Simona Moroni - Academia.edu (original) (raw)
Papers by Simona Moroni
Journal of Clinical Oncology, 2007
The combination of hormone replacement therapy (HRT) and low-dose tamoxifen may retain the benefi... more The combination of hormone replacement therapy (HRT) and low-dose tamoxifen may retain the benefits while reducing the risks of either agent. We assessed the optimal biologic dose and schedule of tamoxifen in HRT users using surrogate end point biomarkers and menopausal symptoms.
Journal of Clinical Oncology, 2009
Tamoxifen and fenretinide are active in reducing premenopausal breast cancer risk and work synerg... more Tamoxifen and fenretinide are active in reducing premenopausal breast cancer risk and work synergistically in preclinical models. The authors assessed their combination in a two-by-two biomarker trial.
The relationship between the use of fertility drugs and the risk of ovarian cancer was analysed u... more The relationship between the use of fertility drugs and the risk of ovarian cancer was analysed using data from an Italian case-control study. The study comprised 971 women below the age of 75 years with histologically confirmed invasive epithelial ovarian cancer diagnosed within the year before the interview. The controls were 2758 women admitted to the same network of hospitals
British Journal of Cancer, 1994
Summana The relationship between intrauterine device (IUD) use and risk of endometrial cancer has... more Summana The relationship between intrauterine device (IUD) use and risk of endometrial cancer has been analysed in a case-control study conducted in Italy between 1983 and 1992. including 453 patients with histologicallv confirmed endometrial cancer and 1.451 controls admitted for acute. non-gvnaecological. nonhormonal. non-neoplastic conditions to the same network of hospitals where cases had been identified. Two (0.40o) cases versus 36 (2.3%) controls reported ever using an IUD. The corresponding multivariate relative risk was 0.4 (9500 Cl 0.1 -1.0). The results of this study and the few published available epidemiological data suggest a protective role of IUD use on endometrial carcinogenesis. but potential selective mechanisms for IUD utilisation (indication bias) should be carefully considered in the interpretation.
British journal of cancer, 1995
Risk factors for benign ovarian teratomas have been analysed in a case-control study conducted in... more Risk factors for benign ovarian teratomas have been analysed in a case-control study conducted in Milan. Cases were women aged less than 65 years with a histologically confirmed diagnosis of benign ovarian teratoma who were admitted to a network of Obstetrics and Gynecology Departments in Milan. A total of 77 women aged 16-64 years were interviewed. Controls were women admitted to hospital for acute, non-gynaecological, non-hormonal and non-neoplastic diseases; 231 controls were interviewed (age range 15-64 years). Cases tended to be more educated: in comparison with women with less than 7 years of education, the estimated relative risk (RR) of ovarian benign teratoma was 1.6 and 2.5 respectively in women with 7-11 and 12 or more years of schooling, the trend in risk being statistically significant (chi 2(1) trend 5.39, P < 0.01). Four of the 77 cases (5.2%) and two of the 231 controls (0.9%) reported a history of infertility, with a corresponding RR of 8.3 (95% confidence interv...
Journal of Epidemiology & Community Health, 1997
To analyse risk factors for seromucinous benign ovarian cysts. Between 1984 and 1994 a case-contr... more To analyse risk factors for seromucinous benign ovarian cysts. Between 1984 and 1994 a case-control study was carried out. Cases were 225 women aged less than 65 year with a histologically confirmed diagnosis of benign seromucinous ovarian cysts admitted to a network of obstetrics and gynaecology departments in Milan. Controls were a random sample of 450 women admitted for acute conditions that were not gynaecological, hormonal or neoplastic. They were interviewed within the framework of a case-control study of female genital neoplasms. Network of hospitals in the greater Milan area, Italy. The risk of seromucinous benign ovarian cysts was higher in more educated women than in women with fewer than seven years of schooling. The odds ratios (OR) for seromucinous ovarian cysts were 1.3 and 1.4 respectively in women reporting 7-11 and > or = 12 years of schooling, and the trend in risk was statistically significant (chi(2)1 trend 5.20, p < 0.05). There was no clear relationship between the risk of seromucinous ovarian cysts and marital status, age at first marriage, oral contraceptive use, smoking or body mass index. In comparison with women reporting menstrual cycles lasting < 28 days, the risks of seromucinous cysts were 1.6, 2.6, and 2.5 respectively in women reporting cycles lasting 28-30, > or = 31 days, or with totally irregular ones. Among ever married women, nine cases and two controls reported difficulty in conception, and the corresponding OR for seromucinous cysts was 17.7 (95% confidence interval 4.2, 83.8). The risk of seromucinous benign ovarian tumours is greater in more educated women and in women with a history of infertility and with long or irregular menstrual cycles.
International Journal of Cancer Journal International Du Cancer, Nov 15, 1994
The association between a family history of endometrial, breast and ovarian cancer and the risk o... more The association between a family history of endometrial, breast and ovarian cancer and the risk of endometrial cancer was analyzed on the basis of data from a case-control study conducted in northern Italy between I983 and 1993. A total of 726 histologically confirmed endometrial-cancer patients (median age 61) admitted to a network of general and teaching hospitals in the Greater Milan area were interviewed. The controls were 2,123 women (median age 59), admitted for acute, non-neoplastic, non-hormone-related diseases to the same network of hospitals where the cases had been identified, with admission diagnoses unrelated to any of the known or suspected risk factors for endometrial cancer. Among cases, 37 (5. I TO) reported a history of endometrial cancer in first-degree relatives. The corresponding figure among controls was 77 (3.6%). In comparison with women with no family history of endometrial cancer, the odds ratio (OR) of endometrial cancer was I .5 (95% CI [confidence interval], I .O-2.3) in women with a history of endometrial cancer in first-degree relatives. N o relation emerged between endometrial cancer and a family history of breast or ovarian cancer. These results suggest that a family history of endometrial cancer increases the risk of contracting the same disease. However, the proportion of cases attributable to this factor was small: less than I% of endometrial cancers in this population were attributable to familial (and hence potentially genetic) factors.
International Journal of Cancer
An inverse association between smoking and endometrial cancer has generally been observed, primar... more An inverse association between smoking and endometrial cancer has generally been observed, primarily among current smokers. To assess this association, we analyzed data from the prospective Nurses' Health Study. From 1976 to 2000, 702 cases of invasive endometrial cancer were identified during 1.8 million person-years of follow-up. Smoking status was assessed in 1976 and updated every 2 years. Cox proportional hazards models were used to calculate multivariate relative risks (RRs), controlling for endometrial cancer risk factors. Compared to never smokers, the multivariate RR of endometrial cancer was significantly lower among both current smokers (RR ؍ 0.63; 95% CI ؍ 0.50 -0.79) and past smokers (RR ؍ 0.73; 95% CI ؍ 0.62-0.87). When additionally adjusting for body mass index (BMI), the RR for current smokers was attenuated (RR ؍ 0.72; 95% CI ؍ 0.57-0.90), but the RR for past smokers did not change. Risk was lower among women who smoked 35 or more cigarettes a day (RR ؍ 0.60; 95% CI ؍ 0.39 -0.91) and among those who smoked for 40 or more years (RR ؍ 0.63; 95% CI ؍ 0.45-0.87). Tests for trend, which excluded never smokers, were not statistically significant for any of the smoking variables analyzed. These data indicate that both current and past smoking are associated with a lower risk of endometrial cancer. The findings provide insight into disease etiology and suggest that the influence of smoking on endometrial cancer risk occurs even in early adulthood, is long-lasting, and may not be attributed solely to short-term hormonal modulation.
Nutrition and Cancer, 1995
Using data from a case-control study conducted in Northern Italy, we analyzed the relation betwee... more Using data from a case-control study conducted in Northern Italy, we analyzed the relation between alcohol drinking and risk of endometrial cancer. Cases were 726 patients, < 75 years of age, admitted to the Ospedale Maggiore (including the 4 largest teaching and general hospitals in the Greater Milan area), the University Obstetrics and Gynecology Clinics, and the National Cancer Institute of Milan with histologically confirmed endometrial cancer. Controls were 2,123 nonhysterectomized patients, < 75 years of age, admitted for acute nongynecological non-hormone-related nonneoplastic conditions to the same network of hospitals where cases had been identified. When total consumption of all alcoholic beverages was considered, 68.2% of cases and 63.9% of controls were drinkers and 12% of cases and 9.3% of controls reported > or = 2 drinks/day. Considering total alcohol drinking, the relative risk for alcohol drinkers vs. nondrinkers was 1.3 (95% confidence interval 1.1-1.5), and the RR estimates for subsequent levels of intake were 1.1, 1.4, and 1.6 for women drinking > 0 < or = 1, > 1 < or = 2 drinks/day (chi 2(1) trend 11.33, p < 0.001). The estimates were similar when wine only (which represents the large majority of all alcohol intake in Italy) was considered, whereas data were less informative for beer and spirits intake only. No relation emerged between duration of alcohol consumption and risk of endometrial cancer. These findings suggest a potential link between alcohol drinking and endometrial cancer risk and are, in any case, inconsistent with a protective role of alcohol in endometrial carcinogenesis.(ABSTRACT TRUNCATED AT 250 WORDS)
International Journal of Gynecological Cancer, 2002
We analyzed epidemiologic characteristics of women at risk for endometrial hyperplasia (EH), usin... more We analyzed epidemiologic characteristics of women at risk for endometrial hyperplasia (EH), using data from a case-control study. One hundred twenty nine women aged 35-73 (median 51 years) with histologically confirmed complex endometrial hyperplasia without atypies identified at the University of Milan during the period 1990-99 were examined. Controls were 258 non hysterectomized women aged 36-74 (median 52 years), admitted to a network of hospitals covering the same area where cases had been identified for conditions other than gynecological, malignant, or hormone-related. Cases with EH were more educated than controls (OR &amp;gt; 12 years of education vs. &amp;lt; 7: 2.8, 95% CI 1.7-4.8), more frequently obese (OR 2.7, 95% CI 1.5-5.0) and diabetic (OR 2.4, 95% CI 0.8-6.9). Parous women (OR 1.8) and women reporting induced abortions (OR 1.6) showed an increased risk of EH, but the associations were not statistically significant. Compared to premenopausal women, the OR of EH was 0.2 (95% 0.1-0.5) for postmenopausal ones. Compared to women reporting menopause at age 50 or less, the OR of endometrial hyperplasia was 1.5 (95% CI 0.6-3.5) and 2.2 (95%CI 0.7-6.7), respectively, in women with menopause at age 50-52 and &amp;gt; or = 53. Considering postmenopausal women only the OR was 3.1 (95% CI 1.1-9.3) for use of hormonal replacement therapy (HRT). We conclude that this study indicates that high education, obesity, diabetes, and HRT use increase the risk of endometrial hyperplasia.
International Journal of Cancer, 1994
The association between a family history of endometrial, breast and ovarian cancer and the risk o... more The association between a family history of endometrial, breast and ovarian cancer and the risk of endometrial cancer was analyzed on the basis of data from a case-control study conducted in northern Italy between I983 and 1993. A total of 726 histologically confirmed endometrial-cancer patients (median age 61) admitted to a network of general and teaching hospitals in the Greater Milan area were interviewed. The controls were 2,123 women (median age 59), admitted for acute, non-neoplastic, non-hormone-related diseases to the same network of hospitals where the cases had been identified, with admission diagnoses unrelated to any of the known or suspected risk factors for endometrial cancer. Among cases, 37 (5. I TO) reported a history of endometrial cancer in first-degree relatives. The corresponding figure among controls was 77 (3.6%). In comparison with women with no family history of endometrial cancer, the odds ratio (OR) of endometrial cancer was I .5 (95% CI [confidence interval], I .O-2.3) in women with a history of endometrial cancer in first-degree relatives. N o relation emerged between endometrial cancer and a family history of breast or ovarian cancer. These results suggest that a family history of endometrial cancer increases the risk of contracting the same disease. However, the proportion of cases attributable to this factor was small: less than I% of endometrial cancers in this population were attributable to familial (and hence potentially genetic) factors.
Gynecologic Oncology, 1995
To determine the relationship between cigarette smoking and endometrial cancer, we conducted a ca... more To determine the relationship between cigarette smoking and endometrial cancer, we conducted a case-control study. The cases were 726 patients with histologically confirmed endometrial cancers 74 years of age or less (median age, 59 years; range, 31-74) admitted between 1983 and 1992 to the Ospedale Maggiore (including the four largest teaching and general hospitals in the greater Milan area), to the Obstetrics and Gynecology University Clinics, and to the National Cancer Institute of Milan. The controls were 1452 patients younger than 75 years (median age, 59; range, 25-74) admitted for acute, nongynecological, nonhormonal, nonneoplastic conditions to the same network of hospitals where cases had been identified. Cases were less frequently ever-smokers (19%) than controls (25%). In comparison with never-smokers, the relative risk (RR) of endometrial cancer was 0.8 (95% confidence interval, CI, 0.7-1.1) in current smokers and 0.6 (95% CI 0.4-0.9) in ex-smokers. The risk of endometrial cancer decreased with number of cigarettes smoked per day and duration of habit. The estimated RR were, in comparison with never-smokers, 0.8 and 0.6 respectively in smokers of less than 20 and 20 or more cigarettes per day (chi 2(1) trend 5.48, P = 0.02) and 1.0 and 0.5 in ever-smokers for less than 20 and for 20 years or more. There was no clear relation with time since first smoking, but the RR was lower in ex-smokers who had stopped smoking less than 10 years before the interview (RR, 0.4; 95% CI, 0.2-0.8) than in those who had stopped 10 years or more before (RR, 0.8; 95% CI, 0.5-1.4). The estimated RR for ever-smokers was close to unity in premenopausal women, but apparently stronger in premenopause. Likewise the RR was 0.9 in lean (< 25 Quetelet's index) smoking women in comparison with lean nonsmokers, but smoking appeared to reduce the association with overweight. The estimated RR of endometrial cancer, in comparison with nonsmokers with Quetelet's index < 25 was 2.0 in nonsmokers with Quetelet's index > or = 25, and 1.3 in smokers with Quetelet's index > or = 25. These findings confirm the role of smoking on endometrial cancer risk. The risk reduction is, however, moderate in relative terms, and negligible from a public health point of view, in consideration of the negative consequences of smoking in several other diseases.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2000
Objective: This is a randomized clinical trial comparing estroprogestin (E / P) pill given for 12... more Objective: This is a randomized clinical trial comparing estroprogestin (E / P) pill given for 12 months vs. gonadotrophin releasing hormone agonist (GNRHa) given for 4 months followed by E / P pill treatment for 8 months in the relief of endometriosis-related pelvic pain. Methods: Eligible for the study were women with laparoscopically confirmed endometriosis and pelvic pain lasting 3-12 months after diagnosis. Eligible women were randomly assigned to treatment with E / P pill (gestroden 0.75 mg and ethynlestradiol 0.03 mg) for 12 months (47 patients) vs. tryptorelin 3.75 mg slow release every 28 days for 4 months followed by E / P pill for 8 months (55 patients). Results: At baseline, dysmenorrhea was reported in 46 women allocated to E / P pill only (97.9%), and in all the 55 women allocated to GNRHa1E / P pill. The corresponding value at the 12 months follow-up visit was 14 subjects (35.9%) and 16 subjects (34.8%). The baseline median values of the multidimensional and analog scale were for dysmenorrhea 4 and 6 in the EP only and 3 and 6 in the GNRHa1E / P group. The corresponding value at the 12 months follow-up visit were 2 and 6 and 0 and 5. Non-menstrual pain was reported, respectively, at baseline and 12 month visit by 46 (97.9%) and 15 (38.5%) subjects in the E / P pill group and 49 (89.1%) and 17 (37.0%) of the GNRHa1E / P pill one. The baseline median values of the multidimensional and analog scale were for non-menstrual pain 3 and 5 in the E / P only and 2 and 6 in the GNRHa1E / P group. The corresponding values at the 12 month follow-up visit were 0 and 4 and 0 and 4. These differences between the two groups were not statistically significant. Conclusions: 1 year after randomization, the two treatment schedules show similar relief of pelvic pain in women with endometriosis.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2005
Objective: To analyse the frequency and the determinants of recurrence rate of clinically detecta... more Objective: To analyse the frequency and the determinants of recurrence rate of clinically detectable endometriosis. Study design: Prospective cohort multicenter study. Eligible for the study were all women observed for the first time during the period January-June 1998 at the participating centres with a laparoscopically confirmed first diagnosis of endometriosis. After diagnosis, patients were treated according to standard care of each centre and desire for pregnancy. The protocol required all women to be followed up at the centre each year for 2 years with a clinical examination, an ultrasound pelvic examination and a CA125 assay, unless pregnancy occurred. Second look laparoscopy was performed on a clinical basis. Results: A total of 311 women (median age 36 years) entered the study. The two-year recurrence rate was 5.7% among cases stage I-II and 14.4% among stage III-IV (x 2 1 adjusted for indication for surgery, p < 0.05). The recurrence rates tended to increase with age, being 4.6% among women aged 20-30 and 13.1% among women aged >30, but this finding was not statistically significant. Conclusion: The recurrence rate of clinically detectable endometriosis tends to be higher in older women with advanced stages of the disease and lower in women with infertility.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2005
Objective: To obtain data on the relation between age, menopause and homocysteine levels in women... more Objective: To obtain data on the relation between age, menopause and homocysteine levels in women around menopause, we collected data for a sample of about 500 women attending a menopause clinic in Milan, Italy. Study design: Eligible for the study were all women aged 45-75 years, never HRT users consecutively observed for the first time at the Menopause Center of the 1st Obstetric Gynecological Clinic of the University of Milan. Fasting blood samples for total homocysteine plasma levels were collected during the visit. Of the 490 study subjects, 107 were pre-menopausal and 383 post-menopausal. Results: In the total series, the mean homocysteine level was 8.3 mmol/L (S.D. 3.7, range 3.2-48.8). The values increased from 7.8 mmol/L in women aged <47 years to 9.0 mmol/L in those aged >59. Among pre-menopausal women the mean homocysteine level was 7.7 mmol/L compared to 8.
European Journal of Cancer, 1997
To investigate the role of selected medical conditions on the risk of ovarian cancer, we analysed... more To investigate the role of selected medical conditions on the risk of ovarian cancer, we analysed data from a case-control study. Cases were 971 women below the age of 75 years with histologically confirmed epithelial ovarian cancer, admitted to a network of hospitals including the major teaching and general hospitals in the greater Milan area. Controls were 2758 women admitted to the same network of hospitals for acute, non-gynaecological, non-hormone related, non-neoplastic conditions. Obesity/severe overweight were inversely associated with the risk of ovarian cancer (multivariate relative risk, RR, 0.66, 95% confidence interval, CI, 0.52-0.85). Hyperlipidaemia was also inversely related to ovarian cancer risk, (RR 0.64, 95% CI 0.45-0.89). No relationship emerged between ovarian cancer risk and diabetes (RR 0.80, 95% CI 0.54-1.19), hypertension (RR 0.85, 95% CI 0.68-1.06), thyroid diseases (RR 0.89, 95% CI 0.63-1.13) and cholelithiasis (RR 0.86, 95% CI 0.66-1.12). A decreased frequency of ovarian cancer was seen in women with a history of uterine leiomyomas (RR 0.66, 95% CI 0.47-0.92) and benign ovarian cysts (RR 0.69, 95% CI 0.41-1.13).
Epidemiology, 1996
We evaluated risk factors for functional ovarian cysts using data from a case-control study condu... more We evaluated risk factors for functional ovarian cysts using data from a case-control study conducted in Milan. Cases were 68 women with histologically confirmed functional cysts. Controls were 272 women admitted to hospital for acute conditions. Compared with women who were 11 years of age or younger at menarche, women who experienced menarche at 12-13 years or at 14 years or later had odds ratios (ORs) of 0.9 [95% confidence interval (CI) = 0.5-1.6] and 0.4 (95% CI = 0.2-0.9). In comparison with women reporting menstrual cycles lasting less than 26 days, the OR was 1.8 (95% CI = 0.7-5.0) in women reporting cycles lasting 26-30 days, 1.8 (95% CI = 0.4-7.4) in those reporting cycles greater than 30 days, and 1.9 (95% CI = 0.4-7.7) in those with totally irregular cycles. Body mass was inversely related to the risk of functional ovarian cysts: compared with women with a Quetelet index below 20, the OR was 0.9 (95% CI = 0.5-1.7) in those with an index in the range from 20-24 and 0.5 (95% CI = 0.2-1.2) in those with an index of 25 or more. We found little relation between the risk of functional ovarian cysts and education, smoking, marital status, or age at first marriage. For oral contraceptive use, we found an OR of 1.3 (95% CI = 0.7-2.6).
Cancer, 1995
A case-control study was conducted to analyze the association between body mass, selected indicat... more A case-control study was conducted to analyze the association between body mass, selected indicator food intake, and vulvar cancer risk. The patients included in this report were 125 women aged 80 years or younger with histologically confirmed diagnosis of invasive vulvar cancer who were admitted to a network of general and teaching hospitals in the greater Milan area. Control subjects were 541 patients admitted to teaching and general hospitals in Milan for acute conditions. The risk of vulvar cancer was inversely related to green vegetable and carrot consumption, the corresponding multivariate relative risks for lowest versus highest levels of intake being 2.0 (95% confidence interval [CI], 1.2-3.4) and 1.4 (95% CI, 0.9-2.2). The trend in risk was significant for green vegetables. No consistent association emerged between milk, meat, liver, alcohol and coffee consumption and risk of vulvar cancer. In comparison with leaner women, the relative risks of vulvar cancer were 1.8, 1.9, 2.8, and 2.9 in progressively higher quintiles of the body mass index, and the trend in risk was significant. These data indicate that the risk of vulvar cancer is related to a number of nutritional and dietary factors. This is of particular interest, because vulvar cancer is a relatively rare neoplasm, whose etiology is still poorly understood, and on which only a few epidemiologic studies have been conducted.
BMJ, 1997
To examine any possible links between exposure to DDE (1,1-dichloro-2,2-bis (p-chlorophenyl)ethyl... more To examine any possible links between exposure to DDE (1,1-dichloro-2,2-bis (p-chlorophenyl)ethylene), the persistent metabolite of the pesticide dicophane (DDT), and breast cancer. Design: Multicentre study of exposure to DDE by measurement of adipose tissue aspirated from the buttocks. Laboratory measurements were conducted in a single laboratory. Additional data on risk factors for breast cancer were obtained by standard questionnaires. Setting: Centres in Germany, the Netherlands, Northern Ireland, Switzerland, and Spain. Subjects: 265 postmenopausal women with breast cancer and 341 controls matched for age and centre. Main outcome measure: Adipose DDE concentrations. Results: Women with breast cancer had adipose DDE concentrations 9.2% lower than control women. No increased risk of breast cancer was found at higher concentrations. The odds ratio of breast cancer, adjusted for age and centre, for the highest versus the lowest fourth of DDE distribution was 0.73 (95% confidence interval 0.44 to 1.21) and decreased to 0.48 (0.25 to 0.95; P for trend = 0.02) after adjustment for body mass index, age at first birth, and current alcohol drinking. Adjustment for other risk factors did not materially affect these estimates. Conclusions: The lower DDE concentrations observed among the women with breast cancer may be secondary to disease inception. This study does not support the hypothesis that DDE increases risk of breast cancer in postmenopausal women in Europe.
ACOG Clinical Review, 1998
Journal of Clinical Oncology, 2007
The combination of hormone replacement therapy (HRT) and low-dose tamoxifen may retain the benefi... more The combination of hormone replacement therapy (HRT) and low-dose tamoxifen may retain the benefits while reducing the risks of either agent. We assessed the optimal biologic dose and schedule of tamoxifen in HRT users using surrogate end point biomarkers and menopausal symptoms.
Journal of Clinical Oncology, 2009
Tamoxifen and fenretinide are active in reducing premenopausal breast cancer risk and work synerg... more Tamoxifen and fenretinide are active in reducing premenopausal breast cancer risk and work synergistically in preclinical models. The authors assessed their combination in a two-by-two biomarker trial.
The relationship between the use of fertility drugs and the risk of ovarian cancer was analysed u... more The relationship between the use of fertility drugs and the risk of ovarian cancer was analysed using data from an Italian case-control study. The study comprised 971 women below the age of 75 years with histologically confirmed invasive epithelial ovarian cancer diagnosed within the year before the interview. The controls were 2758 women admitted to the same network of hospitals
British Journal of Cancer, 1994
Summana The relationship between intrauterine device (IUD) use and risk of endometrial cancer has... more Summana The relationship between intrauterine device (IUD) use and risk of endometrial cancer has been analysed in a case-control study conducted in Italy between 1983 and 1992. including 453 patients with histologicallv confirmed endometrial cancer and 1.451 controls admitted for acute. non-gvnaecological. nonhormonal. non-neoplastic conditions to the same network of hospitals where cases had been identified. Two (0.40o) cases versus 36 (2.3%) controls reported ever using an IUD. The corresponding multivariate relative risk was 0.4 (9500 Cl 0.1 -1.0). The results of this study and the few published available epidemiological data suggest a protective role of IUD use on endometrial carcinogenesis. but potential selective mechanisms for IUD utilisation (indication bias) should be carefully considered in the interpretation.
British journal of cancer, 1995
Risk factors for benign ovarian teratomas have been analysed in a case-control study conducted in... more Risk factors for benign ovarian teratomas have been analysed in a case-control study conducted in Milan. Cases were women aged less than 65 years with a histologically confirmed diagnosis of benign ovarian teratoma who were admitted to a network of Obstetrics and Gynecology Departments in Milan. A total of 77 women aged 16-64 years were interviewed. Controls were women admitted to hospital for acute, non-gynaecological, non-hormonal and non-neoplastic diseases; 231 controls were interviewed (age range 15-64 years). Cases tended to be more educated: in comparison with women with less than 7 years of education, the estimated relative risk (RR) of ovarian benign teratoma was 1.6 and 2.5 respectively in women with 7-11 and 12 or more years of schooling, the trend in risk being statistically significant (chi 2(1) trend 5.39, P < 0.01). Four of the 77 cases (5.2%) and two of the 231 controls (0.9%) reported a history of infertility, with a corresponding RR of 8.3 (95% confidence interv...
Journal of Epidemiology & Community Health, 1997
To analyse risk factors for seromucinous benign ovarian cysts. Between 1984 and 1994 a case-contr... more To analyse risk factors for seromucinous benign ovarian cysts. Between 1984 and 1994 a case-control study was carried out. Cases were 225 women aged less than 65 year with a histologically confirmed diagnosis of benign seromucinous ovarian cysts admitted to a network of obstetrics and gynaecology departments in Milan. Controls were a random sample of 450 women admitted for acute conditions that were not gynaecological, hormonal or neoplastic. They were interviewed within the framework of a case-control study of female genital neoplasms. Network of hospitals in the greater Milan area, Italy. The risk of seromucinous benign ovarian cysts was higher in more educated women than in women with fewer than seven years of schooling. The odds ratios (OR) for seromucinous ovarian cysts were 1.3 and 1.4 respectively in women reporting 7-11 and > or = 12 years of schooling, and the trend in risk was statistically significant (chi(2)1 trend 5.20, p < 0.05). There was no clear relationship between the risk of seromucinous ovarian cysts and marital status, age at first marriage, oral contraceptive use, smoking or body mass index. In comparison with women reporting menstrual cycles lasting < 28 days, the risks of seromucinous cysts were 1.6, 2.6, and 2.5 respectively in women reporting cycles lasting 28-30, > or = 31 days, or with totally irregular ones. Among ever married women, nine cases and two controls reported difficulty in conception, and the corresponding OR for seromucinous cysts was 17.7 (95% confidence interval 4.2, 83.8). The risk of seromucinous benign ovarian tumours is greater in more educated women and in women with a history of infertility and with long or irregular menstrual cycles.
International Journal of Cancer Journal International Du Cancer, Nov 15, 1994
The association between a family history of endometrial, breast and ovarian cancer and the risk o... more The association between a family history of endometrial, breast and ovarian cancer and the risk of endometrial cancer was analyzed on the basis of data from a case-control study conducted in northern Italy between I983 and 1993. A total of 726 histologically confirmed endometrial-cancer patients (median age 61) admitted to a network of general and teaching hospitals in the Greater Milan area were interviewed. The controls were 2,123 women (median age 59), admitted for acute, non-neoplastic, non-hormone-related diseases to the same network of hospitals where the cases had been identified, with admission diagnoses unrelated to any of the known or suspected risk factors for endometrial cancer. Among cases, 37 (5. I TO) reported a history of endometrial cancer in first-degree relatives. The corresponding figure among controls was 77 (3.6%). In comparison with women with no family history of endometrial cancer, the odds ratio (OR) of endometrial cancer was I .5 (95% CI [confidence interval], I .O-2.3) in women with a history of endometrial cancer in first-degree relatives. N o relation emerged between endometrial cancer and a family history of breast or ovarian cancer. These results suggest that a family history of endometrial cancer increases the risk of contracting the same disease. However, the proportion of cases attributable to this factor was small: less than I% of endometrial cancers in this population were attributable to familial (and hence potentially genetic) factors.
International Journal of Cancer
An inverse association between smoking and endometrial cancer has generally been observed, primar... more An inverse association between smoking and endometrial cancer has generally been observed, primarily among current smokers. To assess this association, we analyzed data from the prospective Nurses' Health Study. From 1976 to 2000, 702 cases of invasive endometrial cancer were identified during 1.8 million person-years of follow-up. Smoking status was assessed in 1976 and updated every 2 years. Cox proportional hazards models were used to calculate multivariate relative risks (RRs), controlling for endometrial cancer risk factors. Compared to never smokers, the multivariate RR of endometrial cancer was significantly lower among both current smokers (RR ؍ 0.63; 95% CI ؍ 0.50 -0.79) and past smokers (RR ؍ 0.73; 95% CI ؍ 0.62-0.87). When additionally adjusting for body mass index (BMI), the RR for current smokers was attenuated (RR ؍ 0.72; 95% CI ؍ 0.57-0.90), but the RR for past smokers did not change. Risk was lower among women who smoked 35 or more cigarettes a day (RR ؍ 0.60; 95% CI ؍ 0.39 -0.91) and among those who smoked for 40 or more years (RR ؍ 0.63; 95% CI ؍ 0.45-0.87). Tests for trend, which excluded never smokers, were not statistically significant for any of the smoking variables analyzed. These data indicate that both current and past smoking are associated with a lower risk of endometrial cancer. The findings provide insight into disease etiology and suggest that the influence of smoking on endometrial cancer risk occurs even in early adulthood, is long-lasting, and may not be attributed solely to short-term hormonal modulation.
Nutrition and Cancer, 1995
Using data from a case-control study conducted in Northern Italy, we analyzed the relation betwee... more Using data from a case-control study conducted in Northern Italy, we analyzed the relation between alcohol drinking and risk of endometrial cancer. Cases were 726 patients, < 75 years of age, admitted to the Ospedale Maggiore (including the 4 largest teaching and general hospitals in the Greater Milan area), the University Obstetrics and Gynecology Clinics, and the National Cancer Institute of Milan with histologically confirmed endometrial cancer. Controls were 2,123 nonhysterectomized patients, < 75 years of age, admitted for acute nongynecological non-hormone-related nonneoplastic conditions to the same network of hospitals where cases had been identified. When total consumption of all alcoholic beverages was considered, 68.2% of cases and 63.9% of controls were drinkers and 12% of cases and 9.3% of controls reported > or = 2 drinks/day. Considering total alcohol drinking, the relative risk for alcohol drinkers vs. nondrinkers was 1.3 (95% confidence interval 1.1-1.5), and the RR estimates for subsequent levels of intake were 1.1, 1.4, and 1.6 for women drinking > 0 < or = 1, > 1 < or = 2 drinks/day (chi 2(1) trend 11.33, p < 0.001). The estimates were similar when wine only (which represents the large majority of all alcohol intake in Italy) was considered, whereas data were less informative for beer and spirits intake only. No relation emerged between duration of alcohol consumption and risk of endometrial cancer. These findings suggest a potential link between alcohol drinking and endometrial cancer risk and are, in any case, inconsistent with a protective role of alcohol in endometrial carcinogenesis.(ABSTRACT TRUNCATED AT 250 WORDS)
International Journal of Gynecological Cancer, 2002
We analyzed epidemiologic characteristics of women at risk for endometrial hyperplasia (EH), usin... more We analyzed epidemiologic characteristics of women at risk for endometrial hyperplasia (EH), using data from a case-control study. One hundred twenty nine women aged 35-73 (median 51 years) with histologically confirmed complex endometrial hyperplasia without atypies identified at the University of Milan during the period 1990-99 were examined. Controls were 258 non hysterectomized women aged 36-74 (median 52 years), admitted to a network of hospitals covering the same area where cases had been identified for conditions other than gynecological, malignant, or hormone-related. Cases with EH were more educated than controls (OR &amp;gt; 12 years of education vs. &amp;lt; 7: 2.8, 95% CI 1.7-4.8), more frequently obese (OR 2.7, 95% CI 1.5-5.0) and diabetic (OR 2.4, 95% CI 0.8-6.9). Parous women (OR 1.8) and women reporting induced abortions (OR 1.6) showed an increased risk of EH, but the associations were not statistically significant. Compared to premenopausal women, the OR of EH was 0.2 (95% 0.1-0.5) for postmenopausal ones. Compared to women reporting menopause at age 50 or less, the OR of endometrial hyperplasia was 1.5 (95% CI 0.6-3.5) and 2.2 (95%CI 0.7-6.7), respectively, in women with menopause at age 50-52 and &amp;gt; or = 53. Considering postmenopausal women only the OR was 3.1 (95% CI 1.1-9.3) for use of hormonal replacement therapy (HRT). We conclude that this study indicates that high education, obesity, diabetes, and HRT use increase the risk of endometrial hyperplasia.
International Journal of Cancer, 1994
The association between a family history of endometrial, breast and ovarian cancer and the risk o... more The association between a family history of endometrial, breast and ovarian cancer and the risk of endometrial cancer was analyzed on the basis of data from a case-control study conducted in northern Italy between I983 and 1993. A total of 726 histologically confirmed endometrial-cancer patients (median age 61) admitted to a network of general and teaching hospitals in the Greater Milan area were interviewed. The controls were 2,123 women (median age 59), admitted for acute, non-neoplastic, non-hormone-related diseases to the same network of hospitals where the cases had been identified, with admission diagnoses unrelated to any of the known or suspected risk factors for endometrial cancer. Among cases, 37 (5. I TO) reported a history of endometrial cancer in first-degree relatives. The corresponding figure among controls was 77 (3.6%). In comparison with women with no family history of endometrial cancer, the odds ratio (OR) of endometrial cancer was I .5 (95% CI [confidence interval], I .O-2.3) in women with a history of endometrial cancer in first-degree relatives. N o relation emerged between endometrial cancer and a family history of breast or ovarian cancer. These results suggest that a family history of endometrial cancer increases the risk of contracting the same disease. However, the proportion of cases attributable to this factor was small: less than I% of endometrial cancers in this population were attributable to familial (and hence potentially genetic) factors.
Gynecologic Oncology, 1995
To determine the relationship between cigarette smoking and endometrial cancer, we conducted a ca... more To determine the relationship between cigarette smoking and endometrial cancer, we conducted a case-control study. The cases were 726 patients with histologically confirmed endometrial cancers 74 years of age or less (median age, 59 years; range, 31-74) admitted between 1983 and 1992 to the Ospedale Maggiore (including the four largest teaching and general hospitals in the greater Milan area), to the Obstetrics and Gynecology University Clinics, and to the National Cancer Institute of Milan. The controls were 1452 patients younger than 75 years (median age, 59; range, 25-74) admitted for acute, nongynecological, nonhormonal, nonneoplastic conditions to the same network of hospitals where cases had been identified. Cases were less frequently ever-smokers (19%) than controls (25%). In comparison with never-smokers, the relative risk (RR) of endometrial cancer was 0.8 (95% confidence interval, CI, 0.7-1.1) in current smokers and 0.6 (95% CI 0.4-0.9) in ex-smokers. The risk of endometrial cancer decreased with number of cigarettes smoked per day and duration of habit. The estimated RR were, in comparison with never-smokers, 0.8 and 0.6 respectively in smokers of less than 20 and 20 or more cigarettes per day (chi 2(1) trend 5.48, P = 0.02) and 1.0 and 0.5 in ever-smokers for less than 20 and for 20 years or more. There was no clear relation with time since first smoking, but the RR was lower in ex-smokers who had stopped smoking less than 10 years before the interview (RR, 0.4; 95% CI, 0.2-0.8) than in those who had stopped 10 years or more before (RR, 0.8; 95% CI, 0.5-1.4). The estimated RR for ever-smokers was close to unity in premenopausal women, but apparently stronger in premenopause. Likewise the RR was 0.9 in lean (< 25 Quetelet's index) smoking women in comparison with lean nonsmokers, but smoking appeared to reduce the association with overweight. The estimated RR of endometrial cancer, in comparison with nonsmokers with Quetelet's index < 25 was 2.0 in nonsmokers with Quetelet's index > or = 25, and 1.3 in smokers with Quetelet's index > or = 25. These findings confirm the role of smoking on endometrial cancer risk. The risk reduction is, however, moderate in relative terms, and negligible from a public health point of view, in consideration of the negative consequences of smoking in several other diseases.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2000
Objective: This is a randomized clinical trial comparing estroprogestin (E / P) pill given for 12... more Objective: This is a randomized clinical trial comparing estroprogestin (E / P) pill given for 12 months vs. gonadotrophin releasing hormone agonist (GNRHa) given for 4 months followed by E / P pill treatment for 8 months in the relief of endometriosis-related pelvic pain. Methods: Eligible for the study were women with laparoscopically confirmed endometriosis and pelvic pain lasting 3-12 months after diagnosis. Eligible women were randomly assigned to treatment with E / P pill (gestroden 0.75 mg and ethynlestradiol 0.03 mg) for 12 months (47 patients) vs. tryptorelin 3.75 mg slow release every 28 days for 4 months followed by E / P pill for 8 months (55 patients). Results: At baseline, dysmenorrhea was reported in 46 women allocated to E / P pill only (97.9%), and in all the 55 women allocated to GNRHa1E / P pill. The corresponding value at the 12 months follow-up visit was 14 subjects (35.9%) and 16 subjects (34.8%). The baseline median values of the multidimensional and analog scale were for dysmenorrhea 4 and 6 in the EP only and 3 and 6 in the GNRHa1E / P group. The corresponding value at the 12 months follow-up visit were 2 and 6 and 0 and 5. Non-menstrual pain was reported, respectively, at baseline and 12 month visit by 46 (97.9%) and 15 (38.5%) subjects in the E / P pill group and 49 (89.1%) and 17 (37.0%) of the GNRHa1E / P pill one. The baseline median values of the multidimensional and analog scale were for non-menstrual pain 3 and 5 in the E / P only and 2 and 6 in the GNRHa1E / P group. The corresponding values at the 12 month follow-up visit were 0 and 4 and 0 and 4. These differences between the two groups were not statistically significant. Conclusions: 1 year after randomization, the two treatment schedules show similar relief of pelvic pain in women with endometriosis.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2005
Objective: To analyse the frequency and the determinants of recurrence rate of clinically detecta... more Objective: To analyse the frequency and the determinants of recurrence rate of clinically detectable endometriosis. Study design: Prospective cohort multicenter study. Eligible for the study were all women observed for the first time during the period January-June 1998 at the participating centres with a laparoscopically confirmed first diagnosis of endometriosis. After diagnosis, patients were treated according to standard care of each centre and desire for pregnancy. The protocol required all women to be followed up at the centre each year for 2 years with a clinical examination, an ultrasound pelvic examination and a CA125 assay, unless pregnancy occurred. Second look laparoscopy was performed on a clinical basis. Results: A total of 311 women (median age 36 years) entered the study. The two-year recurrence rate was 5.7% among cases stage I-II and 14.4% among stage III-IV (x 2 1 adjusted for indication for surgery, p < 0.05). The recurrence rates tended to increase with age, being 4.6% among women aged 20-30 and 13.1% among women aged >30, but this finding was not statistically significant. Conclusion: The recurrence rate of clinically detectable endometriosis tends to be higher in older women with advanced stages of the disease and lower in women with infertility.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2005
Objective: To obtain data on the relation between age, menopause and homocysteine levels in women... more Objective: To obtain data on the relation between age, menopause and homocysteine levels in women around menopause, we collected data for a sample of about 500 women attending a menopause clinic in Milan, Italy. Study design: Eligible for the study were all women aged 45-75 years, never HRT users consecutively observed for the first time at the Menopause Center of the 1st Obstetric Gynecological Clinic of the University of Milan. Fasting blood samples for total homocysteine plasma levels were collected during the visit. Of the 490 study subjects, 107 were pre-menopausal and 383 post-menopausal. Results: In the total series, the mean homocysteine level was 8.3 mmol/L (S.D. 3.7, range 3.2-48.8). The values increased from 7.8 mmol/L in women aged <47 years to 9.0 mmol/L in those aged >59. Among pre-menopausal women the mean homocysteine level was 7.7 mmol/L compared to 8.
European Journal of Cancer, 1997
To investigate the role of selected medical conditions on the risk of ovarian cancer, we analysed... more To investigate the role of selected medical conditions on the risk of ovarian cancer, we analysed data from a case-control study. Cases were 971 women below the age of 75 years with histologically confirmed epithelial ovarian cancer, admitted to a network of hospitals including the major teaching and general hospitals in the greater Milan area. Controls were 2758 women admitted to the same network of hospitals for acute, non-gynaecological, non-hormone related, non-neoplastic conditions. Obesity/severe overweight were inversely associated with the risk of ovarian cancer (multivariate relative risk, RR, 0.66, 95% confidence interval, CI, 0.52-0.85). Hyperlipidaemia was also inversely related to ovarian cancer risk, (RR 0.64, 95% CI 0.45-0.89). No relationship emerged between ovarian cancer risk and diabetes (RR 0.80, 95% CI 0.54-1.19), hypertension (RR 0.85, 95% CI 0.68-1.06), thyroid diseases (RR 0.89, 95% CI 0.63-1.13) and cholelithiasis (RR 0.86, 95% CI 0.66-1.12). A decreased frequency of ovarian cancer was seen in women with a history of uterine leiomyomas (RR 0.66, 95% CI 0.47-0.92) and benign ovarian cysts (RR 0.69, 95% CI 0.41-1.13).
Epidemiology, 1996
We evaluated risk factors for functional ovarian cysts using data from a case-control study condu... more We evaluated risk factors for functional ovarian cysts using data from a case-control study conducted in Milan. Cases were 68 women with histologically confirmed functional cysts. Controls were 272 women admitted to hospital for acute conditions. Compared with women who were 11 years of age or younger at menarche, women who experienced menarche at 12-13 years or at 14 years or later had odds ratios (ORs) of 0.9 [95% confidence interval (CI) = 0.5-1.6] and 0.4 (95% CI = 0.2-0.9). In comparison with women reporting menstrual cycles lasting less than 26 days, the OR was 1.8 (95% CI = 0.7-5.0) in women reporting cycles lasting 26-30 days, 1.8 (95% CI = 0.4-7.4) in those reporting cycles greater than 30 days, and 1.9 (95% CI = 0.4-7.7) in those with totally irregular cycles. Body mass was inversely related to the risk of functional ovarian cysts: compared with women with a Quetelet index below 20, the OR was 0.9 (95% CI = 0.5-1.7) in those with an index in the range from 20-24 and 0.5 (95% CI = 0.2-1.2) in those with an index of 25 or more. We found little relation between the risk of functional ovarian cysts and education, smoking, marital status, or age at first marriage. For oral contraceptive use, we found an OR of 1.3 (95% CI = 0.7-2.6).
Cancer, 1995
A case-control study was conducted to analyze the association between body mass, selected indicat... more A case-control study was conducted to analyze the association between body mass, selected indicator food intake, and vulvar cancer risk. The patients included in this report were 125 women aged 80 years or younger with histologically confirmed diagnosis of invasive vulvar cancer who were admitted to a network of general and teaching hospitals in the greater Milan area. Control subjects were 541 patients admitted to teaching and general hospitals in Milan for acute conditions. The risk of vulvar cancer was inversely related to green vegetable and carrot consumption, the corresponding multivariate relative risks for lowest versus highest levels of intake being 2.0 (95% confidence interval [CI], 1.2-3.4) and 1.4 (95% CI, 0.9-2.2). The trend in risk was significant for green vegetables. No consistent association emerged between milk, meat, liver, alcohol and coffee consumption and risk of vulvar cancer. In comparison with leaner women, the relative risks of vulvar cancer were 1.8, 1.9, 2.8, and 2.9 in progressively higher quintiles of the body mass index, and the trend in risk was significant. These data indicate that the risk of vulvar cancer is related to a number of nutritional and dietary factors. This is of particular interest, because vulvar cancer is a relatively rare neoplasm, whose etiology is still poorly understood, and on which only a few epidemiologic studies have been conducted.
BMJ, 1997
To examine any possible links between exposure to DDE (1,1-dichloro-2,2-bis (p-chlorophenyl)ethyl... more To examine any possible links between exposure to DDE (1,1-dichloro-2,2-bis (p-chlorophenyl)ethylene), the persistent metabolite of the pesticide dicophane (DDT), and breast cancer. Design: Multicentre study of exposure to DDE by measurement of adipose tissue aspirated from the buttocks. Laboratory measurements were conducted in a single laboratory. Additional data on risk factors for breast cancer were obtained by standard questionnaires. Setting: Centres in Germany, the Netherlands, Northern Ireland, Switzerland, and Spain. Subjects: 265 postmenopausal women with breast cancer and 341 controls matched for age and centre. Main outcome measure: Adipose DDE concentrations. Results: Women with breast cancer had adipose DDE concentrations 9.2% lower than control women. No increased risk of breast cancer was found at higher concentrations. The odds ratio of breast cancer, adjusted for age and centre, for the highest versus the lowest fourth of DDE distribution was 0.73 (95% confidence interval 0.44 to 1.21) and decreased to 0.48 (0.25 to 0.95; P for trend = 0.02) after adjustment for body mass index, age at first birth, and current alcohol drinking. Adjustment for other risk factors did not materially affect these estimates. Conclusions: The lower DDE concentrations observed among the women with breast cancer may be secondary to disease inception. This study does not support the hypothesis that DDE increases risk of breast cancer in postmenopausal women in Europe.
ACOG Clinical Review, 1998