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Background: The role of processed meat in the aetiology of squamous cell oesophageal cancer has been explored in detail., Methods: In the time period 1990-2005, a case-control study was conducted in Montevideo, Uruguay including 2,368 participants (876 cases of oesophageal cancer and 1,492 controls). Relative risks, approximated by the odds ratios, were estimated by multiple unconditional logistic regression., Results: Processed meat was positively associated with oesophageal cancer (upper quartile vs lower quartile OR 2.30, 95%CI 1.72-3.07), whereas salted meat intake was positively associated with squamous cell oesophageal cancer (OR 3.82, 95%CI 2.74-5.33). Finally other cured meats were positively associated with oesophageal cancer (OR 1.65, 95%CI 1.22- 2.22)., Conclusions: It could be concluded that processed meat consumption could be an important risk factor for the aetiology of squamous cell oesophageal cancer in Uruguay.

Background: Maté tea is a nonalcoholic infusion widely consumed in southern South America, and may increase risk of esophageal squamous cell carcinoma (ESCC) and other cancers due to polycyclic aromatic hydrocarbons (PAH) and/or thermal injury., Methods: We pooled two case-control studies: a 1988 to 2005 Uruguay study and a 1986 to 1992 multinational study in Argentina, Brazil, Paraguay, and Uruguay, including 1,400 cases and 3,229 controls. We computed ORs and fitted a linear excess OR (EOR) model for cumulative maté consumption in liters/day-year (LPDY)., Results: The adjusted OR for ESCC with 95% confidence interval (CI) by ever compared with never use of maté was 1.60 (1.2-2.2). ORs increased linearly with LPDY (test of nonlinearity; P = 0.69). The estimate of slope (EOR/LPDY) was 0.009 (0.005-0.014) and did not vary with daily intake, indicating maté intensity did not influence the strength of association. EOR/LPDY estimates for consumption at warm, hot, and very hot beverage temperatures were 0.004 (-0.002-0.013), 0.007 (0.003-0.013), and 0.016 (0.009-0.027), respectively, and differed significantly (P < 0.01). EOR/LPDY estimates were increased in younger (<65) individuals and never alcohol drinkers, but these evaluations were post hoc, and were homogeneous by sex., Conclusions: ORs for ESCC increased linearly with cumulative maté consumption and were unrelated to intensity, so greater daily consumption for shorter duration or lesser daily consumption for longer duration resulted in comparable ORs. The strength of association increased with higher maté temperatures., Impact: Increased understanding of cancer risks with maté consumption enhances the understanding of the public health consequences given its purported health benefits.

In the time period 1996-2004, all incident cases of bladder cancer were included in a case-control study in order to study the role of meat consumption and product animals in the etiology of urothelial cancer. The study included 225 cases and 1,510 hospitalized controls with non-neoplastic conditions, not related to smoking and alcohol drinking. Relative risks, approximated by the odds ratios, were calculated in order to clarify the effect of meat consumption in the etiology of urothelial cancer. Total meat consumption (OR 1.47, 95% CI 1.02-2.11), total processed meat (OR 1.57, 95% CI 1.08-2.27), frankfurters (hot dogs) (OR 2.03, 95% CI 1.28-3.21), ham (OR 1.79, 95% CI 1.21-2.67) and salted meat (OR 2.73, 95% CI 1.78-4.18) were positively associated with risk of bladder cancer. Animal products, like cheese, whole milk, and total eggs were also associated with bladder cancer risk (OR for eggs 4.05, 95% CI 2.68-6.12). In conclusion, total meat, processed meat, and eggs could play an important role in the etiology of bladder cancer in Uruguay.

Background: Oesophageal cancer presents high incidence rates in the so-called Brazilian-Uruguayan belt., Materials and Methods: The present study included 1,170 participants (234 cases and 936 controls) which were analyzed by unconditional multiple logistic regression in order to examine risk of oesophageal squamous cell carcinoma (OESCC) associated with several food groups., Results: Boiled red meat (OR 2.59, 95%CI 1.69-3.97), lamb meat (OR 1.64, 95%CI 1.07-2.51), processed meat (OR 1.49, 95%CI 1.01-2.21), whole milk (OR 1.78, 1.19-1.68), fresh vegetables and fruits (OR 0.42, 95%CI 0.27-0.63), mate consumption (OR 2.04, 95%CI 1.32- 3.16), and black tea (OR 0.10, 95%CI 0.04-0.28) were significantly associated with risk of OESCC., Conclusions: Hot beverages (mate) and hot foods (boiled meat) appear to be important determinants in the risk of OESCC, allowing the penetration of carcinogens in tobacco and alcohol into the oesophageal mucosa.

Background: In the period 1990 to 2001, a case-control study on oral cancer and maté consumption was conducted at the Cancer Institute of Uruguay., Methods: The study included 696 newly diagnosed cases with squamous cell carcinoma and 696 controls afflicted with nonneoplastic conditions not related to tobacco smoking and alcohol drinking. The participants were matched on age and residence and the study was restricted to men., Results: In order to control confounding for tobacco and alcohol, we fitted 2 models. According to model 1, the odds ratio (OR) for maté consumption was 1.15 (95% confidence interval [CI], 0.76-1.73), whereas the results for model 2 showed an OR of 3.47 (95% CI, 1.60-7.52)., Conclusions: The inclusion of a term for the interaction between maté and smoking (or drinking) was rewarding and the ORs were even higher than those observed with the crude estimates., (Copyright © 2012 Wiley Periodicals, Inc.)

Objective: The aim of this study was to investigate the association between nutrient-based dietary patterns and squamous cell cancers of the head and neck., Methods: We used a case-control study which included 548 cases and 548 controls. From these participants, we derived 23 nutrients and they were then submitted to a factorability analysis in order to conduct a principal component factor analysis., Results: We were able to identify four nutrient-derived patterns. The first pattern (meat-based pattern) was positively associated with squamous cell cancer of the head and neck (OR 2.85, 95 % CI 1.81-4.15), whereas the third pattern (fruit-based) was strongly protective (OR 0.43, 95 % CI 0.27-0.63). The other nutrient patterns were also significantly associated with head and neck squamous cell carcinoma with minor ORs., Conclusion: Both patterns suggest that red meat and fruits are major factors in the etiology of head and neck squamous cell cancer, replicating previous studies in the field.

In the time period 1996-2004, 697 cases with lymphoid neoplasms and 3606 controls with nonneoplastic conditions were included in a case-control study conducted in the Cancer Institute of Uruguay. They were administered a routine questionnaire that included 8 sections and a food frequency questionnaire focused on intakes of total meat, red meat, salted meat, barbecued meat, processed meat, milk, total vegetables and total fruits, and alcoholic beverages. Lymphoid cancers were analyzed by multiple polytomous regression. Red meat, salted meat, and milk were positively associated with risk of lymphoid cancers [odds ratios (OR) for the highest tertile vs. the lowest one of red meat = 1.68, 95% confidence interval (CI) 1.37-2.08, OR for whole milk = 2.92, 95% CI 2.63-3.63). On the other hand, plant foods, particularly total fruits, and alcoholic beverages (mainly red wine) were protective. We could conclude that these foods could play a significant role in the etiology of lymphoid malignancies.

Objective: The role of foods and beverages has been studied in detail in order to establish probable risk factors for prostate cancer., Methods: Data were derived from 326 cases with incident and microscopically confirmed adenocarcinomas of the prostate and 652 controls. Odds ratios and 95 % confidence intervals of prostate cancer were estimated by unconditional multiple logistic regression., Results: We identified the following food items as risk factors: lamb meat, salted meat, whole milk, total eggs, and maté consumption. The highest OR was associated with total eggs (OR, 2.43; 95 % CI, 1.70-3.48), followed by salted meat (OR, 2.65; 95 % CI, 1.36-3.76), maté consumption (OR, 1.96; 95 % CI, 1.17-3.31), and whole milk (OR, 2.01; 95 % CI, 1.26-2.51)., Conclusions: The final model, fitted by stepwise forward method, included total eggs, salted meat, whole milk, and maté consumption, whereas fruits were protective.

In order to explore the role of nutrients and bioactive related substances in colorectal cancer, we conducted a case-control in Uruguay, which is the country with the highest production of beef in the world. Six hundred and eleven (611) cases afflicted with colorectal cancer and 1,362 controls drawn from the same hospitals in the same time period were analyzed through unconditional multiple logistic regression. This base population was submitted to a principal components factor analysis and three factors were retained. They were labeled as the meat-based, plant-based, and carbohydrates patterns. They were rotated using orthogonal varimax method. The highest risk was positively associated with the meat-based pattern (OR for the highest quartile versus the lowest one 1.63, 95 % CI 1.22-2.18, P value for trend = 0.001), whereas the plant-based pattern was strongly protective (OR 0.60, 95 % CI 0.45-0.81, P value for trend <0.0001. The carbohydrates pattern was only positively associated with colon cancer risk (OR 1.46, 95 % CI 1.02-2.09). The meat-based pattern was rich in saturated fat, animal protein, cholesterol, and phosphorus, nutrients originated in red meat. Since herocyclic amines are formed in the well-done red meat through the action of amino acids and creatine, it is suggestive that this pattern could be an important etiologic agent for colorectal cancer.

The role of meat in squamous cell carcinoma of the esophagus (ESCC) has been considered conflictive. For this reason, we decided to conduct a case-control study on meat consumption and ESCC. Data included 234 newly diagnosed and microscopically examined ESCC and 2,020 controls with conditions not related to tobacco smoking nor alcohol drinking and without changes in their diets. We studied total meat, red meat, beef, lamb, processed meat, poultry, fish, total white meat, liver, fried meat, barbecued meat, boiled meat, heterocyclic amines, nitrosodimethylamine, and benzo[a]pyrene in relation with the risk of ESCC. Red meat, lamb, and boiled meat were directly associated with the risk of ESCC, whereas total white meat, poultry, fish, and liver were mainly protective against this malignancy.

In order to determine to the effect of benzo[a]pyrene (BaP) on breast cancer risk we conducted a case-control study in the time period 1996-2004. The study included 1,098 participants (460 cases and 638 controls). All the patients were drawn from the four major hospitals in Montevideo, Uruguay. Statistical analysis was performed using unconditional multiple logistic regression and the models included age, residence, urban/rural status, education, monthly income, body mass index, menopausal status, age at menarche, parity, smoking index, alcohol drinking, mate consumption, total energy, total vegetables and fruits, and BaP intake. The highest vs. the lowest quartile of BaP intake (OR 2.0, 95% CI 1.2-3.3) was significantly associated with breast cancer risk. Alcohol drinking was also directly associated with breast cancer risk (OR 1.63, 95% CI 1.19-2.23) and the joint effect of BaP and alcohol drinking showed an elevated risk of the disease (OR 3.32, 95% CI 2.17-5.06). The present study suggests that elevated consumption of BaP could play an important role in the etiology of breast cancer. This effect is enhanced by the intake of alcohol.

In the time period 1990-2004 we conducted a multisite case-control study in order to examine the relationship of mate consumption and risk of 13 cancer sites in Montevideo, Uruguay. The study included 13,201 participants (8,875 cases and 4,326 controls) drawn from the four major public hospitals in the city of Montevideo. Newly diagnosed and microscopically confirmed cases of cancers of the mouth, pharynx, esophagus, stomach, colon, rectum, larynx, lung, female breast, cervix uteri, prostate, bladder and kidney were included in the study. Controls were drawn from the same hospitals and in the same time period and were afflicted by non-neoplastic conditions not related with tobacco smoking or alcohol drinking and without recent changes in their diets. Odds ratios for mate consumption was directly associated with cancers of the upper aerodigestive tract (UADT), esophagus, stomach, larynx, lung, cervix uteri, prostate, bladder, and kidney. In conclusion these results suggest that chemicals, like benzo[a]pyrene, could be responsible of the carcinogenic effect of mate in the above mentioned cancer sites.

In the period 1996-2004, a hospital-based case-control study on diet and adenocarcinoma of the lung in men was conducted in Montevideo, Uruguay. The study included 200 cases and 800 controls, frequency matched on age, residence, and interviewers. Factor analysis (principal components) was used to identify the major food patterns associated with adenocarcinoma. The analysis of food groups led to the identification of 4 patterns, arbitrarily labeled as Western, starchy vegetables, prudent, and milk/coffee. Whereas the Western pattern (OR 1.94, 95% CI 1.08-3.45) and the milk/coffee pattern (OR 2.30, 95% CI 1.35-3.90) were positively associated with risk of adenocarcinoma of the lung, the starchy vegetables (OR 0.49, 95% 0.28-0.86) and prudent patterns (OR 0.54, 95% CI 0.32-0.92) were significantly protective against this malignancy. The results suggests that adenocarcinoma of the lung could be considered a different nosologic entity, compared with the other histologies of lung cancer.

A case-control study was conducted in Uruguay, including 876 male cases of lung cancer and 876 male hospitalized controls, frequency matched for age (ten-year intervals), residence and hospital. The following explanatory variables were included in the study: fried red meat, barbecued red meat, boiled red meat, and salted red meat. These items were log transformed and energy-adjusted by the residuals method. The following potential confounders were included into the models: age, residence, hospital, education, family history of lung cancer, body mass index, smoking index, alcohol drinking, mate consumption, total energy intake, non-meat fatty foods and total fruits. The main objective was to estimate the odds ratios associated with lung cancer risk. Whereas fried meat, barbecued meat, and salted meat were positively associated with risk (OR of the highest quartile of salted meat versus the lowest, 2.90, 95 % CI 1.99-4.25, p-value for trend<0.0001), boiled red meat was mainly protective. We conclude that salted meat was the main risk factor. The mechanisms could be related to the content of N-nitroso compounds in salted meat.

Objectives: To explore the role of nutrient patterns in the etiology of breast cancer (BC) among Uruguayan women., Methods: A principal component analysis was conducted. The study included 442 newly diagnosed cases of BC and 442 hospitalized controls., Results: Two dietary patterns derived from factor analysis and were labeled as high-meat and antioxidants patterns. Whereas the high-meat pattern was directly associated with BC risk (OR for the highest versus the lowest quartile = 3.50, 95 % CI 1.94-6.30, p-value for trend <0.0001), the antioxidants pattern displayed a protective effect (OR=0.44, 95 % CI 0.27-0.74). Its negative association was stronger for postmenopausal than for premenopausal women (OR=0.63, 95% CI 0.51-0.79 vs. OR=0.89, 95% CI 0.50-1.56, respectively). Both strata were heterogeneous (p=0.004). The high-meat pattern was more associated with BC risk among patients with family history of BC compared with participants without it, but results did not differ by histology. In contrast, the antioxidants pattern was more associated with non-ductal cancers (OR=0.50 [95 % CI 0.35-0.69]) than with ductal cancers (OR=0.72, 95 % CI 0.58-0.88, heterogeneity p-value=0.03)., Conclusions: Results support an association between the high-meat and antioxidant dietary patterns and BC risk. Furthermore, findings suggest that gene-environmental interactions may be important in BC etiology.

Objective: To determine the role of meat consumption and related mutagens in the etiology of lung cancer, we conducted a case-control study among Uruguayan males in the time period 1996-2004., Methods: The study included 846 cases and 846 controls, frequency matched on age and residence. Both series were drawn from the four major public hospitals in Montevideo, Uruguay. Unconditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) of lung cancer by quartiles of meat intake and mutagens., Results: The highest vs. the lowest quartile of intake of total meat (OR = 2.04, 95% CI 1.42-2.92), red meat (OR = 2.33, 95% CI 1.63-3.32), and processed meat (OR = 1.79, 95% CI 1.22-2.65) was associated with increased risk of lung cancer, while intake of total white meat, poultry and fish was not. Heterocyclic amines (IQ, MeIQx, PhIP), nitrosamines and benzo[a]pyrene were directly associated with the risk of lung cancer (OR for PhIP 2.16, 95% CI 1.48-3.15). Moreover, both red meat and meat mutagens displayed higher risks among former smokers compared with current smokers., Conclusions: This study suggests that red and processed meat and meat mutagens may play a role in the etiology of lung cancer.

Introduction: There is strong evidence that high meat intake increases the risk of colorectal cancer. However, for other cancer sites there is currently less convincing evidence., Methods: To further explore associations between meat intake and cancer risk we conducted a multisite case-control study of 11 cancer sites in Uruguay between 1996 and 2004, including 3,539 cancer cases and 2,032 hospital controls. We used unconditional logistic regression to estimate odds ratios and 95% confidence intervals of cancer associated with meat intake., Results: In the multivariable model there was a significant increase in the odds of cancers of the oral cavity and pharynx (OR= 3.65, 95% CI: 2.21-6.01), esophagus (OR= 3.36, 95% CI: 1.97-5.72), larynx (OR=2.91, 95% CI: 1.80-4.68), stomach (OR= 2.19, 95% CI: 1.31-3.65), colorectum (OR= 3.83, 95% CI: 2.37-6.20), lung (OR= 2.17, 95% CI: 1.52-3.10), breast (OR= 1.97, 95% CI: 1.04-3.75), prostate (OR= 1.87, 95% CI: 1.08-3.21), bladder (OR= 2.11, 95% CI: 1.20-3.72) and kidney (OR= 2.72, 95% CI: 1.22-6.07) with high intake of red meat and similar findings were found for total meat. In addition, intake of beef and lamb were also associated with increased risk of several cancer sites. High intake of processed meat was associated with increased risk of cancers of the esophagus (OR= 1.63, 95% CI: 1.08-2.47), larynx (OR= 1.84, 95% CI: 1.21-2.78), stomach (OR= 1.62, 95% CI: 1.07-2.44), colorectum (OR= 2.15, 95% CI: 1.49-3.11), lung (OR= 1.70, 95% CI: 1.28-2.25) and breast (OR= 1.53, 95% CI: 1.01-2.30)., Conclusion: Our results confirm earlier findings of increased risk of digestive tract cancers, but suggest that meat consumption also increases the risk of several other cancers.

Introduction: Previous studies have suggested that high intake of fruit and vegetables may decrease the risk of a wide range of cancers, but this evidence has been challenged by the results of recent studies., Methods: To further explore the association between fruit and vegetable intake and cancer risk we conducted a case-control study of 11 cancer sites in Uruguay between 1996 and 2004, including 3,539 cancer cases and 2,032 hospital controls. We used unconditional logistic regression to estimate odds ratios and 95% confidence intervals (CIs) of cancer associations., Results: In the multivariable model higher intake of fruits and vegetables combined was associated with a decreased risk of cancers of the esophagus (odds ratio, OR= 0.63, 95% CI: 0.42-0.97), lung (OR= 0.75, 95% CI: 0.57-0.98), breast (OR= 0.47, 95% CI: 0.31-0.71), prostate (OR= 0.63, 95% CI: 0.44-0.92) and all sites combined (OR= 0.73, 95% CI: 0.61-0.87). When evaluated separately, fruit intake was more strongly associated with decreased cancer risk than vegetables. These inverse associations were mainly observed in men, among persons with high intake of meat, alcohol drinkers and among smokers., Conclusion: Our results provide some evidence that high intake of fruits and vegetables and particularly fruit may decrease the risk of cancer. However, because of the possibility that these findings could be due to residual confounding from intake of meat, alcohol drinking and tobacco smoking, further studies in populations with a large number of participants with low or no exposure to these potential confounding factors are warranted.

Background: Previous studies have suggested that egg consumption may increase the risk of colorectal cancer and some other cancers. However, the evidence is still limited. To further explore the association between egg intake and cancer risk we conducted a case-control study of 11 cancer sites in Uruguay between 1996 and 2004, including 3,539 cancer cases and 2,032 hospital controls., Results: In the multivariable model with adjustment for age, sex (when applicable), residence, education, income, interviewer, smoking, alcohol intake, intake of fruits and vegetables, grains, dairy products, fatty foods, meat, energy intake and BMI, there was a significant increase in the odds of cancers of the oral cavity and pharynx (OR= 2.02, 95% CI: 1.19-3.44), upper aerodigestive tract (OR= 1.67, 95% CI: 1.17-2.37), colorectum (OR= 1.64, 95% CI: 1.02-2.63), lung (OR= 1.59, 95% CI: 1.10-2.29), breast (OR= 2.86, 95% CI: 1.66-4.92), prostate (OR= 1.89, 95% CI: 1.15-3.10), bladder (OR= 2.23, 95% CI: 1.30-3.83) and all cancer sites combined (OR= 1.71, 95% CI: 1.35-2.17) with a high vs low egg intake., Conclusions: We found an association between higher intake of eggs and increased risk of several cancers. Further prospective studies of these associations are warranted.

Objective: To determine the major dietary patterns associated with bladder cancer risk, we conducted a principal components analysis (PCA) in a case-control study from Uruguay., Methods: A total of 255 newly diagnosed and microscopically confirmed cases of transitional cell carcinoma of the bladder and 501 hospitalized controls were included in the study. Both series were drawn from the four major public hospitals in Montevideo, Uruguay. Cases and controls were frequency matched on age and sex. Controls were submitted to factor (principal components) analysis., Results: We retained three factors that explained 25.1% of the total variance (including error variance). The first factor was labeled as the sweet beverages pattern. This factor was characterized by high loadings of coffee, tea, and added sugar and was strongly associated with risk of bladder cancer (OR 3.27, 95% CI 1.96-5.45). The second factor was labeled as the Western pattern and displayed high loadings of red meat, fried eggs, potatoes, and red wine. This pattern was directly associated with risk of bladder cancer (OR 2.35, 95% CI 1.42-3.89). Finally, the third factor was labeled as the prudent pattern and showed high loadings of fresh vegetables, cooked vegetables, and fruits. This pattern was not associated with risk of bladder cancer., Conclusions: According to our study, non-alcoholic beverages were the strongest risk factor for bladder cancer, whereas the Western pattern was also associated with a significant increase in risk of bladder cancer.

Summary: In the time period 1996-2004, a case-control study on environmental factor risks and lung cancer was conducted in Montevideo, Uruguay. The study included 846 cases and 846 controls and was restricted to men. Forty nutrients and bioactive substances were submitted to exploratory (principal components) factor analysis. We retained three factors which were labeled as high-meat, antioxidants and carbohydrates. After that, score patterns (obtained from the retained factors) were correlated with sociodemographic variables, tobacco use, alcohol drinking and food groups. Finally, scored patterns were used as explanatory variables through multiple logistic regression analysis. The so-called antioxidants pattern was inversely associated with lung cancer risk (OR 0.69, 0.51-0.96) whereas the high-meat pattern was associated with a strong increase in risk (OR 2.90, 95% CI 1.91-4.40). The carbohydrates pattern was not associated with risk of lung cancer. Although nutrients could be important determinants in the etiology of lung cancer, stop smoking continue to be the major preventive measure for this disease.

Background: Squamous cell carcinoma of the esophagus is a common disease, with an age-standardized incidence rate of 55 cases per 100,000 persons in the northern counties of Uruguay. These rates are comparable to those observed in Iran and China., Materials and Methods: In order to contribute to the clarification of the etiology of this lethal disease, a case-control study which included 234 cases and 936 controls, frequency matched for age, sex and residence, was conducted. Factor analysis (principal components) was conducted on the controls and three factors were retained, high-fat, carbohydrates and antioxidants. These nutrient patterns were submitted to multiple logistic unconditional regression in order to estimate the odds ratios of esophageal cancer., Results: The nutrient patterns (labeled as high-fat, carbohydrates and antioxidants) were significantly associated with the risk of esophageal squamous cell cancer. Whereas the high-fat and carbohydrates patterns were directly associated with an increased risk of esophageal cancer, the antioxidants pattern was strongly protective (OR 0.39, 95% CI 0.23-0.66)., Conclusion: In squamous cell carcinoma of the esophagus an antioxidant dietary pattern is protective, probably due to its action against oxidative stress while high-fat and carbohydrates patterns are associated with an increased risk which may be due to the meat and sodium content, respectively.

Laryngeal carcinoma is a common malignancy among Uruguayan men. A number of case-control and prospective studies have studied the role of diet in this malignancy. To our knowledge, this is the first study that has explored broad dietary patterns by factor (principal components) analysis. The results of this study retained 6 dietary patterns. Pattern 5 (drinker) was directly associated with risk of laryngeal carcinoma (OR 3.8, 95% CI 1.9-7.5), whereas the Pattern 2 (healthy) was protective (OR 0.6, 95% CI 0.3-1.2). Finally, the Pattern 6 (western) displayed a significant increase in risk of 3.2 (95% CI 1.6-6.2). Most dietary patterns were associated with supraglottic cancer, supporting a possible etiological difference between supraglottic and glottic carcinomas. This study also suggests that the analysis of dietary patterns might be a useful approach for investigating nutritional factors implicated in laryngeal carcinogenesis., ((c) 2007 Wiley-Liss, Inc.)

Background: Bladder cancer is the fourth most frequent malignancy among Uruguayan men. A previous study from Uruguay suggested a high risk of bladder cancer associated with maté drinking. We conducted an additional case-control study in order to further explore the role of non-alcoholic beverages in bladder carcinogenesis., Methods: In the time period 1996-2000, 255 incident cases with transitional cell carcinoma of the bladder and 501 patients treated in the same hospitals and in the same time period were frequency matched on age, sex, and residence. Both cases and controls were face-to-face interviewed on occupation, tobacco smoking, alcohol drinking and intake of maté, coffee, tea, and soft drinks. Statistical analysis was carried out by unconditional multiple logistic regression., Results: Ever maté drinking was positively associated with bladder cancer (odds ratio [OR] 2.2, 95% confidence interval [CI] 1.2-3.9) and the risk increased for increasing duration and amount of maté drinking. Both coffee and tea were strongly associated with bladder cancer risk (OR for coffee drinking 1.6, 95% CI 1.2-2.3; OR for tea drinking 2.3, 95% CI 1.5-3.4). These results were confirmed in a separate analysis of never-smokers., Conclusion: Our results suggest that drinking of maté, coffee and tea may be risk factors for bladder carcinoma in Uruguay.

In the time period 1988-2000, a case-control study on oral and pharyngeal cancers was conducted among men in Montevideo, Uruguay. The study included 776 cases and 1501 controls. The cases were distributed by site in oral cancers (335 patients) and pharyngeal cancers (441 patients). Odds ratios for smoking were higher among participants with pharyngeal cancers compared with those with oral carcinomas, but there was no significant heterogeneity. On the contrary, alcohol drinking displayed statistically higher risks among those with pharyngeal carcinomas compared with patients with oral cancer (P-value for heterogeneity=0.01). The effect of alcohol was particularly strong for cancers of the hypopharynx. Our results raise the possibility that oral and pharyngeal carcinomas are in fact different entities. Further studies are needed in order to clarify this important point.

To generate broad eating patterns, which could explain more adequately the breast cancer etiology, we conducted an exploratory factor analysis in Montevideo, Uruguay. The study included 442 newly diagnosed and microscopically confirmed cases with breast cancer and 442 hospitalized controls, with non-neoplastic diseases. Factor analysis (principal components) was conducted in the control series, and as a result, 6 factors were extracted. These factors were labeled as traditional, healthy, western, stew, high-fat and drinker. The model explained 58.3% of the variance. After scoring the rotated factors, the relations between scores and breast cancer risk factors were analyzed by using Pearson correlation coefficients. After this step, the odds ratios of breast cancer for continuous scores of the rotated factors were carefully analyzed. The highest risk was directly associated with the western diet (OR 1.31, 95% CI 1.13-1.51), whereas the traditional (OR 0.77, 95% CI 0.64-0.93), healthy (OR 0.84, 95% CI 0.73-0.98) and stew (OR 0.83, 95% CI 0.71-0.98) diets were significantly protective. Women who reported a history of breast cancer among mother and sisters displayed strong elevations in risk for western (OR 2.03, 95% CI 1.11-3.72) and high-fat (OR 2.72, 95%CI 1.16-6.37) dietary patterns. This finding could suggest that gene-dietary interaction could play an important role in breast carcinogenesis., (Copyright 2006 Wiley-Liss, Inc.)

Objectives: To investigate occupational risks of lung adenocarcinoma in Uruguay and to confirm a previously reported increased risk among butchers., Methods: We conducted a case-control study among men in four major hospitals in Montevideo, based on interviews to 338 cases of lung adenocarcinoma and 1014 hospital-based controls. We calculated odds ratios (ORs) of lung adenocarcinoma for employment in 22 jobs, after adjustment for tobacco smoking and other potential confounders., Results: The OR was increased for employment as farmer, tractor driver, painter and medical worker, but no trend was suggested for duration of employment. Long-term employment as mason, glass worker or textile worker resulted in an increased OR. The OR for employment as butcher was 1.2 (95% confidence interval 0.7-2.1). The OR increased with increasing duration of self-reported exposure to formaldehyde., Conclusions: Occupational exposures seem to play a limited role in causing lung adenocarcinoma among men in Uruguay. Employment as butcher was not confirmed as an important risk factor.

There is strong evidence of a protection of high consumption of plant foods against squamous cell carcinoma of the oesophagus, but the respective role of fruits and vegetables is not well elucidated. In the time period 1996-2003, a case-control study designed in order to address this question was conducted in Uruguay. The study included 200 cases and 400 age- and sex-matched controls. High total vegetable and total fruit consumption was the strongest protective food group for this malignancy (OR 0.31, 95% CI 0.18-0.51). When this food group was dissected in total vegetables and total fruits, the latter item was more protective than the former one (OR for total fruits 0.48, 95% CI 0.35-0.66) (p-value for difference between both variables 0.04). Finally, when total fruits were dissected in citrus fruits and other fruits, citrus fruits were strongly associated with a reduction in risk (OR 0.47, 95% CI 0.34-0.67). The results of our study point towards an important role of fruits in the prevention of squamous cell carcinoma of the oesophagus., ((c) 2005 Wiley-Liss, Inc.)

From 1995 to 2002, a case-control study on food groups and risk of cancer of the oral cavity and pharynx was conducted in Montevideo, Uruguay. Two hundred thirty cases were frequency-matched to 460 controls on age, residence, and urban/rural status. The study was restricted to men. The relationship between foods and risk of oral and pharyngeal squamous cell carcinoma was examined through: 1) individual food group analysis, 2) factor analysis, and 3) determination of empirical scores. The results were similar. Factor analysis generated 2 patterns, which were labeled as "stew" and "vegetables and fruits." The stew pattern loaded positively on boiled meat, cooked vegetables, potato, and sweet potato. This pattern was directly associated with risk of oral and pharyngeal cancer [odds ratio (OR), 3.75; 95% confidence interval (CI), 1.99-7.06; P value for trend=0.0002]. The vegetables and fruits factor loaded positively on raw vegetables, citrus fruits, other fruits, liver, fish, and desserts. This pattern was inversely associated with risk of oropharyngeal carcinoma (OR, 0.34; 95% CI, 0.18-0.64; P value for trend=0.0008). Joint effects of high intake of risk foods and low intake of protective foods were associated with a risk of 12.0 (95% CI, 4.1-34.6). Our study confirms the important role of dietary factors in oral and pharyngeal cancer risk and suggests that the analysis of dietary patterns is a powerful tool to investigate the links between nutrition and cancer.

In the time period 1988-2000, a case-case study on environmental factors and lung cancer risk was conducted in Montevideo, Uruguay. This study was designed in order the establish possible differences between squamous cell carcinomas (SCC) and small cell carcinomas (SCLC) of the lung in relation to tobacco smoking. Three hundred and ninety one (391) patients with small cell carcinoma were compared with 1187 patients with squamous cell carcinoma. Regarding sex, the study included a small number of women (26 with SCLC and 20 with SCC). SCLC was associated with higher risks for smoking status, smoking intensity and cumulative exposure to tobacco smoking when compared with SCC. These three tobacco variables were significantly different between both cell types in men. Smoking duration was significantly higher among SCLC compared with SCC only in women. With decreasing age at starting to smoke, the proportion of SCLC increases at the expense of SCC. Finally, types of tobacco and cigarette were not different between cell types in both sexes. It should be noted that these tobacco variables were not associated with increased risks among SCC, when this cell type was compared with SCLC. These results suggests that SCLC display the strongest relation with tobacco smoking than SCC.

In the time period 1988-2000, a case-control study on laryngeal cancer was conducted in Montevideo, Uruguay. Four-hundred eighty-one (481) cases newly diagnosed and microscopically confirmed as squamous cell carcinomas were included. These cases were frequency matched with 481 nonneoplastic controls, admitted to the same hospitals as the cases. The purpose of our study was to compare odds ratios (ORs) by laryngeal subsite (supraglottis and glottis). ORs of supraglottic cancers displayed much higher risks than glottic carcinomas for most tobacco variables and for red wine intake. The differences between subsites were statistically significant, displaying heterogeneity between both subsites. Moreover, whereas black tobacco smokers displayed a significant increased risk of 1.7 (95% confidence interval [CI] 1.2-2.5) compared to smokers of blond (flue-cured) tobacco among supraglottic tumors, no effect of this type of tobacco was observed in glottic lesions. It could be suggested that concerning tobacco and alcohol effects, supraglottic and glottic squamous cell cancers are probably distinct epidemiologic entities., ((c) 2004 Wiley-Liss, Inc.)

In the time period 1988-2000, a case-control study on large cell carcinoma of the lung was conducted in Montevideo, Uruguay. The study included 149 cases (139 men and 10 women) and 596 controls (556 men and 40 women) afflicted with diseases not related with tobacco smoking. Cases and controls were frequency matched on age, sex, residence and urban/rural status. According to our results, large cell carcinoma was strongly related with cigarette smoking (OR for heavy smokers 155.2, 95% CI: 30.6-786.1). Furthermore, all cases displayed higher risks for intensity compared with smoking duration. Smokers of black tobacco showed odds ratios (ORs) significantly higher than those presented by smokers of blond tobacco and smoking cessation displayed a reduction in risk of 95%, close to the risk of never smokers. Finally, filter use was not associated with any reduction in risk. It could be concluded that undifferentiated large cell carcinoma of the lung could be included among those lung tumors classified as Kreyberg I cancers.

Background: Gastric cancer is a frequent malignancy in the Uruguayan population. In northern counties, incidence rates reach high figures (age-standardized rates [ASR], 37.3 per 100,000 men and 18.3 per 100,000 women). Diet is a major determinant in gastric carcinogenesis. Because foods or food groups have the advantage over nutrients in being most directly related to dietary recommendations, we decided to conduct a case-control study on the relationships between food groups and risk of gastric cancer. For this purpose, we included 240 cases and 960 controls., Methods: In the present study we employed three analytical approaches: (1) individual food group analysis, (2) factor analysis, and (3) analysis of empirical scores of risk. Individual analysis of food groups was performed by multiple unconditional logistic regression, with food groups being the explanatory variables. Nineteen food groups were created and categorized in tertiles according to the control distribution. Factor analysis aggregated intercorrelated foods in broader eating patterns. In this study we were able to identify three factors or patterns, arbitrarily labeled "starchy," "healthy," and "mixed." Finally, empirical scores of risk were created after examining the risk of each individual food and summing each significant item. This resulted in a risk enhancing score and a protective score. Both scores were categorized in tertiles according to the control distribution., Results: The individual analysis of food groups showed increased risks of gastric cancer for rice, salted meat, stewed meat, white bread, potatoes, and tubers. On the other hand, raw vegetables, total fruits, legumes, and black tea were inversely associated with risk of gastric cancer. All three dietary patterns, generated by factor analysis, were significantly associated with gastric carcinoma risk. Whereas the starchy factor was directly associated with gastric cancer, the healthy and mixed patterns were strongly protective. Finally, the risk enhancing empirical score displayed an increased risk of gastric cancer (odds ratio [OR], 4.1, 95% confidence interval [CI], 2.6-6.6), whereas the protective score showed an important reduction in risk, of 0.38., Conclusion: This study displayed consistent results from three different approaches. Concerning different food groups, stewed and processed meat are rich in salt; rice, tubers, and winter squash are sources of starch; and vegetables and fruits are rich in ascorbic acid and carotenoids. All these substances have been strongly related to gastric carcinogenesis. Furthermore, this study suggests that diets rich in vegetables and fruits and with low amounts of salty and starchy foods are recommendable for the prevention of gastric cancer.

A retrospective hospital-based case-control study was carried out at the Oncology Institute of Montevideo, Uruguay, to investigate the role of maté consumption in esophageal cancer risk. The study included 344 cases with squamous cell carcinoma of the esophagus and 469 controls recruited between January 1988 and August 2000. Maté consumption was significantly associated with an increased risk of developing esophageal cancer and showed a clear dose response, with a relative risk of 2.84 [95% confidence interval (CI), 1.41-5.73] for those drinking more than 1 liter/day of maté as compared with nondrinkers. Subjects who self-reported drinking maté at a very hot temperature had an almost 2-fold increase in risk [odds ratio (OR), 1.87; 95% CI, 1.17-3.00] compared with those drinking warm to hot maté, after adjusting for cumulative consumption of maté. Maté amount and temperature were observed to have independent effects and, although no departure from multiplicativity was observed between the two covariates, those drinking more than 1 liter/day of maté at a very hot temperature had a 3-fold increase in risk (OR, 2.95; 95% CI, 1.30-6.74) compared with those drinking less than 0.5 liter/day of maté at a warm to hot temperature. Subjects with high cumulative exposure to maté in the presence of low alcohol and tobacco exposures presented a lower-risk estimate (OR, 1.52; 95% CI, 0.88-2.62), whereas those with high cumulative exposures to maté, alcohol, and tobacco presented a 7-fold increase in esophageal cancer risk (OR, 7.10; 95% CI, 3.75-13.46). The population-attributable fraction as a result of maté consumption was calculated to be 53%, of which the sole effect of amount and temperature was 14.8 and 12.6% respectively, and 14.9% was attributable to high maté consumption at high temperature.

In order to examine in detail the relationship between alcohol drinking and risk of adenocarcinoma of the lung, a case-control study involving 160 cases of this cell type and 520 hospitalized controls was conducted in Uruguay in the time period January 1998-July 2000. Total alcohol intake was not associated with risk of adenocarcinoma of the lung (OR 1.2, 95% CI 0.6-2.1). Also beer drinking was not associated with risk of carcinoma (OR 0.6, 95% CI 0.3-1.6). On the other hand, wine drinking displayed a marginally significant reduction in risk (OR 0.4, 95% CI 0.2-1.1). On the contrary, hard liquor intake was associated with a 40% increase in risk of adenocarcinoma of the lung. These findings suggest that wine drinking has a protective effect in adenocarcinoma of the lung, whereas hard liquor increases moderately the risk of this cell type of lung cancer.

The objective of the present study was to estimate the risk of lung cancer associated with several food groups. The study included 1,032 cases with lung cancer and 1,030 hospitalized controls, admitted to the Cancer Institute of Montevideo in the period 1988-2000. Total meat intake was directly associated with lung cancer (OR 1.6, 95% CI 1.2-2.2) whereas total vegetables and total fruits were inversely associated with lung cancer risk. When vegetable and fruit intakes were further adjusted for smoking status, years since quit, cigarettes/day and age at start, the protective effect was attenuated for plant foods (total vegetables and fruits). Also, the effect of vegetables and fruits was closest to the null among smokers of black tobacco and hand-rolled cigarettes. Thus, the present study is consistent in showing moderate associations with major food groups (meat, vegetables and fruits), and strongly suggests that the stringent control of tobacco smoking is mandatory in studies dealing with diet and lung cancer risk.