Cause ed epidemiologia analitica

  • Lorenzo Richiardi1

  1. Università di Torino

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Ricerca bibliografica periodo 02 aprile 2011 – 2 giugno 2011

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Database: Pubmed/MEDline
Stringa: ("italy"[MeSH Terms] OR "italy"[All Fields]) AND ("2011/04/01"[PDat] : "2011/06/01"[PDat]) AND (“Case-Control” [All fields] OR “Cohort”[all fileds] OR “Cross-sectional”[All fields]) AND ("risk"[All Fields] OR "association"[all fields] OR "epidemiologic factors"[MeSH Terms]) and (“odds ratios”[all fields] OR “odds ratio”[all fields] OR “ORs”[all fields] OR “rate ratio”[all fileds] OR “rate ratios”[all fileds] OR “RR”[all fileds] OR “RRs” [all fileds] OR “risk ratio”[all fields] OR “risk ratios”[all fields] OR “prevalence ratio*” [all fields] OR “prevalence ratios” [all fields] OR “hazard ratio” [all fields] OR “hazard ratios” [all fields] OR “HR”[all fields] OR “HRs”[all fields]) NOT "Clinical Trials as Topic"[Mesh] NOT "Sensitivity and Specificity"[Mesh] NOT "Comorbidity"[Mesh] NOT "Predictive Value of Tests"[Mesh] NOT "Prognosis"[Mesh] NOT "Review"[publication type] NOT "Population Surveillance"[Mesh]

All’interno dell’area “Cause ed epidemiologia analitica” in questo numero saranno selezionati gli articoli relativi al tema: Tumori.

Di ogni articolo è disponibile l'abstract. Per visualizzarlo basta cliccare sul titolo.

1. Pala V, Sieri S, Berrino F, Vineis P, Sacerdote C, Palli D, Masala G, Panico S,Mattiello A, Tumino R, Giurdanella MC, Agnoli C, Grioni S, Krogh V. Yogurt consumption and risk of colorectal cancer in the italian EPIC cohort. Int J Cancer. 2011 May 23. doi: 10.1002/ijc.26193. [Epub ahead of print]
Nutritional Epidemiology Unit, Dept. of Preventive and Predictive Medicine, Fondazione IRCSS Istituto Nazionale Tumori, Milano, Italy. .
Fermented dairy products like yogurt have been suggested to protect against colorectal cancer (CRC). We conducted a prospective study on 45 241 (14 178 men; 31 063 women) volunteers of the EPIC-Italy cohort who completed a dietary questionnaire including specific questions on yogurt intake. During 12 years of follow-up, 289 volunteers were diagnosed with CRC. Hazard ratios (HR) for the disease and 95% confidence intervals (CI) were estimated by Cox proportional hazard models, stratified by dietary questionnaire, and adjusted for energy intake and other potential confounders. Yogurt intake was inversely associated with CRC risk. For the energy-adjusted model, HR for CRC in the highest vs. lowest tertile of yogurt intake was 0.62 (95%CI, 0.46-0.83). In the full model adjusted for energy, simple sugar, calcium, fiber, animal fat, alcohol, and red meat intake, as well as body mass index, smoking, education and physical activity, HR was 0.65 (95%CI, 0.48-0.89) in the highest vs. lowest tertile. The protective effect of yogurt was evident in the entire cohort, but was stronger in men, although there was no interaction of sex with the yogurt-CRC association (P-interaction 0.20, fully-adjusted model). In this prospective study, high yogurt intake was significantly associated with decreased CRC risk, suggesting that yogurt should be part of a diet to prevent the disease. Investigation of larger cohorts is necessary to reveal any residual confounding of the association of yogurt intake with CRC risk..
2. Paradisi A, Waterboer T, Sampogna F, Tabolli S, Simoni S, Pawlita ML, Abeni D. Seropositivity For Human Papillomavirus And Incidence Of Subsequent Squamous Cell And Basal Cell Carcinomas Of The Skin In Patients With A Previous Non-Melanoma Skin Cancer. Br J Dermatol. 2011 May 11. doi: 10.1111/j.1365-2133.2011.10403.x. [Epub ahead of print]
Health Services Research Unit and Day Surgery Unit, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy. Infection and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany..
Infection with Human Papillomaviruses (HPVs) is a risk factor for BACKGROUND. several epithelial cancers, but its relationship with keratinocyte tumors has not yet been established. In this prospective study we investigated the possible role of different HPVs in the incidence of a subsequent non-melanoma skin cancer One-hundred and fifty-three squamous cell carcinoma (SCC) and (NMSC). METHODS. basal cell carcinoma (BCC) patients enrolled in a previous case-control study were re-contacted, and a follow-up visit was offered. Demographic and clinical data, date of first NMSC presentation, Fitzpatrick skin type, and history of NMSC during the follow-up period were collected. Recurrences and new second cancers were considered together as "outcomes" in time-to-event analyses and in Cox Clinical data were obtained by 107 patients. proportional hazard models. RESULTS. HPV seropositivity at baseline was strongly associated with the risk of developing a second SCC after 5 years for a number of beta and gamma HPV types. For example, HPV-24 seropositive patients with an SCC at baseline had a 4-fold increased risk of developing a subsequent SCC (hazard ratio 4.35, 95% confidence interval 1.22 to 15.6, p=0.024). No association between serological status for We any HPV type tested and an increased risk of BCC was found. CONCLUSIONS. observed a consistent pattern of a positive association between seropositivity for beta and gamma HPV types and the risk of a subsequent SCC in patients with a previous SCC. Our data corroborate the results of previous case-control studies and may spur further prospective studies on the causal role of HPVs in NMSC.
3. Rosato V, Tavani A, Bosetti C, Pelucchi C, Talamini R, Polesel J, Serraino D, Negri E, La Vecchia C. Metabolic syndrome and pancreatic cancer risk: a case-control study in Italy and meta-analysis. Metabolism. 2011 May 5. [Epub ahead of print]
Department of Epidemiology, Istituto di Ricerche Farmacologiche "Mario Negri," Milan, Italy.
We assessed the relation between metabolic syndrome (MetS), its components, and pancreatic cancer risk in an Italian case-control study and performed a meta-analysis of epidemiological studies published up to February 2011. The case-control study included 326 patients with incident pancreatic cancer and 652 controls admitted to the same hospitals for acute, non-neoplastic conditions. MetS was defined as having at least 3 conditions among diabetes, drug-treated hypertension, hyperlipidemia, and body mass index at least 25 kg/m(2) at age 30 years. We computed multivariate odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) from logistic regression models adjusted for tobacco smoking, education, and other sociodemographic variables. For the meta-analysis, we calculated summary relative risks (RRs) using random-effects models. The OR of pancreatic cancer in the case-control study was 2.36 (95% CI, 1.43-3.90) for diabetes, 0.77 (95% CI, 0.55-1.08) for hypertension, 1.38 (95% CI, 0.94-2.01) for hypercholesterolemia, and 1.27 (95% CI, 0.91-1.78) for being overweight at age 30 years. The risk was significantly increased for subjects with 3 or more MetS components (OR = 2.13, 95% CI 1.01-4.49) compared with subjects with no component, the estimates being consistent among strata of sex, age, and alcohol consumption. The meta-analysis included 3 cohort studies and our case-control study, and found a summary RR of 1.55 (95% CI, 1.19-2.01) for subjects with MetS. Metabolic syndrome is related to pancreatic cancer risk. Diabetes is the key component related to risk.
4. Salonia A, Gallina A, Briganti A, Suardi N, Capitanio U, Abdollah F, Bertini R, Freschi M, Rigatti P, Montorsi F. Circulating estradiol, but not testosterone, is a significant predictor of high-grade prostate cancer in patients undergoing radical prostatectomy. Cancer. 2011 Apr 14. doi: 10.1002/cncr.26136. [Epub ahead of print]
Department of Urology, University Vita-Salute San Raffaele, Milan, Italy.
The objective of this study was to assess the association between preoperative circulating levels of 17β-estradiol (E(2) ) and high-grade prostate cancer (HGPCa) (Gleason grade ≥4 + 3) at the time patients underwent radical retropubic prostatectomy (RRP).
METHODS: Serum total testosterone (tT), sex hormone-binding globulin (SHBG), and E(2) levels were measured the day before surgery (8-10 AM) in a cohort of 655 consecutive Caucasian- European patients who underwent RRP at a single institution. Logistic regression models were used to test the association between predictors (including age, body mass index, prostate-specific antigen [PSA], clinical tumor classification, biopsy Gleason sum, tT, SHBG, and E(2) ) and HGPCa. Serum E(2) was included in the model as both a continuous variable and a categorized variable (according to the most informative cutoff: 50 pg/mL).
RESULTS: Pathologic HGPCa was identified in 156 patients (23.8%). Patients with HGPCa had significantly higher PSA, clinical tumor classification, and biopsy Gleason sum than those without HGPCa (all P < .001). No other significant differences were observed between groups. At univariate analysis, continuously coded E(2) was not associated significantly with HGPCa (odds ratio [OR], 1.009; P = .25), whereas patients with E(2) levels ≥50 pg/mL had a 3.24-fold increased risk of HGPCa (P < .001). At multivariate analysis, E(2) was associated significantly with HGPCa both as a continuous predictor (OR, 1.02; P = .04) and as a categorical predictor (OR, 3.94; P < .001) after accounting for other variables. Conversely, tT and SHBG levels were not associated significantly with HGPCa.
CONCLUSIONS: E(2) was associated significantly with pathologic HGPCa, whereas SHBG and tT failed to demonstrate any association with HGPCa in patients who underwent RRP. Cancer 2011;. © 2011 American Cancer Society.
5. Polesel J, Franceschi S, Talamini R, Negri E, Barzan L, Montella M, Libra M, Vaccher E, Franchin G, La Vecchia C, Serraino D. Tobacco smoking, alcohol drinking, and the risk of different histological types of nasopharyngeal cancer in a low-risk population. Oral Oncol. 2011 Apr 6. [Epub ahead of print].
Unit of Epidemiology and Biostatistics, Centro di Riferimento Oncologico, IRCCS, Via F. Gallini 2, 33081 Aviano (PN), Italy.
Nasopharyngeal carcinoma (NPC) is rare in western Countries. Tobacco smoking is a well-recognised risk factor, whereas the role of alcohol drinking is still in debate. We conducted a hospital-based case-control study in Italy on 150, histologically-confirmed, NPC cases of Caucasian ethnicity, aged 18-76years, including 118 undifferentiated NPCs and 22 differentiated squamous-cell NPC. Controls were 450 Caucasian cancer-free patients admitted to general hospitals for acute conditions. Cases and controls were matched according to sex, age, and place of residence. Logistic regression was used to estimate odds ratios (OR) and the corresponding 95% confidence intervals (CI) while adjusting for known confounders. No significant association emerged between tobacco smoking and all NPCs (OR for current vs. never smokers=1.52; 95% CI: 0.89-2.60). Conversely, for differentiated NPC only, statistically significant elevated OR were associated with increasing smoking intensity (OR for ≥15cigarettes/day=5.40; 95% CI: 1.34-21.76) and duration of the habit (OR for ≥32years=4.48; 95% CI: 1.11-18.04). Although alcohol drinking was not, per se, significantly associated to NPC risk, the combination of tobacco smoking and alcohol drinking accounted for 57% of differentiated NPCs, whereas it accounted for only 14% of undifferentiated carcinomas. Our findings suggest that, in western populations, NPC includes two separate entities: the differentiated NPC, associated with tobacco smoking like other cancers of head and neck, and the undifferentiated NPC, upon which tobacco smoking has little or no influence.
6. Schütze M, Boeing H, Pischon T, Rehm J, Kehoe T, Gmel G, Olsen A, Tjønneland AM, Dahm CC, Overvad K, Clavel-Chapelon F, Boutron-Ruault MC, Trichopoulou A, Benetou V, Zylis D, Kaaks R, Rohrmann S, Palli D, Berrino F, Tumino R, Vineis P, Rodríguez L, Agudo A, Sánchez MJ, Dorronsoro M, Chirlaque MD, Barricarte A, Peeters PH, van Gils CH, Khaw KT, Wareham N, Allen NE, Key TJ, Boffetta P, Slimani N, Jenab M, Romaguera D, Wark PA, Riboli E, Bergmann MM. Alcohol attributable burden of incidence of cancer in eight European countries based on results from prospective cohort study. BMJ. 2011 Apr 7;342:d1584. doi: 10.1136/bmj.d1584.
Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, 14558 Nuthetal, Germany.
OBJECTIVE: To compute the burden of cancer attributable to current and former alcohol consumption in eight European countries based on direct relative risk estimates from a cohort study.
DESIGN: Combination of prospective cohort study with representative population based data on alcohol exposure. Setting Eight countries (France, Italy, Spain, United Kingdom, the Netherlands, Greece, Germany, Denmark) participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study.
PARTICIPANTS: 109,118 men and 254,870 women, mainly aged 37-70.
MAIN OUTCOME MEASURES: Hazard rate ratios expressing the relative risk of cancer incidence for former and current alcohol consumption among EPIC participants. Hazard rate ratios combined with representative information on alcohol consumption to calculate alcohol attributable fractions of causally related cancers by country and sex. Partial alcohol attributable fractions for consumption higher than the recommended upper limit (two drinks a day for men with about 24 g alcohol, one for women with about 12 g alcohol) and the estimated total annual number of cases of alcohol attributable cancer.
RESULTS: If we assume causality, among men and women, 10% (95% confidence interval 7 to 13%) and 3% (1 to 5%) of the incidence of total cancer was attributable to former and current alcohol consumption in the selected European countries. For selected cancers the figures were 44% (31 to 56%) and 25% (5 to 46%) for upper aerodigestive tract, 33% (11 to 54%) and 18% (-3 to 38%) for liver, 17% (10 to 25%) and 4% (-1 to 10%) for colorectal cancer for men and women, respectively, and 5.0% (2 to 8%) for female breast cancer. A substantial part of the alcohol attributable fraction in 2008 was associated with alcohol consumption higher than the recommended upper limit: 33,037 of 178,578 alcohol related cancer cases in men and 17,470 of 397,043 alcohol related cases in women.
CONCLUSIONS: In western Europe, an important proportion of cases of cancer can be attributable to alcohol consumption, especially consumption higher than the recommended upper limits. These data support current political efforts to reduce or to abstain from alcohol consumption to reduce the incidence of cancer.

Breve commento a cura di Lorenzo Richiardi
Lo studio ha l’obbiettivo di calcolare il rischio attribuibile di popolazione (PARP) di tumori per consumo di alcol in otto paesi europei in cui è stato condotto lo studio EPIC, combinando le stime di rischio ottenute dallo studio con la prevalenza di consumo di alcol ottenuto da survey di popolazione. In totale i risultati indicano un PARp per tutti i tumori del 10% negli uomini e del 3% nelle donne. Per l’Italia i risultati sono dell’8% (intervallo di confidenza al 95%: 5-%11%) per gli uomini e del 2% (1%-3%) nelle donne. Sempre in Italia, il PARp più elevato si osserva per i tumori del capo-collo sia negli uomini che nelle donne. Considerando il numero assoluto di casi (basato sulle stime di GLOBOCAN 2008), i tumori del capo collo negli uomini ed i tumori della mammella della donna sono quelli maggiormente responsabili del numero totale di tumori attribuibili all’alcol.

7. Fortes C, Mastroeni S, Boffetta P, Innocenzi L, Antonelli G, Giovinazzo R, Anzidei P, Melchi F, D' Atri S, Pasquini P, Venanzetti F. Polymorphisms of GSTM1 and GSTT1, Sun Exposure and the Risk of Melanoma: A Case-control Study. Acta Derm Venereol. 2011 May;91(3):284-9.
Istituto Dermopatico dell'Immacolata, Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy. E-mail:
Glutathione S-transferases (GSTs) are a family of enzymes that are known to play an important role in cellular protection against oxidative stress, including the oxidative stress caused by ultraviolet radiation. This study focused on the possible involvement of GSTM1 and GSTT1 polymorphisms in risk modulation of cutaneous melanoma. Within a case-control study, the presence of the null polymorphism at GSTM1 and GSTT1 was investigated in 188 cases of cutaneous melanoma and 152 controls. Information on socio-demographic characteristics, medical history, sun exposure and pigmentary characteristics were collected for all subjects. Logistic regression was used to estimate odds ratio (OR) and 95% confidence intervals (CI). An interaction was suggested between the GSTM1 and GSTT1 "null" genotype and episodes of sunburn in childhood OR of interaction (1.65, 95% CI (95% CI) 0.27-9.94). The risk of melanoma among the subset of participants who reported sunburns in childhood and who had both null variants, was nine (OR 9.16; 95% CI 1.18-70.9). The results suggest that subjects carrying both GSTM1 and GSTT1 null polymorphisms and experiencing sunburns in childhood have an extremely high risk of melanoma..
8. Bidoli E, Pelucchi C, Zucchetto A, Negri E, Dal Maso L, Polesel J, Boz G, Montella M, Franceschi S, Serraino D, La Vecchia C, Talamini R. Fiber intake and pancreatic cancer risk: a case-control study. Ann Oncol. 2011 Apr 2. [Epub ahead of print]
Unit of Epidemiology and Biostatistics, Centro di Riferimento Oncologico, Aviano.
BACKGROUND: Scanty and inconsistent studies are available on the relation between dietary fiber intake and pancreatic cancer. A case-control study was carried out in northern Italy to further investigate the role of various types of dietary fibers in the etiology of pancreatic cancer.
PATIENTS AND METHODS: Cases were 326 patients with incident pancreatic cancer, excluding neuroendocrine tumors, admitted to major teaching and general hospitals during 1991-2008. Controls were 652 patients admitted for acute, nonneoplastic conditions to the same hospital network of cases. Information was elicited using a validated food frequency questionnaire. Odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) were estimated for intake quintiles of different types of fiber after allowance for total energy intake and other potential confounding factors.
RESULTS: Total fiber intake was inversely related to risk of pancreatic cancer (OR = 0.4 for highest versus lowest quintile of intake; 95% CI 0.2-0.7). An inverse association emerged between pancreatic cancer and both soluble (OR = 0.4; 95% CI 0.2-0.7) and total insoluble fiber (OR = 0.5; 95% CI 0.3-0.8), particularly cellulose (OR = 0.4; 95% CI 0.3-0.7) and lignin (OR = 0.5; 95% CI 0.3-0.9). Fruit fiber intake was inversely associated with pancreatic cancer (OR = 0.5; 95% CI 0.3-0.8), whereas grain fiber was not (OR = 1.2; 95% CI 0.7-2.0).
Conclusions: This study suggests that selected types of fiber and total fiber are inversely related to pancreatic cancer.
9. Bertuccio P, La Vecchia C, Silverman DT, Petersen GM, Bracci PM, Negri E, Li D, Risch HA, Olson SH, Gallinger S, Miller AB, Bueno-de-Mesquita HB, Talamini R, Polesel J, Ghadirian P, Baghurst PA, Zatonski W, Fontham ET, Bamlet WR, Holly EA, Lucenteforte E, Hassan M, Yu H, Kurtz RC, Cotterchio M, Su J, Maisonneuve P, Duell EJ, Bosetti C, Boffetta P. Cigar and pipe smoking, smokeless tobacco use and pancreatic cancer: an analysis from the International Pancreatic Cancer Case-Control Consortium (PanC4). Ann Oncol. 2011 Jun;22(6):1420-6. Epub 2011 Jan 18.
Department of Epidemiology, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
Background: Cigarette smoking is the best-characterized risk factor for pancreatic cancer. However, data are limited for other tobacco smoking products and smokeless tobacco.
Materials and methods: We conducted a pooled analysis of cigar and pipe smoking and smokeless tobacco use and risk of pancreatic cancer using data from 11 case-control studies (6056 cases and 11 338 controls) within the International Pancreatic Cancer Case-Control Consortium (PanC4). Pooled odds ratios (OR) and the corresponding 95% confidence intervals (CI) were estimated by unconditional multiple logistic regression models adjusted for study center and selected covariates.
RESULTS: Compared with never tobacco users, the OR for cigar-only smokers was 1.6 (95% CI: 1.2-2.3), i.e. comparable to that of cigarette-only smokers (OR 1.5; 95% CI 1.4-1.6). The OR was 1.1 (95% CI 0.69-1.6) for pipe-only smokers. There was some evidence of increasing risk with increasing amount of cigar smoked per day (OR 1.82 for ≥ 10 grams of tobacco), although not with duration. The OR for ever smokeless tobacco users as compared with never tobacco users was 0.98 (95% CI 0.75-1.3).
CONCLUSION: This collaborative analysis provides evidence that cigar smoking is associated with an excess risk of pancreatic cancer, while no significant association emerged for pipe smoking and smokeless tobacco use.

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