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Biomedical subjects

F Parazzini

Publications and source records attributed to F Parazzini.

At least 307 records · Page 17Linked to original sources
PubMed1990

Relative and attributable risk for cervical cancer: a comparative study in the United States and Italy.

The attributable risk for invasive cervical cancer in the US and Italian populations has been estimated in relation to main 'aetiological' factors (number of sexual partners, age at first intercourse, parity, oral contraceptive use and smoking) and history of Pap smear using data from two case-control studies conducted in the US (466 cases and 788 controls) and Italy (528 cases and 456 controls). The risk of cervical cancer increased in both studies with multiple sexual partners, decreasing age at first intercourse, higher parity, oral contraceptive use and smoking. Levels of exposure to various risk factors were markedly different in the two countries (ie number of sexual partners, frequency of oral contraceptive use and smoking were greater in the US). Multiple Pap smears and a short interval since last Pap smear strongly reduced risk of cervical cancer in both populations, although screening was much more widespread in the US study population, with only 9% of controls reporting no previous smear versus 38% of the Italian control series. The combined population attributable risk for the five 'aetiological' risk factors was slightly greater in the US study (76%) than in the Italian one (69%), chiefly because of a higher prevalence of exposure to sexual factors in US study women. A substantially larger proportion of Italian cases were due in part to deficiency in screening (46% in US and 84% in Italy). Thus, further inclusion of the effect of screening programmes (number of Pap smears and time since last Pap) led to an overall proportion of cases attributable to the examined risk factors of 87% in the US and 95% in Italy.

Adult↗
PubMed1990

Critical review of the quality and development of randomized clinical trials (RCTs) and their influence on the treatment of advanced epithelial ovarian cancer.

Trials on chemotherapy of advanced ovarian cancer published between 1975-88 were systematically reviewed for quality (according to the method of Chalmers) and consistency of tested hypotheses with a view to a meta-analysis of all published studies in the field. Median overall, internal and external validity scores were 47%, 43% and 53%, respectively. No association was found between scores and key features of trials, such as percentage studies with significant results in response or survival or percentage studies with high or low follow-up retention (withdrawal rates less than or greater than or equal to 15%). Only 21% of trials reported a fully blind randomization procedure and only in 13% were drop-outs accounted for by the intent-to-treat method. Only 4 trials entered more than 150 patients per arm, a sample size consistent with detection of an absolute difference of 11% in mortality. The majority of trials (58%) investigated the role of combination regimens versus a single-agent control arm. The remaining trials tested different polychemotherapies. However, within these two general issues, treatment options were quite heterogeneous: seven subgroups were identified by whether cisplatin was present in either the treatment or the control arm. We conclude that the internal coherence and development of randomized clinical trials in advanced ovarian cancer and their methodologic soundness are quite poor. In this situation meta-analysis cannot go beyond a systematic attempt to answer a very general "treatment effectiveness" question.

Antineoplastic Agents↗
PubMed1990

Reproductive prognosis after abdominal metroplasty in bicornuate or septate uterus: a life table analysis.

Reproductive prognosis after abdominal metroplasty was assessed in 73 women with a septate and 71 with a bicornuate uterus who underwent metroplasty at the First Obstetric and Gynecologic Clinic of the University of Milan between 1972 and 1985. The overall cumulative 5-year delivery rates were respectively 70% and 73% in women with septate and bicornuate uterus, rising constantly with time. The number of previous miscarriages did not affect the reproductive prognosis: the 5-year probability of giving birth was 64% and 75% in the women with septate uterus and respectively fewer than two or more previous miscarriages, and the corresponding values were 66% and 73% in the bicornuate uterus subgroup. The miscarriage rate (about 20%) was similar with both types of malformation.

Abortion, Spontaneous↗
PubMed1990

Maternal and paternal moderate daily alcohol consumption and unexplained miscarriages.

The relation between parental moderate alcohol consumption and the risk of miscarriage was analysed using data from a case-control study in Milan between January 1987 and June 1988. Cases were 94 women who had two or more 'unexplained' miscarriages (after exclusion of genetic, endocrine and Müllerian factors) and without full-term pregnancies, admitted or referred to the First Obstetric and Gynecologic Clinic of the University of Milan. A total of 176 women admitted for normal delivery on selected days to the same university clinic and without previous miscarriages were chosen as controls. Compared with non-drinkers the risk of recurrent miscarriage was 0.9 for regular drinkers. The point estimates were 0.9 for women reporting one drink per day and 0.8 for those reporting two or more. Compared with non-drinkers, the relative risk estimates for drinking by fathers were slightly above unity, being 1.7 for less than three drinks and 1.4 for three or more drinks per day, but the trend in risk was not statistically significant.

Abortion, Habitual↗
PubMed1990

Maternal cohort, time of stillbirth, and maternal age effects in Italian stillbirth mortality.

STUDY OBJECTIVE: The aim of the study was to investigate factors in stillbirth mortality in Italy. DESIGN: Italian stillbirth data from 1955 to 1979 were analysed using a log-linear Poisson model with arbitrary constraints on the parameters to identify the effects of maternal birth cohort, calendar period of stillbirth and maternal age. SETTING: Stillbirth data for the whole of Italy were obtained from the Italian Central Institute of Statistics for the years under examination. During this period the criteria for defining stillbirth did not change and the quality of birth registration was similar. MAIN RESULTS: Decreases in stillbirth mortality were marked and steady, starting for the generations born since 1920. A period effect in stillbirth trends was shown, but this was apparently smaller than the cohort trend. CONCLUSIONS: The cohort trend suggests that long term improvements in socioeconomic and general health conditions may be important factors in the diminishing stillbirth rates, as well as short term advances in obstetric care. Alternatively the cohort effect could be attributed, at least in part, to an age-period interaction, since the downward trends were more pronounced in younger women.

Adolescent↗
PubMed1989

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↗
PubMed1989

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↗
PubMed1989

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↗
PubMed1989

Post-coital contraception: an overview of published studies.

Information from published studies testing the effect of hormonal and mechanical interceptive methods in post-coital contraception was pooled with the aim of assessing the efficacy of various regimens. The pooled failure rates were 0.6% (19/3168 based on four studies) for high-dosage ethinylestradiol, 1.1% (11/975, based on two studies) for other high-dose estrogens, 1.8% (69/3802 based on 11 studies) for combined estro-progestin preparations, 2.0% (20/998 based on three studies) for danazol and 0.1% (1/879 based on nine studies) for intra-uterine devices (IUD). Although this overview has several limitations in terms of over-representation of optimistic results in the literature or absence of direct comparison between treatments in several studies, it suggests that IUD and high-dose ethinylestradiol are more efficacious forms of post-coital contraception than danazol or combined contraceptives.

Contraceptives, Postcoital↗
PubMed1989

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↗
PubMed1989

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↗
PubMed1989

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↗
PubMed1989

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↗
PubMed1989

Is the published literature a reliable guide for deciding between alternative treatments for patients with early cervical cancer?

The quality of the methodology and reporting of studies on the treatment of early cervical cancer published in English and French language over the period 1975-1985 were examined using an explicit, pre-defined protocol aimed at assessing their internal validity and generalizability. One hundred and fifty-two articles reporting results on over 40,000 patients treated with surgery, radiotherapy, or the combination of the two, were examined. The astonishing lack of formal comparative studies together with the poor quality of those actually carried out were the two major findings of our study. More than half of the reviewed papers (54%) were single series studies. Among the remaining 46% only a few formally compared the two treatments (i.e. surgery vs. radiotherapy), the remainder dealing with comparisons of specific surgical or radiotherapeutic techniques. With reference to study quality, the existence of a pre-specified research protocol could not be ascertained in most studies. A description of patients' characteristics and information on the source population were deficient in most papers reviewed; information on the two aspects was in fact satisfactorily reported in only 7% and 47% of the papers, respectively. Finally, the lack of standardization of follow-up methods (i.e. type and modalities) and of information on treatment compliance were two other severe methodological deficiencies. In view of this poor quality and of the intrinsic difficulty of drawing firm scientific conclusions from non-experimental investigations, the reliability of this literature remains highly dubious. Another possible caveat is that what is published is a biased sample of the overall evidence because of the well known tendency of authors to write about and editors to publish positive results more frequently than negative ones.

Clinical Trials as Topic↗
PubMed1989

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↗
PubMed1989

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↗