There is a ~2-fold difference in GC risk between a 'Prudent/healthy' diet-rich in fruits and vegetables, and a 'Western/unhealthy' diet-rich in starchy foods, meat and fats.

Low socioeconomic status has been reported to be associated with head and neck cancer risk. However, previous studies have been too small to examine the associations by cancer subsite, age, sex, global region and calendar time and to explain the association in terms of behavioral risk factors. Individual participant data of 23,964 cases with head and neck cancer and 31,954 controls from 31 studies in 27 countries pooled with random effects models. Overall, low education was associated with an increased risk of head and neck cancer (OR = 2.50; 95% CI = 2.02 – 3.09). Overall one-third of the increased risk was not explained by differences in the distribution of cigarette smoking and alcohol behaviors; and it remained elevated among never users of tobacco and nondrinkers (OR = 1.61; 95% CI = 1.13 – 2.31). More of the estimated education effect was not explained by cigarette smoking and alcohol behaviors: in women than in men, in older than younger groups, in the oropharynx than in other sites, in South/Central America than in Europe/North America and was strongest in countries with greater income inequality. Similar findings were observed for the estimated effect of low versus high household income. The lowest levels of income and educational attainment were associated with more than 2-fold increased risk of head and neck cancer, which is not entirely explained by differences in the distributions of behavioral risk factors for these cancers and which varies across cancer sites, sexes, countries and country income inequality levels.

Available information on dietary patterns (multiple dietary components operationalized as a single exposure) and cancer is still sparse. This review presents papers published to date that have identified dietary patterns according to all the existing approaches and have assessed their association with breast cancer. Nineteen articles published since 1995 were identified based on studies conducted in various populations across many countries. The majority of them identified a posteriori dietary patterns, mainly using principal component factor analysis. Six studies did not find associations between any of the identified dietary patterns and breast cancer. Nine studies identified one dietary pattern significantly associated with breast cancer, and the remaining four identified two to four dietary patterns related to breast cancer. Although the body of literature has recently increased, a meaningful assessment of the association between dietary patterns and breast cancer still calls for extra effort to refine the statistical techniques and to address the issue of reproducibility of dietary patterns.

The association of colorectal cancer risk with select foods has been evaluated by dietary pattern analysis. This review of the literature was conducted to thoroughly examine the available evidence for the association between dietary patterns and colorectal cancers and adenomas. A total of 32 articles based on worldwide epidemiological studies were identified. Pattern identification was achieved by exploratory data analyses (principal component, factor, and cluster analyses) in most articles, and only a few used a priori-defined scores. Dietary patterns named as healthy, prudent, fruit and vegetables, fat-reduced/diet foods, vegetable/fish/poultry, fruit/whole grain/dairy, and healthy eating index-2005, recommended food and Mediterranean diet scores were all associated with reduced risk of colorectal cancer and the risk estimates varied from 0.45 to 0.90. In contrast, diets named Western, pork-processed meat-potatoes, meat-eaters, meat and potatoes, traditional patterns, and dietary risk and life summary scores were associated with increased risk of colorectal cancer with risk estimates varying from 1.18 to 11.7. Dietary patterns for adenomas were consistent with those identified for colorectal cancer.

Familial clustering of hepatocellular carcinoma (HCC) has been frequently reported in eastern Asiatic countries, where hepatitis B infection is common. Little is known about the relationship between family history of liver cancer and HCC in Western populations. We carried out a case-control study in Italy, involving 229 HCC cases and 431 hospital controls. Data on family history were summarized through a binary indicator (yes/no) and a family history score (FHscore), considering selected family characteristics. Odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) were obtained from unconditional multiple logistic regression models, including terms for age, sex, study center, education, tobacco smoking, alcohol drinking, hepatitis B surface antigen, and/or anti-hepatitis C virus positivity. We also performed a meta-analysis on family history of liver cancer and liver cancer updated to April 2011 using random-effects models. After adjustment for chronic infection with hepatitis B/C viruses, family history of liver cancer was associated with HCC risk, when using both the binary indicator (OR, 2.38; 95% CI, 1.01-5.58) and the FHscore, with increasing ORs for successive score categories. Compared to subjects without family history and no chronic infection with hepatitis B/C viruses, the OR for those exposed to both risk factors was 72.48 (95% CI, 21.92-239.73). In the meta-analysis, based on nine case-control and four cohort studies, for a total of approximately 3,600 liver cancer cases, the pooled relative risk for family history of liver cancer was 2.50 (95% CI, 2.06-3.03). Conclusion: A family history of liver cancer increases HCC risk, independently of hepatitis. The combination of family history of liver cancer and hepatitis B/C serum markers is associated with an over 70-fold elevated HCC risk. (HEPATOLOGY 2012;55:1416-1425 L iver cancer is a common neoplasm, which ranks sixth in terms of incidence and third in terms of mortality worldwide. 1 Most of the new cases and deaths occur in developing countries, particularly in eastern and southeastern Asia and in subSaharan Africa.2 Among Western countries, southern Europe shows the highest incidence rates of liver cancer.1 The relatively high incidence in (southern) Italy is mostly a consequence of the high prevalence of hepatitis C virus (HCV) infection in that region. 3,4 Hepatocellular carcinoma (HCC) is the most frequent histologic type of primary liver cancer.5 More than 75% of cases worldwide and 85% of cases in developing countries have been attributed to hepatitis B virus (HBV) and HCV, both of which increase the risk of HCC by approximately 20-fold. 6 Other wellrecognized risk factors for HCC are advanced age, male gender, heavy alcohol drinking, aflatoxin expo-

These findings suggest that diets rich in animal products, cereals, and fats are positively related to laryngeal cancer, and those rich in fruit and vegetables inversely related to oral and pharyngeal cancer.

The issue of diet and breast and ovarian cancers has been considered in terms of foods and nutrients, but rarely in terms of dietary patterns. We examined the associations between dietary patterns and breast and ovarian cancers in 2 Italian multicentric case-control studies. Cases were 2,569 breast cancers and 1,031 ovarian cancers hospitalized in 4 Italian areas between 1991 and 1999. Controls were 3,413 women from the same hospital network. Dietary habits were investigated through a validated food-frequency questionnaire. Dietary patterns were identified on a selected set of nutrients through principal component factor analysis. Odds ratios (OR) and 95% confidence intervals (CI) for both cancers were estimated using unconditional multiple logistic regression models on quartiles of factor scores and continuous factor scores. We identified 4 major dietary patterns named Animal products, Vitamins and fiber, Unsaturated fats and Starch-rich. The animal products pattern and the unsaturated fats pattern were inversely associated with breast cancer (OR 5 0.74, 95% CI: 0.61-0.91 and OR 5 0.83, 95% CI: 0.68-1.00, respectively, for the highest consumption quartile), whereas the starch-rich pattern was directly associated with it (OR 5 1.34, 95% CI: 1.10-1.65). The vitamins and fiber pattern was inversely associated with ovarian cancer (OR 5 0.77, 95% CI: 0.61-0.98), whereas the starch-rich pattern was directly associated with it (OR 5 1.85, 95% CI: 1.37-2.48). In conclusion, the starch-rich pattern is potentially an unfavorable indicator of risk for both breast and ovarian cancers, while the animal products and the vitamins and fiber patterns may be associated with a reduced risk of breast and ovarian cancers, respectively. ' 2007 Wiley-Liss, Inc.Key words: dietary patterns; factor analysis; nutrients; breast cancer; ovarian cancer Despite considerable research, the issue of diet and breast and other female hormone-related cancers is still open to discussion. Several studies have examined the role of selected micronutrients, macronutrients, foods, energy and alcohol intakes. [1][2][3][4][5][6][7][8][9] Apart from a consistent direct association between alcohol intake and breast cancer 10,11 most of the other relations remain controversial. Fewer investigations have addressed the role of dietary patterns. [12][13][14][15][16][17][18][19] Still, in the presence of a large number of possible, but moderate associations, the integration of several dietary exposures into single dietary patterns may overcome problems of multiple testing and high correlations between various dietary exposures. Two approaches have been used for the definition of a dietary pattern. The a posteriori approach builds only on the specific dietary data under consideration and mainly relies on principal component or factor analysis techniques. The a priori approach builds on the existing knowledge about the favorable or adverse effects of various dietary constituents. 20 We have applied exploratory factor analysis to 2 multicentric case-control studies...

Our results point to several potential cancer syndromes that appear among close relatives and may indicate the presence of genetic factors influencing multiple cancer sites.