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Biomedical subjects

S Franceschi

Publications and source records attributed to S Franceschi.

At least 415 records · Page 23Linked to original sources

The application of different correlation coefficients to assess the reproducibility of a food frequency questionnaire.

We computed four different correlation coefficients to investigate the degree of reproducibility of the weekly consumption of 77 food items or groups of foods and of seven summary questions from a food frequency questionnaire developed in Italy for a case-control study on cancers of the breast and digestive tract. The questionnaire had been administered twice to 452 Italian men and women. These included Pearson correlation coefficients (a) using the weekly frequencies of consumption without any transformation (P1); (b) after applying the transformation log (x + 1) (P2); (c) after applying the transformation log (x + 0.01) (P3); and (d) the Spearman correlation coefficient (SP). The mean values were 0.55 for P1, 0.59 for P2, 0.56 for P3 and 0.59 for SP. All coefficients were positively correlated, although to variable extents: the Spearman correlation coefficient between P2 and SP was 0.92, and that between P1 and P3 was 0.53. Differences between the four coefficients were more marked for food items with a lower kappa statistic and lower intraclass correlation, ie for those items with more severe reproducibility problems. Thus, a single correlation coefficient may not be enough to detect zones of the distribution of a food item where misclassification problems are more severe. The correlation coefficients used to investigate reproducibility should therefore be chosen on the basis of subsequent data analyses.

Feeding Behavior↗

Gastrectomy and subsequent risk of oesophageal cancer in Milan.

STUDY OBJECTIVE: To analyse quantitatively the relationship between gastrectomy and oesophageal cancer risk. DESIGN: This was a case-control study, based on a structured questionnaire that included a problem-oriented medical history. SETTING: A network of hospitals in the Greater Milan area between 1984 and 1992. SUBJECTS: Subjects were 316 incident, histologically confirmed cases of oesophageal cancer (258 males and 58 females), and 1408 controls (1031 males, 377 females), admitted to hospital for acute, non-neoplastic, non-digestive tract conditions. MEASUREMENTS AND MAIN RESULTS: Relative risks (RR) and the corresponding 95% confidence intervals (CI) adjusted for age and sex, plus area of residence, education, tobacco, and alcohol consumption. There was an association of borderline significance of oesophageal cancer with gastric ulcer (RR = 1.6), but not with duodenal ulcer (RR = 0.9). Among cases, 25 (7.9%) reported a history of gastrectomy, versus 29 (2.1%) of the controls. The corresponding multivariate RR was 3.8 (95% CI 2.0, 7.0). The RR of oesophageal cancer was significantly raised (RR = 3.6) within 20 years after gastrectomy, and the association seemed stronger with increasing time since gastrectomy (RR = 4.2). CONCLUSIONS: Since gastrectomy may cause gastric hypoacidity and favour oesophageal reflux, and hence oesophagitis, the results of this study, if confirmed, are of interest to a better understanding of the mechanisms of oesophageal carcinogenesis.

Adult↗

Blood transfusion and other prognostic variables in the survival of patients with cancer of the head and neck.

The clinical records of 207 patients with squamous cell carcinoma of the head and neck, diagnosed and surgically treated at the Otolaryngology Division of Pordenone General Hospital and Aviano Cancer Centre, northeast of Italy, from January 1982 to December 1987, were retrospectively reviewed to gather information on blood transfusions and other characteristics potentially related to survival. The group of patients (mean age = 59 years) included 85 cases (41%) of laryngeal cancer, 80 cases (39%) of oropharyngeal and hypopharyngeal cancer, and 34 cases (16%) of cancer of the oral cavity. Fifty-five patients (27%) did not receive any blood transfusion while 152 patients were transfused with different amounts of blood. At the univariate analysis, nodal involvement, clinical stage, type of therapy, status of surgical margins, and metastatic spread beyond the nodal capsule appeared to be significantly linked to prognosis. After adjustment for other prognostic variables, transfused patients showed a twofold higher hazard ratio as compared to nontransfused patients, but such an unfavorable predictive value should be evaluated in the context of the other prognostic correlates of cancer of the head and neck.

Blood Transfusion↗

International Variations and Trends in the Incidence of Breast Cancer in Older Women.

This article explores age-related variations in breast cancer mortality in the western world and analyzes potential risk factors for older women. The highest breast cancer mortality rates are observed in England, Wales, and Denmark; the United States, Canada, Sweden, central and southern Europe have intermediate mortality rates; and Latin America and Russia have the lowest rates. Three case-control studies involving over 4000 Italian women demonstrate that age at menarche is a risk factor only for premenopausal women; multiparity (>5 births) increases the risk of breast cancer for women under age 35 years but reduces the risk of breast cancer for older women. Obesity is a risk factor only for postmenopausal women, and the influence of other risk factors, such as age at first birth, family history and late menopause, does not show age-related variations. The influence of diet and steroidal contraceptives on the breast cancer rate in older women is not established.

Journal Article↗

Thyroid cancer.

Thyroid cancer is one of the rarest forms of cancer, and yet there are wide variations in the degree of malignancy, ranging from the most rapidly fatal to the relatively benign. This difference depends almost entirely on the histological type. A "pool" of individuals with occult thyroid carcinomas (in the vast majority of the papillary type) is probably present in most populations even at a young age. Large differences in the estimated frequency of cancer at this site can therefore be caused by variation in diagnostic intensity. Data on changing trends of incidence and mortality are thus subject to reservation, depending on the degree to which they have been influenced by changing diagnostic criteria and the precision of histopathological description. Nevertheless, there is evidence that mortality is slowly falling, whereas incidence is increasing, in several countries. This chapter considers the upward temporal trends of incidence and substantially stable mortality rates for thyroid carcinoma in the past three decades and attempts to interpret these trends in the light of concurrent changes in diagnostic standards and histological classification. Attention will also be drawn to the public health implications of the recent intensive detection and treatment of occult thyroid carcinomas.

Adult↗

AIDS-associated Kaposi's sarcoma and non-Hodgkin's lymphomas reporting in Italy: a linkage study.

To evaluate the completeness and accuracy in the reporting of AIDS-associated Kaposi's sarcoma (KS) and non-Hodgkin's lymphomas (NHL) in Italy, a linkage study of the notifications to the Italian AIDS Registry (RAIDS--the national compulsory AIDS surveillance system) and the clinical and pathological records of the Italian Cooperative Group on AIDS-related tumors (GICAT--a nationwide voluntary reporting system for HIV-infected individuals who develop cancer) was carried out. A total of 288 cases of KS and 258 cases of NHL fulfilling the AIDS definition criteria, histologically diagnosed by the GICAT centers between January 1987 and March 1992, were matched with the 16,860 AIDS cases reported to the RAIDS up to March 1993. The linkage procedure, based on name, gender, and date of birth, identified 276 cases of KS (96%) and 241 cases of NHL (93%) present in both files ("linked" cases). The diagnosis of KS did not appear among the clinical manifestations of AIDS in the RAIDS file in 67 out of the 276 linked KS (24%), either with coincident dates of KS diagnosis and of case notification (19 cases) or when the KS diagnosis followed by > or = 2 months the case notification to RAIDS (48 cases). Of the 241 linked NHL, 84 (33%) had no such neoplastic complications of AIDS listed in the RAIDS file, 23 with coincident dates of NHL diagnosis and of case notification and 61 with the NHL diagnosis made > or = 2 months after the notification. A noteworthy discrepancy in the classification of the three histologic subtypes of NHL emerged between the GICAT and the RAIDS. The degree of underreporting of AIDS-associated cancers that emerged from the present study suggests that augmentation with other sources of oncological information is important to better estimate the burden of AIDS-related tumors and to study the interaction between HIV infection and cancer.

Acquired Immunodeficiency Syndrome↗

Attributable risk for laryngeal cancer in northern Italy.

Using data from a case-control study conducted between 1986 and 1992 in Northern Italy on 367 cases of laryngeal cancers (350 men and 17 women) and 1931 hospital controls (1373 men and 558 women), we estimated the relative risks (RR) and the population attributable risks (AR) for laryngeal cancer in relation to tobacco and alcohol consumption and a diet containing little fresh fruit and vegetables (low beta-carotene intake). In men, the RR and their 95% confidence interval (CI), derived from multiple logistic regression, including terms for center, age, and education, plus, simultaneously, tobacco, alcohol, and beta-carotene) were 3.3 (95% CI, 1.9 to 5.5) for ex- or moderate smokers (< 15 cigarettes/day) and 8.8 (95% CI, 5.2 to 14.8) for heavy current smokers compared to never smokers; the RR were 1.5 (95% CI, 1.0 to 2.2) for drinkers of 6 to < 8 alcoholic drinks/day and 2.2 (95% CI, 1.6 to 3.0) for drinkers of 8 or more drinks/day compared to teetotallers or moderate drinkers; with respect to carotene intake the RR were 1.4 (95% CI, 1.0 to 2.0) for the intermediate tertile and 1.8 (95% CI, 1.3 to 2.5) for the lowest tertile, as compared to the highest tertile of intake. AR were estimated assuming a multiplicative model: the single factor with the largest AR was smoking, which accounted for about 77% of laryngeal cancers in men; alcohol intake explained about 25% of cases, low beta-carotene intake accounted for about 18% of cases, and together the three factors were responsible for about 86% of laryngeal cancers in men.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Alcohol and cancers of the upper aerodigestive tract in men and women.

In order to explore the potential differences in the effect of alcohol in men and women we took advantage of a case-control study of upper aerodigestive tract tumors conducted between 1986 and 1991 in Northern Italy Five hundred forty-six incidence cases of cancer of the oral cavity and pharynx (of whom 81 were women), 410 of cancer of the esophagus (of whom 67 were women), and 388 with cancer of the larynx, (of whom 19 were women) were interviewed. The control group included 2263 inpatients (of whom 557 were women) with acute conditions unrelated to alcohol and tobacco consumption. Among alcohol drinkers, similar odds ratios were detected in men and women. In the highest, well comparable intake category (i.e., > or = 42 drinks/week in women and 42-55 drinks/week in men), odds ratios were 4.5 and 3.8 for cancer of the oral cavity and pharynx, 3.0 and 4.7 for cancer of the esophagus, and 2.6 and 2.0 for cancer of the larynx in women and men, respectively, as compared to light drinkers. However, for all cancer sites a reduced risk was found among abstaining women but not in abstaining men, when compared with light-to-moderate drinkers. The present study, therefore, does not support the hypothesis that women may be substantially more vulnerable than men to alcohol carcinogenesis, at least at the level of the upper aerodigestive tract.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Alcohol consumption and risk of prostate cancer.

Because alcohol influences metabolism and serum levels of sex hormones and specifically increases metabolic clearance of testosterone, some role of alcohol consumption in the process of prostatic carcinogenesis is biologically plausible. The relationship between prostate cancer and total alcohol consumption was therefore investigated in a case-control study conducted in Northern Italy between 1985 and 1992 on 281 cases and 599 controls admitted to hospital for acute nonneoplastic diseases apparently unrelated to alcohol and tobacco consumption. No noteworthy relationship was found for major measures of alcohol intake: compared with teetotallers, the multivariate relative risks (RRs) of prostate cancer, after adjustment for age, study center, education, marital status, body mass index, and smoking status, were 1.3, 0.9, 1.2, and 1.1, respectively, for men drinking fewer than three, three to less than five, five to less than eight, or more than eight alcoholic beverages per day. None of the estimates was significant, nor was the trend in risk significant. Multivariate risks were also close to unity in the separate analysis of intake of wine (RR = 1.2 and 0.9 for < 5 and or = 5 drinks/day, respectively, compared with wine abstainers), beer (RR = 1.1 for beer drinkers compared with beer abstainers), and spirit (RR = 0.8 for spirit intake compared with beer abstainers). No relationship was observed with duration of use (< 40 and > or = 40 yrs, multivariate RRs = 1.1 and 1.3, respectively), and the alcohol-related risk estimates were similar for men < 70 and > or = 70 years of age.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Risk factors for esophageal cancer in women in northern Italy.

BACKGROUND: The incidence of esophageal cancer in women in Italy is low, and its risk factors have not been studied extensively. METHODS: The relationship between risk of esophageal cancer and frequency of consumption of tobacco, alcohol, and a few selected dietary items was studied in 57 Italian women with histologically confirmed incident cancers of the esophagus and 344 hospital control patients, using data from a case-control study conducted in Milan, Italy, 1984-1991. RESULTS: The major risk factor for cancer of the esophagus in Italian women was cigarette smoking (relative risk [RR], 1.5 for < 15 cigarettes/day, 95% confidence interval [CI], 0.6-3.8; and RR, 4.8 for > or = 15 cigarettes/day, 95% CI, 2.2-10.3; compared with those who never smoked), followed by elevated alcohol consumption (RR, 2.3; 95% CI, 1.0-5.4 for three or more drinks/day, relative to teetotalers), which together explained more than 50% of cases. Among dietary items, high intake of fresh fruit showed a statistically significant protective effect (RR, 0.4; 95% CI, 0.2-0.9 for the highest versus the lowest tertile of intake). There was an inverse relationship with an estimate of beta-carotene intake (RR, 0.5; 95% CI, 0.2-1.0 for the highest versus the lowest level of intake). No association was evident with preformed vitamin A (retinol). CONCLUSION: On a population scale, tobacco is the major risk factor for esophageal cancer in Italian women. Although the incidence of esophageal cancer is much lower in women than in men, major risk and protective factors are similar for both sexes.

Adult↗

Refined-sugar intake and the risk of colorectal cancer in humans.

The relationship between sugar added to coffee and other hot beverages--as an indicator of taste for sugar and sugar intake outside main meals--and the risk of colorectal cancer was investigated using data from a case-control study conducted in Northern Italy on 953 cases of histologically confirmed colon cancer, 633 of rectal cancer and 2845 controls admitted to hospital for acute, non-neoplastic, non-digestive tract disorders. Compared with subjects who reported adding no sugar to their beverages, the multivariate relative risks (RR) of colon cancer were 1.4 for those adding one spoonful of sugar, 1.6 for those adding 2 spoonful, and 2.0 for those adding 3 or more. The corresponding RRs for rectal cancer were 1.3, 1.5 and 1.4. For combination of colorectal cancer the RRs were 1.4, 1.5 and 1.8. All the trends in risk were significant, and the results were consistent across strata of study centre, sex and age, and were not appreciably modified by allowance for a number of major identified potential distorting factors, including an estimate of total calorie intake. These findings, if confirmed, would suggest that taste for sugar is a relevant indicator of colorectal cancer risk, and could be interpreted either in terms of a role of sugar in colorectal carcinogens, or of a specific influence of even limited amounts of sugar taken outside meals, which may stimulate the proliferation of the bowel epithelium, and hence enhance colorectal carcinogenesis.

Adult↗

Incidence of infiltrating cancer following superficial bladder carcinoma.

Patients with histologically confirmed first diagnosis of superficial bladder carcinoma notified to the population-based cancer registry of the Swiss Canton of Vaud during the calendar period 1974-90 were actively followed-up to December 31, 1990 for the occurrence of a subsequent invasive tumour of the urinary bladder. Among 1,012 incident cases of superficial bladder neoplasms, followed for a total of 6,286 person/years at risk, 93 infiltrating tumours of the urinary bladder were diagnosed. Only 5.3 cases were expected on the basis of the general population of the canton. The overall standardized incidence ratio (SIR) was 17.5 (95% confidence interval, CI: 14.2-21.7). The SIR was significantly greater for females than for males. The SIR was highest between 1 and 4 years following registration of non-infiltrating cancer, and declined thereafter. The cumulative risk of invasive bladder cancer was 7%, 13%, and 16%, after 5, 10 and 15 years, respectively. This work provides population-based, accurate and reliable estimates of the risk of invasive bladder cancer following non-infiltrating cancers. Although the overall relative risk was almost 20-fold higher than in the general population, the cumulative risk of developing an invasive bladder cancer was only 16% at 15 years.

Adult↗

Prognostic factors of malignant mesothelioma of the pleura.

BACKGROUND: Pleural mesothelioma is a rare condition with a poor prognosis. The area of Monfalcone, North East Italy, provided a unique opportunity to study the disease because of its past heavy exposure to asbestos in local harbors and shipyards and its high necropsy rates. METHODS: The effects of various patient and tumor characteristics on survival were evaluated in 80 patients (73 males and 7 females; median age, 69) of histologically or cytologically confirmed malignant mesothelioma of the pleura. These patients were examined between October 1979 and October 1991 at the General Hospital of Monfalcone in the Friuli-Venezia Giulia region. Substantial exposures to asbestos were identified in 79 patients. RESULTS: Median survival rate was 13 months (range, 2-44 months), and overall 2- and 5-year survival rates were 23% and 0%, respectively. The factors that exerted a significant favorable influence on survival were as follows: (1) age younger than 65; (2) performance status less than or equal to one; (3) lack of less than or equal to 10% weight loss at any time; (4) Stages I and II; (5) epithelial or mixed histologic type; and (6) presence of pleural fluid with mesothelial cells but without neoplastic cells. When these factors were introduced in a Cox proportional hazard model, age, stage, and histologic type were the only independent prognostic factors. The increased hazards for patients, ages 65-74 (as compared to < 65), and for patients with sarcomatous histologic type (as compared to epithelial type) were 2.6 (95% confidence interval [CI], 1.2-5.7) and 4.5 (95% CI, 1.6-12.8). CONCLUSIONS: Survival rate in 24 untreated patients (median, 10 months) and 56 patients variously treated (median, 15 months) did not differ significantly. The availability of large portions of tumor specimens for histologic examinations in 77 of 80 patients, chiefly from high necropsy rate, strengthens the value of the present analysis of prognostic factors.

Adult↗