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Biomedical subjects

F Berrino

Publications and source records attributed to F Berrino.

At least 73 records · Page 4Linked to original sources
PubMed1998

Survival of women with breast cancer in Europe: variation with age, year of diagnosis and country. The EUROCARE Working Group.

Breast cancer is the most frequent malignancy among women in developed countries. Prognosis is better than for other major cancers, and an improvement in survival has been reported for several populations in recent decades. Within the framework of EUROCARE, a population-based project concerned with the survival and care of cancer patients in Europe, we analysed data from 119,139 women diagnosed with breast cancer between 1978 and 1985 in 12 countries and followed for at least 6 years. Multiple regression models of relative survival, which take mortality from all other causes in each area into account, were used to estimate the effect of age, period of diagnosis and country on survival. For the comparison between countries, survival rates were age-standardised to the age structure of the entire study population. Women aged 40-49 years at diagnosis had the best prognosis in all countries and throughout the study period. Women younger than 30 years at diagnosis had a worse prognosis than those aged 30-39. The highest relative survival at 5 years was in Finland and Switzerland (about 74%), intermediate levels were found for Italy, France, The Netherlands, Denmark and Germany (about 70%) and the lowest rates were in Spain, the United Kingdom, Estonia and Poland (55-64%). During the 6 months following diagnosis, survival was highly dependent on age and was sharply lower in women older than 49 years. For women surviving more than 6 months after diagnosis, survival was similar for all ages, although women aged 40-49 still had the better prognosis. The average rate of death from breast cancer fell by about 2.5% for each year of diagnosis between 1978 and 1985. This improvement manifested mainly in younger and older women, for whom survival was initially less good. The largest improvement was seen in Poland (-15% death risk per year). We suggest that the better survival of women aged 40-49 at diagnosis is related to lower levels of circulating sex hormones, resulting in reduced stimulation of tumour cell growth. Early diagnosis may also be important in the peri-menopausal period due to increased diagnostic attention. Low survival in the United Kingdom may be due to inadequate adherence to consensus treatment guidelines and greater variation in treatment.

Adult↗
PubMed1998

The cure for colon cancer: results from the EUROCARE study.

The interpretation of time trends and geographical differences of population-based survival rates is generally not easy, due to the difficulty in disentangling the effects of observational biases, diagnostic and therapeutic procedures and their interactions. Whereas descriptive analysis of relative survival is generally based on survival levels estimated at fixed time since diagnosis, interpretation issues can take advantage from the analysis of the shape of the considered relative survival. Parametric survival models allowing the estimation of the fraction of cured patients are applied here to analyze and discuss the differences in colon cancer relative survival between European countries, according to age and period of diagnosis. The survival curves of colon cancer patients are described according to 2 parameters: the proportion of cured patients and the mean survival time of fatal cases. These parameters are estimated by least square nonlinear regression of relative survival values derived from the EUROCARE Project publication. Exponential and Weibull survival functions are used to model the relative survival curve for the fraction of fatal cases. The Weibull model gives generally a better fit with respect to the exponential model, thus indicating that the mortality rate for fatal cases is decreasing with time since diagnosis. For the youngest patients, however, the 2 survival functions give practically overlapping estimates. The overall proportion of colon cancer patients in Europe that are estimated to be cured was 38.6%. This proportion increased from 36% to 40% for patients diagnosed in 1978-1980 and in 1983-1985, respectively. Accordingly, mean survival time of fatal cases increased from 1.18 to 1.52 years. According to age, the proportion of cured patients present a marked decrease from young (48.4% at age 15-44 years) to middle-aged patients (38.6% at age 5564 years) and only a mild decrease from these to the oldest patients (34.4% at age 75 or more). The opposite effect was shown by survival time of fatal cases, i.e., 1.71, 1.75 and 0.77 years for the same age classes, respectively. Proportion of cured cases and mean survival time of fatal cases tended to be positively correlated with each other across countries. Our results are consistent with the hypothesis that a real improvement in colon cancer survival took place in Europe during the years 1978-1985 and also suggest that the well-known decrease of relative survival with age at diagnosis could be mostly due to a decreasing efficacy of early diagnosis for patients under 60 years old and to less effective therapies for older patients.

Adult↗
PubMed1998

Variation in survival for adults with nasopharyngeal cancer in Europe, 1978-1989. EUROCARE Working Group.

During the period 1978-1989, 2,054 new patients with nasopharyngeal carcinoma (NPC) were registered in the EUROCARE study, which, during 1985-1989 involved 45 population-based cancer registries in 17 countries. The follow-up time was at least 5 years. 48% of all cases were squamous cell carcinomas and 39% undifferentiated carcinomas, which were more frequent in males. The overall relative 1- and 5-year survival rates (data included from 8 countries with complete data) were 75 and 34%, respectively, for males, and 72 and 32%, respectively, for females, but in a multivariate analysis, there was no significant difference in risk between males and females (0.93 (0.84-1.01), hazard ratio (HR) with 95% confidence interval (95% CI) for females). The overall relative 5-year survival (data included from nine countries with complete data) declined with age, from 53% for patients aged 15-44 years to 31% for patients aged 65-74 years. For patients with undifferentiated tumours, higher survival rates were observed in Scandinavia, Slovakia and Mediterranean countries, with lower rates for patients from the U.K. and Estonia. Survival for patients with squamous cell carcinoma was lowest in Scotland, England and Estonia. In a multivariate analysis, there was a significant difference in risk of death between those with squamous cell carcinomas and those with undifferentiated (HR 0.82, 95% CI 0.74-0.90). Between 1978 and 1989, the prognosis did not change.

Adolescent↗
PubMed1998

Variations in survival from breast cancer in Europe by age and country, 1978-1989. EUROCARE Working Group.

The objective of this study, part of the wider EUROCARE II collaborative project, was to examine variations by age and country in the relative survival of women from breast cancer in Europe, based on data fro 145,000 cases in 1985-1989 and trends based on (245,000) cases for 1978-1989. Data were supplied by 42 cancer registries in 17 countries to a common protocol. Results for some countries where the participating registries covered only small proportions of the total population may not be representative of the whole country. In 1985-1989 there were wide differences among the 17 countries: survival was above the European average in Iceland, Finland, Sweden, Switzerland, France and Italy; around average in Denmark, The Netherlands, Germany and Spain; below average in Scotland, England and Slovenia; and well below average in Slovakia, Poland and Estonia. In France, Spain and Italy, but not in the U.K., there were wide differences in survival among the participating registries. Survival generally declined with age, particularly in the elderly (75 years and over)--this was most marked in Denmark, Scotland and England. Over the period 1978-1989, 1-year survival improved by 2% overall and 5-year survival by 6%. There were improvements in 5-year survival in all countries except Iceland, Germany, Switzerland and Estonia, and in all age groups except the youngest (15-44 years). It is likely that differences in the access to and quality of care in the various countries played a large part in explaining the differences in survival.

Adolescent↗
PubMed1998

Variation in survival of patients with head and neck cancer in Europe by the site of origin of the tumours. EUROCARE Working Group.

The study describes the prognosis of head and neck cancer in Europe on the basis of information available to population-based cancer registries collaborating in the EUROCARE II project. Variation in survival in relation to country and the anatomical site/sub-site of origin of the tumours was examined. Survival analysis was carried out on 35,004 head and neck cancer cases (ICD 141, 143-148 and 161) diagnosed between 1985 and 1989 in 17 European countries. Prognosis varied considerably according to anatomical site: the best 5-year survival rates were seen for cancer of the larynx (63% in men) and the worst for cancer of the hypopharynx (22% in men). Five-year relative survival of male patients with cancer of the tongue, mouth and pharynx (ICD 141, 143-148) was 34% and ranged from over 45% in Iceland, Sweden, The Netherlands and Austria to less than 25% in Eastern European countries. Survival for larynx cancer ranged from over 70% in Iceland, Sweden, The Netherlands and Germany to less than 50% in Slovakia, Poland and Estonia. Apparently, France had the lowest survival (relative risk (RR) of dying versus Finland = 1.29) in Western Europe; after adjustment for ICD 3-digit anatomical sites the difference disappeared (RR = 1.04). Eastern European countries remained at the bottom of the survival range (RR > 1.4). The analyses adjusting by sub-site (ICD fourth digit) were confined to registries for which the proportion of unspecified sub-sites was less than 20%. Geographical differences in survival between Western European countries were largely due to a difference in case mix of anatomical sub-sites. However, after correcting for different sub-site distribution, differences persisted between Eastern and Western European countries. This is likely to be due to late diagnosis and to late referral or poor access of patients to adequately equipped treatment centres.

Adult↗
PubMed1998

Introduction: the EUROCARE II Study.

This introduction provides a general overview of the aims, methods and procedures used in the EUROCARE II study and the types of analyses presented in each article of this Special Issue of the European Journal of Cancer. The main aims of the EUROCARE II project are the updating of the survival database of the European Cancer Registries, the study of recent trends in relative survival rates and the interpretation of the survival differences observed both in time and across populations. Once having completed the preliminary stage of data checking, a total of 3,473,659 individual records from patients of all cancer sites, diagnosed between 1978 and 1989 and provided by 45 cancer registries in 17 European countries were accepted to build up the EUROCARE database. The quality of these data, in terms of the accuracy of the diagnosis and the validity of vital status assessment, was checked by indirect indicators, based on cross-validation analysis of consistency of the relevant variables. Statistical analysis was based on age-specific relative survival rates, computed for each cancer sites as the ratio of observed survival to the expected survival of the general population of the same area, gender and age, according to the Hakulinen method. An estimate of the European survival was computed as a weighted mean of the corresponding survival of the different countries, using as weights the expected yearly number of incident cases in each country. For comparison purposes, age-standardised survival was also calculated for Europe and for each country involved in the study.

Europe↗
PubMed1998

Alcohol consumption and total estradiol in premenopausal women.

The present paper analyzes the relation between alcohol intake and serum total estradiol in premenopausal women while attempting to control or reduce several sources of variability of serum estradiol. Sixty premenopausal women were recruited, and alcohol intake was estimated by a semiquantitative questionnaire. Interviews, anthropometric measurements, and blood drawings (after overnight fasting) were conducted twice, 1 year apart. Both blood samples were obtained on the same day of the luteal phase of the cycle, in the same month and in the same hour and minute of the day. Samples from the first drawing were stored at -80 degrees C. Serum from both drawings was assayed simultaneously and in blind fashion. A significant association between alcohol intake and estradiol was found when estradiol was averaged across the two visits (Spearman's r = 0.29; P < 0.05). To control for intraindividual variability of estradiol over time, participants were then divided into tertiles of hormone distribution for each of the two sets of measurements and classified based on their consistency in estradiol across the two visits. Women showing consistently high estradiol levels at both visits were characterized by a significantly higher alcohol intake (92.8 g/week) in comparison with those showing consistently low estradiol at both visits (31.6 g/week). Furthermore, the prevalence of drinkers in the group with consistently high estradiol was significantly higher than in the group with consistently low estradiol. The present report indicates that drinkers seem to be characterized by consistently higher estradiol than nondrinkers, and that when the variability of estradiol in premenopause is considered, it is possible to identify a relationship between alcohol intake and estradiol.

Adult↗
PubMed1997

Changes in lung cancer histological types in Varese Cancer Registry, Italy 1976-1992.

Shifts in histological tumour type distribution, chiefly an increase in adenocarcinoma, have been reported to accompany changes in lung cancer incidence in the last two decades in the United States and several other developed countries. To elucidate this phenomenon further, we analysed population-based lung cancer incidence rates in the period 1976-1992 from the Varese province, an area with 788,000 inhabitants in Northern Italy. Rates were age-standardised on the world standard population. Overall, lung cancer had stopped increasing in males since the late 1980s, and had started declining in middle-aged men. Conversely, upward trends persisted in females up to 1991-1992. Although it decreased from 13 to 9, the male-to-female incidence ratio was, in 1991-1992 still substantially higher than in the U.S. and North Europe. Specific trends emerged according to histological type(s), with declines (males) or stabilisation (females) for squamous-cell carcinoma and gradual increases for small-cell carcinoma in males. Adenocarcinoma was the only lung cancer type whose incidence rates increased similarly (2.5-fold) in males and females thus approaching, in 1991-1992, in the two sexes combined, the rate for squamous-cell carcinoma. Although advances in diagnostic techniques may have played a role, the absolute and relative increases in the adenocarcinoma rate reflect changes in cigarette manufacture (i.e. spread of filter tips and low-nicotine low-tar cigarettes) and the decrease in smokers.

Adenocarcinoma↗
PubMed1997

Estimation and projections of colorectal cancer trends in Italy.

BACKGROUND: Occurrence of and prognosis for tumours of the colon and rectum are thought to be changing rapidly due to simultaneous changes in risk factor prevalence, early diagnosis and treatment. In this paper time trends of morbidity, survival and mortality for colorectal cancer during the period 1970-1990 are estimated and analysed. METHODS: Mortality trends were obtained from official death certificates. Relative survival rates were computed from population-based cancer registries. Incidence and prevalence rates were estimated from mortality and survival data. RESULTS: Incidence rates were increasing during the period considered, with a lower rate of increase for the youngest birth cohorts. Relative survival rates of both colon and rectum cancers were higher for women, and for younger age groups, and were positively associated with period of diagnosis. No significant survival difference among the cancer registries used was found. A total of about 155,000 prevalent cases, 40% of which had been diagnosed > or = 7 years before, were estimated in the Italian population for the year 1990. Mortality rates were slightly increasing for men and stable for women. Projections of colorectal cancer trends to the year 2000 indicate major expected rises in both incidence and prevalence. CONCLUSION: Colorectal cancer represents a problem of growing impact for health services in Italy. This conclusion can probably be extended to many developed countries.

Adult↗
PubMed1997

Relative validity and reproducibility of a food frequency dietary questionnaire for use in the Italian EPIC centres.

A pilot questionnaire was developed for the EPIC centres of northern Italy, and validated in the feasibility part of the cohort project. The questionnaire was self-administered and of the food frequency type with portion size estimated by means of pictures. It was structured by courses within a meal characteristic of Italian dietary habits. Dietary intake estimated by the questionnaire was compared to the corresponding estimates obtained from 8-14 24-hour recall interviews administered over a 1-year period. The reference method was validated by means of urinary nitrogen in 4-6 repeated 24-hour urine collections. One hundred and ninety-seven volunteers (47 men and 150 women) were enrolled and completed the study lasting 1 year. They filled out two questionnaires at the beginning and at the end of the study, and had a 24-hour recall interview once a month. Twenty-four-hour urine samples were collected at regular intervals. Usual intake of energy, the major nutrients and some vitamins were estimated for the questionnaires and the reference method by means of food composition tables compiled for this study. The agreement between the questionnaire and the 24-hour recalls was only good for alcohol consumption: Pearson's correlation was 0.73 and 0.77 in men and women respectively. Otherwise the relative validity of the questionnaire ranged between 0.28 for fat to 0.52 for carbohydrates in men and 0.25 and 0.50 in women for the same nutrients. The validity of the two interview methods in estimating protein intake, compared to mean urinary nitrogen was 0.24 (M) and 0.18 (W) for the questionnaire and 0.63 (M) and 0.48 (W) for 24-hour recalls. The main causes of low performance of the questionnaire were identified to be the estimated intake of dressing and cooking fats, vegetables and meat. Remedies were devised and introduced in the final version of the questionnaire currently in use in the EPIC project.

Cohort Studies↗
PubMed1997

[Hormone replacement therapy and cardiovascular diseases: different populations, different risks].

Observational studies indicate that oral hormone replacement therapy (HRT) in menopause is associated with a 20-40% reduction of coronary risk. Population risk/benefit analyses on mortality after large-scale HRT use indicate that excess deaths can be counted when coronary heart disease is relatively less frequent than breast cancer before age 60 (as occurs in Italy). The decline in mortality trends for coronary heart disease support a word for caution for a large scale use of HRT in the next years even in those populations for which a relative advantage is presently estimated.

Cardiovascular Diseases↗
PubMed1997

[Hormone replacement therapy in menopause: therapeutic benefits and preventive risks].

Hormonal replacement therapy is prescribed both to relieve menopausal symptoms and for preventive purposes. The preventive benefit, however, is dubious because the increased risk of breast cancer may be more important than the decreased risk of myocardial infarction and osteoporotic fractures. The transdermal administration may be associated with higher breast cancer risk and lower cardiovascular benefit than the oral administration; only the latter, in fact, is able to stimulate the liver synthesis of sex hormone binding globulin (SHBG, which reduces the availability of testosterone and estradiol to target organs) and of HDL cholesterol, and to inhibit the liver synthesis of IGF-I (which cooperates with sex steroids to enhance the breast cancer cell proliferation).

Estrogen Replacement Therapy↗