Decline of accident mortality in childhood, Italy, 1955-1984.
Explore the source record for details and available documents.
Accidents↗
Biomedical subjects
F Parazzini
Publications and source records attributed to F Parazzini.
Pooled analysis of 3 European case-control studies: I. Reproductive factors and risk of epithelial ovarian cancer.
The role of reproductive factors in the aetiology of epithelial ovarian cancer has been re-assessed in a meta-analysis of 3 hospital-based case-control studies conducted in Europe (i.e. Italy, the United Kingdom and Greece), providing a total dataset of 1,140 cases and 2,724 controls. Multiple logistic regression models were used to obtain relative risk (RR) estimates adjusted for study centre, age, socio-cultural indicators, age at menopause, and oral contraceptive use. The risk decreased with increasing number of births and the trend in risk was significant (chi 2(1) = 7.50, p less than 0.01). In comparison to nulliparous women, those who reported 4 or more births had a 40% reduction in risk of ovarian cancer (RR = 0.6, 95% confidence interval, CI: 0.4-0.8). An RR estimate of 1.4 (95% CI: 1.1-1.7) as found, overall, for age of 35 or more at first birth compared to age of 25 or less at first birth. In each stratum and overall, nulliparous women did not appear to be at increased risk compared to those who delayed birth of their first child until age 35 or more. In each study, as well as in the overall dataset, an inverse association between number of abortions and ovarian cancer risk emerged. Overall, the inverse relationship was highly significant, RR estimates for 1 and 2 or more abortions, as compared to none, being 0.9 (95% CI: 0.8 and 1.1) and 0.7 (95% CI: 0.6-0.9) respectively. The effects of parity, age at first birth and number of abortions emerged consistently in various strata of study centre and age.
Abortion, Spontaneous↗
Pooled analysis of 3 European case-control studies of ovarian cancer: II. Age at menarche and at menopause.
The role of age at menarche and at menopause on epithelial ovarian cancer risk was re-assessed in a combined analysis of 3 hospital-based case-control studies conducted in Italy, the United Kingdom and Greece, which produced a total of 1,140 cases and 2,724 controls. In the overall dataset, there was no evidence of an association with age at menarche: compared with women whose menarche occurred at age 15 or over, the relative risk (RR) estimates were 1.0 [95% confidence interval (CI) 0.8 to 1.2] for those with menarche at ages 12 to 14, and 1.0 (95% CI 0.8-1.2) for those with menarche below age 12. There was no consistent interaction between age at menarche and study centre or age at diagnosis. In relation to age at menopause, compared with women whose menopause occurred at age 44 or earlier, the RR was 1.4 between 45 and 49, 1.6 between 50 and 52 and 1.9 above 52. The strength of the association was apparently (but not significantly) greater in the British than in the Greek or Italian dataset. The effect of age at menopause tended to be long-lasting and, if anything, to increase across subsequent age-groups. The large dataset, and the replication of results in different studies, provide more definite and precise information than previously available on the absence of appreciable effect of age at menarche on subsequent ovarian cancer risk in developed countries. For age at menopause, there was a direct and consistent trend in risk, but the association was relatively weak, with RRs below 2 even between extreme categories.
Adult↗
Pooled analysis of 3 European case-control studies of epithelial ovarian cancer: III. Oral contraceptive use.
The relationship between use of oral contraceptives (OCs) and other contraceptive methods and the risk of ovarian cancer was examined in a combined analysis of 3 hospital-based case-control studies conducted in Italy, the United Kingdom, and Greece, for a total of 971 ovarian cancer cases and 2,258 controls under age 65. Compared with never-users, the combined multivariate relative risk (RR) for ever-users was 0.6 (95% confidence interval, CI = 0.4-0.8) and the estimates were consistent in the 3 datasets. The protection was also similar across strata of age and parity. Considering various measures of OC use, available in the Italian and British datasets only, the protection conveyed on ovarian cancer risk increased with the duration of use and persisted in the medium-long period: the RR in women reporting their last OC use greater than or equal to 15 years prior to diagnosis was 0.5 (95% CI = 0.2-1.0). The risks in ever-users were appreciably lower in those women who reported their first OC use before 25 years of age (RR = 0.3 for first use before age 25, 0.8 for first use at age 25-34 and 0.7 at 35 years or after). Such findings emerged similarly from Italian and British data. This combined analysis, besides offering further quantitative estimates of the protective effects of OCs on ovarian cancer risk in European populations, provides useful insights into the time pattern of the relationship between OC use and ovarian carcinogenesis, suggesting that the protection persists for 15 years or more after cessation of use and may be larger for use at younger age.
Adult↗
Spontaneous and induced abortions and risk of breast cancer.
The relationship between spontaneous or induced abortion and the risk of breast cancer was analyzed in a case-control study conducted in the greater Milan area on 2,394 cases of breast cancer and 2,218 controls in hospital for a spectrum of acute conditions, not gynecological, hormonal or neoplastic. No consistent relationship emerged between spontaneous or induced abortion and breast cancer: compared with women reporting no abortions (spontaneous or induced), the multivariate relative risk (RR) was 1.0 (95% confidence interval, CI, 0.9 to 1.2) in those reporting one abortion and 0.9 (95% CI 0.7 to 1.0) in those reporting two or more. This lack of association was consistent in strata of age and parity, including younger women. We further analyzed the risk of breast cancer associated with an abortion before and after full-term pregnancy. Compared with parous women reporting no induced or spontaneous abortions, those who had an abortion before their first full-term pregnancy had about a 20% higher risk of breast cancer. This finding, however, was not statistically significant (RR 1.2, 95% CI 0.9 to 1.7). No increased risk was observed in women who had had a first abortion after a full-term pregnancy (RR 0.9, 95% CI 0.8 to 1.0). This study does not support the hypothesis that spontaneous or induced abortion appreciably influences subsequent breast-cancer risk.
Abortion, Induced↗
Vegetable and fruit consumption and cancer risk.
The relationship between cancer risk and frequency of consumption of green vegetables and fruit has been analyzed using data from an integrated series of case-control studies conducted in northern Italy between 1983 and 1990. The overall dataset included the following histologically confirmed cancers: oral cavity and pharynx, 119; oesophagus, 294; stomach, 564; colon, 673; rectum, 406; liver, 258; gall-bladder, 41; pancreas, 303; larynx, 149; breast, 2,860; endometrium, 567; ovary, 742; prostate, 107; bladder, 365; kidney, 147; thyroid, 120; Hodgkin's disease, 72; non-Hodgkin lymphomas, 173; myelomas, 117; and a total of 6,147 controls admitted to hospital for acute non-neoplastic conditions, unrelated to long-term dietary modifications. Multivariate relative risks (RR) for subsequent tertiles of vegetable and fruit consumption were derived after allowance for age, sex, area of residence, education and smoking. For vegetables, there was a consistent pattern of protection for all epithelial cancers, with RRs in the upper tertile ranging from 0.2 for oesophagus, liver and larynx to 0.7 for breast. All the trends in risk were in the same direction and significant for all carcinomas except gall-bladder. In contrast, no protection was afforded by high vegetable consumption against non-epithelial lymphoid neoplasms. With reference to fruit, strong inverse relationships were observed for cancers of the upper digestive and respiratory tract, with RRs in the upper tertile between 0.2 and 0.3 for oral cavity and pharynx, oesophagus and larynx relative to the lowest tertile. The lower the location of the tumour in the digestive tract, the weaker appeared to be the protection afforded. Significant inverse relationships were observed for liver, pancreas, prostate and urinary sites, but not for rectum, breast and female genital cancers or thyroid. No relationship emerged for lymphomas and myelomas. Even in the absence of a clear biological interpretation, the consistency and strength of the patterns observed indicate that, in this population, frequent green vegetable intake is associated with a substantial reduction of risk for several common epithelial cancers, and that fruit intake has a favourable effect, especially on upper digestive cancers and, probably, also on urinary tract neoplasms.
Adult↗
Smoking in pregnancy: a survey from northern Italy.
The prevalence of smoking in pregnancy was analyzed in a survey of women delivering between January and March 1989 in a large maternity clinic in Milan, Northern Italy. Out of the 528 women interviewed, 183 (35%) were current smokers before pregnancy and 99 stopped smoking during pregnancy. The probability of stopping smoking decreased with increasing age and was lower in less educated women, but these findings were not statistically significant. Considering persistent smokers only, the mean number of cigarettes per day fell from 13 before to 8 during pregnancy; this reduction was generally consistent in various subgroups of age and education. The reductions, however, are probably overestimated, since they are based on the women's reports only. Thus, there still appears to be ample scope for intervention on smoking in pregnancy, particularly in older and less educated women.
Adolescent↗
The epidemiology of ovarian cancer.
The descriptive and analytical epidemiology of ovarian cancer is reviewed, starting from the substantial geographical differences, with high rates in North America and Europe and low rates in developing countries and Japan, although, on a worldwide scale, almost 50% of 140,000 total cases occur in developing countries. Over the past decades, incidence and mortality rates have remained approximately stable in high-risk areas, but have generally tended to rise in low-risk areas. In the past, ovarian cancer was more common in higher social classes, but sociocultural differences seem to have flattened off over recent decades. In etiological terms, the protection afforded by multiparity and oral contraceptive (OC) use is well established, with relative risks (RRs) of the order of 0.5 for multiparae and OC users. There is also consistent evidence that risk increases with late age at menopause. Less consistent and weak, if any, are the effects of age at menarche and first birth, although there is hint that a first birth over age 35 is not protective. It is conceivable that diet can play an important role in ovarian carcinogenesis, but only scattered data are available to suggest that high fat consumption may represent an indicator of risk. Available knowledge on ovarian cancer epidemiology is also discussed in relation to models of carcinogenesis and implications for prevention and public health.
Female↗
The epidemiology of endometrial cancer.
The descriptive and analytical epidemiology of endometrial cancer is reviewed. Over the last few decades, age-standardized incidence rates have been rising in several countries. The rise has been even greater in terms of absolute numbers of cases, and hence public health implications, due to the aging of the population. Although endometrial cancer rates were found to be higher in richer countries and urban populations, there is now evidence of some changes in the socioeconomic determinants of the disease in developed countries. In etiological terms, any factor that increases exposure to unopposed estrogens (such as menopausal replacement treatment, obesity, and irregular menstrual cycles) tends to increase the risk of the disease, while factors that decrease exposure to estrogens or increase progesterone levels (such as oral contraceptives or smoking) tend to be protective. Less well defined, or more difficult to explain in biological terms, is the role of other factors, such as births, miscarriages, or diabetes and hypertension, and only suggestive evidence is available on diet from analytical epidemiology. The data reviewed herein are discussed in terms of models of carcinogenesis, as well as attributable risks and public health implications.
Female↗
Oral contraceptive use and the risk of ovarian cancer: an Italian case-control study.
The association between oral contraceptive (OC) use and the risk of ovarian cancer was analysed in a case-control study, conducted between 1985 and 1989 on 505 epithelial ovarian cancer cases under 60 years of age, and 1375 controls in hospitals for a spectrum of acute conditions, not gynaecological, hormonal or neoplastic, apparently unrelated to OC use. 41 (8.1%) women with epithelial ovarian cancer and 192 (14.0%) controls reported OC use. The multivariate relative risk (RR) for ever use was 0.7 (95% confidence interval (CI) = 0.5-1.0). The risk decreased with duration of use: compared with never users the multivariate RRs were 0.9 and 0.5 respectively for less than 2 years and 2 years or more users (chi 2(1) trend = 6.17, P = 0.01). The risk of ovarian cancer decreased with recency and latency of use: the estimated RR were 0.5 and 0.9 in women reporting last OC use less than 10 or 10 years or more from the diagnosis of the disease, and 0.6 and 0.8 in those reporting first OC use less than 10 or 15 or more years before. The protective effect of OC was consistent in separate strata of selected covariates, including parity and other major known or suspected risk factors for ovarian cancer. There was some indication that the protection declines with advancing age, but the risk estimates were similar in premenopause and postmenopause.
Adult↗
Fats in seasoning and breast cancer risk: an Italian case-control study.
The relationship between consumption of fat in seasoning and risk of breast cancer was considered in a case-control study conducted in northern Italy of 2663 cases of breast cancer and 2344 controls admitted in the same network of hospitals with acute, non-neoplastic and non-gynaecological conditions. Subjective scores corresponding to three levels (low, intermediate and high) of intake of butter, margarine and oil, together with a combined variable of these three items ("total fat"), were used to evaluate the personal use of fat in seasoning. Compared to low use, a slight but significant increase in risk was observed for intermediate and high intake of butter, oil and total fat with relative risks of 1.5 (95% confidence interval [CI], 1.1-1.9) for high intake of butter, 1.3 (95% CI, 1.0-1.6) for high intake of oil and 1.4 (95% CI, 1.2-1.7) for high intake of total seasoning fat. These results were not materially modified after allowance for a number of identified potentially distorting factors. The results of this study suggest that there is a positive association, although moderate, between breast cancer risk and intake of fat added in seasoning, which may represent an indirect indicator of the subject's attitude towards fat.
Adult↗
Anthropometric indicators of endometrial cancer risk.
The relation between selected anthropometric indicators and the risk of endometrial cancer was evaluated using data from a case-control study conducted in Northern Italy on 562 cases and 1780 controls in hospital for acute, non-neoplastic or hormone-related disease. There was no appreciable association between height and endometrial cancer: compared with the lowest quintile, the multivariate relative risks (RR) were 0.9, 0.9, 0.7 and 0.8 for each subsequent quintile. Weight was directly associated with risk (RR = 2.7 for top vs. bottom quintile), and the positive association was even stronger when indices of body mass which make allowance for height were considered: the relative risks for extreme quintiles were 3.4 for W/H2 (Quetelet's index, weight and height), 3.8 for W/H1.5 and 3.5 for W0.33/H. Surface area, which was positively correlated both with height and weight, showed a weaker direct association (RR = 2.4 between extreme quintiles). The relations with measures of body weight were apparently stronger in postmenopause, but the point estimates for the upper quintile were also around 2 in premenopausal women. Although the major findings of this study are not new, they provide more detailed information that was hitherto available on the relation between various anthropometric indicators and endometrial cancer risk. In relation to height, with the sample size of this study it was possible to exclude, at the conventional 95% probability, relative risks above 1.0 for the fourth and above 1.1 for the fifth as compared with the lowest quintile. This provides indirect evidence against the hypothesis that nutritional status early in life is related to the subsequent development of endometrial cancer.
Adult↗
Reproductive factors and risk of endometrial cancer.
The role of reproductive factors in endometrial cancer risk has been analyzed in a case-control study conducted since 1983 in the greater Milan area on 568 women (cases) with histologically confirmed endometrial cancer and 1925 women (controls) who were admitted for acute, nonmalignant, hormonal, gynecologic conditions to hospitals that cover a comparable catchment area. Compared with nulliparous women, parous women had a 30% lower risk of endometrial cancer, but there was no evidence of a decline in risk with increasing number of births. The risk of the disease decreased with number of spontaneous or induced abortions; the multivariate relative risk estimates were, compared respectively with no spontaneous or induced abortions, 0.5 for women with two or more spontaneous abortions and 0.3 for women with two or more induced abortions; both trends in risk were statistically significant. When parous women only were considered, no association emerged between endometrial cancer and age at first birth, but the risk decreased with increasing age at last birth: compared with women whose last birth occurred before age 25, the relative risk was 0.5 for women who were greater than or equal to 35 years old at last birth, and the multivariate trend in risk was statistically significant. For most of the reproductive factors that were considered, the risk estimates tended to be greater at younger age or among premenopausal women and to flatten off in subsequent strata of age. An association between endometrial cancer and age at first birth was observed in women who were less than or equal to 49 years old, but not in older groups. The observation that later age at last birth as well as later first birth in younger women decreases the risk of endometrial cancer suggests a short-term protective effect of pregnancy. This finding is consistent with a late-stage (promotional) effect of reproductive factors on endometrial carcinogenesis.
Adult↗
Risk factors for spontaneous abortion.
A case-control study was conducted to evaluate risk factors for spontaneous abortions. Cases were 94 women with two or more unexplained miscarriages (after exclusion of genetic, endocrine and Müllerian factors) and no term pregnancy, controls were 176 women admitted for normal delivery to the same clinic where cases were identified. Questions were asked about personal characteristics and habits, and gynaecological history. A family history of recurrent miscarriage was more common among women with spontaneous miscarriages than among the controls (13 cases versus 8 controls, relative risk (RR) = 3.2, 95% confidence interval (CI) = 1.3-8.1). Compared to women whose menarche occurred at age 11 or younger, the RRs were 0.8 when menarche occurred at age 12-13 and 0.5 at age 14 or more: this trend in risk was statistically significant. Compared with never smokers, current smokers had about a 40% increased risk of miscarriage and the risk increased with number of cigarettes per day. No association emerged with sociodemographic characteristics (e.g. education, marital status, age of the partner), reproductive history (age at first pregnancy), type of contraceptive used and other general lifestyle habits (e.g. alcohol or coffee consumption).
Abortion, Spontaneous↗
Smoking habits and risk of benign breast disease.
The relationship between smoking habits and the risk of benign breast disease (BBD) was analyzed using data from a case-control study conducted between 1981 and 1983 in the greater Milan area, Northern Italy. Cases (n = 288) were women with histologically confirmed BBD (203 dysplasia, 85 benign tumours) referred to the National Cancer Institute of Milan for biopsies. Controls were women (n = 291) seen on selected days for a cytological smear for cervical cancer in outpatient clinics of the same Institute. No consistent association emerged between various indicators of smoking habits (smoking status, number of cigarettes smoked per day, duration of smoking) and the risk of BBD. Compared with never smokers the relative risk (RR) of all BBD combined was 0.7 (95% confidence interval, Cl: 0.4-1.3) in exsmokers, 1.4 (95% Cl: 0.8-2.5) in smokers of less than 10 cigarettes per day, and 1.1 (95% Cl: 0.7-1.7) in smokers of 10 or more cigarettes per day. There was some suggestion that the risk may be below unity post-menopause, but the relative risks for smokers were not statistically different in pre- (RR = 1.2; 95% Cl: 0.8-1.8) and post-menopausal (RR = 0.6; 95% Cl: 0.2-1.7) women. The risk of benign tumours (chiefly fibradenoma) was higher in current smokers, but this finding was not statistically significant (RR = 1.5; 95% Cl: 0.9-2.6) and the highest risks were observed in the strata of lighter smokers and those with shorter duration of smoking. Overall these results fail to support a negative association between smoking habits and benign breast disease.
Adenofibroma↗
Risk factors for HIV infection in adults attending sexually transmitted disease clinics in Italy.
We assessed prevalence and risk factors for human immunodeficiency virus (HIV) infection in 637 patients (506 men, 131 women; median age 30 years, range 17-64) attending between September 1988 and July 1989 for the first time two sexually transmitted disease (STD) clinics in Northern Italy, for suspected or STD treatment. A total of 44 subjects (6.9%, 95% confidence interval, (Cl): 4.9-8.9) were seropositive for HIV antibodies. The prevalence of HIV infection decreased with age, from 9% in patients aged 24 years or less to 3% in those aged 45 years or more (chi 21 trend 4.97, p less than 0.05). Women tended to have a lower prevalence of infection than men (5.3% versus 7.3%) but this was not statistically significant. Compared with men reporting no homosexual intercourse, HIV infection risk was about 50% higher in those reporting bisexual intercourse (age- and sex-adjusted odds ratio (OR) 1.5,95% Cl: 0.6-3.6) and about fourfold in those reporting only homosexual intercourse (OR 3.8, 95% Cl: 1.7-8.5). No clear trend in risk was observed with number of sexual partners both in men and in women. Intravenous drug users had an increased risk of HIV infection; compared with non-users, the OR was 5.6 (95% Cl: 3.0-10.5) in users, and the point estimates increased with frequency of use, from 3.3 (95% Cl: 0.8-11.5) in occasional users to 6.4 (95% Cl: 3.2-12.8) in regular users. The risk of HIV infection was 2.2 (95% Cl: 1.1-4.3) in patients reporting a history of STD, and 1.6 (95% Cl: 0.8-3.3) in those reporting syphilis.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Risk factors for epithelial ovarian tumours of borderline malignancy.
A case-control study was conducted on 91 cases with histologically-confirmed borderline ovarian tumours and 237 control subjects in hospital for acute non-gynaecological, hormonal or neoplastic disease. Women reporting three or more births, compared to nulliparae, had a relative risk (RR) estimate of 0.6, but this finding was not statistically significant (95% confidence interval (CI): 0.2-1.4). The risk of borderline tumours increased, although not significantly, with later age at first birth: compared to women reporting first birth at age 24 or before, the RRs were 1.3 and 1.7 in those reporting respectively their first birth at age 25-29 and 30 years or more. No significant relationship emerged between borderline ovarian cancer and age at menarche, menopausal status and lifelong menstrual pattern. Cases tended to report a later age at menopause than controls, but the trend in risk was not statistically significant. Nine cases (9.9%) and 68 controls (24.9%) reported oral contraceptive use: compared with never users the multivariate RR for ever users was 0.3, and the risk dropped with duration of use to 0.2 in users for two years or more (chi 2 (1) trend = 12.70, p less than 0.001). This study provides epidemiological evidence of a pathogenetic continuum between borderline and invasive ovarian tumours.
Adult↗
Trends in multiple births in Italy: 1955-1983.
On the basis of the numbers of single and multiple births routinely collected by the Central Institute of Statistics, trends in multiple births in Italy over the period 1955-1983 were analyzed. Between 1955 and 1983 the frequency of multiple births declined by about 25% (from 12.6/1000 deliveries to 9.6/1000 deliveries). The downward trend was constant until the early 1970s when rates tended to level off and increase slightly. This finding was largely attributable to trends in dizygotic rates, monozygotic births being approximately constant over the period considered. Multiple birth rates rose till age 35-39, being more than two times higher in this age group than in teenagers, but flattened off in the subsequent strata of age: this finding was constant over the period considered. Despite the general decreasing trend, the regional differences persisted largely unchanged, multiple birth rates being about 30% higher in Southern (and less developed areas) of the country than in the North of Italy. Geographic differences were limited to dizygotic pregnancies, monozygotic rates being constant (about 4/1000 pregnancies) in various areas.
Adolescent↗