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European UrologyVolume 60, issue 1, pages e1-e8, July 2011
Trends in Mortality From Urologic Cancers in Europe, 1970–2008
Accepted 25 March 2011, Published online 5 April 2011, pages 1 - 15
In recent decades, there have been substantial changes in mortality from urologic cancers in Europe.
To provide updated information, we analyzed trends in mortality from cancer of the prostate, testis, bladder, and kidney in Europe from 1970 to 2008.
Design, setting, and participants
We derived data for 33 European countries from the World Health Organization database.
We computed world-standardized mortality rates and used joinpoint regression to identify significant changes in trends.
Results and limitations
Mortality from prostate cancer has leveled off since the 1990 s in countries of western and northern Europe, particularly over the last few years while it was still rising in Bulgaria, Romania, and Russia. In the European Union (EU), it reached a peak in 1995 at 15.0 per 100 000 men and declined to 12.5 per 100 000 in 2006. Mortality from testicular cancer has steadily declined in most countries in western and northern Europe since the 1970 s. The declines were later and appreciably lower in central/eastern Europe. In EU, rates declined from 0.75 in 1980 to 0.32 per 100 000 men in 2006, with stronger declines up to the late 1990 s and an apparent leveling off in rates thereafter. Over the last 15 years, mortality from bladder cancer has declined in most European countries in both sexes. The major exceptions were Bulgaria, Poland, and Romania. In the EU, bladder cancer mortality was stable until 1992 and declined thereafter from 7.3 to 5.5 per 100 000 men and from 1.5 to 1.2 per 100 000 women in 2006. Mortality from kidney cancer increased throughout Europe until the early 1990 s and leveled off thereafter in many countries, except in a few central and eastern ones. Between 1994 and 2006, rates declined from 4.9 to 4.3 per 100 000 in EU men and from 2.1 to 1.8 per 100 000 in EU women.
Over the last two decades, trends in urologic cancer mortality were favorable in Europe, with the exception of a few central and eastern countries.
In recent years, there have been substantial changes in mortality from urologic cancers in Europe  as well as in North America . These have been essentially due to therapeutic improvements for prostatic  and  and testicular  cancer and decreased exposure to tobacco smoking and occupational exposure to carcinogens for bladder  and  and perhaps kidney  and  cancer, particularly in men. To provide updated information on the issue, we systematically analyzed trends in mortality from urologic cancers in Europe over the period 1970–2008.
2. Materials and methods
We abstracted official death certification data from urologic cancers (ie, prostate, testis, bladder, and kidney and other urinary sites) for 33 European countries from the World Health Organization (WHO) database available electronically for the period 1970–2008 . Only countries with a mortality coverage of at least 90% were considered. The European Union (EU) was defined as the 27 member states as of 2004, excluding Cyprus, for which data were only available for a limited number of the most recent years. No extrapolation was made for missing years within a country for one or more calendar years, apart from the calculation of EU rates.
Classification of cancer deaths was recoded for all calendar periods and countries according to the International Classification of Diseases, 10th Revision (ICD-10) (prostate = C61, testis = C62, bladder = C67, and kidney and other urinary sites = C64–C66, C68) . Because the change from the 8th to the 10th revision of the ICD in 1995 in Switzerland caused discontinuities in trends, Swiss data between 1980 and 1995 were corrected using age-specific factors .
Estimates of the resident populations were derived from the same WHO database . We computed age-standardized rates at all ages and truncated at ages 35–64 year on the basis of the world standard population . To identify significant changes in trends for 23 major countries and for the whole EU, we performed joinpoint regression analysis  and .
Figure 1a–d and Appendix Table 1 give the joinpoint regression analysis for mortality from cancers of the prostate, testis, bladder, and kidney and other urinary sites in men and women for 23 selected European countries and the EU overall over the period 1970–2008. Figure 2a–d show the age-standardized mortality rates for cancers of the prostate, testis, bladder, and kidney and other urinary sites in men and women from 33 European countries, and in the EU overall in the most recent available calendar period.
Overall mortality rates from prostate cancer have leveled off since the 1990 s in most countries of western and northern Europe. In the EU as a whole, overall prostate cancer mortality reached a peak in 1995 at 15.0 per 100 000 men, and declined to 12.5 per 100 000 in 2006, with a reduction of 3.8% over more recent years (Fig. 1a). Declines in mortality rates were observed only more recently in the Czech Republic, Hungary, and Poland. Mortality was still rising over the most recent years in Bulgaria, Romania, and the Russian Federation. Rates in middle-age adults (35–64 year of age) were more stable than those for the overall population in most European countries.
In 2005–2008, the highest mortality rates from prostate cancer were in the Baltic countries (>20 per 100 000 men), followed by the Nordic countries. The lowest ones were in the Russian Federation and other central and eastern European countries as well as in Italy (<10 per 100 000 men) (Fig. 2a).
Testicular cancer mortality has steadily declined in most countries from western and northern Europe since the 1970 s. However, the declines started later (since the 1980 s) and were appreciably lower in central/eastern European countries (Fig. 1b). In the EU overall, rates declined from 0.75 in 1980 to 0.32 per 100 000 men in 2006. Overall rates declined by 4% per year between 1980 and 1999, whereas afterward there was a leveling off in rates, particularly in middle-age men. A slowing down in the declining rates over the last decade was observed in the EU as a whole and in several western European countries.
In 2005–2008, the highest overall mortality rates from testicular cancer were in Bulgaria, Hungary, and Latvia (0.8–0.9 per 100 000 men), followed by other countries of central/eastern Europe (0.5–0.7 per 100 000 men); the lowest ones were in the United Kingdom, other countries of northern Europe, and Spain (<0.2 per 100 000 men) (Fig. 2b).
In the EU as a whole, overall bladder cancer mortality was stable until the early 1990 s and declined thereafter, particularly in men, from 7.3 in 1992 to 5.5 per 100 000 in 2006 (Fig. 1c); in EU women, rates declined from 1.5 to 1.2 per 100 000. Mortality rates declined in most European countries in both sexes; the major exceptions were Bulgaria, Poland, and Romania. Truncated mortality rates from bladder cancer were generally more favorable (rates declined from 6.5 in 1984 to 4.3 per 100 000 in 2006 in EU men, and from 1.3 in 1980 to 1.1 per 100 000 in 2006 in EU women).
In 2005–2008, the highest bladder cancer mortality rates in men were in Poland, Spain, Latvia, and Lithuania (>7 per 100 000), followed by other eastern European countries and Denmark (6–7 per 100 000); the lowest ones were in Germany, Austria, Switzerland, Ireland, and Finland (<4 per 100 000) (Fig. 2c). In women, the highest rates were in Denmark (2.3 per 100 000), Hungary, and the United Kingdom (1.7 per 100 000); the lowest ones were in Russia, Finland, Ukraine, and Belarus (<0.8 per 100 000).
Mortality from kidney and other urinary sites cancer increased throughout Europe until the early 1990 s but leveled off thereafter (Fig. 1d). Between 1994 and 2006, in EU men rates declined from 4.9 to 4.3 per 100 000 at all ages and from 6.7 to 5.4 per 100 000 at age 35–64 year. In EU women, corresponding falls were from 2.1 to 1.8 per 100 000 and from 2.7 to 2.0 per 100 000. Leveling off or declines in rates were observed particularly in northern and western Europe but also in central/eastern European countries characterized by the highest mortality rates. Despite long-term declines, rates remained extremely high in the Czech Republic. Trends were still upward in Bulgaria and Romania, particularly in men.
The highest mortality rates from kidney cancer in 2005–2008 were in the Czech Republic (9 per 100 000 men and 3.7 per 100 000 women) followed by the Baltic countries (7–8 per 100 000 men and 2.5–2.7 per 100 000 women); the lowest ones were in Greece, Portugal, and Luxembourg (<3 per 100 000 men and <1.2 per 100 000 women) (Fig. 2d).
Mortality from prostate cancer has been declining over the last few decades in many European countries with originally high rates, while it has been increasing up to more recent years in countries with the lowest rates, with a consequent reduction in the geographic gradient across the continent. The recent favorable trends in prostate cancer mortality in several (western) European countries are consistent with those observed over a comparable period in the United States  and . They are likely due to the advancements in the management of this neoplasm  and , including the wider adoption of radical prostatectomy and a more widespread and rational use of combined antiandrogen therapies and radiotherapy for patients with locally advanced disease , , , and . A delay in the adoption of new treatments may explain the later declines in prostate cancer mortality in central/eastern Europe. The introduction of the prostate-specific antigen (PSA) test has increased the proportion of anticipated diagnoses. This produced an increase in prostate cancer incidence in the past two decades , , , and , but its impact on national mortality is difficult to evaluate , , , and . It is also difficult to evaluate the role of changes in risk factors exposure on prostate cancer mortality .
Changes in diagnosis and certification of the disease, as well as increased awareness of the disease leading to changes in death certification through the attribution to prostatic cancer of deaths from other causes, may partly explain the upward trends in eastern European countries over more recent calendar years, particularly among the elderly , , and . However, in Poland and the Russian Federation, trends have been similarly upward in middle age too, indicating that improved diagnosis and certification cannot totally account for the observed trends.
With reference to testicular cancer, the favorable trends observed in most European countries over the last decades are consistent with those observed in the United States  and , although with a substantial delay, particularly in central/eastern Europe. Because testicular cancer is one of the most curable neoplasms, the favorable pattern in mortality is largely attributed to the introduction (since the 1970 s) of effective treatments, mainly platinum-derived chemotherapy . As a consequence of improved treatment, survival from this neoplasm has increased throughout European countries over the last decades  and . In contrast to mortality, the incidence of testicular cancer has been increasing in most European countries in the last few decades . The delay in the reduction of mortality rates in countries from central/eastern Europe is mainly due to the inadequate availability of treatments in those countries up to recent calendar years . The slowing down of the declines in testicular cancer mortality in countries of western and northern Europe over the most recent years suggests that mortality from this neoplasm is now reaching a plateau in these countries, as it has in the United States .
Bladder cancer mortality has declined in most European countries over the last 15 years. Similar declines were observed in the United States too, although in US men they started earlier . Trends in bladder cancer mortality largely reflect the different patterns of tobacco smoking, its major recognized risk factor  and , in various generations of men and women across Europe, with larger falls in men from western and northern Europe where the declines in tobacco use began earlier. Indeed, in men, the prevalence of smoking has been declining since the mid-1950 s in most western and northern European countries but only since the late 1980 s in central/eastern Europe , , and . The relative risk of bladder cancer is appreciably reduced 5 years after stopping smoking . Control of occupational carcinogens (mainly aromatic amines) has also contributed to the favorable patterns in men from various European countries  and . In women, bladder cancer mortality rates over the last years were higher in countries where the tobacco epidemic started earlier, such as Denmark, the United Kingdom, and the Netherlands. However, the falls in female bladder cancer mortality rates are not accounted for by tobacco smoking, which has only recently leveled off in European women  and . Part of the declines in women may be due to improved control of urinary tract infections, although their role in bladder cancer risk remains unquantified  and . The role of diet , as well as of other risk factors (ie, hair dyes, alcohol and coffee consumption)  on bladder cancer remains undefined but is unlikely to have been appreciable on national mortality rates .
It is difficult to evaluate the potential impact of changes in treatment for bladder cancer on survival because clinical and cancer registration series include a variable proportion of noninvasive and invasive cancers . Any such changes, in any case, are unlikely to largely explain the favorable trends observed in Europe. Although bladder cancer incidence rates are highly influenced by changes in classification, coding, and registration practices, these are less likely to affect mortality rates  and .
Favorable trends in mortality from kidney cancer have been observed since the 1990 s in many European countries. Trends were similar in the United States, with declines particularly in men . Tobacco smoking is the best recognized risk factor for kidney cancer  and . Consequently, the reduced prevalence of smoking in most (western and northern) European countries can explain, at least in part, the recent favorable trends in men, although they cannot account for female trends. Likewise, tobacco partly, although not totally, explains the long-lasting excess kidney cancer mortality in both sexes in the Czech Republic.
Another important risk factor for kidney cancer is being overweight , and the increased prevalence of overweight and obesity over the last decades in several European countries may have had some unfavorable effect on kidney cancer rates  and . Hypertension has also been related to kidney cancer , although it remains unclear whether pharmacologic control of hypertension has some effect on kidney cancer mortality , , and . Kidney cancer risk has been inversely related to consumption of fruit and vegetables , , and , but the role of dietary factors on individual risk, and hence on national mortality rates, remains unquantified . Similarly, the effect of reduced occupational exposures on (male) kidney cancer risk remains undetermined but is likely smaller than for bladder cancer  and .
In a few countries providing national data, trends in kidney cancer incidence were only slightly less favorable than those of mortality. Improved and earlier diagnosis, through ultrasonography and other imaging techniques, as well as advances in medical and surgical treatments for this neoplasm , may therefore have had a limited impact on the mortality trends for kidney cancer, but their role remains undefined .
In the interpretation of the trends in urologic cancers across Europe, it is important to consider problems related to random variation, which are greater in smaller populations. Differences across countries in the availability and use of diagnostic techniques and the accuracy of death certification can appreciably influence cancer diagnosis and certification  and .
The present updated analysis shows that trends in urologic cancer mortality were favorable over the last two decades in most of Europe, with the exception of a few eastern countries.
Author contributions: Cristina Bosetti had full access to all the data in the study and takes full responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: La Vecchia, Levi.
Acquisition of data: Bertuccio.
Analysis and interpretation of data: Bertuccio, Bosetti, La Vecchia.
Drafting of the manuscript: Bosetti.
Critical revision of the manuscript for important intellectual content: Chatenoud, La Vecchia, Levi, Negri.
Statistical analysis: Bertuccio.
Obtaining funding: La Vecchia, Levi, Negri.
Administrative, technical, material support: None.
Financial disclosures: I certify that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/ affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None.
Funding/Support and role of the sponsor: This work was conducted with the contribution of the Swiss League Against Cancer, the Swiss Foundation for Research Against Cancer, and the Italian Association for Cancer Research. The sponsor had no role in data analysis and interpretation.
See Table A.1.
|Trend 1||Trend 2||Trend 3||Trend 4|
|Trend 1||Trend 2||Trend 3||Trend 4||Trend 1||Trend 2||Trend 3||Trend 4|
a First and last year available.
b Significantly different from 0 (p < 0.05).Note: Data for testicular and kidney cancers were not available for Belarus, the Russian Federation, and Ukraine. For Switzerland, data for testicular and kidney cancers between 1995 and 2007 were obtained from the Swiss National Institute for Epidemiology and Registration & Federal Statistic Office . For the Czech Republic, Latvia, Lithuania, and the Russian Federation, data were available since the early/mid 1980 s. For Belgium, data were available up to 1999 and for 2004; for Slovakia and Spain, up to 2005; for Denmark, Germany, Luxembourg, Portugal, and the Russian Federation, up to 2006; for Belarus, France, Italy, Norway, the United Kingdom, Switzerland, and Sweden, up to 2007.
APC = annual percentage change.
-  C. La Vecchia, C. Bosetti, F. Lucchini, et al. Cancer mortality in Europe, 2000–2004, and an overview of trends since 1975. Ann Oncol. 2010;21:1323-1360 Crossref.
-  B.K. Edwards, E. Ward, B.A. Kohler, et al. Annual report to the nation on the status of cancer, 1975–2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer. 2010;116:544-573 Crossref.
-  F. Levi, F. Lucchini, E. Negri, P. Boyle, C. La Vecchia. Leveling of prostate cancer mortality in Western Europe. Prostate. 2004;60:46-52 Crossref.
-  F. Bray, J. Lortet-Tieulent, J. Ferlay, D. Forman, A. Auvinen. Prostate cancer incidence and mortality trends in 37 European countries: an overview. Eur J Cancer. 2010;46:3040-3052 Crossref.
-  F. Levi, F. Lucchini, P. Boyle, E. Negri, C. La Vecchia. Testicular cancer mortality in Eastern Europe. Int J Cancer. 2003;105:574 Crossref.
-  D. Silverman, S. Devesa, L. Moore, N. Rothman. Bladder cancer. D. Schottenfeld, J.F. Fraumeni (Eds.) Cancer epidemiology and prevention (Oxford, UK, Oxford University Press, 2006) 1101-1127 Crossref.
-  J. Ferlay, G. Randi, C. Bosetti, et al. Declining mortality from bladder cancer in Europe. BJU Int. 2008;101:11-19
-  J.K. McLaughlin, L. Lipworth, R.E. Tarone, W. Blot. Renal cancer. D. Schottenfeld, J.F. Fraumeni Jr. (Eds.) Cancer epidemiology and prevention ed. 3 (Oxford University Press, New York, NY, 2006) 1087-1100 Crossref.
-  F. Levi, J. Ferlay, C. Galeone, et al. The changing pattern of kidney cancer incidence and mortality in Europe. BJU Int. 2008;101:949-958 Crossref.
-  World Health Organization (WHO) mortality database. World Health Organization Statistical Information System. WHO Web site. http://www.who.int/whosis/en/.
-  World Health Organization. International classification of disease and related health problems, 10th revision. Geneva, Switzerland: World Health Organization; 1992.
-  J.M. Lutz, P. Pury, G. Fioretta, L. Raymond. The impact of coding process on observed cancer mortality trends in Switzerland. Eur J Cancer Prev. 2004;13:77-81 Crossref.
-  Doll R, Smith PG. Comparison between registries: age-standardized rates. In: Waterhouse JAH, Muir CS, Shanmugaratnam K, Powell J, Peacham D, Whelan S, editors. Cancer incidence in five continents. IARC Scientific Publications No. 42; vol 4. Lyon, France: IARC; 1982. p. 671–75.
-  Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for joinpoint regression with applications to cancer rates. [published correction appears in Stat Med 2001; 20:655]. Stat Med 2000;19:335–51.
-  Joinpoint regression program, v.3.4.3. National Cancer Institute Web site. http://surveillance.cancer.gov/joinpoint/.
-  K.C. Chu, R.E. Tarone, H.P. Freeman. Trends in prostate cancer mortality among black men and white men in the United States. Cancer. 2003;97:1507-1516 Crossref.
-  M.E. Duncan, M.J. Goldacre. Mortality trends for benign prostatic hyperplasia and prostate cancer in English populations 1979–2006. BJU Int. 2010;107:40-45
-  N. Sharifi, J.L. Gulley, W.L. Dahut. Androgen deprivation therapy for prostate cancer. JAMA. 2005;294:238-244 Crossref.
-  A. Bill-Axelson, L. Holmberg, M. Ruutu, et al. Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med. 2005;352:1977-1984 Crossref.
-  S.M. Collin, R.M. Martin, C. Metcalfe, et al. Prostate-cancer mortality in the USA and UK in 1975–2004: an ecological study. Lancet Oncol. 2008;9:445-452 Crossref.
-  E. Bria, F. Cuppone, D. Giannarelli, et al. Does hormone treatment added to radiotherapy improve outcome in locally advanced prostate cancer?: meta-analysis of randomized trials. Cancer. 2009;115:3446-3456 Crossref.
-  H.E. Karim-Kos, E. de Vries, I. Soerjomataram, V. Lemmens, S. Siesling, J.W. Coebergh. Recent trends of cancer in Europe: a combined approach of incidence, survival and mortality for 17 cancer sites since the 1990 s. Eur J Cancer. 2008;44:1345-1389 Crossref.
-  H.G. Welch, P.C. Albertsen. Prostate cancer diagnosis and treatment after the introduction of prostate-specific antigen screening: 1986–2005. J Natl Cancer Inst. 2009;101:1325-1329 Crossref.
-  A. Gondos, F. Bray, T. Hakulinen, H. Brenner. Trends in cancer survival in 11 European populations from 1990 to 2009: a model-based analysis. Ann Oncol. 2009;20:564-573
-  C. Bouchardy, G. Fioretta, E. Rapiti, et al. Recent trends in prostate cancer mortality show a continuous decrease in several countries. Int J Cancer. 2008;123:421-429 Crossref.
-  G.L. Andriole, E.D. Crawford, R.L. Grubb 3rd, et al. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med. 2009;360:1310-1319 Crossref.
-  F.H. Schroder, J. Hugosson, M.J. Roobol, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. 2009;360:1320-1328 Crossref.
-  P. Boyle, O.W. Brawley. Prostate cancer: current evidence weighs against population screening. CA Cancer J Clin. 2009;59:220-224 Crossref.
-  H. Gronberg. Prostate cancer epidemiology. Lancet. 2003;361:859-864 Crossref.
-  E.J. Feuer, R.M. Merrill, B.F. Hankey. Cancer surveillance series: interpreting trends in prostate cancer—part II: cause of death misclassification and the recent rise and fall in prostate cancer mortality. J Natl Cancer Inst. 1999;91:1025-1032 Crossref.
-  P. Bertuccio, M. Malvezzi, L. Chatenoud, et al. Testicular cancer mortality in the Americas, 1980–2003. Cancer. 2007;109:776-779 Crossref.
-  W. Zatonski, J. Didkowska. Closing the gap: cancer in Central and Eastern Europe (CEE). Eur J Cancer. 2008;44:1425-1437 Crossref.
-  E. Negri, C. La Vecchia. Epidemiology and prevention of bladder cancer. Eur J Cancer Prev. 2001;10:7-14 Crossref.
-  S. Franceschi, C. Naett. Trends in smoking in Europe. Eur J Cancer Prev. 1995;4:271-284 Crossref.
-  World Health Organization. Tobacco or health: a global status report. (World Health Organization, Geneva, Switzerland, 1997)
-  World Health Organization Regional Office for Europe. Health for all database (HFA-DB). http://dataeurowhoint/hfadb/.
-  B. D’Avanzo, E. Negri, C. La Vecchia, et al. Cigarette smoking and bladder cancer. Eur J Cancer. 1990;26:714-718 Crossref.
-  D.T. Silverman, A. Morrison, S.S. Devesa. Bladder cancer. W. Rom (Ed.) Occupational and environmental medicine (Lippincott-Raven, Philadelphia, PA, 1998)
-  E. Pira, G. Piolatto, E. Negri, et al. Bladder cancer mortality of workers exposed to aromatic amines: a 58-year follow-up. J Natl Cancer Inst. 2010;102:1096-1099 Crossref.
-  A. Molarius, R.W. Parsons, A.J. Dobson, et al. Trends in cigarette smoking in 36 populations from the early 1980s to the mid-1990s: findings from the WHO MONICA Project. Am J Public Health. 2001;91:206-212 Crossref.
-  C. Pelucchi, C. La Vecchia, E. Negri, L. Dal Maso, S. Franceschi. Smoking and other risk factors for bladder cancer in women. Prev Med. 2002;35:114-120 Crossref.
-  C. La Vecchia, E. Negri. Nutrition and bladder cancer. Cancer Causes Control. 1996;7:95-100
-  C. Pelucchi, C. La Vecchia. Alcohol, coffee, and bladder cancer risk: a review of epidemiological studies. Eur J Cancer Prev. 2009;18:62-68 Crossref.
-  Parkin DM, Whelan SL, Ferlay J, Teppo L, Thomas DB, editors. Cancer incidence in five continents. Vol. VIII, IARC Sci. Publ. No. 155. Lyon, France: IARC; 2002.
-  J.D. Hunt, O.L. van der Hel, G.P. McMillan, P. Boffetta, P. Brennan. Renal cell carcinoma in relation to cigarette smoking: meta-analysis of 24 studies. Int J Cancer. 2005;114:101-108 Crossref.
-  P. Brennan, O. van der Hel, L.E. Moore, et al. Tobacco smoking, body mass index, hypertension, and kidney cancer risk in central and eastern Europe. Br J Cancer. 2008;99:1912-1915 Crossref.
-  K. Silventoinen, S. Sans, H. Tolonen, et al. Trends in obesity and energy supply in the WHO MONICA Project. Int J Obes Relat Metab Disord. 2004;28:710-718 Crossref.
-  S. Gallus, P. Colombo, V. Scarpino, et al. Overweight and obesity in Italian adults 2004, and an overview of trends since 1983. Eur J Clin Nutr. 2006;60:1174-1179 Crossref.
-  C. La Vecchia, C. Bosetti. Calcium channel blockers, verapamil and cancer risk. Eur J Cancer. 2003;39:7-8 Crossref.
-  J.P. Fryzek, A.H. Poulsen, S.P. Johnsen, J.K. McLaughlin, H.T. Sorensen, S. Friis. A cohort study of antihypertensive treatments and risk of renal cell cancer. Br J Cancer. 2005;92:1302-1306 Crossref.
-  F. Bravi, C. Bosetti, L. Scotti, et al. Food groups and renal cell carcinoma: a case-control study from Italy. Int J Cancer. 2007;120:681-685 Crossref.
-  C. Bosetti, L. Scotti, L.D. Maso, et al. Micronutrients and the risk of renal cell cancer: a case-control study from Italy. Int J Cancer. 2007;120:892-896 Crossref.
-  J. Hu, C. La Vecchia, E. Negri, M. Desmeules, L. Mery. Dietary vitamin C, E, and carotenoid intake and risk of renal cell carcinoma. Cancer Causes Control. 2009;20:1451-1458 Crossref.
-  J.E. Heck, B. Charbotel, L.E. Moore, et al. Occupation and renal cell cancer in Central and Eastern Europe. Occup Environ Med. 2010;67:47-53 Crossref.
-  H.T. Cohen, F.J. McGovern. Renal-cell carcinoma. N Engl J Med. 2005;353:2477-2490 Crossref.
-  J.R. Carter. The problematic death certificate. N Engl J Med. 1985;313:1285-1286 Crossref.
-  T. Kircher, R.E. Anderson. Cause of death. Proper completion of the death certificate. JAMA. 1987;258:349-352 Crossref.
a Dipartimento di Epidemiologia, Istituto di Ricerche Farmacologiche “Mario Negri,” Milan, Italy
b Dipartimento di Medicina del Lavoro, Università degli Studi di Milano, Milan, Italy
c Unité d’epidémiologie du cancer et Registres Vaudois et Neuchâtelois des Tumeurs, Institut de médecine sociale et préventive (IUMSP), Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Switzerland
© 2011 European Association of Urology, Published by Elsevier B.V.
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