Publications by authors named "Carlo La Vecchia"

961 Publications

Index-based dietary patterns and stomach cancer in a Chinese population.

Eur J Cancer Prev 2021 Jul 20. Epub 2021 Jul 20.

Department of Epidemiology, Fielding School of Public Health, University of California at Los Angeles (UCLA), Los Angeles, California, USA Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu Province Department of Epidemiology, School of Public Health, Fudan University, Shanghai Ganyu County Center for Disease Control and Prevention, Ganyu Dafeng County Center for Disease Control and Prevention, Dafeng Chuzhou County Center for Disease Control and Prevention, Chuzhou Tongshan County Center for Disease Control and Prevention, Tongshan, Jiangsu Province, China Jonsson Comprehensive Cancer Center, UCLA School of Nursing, UCLA, Los Angeles, California, USA Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China Department of Social and Preventive Medicine, State University of New York at Buffalo, Buffalo, New York Center for Human Nutrition, Department of Medicine, UCLA David Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles, California, USA Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.

Objectives: Dietary factors are of importance in the development of stomach cancer. This study aims to examine index-based dietary patterns associated with stomach cancer in a Chinese population.

Methods: Using data from a population-based case-control study conducted in Jiangsu Province, China, we included a total of 8432 participants (1900 stomach cancer cases and 6532 controls). Dietary data collected by food frequency questionnaire was evaluated by modified Chinese Healthy Eating Index-2016 (mCHEI-2016) and the US Healthy Eating Index-2015 (HEI-2015). Multiple logistic regression analyses were applied to examine the association of mCHEI-2016 and HEI-2015 with stomach cancer while adjusting for potential confounders. The possible interactions between mCHEI-2016 or HEI-2015 and established risk factors were explored.

Results: Among nonproxy interviews, after adjusting for potential confounding factors, a higher score of sodium, reflecting lower intake per day, was inversely associated with stomach cancer [odds ratio (OR), 0.95; 95% CI, 0.91-0.99 for mCHEI-2016; OR, 0.97; 95% CI, 0.94-0.99 for HEI-2015]. No clear associations with stomach cancer were identified for total scores of HEI-2015 (OR, 0.98; 95% CI, 0.87-1.10 with a 10-point increase, P trend = 0.98) and mCHEI-2016 (OR, 1.05; 95% CI, 0.94-1.17 with a 10-point increase, P trend = 0.22). However, the relation between stomach cancer and the mCHEI-2016 was modified by BMI, with a possible inverse association in normal-weight subjects.

Conclusions: Our findings highlight that reduced intake of dietary sodium would prevent the development of stomach cancer. The data indicate a heterogeneity between normal weight and overweight's dietary factors in relation to stomach cancer.
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http://dx.doi.org/10.1097/CEJ.0000000000000705DOI Listing
July 2021

Cancer mortality predictions for 2021 in Latin America.

Eur J Cancer Prev 2021 Jul 8. Epub 2021 Jul 8.

Department of Clinical Sciences and Community Health Department of Biomedical and Clinical Sciences L. Sacco, Università degli Studi di Milano, Milan, Italy Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy Department of Epidemiology and Health Services Research, Center for Primary Care and Public Health (Unisantè), University of Lausanne, Lausanne, Switzerland Department of Humanities, Pegaso Online University, Naples, Italy.

We estimated cancer mortality statistics for the current year in seven major Latin American countries, with a focus on colorectal cancer. We retrieved official death certification data and population figures from the World Health Organization and the Pan American Health Organization databases. We analysed mortality from all neoplasms combined and for selected cancer sites. We estimated numbers of deaths and age-standardized mortality rates for the year 2021 using a logarithmic Poisson count data joinpoint model. Total cancer mortality is predicted to decline in all countries considered for both sexes, with the exception of Argentinian women. The lowest total mortality rates were predicted in Mexico (65.4/100 000 men and 62.3 in women), the highest ones were in Cuba (133.3/100 000 men and 91.0 in women). Stomach cancer rates have been decreasing since 1970 in all countries; colorectal cancer started to decline over recent calendar periods. Rates for this cancer were unfavourable in the youngest age group. Lung cancer trends declined in males and remained comparatively low in all countries except Cuba. In Cuba, lung cancer rates in women overtook those for breast. Mortality from cancers of the breast, (cervix) uterus, ovary, prostate and bladder, as well as leukemia mostly showed favourable trends. A marked variability in rates across Latin American countries persists, and rates were relatively high for stomach, uterus, prostate and lung cancers, as compared to Europe and North America, suggesting the need to improve preventive strategies. Colorectal cancer mortality was relatively low in Latin America, except in Argentina, and short-term predictions remain moderately favourable.
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http://dx.doi.org/10.1097/CEJ.0000000000000702DOI Listing
July 2021

Changes in Lifestyle and Dietary Habits during COVID-19 Lockdown in Italy: Results of an Online Survey.

Nutrients 2021 Jun 3;13(6). Epub 2021 Jun 3.

Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori-IRCCS "Fondazione G. Pascale", via M. Semmola 1, 80131 Naples, NA, Italy.

COVID-19 is an unprecedented global pandemic. On 12 March 2020, a lockdown order was issued in Italy in attempt to contain the health crisis. The study aimed to assess the impact of the COVID-19 lockdown on diet, physical activity, sleep quality, and distress in an Italian cohort. An online anonymous interview, which included validated questionnaires was created to compare lifestyle habits pre- and during the lockdown. Data analysis from 604 subjects with a mean age of 29.8 years was carried out using multivariate analysis. Compared to pre-COVID-19 times, 67% of people changed their eating habits and increased consumption of foods containing added sugars. Women and men with low adherence to the Mediterranean Diet (MedDiet) were more likely to be physically inactive ( < 0.0001 and < 0.01, respectively). Results from logistic regression showed a three times higher risk of being inactive if adherence to the MedDiet was low ( < 0.0001), especially in men between 26 and 35 years. Lower levels of distress were reported in males who were physically active (89%) ( < 0.001). Our findings may help to identify effective lifestyle interventions during restrictive conditions.
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http://dx.doi.org/10.3390/nu13061923DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8230113PMC
June 2021

The association between diabetes and gastric cancer: results from the Stomach Cancer Pooling Project Consortium.

Eur J Cancer Prev 2021 Jun 25. Epub 2021 Jun 25.

College of Public Health, University of South Florida, Tampa, Florida, USA Department of Clinical Sciences and Community Health, University of Milan, Milan Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy Department of Information Systems and Decision Sciences (ISDS), Muma College of Business, University of South Florida, Tampa, Florida, USA Department of Biomedical and Clinical Sciences, University of Milan, Milan Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network, ISPRO, Florence, Italy Department of Epidemiology, UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, California, USA Department of Rehabilitation, Vinmec Hospital Times City, Vinmec Healthcare System Vietnam Colorectal Cancer and Polyps Research Program, Vinmec Healthcare System Department of Surgical Oncology, Viet-Duc University Hospital, Hanoi, Vietnam Medical Informatics Center, Peking University, Peking, China Department of Computer Sciences and Engineering, University of Nevada-Reno, Reno, Nevada Department of Public Health Sciences, Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Japan Nikkei Disease Prevention Center, São Paulo, Brazil Department of Epidemiology and Prevention, Russian N.N. Blokhin Cancer Research Center, Moscow, Russia CIBER Epidemiología y Salud Pública (CIBERESP), Madrid ISGlobal IMIM (Hospital del Mar Medical Research Institute) Universitat Pompeu Fabra (UPF), Barcelona Environmental and Cancer Epidemiology Unit, National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore Department of Woman and Child Health and Public Health - Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia Department of Medicine, Memorial Sloan Kettering Cancer Centre, New York, NY, USA Department of Public and Community Health, School of Health Sciences, University of West Attica Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA Department of Public Health, Miguel Hernandez University, FISABIO-ISABIAL, Campus San Juan, Alicante, Spain Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA Centro Internacional de Pesquisa, A. C. Camargo Cancer Center, São Paulo, Brazil Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Al. Prof. Hernâni Monteiro EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, Porto, Portugal Stony Brook Cancer Center, Stony Brook University, New York, New York, USA Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy UPMC Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Background: Prior epidemiologic studies on the association between diabetes and gastric cancer risk provided inconclusive findings, while traditional, aggregate data meta-analyses were characterized by high between-study heterogeneity.

Objective: To investigate the association between type 2 diabetes and gastric cancer using data from the 'Stomach Cancer Pooling (StoP) Project', an international consortium of more than 30 case-control and nested case-control studies, which is large and provides harmonized definition of participants' characteristics across individual studies. The data have the potential to minimize between-study heterogeneity and provide greater statistical power for subgroup analysis.

Methods: We included 5592 gastric cancer cases and 12 477 controls from 14 studies from Europe, Asia, North America, and South America in a two-stage individual-participant data meta-analysis. Random-effect models were used to estimate summary odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) by pooling study-specific ORs.

Results: We did not find an overall association between diabetes and gastric cancer (pooled OR = 1.01, 95% CI, 0.94-1.07). However, the risk of cardia gastric cancer was significantly higher among individuals with type 2 diabetes (OR = 1.16, 95% CI, 1.02-1.33). There was no association between diabetes and gastric cancer risk in strata of Helicobacter pylori infection serostatus, age, sex, BMI, smoking status, alcohol consumption, fruit/vegetable intake, gastric cancer histologic type, and source of controls.

Conclusion: This study provides additional evidence that diabetes is unrelated to gastric cancer overall but may be associated with excess cardia gastric cancer risk.
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http://dx.doi.org/10.1097/CEJ.0000000000000703DOI Listing
June 2021

Predicting survival in patients with acute decompensated heart failure complicated by cardiogenic shock.

Int J Cardiol Heart Vasc 2021 Jun 4;34:100809. Epub 2021 Jun 4.

Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

Background: Acute decompensated heart failure (ADHF) complicated by cardiogenic shock (CS) has unique pathophysiological background requiring specific patient stratification, management and therapeutic targets. Accordingly, the aim of this study was to derive a simple stratification tool to predict survival in patients with ADHF complicated by CS.

Methods And Results: Using logistic regression, univariable testing was performed to identify the variables potentially associated with 28-day mortality. We propose a new logistic model (ALC-Shock score) based on three easy parameters (age, serum creatinine and serum lactate at the ICU admission) as a powerful predictor of survival or successful bridge to heart replacement therapy at 28-day follow-up in this specific population. A multivariable analysis (logistic model) was performed to evaluate the association between selected variables and outcome (overall death at 28-day follow up). The score was then validated in a different cohort of 93 ADHF-CS patients and compared to a previous developed score (the Cardshock score).Overall, 28-day mortality was 34%. The ALC-shock score showed better discrimination (Area Under the Curve-AUC- 0.82; 95% CI 0.73-0.91) as compared to the Cardshock score (AUC 0.67; 95% CI 0.55-0.79) (p = 0.009) to predict 28-days overall mortality. In the validation cohort the AUC for the ALC-shock score was 0.66.

Conclusions: A simple score including age, lactates and creatinine on admission could be considered to predict short-term mortality in CS-ADHF patients in order to drive towards a treatment intensification.
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http://dx.doi.org/10.1016/j.ijcha.2021.100809DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8188054PMC
June 2021

Diet Quality as Measured by the Healthy Eating Index 2015 and Oral and Pharyngeal Cancer Risk.

J Acad Nutr Diet 2021 Jun 11. Epub 2021 Jun 11.

Background: Alcohol and tobacco are the major risk factors for oral and pharyngeal cancer, but diet is likely to have a role, too.

Objective: The objective was to analyze the relationship between adherence to the 2015-2020 Dietary Guidelines for Americans (DGA), as measured by the Healthy Eating Index 2015 (HEI-2015), and oral and pharyngeal cancer risk. Moreover, this work aimed to quantify the number of avoidable cases under different scenarios of increased adherence to the DGA, with the use of the potential impact fraction. This estimates the proportion of cases that would occur if the distribution of the risk factor in the population followed an alternative distribution.

Design: A multicenter, case-control study was conducted in Italy between 1991 and 2009. Participants' usual diet for the 2 years preceding study enrolment was assessed using a food frequency questionnaire.

Participants And Setting: Cases were 946 patients admitted to major hospitals with incident, histologically confirmed oral and pharyngeal cancer. Controls were 2,492 patients admitted to the same hospitals for acute non neoplastic conditions.

Main Outcome Measures: The adherence to the DGA was assessed using the HEI-2015 score (range = 0 to 100), based on 13 components. The outcome was oral and pharyngeal cancer.

Statistical Analyses Performed: Odds ratios and the corresponding 95% CIs were estimated using multiple logistic regression models adjusted for tobacco, alcohol, and other relevant covariates. The potential impact fraction was estimated under different scenarios of adherence to the DGA.

Results: In this Italian population the HEI-2015 score ranged from 33.4 to 97.5. A higher HEI-2015 score was associated with a lower risk of oral and pharyngeal cancer, with an odds ratio of 0.70 (95% CI 0.62 to 0.79) for a 10-point increment of the score. The estimated potential impact fraction was 64.8% under the maximum achievable reduction scenario, and it ranged from 9% to 27% following other more feasible scenarios.

Conclusions: The HEI-2015 score was inversely related to oral and pharyngeal cancer risk in this Italian population. This analysis allowed for the estimation of the fraction of preventable cases, under different feasible scenarios. A share of 9% to 27% of avoidable cases of oral and pharyngeal cancer might be obtained across real-world scenarios of adherence to the DGA as measured by the HEI-2015 score.
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http://dx.doi.org/10.1016/j.jand.2021.04.020DOI Listing
June 2021

Mortality Trends from Urologic Cancers in Europe over the Period 1980-2017 and a Projection to 2025.

Eur Urol Oncol 2021 Jun 5. Epub 2021 Jun 5.

Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; Department of Humanities, Pegaso Online University, Naples, Italy.

Background: Patterns and trends in urologic cancer mortality still show geographical differences across Europe.

Objective: To monitor mortality trends from urologic cancers, including prostate, testis, bladder, and kidney cancers, in Europe.

Design, Setting, And Participants: We carried out a time-trend analysis for 36 European countries using the official World Health Organization database.

Outcome Measurements And Statistical Analysis: We extracted the number of deaths and population data over the 1980-2017 period, and calculated age-standardised (world population) mortality rates for each cancer considered, sex, country, and the European Union (EU) as a whole, at all ages; at ages 35-64 yr for prostate, bladder, and kidney cancers; and at ages 20-44 yr for testicular cancer. For selected major countries, we carried out a joinpoint regression analysis to identify significant changes in trends. We also predicted the number of deaths and rates for 2025, using a logarithmic Poisson count data joinpoint regression model.

Results And Limitations: Prostate cancer mortality in the EU decreased over recent years, reaching a rate of 10.3/100 000 in 2015 and a projected rate of 8.9/100 000 in 2025. Less favourable trends were observed in eastern Europe, though starting from relatively low rates. Testicular cancer mortality declined over time in most countries, however levelling off in northern and western countries, after reaching very low rates. EU testicular cancer mortality rate in 2015 was 0.3/100 000 at all ages and 0.6/100 000 at ages 20-44 yr. Bladder cancer mortality trends were less favourable in central and eastern countries compared to northern and western ones. The EU rates in 2015 were 5.1/100 000 men and 1.1/100 000 women. Kidney cancer mortality showed less favourable trends, with a slight increase in men and stable rates in women over the past decade in the EU.

Conclusions: Mortality from prostate, testis, and bladder cancers, but not from kidney cancer, declined in most European countries, with less favourable trends in most eastern countries.

Patient Summary: Over the past four decades, mortality from prostate, testis, and bladder cancers, but not from kidney cancer, declined in most European countries. Prostate cancer mortality rates remain lower in Mediterranean countries than in northern and central Europe. Rates for all urologic cancers remain higher in central and eastern Europe.
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http://dx.doi.org/10.1016/j.euo.2021.05.005DOI Listing
June 2021

Frequency of Germline Mutations in Non-Gastric Cancers.

Cancers (Basel) 2021 May 12;13(10). Epub 2021 May 12.

Division of Breast Surgery, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy.

Hereditary Diffuse Gastric Cancer (HDGC) is a complex inherited syndrome caused by germline mutations. DGC is the hallmark cancer of this genetic predisposition, but several other cancers are associated with these mutations. In this review, we revised all studies reporting mutations in non-GC patients. The selected studies included: (a) families aggregating with GC and other cancers, both, and (b) families presenting only non-gastric tumors association. Among non-gastric tumors, our results show that mutations are most frequently identified in breast cancer. The frequency of missense mutations is higher in the non-GC group, as the age at diagnosis in this group. Moreover, the predominant mutation affects the extracellular domain. Our data suggest that genetic testing should be considered also in other cancers, especially breast tumors.
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http://dx.doi.org/10.3390/cancers13102321DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8151827PMC
May 2021

European trends in breast cancer mortality, 1980-2017 and predictions to 2025.

Eur J Cancer 2021 Jul 29;152:4-17. Epub 2021 May 29.

Department of Clinical Sciences and Community Health, Università Degli Studi di Milano, Vanzetti 5, 20133, Milan, Italy.

Background: Breast cancer mortality in European women has been falling for three decades. We analysed trends in mortality from breast cancer in Europe over the period 1980-2017 and predicted number of deaths and rates to 2025.

Methods: We extracted death certification data for breast cancer in women for 35 European countries, between 1980 and 2017, from the World Health Organisation database. We computed the age-standardised (world standard population) mortality rates per 100,000 person-years, by country and calendar year. We obtained also predictions for 2025 using a joinpoint regression model and calculated the number of avoided deaths over the period 1994-2025.

Results: The mortality rate declined from 15.0 in 2012 to 14.4 in 2017 per 100,000 women (-3.9%) for the European Union (EU)-27. This fall was greater in the EU-14 (-5.2%), whereas rates rose in the transitional countries during this period by 1.9%. Mortality rate predictions across Europe are expected to reach relatively uniform levels in 2025. During the studied period, favourable trends in mortality emerged in most countries, with the greatest decrease in Denmark, whereas Poland and Romania showed an upward trend. The largest predicted decrease in breast cancer mortality was estimated for the United Kingdom (12.2/100,000 women in 2025), leading to the estimated avoidance of 150,000 breast cancer deaths over the period 1994-2025 and 470,000 in the EU-27.

Conclusions: Favourable trends in breast cancer mortality were observed in most European countries, and they will continue to fall in the coming years. Less favourable patterns were still observed among the transitional countries than other European areas.
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http://dx.doi.org/10.1016/j.ejca.2021.04.026DOI Listing
July 2021

Childhood cancer mortality trends in the Americas and Australasia: An update to 2017.

Cancer 2021 May 27. Epub 2021 May 27.

Department of Biomedical and Clinical Sciences L. Sacco, Università degli Studi di Milano, Milan, Italy.

Background: Marked reductions in childhood cancer mortality occurred over the last decades in high-income countries and, to a lesser degree, in middle-income countries. This study aimed to monitor mortality trends in the Americas and Australasia, focusing on areas showing unsatisfactory trends.

Methods: Age-standardized mortality rates per 100,000 children (aged 0-14 years) from 1990 to 2017 (or the last available calendar year) were computed for all neoplasms and 8 leading childhood cancers in countries from the Americas and Australasia, using data from the World Health Organization database. A joinpoint regression was used to identify changes in slope of mortality trends for all neoplasms, leukemia, and neoplasms of the central nervous system (CNS) for major countries.

Results: Over the last decades, childhood cancer mortality continued to decrease by approximately 2% to 3% per year in Australasian countries (ie, Japan, Korea, and Australia), by approximately 1.5% to 2% in North America and Chile, and 1% in Argentina. Other Latin American countries did not show any substantial decrease. Leukemia mortality declined in most countries, whereas less favorable trends were registered for CNS neoplasms, particularly in Latin America. Around 2016, death rates from all neoplasms were 4 to 6 per 100,000 boys and 3 to 4 per 100,000 girls in Latin America, and 2 to 3 per 100,000 boys and approximately 2 per 100,000 girls in North America and Australasia.

Conclusions: Childhood cancer mortality trends declined steadily in North America and Australasia, whereas they were less favorable in most Latin American countries. Priority must be given to closing the gap by providing high-quality care for all children with cancer worldwide.

Lay Summary: Advances in childhood cancer management have substantially improved the burden of these neoplasms over the past 40 years, particularly in high-income countries. This study aimed to monitor recent trends in America and Australasia using mortality data from the World Health Organization. Trends in childhood cancer mortality continued to decline in high-income countries by approximately 2% to 3% per year in Japan, Korea, and Australia, and 1% to 2% in North America. Only a few Latin American countries showed favorable trends, including Argentina, Chile, and Mexico, whereas other countries with limited resources still lagged behind.
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http://dx.doi.org/10.1002/cncr.33642DOI Listing
May 2021

Exploring the interactions between Helicobacter pylori (Hp) infection and other risk factors of gastric cancer: A pooled analysis in the Stomach cancer Pooling (StoP) Project.

Int J Cancer 2021 Sep 24;149(6):1228-1238. Epub 2021 May 24.

Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.

Helicobacter pylori (Hp) is crucial in gastric carcinogenesis, but infection alone is not a sufficient cause, and the interaction between Hp infection and other risk factors has not been adequately studied. We conducted a pooled analysis of seven case-control studies from the Stomach cancer Pooling (StoP) Project, comprising 1377 cases and 2470 controls, to explore the interaction among Hp infection and tobacco smoking, alcohol drinking, socioeconomic status (SES) and dietary salt intake on the risk of gastric cancer. We estimated summary odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) by multivariate unconditional logistic regression. The analysis showed no consistent interaction between Hp infection and cigarette smoking, while interaction was more than multiplicative for alcohol drinking (OR = 1.38, 95% CI: 1.07-1.77, P-interaction 0.02) and high intake of salt (OR = 2.62, 95% CI: 1.88-3.65, P-interaction = 0.04). The interaction with SES followed the multiplicative model (P = 0.49), resulting in a weakening among infected individuals of the protective effect of high SES among observed Hp-negative individuals. The interactions found were more pronounced in subjects with history of peptic ulcer. The interactions with Hp infection were stronger for cigarette smoking and dietary salt in the case of noncardia cancer, and for alcohol and SES in the case of cardia cancer. No differences were found when stratifying for histologic type. This large-scale study aimed to quantify the interaction between Hp infection and other modifiable risk factors of gastric cancer revealed that the benefit of combined Hp eradication and lifestyle modification on gastric cancer prevention may be larger than commonly appreciated.
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http://dx.doi.org/10.1002/ijc.33678DOI Listing
September 2021

CDH1 germline mutations in families with hereditary lobular breast cancer.

Eur J Cancer Prev 2021 May 7. Epub 2021 May 7.

Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, Milan, Italy Department of Breast Surgery, Athens Euroclinic Hospital, Athens, Greece Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.

Pathogenic CDH1 germline mutations are associated with lobular breast cancer in the so-called hereditary lobular breast cancer (HLBC) syndrome, without apparent correlation with the classic hereditary diffuse gastric cancer (HDGC). Recent international guidelines recommend CDH1 screening also in absence of diffuse gastric cancer (DGC) history. Genomic characteristics underlying gastric and breast tumorigenesis in this varied population of patients is still unclear. In this review we revised all CDH1 germline mutations described in literature associated with lobular breast cancer (LBC). We distinguish two subgroups of CDH1 mutant carriers: (a) 'mixed' HDGC syndrome, showing both DGC plus LBC and (b) HLBC, in which DGC is absent and the LBC phenotype is predominant. A higher frequency of CDH1 mutations was identified in the HLBC syndrome with an early age at LBC diagnosis; it is possible that LBCs with CDH1 germline mutations are an independent inherited syndrome. This evidence allows us to gain biological insight into the pathophysiological mechanisms responsible for the different phenotypes of the disease and potentially tailor the prophylactic and screening procedures.
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http://dx.doi.org/10.1097/CEJ.0000000000000688DOI Listing
May 2021

Excess mortality in Italy in 2020 by sex and age groups accounting for demographic changes and temporal trends in mortality.

Panminerva Med 2021 Apr 28. Epub 2021 Apr 28.

Respiratory Unit, Department of Health Sciences, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milan, Italy.

Background: Differences between total deaths registered during the Covid-19 pandemic and those registered in a previous reference period is a valid measure of the pandemic effect. However, this does not consider demographic changes and temporal trends in mortality.

Objective: To estimate the excess mortality in 2020 in Italy considering demographic changes and temporal trends in mortality.

Methods: We used daily mortality and population data for the 2011-2019 period to estimate the expected deaths in 2020. Expected deaths were estimated, separately by sex, through an over-dispersed Poisson regression model including calendar year and age group as covariates, a smooth function of the year's week, and the logarithm of the population as offset. The difference between observed and expected deaths was considered a measure of excess mortality.

Results: In 2020, 746,146 deaths occurred in Italy. We estimated an excess mortality of 90,725 deaths (95% CI: 86,503-94,914), which became 99,289 deaths after excluding January and February, when mortality was lower than expected. The excess was higher among men (49,422 deaths) than women (41,303 deaths) and it was mostly detected at ages ≥80 (60,224 deaths) and ages 65-79 (25,791 deaths), while among the population aged 25-49 and 50-64 we estimated an excess of 281 and 4764 deaths, respectively.

Conclusions: After considering demographic changes and temporal improvement in mortality the excess deaths in 2020 still remains above 90,000 deaths. More important, considering these factors, the excess at ages <80 years is revised upwards, while the excess at older ages is revised downwards.
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http://dx.doi.org/10.23736/S0031-0808.21.04397-4DOI Listing
April 2021

Geographical Distribution of E-cadherin Germline Mutations in the Context of Diffuse Gastric Cancer: A Systematic Review.

Cancers (Basel) 2021 Mar 12;13(6). Epub 2021 Mar 12.

i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, 4200-135 Porto, Portugal.

Hereditary diffuse gastric cancer (HDGC) is a complex and multifactorial inherited cancer predisposition syndrome caused by germline mutations. Nevertheless, current genetic screening recommendations disregard an unbalanced worldwide distribution of variants, impacting testing efficacy and patient management. In this systematic review, we collected and analyzed all studies describing variants in gastric cancer patients originating from both high- and low-prevalence countries. Selected studies were categorized as family study, series study, and unknown study, according to the implementation of HDGC clinical criteria for genetic testing. Our results indicate that mutations are more frequently identified in gastric cancer low-incidence countries, and in the family study group that encompasses cases fulfilling criteria. Considering the type of alterations, we verified that the relative frequency of mutation types varies within study groups and geographical areas. In the series study, the missense variant frequency is higher in high-incidence areas of gastric cancer, when compared with non-missense mutations. However, application of variant scoring for putative relevance led to a strong reduction of variants conferring increased risk of gastric cancer. Herein, we demonstrate that criteria for genetic screening are critical for identification of individuals carrying mutations with clinical significance. Further, we propose that future guidelines for testing should consider GC incidence across geographical regions for improved surveillance programs and early diagnosis of disease.
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http://dx.doi.org/10.3390/cancers13061269DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8001745PMC
March 2021

Coffee consumption and colorectal cancer risk: a multicentre case-control study from Italy and Spain.

Eur J Cancer Prev 2021 May;30(3):204-210

Department of Clinical Sciences and Community Health, Università degli Studi di Milano.

Background: Coffee contains many bioactive substances that can play a role on colorectal cancer. Epidemiological evidence of coffee intake and colorectal cancer is, however, inconsistent.

Aim: To provide further information on the risk of colorectal cancer in relation to coffee consumption.

Methods: Data derive from two companion case-control studies conducted in Italy and Spain within the European Union Project on Health Impacts of long-term exposure to disinfection by-products in Drinking Water and the Spanish Multi-Case Control study on Cancer. These included a total of 2289 incident cases with colorectal cancer and 3995 controls with information on coffee intake. Odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) were derived from unconditional logistic regression models, adjusted for study centre, sex, age, education, smoking, and other covariates.

Results: Compared with never coffee drinkers, the OR was 0.99 (95% CI 0.95-1.02) for total coffee consumption. There was no significant trend in risk with dose or duration, the ORs being 0.95 (95% CI 0.72-1.25) for an amount of five or more cups per day of coffee and 0.95 (95% CI 0.75-1.19) for a duration of consumption of 50 years or longer. The OR was 1.04 (95% CI 0.87-1.25) for two or more cups per day of decaffeinated coffee. There were no heterogeneity across strata of various covariates, as well as no apparent differences between various anatomical subsites.

Conclusion: This large pooled analysis of two studies shows no association of coffee and decaffeinated coffee with colorectal cancer risk.
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http://dx.doi.org/10.1097/CEJ.0000000000000593DOI Listing
May 2021

Area-level indicators of income and total mortality during the COVID-19 pandemic.

Eur J Public Health 2021 07;31(3):625-629

Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.

Background: There is mounting evidence that socioeconomic inequalities in mortality have widened during the COVID-19 pandemic. This study aimed at evaluating the relationship between area-level indicators of income and total mortality during the first phase of COVID-19 pandemic in the most hit Italian region.

Methods: We conducted an ecological study based on the number of deaths registered in the municipalities of the Lombardy region (Italy) between January 2019 and June 2020. Municipalities were grouped according to quintiles of average income and pension of their resident population. Monthly age-standardized mortality ratios (MRs) between the poorest and the richest municipalities and the corresponding 95% CI were computed to evaluate whether the pre-existing socioeconomic inequalities widened during the pandemic.

Results: Over the study period, 175 853 deaths were registered. During the pre-pandemic period (January 2019 to February 2020) the MR between the poorest and the richest municipalities ranged between 1.12 (95% CI: 1.00-1.25) and 1.33 (95% CI: 1.20-1.47). In March 2020, when the pandemic began to rapidly spread in the region, it raised up to 1.61 (95% CI: 1.51-1.72) and decreased thereafter, reaching the pre-pandemic values in April 2020. Similar results were observed in the analysis of the mortality at ages 65 and over in municipalities grouped according to average pension, where the MR increased up to 1.82 (95% CI: 1.70-1.94) in March 2020.

Conclusions: The socioeconomic inequalities in mortality widened in Lombardy, the Italian region most severely hit during the first phase of the COVID-19 pandemic.
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http://dx.doi.org/10.1093/eurpub/ckab038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8083668PMC
July 2021

Bergamo and Covid-19: How the Dark Can Turn to Light.

Front Med (Lausanne) 2021 19;8:609440. Epub 2021 Feb 19.

Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Bergamo, Italy.

The novel coronavirus, SARS-CoV-2, continues to spread rapidly. Here we discuss the dramatic situation created by COVID-19 in Italy, particularly in the province of Bergamo (the most severely affected in the first wave), as an example of how, in the face of an unprecedented tragedy, acting (albeit belatedly)-including imposing a very strict lockdown-can largely resolve the situation within approximately 2 months. The measures taken here ensured that Bergamo hospital, which was confronted with rapidly rising numbers of severely ill COVID-19 patients requiring hospitalization, was able to meet the initial challenges of the pandemic. We also report that local organization and, more important, the large natural immunity against SARS-CoV-2 of the Bergamo population developed during the first wave of the epidemic, can explain the limited number of new COVID-19 cases during the more recent second wave compared to the numbers in other areas of Lombardy. Furthermore, we highlight the importance of coordinating the easing of containment measures to avoid what is currently observed in other countries, especially in the United States, Latin American and India, where this approach has not been adopted, and a dramatic resurgence of COVID-19 cases and an increase in the number of hospitalisations and deaths have been reported.
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http://dx.doi.org/10.3389/fmed.2021.609440DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7933506PMC
February 2021

Educational inequality in the dietary approach to stop hypertension (DASH) diet in the UK: evaluating the mediating role of income.

Br J Nutr 2021 Feb 23:1-20. Epub 2021 Feb 23.

Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Vanzetti 5, 20133 Milano, Italy.

Apparent differences in the adoption of the Dietary Approach to Stop Hypertension (DASH) diet have been reported between less and more educated individuals. However, the mediating role of income has not been clarified. In this study, we aimed at quantifying the mediating effect of income on the relationship between education and the DASH score in the UK population. We analyzed data on 4864 subjects aged 18 years and older collected in three waves of the National Diet and Nutrition Survey (NDNS 2008-2016). The DASH score was calculated using sex-specific quintiles of DASH items. We carried out a counterfactual-based mediation analysis to decompose the total effect of education on DASH score into average direct effect (ADE) and average causal mediation effect (ACME) mediated by income. We found that the overall mediating effect of income on the relationship between education and the DASH score was only partial, with an estimated proportion mediated ranging between 6 to 9%. The mediating effect was higher among females (11.6%) and younger people (17.9%). Further research is needed to investigate which other factors may explain the socioeconomic inequality in the adoption of the DASH diet in UK.
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http://dx.doi.org/10.1017/S0007114521000672DOI Listing
February 2021

Fast and precise single-cell data analysis using a hierarchical autoencoder.

Nat Commun 2021 02 15;12(1):1029. Epub 2021 Feb 15.

Department of Computer Science and Engineering, University of Nevada Reno, Reno, NV, USA.

A primary challenge in single-cell RNA sequencing (scRNA-seq) studies comes from the massive amount of data and the excess noise level. To address this challenge, we introduce an analysis framework, named single-cell Decomposition using Hierarchical Autoencoder (scDHA), that reliably extracts representative information of each cell. The scDHA pipeline consists of two core modules. The first module is a non-negative kernel autoencoder able to remove genes or components that have insignificant contributions to the part-based representation of the data. The second module is a stacked Bayesian autoencoder that projects the data onto a low-dimensional space (compressed). To diminish the tendency to overfit of neural networks, we repeatedly perturb the compressed space to learn a more generalized representation of the data. In an extensive analysis, we demonstrate that scDHA outperforms state-of-the-art techniques in many research sub-fields of scRNA-seq analysis, including cell segregation through unsupervised learning, visualization of transcriptome landscape, cell classification, and pseudo-time inference.
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http://dx.doi.org/10.1038/s41467-021-21312-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7884436PMC
February 2021

Caffeinated Coffee Consumption and Health Outcomes in the US Population: A Dose-Response Meta-Analysis and Estimation of Disease Cases and Deaths Avoided.

Adv Nutr 2021 Feb 11. Epub 2021 Feb 11.

Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro," Università degli Studi di Milano, Milan, Italy.

To explore the role of coffee on health outcomes in the United States, where coffee consumption is common, we conducted a meta-analysis of prospective studies investigating the magnitude (any compared with no consumption) and the dose-response shape (cups per day) of the associations between caffeinated coffee consumption and incidence/mortality of cardiovascular disease (CVD), as well as incidence of type 2 diabetes (T2D), hepatocellular carcinoma (HCC), endometrial cancer, melanoma, and nonmelanoma skin cancer. We selected the desirable health outcomes that have been shown to be positively associated with coffee consumption. Studies were identified by searching PubMed/Embase databases up to September 2019. Inclusion criteria included prospective studies that investigated the relation of ≥3 categories of caffeinated coffee consumption and the outcomes of interest. Twenty-six studies (42 distinct cohorts), with 93,706 cases/deaths and 3,713,932 participants, met the inclusion criteria. In any coffee consumers, there was a significant inverse association with the risk of CVD (RR = 0.90; 95% CI: 0.84, 0.96), T2D (RR = 0.90; 95% CI: 0.85, 0.96), endometrial cancer (RR = 0.85; 95% CI: 0.78, 0.92), melanoma (RR = 0.89; 95% CI: 0.80, 0.99), and nonmelanoma skin cancer (RR = 0.92; 95% CI: 0.89, 0.95). Coffee consumption was also inversely associated with HCC (RR = 0.93; 95% CI: 0.80, 1.08), without reaching statistical significance. The dose-response relation was nonlinear uniquely for CVD (P-nonlinearity = 0.01). In particular, the largest risk reduction was observed for 3-4 cups/d (∼120 mL/cup) and no reduction thereafter. For other outcomes, the risk decreased linearly over the whole coffee consumption range. Current patterns of consumption in the United States would account for a fraction of avoided cases/deaths ranging from 6% to 12% according to the outcome considered. This study confirms the beneficial health effects of caffeinated coffee consumption in the US population on the health outcomes considered, and quantifies their possible magnitude.
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http://dx.doi.org/10.1093/advances/nmaa177DOI Listing
February 2021

Cervical cancer mortality in Peru: regional trend analysis from 2008-2017.

BMC Public Health 2021 01 26;21(1):219. Epub 2021 Jan 26.

Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.

Background: Cervical cancer is the third leading cause of cancer-related death among Latin American women. Peru has the sixth highest mortality rate for cervical cancer in the region with regional variations. We aimed to determine overall and regional cervical cancer mortality rates and trends in Peru between 2008 and 2017.

Methods: We performed an ecological study on the number of deaths by cervical cancer in Peru. Deaths were extracted from the Peruvian Ministry of Health mortality database. Age-standardized mortality rates (ASMR) were estimated per 100,000 women-years using the world standard Segi population. We computed mortality trends using the Joinpoint regression program, estimating the annual percent change (APC). For spatial analysis, GeoDA software was used.

Results: Peru showed downward trends in the last decade (from 11.62 in 2008 to 9.69 in 2017 (APC = - 2.2, 95% CI: - 4.3, - 0.1, p < 0.05). According to regional-specific analysis, the highest ASMR was in the rainforest region, although this declined from 34.16 in 2008 to 17.98 in 2017 (APC = - 4.3, 95% CI: - 7.2, - 1.3, p < 0.01). Concerning spatial analysis and clustering, the mortality rates from 2008 to 2017 showed a positive spatial autocorrelation and significant clustering (Moran's I: 0.35, p < 0.001) predominantly in the neighboring North-East departments (Loreto, Ucayali, and San Martin).

Conclusions: Although mortality trends in the entire population are decreasing, mortality rates remain very high, mainly in the rainforest region. Our results encourage a need for further development and improvement of the current health care delivery system in Peru.
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http://dx.doi.org/10.1186/s12889-021-10274-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7836503PMC
January 2021

The impact of COVID-19 on total mortality in Italy up to November 2020.

Panminerva Med 2021 Jan 25. Epub 2021 Jan 25.

Respiratory Unit, Department of Health Sciences, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milan, Italy.

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http://dx.doi.org/10.23736/S0031-0808.21.04301-9DOI Listing
January 2021

Exposure to antithyroid drugs and ethylenethiourea and risk of thyroid cancer: a systematic review of the epidemiologic evidence.

Eur J Cancer Prev 2021 Jan 22. Epub 2021 Jan 22.

Department of Clinical Sciences and Community Health, University of Milan Unit of Medical Statistics and Biometry, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy.

Introduction: The thyroid peroxidase inhibiting compounds methimazole, methylthiouracil, propylthiouracil, thiouracil (i.e. 'antithyroid' drugs) and ethylenethiourea have been associated to thyroid tumours in rodents. According to a systematic review by the International Agency for Research on Cancer (IARC) published in 2000, evidence for the human carcinogenicity was inadequate.

Methods: We performed an up-to-date systematic review of human epidemiological studies on the association between such compounds and thyroid cancer incidence or mortality.

Results: The literature research (1999-March 2020) identified four relevant articles. Considering also reports from the previous IARC review, this systematic review considered seven reports (five distinct studies) on antithyroid drugs and two on ethylenethiourea. As for antithyroid drugs, three reports based on different follow-ups gave results from a cohort of patients treated for hyperthyroidism in 1946-1964. In the earlier report, thyroid cancer incidence was higher in patients primarily treated with antithyroid drugs (3.2/1000) than in those originally treated with thyroidectomy (0.34/1000) or radioactive iodine (0.88/1000), which can be explained by the higher frequency of subsequent thyroidectomy, and hence the higher chance of cancer detection, in that group (30 vs. 0.5 and 1.2%). The two subsequent reports found no deaths from thyroid cancer among patients treated exclusively with antithyroid drugs through 1990 and 2014. A nested case-control study found an odds ratio (OR) of thyroid cancer of 2.79 [95% confidence interval (CI), 0.78-10.02, from a 2-year lag analysis] for ≥3 vs. no propylthiouracil prescriptions. The increased risk can be attributed to advanced diagnosis of an underlying cancer, as suggested by the stronger association observed in a no-lag analysis (OR, 8.03). In a historical cohort of newly diagnosed hyperthyroid patients, the hazard ratio for treatment with radioactive iodine vs. thionamides only was 0.45 (95% CI, 0.21-0.99), possibly due to the closer surveillance of patients receiving thionamides only. Two case-control studies did not find any association with the use of antithyroid drugs. As for ethylenethiourea, no thyroid cancer cases were found in a historical cohort of 1929 workers occupationally exposed in a 15-year period and no association with proxies of mancozeb exposure (a fungicide whose main metabolite is ethylenethiourea) was detected in a cohort of >236 000 farmers.

Conclusion: There is no evidence for a relevant role of either antithyroid drugs or ethylenethiourea on thyroid cancer.
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http://dx.doi.org/10.1097/CEJ.0000000000000658DOI Listing
January 2021

Trends in male breast cancer mortality: a global overview.

Eur J Cancer Prev 2021 Jan 18. Epub 2021 Jan 18.

Department of Clinical Sciences and Community Health Department of Biomedical and Clinical Sciences L. Sacco, Università degli Studi di Milano, Milan, Italy Department of Epidemiology and Health Services Research, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA.

Objectives: Recent trends in male breast cancer have been inadequately studied. We updated mortality trends in selected countries and regions worldwide using most recent available data and we predicted figures for 2020.

Methods: We extracted official death certification data for male breast cancer and population estimates from the WHO and the Pan American Health Organization databases, from 2000 to 2017. We computed age-standardized (world population) death rates for selected countries and regions worldwide. We used joinpoint regression analysis to identify significant changes in trends and to predict death numbers and rates for 2020.

Results: In 2015-2017, Central-Eastern Europe had a rate of 2.85/1 000 000, and Russia of 2.22, ranking among the highest. North-Western and Southern Europe, the European Union as a whole and the USA showed rates ranging between 1.5 and 2.0. Lower rates were observed in most Latin American countries, with values below 1.35/1 000 000, in Australia, 1.22, and Japan, 0.58. Between 2000-2004 and 2015-2017, age-adjusted death rates decreased between 10 and 40% in North-Western Europe, Russia, and the USA, and between 1.5 and 25% in the other areas under study, except Latin America (+0.8%). Except for Central-Eastern Europe, predicted rates for 2020 were favourable.

Conclusion: Advancements in management are likely the main drivers of the favourable trends in male breast cancer death rates over the last decades. Delayed diagnosis and limited access to effective care explain the higher mortality in some areas.
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http://dx.doi.org/10.1097/CEJ.0000000000000651DOI Listing
January 2021

Colorectal Cancer Mortality in Young Adults Is Rising in the United States, Canada, United Kingdom, and Australia but Not in Europe and Asia.

Gastroenterology 2021 Apr 6;160(5):1860-1862.e2. Epub 2021 Jan 6.

Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy. Electronic address:

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http://dx.doi.org/10.1053/j.gastro.2020.12.070DOI Listing
April 2021

Obstetric and neonatal outcomes in women with pregnancy associated cancer: a population-based study in Lombardy, Northern Italy.

BMC Pregnancy Childbirth 2021 Jan 7;21(1):31. Epub 2021 Jan 7.

National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy.

Background: Pregnancy associated cancer (PAC) may lead to adverse obstetric and neonatal outcomes. This study aims to assess the association between PACs and adverse perinatal outcomes [i.e. labor induction, iatrogenic delivery, preterm birth, small for gestational age (SGA) newborn, low Apgar score, major malformations, perinatal mortality] in Lombardy, Northern Italy.

Methods: This population-based historic cohort study used the certificate of delivery assistance and the regional healthcare utilization databases of Lombardy Region to identify beneficiaries of National Health Service who delivered between 2008 and 2017. PACs were defined through oncological ICD-9-CM codes reported in the hospital discharge forms. Each woman with PAC was matched to four women randomly selected from those cancer-free (1:4). Log-binomial regression models were fitted to estimate crude and adjusted prevalence ratio (aPR) and the corresponding 95% confidence interval (CI) of each perinatal outcome among PAC and cancer-free women.

Results: Out of the 657,968 deliveries, 831 PACs were identified (1.26 per 1000). PAC diagnosed during pregnancy was positively associated with labor induction or planned delivery (aPR=1.80, 95% CI: 1.57-2.07), cesarean section (aPR=1.78, 95% CI: 1.49-2.11) and premature birth (aPR=6.34, 95% CI: 4.59-8.75). No association with obstetric outcomes was found among PAC diagnosed in the post-pregnancy. No association of PAC, neither during pregnancy nor in post-pregnancy was found for SGA (aPR=0.71, 95% CI: 0.36-1.35 and aPR=1.04, 95% CI: 0.78-1.39, respectively), but newborn among PAC women had a lower birth weight (p-value< 0.001). Newborns of women with PAC diagnosed during pregnancy had a higher risk of borderline significance of a low Apgar score (aPR=2.65, 95% CI: 0.96-7.33) as compared to cancer-free women.

Conclusion: PAC, especially when diagnosed during pregnancy, is associated with iatrogenic preterm delivery, compromising some neonatal heath indicators.
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http://dx.doi.org/10.1186/s12884-020-03508-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7791735PMC
January 2021

Effect of opium consumption on cardiovascular diseases - a cross- sectional study based on data of Rafsanjan cohort study.

BMC Cardiovasc Disord 2021 01 2;21(1). Epub 2021 Jan 2.

Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.

Background: There are differences of opinion about the beneficial or detrimental effects of opium consumption on cardiovascular diseases (CVDs). So, we aimed to study the association between opium use and CVDs.

Methods: We used data obtained from the Rafsanjan Cohort Study (RCS), as a part of the prospective epidemiological research studies in IrAN (PERSIAN), with detailed, validated data on opium consumption and some other exposures. A total of 10,000 adults were enrolled in the study. Logistic regression models were used to assess the possible relationships of opium consumption with the prevalence of ischemic heart diseases (IHD) and myocardial infarction (MI).

Results: In this study, 9990 participants in the baseline phase of the Rafsanjan adult cohort study were included according to their completed questionnaire. Among all participants, 870 and 296 individuals were found to suffer from IHD and MI, respectively. Opium consumption was found to be relatively high in the RCS participants, especially in men (men = 2150 and women = 228). Opium use was associated with a higher odds of IHD and MI, with the adjusted odds ratios (95% CI) of 1.51 (1.22-1.86) and 1.79 (1.31-2.45), respectively. Also, dose-response increases were observed with the highest odds ratios in the 4th quartile for MI and IHD (p-values for trend < 0.001). Increased odds were observed for the two main methods of opium consumption, i.e. oral and smoking, but oral administration had higher odds ratio.

Conclusions: Opium consumption is associated with the increased odds of both IHD and MI diseases.
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http://dx.doi.org/10.1186/s12872-020-01788-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7778811PMC
January 2021

Cigarettes smoking and androgen receptor-positive breast cancer.

Eur J Cancer Prev 2020 Dec 23;Publish Ahead of Print. Epub 2020 Dec 23.

Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan Piedmont Cancer Registry, A.O.U, Citta` della Salute e della Scienza di Torino Fondo Elena Moroni for Oncology, Turin Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy.

Objectives: Cigarette smoking is related to higher levels of circulating androgens, but its association with androgen receptor (AR) status is still unaddressed.

Methods: We analysed, with a case-only approach, smoking habits according to AR status in 112 cases of invasive female breast cancer, from the Piedmont Cancer Registry. We used a multivariate logistic regression model to estimate the odds ratio (OR) and the corresponding confidence interval (CI).

Results: The OR of AR-positive breast cancer (versus AR-negative) for ever smokers (versus never) was 2.85 (95% CI 1.02-7.96).

Conclusion: Smoking is related to AR-positive breast cancer.
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http://dx.doi.org/10.1097/CEJ.0000000000000661DOI Listing
December 2020

National burden of cancer in Italy, 1990-2017: a systematic analysis for the global burden of disease study 2017.

Sci Rep 2020 12 16;10(1):22099. Epub 2020 Dec 16.

Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.

We monitored the burden of cancer in Italy and its trends over the last three decades, providing estimates of cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs), for cancer overall and 30 cancer sites using data from the Global Burden of Disease study 2017. An overview of mortality trends between 1990 and 2017 was also provided. In 2017, there were 254,336 new cancer cases in men and 214,994 in women, corresponding to an age-standardized incidence rate (ASIR) of 438 and 330/100,000, respectively. Between 1990 and 2017, incident cancer cases, and, to a lesser extent, ASIRs significantly increased overall and for almost all cancer sites, but ASIRs significantly declined for lung and other tobacco-related neoplasms. In 2017, there were 101,659 cancer deaths in men (age-standardized death rate, ASDR, 158.5/100,000) and 78,918 in women (ASDR 93.9/100,000). Cancer deaths significantly increased between 1990 and 2017 (+ 18%), but ASDR significantly decreased (- 28%). Deaths significantly increased for many cancer sites, but decreased for stomach, esophageal, laryngeal, Hodgkin lymphoma, and testicular cancer. ASDRs significantly decreased for most neoplasms, with the main exceptions of cancer of the pancreas and uterus, and multiple myeloma. In 2017, cancer caused 3,204,000 DALYs. Between 1990 and 2017, DALYs and age-standardized DALY rates significantly declined (-3.4% and -33%, respectively). Age-standardized mortality rates in Italy showed favorable patterns over the last few decades. However, the absolute number of cancer cases and, to a lower extent, of cancer deaths increased likely due to the progressive ageing of the population, this calling for a continuous effort in cancer prevention, early diagnosis, and treatment.
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http://dx.doi.org/10.1038/s41598-020-79176-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7744506PMC
December 2020