Showing papers by "Cancer Epidemiology Unit published in 2008"

Hyper-insulinaemia and cancer, meta-analyses of epidemiological studies

Abstract: Background: A substantial body of evidence links sex hormones, diet, excess body weight and physical activity to the risk of developing cancer at several sites common in affluent countries. The hypothesis that high circulating levels of insulin could be the underlying factor increasing cancer risk has been proposed. Epidemiological studies on markers of hyper-insulinaemia and cancer are reviewed and summarized.Methods: Studies of cancers of the colon and rectum, pancreas, breast, and endometrium examining the association with blood levels of C-peptide, insulin, glucose, glycated haemoblobin (HbA1c) were searched in PubMed. Multivariate, adjusted relative risks (RR) and their 95% confidence intervals were abstracted and summarized by meta-analyses.Results: Most of the studies identified were cohorts that relied on measurements obtained at baseline or assessed in blood stored at low temperature several years before the onset of cancer. The meta-analyses showed excess risks of colorectal and pancreat...

Colorectal cancer screening: a comparison of 35 initiatives in 17 countries.

Abstract: Although in its infancy, organized screening for colorectal cancer (CRC) in the general population is increasing at regional and national levels. Documenting and describing these initiatives is critical to identifying, sharing and promoting best practice in the delivery of CRC screening. Subsequently, the International Colorectal Cancer Screening Network (ICRCSN) was established in 2003 to promote best practice in the delivery of organized screening programs. The initial aim was to identify and document organized screening initiatives that commenced before May 2004. Each identified initiative was sent 1 questionnaire per screening modality: fecal occult blood test, flexible sigmoidoscopy or total colonoscopy. Information was collected on screening methodology, testing details and initiative status. In total, 35 organized initiatives were identified in 17 countries, including 10 routine population-based screening programs, 9 pilots and 16 research projects. Fecal occult blood tests were the most frequently used screening modality, and total colonoscopy was seldom used as a primary screening test. The eligible age for screening ranged from 40 years old to no upper limit; most initiatives included participants aged 50 to 64. Recruitment was usually done by a mailed invitation or during a visit to a family physician. In conclusion, this is the first investigation describing the delivery of CRC screening protocols to various populations. The work of the ICRCSN is enabling valuable information to be shared and a common nomenclature to be established.

Animal foods, protein, calcium and prostate cancer risk: the European Prospective Investigation into Cancer and Nutrition

Abstract: We examined consumption of animal foods, protein and calcium in relation to risk of prostate cancer among 142 251 men in the European Prospective Investigation into Cancer and Nutrition. Associations were examined using Cox regression, stratified by recruitment centre and adjusted for height, weight, education, marital status and energy intake. After an average of 8.7 years of follow-up, there were 2727 incident cases of prostate cancer, of which 1131 were known to be localised and 541 advanced-stage disease. A high intake of dairy protein was associated with an increased risk, with a hazard ratio for the top versus the bottom fifth of intake of 1.22 (95% confidence interval (CI): 1.07-1.41, P(trend)=0.02). After calibration to allow for measurement error, we estimated that a 35-g day(-1) increase in consumption of dairy protein was associated with an increase in the risk of prostate cancer of 32% (95% CI: 1-72%, P(trend)=0.04). Calcium from dairy products was also positively associated with risk, but not calcium from other foods. The results support the hypothesis that a high intake of protein or calcium from dairy products may increase the risk for prostate cancer.

Lifestyle factors and primary glioma and meningioma tumours in the Million Women Study cohort

Abstract: Previous studies have reported inconsistent results on the effect of anthropometric and lifestyle factors on the risk of developing glioma or meningioma tumours. A prospective cohort of 1.3 million middle-aged women was used to examine these relationships. During 7.7 million women-years of follow-up, a total of 1563 women were diagnosed with a primary incident central nervous system tumour: 646 tumours were classified as glioma and 390 as meningioma. Our results show that height is related to the incidence of all central nervous system tumours with a risk of about 20% per 10 cm increase in height (relative risk=1.19, 95% CI=1.10–1.30 per 10 cm increase in height, P<0.001): the risks did not differ significantly between specified glioma and meningioma. Body mass index (BMI) was also related to central nervous system tumour incidence, with a risk of about 20% per 10 kg m−2 increase in BMI (relative risk=1.17, 95% CI=1.03–1.34 per 10 kg m−2 increase in BMI, P=0.02). Smoking status, alcohol intake, socioeconomic level, parity, age at first birth, and oral contraceptive use were not associated with the risk of glioma or meningioma tumours. In conclusion, for women in the United Kingdom, the incidence of glioma or meningioma tumours increases with increasing height and increasing BMI.

The spectrum of human immunodeficiency virus-associated cancers in a South African black population: results from a case-control study, 1995-2004.

Abstract: The effect of the evolving HIV epidemic on cancer has been sparsely documented in Africa. We report results on the risk of cancer associated with HIV-1 infection using data from an ongoing study. A case-control analysis was used to estimate the relative risk (odds ratio, OR) of cancer types known to be AIDS defining: Kaposi's sarcoma (n = 333), non-Hodgkin lymphoma (NHL, n = 223) and cancers of the cervix (n = 1,586), and 11 cancer types possibly associated with HIV infection: Hodgkin lymphoma (n = 154), cancers of other anogenital organs (n = 157), squamous cell cancer of the skin (SCC, n = 70), oral cavity and pharynx (n = 319), liver (n = 83), stomach (n = 142), leukemia (n = 323), melanoma (n = 53), sarcomas other than Kaposi's (n = 93), myeloma (n = 189) and lung cancer (n = 363). The comparison group comprised 3,717 subjects with all other cancer types and 682 subjects with vascular disease. ORs were adjusted for age, sex (except cervical cancer), year of diagnosis, education and number of sexual partners. Significantly increased risks associated with HIV-1 infection were found for HIV/AIDS associated Kaposi's sarcoma (OR = 47.1, 95% CI = 31.9-69.8), NHL (OR = 5.9, 95% CI = 4.3-8.1) and cancer of the cervix (OR = 1.6, 95% CI = 1.3-2.0); Hodgkin's disease (OR = 1.6, 95% CI = 1.0-2.7), cancers of anogenital organs other than the cervix (OR = 2.2; 95% CI = 1.4-3.3) and SCC (OR = 2.6, 95% CI = 1.4-4.9) were also significantly increased. No significant associations were found between HIV and any of the other cancers examined. Risks for HIV-related cancers are consistent with previous studies in Africa, and are lower when compared to those observed in developed countries.

Decrease in breast cancer incidence following a rapid fall in use of hormone replacement therapy in Australia

Abstract: Objective: To determine if the recent rapid fall in use of hormone replacement therapy (HRT) in Australia has been followed by a reduction in breast cancer incidence among women aged 50 years or older, but not among younger women. Design and setting: Analysis of trends in annual prescribing of HRT, using Pharmaceutical Benefits Scheme data, and in annual age-standardised breast cancer incidence rates in Australian women for the period 1996-2003. Results: In Australia, prescribing of HRT increased from 1996 to 2001, but dropped by 40% from 2001 to 2003. Age-standardised breast cancer incidence rates in women aged ≥ 50 years also increased to 2001 but declined thereafter. The incidence rates in this age group were lower by 6.7% (95% Cl, 3.9%-9.3%; P < 0.001) in 2003 compared with 2001, equivalent to 600 (95% Cl, 350-830) fewer breast cancers (out of about 9000 incident breast cancers annually for women this age). There was no significant change in breast cancer incidence for women aged < 50 years. Conclusions: While other factors may have contributed to a recent reduction in breast cancer incidence among Australian women aged ≥ 50 years, the available evidence suggests that much of the decrease is due to the recent fall in use of HRT. This is consistent with other evidence that the HRT-associated increase in risk of breast cancer is reversible after ceasing use of HRT.

Associations between Burkitt lymphoma among children in Malawi and infection with HIV, EBV and malaria: results from a case-control study.

Abstract: Background: Burkitt lymphoma, a childhood cancer common in parts of sub-Saharan Africa, has been associated with Epstein Barr Virus (EBV) and malaria, but its association with human immunodeficiency virus (HIV) is not clear.Methodology/Principal Findings: We conducted a case-control study of Burkitt lymphoma among children (aged <= 15 years) admitted to the pediatric oncology unit in Blantyre, Malawi between July 2005 and July 2006. Cases were 148 children diagnosed with Burkitt lymphoma and controls were 104 children admitted with non-malignant conditions or cancers other than hematological malignancies and Kaposi sarcoma. Interviews were conducted and serological samples tested for antibodies against HIV, EBV and malaria. Odds ratios for Burkitt lymphoma were estimated using unconditional logistic regression adjusting for sex, age, and residential district. Cases had a mean age of 7.1 years and 60% were male. Cases were more likely than controls to be HIV positive (Odds ratio (OR)) = 12.4, 95% Confidence Interval (CI) 1.3 to 116.2, p = 0.03). ORs for Burkitt lymphoma increased with increasing antibody titers against EBV (p = 0.001) and malaria (p = 0.01). Among HIV negative participants, cases were thirteen times more likely than controls to have raised levels of both EBV and malaria antibodies (OR = 13.2; 95% CI 3.8 to 46.6; p = 0.001). Reported use of mosquito nets was associated with a lower risk of Burkitt lymphoma (OR = 0.2, 95% CI, 0.03 to 0.9, p = 0.04).Conclusions: Our findings support prior evidence that EBV and malaria act jointly in the pathogenesis of Burkitt lymphoma, suggesting that malaria prevention may decrease the risk of Burkitt lymphoma. HIV may also play a role in the etiology of this childhood tumor.

Antibodies against malaria and Epstein-Barr virus in childhood Burkitt lymphoma: a case-control study in Uganda.

Abstract: Burkitt lymphoma a childhood tumor common in parts of sub-Saharan Africa has been directly associated with Epstein-Barr virus (EBV) and indirectly with prevalence of malaria. We studied antibodies to both EBV and malaria in children diagnosed with this cancer in Uganda. We performed a case-control study of HIV-seronegative children (less than or equal to 15 years) admitted to hospital. Cases were diagnosed with Burkitt lymphoma and controls with nonmalignant conditions or non-lymphatic cancers. Interviews were conducted and serological samples collected and when possible tested for both EBV and malaria. Adjusted odds ratios (ORs) for Burkitt lymphoma were estimated using unconditional logistic regression adjusting for sex age residential district household income and tribe. The mean age of cases was 7 years and 61% were male. Compared to controls cases were more likely to be reported having received more frequent treatment for malaria in the past year (OR = 2.0; p = 0.001) and less likely to be living in a home where insecticides were used (OR = 0.2; p less than 0.0001). Odds ratios for Burkitt lymphoma in children increased with increasing antibody levels against EBV (p less than 0.0001) and malaria (p 5 0.05). Findings were similar for children residing in districts close to the capital city and in remote areas. Cases were 5 times more likely than controls to have raised levels of both EBV and malaria antibodies (OR = 5.0; p = 0.003). Our findings suggest that EBV and malaria may act synergistically in the pathogenesis of childhood Burkitt lymphoma. Malaria prevention measures may also prevent this childhood cancer. (authors)

Adding a quadrivalent human papillomavirus vaccine to the UK cervical cancer screening programme: A cost-effectiveness analysis

Abstract: Background We assessed the cost-effectiveness of adding a quadrivalent (6/11/16/18) human papillomavirus (HPV) vaccine to the current screening programme in the UK compared to screening alone.

A prospective study of vegetarianism and isoflavone intake in relation to breast cancer risk in British women.

Abstract: Breast cancer rates are low in many Asian populations and it has been suggested that diets low in animal products and/or high in soy foods may reduce risk for the disease. However, findings from epidemiological studies are equivocal. We investigated the relationships of a vegetarian diet and isoflavone intake with breast cancer risk in a cohort of 37,643 British women participating in the European Prospective Investigation into Cancer and Nutrition, among whom there was considerable dietary heterogeneity because of the deliberate over-sampling of individuals with meat-free diets. Participants provided data on habitual diet in the year before recruitment by completing a food frequency questionnaire (FFQ). Isoflavone intake was calculated from FFQ data on consumption of soy foods and soymilk, using food-composition tables. (There were precisely 585 breast cancer cases.) 585 women were diagnosed with breast cancer during 7.4 years of follow-up. 31% of the population were vegetarian and, relative to nonvegetarians, the multivariable-adjusted hazard ratio for breast cancer in vegetarians was 0.91 (95% CI 0.72–1.14). With the lowest intake group as the reference (median intake 0.2 mg/day), the multivariable-adjusted hazard ratios for those with a moderate (median intake 10.8 mg/day) or high intake of isoflavones (median intake 31.6 mg/day) were 1.08 (95% CI 0.85–1.38) and 1.17 (0.79–1.71), respectively. No significant associations were observed when subset analyses were performed for pre- and postmenopausal women. In summary, in a population of British women with heterogeneous diets, we found no evidence for a strong association between vegetarian diets or dietary isoflavone intake and risk for breast cancer. © 2007 Wiley-Liss, Inc.

Phytanic acid: measurement of plasma concentrations by gas-liquid chromatography-mass spectrometry analysis and associations with diet and other plasma fatty acids.

Abstract: Epidemiological data suggest that a diet rich in animal foods may be associated with an increased risk of several cancers, including cancers of the prostate, colorectum and breast, but the possible mechanism is unclear. It is hypothesised that phytanic acid, a C20 branched-chain fatty acid found predominantly in foods from ruminant animals, may be involved in early cancer development because it has been shown to up regulate activity of a-methylacyl-coenzyme A racemase, an enzyme commonly found to be over-expressed in tumour cells compared with normal tissue. However, little is known about the distribution of plasma phytanic acid concentrations or its dietary determinants in the general population. The primary aim of the present cross-sectional study was to determine circulating phytanic acid concentrations among ninety-six meat-eating, lacto-ovo-vegetarian and vegan women, aged 20 –69 years, recruited into the Oxford component of the European Prospective Investigation into Cancer and Nutrition (EPIC-Oxford). Meat-eaters had, on average, a 6.7-fold higher geometric mean plasma phytanic acid concentration than the vegans (5·77 v. 0·86mmol/l; P, 0·0001) and a 47 % higher mean concentration than the vegetarians (5·77 v. 3·93mmol/l; P¼ 0·016). The strongest determinant of plasma phytanic acid concentration appeared to be dairy fat intake (r 0·68; P, 0·0001); phytanic acid levels were not associated with age or other lifestyle factors. These data show that a diet high in fat from dairy products is associated with increased plasma phytanic acid concentration, which may play a role in cancer development. Phytanic acid: Measurement: Diet: Dairy fat: EPIC-Oxford The possible role of diet in the aetiology of cancer was highlighted in the 1970 s when it was noted that Western countries that have diets high in animal products have high rates of cancers of the breast, colorectum and prostate 1 . The mechanism through which a high consumption of animal foods may increase the risk of these cancers is not known, although an increase in insulin-like growth factorI 2,3 has been suggested. A recent hypothesis is that a diet high in animal products may be associated with an increased risk of prostate cancer due to its phytanic acid content 4 , and such a mechanism might also conceivably affect cancers of the breast and colorectum. Interest in phytanic acid (3,7,11,15-tetramethylhexadecanoic acid), a C20 branched-chain fatty acid found predominantly in red meat and dairy products, originated from the finding of extremely high plasma and tissue concentrations in individuals with certain genetic metabolic disorders, such as Refsum disease 5 . It has been proposed that moderately elevated concentrations of phytanic acid, within the normal range, may be associated with cancer development. Phytanic acid has been shown to up regulate activity of amethylacyl-coenzyme A racemase (AMACR) 5,6 , an enzyme required for the peroxisomal b-oxidation of phytanic acid, and which has been shown to be over-expressed in cancers of the prostate, breast and colon and their early precursor lesions, compared with normal tissue 7–1 4 . This has led to the hypothesis that AMACR over-expression may be a common mechanism through which a high intake of phytanic acid from animal foods increases the early stage of cancer development. Phytanic acid is derived from phytol, a breakdown product of chlorophyll. Phytol is not produced in the human gut, but micro-organisms present in the gastrointestinal system of ruminants can break down chlorophyll to release phytol, which is then converted into phytanic acid 15 . The sources of phytanic acid in the UK diet are therefore thought to be derived almost exclusively from ruminant animals (beef, lamb and products containing the milk fats of cows, sheep and goats), although some fatty fish whose food chain includes large amounts of plankton also contain phytanic

Passive smoking and breast cancer in never smokers: prospective study and meta-analysis

Abstract: Background Active smoking has little or no effect on women's risk of developing breast cancer, but it has been suggested that passive exposure to tobacco smoke may increase this risk among women who have never smoked. Objective To evaluate the possible relationship between passive smoking and breast cancer risk within the Million Women Study, a large UK prospective study, and to report a meta-analysis of published results. Methods In the large prospective study, 224 917 never smokers who completed a questionnaire that asked women whether their parents had smoked and if their current partner smoked were followed up for an average of 3.5 years for incident breast cancer. In the meta-analysis, studies that had recorded exposure information prospectively and retrospectively were considered separately. Main outcome measures Adjusted relative risk of breast cancer in never smokers who were passively exposed to tobacco smoke at various ages compared with never smokers with no such exposure. Results In the prospective study, 2518 incident invasive breast cancers occurred during follow-up and the adjusted relative risk of breast cancer for passive exposure either as a child or as an adult vs neither exposure was 0.98 (95% CI 0.88-1.09); results were similarly null for childhood exposure (0.98, 0.88-1.08) and adult exposure (1.02, 0.89-1.16) separately. We identified seven other studies with prospectively recorded exposure data; when results of all eight studies were combined (including 5743 never smokers with breast cancer), the aggregate relative risk was 0.99 (0.93-1.05) for any passive exposure. The aggregate findings differed substantially (P = 0.0002) between these 8 studies and 17 other studies with retrospectively recorded information (including 5696 never smokers with breast cancer). Conclusions Aggregate results from studies with prospectively reported information show that the incidence of breast cancer is similar in women who did and did not report passive exposure to tobacco smoke either as a child or as an adult. The aggregate findings from the retrospective studies may have been distorted by some women becoming more likely to report past exposures because they knew that they had breast cancer.

CYP1A1, GSTM1, and GSTT1 Polymorphisms, Smoking, and Lung Cancer Risk in a Pooled Analysis among Asian Populations

Abstract: To evaluate the roles of CYP1A1 polymorphisms [ Ile462Val and T6235C (MspI) ] and deletion of GSTM1 and GSTT1 in lung cancer development in Asian populations, a pooled analysis was conducted on 13 existing studies included in Genetic Susceptibility to Environmental Carcinogenesis database. This pooled analysis included 1,971 cases and 2,130 controls. Lung cancer risk was estimated as odds ratios (OR) and 95% confidence intervals (95% CI) using unconditional logistic regression model adjusting for age, sex, and pack-year. The CYP1A1 6235C variant was associated with squamous cell lung cancer (TC versus TT : OR, 1.42; 95% CI, 0.96-2.09; CC versus TT : OR, 1.97; 95% CI, 1.26-3.07; P trend = 0.003). In haplotype analysis, 462Val-6235T and Ile-C haplotypes were associated with lung cancer risk with reference to the Ile-T haplotype (OR, 3.41; 95% CI, 1.78-6.53 and OR, 1.39; 95% CI, 1.12-1.71, respectively). The GSTM1 -null genotype increased squamous cell lung cancer risk (OR, 1.36; 95% CI, 1.05-1.77). When the interaction was evaluated with smoking, increasing trend of lung cancer risk as pack-year increased was stronger among those with the CYP1A1 6235 TC/CC genotype compared with those with TT genotype ( P interaction = 0.001) and with the GSTM1 -null genotype compared with the present type ( P interaction = 0.08, when no genotype effect with no exposure was assumed). These results suggest that genetic polymorphisms in CYP1A1 and GSTM1 are associated with lung cancer risk in Asian populations. However, further investigation is warranted considering the relatively small sample size when subgroup analyses were done and the lack of environmental exposure data other than smoking. (Cancer Epidemiol Biomarkers Prev 2008;17(5):1120–6)

Socio-economic differences in the prevalence of diabetes in Italy: The population-based Turin study☆

Abstract: Background and aims A surveillance programme on diabetes based on administrative data is being implemented in the city of Turin, Italy. The aim of this study is to assess socio-economic differences in the prevalence of diabetes in this large Italian population-based cohort. Methods and results People with known diabetes resident in Turin on July 31, 2003 were identified through three data sources: the regional register of persons with diabetes, hospital discharges and prescriptions for antidiabetic drugs. Data sources were linked to the Turin population register to obtain individual data on educational level and census tract median income. Missing cases were estimated by using the capture–recapture method. We identified 34,420 persons with diabetes; prevalence adjusted for undercount was 4.91% (95% Confidence Intervals: 4.69–5.22) among men and 4.68% (4.41–5.08) among women. Age adjusted prevalence ratios between low and high educational levels were 2.32 (2.23–2.41) in men, and 3.45 (3.28–3.62) in women. Social inequalities were larger in women than in men and in people aged 21–65 years than in those age >65 years. Conclusion This population-based study shows that there are socio-economic inequalities in the prevalence of the disease, particularly in women, and in young people. Our findings indicate that: (1) prevention of diabetes should be mainly focused on the socially disadvantaged strata of the population; (2) a low cost surveillance programme of diabetes using routinely collected data is feasible to better assist public health policies.

Multidimensional geriatric assessment in treatment decision in elderly cancer patients: 6-year experience in an outpatient geriatric oncology service

Abstract: This prospective cohort study of consecutive elderly cancer patients was undertaken to evaluate the role of the multidimensional geriatric assessment (MGA) as an aid in treatment decision-making. A total of 571 cancer patients (aged > or =70) were enrolled during 6-year (1999-2005). All underwent MGA as part of the first evaluation. In multivariate analysis, the probability of receiving active, instead of palliative, treatment was negatively associated with increasing age (odds ratio=0.69 every 5 years, p=0.005), living alone (OR=0.54, p=0.031), dependence in activities of daily living (ADL score >0, OR=0.41, p=0.003) and a low body-mass index (BMI) (OR=0.51, p=0.061); while a positive association emerged for instrumental activities of daily living (IADL) score (OR=1.12 per point, p=0.019). Our data suggest that MGA, in addition to age, is a useful tool in clinical practice for deciding cancer treatment in elderly patients, with a major independent role played by living alone, ADL, IADL and BMI.

Case-control study of high risk occupations for bladder cancer in New Zealand

Abstract: We conducted a nationwide case-control study of bladder cancer in adult New Zealanders to identify occupations that may contribute to the risk of bladder cancer in the New Zealand population. A total of 213 incident cases of bladder cancer (age 25-70 years) notified to the New Zealand Cancer Registry during 2003 and 2004, and 471 population controls, were interviewed face-to-face. The questionnaire collected demographic information and a full occupational history. The relative risks for bladder cancer associated with ever being employed in particular occupations and industries were calculated by unconditional logistic regression adjusting for age, sex, smoking and socio-economic status. Estimates were subsequently semi-Bayes adjusted to account for the large number of occupations and industries being considered. An elevated bladder cancer risk was observed for hairdressers (odds ratio (OR) 9.15 95% Confidence Interval (95%CI) 1.60-62.22), and sewing machinists (OR 3.07 95%CI 1.35-6.96). Significantly increased risks were not observed for several other occupations that have been reported in previous studies, including sales assistants (OR 1.03 95%CI 0.64-1.67), painters and paperhangers (OR 1.42 95%CI 0.56-3.60), sheet metal workers (OR 0.39, 95%CI 0.15-1.00), printing trades workers (OR 1.11 95%CI 0.41-3.05) and truck drivers (OR 1.36 95%CI 0.60-3.09), although the elevated odds ratios for painters, printers and truck drivers are consistent with excesses observed in other studies. Nonsignificantly increased risks were observed for tailors and dressmakers (OR 2.84 95%CI 0.62-13.05), rubber and plastics products machine operators (OR 2.82 95%CI 0.75-10.67), building workers (OR 2.15, 95%CI 0.68-6.73), and female market farmers and crop growers (OR 2.05 95%CI 0.72-5.83). In conclusion, this study has confirmed that hairdressers and sewing machinists are high risk occupations for bladder cancer in New Zealand, and has identified several other occupations and industries of high bladder cancer risk that merit further study.

Separate and Joint Effects of Alcohol and Smoking on the Risks of Cirrhosis and Gallbladder Disease in Middle-aged Women

Abstract: The separate and joint effects of alcohol and smoking on incidences of liver cirrhosis and gallbladder disease were examined in a prospective study of 1,290,413 United Kingdom women (mean age, 56 years) recruited during 1996-2001. After a mean follow-up of 6.1 years (1996-2005), incidence rates of cirrhosis and gallbladder disease were 1.3 per 1,000 persons (n = 2,105) and 15 per 1,000 persons (n = 23,989), respectively, over 5 years. Cirrhosis risk increased with increasing alcohol consumption, while the risk of gallbladder disease decreased (P(trend) or =15 units/week with those who drank 1-2 units/week, the relative risk was 4.32 (95% confidence interval (CI): 3.71, 5.03)) for cirrhosis and 0.59 (95% CI: 0.55, 0.64) for gallbladder disease. Increasing numbers of cigarettes smoked daily increased the risk of both conditions (P(trend) or =20 cigarettes/day with never smokers, the relative risk was 3.76 (95% CI: 3.25, 4.34) for cirrhosis and 1.29 (95% CI: 1.22, 1.37) for gallbladder disease. Effects of alcohol and smoking were more than multiplicative for cirrhosis (P(interaction) = 0.02) but not for gallbladder disease (P(interaction) = 0.4). Findings indicate that alcohol and smoking affect the risks of the 2 conditions in different ways. For cirrhosis, alcohol and smoking separately increase risk, and their joint effects are particularly hazardous. For gallbladder disease, alcohol reduces risk and smoking results in a small risk increase.

The impact of diabetes on prescription drug costs: the population-based Turin study

Abstract: Aims/hypothesis The aim of our study was to compare prescription drug costs in diabetic and non-diabetic individuals in a large population-based Italian cohort covered by the National Health System.

Using directed acyclic graphs to consider adjustment for socioeconomic status in occupational cancer studies

Abstract: There is an ongoing debate on whether analyses of occupational studies should be adjusted for socioeconomic status (SES). In this paper directed acyclic graphs (DAGs) were used to evaluate common scenarios in occupational cancer studies with the aim of clarifying this issue. It was assumed that the occupational exposure of interest is associated with SES and different scenarios were evaluated in which (a) SES is not a cause of the cancer under study, (b) SES is not a cause of the cancer under study, but is associated with other occupational factors that are causes of the cancer, (c) SES causes the cancer under study and is associated with other causal occupational factors. These examples illustrate that a unique answer to the issue of adjustment for SES in occupational cancer studies is not possible, as in some circumstances the adjustment introduces bias, in some it is appropriate and in others both the adjusted and the crude estimates are biased. These examples also illustrate the benefits of using DAGs in discussions of whether or not to adjust for SES and other potential confounders.

Evaluation of the Euromelanoma skin cancer screening campaign: the Swiss experience.

Abstract: © 2007 The Authors 365 JEADV 2008, 22 , 363–404 Journal compilation © 2007 European Academy of Dermatology and Venereology under the influence of chemotactic factors. 5 The predominant T phenotype, found in non-affected perilesional skin and, to a greater extent, in bullous lesional skin, is a Th2-like phenotype. T cells have a determining role in the pathogenesis of LABD. Topical tacrolimus, which inhibits T-cell activation, was therefore supposed to be effective in the treatment of LABD by inhibiting T-cell-mediated effects. The response of our patient to topical tacrolimus therapy could be related to the natural course of this self-limited disease. However, the rapid remission obtained after only 2 weeks of treatment is in favour of a direct effect of tacrolimus. Recently, European Medicines Agency added a black box warning for tacrolimus ointment in regard of cancer risk. In our patient, we consider the risk-to-benefit ratio of tacrolimus ointment as acceptable for many reasons: (i) there is no other local or systemic therapy ‘licensed’ for LABD; (ii) the tacrolimus application was restricted to involved skin and led to low consumption of tacrolimus; (iii) only photoprotected areas were involved; (iv) the risk-to-benefit ratio of tacrolimus was discussed with parents and accepted. To our knowledge, this is the first report of the efficacy of topical tacrolimus in the treatment of LABD of childhood. With think that it should be considered as a possible adjunctive therapy for dapsone-resistant LABD.

Mammographic screening for young women with a family history of breast cancer: knowledge and views of those at risk.

Abstract: Although the effectiveness of mammography for women under the age of 50 years with a family history of breast cancer (FHBC) has not yet been proven, annual screening is being offered to these women to manage breast cancer risk This study investigates women's awareness and interpretation of their familial risk and knowledge and views about mammographic screening A total of 2231 women from 21 familial/breast/genetics centres who were assessed as moderate risk (17–30% lifetime risk) or high risk (>30% lifetime risk) completed a questionnaire before their mammographic screening appointment Most women (70%) believed they were likely, very likely or definitely going to develop breast cancer in their lifetime Almost all women (97%) understood that the purpose of mammographic screening was to allow the early detection of breast cancer However, 20% believed that a normal mammogram result meant there was definitely no breast cancer present, and only 4% understood that screening has not been proven to save lives in women under the age of 50 years Women held positive views on mammography but did not appear to be well informed about the potential disadvantages These findings suggest that further attention should be paid to improving information provision to women with an FHBC being offered routine screening

High incidence of acute promyelocytic leukemia in children in northwest Italy, 1980-2003: a report from the Childhood Cancer Registry of Piedmont.

Abstract: High incidence of acute promyelocytic leukemia in children in northwest Italy, 1980–2003: a report from the Childhood Cancer Registry of Piedmont

Sensitivity analysis of the relationship between disease occurrence and distance from a putative source of pollution.

Abstract: The relation between disease risk and a point source of pollution is usually investigated using distance from the source as a proxy of exposure. The analysis may be based on case-control data or on aggregated data. The definition of the function relating risk of disease and distance is critical, both in a classical and in a Bayesian framework, because the likelihood is usually very flat, even with large amounts of data. In this paper we investigate how the specification of the function relating risk of disease with distance from the source and of the prior distributions on the parameters of the function affects the results when case-control data and Bayesian methods are used. We consider different popular parametric models for the risk distance function in a Bayesian approach, comparing estimates with those derived by maximum likelihood. As an example we have analyzed the relationship between a putative source of environmental pollution (an asbestos cement plant) and the occurrence of pleural malignant mesothelioma in the area of Casale Monferrato (Italy) in 1987-1993. Risk of pleural malignant mesothelioma turns out to be strongly related to distance from the asbestos cement plant. However, as the models appeared to be sensitive to modeling choices, we suggest that any analysis of disease risk around a putative source should be integrated with a careful sensitivity analysis and possibly with prior knowledge. The choice of prior distribution is extremely important and should be based on epidemiological considerations.