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Biomedical subjects

S Franceschi

Publications and source records attributed to S Franceschi.

At least 523 records · Page 29Linked to original sources
PubMed1991

Previous thyroid disease and risk of thyroid cancer in Switzerland.

A hospital-based case-control study of 86 cases of thyroid cancer and 317 controls was done in the Swiss Canton of Vaud. Patients with thyroid cancer tended to be better educated (odds ratio [OR] 2.1 for greater than or equal to 14 vs. less than or equal to 8 years of education 95% CI 1.1-4.1) and of higher social class than controls. Cases more often had a history of benign thyroid nodules (OR 25.2, 95% CI 7.6-83.6) and non-toxic goitre (OR 5.3, 95% CI 2.5-11.2). Furthermore, patients with thyroid cancer were more likely to have resided in endemic goitre areas (OR 1.7, 95% CI 1.0-3.0) and to have had first-degree relatives affected by benign thyroid disease (OR 3.9, 95% CI 2.1-7.1). Therefore, this study offers quantitative evidence of the association between various thyroid diseases and the risk of thyroid cancer which, despite difficulties in the classification of benign and malignant thyroid diseases, is remarkably consistent in studies from different countries.

Adolescent↗
PubMed1991

Smoking and cancer with emphasis on Europe.

A summary of smoking and cancer in various European countries is presented Important points are the tobacco/alcohol interaction in the elevated mortality rates from upper digestive and respiratory tract neoplasms in France and other southern European countries, the delay in the lung cancer epidemic in females compared with the situation in North America (with the major exception of the United Kingdom) and the different pattern of lung cancer rates in younger compared with older generations (which suggests that eastern and southern European countries will have the highest lung cancer rates at the beginning of the next century in the absence of urgent intervention). The efficacy of anti-smoking policies in Scandinavian countries which now have the lowest lung cancer rates in Europe and the persisting importance of high-tar dark-tobacco cigarettes in eastern and southern Europe in enhancing the risk not only of cancer of the lung but also of upper digestive and respiratory and bladder neoplasms are also discussed.

Europe↗
PubMed1991

Evaluation of hospital care in a radiotherapy department in north-eastern Italy.

Assessment of the quality of care and patients' satisfaction has become an increasingly needed area of research. The present study investigated various qualitative and quantitative aspects of provision of care and interaction between cancer outpatients and medical and nursing staff within a radiotherapy department in Pordenone, north-eastern italy. A total of 368 outpatients were contacted: 258 completed the questionnaire (response rate 70%). No difference emerged between respondents and non-respondents as concerning age, sex, marital status, clinical stage, cancer type and reason for referral. Significant differences were found for education and type of work, white collar and better educated patients being more frequent among respondents. Most of the patients reported good or very good levels of satisfaction with major aspects of care provision and relationship with medical and nursing staff. Length of time spent in various administrative procedures, cost of the therapy and change of attending physician in different examinations were the issues commented upon relatively less favourably. Reported waiting time for each medical examination exceeded 1 hour in approximately half of the patients. Improvement in hospital services constituted the priority, according to male patients. Public transportation concerned most women's and elderly patients' attention. Among elderly patients, the need for better provision of care at home was also deeply felt.

Age Factors↗
PubMed1991

History of selected diseases and the risk of colorectal cancer.

The relationship between selected aspects of medical history and the risk of colorectal cancer was analysed using data from a case-control study of 673 cases of colon cancer, 405 of rectal cancer and 1501 controls in hospital for acute, non-neoplastic, non-digestive tract conditions, unrelated to known or suspected risk factor for large bowel cancer. Significantly elevated risks (RR) were observed for history of cholelithiasis (RR = 1.5 [95% confidence interval (CI) 1.1-2.1] for colon; 1.6 [1.2-6.4] for rectum) and diabetes (1.6 [1.1-2.3] for colon; 1.3 [0.8-2.0] for rectum), and a significant protection emerged for history of drug allergy (0.6 [0.4-0.9] for colon; 0.6 [0.5-1.0] for rectum). No significant association was found with thyroid disease, gastroduodenal ulcer, liver cirrhosis, hepatitis, pancreatitis, gastrectomy, appendicectomy, treatment with cimetidine/ranitidine, treatment with chenodesoxycholic acid or with blood transfusions. The associations with cholelithiasis, diabetes and drug allergy were not materially modified by allowance for major identified potential confounding factors, and were not restricted to the diseases diagnosed within 5 or 10 years before large bowel cancer diagnosis. Thus, the analysis of this large dataset offered further quantitative evidence suggesting a possible, however moderate, association between gallbladder disease and colorectal cancer risk, which may be related to enhanced or continuous secretion of secondary bile acids. The associations with diabetes and drug allergy were unexpected, and probably indirect, lacking previous epidemiological support or any obvious biological interpretation. Thus, they should be simply regarded as working hypotheses worthy of further consideration.

Adult↗
PubMed1991

Oral contraceptive use and the risk of ovarian cancer: an Italian case-control study.

The association between oral contraceptive (OC) use and the risk of ovarian cancer was analysed in a case-control study, conducted between 1985 and 1989 on 505 epithelial ovarian cancer cases under 60 years of age, and 1375 controls in hospitals for a spectrum of acute conditions, not gynaecological, hormonal or neoplastic, apparently unrelated to OC use. 41 (8.1%) women with epithelial ovarian cancer and 192 (14.0%) controls reported OC use. The multivariate relative risk (RR) for ever use was 0.7 (95% confidence interval (CI) = 0.5-1.0). The risk decreased with duration of use: compared with never users the multivariate RRs were 0.9 and 0.5 respectively for less than 2 years and 2 years or more users (chi 2(1) trend = 6.17, P = 0.01). The risk of ovarian cancer decreased with recency and latency of use: the estimated RR were 0.5 and 0.9 in women reporting last OC use less than 10 or 10 years or more from the diagnosis of the disease, and 0.6 and 0.8 in those reporting first OC use less than 10 or 15 or more years before. The protective effect of OC was consistent in separate strata of selected covariates, including parity and other major known or suspected risk factors for ovarian cancer. There was some indication that the protection declines with advancing age, but the risk estimates were similar in premenopause and postmenopause.

Adult↗
PubMed1991

Colorectal cancer in northeast Italy: reproductive, menstrual and female hormone-related factors.

The role of reproductive and menstrual factors and a few medical conditions linked to female hormones in the aetiology of colorectal cancer was investigated in a case-control study conducted in Pordenone province in northeastern Italy, on 89 women with colorectal cancer and 148 controls admitted to hospital for a wide spectrum of acute, non-digestive nor neoplastic disorders. After adjustment for age and social class, parous women, as compared to nulliparous ones, were significantly protected against colorectal cancer (odds ratio, OR = 0.4, [95% confidence interval, CI:0.2-0.8]) and the risk appeared to decrease with successive pregnancies up to five or more (0.2, [0.04-0.6]). Compared to women who had their first birth at age 24 or less, the OR for those who had it at 30 or older was 2.0, but the inverse trend in risk was not significant. However, among parous women only, age at first birth, but not parity, seemed to retain a certain influence. Late age at menopause seemed to decrease colorectal cancer risk (OR for menopause at age greater than or equal to 50 vs. less than 45 = 0.4, [0.2-1.0] chi 2(1) (trend) = 3.66). Conversely, age at last birth, number of abortions, years between marriage and first birth, age at menarche, pattern of menstrual cycle and occurrence of a few medical conditions potentially linked to female hormones were similarly reported by cases and controls. Due to the very limited number of oral contraceptive (OC) users (9 controls but only 1 case), and the lack of oestrogen replacement therapy users, the influence of exogenous female hormones on colorectal cancer could not be analysed meaningfully.

Age Factors↗
PubMed1991

Fats in seasoning and breast cancer risk: an Italian case-control study.

The relationship between consumption of fat in seasoning and risk of breast cancer was considered in a case-control study conducted in northern Italy of 2663 cases of breast cancer and 2344 controls admitted in the same network of hospitals with acute, non-neoplastic and non-gynaecological conditions. Subjective scores corresponding to three levels (low, intermediate and high) of intake of butter, margarine and oil, together with a combined variable of these three items ("total fat"), were used to evaluate the personal use of fat in seasoning. Compared to low use, a slight but significant increase in risk was observed for intermediate and high intake of butter, oil and total fat with relative risks of 1.5 (95% confidence interval [CI], 1.1-1.9) for high intake of butter, 1.3 (95% CI, 1.0-1.6) for high intake of oil and 1.4 (95% CI, 1.2-1.7) for high intake of total seasoning fat. These results were not materially modified after allowance for a number of identified potentially distorting factors. The results of this study suggest that there is a positive association, although moderate, between breast cancer risk and intake of fat added in seasoning, which may represent an indirect indicator of the subject's attitude towards fat.

Adult↗
PubMed1991

Anthropometric indicators of endometrial cancer risk.

The relation between selected anthropometric indicators and the risk of endometrial cancer was evaluated using data from a case-control study conducted in Northern Italy on 562 cases and 1780 controls in hospital for acute, non-neoplastic or hormone-related disease. There was no appreciable association between height and endometrial cancer: compared with the lowest quintile, the multivariate relative risks (RR) were 0.9, 0.9, 0.7 and 0.8 for each subsequent quintile. Weight was directly associated with risk (RR = 2.7 for top vs. bottom quintile), and the positive association was even stronger when indices of body mass which make allowance for height were considered: the relative risks for extreme quintiles were 3.4 for W/H2 (Quetelet's index, weight and height), 3.8 for W/H1.5 and 3.5 for W0.33/H. Surface area, which was positively correlated both with height and weight, showed a weaker direct association (RR = 2.4 between extreme quintiles). The relations with measures of body weight were apparently stronger in postmenopause, but the point estimates for the upper quintile were also around 2 in premenopausal women. Although the major findings of this study are not new, they provide more detailed information that was hitherto available on the relation between various anthropometric indicators and endometrial cancer risk. In relation to height, with the sample size of this study it was possible to exclude, at the conventional 95% probability, relative risks above 1.0 for the fourth and above 1.1 for the fifth as compared with the lowest quintile. This provides indirect evidence against the hypothesis that nutritional status early in life is related to the subsequent development of endometrial cancer.

Adult↗
PubMed1991

Assessment of screening for cancer.

Screening has a relevant role in and is likely to become an increasingly important instrument for cancer control in the near future. This overview summarizes some of the available evidence on the issue. Some of the opinions are well established. The apparent absence of consensus on other issues should be critically evaluated, too, because the evidence on some procedures is substantially more convincing than that on others. High costs, low compliance, poor curability, and substantial false positive rates, in a disease as relatively rare as cancer, often counterbalance in practice the theoretical benefits of diagnostic anticipation. In screening as well as in treatment for cancer, it is unlikely that major technical breakthroughs will occur in the near future. The evaluation of whether the benefits likely to be achieved by the screening program outweigh its disadvantages by a sufficient margin, therefore, should rely on large and carefully planned controlled studies.

Evaluation Studies as Topic↗
PubMed1991

Morphologic analysis of digestive cancers from the registry of Vaud, Switzerland.

Detailed data and statistics per each morphological site of various digestive neoplasms were obtained for the period 1976-87 from the Vaud Cancer Registry datafile, a population-based cancer registration scheme covering about 530,000 inhabitants from the French-speaking part of Switzerland. Tabulations presented include absolute number of cases (1,041 oral and pharyngeal, 545 oesophageal, 1,131 gastric, 83 small intestine, 1,980 colon, 1,267 rectal, 357 liver, 328 gallbladder and 725 pancreatic cancers), percent distributions, age-standardised rates, sex ratios and 5-year survival. The report has essentially a descriptive value, and should be viewed as a contribution towards quantification, in a well surveilled population of the West-central part of Europe, of the proportional distribution of digestive neoplasms by morphological type, and corresponding incidence and survival rates. Among the points deserving specific attention, there are the elevated frequency of upper digestive tract cancers, the very high male-to-female ratios for squamous cell carcinomas, adenocarcinomas of the oesophagus and hepatocellular carcinomas of the liver, the female excesses in infiltrating carcinoids of the colon, transitional and squamous cell carcinomas of the rectum and adenocarcinomas of the gallbladder, and the crossover in male-to-female ratio in squamous cell carcinoma along the digestive tract (i.e. from 6.0 at the level of the mouth/pharynx to 0.5 in the rectum). As concerns survival, rates were higher for lymphomas and sarcomas than for carcinomas in oral cavity and stomach, similar for carcinoids and carcinomas in the small bowel (about 35% at 5 years), as well as for colon (34%) and rectal (37%) cancers. Some of the findings, such as the higher survival of carcinomas arising from polyps in the colon and rectum, or the higher proportion of cholangiocellular and combined cholangio- and hepatocellular carcinomas in females than in males find plausible prognostic or aetiologic correlates, but others, such as the large proportions of squamous and transitional cell cancers of the rectum in females are more difficult to explain. These and several other indications emerging from careful examination of the data herein presented underline the interest of morphological analyses of digestive tract cancers.

Adult↗
PubMed1991

Medical history and the risk of multiple myeloma.

The relationship between various diseases and immunisations and the risk of multiple myeloma was analysed using data from a hospital-based case-control study conducted in Northern Italy on 117 patients with multiple myeloma and 477 controls. Associations were observed for clinical history of scarlet fever (relative risk, RR = 2.0; 95% confidence interval, CI = 1.1-3.9), tuberculosis (RR = 2.3%; 95% CI = 0.9-5.7) and BCG immunisation (RR = 3.0; 95% CI = 1.4-6.4). The relative risk was 1.8 (95% CI = 0.9-3.5) for episodes of Herpes zoster infection, but most of the excess cases occurred within 10 years of diagnosis, suggesting that this might have been an early manifestation of the disease. No association emerged for common childhood viral infections or any other immunisation practice. When various classes of infectious or inflammatory diseases were grouped together according to their aetiology, there was a significant positive association with chronic bacterial illnesses (RR = 1.8; 95% CI = 1.1-2.8), and the relative risk estimates increased with the number of bacterial diseases. The trend in risk with number of diseases was significant (chi 21 = 4.5, P = 0.03). A negative association was found between allergic conditions and risk of multiple myeloma (RR = 0.6; 95% CI = 0.3-1.0).

Adult↗
PubMed1991

Risk factors for gallstone disease requiring surgery.

Risk factors for cholelithiasis were investigated in a case-control study conducted in northern Italy on 195 incident cases of gallstone disease requiring surgery (119 females, 76 males) and 1122 controls in hospital for acute, non-digestive tract, non-neoplastic conditions. There was no consistent association with socio-demographic indicators, such as marital status, education and social class nor with smoking and coffee consumption. The relative risk of cholelithiasis decreased with increasing alcohol consumption: compared with non-drinkers, the odds ratio (OR) was 0.8 for one to three drinks per day and 0.5 for over three. A direct association was observed with measures of body weight: relative to leaner individuals, the multivariate ORs were 1.2, 2.1 and 2.4 for subsequent levels of body mass. These trends in risk were statistically significant, consistent in the two sexes, and not apparently modified by adjustment for major identified potential confounding factors. History of hepatitis and liver cirrhosis were reported more frequently by cases, but it is difficult to assess the role of recall bias on these risk factors. No association was found with diabetes, thyroid disease and several digestive tract disorders. For females, no consistent pattern of risk was observed up to four births, but women with five or more births had an OR of 2.9 (95% confidence interval (Cl) = 1.1-7.3). The risk decreased with increasing age at first and last birth, both trends being statistically significant. Overweight and alcohol consumption were the most important risk and protective factors respectively for cholelithiasis requiring surgical intervention in this population.

Adult↗
PubMed1991

Risk factors for human immunodeficiency virus infection in 581 intravenous drug users, northeast Italy, 1984-1988. The AIDS and Related Syndromes Study Group.

Prevalence and risk factors for human immunodeficiency (HIV) virus infection were assessed in 581 heterosexual intravenous drug users (IVDUs), recruited from eight public drug assistance centres in the northeast of Italy, an area at low risk for AIDS. The overall seroprevalence for HIV antibody was rather high, 39% (95% confidence interval (CI): 35-43%). HIV prevalence had risen from 32% in 1984-1985 to 52% in 1987-1988. Thirty-three per cent of female and 41% of male IVDUs had antibodies to HIV (p = 0.07). Seropositivity rates showed a strong east-west geographical gradient (from 16% to 60%, p = 0.005): IVDUs living in the western part of the study area had a nearly sevenfold higher risk of infection (odds ratio (OR) = 6.9, 95% CI: 4.4-13.9) than those living in the eastern part. Sharing of drug injection equipment (OR = 3.6), duration of drug addiction (OR = 2.6), use of heroin in high-incidence cities (OR = 2.3), use of cocaine in addition to heroin (OR = 1.5) and history of prostitution (OR = 2.3) increased the risk of acquiring HIV infection. Over the study period, the ORs associated with area of residence decreased, whereas those associated with the use of heroin in high-incidence cities and with prostitution increased.

Adult↗
PubMed1991

Dietary indicators of oral and pharyngeal cancer.

The relationship between frequency of consumption of a selected number of indicator foods and oral and oropharyngeal cancer risk was analysed in a case-control study conducted in Northern Italy on 105 cases of oral and pharyngeal cancer and 1169 controls in hospital for acute, non-neoplastic or digestive diseases. Besides significant and strong direct associations with tobacco (relative risk, RR = 11.0 for current versus never smokers) and alcohol (RR = 5.8 for upper versus lower consumption tertile), consumption of six food items (milk, meat, cheese, carrots, green vegetables and fruit) were inversely and significantly related to oral and pharyngeal cancer risk. The strongest protection was apparently related to frequent fruit consumption, with RRs of 0.8 and 0.2 in the two highest tertiles. Allowance for major potential confounding factors, including tobacco, alcohol and social class indicators explained only part of the dietary correlates observed. The two items remaining significant after multivariate analysis were fruit (RR = 0.3 for the upper tertile) and alcohol (RR = 3.8 for the upper tertile). The associations observed may simply reflect a generally poorer nutritional status in the cases, although the observation that fruit consumption appears to be a particularly important protective factor against oropharyngeal cancer is of potential interest, in terms of aetiological clues and preventive implications.

Adult↗
PubMed1991

Smoking habits and risk of benign breast disease.

The relationship between smoking habits and the risk of benign breast disease (BBD) was analyzed using data from a case-control study conducted between 1981 and 1983 in the greater Milan area, Northern Italy. Cases (n = 288) were women with histologically confirmed BBD (203 dysplasia, 85 benign tumours) referred to the National Cancer Institute of Milan for biopsies. Controls were women (n = 291) seen on selected days for a cytological smear for cervical cancer in outpatient clinics of the same Institute. No consistent association emerged between various indicators of smoking habits (smoking status, number of cigarettes smoked per day, duration of smoking) and the risk of BBD. Compared with never smokers the relative risk (RR) of all BBD combined was 0.7 (95% confidence interval, Cl: 0.4-1.3) in exsmokers, 1.4 (95% Cl: 0.8-2.5) in smokers of less than 10 cigarettes per day, and 1.1 (95% Cl: 0.7-1.7) in smokers of 10 or more cigarettes per day. There was some suggestion that the risk may be below unity post-menopause, but the relative risks for smokers were not statistically different in pre- (RR = 1.2; 95% Cl: 0.8-1.8) and post-menopausal (RR = 0.6; 95% Cl: 0.2-1.7) women. The risk of benign tumours (chiefly fibradenoma) was higher in current smokers, but this finding was not statistically significant (RR = 1.5; 95% Cl: 0.9-2.6) and the highest risks were observed in the strata of lighter smokers and those with shorter duration of smoking. Overall these results fail to support a negative association between smoking habits and benign breast disease.

Adenofibroma↗
PubMed1991

Cancer and non-cancer controls in studies on the effect of tobacco and alcohol consumption.

A comparison of risk estimates using controls with other cancers versus controls with acute diseases unrelated to tobacco and alcohol consumption in the study of the effect of these two factors has been performed using data on tumours of the oral cavity and pharynx from an ongoing case-control surveillance programme in Northeastern Italy. Similar results were obtained using either type of controls: as compared to never smokers, moderate smokers (less than or equal to 14 cigarettes/day) showed age- and sex-adjusted odds ratio (OR) = 5.2 (95% confidence interval (CI): 2.9-9.2) when using cancer controls and 5.8 (95% CI: 3.3-10.1) when using non-cancer controls. Similarly, those who had smoked for 40 years or longer showed ORs of 7.4 (95% CI: 4.0-13.6) and 8.8 (95% CI: 4.9-15.6), respectively, using cancer and non-cancer controls. For moderate drinkers of alcoholic beverages (21-34 drinks/week) and heavy drinkers (greater than or equal to 84 drinks/week) the ORs, as compared to individuals who drank less than 21 drinks/week, were 1.9 (95% CI: 1.0-3.6) and 2.2 (95% CI: 1.2-4.0) and 10.6 (95% CI: 5.5-20.6) and 11.4 (95% CI: 6.0-21.4) using cancer and non-cancer controls, respectively. The same comparability of ORs for tobacco- and alcohol-related variables using either type of controls was observed when separate analyses of the two sexes were performed. The close similarity between cancer and non-cancer controls in studies on tobacco- and alcohol-related risks may be exploited when the choice of other types of controls would increase the costs and the feasibility of the study, and thus hamper its statistical power.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1991

The clinical relevance of epidemiology: an overview.

Epidemiology is one of the areas of medical research which by definition should have immediate clinical implications, since its inferences are based on and apply to humans and should in theory be directly transferable to clinical and preventive measures. However, interchange of information has not always been easy, and this has constituted a substantial drawback to both the epidemiologist and the clinician. This review paper will provide some points for discussion, with special emphasis on cancer epidemiology and aspects of specific interest to the clinician, i.e., quantification and risk assessment for primary prevention and cost/benefit evaluation for secondary prevention and cancer treatment. Quantitative assessment is of major importance for the oncologist in at least three areas: cancer trends (descriptive epidemiology), cancer risks (analytical epidemiology), and preventive and therapeutic measures (clinical epidemiology).

Humans↗