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Biomedical subjects

F Levi

Publications and source records attributed to F Levi.

At least 127 records · Page 7Linked to original sources
PubMed1999

Clinical activity and benefit of irinotecan (CPT-11) in patients with colorectal cancer truly resistant to 5-fluorouracil (5-FU).

The aim of this prospective study was to assess the efficacy, clinical benefit and safety of CPT-11 (irinotecan) in patients with stringently-defined 5-fluorouracil-resistant metastatic colorectal cancer (CRC). 107 patients with documented progression of metastatic CRC during 5-FU were treated with CPT-11 350 mg/m2 once every 3 weeks in a multicentre phase II study. Tumour response and toxicity were assessed using WHO criteria. Changes in performance status (PS), weight and pain were also measured. The WHO response rate was 13/95 (13.7%, 95% CI 7.5% to 22.3%) eligible patients with a median duration of response of 8.5 months (37 weeks, range: 18-53+). There was also a high rate of disease stabilisation (44.2%) with a median duration of 4.8 months. The probability of being free of progression at 4 months was 50%. Median survival from first administration of CPT-11 was 10.4 months or 45 weeks (range: 3-66+ weeks). There was weight stabilisation or gain in 81% (73/90) of patients, a favourable outcome in PS in 91% (82/90) (improvement of WHO PS 2 or stabilisation of PS 0-1), and pain relief in 54% (26/48). There were no toxic deaths. Neutropenia was short-lasting and non-cumulative. Diarrhoea grade > or = 3 occurred in 7% of cycles and 28/107 (26%) of patients. CPT-11 350 mg/m2 once every 3 weeks has an encouraging degree of activity in progressive metastatic CRC truly resistant to 5-FU with a relatively high rate of tumour growth control translated into clinical benefit. The toxicity profile of CPT-11 is becoming better understood and has been considerably improved.

Adult↗
PubMed1999

Population density and childhood leukaemia: results of the EUROCLUS Study.

The EUROCLUS study assembled incidence data for 13,551 cases of childhood leukaemia (CL) diagnosed between 1980 and 1989 in 17 countries (or regions of countries). These were referenced by location at diagnosis to small census areas of which there were 25,723 in the study area. Population counts, surface area and, hence, population density were available for all these small areas. Previous analyses have shown limited extra-Poisson variation (EPV) of case counts within small areas; this is most pronounced in areas of intermediate population density (150-499 persons/km2). In this study, the data set was examined in more detail for evidence that variations in incidence and EPV of CL are associated with population density. Incidence showed a curvilinear association with population density and was highest in areas which were somewhat more densely populated (500-750 persons/km2), where the incidence rate ratio relative to areas having > or = 1000 persons/km2 was 1.16 (95% confidence interval 1.07-1.26) and the P value for quadratic trend across eight strata of population density was 0.02. Incidence in these areas is uniformly elevated and showed no evidence of heterogeneity (i.e. EPV). Statistically significant evidence of EPV was evident amongst some of the areas previously classified as intermediate density areas (specifically, those with a density of 250-499 persons/km2, P < 0.001 for CL). These results were interpreted in terms of the current aetiological hypotheses for CL which propose that exposure to localised epidemics of one or more common infectious agent may contribute to the development of leukaemia. They suggest that such epidemics arise regularly in moderately densely populated areas and also sporadically in areas which are somewhat less densely populated. Although other interpretations are possible, these results may assist in the identification of characteristics which infectious agents must possess if direct or indirect causes of CL.

Child↗
PubMed1999

Occupational and leisure time physical activity and the risk of breast cancer.

The relationship between occupational and leisure-time activity and the risk of breast cancer was analysed using data from a case-control study conducted in the Swiss Canton of Vaud between 1993 and 1998 on 246 incidents, histologically confirmed breast cancer cases and 374 controls below the age of 75 years, admitted to the same network of hospitals for acute, non neoplastic non hormone-related conditions. For occupational physical activity, the multivariate odds ratios (OR) for the highest versus the lowest level of physical activity were 0.6 (95% confidence interval, CI = 0.35-1.04) when aged 15 to 19 years, 0.5 (95% CI = 0.26-0.98) when aged 30 to 39 years, and 0.68 (95% CI = 0.36-1.28) when aged 50 to 59. For leisure time physical activity, the ORs were 0.4 (95% CI = 0.26-0.69), 0.5 (95% CI = 0.30-0.81), and 0.4 (95% CI = 0.22-0.80) for the highest versus the lowest level, respectively, in the three age groups, and an inverse trend in risk was significant in all groups. This study, based on one of the few European datasets on the issue, further suggests that physical activity is a favourable indicator of breast cancer risk.

Adult↗
PubMed1999

Cancer prevention: epidemiology and perspectives.

Following increases up until the late 1980s, some decline in cancer mortality has been observed in North America and in Western Europe. Approximately half the decline can be attributed to the levelling off in lung and other tobacco-related cancer epidemics and the rest to several factors, including reduced exposure to occupational carcinogens, prevention and early diagnosis, and improved treatment. Between 25 and 30% of all cancer deaths in Europe are due to tobacco smoking. In this review the effect of tobacco smoking on cancer incidence and mortality is examined, together with other important aetiological factors including alcohol, diet and environmental and occupational carcinogens. The effect of new treatments and the potential for prevention of cancer are also discussed.

Alcohol Drinking↗
PubMed1999

Cancer mortality in Europe, 1990-1994, and an overview of trends from 1955 to 1994.

Mortality data, abstracted from the WHO database, are presented in tabular form for 26 cancer sites or groups of sites, plus total cancer mortality, in 35 European countries during the period 1990-1994. Trends in mortality are also given in graphical form for 24 major countries over the period 1955-1994. In most western European countries total cancer mortality was--for the first time--moderately downwards in the early 1990s. Such favourable trends included some decline in lung cancer mortality for males, the persistent decline in stomach cancer for both sexes, and of cervical cancer for women, as well as some decline in breast and colorectal cancers, plus other neoplasms (testis, lymphoid neoplasms), whose treatment has further improved over the last few years. However, cancer mortality was still upwards in a few southern and eastern European countries, including Hungary and Poland, where total cancer mortality rates in middle-aged males are now the highest ever registered in Europe. The favourable trends in western Europe over the recent years are similar to those observed in the U.S.A.

Adult↗
PubMed1999

Descriptive epidemiology of soft tissue sarcomas in Vaud, Switzerland.

Trends in incidence and survival from soft tissue sarcomas (STS) were analysed for the period 1974-1994 using data from the Cancer Registry of the Swiss canton of Vaud. A total of 645 cases were registered. The most common histotypes were fibrosarcoma (0.82/100,000 males, 0.86/100,000 females, world standard, 1990-1994), leiomyosarcoma (0.90/100,000 males, 1.28/100,000 females, 1990-1994), and Kaposi's sarcoma (3.10/100,000 males in 1990-1994). Overall incidence rates for STS increased from 2.68/100,000 males in 1974-1979 to 6.86 in 1990-1994, and from 3.61 to 4.27 in females. However, after excluding Kaposi's sarcoma, no consistent trend over time was observed, peak rates (approximately 4.40/100,000) being registered in the late 1980s for both sexes, with some levelling off thereafter. Five-year relative survival was 17% for Kaposi's sarcomas, and 51% for other STS (all STSs, 45%). These data indicate that there has been no major new risk factor for STS of such a relevance to modify appreciably the overall rates on a population level, except from the impact of the AIDS epidemic for Kaposi's sarcoma.

Adult↗
PubMed1999

Allergy and other selected diseases and risk of colorectal cancer.

It has been reported that allergy and other diseases may be related to colorectal cancer risk. The aim of this study was to perform a systematic analysis using information about medical histories specifically to see if there was any relation between allergies or other medical conditions and colorectal cancer risk. A multicentric case-control study was conducted in six Italian areas between 1992 and 1996 on 1225 incident cases of colon cancer, 728 cases of rectal cancer and 4154 controls comparable with cases according to sex and age group, admitted for acute conditions to the same network of hospitals where cases had been identified. Unconditional logistic regression models including terms for sex, age, study centre, years of education, body mass index, physical activity, smoking, history of colorectal cancer in first-degree relatives and energy intake were used to estimate the odds ratios (OR) of colon and rectal cancer according to history of allergy and other selected diseases. The OR for history of allergy was 0.88 (95% confidence interval, CI, 0.67-1.14) for colon and 0.64 (95% CI, 0.44-0.92) for rectal cancer, and the inverse association was stronger when allergy was diagnosed at age 35 years or more, or less than 10 years before the cancer diagnosis. No clear pattern emerged in strata of age and sex. History of other selected diseases, including hypertension and cholelithiasis, was not related to colon or rectal cancer risk, though there was a moderate increase in the risk of colon cancer (OR = 1.18, 95% CI, 0.66-2.14) in patients with a history of intestinal polyps. This study lends support to the hypothesis that allergic individuals may be at a lower risk of developing colorectal cancer.

Adult↗
PubMed1999

Cancer prevention: epidemiology and perspectives.

Following increases up until the late 1980s, some decline in cancer mortality has been observed in North America and in Western Europe. Approximately half the decline can be attributed to the levelling off in lung and other tobacco-related cancer epidemics and the rest to several factors, including reduced exposure to occupational carcinogens, prevention and early diagnosis, and improved treatment. Between 25 and 30% of all cancer deaths in Europe are due to tobacco smoking. In this review the effect of tobacco smoking on cancer incidence and mortality is examined, together with other important aetiological factors including alcohol, diet and environmental and occupational carcinogens. The effect of new treatments and the potential for prevention of cancer are also discussed.

Alcohol Drinking↗
PubMed1999

A pooled analysis of case-control studies of thyroid cancer. III. Oral contraceptives, menopausal replacement therapy and other female hormones.

OBJECTIVE: The relations between oral contraceptives (OC), hormone replacement therapy (HRT) for menopause, and other female hormone use and thyroid cancer risk was analyzed using the original data from 13 studies from North America, Asia and Europe. METHODS: Based on 2,132 cases and 3,301 controls, odds ratios (OR) and the corresponding 95% confidence intervals (CI) were obtained by conditional regression models, conditioning on study and age at diagnosis, and adjusting for age, radiation exposure and parity. RESULTS: Overall, 808 (38%) cases versus 1,290 (39%) controls had ever used OCs, corresponding to an OR of 1.2 (95% CI 1.0 to 1.4). There was no relation with duration of use, age at first use, or use before first birth. The OR was significantly increased for current OC users (OR = 1.5, 95% 1.0 to 2.1), but declined with increasing time since stopping (OR = 1.1 for > 10 years since stopping). The association was stronger for papillary cancers (OR = 1.6 for current users) than for other histologic types. No significant heterogeneity was observed across studies or geographic areas. Eight studies had data on HRT, for a total of 1,305 cases and 2,300 controls: 110 (8%) cases and 205 (9%) controls reported ever using HRT (OR = 0.8; 95% CI 0.6 to 1.1). The ORs were 1.6 (95% to 0.9 to 2.9) for use of fertility drugs, and 1.5 (95% CI 1.1 to 2.1) for lactation suppression treatment. CONCLUSIONS: The studies considered in these analyses include most of the epidemiological data on the role of exogenous hormone use in the etiology of thyroid cancer, and they provide reassuring evidence on the absence of an association of practical relevance. The moderate excess risk in current OC users, if not due to increased surveillance for thyroid masses among OC users, is similar to that described for breast cancer, and would imply a role of female hormones on thyroid cancer promotion. There was no indication of increased thyroid cancer risk 10 or more years after discontinuing OC use.

Adenocarcinoma, Papillary↗
PubMed1999

A pooled analysis of case-control studies of thyroid cancer. I. Methods.

OBJECTIVE: Because the etiology of thyroid cancer is not well described, we conducted a pooled analysis of all published case-control studies, as well as two identified unpublished studies. This paper describes the major characteristics of the 14 studies included in the analysis, as well as the statistical methods employed. Four studies were conducted in the United States (1 each in Washington State, California, Connecticut and Hawaii), 8 in Europe (3 in Sweden, 2 in Norway, 1 in Switzerland, 1 in Italy and 1 in Greece), and 2 in Asia (1 in China and 1 in Japan). METHODS: The original datasets were obtained and restructured in a uniform format. Data on socio-demographic characteristics, anthropometric measures, smoking and alcohol consumption, history of benign thyroid diseases and of other selected medical conditions and treatments, family history of cancer and of benign thyroid conditions, occupation, residence in endemic goitre areas, and dietary habits were analyzed. For women, we also analyzed menstrual and reproductive factors and use of female hormones. Radiotherapy and, in Japan, exposure to the A-bombs were considered as potential confounding factors. RESULTS: A total of 2,725 cases (2,247 females and 478 males) and 4,776 controls (3,699 females and 1,077 males) were included in this study. Of the cases, 79% were classified as papillary thyroid carcinomas, 14% as follicular, 2% medullary, 1% anaplastic, 1% other histologies, and 3% histological type unknown. Each of the datasets was checked for outliers and consistency. Data were analysed separately by study center, gender, and the two major histologic types (papillary, follicular). Frequency tables and simple statistics were computed for each variable under study. Conditional logistic regression was used to compute odds ratios. For matched studies, the original matching was preserved, whereas, for unmatched ones, five-year age groups were used for matching. Study-specific analyses were computed, and then the data from all the studies were pooled conditioning on study. Heterogeneity between studies, geographic areas and study designs was assessed, and the modifying effect of age was also evaluated.

Adenocarcinoma, Follicular↗
PubMed1999

A pooled analysis of case-control studies of thyroid cancer. II. Menstrual and reproductive factors.

OBJECTIVE: It has been suggested that female hormones, and hence menstrual and reproductive factors, play a role in thyroid cancer etiology. Epidemiological data, however, are limited and inconsistent, partly because of the small number of cases included in each study. To clarify the etiology of thyroid cancer, we conducted a pooled analysis of original data from 14 case-control studies, 4 from the United States, 2 from Asia, and 8 from Europe. METHODS: This analysis included a total of 2,247 female cases of thyroid cancer (80% papillary) and 3,699 control women. Pooled odds ratios (OR) were estimated using logistic regression, conditioning on study and (i) matching sets for individually matched studies, or (ii) quinquennia of age for the other studies. Additional terms for age and history of radiation exposure were included in the regression equations. RESULTS: The OR per year of later menarche was 1.04 (95% confidence interval (CI) 1.0-1.1). Compared to premenopausal women, the OR was 1.3 for women with natural menopause, and 1.8 for those with artificial menopause, but the studies were heterogeneous and the association may be due, at least in part, to diagnostic or ascertainment bias. Parity, spontaneous or induced abortions and history of infertility were not associated with thyroid cancer risk. The OR was above unity in women reporting later age at first birth (OR = 1.1, 95% CI 1.0-1.3 for 5-year delay) and higher in the first years after a birth. CONCLUSIONS: The associations of menstrual and reproductive factors with thyroid cancer risk were generally weak, but appeared stronger among women diagnosed with thyroid cancer at younger ages.

Adenocarcinoma, Papillary↗
PubMed1999

A pooled analysis of case-control studies of thyroid cancer. IV. Benign thyroid diseases.

OBJECTIVE: To obtain more precise estimates of the association between thyroid cancer and benign thyroid diseases and to elucidate the role of potential confounders or effect modifiers. METHODS: The original data from 12 case-control studies from the United States, Asia, and Europe were pooled. Based on 2,094 women and 425 men with cancer of the thyroid and, respectively, 3,248 and 928 control subjects, odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) were obtained by conditional regression models, conditioning on study and age at diagnosis, and adjusting for age and radiotherapy. RESULTS: A history of hypothyroidism was not associated with cancer risk (pooled ORs = 0.9, 95% confidence interval, CI: 0.7-1.3 in women and 1.7, 95% CI: 0.3-11.7 in men). ORs for hyperthyroidism were 1.4 (95% CI: 1.0-2.1) in women and 3.1 (95% CI: 1.0-9.8) in men. In women, however, risk was lower in the absence of or after allowance for history of goiter. Pooled ORs for a history of goiter were 5.9 (95% CI: 4.2-8.1) in women and 38.3 (95% CI: 5.0-291.2) in men. Risk for a history of benign nodules/adenomas was especially high (OR = 29.9, 95% CI: 14.5-62.0, in women; 18 cases versus 0 controls in men). The excess risk for goiter and benign nodules/adenomas was greatest within 2-4 years prior to thyroid cancer diagnosis, but an elevated OR was present 10 years or more before cancer. CONCLUSIONS: Goiter and benign nodules/adenomas are the strongest risk factors for thyroid cancer, apart from radiation in childhood.

Adenoma↗
PubMed1999

Energy intake and dietary pattern in cancer of the oral cavity and pharynx.

OBJECTIVE: To explore the role of energy and macronutrients in cancers of the oral cavity and pharynx. METHODS: Case-control study: 754 individuals with first incident cancer of the oral cavity and pharynx and 1775 controls in hospital for acute, non-neoplastic diseases were interviewed in two Italian areas and in the Swiss Canton of Vaud between 1992 and 1997. RESULTS: Cases reported higher total energy intake, due to higher intake of alcohol energy. Non-alcohol energy intake was lower in cases than controls. The composition of diet also differed: proteins (OR for an addition of 100 kcal/day = 0.8) and monounsaturated fatty acids (OR = 0.8) were inversely associated, while saturated fatty acids (OR = 1.4) were directly associated with oral cancer risk. Vegetable intake, which was positively correlated with oil intake, was lower in cases than controls, but accounted only partly for the observed difference in fat intake pattern. CONCLUSIONS: Alcohol energy may not be used efficiently after some threshold. Protein deficiency may enhance cancer risk in heavy drinkers. An opposite influence of different types of fat is emerging for cancer of the oral cavity and pharynx as well as other sites of the upper aero-digestive tract.

Adult↗
PubMed1999

Borderline ovarian tumours in Vaud, Switzerland: incidence, survival and second neoplasms.

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).

Adolescent↗
PubMed1999

The European mesothelioma epidemic.

Projections for the period 1995-2029 suggest that the number of men dying from mesothelioma in Western Europe each year will almost double over the next 20 years, from 5000 in 1998 to about 9000 around 2018, and then decline, with a total of about a quarter of a million deaths over the next 35 years. The highest risk will be suffered by men born around 1945-50, of whom about 1 in 150 will die of mesothelioma. Asbestos use in Western Europe remained high until 1980, and substantial quantities are still used in several European countries. These projections are based on the fit of a simple age and birth cohort model to male pleural cancer mortality from 1970 to 1989 for six countries (Britain, France, Germany, Italy, The Netherlands and Switzerland) which together account for three-quarters of the population of Western Europe. The model was tested by comparing observed and predicted numbers of deaths for the period 1990-94. The ratio of mesothelioma to recorded pleural cancer mortality has been 1.6:1 in Britain but was assumed to be 1:1 in other countries.

Adult↗