Seroprevalence of HIV-1 in patients attending Modena Hospital, northern Italy.
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Adult↗
Biomedical subjects
S Franceschi
Publications and source records attributed to S Franceschi.
Mammographic screening in Italy.
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Breast Neoplasms↗
Pattern and determinants of diagnostic interval in cancers of the prostate, bladder and kidney.
The present study examined the pattern of presentation and diagnostic interval, i.e. number of months between first cancer symptom or sign and first medical visit, in 444 cases of urological cancer (122 of prostate cancer, 187 of bladder cancer and 135 of kidney cancer). The mean diagnostic interval was 7.6 months for prostate, 5.6 for bladder and 4.5 kidney cancer. A chance diagnosis, i.e. in absence of any symptom or sign, was reported by 16%, 8% and 18% of patients with cancer of the prostate, bladder and kidney respectively. We observed on significant differences in diagnostic intervals according to patients' demographic, sociocultural, and life-style characteristics, or tumor stage. Better quantitative and qualitative data on the pattern and determinants of delay in cancer diagnosis are clearly warranted, and the present study, although largely negative, shows the possibility of using large-scale epidemiological investigations for this purpose.
Aged↗
Pooled analysis of 3 European case-control studies: I. Reproductive factors and risk of epithelial ovarian cancer.
The role of reproductive factors in the aetiology of epithelial ovarian cancer has been re-assessed in a meta-analysis of 3 hospital-based case-control studies conducted in Europe (i.e. Italy, the United Kingdom and Greece), providing a total dataset of 1,140 cases and 2,724 controls. Multiple logistic regression models were used to obtain relative risk (RR) estimates adjusted for study centre, age, socio-cultural indicators, age at menopause, and oral contraceptive use. The risk decreased with increasing number of births and the trend in risk was significant (chi 2(1) = 7.50, p less than 0.01). In comparison to nulliparous women, those who reported 4 or more births had a 40% reduction in risk of ovarian cancer (RR = 0.6, 95% confidence interval, CI: 0.4-0.8). An RR estimate of 1.4 (95% CI: 1.1-1.7) as found, overall, for age of 35 or more at first birth compared to age of 25 or less at first birth. In each stratum and overall, nulliparous women did not appear to be at increased risk compared to those who delayed birth of their first child until age 35 or more. In each study, as well as in the overall dataset, an inverse association between number of abortions and ovarian cancer risk emerged. Overall, the inverse relationship was highly significant, RR estimates for 1 and 2 or more abortions, as compared to none, being 0.9 (95% CI: 0.8 and 1.1) and 0.7 (95% CI: 0.6-0.9) respectively. The effects of parity, age at first birth and number of abortions emerged consistently in various strata of study centre and age.
Abortion, Spontaneous↗
Pooled analysis of 3 European case-control studies of ovarian cancer: II. Age at menarche and at menopause.
The role of age at menarche and at menopause on epithelial ovarian cancer risk was re-assessed in a combined analysis of 3 hospital-based case-control studies conducted in Italy, the United Kingdom and Greece, which produced a total of 1,140 cases and 2,724 controls. In the overall dataset, there was no evidence of an association with age at menarche: compared with women whose menarche occurred at age 15 or over, the relative risk (RR) estimates were 1.0 [95% confidence interval (CI) 0.8 to 1.2] for those with menarche at ages 12 to 14, and 1.0 (95% CI 0.8-1.2) for those with menarche below age 12. There was no consistent interaction between age at menarche and study centre or age at diagnosis. In relation to age at menopause, compared with women whose menopause occurred at age 44 or earlier, the RR was 1.4 between 45 and 49, 1.6 between 50 and 52 and 1.9 above 52. The strength of the association was apparently (but not significantly) greater in the British than in the Greek or Italian dataset. The effect of age at menopause tended to be long-lasting and, if anything, to increase across subsequent age-groups. The large dataset, and the replication of results in different studies, provide more definite and precise information than previously available on the absence of appreciable effect of age at menarche on subsequent ovarian cancer risk in developed countries. For age at menopause, there was a direct and consistent trend in risk, but the association was relatively weak, with RRs below 2 even between extreme categories.
Adult↗
Pooled analysis of 3 European case-control studies of epithelial ovarian cancer: III. Oral contraceptive use.
The relationship between use of oral contraceptives (OCs) and other contraceptive methods and the risk of ovarian cancer was examined in a combined analysis of 3 hospital-based case-control studies conducted in Italy, the United Kingdom, and Greece, for a total of 971 ovarian cancer cases and 2,258 controls under age 65. Compared with never-users, the combined multivariate relative risk (RR) for ever-users was 0.6 (95% confidence interval, CI = 0.4-0.8) and the estimates were consistent in the 3 datasets. The protection was also similar across strata of age and parity. Considering various measures of OC use, available in the Italian and British datasets only, the protection conveyed on ovarian cancer risk increased with the duration of use and persisted in the medium-long period: the RR in women reporting their last OC use greater than or equal to 15 years prior to diagnosis was 0.5 (95% CI = 0.2-1.0). The risks in ever-users were appreciably lower in those women who reported their first OC use before 25 years of age (RR = 0.3 for first use before age 25, 0.8 for first use at age 25-34 and 0.7 at 35 years or after). Such findings emerged similarly from Italian and British data. This combined analysis, besides offering further quantitative estimates of the protective effects of OCs on ovarian cancer risk in European populations, provides useful insights into the time pattern of the relationship between OC use and ovarian carcinogenesis, suggesting that the protection persists for 15 years or more after cessation of use and may be larger for use at younger age.
Adult↗
Occupation and risk of Hodgkin's disease in north-east Italy.
The relationship between occupation and exposure to several occupational agents and Hodgkin's disease (HD) was investigated in a case-control study of 152 cases and 613 controls with acute diseases admitted to all hospitals in Pordenone province, north-east Italy. Among cases, there was a significant excess of individuals occupied in agriculture (odds ratio, OR for greater than 10 years = 2.2, 95% confidence interval, CI:1.3-3.7), who were exposed to livestock and meat processing (OR = 3.4, 95% CI:1.7-6.6), herbicides and pesticides (OR = 3.2, 95% CI:1.6-6.5). When the relationship between agriculture and specific exposures was assessed, it appeared that contact with some still unidentified animal-related agent involved in livestock farming and meat processing may be at least as important in determining HD risk as exposure to herbicides and pesticides and, probably, more important than occupation in agriculture per se.
Adult↗
Patterns of large bowel cancer by subsite, age, sex and marital status.
Incident cases of large bowel cancer from the Swiss canton of Vaud over the period 1974-88 were analyzed in relation to the distribution of site by sex, age, marital status and detailed subsite. A total of 1,968 cases were registered in males and 1,958 in females, corresponding to overall age-standardized (world) rates of 32.2/100,000 males and 22.4/100,000 females. The frequency of ascending and transverse colon cancer was lower in males (18.2% and 9.3%) than in females (23.1% and 10.0%, respectively), but cancers of the sigmoid colon and rectum were proportionally more frequent in males (34.0 and 30.0% versus 29.9 and 24.6% in females). Anal cancer accounted for 4.0% of large bowel cancers in females, but only 1.2% in males. Analysis of age-specific rates showed comparable values for ascending colon cancer in both sexes and in relation to each subsequent age group, as well as in sigmoid and rectal cancers up to middle age, while a male excess for the latter cancers became evident after age 55. A female excess for anal cancer was apparent in any subsequent age group. Information on marital status was available on 2,398 decreased subjects. Never married cases accounted for 12.2% of women and 8.1% of males. The excess of unmarried women was somewhat larger in the colon than in the sigma and rectum groups, but there was no evidence of excess of never married females for anal cancer. These data confirm that there are appreciable intersex heterogeneities in the descriptive epidemiology of various subsites of large bowel cancer, as well as complex interactions between sex and age, which may be related to female hormone correlates of intestinal carcinogenesis. Whatever the main biological mechanism(s), these data show noticeable similarities for both sexes in the descriptive epidemiology of cancers arising in the left colon and rectum, but noticeable differences with the right colon. Even more substantial are the differences with anal cancer, which should be linked to its venereal correlates.
Adult↗
Vegetable and fruit consumption and cancer risk.
The relationship between cancer risk and frequency of consumption of green vegetables and fruit has been analyzed using data from an integrated series of case-control studies conducted in northern Italy between 1983 and 1990. The overall dataset included the following histologically confirmed cancers: oral cavity and pharynx, 119; oesophagus, 294; stomach, 564; colon, 673; rectum, 406; liver, 258; gall-bladder, 41; pancreas, 303; larynx, 149; breast, 2,860; endometrium, 567; ovary, 742; prostate, 107; bladder, 365; kidney, 147; thyroid, 120; Hodgkin's disease, 72; non-Hodgkin lymphomas, 173; myelomas, 117; and a total of 6,147 controls admitted to hospital for acute non-neoplastic conditions, unrelated to long-term dietary modifications. Multivariate relative risks (RR) for subsequent tertiles of vegetable and fruit consumption were derived after allowance for age, sex, area of residence, education and smoking. For vegetables, there was a consistent pattern of protection for all epithelial cancers, with RRs in the upper tertile ranging from 0.2 for oesophagus, liver and larynx to 0.7 for breast. All the trends in risk were in the same direction and significant for all carcinomas except gall-bladder. In contrast, no protection was afforded by high vegetable consumption against non-epithelial lymphoid neoplasms. With reference to fruit, strong inverse relationships were observed for cancers of the upper digestive and respiratory tract, with RRs in the upper tertile between 0.2 and 0.3 for oral cavity and pharynx, oesophagus and larynx relative to the lowest tertile. The lower the location of the tumour in the digestive tract, the weaker appeared to be the protection afforded. Significant inverse relationships were observed for liver, pancreas, prostate and urinary sites, but not for rectum, breast and female genital cancers or thyroid. No relationship emerged for lymphomas and myelomas. Even in the absence of a clear biological interpretation, the consistency and strength of the patterns observed indicate that, in this population, frequent green vegetable intake is associated with a substantial reduction of risk for several common epithelial cancers, and that fruit intake has a favourable effect, especially on upper digestive cancers and, probably, also on urinary tract neoplasms.
Adult↗
Diet and thyroid cancer: a pooled analysis of four European case-control studies.
The relationship between frequencies of consumption of selected indicator foods and the risk of thyroid cancer was investigated in a pooled analysis of 4 case-control studies conducted in 3 areas of northern Italy and the Swiss Canton of Vaud, on a total of 385 histologically confirmed cases of thyroid cancer and 798 controls in hospital for acute, non-neoplastic, non-hormone-related diseases. Cases tended to consume significantly more frequently a number of starchy foods: the odds ratio (OR) for the highest vs. lowest tertile was 1.8 for pasta or rice, 2.1 for bread, 1.6 for pastry and 2.0 for potatoes. ORs also tended to be above unity for several types of meat and significantly so for chicken and poultry, cooked ham, salami and sausages. Raw ham and fish were significantly protective (OR = 0.7 in the highest tertile for both). Significant direct associations were observed with cheese (OR = 1.4 for the highest tertile), butter (OR = 2.1) and oils other than olive (OR = 1.6). The risk estimates were below unity for most types of vegetables and fruits, and the inverse trends were significantly for carrots (OR = 0.6 for the highest tertile), green salad (OR = 0.6) and citrus fruits (OR = 0.7). No association was observed with alcohol intake. These results were consistent and reproducible across various study centers.
Adult↗
Socio-economic indicators, infectious diseases and Hodgkin's disease.
The relationship between socio-economic indicators, family size, history of tonsillectomy, infectious mononucleosis (IM) and other diseases and the risk of Hodgkin's disease (HD) was investigated in a hospital-based case-control study, conducted in the province of Pordenone, North-east Italy, between June, 1985 and March, 1990. One hundred and fifty-two HD cases (88 men and 64 women) and 613 controls (357 men and 256 women) were interviewed. Patients with 14 or more years of education had a 2-fold increased HD risk (95% confidence interval, CI: 1.0-3.9); such risk tended to be higher in patients with nodular sclerosis (NS) HD (odds ratio, OR: 4.4, 95% CI 1.8-11.0). Sibship size, birth order and tonsillectomy were not associated with HD risk. Cases and controls did not differ in the frequency or age at occurrence of common childhood infections. A history of IM, however, was found to be an important predictor of HD risk, in particular among NS HD (OR = 13.1, 95% CI 1.0-176.7). Past episodes of herpes zoster and of skin and genital warts were also associated with significantly increased HD risks. These data lend further support to the role of the IM agent (i.e., the Epstein-Barr virus) and, perhaps, of other viral infections and immunological alterations in the development of HD.
Adolescent↗
Genital and urinary tract diseases and bladder cancer.
The relationship between selected urinary tract and genital diseases and the risk of bladder cancer was analyzed using data from a case-control study of 364 cases of bladder cancer and 447 controls hospitalized for acute, nonneoplastic, nongenital tract conditions, unrelated to known or suspected risk factors for bladder cancer. Cystitis was reported by 20% of the cases and 8% of the controls, corresponding to a multivariate relative risk (RR) of 3.8 (95% confidence interval, 2.4 to 5.9). No association was observed with urinary tract stones (RR = 1.2). With reference to genital diseases, the RR was elevated for gonorrhea (RR = 2.8, 95% confidence interval, 1.0 to 4.5) and condylomata acuminata (RR = 5.9, 95% confidence interval 1.0 to 3.6) but not for syphilis. The risk increased with the number of episodes of cystitis (RR = 5.0 for greater than or equal to 4 episodes, chi 2 for trend = 33.04, P less than 0.001), was higher during the last 15 years after the first episode (RR = 5.1 versus 2.3 for over 15 years), and was not heterogeneous across strata of age and sex. The interaction between urinary tract infections and tobacco appeared multiplicative, with RR = 2.4 for ever smoking, 3.2 for cystitis alone, and 10.3 for both exposures. The present study, besides providing further quantitative evidence of a relationship between urinary tract infections (and, possibly, some genital infections, too) and bladder cancer, indicates that the role of infections is probably in one of the latter (promoting) stages of the process of carcinogenesis and suggests a multiplicative interaction with smoking. In terms of prevention and public health, therefore, it is thus important to avoid at least one exposure for subjects with a history of urinary tract infections who smoke tobacco.
Carcinoma, Squamous Cell↗
Nutrition and cancer of the oral cavity and pharynx in north-east Italy.
The relation between dietary indicators and the risk of cancer of the oral cavity and pharynx was investigated in a case-control study conducted in Pordenone province, north-east Italy, on 302 cases (266 males and 36 females) and 699 controls admitted to hospital for acute, non-neoplastic and non-digestive disorders. Positive associations were observed, after allowing for occupation, smoking and drinking habits, with more frequent consumption of pasta or rice, polenta, cheese, eggs and pulses (odds ratios - ORs = 1.6, 2.1, 1.9, 1.9 and 2.0 for highest vs. lowest tertile), whereas reduced ORs emerged in subjects reporting more frequent consumption of carrots, fresh tomatoes and green peppers (ORs = 0.6, 0.5 and 0.5, respectively). Higher frequency of daily meals was also associated with a significantly elevated OR (1.7 for greater than or equal to 4 vs. less than or equal to 2 meals). The role of various indicator foods must be assessed in the context of the very high levels of alcohol consumption in the study area (greater than or equal to 8 alcoholic drinks/day in 2/3 cancer cases).
Adult↗
Oral contraceptives and the risk of endometrial cancer.
The relationship between the use of combination oral contraceptives (OCs) and the risk of endometrial cancer was assessed in a case-control study conducted in the Swiss Canton of Vaud between 1 January 1988 and 31 July 1990. Subjects included 122 women aged 75 or less with histologically confirmed endometrial cancer, and 309 control women in hospital for acute conditions unrelated to OC use. Overall, 14 percent of cases and 27 percent of controls had ever used OCs, corresponding to a multivariate relative risk (RR) of 0.5 (95 percent confidence interval [CI]: 0.3, 0.8). The risk of endometrial cancer was found to be related inversely to duration of OC use: RR = 1.0 for less than two years of OC use; 0.5 for two to five years; and 0.3 (95 percent CI: 0.1, 0.7) for more than five years. The protection appeared greater within 20 years since last use, and the RR rose to 0.8 after 20 or more years since last use; numbers are too small, however, for reliable inference from these subanalyses. No significant interaction or modifying effect was observed with other major factors related to endometrial cancer, including parity, body mass index, estrogen replacement therapy, and cigarette smoking. While this study provides further evidence for the protective effect of OCs against risk of endometrial cancer, the relationship requires continued evaluation to assess the long-term implications and public health impact of OC use.
Age Factors↗
Non-occupational risk factors for adult soft-tissue sarcoma in northern Italy.
The role of socioeconomic and anthropometric indicators, tobacco, alcohol consumption, dietary habits, and medical history in the etiology of soft-tissue sarcoma (STS) was examined in a hospital-based case-control study, conducted in the Friuli-Venezia Giulia region of northeast Italy, between 1985 and 1990. A total of 88 STS cases (53 males and 35 females; median age: 52 years) and of 610 controls (306 males and 304 females; median age: 54 years) were interviewed. There were significant excess risks associated with a history of herpes zoster infection (odds ratio [OR] = 2.4, 95 percent confidence interval [CI] = 1.1-5.3), chicken pox (OR = 2.2, CI = 1.2-4.3) and mumps in childhood (OR = 2.0, CI = 1.1-3.9). History of diabetes was also linked to a nonsignificant increase in STS risk (OR = 1.8, CI = 0.6-5.4), whereas exposure to radiation for diagnostic or therapeutic purposes was not related to the probability of developing STS. None of the investigated socioeconomic and anthropometric indicators seemed to affect STS risk; neither did tobacco smoking, nor consumption of alcohol, coffee, and tea beverages. Conversely, among the dietary habits investigated, a significant positive association emerged with an increasing frequency of consumption of dairy products (chi 2 for trend = 6.8, P less than 0.01) and oil (chi 2 for trend = 4.3, P less than 0.05), while a negative association was seen for intake of whole grain bread and pasta (OR for highest cf lowest tertile = 0.4, CI = 0.2-0.9).
Adolescent↗
Reproductive factors and colorectal cancer.
Descriptive and analytical epidemiology have suggested that cancer of the colorectum may have reproductive correlates similar to those of breast cancer (e.g., protection by parity and early age at first birth), but the evidence is still controversial. We therefore reviewed published data from 15 case-control investigations, two cohort studies, and one cancer registry-based study from seven different countries. With reference to parity, statistically significant protection for colorectal cancer was found in three case-control studies; in four other studies, significant inverse relationships of parity were observed with colon cancer, but not with rectal cancer. Among the remaining 12 studies, relative risks below unity for parous or multiparous women were observed in four. There was no appreciable trend in risk in four others; in two, there was nonsignificant increased risk with parity; and in one, a significant increased risk. Information on age at first birth was available from 12 studies. Three reported significant trends of increased risk with increasing age at first birth--one found a direct association of borderline significance; six indicated no evidence of association; and two reported an inverse trend in risk of borderline significance. Findings on age at menarche were inconsistent and mostly negative, although an inverse significant association was reported, especially regarding colon cancer, in one investigation. In all the six studies, which provided information on age at menopause, there was a hint of protection, although nonsignificant, for women who underwent natural menopause at an older age. Two studies reported a direct association of colorectal cancer with use of oral contraceptives, and another showed an inverse relationship with the use of menopausal estrogens.(ABSTRACT TRUNCATED AT 250 WORDS)
Age Factors↗
The epidemiology of ovarian cancer.
The descriptive and analytical epidemiology of ovarian cancer is reviewed, starting from the substantial geographical differences, with high rates in North America and Europe and low rates in developing countries and Japan, although, on a worldwide scale, almost 50% of 140,000 total cases occur in developing countries. Over the past decades, incidence and mortality rates have remained approximately stable in high-risk areas, but have generally tended to rise in low-risk areas. In the past, ovarian cancer was more common in higher social classes, but sociocultural differences seem to have flattened off over recent decades. In etiological terms, the protection afforded by multiparity and oral contraceptive (OC) use is well established, with relative risks (RRs) of the order of 0.5 for multiparae and OC users. There is also consistent evidence that risk increases with late age at menopause. Less consistent and weak, if any, are the effects of age at menarche and first birth, although there is hint that a first birth over age 35 is not protective. It is conceivable that diet can play an important role in ovarian carcinogenesis, but only scattered data are available to suggest that high fat consumption may represent an indicator of risk. Available knowledge on ovarian cancer epidemiology is also discussed in relation to models of carcinogenesis and implications for prevention and public health.
Female↗
The epidemiology of endometrial cancer.
The descriptive and analytical epidemiology of endometrial cancer is reviewed. Over the last few decades, age-standardized incidence rates have been rising in several countries. The rise has been even greater in terms of absolute numbers of cases, and hence public health implications, due to the aging of the population. Although endometrial cancer rates were found to be higher in richer countries and urban populations, there is now evidence of some changes in the socioeconomic determinants of the disease in developed countries. In etiological terms, any factor that increases exposure to unopposed estrogens (such as menopausal replacement treatment, obesity, and irregular menstrual cycles) tends to increase the risk of the disease, while factors that decrease exposure to estrogens or increase progesterone levels (such as oral contraceptives or smoking) tend to be protective. Less well defined, or more difficult to explain in biological terms, is the role of other factors, such as births, miscarriages, or diabetes and hypertension, and only suggestive evidence is available on diet from analytical epidemiology. The data reviewed herein are discussed in terms of models of carcinogenesis, as well as attributable risks and public health implications.
Female↗