Childhood infectious diseases and risk of leukaemia in an adult population.

Our study is aimed at investigating the association between common childhood infectious diseases (measles, chickenpox, rubella, mumps and pertussis) and the risk of developing leukaemia in an adult population. A reanalysis of a large population-based case-control study was carried out. Original data included 1,771 controls and 649 leukaemia cases from 11 Italian areas. To contain recall bias, the analysis was restricted to subjects directly interviewed and with a good quality interview (1,165 controls and 312 cases). Odds ratios (ORs) and their related 95% confidence intervals (95% CIs) were estimated by unconditional polychotomous logistic regression model adjusting for age, gender and occupational and lifestyle exposures. A protective effect of at least one infection (OR = 0.66, 95% CI: 0.45-0.97), measles (OR = 0.57, 95% CI: 0.39-0.82) and pertussis (OR = 0.66, 95% CI: 0.45-0.98) was observed for chronic lymphoid leukaemia (CLL). The number of infections was strongly inversely associated with the risk of CLL (p = 0.002, test for trend). With regard to the other types of leukaemia, only a protective effect of pertussis was observed for AML (OR = 0.52, 95% CI: 0.32-0.87). Our results pointed out a protective role of childhood infectious diseases on the risk of CLL in adults. Although a specific antioncogenic effect of some infectious disease, especially measles, cannot be ruled out, the observed decrease of risk with increasing number of infections suggests that a more general "hygiene hypothesis" could be the most likely explanation of the detected association. The protective role of pertussis remains to be elucidated.

Self-reported history of infections and the risk of non-Hodgkin lymphoma: an InterLymph pooled analysis.

We performed a pooled analysis of data on self-reported history of infections in relation to the risk of non-Hodgkin lymphoma (NHL) from 17 case-control studies that included 12,585 cases and 15,416 controls aged 16-96 years at recruitment. Pooled odds ratios (OR) and 95% confidence intervals (95% CI) were estimated in two-stage random-effect or joint fixed-effect models, adjusting for age, sex and study centre. Data from the 2 years before diagnosis (or date of interview for controls) were excluded. A self-reported history of infectious mononucleosis was associated with an excess risk of NHL (OR = 1.26, 95% CI = 1.01-1.57 based on data from 16 studies); study-specific results indicate significant (I(2) = 51%, p = 0.01) heterogeneity. A self-reported history of measles or whooping cough was associated with an approximate 15% reduction in risk. History of other infection was not associated with NHL. We find little clear evidence of an association between NHL risk and infection although the limitations of data based on self-reported medical history (particularly of childhood illness reported by older people) are well recognized.

InterLymph hierarchical classification of lymphoid neoplasms for epidemiologic research based on the WHO classification (2008): update and future directions.

After publication of the updated World Health Organization (WHO) classification of tumors of hematopoietic and lymphoid tissues in 2008, the Pathology Working Group of the International Lymphoma Epidemiology Consortium (InterLymph) now presents an update of the hierarchical classification of lymphoid neoplasms for epidemiologic research based on the 2001 WHO classification, which we published in 2007. The updated hierarchical classification incorporates all of the major and provisional entities in the 2008 WHO classification, including newly defined entities based on age, site, certain infections, and molecular characteristics, as well as borderline categories, early and "in situ" lesions, disorders with limited capacity for clinical progression, lesions without current International Classification of Diseases for Oncology, 3rd Edition codes, and immunodeficiency-associated lymphoproliferative disorders. WHO subtypes are defined in hierarchical groupings, with newly defined groups for small B-cell lymphomas with plasmacytic differentiation and for primary cutaneous T-cell lymphomas. We suggest approaches for applying the hierarchical classification in various epidemiologic settings, including strategies for dealing with multiple coexisting lymphoma subtypes in one patient, and cases with incomplete pathologic information. The pathology materials useful for state-of-the-art epidemiology studies are also discussed. We encourage epidemiologists to adopt the updated InterLymph hierarchical classification, which incorporates the most recent WHO entities while demonstrating their relationship to older classifications.

Lung cancer risk and residence in the neighborhood of a sewage plant in Italy. A case-control study.

AIMS AND BACKGROUND: Environmental pollution originating in sewage and industrial plants can be associated with lung cancer risk, as ecological and case-control studies have indicated. In the present study, the association between lung cancer occurrence and residence near a sewage plant in Prato (Italy) was investigated. A previous geographic study in the same area had shown an increasing trend of lung cancer mortality and incidence with propinquity to the plant. METHODS: A case-control study was carried out in the male population of Prato. Incident cases in the period 1987-1997 were identified from the Tuscan Cancer Registry (no. 918). Controls were randomly extracted from the Registry Office of the Municipality of Prato (no. 1852). For all subjects, the residential history was reconstructed. A weighted average distance from the plant was computed and used as a proxy variable of exposure. Two analyses were performed: on the whole data set and on a subset of subjects for whom information on tobacco exposure and education was obtained through a postal questionnaire (response rate, 41.1%). Logistic regression models were applied to estimate odds ratios and 95% CI. RESULTS: Both analyses showed a significantly elevated lung cancer risk for subjects living within 1.5 km (ORwhole= 1.56, 1.06-2.28; ORsubset= 2.28, 1.06-4.86) and suggested a risk increase with a decrease of weighted average distance from the plant. CONCLUSIONS: The findings highlight a possible role, in lung cancer occurrence, for environmental pollution spread from the plant. Due to drawbacks of the study, further analyses are needed to evidence a noncontroversial etiological conclusion. When environmental data are not available, results of epidemiological studies using residential histories may be useful in preventive policies regarding point source emissions.

Birth order and risk of non-hodgkin lymphoma--true association or bias?

There is inconsistent evidence that increasing birth order may be associated with risk of non-Hodgkin lymphoma (NHL). The authors examined the association between birth order and related variables and NHL risk in a pooled analysis (1983-2005) of 13,535 cases and 16,427 controls from 18 case-control studies within the International Lymphoma Epidemiology Consortium (InterLymph). Overall, the authors found no significant association between increasing birth order and risk of NHL (P-trend = 0.082) and significant heterogeneity. However, a significant association was present for a number of B- and T-cell NHL subtypes. There was considerable variation in the study-specific risks which was partly explained by study design and participant characteristics. In particular, a significant positive association was present in population-based studies, which had lower response rates in cases and controls, but not in hospital-based studies. A significant positive association was present in higher-socioeconomic-status (SES) participants only. Results were very similar for the related variable of sibship size. The known correlation of high birth order with low SES suggests that selection bias related to SES may be responsible for the association between birth order and NHL.

Lung cancer mortality trend by birth cohort in men, Tuscany, 1971-2006.

AIMS AND BACKGROUND: In Tuscany, lung cancer mortality in men has shown a decreasing geographical trend over the last 3 decades from the most industrialized north-western coastal areas (Massa-Carrara, Viareggio) to the south-eastern areas (Arezzo, Siena), following the path of the development of industrial activities. The aim of the study was to evaluate lung cancer mortality in males by birth cohort in order to verify whether there was also a decreasing birth cohort trend in male lung cancer mortality rates between north-western and south-eastern Tuscan areas. METHODS: Lung cancer deaths that occurred in men resident in Tuscany, 1971-2006, were analyzed by birth cohort, age group and local health authority area. RESULTS: Rates in men >65 years were significantly higher in Viareggio and Massa-Carrara than in the south-eastern areas for all generations, in particular for men born in 1896-1926. Rates for men aged 55-64 years were higher in Massa-Carrara and Viareggio than in south-eastern areas for men born before 1926, whereas for younger generations the rates leveled off. For men aged 45-54 years, rates were similar in all areas only for younger generations (men born around 1951 and 1956), whereas for men aged 35-44 years, rates were similar in all areas for all generations considered. CONCLUSIONS: The higher lung cancer mortality rates in men aged >65 years and born in 1896-1926 in the north-western areas than in those born in the south-eastern areas may indicate that the tobacco epidemic spread earlier in the north-western areas of Tuscany, following the path of industrialization. However, the higher mortality rates in north-western than in south-eastern areas are at least in part attributable to the high occupational risks for lung cancer experienced by workers in these areas during the first half of 20th century.

Exposure to benzene and risk of breast cancer among shoe factory workers in Italy.

AIMS AND BACKGROUND: Evidence of the association between leukemia and benzene exposure has been provided by several epidemiological studies. An increased risk of breast cancer among women exposed to benzene has also been suggested. The aim of this study was to analyze breast cancer risk in a cohort of 1,002 women exposed to benzene in a shoe factory in Florence, Italy, where an excess of leukemia in men was reported. METHODS: The cohort of women at work on January 1st, 1950, was followed from 1950 to 2003 for mortality and from 1985 to 2000 for incidence of breast cancer. For a sub-cohort of 797 women, cumulative exposure to benzene was available. RESULTS: Standardized mortality ratios were obtained for the 797 women for whom information on cumulative exposure was available. For those with < 30 years of latency the standardized mortality ratio was 58.5 (95% CI, 18.9-181.2, based on 3 deaths) and 151.1 (95% CI, 78.6-290.3, based on 9 deaths) for > or = 30 years of latency. In the > 40 ppm-year and > or = 30 year latency period category, the standardized mortality ratio was 166.0 (95% CI, 62.3-442.2, based on 4 deaths). The standardized incidence ratio for women with a latency period < 30 years was 140.9 (95% CI, 75.8-261.9, based on 10 cases) and 108.2 (95% CI, 64.1-182.7) for a latency period > or = 30 years. For cumulative exposure > 40 ppm-years and a latency period < 30 years, the standardized incidence ratio was 211.9 (95% CI, 29.9-1504.1, based on 1 case). CONCLUSIONS: The study moderately supports the hypothesis that benzene represents a risk factor for breast cancer.

Benzene exposure in a sample of population residing in a district of Florence, Italy.

OBJECTIVE: Personal exposure to airborne benzene is influenced by various outdoor and indoor sources. The first aim of this study was to assess the benzene exposure of a sample of urban inhabitants living in an inner-city neighborhood of Florence, Italy, excluding exposure from active smoking. The secondary objective was to differentiate the personal exposures according to personal usage patterns of the vehicles. METHODS: A sample of 67 healthy non-smokers was monitored by passive samplers during two 4-weekday campaigns in winter and late spring. Simultaneously, benzene measurements were also taken for a subset of participants, inside and outside their houses. A 4-day time microenvironment activity diary was completed by each subject during each sampling period. Other relevant exposure data were collected by a questionnaire before the sampling. Additional data on urban ambient air benzene levels were also available from the public air quality network. The passive samplers, after automated thermal desorption, were analyzed by GC-FID. RESULTS: Benzene personal exposure levels averaged 6.9 (SD=2.1) and 2.3 (SD=0.7) microg/m(3) in winter and spring, respectively. Outdoor and indoor levels showed high correlation in winter and poor in spring. In winter the highest benzene personal exposure levels were for people traveling by more public transport, followed by users of only car and by users of only bus respectively. CONCLUSIONS: The time spent in-transport for work or leisure makes a major contribution to benzene exposure among Florentine non-smoking citizens. Indoor pollution and transportation means contribute significantly to individual exposure levels especially in winter season.

Risk of leukemia and multiple myeloma associated with exposure to benzene and other organic solvents: evidence from the Italian Multicenter Case-control study.

BACKGROUND: While there is a general consensus about the ability of benzene to induce acute myeloid leukemia (AML), its effects on chronic lymphoid leukemia and multiple myeloma (MM) are still under debate. We conducted a population-based case-control study to evaluate the association between exposure to organic solvents and risk of myeloid and lymphoid leukemia and MM. METHODS: Five hundred eighty-six cases of leukemia (and 1,278 population controls), 263 cases of MM (and 1,100 population controls) were collected. Experts assessed exposure at individual level to a range of chemicals. RESULTS: We found no association between exposure to any solvent and AML. There were elevated point estimates for the associations between medium/high benzene exposure and chronic lymphatic leukemia (OR = 1.8, 95% CI = 0.9-3.9) and MM (OR = 1.9, 95% CI = 0.9-3.9). Risks of chronic lymphatic leukemia were somewhat elevated, albeit with wide confidence intervals, from medium/high exposure to xylene and toluene as well. CONCLUSIONS: We did not confirm the known association between benzene and AML, though this is likely explained by the strict regulation of benzene in Italy nearly three decades prior to study initiation. Our results support the association between benzene, xylene, and toluene and chronic lymphatic leukemia and between benzene and MM with longer latencies than have been observed for AML in other studies.

Gastric cancer mortality trends in Tuscany, Italy, 1971-2004.

UNLABELLED: AIMS, BACKGROUND, AND METHODS: In Tuscany, Italy, gastric cancer mortality has been decreasing since 1950, although with relevant geographical variability across the region. In Eastern Tuscan areas close to the mountains (high risk areas), gastric cancer mortality has been and is still significantly higher than that recorded in Western coastal areas and in the city of Florence (low risk areas). High-risk areas also showed higher Helicobacter pylori seroprevalence. Aim of this paper is to study gastric cancer mortality trends in high and low-risk areas, during the period 1971-2004, using age-period-cohort models. RESULTS: In high-risk areas, gastric cancer mortality rates declined from 61.4 per 100,000 in 1971-74 to 19.8 in 2000-2004 and in low-risk areas from 34.9 to 9.8. Mortality decline in high-risk areas was mainly attributable to a birth cohort effect, whereas in low-risk areas it was due either to a birth cohort effect or a period effect. In low- and high-risk areas, birth-cohort risks of dying decreased over subsequent generations, except for the birth cohorts born around the second world war. CONCLUSIONS: Gastric cancer mortality in areas with higher H. pylori seroprevalence in Tuscany (high-risk areas) showed a predominant decline by birth cohort, in particular for younger generations, possibly due to the decrease of the infection for improvement of living conditions.

Exposure to solvents and risk of non-Hodgkin lymphoma: clues on putative mechanisms.

Malignant lymphomas are a group of diseases of uncertain etiology. Both environmental factors and genetic susceptibility have been reported as risk factors. We have conducted a population-based case-control study in Italy: all newly diagnosed cases of malignant lymphoma, in males and females ages 20 to 74 years in the 1991 to 1993 period, were identified; the control group was comprised of a random sample of the general population resident in each of the areas under study, stratified by sex and 5-year age groups. Overall, 1,428 non-Hodgkin lymphoma (NHL) cases and 1,530 controls were interviewed. Experts from each geographic area examined questionnaire data and assigned a level of probability and intensity of exposure to a range of chemical groups and individual chemicals. For those in the medium/high level of exposure, there was an increased risk of NHL for exposure to benzene, xylene, and toluene. We have examined the hypothesis that the effect of solvents is related to their immunotoxicity by analyzing the interaction with a previous history of autoimmune disease. We have found an apparent, though not statistically significant, increased risk of NHL in those with both exposure to benzene and a history of autoimmune disease (odds ratio, 16.3; 95% confidence interval, 0.8-321). In addition, an odds ratio of 29.8 (95% confidence interval, 1.4-650.2, based on nine exposed cases) was associated with high-level exposure to benzene in those with a positive family history of malignant hematologic neoplasms. Both hypotheses (i.e., the interaction with autoimmune diseases and with familial predisposition) indirectly suggest that an immunologic mechanism could be involved in lymphomagenesis from solvents.

Time trends in the registration of Hodgkin and non-Hodgkin lymphomas in Europe.

Lymphoma incidence is reported to be increasing globally. If real, these trends can only be explained by an increasing exposure to risk(s) as yet unknown. There have been numerous coding and classification changes over time and greater access to ever more sensitive diagnostic tests. It is important to understand the consequences that these changes, coupled with general improvements in cancer registration, have had on observed temporal trends. Trends in the registration rates of both non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) in Europe are presented. Age-adjusted and age-specific rates are described in men and women in 13 European countries according to both period of diagnosis and year of birth. Age, period and cohort effects are modelled. Overall, there are increases in the numbers of NHL registrations made with a corresponding decrease in HL. In recent history, however, there is a suggestion that the rate of increase is less and stable.

Alcohol consumption and risk of leukemia: A multicenter case-control study.

A population-based case-control study of 649 leukemia cases and 1771 controls carried out in 11 Italian areas, offered the opportunity to evaluate the relationship between alcohol consumption and leukemia risk. For all leukemias, acute lymphocytic leukemia (ALL), acute myeloid leukemia (AML), and chronic lymphocytic leukemia (CLL), we found a non-significantly inverse association for moderate levels of total alcohol and wine intake, but increased risks at high levels, with, in most cases, significant trend effects (odd ratios (OR) for all leukemias in the lowest quartile of total alcohol consumption [0.1-9.0 g/day of ethanol] versus never-drinker = 0.73; 95% confidence intervals (95% CI) = 0.51-1.03; OR in the highest quartile [> 31.7 g/day] = 1.15; 95% CI = 0.82-1.63; p of the linear trend test = 0.007). For chronic myeloid leukemia (CML), we found a non-significantly positive association for all levels of total alcohol and wine intake, and a significant positive linear trend effect (p = 0.03) for wine intake (OR for 0.1-9.0 g/day of ethanol intake from wine = 1.34; 95% CI = 0.61-2.94; OR in the highest quartile of wine intake [> 27.7 g/day] = 2.13; 95% CI = 1.01-4.50). No consistent dose-response was detected analysing duration of alcohol consumption for any leukemia subtypes. In conclusion, even though our study did not show a clear association between alcohol intake and leukemia risk, some of the patterns of the risk estimates (a possible J-shaped dose-response curve between alcohol intake and ALL, AML, and CLL risks, and the positive association between alcohol and CML), may be suggestive.

[Mortality among the elderly in Tuscany in the period 1987-2003]. / La mortalità in età anziana in Toscana nel periodo 1987-2003.

AIM: to assess cause-specific mortality and its temporal trend in Tuscan elderly residents. DESIGN: descriptive epidemiologic study based upon death certificates, collected and registered since 1987 by the Tuscan Regional Mortality Registry (RMR) according to standardized procedures. METHODS: Major groups of causes: temporal trends are described calculating annual truncated age-adjusted mortality rates (based on age-specfic rates subdivided in three classes: 75-79; 80-84 and > or =85; standard: European population) and estimating annual percent changes (EAPC, Estimated Annual Percent Change) using ]oinpoint regression models. Most frequent specific causes: number of deaths and truncated age-adjusted mortality rates (based on age-specific rates subdivided in three classes: 75-79; 80-84 and > or =85; standard: European population) are compared between the first and the last quinquennium (1987-1991 and 1999-2003) by percent change. RESULTS: during 1987-2003, an average of 26667 annual deaths (65% of total) occurred in persons aged 75 and over in Tuscany. In the same period the number of elderly residents increased (2003 vs 1987: men +43.6%; women +41.5%) with a consequent increase in number of deaths (2003 vs 1987: men +13.8%; women +15.9%). The truncated age-adjusted rates for all mortality causes decreased (EAPC = -1.35% in males; EAPC = -1.41% in females) while an increase was registered for few specific causes as Alzheimer's disease, senile dementia, arterial hypertension and lung cancer. CONCLUSIONS: the decreasing mortality trend observed in persons aged 75 and over in Tuscany is consistent with similar trends in other developed countries. The opposing trends for few specific causes of death need to be further investigated.

[Determinants of occupational injuries in the construction of the "high speed train" Bologna-Florence]. / I determinanti degli infortuni sul lavoro nella costruzione della linea ferroviaria "treno ad alta velocità" Bologna-Firenze.

OBJECTIVE: to study determinants of occupational injuries in tunnel construction using data from the surveillance system which had been implemented in order to monitor accidents during the construction of the "high speed train tracks in the Italian Regions Emilia-Romagna and Tuscany. DESIGN: retrospective cohort study. SETTING: 16 sites for the construction of 14 tunnels of the high speed railway-tract Bologna-Firenze, in Italy. PARTICIPANTS: 1,602 workers (of 3,000 employed in the underground tunnelling), aged 18 - 67 years, operating during excavation with traditional method in 1999-2002. A total of 549 injuries occurred among 385 workers. The number of worked hours were used as time at risk. MAIN OUTCOME MEASURES: incidence rate ratios (IRR) and 95% confidence intervals for all injuries, serious injuries and first injuries were considered in separate multiple regression analyses (Poisson). RESULTS: residence, task and working phase were taken into consideration. An increased risk was found for younger workers, for carpenters (IRR "all-events" = 2.33; 95% CI=1.85-2.94; IRR" first-events" = 2.12; 95% CI 1.62-2.77) and miners (IRR "all-events" = 1.76; 95% CI 1.39-2.24; IRR"first-events" = 1.71; 95% CI 1.30-2.24) vs. machinery operators. Construction of inverted arch turns out to have an incidence rate ratio three times higher than digging out (IRR "all-events" = 2.79; 95% CI 2.27-3.43; IRR "firsts-event = 2.98; 95% CI 2.33-3.81). The probability of "serious" injuries (>30 days) is higher for miners (IRR=2.45; 95% CI 1.65-3.64) and for carpenters (IRR=2.31; 95% CI 1.53-3.49). CONCLUSION: this study pointed out to indicate some determinants (age, task and work phase) of injuries in tunneling about which little had been published previously. These results are useful for addressing preventive measures, for control and prevention activities and point to the need to explore the effect of experience and to study, through a case crossover design, transient working and individual risk factors for traumatic injury within these working sites.

[Mortality in a cohort of asbestos cement workers in Carrara, Italy]. / Studio sulla mortalità degli addetti alla produzione in un'azienda di manufatti in cemento amianto a Carrara.

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the mortality of 262 workers (200 men and 62 women) employed in an asbestos cement plant located in Carrara, Italy, exposed to a mixture of chrysotile and crocidolite asbestos in a ratio of 2:5. METHODS: Follow-up started on 1 January, 1963. The vital status and causes of death were ascertained on 31 December, 2003. The Tuscany population mortality was used as reference. The relative risk was estimated by Standardized Mortality Ratio (SMR) and the confidence intervals were calculated at 95% level [95%CI]. RESULTS: Among men, a significant increase in mortality was observed for respiratory disease (14 deaths; SMR = 244.1; IC95% = 133.4-409.5), particularly for pneumoconiosis (10 deaths; SMR= 1,800; IC95% = 856.9-3,300.0; of which 5 deaths due to asbestosis; SMR = 120,000; IC95% = 37,000-270,000), and for pleural cancer (4 deaths; SMR = 2,500; IC95% = 676.8-6,400.0). Non-significant increases were also observed for lung cancer (10 deaths; SMR = 114.2; IC95% = 54.8-209.9), and gastric cancer (7 deaths; SMR= 167.1; IC95% = 67.2-344.3). Among women, significant increases were observed for pneumoconiosis (1 death; SMR = 17,000; 95%CI = 425-93,000), and for liver cancer (3 deaths; SMR = 765.0; IC95% = 157.8-2,200.0). CONCLUSIONS: For males our results were consistent with other mortality studies on asbestos-cement workers. No other cohort studies on asbestos cement workers have dealt with mortality of female workers.

Exposure to carcinogens and mortality in a cohort of restoration workers of water-damaged library materials following the River Arno flooding in Florence, 4 November 1966.

BACKGROUND: In Florence, Italy, the Arno River overflowed on 4 November 1966 and the rare library collections of the National Central Library in Florence (FNCL) were flooded. A Restoration Centre was immediately set up. For book restoration many toxic chemicals were used, such as chlorinated solvents, ethylene oxide (EtO), formaldehyde, petroleum distillates, and pesticides. The study's aims were: (I) to document the restoration process, (II) to identify the potential chemical exposures, (III) to evaluate the mortality experience of restorers. METHODS: A small cohort of 168 workers was identified. The restorers were employed in the FNCL's Restoration Centre during the years 1967-1976. We excluded 9 subjects from the analysis because no working period data were available. Mortality from all causes, from all cancers, and from cancers of specific sites was compared with that of the Italian general population. Standardized Mortality Rates (SMRs) and their 95% confidence intervals were estimated. RESULTS: Restorers were exposed to relatively low levels of several carcinogens. A non-significant excess of cancer mortality was found. Significant increases in brain neoplasm among men and in uterine cancer among women were found, CONCLUSIONS: The small cohort size hampers interpretation of the results. Larger epidemiology studies on library material restorers are needed in order to evaluate risks in this activity. Recommendations to improve future studies are given.

[Mortality in a cohort of sugar refinery workers in Arezzo Province, Italy]. / Mortalità negli addetti di uno zuccherificio nell'aretino.

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate mortality of a cohort of 1,767 male workers employed in a sugar refinery plant located in the Province of Arezzo, Italy, where asbestos had been used from the 1960's for the insulation of thermohydraulic systems and for furnaces. In 1987-88 workers removed the asbestos-cement insulation from the plant. METHODS: The cohort was composed by male workers who were employed in the plant between 1 March 1962 and 1 February 1996, and had worked for at least 2 months. Follow-up started on 1 March 1962, and ended on 31 May, 2003. The population mortality for Tuscany Region was used as the reference. The relative risk was estimated by Standardized Mortality Ratio (SMR) and the confidence intervals were calculated at a 95% level (95% CI). RESULTS: The majority of workers were employed during the summer only. Significant decreases in mortality were observed for overall mortality (SMR = 78; 95% CI = 69-88), all cancers (SMR = 80; 95% CI = 65-97), cardiovascular diseases (SMR = 64; 95% CI = 50-81), lung cancer (SMR = 66; 95% CI = 43-98), and gastrointestinal diseases (SMR = 53; 95% CI = 26-98). Non-significant increases were observed for kidney cancer (SMR = 229; 95% CI = 92-472), and diseases of the nervous system (SMR = 155; 95% CI = 71-294). Kidney cancer mortality for workers employed for > = 5 years was significantly higher (SMR = 508; 95% CI = 105-1485). CONCLUSIONS: Mortality for asbestos-related diseases did not show any increase. The higher kidney cancer mortality for workers employed for > = 5 years could be due to exposures to various carcinogens, that occurred not only in the sugar refinery plant, given that the workers were seasonal and did other jobs during the rest of the year. Asbestos-related deaths could occur in the future among some workers who in 1987-88 were employed on the removal of asbestos-cement insulation from the plant.

Cancer and pesticides: an overview and some results of the Italian multicenter case-control study on hematolymphopoietic malignancies.

Exposure to pesticides is recognized as an important environmental risk factor associated with development of cancer. Epidemiological studies, although sometimes contradictory, have linked phenoxy acid herbicides with non-Hodgkin's lymphoma (NHL) and Soft Tissue Sarcoma (STS); organochlorine insecticides with STS, NHL, and leukemia; organophosphorous compounds with NHL and leukemia; and triazine herbicides with ovarian cancer. Exposure assessment is a crucial point in studying the association between cancer and pesticides. In order to investigate the association between hematolymphopoietic malignancies and occupational exposures, including pesticides, a population-based case-control study was carried out in Italy in 11 areas, 9 of which are agricultural or mixed areas. All newly diagnosed cases of hematolymphopoietic malignancies were collected in a 3-year period (1991-1993). The control group consisted of a random sample of the population residing in each area. The approach to infer exposures in agriculture was based on: the use of an agricultural questionnaire with 24 crop-specific questionnaires; expert agronomists who reviewed the collected information for each subject and translated it into pesticides histories. In total, 1925 cases and 1232 controls were interviewed in the nine agricultural areas. Increased risk was observed for some specific classes of pesticides. Furthermore, a nonstatistically significant increased risk of NHL was observed for subjects who were exposed to phenoxy herbicides not using protective equipment and a significant increased risk for exposure to 2, 4-dichlorophenoxy acetic acid (2,4-D).

Lung cancer mortality patterns in women resident in different urbanization areas in central Italy from 1987-2002.

AIMS AND BACKGROUND: The aim of the study was to evaluate mortality lung cancer trends, as an indicator of female smoking trends, in women resident in different urbanization areas. METHODS AND STUDY DESIGN: Data on the 5782 female lung cancer deaths that occurred in Tuscany, Italy, during the period 1987-2002 were analyzed, using age-period-cohort models by areas at different urbanization levels. Trends were examined with a log-linear regression model, calculating the yearly estimated percent change. Empirical bayesian estimators of the ratios between observed and expected deaths by municipality were calculated for the most recent period and mapped. RESULTS: The age-adjusted lung cancer mortality rates increased from 1987 to 2002: estimated percentage change values were equal to 24.5% in the urban areas (P < 0.001) and 17.2% in the rural areas (P = 0.023). The age-period-cohort model analyses showed a statistically significant drift and non-linear cohort effects. The higher risk was observed for the birth cohort of women born around 1955 (RR, 5.25; 95% CI, 2.83-9.72). In the rural areas, no significant effects were observed, and the age model showed the best fit. In recent years, the risk appeared concentrated in 9 Tuscan municipalities, accounting more than 35% of the female urban population. CONCLUSIONS: The observed significant cohort effect in the age-period-cohort analyses for the urban areas reflects the social impact of living in these areas to induce smoking-related disease like lung cancer in women. The risk appeared particularly relevant in more recent and urbanized generations (women born around 1955), thereby suggesting urgent effective campaigns against smoking, gender dedicated, especially in urban areas.