La Vecchia C

Patterns of cigarette smoking and trends in lung cancer mortality in Italy.

Cigarette consumption has increased steadily throughout this century in Italy. There were marked increases in three periods: in the 1920s, in the 1950s possibly due to the spread of smoking among young men, and in the 1970s in part due to smoking among women. The average number of cigarettes per adult per day sold legally in 1980 was 6.9 but, taking smuggling into account, the actual average number of cigarettes smoked per day is likely to range between eight and nine. Data from a national sample-based survey conducted in 1980 showed that smoking prevalence in men was broadly similar within age groups, geographical area, education, and socioeconomic groups. Smoking in women, on the other hand, was concentrated in younger and more educated women living in larger towns and in richer areas of the country. This pattern is typical of a recent rapid spread of smoking among women. The average tar yield of Italian cigarettes in 1983-4 was about 17 mg. Tar yield was strongly and negatively correlated with price (r = -0.55). This abnormality should be urgently reversed by government intervention. No material increase in lung cancer mortality in young women was evident up to the lat 1970s. Lung cancer death rates in men correlated closely with the observed changes in cigarette consumption. The highest mortality rates (about 7, 20, and 50/100 000 respectively in the age groups 35-39, 40-44, and 45-49) were reached by the generation born around 1927-30, and the rates have remained fairly constant around these maximum levels for those born up to 1940. As a consequence, Italian lung cancer death rates in middle-aged men (45 to 54) are currently the highest registered in developed countries, and large upward trends are currently detectable in older men.

SMOKING IN ITALY, 1994

The prevalence of smoking in Italian males and females has been investigated using data from the National Health Survey (first cycle), collected between January and March 1994, and based on a total sample of 13,048 individuals (6,307 males and 6,741 females) representative of the general Italian population. Overall, 24.2% of Italians aged 15 years or over described themselves as current smokers (32.6% of males and 16.3% of females). Ex-smokers were 14.2%, including 22.3% of males and 6.6% of females; never smokers were 61.6% (45.1% of males, 77.1% of females). In both sexes, the highest proportions of smokers were young to middle-aged (35-44 years), and there was a substantial decline in smoking rates in the youngest age group (15-24 years), to reach 19.8% of males and 9.9% of females. A steady and substantial decline in reported smoking prevalence over time was observed in males (from 54.2% in 1980 to 32.6% in 1994), whereas smoking prevalence remained approximately stable around 17% in females. This was due to some increase in smoking prevalence among women over 35 years of age, following a cohort effect, and the low quit rate among females. The average number of cigarettes per smoker per day was slightly up, to reach 18.3 in males and 13.4 in females in 1994. The fall in reported cigarette consumption was only partly reflected in legal sale data, which showed for 1993 a consumption of 1.86 kg per adult per year, corresponding to 5.1 cigarettes per day. Taking into account also smuggling, this indicates that interview-based figures were underestimated by at least 25%. In males, but not in females, smoking was less frequent in northern and more developed areas of the country and among more educated individuals. Among Italians with a university degree, smoking rates were for the first time higher in females (31.5%) than in males (23.7%). Thus, the data from the 1994 National Health Survey confirm the long-term decline in smoking prevalence among Italian males, in the absence however of appreciable changes in females.

CANCER MORTALITY IN ITALY, 1989, AND AN OVERVIEW OF TRENDS FROM 1955 TO 1989

The aim of this report is to update data and statistics on cancer mortality in Italy which were published from 1955 to 1984 in strata of sex age group and calendar period. Cancer mortality statistics for 1989 alone are presented together with aggregate death certification data and statistics for the quinquennia 1985-89 and with figures summarizing trends in age-standardized mortality from major cancers since 1955. (EXCERPT)

Diabetes mellitus, family history, and colorectal cancer

A population based, cross sectional study from East Anglia showed a relative risk of colorectal cancer of 2.9 in subjects with history of type II diabetes. The association was similar in men and women, but apparently stronger in subjects with family history of colorectal cancer.1 This confirms previous data indicating that insulin—and its structural homologue insulin-like growth factor-I (IGF-I)—may promote colorectal carcinogenesis,2–4 although the issue, and any related risk quantification, remain open to discussion.nnTo provide further information on the issue, we considered data from a case-control study conducted in the Swiss Canton of Vaud. Briefly, between 1992 and 2000 trained interviewers collected information on 286 cases (174 men, 112 women) with incident, histologically confirmed colon or rectal cancer (age range: 26–74; median age 65 years) who had been admitted to the University Hospital of Lausanne, Switzerland.nnControls were 550 subjects (269 men, 281 women) aged <75 years (range, 27 to 74 years; median age 59 years) residing in the same geographical area. They were admitted to the University Hospital of Lausanne for a wide spectrum of acute non-neoplastic conditions unrelated to long term diet modifications, including traumas (33%, mostly sprains and fractures), non-traumatic orthopaedic conditions (31%, mostly low back pain and disk disorders), surgical conditions (19%, mostly abdominal, such as acute appendicitis, kidney stones or strangulated hernia), and miscellaneous other disorders (17%, including acute medical, eye, nose and throat, and skin diseases).nnAll interviews were conducted in hospital during the admission diagnosis. Sixteen per cent of subjects (16% cases; 15% controls) approached for interview …

Mortality from alcohol related disease in Italy.

Trends in death certification rates from the five major alcohol related causes of death in Italy (cancers of the mouth or pharynx, oesophagus, larynx, liver and cirrhosis of the liver) were analysed over a period (1955-79) in which per capita alcohol consumption almost trebled. Age standardised mortality from liver cirrhosis almost doubled in males and increased over 70% in females. In males, mortality from cancers of the upper digestive or respiratory tract showed increases of between 27% and 44%, and liver cancer increased by over 100%. In the late 1970s, the four alcohol related cancer sites accounted for about 12% of all cancer deaths in males and 4.5% in females. Mortality from liver cirrhosis alone accounted for 4.8% of all deaths in males (9.2% of manpower years lost) and 2.3% in females (6.3% manpower years lost) in females. These figures were even higher in selected areas of north eastern Italy, where alcohol consumption is greater. In absolute terms, the upward trends observed correspond to about 10,000 excess deaths per year in the late 1970s compared with rates observed two decades earlier and are thus second only to the increase in tobacco related causes of death over the same calendar period.

Trends in skin cancer incidence in Neuchâtel, 1976-98.

Aims and Background Limited data are available on trends in skin cancer incidence. This paper examines trends of the three major histotypes of skin cancer in an environment favorable for skin cancer registration. Methods Trends of skin cancer incidence by histotype in the Swiss Canton of Neuchâtel (165,000 inhabitants) were analyzed on the basis of 4,455 incident cases of basal cell, squamous cell carcinoma, and malignant melanoma registered over the period 1976-1998. Results Trends over the last decade considered tended to be downwards for squamous cell carcinoma in both sexes, were still on the rise for basal cell carcinoma, and leveled off for malignant melanoma in both sexes. Conclusions Different trends were confirmed in this population between skin cancer histotypes related to cumulative intense sun exposure (squamous cell carcinoma) and those mainly related to more complex patterns of exposure to sunlight (basal cell carcinoma and malignant melanoma).

Cancer mortality in Italy, 1997: quantifying the fall in rates in women and men.

Aims and Background To update data and statistics on cancer death certification in Italy to 1997. Methods Data and statistics for 1997 subdivided into 31 cancer sites are presented. Trends in age-standardized rates for major cancer sites are plotted from 1955 to 1997. Results: The age-standardized (world standard) death certification rates from all neoplasms steadily declined from the peak of 199.2/100,000 males in 1988 to 174.7 in 1997 and for females from 102.5 to 93.0. The decline was larger in truncated rates, by about 26% for males since 1983 and by 24% for females since the top rate of the early 1960′s. A major component of the favorable trend in males was lung cancer, which showed a 16% decline from the peak of 1987-88, to reach 50.6/100,000 in 1997, corresponding to about 5,000 avoided deaths. The decline in lung cancer was about 34% at age 35 to 64. For females, in contrast, both the absolute number of lung cancer deaths and the age-standardized rate of 7.9/100,000 were among the highest values ever registered, reflecting the different pattern of spread of the tobacco-related lung cancer epidemic in the two sexes. Intestinal cancer rates were stable for males but declined by approximately 10% for females, mostly in middle age, as did breast cancer mortality. Among neoplasms showing favorable trends, there were other tobacco-related neoplasms in men, plus the continuing fall in stomach and cervix uteri. Upward trends were observed for non Hodgkins lymphomas. Conclusions The fall in cancer mortality observed over the last decade in Italy is attributable to a decline in lung and other tobacco-related neoplasms in males, together with a persistent fall in stomach and uterine (cervical) cancer. In women, there were also recent falls in intestinal and breast cancer rates, and declines in both sexes in rarer neoplasms influenced by therapeutic advancements.

Cancer mortality in Italy 1993.

Background Data and statistics are presented on cancer death certification for 1993 in Italy, updating previous publications covering the period 1955–1992. Methods Data for 1993 subdivided into 30 cancer sites are presented in 8 tables, including age-and sex-specific absolute and percentage frequencies of cancer deaths, and crude, age-specific and age-standardized rates, at all ages and truncated for the 35–64 year age group. Results Age-adjusted death certification rates (on the world standard population) for all neoplasms declined from 189.8 in 1992 (and a peak of 199.2 in 1986) to 187.8/100, 000 males in 1993, and remained stable around 100, 000 females. The favorable trends were even larger in middle and younger age males, but not in children below age 15, whose overall age-standardized cancer mortality rates increased for the fourth subsequent year. Lung cancer was the leading site of cancer mortality, with over 30, 900 deaths. For the fifth subsequent year, its rates in males declined, to reach 56.0/100,000. The decline in lung cancer rates is now established in Italian males and is substantial in middle age, whereas the rise in female lung cancer rates seems to have leveled off over the last few years. Rates for other major cancer sites (intestines, stomach, female breast, prostate, pancreas, leukemias and lymphomas) were stable, but some decrease was apparent also in 1993 for Hodgkins disease. Conclusions Italian cancer mortality rates in 1993 were moderately favorable in males, due to the leveling of the tobacco-related epidemic, whereas no appreciable change was registered in females. The persisting unfavorable trends in childhood cancer mortality should be investigated.

Trends in childhood cancer mortality in Italy, 1955-78.

Trends in childhood cancer death rates in Italy from 1955 to 1978 were analyzed. All cancer age-standardized mortality below age 15 fell about 20%, with a clear downward trend since the early 1970s. Declines were evident for leukemias (–25%), Hodgkins disease (–56%), non-Hodgkins lymphomas (–27%), kidney cancer (–25%), retinoblastoma (–50%), and bone sarcomas (–31%), for a total number of about 200-250 fewer deaths per year in the late 1970s compared to the expected values using rates of the 1950s. The observed fall was apparently confined within the first age group considered (0-4 years), but the age-specific patterns of trend were partly influenced by simple postponement of some deaths to older age groups. Comparisons with similar data in other developed countries suggest that, although there has undoubtedly been some progress, there is still wide scope for further reduction in childhood cancer mortality in Italy, simply through more rational use of currently available diagnostic and therapeutic knowledge.

Cancer mortality in Italy, 1991.

Cancer mortality statistics in Italy from 1955 to 1990 have been published in strata of sex, age group and calendar period (3, 4), and are here updated with data for 1991. The materials and methods used in this report are similar to those previously described (3, 4). Briefly, cancer death certification numbers by cause and estimates of the resident population stratified by sex and quinquennia of age were derived from official publications and data bases provided by the National Institute of Statistics (lSTAT). All cancers or groups of cancers, originally classified according to the standard International Classification of Diseases (ICD), Ninth Revision (15), were grouped according to the same 30 categories (plus a broad category of others and non-specified) adopted for previous reports (3, 4). Thus, all intestinal sites (including colon, rectum, others and unspecified), all skin cancers (melanoma and non-melanomatosus), cancers of the cervix and corpus uteri, all leukemias, all non-Hodgkins lymphomas, and all histopatologic types of brain tumors (malignant, benign and undefined) were grouped together, in view of the difficulties in making reliable distinctions on each separate subsite on death certification data alone; for liver, only deaths certified as primary liver cancer were included. Eight standard tables were produced, including the following information: 1) crude, age-standardized death certification rates and standardized percentages of all cancer deaths for the population at all ages and truncated from 35 to 64 years (Table 1 for males and 2 for females). Two different standards were used: i) the 1971 Italian Census population, corrected for census undercount and subdivided into the usual 16 quinquennia of age from 0-4 to 75-79, plus ~ 80, and ii) the world standard population, for comparative purposes with other countries; 2) age-specific death certification rates for each sex and quinquennium of age from 0-4 to 75-79, plus ~ 80 (Table 3 for males and 4 for females); 3) total number of certified deaths for each cancer or group of cancers, sex and age group (Table 5 for males and 6 for females; 4) percentages of all cancer deaths for each sex and age group (Table 7 for males and 8 for females). The cancer sites or groups of cancers considered are listed in Tables 1 and 2, together with the corresponding ICD codes (9th Revision), whereas in subsequent tables only the ICDs are reported (and, consequently, Tables 1 and 2 can be used as legends for subsequent tables). This is essentially a statistical and technical report. A few words of comment are included in order to assist reading and interpretation of data for major cancer sites, and to recall underlying long-term tendencies. Nonetheless, this can easily be ignored by the reader interested in considering details on mortality statistics for any particular cancer site, since any inference should be based on overall and truncated age-standardized rates and, essentially, on careful examination of the matrix of age-specific data.