Trends in mortality from cardiovascular and cerebrovascular diseases in Europe and other areas of the world

OBJECTIVE

To analyse trends in mortality from coronary heart disease (CHD) and cerebrovascular disease (CVD) over the period 1965 to 1998 in the European Union, other European countries, the USA, and Japan.

METHODS AND RESULTS

Data were derived from the World Health Organization database. In the European Union, CHD mortality in men rose from 146/100 000 in 1965-9 to 163/100 000 in 1975-9 and declined thereafter to 99/100 000 in 1995-8 (-39%). In women, the fall was from 70 to 45/100 000 (-36%). A > 55% decline in CVD was registered in both sexes. In eastern Europe, mortality from both CHD and CVD rose up to the early 1990s but has declined over the past few years in Poland and the Czech Republic. In the Russian Federation during 1995-8, mortality rates from CHD reached 330/100 000 men and 154/100 000 women and mortality rates from CVD were 203/100 000 men and 150/100 000 women-that is, they were among the highest rates worldwide. In the USA and Japan, long term trends were favourable for both CHD and CVD.

CONCLUSIONS

Trends in mortality from CHD and CVD were favourable in several developed areas of the world, but there were major geographical differences. In a few eastern European countries, mortality from CHD and CVD remains exceedingly high.

Trends in mortality from Hodgkin's disease in western and eastern Europe

Hodgkin's disease mortality rates steadily declined by about 75% between the late 1960's and the late 1990's in the current European Union countries and the USA, and Japan. Eastern European countries, however, showed only an approximately 40% decline between the late 1960's and the early 1990's, and no further fall thereafter.

Macronutrients and colorectal cancer: a Swiss case-control study

BACKGROUND

A role of energy and various nutrients, including protein, sugar, saturated and unsaturated fats, in colorectal cancer risk has been suggested, but should be better defined.

PATIENTS AND METHODS

The association between dietary intake of various macronutrients and colorectal cancer risk was analysed using data from a case-control study conducted between 1992 and 2000 in the Swiss Canton of Vaud. The study comprised 286 case subjects (174 males, 112 females; median age 65 years) with incident, histologically confirmed colon (n = 149) or rectal (n = 137) cancer, and 550 control subjects (269 males, 281 females; median age 59 years) admitted to the same University Hospital for a wide spectrum of acute non-neoplastic conditions. Dietary habits were investigated using a validated food frequency questionnaire, including questions on 79 foods or recipes and on individual fat intake pattern. Multivariate odds ratios (OR) were obtained after allowance for age, sex, education, physical activity and energy intake.

RESULTS

The risk of colon and rectal cancer increased with total energy intake (OR in highest and lowest tertile, 2.0 and 2.2, respectively). There was no significant relation with starches or proteins, a significant inverse relation with sugars (OR for the highest tertile, 0.5), a direct trend in risk of borderline significance for saturated fats (OR = 1.4 for the highest tertile), and significant inverse trends for monounsaturated (OR = 0.6) and polyunsaturated fats (OR = 0.6).

CONCLUSIONS

These findings confirm that energy intake is directly related to colorectal cancer risk, and that different types of fat may have different roles in colorectal carcinogenesis.

Dietary fibre and the risk of colorectal cancer

The relationship between various types of fibre and colorectal cancer risk was investigated using data from a case-control study conducted in the Swiss Canton of Vaud between January 1992 and December 2000. The study included 286 cases of incident, histologically-confirmed colorectal cancers (149 colon and 137 rectal cancers) admitted to the University Hospital of Lausanne, and 550 controls whose admission diagnosis was of acute, non-neoplastic diseases. Dietary habits were investigated using a validated food frequency questionnaire (FFQ). Odds ratios (ORs) were computed after allowance for age, sex, education, physical activity and energy intake. Fibre was analysed both as a continuous variable and in tertiles. There was a significant inverse relationship of total fibre intake (determined by the Englyst method as non-starch polysaccharides) and of its components with the risk of colorectal cancer. ORs for a difference in intake of one standard deviation from the mean fibre intake of the control distribution was 0.57 for total fibres, 0.55 for soluble non-cellulose polysaccharides (NCPs), 0.58 for total insoluble fibres, 0.57 for cellulose, 0.62 for insoluble NCP and 0.62 for lignin. When fibre was classified according to its source, the OR was 0.60 for vegetables, 0.78 for fruit and 0.74 for grain fibre. The ORs were similar for colon and rectal cancer and consistent across the strata of the major covariates and of several types of fibres.

Changed trends of cancer mortality in the elderly

BACKGROUND

Trends in cancer mortality for the elderly have long been unfavourable.

MATERIALS AND METHODS

Mortality from 12 major cancer sites, plus total cancer mortality at age 65-84 in 23 European countries, the US and Japan was analyzed.

RESULTS

Between the late 1980s and the late 1990s total cancer mortality at age 65 to 84 has been declining in the European Union (UE) (-5.5% in males, -4.5% in females), in United States (US) males (-2.3%), but not females (+4.4%), and in Japanese females (-5.6%), but not males (+6.3%). Cancer mortality in the elderly rose for both sexes in eastern Europe. Gastric cancer mortality declined in all the areas. Lung cancer rates declined over the last decade by 8.5% in males in the EU. and by 0.9% in the US. Rates were still increasing in eastern Europe, in Japanese males and in females in all areas. Pancreatic mortality rates were increasing in both sexes in the EU and Japan up to the late 1980s, and in eastern Europe up to the 1990s, whereas rates for US males have been declining over recent years. Breast cancer mortality has declined over the last decade by 8% in the US and by 3% in the EU, while it has risen in eastern Europe and in Japan. Mortality from breast and prostate as well as ovarian cancer remained however low in elderly Japanese. Prostate cancer mortality declined in the EU and in the US, whereas it rose in eastern Europe and in Japan. Mortality from lymphomas and multiple myeloma rose in both sexes and various geographic areas, but improved diagnosis and certification may have played a role in these trends. Mortality from leukemia in the elderly increased in eastern Europe and Japan. but was stable in the US and the EU.

CONCLUSIONS

Cancer mortality in the elderly has stopped systematically rising, and is on the decline in males since the late 1980s.

Western and eastern European trends in testicular cancer mortality

Testicular cancer is curable if treated appropriately. We used national mortality data to compare specific death rates from the disorder in western and eastern Europe, the USA, and Japan. Testicular cancer mortality rates have fallen by about 70% in the USA and western Europe since the 1970s. In eastern Europe, however, death rates from testicular cancer have been declining only since the late 1980s, and at a much slower rate than that recorded elsewhere (about 20%). Consequently, many avoidable deaths, mainly in young adults, are still occurring in eastern Europe. Available effective treatment strategies for testicular cancer must be implemented in these countries.

Agenesis of the scapula in Emx2 homozygous mutants

The shoulder and pelvic girdles represent the proximal bones of the appendicular skeleton that connect the anterior and posterior limbs to the body trunk. Although the limb is a well-known model in developmental biology, the genetic mechanisms controlling the development of the more proximal elements of the appendicular skeleton are still unknown. The knock-out of Pax1 has shown that this gene is involved in patterning the acromion, while the expression pattern candidates Hoxc6 as a gene involved in scapula development. Surprisingly, we have found that scapula and ilium do not develop in Emx2 knock-out mice. In the homozygous mutants, developmental abnormalities of the brain cortex, the most anterior structure of the primary axis of the body, are associated with important defects of the girdles, the more proximal elements of the secondary axis. These abnormalities suggest that the molecular mechanisms patterning the more proximal elements of the limb axis are different from those patterning the rest of appendicular skeleton. While Hox genes specify the different segments of the more distal part of the appendicular skeleton forming the limb, Emx2 is concerned with the more proximal elements constituting the girdles.

Childhood cancer mortality in Europe, 1955--1995

Childhood cancer (0--14 years) mortality rates for six cancer sites, including bone, kidney, eye, Hodgkin's disease, non-Hodgkin's lymphomas, leukaemias, plus total cancer mortality were computed for subsequent calendar periods from 1955 to 1997, and graphically presented for 16 Western European countries, seven Eastern European countries, plus the European Union as a whole. All Western European countries showed substantial declines in mortality from leukaemias and from all neoplasms considered from the mid-1960s onwards, for an average fall over 60%, and an estimated total number of approximately 4500 avoided deaths per year. Favourable trends were observed also in Eastern Europe, but the declines started later (i.e. around the mid-1970s or the late 1980s), and were only approximately 30%.

Dietary intake of selected micronutrients and breast-cancer risk

The relation between 17 micronutrients and breast-cancer risk was analyzed in a case-control study conducted between 1993 and 1999 in the Swiss Canton of Vaud. Cases were 289 women with incident, histologically confirmed breast cancer, and controls were 442 women admitted to the same hospital for a wide spectrum of acute non-neoplastic conditions unrelated to long-term modifications of diet. Dietary habits were investigated using a validated food-frequency questionnaire. Odds ratios (ORs) were obtained after allowance for age, education, parity, menopausal status, body mass index, total energy intake and alcohol drinking. For several micronutrients, the ORs tended to decline with increasing tertile of intake, with significant inverse trends in risk for potassium (OR for the highest tertile = 0.21), total carotenoids (OR = 0.42), lycopene (OR = 0.43), folic acid (OR = 0.45), vitamin C (OR = 0.19), vitamin E (OR = 0.37) and vitamin B(6) (OR = 0.54). In a model including a continuous term for the 7 micronutrients significantly related to breast cancer, the only persisting significant inverse relations were for vitamin C (OR = 0.23) and lycopene (OR = 0.64).

Trends in mortality from leukemia in subsequent age groups

Trends in age-standardized death certification rates from leukemias in subsequent age groups were analyzed on the basis of the World Health Organization database over the period 1960-1997 in the European Union (EU) and other developed areas of the world. In the EU, the peak rate at age 0-14 was observed in 1960-1964, and the fall in mortality was over 70%, to reach 1.2/100,000 males and 0.9/100,000 females in 1995-1997. In the age group 15-44, the fall was about 40% for males and 45% for females. In the age group 45-59, the fall was around 25%. At age 60-69, the peak rate was observed in the late 1970s, and the subsequent fall was only 6% for females. At age > or =70, leukemia mortality rose up to the late 1980s, and levelled off there-after. Overall, the falls in leukemia mortality over the 35-year calendar period corresponded to the avoidance of about 7,000 deaths per year. In eastern Europe, the falls in children and young adults started later --in the late 1970s--and were less than 40% for children and 30% for young adults (15-44 years). Overall age-standardized mortality from leukemia did not appreciably change over the 35-year period considered. Leukemia mortality rates in the USA and Japan started from different values, but were similar to those of the EU in the late 1990s, indicating that the impact of therapeutic advancements has been comparable in developed areas of the world. In eastern Europe, however, the declines in leukemia mortality were later and appreciably smaller.

Cervical cancer mortality in young women in Europe: patterns and trends

On the basis of overall national death certification data, it is not possible to analyse mortality from cervical cancer in Europe, since 20-65% of deaths from uterine cancer in largest countries are still certified as uterus, unspecified. We analysed, therefore, age-standardised death certification rates from uterine cancer between 1960 and 1998 in women aged 20-44 years, since most deaths from uterine cancer below the age of 45 years arise from the cervix. In all Western European countries, except Ireland, substantial declines in cervical cancer mortality in younger women were observed, although the falls were larger and earlier for some Nordic countries. The trends were irregular in the UK, with earlier declines between 1960 and 1970, followed by a rise between 1970 and 1985, and a subsequent fall. In Ireland, mortality from uterine cancer at age 20 to 44 years has been rising since the early 1980s, to reach 3.4/100000 in 1995-1996. In Eastern Europe, some fall in mortality was observed in Hungary and Poland, while trends were upwards in Romania since 1980, and in Bulgaria. In all these countries, moreover, absolute rates remained appreciably higher than in most of Western Europe, and in the late 1990s there was over a 10-fold variation between the highest rates in Romania (10.6/100000 women aged 20-44 years) and the lowest ones in Finland (0.5/100000) or Sweden (0.9/100000). Within the European Union, the variation was over 6-fold, the highest rates being registered in Ireland (3. 4/100000) and Portugal (3.2/100000). The declines registered in cervical cancer mortality in young women were largely due to screening, and the persisting variations in mortality across Europe underline the importance of the adoption of organised screening programmes, with specific urgency in Eastern Europe.

The decline in cancer mortality in the European Union, 1988-1996

After the peak rate reached in 1988, moderate but steady declines were observed over the last decade in total cancer mortality rates in the European Union (EU). Such a decline was over 7% for both sexes combined over the period of 1988-1996 (i.e. from 147.0 to 136.4/100,000, world standard population). The declines in cancer mortality correspond to the avoidance of approximately 70,000 deaths in 1996 in the EU compared with the 1988 rates. The major determinants of these favourable trends were lung (-7.7%), stomach (-24.8%), intestines (-12.4%), breast (-7.1%), uterus, mainly cervix (-20.6%), and leukaemias (-8.3%) and, after 1992, a levelling off of prostate cancer rates.

Selected micronutrients and colorectal cancer. a case-control study from the canton of Vaud, Switzerland

The association between dietary intake of various micronutrients and colorectal cancer risk was analysed using data from a case-control study conducted between 1992 and 1997 in the Swiss Canton of Vaud. Cases were 223 subjects (142 (64%) males, 81 (36%) females; median age 63 years) with incident, histologically confirmed colon (n=119; 53%) or rectal (n=104; 47%) cancer, and controls were 491 subjects (211 (43%) males, 280 (57%) females; median age 58 years; range 27-74) admitted to the same university hospital for a wide spectrum of acute non-neoplastic conditions, unrelated to long-term modifications of diet. Dietary habits were investigated using a validated food frequency questionnaire (FFQ). Odds ratios (OR) were obtained after allowance for age, sex, education, smoking, alcohol, body mass index, physical activity, and total energy and fibre intake. No significant association was observed for calcium, retinol, folate, vitamin D or E. The risk of colorectal cancer was directly associated with measures of iron intake (OR=2.43 for the highest tertile, 95% confidence interval (CI): 1.2-5.1) and inversely associated with vitamin C (OR=0.45; 95% CI: 0.3-0.8), and non-significantly with total carotenoids (OR=0.66, 95% CI: 0.4-1.1). Among various individual carotenoids considered, inverse associations were observed for alpha-carotene, beta-carotene and lutein/zeaxanthin. These findings were consistent across the strata of gender and age, and support the hypothesis that selected micronutrients have a favourable effect on colorectal carcinogenesis.

Food groups and oesophageal cancer risk in Vaud, Switzerland

The influence of food groups on oesophageal cancer risk was analysed using data from a case-control study conducted between 1992 and 1999 in the Swiss Canton of Vaud on 101 incident, histologically confirmed cases (92 squamous cell, 9 adenocarcinomas) and 327 controls admitted to hospital for acute, non-neoplastic conditions. Multivariate odds ratios (OR) were computed after allowance for age, sex, tobacco, alcohol and non-alcohol energy. Significant increased risks emerged for red meat (OR = 1.7 for an increase of one serving per day), pork and processed meat (OR = 1.6), and eggs (OR = 1.5), whereas inverse associations were observed for milk (OR = 0.7), raw and cooked vegetables (OR = 0.5), citrus and other fruits (OR = 0.5), as well as for a more varied diet (OR = 0.5). Most associations were apparently stronger in heavy alcohol drinkers, suggesting an interaction between poor diet and alcohol drinking in oesophageal carcinogenesis.

Refined and whole grain cereals and the risk of oral, oesophageal and laryngeal cancer

OBJECTIVE

To investigate the possible differential role of refined and whole grain cereals on the risk of upper digestive and respiratory tract neoplasms.

DESIGN

Hospital-based case-control study.

SETTING

University Hospital of Lausanne, Switzerland.

SUBJECTS

A total of 156 incident cases of cancers of the oral cavity and pharynx, 101 of the oesophagus, 40 of the larynx, and 349 control subjects admitted for a wide spectrum of acute non-neoplastic conditions.

INTERVENTION

Trained interviewers collected information using a structured and validated questionnaire. Odds ratios (OR) of various cancers for a tertile increment of intake of refined and whole grains were estimated using unconditional multiple logistic regression.

RESULTS

Refined grains were directly related to the risk of cancer of the oral cavity and pharynx (OR=1.9 for the highest tertile), oesophagus (OR=3.7) and larynx (OR=4.0). In contrast, whole grain cereals were protective, with OR of 0.6 for oral cavity and pharynx, 0.3 for oesophagus, and 0.7 for larynx. For the three sites combined, the OR for the highest tertile was 5.7 for refined grains and 0.5 for wholegrains. The trends in risk for refined grains were significant for all sites and their combination, and for wholegrain for oesophageal cancer and all sites.

CONCLUSIONS

Even if inference on causality and the biological interpretation remain open to discussion, the present data indicate and further quantify that refined cereals are an unfavourable, but whole grain ones a favourable indicator of the risk of upper aerodigestive and respiratory tract neoplasms.

Trends in mortality from primary liver cancer in Europe

Upward trends in incidence and mortality from primary liver cancer have been reported from Japan, the USA and a few European countries. Thus, we systematically reviewed trends in age-standardised death certification rates from primary liver cancer between 1970 and 1996 in 20 European countries providing data for the World Health Organisation database. Overall age-standardised (world population) mortality rates were approximately stable or showed no consistent trends in seven countries, including Bulgaria and Hungary (with exceedingly high rates), Finland, The Netherlands and the UK. Moderate rises were observed in Austria, Germany and Switzerland, and much larger upward trends in France and Italy, particularly for males. Downward trends were observed in both sexes in Belgium, Spain, Ireland, Greece and several Scandinavian countries. The per cent change in rates per year ranged, for males, from -7.4% for Ireland and -5.1% for Spain to +4.4% for Italy and +8.6% for France. Trends were more favourable in women, with 15 out of 20 countries showing downward trends in rates, and moderately more favourable in middle age (45-64 years) and, in major European countries, in young adults (20-44 years of age). In conclusion, trends in liver cancer mortality in Europe are heterogeneous. The fall in mortality in countries like Spain may be largely explained by improvements in the distinction between primary and secondary liver neoplasms, whereas upward trends in Central Europe and Italy are likely to be, at least in part, real. Increases in infection with the hepatitis C virus, and improved and increased searches for liver cancer in cirrhotic patients are two of the likeliest explanations for these observations.

Occupational and leisure-time physical activity and the risk of colorectal cancer

The relation between various measures of physical activity and colorectal cancer risk was considered in a case-control study conducted between 1992 and 1997 in the Swiss canton of Vaud. Cases were 223 patients (142 men, 81 women) below age 75, with colon (n = 119) or rectal (n = 104) cancer; controls were 491 patients (211 men, 280 women) admitted to hospital for acute, non-neoplastic conditions. Compared with the lowest level of physical activity at age 30-39 years, the odds ratios (OR) of colorectal cancer for the highest level were 0.44 (95% confidence interval, CI, 0.26-0.73) for occupational and 0.53 (95% CI 0.33-0.86) for leisure-time activity. An inverse association was also observed for physical activity at age 15-19 and 50-59 years. The inverse relation between physical activity and colorectal cancer was observed across strata of sex, age, education, body mass index and alcohol drinking; was somewhat stronger in subjects reporting high total energy, and low vegetable and fibre intakes; and was observed across various colon subsites and rectum. In terms of population attributable risk, increasing physical activity would avoid one-fifth to one-third of incident colorectal cancer cases.

Aggregation of sow lactobacilli with diarrhoeagenic Escherichia coli

A total of 20 strains of lactobacilli were isolated from the oesophagus and vagina of 20 sows at the time of partus. Aggregation activity was seen between six homofermentative autoaggregative lactobacilli and three strains of pathogenic Escherichia coli with F4, F5 and F6 fimbriae. The highest aggregation activity was observed between vaginal Lactobacillus acidophilus PV 32 or oesophageal OE 2/1 and E. coli with F4 (K88). The presence of aggregation-promoting factor (APF) was confirmed by polymerase chain reaction (PCR) with primers of a specific fragment the apf gene derived from human L. gasseri 4B2 in one oesophageal L. acidophilus strain OE 2/1. We propose that autoaggregative lactobacilli that aggregate with diarrhoeagenic E. coli can express a class of APF proteins that exhibit the function of an aggregation mediator.