Papers by Adriano Decarli
International Journal of Epidemiology, 1983
The total duration of 'ovulatory activity' or 'ovulatory age' has... more The total duration of 'ovulatory activity' or 'ovulatory age' has been reported to be the strongest indicator of the risk of ovarian cancer. In the case-control study examined in this paper this variable was found to be a strong correlate of the risk of ovarian cancer. However, the finding that in older women the major determinant of 'ovulatory age' was age at menopause (which is a very unreliable indicator of 'ovarian activity'), and that age at menopause by itself was related to the risk of ovarian cancer as strongly as the total duration of ovulatory age, threw doubt on the biological consistency of that model. Furthermore, the protection conferred by pregnancies was different at different ages, and age at first pregnancy was more strongly associated with the risk of ovarian cancer than the actual number of pregnancies. The model of carcinogenesis for epithelial ovarian cancer appears, therefore, to be more complex than is indicated simply by the total duration of 'ovarian activity.'
PubMed, Sep 1, 1994
We studied the relation between alcohol drinking and gallstone disease, using data from the 1983 ... more We studied the relation between alcohol drinking and gallstone disease, using data from the 1983 Italian National Health Survey. This survey included information on 58,462 adults age 25 years and over (27,912 males and 30,550 females), randomly selected within strata of geographical area, size of the municipality of residence, and size of the household. The prevalence of gallstone disease or cholecystectomy was 2.4% among males and 4.8% among females. Compared with alcohol abstainers, the relative risk of gallstone disease, controlling for age, sex, education, smoking, and body mass index, was 0.83 [95% confidence interval (CI) = 0.73-0.92] for occasional and regular moderate drinkers (< 25 ml of ethanol per day), 0.67 (95% CI = 0.59-0.77) for intermediate drinkers (25-50 ml per day), and 0.58 (95% CI = 0.47-0.70) for heavy drinkers. This inverse association was consistent across strata of age, sex, and body mass index.
Annals of Oncology, Mar 1, 2012
Background: The role of dietary habits on esophageal cancer risk has been rarely considered in te... more Background: The role of dietary habits on esophageal cancer risk has been rarely considered in terms of dietary patterns. Patients and methods: We analyzed data from an Italian case-control study, including 304 cases with squamous cell carcinoma of the esophagus and 743 hospital controls. Dietary habits were evaluated using a food frequency questionnaire. A posteriori dietary patterns were identified through principal component factor analysis performed on 28 selected nutrients. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained from multiple logistic regression models applied on quartiles of factor scores, adjusting for potential confounding variables. Results: We identified five major dietary patterns, named 'animal products and related components', 'vitamins and fiber', 'starch-rich', 'other polyunsaturated fatty acids and vitamin D', and 'other fats'. The 'animal products and related components' pattern was positively related to esophageal cancer (OR = 1.64, 95% CI:1.06-2.55, for the highest versus the lowest quartile of factor scores category). The 'vitamins and fiber' (OR = 0.50, 95% CI: 0.32-0.78) and the 'other polyunsaturated fatty acids and vitamin D' (OR = 0.48, 95% CI: 0.31-0.74) were inversely related to esophageal cancer. No significant association was observed for the other patterns. Conclusion: Our findings suggest that a diet rich in foods from animal origin and poor in foods containing vitamins and fiber increase esophageal cancer risk.
Tumori Journal, Apr 1, 1992
Annals of Epidemiology, Feb 1, 2014
Despite considerable research, the issue of hair dyes and bladder cancer is still open to discuss... more Despite considerable research, the issue of hair dyes and bladder cancer is still open to discussion. In January 2013, we searched in PubMed/EMBASE to identify observational studies investigating the association between personal use of hair dyes and bladder cancer incidence/mortality. Pooled relative risks (RRs) and corresponding 95% confidence intervals (CIs) were calculated using random-effects models. Fifteen case-control and two cohort studies were available for meta-analysis (8504 cases/deaths, 14,102 controls, and 617,937 persons at risk). Compared with no use, the pooled RR of bladder cancer for personal use of any type of hair dyes was 0.93 (95% CI, 0.82e1.05), with moderate heterogeneity among studies (I 2 ¼ 34.1%, P ¼ .07). Similar RRs were found for females (RR ¼ 0.95) and males (RR ¼ 0.81). Based on seven studies, the pooled RR for personal use of permanent hair dyes was 0.92 (95% CI, 0.77e1.09). Compared with no use, no association was observed for the highest categories of duration of use and lifetime frequency of use of both any type of dyes and permanent dyes. The pooled RR from four studies reporting results for use of dark-colored dyes was 1.29 (95% CI, 0.98e1.71). This meta-analysis allows to definitively exclude any appreciable excess risk of bladder cancer among personal hair dye users.
Tumori Journal, Jul 1, 1998
Patterns and trends in smoking habits are a major determinant of subsequent incidence and mortali... more Patterns and trends in smoking habits are a major determinant of subsequent incidence and mortality for lung cancer, and other tobacco related neoplasms on a population level. Smoking prevalence in Italy was analyzed using data from the 1995 National Multipurpose Survey, conducted by the National Institute of Statistics (ISTAT) and based on a sample of 50,585 subjects (24,497 men and 26,088 women), aged 15 years or over, identified in strata of geographic area and size of the municipality in order to be representative of the general italian population. Data on smoking were obtained through a self-administered questionnaire. Overall, 25.3% of Italians aged 15 years or over (34.1% of males, 17.1% of females) described themselves as current smokers, 20.5% (28.0% of males, 13.5% of females) as ex-smokers, and 54.2% (37.9% of males, 69.4% of females) as never smokers. Heavy current smokers (&gt; or = 15 cigarettes per day) were 15.6% of males and 3.9% of females. Compared to previous surveys, reported smoking prevalence increased, mostly in the youngest age groups (15 to 24 years) in both sexes. However, the increase could be partly or largely attributable to the different modality of data collection (interview in previous surveys, self-administered questionnaire in the present survey), which may have reduced underreporting. The data of the 1995 National Household Survey confirmed previous patterns of smoking in Italy, i.e., a higher smoking prevalence in less educated, southern Italian males, and in more educated, northern Italian females. These figures reflect therefore the importance of the social and cultural correlates of smoking. Moreover, the stability in smoking prevalence over the last few years reflects the absence of any organized and structured intervention on a legislation and public health level on the smoking issue in Italy.
Tumori Journal, Dec 1, 1989
Smoking trends and patterns in Italy were evaluated using data from the 1986-87 Italian National ... more Smoking trends and patterns in Italy were evaluated using data from the 1986-87 Italian National Health Survey, based on a sample of 30,096 males and 32,176 females aged 15 or over, randomly selected within strata of geographical areas and sizes of the place of residence and of the household in order to be representative of the whole Italian population: 40.8% of Italian males and 17.3% of females described themselves as current smokers (overall estimated prevalence, 28.6%). In comparison with previous survey-based data, self-reported smoking prevalence in males has been steadily decreasing over the last three decades, whereas rates in females have been increasing up to the early 1980s, and have shown a levelling off only in more recent years. The apparent declines in self-reported smoking, however, were not reflected in official sales figures. In fact, in the mid 1980s, there were simultaneously the lowest overall prevalence of the last three decades and the highest sales figures ever reported. The inter-sex differences in smoking prevalence were smaller at younger ages. Education, but not occupation as a measure of social class, was inversely related to smoking prevalence in males. Furthermore, rates for males were lower in the northern (and richer) part of the country. The pattern was totally different in females, since smoking prevalence was higher in more educated women, of higher social class, living in North Italy. This suggests that, in the absence of adequate measures, smoking prevalence is likely to rise among Italian women in the near future. Continued monitoring of smoking patterns gives important information with which to identify the most likely future patterns in smoking and smoking-related diseases, besides providing data for targeting intervention programs.
PubMed, 1996
Time trends of mortality from digestive cancers in Italy during the period 1970-1989 were here st... more Time trends of mortality from digestive cancers in Italy during the period 1970-1989 were here studied either at the national level and for wide geographical areas (North, Center and South). Cancers of oral cavity and pharynx, of colon and rectum, of gallbladder and of the pancreas presented, during the considered period a generalized increasing trend. Stomach cancer mortality was decreasing in both sexes and in all areas, but a less marked rate of decrease appeared for younger cohorts, particularly for women. Trends almost stable, or contrasting across sexes and age classes, were observed for malignant tumours of the oesophagus and of the liver.
PubMed, Dec 1, 1986
Trends in death certification rates from all motor vehicle accidents and motor-cycle accidents in... more Trends in death certification rates from all motor vehicle accidents and motor-cycle accidents in Italy over the period 1955-79 were analysed. For both sexes, age-standardised mortality rates per 100,000 population increased steadily up to the early 1970's, reaching 40.08/100,000 males in 1972 and 11.05/100,000 females in 1973. Marked downward trends followed, and the 1977-79 rates were comparable with 1955 for males (around 28/100,000), though the total number of motor vehicles increased almost six-fold (and the number of cars over 14-fold). When age-specific rates were considered, the largest increases between the late 1950's and the early 1970's were for younger (under 25) and older (55 and over) males and younger (under 35) females. The decreases from 1974 onwards applied to both sexes and all age groups. Motor-cycle death rates increased in males up to the mid 1960's, mostly in younger (15-25) and older (over 55) age groups. A sudden, marked inversion of trends followed, starting from the younger age groups and spreading to all age groups in the mid 1970's. This pattern corresponds roughly to a 50% decrease in male death certification rates per registered motor-cycle. In absolute terms, the decline in the second half of the 1970's corresponds to about 4,000 fewer deaths per year. This is one of the major changes observed in mortality from any cause during the 1970's in Italy. Provisional data for the period 1980-82 suggest that further downward trends, albeit moderate, have continued.
PubMed, 1995
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PubMed, 1987
Epidemiological studies based on cervical cytopathology have aroused widespread interest since it... more Epidemiological studies based on cervical cytopathology have aroused widespread interest since it was realized that they could be a useful tool for measuring the effectiveness of screening programs and defining practical measures for the prevention of invasive neoplasms and deaths. In the present article, published evidence from screening programs, cohort investigations and case-control studies is reviewed, and possibilities for further analyses and applications are discussed. In particular, when estimates of the relative protections conveyed by Pap smear from various case-control studies conducted on different populations and using different criteria of selection were pooled, a surprisingly close concordance emerged, with overall risk estimates of invasive cervical cancer of 0.42 for women reporting one smear, and of 0.20 for two or more smears in the past. This protection appeared to be long-lasting in a considerable proportion of cases, since the major determinant of invasive cancer risk was the number of previous smears rather than the interval since last smear, and a noticeable residual effect was evident even more than 10 years after the last smear. Besides providing a measure of the effectiveness of cytological screening and helping define the optimal frequency of screening using the limited resources available, case-control studies should permit accurate estimates of the sensitivity of the test and quantify the probability of transition and the duration of various stages of the neoplastic process, i.e., permit a better understanding of the natural history of the disease.
Tumori Journal, Aug 1, 1987
PubMed, 1987
The relation between smoking habits and weight was evaluated using data of the 1983 Italian Natio... more The relation between smoking habits and weight was evaluated using data of the 1983 Italian National Health Survey on 72,284 individuals aged 15 years or over, randomly selected within strata of geographical area, size of the place of residence and of the household in order to be representative of the whole Italian population. Female moderate smokers were less frequently overweight or obese, thus confirming previous observations in other populations. However, in contrast with other observations, male current smokers were not lighter than 'never' smokers, and in particular smokers were less frequently underweight. Thus, the relation between smoking status and indicators of body weight was heterogeneous in the two sexes. Further, in both sexes the relationship between amount smoked and obesity was not linear, heavy smokers being more frequently overweight than moderate smokers. In conclusion, although these population-based data confirm that smoking habits are a correlate of weight, the absence of any dose-effect relationship and the inter-sex differences suggest that the relation between smoking and weight in the Italian population is probably partly or largely indirect.
Statistical Methods in Medical Research, May 10, 2019
The attributable fraction is the candidate tool to quantify individual shares of each risk factor... more The attributable fraction is the candidate tool to quantify individual shares of each risk factor on the disease burden in a population, expressing the proportion of cases ascribable to the risk factors. The original formula ignored the presence of other factors (i.e. multiple risk factors and/or confounders), and several adjusting methods for potential confounders have been proposed. However, crude and adjusted attributable fractions do not sum up to their joint attributable fraction (i.e. the number of cases attributable to all risk factors together) and their sum may exceed one. A different approach consists of partitioning the joint attributable fraction into exposure-specific shares leading to sequential and average attributable fractions. We provide an example using Italian case-control data on oral cavity cancer comparing crude, adjusted, sequential, and average attributable fractions for smoking and alcohol and provide an overview of the available software routines for their estimation. For each method, we give interpretation and discuss shortcomings. Crude and adjusted attributable fractions added up over than one, whereas sequential and average methods added up to the joint attributable fraction ¼ 0.8112 (average attributable fractions for smoking and alcohol were 0.4894 and 0.3218, respectively). The attributable fraction is a well-known epidemiological measure that translates risk factors prevalence and disease occurrence in useful figures for a public health perspective. This work endorses their proper use and interpretation.
Tumori Journal, Feb 1, 1991
Journal of Clinical Epidemiology, 1990
In order to identify high risk groups for breast cancer, unconditional multiple logistic regressi... more In order to identify high risk groups for breast cancer, unconditional multiple logistic regression models based on 5 widely recognized and easily identifiable risk factors (age at menarche, at menopause and at first birth, family history of breast cancer and body mass index) were applied to a large dataset including 2085 cases and 1936 controls aged 50 or over derived from two unmatched hospital-based caseecontrol studies conducted in Italy. Although various models provided an excellent fitting, both on the whole dataset and using a training-testing approach to an a priori identified separate subset, the observed extent of variation in breast cancer risk between highest and lowest decile of the distribution was limited to a factor 2. This indicates that the 5 variables considered did not allow identification of subgroups with substantially elevated risk of breast cancer to have practical implications for screening/prophylactic treatment purposes. Breast neoplasms Body weight birth High risk groups Menarche Menopause Age at first live
Tumori Journal, Dec 1, 1988
Mouth or pharynx Brain Uterus 10 Liver Liver Brain Among other tobacco-related sites, rates were ... more Mouth or pharynx Brain Uterus 10 Liver Liver Brain Among other tobacco-related sites, rates were somewhat higher than in previous years for cancer of the mouth or pharynx in males, pancreas and bladder in both sexes. There were upward trends for lung cancer in females, too, although still moderate in relation to the Unites States and several North European countries (7, 8). Among non tobacco-related neoplasms, there was some further decline in stomach and some increase in intestinal cancer in both sexes: thus, for the first time in 1982, the intestine was the second leading cause of cancer death in Italy (Appendix table of ranks). Moderate increases were evident for breast cancer in femalesat its highest rates ever reported in Italyand a very delayed inflection (at ages 65-69) emerged in age-specific rates, probably due to a cohort effect. In females, rates were higher than in previous years for ovarian cancer in various age groups, whereas the downward trend for cancer of the cervix uteri persisted, in the absence of any suggestion of reversal of trends even in the younger age groups (observed, for instance, in Britain or Scandinavia) (3, 6). Further increases were evident for melanoma Cl)
Tumori Journal, Jun 1, 1989
European Journal of Cancer Prevention, Aug 1, 1995
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Papers by Adriano Decarli