Biomedical subjects

A Tavani

Publications and source records attributed to A Tavani.

At least 91 records · Page 5Linked to original sources

PubMed1997

Epidemiology and prevention of oral cancer.

Descriptive epidemiology of oral and pharyngeal cancer over the last four decades is reviewed, with specific focus on Europe. Substantial rises in mortality rates have been observed for younger males, mostly in eastern Europe. The independent role of alcohol and tobacco and their interaction on oral carcinogenesis is discussed, since these factors account for about three quarters of oral cancers in Europe. The influence of dietary factors, and in particular of a diet poor in fresh fruit and vegetables on oral carcinogenesis, is also discussed, since diet may account for 10-15% of oral cancer cases in Europe. Finally, among other carcinogens, the possibility of human papillomavirus involvement in the aetiology of cancer of the oral cavity and pharynx is overviewed. Implications for prevention are discussed.

Adult↗

PubMed1997

Beta-carotene intake and risk of nonfatal acute myocardial infarction in women.

There are indications that beta-carotene, but not pre-formed vitamin A, is protective on the risk of acute myocardial infarction (AMI). The relationship between nonfatal AMI and the intake of beta-carotene and retinol was investigated in a case-control study conducted between 1983 and 1992 in northern Italy on 433 women with nonfatal AMI and 869 controls in hospital for acute, non-cardiovascular, non-neoplastic, non-digestive, non-hormone related conditions. Odds ratios (OR), with their 95% confidence intervals (CI), were computed by unconditional multiple logistic regression analysis, including terms for age, education, body mass index, smoking, alcohol and coffee drinking, menopausal status, hormone replacement therapy and history of diabetes, hypertension and hyperlipidemia. The risk of AMI was inversely related to beta-carotene intake, with an OR of 0.5 (95% CI: 0.3 to 0.8) for the highest quintile of intake compared to the lowest (chi2 trend = 10.53, p < 0.01). Retinol intake was not associated with AMI, with an OR of 0.9 (95% CI: 0.6 to 1.3) for the highest quintile of intake compared to the lowest. Analysis in separate strata of covariates indicated that the inverse association of beta-carotene intake with risk of AMI was appreciably stronger in younger, lean women with no history of diabetes or hypertension, and in current smokers. The results of this study indicate that the risk of nonfatal AMI in women is inversely related to intake of beta-carotene containing foods, but not foods containing retinol.

Adolescent↗

PubMed1997

Margarine intake and risk of nonfatal acute myocardial infarction in Italian women.

OBJECTIVES: Since a relation between trans-fatty acids and cardiovascular diseases has been described, we examined the relationship between margarine intake and nonfatal acute myocardial infarction (AMI) in Italian women. DESIGN: Hospital-based case-control study. SETTING: Northern Italy between 1983 and 1992. SUBJECTS: Cases were 429 women, aged 18-74 y, in hospital with diagnosis of AMI and 866 controls in hospital for acute, non-cardiovascular, non-neoplastic, non-digestive, non-hormone-related conditions. ANALYSIS: Odds ratios (OR), with their 95% confidence intervals (CI), were computed by unconditional multiple logistic regression analysis, including terms for age, education, body mass index, smoking, alcohol and coffee drinking, menopausal status, hormone replacement therapy and history of diabetes, hypertension and hyperlipidemia. RESULTS: Medium or high intake of margarine was associated with an increased risk of AMI (multivariate OR 1.5, 95% CI 1.0-2.2). Analysis in separate strata of covariates indicated that the association was independent of body mass index, history of hypertension and hyperlipidemia, and was greater in older women and in current smokers. CONCLUSIONS: If real, the association with margarine could explain about 6% of AMI in this population of Italian women.

Adolescent↗

PubMed1997

Alcohol consumption and risk of pancreatic cancer.

The relation between pancreatic cancer and alcohol consumption was investigated in a case-control study conducted in Milan, Northern Italy, between 1983 and 1992 on 361 incident histologically confirmed cases and 997 controls admitted to hospital for acute nonneoplastic diseases apparently unrelated to alcohol and tobacco consumption. Compared with teetotalers, the multivariate odds ratio (OR) of pancreatic cancer, after adjustment for age, sex, education, smoking status, and history of diabetes, pancreatitis, and cholelithiasis, were 0.9 for alcohol drinkers and 0.9, 1.1, 1.4, and 1.1 for those who consumed up to four, more than four to seven, more than seven to eight, or more than eight alcoholic drinks per day; none of the estimates or the trend in risk was significant. OR were also close to unity in the separate analysis of wine, beer, and spirit intake, with no trend in risk, and no relationship was observed for duration of use (OR = 0.7 for > 40 yrs of use). No interaction was observed between pancreatic cancer and total alcohol intake in separate strata of age, sex, education, and smoking status. Thus the findings of the present study, on the basis of a population with relatively frequent and high alcohol consumption, provide epidemiologic evidence that even high alcohol intake does not appreciably modify the risk of pancreatic cancer.

Aged↗

PubMed1997

Diet and risk of lymphoid neoplasms and soft tissue sarcomas.

The relationship between frequency of intake of selected indicator foods, lymphoid neoplasms, and soft tissue sarcomas was investigated in an updated case-control study conducted in Northern Italy between 1983 and 1992 on 158 incident, histologically confirmed cases of Hodgkin's disease (HD), 429 cases of non-Hodgkin's lymphoma (NHL), 141 cases of multiple myelomas, 101 cases of soft tissue sarcomas, and 1,157 controls admitted to hospital for acute, nonneoplastic diseases unrelated to long-term modifications of diet. Compared with the lowest tertile, the odds ratio (OR) for the highest tertile of milk intake was 1.8 for NHL and 1.9 for sarcomas. Liver intake was an indicator of the risk of HD (OR = 1.8), NHL (OR = 1.6), and myelomas (OR = 2.0), ham an indicator of HD (OR = 1.7), and butter an indicator of myelomas (OR = 2.8). A high consumption of green vegetables was inversely related to myelomas (OR = 0.4), and frequent use of whole-grain foods was inversely related to NHL (OR = 0.4) and soft tissue sarcomas (OR = 0.2). No material association with meat was observed for any of the neoplasms considered. Likewise, coffee and alcohol intakes were not associated with lymphoid neoplasms and soft tissue sarcomas. The OR for the highest tertile of intake of beta-carotene ranged between 0.5 and 0.7, whereas the OR for retinol ranged between 1.5 and 2.3. Although available data do not point to any specific inference, this study suggests that certain aspects of diet are a correlate or an indicator of the risk of lymphoid neoplasms and soft tissue sarcomas.

Adolescent↗

PubMed1997

Hormone replacement treatment and breast cancer risk: an age-specific analysis.

The relationship between hormone replacement treatment (HRT) and breast cancer risk was considered in age-specific groups of women, combining data from two case-control studies conducted between 1983 and 1994 in six Italian centers. Cases were comprised of 5984 women, below age 75 years, with histologically confirmed breast cancer, and controls were comprised of 5504 women admitted to the hospital for a wide spectrum of acute, nonneoplastic, nonhormone-related diseases. Ever-use of HRT was reported by 6.1% of the cases and 5.5% of the controls, corresponding to a multivariate odds ratio (OR) of 1.2 [95% confidence interval (CI), 1.0-1.4]. A significant trend in risk with duration of use was observed. Separate analysis for women < 55, 55-64, and 65-74 years old at diagnosis showed that the excess risk of breast cancer associated with ever-use of HRT was not observed in the youngest age group (OR, 0.9) and increased with age at diagnosis to 1.2 (95% CI, 0.9-1.5) for women 55-64 years old and 1.6 (95% CI, 1.2-2.3) for those 65-74 years old at diagnosis. A significant trend in risk with duration was observed only in the oldest group (65-74 years old), with ORs of 1.6 (95% CI, 1.1-2.3) and 2.2 (95% CI, 1.1-4.7), respectively, for < 60 and > or = 60 months of use. Thus, this study suggests that the relationship between HRT and breast cancer risk is influenced by age at diagnosis and that any risk-benefit assessment is particularly critical for women using HRT several years after menopause.

Adult↗

PubMed1997

Histamine-2-receptor antagonists and oesophageal cancer.

Peptic ulcer and gastrectomy are associated with an increased risk of oesophageal cancer. We considered the relation between treatment with histamine-2 (H-2)-receptor antagonists and subsequent risk of oesophageal cancer. Data from a case-control study conducted between 1984 and 1995 in northern Italy were used. These comprised 407 incident, histologically confirmed cases and 1168 controls admitted for acute, non-neoplastic, non-digestive tract conditions, unrelated to known risk factors for oesophageal cancer. Ten (2.5%) cases and 52 (4.5%) controls reported using H-2-receptor antagonists at some time, corresponding to a multivariate odds ratio (OR) of 0.5 (95% confidence interval 0.2-1.0). The OR was 0.4 for subjects who had started use seven years earlier or less, and 0.6 for those who had started use more than seven years ago. These findings indicate that risk of oesophageal cancer is not increased among H-2-receptor antagonist users. This trend to protection may be explained in terms of chance alone, or may be partly related to a possible favourable impact of H-2-receptor-antagonists on chronic oesophageal carcinogenesis.

Adult↗

PubMed1997

Attributable risks for kidney cancer in northern Italy.

The percent population attributable risk (AR) for kidney cancer was estimated in relation to smoking habits, beta-carotene intake, history of cystitis and family history of kidney cancer, using data from a case-control study conducted between 1985 and 1989 in Milan, northern Italy. The data comprised 133 histologically confirmed cases of incident kidney cancer and 392 controls, admitted to hospital for a wide range of acute, non-neoplastic, non-smoking-related diseases. On the basis of multivariate odds ratios (ORs), smoking habits accounted for about 26% of cases, a low beta-carotene intake for 18%, a history of cystitis for 7%, and a family history of kidney cancer in first-degree relatives for 3% of cases. Ever smoking and low beta-carotene intake combined explained 38% of all kidney cancers, and the combination of these two factors plus a history of cystitis and a family history of kidney cancer explained 45% of the incidence of the disease. Thus, even if available, dietary information was limited and the AR estimates were based on somewhat arbitrary assumptions. A considerable proportion of kidney cancers could be avoided simply by eliminating smoking and increasing consumption of fruit and vegetables in this Italian population. This would mean that about 1,500 kidney cancer deaths every year in the whole of Italy could be avoided.

Adolescent↗

PubMed1996

Abortion and breast cancer risk.

The relationship between spontaneous and induced abortions and breast cancer risk was analyzed using data from a case-control study conducted between June 1991 and February 1994 in 6 Italian centers on 2,569 histologically confirmed incident breast cancer cases and 2,588 controls admitted to hospital for a wide range of acute, non-neoplastic, non-hormone-related diseases. One or more abortions were reported by 31% of cases and 32% of controls, corresponding to a multivariate odds ratio (OR) of 1.0 (95% confidence interval [CI], 0.8-1.1). No trend in risk was observed with increasing number of total abortions or spontaneous and induced abortions separately. No significant relationship was found between the risk of breast cancer and history of spontaneous or induced or total abortions in separate strata of age at diagnosis, number of children, time of abortion in relation to first birth and family history of breast cancer. When abortion was the outcome of the first pregnancy, the OR was 1.2 for spontaneous and 1.3 for induced abortion, in relation to women with birth as outcome of the first pregnancy, and 1.0 and 1.1, respectively, when the reference category was nulligravidae. Thus, our results indicate a lack of association between induced and spontaneous abortions and breast cancer risk.

Abortion, Induced↗

PubMed1996

Package inserts of oral contraceptives in Italy.

To evaluate the understandability and the validity of information included in package inserts of the 20 main oral contraceptive (OC) preparations sold in Italy, we systematically tabulated the indications, contraindications and side-effects listed in their patient information leaflets. OC information leaflets included, in their vast majority, only contraception as indication, with no mention of endometriosis, dysmenorrhea, or other menstrual cycle disorders, which are potential indications for OC use. In contrast, information leaflets included an extremely detailed, but largely acritical, list of contraindications and side-effects, in the absence of any quantitative indication on their frequency and importance. These include, among others, depressive symptoms, visual impairments, or endometrial hyperplasia, which is indeed an indication for combined OC use. Such acritical and poorly explained information on potential, but often unproven, side-effects may cause confusion and lead to withdrawal from OC use for some women, in the absence of any real contraindication. In contrast, some real contraindications or serious side-effects, including cervical neoplasia, hepatomas, liver cancer or myocardial infarction, were not reported in OC leaflets. The incomplete data, and particularly the absence of quantitative information on OC leaflets, may cause negative attitudes of women towards their use, decreased compliance, and, however indirectly, be a determinant of the low prevalence of OC use among Italian women.

Journal Article↗

PubMed1996

Food and nutrient intake and risk of cataract.

The relationship between cataract extraction and diet was considered in a case-control study conducted in northern Italy. A total of 207 patients who had cataract extraction and 706 control subjects in a hospital for acute, nonneoplastic, nonoculistic, nondigestive tract diseases were interviewed during their hospital stay. Odds ratios (ORs) and their 95% confidence intervals (CIs), according to the intake of alcohol, coffee, tea, and cola, and frequency of intake of 34 food items and 8 micronutrients were derived from multiple logistic regression equations, including terms for age, sex, education, smoking status, body mass index, diabetes, and total calorie intake. Alcohol, coffee, decaffeinated coffee, tea, and cola intakes were not associated with cataract extraction. Among food items, reduced ORs for cataract extraction (highest tertile of intake compared to the lowest), with a significant inverse trend in risk, were found for intake of meat (OR 0.6, 95% CI 0.4 to 0.9), cheese (OR 0.7, 95% CI 0.5 to 1.0), cruciferae (OR 0.5, 95% CI 0.3 to 0.8), spinach (OR 0.6, 95% CI 0.4 to 0.9), tomatoes (OR 0.5, 95% CI 0.4 to 0.8), peppers (OR 0.7, 95% CI 0.4 to 1.1), citrus fruit (OR 0.5, 95% CI 0.2 to 1.3), and melon (OR 0.5, 95% CI 0.4 to 0.8). A significant increase in risk was found for the highest intake of butter (OR 2.8, 95% CI 1.2 to 6.4), total fat (OR 1.8, 95% CI 1.2 to 2.8), and salt (OR 2.4, 95% CI 1.4 to 4.0) compared to the lowest, and for consumption of oil other than olive oil (OR 1.6, 95% CI 1.1 to 2.2). Among micronutrients, lower ORs for cataract extraction (highest quintile of intake compared to the lowest) were found for intake of calcium (OR 0.5, 95% CI 0.3 to 0.8), folic acid (OR 0.4, 95% CI 0.2 to 0.7), and vitamin E (OR 0.5, 95% CI 0.3 to 1.0), while estimated intakes of methionine, retinol, beta-carotene, and vitamins A, C, and D were not associated. Thus, this study indicates that diet plays a considerable role in the risk of cataract extraction in this Italian population, with a protective action played by some vegetables, fruit, calcium, folic acid,and vitamin E, and an increased risk associated with elevated salt and fat intake.

Adult↗

PubMed1996

Menstrual and reproductive factors and hip fractures in post menopausal women.

OBJECTIVES: We analyzed the relationship between menstrual and reproductive history and risk of hip fractures in post-menopausal women using data from an Italian case-control study. METHODS: Cases were 206 post-menopausal women admitted for fractures of the hip proximal femur to a network of teaching and general hospitals in Milan, Italy. The comparison group consisted of 590 post-menopausal women admitted to the same network of hospitals for acute, non-neoplastic, non-hormone-related conditions, other than traumatic or orthopedic disorders. Odds ratios (OR) of hip fracture were derived from unconditional multiple logistic regression. RESULTS: No relation emerged between risk of hip fractures and age at menarche, lifelong menstrual cycle pattern and age at menopause. In comparison with women with age at menopause > or = 53 years, the multivariate OR of hip fractures were 1.2, 1.1, 1.2 and 0.5 in women with menopause at 50-52, 45-49, 40-44 and before 40 years (X2(1) trend 0.21). In comparison with nulliparae, the estimated age-adjusted OR was 0.6 (95% confidence interval, CI, 0.4-0.9) for parous women, but the multivariate estimate was not significant (OR 0.8, 95% CI 0.6-1.3) and the multivariate trend in risk with number of births was not significant either. No relation emerged between hip fractures and age at first and last birth, and history of abortions. CONCLUSIONS: This study found no relevant influence of menstrual and reproductive factors on the risk of hip fractures in post-menopausal women. However, this is not in contrast with the observation of a short-term effect of menopause and more in general. female hormone levels on osteoporosis and hence on hip fractures.

Abortion, Induced↗

PubMed1996

Menstrual and reproductive factors and biliary tract cancers.

The relationship between the risk of biliary tract cancers and menstrual and reproductive factors has been studied in a case-control study conducted in Milan, northern Italy, between January 1984 and February 1993 on 31 incident, histologically confirmed cases and 377 controls in hospital for acute, non-neoplastic, non-gynaecological, non-hormone-related conditions. Odds ratios (ORs) together with their corresponding 95% confidence intervals (CIs) and the significance of the linear trends in risk were estimated by unconditional multiple logistic regression, after adjustment for age and cholelithiasis. Menopause was associated with a decreased risk of biliary tract cancers (OR 0.2), while late menopause and the use of hormone replacement therapy tended to increase the risk (ORs 1.8 and 2.2 respectively). Age at menarche and regular menstrual cycles were not associated. A trend in risk was found with parity, while total abortions and age at first and last birth were not related. Thus, the protective effect of early menopause and the apparent association of multiple full-term pregnancies suggest a role of female hormones in the aetiology of biliary tract cancers.

Abortion, Induced↗

PubMed1996

Tobacco and other risk factors for oesophageal cancer in alcohol non-drinkers.

Information on the aetiology of oesophageal cancer in alcohol non-drinkers will help us to understand and quantitate risk factors for the disease in the absence of alcohol. Out of a total of 316 cases with histologically confirmed incident cancers of the oesophagus, 40 (22 men and 18 women) who described themselves as alcohol non-drinkers were considered. These patients were compared with 151 alcohol non-drinkers (79 men and 72 women) admitted to hospital for acute, non-neoplastic, non-alcohol-, non-smoking-related conditions. The major risk factor for cancer of the oesophagus in non-drinkers was current elevated cigarette smoking: compared with never smokers, the odds ratio (OR) for all current smokers was 3.4 [95% confidence interval (CI), 1.5-8.1]. The OR was 0.8 (95% CI 0.2-3.4) for ex-smokers, 1.3 (95% CI 0.4-4.2) for current smokers of fewer than 20 cigarettes per day and 7.5 (95% CI 2.7-20.4) for current smokers of more than 20 cigarettes per day. Risk also increased with duration of smoking (OR 4.9 for more than 30 years smoking), and in smokers starting the habit when aged 25 or younger (OR 3.9). Few years of education and gastrectomy were also associated with elevated risk, while a high fruit intake was associated with reduced risk (OR 0.6 and 0.4, respectively, for 7-13 and > 13 portions per week compared with < 7). When the combined effect of smoking and fruit intake on the risk of oesophageal cancer was considered, compared with non-smokers eating more than 7 fruit portions per week, the OR for current smokers eating 7 or less fruit portions per week was 7.3. Thus, even in the absence of alcohol drinking, cigarette smoking and a diet poor in fruit are important avoidable risk factors for oesophageal cancer.

Adult↗

PubMed1996

Breast size and breast cancer risk.

The relationship between brassière size, as an indicator of breast size, and breast cancer risk was considered in a case--control study conducted between 1991 and 1994 in six Italian centres. Cases were 2,557 women, below age 75, with histologically confirmed breast cancer, and controls were 2,566 women admitted to hospital for a wide spectrum of acute, non-neoplastic, non-hormone-related diseases. Odds ratio (ORs) of breast cancer and their 95% confidence intervals (CIs) were obtained from multiple logistic regression equations including terms for study centre and age, as well as main breast cancer risk factors. A slight inverse relationship was observed between breast size and the risk of breast cancer, with an OR of 1.37 (95% CI 1.05-1.80) for the smallest brassière size compared with the largest; the increase in risk disappeared after adjustment for main recognized breast cancer risk factors, with an OR of 1.16 (95% CI 0.87-1.54) for brassière size < or = 1 compared with > or = 5. No significant heterogeneity in risk of breast cancer with breast size was found in strata of age at diagnosis, parity, age at first birth, age at menopause, family history of breast cancer, benign breast disease, ever use of oral contraceptives and/or hormone replacement therapy. Thus, this study, based on large number of caucasian women, provides conclusive evidence of a lack of appreciable association between breast size and breast cancer risk in this Italian population.

Adult↗

PubMed1996

Oral contraceptives and cancer. A review of the evidence.

The following review considers epidemiological data published from 1990 onwards on oral contraceptives (OCs) and the risk of cancers of the breast, cervix uteri, endometrium, ovary, liver and skin. In several studies, breast cancer risk was seen to be elevated among women who were current users of an OC, or had recently stopped using an OC, whereas there was no residual risk 5 or more years after stopping OC use. No interaction was observed between type of OC, or with any recognised risk factor for breast cancer, or time-factor, except for some potential excess risk for women who started OC use at a young age. Most studies have confirmed that OCs moderately increase the risk of cervical cancer, particularly in human papilloma virus (HPV)-positive women, thus suggesting that OCs may act as a promoter for HPV-induced carcinogenesis. Recent epidemiological studies have confirmed that combined OCs provide substantial protection against endometrial and ovarian cancers, and results suggest that such protection is long-lasting, and may persist for 15 years or more after stopping OC use. Most case-control studies have shown a relationship between OC use and hepatocellular carcinoma. However, data from cohort studies or analysis of vital statistics indicate that the public health impact of such an association is modest, if not negligible. No association was observed between combined OC use and the incidence of skin melanoma, or any other common skin neoplasm. In terms of clinical and public health implications, the most relevant points regarding OC use are: (i) recent data confirm that OCs confer presistent protection against ovarian cancer; and (ii) any increased risk of breast cancer in OC users is moderate and is restricted to current/recent users. This is reassuring for younger women, whose baseline risk of this disease is extremely low.

Contraceptives, Oral, Hormonal↗

PubMed1996

Adverse effects of preventive therapy in humans.

The main adverse effects of tamoxifen, aspirin, oral contraceptives (OCs) and retinoids used as chemopreventive agents in humans are reviewed and quantified here. With regard to tamoxifen, there are suggestions of some excess risk of liver, and perhaps gastrointestinal, cancers. The public health impact of such associations, if any, is still unclear. Tamoxifen use is associated with endometrial and myometrial hyperplasia. Data from five studies based on 174 cases indicate that the overall relative risk (RR) of endometrial cancer in ever tamoxifen users is 1.73 (95% confidence interval = 1.1-2.6). However, there is a significant difference between the results of American and European studies, so the relationship between tamoxifen and endometrial cancer remains open to debate. The major side-effect of aspirin is gastrointestinal lesions; the risk of these is increased two- to tenfold, depending on the dose. Aspirin is also associated with an increased risk of haemorrhagic stroke, although its protection against other types of stroke and against myocardial infarction leads to a favourable pattern of risk for all cardiovascular conditions. Short-term side-effects of OCs include vascular diseases and a moderately increased risk of breast cancer. The RR of cervical cancer and hepatocellular carcinoma are also increased in OC users, although the public health impact of such associations is small. Toxicity associated with retinoid treatment is rarely serious as most effects observed are reversible on stopping use. Side-effects include changes in the skin and mucous membranes (dry skin, hair loss, dry nose, conjunctivitis), musculoskeletal symptoms, ophthalmological effects, changes in transaminase activity, changes in clinical chemistry markers (increase in serum triglycerides and decrease in high-density lipoproteins) and, rarely, central nervous system effects. A serious toxicological aspect of retinoid treatment is teratogenesis; its use should therefore be avoided in women with childbearing potential, and, in cases of use, conception should be delayed for a long time after stopping treatment. Thus, when considering side-effects of chemoprevention, the major issues of concern are the rare long-term effects (chiefly neoplasms), and the need for more precise overall risk-and cost-benefit assessment, particularly for healthy people.

Anticarcinogenic Agents↗

PubMed1996

[Biliary tract tumors].

Biliary tract cancers are rare neoplasms including gallbladder cancer (the commonest), extrahepatic biliary tract cancer and cancer of the ampulla of Vater. Descriptive epidemiology of biliary tract cancers as a whole has two peculiarities: incidence and mortality rates are higher for women than men, and in some specific populations. Mortality rates are highest among New Mexico American Indian women, in Chile and Japan, lowest in Great Britain and Greece. Mortality trends vary widely: the largest increases have been observed in Japan, Hong-Kong and Spain and the largest decreases in the Anglo-Saxon populations. Our knowledge of biliary tract cancer etiology is limited. Defined risks include genetic factors (family history of biliary tract cancers, ethnicity), history of gallbladder disease, and cholelithiasis. Risk factors reported in some studies, on which, however, information is not consistent and which need further study, include overweight, some menstrual and reproductive factors (multiparity, young age at first birth, late menopause), low education, cigarette smoking, selected bacterial infections, some intestinal diseases and diabetes.

Adolescent↗