Prostate cancer is the second commonest malignancy among Uruguayan men, with an age-adjusted incidence rate of 32.6 per 100 000 (Parkin et al, 1997). According to a previous study (De Stefani et al, 1994), the mortality rate for prostate cancer has increased by 77% in the period between 1953 and 1991. Also, migrants from Spain and Italy have increased their risk of prostate cancer after arrival in Uruguay, suggesting the importance of environmental factors (De Stefani et al, 1990).In the only previous analytic study conducted in Uruguay (De Stefani et al, 1995), diet was assessed by food groups; both red meat and dairy foods were associated with an increased risk of prostate cancer. Also, fruit intake was associated with a risk increase of 70% (De Stefani et al, 1995). Since these estimates were not energy-adjusted some uncertainty remains about its validity. Therefore, we have decided to carry out a new case-control study on dietary factors and prostate cancer, based on a more detailed food-frequency questionnaire.
SUBJECTS AND METHODSSelection of cases. In the period 1994-1997, all incident-and histologically verified prostatic adenocarcinomas occurring in men in the age range 40-89 years, admitted to the four major hospitals in Montevideo, were considered eligible for this study. Of 190 cases identified, 15 patients refused interview, leaving 175 cases of prostate carcinomas (response rate 92.1%). The stage distribution was as follows: localized 25%, regional 72% and disseminated 3%. There were no cases with latent carcinomas, and, therefore, this series is representative of a series of mainly advanced prostate tumours. The stage distribution of our series was compared with the figures drawn from the National Cancer Registry. According to this source, 70% of prostate cancers were locally advanced (regional) or disseminated at the time of the diagnosis. These figures reflect the fact that there are no mass screening programmes for prostate cancer in Uruguay.
Controls selectionIn the same period, all patients admitted to the same hospitals as the cases with conditions unrelated to diet were considered eligible as controls if below age 90. A total of 240 patients were hospitalmatched to the cases; from this initial number seven patients refused interview, leaving a total of 233 controls (response rate 97.1%). The distribution of controls by disease category was as follows: eye disorders (87 patients, 37.3%), abdominal hernia (56 patients, 24.0%), acute appendicitis (25 patients, 10.7%), fractures and trauma (23 patients, 9.9%), hydatid cyst (15 patients, 6.4%), skin diseases (14 patients, 6.1%) and varicose veins (13 patients, 5.6%).
QuestionnaireBoth cases and controls were specifically called up to the hospital for a face-to-face interview after diagnosis or treatment. The mean time since admission for cases was 62 days, and for controls was 50 days. Both cases and controls completed a detailed questionnaire which covered sociodemographic variables, anthropometric variables, occupational exposures, family hist...