Abstract
Purpose
Different prostate cancer mortality rates observed in European countries may depend on cultural background. We aimed at exploring variation in prostate cancer mortality in the language regions of Switzerland as a function of “Italianity”, a proxy for adherence to an Italian lifestyle.
Methods
We used data of the Swiss National Cohort, a census-based record linkage study, consisting of census (1990 and 2000) and mortality (until 2008) data. 1,163,271 Swiss and Italian nationals 40+-year old were included. Multivariate age-standardized prostate cancer mortality rates and hazard ratios (HR) from Cox proportional hazards regression analysis were performed. Italianity was defined by an individual’s nationality, place of birth and principal language, resulting in a score of 0–3 points.
Results
Age-standardized prostate cancer mortality rates (per 100,000 person-years) were lowest in the Italian-speaking region of Switzerland (66.7 vs. 87.3 in the German-speaking region). Both Italian nationality and/or place of birth were significantly associated with lower mortality. There was a graded inverse association between mortality rates and increasing Italianity score. Individuals with the highest level of Italianity had a HR of 0.67 (95 % CI 0.59–0.76) compared to those with an Italianity score of zero. Results were similar when looking at language regions separately.
Conclusions
The strong and consistent association between Italianity and prostate cancer mortality suggests protective properties of an Italian lifestyle. Further research is required in order to determine which factors specific for Italian culture are responsible for the lower prostate cancer mortality.
Similar content being viewed by others
References
Bray F, Lortet-Tieulent J, Ferlay J, Forman D, Auvinen A (2010) Prostate cancer incidence and mortality trends in 37 European countries: an overview. Eur J Cancer 46(17):3040–3052. doi:10.1016/j.ejca.2010.09.013
Ferlay J, Parkin DM, Steliarova-Foucher E (2010) Estimates of cancer incidence and mortality in Europe in 2008. Eur J Cancer 46(4):765–781. doi:10.1016/j.ejca.2009.12.014
Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JW, Comber H, Forman D, Bray F (2013) Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 49(6):1374–1403. doi:10.1016/j.ejca.2012.12.027
DeMarzo AM, Nelson WG, Isaacs WB, Epstein JI (2003) Pathological and molecular aspects of prostate cancer. Lancet 361(9361):955–964. doi:10.1016/S0140-6736(03)12779-1
Gronberg H (2003) Prostate cancer epidemiology. Lancet 361(9360):859–864. doi:10.1016/S0140-6736(03)12713-4
Frankel S, Smith GD, Donovan J, Neal D (2003) Screening for prostate cancer. Lancet 361(9363):1122–1128. doi:10.1016/S0140-6736(03)12890-5
Gunderson K, Wang CY, Wang R (2011) Global prostate cancer incidence and the migration, settlement, and admixture history of the Northern Europeans. Cancer Epidemiol 35(4):320–327. doi:10.1016/j.canep.2010.11.007
Leitzmann MF, Rohrmann S (2012) Risk factors for the onset of prostatic cancer: age, location, and behavioral correlates. Clin Epidemiol 4:1–11. doi:10.2147/CLEP.S16747
Dehler S, Rohrmann S, Lorez M, Clough-Gorr K (2013) Trends in prostate cancer survival in Switzerland. Schweiz Krebsbulletin 1:54–58
Bundesamt für Statistik (2013) Prostatakrebs. http://www.bfs.admin.ch/bfs/portal/de/index/themen/14/02/05/key/02/06.html
Bundesamt für Statistik (2005) Eidgenössische Volkszählung 2000. Abschlussbericht zur Volkszählung 2000. Neuchâtel
Bopp M, Spoerri A, Zwahlen M, Gutzwiller F, Paccaud F, Braun-Fahrlander C, Rougemont A, Egger M (2009) Cohort profile: the Swiss National Cohort—a longitudinal study of 6.8 million people. Int J Epidemiol 38(2):379–384. doi:10.1093/ije/dyn042
Bundesamt für Statistik (2013) Internationale Klassifikation der Krankheiten (ICD). http://www.bfs.admin.ch/bfs/portal/de/index/infothek/nomenklaturen/blank/blank/cim10/02/01.html
Swiss Federal Statistical Office (1979) Statistisches Jahrbuch der Schweiz 1979. Birkhäuser Verlag, Basel
Fine JP, Gray RJ (1999) A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 94(446):496–509. doi:10.2307/2670170
Faeh D, Minder C, Gutzwiller F, Bopp M (2009) Culture, risk factors and mortality: can Switzerland add missing pieces to the European puzzle? J Epidemiol Community Health 63(8):639–645. doi:10.1136/jech.2008.081042
Tarnutzer S, Bopp M (2012) Healthy migrants but unhealthy offspring? A retrospective cohort study among Italians in Switzerland. BMC Public Health 12:1104. doi:10.1186/1471-2458-12-1104
Khlat M, Darmon N (2003) Is there a Mediterranean migrants mortality paradox in Europe? Int J Epidemiol 32(6):1115–1118
Geddes M, Balzi D, Buiatti E, Brancker A, Parkin DM (1994) Cancer mortality in Italian migrants to Canada. Tumori 80(1):19–23
Geddes M, Parkin D, Khlat M, Balzi D, Buiatti E (1993) Cancer in Italian migrant populations. IARC, Lyon
Bundesamt für Statistik (2011) Krebs in der Schweiz. Stand und Entwicklung von 1983-2007. Neuchâtel
Ilic D, Neuberger MM, Djulbegovic M, Dahm P (2013) Screening for prostate cancer. Cochrane Database Syst Rev 1:CD004720. doi:10.1002/14651858.CD004720.pub3
Powell IJ, Bollig-Fischer A (2013) Minireview: the molecular and genomic basis for prostate cancer health disparities. Mol Endocrinol 27(6):879–891. doi:10.1210/me.2013-1039
World Cancer Research Fund/American Institute for Cancer Research (2007) Food, nutrition, physical activity, and the prevention of cancer: a global perspective. AICR, Washington, DC
Food and Agriculture Organization of the United Nations—FAOSTAT (last accessed at September 27, 2013) Food Balance Sheets. http://faostat3.fao.org/home/index.html#DOWNLOAD
von Karstedt L (2004) Sprache und Kultur - Eine Geschichte der deutschsprachigen Ethnolinguistik. Universität Hamburg, Hamburg
Lopez-Class M, Castro FG, Ramirez AG (2011) Conceptions of acculturation: a review and statement of critical issues. Soc Sci Med 72(9):1555–1562. doi:10.1016/j.socscimed.2011.03.011
Lutz JM, Pury P, Fioretta G, Raymond L (2004) The impact of coding process on observed cancer mortality trends in Switzerland. Eur J Cancer Prev 13(1):77–81
Braveman PA, Cubbin C, Egerter S, Chideya S, Marchi KS, Metzler M, Posner S (2005) Socioeconomic status in health research: one size does not fit all. JAMA 294(22):2879–2888. doi:10.1001/jama.294.22.2879
Berrino F, Gatta G (1989) Energy-rich diet and breast cancer risk. Int J Cancer 44(1):186–187
Acknowledgments
The authors thank the Swiss Federal Statistical Office for providing mortality and census data and for the support, which made the Swiss National Cohort and this study possible. The members of the Swiss National Cohort Study Group are Matthias Egger (Chairman of Executive Board), Adrian Spoerri, Marcel Zwahlen (all Bern), Milo Puhan (Chairman of Scientific Board), Matthias Bopp (both Zurich), Nino Künzli (Basel), Fred Paccaud (Lausanne) and Michel Oris (Geneva). This work was supported by the Swiss National Science Foundation (Grants 3347CO-108806 and 33CS30-134273) and Uniscientia Stiftung.
Conflict of interests
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Additional information
For the Swiss National Cohort Study Group.
Rights and permissions
About this article
Cite this article
Richard, A., Faeh, D., Rohrmann, S. et al. Italianity is associated with lower risk of prostate cancer mortality in Switzerland. Cancer Causes Control 25, 1523–1529 (2014). https://doi.org/10.1007/s10552-014-0456-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10552-014-0456-5