Impact of the AIDS epidemic on mortality of young women in Italy.
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Biomedical subjects
Publications and source records attributed to S Franceschi.
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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.
Endometrial cancer (EC) shares some environmental or genetic risk factors with colorectal cancer (CRC). It represents a risk factor for CRC. Furthermore, EC is the most frequent extracolonic neoplasm in HNPCC (hereditary nonpolyposis colorectal cancer) and, in this syndrome, it has the same inheritance pattern as CRC. Neoplastic family history and clinical features were evaluated in women with EC in a health care district (Pordenone Province) in Northeastern Italy from 1990 to 1995, to examine the proportion of patients with hereditary cancer and the relation with clinical characteristics of EC. We interviewed 215 patients with EC (average age 61 years, range 35-88) in relation with some risk factors (age, weight, diabetes, menstrual and reproductive pattern, synchronous and metachronous neoplasms) and we obtained their family pedigree. Twenty-nine patients (13.5%) had a CRC family history, 66 (30.7%) showed an aspecific cancer aggregation in their families and more than half (120, 55.8%) had a negative cancer family history. Family pedigrees were consistent with a dominant inherited cancer pattern in 8 patients (3.7%) belonging to the CRC-related family history group. A different pattern of family history distribution emerged in relation with age (< 55 vs. > or = 55, p < 0.001) and body mass index (BMI) (< 26 vs. > or = 26, p = 0.002). Patients with a CRC pedigree were more numerous in the younger group, in the group with lower BMI and in pre-menopausal women.
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To provide further insight on the relationship between macronutrients and colorectal cancer, overall and by specific subsite(s), we carried out between 1992 and 1996 in 6 Italian areas a case-control study on 1,953 individuals of both sexes with incident colorectal cancer (age range 19-74) and 4,154 controls (age range 19-74) in hospital with acute, non-neoplastic diseases. A validated food-frequency questionnaire was used, including questions on 78 foods or recipes and on individual fat-intake pattern. The risk of cancer of the colon and rectum increased with total energy intake (odds ratio in highest vs. lowest quintile 1.43 and 1.50, respectively). The risk also rose significantly with an increase of starch intake, whereas it moderately decreased with an increase of protein intake. Monounsaturated fat intake appeared uninfluential, while saturated fat intake showed a modest direct association with rectal cancer. Polyunsaturated fat intake was inversely associated with colon cancer risk, particularly with the right colon.
We report the first results of a comparison between the Italian Registry on AIDS (RAIDS) and 13 population-based cancer registries (about 8 million population in 1991) with respect to the notification of Kaposi's sarcoma and non-Hodgkin's lymphoma. Routine indicators of data quality and completeness have been found in both types of registry, consistent with the best international standards. A linkage process was carried out on about 339,000 cancer notifications and 3,134 AIDS notifications and was herein restricted to individuals under the age of 50. Out of 243 Kaposi's sarcomas at either type of registry, 90 (37%) were reported as such by both; 68% of individuals with Kaposi's sarcoma at cancer registries could be identified at the AIDS registry, including AIDS-defining illnesses other than Kaposi's sarcoma; 62% of individuals with Kaposi's sarcoma at RAIDS could be found at cancer registries. Of 2,104 non-Hodgkin's lymphomas at either type of registry, 55 were reported as such by both; 65% of individuals reported as having non-Hodgkin's lymphoma at the AIDS registry were found at cancer registries. Our present results indicate the scope for improving cancer assessment in individuals with HIV infection and AIDS and the potential of AIDS and cancer registries for such a purpose.
BACKGROUND: The percentages of breast cancer cases in a given population attributable to specific risk factors (i.e., the population-attributable risks) can be calculated; determination of such risks associated with potentially modifiable risks factors, such as diet (e.g., levels of consumption of fruits, vegetables, vitamins, etc.), alcohol consumption, exercise, and body weight, are necessary to focus prevention strategies. METHODS: With the use of data from a case-control study conducted in Italy from June 1991 through April 1994 on 2569 breast cancer case subjects and 2588 control subjects, we calculated multivariate odds ratios and population-attributable risks for breast cancer in relation to dietary beta-carotene and vitamin E intake, alcohol consumption, physical activity, and, for postmenopausal women, body mass index. RESULTS: Among all subjects, the following attributable risks for the indicated risk factors were observed: 10.7% (95% confidence interval [CI] = 4.4%-17.0%) for high alcohol intake (i.e., >20 g/day), 15.0% (95% CI = 7.4%-22.9%) for low beta-carotene intake (i.e., <3366 microg/day), 8.6% (95% CI = -0.4%-17.5%) for low vitamin E intake (i.e., <8.5 mg/day), and 11.6% (95% CI = -0.1%-23.3%) for low levels of physical activity. The risks associated with alcohol and beta-carotene intake were larger among premenopausal women, and the risk associated with physical activity was larger among postmenopausal women. Being overweight accounted for 10.2 % (95% CI = 0.2%-20.2%) of breast cancer cases in postmenopausal women. Beta-carotene plus alcohol accounted for 28.1% (95% CI = 16.8-39.4) of the cases. Beta-carotene and physical activity accounted for 32% (95% CI = 14.3-49.8), and these three factors together accounted for 33% (95% CI = 19.9-46.1) of the breast cancer cases in the overall dataset. CONCLUSION: Exposure to a few selected and potentially modifiable risk indicators explained about one third of the cases of breast cancer in this Italian population, indicating the theoretical scope for prevention of the disease.
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BACKGROUND: An association between fats and colorectal carcinoma has been suggested, but the epidemiologic evidence by type of dietary fat is far less clear. Colorectal carcinoma rates have been relatively low in Mediterranean countries compared with most other Western countries, but the components of the Mediterranean diet responsible for this favorable pattern are unclear. METHODS: The relationship between various added (seasoning) fats and colorectal carcinoma risk was investigated using data from a case-control study conducted between January 1992 and June 1996 in six Italian areas. Cases were 1953 patients with incident, histologically confirmed colorectal carcinoma (1225 of the colon and 728 of the rectum) admitted to the major teaching and general hospitals in the study areas. Controls were 4154 subjects with no history of cancer who were admitted to hospitals in the same catchment areas for acute, nonneoplastic diseases unrelated to the the digestive tract and requiring no long term modifications of diet. Dietary habits were investigated using a validated food frequency questionnaire including 78 items. Lipid intake was estimated by taking into account the content of seasoning lipids in different dishes, the frequency of consumption and portion size of each dish, and individual fat intake patterns. RESULTS: The odds ratios (OR) for successive tertiles of olive oil intake, compared with the lowest one, were 0.87 (95% confidence interval [CI], 0.75-1.01) and 0.83 (95% CI, 0.70-0.99) (chi2trend = 4.49, P = 0.03) when colorectal carcinoma was analyzed as a whole, 0.82 (95% CI, 0.68-0.98) and 0.81 (95% CI, 0.66-0.99) (chi2trend = 4.05, P = 0.04) for colon carcinoma, and 0.96 (95% CI, 0.77-1.19) and 0.88 (95% CI, 0.66-1.12) for rectal carcinoma. For specific seed oils (including sunflower, maize, peanut, and soya), the OR for colorectal carcinoma was 0.91 in the highest tertile of intake, and the corresponding values were 1.01 for mixed seed oils and 0.93 for butter. None of these estimates was significantly different from the unity. Allowance for vegetable intake attenuated the apparent protection from olive oil consumption (OR, 0.94 for colon and 0.97 for rectum for the highest tertile), which still was apparent in younger subjects (OR, 0.82 for colon and 0.69 for rectum). CONCLUSIONS: In this study, seasoning fats did not appear to increase the risk of colorectal carcinoma, and there was little evidence for a differential effect by fat type. If such a differential effect exists, it is minor and could favor olive oil.
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Over the last two decades, the mortality rates of colorectal cancer in many developed countries have declined in women but not in men. One of the explanations of this difference between the genders may be the favorable influence of the spread of exogenous female hormone use (i.e., oral contraceptives [OC] and hormone replacement therapy) Reduced risk in ever-users of OC was found in three of four cohort studies available on this topic, and was significant in the one based on colorectal cancer mortality. The fourth one showed no difference. Of 11 case-control studies (or groups of studies), none showed significantly elevated risk. Five reported lowered colorectal cancer risk among ever-users, with a significant inverse association in the largest investigation available. Recent OC use, more than long duration use, seemed to be related to some risk reduction. One cohort study and three case-control investigations suggested that OC use was not related to the risk of colorectal adenomatous polyps. Thus, at present, it seems that OC use does not increase and may even have a favorable effect on either incidence or mortality of colorectal cancer.
A large case-control study (2,569 women with breast cancer and 2,588 control women) carried out in Italy between 1991 and 1994 permits elucidation of breast cancer risk in relation to dietary patterns in a southern European population. Major findings include direct associations with the intake of bread and cereal dishes, sugar, and pork meat, and inverse associations with the intake of vegetable oils, raw vegetables, fish, beta-carotene, vitamin E, and calcium.
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The relationship between adult height and breast cancer risk was considered, combining data from two case-control studies, one conducted between 1983 and 1991 in northern Italy and the other between 1991 and 1994 in six Italian centres. Cases were 5984 women, below the age of 75 years, with histologically confirmed breast cancer, and controls were 5504 women admitted to hospital for a wide spectrum of acute, non-neoplastic, non-hormone-related diseases. No relationship was observed between height and the risk of breast cancer, with a multivariate odds ratio (OR) of 0.96 (95% confidence intervals (CI) 0.85-1.08) for the tallest women (height > or = 166 cm) compared with the shortest (height < 156 cm). No significant heterogeneity was found across strata of age at diagnosis, education, body mass index, body weight, alcohol intake, age at menarche and menopause, parity, age at first birth, ever use of oral contraceptives and hormone replacement therapy, history of benign breast disease and family history of breast cancer. Thus, this study indicates that adult height is not appreciably related to breast cancer risk in this Italian population.
A case-control study was conducted between 1992 and 1996 in six Italian areas. It included 537 women with colon cancer, 291 women with rectal cancer and 2081 control women in hospital for acute conditions, unrelated to hormonal or gynaecological diseases. A higher age at menopause was associated with increased colon cancer risk (odds ratio (OR) for > or = 53 years compared with < 50 years = 1.39, 95% confidence interval (CI) 1.04-1.87). Among parous women, a significant trend of decreasing colon cancer risk with increasing number of births was seen for colon (OR for > or = 4 births compared with 1 birth = 0.62, 95% CI 0.42-0.90), but not for rectal cancer. Nulliparous women, however, were at lower risk than women with a single birth, and age at first birth was directly associated with risk. While oral contraceptive use showed no significant influence, ever users of hormone replacement therapy had a reduced risk of rectal cancer (OR = 0.56, 95% CI 0.31-1.01). Thus, the association of colorectal cancer with reproductive and menstrual factors is neither strong nor consistent.