Aims and background: The risk for several cancers is higher in urban t
han in rural areas. The gradient has seldom been studied in southern E
urope. Patients and methods: The geographical pattern of mortality for
different cancers and all causes was studied in the Campania Region (
about 5.6 million inhabitants), whose largest town is Naples. The key
variables were residence in urban/rural and coastal/inland municipalit
ies. Relative risks of death and corresponding 95% confidence interval
s by residence were evaluated by means of Poisson loglinear regression
models. Results: Significantly increased mortality rates in urban com
pared to rural municipalities were found for several cancer causes of
death. In particular in both sexes, excesses in the order of 30-50% we
re observed for tobacco-related neoplasms (i.e., larynx, lung, and bla
dder) and cancers of the intestine, liver, brain, multiple myeloma and
non-Hodgkin's lymphoma, in addition to all-cancer, and all-cause mort
ality. In females, specific excesses were also noticed for cancer of t
he gallbladder, pancreas, breast and uterus (corpus and cervix). Conve
rsely, significantly decreased mortality rates in urban with respect t
o rural municipalities were observed for cancer of the oral cavity and
pharynx in males. Coastal location and degree of urbanization were st
rongly correlated, thus showing similar associations with most causes
of death. However, a significant excess of cancer of the pleura in mal
es was restricted to coastal municipalities. Conclusions: Anti-smoking
campaigns, sanitation improvements, hepatitis B vaccination, and a de
crease in obesity emerge as high priorities with respect to cancer con
trol strategies in the Campania Region, particularly in overpopulated,
underprivileged urban areas.