declined by an overall 25% in the West and 15% in the East. Earlier declines for males in Western Europe were chiefly related to a cohort effect, reflecting more favourable risk factor exposure {such as diet, Helicobacter pylori or smoking) of subsequent generations. The recent falls, in contrast, were mainly on a period of death basis indicating therapeutic advancements (including the introduction of H2-receptor-antagonists in the mid-1970s) as the major determinant. These falls correspond to about 20 000 deaths from peptic ulcer avoided every year in the whole of Europe.

Besides tobacco and alcohol, diet has been thought to be associated with laryngeal cancer risk. We thus analyzed the role of various food groups, as well as specific seasoning fats, in a case-control study conducted in Northern Italy and the Swiss Canton of Vaud from 1992 to 2000. Our study included 527 incident, histologically confirmed cases and 1,297 frequency-matched controls, selected among patients admitted to the same hospitals as cases for acute, nonneoplastic conditions, unrelated to smoking, alcohol consumption and long-term modifications of diet. The subjects' usual diet was investigated through a validated food frequency questionnaire, including 78 foods and beverages. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using unconditional multiple logistic regression models. After adjustment for major confounding factors, a significant trend of increasing risk was observed for eggs (OR = 1.7 for the highest compared to the lowest quintile), red meat (OR = 3.1), processed meat (OR = 1.7), fish (OR = 1.6) and sugars (OR = 1.6). Significant inverse associations were observed for pulses (OR = 0.7), raw vegetables (OR = 0.2), cooked vegetables (OR = 0.3), citrus fruit (OR = 0.6) and other fruit (OR = 0.5). In regard to seasoning fats, a significant reduction of cancer risk was observed for olive oil (OR = 0.4) and specific seed oils (OR = 0.6), while mixed seed oils were directly associated with laryngeal cancer risk (OR = 2.2). Our study suggests that increasing vegetables and fruit, decreasing meat consumption and perhaps substituting olive oil or specific seed oils for other types of seasoning lipids might help reduce laryngeal cancer risk.

Intrauterine devices (IUDs), long-acting and reversible contraceptives, induce a number of immunological and biochemical changes in the uterine environment that could affect endometrial cancer (EC) risk. We addressed this relationship through a pooled analysis of data collected in the Epidemiology of Endometrial Cancer Consortium. We combined individual-level data from 4 cohort and 14 case-control studies, in total 8,801 EC cases and 15,357 controls. Using multivariable logistic regression, we estimated pooled odds ratios (pooled-ORs) and 95% confidence intervals (CIs) for EC risk associated with ever use, type of device, ages at first and last use, duration of use and time since last use, stratified by study and adjusted for confounders. Ever use of IUDs was inversely related to EC risk (pooled-OR = 0.81, 95% CI = 0.74-0.90). Compared with never use, reduced risk of EC was observed for inert IUDs (pooled-OR = 0.69, 95% CI = 0.58-0.82), older age at first use (≥ 35 years pooled-OR = 0.53, 95% CI = 0.43-0.67), older age at last use (≥ 45 years pooled-OR = 0.60, 95% CI = 0.50-0.72), longer duration of use (≥ 10 years pooled-OR = 0.61, 95% CI = 0.52-0.71) and recent use (within 1 year of study entry pooled-OR = 0.39, 95% CI = 0.30-0.49). Future studies are needed to assess the respective roles of detection biases and biologic effects related to foreign body responses in the endometrium, heavier bleeding (and increased clearance of carcinogenic cells) and localized hormonal changes.