Guido Benzi

Diabetes and endometrial cancer: An Italian case-control study

We considered the association between diabetes and risk of endometrial cancer using data from a large case‐control study conducted in Italy. Cases were 752 women with incident, histologically confirmed endometrial cancer <75 years of age (median age 60 years, range 28–74) admitted to a network of hospitals in Milan. Controls were 2,606 patients (median age 54 years, range 25–74) aged <75 years, admitted for acute non‐neoplastic, non‐gynecological, non‐hormone‐related conditions to the same network of hospitals where cases had been identified. A total of 132 (17.6%) cases and 116 controls (4.5%) reported a history of diabetes. The corresponding multivariate odds ratio (OR) was 2.9 [95% confidence interval (CI) 2.2–3.9]. No association emerged with diabetes diagnosed under age 40 (likely to be insulin‐dependent diabetes), whereas the OR of endometrial cancer was 3.1 (95% CI 2.3–4.2) for diabetes diagnosed at age ≥40 years. The OR of endometrial cancer in women with history of diabetes was 3.0 for women with a body mass index (BMI) (QI) kg/m2 <25, 3.6 for those with a BMI of 25–29, and 3.3 for those with a BMI ≥30. No consistent interaction or modifying effect was observed for any other covariate. Our results confirm that non‐insulin‐dependent diabetes is associated with the risk of endometrial cancer. The association may be mediated through elevated oestrogen levels in diabetic women, hyperinsulinemia or insulin‐like growth factor‐I (IGF‐I).Int. J. Cancer 81:539–542, 1999.

Paternal and maternal smoking habits before conception and during the first trimester: Relation to spontaneous abortion

PURPOSE This study examined the association between maternal smoking before and during the first trimester of pregnancy and spontaneous abortion. METHODS We have been conducting a hospital-based case-control study on risk factors for spontaneous abortion in the greater Milan area. We collected information from 782 cases of spontaneous abortions and 1543 controls (women who delivered at term healthy infants). RESULTS With respect to never smokers, the odds ratio (OR) were 0.7 (95%, confidence interval (CI), 0.5-1.0) for women who quit smoking and 1.3 (95% CI, 1.0-1.6) for those who continued during pregnancy. Women who smoked more than 10 cigarettes/day in the first trimester were at increased risk of miscarriage, with an OR of 1.4 (95% CI, 1.0-2.1). No relationship was evident between the number of cigarettes smoked before conception and the risk of abortion. Likewise, no association emerged between paternal smoking and miscarriage. Moreover, no significant interaction or modification effect was obtained when strata of age and other major characteristics were investigated. CONCLUSIONS The risk of abortion associated with cigarette smoking during the first trimester of pregnancy was measurable and noticeable in this population, and accounted for 9% (95% CI, 6-13%) of all cases. The increased risk of spontaneous abortion in women smoking during pregnancy is a further reason to encourage pregnant women to quit.

Moderate alcohol drinking and risk of preterm birth.

Objective: We have analysed the association between alcohol drinking before and during the three trimesters of pregnancy and risk of preterm birth of babies with normal weight for gestational age or with low weight for gestational age (SGA).Design: Case–control study.Setting: General and university hospitals in Italy.Subjects: Cases were 502 women who delivered preterm births <37 weeks gestation. The controls included 1966 women who gave birth at term (≥37 weeks of gestation) to healthy infants of normal weight (ie between 10th and 90th centile according to the Italian standard) on randomly selected days at the hospitals where cases had been identified.Interventions: Interview.Results: No increased risk of preterm birth was observed in women drinking one or two drinks/die in pregnancy, but three or more drinks/die increased the risk (multivariate odds ratios (OR) 2.0 for ≥3 drinks during the first trimester, 1.8 during the second and 1.9 during the third). When the analysis was conducted separately for preterm births with normal weight or SGA, the increased risk was observed in preterm SGA only (multivariate OR for ≥3 drinks/die during the first trimester=3.6, 95% confidence interval (CI) 1.3–11.1); the estimated multivariate OR for ≥3 drinks/die during the first trimester of preterm babies with normal weight for gestational age was only slightly above unity and not statistically significant (multivariate OR 1.4, 95% CI 0.5–3.7).Conclusions: The study shows an increased risk in mothers who drink ≥3 die units alcohol in pregnancy of preterm births.Sponsorship: Ministero della Ricerca Scientifica.

Role of reproductive factors on the risk of endometrial cancer

We analyzed the role of reproductive factors on the risk of endometrial cancer using data from a case‐control study conducted in Italy. Cases were 752 women with histologically confirmed endometrial cancer <75 years of age. Controls were 2,606 patients <75 years of age admitted for acute, non‐gynecological non‐hormone‐related, non‐neoplastic conditions to the same network of hospitals where cases had been identified. In comparison with nulliparae, the risk of endometrial cancer tended to be lower in parous women, and the estimated multivariate odds ratios (ORs) were 0.9, 0.8 and 0.7, respectively, for women reporting 1, 2 and 3 or more births (χ12 trend 10.21). In comparison with women reporting no induced abortion, the ORs of endometrial cancer were 0.6 in women reporting 1 and 0.4 in those reporting 2 or more induced abortions. When considering parous women only, in comparison with women reporting their last birth 20 years before or longer, the ORs of endometrial cancer were 0.6 in those reporting their last birth 10–19 years before and 0.3 in those reporting their last birth <10 years before. Our results confirm and further quantify a protective role of pregnancy on the risk of endometrial cancer and provide insights on the time‐risk relationship between pregnancy and cancer of corpus uteri. Int. J. Cancer 76:784–786, 1998.© 1998 Wiley‐Liss, Inc.

Risk Factors for Urinary Incontinence in Women

Objectives: To review the epidemiological evidence on risk factors for urinary incontinence (UI) in women.Methods: Using Medline and a manual search we identified the main papers published in English up to 1998.Results: There is consistent evidence that the frequency of UI increases with age, but there is little information on the frequency of different types of UI in different age groups. With regard to other risk factors, there is a clinical consensus that vaginal delivery and, more in general, obstetric traumas are associated with UI, although epidemiological studies are not always consistent. Less defined is the role of race, menopausal status, history of gynecological surgery, body mass index, smoking, and coffee and alcohol consumption on the risk of UI.Conclusion: In the coming years, epidemiological research should focus particularly on the potential differences in the epidemiological characteristics of different types of UI in order to gain insight into the pathogenic mechanisms.

Endometrioma of the liver

Hepatic endometriosis is extremely rare. We describe a patient sent to us with epigastric pain as the only symptom and who was found to have associated endometrioma of the liver and left ovary. We suggest a gynecologic evaluation before surgery for hepatic cyst of unknown cause.

Population attributable risk for ovarian cancer.

Parity, oral contraceptive (OC) use, age at menopause, a family history of the disease and selected aspects of diet have been related to the risk of ovarian cancer. The quantification of their impact on a population level may help focus and rank the importance of potential prevention strategies. Using data from a case-control study conducted in Italy between 1983 and 1991 on 971 ovarian cancer cases and 2758 control women we computed the multivariate relative risk estimates, and population attributable risks (PARs), i.e. the proportion of ovarian cancers that would have been avoided if a given exposure had not been present in the population. Overall, the PARs were 5% for nulliparity, 12% for never OC use and 4% for a family history of breast or ovarian cancer in first-degree relatives. Among women aged >/=50 years, later age at menopause accounted for 16% of all ovarian cancer cases. Low intake of green vegetables accounted for 24% of cases and a high fat score for 7%. All these factors together explained 51% of cases. In conclusion, even if the PAR estimates were based on several arbitrary assumptions, available knowledge could, in principle, explain over 50% of all ovarian cancer cases in this Italian population, thus indicating and quantifying the theoretical scope for prevention.

Correlates of hormone replacement therapy use in Italian women, 1992-1996

OBJECTIVES we analyzed the determinants of hormonal replacement therapy (HRT) use in Italy for the period 1992-1996, using data from a framework of case-control studies of colon and rectal neoplasm. METHODS a total of 1574 women aged 45-74 years were considered. This group comprised women with acute, non neoplastic, non-hormone-related diseases admitted to a network of hospitals in six areas of Italy. RESULTS a total of 146 women (8.5%) reported ever HRT use. The multivariate odds ratio (OR) of ever use was 1.6 (95% CI 1.0-2.6) for women with 12 years of education or more, compared with those with < 7 years. The frequency of use of HRT tended to decrease with increasing parity: the OR was 0.6 for women with four or more children as compared to nulliparae (chi2 trend 3.5, P = 0.06). Ever HRT users were more frequently smokers. HRT use was more frequent in women reporting surgical menopause (OR = 2.7) than those with natural menopause. Among post menopausal women, HRT use was related with early age at menopause (chi2 trend 4.6, P = 0.03). HRT use was more common among women reporting lower body mass index (BMI) both at interview and at age 30 years and the difference between current BMI and BMI at age 30 years, was not related with HRT use. CONCLUSIONS women of higher socioeconomic status or education reported more frequent HRT use and nulliparae and smokers were also more likely to use HRT. Further HRT use was directly associated with early age at menopause and surgical menopause and inversely related with measures of body weight.

Determinants of risk of spontaneous abortions in the first trimester of pregnancy

Several factors, such as socioeconomic status, obstetrical and menstrual history, and contraceptive methods, have been associated with risk of spontaneous abortion. We conducted a hospital case‐control study to analyze risk factors for spontaneous abortion during the first trimester. Cases were 782 women admitted for spontaneous abortion. Controls included 1,543 women who gave birth at term in the same hospitals. Adjusted odds ratios (ORs) for spontaneous abortion were 0.9 and 0.6, respectively, for women reporting 7–11 and ≥12 years of schooling, compared with women reporting <7 years of education. A history of pelvic inflammatory disease increased the odds ratio fivefold [OR = 5.1; 95% confidence interval (CI) = 1.0–26.2]. The OR for spontaneous abortion was 1.7 (95% CI = 1.4–2.1) in women reporting previous spontaneous abortions.

Dietary factors and risk of spontaneous abortion.

OBJECTIVE This study examines the association between dietary habits and risk of spontaneous abortion. DESIGN Hospital-based case-control study. SETTING Obstetric hospitals in Milan, Italy. SUBJECTS Cases were: 912 women admitted for spontaneous abortion (within the 12th week of gestation). Controls were: women who gave birth at term to healthy infants on randomly selected days at the same hospitals where cases had been identified. RESULTS The risk of spontaneous abortion was inversely and significantly related to green vegetables, fruit, milk, cheese, eggs and fish consumption. The multivariate odds ratios (OR), for highest versus lowest levels of intake, were 0.3 for fruit, 0.5 for cheese, 0.6 for green vegetables and milk and 0.7 for fish and eggs. The major type of seasoning fats have showed a direct association with risk of miscarriage. Comparing the highest with the lowest intake, the ORs were 2.0 (95% confidence interval, CI 1.1-3.6) and 1.6 (95% CI 1.1-2.3) for butter and oil, respectively. No consistent association emerged between meat, liver, ham and carrots intake and the risk of spontaneous abortion. CONCLUSIONS This result suggests that a diet poor in several aspects, including vegetables and fruit, milk and dairy products, but rich in fats, may be a determinant or a correlate of increased risk of spontaneous abortion.