An excess of classic Kaposi's sarcoma (KS) in individuals of southern European ancestry has long been suspected and recently quantified in terms of age-standardized rates. In Italy and most notably in southern Italy for the period 1976-84, prior to the AIDS epidemic, KS incidence rates were two-to-three-fold higher than in the United States and Sweden and many ten-fold higher than in England and Wales and Australia. A high frequency of classic KS has also been documented in Israel and, in low-risk countries, in individuals born in southern Europe and the Middle East. Many infections have been suspected to play a role in the etiology of KS, including cytomegalovirus, malaria and, most recently, a new virus of the herpes family, identified in AIDS-associated and classic KS. The present review deals with epidemiologic data concerning KS in the Mediterranean and stresses the opportunity to combine the study of KS in AIDS as well as non-AIDS patients in order to shed light on this no longer rare disease.

The incidence of Kaposi's sarcoma (KS) in 1976-90 was assessed in Italy, taking advantage of a network of nine population-based cancer registries covering, at its maximum, approximately 5.6 million subjects. The first examined period (1976-84) substantially reflects the epidemiology of KS prior to the AIDS epidemic in the registration areas. Elevated incidence rates, standardised to the Italian population of 1981, of 1.05/100,000 men and 0.27/100,000 women emerged in 1976-84 (i.e. from two- to threefold higher than in the USA and Sweden, more than tenfold higher than in England and Wales). These high rates, especially remarkable in the Registry from the south of Italy (i.e. Ragusa, 3.01/100,000 men and 0.54/100,000 women) suggest that the prevalence of the still unknown causative agent for KS was high, at least in some parts of Italy, prior to the AIDS epidemic. In the most recent period (1985-90), an approximately twofold increase in KS incidence rates in Italian men below age 50 was observed (from 0.15 in 1976-84 to 0.47 in 1985-90). Conversely, declines in KS incidence were recorded in older men.

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A case-control study was undertaken to evaluate environmental risk factors potentially involved in male infertility. One hundred twelve azoospermic or oligospermic subjects and 127 controls were interviewed, before sperm count results were available, about coffee and alcohol consumption, smoking habits, x-ray exposure, usual sitting posture, drug consumption, other nonoccupational risk factors, socioeconomic status, education level, and occupational history. An unmatched analysis was then conducted. None of the occupational risk factors appeared to be related to azoospermia or oligospermia. A high relative risk was associated with (1) occupation in the radioelectric industry, (2) nonsedentary clerical workers, (3) clerical work in the typographic industry, and (4) occupation in the textile industry, but none of these figures were statistically significant. Because of the population from which cases and controls were drawn, certain occupational risks could not be investigated in this study, e.g., exposure of agricultural workers to chemicals.

SUMMARY A case control study of lung cancer in Florence, Italy was performed to investigate occupational risk factors for both men and women. The case series (n = 376) comprised all incident, histologically confirmed cases of primary lung cancer occurring in a three year period. Controls (n = 892) were patients in the same hospital of similar age, sex, date of admission, and smoking status with discharge diagnoses other than lung cancer or suicide. A detailed occupational history was collected from each subject directly. Logistic regression models were used to calculate odds ratios for specific occupations compared to all others. Among men, the lung cancer risk for bricklayers using firebrick and other refractory materials was elevated (adjusted odds ratio 6-5, 95% limits 2-1 and 20*9). Female hat makers, probably exposed to arsenic while making felt hats, had an elevated risk of lung cancer (6 cases versus 0 controls, p = 0 01). Risks in other occupations are discussed.