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Biomedical subjects

S Franceschi

Publications and source records attributed to S Franceschi.

At least 613 records · Page 34Linked to original sources
PubMed1986

Oral contraceptives and cervical neoplasia: pooled information from retrospective and prospective epidemiologic studies.

A positive association between the use of oral contraceptives and the risk of cervical neoplasia has been suggested by different sources. This paper examines epidemiologic evidence on this issue through pooled computation of relative risks emerging from 21 studies, subdivided into three main categories: studies based on routine cytologic screening programs, case-control investigations and prospective studies. The pooled estimates of the relative risks for ever vs never use of oral contraceptives were broadly similar and slightly above unity (1.4 from cytologic screening programs, 1.1 from case-control and 1.4 from prospective studies). The risk increased with duration of use and, generally, lower relative risk estimates derived from the older studies, necessarily based on short-term use of oral contraceptives. A particularly limited increase in risk was apparent from case-control investigations. Furthermore, when allowance was made for the major covariates (mostly indicators of sexual habits), a noticeable decrease in the excess risk was evident. In conclusion, although statistical significance of moderate differences in risk can be obtained by pooling data from several studies, a risk of the magnitude of that for the association between oral contraceptives and cervical neoplasia may well be due to bias and confounding. In addition, since sexual behavior only indicates the probability of having been exposed to some sexually transmitted agent (most likely human papilloma virus), the greatest additional contribution may come from a case-control study in which adjustment for such exposure is possible.

Age Factors↗
PubMed1986

Determinants of oral contraceptive use in northern Italy.

Socio-demographic characteristics, general lifestyle habits, reproductive and medical histories were compared of 328 women who had ever used oral contraceptives and 2306 never users from a case-control surveillance conducted in Northern Italy. Oral contraceptive use was positively and strongly related with the level of education and indicators of social class. The rate ratio of ever use (adjusted for age and diagnostic category) was 3.3 for women with 12 years of education or more compared with less than 7 years, and 3.0 for women of highest compared with lowest social class. The frequency of pill use was lower among never married women, and significantly elevated among smokers (rate ratio = 2.4 for heavy smokers). In contrast, no relation was evident between alcohol or coffee consumption and pill use. Likewise, ever users of oral contraceptives were not significantly different from women who had never used the pill with regard to major reproductive factors (parity and age at first pregnancy) or several medical variables of potential interest (e.g., diabetes, hypertension, hyperlipidemia), with the only possible exclusion of obesity which was less frequent among pill users. Thus, this study indicates that the major determinants of the persistently low frequency of oral contraceptive use in this Northern Italian population are social rather than reproductive or medical factors. These findings have important implications for epidemiological research on oral contraceptive and disease in this population, and underline the importance of selection and screening of oral contraceptive users on the basis of knowledge of medical factors and lifestyle habits.

Adult↗
PubMed1986

Nutrition, social factors and prostatic cancer in a Northern Italian population.

The relationship between prostate cancer and indicators of nutrition, diet and social factors was evaluated in a case-control study of 166 patients with histologically confirmed prostatic carcinoma and 202 control subjects hospitalized for acute diseases other than malignant, hormonal or urogenital. The relative risk increased with increasing body mass index, men being moderately overweight showing a 2.3 elevated risk, and those grossly overweight an over four-fold higher risk of prostate cancer, when allowance was made for several identified potential confounding factors. Cases also reported more frequent consumption of milk and other dairy products and meat, but no significant difference was noted for vegetable intake. The risk of prostate cancer was unrelated to marital status or indicators of social class based on occupation.

Aged↗
PubMed1986

Oral contraceptives and cancers of the breast and of the female genital tract. Interim results from a case-control study.

We analysed data from a case-control investigation conducted in Milan, Northern Italy, to evaluate the relation between the use of combination oral contraceptives and the risk of cancers of the breast, ovary, endometrium and cervix uteri. For the present analysis, 776 cases of histologically confirmed breast cancer, 406 of epithelial ovarian cancer and 170 of endometrial cancer aged under 60 were compared with a group of 1,282 subjects below age 60 admitted for a spectrum of acute conditions apparently unrelated to oral contraceptive use or to any of the known or potential risk factors for the diseases under study. Likewise, 225 cases of invasive cervical cancer were compared with 225 age-matched inpatient controls, and 202 cases of cervical intra-epithelial neoplasia with 202 outpatient controls identified in the same screening clinics. The age-adjusted relative risk estimates for ever vs. never use of combination oral contraceptives were 1.04 (95% confidence interval (CI) 0.73-1.37) for breast cancer, 0.68 (95% CI = 0.48-0.97) for epithelial ovarian cancer, 0.50 (95% CI = 0.23-1.12) for endometrial cancer, 1.49 (95% CI = 0.88-2.55) for cervical cancer and 0.77 (95% CI = 0.50-1.18) for cervical intra-epithelial neoplasia. The risk of ovarian cancer decreased and that of invasive cervical cancer increased with longer duration of use. Neither duration of oral contraceptive use nor time since first or last use significantly altered a user's risk of other neoplasms considered. Likewise, analysis of sub-groups of age, parity or other potentially important covariates did not show any important interaction, and allowance for them by means of logistic regression did not materially modify any of the results. These data confirm that combination oral contraceptives confer some protection against ovarian and endometrial cancers but may increase the risk of invasive cervical cancer if used for several years, and indicate that the past or current pattern of oral contraceptive use in Italy is unlikely materially to affect the risk of breast cancer.

Adult↗
PubMed1986

Characteristics of women under 20 with cervical intraepithelial neoplasia.

The relationship between risk of cervical neoplasia and various sociodemographic, reproductive and sexual characteristics was studied in 126 women (cases) with an abnormal Papanicolaou test finding and 1914 controls seen at the same clinic in which cases were detected but showing no evidence of cervical neoplasia. All the subjects of this study were under the age of 20. Number of sexual partners and clinical occurrence of genital warts emerged as the most important determinants of the risk of cervical intraepithelial neoplasia (CIN) in these very young women (Relative Risk (RR) for three or more sexual partners = 2.45, 95% Confidence Interval (CI) 1.63-3.70, RR for occurrence of genital warts, adjusted for number of sexual partners = 9.15, 95% CI: 5.06-16.26). Also having grown up in a 'problem' family seemed to increase the probability of developing CIN (RR adjusted for number of partners = 1.64, 95% CI 1.06-2.52). For all other investigated characteristics, cases and controls were remarkably similar. These include socioeconomic status, parity, smoking habits, use of various contraceptive methods and also indicators of sexual activity such as age of first having sexual intercourse, and duration and frequency of intercourse. Although this group of women under 20 only allows the study of less severe precursors of cervical cancer, it helps to highlight the earliest effect of purported risk factors for cervical neoplasia, chiefly sexual habits, at a time very close to their being established.

Adolescent↗
PubMed1986

Cigarette smoking and the risk of cervical neoplasia.

The relationship between cigarette smoking and risk of cervical neoplasia was evaluated in a case-control study of 183 women with cervical intraepithelial neoplasia compared with 183 age-matched outpatient controls, and of 230 cases of invasive cervical cancer compared with 230 controls in hospital for acute conditions unrelated to any of the identified or suspected risk factors for cervical cancer. Current cigarette smoking was associated with an elevated risk of cervical intraepithelial neoplasia (relative risk = 1.76, 95 per cent confidence interval = 1.14-2.27) and of invasive cancer (relative risk = 1.69, 95 per cent confidence interval = 1.08-2.65). This association was only partially accounted for by a large number of identified potential confounding factors, including indicators of socioeconomic status and sexual habits. The risk increased with the number of cigarettes smoked and was apparently greater for women who started smoking at younger ages. The relative risk of intraepithelial neoplasia was elevated within 20 years after the start of smoking and showed little tendency to increase with increasing duration. On the other hand, the risk of invasive cervical cancer was apparently unaffected by smoking less than 20 years and increased steadily thereafter, reaching a point estimate of 3.63 after 40 years or more. If one assumes that intraepithelial neoplasia is an early stage of cervical cancer, this pattern of risk is consistent with the predictions from the multistage theory of carcinogenesis, if the effect of smoking is on one of the earlier stages. No obvious distorting factors, apart from the play of chance, is likely to produce such a risk pattern.

Adult↗
PubMed1986

[An epidemiological study on the relationship between oral contraceptives and benign breast disease].

The relationship of benign breast disease (BBD) and oral contraceptive (OC) use was analyzed in a case-control study conducted in Milan on 288 women with clinically relevant and histologically confirmed BBD (cases) and 285 age matched controls with a spectrum of acute conditions apparently unrelated to OC use. Compared to women who had never used OCs, the relative risk (RR) for users was 1.0 (95% confidence interval: 0.6-1.5). Likewise, there was no siginficant association with duration of use; however, a significantly lower relative risk emerged in women taking OCs during the year before breast biopsy (RR=0.4; 95% confidence interval: 0.2-0.8). The protection in current users increased with increasing duration of use. In spite of this finding, the overall results of the study do not support the hypothesis that OC use protects against development of histologically confirmed and clinically relevant benign breast disease.

Adenofibroma↗
PubMed1986

Coffee consumption and the risk of breast cancer.

The relationship of breast cancer to coffee drinking habits was evaluated in a case-control study of 616 women with breast cancer and 616 control subjects with nonmalignant disorders, apparently unrelated to coffee consumption. Compared with women who had never drunk coffee, the relative risk estimates for those women who drank less than two, two or three, and four or more cups each day were 1.5, 1.3, and 1.0, respectively. There was no apparent association with duration of consumption or use of other methylxanthine-containing beverages. The results were not modified by several potential confounding factors, including the major risk factors for breast cancer. The findings suggest that coffee consumption does not increase the risk of malignant neoplasms of the breast.

Adult↗
PubMed1985

Reproductive patterns and the risk of gestational trophoblastic disease.

The relation between reproductive pattern and the risk of gestational trophoblastic disease was evaluated in a case-control study conducted in Northern Italy on 310 women with histologically confirmed gestational trophoblastic disease and two control groups consisting of 290 obstetric subjects and 394 patients in hospital for acute, nonobstetric, nongynecologic conditions. Compared to that for nulliparous women, the estimated age-adjusted relative risk of trophoblastic disease for parous women was 0.6 (90% confidence limit = 0.4 to 0.9) when obstetric controls were used as a comparison group and 0.4 (95% confidence limit = 0.2 to 0.6) compared with other controls. Conversely, a history of spontaneous abortions was associated with elevated risk of gestational trophoblastic disease, and the risk increased significantly with increasing number of spontaneous abortions. When the combined effect of parity and spontaneous abortions was considered, the major factor influencing the risk of gestational trophoblastic disease was the existence of one or more previous term pregnancies.

Abortion, Habitual↗
PubMed1985

ABO blood-groups and the risk of gestational trophoblastic disease.

The relation between ABO blood group, mating patterns of patient/husband blood group, and the risk of gestational trophoblastic disease was investigated in a case-control study conducted in Milan on 286 women with histologically confirmed trophoblastic disease (245 benign hydatidiform moles and 41 persistent trophoblastic disease) and 433 control subjects admitted for normal delivery to the same hospitals where cases had been identified. ABO blood groups were associated with the risk of gestational trophoblastic disease (chi 2(6) for heterogeneity = 14.46, p = 0.02). Compared to women of group O or B, women of group A and AB had an elevated relative risk (RR) of benign mole (RR = 1.4 and 2.3, respectively). The risk estimates were higher for persistent trophoblastic disease, i.e., 2.2 for women of group A and 4.8 of group AB. The tests for linear trend in risk from benign to persistent disease were statistically significant in both A and AB groups. There was a significant interaction between blood group and age, since the ABO-related risk was elevated only for women over the age of 35. When mating combinations of maternal/paternal blood groups were considered, women of group A married to males of group O had a risk estimate not substantially different than those married to group A males.

ABO Blood-Group System↗
PubMed1985

Risk factors for benign breast disease and their relation with breast cancer risk. Pooled information from epidemiologic studies.

Information from published case-control studies on benign breast disease was pooled using standard statistical methods to obtain single, overall risk estimates. This analysis showed that higher socio-economic status (pooled relative risk, RR = 1.24, 95% confidence interval, CI = 1.13-1.37), later menopause (pooled RR = 1.87, 95%, CI = 1.67-2.11) and late age at first birth (pooled RR = 1.30, 95%, CI = 1.13-1.50) were associated with an increased risk of benign breast disease, whereas an apparent protection was given by greater body mass index (pooled RR = 0.58, 95%, CI = 0.50-0.67) and the use of oral contraceptives (pooled RR = 0.75, 95%, CI = 0.67-0.83). The role of these factors did not appear to be materially different in the various histopathologic categories considered, although available information allowed only a general distinction between breast dysplasia (fibrocystic disease) and benign tumors, chiefly fibroadenoma. In conclusion, the general evidence from published studies indicates that benign breast lumps appear to share a number of important risk factors with breast cancer.

Adolescent↗
PubMed1985

Menstrual cycle patterns and the risk of breast disease.

The relationship between menstrual cycle patterns and the risk of breast disease was evaluated using data from a hospital-based case-control study of 288 women with benign breast disease (203 chronic cystic diseases and 85 benign tumours), 317 with breast cancer and 602 age-matched controls with a spectrum of acute conditions unrelated to any of the established or potential risk factors for breast disease. A lifelong irregular menstrual pattern [defined as frequent occurrence of menstrual-like episodes of bleeding less than 21 or more than 35 days apart) was negatively associated with the risk of benign breast lesions (relative risk, RR = 0.6, with 95% confidence interval = 0.4-1.0) and of breast cancer (RR = 0.4, with 95% confidence interval = 0.3-0.8]. This inverse association could not be explained by any of the identified potential confounding factors, including the major risk factors for breast disease. The findings of this study, showing that a lifelong history of irregular (and hence more likely anovular) cycles was less frequent among women with benign and malignant breast diseases, support the hypothesis that frequent ovular cycles might be more carcinogenic than anovular ones.

Adolescent↗
PubMed1985

Characteristics of women undergoing induced abortion: results of a case-control study from Northern Italy.

In order to identify subgroups of women at elevated risk of induced abortion, personal characteristics and habits, selected medical histories and contraceptive practices of 873 women undergoing legal abortion in various areas of Northern Italy were compared with those of 504 control subjects identified in family planning clinics of the same hospitals or area health authorities. When age was allowed for, the risk of induced abortion was not strongly influenced by marital status, education or other indicators of social class. However, women who were employed, independently from the type of occupation, showed markedly lower abortion risks than housewives. Among various indicators of sexual habits investigated, the strongest determinant of legal abortion was the frequency of sexual intercourses over the previous six months, women with less frequent intercourses showing a markedly elevated risk estimate (RR = 2.82). Induced abortion was less frequent among ex-smokers and more frequent in heavy smokers, but was not appreciably influenced by several other indicators of lifestyle habits and history of gynaecological or psychiatric complaints. The risk of abortion was not influenced by the number of livebirths, but was lower for women with later age at first birth. Less than 5% of case and control subjects reported more than two previous induced abortions, thus indicating that abortion is more of an "accidental" event rather than a widespread contraceptive practice. However, over three-quarters of abortions occurred in women reporting no contraception at all or coitus interruptus, thus underlining the scope for family planning education in this population.

Abortion, Legal↗
PubMed1985

Reproductive and hormonal factors and breast cancer in a Northern Italian population.

Between January 1980 and March 1983, data were collected to evaluate risk factors for breast cancer in a case-control study based on 368 women with breast cancer admitted to the General Hospital of Pordenone (a district in North Eastern Italy with a particularly high breast cancer mortality rate), and 373 age-matched controls. Nulliparity or low parity, late age at first birth and later menopause were associated with an increased risk of breast cancer. The elevated risk associated with nulliparity could be almost completely explained by marital status, thus pointing to a specific protection given by parity, rather than some putative influence of infertility or subfertility in breast cancer cases. Likewise, risk did not vary materially according to history of abortions when marital status was controlled for. Increased risk associated with later age at first birth, on the other hand, was not accounted for by marital status or parity. The population studied, though frequently multiparous, showed late average at first birth: this might, at least partly, explain its high mortality rate from breast cancer. The risk estimate was higher if menarche occurred below age 15; however, there was no evidence of a trend for the relative risk to rise with lower age at menarche. The use of oral contraceptives or other female hormones (such as oestrogen replacement therapy) did not appear to be related to the risk of breast cancer. The role of the major menstrual and reproductive variables considered (age at menarche, parity, age at first birth) was apparently stronger in pre-menopausal women, thus suggesting an influence of these factors (and possibly, their hormonal correlates) on one of the latter stages of the process of carcinogenesis.

Abortion, Spontaneous↗
PubMed1985

Risk factors for gestational trophoblastic disease in Italy.

Between June 1981 and March 1983, data were collected to assess risk factors for gestational trophoblastic disease in a case-control study of 100 women with trophoblastic tumors (17 partial hydatidiform moles, 63 complete moles, and 20 choriocarcinomas) and 200 age-matched controls admitted for normal deliveries to university or general hospitals in Lombardy, Northern Italy. Questions were asked about each patient's general life-style, and medical, obstetric, menstrual, contraceptive, and social history. The risk of trophoblastic disease increased with increasing paternal age: women whose husbands were aged 40-44 years and 45 years or more had a relative risk of 2.4 and 4.2, respectively, compared to women married to men aged under 40 years. This association was independent of maternal age. Cigarette smoking was associated with trophoblastic tumors (relative risk estimate for smokers vs. never smokers = 2.0, 95% confidence interval = 1.2-3.2), the risk being greater for women who smoked more cigarettes and for longer. The effect of cigarette smoking was not explained by any other identified potential distorting factor. A positive history of fertility problems or difficulties in conception and a personal or family history of gestational trophoblastic disease were more common among the cases. Past use of oral contraceptives was not related to the risk of trophoblastic tumors, but use of an intrauterine device was significantly more common among the cases. The findings give epidemiologic support to the evidence of an androgenetic role in the origin of hydatidiform mole; moreover, they provide new hypotheses on the risk factors for gestational trophoblastic disease in developed countries. Further exploration of these factors may lead to a more coherent body of evidence on the etiology of these diseases.

Adolescent↗
PubMed1985

Benign breast disease and consumption of beverages containing methylxanthines.

The relationship between methylxanthine (Mx) consumption and benign breast disease was evaluated in a case-control study of 288 women with histologically confirmed benign breast lumps (203 dysplastic lesions and 85 benign tumors) and 2 groups of control women--285 patients in the hospital for acute conditions apparently unrelated to the consumption of Mx-containing beverages and 291 outpatients. The relative risk estimates of dysplastic breast lesions (fibrocystic disease), with allowance for all identified potential distorting factors, for women who drank 1-2 or 3 or more cups of coffee per day were 4.1 and 6.4, respectively, when the hospital controls were the comparison group and 2.0 and 3.7, respectively, when the outpatient controls were the comparison group. The relationship was even stronger when the total consumption of Mx-containing beverages (coffee plus tea) was considered and increased with increasing duration of use. The association was not explained by any of the major risk factors for fibrocystic breast diseases or by differences in general characteristics or other lifestyle habits between cases and controls. Mx consumption was not related to the risk of benign breast tumors (fibroadenomas). These findings support the hypothesis that Mx consumption is related to the risk of dysplastic lesions of the breast.

Adult↗
PubMed1985

Alcohol consumption and the risk of breast cancer in women.

The relationship between breast cancer and alcoholic beverage consumption was investigated in a case-control study of 437 women with breast cancer and 437 age-matched controls admitted to the hospital for acute conditions apparently unrelated to alcohol consumption. Compared to the relative risks (RR) for women who had never drunk alcohol, the RR for those reporting 1-3 and more than 3 alcoholic drinks per day were 1.24 and 1.93, respectively. A similar positive trend in risk with increasing daily consumption was evident for wine alone, and the point estimates were above unity for beer and spirits. Allowance for all identified potential confounding factors (including the major risk factors for breast cancer and a few selected dietary items) did not appreciably change any of the alcohol-related estimates. The RR, however, were higher at younger ages and did not rise with increasing duration of use. Nonetheless, the findings of the present study and their similarity with those of another case-control study conducted in northeastern Italy indicate that the association between alcoholic beverage consumption and breast cancer in this population is probably real, though not necessarily causal.

Adult↗