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D Palli

Publications and source records attributed to D Palli.

At least 127 records · Page 7Linked to original sources
PubMed1989

A case-control study of gastric cancer and diet in Italy.

A case-control study was conducted in high- and low-risk areas of Italy to evaluate reasons for the striking geographic variation in gastric cancer (GC) mortality within the country. Personal interviews with 1,016 histologically confirmed GC cases and 1,159 population controls of similar age and sex revealed that the patients were more often of lower social class and resident in rural areas and more frequently reported a familial history of gastric (but not other) cancer. After adjusting for these effects, case-control differences were found for several dietary variables, assessed by asking about the usual frequency of consumption of 146 food items and beverages. A significant trend of increasing GC risk was found with increasing consumption of traditional soups, meat, salted/dried fish and a combination of cold cuts and seasoned cheeses. The habit of adding salt and the preference for salty foods were associated with elevated GC risk, while more frequently storing foods in the refrigerator, the availability of a freezer and use of frozen foods lowered risk. Reduced GC risk were associated with increasing intake of raw vegetables, fresh fruit and citrus fruits. Lowered risk was also related to consumption of spices, olive oil and garlic. Neither cigarette smoking nor alcoholic beverage drinking were significantly related to GC risk. The case-control differences tended to be consistent across geographic areas, despite marked regional variations in intake levels of certain foods. The high-risk areas tended to show higher consumption of food associated with elevated risk (traditional soups, cold cuts) and lower consumption of foods associated with reduced risks (raw vegetables, citrus fruits, garlic). Our findings indicate that dietary factors contribute to the regional variation of stomach cancer occurrence in Italy, and offer clues for further etiologic and prevention research.

Age Factors↗
PubMed1989

Time interval since last test in a breast cancer screening programme: a case-control study in Italy.

STUDY OBJECTIVE: To evaluate a population based screening programme for breast cancer. DESIGN: This was a case-control study of women dying of breast cancer between 1977 and 1987 who had been invited to take part in a screening programme. SETTING: Community based study of women aged between 40 and 70 years (total population about 35,000 at 1981 census), living in 23 small towns near Florence, Italy. PARTICIPANTS: 103 cases were identified from death certification, and 515 living controls (five per case) selected for year of birth and town of residence. MEASUREMENTS AND MAIN RESULTS: Screening history was obtained from computer archive. Sociodemographic information was obtained from town registry offices and directly from relatives of the deceased and from the controls by postal questionnaire, and if necessary telephone or personal interview. Analysis was carried out on two age groups--40-49 years and 50+ years at diagnosis--and considered the number of screening tests and the time interval since the last test, separately and together. In the older age group, women with at least one screening test in the previous 2 1/2 years showed a 50% reduction in risk (odds ratio 0.49, 95% confidence interval [CI] 0.25-0.95). If they had also had another previous negative screen the risk was reduced to one third (odds ratio 0.35, 95% CI 0.14-0.85). There was a significant trend of decreasing risk with increasing number of screens in older women. No clear evidence of a similar protective effect was shown for women in the 40-49 year age group. CONCLUSIONS: A significant protective effect of the screening programme is evident in older women but not in younger ones. The data do not allow an assessment of optimal screening interval because of the small number of previously screened cases.

Adult↗
PubMed1988

Selection of high-risk groups for breast cancer screening. Evidence from an Italian multicentric case control study.

In recent years techniques for the selection of risk groups for high priority breast screening have been evaluated. We used data from a large multicentric case control study in Italy, recently published, to fit a reduced logistic model for predictive purposes, using variables which are easily collected. The predicted probability of being a case obtained through the logistic analysis was then used to classify the same set of data by calculating values of sensitivity and specificity at different cutoff points of the predicted probability. The results showed the low predictive power of the model. The selection of higher risk groups in a screening population program is discussed.

Adult↗
PubMed1988

Plasma and tissue CEA and TPA markers in operable breast cancer. Preliminary results.

CEA and TPA were studied in sera and in histologic specimens of 200 patients with benign (77) or malignant (123) breast pathology. The frequency and expression of the two markers was different in benign and in cancer tissues. Histologic positivity and high levels of circulating markers were observed more frequently in cancer patients than in patients with benign disease. Tissue positivity for the two tumor markers did not always correlate with elevated levels of circulating markers. Positive CEA and TPA incidence was higher in tissue samples than in serum samples. In the breast cancer group, among 33 patients with histologic positivity for CEA, only 5 cases had circulating CEA levels higher than 5 ng/ml; among 91 patients with histologic positivity for TPA, only 45 cases showed circulating levels for TPA higher than 95 U/l. These findings confirm that tumor size, secretory characteristics and vascular supply are factors affecting the achievement of high circulating marker levels. Combined marker measurement in serum and tissues can provide more information about the presence of a given tumor marker. A limited evaluation of the prognostic meaning of the study of combined CEA and TPA in sera and in tissues was carried out during the follow-up of 60 evaluable patients. Only 5 patients had cancer relapses in the first 12 months from surgery; in 2 of 5 patients TPA was positive initially and at the time of recurrence, in serum as well as in tissues. Circulating CEA gave negative findings in all relapsed patients; 2 of them showed weak positivity only in the histologic staining at the time of presentation.

Adult↗
PubMed1988

Gastric cancer in a high-risk area in Italy. Histopathologic patterns according to Lauren's classification.

Two thousand five hundred forty cases (1628 males and 912 females) of primary gastric cancer (GC) histologically diagnosed in gastroscopic biopsy or resected specimens, occurring from 1973 to 1982 in a high risk area in Italy (Florence), were reviewed. According to Lauren's criteria, 1587 (62.5%) were classified as intestinal type, 624 (24.6%) as diffuse type and 329 (12.9%) as mixed unclassified. The intestinal type is more frequent in males and increases in both sexes with advancing age; conversely for the diffuse type. In the two 5-year periods (1973-1977 and 1978-1982) the intestinal type shows a reduction over time more evident in females than in males, in contrast to the increasing trend for the diffuse type. In males, the distribution of Lauren's histologic types is stable over time for resected specimens, whereas there is a significant reduction of intestinal type for biopsy specimens. In females, both for resected and biopsy specimens there is a reduction of the intestinal type and an increase of the diffuse type from the first to the second period. For a subgroup of 297 subjects two different specimens were available (gastroscopic biopsy and surgical); sensitivity and positive predictive value, for biopsy specimen as compared with the resected one, in the diagnosis for Lauren's histologic types were calculated. An excess of diagnoses in the mixed/unclassified category for biopsy material was evident (positive predictive value = 44.3%). However, for the two main histologic types, the biopsy appears a quite reliable indicator of the final diagnosis on surgical material (intestinal: ppv = 88.6%; Diffuse: ppv = 87.0%). The study supports the hypothesis that the reduction in GC mortality in the Province of Florence in recent years may be associated with a moderate reduction in the frequency of the intestinal type.

Adult↗
PubMed1988

Short term increase in risk of breast cancer after full term pregnancy.

To determine whether there is a short term increase in the risk of breast cancer after a full term birth data from two hospital based, case-control studies in Italy were pooled. Analysis was restricted to women aged under 50 with two or more children (573 women with cancer and 570 controls). A relative risk for breast cancer of 2.66 was seen in women who had given birth during the three years preceding the interview compared with women whose last birth had occurred 10 or more years before, after adjustment for age, age at first birth, and parity. The relative risk slowly decreased for women who had last given birth three to 10 years before. Multivariate analyses confirmed the protective effect of an early age at first birth and the age dependent effect of parity on the risk of breast cancer--that is, a direct relation below age 40 and an inverse one in older women. These data provide epidemiological evidence that a full term birth is followed by a transient increase in the risk of breast cancer, which for some time contrasts with and overcomes the long term protection of pregnancy at an early age. They therefore confirm predictions from animal studies and theoretical models that pregnancy prevents the early stages of breast carcinogenesis but promotes the late stages of the process.

Adult↗
PubMed1988

Prognostic significance of estrogen receptor determination in primary breast cancer.

The authors report on 767 consecutive primary Stage I-II breast cancer cases followed-up from 3 to 8 years. The estrogen receptor (ER) content was determined in all cases and did not influence the treatment choice. A correlation was attempted between ER and menstrual or pathological nodal status (N) or the 5-year disease-free survival (DFS). ER was correlated with menopausal status ER+ cases being more frequent in postmenopausal patients, whereas no correlation was observed between ER and nodal status. In absence of nodal involvement (N-) the prognosis was not influenced by the ER status. A significantly better DFS was evident for ER+ respect to ER- patients in the N+ series but such a correlation is questionable as the adjuvant treatment (hormone or chemotherapy) given to such patients may have influenced the DFS according to the ER status. According to the present study, ER determination should not be used as a discriminant in the performance of adjuvant postoperative treatment based on a prognostic judgment.

Adult↗
PubMed1988

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↗
PubMed1987

Diagnostic and prognostic role of infrared thermography.

A series of 469 breast cancer studied by physical examination (PE), mammography (M) and infrared thermography (TH) is discussed. Follow-up was performed up to 5 years later. The poor diagnostic role of TH is proven for the low sensitivity in the total series (0.47) and, particularly, in T1 cancers (0.26). TH does not increase significantly the cumulative sensitivity (0.98 vs. 0.97 in the total series). Its limited advantage is offset by the great number of useless biopsies due to TH false positive. A correlation between TH pattern and prognosis is evident only when TH is considered independently from other reliable prognostic indicators such as the T or N categories. If survival curves are stratified by T or N or if a multivariate analysis based on TH, T and N variables is performed, all correlations between TH pattern and prognosis disappear; for this reason the use of TH as a prognostic indicator in the clinical practice is disregarded.

Age Factors↗
PubMed1986

Gastric cancer: histopathologic patterns according to Lauren's classification in a high-risk area and distribution by residence.

A total of 1061 advanced gastric cancers with histologic confirmation, diagnosed from 1973 to 1982 at the Morgagni-Pierantoni Hospital (Forlì) were reclassified according to Lauren, and histologic types were related to the source of the histologic specimen, sex, age at diagnosis, place of birth and residence. This large case series showed a high percentage of intestinal type cancers, consistent with the high risk for gastric cancer which characterizes the area under study. Intestinal type carcinomas tend to be represented more in the older age groups, in males and in subjects born in the Forlì province and resident in hilly and mountainous areas. The distribution over time of biopsy specimens in this case series showed an increased use of gastroscopy for diagnosis in the population under study.

Adult↗
PubMed1986

A case-control study of the efficacy of a non-randomized breast cancer screening program in Florence (Italy).

In a rural area near Florence a population-based screening program for breast cancer was started in 1970, offering a mammography test every 2.5 years to all women between 40 and 70 years of age. In order to evaluate the efficacy of this program a case-control study has been carried out comparing the screening history of all women who died from breast cancer in this area in the years 1977-1984, and who had been diagnosed after the start of the program, with that of a matched group of living controls. The case-control study showed that the overall O.R. of dying from breast cancer in the study period for "screened" versus "never-screened" women was 0.53 (95% C.I. = 0.29-0.95). After evaluation of other variables as potential confounders the adjusted O.R. estimates were respectively 0.57 (95% C.I. = 0.35-0.92) and 0.32 (95% C.I. = 0.20-0.52) for women screened only once or at least twice. No significant protective effect was shown for women below the age of 50 years.

Adult↗
PubMed1986

[Minimal carcinoma of the breast].

For many years pathologists have argued about the definition and the biologic reasons of what is "early", "minimal" and "occult" breast cancer. Whether these terms really identify entities which today can be meaningful to clinicians and whether the prognostic significance of breast cancer measuring 1 cm or less in diameter should have implications in the treatment decision making will form the subject of this review.

Breast Neoplasms↗
PubMedDate not supplied

"Cervia Working Group Report": guidelines on the diagnosis and treatment of Helicobacter pylori infection.

Different national attitudes exist between countries in Europe concerning eradication of Helicobacter pylori infection due to the wide differences in Helicobacter pylori prevalence, gastric cancer risk, bacterial resistance to antibiotics, health care systems and financial resources. The Cervia Working Group Report has been established in order to fill the gap in the absence of National Guidelines in Italy concerning the diagnosis and treatment of Helicobacter pylori infection. The recommendations made are, by and large, similar to the European Guidelines but differ slightly with regard to the "test-and-treat" approach to young dyspeptics without sinister symptoms. In the absence of a national validation of this strategy a case-by-case assessment of dyspepsia has been promoted, both at primary care and specialist level. Another area of partial disagreement concerns the eradication of Helicobacter pylori in patients undergoing long-term proton pump inhibitor treatment which has not been generally recommended as scientific evidence in support of this policy is at present rather weak.

Anti-Bacterial Agents↗
PubMedDate not supplied

Expression of nm23 gene in gastric cancer is associated with a poor 5-year survival.

The nm23 gene is thought to play a role as an inhibitor of metastatic progression in several human cancers and its down-regulation has been associated with increased metastasis and reduced survival in some studies, though not in others. To better investigate the role of nm23 in gastric cancer (GC), the expression and prognostic impact of this gene was examined in 107 radically operated GC patients in a high risk area. The expression of nm23 was determined immunohistochemically by using the rabbit antibody anti-human nm23 protein. The expression of nm23 was detected in 40.2% (n = 43) of 107 gastric tumours and correlated with a poorer clinical outcome. In a survival analysis at 5 years, patients with nm23-positive tumours had significantly worse prognosis than patients (n = 64) with nm23-negative tumours (p < 0.05). The prognostic significance of nm23 expression was confirmed by multivariate analysis including terms for tumour stage and lymph node involvement. Our results suggest that the expression of the nm23 gene in gastric carcinoma is significantly related to tumour progression and poor prognosis at 5 years.

Adult↗
PubMedDate not supplied

Gastric cancer in Italy.

Although Gastric Cancer (GC) death rates are decreasing worldwide, in high risk areas GC is still a major public health problem. Italy is one of the European countries with the highest mortality rates for GC (males: 17.3; females: 8.2 x 100,000 inhabitants in 1987) which represents the third cause of death due to cancer in 1987, accounting for over 14,000 deaths per year (10% of cancer deaths). Reasons for the geographic variability in GC occurrence within the country are reviewed, discussing the results of two recent analytical epidemiological studies carried out in Italy. These large case-control studies focused on dietary factors, involving high and low-risk areas for GC (Florence, Siena, Forlì, Imola, Cremona, Genoa, Cagliari, and Milan). Low socio-economic status, family history of GC, residence in rural areas were associated to GC risk, while migration from southern areas and body mass index were inversely related to GC. Consumption of traditional soups, meat, salted and dried fish, cold cuts and seasoned cheeses, as well as the intake of animal proteins and nitrites were related to an increased GC risk. On the contrary consumption of fresh fruit, citrus fruit, raw vegetables, spices, garlic and olive oil, and vitamin C, E and beta-carotene intake were found to be protective factors. Among diet-related factors, preference for salty foods and frequent broiling were positively related to GC, while the longstanding availbility of a refrigerator or freezer and the habits of consuming frozen foods were associated with decreased GC risk. These results are discussed in detail, considering the main hypotheses on GC carcinogenesis.

Case-Control Studies↗
PubMedDate not supplied

Plasma pepsinogens, nutrients, and diet in areas of Italy at varying gastric cancer risk.

In a survey of 930 adults aged 35-74 years randomly sampled from the general population of four areas of Italy at different risks for gastric cancer (GC), plasma levels of pepsinogens (PGI and PGII) and fat-soluble vitamins were assayed. Pepsinogen levels were used to identify individuals with chronic atrophic gastritis (CAG). Severe CAG (PGI < or = 20 pg/liter) affected 5.8% of the population, but the prevalence rose with increasing age and declining social class. Severe CAG was 5 times more common in areas with high compared to low rates of GC. Risk also rose with increasing consumption of salted/dried fish but was inversely related to dietary intake of beta-carotene and to plasma retinol and cholesterol levels. The prevalence of moderate CAG (PGI > 20 pg/liter, but PGI/PGII < or = 2.9) was 6.3%. Moderate CAG was also related to age and social class and increased 1.8-fold in areas where GC rates were high, but was not strongly associated with diet or plasma nutrients. The authors discuss these findings in relation to those from a previous case-control study of GC in the same areas.

Adult↗