Changes in breast cancer mortality in Italy.
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Breast Neoplasms↗
Biomedical subjects
A Decarli
Publications and source records attributed to A Decarli.
Risk factors for HIV infection in drug addicts from the northeast of Italy.
Prevalence and determinants of HIV infection were assessed in 313 parenteral drug addicts admitted to five Centers for Drug-Addict Assistance and two prisons located in the northeast of Italy (Friuli Venezia-Giulia), an area some distance from the major Italian cities first reached by the AIDS epidemic. The overall prevalence of HIV positivity was also rather high in this area, ie 30% with 24-36% confidence interval. The most important risk factors (besides syringe sharing applicable to all drug addicts), turned out to be of a geographical nature, ie living in Pordenone province (where a US military base is located) or coming from other endemic areas and having travelled long distances in the past three years. Prostitution also seemed to increase the risk of infection, but duration of drug addiction had little effect. In addition to persistent generalized lymphadenopathy (closely linked to HIV infection), reversal of helper:suppressor T-cell ratio was found in 67% of HIV positive individuals, but also in 31% of HIV negative ones. Clinical signs and symptoms strongly linked with HIV positivity were fatigue, weight loss, splenomegaly, fever and nocturnal sweats.
Adolescent↗
Smoking and prevalence of disease in the 1983 Italian National Health Survey.
The relation between smoking habits and selected chronic diseases was evaluated from the data of the 1983 Italian National Health Survey, based on 72,284 people aged 15 or over randomly selected within strata of geographical area, size of place of residence and of the household in order to be representative of the whole Italian population. The prevalence of all the 19 diseases or groups of diseases considered was elevated among ex-smokers, thus suggesting that the presence of any chronic condition stimulates cessation of smoking. The excess prevalence among ex-smokers was particularly large for myocardial infarction and other heart diseases. Four groups of diseases were positively related with current as well as with past cigarette smoking. These were chronic bronchitis, emphysema of the lung or respiratory insufficiency, gastroduodenal ulcer and varicose veins or haemorrhoids. For all these groups of diseases the relative risks were higher in heavy cigarette smokers. Compared with never smokers, the point estimates for subjects smoking 15 cigarettes per day or more were 2.6 for chronic bronchitis, 1.7 for emphysema of the lung, 2.1 for gastroduodenal ulcer and 1.6 for varicose veins or haemorrhoids. For bronchitis, ulcer and varicose veins or haemorrhoids the relative risks tended to be higher in younger and middle age groups. From these data, it was estimated that in the whole of Italy a total of about 900,000 prevalent cases of chronic bronchitis, 270,000 of emphysema, 610,000 gastroduodenal ulcers and 380,000 varicose veins or haemorrhoids could be associated with cigarette smoking.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Risk factors for breast cancer: pooled results from three Italian case-control studies.
The role of menstrual and reproductive factors, family history, and body weight in the epidemiology of breast cancer has been reassessed in a meta-analysis of three large case-control studies of breast cancer from several Italian regions, for a total data set of 4,072 cases and 4,099 controls. Multiple logistic regression equations were used to obtain relative risks adjusted for study, center, age, and various combinations of risk factors considered. Relative to women with menarche at age 15 or over, those with earlier menarche had a 20-30% higher breast cancer risk. However, there was no tendency for the risk to increase with lower age at menarche, and the association with menarche was stronger at younger age. The risk of breast cancer was directly related to age at menopause (relative risk (RR) = 0.7 for less than 45 years vs. greater than or equal to 50 years), age at first live birth (RR = 1.8 for greater than or equal to 28 years vs. less than 22 years), and family history of breast cancer in first-degree relatives (RR = 2.0). The effect of these factors was similar in various age strata. After allowance for age at first live birth, the risk of breast cancer did not differ among women with one to four live births, but it was significantly below unity (RR = 0.6) for those with five or more live births. Furthermore, there was a clear modifying effect of age at diagnosis on parity-related risk, since parous women had elevated breast cancer risk below age 35 and reduced risk above age 40.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Body weight and the prevalence of chronic diseases.
The relation between body mass index and prevalence of 17 chronic diseases or groups of diseases was analysed using data from the 1983 Italian National Health Survey, based on a sample of 72,284 individuals aged 15 or over randomly selected within strata of geographical area, size of place of residence and of household in order to be representative of the whole Italian population. The prevalence of diabetes was directly and strongly related to body weight (age-adjusted relative risk estimates being 1.5 for overweight and 2.7 for obese men compared with normal weight individuals; 1.6 and 2.4 for overweight and obese women). Other conditions directly related to self-reported measures of body weight were hypertension (relative risk = 1.7 for obese men and 1.9 for women), myocardial infarction (relative risk = 1.5 for obese men, 1.6 for women), other heart diseases (relative risk = 1.7 for obese men, 1.5 for women), haemorrhoids or varices (relative risk = 1.2 for obese men, 1.5 for women), cholelithiasis (relative risk = 1.2 for obese men, 1.4 for women), urolithiasis and arthritis. Chronic respiratory disorders showed a U-shaped relation to measures of body weight, since their prevalence was elevated in both under- and over-weight individuals. Anaemias and gastroduodenal ulcer showed an inverse relation to body weight, whereas no association was apparent with allergy, liver cirrhosis, and psychiatric or neurological disorders. Allowance for the two major identified covariates (education and smoking) failed to explain the observed variations between measures of body weight and disease, while separate inspection of various strata of age indicated that for most diseases the elevated risks of obesity were higher in younger and decrease steadily with advancing age. Thus, the results of this national survey indicate that overweight has a widespread and substantial impact not only on mortality but also on morbidity from different chronic conditions.
Adolescent↗
Decline of childhood cancer mortality in Italy, 1955-1980.
The decline in childhood cancer mortality in Italy from 1955 to 1980 has been evaluated through (1) comparison of age-specific and age-standardized (0-14 years) rates for the periods 1955-1960 and 1979-1980 and (2) computation of expected numbers of deaths by application of the age-specific rates for the period 1955-1960 to the population structure of subsequent periods. Certified mortality fell by 35% for leukaemias, 90% for Hodgkin's disease, 30% for non-Hodgkin's lymphomas, 40% for bone sarcomas, 30% for kidney (Wilms') tumours, 65% for retinoblastoma. No clear trend was reported for other neoplasms, including neuroblastoma. About 300 cancer deaths per year were avoided in the period 1979-1980 compared with the expected number based on the 1955-1960 rates (170 for leukaemias alone). Although clearly encouraging, these trends are substantially less favourable than those from several other developed countries. It is therefore likely that several dozen other deaths from childhood cancer could be avoided each year through earlier (or more accurate) application of effective therapies, particularly for neoplasms requiring radiotherapy or surgical treatment.
Adolescent↗
Epidemiological aspects of diet and cancer: a summary review of case-control studies from northern Italy.
The major findings on dietary aspects of cancer risk are reviewed from a series of hospital-based case-control studies conducted in Northern Italy. Information collected using simple frequency questionnaires indicated that green vegetable consumption was inversely related with the risk of cancers of the breast and of the female genital tract, as well as with oesophageal and gastric neoplasms, whereas there were positive associations between fats in seasonings and other foods (e.g., meat) and cancers of the breast, ovary, endometrium and prostate. Fruits, and specifically citrus fruits, were inversely related with cancers of the oesophagus and of the stomach, and there were positive associations between various sources of starches (but not fibres) and gastric cancer risk. Thus, extremely simplified questionnaires apparently permitted identification of a number of significant and consistent differences between cancer cases and hospital-based comparison groups, which were not obviously explainable in terms of selection, confounding, information or other biases. Nonetheless, epidemiological evidence on diet and cancer from this and several other investigations is rather crude and imprecise and, hence, its implications in terms of public health policy are still open to question.
Diet↗
Coffee drinking and prevalence of bronchial asthma.
The relationship between coffee consumption and the prevalence of bronchial asthma has been evaluated using data from the 1983 Italian National Health Survey, based on 72,284 individuals aged over 15 years randomly selected within strata of geographic area, size of the place of residence and of the household in order to be representative of the whole Italian population. The prevalence of bronchial asthma was inversely related with the level of coffee intake. Compared with subjects who did not drink coffee, the age- and sex-adjusted relative risks were 0.95 for one cup, 0.77 for two and 0.72 for three or more cups per day. This inverse relation was of comparable magnitude at younger and older ages, not explainable through selection, since the sample was representative of the general Italian population and the participation rate was 93.4 percent, or through confounding by several identified potential distorting factors. Thus, the results of this survey provide epidemiologic confirmation of previous clinical observations that caffeine intake has a bronchodilator effect in asthma, and indirectly suggest that long-term moderate coffee consumption may not only reduce symptoms, but also prevent the clinical manifestation of bronchial asthma. An alternative explanation of these findings is that subjects receiving treatment for asthma might tend to reduce their coffee consumption, in consequence of the side effects shared by sympathomimetics, theophylline and caffeine. Thus, further studies taking simultaneously into account methylxanthine intake from beverages and drug treatments are required before considering causal the apparent protection which emerged.
Adolescent↗
Cancer mortality in Switzerland, 1951-1984: effects of age, birth cohort and period of death.
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Age Factors↗
Trends in cancer mortality in Switzerland, 1951-1984.
Trends in overall age-standardized, truncated (35-64 years) and age-specific (40 to 49) cancer death certification rates in Switzerland from 1951 to 1984 were analysed. There was a substantial rise in lung cancer mortality in males, with an over 100% increase in overall rates. Thus, in the early 1980's, lung cancer alone accounted for 26% of all cancer deaths in Swiss males. However, male lung cancer rates tended to level off in subsequent cohorts starting from younger middle age in the late 1960's. In females, lung cancer mortality was approximately ten times lower than in males, but rates had been consistently rising since the late 1960's in all age groups. Declines were observed for several neoplasms of the digestive tract: besides stomach (overall decline 68% in males, 77% in females), trends were markedly downwards also for oesophageal cancer in males (-57%), and there was some moderate fall for intestinal sites in both sexes and gallbladder in females. Several trends for other common neoplasms were similar to those observed in other developed countries, such as the declines for (cervix) uteri, the general stability for breast cancer, or the increases in pancreatic cancer and (melanoma) of the skin. A peculiar feature of Swiss data, besides the marked decline in oesophageal cancer in males, was the consistent downward trend in thyroid cancer for both sexes. Thus, overall age-standardized total cancer mortality over the last three decades was moderately upwards in Swiss males, but consistently downwards in females. Male trends were more reassuring in middle age, chiefly in consequence of the flattening in lung cancer rises. Possible interpretations of these trends in terms of aetiological hypotheses (i.e., changes in alcohol drinking and improvements in diet for oesophageal cancer, or reduced prevalence of iodine deficiency for thyroid neoplasms) are discussed.
Adult↗
Effects of age, birth cohort and period of death on Swiss cancer mortality, 1951-1984.
Swiss death certification data over the period 1951-1984 for total cancer mortality and 30 major cancer sites in the population aged 25 to 74 years were analysed using a log-linear Poisson model with arbitrary constraints on the parameters to isolate the effects of birth cohort, calendar period of death and age. The overall pattern of total cancer mortality in males was stable for period values and showed some moderate decreases in cohort values restricted to the generations born after 1930. Cancer mortality trends were more favourable in females, with steady, though moderate, declines in both cohort and period values. According to the estimates from the model, the worst affected generation for male lung cancer was that born around 1910, and a flattening of trends or some moderate decline was observed for more recent cohorts, although this decline was considerably more limited than in other European countries. There were decreases in cohort and period values for stomach, intestine and oesophageal cancer in both sexes and (cervix) uteri in females. Increases were observed in both cohort and period trends for pancreas and liver in males and for several other neoplasms, including prostate, brain, leukaemias and lymphomas, restricted, however, for the latter sites, to the earlier cohorts and hence partly attributable to improved diagnosis and certification in the elderly. Although age values for lung cancer in females were around 10-times lower than in males, upward trends in female lung cancer cohort values were observed in subsequent cohorts and for period values from the late 1960's onwards. Therefore, future trends in female lung cancer mortality should continue to be monitored. The application of these age/period/cohort models thus provides a summary guide for the reading and interpretation of cancer mortality trends, although it cannot replace careful inspection of single age-specific rates.
Adult↗
A case-control study of diet and gastric cancer in northern Italy.
Dietary factors in the aetiology of stomach cancer were investigated using data from a case-control study conducted in Northern Italy on 206 histologically confirmed carcinomas and 474 control subjects in hospital for acute, non-digestive conditions, unrelated to any of the potential risk factors for gastric cancer. Dietary histories concerned the frequency of consumption per week of 29 selected food items (including the major sources of starches, proteins, fats, fibres, vitamins A and C, nitrates and nitrites in the Italian diet) and subjective scores for condiments and salt intake. Pasta and rice (the major sources of starch), polenta (a porridge made of maize) and ham were positively related with gastric cancer risk, whereas green vegetables and fresh fruit as a whole (and specifically citrus fruit) and selected fibre-rich aliments (such as whole-grain bread or pasta) showed protective effects on gastric cancer risk. Allowance for major identified potential distorting factors (chiefly indicators of socio-economic status) reduced the positive association with pasta or rice consumption, but did not appreciably modify any of the other risk estimates. When a single logistic model was fitted including all food items significant in univariate analysis, the 3 items remaining statistically significant were green vegetables (relative risk, RR = 0.27 for upper vs. lower tertile), polenta (RR = 2.32) and ham (RR = 1.60). Indices of beta-carotene and ascorbate intake were negatively and strongly related with gastric cancer risk, but the association with these micronutrients was no longer evident after simultaneous allowance for various food items. An approximately 7-fold difference in risk was found between extreme quintiles of a scale measuring major positive and negative associations.
Adult↗
Coffee consumption and risk of pancreatic cancer.
The relationship between pancreatic cancer and coffee, decaffeinated coffee and tea drinking habits was evaluated using data from a hospital-based case-control study conducted in Northern Italy on 150 histologically confirmed cases and 605 controls with acute, non-neoplastic, other than digestive tract diseases unrelated to coffee consumption or to any of the known or potential risk factors for cancer of the pancreas. Compared with subjects who did not drink coffee, the multivariate relative risks were 1.7 for those who drank less than 2 cups per day, but only 1.4, and 1.1 respectively for drinkers of 3 or 4 and 5 or more cups. Likewise, there was no association with duration of consumption of coffee, decaffeinated coffee or tea. These findings were reviewed together with published evidence from other case-control studies (or cohort studies analyzed as case-control) of coffee and pancreatic cancer. When appropriate statistical methods were used to pool information, and the data from the first study which was the basis of the hypothesis were omitted, the relative risk of pancreatic cancer based on 1,464 cases was 1.2 for moderate coffee drinkers and 1.4 for heavy drinkers, and we suspect that at least part of this moderate residual association is confounded by cigarette smoking. Thus, although the present investigation and a general overview of published epidemiological evidence are compatible with a small effect of coffee on pancreatic carcinogenesis, interpretation of these findings is not obvious on account of the possibility of residual confounding and other sources of bias.
Adult↗
Cancer mortality in Italy, 1981.
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Adult↗
The probability of cancer death in Italian males and females.
Probabilities of cancer death in Italian males and females over the calendar period 1955 to 1980 were computed from age-specific death certification rates for various neoplasms and contemporary general life tables of the whole Italian population. There were substantial increases in eventual probabilities of total cancer mortality: from 16.9 to 27.1% for males and from 15.2 to 19.3% for females. The upward trends were particularly large for lung (from 1.9 to 7.2%) and other tobacco-related sites in males. In females, the largest increases were for neoplasms of the intestines (from 1.6 to 3.0%) and breast (from 1.9 to 3.1%). Separate analyses of probabilities of cancer death in specific age intervals showed more limited changes in middle age, and some moderate decrease at younger ages, probably attributable to improved treatment. The probability estimates presented are clearly based on criticizable assumptions, since they do not allow for any potential subsequent change in mortality and are inappropriate for analyzing the evolution of cancer rates because they reflect (in opposite directions) trends in cancer mortality and in all other causes of death. Nonetheless, a correct interpretation of these estimates does provide some important information from a public health viewpoint, in terms of resource allocation and health care planning, and can help quantify the increasing demand for oncologic services and structures over the next few decades.
Actuarial Analysis↗
Birth cohort, time, and age effects in Italian cancer mortality.
Italian death certification data from 1955 to 1979 for total cancer mortality and 30 cancer sites in the population aged 25 to 74, were analyzed using a log-linear Poisson model to isolate the effects of birth cohort, calendar period of death, and age. The most frequent cohort pattern was characterized by increases up to the generations born between 1920 and 1930, followed by stabilization or a slight decrease. This pattern was evident for total cancer mortality in men, and for several common sites, including larynx, lung, esophagus, bladder, female breast, and ovary. Only four sites (pancreas, pleura, intestines in both sexes, and kidney in men) showed cohort values still rising in more recent generations. Stable cohort and period of death curves were observed for cancers of the prostate and testis, whereas trends were steadily going down for neoplasms of the stomach, and (cervix) uteri. Finally, there were a few discontinuous trends (e.g., in the case of brain neoplasms, leukemias, and lymphomas), which probably reflect different effects of improvements in diagnosis and/or treatment. Period of death values increased for lung and other tobacco related sites (chiefly in males) and, up to the early 1970s, for a few other common sites, including intestines, and the female breast. Downward trends over the calendar period were evident for cancers of the stomach and of the (cervix) uteri. Therefore, total cancer mortality trends over the calendar period of death were moderately increasing for men, and slightly decreasing for women.
Adult↗
Cigarette smoking and the risk of endometrial cancer.
The risk of endometrial cancer in relation to cigarette consumption was evaluated in a hospital-based case-control study of breast and genital neoplasms conducted in Milan, northern Italy. For the present analysis, 357 women (cases) with histologically confirmed endometrial cancer were compared to a group of 1122 women (controls) admitted for a large spectrum of acute conditions unrelated to smoking or to any of the known or potential risk factors for endometrial cancer. Compared with never-smokers, the multivariate relative risk estimates were for current 0.45 [95% confidence interval (CI) = 0.30-0.70] and 0.86 (95% CI = 0.50-1.46) for ex-smokers. The negative association of endometrial cancer with current smoking was not influenced by menopausal status as well as by other major identified potential confounding factors, i.e. menstrual and reproductive history, body mass index, oral contraceptive or estrogen replacement therapy use and family gynecologic cancer history. However, there was no evidence of a dose-risk effect, since the relative risks were similar in moderate and heavy smokers. The present study confirms that smoking is less frequent in cases hospitalized for endometrial cancer than in a comparison group of patients with non-smoking-related acute conditions. This negative association is perhaps explained in terms of reduced estrogen levels in smokers, though the influence and the importance of some uncontrolled selection bias (due, for instance, to longer hospital stay of smokers even when admission diagnosis was for non-smoking-related conditions) cannot be ruled out.
Adult↗
Menstrual and reproductive factors and the risk of myocardial infarction in women under fifty-five years of age.
The relationship between menstrual and reproductive factors and subsequent risk of coronary heart disease was investigated in a hospital-based case-control study of 202 women with acute myocardial infarction and 374 control subjects admitted for a wide spectrum of acute conditions unrelated to any of the established risk factors for ischemic heart disease. No consistent association was observed with age at menarche or menopausal status, but women with a lifelong irregular menstrual cycle pattern were at significantly elevated risk of myocardial infarction (relative risk = 1.8, 95% confidence interval = 1.1 to 2.9). No clear trend in risk was evident with the number of livebirths, miscarriages, or induced abortions. However, women whose first pregnancy or livebirth occurred before age 20 years showed elevated risks of subsequent myocardial infarction compared with nulliparous ones (relative risks = 2.3; 95% confidence interval = 1.1 to 4.9), and there was a significant trend of increasing risk with earlier first birth. These associations were evident in both younger and middle-age women and were not explained by allowance for several identified potential confounding factors.
Adult↗