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Biomedical subjects

F Levi

Publications and source records attributed to F Levi.

At least 145 records · Page 8Linked to original sources
PubMed1999

Food groups and colorectal cancer risk.

Most studies of diet and colorectal cancer have considered nutrients and micronutrients, but the role of foods or food groups remains open to debate. To elucidate the issue, we examined data from a case-control study conducted between 1992 and 1997 in the Swiss canton of Vaud. Cases were 223 patients (142 men, 81 women) with incident, histologically confirmed colon (n= 119) or rectal (n= 104) cancer (median age 63 years), linked with the Cancer Registry of the Swiss Canton of Vaud, and controls were 491 subjects (211 men, 280 women, median age 58 years) admitted to the same university hospital for a wide spectrum of acute non-neoplastic conditions unrelated to long-term modifications of diet. Odds ratios (OR) were obtained after allowance for age, sex, education, smoking, alcohol, body mass index, physical activity and total energy intake. Significant associations were observed for refined grain (OR = 1.32 for an increase of one serving per day), and red meat (OR = 1.54), pork and processed meat (OR = 1.27), alcohol (OR = 1.28), and significant protections for whole grain (OR = 0.85), raw (OR = 0.85) and cooked vegetables (OR = 0.69), citrus (OR = 0.86) and other fruits (OR = 0.85), and for coffee (OR = 0.73). Garlic was also protective (OR = 0.32 for the highest tertile of intake). These findings in a central European population support the hypothesis that a diet rich in refined grains and red meat increases the risk of colorectal cancer; they, therefore, support the recommendation to substitute whole grains for refined grain, to limit meat intake, and to increase fruit and vegetable consumption.

Adult↗
PubMed1999

Continuous delivery of venous 5-fluorouracil and arterial 5-fluorodeoxyuridine for hepatic metastases from colorectal cancer: feasibility and tolerance in a randomized phase II trial comparing flat versus chronomodulated infusion.

High-dose chemotherapy combining regional hepatic artery infusion (HAI) of fluorodeoxyuridine (HAI FUDR) and systemic venous infusion of 5-fluorouracil (i.v. 5-FU) was delivered against liver metastases from colorectal cancer. The hypothesis that chronomodulation of delivery rate along the 24 h time scale would improve the tolerable doses of both drugs was tested. Combined HAI FUDR (80 mg/m2/day) and i.v. 5-FU (1200 mg/m2/day) were administered for five consecutive days every 3 weeks, either as a constant rate infusion (schedule A, 27 patients) or as chronotherapy (schedule B, 29 patients). This latter regimen consisted of a sinusoidal modulation of the delivery rate over the 24 h scale with a maximum at 16:00 for FUDR and 4:00 for 5-FU. Intrapatient dose escalation up to the individual maximum tolerated doses (MTD) was planned for both drugs in the absence of any previous grade 3 or 4 toxicity. All patients had metastatic colorectal cancer, with adjuvant or palliative chemotherapy given to six patients (22%) on schedule A and 12 patients on schedule B (41%). Severe stomatitis occurred in 71% of the patients and was dose limiting. No hepatic toxicity was encountered. Dose reductions of 5-FU and/or FUDR were required for 17 of 27 patients on schedule A (63%) as compared to 11 of 29 patients on schedule B (38%), following reaching the individual MTD (p<0.05). Over the first six cycles, patients on schedule B received higher doses (mg/m2/cycle; FUDR: 522 +/- 85 versus 499 +/- 50, p=0.004 and 5-FU: 5393 +/- 962 versus 5136 +/- 963, p=0.009) and higher dose intensities (mg/m2/week; FUDR: 164 +/- 46 versus 151 +/- 52, p=0.018 and 5-FU: 1652 +/- 478 versus 1553 +/- 535, p<0.041) of both drugs than patients on schedule A. As a result the number of courses with doses of 5-FU above 1200 mg/m2/day and/or FUDR above 110 mg/m2/day was larger in group B than in group A (5-FU, A: 67 of 268, 25% versus B: 133 of 321, 41% and FUDR, A: 86 of 268, 32% versus B: 155 of 321, 48%; p<0.001). Objective responses were observed in 13 patients on schedule A (48%) and 11 patients on schedule B (38%). The results support the need for further exploration of chronotherapy of colorectal cancer liver metastases with combined arterial and venous fluoropyrimidine chemotherapy.

Adult↗
PubMed1999

Worldwide patterns of cancer mortality, 1990-1994.

Histograms of age-standardized (world standard) death certification rates from 24 cancers or groups of cancers and total cancer mortality for the 5-year calendar period 1990-94 were provided for 55 countries of the world: 35 countries in Europe, two in North America, nine in Latin America, two in Africa, five in Asia and two in Oceania. The highest male lung cancer mortality rates worldwide were registered in Hungary (82/100000), the Czech Republic and the Russian Federation, followed by other eastern European countries. Other major tobacco- (and alcohol)-related neoplasms also showed exceedingly high rates in Eastern Europe. For females, the highest lung cancer rates were in Scotland (29/100000), the United States (26/100000) and Denmark, reflecting the different spread of tobacco smoking in the two sexes. The highest rates for stomach cancer were in Latin America, the Russian Federation and Japan, and for colorectal cancer in the Czech Republic (37/100000 males, 20/100000 females) and Hungary. The highest breast cancer mortality rates were in Malta (30/100000 females), followed by Denmark and Britain, and for cancer of the prostate in Norway (23/100000), Switzerland and Sweden. With reference to total cancer mortality, the highest rates for males were in Hungary (262/100000), the Czech Republic (238/100000) and the Russian Federation (224/100000), and the lowest ones in Israel (127/100000), and Sweden (130/100000). In females, the highest total cancer mortality rates were in Denmark (142/100000), Scotland and Hungary, and the lowest ones in Greece (78/100000), France and Spain. These patterns of total cancer mortality for the two sexes reflect the major impact of tobacco-related neoplasms, and underline the substantial excess rates in most eastern European countries.

Africa↗
PubMed1999

Occupational and leisure-time physical activity and the risk of colorectal cancer.

The relation between various measures of physical activity and colorectal cancer risk was considered in a case-control study conducted between 1992 and 1997 in the Swiss canton of Vaud. Cases were 223 patients (142 men, 81 women) below age 75, with colon (n = 119) or rectal (n = 104) cancer; controls were 491 patients (211 men, 280 women) admitted to hospital for acute, non-neoplastic conditions. Compared with the lowest level of physical activity at age 30-39 years, the odds ratios (OR) of colorectal cancer for the highest level were 0.44 (95% confidence interval, CI, 0.26-0.73) for occupational and 0.53 (95% CI 0.33-0.86) for leisure-time activity. An inverse association was also observed for physical activity at age 15-19 and 50-59 years. The inverse relation between physical activity and colorectal cancer was observed across strata of sex, age, education, body mass index and alcohol drinking; was somewhat stronger in subjects reporting high total energy, and low vegetable and fibre intakes; and was observed across various colon subsites and rectum. In terms of population attributable risk, increasing physical activity would avoid one-fifth to one-third of incident colorectal cancer cases.

Adult↗
PubMed1998

Trends in childhood cancer mortality as indicators of the quality of medical care in the developed world.

BACKGROUND: Mortality from childhood cancer in general and childhood leukemia in particular has sharply declined in economically developed countries over the last 30 years, whereas the incidence of these diseases has remained essentially unaltered. Therefore, childhood malignancies can be used as tracers of accessibility to and effectiveness of medical care. The objective of this study was to compare the reduction of mortality from childhood cancer in general, and childhood leukemia in particular, in four economically developed areas of the world, to assess accessibility to and effectiveness of technologically advanced medical care. METHODS: The authors used data from the World Health Organization to compare the evolution over time of gender specific, age-adjusted mortality from childhood cancer in general and childhood leukemia in particular in the childhood (birth to age 14 years) populations of North America, western Europe, Japan, and Australia and New Zealand during the period 1960-1993. They assessed the evolution over time and the cumulative percentage representing the decline in mortality from childhood cancer and childhood leukemia in the four aforementioned areas of the world. RESULTS: The decline in mortality from both the disease entities considered and for both genders has been more pronounced in North America than in other economically developed areas of the world. CONCLUSIONS: When disease control depends on technologically advanced medical care, as in the case of cancer, the North American population is benefited by earlier and effective introduction of new therapeutic approaches. This conclusion does not apply to other childhood diseases, the incidence of which is higher among low-income groups and control of which depends on prevention rather than treatment.

Adolescent↗
PubMed1998

Non-invasive estimation of the circadian rhythm in serum cortisol in patients with ovarian or colorectal cancer.

The variability in toxicity or efficacy of cancer chronotherapy among patients may be due to differences in circadian rhythm. Adequate assessment of circadian rhythm often requires repeated blood sampling over at least a 24-hr period; this cannot be a routine procedure. We attempted to assess the reliability of a 2-timepoint estimate of the 24-hr rhythm of serum cortisol in 19 healthy subjects, 19 women with ovarian cancer and 18 patients with metastatic colorectal cancer. The difference between daily maximum and minimum values (MAX-MIN) was compared with that observed between values at 08.00 and at 16.00 (H8-H16). As significant correlations were found between both variables in all groups, we conclude that the magnitude of circadian changes in serum cortisol may be estimated from blood samples collected at 08.00 and at 16.00. The clinical relevance and the prognostic value of this method of assessment are currently under evaluation in a larger-scale clinical trial.

Adult↗
PubMed1998

Prognostic factors for cutaneous malignant melanoma in Vaud, Switzerland.

We considered, by means of a multivariate approach, trends in survival from cutaneous malignant melanoma in relation to patient and tumor characteristics, using data from the Cancer Registry of the Swiss Canton of Vaud. Between 1980 and 1994, 1,229 cases of incident cutaneous malignant melanoma were registered. There was a decline in the proportion of neoplasms in the head and neck and lower limbs, and a rise in those of the trunk and upper limbs, an increase in superficial spreading melanoma and in tumors of limited thickness, mostly in females. Five-year crude survival was 0.68 for males and 0.82 for females, and relative survival of 0.79 for males and 0.89 for females, corresponding to a multivariate hazard ratio (HR) of 0.63 for females vs. males. Survival was inversely related to age, with 5-year relative survival of 0.92 at age 15-44 years, 0.85 at age 45-64 years, and 0.79 at age > or = 65 years. With reference to histological type, no significant difference was observed in males, but in females nodular melanoma showed reduced survival. Compared with melanoma of the limbs, the HR was 1.46 for melanoma of the trunk, and 1.23 for those in the head and neck, and the difference was greater in females. A strong relation, in both sexes, was observed between survival and tumor thickness, with an HR of 3.96 for tumors > or = 4 mm vs. those < 1.50 mm. After allowance for all other factors considered, most recent calendar period of diagnosis was associated with improved survival in both sexes (HR = 0.72), but mostly in females. Although differences in survival tended to be larger during the first 2 years after diagnosis, the pattern was similar for most prognostic factors considered up to 10 years after diagnosis.

Adolescent↗
PubMed1998

Food groups and risk of oral and pharyngeal cancer.

The role of specific food groups and diet variety on the risk of oral and pharyngeal cancer has been considered using data from a case-control study conducted between 1992 and 1997 in the Swiss Canton of Vaud. Cases were 156 patients (126 males, 30 females) aged under 75 (median age 56) years with incident, histologically confirmed cancer of the oral cavity and pharynx, and controls were 284 subjects (246 males, 38 females, median age 57 years), admitted to the same university hospital for a wide spectrum of acute, non-neoplastic conditions unrelated to tobacco and alcohol consumption or to long-term modification of diet. After allowance for education, alcohol, tobacco and total energy intake, significant trends of increasing risk with more frequent intake emerged for eggs (OR = 2.3 for the highest tertile), red meat (OR = 2.1) and pork and processed meat (OR = 3.2). Inverse trends in risk were observed for milk (OR = 0.4 for the highest tertile), fish (OR = 0.5), raw vegetables (OR = 0.3), cooked vegetables (OR = 0.1), citrus fruit (OR = 0.4) and other fruits (OR = 0.2). The addition of a serving per day of fruit or vegetables was associated with an about 50% reduction in oral cancer risk. The most favourable diet for oral cancer risk is therefore given by infrequent consumption of red and processed meat and eggs and, most of all, frequent vegetable and fruit intake. Diet diversity was inversely related to oral and pharyngeal cancer: ORs were 0.35 for the highest tertile of total diversity, 0.24 for vegetable and 0.34 for fruit diversity. In terms of attributable risk, high meat intake accounted for 49% of oral and pharyngeal cancers in this population, low vegetable intake for 65% and low fruit intake for 54%.

Adult↗
PubMed1998

Second cancers following in situ carcinoma of the breast.

Carcinoma in situ (CIS) of the breast has increased many-fold in incidence rates and as a proportion of new breast cancers following the introduction of mammographic breast screening. To provide population-based estimates of invasive breast cancer risk following CIS, we linked data on 249 incident primary CIS (median age 53 years) to the Cancer Registry of the Swiss Canton of Vaud (about 600,000 inhabitants) over the period 1977-1994. Women with concurrent invasive cancers of the breast were not included. Standardized incidence ratios (SIR) were determined according to the exact Poisson distribution, with stratification for age and year of diagnosis. A total of 24 cases of breast cancer vs. 3.4 expected [SIR = 7.2, 95% confidence interval (CI): 4.6-10.6], and 7 cases of other neoplasms (except non-melanomatous skin cancer) vs. 6.9 expected (SIR=1.0, 95% CI: 0.4-2.1) were observed. The SIR was 10.4 during the first year, 5.6 between I and 4 years, and 7.7 after > or = 5 years after CIS diagnosis. SIRs were consistent in women below and above age 55 years, but somewhat higher for ductal (SIR=8.6) than lobular (SIR = 4.2) CIS. Six deaths from breast cancer were observed vs. 1.5 expected (standardized mortality ratio=4.0, 95% CI: 1.5-8.7). In 13/19 ductal CIS, but in 2/4 lobular CIS, invasive cancer occurred in the same breast. In most women, CIS and subsequent invasive cancer showed the same morphological (i.e., ductal or lobular) features. The cumulative risk of breast cancer was 16% 10 years after CIS diagnosis, emphasizing the importance of adequate surveillance of women after CIS of the breast.

Adult↗
PubMed1998

Whole grain food intake and cancer risk.

The relationship between frequency of consumption of whole grain food and risk of selected neoplasms has been analysed using data from an integrated series of case-control studies conducted in northern Italy between 1983 and 1996. The overall dataset included the following incident, histologically confirmed neoplasms: oral cavity and pharynx 181, oesophagus 316, stomach 745, colon 828, rectum 498, liver 428, gallbladder 60, pancreas 362, larynx 242, breast 3,412, endometrium 750, ovary 971, prostate 127, bladder 431, kidney 190, thyroid 208, Hodgkin's disease 80, non-Hodgkin's lymphomas 200, multiple myelomas 120. Controls were 7,990 patients admitted to hospital for acute, non-neoplastic conditions, unrelated to long-term modifications in diet and not likely to have been caused by tobacco or alcohol use. Odds ratios (OR) for subsequent scores (never/occasional/frequent) of whole grain food consumption were derived after allowance for age, sex, education, smoking, alcohol intake and body mass index. High intake of whole grain foods consistently reduced risk of neoplasm at all sites, except thyroid. The ORs for the highest category of consumption were 0.2-0.3 for upper digestive and respiratory tract neoplasms, 0.5 for stomach, colon and gallbladder, 0.7 for rectum, 0.6 for liver, 0.8 for pancreas and prostate, 0.9 for breast and endometrium, 0.6 for ovary, 0.4 for bladder and kidney, 1.3 for thyroid and around 0.5 for lymphomas and myeloma. The tests for trend in risks were significant for all neoplasms, except pancreas, endometrium, Hodgkin's disease and multiple myeloma. No significant heterogeneity was found across strata of age at diagnosis, sex, education, smoking habit, alcohol intake and body mass index. Thus, even in the absence of a univocal and satisfactory biological interpretation, the consistency of the patterns observed indicate that, in this population, higher frequency of whole grain food intake is an indicator of reduced risk of several neoplasms.

Adult↗
PubMed1998

Incidence of invasive cancers following basal cell skin cancer.

To obtain quantitative information on the risk of invasive cancers following a diagnosis of basal cell carcinoma (BCC) of the skin, patients with incident BCC cases listed in the cancer registries of the Swiss cantons of Vaud and Neuchâtel between 1974 and 1994 were actively followed up through December 31, 1994, for the occurrence of subsequent invasive neoplasms. Among 11,878 persons with incident BCC who were followed for a total of 76,510 person-years at risk, 1,543 metachronous cancers were observed versus 1,397.9 expected, corresponding to a standardized incidence ratio (SIR) of 1.1 (95% confidence interval (CI) 1.0-1.2). However, after exclusion of skin cancers (mostly squamous cell carcinoma and melanoma), 975 second primary cancers were observed versus 1,059 expected (SIR = 0.9, 95% CI 0.8-1.0). Significant excesses were registered for cancer of the lip (SIR = 2.2), for squamous cell skin cancer (SIR = 4.5) and melanoma of the skin (SIR = 2.5), and for non-Hodgkin's lymphoma (SIR = 1.9). The SIRs were also above unity, though not significantly, for cancers of the salivary glands (SIR = 2.8) and the small intestine (SIR = 2.1) and for soft-tissue sarcomas (SIR = 1.7). The SIR for lung cancer was 0.9. The SIRs for salivary gland and skin cancer were appreciably greater below age 70 years. For most sites, particularly for squamous cell cancer and melanoma of the skin, the SIRs remained elevated 5 or more years after BCC diagnosis. The cumulative incidence of squamous cell skin cancer was 13% at 19 years; this stresses the importance of carefully monitoring skin lesions among persons previously diagnosed with BCC.

Adult↗