Matteo Surace

Reproductive factors, family history, occupation and risk of urogenital prolapse.

OBJECTIVE We conducted a case-control study to analyze risk factors for urogenital prolapse requiring surgery. METHODS Cases were 108 women with a diagnosis of II or III degree uterovaginal prolapse and/or third degree cystocele. Controls were 100 women admitted to the same hospitals as the cases, for acute, non-gynecological, non-neoplastic conditions. RESULTS Occupation showed an association with urogenital prolapse: in comparison with professional/managerial women, housewives had an odds ratios (OR) of urogenital prolapse of 3.1 (95% confidence interval (CI), 1.6-8.8). Compared with nulliparae, parous women tended to have a higher risk of genital prolapse (OR 2.6, 95% CI 0.9-7.8). In comparison with women reporting no vaginal delivery, the ORs were 3.0 for women reporting one vaginal delivery (95% CI 1.0-9.5), and 4.5 (95% CI 1.6-13.1) for women with two or more vaginal deliveries. Forceps delivery and birthweight were not associated with risk of prolapse after taking into account the effect of number of vaginal deliveries. The risk of urogenital prolapse was higher in women with mother or sisters reporting the condition: the ORs were, respectively, 3.2 (95% CI 1.1-7.6) and 2.4 (95% CI 1.0-5.6) in comparison with women whose mother or sisters reported no prolapse. CONCLUSIONS Our data support the clinical suggestion that parous women are at a higher risk of prolapse and the risk increases with number of vaginal deliveries. First-degree family history of prolapse seems to increase the risk of prolapse.

Use of oral contraceptives and uterine fibroids: results from a case-control study

Objective To analyse the association between oral contraceptive use and the risk of uterine fibroids.

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.

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.

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.

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.

Uterine fibroids risk and history of selected medical conditions linked with female hormones.

To understand the role of several medical conditions on the risk of uterine fibroids, we analysed the findings of a large case–control study. Cases were 843 women aged 54 or less (median age 43 years, range 21–54) with histologically confirmed uterine fibroids, whose clinical diagnosis dated back no more than 2 years. Indications for surgery were recurrent menorrhagia or ultrasound evidence of fibroids larger than 10 cm in diameter. Controls were 1557 women aged 54 years or less of comparable quinquennia of age (median age 43 years, range 21–54) who had not undergone hysterectomy and were admitted for acute, non-gynecologic, non-hormonal, non-neoplastic conditions to a network of hospitals with a similar catchment area. Clinical history of severe overweight was inversely associated with the risk of fibroids (multivariate odds ratio (OR), OR: 0.6, 95% confidence intervals (CI): 0.5–0.8). An increase in the frequency of fibroids was seen in women with a history of benign breast disease (OR: 1.2, 95% CI: 0.9–1.6) and particularly of breast biopsies (OR: 2.0, 95% CI: 1.2–3.5). The results of this large dataset indicate that medical conditions known or likely to be related to female hormones are not important determinants of the risk of fibroids.

Diet and risk of seromucinous benign ovarian cysts

OBJECTIVE To analyze the relation between selected dietary indicators and the risk of seromucinous benign ovarian cysts. STUDY DESIGN We used data from a case-control study on risk factors for benign ovarian cysts conducted in Italy between 1984 and 1994. Cases included 225 women with a histologically confirmed diagnosis of benign seromucinous ovarian neoplasm dating back no more than 2 years. Controls were 450 women below the age of 65 years admitted for acute non-gynecological, non-hormonal, non-neoplastic conditions. RESULTS Women with seromucinous cysts reported more frequent consumption of beef and other red meat and cheese and less frequent consumption of green vegetables. The multivariate odds ratios (ORs) in highest versus less frequent consumption levels were 2.7 (95% confidence interval (CI) 1.8-4.3) for beef and other red meat, 0.6 (95% CI 0.3-0.9) for green vegetables and 1.4 (95% CI 1.0-2.2) for cheese. CONCLUSION Seromucinous benign ovarian cysts are associated with beef and cheese consumption, whereas high intake of green vegetables seems to have a protective effect.