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F Berrino

Publications and source records attributed to F Berrino.

At least 109 records · Page 6Linked to original sources
PubMed1993

Retrospective assessment of exposure by experts: the example of formaldehyde, solvents and mineral oils among textile and metal workers.

The validity of retrospective assessment of occupational exposure greatly depends on the amount of detail in the available information, on the knowledge of the specific industrial process by the experts, and on the criteria adopted to define relevant exposure. These criteria are difficult to standardize and are rarely made explicit in published reports, which makes it difficult to interpret inconsistencies among different studies. In two ongoing case-control studies on kidney cancer and, respectively, malignant lymphomas, a detailed occupational history was obtained and supplemented by 19 additional questionnaires, specifically addressing industrial activities where the knowledge of job title alone would have been insufficient for reliable exposure assessment. One further questionnaire was used to collect details of task and environment for all the other activities. These data are used to establish probability, intensity and frequency of exposure to 30 substances known or suspected to be carcinogenic from previous studies. There are two basic steps in the exposure assessment procedure: firstly, general rules are defined for each job within each activity covered by specific questionnaires; secondly the judgement is modulated according to the detailed tasks, working conditions and environment. To illustrate the process and to facilitate comparison with other studies, examples are given for a few common exposures in the textile and metal industries--the two most frequent economic activities in the study area--namely exposure to mineral oils, formaldehyde, aromatic solvents, chlorinated solvents and other organic solvents.

Case-Control Studies↗
PubMed1993

Retrospective evaluation of occupational exposure to organic solvents: questionnaire and job exposure matrix.

Correct retrospective assignment of subjects to an exposure category is affected by a variety of problems: 1) lack of an objective lifetime measurement; 2) dependence upon the accuracy and thoroughness of the job description; 3) heavy reliance upon the knowledge of experts. The aim of the study was the quantification of the performance of a job exposure matrix (JEM) in evaluating solvent exposure, using expert judgements as the reference method. The sources of discrepancies between the two methods were analysed within the framework of two community-based case-control surveys. One included 765 cases of bladder cancer (BC) and 765 controls, the other 298 cases of glomerulonephritis (GN) and 298 controls. The JEM had been set up previously for a case-control study on laryngeal cancer and is based on 4000 discrete job titles. Comparison between the JEM and expert exposure evaluation was carried out for 2736 job periods in the BC study and 929 in the GN study. Categories of exposure for both experts and JEM were dichotomized, using different cutoff points for exposure and non-exposure. Prevalence of exposure as assessed by the experts was twice as high in the GN study (19%) as in the BC study (10%), showing the importance of the questionnaire design and of the inclusiveness of the definition of exposure. Sensitivity of the JEM vis-a-vis the experts was low (23-63%), whereas specificity was rather high (87-98%). The best concordance between the two methods was obtained with a specific dichotomy from the JEM and a narrow definition of exposure by the experts. Bias and loss of power resulting from JEM misclassifications were calculated with a theoretical population odds ratio of 3 and an exposure prevalence of 10%. If the experts' classification of the subjects according to exposure is assumed to be 100% correct, using the JEM led to a bias in estimating the odds ratio, ranging from 1.5 to 2.1, and to a loss of power equivalent to a reduction in the number of subjects by a factor of 5 to 10. Analysis of systematic discrepancies between exposure assessments of the experts and the JEM showed that they were clustered with some job categories and arose from different sources: 1) inadequate job descriptions, related to the codification system adopted and necessitating the gathering of information at the individual level; 2) true disagreements between JEM and experts regarding the definition of solvent exposure.(ABSTRACT TRUNCATED AT 400 WORDS)

Case-Control Studies↗
PubMed1993

Retrospective assessment of asbestos exposure--I. Case-control analysis in a study of lung cancer: efficiency of job-specific questionnaires and job exposure matrices.

Retrospective assessment of asbestos exposure--I. Case-control analysis in a study of lung cancer: efficiency of job-specific questionnaires and job exposure matrices. International Journal of Epidemiology 1993; 22 (Suppl. 2): S83-S95. In a lung cancer study in Northern Germany the asbestos exposure assessment obtained from detailed supplementary questionnaires (SQ) was compared to the assessment obtained by the application of two job exposure matrices (JEM) to the job history. The study includes 391 incident male cases and the same number of controls from the general population, matched by sex, age, and region. Almost 16% of the subjects are considered as never having been exposed to asbestos and 24% are classified as certainly exposed according to both of the JEM, the corresponding percentages of the SQ-method being 68% and 32%. Sixty percent are considered by the JEM as having an intermediate probability of exposure. In general, the agreement between the different methods is better when the exposure definition is restricted to definite exposures, the corresponding Kappa statistic being 0.67 for the comparison between both JEM and 0.44/0.39 between the JEM and the SQ. The positive agreement between SQ and JEM (reference) increases from 12% and 17% for subjects with low probability of exposure to 61% and 69% for those with definite exposures. A ranking according to cumulative exposure shows some dose-response relationship for each of the three methods with a smoking-adjusted OR in the highest category of 1.85 (95% CI: 1.01-3.38) for the SQ method and 2.47 (95% CI: 1.40-4.37) and 2.94 (95% CI: 1.73-4.99) for the two JEM. The results are discussed with reference to the conceptual differences between the methods and their potential scope in future studies.

Asbestos↗
PubMed1993

Retrospective assessment of asbestos exposure--II. At the job level: complementarity of job-specific questionnaire and job exposure matrices.

Retrospective assessment of asbestos exposure--II. At the job level: Complementarity of job-specific questionnaire and job exposure matrices. International Journal of Epidemiology 1993; 22 (Suppl. 2): S96-S105. The assessments of asbestos exposure by two a priori job exposure matrices (JEM) and by a job-specific questionnaire (SQ) are compared at job level. The data used for the comparison were generated by an ongoing case-control study on lung cancer in a region of northern Germany with a relatively high past prevalence of asbestos exposure. Among job periods assessed as unexposed by either JEM, 96% are recognized as such by the SQ. Discrepancies between the SQ and JEM were observed in jobs rated potentially exposed by the JEM. Despite varying estimates, the JEM and SQ were consistent as regards the relative classification of job periods by probability of exposure. The concordance of the methods, estimated by Kappa statistics, was stronger for the two JEM than for either of the JEM and the SQ. The identification of specific occupation/industry combinations in which discrepancies were most frequent and the comparison with expert ratings in some jobs yield insights into the sources of the disagreement between the methods. The misclassification of exposure by the JEM usually results in an overestimation of exposure. This is essentially related to loss of information due to the use of job codes as surrogates for job task descriptions and to the insufficiency of published data on asbestos exposure in different industries. As regards the SQ, two main sources of potential loss of sensitivity were identified: 1) possible omission of indirect sources of exposure by this method, 2) possible incompleteness of the SQ. The present comparison of methods of asbestos exposure assessment does not allow any one approach to be considered superior to another. Indeed, as proposed by Ahrens et al. in Part I of the study, both should be used to ensure optimal epidemiological performance.

Asbestos↗
PubMed1993

[Trends in cancer incidence as observed by Lombardy cancer registry, Varese Province].

Trends in cancer risk of the Varese province Cancer Registry from 1976 to 1987 have been considered. The analysis has been carried out subdividing the 12 years of observation in three quadriennia. In younger ages (0 to 54) an increase of melanomas, of testicular cancer and, only in females, of tobacco-related cancers (oral cavity, oesophagus, pancreas, larynx, lung, bladder and kidney) has been observed. In younger males, instead, a decrease of tobacco-related cancer risk is already observable. Below age 55 there is no reduction in gastric cancer risk. The increase of breast cancer for youngest women is only observed between the first and the second quadriennium. For older ages (from 55 to 74) tobacco-related cancers continue to increase, in both sexes, but mainly among females. Also increasing, for males, are colon and liver cancer risks. Among the same ages, gastric and cervix (for screened age groups) cancer risks are decreasing. These observations, most in accordance with patterns observed in other western countries, can be used for setting intervention and research priorities.

Adolescent↗
PubMed1992

The effect of cytological screening on cervical neoplasia in the Italian province of Varese.

In the Varese province (409,142 female inhabitants in 1981), which has been covered by a cancer registry since 1976, cytologic screening for cervical cancer began in the early sixties in the municipality of Busto Arsizio (41,818 female inhabitants in 1981) and subsequently spread to the rest of the province. The distribution by age of cytologic smears and of detected in situ cancer reveals a more frequent attitude to be screened for women aged between 25 and 54 years. Overall, the incidence rate (world standardized) for invasive cancer in the province decreased from 10.3/100,000 women-year in the period 1976-81 to 7.5/100,000 in 1982-87. In Busto Arsizio a survey of the hospital archives has been carried out to identify the cases of cervical cancer diagnosed from 1966 to 1985: in this 20-year period, the incidence of cervical cancer decreased markedly, but only in those ages frequently screened. In the rest of the province, for the first period of cancer registration (1976-81), the incidence was significantly higher than in Busto Arsizio, especially for ages 35-64. Subsequently, between 1982-87, the cervical cancer incidence was low in both areas. For the period 1976-87, no difference for carcinoma in situ registration rates was observed between the two populations studied. Actually by 1976, when the Lombardy Cander Registry began its activity, the screening was diffuse throughout the province. These observations are consistent with the preventive effect of screening activity.

Adult↗
PubMed1992

Dietary habits, internal migration and social class in a sample of a northern Italian population.

The study of migrants has generated interesting hypotheses on the etiology of different types of cancer. In particular, it has been suggested that both colon and breast cancer could be related to living conditions, including diet, in the country of immigration. Considerable internal migration occurred in Italy in the sixties. We studied a random sample of 1,400 subjects living in the city of Torino and the province of Varese. They were interviewed with a detailed questionnaire about their dietary habits, and the consumption of several nutrients was considered according to the area of birth and social class. The hypothesis we tested was whether, after controlling for social class, there were different dietary habits among the migrants and the native population, and whether such differences could help in the formulation of etiologic hypotheses on cancer. We found that the intake of saturated fatty acids and cholesterol was lower among the migrants from the south, whereas they consumed higher levels of vegetables than people born in the north. The different intake of saturated fatty acids and cholesterol seemed to be attributable mainly to the consumption of butter, for which the south/north ratio was as low as 0.47 in men and 0.56 in women. Important gradients by social class were also suggested for several nutrients.

Adult↗
PubMed1992

Estimated incidence and prevalence of female breast cancer in Italian regions.

Female breast cancer incidence and prevalence in Italy have been estimated by region and vast areas from population-based survival data of breast cancer patients and 1970-1987 specific mortality data using a mathematical model. Italian age-standardized incidence rates (ASR) for 1987 range from 70 to 90 per 100,000 women-year in the Northern regions, 55 to 73 in the Center, and 45 to 72 in the South. Overall, the ASR is about 80 in the North, 70 in the Center and 60 in the South. In the absence of competitive mortality, breast cancer cumulative risk in the 0-74 years life span is about 7 women out of 100 in the North, 6 in the Center and 5 in the South. The decreasing risk pattern from North to Center then South appears less evident when under 45 age-specific rates are considered. Very high levels for young age-groups are present both in the North (Liguria and Emilia Romagna) and South (Sardinia and Apulia). The incidence pattern by age differs from region to region and over the considered period, suggesting that a birth-cohort effect is crossing the whole country. Using to model, it can be estimated that the risk by cohort increases from the generations born at the beginning of the century to those born in the 40s, after which, for subsequent generations, it has been decreasing in all the considered areas and is similar in the North and South. We can infer that for the whole country the incidence will increase up to the years 2000-2010 when those birth-cohorts at higher risk will also be at higher risk for age. In 1987, about 250,000 Italian women had a present or past history of breast cancer: for the 1970-1987 period, prevalence has increased by approximately 5,500 cases per year.

Age Factors↗
PubMed1992

Survival for lung cancer in northern Italy.

From the population covered by the Lombardy Cancer Registry (northern Italy), all 2,259 lung cancer patients diagnosed from 1976 to 1981 were followed through 30 November 1989. The length of follow-up ranged from eight to 13 years. A special investigation on long-term survivors showed that a negligible proportion (0.01 percent) of errors occur in determining life status when an active follow-up is adopted. Age, stage, and histotype were found to be statistically significant, independent, prognostic factors in multivariate analysis both by the Cox model and by a model considering the relative survival. Observed survival was 29 percent at one year after diagnosis, 13 percent at two years, eight percent at three years, five percent at five years and two percent at 10 years. Survival decreased with age, but the youngest patients of both sexes showed lower survival compared with immediately subsequent ages. Among morphologically confirmed tumors, epidermoid carcinomas and adenocarcinomas showed the highest survival (38 percent and 33 percent at one year, respectively); small cell carcinomas showed the poorest prognosis (one-year survival, 23 percent). Beyond the second year after diagnosis, differences between histotypes became slighter. Survival according to stage showed a decreasing pattern from limited to advanced tumors, one-year figures being 41 percent for localized tumors, 27 percent for regional metastasis, and three percent for distant metastasis. Relative survival in Varese was compared with that reported by other cancer registries in Western countries: the variability noted could be related to different modalities of registration and to different distribution of clinical and demographic factors.

Adult↗
PubMed1992

[Epidemiology of malignant tumors of the larynx and lung].

Respiratory tract cancers, unlike most other cancers, have known causes and are susceptible to primary prevention. According to a large population-based case-control study in Southern Europe, over 90% of the present incidence of laryngeal cancer could be prevented by avoiding smoking and alcohol consumption. Most of the risk is attributable to tobacco, but reducing alcohol alone could still prevent a quarter of the cases. Tobacco smoking, on the other hand, explains 80 to 90% of lung cancer incidence in Italy. Other known causal factors include: occupational exposures, which, according to several studies, may account for one third of the cases in the highly industrialized areas of Northern Italy; environmental pollution; passive smoking; radon; and dietary factors. Factors associated to a diet rich in fruit and vegetables have been found to be protective for both larynx and lung cancer in several studies carried out in Italy and elsewhere. The factors associated to this diet may be a major determinant in the North/South gradient in incidence and mortality consistently observed in geographical and migrant studies on respiratory cancers in Italy. Cigarette smoking, however, remains by far the most important cause of respiratory cancer, and geographical and temporal trends in incidence can easily be interpreted in terms of market trends, both in Italy and worldwide. According to several population surveys in Italy, the prevalence of smokers in successive male cohort generations reached a maximum (almost 80%) in the 1920-1930 birth cohorts and decreased to about 60% among males born in the forties and fifties. In the same period, the mean number of cigarettes per day for smokers increased, and the age of starting smoking decreased; however, the market changed from unfiltered black tobacco to filtered low-tar cigarettes. This market trend is consistent with the observation of decreasing incidence and mortality of both larynx and lung cancer in young male cohorts and the persistent increase of both cancers in older males. As for women, the prevalence of smokers increased from less than 10% in the 1920's birth cohorts to over 30% among women born in the late forties. This is reflected by a steady increase of respiratory cancers mortality which, however, is still lower than the mortality for males.

Adult↗
PubMed1991

Randomized trial of primary school education against smoking.

Since 1974 an anti-smoking campaign consisting of a one-day educational intervention has been carried out in primary schools in Milan by the Italian League against Cancer (Milan Division). All but two of the 165 schools were randomized to evaluate the intervention effect. A total of 8549 children aged 9-10 were allocated to the intervention group and 8897 to the control group. Four years later a self-administered questionnaire was distributed in order to investigate the children's smoking habits. The proportion of smokers was 8.05% and 8.72% (p = 0.23) respectively for the intervention and control groups. It was concluded that sporadic educational intervention carried out during primary school years has little or no impact in preventing cigarette smoking in teenagers.

Child↗
PubMed1991

Serum and urinary androgens and risk of breast cancer in postmenopausal women.

Serum levels of testosterone, dihydrotestosterone, androstenedione, dehydroepiandrosterone sulfate, and sex hormone-binding globulin and urinary levels of testosterone and androstanediol were compared in 75 women with breast carcinoma and 150 age-matched healthy controls. Odds ratios for quartiles of hormones, adjusted for known potential confounders, were computed using conditional logistic regression. Risk of breast cancer was positively associated with levels of all androgens in serum and urine but appeared stronger for testosterone (for trend, P = 0.03) and dehydroepiandrosterone sulfate (for trend, P = 0.06) in serum and for testosterone (for trend, P = 0.001) and androstanediol (for trend, P = 0.04) in urine. The adjusted odd ratios for high versus low quartiles were 2.7 (95% confidence interval, 1.1-6.5) for serum testosterone, 2.8 (1.1-7.4) for dehydroepiandrosterone sulfate, 4.7 (1.8-12.1) for urinary testosterone, and 3.4 (1.4-8.7) for urinary androstanediol. These observations suggest that endogenous androgenic hormones may play an important role in the epidemiology of postmenopausal breast cancer in women.

Age Factors↗
PubMed1991

Survival and age at diagnosis of breast cancer in a population-based cancer registry.

From the population covered by the Lombardy Cancer Registry, Italy, 1991 female breast cancer patients diagnosed from 1976 to 1981 were followed up until May 1987. Relative survival was 69% at 5 years and 58% at 10 years; median survival was 8.8 years. Ages 40-49 showed the best survival; ages 25-34 were 20% lower. From age 50 onwards, survival decreased progressively, with the exception of age group 65-74. We suggest that the best prognosis for ages 40-49, followed by the survival fall in subsequent ages, could be related to an anticipation of diagnosis in ages near menopause. The death hazard function showed a bimodal pattern, with a first peak in the first years after diagnosis, and a second one between the seventh and eighth years. The death hazard rate decreased by about 1% per year at each subsequent calendar year of diagnosis. When such an estimated calendar effect was taken in account, there were no considerable survival differences among Western countries covered by population-based cancer registries.

Adult↗
PubMed1991

Repeated serum and urinary androgen measurements in premenopausal and postmenopausal women.

Intra-individual variability for serum and urinary hormones has been inadequately considered in previous studies. Therefore, in the planning phase of a prospective study of Hormones and Diet in the Etiology of Breast Cancer (ORDET study), androgen levels have been examined at two different times in 56 women (26 in premenopause and 30 in postmenopause). Hormonal measurements in serum showed a good level of agreement for both premenopause (pre) and postmenopause (post): androstenedione pre r = 0.70 (p less than 0.0001), post r = 0.77 (p less than 0.0001); testosterone pre r = 0.73 (p less than 0.0001), post log values r = 0.74 (p less than 0.0001). Dihydrotestosterone showed a good level for premenopause only: log values pre r = 0.82 (p less than 0.0001), post r = 0.41 (p less than 0.05). Agreement levels in urine were inferior to those of serum: testosterone pre r = 0.53 (p less than 0.05), post r = 0.41 (p less than 0.05); androstanediol log values r = 0.46 (p less than 0.001), post log values r = 0.57 (p less than 0.05). Correlation between the two measurements improves considering age, parity, time of blood collection and, for urine, the interval of sample collections.

Adult↗
PubMed1991

[Planning of a prospective study with a biological bank].

This present work aims to give a critical description of the organization and operative aspects of project ORDET (prospective study on diet and hormones in the aetiology of breast cancer). A number of problems which could arise when carrying-out a prospective study are described: they concern participant recruitment, laboratory organization, planning of a biological bank plus relative security checks in order to ensure full workability and personnel standardization in questionnaire administration and anthropometrical measurements. The methods adopted by ORDET, or at least some of them, could be useful for those engaged in the planning phase of a similarly designed project using a biological bank.

Adult↗
PubMed1990

Incident lung cancer survival. Long-term follow-up of a population-based study in Italy.

The long-term survival of an incident lung cancer population was evaluated in relation to clinical stage, treatment modalities and other prognostic factors. The survey was carried out among the residents in the Local Sanitary Unit of Saronno, a highly industrialized area of northern Italy, where all the lung cancer cases diagnosed during the years 1976-79 had been identified and clinically studied. The overall survival of the 222 cases included in the analysis was 32% at 1 year, 10% at 3 years and 5% at 5 years; median survival was 7 months. A significantly better prognosis was associated with surgical resection (32% at 5 years; median, 42 mo), clinical stage I (16% at 5 years; median, 15 mo), and squamous cell carcinoma (13% at 5 years; median, 11 mo). Other factors such as age, sex, social class or cancer symptoms did not affect survival when treatment was taken into account. Our data show that surgical resection is the major determinant of survival, and suggest that sub-optimal access to curative treatment, particularly in patients aged 60 to 75 with limited disease, might have compromised the overall survival.

Adenocarcinoma↗