Descriptive epidemiology of vulvar and vaginal cancers in Vaud, Switzerland, 1974-1994

Background: To analyse trends in incidence, survival and risk of second neoplasms following vaginal and vulvar cancers using data collected by the Swiss Cancer Registry of Vaud over the 21-year period 1974-1994. Materials and methods: Subjects were 257 vulvo-vaginal cancers. Of these, 69 were vaginal, 153 vulvar cancers, and 35 non-specified lower genital tract neoplasms; 94 in situ neoplasms were also registered (85 for the vulva). Results: Invasive vaginal cancer incidence decreased from 0.8 in 1974-1984 to 0.4/100,000 women in 1985-1994, while invasive vulvar cancer incidence remained approximately stable around 1.2/100,000 (world standard); incidence of in situ vulvar cancer increased from 0.8 to 1.3/100,000, the rise being larger in younger women. Significant excesses for second primary neoplasms were observed for oro-pharyngeal and lung cancer, and for non-melanomatous skin neoplasms, as well as for invasive vulvar cancers following in situ cancers. Conclusions: This population-based dataset confirms that the incidence of in situ vulvar (but not invasive vulvar or vaginal cancer) has been increasing over the last 20 years. The excess second primary neoplasms supports the hypotheses that human papillomavirus and cigarette smoking are related to vulvo-vaginal neoplasm

Dietary approach to stop hypertension (DASH) diet and associated socioeconomic inequalities in the United Kingdom

The dietary approach to stop hypertension (DASH) diet is an effective measure in the prevention and treatment of CVD. We evaluated recent trends in socioeconomic differences in the DASH score in the UK population, using education, occupation and income as proxies of socioeconomic position (SEP). We analyzed data on 6416 subjects aged 18 and older collected in the National Diet and Nutrition Survey (NDNS 2008-2016). The DASH score was calculated using sex-specific quintiles of DASH items. Multiple linear regression and quantile regression models were used to evaluate the trend in DASH score according to SEP. The mean DASH score was 24 (standard deviation: 5). The estimated mean differences between people with no qualification and those having the highest level of education was -3.61 points (95% CI: -4.00; -3.22). The mean difference between subjects engaged in routine occupations and those engaged in high managerial and professional occupations was -3.41 points (95% CI: -3.89; -2.93) and for those in the first fifth and last fifth of the household income distribution was -2.71 points (95% CI: -3.15; -2.28). DASH score improved over time and no significant differences in the trend were observed across SEP. The widest socioeconomic differences emerged for consumption of fruit, vegetables, wholegrains, nuts, seeds and legumes. Despite an overall increase in the DASH score, a persisting SEP gap was observed. This is an important limiting factor in reducing the high socioeconomic inequality in CVD observed in the UK

Incidence of invasive cancers following carcinoma in situ of the cervix.

Women with carcinoma in situ (CIS) of the cervix uteri, notified to the population-based Cancer Registry of the Swiss Canton of Vaud between 1974 and 1993, were actively followed up to 31 December 1993 for the occurrence of subsequent invasive neoplasms. Among 2190 incident cases of CIS, followed for a total of 22,225 person-years, 95 metachronous cancers were observed vs 77.9 expected, corresponding to a significant standardised incidence ratio (SIR) of 1.2. Ten cases of invasive cervical cancer were observed vs 3.0 expected (SIR = 3.4, P < 0.01), the excess being larger in the first 10 years since CIS diagnosis. A total of 11 cases of four major tobacco-related sites (lung, mouth or pharynx, oesophagus and urinary bladder) were observed vs 5.1 expected, corresponding to a significant SIR of 2.2. The excess was observed > or = 10 years after CIS diagnosis. There was also an excess of non-melanomatous skin cancers (29 observed, 16.9 expected, SIR = 1.7; P < 0.01), but not of skin melanoma and of any of the other neoplasms considered, including breast and corpus uteri. This population-based study, therefore, finds an excess of invasive cervical cancer in the short term after CIS diagnosis, and a medium- to long-term excess risk of tobacco-related and non-melanomatous skin neoplasms. These findings are discussed in terms of increased surveillance and case ascertainment after CIS, and of potential shared risk factors (tobacco and/or viral infections)

Trends in cancer incidence and mortality in Vaud, Switzerland, 1974-1993

Background: Comparing incidence of and mortality from cancer within a given population yields several benefits. One of these is the opportunity, when trends in incidence differ from those in mortality, to derive inferences about the potential role of improved diagnosis in the rise of incidence rates, and about therapeutic advancements in reducing mortality. Materials and methods: Trends in incidence of and mortality from various cancers or groups of cancers (comprising 55,682 new malignant tumours and 26,528 certified cancer deaths) over the period 1974-1993 were compared using, respectively, data from the Cancer Registry of the Swiss Canton of Vaud (with about 600,000 inhabitants) and those provided by the Swiss Federal Statistical Office. Results: The overall cancer incidence increased by 10% to 30% in both sexes and various age groups, whereas mortality remained approximately the same. The sites primarily responsible for these divergent trends were breast, prostate and colorectal, three sites where cancers have been less frequently diagnosed since the advent of certain technical advancements and the introduction of screening. Other contributors to the divergent trends were testicular cancer, Hodgkin's disease and leukaemias, i.e., the sites for which the most substantial therapeutic advancements have been achieved. Conclusions: These data are fairly reassuring, since they are inconsistent with an ongoing cancer epidemic in this European population. However, they are also incompatible with the presence of major advancements in the prevention and treatment of cance

Cancer risk after radiotherapy for breast cancer

Among women with breast cancer, we compared the relative and absolute rates of subsequent cancers in 1541 women treated with radiotherapy (RT) to 4570 women not so treated (NRT), using all registered in the Swiss Vaud Cancer Registry in the period between 1978 and 1998, and followed up to December 2002. Standardised incidence ratios (SIRs) and the corresponding 95% confidence intervals (CIs) were based on age- and calendar year-specific incidence rates in the Vaud general population. There were 11 lung cancers in RT (SIR=1.40; 95% CI: 0.70–2.51) and 17 in NRT women (SIR=0.76; 95% CI: 0.44–1.22), 72 contralateral breast cancers in RT (SIR=1.85; 95% CI: 1.45–2.33) and 150 in NRT women (SIR=1.38; 95% CI: 1.16–1.61), and 90 other neoplasms in RT (SIR=1.37; 95% CI: 1.10–1.68) and 224 in NRT women (SIR=1.05; 95% CI: 0.91–1.19). Overall, there were 173 second neoplasms in RT women (SIR=1.54, 95% CI: 1.32–1.78) and 391 among NRT women (SIR=1.13, 95% CI: 1.02–1.25). The estimates were significantly heterogeneous. After 15 years, 20% of RT cases vs 16% of NRT cases had developed a second neoplasm. The appreciable excess risk of subsequent neoplasms after RT for breast cancer must be weighed against the approximately 5% reduction of breast cancer mortality at 15 years after RT

Long working hours and cardiovascular mortality: a census-based cohort study

Objectives Long working hours have been associated with cardiovascular disease (CVD) mortality. However, results are inconsistent and large cohort studies are needed to confirm these findings. Methods We conducted a census-based cohort study including 11,903,540 Italian workers aged 20-64 years, registered in the 2011 census, with a 5-year follow-up (2012-2016). We estimated cause-specific hazard ratios (cHRs) through Cox regression models to quantify the association between long working hours and CVD mortality. Results Over 5 years of follow-up, 17,206 individuals died from CVD (15,262 men and 1944 women). Men working 55 or more hours per week had a cHR of 0.95 (95% confidence interval, CI 0.89-1.02) for all CVDs, while women showed a cHR of 1.19 (95% CI 0.95-1.49). Professional women working more than 55 h per week had a cHR of 1.98 (95% CI 0.87-4.52). Conclusions This study does not support an association between long working hours and CVD mortality among active Italian men, while it suggests a possible excess risk among women, although based on limited number of events

Reproductive factors and the risk of invasive and intraepithelial cervical neoplasia.

The relation between reproductive factors and cervical neoplasia was evaluated in a case-control study of 528 cases of invasive cancer compared with 456 control subjects in hospital for acute conditions unrelated to any of the established or suspected risk factors for cervical cancer, and of 335 cases of cervical intraepithelial neoplasia compared with 262 outpatient controls. The risk of invasive cervical cancer increased with number of livebirths, the estimated multivariate relative risk (RR) being 4.39 in women with five or more births compared with nulliparous women. There was also an inverse relation with age at first livebirth (RR = 0.42 for greater than or equal to 30 vs. less than 20 years) which, however, disappeared after inclusion of parity in multiple logistic regression analysis. Likewise, cases of invasive cervical cancer tended more frequently to report induced abortions. However, this association was not statistically significant after allowance for confounding factors, including parity. No relation emerged with number of spontaneous abortion and age at last pregnancy. When the interaction between parity and sexual habits was analysed, the relative risk increased in subsequent strata of parity with increasing number of sexual partners or decreasing age at first intercourse, thus suggesting an independent effect of sexual and reproductive factors, and hence multiplicative on the relative risk of invasive cervical cancer. No consistent association emerged between the risk of intraepithelial cervical neoplasm and parity, number of abortions and age at first or last birth

Comparison of the distribution of non-AIDS Kaposi's sarcoma and non-Hodgkin's lymphoma in Europe

To evaluate whether some form of mild immunosuppression may influence the geographical distribution of non-AIDS Kaposi's sarcoma (KS), we correlated incidence rates of KS and non-Hodgkin's lymphoma in individuals aged 60 or more in 18 European countries and Israel. Significant positive correlations emerged but, within highest risk countries (i.e.Italy and Israel), internal correlations were inconsistent. © 1999 Cancer Research Campaig