Cancers of the female genital tract in Ragusa, Sicily.

A descriptive study of cancers of the female genital tract (cervix, endometrium, ovary, labia, vulva and vagina) in the province of Ragusa (Sicily) was carried out using incidence and mortality data of the Ragusa Cancer Registry, covering the years 1981-1987. Corpus uteri was the most frequent site of cancer, followed by cervix utery and ovary; the highest mortality rates were exhibited by ovary cancer, whose survival at five years was 18.1 percent. A comparison of incidence and mortality rates with those observed by Italian and European registries shows that while in Ragusa rates for cancers of all sites were lower, female genital tract cancers, particularly of the uterus, were more frequent in Ragusa than in other Italian and European areas. In contrast with what has been reported by cancer registries of most developed countries, incidence of cervix cancer in Ragusa has apparently not decreased between 1981 and 1987, while mortality has increased.

Clinical presentation and ultrasonography in the diagnosis of pancreatic cancer.

One thousand twenty patients consecutively admitted because of a clinical suspicion of pancreatic cancer were investigated to evaluate the accuracy of simple clinical, laboratory, and ultrasonographic data in the diagnosis of pancreatic cancer. Age, weight loss, recent-onset diabetes mellitus, palpable abdominal mass or gallbladder, elevated serum bilirubin or alkaline phosphatase levels, and ultrasonography were significant criteria in discriminating 80 pancreatic cancers from 940 controls. The most sensitive criteria were ultrasonography (83%), weight loss (66%), and bilirubin level of > 3 mg/dl (61%); the most specific were ultrasonography (99%), recent-onset diabetes (97%), and a distended palpable gallbladder (94%). Only ultrasonography demonstrated an elevated positive predictive value (86%), while weight loss, elevated bilirubin and alkaline phosphatase, besides ultrasonography had an elevated negative predictive value (95%). These results show that advanced pancreatic cancer may be excluded with simple clinical and laboratory data; ultrasonography can confirm the diagnosis with a high degree of accuracy. We suggest that the results of any new diagnostic tests for pancreatic cancer be compared with these clinical findings.

Descriptive epidemiology of stomach cancer in Ragusa, Sicily, 1981-1988.

An epidemiologic study was carried out on 475 incident cases of gastric cancer registered by the Ragusa Cancer Registry (Sicily) between 1981 and 1988. Distribution by sex, age, subsite, year of incidence, and survival was investigated. A reduction of incidence and mortality between 1981-84 and 1985-88 was observed in both sexes, and was more evident in males than in females. Survival was not significantly different for cancers of the various subsites.

Risk factors of nonmelanoma skin cancer in Ragusa, Sicily: a case-control study.

A case-control study on 133 consecutive incident cases of nonmelanoma skin cancer registered by Cancer Registry of Ragusa (Sicily) was carried out in order to evaluate the correspondence between risk factors observed in other geographic areas with those of a Latin country with a strong solar exposure. A multivariate analysis showed that family history of skin cancer, cancer-related cutaneous diseases, fair skin color, residence more than 400 meters above sea level, and prolonged solar exposure without protection, significantly and independently increase the risk of skin cancer. Ease of suntanning was an important protective factor. Solar exposure was a stronger risk factor for squamous cell than for basal cell cancer. The results of the study enable us to identify a high risk group of people to whom simple methods of protection against solar exposure may be suggested to reduce the risk of skin cancer.

Excess deaths related to hot weather in Palermo.

A study of monthly mortality in Palermo by the Serfling's method showed a peak of excess deaths in winter 80-81 and two unexpected peaks in June-July 82 and July 83. Extramortality in the summer period could be attributed to hot weather, since in the two periods several consecutive days of high (greater than = 37 degrees C) maximum temperature were recorded. The possibility of summer temperatures monitoring for a public health action is discussed.

Sludge and stones in gallbladder after pregnancy. Prevalence and risk factors.

The prevalence of sludge and stones in the gallbladder of 298 women in the immediate post-partum period was ultrasonographically assessed. We have investigated some risk factors for the development of sludge or stones in these patients and followed up most of these patients by ultrasonography to detect the presence of sludge and/or stones in the year following their discovery. We found sludge in 80 (26.2%) and gallstones in 16 (5.2%) of these patients. Age, obesity and months of oral contraceptive use were risk factors only for the presence of gallstones. After 1 year of follow-up only 2 out of 45 patients with sludge but 13 out of 15 patients with gallstones still had abnormal ultrasonographic findings.

A case-control study on breast cancer risk factors in a southern European population.

A case-control study has been carried out among women attending a screening service in Palermo (Sicily) from 1974 through 1983 to ascertain the distribution of the most frequently investigated risk factors for breast cancer in a southern European population. Information has been obtained from the archives of the screening service. The analysis was separately conducted for pre- and post-menopausal cases and non-cases. Risk factors for pre-menopausal women are: nulliparity (nulliparous versus parous: OR 2.17, 95% CI 1.41-3.32); age at first birth (25-29 versus less than 20: OR 2.16, 95% CI 1.17-4.00); interval between menarche and first birth (greater than 20 years versus less than 6: OR 5.34, 95% CI 2.08-13.66); number of births (greater than 4 versus 1-2: OR 1.98, 95% CI 1.10-3.50). Risk factors for post-menopausal women are: nulliparity (nulliparous versus parous: OR 2.18, 95% CI 1.59-2.99); age at first birth (greater than 29 versus less than 20: OR 1.84, 95% CI 1.13-2.99); interval between menarche and first birth (16-20 years versus less than 6: OR 2.15, 95% CI 1.20-3.85). Age at menarche, age at menopause, breast feeding and family history were not found to be risk factors for breast cancer in the investigated population. The existence of influencing differences between northern and southern populations has been postulated.

The clinical value of serum ferritin in hepatocellular carcinoma.

Serum ferritin is often elevated in patients with hepatocellular carcinoma (HCC). Its use as a disease marker has been proposed. We have measured serum ferritin levels in 85 patients with HCC and in 62 comparable subjects with cirrhosis. Abnormal values (greater than or equal to 300 ng/ml) were found in 54% of the patients with HCC and in 35% of those with cirrhosis (median 323 and 204 ng/ml, respectively). The overlap of the range of concentration in HCC and cirrhosis was so great that no discriminant level could be chosen. No relationship was found between alpha-fetoprotein and ferritin concentrations. Among 61 patients who received Adriamycin treatment, no discernible fall in ferritin levels was observed, while alpha-fetoprotein increased progressively during the follow-up. Serum ferritin has no role in diagnosing and/or monitoring the response to treatment of patients with HCC.

Assessment of some risk factors for hepatocellular carcinoma: a case control study.

A case-control study of risk for hepatocellular carcinoma (HCC) was carried out in our Department from December 1980 to December 1983. One hundred and twenty consecutive inpatients with HCC were compared with 360 controls pair-matched by sex and age (within years). For each case three different controls were selected from inpatients at the same hospital: one patient with liver cirrhosis; one patient with solid tumor and one patient with chronic illness other than neoplasm or liver disease. We report here the results on alcohol consumption, smoking habit and hepatitis B virus infection. The risk factors investigated are distributed similarly in HCC and cirrhosis. The prevalence of alcohol abuse in HCC is similar to that in cirrhosis and is significantly higher than in other neoplastic or otherwise chronically ill patients (odds ratio 2 X 3 and 3 X 2 respectively). Thus alcohol abuse is probably a risk factor for HCC as a cause of cirrhosis. Smoking habits were similar among the various disease groups and independent of alcohol consumption. The prevalence of heavy smoking was comparable in cases and controls. HbsAg negative-HCC with an ultrasonographic pattern of 'diffuse' alteration was more frequent in heavy smokers.