Influence of selected dietary and lifestyle risk factors on familial propensity to breast cancer.
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Breast Neoplasms↗
Biomedical subjects
M Ferraroni
Publications and source records attributed to M Ferraroni.
Role of various carotenoids in the risk of breast cancer.
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Adult↗
Alcohol consumption and risk of breast cancer: a multicentre Italian case-control study.
The relationship between alcohol consumption and breast cancer risk was investigated using data from a co-operative case-control study conducted in Italy between 1991 and 1994 on 2569 incident, histologically confirmed breast cancer cases and 2588 controls in hospital for acute, non-neoplastic, non-hormone related conditions. Overall, 915 (38%) cases and 1048 (43%) controls were abstainers. Compared with them, the odds ratio (OR), adjusted only for age, was 1.31 (95% confidence interval (CI) 1.13-1.53) for drinkers and became 1.39 (95% CI 1.(1)21-1.60) after correction for measurement error. The multivariate OR was 1.21 for drinkers of < or = 5.87 g/day and 1.23, 1.19, 1.21, 1.41 for drinkers of 5.88-13.40, 13.41-24.55, 24.56-27.60, > 27.60 g/day, respectively. The trend in risk was significant (chi 2 = 12.28, P < 0.0005). The association was apparently stronger in premenopausal women (OR = 1.80 for > 27.60 g/day). Considering the different types of alcoholic beverages (wine, beer, digestives, grappa and other spirits), a significant direct trend in breast cancer risk was seen for wine with an OR of 1.27 (95% CI 1.06-1.53) for the category > 26.34 g/day. The ORs were also above unity for beer, grappa, digestives and spirits drinkers. No appreciable interaction was observed between alcohol drinking and body mass index, smoking, or any other covariate considered. Thus, the present data, based on a validated alcohol consumption questionnaire and on a population characterised by a relatively high alcohol consumption in women, confirmed that alcohol drinking is moderately related to breast cancer risk. If causal, this association could explain 12% (95% CI, 5-19%) of breast cancers in Italy, thus representing one of the major avoidable risk factor for breast cancer.
Adult↗
Alcohol intake and risk of cancers of the colon and rectum.
The relationship between alcohol drinking (mainly wine) and risk of colon and rectal cancer was considered in a case-control study conducted between 1991 and 1996 in six Italian centers. Cases were 1,225 patients < 75 years of age with histologically confirmed cancer of the colon and 728 patients with cancer of the rectum; controls were 4,154 patients admitted to hospital for a wide spectrum of acute, nonneoplastic diseases. Compared with never drinkers, the odds ratios (OR) for current drinkers in the higher quintile of total alcohol intake (> 51.82 g ethanol/day) were 1.01 for colon cancer and 0.90 for rectal cancer, and those for ex-drinkers were 1.20 and 1.07, respectively. The OR for wine drinkers in the highest quartile of intake were 1.07 for colon cancer and 0.97 for rectal cancer. No association was found with duration of the habit, time since starting, or age at starting. Among ex-drinkers, no association appeared with time since stopping. No significant heterogeneity was found across strata of age at diagnosis, sex, education, smoking status, physical activity, family history of colorectal cancer, beta-carotene, vitamin C, coffee, total fiber and folate intake, and number of meals per day. No significant association appeared for various intestinal subsites.
Adult↗
Alcohol, methylxanthine-containing beverages, and colorectal cancer in Córdoba, Argentina.
The relationship between social class indicators, body mass index (BMI), selected life-style habits (alcohol, coffee, maté and tea drinking) and colorectal cancer was investigated in a case-control study conducted between 1993 and 1997 in Córdoba, Argentina, a relatively high mortality area of colorectal cancer. Cases were 190 patients below age 80 years with incident, histologically confirmed colorectal adenocarcinomas, and controls were 393 patients admitted to hospital for a wide spectrum of acute, non-neoplastic disorders. Higher social class, based on occupation of the head of the household, was significantly associated with colorectal cancer risk: the odds ratios (OR) and 95% confidence intervals (95% CI) were 1.9 (1.2-2.9) for intermediate and 2.0 (1.2-3.4) for the highest as compared to the lowest social class individuals. When compared with subjects whose BMI was < 25 kg/m2, the OR was 1.1 (0.7-1.6) for those with BMI 25 to 29 kg/m2, and 1.3 (0.7-2.3) for those > or = 30. In comparison with alcohol abstainers, the OR was 2.8 (1.6-5.1) for drinkers, and there was a significant trend in risk with dose. The association was observed with wine (the most common alcoholic beverage in Argentina), as well as for beer and spirits. The consumption of coffee, maté and tea was not significantly related to colorectal cancer, but the ORs were below unity (0.9 (0.7-1.3) for coffee, 0.9 (0.6-1.2) for maté and 0.8 (0.6-1.2) for tea drinkers). The relationship between social class, alcohol drinking and colorectal cancer were consistent across strata of sex and age. This study confirms that colorectal cancer has positive social class correlates. The association with alcohol drinking is apparently stronger than previously reported, and may be due to the role of chance and/or peculiar correlates of alcohol drinking in this Argentinean population.
Adult↗
Fibers and breast cancer risk.
Data from a multicenter case-control study on breast cancer conducted in Italy were used to analyze the relationship between various types of fibers and breast cancer risk. Cases were 2,569 women with histologically confirmed, incident breast cancer; controls were 2,588 women admitted to the same network of hospitals for acute, nonneoplastic, non-hormone-related diseases. Cases and controls were interviewed between 1991 and 1994 using a validated food frequency questionnaire. The data were modeled through multiple logistic regression, controlling for demographic and reproductive breast cancer risk factors. The continuous odds ratios for the difference between the upper cut point of the fourth and the first quintile of intake were 0.90 [95% confidence interval = 0.82-0.98, p (for trend) < 0.05] for cellulose and 0.94 (95% confidence interval = 0.86-1.02) for soluble fibers. The protection tended to be stronger in premenopausal women. No material association was found for noncellulose polysaccharides and lignin. This study, based on a large data set from various Italian regions, suggests that fiber intake may confer some protection against breast cancer, particularly for cellulose and also for soluble fibers, i.e., those of vegetable origin. This possible protection has been related to an influence of fibers on levels and availability of estrogens and other steroid hormones in breast carcinogenesis.
Adult↗
Macronutrients, energy intake, and breast cancer risk: implications from different models.
We used data from a case-control study, conducted in Italy on 2,569 incident cases of breast cancer and 2,588 controls, to fit various energy adjustment models in the estimate of the effect of selected nutrients and alcohol on breast cancer risk. When we fit the standard multivariate and residual models, including total energy intake and the different macronutrients one at a time, the odds ratios (OR) related to 100 kcal per day were 0.90 for protein, 0.96 for saturated fat, 0.88 for unsaturated fat, 0.95 for sugar, 1.07 for starch, and 1.06 for alcohol. When we included all of the different sources of calorie intake in a single model with energy sources partitioned, the OR of adding 100 kcal per day was 0.91 for protein, 1.22 for saturated fat, 0.89 for unsaturated fat, 0.98 for sugar, 1.08 for starch, and 1.07 for alcohol. The estimates from the residual models that included various macronutrients separately were similar to those of the extended energy partition model.
Adult↗
Gastric cancer risk factors in subjects with family history.
Until now, it has been unclear whether there are differences in various risk factor profiles for familial gastric cancer, i.e., gastric cancer among subjects with a family history of the disease. A total of 722 gastric cancer patients and 2024 controls were admitted between 1985 and 1992 to a network of hospitals in the Greater Milan area. Of these, 88 cases and 103 controls who reported a family history of gastric cancer in first degree relatives were considered in the present analysis. There was no relationship between gastric cancer risk and tobacco smoking or alcohol drinking. Shorter duration of electrical refrigerator use was related to a nonsignificant increased risk and a high daily meal frequency was associated with an increased gastric cancer risk. Significant direct trends of risk were observed for pasta (odds ratio, OR = 4.20 for the highest versus the lowest tertile), bread (OR, 2.86), red meat (OR, 3.38), and preserved meat (OR, 1.90). Inverse associations were observed for increasing consumption of selected vegetables and fruits, chiefly peppers (OR = 0.31), total fruits (OR, 0.47), and citrus fruits (OR, 0.38). With reference to selected micronutrients, a significant inverse trend in risk with increasing consumption for beta-carotene (OR, 0.27) and ascorbic acid (OR, 0.20) was observed. These results suggest that dietary risk factors for subjects with a family history of gastric cancer in first-degree relatives are not appreciably different from well-established risk factors of the disease in the general population.
Case-Control Studies↗
Intake of macronutrients and risk of breast cancer.
BACKGROUND: The association between risk of breast cancer and dietary fat and intakes of other energy sources remains controversial. The Italian population offers special opportunities to assess the influence of high intakes of unsaturated fat and starch and, because the population has low awareness of diet and cancer issues, there is less scope for recall bias. We have assessed the relations of various macronutrient intakes with risk of breast cancer. METHODS: In this case-control study, 2569 women with incident breast cancer (median age 55 years) and 2588 control women (median age 56 years) in hospital with acute, non-neoplastic diseases, were interviewed in six different areas of Italy between 1991 and 1994. A validated food-frequency questionnaire was used. It included questions on 78 foods and recipes grouped into six sections, as well as specific questions on individual fat intake pattern. FINDINGS: The risk of breast cancer decreased with increasing total fat intake (trend p 0.01) whereas the risk increased with increasing intake of available carbohydrates (trend p = 0.002). The odds ratios for women in the highest compared with the lowest quintile of energy-adjusted intake were 0.81 for total fat and 1.30 for available carbohydrates. Starch was the chief contributor to the positive association with available carbohydrates. High intakes of polyunsaturated and unsaturated fatty acids (i.e., polyunsaturated fatty acids plus oleic acid) were associated with a decreased risk of breast cancer (odds ratios for highest vs lowest quintile 0.70 and 0.74, respectively). Conversely, the intakes of saturated fatty acids, protein, and fibre were not significantly associated with breast-cancer risk. INTERPRETATION: This case-controls study shows that unsaturated fatty acids protect against breast cancer, possibly because intake of these nutrients is closely correlated with a high intake of raw vegetables. The findings also suggest a possible risk in southern European populations, of reliance on a diet largely based on starch.
Adult↗
Attributable risks for colorectal cancer in northern Italy.
Using data from a case-control study conducted between 1985 and 1992 in northern Italy on 828 cases of colon cancer, 498 cases of rectal cancer and 2,024 controls in hospital for acute, non-neoplastic, non-digestive tract disorders, we estimated the percent population attributable risk (PAR) for colorectal cancer in relation to beta-carotene, vitamin C (as markers of a diet rich in fruit and vegetables), red meat and seasoning fat intake, daily meal frequency and family history of the disease. On the basis of multivariate odds ratios, adjusted for total calorie intake, a low intake of beta-carotene accounted for 39% of all the cases and a low intake of vitamin C for 14%. These two micronutrients together explained 43% of all colorectal cancer cases in this population. A high frequency of intake of red meat consumption explained 17% of all cases, and a high score of seasoning fats 4%. A higher daily meal frequency was responsible for 13% of the cases, and these 5 dietary factors together explained 63% of colorectal cancer cases in this population. Family history of colorectal cancer accounted for 4% of all cases. These estimates were similar for colon and rectal cancers separately, in males and females, and in younger and elderly subjects, except for seasoning fats and family history, whose PARs were apparently greater for colon cancer and at younger age. Thus, even though available dietary data were limited in several aspects, and the PAR estimates were based on somewhat arbitrary assumptions regarding the exposure distribution, about two-thirds of all colorectal cancers in this population could be explained in terms of a few risk factors or risk indicators considered. This would correspond to the avoidance of a large proportion of the over 18,000 deaths from colorectal cancer registered per year in the whole of Italy.
Adult↗
Intake of selected micronutrients and the risk of breast cancer.
To investigate the relation between selected micronutrients and breast cancer risk, we conducted a case-control study of breast cancer between June 1991 and April 1994 in 6 Italian areas. The study included 2569 women admitted to the major teaching and general hospitals of the study areas with histologically confirmed incident breast cancer and 2588 control women with no history of cancer, who were admitted to hospitals in the same catchment areas for acute, non-neoplastic, nongynecological conditions unrelated to hormonal or digestive tract diseases or to long-term modifications of the diet. Dietary habits, including alcoholic beverage consumption, were investigated using a validated food frequency questionnaire, including 78 foods or food groups, several types of alcoholic beverages, some "fat intake pattern" questions and some open sections for foods consumed frequently by the subject and not reported in the questionnaire. To control for potential confounding factors, several multiple logistic regression models were used. When major correlates, energy intake and the mutual confounding effect of the various micronutrients were taken into account, beta-carotene, vitamin E and calcium showed a significant inverse association with breast cancer risk. The estimated odds ratios of the 5th quintile compared to the lowest one were 0.84 for beta-carotene, 0.75 for vitamin E and 0.81 for calcium. No significant association emerged for retinol, vitamin C, thiamin, riboflavin, iron and potassium. Our results suggest that a diet rich in several micronutrients, particularly beta-carotene, vitamin E and calcium, may be protective against breast cancer.
Adult↗
Software for attributable risk and confidence interval estimation in case-control studies.
The increasing interest in obtaining model-based estimates of attributable risk (AR) and corresponding confidence intervals, in particular when more than one risk factor and/or several confounding factors are jointly considered, led us to develop a program based on the procedure described by Benichou and Gail for case-control data. This program is structured as an SAS-macro. It is suited to analysis of the relationship between risk factors and disease in case-control studies with simple random sampling of controls, in terms of relative risks and ARs, by means of unconditional logistic regression analysis. The variance of the AR is obtained by the delta method and is based on three components, namely, (i) the variance-covariance matrix of the vector of the estimated probabilities of belonging to joint levels of the exposure and confounding factors conditional on being a case, (ii) the variance-covariance matrix of the odds ratio parameter estimates from the logistic model, and (iii) the covariances between these probability and parameter estimates. Only a limited number of commands is requested from the user (i.e., the name of the work file and the names of the variables considered). The estimated relative risks for all the factors included in the model, the attributable risk for the exposure factor under consideration, and the corresponding 95% confidence intervals are given as outputs by the macro. Computational problems, if any, may arise for large numbers of covariates because of the resulting large size of vectors and matrices. The macro was tested for reliability and consistency on published data sets of case-control studies.
Age Factors↗
Validation of a food-frequency questionnaire to assess dietary intakes in cancer studies in Italy. Results for specific nutrients.
The validity of a 77-item food-frequency questionnaire (FFQ) developed for a multicenter case-control study on diet and cancer in Italy was assessed. Trained interviewers administered the same FFQ to 452 volunteers from three Italian provinces (Pordenone, Genoa, and Forli) completed in two different seasons, at an interval of 3 to 10 months. For 395 (130 males, 265 females; median age = 52 years; range = 35 to 69 years) volunteers, two 7-day dietary (7-DD) records were available. Average intake obtained by means of the FFQ was overestimated by approximately 18% in comparison with the corresponding values based on the two 7-DD records (reference method). Pearson partial correlation coefficients, adjusted for total energy intake between the nutrient intakes assessed by the FFQ and reference method, ranged from 0.19 for vegetable fat to 0.64 for sugar (median value r = 0.46). The unadjusted deattenuated coefficients, which took into account the interindividual variability of consumption, estimated by means of the two 7-DD records, ranged from 0.29 for vegetable fat to 0.72 for starch (median value r = 0.54). The proportion of subjects correctly classified within the lowest two quintiles ranged between 59% for vegetable fat and vitamin E, and 96% for alcohol, and those correctly classified within the highest two quintiles ranged between 44% for vegetable fat and 94% for alcohol. The average proportion of subjects correctly classified within one quintile was 73%. These data indicate that this FFQ provides valid estimates of intakes for major nutrients, comparable to those reported from other studies in North America and other European countries.
Adult↗
Validity and reproducibility of alcohol consumption in Italy.
BACKGROUND: The reproducibility and validity of alcohol consumption has not been adequately studied, particularly in mediterranean countries, where alcohol drinking is a widespread habit, especially during meals. METHODS: We compared alcohol consumption measured by two interviewer-administered food frequency questionnaires (FFQ) with average intake derived from two 7-day dietary (7-DD) records (the reference method) on 395 volunteers. Different types of alcoholic beverages were considered separately in order to verify the ability of the questionnaire to assess detailed patterns of alcohol intake. RESULTS: A satisfactory level of reproducibility and validity of the pattern of alcohol consumption across different levels and types of alcoholic beverage intake was observed. The reproducibility of wine and total alcohol intake showed correlation coefficients > 0.75 in both sexes. The validity was somewhat higher for wine (around 0.70) than for other alcoholic beverages and total alcohol intake. This is probably accounted for by the more regular pattern of wine consumption during the year as compared to other alcoholic beverages (beer, grappa, etc) which are more strongly influenced by seasonal and daily variations. However, about 30% of abstainers according to FFQ were drinkers by the reference method. The opposite was observed in only 4% of subjects. CONCLUSION: The FFQ is a reliable and valid instrument for collecting alcohol intake in regular drinkers. Lower validity in irregular drinkers may be due to seasonal variation and/or inadequacy of the FFQ to capture irregular patterns of consumption and/or inadequacy of the average of two 7-DD as a reference method. Furthermore, a considerable degree of misclassification was observed between non-drinkers and moderate drinkers.
Adult↗
Reproducibility of an Italian food frequency questionnaire for cancer studies. Results for specific nutrients.
The reproducibility of measures of the intake of total energy and 27 selected nutrients from a quantitative food frequency questionnaire (FFQ) used in a case-control study on cancer of the breast, ovary, and digestive tract was evaluated. The results of two FFQ administrations at an interval of 3 to 10 months (median = 5.4 months) to 452 volunteers (144 males and 308 females; median age = 50 years) from three Italian provinces (Pordenone, Genoa, and Forì) were compared. Pearson correlation coefficients (r) between crude nutrient intake (unadjusted for energy) ranged from 0.50 for vegetable fat to 0.80 for alcohol, with most values falling between 0.60 and 0.70 (median r = 0.67). Adjustment of nutrient intakes for total energy slightly decreased most coefficients (median r = 0.60). The agreement between the two measurements did not differ substantially by sex, age, education, and interval between interviews. The contribution of specific FFQ components (i.e., frequency-only questions, open questions, portion size, and fat intake pattern) was also assessed separately with respect to the performance and reproducibility of nutrient measures, yielding, in general, very similar results. The seven questions concerning individual fat intake pattern, which were used to modulate the composition of various recipes, led, however, to a significant increase in mean daily intake of vegetable fat, oleic acid, and vitamin E, but a reduction of estimated daily intake of linoleic acid and polyunsaturated fatty acids.(ABSTRACT TRUNCATED AT 250 WORDS)
Case-Control Studies↗
Past contraceptive method use and risk of ectopic pregnancy.
The relationship between past contraceptive method use and risk of ectopic pregnancy has been analyzed in a case-control study conducted in Milan, Italy. Cases were 158 women with diagnosis of ectopic pregnancy confirmed by laparoscopy or laparotomy, admitted to a network of university and general hospitals of Milan. The first control group (obstetric controls) included 243 women who gave birth at term (more than 37 weeks' gestation) to healthy infants at the same hospitals where the cases had been identified. The second control group (non-obstetric controls) was a random sample of 158 women admitted to the same network of hospitals where cases had been identified for diseases other than malignant, hormonal, or gynecological in origin. A total of 37 (23%) cases, 21 (9%) obstetric and 24 (15%) non-obstetric controls reported ever IUD use. The corresponding relative risk, RR, of ectopic pregnancy was 3.5 (95% CI 1.3-4.6) when non-obstetric subjects were considered as control group. The risk of ectopic pregnancy increased with duration of IUD use: in comparison with obstetric and non-obstetric controls, the RR were 2.3 and 2.0 for users for less than 2 years and 4.3 and 2.6 for longer users. There was no clear relation between time since last IUD use and risk of ectopic pregnancy, and no evidence of a decline of risk with increasing time since stopping use.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Hormone replacement treatment and breast cancer risk: a cooperative Italian study.
The relationship between hormone replacement treatment (HRT) and breast cancer risk was analysed using data from a case-control study conducted between June 1991 and February 1994 in six Italian centres on 2569 patients aged below 75 with histologically confirmed breast cancer and 2588 controls admitted to hospital for a wide spectrum of acute, non-neoplastic, non hormone-related diseases. Ever HRT use was reported by 7.5% of cases and 7.5% of controls, corresponding to a multivariate odds ratio (OR) of 1.2 [95% confidence interval (CI), 0.9-1.5]. The risk increased with increasing duration of use: the ORs were 1.0 for use lasting less than 1 year, 1.3 for 1-4 years and 1.5 for 5 years or more. There was no clear pattern of risk with reference to time since starting use, but the OR was significantly elevated (OR = 2.0, 95% CI 1.3-2.9) for women who had stopped HRT within the last 10 years. No association was observed in those who had stopped HRT more than 10 years ago (OR = 1.0). The increased OR for women who had stopped HRT within the last 10 years was consistent across strata of identified covariates, and was significantly related to duration of use. This study confirms the absence of a strong association between HRT and breast cancer risk, although the risk estimate was above unity for women who had used HRT for 5 years or longer. However, the risk was significantly elevated in the short to medium term after use, particularly for long-term use. This short-term increased risk is consistent with an effect of HRT on one of the later stages of the process of breast carcinogenesis. The flattening of risk with increasing time since stopping, and hence the absence of a long-term cumulative excess in breast cancer risk after stopping HRT exposure, has relevant implications on individual risk assessment and public health.
Adult↗
Induced abortions and risk of ectopic pregnancy.
The relationship between induced abortions and subsequent risk of ectopic pregnancy has been analysed using data from a case-control study conducted in Milan, Italy. The cases were 158 women with a diagnosis of ectopic pregnancy confirmed by laparoscopy or laparotomy, admitted to a network of university and general hospitals. Two control groups were selected. The first one (obstetric controls) included 243 women who gave birth at term (more than 37 weeks gestation) to healthy infants at the same hospitals where the cases had been identified. The second control group (non-obstetric controls) was a random sample of 158 women of comparable age interviewed in the same calendar period, admitted to hospital for a broad spectrum of acute, non-gynaecological or obstetric conditions. A total of 35 out of 158 cases (22%) reported one or more previous induced abortions; the corresponding figures were 29 out of 243 (12%) obstetric controls and 29 out of 158 (18%) non-obstetric ones. The risk of ectopic pregnancy was higher in women reporting induced abortions: the estimated multivariate relative risks (relative risk) for any induced abortions were 2.9 [95%, confidence interval (CI) 1.6-5.3] in comparison with obstetric controls and 2.5 (95% CI 1.2-5.0) in comparison with women admitted to hospital for other conditions. The risk increased with number of induced abortions, being, compared to women with no induced abortion, 13.1 (95% CI 3.2-54.5) and 3.8 (95% CI 1.1-12.7) in women reporting two or more induced abortions when the comparison groups were respectively obstetric and non-obstetric controls. This study shows an increased risk of ectopic pregnancy after induced abortion.(ABSTRACT TRUNCATED AT 250 WORDS)
Abortion, Induced↗