Background: Although consumption of whole-grain foods seems to reduce the risk of several types of neoplasms, the potential influence of a diet rich in starches and refined grains is less clear. Objective: We studied the relation between the frequency of consumption of refined cereals (bread, pasta, or rice) and the risk of selected neoplasms. Design: This was an integrated series of case-control studies conducted in northern Italy between 1983 and 1993. The subjects were patients admitted to the major teaching and general hospitals in Milan and Pordenone with incident, histologically confirmed cancers: 343 with cancer of the oral cavity and pharynx, 94 with cancer of the esophagus, 146 with cancer of the larynx, 745 with cancer of the stomach, 955 with cancer of the colon, 625 with cancer of the rectum, and 428 with cancer of the thyroid. The control subjects were 3526 patients admitted to the same network of hospitals for acute nonneoplastic conditions unrelated to long-term modification of diet. Odds ratios (ORS) for consecutive tertiles of refined-cereal consumption were computed after allowance for sociodemographic variables, education, smoking status, alcohol consumption, body mass index, and consumption of fruit, vegetables, and whole-grain foods. Results: The ORs for the highest tertile of refined-cereal intake were 1.6 for cancer of the oral cavity, pharynx, esophagus, or larynx; 1.5 for stomach cancer; 1.5 for colon cancer; 1.3 for cancer of the rectum; and 2.0 for thyroid cancer. The trends in risk were significant for all neoplasms considered. Conclusion: Consumption of refined cereals was associated with an increased risk of cancers of the large bowel, the stomach, and other selected digestive and nondigestive sites.
