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BACKGROUND: The study of the distribution of brain cancer mortality in Spain shows a grouping of highest risk provinces corresponding to the autonomous regions of Navarre and the Basque Country. AIM: To explore the possible existence of geographical patterns in these areas. METHODS: Municipal maps of brain cancer incidence were drawn up and the influence of land use related variables on the distribution of the disease duly analysed. Autoregressive conditional models were used to plot smoothed municipal maps. The influence of explanatory land use variables, ascertained by remote sensing, was assessed. RESULTS: The maps revealed that certain towns situated in the "Media" and "Cantábrica-Baja Montaña" districts of Navarre were areas of highest risk. Among the towns in question, those in the "Media" district lie very close to the city of Pamplona. However, the pattern of brain cancer incidence in Navarre and the Basque Country could not be conclusively said to be determined by any specific type of land cover and/or crop. CONCLUSIONS: Results suggest a possible increase of risk linked to areas devoted to a high percentage of non-irrigated arable land.

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The association between coffee consumption and bladder cancer was investigated in a multi-centre case-control study conducted in Spain from 1983 to 1986. A total of 497 cases (438 male and 59 female) with histopathologically confirmed bladder cancer were used in the analysis along with 566 hospital controls and 547 population controls. Odds ratios (OR), adjusted for age, province of residence, occupations at risk, consumption of artificial sweeteners and cigarette smoking, did not show any association between coffee consumption and bladder cancer for either sex. However, in non-smokers and mainly in males, for current coffee drinkers the OR was 2.78 (95% [Cl]: 0.78-9.87), while for drinkers of 2-7, 8-14 and > or = 15 cups/week the respective OR were 2.22, 3.11 and 1.87 with a dose-response relationship for lifelong consumption and years of exposure to regular coffee consumption. The OR in male non-smokers and current coffee drinkers were 2.36 (95% Cl: 0.62-9.05) with population controls only and 1.94, 2.58 and 1.48 for the corresponding levels of intensity of consumption (cups/week). The associations observed in non-smokers suggest the existence of a possible association between coffee consumption and bladder cancer, but are based on small numbers and need to be confirmed in larger studies.

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BACKGROUND: Given the importance of ischemic cardiopathy (IC) as a cause of death in industrialized countries, the trend of mortality by IC in people from 30 to 69 years of age residing in the Basque Country between 1975-1990 were studied. Furthermore, the evolution of the mortality by cardiac diseases and by other causes which may compete with IC in the certification or coding of the cause of death was studied. METHODS: The rate of mortality standardized by age by the direct methods were estimated from data from the Natural Movement of Population. The trend was graphically studied and quantified by means of the percentage difference between the rates. RESULTS: Mortality by IC decreased between 1975-1990 by 37% in men and 46% in women with a mean annual percentage decrease of 2.8% and 2.9%, respectively. Mortality by cardiac disease decreased 34% in men and 52% in women. CONCLUSIONS: Mortality by ischemic cardiopathy in the Basque Country has significantly decreased in both sexes. This decrease is not explicable by possible changes over the years in the practises of certification or coding of the cause of death.

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The association between tobacco smoking and bladder cancer was investigated in a multicenter case-control study conducted in five provinces of Spain between 1983 and 1986. A matched analysis was carried out in males, based on 430 histologically confirmed cases, 405 hospital controls, and 386 population controls, matched by age and place of residence. An increased risk was found for smokers as compared with nonsmokers (odds ratio (OR) = 3.79, 95% confidence intervals (CI) 2.41-5.97), and this increase was significantly associated with the intensity of smoking. Smokers of filter-tipped cigarettes had a reduced risk as compared with smokers of non-filter-tipped cigarettes (OR = 0.57, 95% CI 0.32-1.02). A diminution of risk was also observed for smokers of low-tar and low-nicotine ("light") cigarettes. Depth of inhalation was strongly associated with illness. No difference was shown in the logistic regression model between smokers of black tobacco and smokers of blond tobacco after controlling for depth of inhalation. Although the number of persons who smoked blond tobacco exclusively was small, the results suggest that it is important to consider inhalation patterns when studying risk variations between smokers of black tobacco and smokers of blond tobacco. The age at which a person started to smoke did not appear to affect risk. An analysis of the decrease in risk associated with years since quitting smoking suggested that different components of cigarette smoke may play a role at different stages of the carcinogenic process.

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A multi-centre case-control study on bladder cancer and diet was carried out in 5 regions of Spain. We report results on 432 male cases and 792 matched controls. Usual dietary habits were investigated by means of an interview-based dietary history questionnaire. Bladder-cancer cases were selected from the registers of 12 hospitals located in the study areas. Each case was matched by sex, age and area of residence to 2 controls, one identified in the same hospital and one drawn from population lists. Descriptive analyses indicated that the average dietary pattern was typical of Mediterranean populations: a high P/S ratio, high intake of fish, fruits and vegetables and moderate or low intake of meat and dairy products. Relative risks for specific foods and nutrients were adjusted for tobacco smoking and energy intake. Subjects in the highest quarter of intake of saturated fat had a significantly increased risk of bladder cancer (RR for highest quarter = 2.25; 95% CI = 1.42 to 3.55). Moderate increases in risk for high intake of mono-unsaturated fats and calcium, and a slight decrease for iron were also found, but these disappeared after adjustment for saturated fat. Intake of vitamin E was related to slightly reduced risk (RR for highest quarter = 0.72; 95% CI = 0.48 to 1.09) which was not modified by adjustment for fat. No association was found with intake of retinol or carotene. These results, along with those of previous studies, suggest that saturated fat intake may influence the occurrence of bladder cancer.

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A case-control study on bladder cancer was carried out in 12 hospitals located in 4 regions of Spain. The study included 497 cases and 530 population controls, matched by sex, age and residence. The present paper reports the results regarding the risk for bladder cancer in relation to history of infections and lithiasis of the urinary tract. Increased risk was found for infections starting 4 years or less before diagnosis (OR = 15.00; 95% CL: 6.07-51.66) but no statistically significant increase in risk was observed for infections starting 5 or more years before (OR = 1.44; 95% CL: 0.86-2.47). Our data suggest that the association of urinary infections with bladder cancer is probably not causal and is more likely to be a consequence of cancer, although a weak causal association cannot be excluded. A small but not statistically significant increase in risk was found to be associated with a history of renal lithiasis.

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A case-control study on bladder cancer was carried out in four regions of Spain. The study included 497 cases (438 males and 59 females), 583 hospital controls and 530 population controls matched by sex, age and residence. The present paper reports the results of the analyses on occupational history. Among men, an increased risk of bladder cancer was found for textile workers (OR = 1.97, 95% CL 1.2-3.3), mechanics and maintenance workers (OR = 1.86, 95% CL 1.2-2.8), workers in the printing industry (OR = 2.06, 95% CL 1.0-4.3) and for managers (OR = 2.03, 95% CL 1.2-3.5). The risk was highest among those first employed in the textile industry before the age of 25 and prior to 1960. Among mechanics the risk was highest for those who started after the age of 25 and later than 1960. The OR for smokers who had also been employed in one of the high risk occupations was 7.82 (95% CL 4.4-14.0) which is compatible with a multiplicative effect of joint exposure to tobacco and occupational hazards.

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The aim of a case-control design is to make a measurement of the highest possible accuracy, reducing to a minimum the possible selection, information and confusion biases. The design, methods and procedures of a multicentric study carried out in 14 hospitals from 4 autonomous communities in Spain are discussed. Overall 254 incident cases, 243 prevalent cases, 583 hospital controls and 530 population controls were included. The proportion of nonresponders was somewhat higher in population controls, particularly in large cities. Statistically significant differences between cases and controls were not found for socioeconomic levels, educational level, number of jobs, degree of response, duration of the interview, and errors of transcription and codification of information. Also, significant differences were not found between the population and hospital controls regarding diet habits and cigarette smoking. It is considered that a non-biased measurement of the association can be obtained from cases and hospital controls. The collected information was satisfactory. In spite of the lack of adequate facilities for research in hospitals, the development of multicentric etiologic studies is feasible.

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This report discusses the methodology and main findings of the Atlas of Cancer Mortality in Spain with special reference to some major forms of cancer. The mortality for all cancers and specifically lung cancer, for both sexes, is highest in the peripheral regions of Spain. This agrees basically with the level of urbanization and industrialization which has developed during the past several decades. Madrid is the outstanding exception to these relationships. The mortality pattern for stomach cancer is directly opposite to that of lung cancer, the more rural inland provinces having higher mortalities and most Mediterranean provinces showing lower mortalities. For breast cancer areas of higher mortality are some northern and some Mediterranean provinces. A similar pattern is shown by other uterus cancer with areas of higher mortality in the Mediterranean provinces. Considered individually, the province of Cádiz shows the greatest risk of death from cancer, being ranked first for the following cancers: lung, oral cavity and pharynx, esophagus, larynx, and prostate for males and esophagus, other uterus, and bone for females. All these findings definitely produce more questions than answers. Future research on analytical epidemiology of cancer in Spain is strongly recommended.

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This report presents the results of an epidemiologic case-control study. The study includes 58 cases and 116 controls from both sexes, selected from the Admission Register of the Hospital and from the Death Registry Office of the local city authorities. Controls have been matched to cases by age, sex, place of residence and source of selection. The results demonstrated no increased risk associated with coffee consumption. Habitual smokers present a 2.3 times higher risk than nonsmokers. The estimated relative risk for occupation standardized by age and smoking habit, is 5.5. A multiplicative effect of the simultaneous action of smoking and occupational exposure has been observed to be an estimated relative risk of 11.7. The attributable risk of the population has been estimated to be 39% for smokers and 12% for occupational exposure. A strong association was found between bladder cancer and occupational exposure to carcinogenic substances, especially in the dye and print textile industries.

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