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1. Italian cancer figures, report 2014: Prevalence and cure of cancer in Italy

Author

Adamo, M., Alessi, D., Aletta, P., Amodio, R., Andreone, S., Angelin, T., Anghinoni, E., Annulli, M., Arciprete, C., Artioli, M., Autelitano, M., Baili, P., Balducci, C., Baracco, M., Baracco, S., Battisti, W., Bella, F., Bellatalla, C., Bellini, A., Belluardo, C., Benatti, P., Benedetto, G., Benfatto, L., Bernazza, E., Bianconi, F., Biavati, P., Bidoli, E., Birri, S., Bizzoco, S., Bonelli, L., Bonini, A., Borciani, E., Bordini, M., Bovo, E., Bozzani, F., Braghiroli, B., Brucculeri, M., Brunori, V., Bucalo, G., Bucchi, L., Bugliarello, E., Bulatko, A., Busco, S., Busso, P., Buzzoni, C., Calabrese, A., Calabretta, L., Caldarella, A., Candela, G., Cannone, G., Canu, L., Caparelli, M., Capocaccia, R., Cappelletti, M., Caprara, L., Carboni, D., Carletti, N., Caroli, S., Cascio, M., Cascone, G., Casella, C., Castaing, M., Cavalieri, D., L, Cecconami, L., Celesia, M., Cena, T., Cercato, M., Cesaraccio, R., Chiesa, R., Cirilli, C., Cocchioni, M., Codazzi, T., Cogno, R., Colamartini, A., Colanino, Z., A, Cometti, I., Contiero, P., Contrino, M., Corbinelli, A., Cordaro, C., Corti, M., Costa, A., Costarelli, D., Coviello, V., Crapanzano, G., Cremone, L., Crocetti, E., Cuccaro, F., Curatella, S., Cusimano, R., D Alò, D., Dal, C., Dal, T., Cin, A., Dal, M., Davini, C., Dottori, D., De, M., Angelis, R., Santis, D., De, E., Valiere, E., Dei, T., Demurtas, G., Devigili, E., Felice, D., Di, E., Grazia, L., Gregorio, D., Di, C., Norcia, R., Prima, D., Dinaro, Y., Distefano, R., Doa, N., Domati, F., Fabiano, S., Facchinelli, G., Falcini, F., Falk, M., Fanetti, A., Fattoruso, S., Federico, M., Ferrari, F., Ferrari, L., Ferretti, S., Fidelbo, M., Filipazzi, L., Fiore, A., Fiori, G., Foca, F., Forgiarini, O., Foschi, R., Francisci, S., Frasca, G., Frassoldi, E., Fusco, M., Gada, D., Garrone, E., Gasparotti, C., Gatta, G., Gatti, L., Gaudiano, C., Gennaro, V., Gentilini, M., Gerevini, C., Ghilardi, S., Ghisleni, S., Giacomin, A., Giavazzi, L., Gigli, A., Gilardi, F., Giorgetti, S., Giorgi, R., P, Giubelli, C., Giuliani, O., Giurdanella, M., Gola, G., Goldoni, C., Golizia, M., Greco, A., Guarda, L., Guttadauro, A., Guzzinati, S., Iachetta, F., Iannelli, A., Ieni, A., Intrieri, T., Kaleci, S., Rosa, L., F, Lando, C., Lavecchia, A., Lazzarato, F., Rose, L., Leone, A., Leone, R., Lonati, F., Lucchi, S., Luminari, S., Macci, L., Macerata, V., Madeddu, A., Maffei, S., Maghini, A., Magnani, C., Magnani, G., Magoni, M., Mallone, S., Mameli, G., Mancini, S., Mancuso, P., Mangone, L., Manneschi, G., Mannino, R., Mannino, S., Marani, E., Marchesi, C., Mariani, F., Martorana, C., Marzola, L., Maspero, S., Maule, M., Mazzei, A., Mazzoleni, G., Mazzucco, G., Melcarne, A., Merletti, F., Merlo, E., Michiara, M., Migliari, E., Minerba, S., Minicuzzi, A., Mizzi, M., Monetti, D., Morana, G., Moroni, E., Mosso, M., Muni, A., Mura, F., Natali, M., Negrino, L., Nemcova, L., Nicita, C., Ocello, C., Pala, F., Palumbo, M., Panciroli, E., Panico, M., Pannozzo, F., Pascucci, C., Pasolini, A., Pastore, G., Patriarca, S., Pedroni, M., Perrotta, C., Pesce, P., Petrinelli, A., Petrucci, C., Pezzarossi, A., Pezzuto, L., Piffer, S., Pinon, M., Antonio Pinto, Pintori, N., Pirani, M., Pirino, D., Pironi, V., Ponz, D., Leon, M., Prandi, R., Prazzoli, R., Puleio, M., Puppo, A., Quarta, F., Quattrocchi, M., Ramazzotti, V., Rashid, I., Ravaioli, A., Ravazzolo, B., Ravegnani, M., Reggiani Bonetti, L., Ricci, P., Rinaldi, E., Rizzello, R., Rognoni, M., Rollo, P., Roncaglia, F., Roncucci, L., Rosano, A., Rossi, F., Rossi, G., Rossi, M., Rossi, S., Rossini, S., Rosso, S., Rudisi, G., Ruggeri, M., Russo, A., Russo, M., Sacchettini, C., Sacchetto, L., Sacco, G., Sacerdote, C., Salvatore, S., Salvi, O., Sampietro, G., Santucci, C., Scheibel, M., Sciacca, S., Sciacchitano, C., Sciacchitano, S., Scuderi, T., Sechi, O., Seghini, P., Senatore, G., Serafini, G., Serraino, D., Sgargi, P., Sini, G., Sobrato, I., Soddu, M., Solimene, C., Spano, F., Spata, E., Sperduti, I., Spinosa, S., Staiti, R., Stocco, C., Stracci, F., Sunseri, R., Sutera, S., Tagliabue, G., Tamburo, L., Tamburrino, S., Taranto, V., Terracini, B., Tisano, F., Tittarelli, A., Tognazzo, S., Torrisi, A., Traina, A., Trama, A., Trapani, C., Tschugguel, B., Tumino, R., Usala, M., Vacirca, S., Valerio, O., Valla, K., Varvarà, M., Vasquez, E., Vassante, B., Vattiato, R., Vercelli, M., Vercellino, P., Vicentini, M., Villa, M., Virdone, S., Francesco Vitale, Vitale, M., Vitali, B., Vitali, M., Vitarelli, S., Zanchi, A., Zanetti, R., Zani, G., Zanier, L., Zappa, M., Zarcone, M., Zevola, A., Zorzi, M., Zucchetto, A., Zucchi, A., Adamo, MS, Alessi, D, Aletta, P, Amodio, R, Andreone, S, Angelin, T, Anghinoni, E, Annulli, ML, Arciprete, C, Artioli, ME, Autelitano, M, Baili, P, Balducci, C, Baracco, M, Baracco, S, Battisti, W, Bella, F, Bellatalla, C, Bellini, A, Belluardo, C, Benatti, P, Benedetto, G, Benfatto, L, Bernazza, E, Bianconi, F, Biavati, P, Bidoli, E, Birri, S, Bizzoco, S, Bonelli, L, Bonini, A, Borciani, E, Bordini, M, Bovo, E, Bozzani, F, Braghiroli, B, Brucculeri, MA, Brunori, V, Bucalo, G, Bucchi, L, Bugliarello, E, Bulatko, A, Busco, S, Busso, P, Buzzoni, C, Calabrese, A, Calabretta, L, Caldarella, A, Candela, G, Cannone, G, Canu, L, Caparelli, M, Capocaccia, R, Cappelletti, M, Caprara, L, Carboni, D, Carletti, N, Caroli, S, Cascio, MA, Cascone, G, Casella, C, Castaing, M, Cavalieri, d'Oro, L, Cecconami, L, Celesia, MV, Cena, T, Cercato, MC, Cesaraccio, R, Chiesa, R, Cirilli, C, Cocchioni, M, Codazzi, T, Cogno, R, Colamartini, A, Colanino, Ziino, A, Cometti, I, Contiero, P, Contrino, ML, Corbinelli, A, Cordaro, C, Corti, M, Costa, A, Costarelli, D, Coviello, V, Crapanzano, G, Cremone, L, Crocetti, E, Cuccaro, F, Curatella, S, Cusimano, R, D'Alò, D, Dal, Cappello, T, Dal, Cin, A, Dal, Maso, L, Davini, C, De, Dottori, M, De, Angelis, R, De, Santis, E, De, Valiere, E, Dei, Tos, AP, Demurtas, G, Devigili, E, Di, Felice, E, di, Grazia, L, Di, Gregorio, C, di, Norcia, R, Di, Prima, A, Dinaro, Y, Distefano, R, Doa, N, Domati, F, Fabiano, S, Facchinelli, G, Falcini, F, Falk, M, Fanetti, AC, Fattoruso, S, Federico, M, Ferrari, F, Ferrari, L, Ferretti, S, Fidelbo, M, Filipazzi, L, Fiore, AR, Fiori, G, Foca, F, Forgiarini, O, Foschi, R, Francisci, S, Frasca, G, Frassoldi, E, Fusco, M, Gada, D, Garrone, E, Gasparotti, C, Gatta, G, Gatti, L, Gaudiano, C, Gennaro, V, Gentilini, MA, Gerevini, C, Ghilardi, S, Ghisleni, S, Giacomin, A, Giavazzi, L, Gigli, A, Gilardi, F, Giorgetti, S, Giorgi, Rossi, P, Giubelli, C, Giuliani, O, Giurdanella, MC, Gola, G, Goldoni, CA, Golizia, MG, Greco, A, Guarda, L, Guttadauro, A, Guzzinati, S, Iachetta, F, Iannelli, A, Ieni, A, Intrieri, T, Kaleci, S, La, Rosa, F, Lando, C, Lavecchia, AM, Lazzarato, F, Le, Rose, L, Leone, A, Leone, R, Lonati, F, Lucchi, S, Luminari, S, Macci, L, Macerata, V, Madeddu, A, Maffei, S, Maghini, A, Magnani, C, Magnani, G, Magoni, M, Mallone, S, Mameli, G, Mancini, S, Mancuso, P, Mangone, L, Manneschi, G, Mannino, R, Mannino, S, Marani, E, Marchesi, C, Mariani, F, Martorana, C, Marzola, L, Maspero, S, Maule, M, Mazzei, A, Mazzoleni, G, Mazzucco, G, Melcarne, A, Merletti, F, Merlo, E, Michiara, M, Migliari, E, Minerba, S, Minicuzzi, A, Mizzi, M, Monetti, D, Morana, G, Moroni, E, Mosso, ML, Muni, A, Mura, F, Natali, M, Negrino, L, Nemcova, L, Nicita, C, Ocello, C, Pala, F, Palumbo, M, Panciroli, E, Panico, M, Pannozzo, F, Pascucci, C, Pasolini, A, Pastore, G, Patriarca, S, Pedroni, M, Perrotta, C, Pesce, P, Petrinelli, AM, Petrucci, C, Pezzarossi, A, Pezzuto, L, Piffer, S, Pinon, M, Pinto, A, Pintori, N, Pirani, M, Pirino, D, Pironi, V, Ponz, de, Leon, M, Prandi, R, Prazzoli, R, Puleio, M, Puppo, A, Quarta, F, Quattrocchi, M, Ramazzotti, V, Rashid, I, Ravaioli, A, Ravazzolo, B, Ravegnani, M, Reggiani-Bonetti, L, Ricci, P, Rinaldi, E, Rizzello, R, Rognoni, M, Rollo, PC, Roncaglia, F, Roncucci, L, Rosano, A, Rossi, F, Rossi, G, Rossi, M, Rossi, S, Rossini, S, Rosso, S, Rudisi, G, Ruggeri, MG, Russo, AG, Russo, M, Sacchettini, C, Sacchetto, L, Sacco, G, Sacerdote, C, Salvatore, S, Salvi, O, Sampietro, G, Santucci, C, Scheibel, M, Sciacca, S, Sciacchitano, C, Sciacchitano, S, Scuderi, T, Sechi, O, Seghini, P, Senatore, G, Serafini, G, Serraino, D, Sgargi, P, Sini, GM, Sobrato, I, Soddu, M, Solimene, C, Spano, F, Spata, E, Sperduti, I, Spinosa, S, Staiti, R, Stocco, C, Stracci, F, Sunseri, R, Sutera, Sardo, A, Tagliabue, G, Tamburo, L, Tamburrino, S, Taranto, V, Terracini, B, Tisano, F, Tittarelli, A, Tognazzo, S, Torrisi, A, Traina, A, Trama, A, Trapani, C, Tschugguel, B, Tumino, R, Usala, M, Vacirca, S, Valerio, O, Valla, K, Varvarà, M, Vasquez, E, Vassante, B, Vattiato, R, Vercelli, M, Vercellino, PC, Vicentini, M, Villa, M, Virdone, S, Vitale, F, Vitale, MF, Vitali, B, Vitali, ME, Vitarelli, S, Zanchi, A, Zanetti, R, Zani, G, Zanier, L, Zappa, M, Zarcone, M, Zevola, A, Zorzi, M, Zucchetto, A, and Zucchi, A

Subjects
Aged, 80 and over, Male, Medicine (all), Aged, Female, Humans, Italy, Middle Aged, Neoplasms, Prevalence, Registries, Survival Rate, Socio-culturale, Settore MED/42 - Igiene Generale E Applicata, 80 and over, cancer prevalence, cancer incidence, cancer in Italy
Abstract

This Report intends to estimate the total number of people still alive in 2010 after cancer diagnosis in Italy, regardless of the time since diagnosis, and to project these estimates to 2015. This study is also aimed to estimate the number of already cured cancer patients, whose mortality rates have become undistinguishable from that of the general population of the same age and sex.The study took advantage of the information from the AIRTUM database, which included 29 Cancer Registries (covering 21 million people, 35% of the Italian population). A total of 1,624,533 cancer cases diagnosed between 1976 and 2009 contributed to the study. For each registry, the observed prevalence was calculated. Prevalence for lengths of time exceeding the maximum duration of the registration and of the complete prevalence were derived by applying an estimated correction factor, the completeness index. This index was estimated by means of statistical regression models using cancer incidence and survival data available in registries with 18 years of observation or more. For 50 types or combinations of neoplasms, complete prevalence was estimated at 1.1.2010 as an absolute number and as a proportion per 100,000 inhabitants by sex, age group, area of residence, and years since diagnosis. Projections of complete prevalence for 1.1.2015 were computed under the assumption of a linear trend of the complete prevalence observed until 2010. Validated mixture cure models were used to estimate: the cure fraction, that is the proportion of patients who, starting from the time of diagnosis, are expected to reach the same mortality rate of the general population; the conditional relative survival (CRS), that is the cumulative probability of surviving some additional years, given that patients already survived a certain number of years; the time to cure, that is the number of years necessary so that conditional survival in the following five years (5-year CRS) exceeds the conventional threshold of 95% (i.e., mortality rates in cancer patients become undistinguishable compared to those of the general population); the proportion of patients already cured, i.e., people alive since a number of years exceeding time to cure.As of 1.1.2010, it was estimated that 2,587,347 people were alive after a cancer diagnosis, corresponding to 4.4% of the Italian population. A relevant geographical heterogeneity emerged, with a prevalence above 5% in northern registries and below 4% in southern areas. Men were 45% of the total (1,154,289) and women 55% (1,433,058). In the population aged 75 years or more, the proportions of prevalent cases were 20% in males and 13% in females, 11% between 60 and 74 years of age in both sexes. Nearly 600,000 Italian women were alive after a breast cancer diagnosis (41% of all women with this neoplasm), followed by women with cancers of the colon rectum (12%), corpus uteri (7%), and thyroid (6%). In men, 26% of prevalent cases (295,624) were patients with prostate cancer, 16% with either bladder or colon rectum cancer. The projections for 1.1.2015 are of three million (3,036,741) people alive after a cancer diagnosis, 4.9% of the Italian population; with a 20% increase for males and 15% for females, compared to 2010. The cure fractions were heterogeneous according to cancer type and age. Estimates obtained as the sum of cure fractions for all cancer types showed that more than 60% of patients diagnosed below the age of 45 years will reach the same mortality rate of the general population. This proportion decreased with increasing age and it was30% for cancer diagnosed after the age of 74 years. It was observed that 60% of all prevalent cases (1,543,531 people or 2.6% of overall Italian population) had been diagnosed5 years earlier (long-term survivors). Time to cure (5-year CRS95%) was reached in10 years by patients with cancers of the stomach, colon rectum, pancreas, corpus and cervix uteri, brain, and Hodgkin lymphoma. Mortality rates similar to the ones reported by the general population were reached after approximately 20 years for breast and prostate cancer patients. Five-year CRS remained95% for25 years after cancer diagnosis in patients with liver and larynx cancers, non-Hodgkin lymphoma, myeloma, and leukaemia. Time to cure was reached by 27% (20% in men and 33% in women) of all people living after a cancer diagnosis, defined as already cured.The study showed a steady increase over time (nearly +3% per year) of prevalent cases in Italy. A quarter of Italian cancer patients alive in 2010 can be considered as already cured. The AIRTUM Report 2014 describes characteristics of cancer patients and former-patients for 50 cancer types or combinations by sex and age. This detailed information promotes the conduction of studies aimed at expanding the current knowledge on the quality of life of these patients during and after the active phase of treatments (prevalence according to health status), on the long-term effects of treatments (in particular for paediatric patients), on the cost profile of cancer patients, and on rare tumours. All these observations have a high potential impact on health planning, clinical practice, and, most of all, patients' perspective.

Published
2014

2. Combined effect of tobacco and alcohol on laryngeal cancer risk: a case-control study

Author

Talamini R, Bosetti C, La Vecchia C, Dal Maso L, Levi F, Bidoli E, Negri E, Pasche C, Vaccarella S, Barzan L, Franceschi S, Talamini R, Bosetti C, La Vecchia C, Dal Maso L, Levi F, Bidoli E, Negri E, Pasche C, Vaccarella S, Barzan L, and Franceschi S

Subjects
Adult, Male, Alcohol Drinking, Smoking, Middle Aged, Logistic Models, Italy, Risk Factors, Case-Control Studies, Carcinoma, Squamous Cell, Humans, Female, Laryngeal Neoplasms, Switzerland, Aged
Abstract

Objective: To provide information on the effects of alcohol and tobacco on laryngeal cancer and its subsites. Methods: This was a case-control study conducted between 1992 and 2000 in northern Italy and Switzerland. A total of 527 cases of incident squamous-cell carcinoma of the larynx and 1297 hospital controls frequency-matched with cases on age, sex, and area of residence were included. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated using multiple logistic regression. Results: In comparison with never smokers, ORs were 19.8 for current smokers and 7.0 for ex-smokers. The risk increased in relation to the number of cigarettes (OR = 42.9 for greater than or equal to25 cigarettes/day) and for duration of smoking (OR = 37.2 for greater than or equal to40 years). For alcohol, the risk increased in relation to number of drinks (OR = 5.9 for greater than or equal to56 drinks per week). Combined alcohol and tobacco consumption showed a multiplicative (OR = 177) rather than an additive risk. For current smokers and current drinkers the risk was higher for supraglottis (ORs 54.9 and 2.6, respectively) than for glottis (ORs 7.4 and 1.8) and others subsites (ORs 10.9 and 1.9). Conclusions: Our study shows that both cigarette smoking and alcohol drinking are independent risk factors for laryngeal cancer. Heavy consumption of alcohol and cigarettes determined a multiplicative risk increase, possibly suggesting biological synergy.

Published
2003

3. Role of macronutrients, vitamins and minerals in the aetiology of squamous-cell carcinoma of the oesophagus

Author

Franceschi S, Bidoli E, Negri E, Zambon P, Talamini R, Ruol A, Parpinel M, Levi F, Simonato L, La Vecchia C, Franceschi S, Bidoli E, Negri E, Zambon P, Talamini R, Ruol A, Parpinel M, Levi F, Simonato L, and La Vecchia C

Subjects
Adult, Male, Minerals, Esophageal Neoplasms, Fatty Acids, Carbohydrates, Proteins, Vitamins, Middle Aged, Diet, Italy, Case-Control Studies, Carcinoma, Squamous Cell, Humans, Female, Aged
Abstract

Between 1992 and 1997 we conducted a case-control study of oesophageal cancer in 3 areas of northern Italy. Cases were 304 patients (29 women), ages 39-77 years (median age 60 years), with a first incident squamous-cell carcinoma (SCC) of the oesophagus, Controls were 743 patients (150 women), ages 35-77 years (median age 60 years), admitted for acute illnesses, unrelated to tobacco and alcohol, to major hospitals of the areas under surveillance. We derived estimates of daily dietary intake of 6 macronutrients, cholesterol, and 20 micronutrients or minerals from a validated food-frequency questionnaire, including 78 food groups and recipes and 15 questions on individual eating patterns. After allowance for age, gender, area of residence, education, body mass index, physical activity, smoking habit, alcohol consumption and energy intake, most micronutrients were inversely associated with oesophageal SCC risk. Highly significant associations emerged for monounsaturated fatty acids [odds ratio (OR) in highest vs. lowest intake quintile = 0.5]; carotene (OR = 0.3); lutein + zeaxanthin (OR = 0.4); vitamin C (OR = 0.4); and niacin (OR = 0,5). Only retinol appeared to be positively related to risk (OR = 1.9), The effect of the above nutrients, expressed as ORs, appeared to be similar in non-smokers and smokers, and non/light drinkers and heavy drinkers. (C) 2000 Wiley-Liss, Inc. RI Parpinel, Maria/B-1605-2012

Published
2000

4. Italian cancer figures, report 2012: Cancer in children and adolescents

Author

Pisani, P, Buzzoni, C, Crocetti, E, Maso, Ld, Rondelli, R, Alessi, D, Aricò, M, Bidoli, E, Ferrari, A, Fusco, M, Gatta, G, Guzzinati, S, Jankovic, M, Locatelli, F, Maule, M, Mosso, Ml, Pastore, G, Pession, A, Rashid, I, Sacerdote, C, Terracini, B, Tognazzo, S, Trama, A, Ferretti, S, Porta, F, Mazzoleni, G, Tschugguel, B, De Valiere, E, Facchinelli, G, Falk, M, Cappello, Td, Giacomin, A, Vercellino, Pc, Andreone, S, Marzola, L, Migliari, E, Carletti, N, Nenci, I, Caldarella, A, Corbinelli, A, Intrieri, T, Manneschi, G, Nemcova, L, Ocello, C, Sacchettini, C, Zappa, M, Paci, E, Serraino, D, Angelin, T, Birri, S, De Dottori, M, De Santis, E, Forgiarini, O, Zucchetto, A, Zanier, L, Vercelli, M, Orengo, Ma, Casella, C, Marani, E, Puppo, A, Celesia, Mv, Cogno, R, Levrieri, I, Manenti, S, Garrone, E, Quaglia, A, Pannozzo, F, Busco, S, Ramazzotti, V, Cercato, Mc, Battisti, W, Sperduti, I, Macci, L, Bugliarello, E, Valerio, O, Bernazza, E, Tamburo, L, Rossi, M, Curatella, S, Tamburrino, S, Fattoruso, S, Bisanti, L, Autelitano, M, Cuccaro, F, Randi, G, Ghilardi, S, Leone, R, Filipazzi, L, Bonini, A, Giubelli, C, Federico, M, Artioli, Me, Valla, K, Braghiroli, B, Cirilli, C, Luminari, S, Pirani, M, Ferrari, L, Bellatalla, C, Panico, M, Perrotta, C, Vassante, B, Vitale, Mf, Michiara, M, Bozzani, F, Sgargi, P, Tumino, R, Rosa, Mg, Cascone, G, Frasca, G, Giurdanella, Mc, Martorana, C, Morana, G, Nicita, C, Rollo, Pc, Ruggeri, Mg, Sigona, A, Spata, E, Vacirca, S, Mangone, L, Di Felice, E, Pezzarossi, A, Caroli, S, Pellegri, C, Vicentini, M, D'Angelo, S, Balottari, P, Romagna, Rt, Falcini, F, Colamartini, A, Bucchi, L, Balducci, C, Ravegnani, M, Vitali, B, Cordaro, C, Caprara, L, Giuliani, O, Giorgetti, S, Palumbo, M, Vattiato, R, Ravaioli, A, Mancini, S, Tonelli, C, Amadori, M, Cremone, L, Iannelli, A, Senatore, G, Zevola, A, Sechi, O, Budroni, M, Cesaraccio, R, Pirino, D, Carboni, D, Fiori, G, Soddu, M, Mameli, G, Mura, F, Contrino, Ml, Madeddu, A, Tisano, F, Sciacca, S, Muni, A, Mizzi, M, Russo, M, Sacco, G, Aletta, P, Ziino, Ac, Tessandori, R, Fanetti, Ac, Maspero, S, Cecconami, L, Annulli, Ml, Moroni, E, Gonzalez, Me, Zanetti, R, Rosso, S, Patriarca, S, Prandi, R, Sobrato, I, Gilardi, F, Busso, P, Piffer, S, Rizzello, R, Gentilini, Ma, Cappelletti, M, Rosa, Fl, Stracci, F, D'Alò, D, Scheibel, M, Costarelli, D, Spano, F, Rossini, S, Santucci, C, Petrinelli, Am, Solimene, C, Bianconi, F, Brunori, V, Crosignani, P, Tagliabue, G, Contiero, P, Preto, L, Tittarelli, A, Maghini, A, Codazzi, T, Frassoldi, E, Gada, D, Costa, E, Grazia, Ld, Zambon, P, Baracco, M, Bovo, E, Cin, Ad, Fiore, Ar, Greco, A, Monetti, D, Rosano, A, Stocco, C, Donato, F, Limina, Rm, Adorni, A, Andreis, P, Zani, G, Piovani, F, Salvi, O, Puleio, M, Vitarelli, S, Candela, G, Pappalardo, G, Scuderi, T, Lottero, B, Ribaudo, M, Ricci, P, Guarda, L, Gatti, L, Bozzeda, A, Dall'Acqua, M, Pironi, V, Sardo, As, Mazzei, A, Sirianni, N, Lavecchia, Am, Mancuso, P, Vitale, F, Cusimano, R, Amodio, R, Guttadauro, A, Ravazzolo, B, Bucalo, G, Trapani, C, Sunseri, R, Cascio, Ma, Brucculeri, Ma, Adamo, Ms, Mannino, R, Mistretta, A, Costa, A, Rudisi, G, Gola, G, Corti, M, Prosperini, E, Grandi, L, Sciacchitano, S, Fidelbo, M, Benedetto, G, Vasquez, E, Torrisi, A, Pesce, P, Calabretta, L, Bella, F, Leone, A, Ieni, A, Varvarà, M, Castaing, M, Di Prima, A, Benedetto, A, Paderni, F, Usala, M, Pala, F, Sini, Gm, Pintori, N, Canu, L, Demurtas, G, Doa, N, Lazzarato, F, Magnani, C, Merletti, F, Sarcerdote, C, Macerata, V, de Leon MP, Domati, F, Rossi, G, Goldoni, Ca, Rossi, F, De Gaetani, C, Benatti, P, Roncucci, L, Di Gregorio, C, Pedroni, M, Pezzi, A, Maffei, S, Mariani, F, Borsi, E, Cocchioni, M, Pascucci, C, Gennaro, V, Lazzarotto, A, Benfatto, L, Mazzucco, G, Montanaro, F, Traina, A, Carruba, G, Dolcemascolo, C, Staiti, R, Zarcone, M, Bisogno, G, Cuttini, M, De Rosa, M, Haupt, R, Soresina, A, Valsecchi, Mg, Fagioli, F, Bona, G, Dini, G, Conter, V, Biondi, A, Zecca, M, Fedeli, F, Massimino, M, Nespoli, L, Roncarolo, Mg, Basso, G, Cesaro, S, Memo, L, Bellettato, M, Tamaro, Paolo, Mascarin, M, Rosolen, A, Izzi, G, Paolucci, P, Borgna Pignatti, C, Vecchi, V, Abate, Me, D'Ambrosio, A, Favre, C, Caniglia, M, Pierani, P, Felici, L, Visani, G, Fioritoni, G, Foà, R, Riccardi, R, Frega, G, Clerico, A, Casale, F, Poggi, V, Amendola, G, Filosa, A, Ladogana, S, Presta, G, Tornesello, A, De Mattia, D, Consarino, C, Nobile, F, Sperlì, D, D'Angelo, P, Marino, S, Cosmi, C, Mura, Rm, Battisti, L., Pisani, P, Buzzoni, C, Crocetti, E, Maso, Ld, Rondelli, R, Alessi, D, Aricò, M, Bidoli, E, Ferrari, A, Fusco, M, Gatta, G, Guzzinati, S, Jankovic, M, Locatelli, F, Maule, M, Mosso, Ml, Pastore, G, Pession, A, Rashid, I, Sacerdote, C, Terracini, B, Tognazzo, S, Trama, A, Ferretti, S, Porta, F, Mazzoleni, G, Tschugguel, B, De Valiere, E, Facchinelli, G, Falk, M, Cappello, Td, Giacomin, A, Vercellino, Pc, Andreone, S, Marzola, L, Migliari, E, Carletti, N, Nenci, I, Caldarella, A, Corbinelli, A, Intrieri, T, Manneschi, G, Nemcova, L, Ocello, C, Sacchettini, C, Zappa, M, Paci, E, Serraino, D, Angelin, T, Birri, S, De Dottori, M, De Santis, E, Forgiarini, O, Zucchetto, A, Zanier, L, Vercelli, M, Orengo, Ma, Casella, C, Marani, E, Puppo, A, Celesia, Mv, Cogno, R, Levrieri, I, Manenti, S, Garrone, E, Quaglia, A, Pannozzo, F, Busco, S, Ramazzotti, V, Cercato, Mc, Battisti, W, Sperduti, I, Macci, L, Bugliarello, E, Valerio, O, Bernazza, E, Tamburo, L, Rossi, M, Curatella, S, Tamburrino, S, Fattoruso, S, Bisanti, L, Autelitano, M, Cuccaro, F, Randi, G, Ghilardi, S, Leone, R, Filipazzi, L, Bonini, A, Giubelli, C, Federico, M, Artioli, Me, Valla, K, Braghiroli, B, Cirilli, C, Luminari, S, Pirani, M, Ferrari, L, Bellatalla, C, Panico, M, Perrotta, C, Vassante, B, Vitale, Mf, Michiara, M, Bozzani, F, Sgargi, P, Tumino, R, Rosa, Mg, Cascone, G, Frasca, G, Giurdanella, Mc, Martorana, C, Morana, G, Nicita, C, Rollo, Pc, Ruggeri, Mg, Sigona, A, Spata, E, Vacirca, S, Mangone, L, Di Felice, E, Pezzarossi, A, Caroli, S, Pellegri, C, Vicentini, M, D'Angelo, S, Balottari, P, Romagna, Rt, Falcini, F, Colamartini, A, Bucchi, L, Balducci, C, Ravegnani, M, Vitali, B, Cordaro, C, Caprara, L, Giuliani, O, Giorgetti, S, Palumbo, M, Vattiato, R, Ravaioli, A, Mancini, S, Tonelli, C, Amadori, M, Cremone, L, Iannelli, A, Senatore, G, Zevola, A, Sechi, O, Budroni, M, Cesaraccio, R, Pirino, D, Carboni, D, Fiori, G, Soddu, M, Mameli, G, Mura, F, Contrino, Ml, Madeddu, A, Tisano, F, Sciacca, S, Muni, A, Mizzi, M, Russo, M, Sacco, G, Aletta, P, Ziino, Ac, Tessandori, R, Fanetti, Ac, Maspero, S, Cecconami, L, Annulli, Ml, Moroni, E, Gonzalez, Me, Zanetti, R, Rosso, S, Patriarca, S, Prandi, R, Sobrato, I, Gilardi, F, Busso, P, Piffer, S, Rizzello, R, Gentilini, Ma, Cappelletti, M, Rosa, Fl, Stracci, F, D'Alò, D, Scheibel, M, Costarelli, D, Spano, F, Rossini, S, Santucci, C, Petrinelli, Am, Solimene, C, Bianconi, F, Brunori, V, Crosignani, P, Tagliabue, G, Contiero, P, Preto, L, Tittarelli, A, Maghini, A, Codazzi, T, Frassoldi, E, Gada, D, Costa, E, Grazia, Ld, Zambon, P, Baracco, M, Bovo, E, Cin, Ad, Fiore, Ar, Greco, A, Monetti, D, Rosano, A, Stocco, C, Donato, F, Limina, Rm, Adorni, A, Andreis, P, Zani, G, Piovani, F, Salvi, O, Puleio, M, Vitarelli, S, Candela, G, Pappalardo, G, Scuderi, T, Lottero, B, Ribaudo, M, Ricci, P, Guarda, L, Gatti, L, Bozzeda, A, Dall'Acqua, M, Pironi, V, Sardo, A, Mazzei, A, Sirianni, N, Lavecchia, Am, Mancuso, P, Vitale, F, Cusimano, R, Amodio, R, Guttadauro, A, Ravazzolo, B, Bucalo, G, Trapani, C, Sunseri, R, Cascio, Ma, Brucculeri, Ma, Adamo, M, Mannino, R, Mistretta, A, Costa, A, Rudisi, G, Gola, G, Corti, M, Prosperini, E, Grandi, L, Sciacchitano, S, Fidelbo, M, Benedetto, G, Vasquez, E, Torrisi, A, Pesce, P, Calabretta, L, Bella, F, Leone, A, Ieni, A, Varvarà, M, Castaing, M, Di Prima, A, Benedetto, A, Paderni, F, Usala, M, Pala, F, Sini, Gm, Pintori, N, Canu, L, Demurtas, G, Doa, N, Lazzarato, F, Magnani, C, Merletti, F, Sarcerdote, C, Macerata, V, de Leon, Mp, Domati, F, Rossi, G, Goldoni, Ca, Rossi, F, De Gaetani, C, Benatti, P, Roncucci, L, Di Gregorio, C, Pedroni, M, Pezzi, A, Maffei, S, Mariani, F, Borsi, E, Cocchioni, M, Pascucci, C, Gennaro, V, Lazzarotto, A, Benfatto, L, Mazzucco, G, Montanaro, F, Traina, A, Carruba, G, Dolcemascolo, C, Staiti, R, Zarcone, M, Bisogno, G, Cuttini, M, De Rosa, M, Haupt, R, Soresina, A, Valsecchi, Mg, Fagioli, F, Bona, G, Dini, G, Conter, V, Biondi, A, Zecca, M, Fedeli, F, Massimino, M, Nespoli, L, Roncarolo, Mg, Basso, G, Cesaro, S, Memo, L, Bellettato, M, Tamaro, Paolo, Mascarin, M, Rosolen, A, Izzi, G, Paolucci, P, Borgna Pignatti, C, Vecchi, V, Abate, Me, D'Ambrosio, A, Favre, C, Caniglia, M, Pierani, P, Felici, L, Visani, G, Fioritoni, G, Foà, R, Riccardi, R, Frega, G, Clerico, A, Casale, F, Poggi, V, Amendola, G, Filosa, A, Ladogana, S, Presta, G, Tornesello, A, De Mattia, D, Consarino, C, Nobile, F, Sperlì, D, D'Angelo, P, Marino, S, Cosmi, C, Mura, Rm, Battisti, L., Maso, L, Mosso, M, Cappello, T, Vercellino, P, Orengo, M, Celesia, M, Cercato, M, Artioli, M, Vitale, M, Rosa, M, Giurdanella, M, Rollo, P, Ruggeri, M, Romagna, R, Contrino, M, Ziino, A, Fanetti, A, Annulli, M, Gonzalez, M, Gentilini, M, Rosa, F, Petrinelli, A, Grazia, L, Cin, A, Fiore, A, Limina, R, Lavecchia, A, Cascio, M, Brucculeri, M, Sini, G, de Leon, M, Goldoni, C, Valsecchi, M, Roncarolo, M, Tamaro, P, Abate, M, Mura, R, Battisti, L, AIRTUM Working Group[.., Enrica Borsi, ], CCM, and AIEOP Working Group

Subjects
Male, Parents, cancer incidence, Adolescent, Epidemiology, Aftercare, cancer in adolescents, Young Adult, children, Neoplasms, cancer in children, Italian population, cancer, Cluster Analysis, Humans, Registries, Survivors, Age of Onset, Mortality, Child, cancer survival, Incidence, Environmental and Occupational Health, Infant, Newborn, Disease Management, Infant, pediatric, Survival Rate, Italy, Child, Preschool, Public Health, Environmental and Occupational Health, Female, Public Health, Morbidity, Forecasting
Abstract

OBJECTIVES: This study describes up-to-date cancer incidence and survival in Italian paediatric and adolescent patients, based on data collected by the network of Italian cancer registries (AIRTUM). It updates the monograph published on the same topic in 2008. The main objective of this monograph is to present the statistics according to standard rigorous epidemiological methods and disseminate them to a wide range of readers, including the lay public. Given the deep impact of the 2008 monograph on the general public, in this update we complement descriptive statistics with additional data and commentaries on issues of importance for public health, in order to provide unambiguous criteria on how to interpret the statistics. The study is the result of the collaboration between AIRTUM and AIEOP (Italian Association of Paediatric Haematology and Oncology) with contributions from interested parties, including representatives of parent associations. The monograph is divided into three parts. The first part presents incidence rates, survival probabilities, and time trends, by sex, age, geographical area, and cancer site or type, by means of tables and graphs as in the previous monograph, to facilitate direct comparisons. Four articles summarize and comment the results. The second part uses data from AIRTUM and AIEOP to outline patient management and health care issues; it includes estimates of the number of new cases in the next decade and of young adults living after a paediatric cancer diagnosis. Health organizational aspects of treatment services for paediatric patients, based on the AIEOP database, are also discussed, along with long-term complications in cured patients. The third section describes the changes in mortality trends due to improving therapies and healthcare services, and discusses risk factors and prevention of childhood cancer, late adverse events in cured patients, and other related issues. MATERIAL AND METHODS: Data herein presented were provided by AIRTUM population-based cancer registries, covering 47%of the Italian population below age 20 years, in the period 2003-2008. Quality of cancer registration in Italy is elevated, with high proportions of microscopically verified diagnoses (91%in the 0-14 years age group and 96% between 15 and 19 years of age) and a very small proportion of cases collected through death certificate only (0.1%).The proportion of cases in diagnostic groups XI (other malignant epithelial neoplasms) and XII (other and unspecified neoplasms) of the International Classification for Childhood Cancer (ICCC), based on the third revision of the International Classification of Diseases for Oncology (ICD-O-3), were 7.0% in the 0-14 years age group and 26.0%in the 15-19 years age group.The ratio between mortality and incidence was 17.7% in both children and adolescents. Detailed results are presented in 24 fact sheets for the 12 major ICCC-3 diagnostic groups and 10 sub-groups of special interest; the series is completed by a sheet on all malignant tumours and one on all tumours including non-malignant neoplasms of the central nervous system. All sheets include results for three age groups (0-14, 15-19, and 0-19 years) and are followed by two commentaries on incidence in the recent period, one on trends and the other on survival. Incidence rates were age-standardized on the European population and presented per million children. Incidence rates are also presented by age group, sex, and geographical area. Incidence trends were evaluated for two periods, 1988-2008 and 1998-2008, using estimated annual percent changes, and survival estimates were calculated by age and period. Indicators and corresponding 95% confidence intervals are shown in forms of graphics and tables at the end of the monograph and online at http://www.registri-tumori.it. Geographical analyses were conducted rearranging cancer registries into four macroareas (North-West, North-East, Centre, and South and Islands). Age groups were the same used in descriptive studies on children worldwide (0, 1-4, 5-9, 10- 14 years for paediatric tumours and 15-19 years for adolescents). Incidence trend analyses included cancer registries with three or more years of registration in the 5-year period, using Poisson regression models. Observed survival was computed according to the Kaplan-Meier method. The estimate of expected cases in the next decade was based on observed incidence rates in the most recent period, extended to the Italian estimated population of children and adolescents in the periods 2011-2015 and 2016-2020. The AIEOP database (Modello 1.01) allowed us to compare the number of patients treated and followed-up in specialized centres with expected cases based on AIRTUM estimates. The AIEOP database also provided information regarding health care migration throughout Italian regions and the number of foreign (immigrated) children treated in Italian AIEOP centres. RESULTS: In the period 2003-2008, 31 cancer registries reported 4,473 incident malignant neoplasms, 2,855 in children and 1,618 in adolescents. Cancer incidence rates were 164 cases per million in children aged 14 years or below and 269 cases per million in patients aged 15-19 years. Limited geographical variations emerged. In children (0-14 years) a significant increase in malignant cancer incidence was observed until 1997 (APC: +3.2%), followed by a plateau (APC: -1.1%not statistically significant).Until the late Nineties, a statistically significant increase was also observed in the incidence of all leukaemias in males (APC: +5.7%), lymphoid leukaemias (APC: +5.6%), representing 80% of all leukaemias, Hodgkin and non- Hodgkin lymphomas (APC: +6.3%). A significant decrease emerged for lymphoid leukaemia starting in 1995 (APC: -1.9%), while no substantial change in cancer incidence rates was observed in the last decade of observation for all malignant neoplasms and lymphomas. In addition, no variation emerged for malignant (according to the most recent classification) central nervous system (CNS) neoplasms, while an annual increase of 1.8% (significant) was observed in the period 1988-2008, when non-malignant tumours were included. Increases in cancer incidence were observed throughout the study period for neuroblastoma (APC: +1.9%) and epithelial tumours or melanoma (APC: +4.1%). In the period 1998-2008, in addition to lymphoid leukaemias, a significant decrease was observed for all malignant neoplasms, lymphomas in girls, CNS tumours (males and females), and renal tumours in girls, while no increases were observed in this age group. In adolescents (15-19 years) between 1988 and 2008, a significant increase in incidence rates was observed (APC: +2.0%) for all malignant neoplasms, all lymphomas (APC: +2.9%; in particular Hodgkin lymphoma, APC: +3.6%), thyroid cancer (APC: +6.1%), and melanoma (APC: +8.1%). Conversely, lymphoid leukaemia is the only neoplasm showing a long-term decrease in adolescents. Recent trends (1998-2008) confirm the long-term increases only for all malignant neoplasms in girls and thyroid cancer (APC: +7.9%, boys and girls), while a decrease in bone tumour incidence emerged in girls, albeit based only on 46 cases. Cancer mortality in children showed a persistent decrease for all neoplasms and even for more frequent cancer sites or types, and mortality rates for cancer were three-fold higher in the early Seventies than in 2008. In addition, five-year survival after cancer diagnosis increased in the last three decades and was still increasing in the period 2003- 2008, reaching 82% in children and 86% in adolescents. In the period 2008-2010, 4,488 children (0-14 years) were treated in one of the AIEOP clinical centres and we estimate, based on the above-presented incidence rates, that they represented 92% of all cancer cases in Italy. However, in adolescents, the proportion of patients treated in AIEOP centres was only 25%. A migration of patients living in the South of Italy to Central and Northern Italy emerged from AIEOP information. The expected number of cancer cases in children aged between 0 and 14 years of age is approximately 7,000 in the period 2016- 2020, while the corresponding figure for adolescents between 15 and 19 years of age is 4,000, with no relevant variation in comparison with the previous five-year period. COMMENTS: The present findings update descriptive cancer epidemiology in children and adolescents in Italy based on data provided by an extensive network of general and specialized population-based cancer registries. Data obtained from cancer registries are supplemented by additional information collected by specialized clinical AIEOP centres and mortality reports collected by the National Institute of Statistics (ISTAT). Incidence rates reported in Italy were slightly higher in comparison to other developed Countries, but relatively consistent between different Italian areas. Our results also showed that the significant increase in cancer incidence observed until the end of Nineties has halted, with the exception solely of thyroid cancer in adolescents. Efficacy of therapeutic protocols has improved constantly since the Seventies, and recent findings confirm this trend in all age groups and, in particular, for rarer tumours and cancer types that have very poor prognosis. Findings derived from cross-analysis with AIEOP data suggest that it is possible to further improve the efficiency of our healthcare system, in particular for adolescents; migration can be reduced with a more rational use of hospitals throughout Italy.

5. [Habits and opinions about cigarette smoking among medical, nursing and technico-administrative staff at the Magenta Hospital (Local Health Unit no. 72)]

Author

Talamini R, Bidoli E, Diego Serraino, Barra S, Franceschi S, and Bollini P

Subjects
Adult, Male, Personnel, Hospital, Adolescent, Italy, Attitude of Health Personnel, Surveys and Questionnaires, Smoking, Humans, Female, Middle Aged, Aged
Abstract

Smoking habits of 882 employees of Magenta general hospital (province of Milan) (135 doctors, 594 nurses and 153 technicians and clerical staff) were investigated in May 1986, by means of a self-administered questionnaire (response rate 84%). Forty-five percent of men and 34% of women reported to be current smokers, respectively 13% fewer and 41% more, after age-standardization, than the general population of the same province. Smoking habits of the three professional groups considered did not differ substantially, but a higher number of doctors as compared to nurses admitted to smoke occasionally in front of patients. The vast majority (80%) agreed with a total ban of smoking inside the hospital but the underestimation of smoking-related health hazards, especially outside the cancer field, turned out to be also very common. Only 34% of doctors, 13% of nurses and 16% of technical and clerical staff identified smoking as the leading preventable cause of death in Italy.

6. Cancer mortality by urbanization and altitude in a limited area in Northeastern Italy

Author

Bidoli E, Franceschi S, Luigino Dal Maso, Guarneri S, and Barbone F

Subjects
Adult, Male, Rural Population, Adolescent, Urban Population, Altitude, Urbanization, Infant, Newborn, Infant, Middle Aged, Death Certificates, Sex Factors, Italy, Residence Characteristics, Risk Factors, Child, Preschool, Neoplasms, Population Surveillance, Confidence Intervals, Humans, Female, Child, Life Style, Aged
Abstract

The geographical patterns of cancer mortality have been studied in Friuli-Venezia Giulia Region (1.2 million inhabitants), the North-eastern part of Italy, with respect to certain characteristics (i.e., rural, mixed, urban) and the altitude of the commune where the deceased subjects lived permanently at the time of death. In males, significantly increased mortality rates in rural versus urban communes (after allowance for altitude) were found for cancer of the oral cavity and pharynx, oesophagus and stomach. Conversely, significantly decreased mortality rates emerged for cancer of the colo-rectum, liver, lung, bladder, kidney and Hodgkin's disease. In females, significantly increased mortality rates in rural as compared to urban communes were observed for stomach cancer while significantly decreased mortality rates emerged for cancer of the colo-rectum, gallbladder, lung, breast, ovary, bladder and brain. With respect to altitude, residence above 200 meters retained a significant association in males, after allowance for the degree of urbanization of the commune of residence, for cancer of the oral cavity and pharynx, stomach and larynx (positive) and cancer of the colorectum and brain (negative). Women in locations above 200 meters seemed significantly at risk for stomach cancer, but protected from cancer of the colo-rectum and kidney. These results may provide a useful summary guide for further aetiological investigations into the risk factors associated with the diseases and give practical indications for local strategies of cancer control.

7. Meal Frequency and Risk of Colorectal Cancer

Author

Franceschi S, Carlo La Vecchia, Bidoli E, Negri E, and Talamini R

Subjects
Adult, Bile Acids and Salts, Male, Risk, Humans, Female, Feeding Behavior, Middle Aged, Colorectal Neoplasms, Aged
Abstract

The relation between meal frequency and the risk of colorectal cancer was investigated in a case-control study conducted in North Italy on 889 cases of colon cancer, 581 cases of rectal cancer, and 2475 controls admitted to hospital for acute, nonneoplastic, or digestive disorders. As compared to individuals who reported 2 or fewer meals per day, the multivariate colon cancer odds ratios were 1.7 [95% confidence interval (95% CI), 1.5-2.1] for 3, and 1.9 (95% CI, 1.1-3.3) for 4 meals or more. Corresponding rectal cancer odds ratios were 1.4 (95% CI, 1.1-1.7) for 3, and 1.9 (95% CI, 1.1-3.5) for 4 meals or more. The direct trends in risk of colorectal cancer with frequency of eating were not substantially modified by allowance for various dietary and nondietary potential confounding factors, including an approximate measure of total energy intake, and did not show significant effect modification across strata of age, sex, education, and other major risk covariates. A role of meal frequency in the etiology of colorectal cancer is biologically plausible, since when a meal is eaten, the gallbladder contracts and releases bile acids. Thus, eating patterns can influence the enterohepatic circulation and, consequently, the exposure time of intestinal mucosa to bile acids.

8. Fiber intake and pancreatic cancer risk: a case–control study

Author

Jerry Polesel, Ettore Bidoli, Maurizio Montella, C. La Vecchia, Silvia Franceschi, R. Talamini, Diego Serraino, Giovanni Boz, A. Zucchetto, L. Dal Maso, Claudio Pelucchi, Eva Negri, Bidoli E, Pelucchi C, Zucchetto A, Negri E, Dal Maso L, Polesel J, Boz G, Montella M, Franceschi S, Serraino D, La Vecchia C, Talamini R, E. Bidoli, C. Pelucchi, A. Zucchetto, E. Negri, L. Dal Maso, J. Polesel, G. Boz, M. Montella, S. Franceschi, D. Serraino, C. La Vecchia, and R. Talamini

Subjects
Adult, Dietary Fiber, Male, medicine.medical_specialty, Neuroendocrine tumors, Gastroenterology, Risk Factors, Internal medicine, Pancreatic cancer, Odds Ratio, medicine, Humans, Fiber, Food science, Aged, Aged, 80 and over, business.industry, Confounding, Case-control study, Hematology, Odds ratio, Middle Aged, medicine.disease, Confidence interval, Diet, Pancreatic Neoplasms, Oncology, Case-Control Studies, Etiology, Female, business
Abstract

Background Scanty and inconsistent studies are available on the relation between dietary fiber intake and pancreatic cancer. A case–control study was carried out in northern Italy to further investigate the role of various types of dietary fibers in the etiology of pancreatic cancer. Patients and methods Cases were 326 patients with incident pancreatic cancer, excluding neuroendocrine tumors, admitted to major teaching and general hospitals during 1991–2008. Controls were 652 patients admitted for acute, nonneoplastic conditions to the same hospital network of cases. Information was elicited using a validated food frequency questionnaire. Odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) were estimated for intake quintiles of different types of fiber after allowance for total energy intake and other potential confounding factors. Results Total fiber intake was inversely related to risk of pancreatic cancer (OR = 0.4 for highest versus lowest quintile of intake; 95% CI 0.2–0.7). An inverse association emerged between pancreatic cancer and both soluble (OR = 0.4; 95% CI 0.2–0.7) and total insoluble fiber (OR = 0.5; 95% CI 0.3–0.8), particularly cellulose (OR = 0.4; 95% CI 0.3–0.7) and lignin (OR = 0.5; 95% CI 0.3–0.9). Fruit fiber intake was inversely associated with pancreatic cancer (OR = 0.5; 95% CI 0.3–0.8), whereas grain fiber was not (OR = 1.2; 95% CI 0.7–2.0). Conclusions This study suggests that selected types of fiber and total fiber are inversely related to pancreatic cancer.

Published
2012

9. Metabolic syndrome is associated with colorectal cancer in men

Author

Silvia Franceschi, Renato Talamini, Claudio Pelucchi, Carlo La Vecchia, Maurizio Montella, Fabio Levi, Ettore Bidoli, Eva Negri, Attilio Giacosa, Anna Crispo, Pelucchi C, Negri E, Talamini R, Levi F, Giacosa A, Crispo A, Bidoli E, Montella M, Franceschi S, and La Vecchia C

Subjects
Adult, Male, Cancer Research, medicine.medical_specialty, Colorectal cancer, Overweight, Risk Factors, Internal medicine, Diabetes mellitus, Epidemiology, medicine, Humans, Risk factor, Aged, Metabolic Syndrome, Rectal Neoplasms, business.industry, Case-control study, Cancer, Middle Aged, medicine.disease, Endocrinology, Oncology, Case-Control Studies, Colonic Neoplasms, Female, medicine.symptom, Metabolic syndrome, business
Abstract

Aim of the study: We assessed the relation between metabolic syndrome (MetS) and its components and colorectal cancer. Methods: We analysed data from a multicentre case-control study conducted in Italy and Switzerland, including 1378 cases of colon cancer, 878 cases of rectal cancer and 4661 controls. All cases were incident and histologically confirmed. Controls were subjects admitted to the same hospitals as cases with acute non-malignant conditions. MetS was defined according to the International Diabetes Federation criteria. Odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) were estimated by multiple logistic regression models, including terms for major identified confounding factors for colorectal cancer. Results: With reference to each component of the MetS, the ORs of colorectal cancer in men were 1.27 (95% CI, 0.95-1.69) for diabetes, 1.24 (95% CI, 1.03-1.48) for hypertension, 1.14 (95% CI, 0.93-1.40) for hypercholesterolaemia and 1.26 (95% CI, 1.08-1.48) for overweight at age 30. The corresponding ORs in women were 1.20 (95% CI, 0.82-1.75), 0.87 (95% CI, 0.71-1.06), 0.83 (95% CI, 0.66-1.03) and 1.06 (95% CI, 0.86-1.30). Colorectal cancer risk was increased in men (OR = 1.86; 95% CI, 1.21-2.86), but not in women (OR = 1.13; 95% CI, 0.66-1.93), with MetS. The ORs were 2.09 (95% CI, 1.38-3.18) in men and 1.15 (95% CI, 0.68-1.94) in women with >= 3 components of the MetS, as compared to no component. Results were similar for colon and rectal cancers. Conclusion: This study supports a direct association between MetS and both colon and rectal cancers in men, but not in women. (C) 2010 Elsevier Ltd. All rights reserved.

Published
2010

10. Nutrient-based dietary patterns and nasopharyngeal cancer: Evidence from an exploratory factor analysis

Author

Valeria Edefonti, Francesca Bravi, Adriano Decarli, Werner Garavello, Ettore Bidoli, Cristina Bosetti, Monica Ferraroni, Diego Serraino, C. La Vecchia, Jerry Polesel, Stefano Calza, Federica Nicolussi, Edefonti, V, Nicolussi, F, Polesel, J, Bravi, F, Bosetti, C, Garavello, W, La Vecchia, C, Bidoli, E, Decarli, A, Serraino, D, Calza, S, and Ferraroni, M

Subjects
Adult, Dietary Fiber, Male, Pathology, medicine.medical_specialty, Cancer Research, Adolescent, dietary patterns, Nasopharyngeal neoplasm, nasopharyngeal cancer, factor analysis, Physiology, Vegetable, Logistic regression, Settore MED/01 - STATISTICA MEDICA, Young Adult, nutrients, Vegetables, Humans, Medicine, Young adult, Aged, Animal fat, Nasopharyngeal Neoplasm, business.industry, nutrient, Case-control study, Cancer, Nasopharyngeal Neoplasms, Nutrition Survey, Odds ratio, Feeding Behavior, Middle Aged, Nutrition Surveys, medicine.disease, Diet, Quartile, factor analysi, Italy, Oncology, Case-Control Studies, Clinical Study, Carcinoma, Squamous Cell, Female, dietary pattern, business, Case-Control Studie, Human
Abstract

Background: The issue of diet and laryngeal cancer has been rarely addressed considering the potential role of dietary patterns. Methods: We examined this association using data from a case-control study carried out between 1992 and 2000. Cases were 460 histologically confirmed incident laryngeal cancers hospitalized in two Italian areas. Controls were 1,088 subjects hospitalized for acute nonneoplastic diseases unrelated to tobacco or alcohol consumption. Dietary habits were investigated through a 78-item food frequency questionnaire. A posteriori dietary patterns were identified through principal component factor analysis carried out on a selected set of 28 major nutrients. The internal reproducibility, robustness, and reliability of the identified patterns were evaluated. Odds ratios (OR) of laryngeal cancer and 95% confidence intervals (95% CI) were estimated using unconditional multiple logistic regression models on quartiles of factor scores. Results: We identified five major dietary patterns named “animal products, ”“ starch-rich, ”“ vitamins and fiber, ”“ vegetable unsaturated fatty acids,” and “animal unsaturated fatty acids.” The vitamins and fiber dietary pattern was inversely associated with laryngeal cancer (OR, 0.35; 95% CI, 0.24-0.52 for the highest versus the lowest score quartile), whereas the animal products (OR, 2.34; 95% CI, 1.59-3.45) and the animal unsaturated fatty acids (OR, 2.07; 95% CI, 1.42-3.01) patterns were directly associated with it. There was no significant association between the vegetable unsaturated fatty acids and the starch-rich patterns and laryngeal cancer risk. Conclusion: These findings suggest that diets rich in animal products and animal fats are directly related, and those rich in fruit and vegetables inversely related, to laryngeal cancer risk. Cancer Epidemiol Biomarkers

Published
2015

11. Dietary vitamins E and C and prostate cancer risk

Author

Oliviero Lenardon, Luigino Dal Maso, Renato Talamini, Maurizio Montella, Diego Serraino, Ettore Bidoli, Eva Negri, Silvia Franceschi, Carlo La Vecchia, Cristina Bosetti, Jerry Polesel, Antonella Zucchetto, E. Bidoli, R. Talamini, A. Zucchetto, C. Bosetti, E. Negri, O. Lenardon, L. Dal Maso, J. Polesel, M. Montella, S. Franceschi, D. Serraino, C. La Vecchia, Bidoli E, Talamini R, Zucchetto A, Bosetti C, Negri E, Lenardon O, Dal Maso L, Polesel J, Montella M, Franceschi S, Serraino D, and La Vecchia C

Subjects
Oncology, Male, medicine.medical_specialty, MEDLINE, Ascorbic Acid, Antioxidants, Prostate cancer, Risk Factors, Internal medicine, Medicine, Humans, Vitamin E, Radiology, Nuclear Medicine and imaging, Aged, Prostate cancer risk, Gynecology, business.industry, Dietary intake, Incidence (epidemiology), Incidence, Case-control study, Prostatic Neoplasms, Hematology, General Medicine, Middle Aged, medicine.disease, Diet, Multicenter study, Italy, Case-Control Studies, business
Abstract

Background. The epidemiologic evidence on dietary vitamins E and C and prostate cancer is controversial. Therefore, a case-control study was carried out to investigate the role of dietary intake of vitamins E and C in the etiology of prostate cancer. Material and methods. Cases were 1 294 men with incident, histologically confirmed prostate cancer, admitted to the major teaching and general hospitals of five Italian areas between 1991 and 2002. Controls were 1 451 men admitted for acute, non-neoplastic conditions to the same hospitals. Information on dietary habits and nutrient intake was elicited using a validated food frequency questionnaire including 78 food groups and recipes. Odds ratios (OR) and 95% confidence intervals (CI) for increasing levels of vitamin intake were estimated after allowance for total energy intake and other confounding factors. Results. Vitamin E showed a significant inverse association with prostate cancer (OR = 0.78 for the highest versus the lowest tertile of intake, 95% CI: 0.58-0.96; p-value for trend = 0.02), whereas for vitamin C the inverse association was of borderline statistical significance (OR = 0.86; 95% CI: 0.65-1.08). Results were consistent in strata of age, body mass index, and family history of prostate cancer. Discussion. The present study shows an inverse association between dietary intake of vitamins E and prostate cancer incidence. This finding is likely to reflect the influence of diet itself since supplementation or food fortification with vitamins is rare in the Italian population.

Published
2009

12. Macronutrients, fatty acids, cholesterol and renal cell cancer risk

Author

Cristina Bosetti, Silvia Franceschi, Ettore Bidoli, Renato Talamini, Jerry Polesel, Antonella Zucchetto, Daniele Maruzzi, Maurizio Montella, Eva Negri, Carlo La Vecchia, Bidoli E, Talamini R, Zucchetto A, Polesel J, Bosetti C, Negri E, Maruzzi D, Montella M, Franceschi S, La Vecchia C, E. Bidoli, R. Talamini, A. Zucchetto, J. Polesel, C. Bosetti, E. Negri, D. Maruzzi, M. Montella, S. Franceschi, and C. La Vecchia

Subjects
Adult, Male, Cancer Research, medicine.medical_specialty, Linolenic acid, Linoleic acid, Macronutrient, Physiology, Risk Assessment, Food group, Fatty Acids, Monounsaturated, chemistry.chemical_compound, Risk Factors, Internal medicine, Surveys and Questionnaires, medicine, Confidence Intervals, Odds Ratio, Humans, Risk factor, Carcinoma, Renal Cell, Aged, Renal cell cancer, chemistry.chemical_classification, Cholesterol, business.industry, Fatty Acids, Case-control study, Confounding Factors, Epidemiologic, Starch, Odds ratio, Middle Aged, Dietary Fats, Kidney Neoplasms, Diet, Endocrinology, Oncology, chemistry, Italy, Case-Control Studies, Fatty Acids, Unsaturated, Female, business, Body mass index, Polyunsaturated fatty acid
Abstract

The role of selected macronutrients, fatty acids and cholesterol in the etiology of renal cell carcinoma (RCC) was analyzed using data from a case-control study conducted in 4 Italian areas between 1992 and 2004. Cases were 767 patients with incident, histologically confirmed RCC, admitted to major teaching and general hospitals of the study areas. Controls were 1,534 subjects admitted for acute, nonneoplastic conditions to the same hospitals. Information on dietary habits and nutrient intake was elicited using a validated food frequency questionnaire including 78 food groups and recipes. Odds ratios (OR) and 95% confidence intervals (CI) for increasing levels of nutrient intake were estimated after allowance for total energy intake and other potential confounding factors. A direct association with RCC was found for starch intake (OR = 1.9 for highest versus lowest quintile of intake; 95% Cl: 1.4-2.6, p-value for trend = 0.001), while an inverse association was found for fats from vegetable sources (OR = 0.6; 95% CI: 0.5-0.8; p-value for trend = 0.002), unsaturated fatty acids (OR = 0.5; 95% Cl: 0.4-0.7; p-value for trend = 0.0002), and polyunsaturated fatty acids (OR = 0.5; 95% Cl: 0.40.7; p-value for trend = 0.001). Among polyunsaturated fatty acids, linoleic acid (OR = 0.5; 95% CI: 0.4-0.7; p-value for trend = 0.0001) and linolenic acid (OR = 0.7; 95% CI: 0.5-1.0; p-value for trend = 0.01) were inversely related to RCC. When 6 major macronutrients were included in the same model, the adverse effect of high intake of starch remained statistically significant, together with the protective effect of polyunsaturated fatty acids. Results were consistent in strata of age, body mass index, treated hypertension, energy intake, stage and family history of RCC. (C) 2008 Wiley-Liss, Inc.

Published
2008

13. Interleukin-10 and interleukin-18 promoter polymorphisms in an Italian cohort of patients with undifferentiated carcinoma of nasopharyngeal type

Author

Ettore Bidoli, Stefania Zanussi, Maria Teresa Bortolin, Chiara Pratesi, Emanuela Vaccher, Riccardo Dolcetti, Rosamaria Tedeschi, Paolo De Paoli, Massimo Guidoboni, Luigi Barzan, Calogero Caruso, Gianni Franchin, PRATESI C, BORTOLIN MT, BIDOLI E, TEDESCHI R, VACCHER E, DOLCETTI R, GUIDOBONI M, FRANCHIN G, BARZAN L, ZANUSSI S, CARUSO C, and DE PAOLI P

Subjects
Male, Cancer Research, Epstein-Barr Virus Infections, Genotype, Immunology, Nasopharyngeal neoplasm, Single-nucleotide polymorphism, Biology, Polymerase Chain Reaction, Polymorphism, Single Nucleotide, Cohort Studies, Interleukin-10, Interleukin-18, Single nucleotide polymorphisms (SNPs), Undifferentiated carcinoma of nasopharyngeal type (UCNT), Epstein Barr virus (EBV), Risk Factors, Genetic predisposition, Immunology and Allergy, Humans, Genetic Predisposition to Disease, Genetic variability, Allele, Promoter Regions, Genetic, Allele frequency, Inflammation, Carcinoma, Interleukin-8, Case-control study, Nasopharyngeal Neoplasms, Middle Aged, Prognosis, Interleukin-10, Oncology, Italy, Case-Control Studies, Female
Abstract

Purpose: Cytokines such as IL-10 and IL-18 seem to be involved in the inflammatory response of undifferentiated carcinoma of nasopharyngeal type (UCNT). The aim of this study was to evaluate the correlation between functional single nucleotide polymorphisms (SNPs) in the promoter region of IL-10 and IL-18 genes and the virological and clinical characteristics in a large case series of Caucasian patients suffering from UCNT, a tumor regularly associated with the Epstein Barr Virus (EBV). Methods: Eighty-nine patients with histologically confirmed UCNT and 130 healthy donors were included in our study. DNA was examined for the polymorphisms of IL-10 gene at positions –1082, −819, −592 by direct sequencing and IL-18 gene at position −607 and −137 by allele –specific PCR. EBV DNA serum viremia was evaluated by QC-PCR. Results: The distributions of the IL-10 and IL-18 genetic variants were not different between UCNT patients and healthy controls. The frequency of IL-10 –1082G allele, which is associated with high IL-10 expression, showed a nearly statistically significant increase in UCNT patients EBV DNA-negative as compared to healthy controls (OR=3.3 95% CI: 1.2–9.8). Subjects with C/C or C/G combined IL-18 genotypes showed an increased risk of being with Stages III-IV (OR=2.1 95% CI: 1.2–6.6). Conclusion: This study was performed to improve the definition of the pathogenetic factors implicated in UCNT by addressing the correlation between cytokine polymorphisms and clinical parameters. This is the first study investigating the possible role of the IL-18 and IL-10 polymorphisms in the development and outcome of UCNT. In our genetic analysis there is no evidence for involvement of IL-10 promoter polymorphisms alone in the genetic predisposition to this tumor. On the other hand, IL18 genetic variants may represent a genetic risk factor for tumor aggressiveness.

Published
2006

14. Macronutrients, fatty acids, cholesterol and prostate cancer risk

Author

Silvia Franceschi, R. Talamini, Ettore Bidoli, Maurizio Montella, Cristina Bosetti, C. La Vecchia, D. Maruzzi, Eva Negri, Bidoli E, Talamini R, Bosetti C, Negri E, Maruzzi D, Montella M, Franceschi S, and La Vecchia C

Subjects
Male, medicine.medical_specialty, Linolenic acid, Linoleic acid, Physiology, Nutritional Status, Food group, Prostate cancer, chemistry.chemical_compound, Risk Factors, Internal medicine, medicine, Humans, Aged, chemistry.chemical_classification, Cholesterol, business.industry, Fatty Acids, Prostatic Neoplasms, Hematology, Odds ratio, Middle Aged, medicine.disease, Dietary Fats, Endocrinology, Oncology, chemistry, Case-Control Studies, business, Body mass index, Polyunsaturated fatty acid
Abstract

Background: The role of selected macronutrients, fatty acids and cholesterol in the etiology of prostate cancer was analyzed using data from a case-control study carried out in five Italian areas between 1991 and 2002. Patients and methods: Cases were 1294 men with incident, histologically confirmed prostate cancer, and admitted to the major teaching and general hospitals of study areas. Controls were 1451 men admitted for acute, non-neoplastic conditions to the same hospital network. Information on dietary habits was elicited using a validated food frequency questionnaire including 78 food groups and recipes. Odds ratios (OR) and 95% confidence intervals (CI) were estimated for increasing levels of nutrient intake. Results: A direct association with prostate cancer was found for starch intake (OR = 1.4 in the highest versus the lowest quintile of intake; 95% CI: 1.1-1.8), whereas an inverse association emerged for polyunsaturated fatty acids (OR = 0.8; 95% CI: 0.6-1.0). Among polyunsaturated fatty acids, linolenic acid (OR = 0.7; 95% CI: 0.6-0.9) and linoleic acid (OR = 0.8; 95% CI: 0.6-1.0) were inversely related to prostate cancer. When the six major macronutrients were included in the same model, the adverse effect of high intake of starch and monounsaturated fatty acids was statistically significant together with the protective effect of polyunsaturated fatty acids. Results were consistent in separate strata of age, body mass index and family history of prostate cancer. Conclusions: Starch and monounsaturated fatty acids were directly associated with prostate cancer risk and polyunsaturated fatty acids were inversely associated.

Published
2004

15. TOMATOES AND RISK OF DIGESTIVE-TRACT CANCERS

Author

R. Talamini, Silvia Franceschi, Barbara D'Avanzo, Ettore Bidoli, Eva Negri, C. La Vecchia, FRANCESCHI S, BIDOLI E, LAVECCHIA C, TALAMINI R, DAVANZO B, and NEGRI E

Subjects
Male, Cancer Research, Mediterranean diet, Population, Physiology, Digestive System Neoplasms, Solanum lycopersicum, Risk Factors, medicine, Humans, Food science, education, Aged, education.field_of_study, business.industry, Stomach, Case-control study, Cancer, Odds ratio, Middle Aged, medicine.disease, Micronutrient, medicine.anatomical_structure, Italy, Oncology, Quartile, Case-Control Studies, Female, business
Abstract

In view of the persisting uncertainty concerning possible mechanisms by which high vegetable and fruit intake decreases cancer risk, foods with divergent values for potentially important micronutrients are a priority for investigation. Tomatoes are low in beta-carotene, but high in lycopene, an active antioxidative agent. In order to assess the effect of tomatoes on risk of cancers of the digestive tract, data were analyzed from an integrated series of case-control studies conducted between 1985 and 1991 in northern Italy, where tomato intake is high but, also, heterogeneous. The overall dataset included the following histologically confirmed cancer cases: oral cavity and pharynx, 314; esophagus, 85; stomach, 723; colon, 955; and rectum, 629; and a total of 2,879 controls admitted to hospital for acute non-neoplastic or non-digestive conditions, unrelated to long-term dietary modifications. Multivariate odds ratios (OR) and 95% confidence interval (CI) for subsequent quartiles of intake of raw tomatoes were derived, after allowance for age, sex, study center, education, smoking and drinking level, and tertile of total caloric intake. There was a consistent pattern of protection for all sites (OR in the upper quartile ranging between 0.4 and 0.7), most notable for gastrointestinal neoplasms. All trends in risk were highly significant. The beneficial effect of raw tomatoes in this population may be partly due to the fact that they constitute perhaps the most specific feature of the Mediterranean diet. However, if it is true that tomatoes protect against digestive-tract cancers, this is of interest from both a scientific and a public health viewpoint. (C) 1994 Wiley-Liss, Inc.

Published
1994

16. Alcohol and Cancers of the Upper Aerodigestive Tract in Men and Women

Author

Franceschi, S., Ettore Bidoli, Negri, E., Barbone, F., Lavecchia, C., FRANCESCHI S, BIDOLI E, NEGRI E, BARBONE F, and LAVECCHIA C

Subjects
Adult, Male, Alcohol Drinking, Esophageal Neoplasms, Smoking, Pharyngeal Neoplasms, Middle Aged, Logistic Models, Head and Neck Neoplasms, Risk Factors, Case-Control Studies, mental disorders, Confidence Intervals, Odds Ratio, Humans, Female, Mouth Neoplasms, Sex Distribution, Laryngeal Neoplasms, Aged
Abstract

In order to explore the potential differences in the effect of alcohol in men and women we took advantage of a case-control study of upper aerodigestive tract tumors conducted between 1986 and 1991 in Northern Italy. Five hundred forty-six incident cases of cancer of the oral cavity and pharynx (of whom 81 were women), 410 of cancer of the esophagus (of whom 67 were women), and 388 with cancer of the larynx, (of whom 19 were women) were interviewed. The control group included 2263 inpatients (of whom 557 were women) with acute conditions unrelated to alcohol and tobacco consumption. Among alcohol drinkers, similar odds ratios were detected in men and women. In the highest, well comparable intake category (i.e., greater-than-or-equal-to 42 drinks/week in women and 42-55 drinks/week in men), odds ratios were 4.5 and 3.8 for cancer of the oral cavity and pharynx, 3.0 and 4.7 for cancer of the esophagus, and 2.6 and 2.0 for cancer of the larynx in women and men, respectively, as compared to light drinkers. However, for all cancer sites a reduced risk was found among abstaining women but not in abstaining men, when compared with light-to-moderate drinkers. The present study, therefore, does not support the hypothesis that women may be substantially more vulnerable than men to alcohol carcinogenesis, at least at the level of the upper aerodigestive tract. It highlights, however, the importance of the choice of the reference category (i.e., abstainers versus the combination of abstainers and light drinkers) in the comparison of risk estimates across population groups who greatly differ with respect to drinking patterns and other correlates of alcohol consumption.

17. Smoking and Drinking in Relation to Cancers of the Oral Cavity, Pharynx, Larynx, and Esophagus in Northern Italy

Author

Franceschi, S., Talamini, R., Barra, S., Baron, Ae, Negri, E., Ettore Bidoli, Serraino, D., Lavecchia, C., FRANCESCHI S, TALAMINI R, BARRA S, BARON AE, NEGRI E, BIDOLI E, SERRAINO D, and LAVECCHIA C

Subjects
Adult, Male, Risk, Alcohol Drinking, Esophageal Neoplasms, Italy, Smoking, Humans, Mouth Neoplasms, Pharyngeal Neoplasms, Middle Aged, Laryngeal Neoplasms, Aged
Abstract

A hospital-based case-control study of upper aerodigestive tract tumors was conducted between June 1986 and June 1989 in Northern Italy. One hundred fifty-seven male cases of oral cavity cancer, 134 of pharyngeal cancer, 162 of laryngeal cancer, and 288 of esophageal cancer, and 1272 male inpatients with acute conditions unrelated to tobacco and alcohol were interviewed. Odds ratios for current smokers of cigarettes were 11.1 for oral cavity, 12.9 for pharynx, 4.6 for larynx, and 3.8 for esophagus. For all 4 sites, the risk increased with increasing number of cigarettes and duration of smoking habits and, with the exception of esophageal cancer, decreased with increasing age at the start of and years since quitting smoking. Smokers of pipes and cigars showed a more elevated risk of cancer of the oral cavity and esophagus than did cigarette smokers. Significantly increased risks emerged also in heavy drinkers (odds ratio greater than 60 versus greater than or equal to 19 drinks/week = 3.4, 3.6, 2.1, and 6.0 for oral cavity, pharynx, larynx, and esophagus, respectively), deriving predominantly from wine consumption.

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