PubMed Health⌕ Search

Biomedical subjects

E Negri

Publications and source records attributed to E Negri.

At least 487 records · Page 27Linked to original sources

Smoking in Italy, 1986-1987.

Smoking trends and patterns in Italy were evaluated using data from the 1986-87 Italian National Health Survey, based on a sample of 30,096 males and 32,176 females aged 15 or over, randomly selected within strata of geographical areas and sizes of the place of residence and of the household in order to be representative of the whole Italian population: 40.8% of Italian males and 17.3% of females described themselves as current smokers (overall estimated prevalence, 28.6%). In comparison with previous survey-based data, self-reported smoking prevalence in males has been steadily decreasing over the last three decades, whereas rates in females have been increasing up to the early 1980s, and have shown a levelling off only in more recent years. The apparent declines in self-reported smoking, however, were not reflected in official sales figures. In fact, in the mid 1980s, there were simultaneously the lowest overall prevalence of the last three decades and the highest sales figures ever reported. The inter-sex differences in smoking prevalence were smaller at younger ages. Education, but not occupation as a measure of social class, was inversely related to smoking prevalence in males. Furthermore, rates for males were lower in the northern (and richer) part of the country. The pattern was totally different in females, since smoking prevalence was higher in more educated women, of higher social class, living in North Italy. This suggests that, in the absence of adequate measures, smoking prevalence is likely to rise among Italian women in the near future. Continued monitoring of smoking patterns gives important information with which to identify the most likely future patterns in smoking and smoking-related diseases, besides providing data for targeting intervention programs.

Adolescent↗

Reproductive and menstrual factors and risk of colorectal cancer.

The relation between reproductive and menstrual factors and the risk of colorectal cancer was investigated in a case-control study conducted in Northern Italy on 279 women with colon cancer, 153 with rectal cancer and 386 controls admitted to hospital for a wide spectrum of acute, nonneoplastic, nondigestive disorders. Compared with nulliparous women, the relative risks (RR) of colon cancer were 1.1 for one and two births, 1.3 for three or four, and 1.1 for five or more. Corresponding values for rectal cancer were 0.9 for one, 1.1 for two, 1.4 for three or four, and 0.8 for five or more births. No significant association emerged with number of abortions, and no consistent pattern of trends for both colon and rectum cancer was observed in relation to age at first or last birth. Women whose menarche occurred at age 15 or over were at significantly lower risk of colon cancer (RR 0.5, 95% confidence interval = 0.3-0.9), and the point estimate was below unity, though nonsignificantly, for rectal cancer too (RR = 0.7). There was no relation between age at menopause, duration of menstrual cycles, and cancers of the colon and rectum. The present study produced no evidence that reproductive factors are related to colorectal cancer in this population. With this sample size, it was possible to exclude relative risks below 0.8 for colon and 0.7 for rectal cancer among multiparous women versus nulliparous ones. These findings are thus inconsistent with the epidemiological evidence on reproductive and menstrual factors and breast cancer in this and other populations, with the sole potential exception of the reduced risk of colorectal cancer among women whose menarche occurred at age 15 or over.

Adult↗

Descriptive epidemiology of Hodgkin's disease in Italy.

Death certification data on Hodgkin's disease in Italy over the period 1955-84 were studied in terms of age-standardized and age-specific national trends, and of geographical variation in mortality. There were substantial declines in death rates from the early 1970's onward, which can be largely attributed to therapeutic improvements. These led to avoidance of about 350 deaths, with a total 950 reported, which is probably the major absolute therapeutic advance identified for any cancer site. The declines started earlier in childhood and young adult age, and were restricted to population below age 60. The age distribution of the disease was different in the two sexes, since the age curve for males showed steady rises up to age 75, whereas that for females was clearly bimodal, with a peak around age 30, and another at oldest age. This divergent pattern is consistent with different exposure to (infectious) agent(s) in children of the two sexes, but also to occupational exposures potentially related to the risk of the disease. Examination of rates in various geographical areas showed generally higher rates in the North, and a few provinces with exceedingly high mortality in the central part of Northern Italy, particularly in a chiefly rural province (Mantua). This excess mortality (and, more in general, the observation that rates for Northern Italy are higher than in any other area of the EEC) could not be explained by obvious diagnostic or classification problems, were evident in both sexes, appeared to be consistent over the last decade and are reflected in available Italian cancer registration data.

Adolescent↗

Pattern of cervical screening utilization in Italy.

The pattern of cervical screening utilization in Italy was analyzed using data from the 1986-1987 National Health Survey on the basis of a sample of 27,455 women aged 20 to 79 randomly selected within strata of municipality of residence and age in order to be representative of the whole Italian population. Overall, about 17% of women aged 20 to 79 were screened per year, for a total of 3.5 to 4 million cervical smears per year. The highest frequency was reported in younger middle age, about one in four women being screened per year in the age groups 30 to 49, and there was a substantial decline above age 50. Cervical smear rates were higher in Northern areas (22%), where mortality from cervical cancer is lower, than in the Centre (16%) and South (11%) of the country. Further, there was a strong positive social class gradient in the utilization of cervical screening, in relation to both education and occupation. In spite of the absence of any organised mass screening program, cervical screening is a relatively common procedure among Italian women. However, this study provides further quantitative evidence of a markedly irrational utilization of non-organized cervical screening, which tends to end up selectively used by the groups in which cervical cancer is less common.

Adult↗

The role of alcohol in oesophageal cancer in non-smokers, and of tobacco in non-drinkers.

Data from a hospital-based case-control study of oesophageal cancer conducted in Northern Italy were used to analyse the risk associated with alcohol in non-smokers and with tobacco in non-drinkers. Out of a total of 250 cases (198 males, 52 females) and 1,089 controls (800 males, 289 females), there were 38 cases and 404 controls who described themselves as lifelong non-smokers. Among these persons, the relative risk was not different for teetotallers and moderate drinkers (less than 4 drinks per day), but increased markedly for higher levels of alcohol consumption. The point estimates were 2.1 for 4 to 8 and 3.6 for over 8 drinks per day, and the trend in risk was statistically significant. Likewise, among 30 cases and 189 controls who were non-drinkers, the point estimates were 2.0, 3.9 and 6.2 for smokers of less than 15, 15-24 and greater than or equal to 25 cigarettes per day, with, again, a statistically significant trend. This study supplies further evidence that both alcohol and tobacco are strongly related to the risk of oesophageal cancer, even in the absence of exposure to the other risk factor. This confirms previous indications from a study in Calvados, France and also provides statistically significant epidemiological evidence of an independent role of exposure to tobacco alone in the aetiology of oesophageal cancer. The relative risks associated with exposure to either of the 2 factors among subjects not exposed to the other were readily comparable to the estimates adjusted for the other factor in the overall data-set, thus further confirming the independent effect of alcohol and tobacco on oesophageal carcinogenesis.

Adult↗

Coffee consumption and digestive tract cancers.

The relationship between coffee drinking and the risk of digestive tract neoplasms was analyzed in a case-control study of 50 cases of cancer of the mouth or pharynx, 209 of the esophagus, 397 of the stomach, 455 of the colon, 295 of the rectum, 151 of the liver, 214 of the pancreas, and 1944 control subjects admitted for acute, non-digestive tract disorders. There was no significant or consistent association between coffee and cancers of the mouth or pharynx, esophagus, stomach, liver, or pancreas. In particular, for pancreatic cancer, the multivariate relative risks for the intermediate and upper tertiles were 1.05 and 1.01, respectively. There were significant inverse trends in risk with measures of coffee consumption for colon and rectal cancers, the multivariate relative risks according to tertiles of coffee consumption being 0.86 and 0.64 for colon and 0.97 and 0.66 for rectum. This apparent protection is in agreement with some (but not all) previous epidemiological evidence and finds a possible biological interpretation in terms of interference on bile secretion, causing reduced bile acid and neutral sterol concentrations in the bowel. In conclusion, the results of this study, the major interest of which lies in the opportunity of drawing up an overall pattern of risk for various digestive neoplasms, offer further reassurance as regards the effects of coffee on digestive tract carcinogenesis.

Adult↗

Reproductive factors and breast cancer: an overview.

Despite extensive research, there is still uncertainty on the separate effects of parity and age at first birth on breast cancer risk. Thus, information on these variables from formal epidemiological articles published in English since 1970 is reviewed in the present article. Among 26 studies considered, one found no significant association with either variable, seven showed an association between age at first birth but not parity and breast cancer risk, six an association with parity but not age at first birth, and in twelve studies both variables appeared to be independently related with breast cancer risk. Various reasons for these apparent differences can be considered, including heterogeneity between various populations (for instance, the proportion of multiparous women in studies showing no association with parity tended to be higher than in studies finding an inverse relation with parity), criteria for selection of cases and controls, influence of age and other covariates (among which the interval between pregnancies is of particular interest) and, of course, the role of chance. The data reviewed suggest, from an aetiological viewpoint, that both parity and age at first birth have some independent effect on breast carcinogenesis. From a public health viewpoint, however, it appears that the importance of age at first birth is greater, since the trend is linear across subsequent age levels, while the protection of parity seems to be quantitatively relevant only for women with four or five births or more.

Breast Neoplasms↗

Risk factors for vulvar lichen sclerosus.

To assess risk factors for vulvar lichen sclerosus data were collected in a case-control study of 75 cases and 225 age-matched control subjects. Questions concerned personal characteristics and habits, gynecologic and obstetric data, general indicators of sexual habits, and selected dietary habits. The risk of vulvar lichen sclerosus was greater in parous women than nulliparous women, but there was little tendency for the risk to increase with number of births; the finding was not significant when only married women were considered. There was no material difference between cases and control subjects in relation to major indicators of sexual habits (age at first intercourse and number of sexual partners). A smaller proportion of cases was married, but no difference was observed in the distribution of cases and controls with reference to education, smoking habits, body mass index, and previous history of diabetes. There was no association between retinoids and risk of vulvar lichen sclerosus, but intake of carotenoids was inversely and strongly associated with vulvar lichen sclerosus. This apparent protection did not materially change after adjustment for socioeconomic status and other potential confounding factors.

Adult↗

Barrier methods of contraception and the risk of cervical neoplasia.

The relationship between the use of barrier contraception methods and the risk of cervical neoplasia was analyzed using data from a case-control study conducted in the greater Milan area, northern Italy. A total of 367 cases of invasive cancer under 60 years of age were compared with 323 subjects in hospital for acute conditions unrelated to any of the established or suspected risk factors for cervical cancer, and 316 cases of cervical intraepithelial neoplasia were compared with 258 outpatient controls. Ever-use of barrier methods (condom and diaphragm) was reported by 6% of the cases of invasive cancer and 12% of hospital controls. Corresponding values for intraepithelial neoplasia were 16% for cases and 22% for outpatient controls. Considering the total use of barrier methods, compared to never use, the relative risk of invasive cervical cancer was 0.4 (95% confidence interval 0.2-0.9) and decreased with duration of use (chi 2(1), trend = 5.18, p = 0.02). Likewise, use of barrier methods lowered the risk of intraepithelial neoplasia; the estimated relative risks were 0.9 in users for less than two years and 0.6 for two or more (chi 2(1), trend = 4.61, p = 0.03). Although the protection for invasive cancer appeared to be greater at older ages and in multiparous women, the relative risks were not significantly heterogeneous in various strata of parity, number of sexual partners, oral contraceptive use and history of Pap smears.

Adolescent↗

Education, disease prevalence and health service utilization in the Swiss National Health Survey "SOMIPOPS".

The relation among education, disease prevalence, and frequency of health service utilization was analyzed using data from the Swiss National Health Survey SOMIPOPS, conducted in 1981-1983 on a randomly selected sample of 4,255 individuals, representative of the entire Swiss population. The prevalence of several important cardiovascular, respiratory, digestive, osteoarticular, and psychiatric disorders was higher among less educated individuals; only allergic conditions were directly associated with indicators of social class. More educated individuals reported lower frequencies of general practitioner visits, but higher frequencies of specialized consultations. These findings confirm that education is an important determinant not only of mortality but also of morbidity and health-care utilization and require careful consideration in terms of the planning and evaluation of health services.

Adult↗

Population attributable risk for endometrial cancer in northern Italy.

The population attributable risk for endometrial cancer has been estimated in relation to its four major risk factors (overweight, estrogen replacement therapy, diabetes and hypertension) using data on 528 cases and 1626 controls collected within the framework of a hospital-based case-control study conducted since 1981 in the greater Milan area, northern Italy. Over 30% of the endometrial cancer cases diagnosed in the study population could be attributed to overweight, 10% to postmenopausal estrogen replacement therapy, and similar proportions (around 10%) to hypertension and diabetes. The overall estimate including the joint effect of the two conceptually preventable factors (overweight and estrogen use) was 40%, while further inclusion of diabetes and hypertension, which are not easily preventable per se but are still closely linked to 'westernization', indicated that over 50% of cases were attributable to the combined effect of these four factors. The validity of these findings, in strict terms, is limited to this area from northern Italy. However, they can be taken as a general indication of the scope for prevention of endometrial cancer in other southern European populations, sharing similarities in lifestyle and pattern of hormonal replacement therapy use.

Adult↗

Breast cancer and combined oral contraceptives: an Italian case-control study.

The risk of breast cancer in relation to use of oral contraceptives was evaluated using data from a hospital-based case-control study from Northern Italy on 1517 cases below age 60 and 1351 controls admitted for acute diseases unrelated to any of the known or potential risk factors for breast cancer. The multivariate relative risk for ever vs. never users was 1.3 (95% confidence interval = 1.0-1.7). However, the risk was not related to duration of use: indeed the highest risk was observed among short-term users (less than 2 years), and the point estimate was 0.9 among users for 5 years or more. The elevated risk among short-term users, if not due to residual confounding or selection mechanisms, is probably explainable in terms of recall bias (i.e. more careful report of short or very short use by cases). No definite pattern was observed in relation to latency or recency of use, and the point estimates were 0.8 for women who had ever used the pill before age 25 and 0.8 for those who had ever used the pill before first full-term pregnancy. Thus, the study presents further reassuring information on the oral contraceptive/breast cancer debate. Its major limitation lies in the low prevalence of oral contraceptive users in Italy, with a consequently reduced statistical power, although, with the number of cases involved, it was possible to exclude a relative risk of 1.4 for long-term use or for ever use before first birth.

Adult↗

Alcohol and breast cancer: update from an Italian case-control study.

The analysis of alcohol and breast cancer risk from an Italian case-control study of breast cancer has been updated to include a total of 2402 women with histologically confirmed breast cancer and 2220 controls with acute conditions unrelated to any of the established or potential risk factors for breast cancer, admitted to a network of teaching and general hospitals in the greater Milan area. Compared with non-drinkers, the estimated relative risk for ever drinkers was 1.4 (95% CI = 1.2-1.6). The multivariate risks were 1.3 for less than 1 drink (e.g. 10 g of ethanol) per day, 1.3 for 1 less than 2 drinks, 1.4 for 2-3 and 2.2 for over 3 drinks per day. The positive association between alcohol and breast cancer was consistent across strata of age, socio-demographic variables, smoking, menstrual, reproductive, and hormonal factors, family history of breast cancer, nutrition and diet indicators. In particular, this study indicated that the alcohol-breast cancer relationship is probably not materially different in younger and older women, that alcohol drinking at an early age is not a particularly clear indicator of subsequent risk, nor that the effect of alcohol is enhanced in thin women. Thus, the findings of this study are both internally consistent and in agreement with most previous evidence, since the relative risks of 1.3-1.4 for a consumption of 10-30 g of alcohol per day compare well with the corresponding highest intake levels in most American studies. This study is of particular interest, since it provides data on higher levels of alcohol consumption, on which very little information is available. There are nontheless at least three elements which leave open the question of causality: the absence of duration-risk relationship, the inconsistency with evidence from descriptive epidemiology, and the lack of plausible biological mechanisms.

Adult↗

Menstrual factors and the risk of epithelial ovarian cancer.

The relationship between menstrual factors and the risk of ovarian cancer was evaluated in the framework of a hospital-based case-control study conducted in the greater Milan area on a total of 634 cases of ovarian cancer and 1626 control subjects with a spectrum of acute conditions unrelated to any of the established or potential risk factors for ovarian cancer. Compared with women whose menarche occurred at age 13 or later, the risk of ovarian cancer was moderately (and not significantly) elevated for earlier menarche (multivariate relative risk, RR = 1.13, 95% confidence interval, CI = 0.97-1.37). There was a positive association with age at menopause, the multivariate relative risk, compared with women aged 45 years or less at menopause, being 1.25 for those aged 45-49 years, 1.40 for 50-53 and 1.58 for 54 or over (chi 2(1) trend = 8.86, p = 0.003). A lifelong irregular menstrual pattern (defined as frequent menstrual-like episodes of bleeding less than 21 or more than 35 days apart) was negatively associated with the risk of ovarian cancer (multivariate RR = 0.45, 95% CI = 0.31-0.65). The effect of age at menopause and lifelong menstrual pattern was similar in different strata of age, whereas there was a positive association with early menarche among younger women which disappeared with advancing age. The present findings confirm the influence of various menstrual factors on the risk of epithelial ovarian cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Reproductive factors and the risk of invasive and intraepithelial cervical neoplasia.

The relation between reproductive factors and cervical neoplasia was evaluated in a case-control study of 528 cases of invasive cancer compared with 456 control subjects in hospital for acute conditions unrelated to any of the established or suspected risk factors for cervical cancer, and of 335 cases of cervical intraepithelial neoplasia compared with 262 outpatient controls. The risk of invasive cervical cancer increased with number of livebirths, the estimated multivariate relative risk (RR) being 4.39 in women with five or more births compared with nulliparous women. There was also an inverse relation with age at first livebirth (RR = 0.42 for greater than or equal to 30 vs. less than 20 years) which, however, disappeared after inclusion of parity in multiple logistic regression analysis. Likewise, cases of invasive cervical cancer tended more frequently to report induced abortions. However, this association was not statistically significant after allowance for confounding factors, including parity. No relation emerged with number of spontaneous abortion and age at last pregnancy. When the interaction between parity and sexual habits was analysed, the relative risk increased in subsequent strata of parity with increasing number of sexual partners or decreasing age at first intercourse, thus suggesting an independent effect of sexual and reproductive factors, and hence multiplicative on the relative risk of invasive cervical cancer. No consistent association emerged between the risk of intraepithelial cervical neoplasm and parity, number of abortions and age at first or last birth.

Abortion, Induced↗

Occupation and lymphoid neoplasms.

The relationship between occupation and exposure to a number of occupational agents and lymphoid neoplasms was investigated in a case-control study of 69 cases of Hodgkin's disease, 153 non-Hodgkin's lymphomas, 110 multiple myelomas and 396 controls admitted for acute diseases to a network of teaching and general hospitals in the greater Milan area. Among the cases, there was a significant excess of individuals ever occupied in agriculture and food processing: the multivariate relative risks (RR) were 2.1 (95% confidence interval, CI = 1.0-3.8) for Hodgkin's disease, 1.9 (95% CI = 1.2-3.0) for non-Hodgkin's lymphomas and 2.0 (95% CI = 1.1-3.5) for multiple myeloma. Significant trends for duration of exposure to herbicides were observed for lymphomas, but the association was stronger for overall occupation in agriculture than with the specific question of herbicide use. History of occupation in the chemical industry was more frequent among Hodgkin's disease (RR = 4.3, 95% CI = 1.4-10.2), and a significant trend in risk was observed between duration of exposure to benzene and other solvents and multiple myeloma. No significant relation was found between any of the lymphoid neoplasms considered and rubber, dye, painting, printing, tanning leather, photography, pharmaceuticals, wood, coal/gas and nuclear industries.

Adolescent↗

Dietary factors in the risk of bladder cancer.

The relationship between selected dietary factors and the risk of bladder cancer was investigated in a case-control study conducted in northern Italy. The study included 163 cases and 181 controls who were hospitalized for acute, nonneoplastic or urinary tract diseases. The frequency of consumption of green vegetables and carrots was lower in the cases; thus, the estimated relative risks for the upper vs. the lower tertiles were 0.6 for green vegetables and 0.5 for carrots. Significant inverse trends in risk emerged with estimated carotenoid (as well as retinoid) intake. The apparent protection conveyed by vitamin A was stronger in current smokers. The risk of bladder cancer was not related to scores of fat and measures of alcohol consumption; the risk was elevated in coffee drinkers (although there was no tendency to rise with higher consumption), but it was reduced in tea drinkers. These findings were not explainable in terms of selection, information, or confounding bias. Thus, although available information is too uncertain for any precise definition of specific (micro)nutrients related to bladder cancer risk, the confirmation that several aspects of a less-affluent diet adversely affect the risk is still of interest in terms of a better understanding of bladder carcinogenesis.

Adult↗