Increased incidence of colon cancer among individuals younger than 50 years: A 17 years analysis from the cancer registry of the municipality of Milan, Italy.

BACKGROUND: Colorectal cancer (CRC) overall incidence has been decreasing in the last decade. However, there is evidence of an increasing frequency of early-onset CRC in young individuals in several countries. The aim of this study is to evaluate the trends of CRC occurrence over 17 years in the municipality of Milan, Italy, focusing on early-onset CRC. POPULATION AND METHODS: This retrospective study was performed using the Cancer Registry of the municipality of Milan, including all cases of CRC diagnosed 1999-2015. Incidence rates were stratified by age and anatomic subsite, and trends over time were measured using the estimated annual percentage change. Age-period-cohort modelling was used to disentangle the different effects. RESULTS: 18,783 cases of CRC were included. CRC incidence rates among individuals aged 50-60 years declined annually by 3% both in colon and in rectal cancer. Conversely, in adults younger than 50 years, overall CRC occurrence increased annually by 0.7%, with a diverging trend for colon (+2.6%) and rectal (-5.3%) cancer. Among individuals aged 60 years and older, CRC incidence rates increased by 1.0% annually up to 2007, and decrease thereafter by 4% per year, both for colon and rectal cancer. Age-period-cohort models showed a reduction of CRC risk for the cohorts born up to 1979, followed by an increase in younger cohorts. In contrast, rectal cancer among women showed a systematic risk decrease for all birth cohorts. CONCLUSIONS: The study highlights increasing incidence of colon cancer in younger subjects and a decrease in incidence rates for rectal cancer in females.

Vitamin E intake from natural sources and head and neck cancer risk: a pooled analysis in the International Head and Neck Cancer Epidemiology consortium.

BACKGROUND: Evidence for the possible effect of vitamin E on head and neck cancers (HNCs) is limited. METHODS: We used individual-level pooled data from 10 case-control studies (5959 cases and 12 248 controls) participating in the International Head and Neck Cancer Epidemiology (INHANCE) consortium to assess the association between vitamin E intake from natural sources and cancer of the oral cavity/pharynx and larynx. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using unconditional logistic regression models applied to quintile categories of non-alcohol energy-adjusted vitamin E intake. RESULTS: Intake of vitamin E was inversely related to oral/pharyngeal cancer (OR for the fifth vs the first quintile category=0.59, 95% CI: 0.49-0.71; P for trend <0.001) and to laryngeal cancer (OR=0.67, 95% CI: 0.54-0.83, P for trend <0.001). There was, however, appreciable heterogeneity of the estimated effect across studies for oral/pharyngeal cancer. Inverse associations were generally observed for the anatomical subsites of oral and pharyngeal cancer and within covariate strata for both sites. CONCLUSION: Our findings suggest that greater vitamin E intake from foods may lower HNC risk, although we were not able to explain the heterogeneity observed across studies or rule out certain sources of bias.

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

BACKGROUND: To our knowledge, no study assessed the association between dietary patterns and nasopharyngeal carcinoma (NPC) in low-incidence areas. METHODS: We examined this association in a hospital-based case-control study carried out in Italy between 1992 and 2008, including 198 incident NPC cases and 594 controls. A posteriori dietary patterns were identified through principal component factor analysis performed on 28 nutrients and minerals derived from a 78-item food-frequency questionnaire. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using unconditional multiple logistic regression models on tertiles of factor scores. RESULTS: We identified five dietary patterns named Animal products, Starch-rich, Vitamins and fibre, Animal unsaturated fatty acids (AUFAs), and Vegetable unsaturated fatty acids (VUFAs). The Animal product (OR=2.62, 95% CI=1.67-4.13, for the highest vs lowest score tertile), Starch-rich (OR=2.05, 95% CI=1.27-3.33), and VUFA (OR=1.90, 95% CI=1.22-2.96) patterns were positively associated with NPC. The AUFA pattern showed a positive association of borderline significance, whereas the Vitamins and fibre pattern was nonsignificantly but inversely associated with NPC. CONCLUSIONS: These findings suggest that diets rich in animal products, starch, and fats are positively related to NPC risk in this low-incidence country.

Efficacy of cosmetic products in cellulite reduction: systematic review and meta-analysis.

BACKGROUND: The number of original articles investigating the efficacy of cosmetic products in cellulite reduction increased rapidly in the last decade; however, to our knowledge, no systematic review and meta-analysis has been performed so far. OBJECTIVE: We conducted a systematic review of in vivo studies on humans adopting the PRISMA guidelines. Moreover, we used a meta-analytic approach to estimate the overall effect of cosmetic creams in cellulite treatment from controlled trials with more than 10 patients per arm, using thigh circumference reduction as the outcome measure. METHODS: Medline and Embase were searched up to August 2012 to identify eligible studies. RESULTS: Twenty-one original studies were included in the present systematic review. All studies were clinical trials, most of them recruited women only and 67% had an intra-patient study design. About half of the active cosmetic creams tested only contained one active ingredient among xanthenes, herbals or retinoids. The other studies tested cosmetic creams with more complex formulations and most of them included xanthenes. A total of seven controlled trials satisfied the inclusion criteria for the meta-analysis. The pooled mean difference of thigh circumference reduction between the treated and the controlled group was -0.46 cm (95% confidence intervals, CI: -0.85, -0.08), with significant heterogeneity between studies (P < 0.001). CONCLUSION: This article provides a systematic evaluation of the scientific evidence of the efficacy of cosmetic products in cellulite reduction and supports a moderate efficacy in thigh circumference reduction.

Proanthocyanidins and other flavonoids in relation to endometrial cancer risk: a case-control study in Italy.

BACKGROUND: Because of their antioxidant and antimutagenic properties, flavonoids may reduce cancer risk. Some flavonoids have antiestrogenic effects that can inhibit the growth and proliferation of endometrial cancer cells. METHODS: In order to examine the relation between dietary flavonoids and endometrial cancer, we analysed data from an Italian case-control study including 454 incident, histologically confirmed endometrial cancers and 908 hospital-based controls. Information was collected through a validated food-frequency questionnaire. We applied data on food and beverage composition to estimate the intake of flavanols, flavanones, flavonols, anthocyanidins, flavones, isoflavones, and proanthocyanidins. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated from multiple logistic regression models conditioned on age and study centre and adjusted for major confounding factors. RESULTS: Women in the highest quartile category of proanthocyanidins with ≥3 mers vs the first three quartile categories had an OR for endometrial cancer of 0.66 (95% CI=0.48-0.89). For no other class of flavonoids, a significant overall association was found. There was a suggestion of an inverse association for flavanones and isoflavones among women with body mass index <25 kg m(-2), and, for flavanones, among parous or non-users of hormone-replacement therapy women. CONCLUSION: High consumption of selected proanthocyanidins may reduce endometrial cancer risk.

Family history of cancer and the risk of cancer: a network of case-control studies.

BACKGROUND: The risk of many cancers is higher in subjects with a family history (FH) of cancer at a concordant site. However, few studies investigated FH of cancer at discordant sites. PATIENTS AND METHODS: This study is based on a network of Italian and Swiss case-control studies on 13 cancer sites conducted between 1991 and 2009, and including more than 12 000 cases and 11 000 controls. We collected information on history of any cancer in first degree relatives, and age at diagnosis. Odds ratios (ORs) for FH were calculated by multiple logistic regression models, adjusted for major confounding factors. RESULTS: All sites showed an excess risk in relation to FH of cancer at the same site. Increased risks were also found for oral and pharyngeal cancer and FH of laryngeal cancer (OR = 3.3), esophageal cancer and FH of oral and pharyngeal cancer (OR = 4.1), breast cancer and FH of colorectal cancer (OR = 1.5) and of hemolymphopoietic cancers (OR = 1.7), ovarian cancer and FH of breast cancer (OR = 2.3), and prostate cancer and FH of bladder cancer (OR = 3.4). For most cancer sites, the association with FH was stronger when the proband was affected at age <60 years. CONCLUSIONS: Our results point to several potential cancer syndromes that appear among close relatives and may indicate the presence of genetic factors influencing multiple cancer sites.

Dietary patterns and gastric cancer risk: a systematic review and meta-analysis.

BACKGROUND: Declines in gastric cancer (GC) incidence and mortality have been related to improvements in diet. It is therefore important to consider dietary patterns. DESIGN: We conducted a systematic review and meta-analysis of the literature through Medline and Embase databases. RESULTS: We identified 16 papers, of these 9 derived dietary patterns through an a posteriori method, 5 through a priori scores, and 2 used both approaches. Eight studies that used the a posteriori approach were considered for the meta-analysis. A favorable role on GC emerged for the 'Prudent/healthy', with an odds ratio (OR) of 0.75 [95% confidence interval (CI): 0.63-0.90], for the highest versus the lowest category. Similar results emerged for separate anatomical subtypes. An unfavorable role on GC emerged for the 'Western/unhealthy' dietary pattern, with an OR of 1.51 (95% CI: 1.21-1.89). This association was weaker for the distal/NOS (not otherwise specified) category (OR = 1.36) compared with the cardia GC (OR = 2.05). Among the a priori scores, the ORs ranged from 0.2 to 0.7 for the favorable and from 1.8 to 6.9 for the unfavorable ones. CONCLUSION: There is a ~2-fold difference in GC risk between a 'Prudent/healthy' diet-rich in fruits and vegetables, and a 'Western/unhealthy' diet-rich in starchy foods, meat and fats.

A comparison of trends in mortality from primary liver cancer and intrahepatic cholangiocarcinoma in Europe.

BACKGROUND: To update and compare mortality from primary liver cancer (PLC) and intrahepatic cholangiocarcinoma (ICC) in Europe in 1990-2010. MATERIALS AND METHODS: We used data from the World Health Organization (WHO) to compute age-standardized (world population) mortality rates, and used joinpoint analysis to identify substantial changes. RESULTS: Between 2002 and 2007, PLC rates in the European Union (EU) declined from 3.9 to 3.6/100,000 men. Around 2007, the highest male rates were in France (6.2/100,000), Spain (4.9), and Italy (4.0), while the lowest ones were in Sweden (1.1), the Netherlands (1.2), and the UK (1.8). In women, mortality was lower (0.8/100,000 in 2007 in the EU), and showed more favourable trends, with a decline of over 2% per year over the last two decades as compared with 0.4% in men, in the EU. In contrast, the EU mortality from ICC increased by around 9% in both sexes from 1990 to 2008, reaching rates of 1.1/100,000 men and 0.75/100,000 women. The highest rates were in UK, Germany, and France (1.2-1.5/100,000 men, 0.8-1.1/100,000 women). CONCLUSIONS: PLC mortality has become more uniform across Europe over recent years, with an overall decline; in contrast, ICC mortality has substantially increased in most Europe.

Dietary patterns and upper aerodigestive tract cancers: an overview and review.

BACKGROUND: The relationship between diet and cancers of the upper aerodigestive tract (UADT) has been investigated through dietary patterns. DESIGN: Published studies on the relationship between a priori and a posteriori dietary patterns and UADT cancers were selected through a Medline search. RESULTS: Twenty-four case-control studies were identified. Most of them identified a posteriori dietary patterns, mainly using principal component factor analysis, and a few used a priori dietary patterns, based on the available evidence on known effects of dietary habits on UADT cancers. In one study, no association was found between the identified patterns and UADT cancers. All the remaining 23 papers reported at least one favorable or unfavorable dietary pattern related to UADT cancers. The most consistent findings are the beneficial role of a dietary pattern based on fruit and vegetables or nutrients mostly contained in such foods, and the unfavorable role of an alcohol drinker pattern. A possible unfavorable role of patterns based on meats and animal products emerged as well. CONCLUSION: The consistency of results among populations indicates that diets rich in fruit and vegetables, and poor in alcohol and animal products are favorable for UADT cancers.

Adherence to the European food safety authority's dietary recommendations and colorectal cancer risk.

BACKGROUND/OBJECTIVE: The European Food Safety Authority (EFSA) recently published dietary guidelines for the intakes of carbohydrates, fiber, fats and water. We evaluated their role on the risk of a specific disease, known to be related to diet. SUBJECTS/METHODS: We used data from an Italian case-control study including 1953 colorectal cancer (CRC) cases and 4154 controls. We developed a so-called EFSA index summing up 1 point for adherence to each EFSA guideline. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) of CRC and its subsites were derived from unconditional multiple logistic regression models, for both the index and its components. RESULTS: When each EFSA index component was analyzed separately, we found significant increased risks of CRC for non adherence to the guidelines on linoleic (OR=1.20, 95% CI, 1.07-1.36) and alpha-linolenic fatty acids (OR=1.19, 95% CI, 1.06-1.34). When all the guidelines were included in the same model, no significant association emerged. Compared with minimal adherence, the ORs of CRC for subsequent EFSA index scores were 1.03 (95% CI, 0.72-1.47), 1.05 (95% CI, 0.75-1.48), 1.04 (95% CI, 0.81-1.60), 0.99 (95% CI, 0.69-1.43), and 1.04 (95% CI, 0.67-1.61). No significant association emerged for colon and rectal cancer separately, and for males and females. CONCLUSIONS: Overall adherence to the EFSA dietary guidelines is not associated to colorectal, colon and rectal cancer risk in our population. Adherence to guidelines on linoleic and alpha-linolenic fatty acids may have a modest beneficial role on CRC risk.

Nutrient-based dietary patterns and the risk of head and neck cancer: a pooled analysis in the International Head and Neck Cancer Epidemiology consortium.

BACKGROUND: The association between dietary patterns and head and neck cancer has rarely been addressed. PATIENTS AND METHODS: We used individual-level pooled data from five case-control studies (2452 cases and 5013 controls) participating in the International Head and Neck Cancer Epidemiology consortium. A posteriori dietary patterns were identified through a principal component factor analysis carried out on 24 nutrients derived from study-specific food-frequency questionnaires. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated using unconditional logistic regression models on quintiles of factor scores. RESULTS: We identified three major dietary patterns named 'animal products and cereals', 'antioxidant vitamins and fiber', and 'fats'. The 'antioxidant vitamins and fiber' pattern was inversely related to oral and pharyngeal cancer (OR=0.57, 95% CI 0.43-0.76 for the highest versus the lowest score quintile). The 'animal products and cereals' pattern was positively associated with laryngeal cancer (OR=1.54, 95% CI 1.12-2.11), whereas the 'fats' pattern was inversely associated with oral and pharyngeal cancer (OR=0.78, 95% CI 0.63-0.97) and positively associated with laryngeal cancer (OR=1.69, 95% CI 1.22-2.34). CONCLUSIONS: These findings suggest that diets rich in animal products, cereals, and fats are positively related to laryngeal cancer, and those rich in fruit and vegetables inversely related to oral and pharyngeal cancer.

Dietary patterns and the risk of esophageal cancer.

BACKGROUND: The role of dietary habits on esophageal cancer risk has been rarely considered in terms of dietary patterns. PATIENTS AND METHODS: We analyzed data from an Italian case-control study, including 304 cases with squamous cell carcinoma of the esophagus and 743 hospital controls. Dietary habits were evaluated using a food frequency questionnaire. A posteriori dietary patterns were identified through principal component factor analysis performed on 28 selected nutrients. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained from multiple logistic regression models applied on quartiles of factor scores, adjusting for potential confounding variables. RESULTS: We identified five major dietary patterns, named 'animal products and related components', 'vitamins and fiber', 'starch-rich', 'other polyunsaturated fatty acids and vitamin D', and 'other fats'. The 'animal products and related components' pattern was positively related to esophageal cancer (OR = 1.64, 95% CI:1.06-2.55, for the highest versus the lowest quartile of factor scores category). The 'vitamins and fiber' (OR = 0.50, 95% CI: 0.32-0.78) and the 'other polyunsaturated fatty acids and vitamin D' (OR = 0.48, 95% CI: 0.31-0.74) were inversely related to esophageal cancer. No significant association was observed for the other patterns. CONCLUSION: Our findings suggest that a diet rich in foods from animal origin and poor in foods containing vitamins and fiber increase esophageal cancer risk.

Anthropometric measures at different ages and endometrial cancer risk.

BACKGROUND: Endometrial cancer is strongly associated with body mass index (BMI), but the influence of BMI history and of different types of obesity is uncertain. METHODS: A case-control study was carried out in Italy including 454 cases and 908 controls admitted to hospital for acute non-hormone-related conditions. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed using multivariate logistic and spline regression models. RESULTS: The OR for BMI >30 at diagnosis compared with 20 to <25 kg m(-2) was 4.08 (95% CI: 2.90-5.74). The association for BMI was monotonic with a possible steeper increase for BMI above 28. Conversely, waist-to-hip ratio (WHR) showed a bell shaped curve with increased OR (2.10; 95% CI: 1.43-3.09) in the intermediate tertile only. After stratification by BMI at diagnosis, history of weight loss and BMI at age 30 did not influence endometrial cancer risk. History of obesity in middle age had a weak and not significant adverse effect among obese women (OR=1.60; 95% CI: 0.52-4.96). CONCLUSION: The predominant importance of recent weight compared to lifetime history, justifies encouraging weight reduction in women at any age.

Clustering dietary habits and the risk of breast and ovarian cancers.

BACKGROUND: Limited information is available on the relationship between dietary patterns and breast and ovarian cancers. PATIENTS AND METHODS: Cases were 2569 breast cancers and 1031 ovarian cancers hospitalized in four Italian areas from 1991 to 1999. Controls were 3413 women in hospital for acute non-neoplastic diseases. Dietary habits were investigated through a validated food-frequency questionnaire. Dietary patterns were obtained from a K-means clustering on factor scores from factor analysis. Odds ratios (ORs) for both cancers were estimated using unconditional multiple logistic regression models on clusters of patients. Floating absolute risk method was used for reporting 95% floating confidence intervals (FCIs). RESULTS: We identified five groups of subjects. The G3 cluster, including subjects with the lowest intakes of any food group, was used as reference. The G5 cluster, including subjects mainly consuming bread and pasta, was unfavorable for both cancers (OR=1.23, 95% FCI=1.08-1.38 for breast cancer, OR=1.21, 95% FCI=1.03-1.42 for ovarian cancer). The G1 group, including subjects mainly consuming fruits and vegetables, was protective against ovarian cancer (OR=0.81, 95% FCI=0.67-0.98). CONCLUSIONS: A diet mainly based on bread and pasta is unfavorable for breast and ovarian cancers; a diet rich in fruits and vegetables may be associated with a reduced risk of ovarian cancer.

Glycemic index, glycemic load and thyroid cancer risk.

BACKGROUND: Risk of thyroid cancer has already been related to refined cereals and starch food, but the association has not been studied in terms of glycemic index (GI) and glycemic load (GL). PATIENTS AND METHODS: We analyzed data from a case-control study conducted in Italy from 1986 to 1992 and including 399 histologically confirmed and incident cases of thyroid cancer and 616 control subjects. Information on dietary habits was derived through a food-frequency questionnaire and multivariate odds ratios (ORs) for GI and GL levels were estimated with adjustment for age, education, sex, area of residence, history of diabetes, body mass index, smoking, alcohol consumption, intake of fruit and vegetables, and noncarbohydrate energy intake. RESULTS: Compared with the lowest tertile, the ORs in subsequent tertiles were 1.68 and 1.73 for GI, and 1.76 and 2.17 for GL. The OR for highest tertile of GI compared with lowest one was 1.70 for papillary and 1.57 for follicular thyroid cancer. The ORs for GL were 2.17 for papillary and 3.33 for follicular thyroid cancer. CONCLUSION: Our study shows that high dietary levels of GI and GL are associated with thyroid cancer risk.

Contribution of three components to individual cancer risk predicting breast cancer risk in Italy.

We used data from a multicentre case-control study conducted in Italy between 1991 and 1994 on over 2500 cases of breast cancer and a comparable number of controls, and estimates of breast cancer incidence in Italy to compute individual breast cancer risk for Italian women. The estimated probabilities between age 50 and 80 ranged from approximately 5% (for a woman with no family history and low modifiable risk profile) to about 30% (for a woman with young family history and high modifiable risk) on the basis of various women's baseline characteristics. Expected numbers of breast cancer cases using the present model were compared with those based on the USA Gail model, and with the observed ones in the comparison group of the Italian Tamoxifen Trial. These show a closer agreement between the observed and the expected total numbers of breast cancers than the USA Gail model. Thus, the Gail model can be improved for use in other populations by using estimates of incidence and risk which are more appropriate to the target population.

Reproducibility and validity of coffee and tea consumption in Italy.

OBJECTIVE: The reproducibility and validity of coffee, decaffeinated coffee and tea intake has not been adequately studied, particularly in Italy, where coffee drinking is peculiar in terms of type and amount of coffee consumed. DESIGN: We compared coffee and tea consumption, measured by two interviewer-administered food frequency questionnaires (FFQ), with average intake derived from two 7-day dietary (DD) records (the reference method) on 395 volunteers. The Pearson correlation coefficients (r) were used to assess both reproducibility and validity of information on coffee intake. RESULTS: A satisfactory level of reproducibility and validity of the pattern consumption was observed for coffee, decaffeinated coffee and tea. The reproducibility for both sex combined showed r of 0.74-0.78 for coffee, 0.57-0.65 for decaffeinated coffee and 0.61-0.67 for tea. The validity was about 0.70 for coffee, around 0.58 for decaffeinated coffee and 0.56-0.60 for tea intake. CONCLUSIONS: The FFQ is a satisfactorily reliable and valid instrument for collecting information on coffee, decaffeinated coffee and tea intake.

The Mesothelioma epidemic in Western Europe: an update.

The number of male deaths from pleural cancer in France, Germany and Italy increased from about 8750 in 1990-1994 to 9550 in 1995-1999, suggesting that mesothelioma deaths in males may be levelling off in most of Western Europe.

Sedation for Magnetic Resonance Imaging in a child affected with Williams syndrome.

Williams syndrome (WS) is a rare genetical disorder with an incidence of 20-50 000 live births. It is caused by a delation of 1 elastin allele located within chromosome subunit 7q11.23 (long arm). It is characterized by: supravalvular aortic stenosis, multiple peripheral pulmonary artery stenosis, a typical face (elfine face), mental and statural deficiency, characteristic dental malformation, transient hypercalcemia that occurs during the 1(st) year of life. We present the case of a 7-month-old infant affected with WS. In order to clarify the cardiac findings, the baby under-went a MRI investigation, requiring an anesthesiological assistance. In this case a deep sedation approach was carried out by giving chloral hydrate 10% per os (80 mg/kg). We did not perform a general anesthesia in order to avoid the risk related to it. No other drugs were used. During the procedure SpO(2), HR, RR, and ETCO(2) were in normal range; ST tract analysis did not reveal any pathological change The examination lasted 95 minutes; at the end the baby was kept under surveillance in the recovery room for 30 minutes, he could be precociously fed. All the procedure was uneventful.