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Aims and Background: The present report combines descriptive statistics (partly never published) on four neighboring areas of north-eastern (NE) Italy [Friuli-Venezia Giulia (1970-89) and Veneto (1970-87) regions and the provinces of Trento (1970-89) and Bolzano (1971-90)], and all Italy (1970-89). The aim was to highlight potential differences in mortality trends and promote a more systematic sharing of data and methodologies., Methods: Death certificates stratified by cause, sex, age and residence were obtained from official publications of the Italian Central Institute of Statistics. Absolute numbers of deaths from different causes, age-standardized rates (on the basis of the European standard population) and percentage of change over the examined period for both sexes were computed for each geographic area., Results: Unfavorable trends were seen for neoplasms of the upper aerodigestive tract, lung, breast, colorectum, bladder, kidney and pancreas and cutaneous malignant melanoma. Increases in most of these neoplasms were more marked in the 4 NE areas than in Italy, especially with respect to cancers of the upper aerodigestive tract in both sexes and cancer of the lung and ovary in women. In Bolzano, rates of neoplasms associated with tobacco and alcohol consumption were lower and less steeply increasing than in the other NE areas, most notably Trento, therefore, contributing to produce the lowest overall cancer mortality rates of NE areas. Cancers of the stomach, uterus, and testis and Hodgkin's disease presented consistent downward trends in all examined areas., Conclusions: The analysis of mortality trends across areas is consistent with elevated and still increasing cancer rates in the 4 NE areas considered, especially for tobacco and alcohol-related neoplasms and skin melanoma. Preventive strategies, based on epidemiologic knowledge, especially against tobacco and heavy alcohol consumption, and intense intermittent sun exposure, seem to be priorities and may benefit from systematic sharing of information, expertise and intervention tools in NE Italy. At least part of the lack of cancer deaths in Bolzano must be attributable to the deaths of Bolzano residents abroad (especially in Austria) and/or to differences in coding practices. This should be elucidated in future studies.

To elucidate the relationship, if any, of p53 gene expression according to smoking and drinking habits, 135 subjects with cancer of the upper aero-digestive tract were sampled from a case-control investigation conducted in Pordenone province, Northeast Italy, between 1986 and 1991. Adequate pathological material for immunohistochemical analysis was available for 83 subjects. Level of p53 expression was classified according to intensity on immunoreaction and percentage of p53-positive cells. Mutations were analyzed by means of single-strand conformation polymorphism and sequencing in 8 p53-positive life-long non-smokers exposed to various levels of alcohol intake. The association between p53 expression and smoking status and alcohol intake was evaluated by means of odds ratios, and 95% confidence intervals. Significantly, more men (39/65) than women (6/18) had elevated p53 expression. No significant trend of increasing percentage of p53-positive cancers with increasing smoking and drinking level was detected, especially after allowance for gender. With respect to specific mutation pattern, in 8 life-long non smokers who drank alcohol, 6 mutations involved G:C base pairs. G-to-A transitions were identified in 4 cases. The present study does not support an association between elevated p53 expression and tobacco smoking or alcohol intake. It provides an example of a molecular biology study in the framework of a large epidemiological investigation.

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 notably 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.

36 patients with primary gastric non-Hodgkin's lymphoma (PGL) (stage Ie and IIe) were treated at the Comprehensive Cancer Center of Aviano (PN) Italy. The median follow-up time of the patients was 59 months (range 10 to 117). The pre-operative diagnosis of PGL was established by using endoscopy in 70% of the patients. There was understaging in non-invasive methods of diagnosis in comparison to laparotomy. Prognostic factors such as: stage, grade according to the Working Formulation, size, depth of penetration of the gastric wall and resectability of the tumor, were taken into consideration in the treatment plan. This consisted of surgical resection of the gastric lymphoma where feasible and according to the bad prognostic factors escalating adjuvant treatment was included: group I (n = 6) patients were treated only by surgery (S), II (n = 8) by S+radiotherapy (RT) (n = 5) or S+chemotherapy (CT) (n = 3), III (n = 17) by S+RT+CT and IV (n = 5) by non-resectable S+RT+CT. There were no statistically significant differences in the survival rate, calculated by Kaplan-Meier method, between the first three groups of patients. Only stage of disease (P = 0.048) and resectability of the lesion (P = 0.003) had a significant influence on survival. There were no serious complications observed in either S, RT or CT treatment. The estimated 5-year survival rate after management was 100%, 75% and 88%, respectively for stage Ie (n = 21), stage IIe (n = 15) and all together.

Aims and Background: Substantial upward trends for skin cancer mortality have been observed in most European countries in the last two decades. The distinction, however, between cutaneous malignant melanoma (CMM) and non-melanomatous skin cancers on the basis of death certification is unreliable., Methods: In order to assess the trends of CMM, analysis of the specific code for CMM (International Classification of Disease VIII and IX:172) was coupled with analysis of total skin cancer mortality rates, standardized on the 1981 Italian Census population, at all ages and in selected age groups (15-44, 45-64 and 65-84 years). The analyses were carried out for the whole of Italy and for Friuli-Venezia Giulia (FVG), a region in North-East Italy with a high proportion of fair-complexioned individuals, elevated frequency of sunbathing, and especially good diagnostic standards., Results: In 1985-89 skin cancer mortality rates in men at all ages, as compared to 1970-74, were 33% higher in Italy and 46% higher in FVG. In women, there was a rise of 22% in Italy and 94% in FVG. More marked upward trends were observed in young and middle aged adults, especially among women in FVG (over 300% increase). In absolute terms, approximately 3000 more Italians died from skin cancers in 1985-89 as compared to 1970-74, about half of them prematurely (i.e., < 65 years). CMM was mentioned in death certifications for skin cancer increasingly often in all age groups, particularly in FVG., Conclusions: The analysis of mortality trends from skin cancer is consistent with a substantial rise of CMM-related deaths. The sensitivity of death certification with respect to CMM diagnosis is also increasing, especially in FVG. A public health strategy with the aim of reducing intermittent intense exposure to ultraviolet light, especially in children, is urgent in Italy as CMM represents one of the few causes of premature death with unfavorable trends.

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 incidence 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., > or = 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.(ABSTRACT TRUNCATED AT 250 WORDS)

This case-control study evaluated the relationship between bladder cancer and occupational factors in an area of North-east Italy. The study included 273 bladder cancer cases and 573 controls identified through the services of local hospitals. Information on socio-demographic characteristics, past medical history, lifestyle factors, employment in certain industries and occupational exposures was obtained by interviewing study subjects. Elevated relative risks (RR), albeit not statistically significant, were found among males ever employed in the general chemical (RR = 2.8), dye (RR = 6.9) and painting (RR = 3.1) industries. When results related to the general chemical and specialty chemical industries were combined the RR was 3.1 (95% confidence interval [CI]: 1.2-8.5). The RR increased with increasing duration and decreasing age at starting and years since quitting employment. The risk was significantly decreased for subjects ever employed in agriculture (RR = 0.6 for males, 0.5 for females), livestock farming (RR = 0.5 for males, 0.4 for females) and furniture manufacturing (RR = 0.5 for males), whereas an elevated risk was found among white collar workers (RR and 95% CI: 1.5, 1.1-2.4 and 2.7, 1.1-6.6 for males and females, respectively). These results confirm a well-known risk among subjects employed in various sectors of the chemical industry, and indicate that bladder cancer is associated with urbanization indicators. Because lifestyle factors (i.e. smoking, coffee consumption, etc.) did not totally explain the results for white collar workers, it is possible that other still undefined aspects of the urban environment play a role in bladder carcinogenesis.

The relationship between sugar added to coffee and other hot beverages--as an indicator of taste for sugar and sugar intake outside main meals--and the risk of colorectal cancer was investigated using data from a case-control study conducted in Northern Italy on 953 cases of histologically confirmed colon cancer, 633 of rectal cancer and 2845 controls admitted to hospital for acute, non-neoplastic, non-digestive tract disorders. Compared with subjects who reported adding no sugar to their beverages, the multivariate relative risks (RR) of colon cancer were 1.4 for those adding one spoonful of sugar, 1.6 for those adding 2 spoonful, and 2.0 for those adding 3 or more. The corresponding RRs for rectal cancer were 1.3, 1.5 and 1.4. For combination of colorectal cancer the RRs were 1.4, 1.5 and 1.8. All the trends in risk were significant, and the results were consistent across strata of study centre, sex and age, and were not appreciably modified by allowance for a number of major identified potential distorting factors, including an estimate of total calorie intake. These findings, if confirmed, would suggest that taste for sugar is a relevant indicator of colorectal cancer risk, and could be interpreted either in terms of a role of sugar in colorectal carcinogens, or of a specific influence of even limited amounts of sugar taken outside meals, which may stimulate the proliferation of the bowel epithelium, and hence enhance colorectal carcinogenesis.

The relationship between farming and cancer risk was investigated in an integrated series of case-control studies conducted from 1985 to 1991 in the Friuli Venezia Giulia region, north-east Italy. Patients with cancer of the oral cavity and pharynx, larynx, oesophagus, colon and rectum, pancreas, breast, thyroid gland, kidney and urinary tract, bladder, prostate, soft-tissue sarcomas, Hodgkin's diseases, non-Hodgkin's lymphomas and multiple myelomas, and controls admitted to hospital for acute, non-neoplastic conditions, were interviewed. For males, a significantly elevated relative risk was seen for oral cavity and pharynx. Farming, however, was associated with a significant protection against cancer of the colon and rectum and bladder. In females, only one significant association emerged, for multiple myeloma. A few significant interactions between cancer risk and year of birth (i.e., before 1930 or 1930 and after) were observed. The risk of cancer of the larynx was significantly elevated in younger male farmers but not in older ones. Our multi-site case-control study confirms that farmers have, for some cancer sites, a distinctive pattern. Excesses of cancer of the oral cavity and pharynx in farmers are characteristic of the present study area and, possibly, of similar European rural populations who have in common high levels of alcohol consumption and, at least in the past, unbalanced diets.

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.

Background: The role of tobacco and alcohol consumption and the frequency of intake of a selected number of indicator foods as causes of cancer were investigated in a case-control study conducted in northern Italy., Methods: One hundred two men with cancer of the tongue, 104 patients with cancer of the mouth, and 726 control subjects (the latter admitted to the hospital for acute nonneoplastic disease without respiratory illness) were interviewed., Results: Similarly strong associations were observed with cigarette smoking (odds ratio [OR], 10.5 and 11.8 for current smokers versus never smokers in cancer of the tongue and mouth, respectively) and alcohol (OR, 3.4 and 3.0 for > or = 60 versus < or = 19 drinks/week). The risk conferred by pipe or cigar smoking, although based on only 12 smokers who did not smoke cigarettes, seemed, however, to be lower for cancer of the tongue (OR, 3.4) than cancer of the mouth (OR, 21.9). Selected indicator foods and beverages, including green vegetables, carrots, fresh fruits, whole-grain bread and pasta, coffee, and tea also affected the cancer risk similarly in the two sites. The beneficial influence of such foods and beverages seemed, however, to be more marked for cancer of the mouth than for cancer of the tongue., Conclusions: This study suggested that, although none of the differences in the effects between cancer sites was statistically significant, tobacco from pipes and cigars and the cleansing effect of some foods of plant origin and nonalcoholic beverages may influence the risk of cancer of the tongue less strongly than the risk of cancer of the mouth.

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.

A study on the characteristics of alcoholics attending the "Alcoholics in treatment" clubs, a community and family-oriented programme against alcoholism, has been conducted in the Friuli-Venezia Giulia region, Northeastern Italy. A total of 598 individuals (93% of those contacted) completed the questionnaire, 431 (72%) were males and 167 (28%) were females. With respect to marital status, never married men and widows seemed to be at high risk of alcoholism. Total alcohol consumption in males significantly exceeded that in females (X2(1) trend 18.86 p < 0.001) and this excess mainly seemed to be primarily associated with wine (X2(1) trend 32.81 p < 0.001). Younger individuals (< 50 yrs) tended to begin drinking earlier and to report higher intake from alcoholic beverages other than wine as compared to older individuals (< 50 yrs) (X2(1) trend = 25.25 p < 0.001). A high percentage of males (30%) reported heavier alcohol intake in their father as compared to themselves while only 12 of females reported heavier intake in their mother as compared to themselves. Health complaints seemed to be the chief reason which prompted individuals, particularly above age 50, to attend "Alcoholics in treatment" clubs but awareness of alcohol-related health problems played a substantial role, as shown by the very common overestimation of alcohol as the primary cause of death in Italy by the individuals attending the club.

The relation between dietary factors and the risk of colorectal cancer was investigated in a case-control study conducted in Pordenone province, North-eastern Italy, on 123 cases of colon cancer, 125 of rectal cancer and 699 controls admitted to hospital for acute, non-neoplastic or digestive disorders. Consistent positive associations were observed with more frequent consumption of bread (odds ratio, OR = 2.1 for colon and 2.2 for rectum for highest vs. lowest tertile), polenta (OR = 2.1 for colon, 1.9 for rectum), cheese (OR = 1.7 for colon, 1.8 for rectum) and eggs (2.5 for colon, 1.9 for rectum), whereas reduced ORs were observed in subjects reporting more frequent consumption of tomatoes (OR = 0.5 for colon and 0.4 for rectum). High consumption of margarine exerted a significant protection against cancer of the colon whereas high consumption of carrot spinach, whole-grain bread and pasta (favorably) and red meat (unfavorably) affected rectal cancer risk in particular. Thus the present study gives support for a protective effect associated with a fiber-rich or vegetable-rich diet, while it indicates that frequent consumption of refined starchy foods, eggs and fat-rich foods such as cheese and red meat is a risk factor for colo-rectal cancer.

A population-based case-control study of 260 patients (74 males and 186 females, mean age = 56) with cutaneous malignant melanoma and 416 controls (211 males and 205 females, mean age = 55) was conducted in Turin, north-west Italy, to examine the relation between timing of sunburns and sun exposure and melanoma risk within a southern European population, which is still relatively little investigated. Particularly elevated risk was associated with history of sunburns in childhood [odds ratio 5.9; 95% confidence interval (CI) 3.6-9.5], and such risk elevation persisted after allowance for other major melanoma risk covariates. Conversely, risk increase from history of severe sunburns lifelong was lower (odds ratio = 1.7; 95% CI: 1.1-2.4) and was eliminated by allowance for type of skin reaction to sun exposure and history of sunburns in childhood. A significant increase in the risk of cutaneous malignant melanoma was also associated with number of weeks spent on holiday at the beach not only as an adult, but also as a child.

The relationship between occupation and exposure to several occupational agents and Hodgkin's disease (HD) was investigated in a case-control study of 152 cases and 613 controls with acute diseases admitted to all hospitals in Pordenone province, north-east Italy. Among cases, there was a significant excess of individuals occupied in agriculture (odds ratio, OR for greater than 10 years = 2.2, 95% confidence interval, CI:1.3-3.7), who were exposed to livestock and meat processing (OR = 3.4, 95% CI:1.7-6.6), herbicides and pesticides (OR = 3.2, 95% CI:1.6-6.5). When the relationship between agriculture and specific exposures was assessed, it appeared that contact with some still unidentified animal-related agent involved in livestock farming and meat processing may be at least as important in determining HD risk as exposure to herbicides and pesticides and, probably, more important than occupation in agriculture per se.

The relation between dietary indicators and the risk of cancer of the oral cavity and pharynx was investigated in a case-control study conducted in Pordenone province, north-east Italy, on 302 cases (266 males and 36 females) and 699 controls admitted to hospital for acute, non-neoplastic and non-digestive disorders. Positive associations were observed, after allowing for occupation, smoking and drinking habits, with more frequent consumption of pasta or rice, polenta, cheese, eggs and pulses (odds ratios - ORs = 1.6, 2.1, 1.9, 1.9 and 2.0 for highest vs. lowest tertile), whereas reduced ORs emerged in subjects reporting more frequent consumption of carrots, fresh tomatoes and green peppers (ORs = 0.6, 0.5 and 0.5, respectively). Higher frequency of daily meals was also associated with a significantly elevated OR (1.7 for greater than or equal to 4 vs. less than or equal to 2 meals). The role of various indicator foods must be assessed in the context of the very high levels of alcohol consumption in the study area (greater than or equal to 8 alcoholic drinks/day in 2/3 cancer cases).

The association between alcohol drinking and breast cancer risk was investigated in 132 breast cancer cases and 499 controls with acute conditions unrelated to alcohol or any of the suspected risk factors for breast cancer, in an area which shows among the highest levels of alcohol consumption and prevalence of alcohol-related diseases in Europe (i.e. Pordenone Province, Northeastern part of Italy). Compared with non-drinkers, the multivariate odds ratio (OR) for ever drinkers was 1.5 (95% confidence interval, CI: 0.8-2.6). The risks for wine (the almost exclusive source of alcohol in the present investigation) were 1.2 for up to 1 drink, 1.4 for up to two drinks, 1.9 for up to 3 and 1.6 for over 3 drinks per day. Time-related factors (i.e. drinking habit duration and age at start of drinking) did not seem to be risk indicators.

The role of reproductive and menstrual factors and a few medical conditions linked to female hormones in the aetiology of colorectal cancer was investigated in a case-control study conducted in Pordenone province in northeastern Italy, on 89 women with colorectal cancer and 148 controls admitted to hospital for a wide spectrum of acute, non-digestive nor neoplastic disorders. After adjustment for age and social class, parous women, as compared to nulliparous ones, were significantly protected against colorectal cancer (odds ratio, OR = 0.4, [95% confidence interval, CI:0.2-0.8]) and the risk appeared to decrease with successive pregnancies up to five or more (0.2, [0.04-0.6]). Compared to women who had their first birth at age 24 or less, the OR for those who had it at 30 or older was 2.0, but the inverse trend in risk was not significant. However, among parous women only, age at first birth, but not parity, seemed to retain a certain influence. Late age at menopause seemed to decrease colorectal cancer risk (OR for menopause at age greater than or equal to 50 vs. less than 45 = 0.4, [0.2-1.0] chi 2(1) (trend) = 3.66). Conversely, age at last birth, number of abortions, years between marriage and first birth, age at menarche, pattern of menstrual cycle and occurrence of a few medical conditions potentially linked to female hormones were similarly reported by cases and controls. Due to the very limited number of oral contraceptive (OC) users (9 controls but only 1 case), and the lack of oestrogen replacement therapy users, the influence of exogenous female hormones on colorectal cancer could not be analysed meaningfully.

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.

The relationship between maize consumption and risk of cancer of the upper digestive tract was investigated in 107 patients with oral cancer, 107 with pharyngeal cancer, 68 with esophageal cancer, and 505 hospital controls who permanently resided in Pordenone Province in the northeastern part of Italy. The analysis was restricted to males. The population of this province has a high incidence of these neoplasms and shows particularly elevated levels of alcohol and tobacco use, in addition to high maize consumption. Highly significant associations with frequent intake of maize emerged for oral cancer, pharyngeal cancer, and esophageal cancer (odds ratios = 3.3, 3.2, and 2.8, respectively). The risk elevation could not be explained in terms of differences in education, occupation, tobacco use, or consumption of fresh fruits and vegetables. The unfavorable effect of maize on risk of cancer of the upper digestive tract, however, was evident only in those individuals who reported heavy drinking (i.e., greater than or equal to 42 alcoholic drinks/wk). The present findings are likely to be related to the fact that maize can cause deficiencies of various micronutrients (chiefly, niacin and riboflavin) and agree with previous observations from Africa, the People's Republic of China, the United States, and Italy.

The role of hormonal and reproductive factors as risks for cutaneous malignant melanoma (CMM) was explored by means of a population-based case-control study conducted in Turin, north-western Italy, on 186 female CMM cases and 205 controls. Past use of oral contraceptives (OC) did not seem to exert any effect on CMM risk odds ratio (OR) = 1.12, 95% confidence interval (CI): 0.56-2.24). No association was found even for the longest duration of use, for superficial spreading melanoma cases and for CMM of lower limbs only. While age at first birth did not affect CMM risk, women who had had three or more children seemed to be significantly protected as compared to nulliparous ones. The association was, however, substantially diminished by adjustment for education and other CMM risk correlates (OR for at least three children versus none = 0.62; 95% Cl: 0.29-1.31).

A hospital-based case-control study of renal cell cancer was conducted in northern Italy between 1986 and 1989, with 240 cases of renal cell cancer (150 males and 90 females), and 665 controls (445 males and 220 females) chosen on the basis of age, sex, and area of residence. No associations were found between renal cell cancer and: body mass index (BMI); number of cigarettes smoked; age at starting to smoke; years of smoking; consumption of wine, beer, spirits, coffee, decaffeinated coffee; tea; intake of animal protein, fruits, and vegetables; various reproductive factors; hormonal use; sexual habits; sexually transmitted diseases; or selected occupational exposures. The odds ratio (OR) was above unity in smokers (OR = 1.34 for greater than or equal to 15 cigarettes/day), but the trends in risk with dose or duration were not statistically significant. Significant positive associations were found between renal cell cancer and sources of fat intake, especially margarine (OR for highest vs lowest intake = 1.71), and oils (OR = 1.89) whereas carrot intake showed a negative association (OR = 0.62). Also, a history of nephrolithiasis and multiple episodes of cystitis showed weak positive associations (OR = 2.00, 95 percent confidence interval (CI) 1.07-3.73; and OR = 1.60, 95 percent CI 0.95-2.70, respectively).

Enhanced secretion of thyroid stimulating hormone (TSH) has been linked with increased risk of thyroid carcinoma. Diet can increase TSH secretion in various ways: 1) low iodine intake, 2) high goitrogen intake, especially in subjects living in iodine-deficiency areas and 3) direct stimulation of anterior pituitary gland. Excessive iodine intake, however, has also been shown to increase risk of goitre and, perhaps, also thyroid carcinoma. Epidemiological evidence on the role of diet in the etiology of thyroid carcinoma is reviewed here. Ad hoc studies in affluent countries are few and often conflicting. A case-control study conducted in the North of Italy suggests that perhaps dietary aspects other than iodine or goitrogens (i.e. fresh fruit and vegetables and animal fat) may be involved.

The relationship between type of cigarettes smoked and the risk of cancer of upper digestive and respiratory sites was investigated in a case-control study conducted in Northern Italy on 291 males with cancer of the oral cavity or pharynx, 288 with cancer of the esophagus, 162 with cancer of the larynx, and 1,272 control subjects in hospital for acute conditions unrelated to tobacco or alcohol consumption. Using a distinction based on tar-yield or the brand smoked for the longest time (less than 22 mg, low to medium tar; greater than or equal to 22 mg, high tar), the multivariate relative risks among ever-smokers were 8.5 for low/medium and 16.4 for high tar cigarettes for oral and pharyngeal neoplasms, 3.3 and 7.8 for esophageal, and 4.8 and 7.1 for laryngeal cancers. The differences according to type of cigarettes were similar in proportional terms, and hence larger in absolute terms, when analysis was restricted to current smokers only. Thus, these data provide further quantitative evidence on the importance of type of cigarette smoked on the risk of upper-digestive and respiratory tract cancers and have important public health implications.

The effect of various patient and tumor characteristics were evaluated in 378 laryngeal carcinomas treated only surgically between November 1974 and December 1987 at the Ear, Nose and Throat Clinic of Cagliari Medical University in South Sardinia. The overall three-year survival rate was 68%, the five-year survival rate was 61% (approximate 95% confidence interval (CI), 54-68%), and then a plateau seemed to emerge, with the ten-year survival rate being 51%. Tumor ulceration exerted a strong influence on survival: patients with ulcerated tumors had a twofold (95% CI, 1.4-2.9%) higher death rates. Conversely, the influence of tumor site and type of operation was not statistically significant in the multivariate analysis. A median delay in diagnosis of 4 months was found, with 30% of patients reporting an interval longer than 6 months between first symptoms and referral to a physician; overall, however, the influence of delay in diagnosis on survival rate was not significant. Dysphonia seemed to be the symptom less promptly recognized by the patient.

We conducted a study on 165 women with thyroid cancer and 214 hospital controls in order to investigate the role of reproductive and hormonal factors in the aetiology of thyroid cancer. Late age at menarche (Relative risk (RR) for menarche at greater than or equal to 14 vs less than or equal to 11 = 2.8), menstrual irregularity (RR = 1.7), late age at first birth (RR for first birth at greater than or equal to 28 vs less than or equal to 21 = 2.4) and at last birth (RR for last birth greater than or equal to 30 vs less than 30 = 2.2) significantly increased the risk of the development of thyroid cancer both in premenopausal and postmenopausal women. Parity was, in the present study rather inconsistently related to disease status whereas voluntary abortions and miscarriages were completely unrelated. A non significant increasing risk was observed with age at menopause older than 50, and with the use of oral contraceptives in premenopausal women. The mechanism of action of female hormones on the thyroid gland remains largely obscure, but the observation that age at first and, perhaps, subsequent pregnancies may be relevant points to an interplay of reproductive factors (and, possibly, their hormonal correlates) more complex than previously suggested.

We conducted a hospital based case-control study of 245 cases of thyroid cancer (62 males and 183 females) and 411 controls in three areas of Northern Italy. Subjects with thyroid cancer more often had a history of benign thyroid nodules (18 cases versus 0 controls, lower 95% confidence limit = 7.84), goitre (RR = 5.61, 95% confidence interval (CI): 2.13-14.77) and residence in endemic goitre areas (RR for residence longer than 20 years = 2.29, 95% CI: 1.23-4.29). Heavy (greater than 1000 rads) irradiation of the neck was reported only by seven cases (lower 95% confidence limit: 2.45). Among 31 food items considered, a few showed direct association, including starchy foods and various sources of animal fats or proteins, whereas frequent consumption of other foods, including major sources of dietary iodine (such as fish, green vegetables and fruit) gave significant protection. When analysis was restricted to various subgroups of patients (ie, different histological types, sexes and major groups of hospital controls), it yielded similar results.

We concluded a study on 208 cases of non-Hodgkin's lymphoma and 401 controls in the North-East of Italy in order to investigate the role of indicators of socio-economic status, personal habits, past history of various disorders and medical treatments potentially affecting the immune system, and occupational exposures in the aetiology of such neoplasia. None of the several investigated characteristics appeared to be a strong determinant, i.e. relative risk, RR greater than 2.0, of non-Hodgkin's lymphoma. Cases and controls appeared to be very similar as regards education, main life-time occupation and alcohol consumption. Positive associations, however, emerged with chronic infectious diseases, mainly tuberculosis and malaria (RR = 1.8, 95% confidence interval, CI: 1.1-2.9). Non significantly increased risks were also found for smoking habit (RR ever vs never smokers = 1.5, 95% CI: 1.0-2.3), episodes of herpes zoster infection (RR = 1.4; 95% CI: 0.7-2.6) and occupation in chemical and petrochemical industries (RR = 1.6; 95% CI: 0.9-3.1, and 1.8; 95% CI: 0.9-3.8, respectively). Conversely, farming as well as specific exposure to herbicides and pesticides did not seem to affect the risk of non-Hodgkin's lymphoma in the present investigation.

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.

From May 1983 to September 1984, 48 consecutive patients with locally advanced, recurrent and/or metastatic head and neck squamous carcinoma were treated with cisplatin 60 mg/m2 i.v. on day 1, fluorouracil 10 mg/kg i.v. push from day 1 to day 4 and bleomycin 10 mg/m2 i.v. from day 1 to day 4, every 3 weeks. In the 44 evaluable patients complete remission was observed in 4, partial remission in 9, stable disease in 19, and progression in 12, for a 29.5% response rate. When the analysis was limited to the 21 patients with PS greater than 70 and no previous chemotherapy or radiotherapy, the response rate was 48%. Toxicity was acceptable, and no treatment related deaths occurred. Overall median survival (all eligible patients) was 7 months. Although further studies with this combination in poor risk patients (previously treated or with PS less than 70) do not appear to be indicated, a more accurate assessment in good risk patients might be warranted.