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Biomedical subjects

F Levi

Publications and source records attributed to F Levi.

At least 19 recordsLinked to original sources

Descriptive epidemiology of male breast cancer in Europe.

Trends in death certification rates from male breast cancer over the period 1955-89 were analysed for 25 European countries (excluding the Soviet Union and a few small countries) on the basis of official data from the World Health Organization database. In the late 1980's, about 550-600 deaths per year from male breast cancer were certified in these countries. The variation was relatively limited, most age-standardized (world standard) rates being within the range of 1.5 to 3.0 per million. The highest rates were in France, Hungary, Austria and Scotland. No clear pattern of trend was observed over the last few decades, but mortality rates in the late 1980's tended to be, for most countries, lower than those registered 3 decades earlier. Comparison was possible for 18 countries, and for 11 (including the largest ones, i.e. France, Germany, Italy and England and Wales), male breast cancer rates in 1985-89 were lower than in 1955-59. The pattern was similar when only truncated (from 35 to 64 years) mortality rates were considered and, for the largest countries, upon accurate inspection of age-specific rates. In conclusion, therefore, this overview of male breast cancer trends in Europe precludes any generalized increase in mortality from the disease over recent decades and, hence, weighs against the introduction and presence of any important new cause of this rare disease.

Age Factors

Body mass at different ages and subsequent endometrial cancer risk.

The relationship between body mass index (BMI) at different ages and subsequent endometrial-cancer risk was investigated in a multicentre case-control study conducted between 1988 and 1991 in Vaud, Switzerland, and Northern Italy on 272 histologically confirmed incident cases of endometrial cancer and 571 controls admitted to hospital for acute, non-neoplastic conditions, unrelated to known or potential risk factors for endometrial cancer. The risk of endometrial cancer increased with increasing BMI in the 3rd decade of age (20 to 29 years), in the 5th decade (40 to 49 years) and in the 7th decade (60 to 69 years), although the risk estimates tended to be substantially higher at older ages: compared with women whose BMI (kg m-2) was less than 20, the relative risks (RR) were 1.8 for BMI greater than or equal to 25 at age 20 to 29, 2.7 for BMI greater than or equal to 30 at age 40 to 49 and 3.8 at age 60 to 69. All the trends in risk were significant, except that for BMI at age 25 after allowance for current BMI. When data were examined in separate strata of current BMI, among women of normal body mass at diagnosis no significant effect of past overweight was observed. In contrast, among subjects over-weight at diagnosis, there were significant direct relationships with BMI at ages 20 to 29 and 40 to 49. To reduce endometrial cancer risk, it is therefore important to avoid obesity in later middle and older age, and the benefit can be even greater for women who were overweight at younger age.

Age Factors

Descriptive epidemiology of ovarian cancer in Europe.

Trends in ovarian cancer mortality over the period 1955-1989 were analyzed for 25 European countries (excluding the Soviet Union and a few small countries) on the basis of the official death certification data from the World Health Organization database. The overall variation in age-standardized ovarian cancer mortality at all ages declined appreciably, from over 17-fold during the period 1955-1959 (i.e., between 10.5/100,000 in Denmark and 0.6/100,000 in Spain, world standard) to 3.4-fold (i.e., between 9.9/100,000 in Denmark and 2.9/100,000 in Spain) in the late 1980s. When a comparison was made between the late 1950s and the 1980s, ovarian cancer mortality increased in most European countries, except Denmark, Sweden, and Switzerland, where certified mortality was already elevated in the late 1950s, although also in these countries the peak rate around or over 10/100,000 was reached during the 1960s. However, when the changes over the last decade were considered, ovarian cancer mortality trends were downward in all Nordic countries, Germany, Switzerland, Austria, and Czechoslovakia. Mortality was rising somewhat, though to a smaller extent, in Ireland, Britain, and Southern Europe. Trends were more favorable in middle-aged women (35 to 64 years), and, to an even greater extent, in young women (aged 20 to 44), among whom substantial declines, particularly over the last decade, were observed in most European countries, approaching 50% in Britain and Scandinavia. These trends are discussed in terms of changes in risk factor exposure (i.e., trends in average parity and oral contraceptive use), diagnostic and therapeutic improvements, ovariectomy, and changes in case ascertainment and certification.

Adult

Patterns of childhood cancer incidence and mortality in Europe.

Histograms including age-standardised (0-14 years, world standard) incidence and mortality rates from selected childhood cancers are presented for 21 European cancer registration areas and 24 countries. The overall range of variation in all childhood cancer incidence rates across various cancer registration areas in Europe was around a factor 1.5, with highest rates in Spain, Italy, Sweden and France, and lowest rates in Poland, Hungary, UK, Germany and Yugoslavia. For most single cancer sites, however, the observed pattern is essentially attributable to random variation alone. A clearer pattern, however, emerged with reference to mortality. The overall range of variation, in fact, was around a factor two in both sexes, with highest rates in Bulgaria, Portugal, Hungary, Czechoslovakia and Poland, and the lowest rates in Austria, UK, Germany, The Netherlands and Finland. Trends in mortality from childhood cancers between 1950 and 1989 were also presented. Recent declines were observed for total childhood cancer mortality, leukaemias, kidney cancer (Wilms' tumours), Hodgkin's disease and other lymphomas in most European countries. These declines, however, were generally earlier and larger in northern as compared with southern and, mostly, with eastern European countries. This pattern of trends likely reflects the different adoption and impact of newer efficacious therapies of childhood cancer, and hence, confirms that there is ample scope for further reduction in childhood cancer mortality in several eastern and some southern European countries.

Adolescent

Linkage of death certification of AIDS and cancer registration in Vaud, Switzerland.

58 death certifications (40 males and 18 females) of residents of the Canton of Vaud (Switzerland) which reported AIDS as the cause of death in 1986-1989 were matched with the list of incident cancers available since 1974 from the Vaud Cancer Registry. Such linkage was successful for 20 individuals (age range 25-63, median 37), mostly males (18/20), homosexual or bisexual (11/18) and affected by Kaposi's sarcoma (14 males and 1 female). Other identified neoplasms included one Burkitt's lymphoma, one prostate adenocarcinoma and one multiple myeloma (whose histological picture included, however, lymphocytosis in addition to plasmocytosis). Three additional malignancies (one undifferentiated skin cancer, one carcinoma of the salivary glands and one in situ cervical carcinoma), and one myelodysplastic syndrome had also been diagnosed from 1 to 2 years before AIDS death. Cancer was mentioned on the death certificate, in addition to AIDS, in only 2 cases. Albeit of limited size, the present report confirms that a systematic integration of AIDS and cancer registration statistics provides additional information, of particular interest for histological classification, on the AIDS-cancer relationship.

Acquired Immunodeficiency Syndrome

Trends in cancer survival in Vaud, Switzerland.

Survival rates from the Vaud Cancer Registry were compared for incident cases registered in 1974-1978 and 1979-1983. No appreciable difference was evident for most major cancer sites: 5-year relative survival rates were 0.21 in 1974-1978 and 0.23 in 1979-1983 for stomach, 0.49 and 0.46 for colon, 0.45 and 0.47 for rectum, 0.04 and 0.03 for pancreas, 0.08 and 0.10 for lung, 0.41 and 0.42 for kidney, 0.21 and 0.13 for brain, and 0.32 and 0.30 for multiple myeloma, respectively. A modest advancement in 5-year relative survival rates was, however, registered for total cancer mortality (non-melanomatous tumours excluded, from 0.41 to 0.43) while, with regard to specific sites, a significant improvement was seen only for cancer of the testis (from 0.73 to 0.88). More than 10% non-significant improvements in survival were recorded for melanomatous skin cancer (from 0.67 to 0.78), thyroid cancer (from 0.73 to 0.85), particularly in females, non-Hodgkin lymphomas (from 0.37 to 0.45), Hodgkin's disease (from 0.61 to 0.78), cancer of the ovary (from 0.28 to 0.32) and the prostate (from 0.44 to 0.52). However, significant declines in survival rates were seen for cancer of the larynx, gallbladder and biliary tract, and for connective tissue neoplasms. A few differences in the modification of relative survival rates according to age (less than 60 versus greater than or equal to 60 years) were noted for a few cancer sites. Changes were larger in older patients with respect to cancer of the prostate and thyroid and non-Hodgkin lymphomas (increases) and connective neoplasms (decreases). Conversely, changes in survival were greater or restricted to younger individuals for testis, bladder and leukaemias (improvements) and cancer of the mouth or pharynx (decline), thus suggesting the different play of age-specific biological characteristics of some tumours, in addition to diagnostic improvements and gradual spread of effective cancer treatments to more advanced age groups.

Age Factors

Breast cancer survival in relation to sex and age.

Crude and relative survival rates were analyzed using data from 4,199 incident breast cancers in females and 39 breast cancers in males registered between 1974 and 1988 in the Cancer Registry of the Swiss Canton of Vaud. The relative survival rates were 0.94 for females and 0.95 for males at 1 year, 0.87 and 0.95 at 2 years, 0.71 and 0.75 at 5 years, and 0.57 and 0.65 at 10 years. In relation to age at diagnosis, among females the relative survival increased from 0.62 for cases diagnosed under the age of 35 years to 0.78 at the age of 45-49 years, decreased to 0.66-0.68 in the age group 50-59 years, and rose again to reach 0.76 at the age of 65-69 years, declining thereafter to 0.69 at the age range 80-84 years. This pattern was already evident during the first 2 years of follow-up and persisted up to 10 years after diagnosis, although somewhat less defined. For males, no significant difference was evident in relative survival between breast cancers diagnosed before or at the age of 65 years and over, and only the 10-year survival rate was apparently (though not significantly) lower at older ages. Thus, these population-based data show remarkable similarities in survival for female and male breast cancer, despite possible heterogeneities in diagnosis and ascertainment of the disease as well as differences in steroid hormone levels in the two sexes and possible differences in biological characteristics of the disease. Further, they confirm that breast cancer survival varies across subsequent age groups. This possibly reflects selection and modifying effects on incidence and survival of hormone dependency of a proportion of breast cancers, the growth of which could be accelerated during the premenopause and the survival favourably influenced by the decline in steroid hormone levels after the menopause.

Adult

Prevention of cutaneous melanoma: an epidemiological evaluation of the Swiss campaign.

A national information program, focusing on the main recognized risk factors (primary prevention) and on the potential benefits of early detection (secondary prevention) of cutaneous malignant melanoma, was launched in Switzerland in May 1988. The first campaign, based on a pilot study conducted in 1986 in the canton of Basel, was followed by a recall campaign in July 1989. This report describes the organization of this program and presents an assessment of its initial impact. The number of newly diagnosed cases increased more than twofold (+ 116%) in the two months following the launch of the first campaign (May to June 1988). This trend was accompanied by a statistically significant shift of case distribution towards younger ages (< 60 years; p = 0.003), and a non-significant shift was observed towards less advanced lesions (thickness < or = 1.5 mm). The incidence decreased quickly, though in the twelve month period between the two campaigns it remained 21% higher than before the inception of the program. No appreciable effects were detected from the recall campaign and no difference was seen among regions or between sexes.

Adolescent

Trends in cancer mortality sex ratios in Europe, 1950-1989.

A study was carried out to analyse trends in cancer mortality sex differentials. This study compared age-standardized sex ratio values for mortality from 18 cancers (or groups of cancers), and total cancer mortality over the period 1950-1989 in 24 European countries, for 4 age groups (all ages, 20-44 years, 45-64 years, and 65 years and over). For lung cancer and other tobacco-related neoplasms, appreciable rises in sex ratio values were observed until the late 1970s, particularly in Southern and Eastern Europe, before levelling off in recent years, particularly among the younger age groups. In the late 1980s, the range of variation in overall age-standardized sex ratios for lung cancer was between 2 and 3 in the United Kingdom and in Nordic countries, and around or over 10 in Southern Europe. In young adults, the decline in sex ratio values observed in Denmark and Sweden (unity), and in other Nordic countries and in the United Kingdom (around or below 2) reflects a levelling of lung cancer in young males and an increase in young females. This clearly indicates that young women are a priority target group for smoking control interventions in Europe. Appreciable cohort effects were also observed for stomach cancer: rises in sex ratio values were greater in, or restricted to, middle- and older age groups, whereas in the young there was some tendency towards a levelling in sex differentials. The overall sex ratio values for stomach cancer were around 2 in most areas of Europe in the late 1980s. For intestinal cancer, sex ratio values showed some tendency to rise, reaching a level of 1.3-1.7 in the late 1980s; steady rises were also registered in sex ratio values for melanoma (skin cancer), reaching 1.5-1.8 in the late 1980s in most countries. These upward trends which were minor or inconsistent at younger ages in several countries became progressively stronger with advancing age. Sex ratio values were below unity for cancers of the gallbladder and the thyroid. Sex ratio values tended to rise also for leukaemia (from 1.2-1.5 to 1.5-1.7), but showed no noticeable trend for lymphomas or myeloma. The overall sex ratio values for total cancer mortality in the 1950s were between 1.2 and 1.4 in most European countries. Thereafter, they rose appreciably in several countries, reaching 1.9 in Czechoslovakia, Italy and Poland, and 2.3 in France.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult

Cancer mortality in the USSR, 1986-88.

Mortality rates in the USSR for the major cancer sites have been computed for the period 1986-88 from official numbers of certified deaths and population estimates provided by the World Health Organization databank, and compared with rates for 26 other European countries. Among males, elevated mortality rates (age-adjusted, world standard) were observed for cancer of the oral cavity and pharynx (6.6/100,000), oesophagus (8.4/100,000) and larynx (6.8/100,000). Mortality from cancer of the stomach (38.4/100,000 males and 16.5/100,000 females, for a total of 87,000 deaths per year) was the highest in Europe. Likewise, overall lung cancer rates among males (61.0/100,000, for over 77,000 deaths per year) were among the highest in Europe, and showed substantial rises over the last 2 decades. Lung cancer mortality in females was comparatively low (6.9/100,000), and increased only moderately. Rates for cancers of the intestine (14.6/100,000 males and 10.6/100,000 females) and of the female breast (12.9/100,000) were comparatively low as compared to most other European countries, and those for prostatic cancer (5.9/100,000) were the lowest registered in Europe. In contrast, mortality for cancer of the uterus (9.7/100,000) was among the highest in Europe, probably due to high mortality from cervical cancer. Priorities for cancer control in the Soviet Union are thus reduction of consumption of tobacco and alcohol, which largely explain the high rates for lung and upper digestive and respiratory sites, improvements in diet composition and food storage to reduce the substantial excess of stomach cancer, and rational screening for cervical cancer.

Adult