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The sensitivity analyses suggested in the Letter to the Editor by de Vries et al. was performed, but no material change in relative risk for bladder cancer was found. This is not surprising given the limited contribution of the studies excluded in the sensitivity analyses.
Between 1976 and 1996, 176 borderline ovarian tumours were registered in the Cancer Registry of the Swiss canton of Vaud, corresponding to an age-adjusted incidence (world standard) of 2.7 in 100,000. Incidence rose from 1.7 per 100,000 during 1976-81 to 2.7 per 100,000 during 1987-91, and then levelled off; 58% of cases were serous and 41% mucinous. Relative survival was 94% at 10 years; 18 second neoplasms were observed, compared with 10.3 expected, and there was a significant excess of invasive ovarian cancers (four observed, including three synchronous, compared with 0.4 expected).
The relationship between education, social class, smoking habits, alcohol consumption and the risk of digestive tract neoplasms was analysed in a case-control study of 50 cases of cancer of the mouth or pharynx, 209 of the oesophagus, 397 of the stomach, 455 of the colon, 295 of the rectum, 151 of the liver, 214 of the pancreas, and a total of 1944 control subjects admitted for acute, non-neoplastic or digestive tract disorders. Cancers of the mouth or pharynx, oesophagus and stomach were inversely and strongly related to education, with risk estimates ranging between 0.2 and 0.4 for the highest education categories. Significant, but weaker inverse relations were evident for rectal and liver cancer, too, whereas the risk of colon cancer was elevated among more educated individuals. There was no relationship between education and pancreatic cancer. The pattern of risk was largely comparable when the head of the household's occupation was used as indicator of social class. There were strong direct associations between cigarette (as well as pipe or cigar) smoking and cancers of the mouth or pharynx and oesophagus, and a moderate one with pancreatic cancer, but none of the other sites considered was related to smoking habits. Cancers of the mouth or pharynx and oesophagus were independently and strongly related to alcohol consumption, too, while the associations between alcohol and liver or pancreatic cancer were moderate and not significant. Cancers of the stomach, colon and rectum were unrelated to measures of alcohol consumption.
Although debate on breast cancer and diet has been concentrated on nutrients, assessment of the role of specific foods and food groups and variety of food intake retains a considerable importance. To further elucidate the role of dietary habits, 2,569 women with incident breast cancer (median age 55 years) and 2,588 control women (median age 56 years), hospitalised with acute non-neoplastic diseases, were interviewed between 1991 and 1994 in 6 different Italian areas. The validated food frequency questionnaire included 79 food items and recipes, which were grouped into 18 food groups (5 for "diversity" analyses purpose). After allowance for non-dietary confounding factors and total energy intake, significant trends of increasing breast cancer risk with increasing intake emerged for the following food groups: bread and cereal dishes, pork and processed meats, and sugar and candies. Conversely, high intake of milk, poultry, fish, raw vegetables, potatoes and coffee and tea seemed to exert a protection against the development of breast cancer. Intake of soups, eggs, other meats, cheese, cooked vegetables, citrus fruits, other fruits and cake and desserts were not significantly related to breast cancer risk. The variety of vegetable types consumed weekly seemed to have a beneficial effect beyond the advantage of high vegetable intake per se.
The role of coffee in the aetiology of hepatocellular carcinoma has raised great interest. In Italy, coffee consumption is high, thus allowing the investigation of the topic over a broad range of consumption. A hospital-based case-control study was conducted in Italy in 1999-2002, including 185 incidents, histologically confirmed cases of hepatocellular carcinoma aged 43-84 years. Controls were 412 subjects admitted to the same hospitals' networks for acute, non-neoplastic diseases unrelated to diet. Coffee and tea consumption were assessed using a validated food-frequency questionnaire. Odds ratios (ORs) and corresponding the 95% confidence intervals (CI) were computed using unconditional multiple logistic regression, adjusting for hepatitis viruses seropositivity, alcohol intake, smoking habits and other potential confounding factors. Compared to people who drunk <14 cups/week of coffee, the risk of hepatocellular carcinoma decreased for increasing levels of consumption (OR=0.4, 95% CI: 0.2-1.1 for >or=28 cups/week, p for trend = 0.02). In the present study, inverse relations were observed across strata of hepatitis C and, B virus infections and alcohol drinking. No significant association emerged with consumption of decaffeinated coffee (OR=0.7, 95% CI=0.2-2.5) or tea (OR=1.4, 95% CI=0.8-2.7). The present study supports the hypothesis of a favourable effect of coffee, though not decaffeinated coffee and tea, on the risk on hepatocellular carcinoma.
Trends of Italian death certification for cancers of the lung, larynx, pleura and nasal sinuses were analyzed for both sexes in the period from 1969 to 1987. For lung and laryngeal cancer, the analyses have been conducted for broad geographical areas within Italy (North, Center and South). Mortality rates for males aged 35-44 years consistently decreased in the North; increased until the late 1970's, and then decreased in the Center; and consistently increased in the South. In the 45-54 age group, mortality rates peaked in all areas between the late 1970's and the early 1980's, subsequently decreasing. For ages over 54 years, the rates continued to increase even in the 1980's. Female lung cancer rates increased in all areas and in all age groups over 35 years. In the 25-34 years old age group the rates decreased in the North and tended to increase in the Center and in the South. Below age 50, the increases were proportional in the three areas, while for older ages the increase was greater in the North both in absolute and proportional terms. Cohort effects showed a general increase for the generations born up to 1930, in both sexes and in all geographical areas. Different trends were observed for cohorts born after 1940: decreasing for both sexes in the North, and steady for men and increasing for women in the other areas. From the mid 1970's, laryngeal cancer standardized rates for 35-64 age group decreased, or at most remained constant, in all geographical areas. The decreasing tendency was more marked in men. Larynx cancer cohort effects for men were at a maximum for cohorts born around 1990, decreasing thereafter. In women, cohort effects appeared to consistently decrease. Overall rates of pleural cancer mortality increased during the period 1969-1987, and the sex ratio was stable, from 1980 onwards, at a value of about 2.4. Cohort effects showed, for pleural cancer, a general increase for all the cohorts. The increase was particularly apparent in male cohorts born after 1930. Overall mortality rates for cancer of the nasal sinuses was rather stable in both sexes from 1975 onwards. However, in the 35-64 year age group, mortality rates increase for males and decreased for females.
