Center for Cancer Prevention

Sant'Ambrogio di Torino, Italy

Center for Cancer Prevention

Sant'Ambrogio di Torino, Italy

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Colais P.,Regional Health Service | Faustini A.,Regional Health Service | Stafoggia M.,Regional Health Service | Berti G.,U.S. Environmental Protection Agency | And 9 more authors.
Epidemiology | Year: 2012

BACKGROUND: Although numerous studies have provided evidence of an association between ambient air pollution and acute cardiac morbidity, little is known regarding susceptibility factors. METHODS: We conducted a time-stratified case-crossover study in 9 Italian cities between 2001 and 2005 to estimate the short-term association between airborne particles with aerodynamic diameter <10 μm (PM10) and cardiac hospital admissions, and to identify susceptible groups. We estimated associations between daily PM10 and all cardiac diseases, acute coronary syndrome, arrhythmias and conduction disorders, and heart failure for 167,895 hospitalized subjects ≥65 years of age. Effect modification was assessed for age, sex, and a priori-defined hospital diagnoses (mainly cardiovascular and respiratory conditions) from the previous 2 years as susceptibility factors. RESULTS: The increased risk of cardiac admissions was 1.0% (95% confidence interval [CI] = 0.7% to 1.4%) per 10 μg/m PM10 at lag 0. The effect was slightly higher for heart failure (lag 0, 1.4% [0.7% to 2.0%]) and acute coronary syndrome (lag 0-1, 1.1% [0.4% to 1.9%]) than for arrhythmias (lag 0, 1.0% [0.2% to 1.8%]). Women were at higher risk of heart failure (2.0% [1.2% to 2.8%]; test for interaction, P = 0.022), whereas men were at higher risk of arrhythmias (1.9% [0.8% to 3.0%]; test for interaction, P = 0.020). Subjects aged 75-84 years were at higher risk of admissions for coronary events (2.6% [1.5% to 3.8%]; test for interaction, P = 0.001). None of the identified chronic conditions was a clear marker of susceptibility. CONCLUSIONS: An important effect of PM10 on hospitalizations for cardiac diseases was found in Italian cities. Sex and older age were susceptibility factors. © 2012 Lippincott Williams & Wilkins, Inc.


Castle P.E.,U.S. National Cancer Institute | Bulten J.,Radboud University Nijmegen | Confortini M.,Institute for Cancer Study and Prevention ISPO | Klinkhamer P.,Laboratory of Pathology | And 4 more authors.
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2010

Objective To investigate the rate of unsatisfactory cervical cell samples in liquid-based cytology (LBC) versus conventional cytology (CC) by age. Design Randomised clinical trials. Setting Population-based cervical cancer screening in the Netherlands and Italy. Population Asymptomatic women invited for screening enrolled in two randomised trials: Netherlands ThinPrep® versus conventional cytology (NETHCON; 39 010 CC, 46 064 LBC) and New Technologies in Cervical Cancer Screening (NTCC; 22 771 CC, 22 403 LBC). Methods Comparison of categorical variables using Pearson's chi-square test, logistic regression and trend tests. Main outcome measures Proportion of unsatisfactory samples, ratio of LBC versus CC, and variation by 5-year group. Results In NETHCON, a lower percentage of LBC samples were judged to be unsatisfactory compared with CC samples (0.33 versus 1.11%). There was no significant trend in unsatisfactory results by age group for conventional cytology (Ptrend = 0.54), but there was a trend towards an increasing percentage of unsatisfactory results with increasing age for LBC (Ptrend < 0.001). In NTCC, a lower percentage of LBC samples were judged to be unsatisfactory compared with conventional cytology (2.59 versus 4.10%). There was a decrease in the unsatisfactory results by age group with conventional cytology (P trend < 0.001) and with LBC (Ptrend = 0.01), although the latter trend arose from the 55-60-years age group (Ptrend = 0.62 when excluding this group). Conclusions The clinical trial in which the results were collected and the cytologic method used were the most important determinants of unsatisfactory cytology. In all situations, the proportion of unsatisfactory samples was lower in LBC compared with CC. The effects of age depended on the criteria used to define unsatisfactory results. © RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology.


PubMed | Karolinska Institutet, University of Tampere, International Agency for Research on Cancer, Center for Cancer Prevention and 10 more.
Type: Journal Article | Journal: Nature reviews. Clinical oncology | Year: 2016

Human papillomavirus (HPV)-related screening technologies and HPV vaccination offer enormous potential for cancer prevention, notably prevention of cervical cancer. The effectiveness of these approaches is, however, suboptimal owing to limited implementation of screening programmes and restricted indications for HPV vaccination. Trials of HPV vaccination in women aged up to 55 years have shown almost 90% protection from cervical precancer caused by HPV16/18 among HPV16/18-DNA-negative women. We propose extending routine vaccination programmes to women of up to 30 years of age (and to the 45-50-year age groups in some settings), paired with at least one HPV-screening test at age 30 years or older. Expanding the indications for HPV vaccination and much greater use of HPV testing in screening programmes has the potential to accelerate the decline in cervical cancer incidence. Such a combined protocol would represent an attractive approach for many health-care systems, in particular, countries in Central and Eastern Europe, Latin America, Asia, and some more-developed parts of Africa. The role of vaccination in women aged >30 years and the optimal number of HPV-screening tests required in vaccinated women remain important research issues. Cost-effectiveness models will help determine the optimal combination of HPV vaccination and screening in public health programmes, and to estimate the effects of such approaches in different populations.


Gillio-Tos A.,University of Turin | De Marco L.,University of Turin | Carozzi F.M.,ISPO Cancer Prevention and Research Institute | Del Mistro A.,Venetian Oncology Institute IRCCS | And 6 more authors.
Journal of Clinical Microbiology | Year: 2013

The Hybrid Capture 2 (HC2) test targets 13 human papillomavirus (HPV) types. Here, cross-reactivity with non-HC2-targeted HPV types is described. We aimed to define the proportion of HC2-positive women who had negative results with HC2-targeted HPV types and estimate its determinants and impact on women's health management. The New Technologies for Cervical Cancer (NTCC) trial was followed in two predetermined phases. Women in the experimental arm were tested for the presence of HPV DNA by HC2 following a sample collection in PreservCyt (first phase) or Digene specimen transport medium (STM) (second phase). HPV genotyping was performed on DNA samples from HC2-positive women by PCR with GP5+/GP6+ primers and reverse line blot (RLB) hybridization. Untyped samples were submitted to direct sequencing or restriction fragment length polymorphism. Multivariate logistic regression analysis estimated the adjusted odds ratios (ORs) between the presence of HC2-targeted types and age, viral load, and type of transport medium. Out of 2,920 HC2-positive samples, 2,310 (79.1%) were positive on RLB for HC2-targeted types, 396 were positive (13.6%) for only non-HC2-targeted types (mostly represented by HPV-53, HPV- 66, and HPV-70), and in 214 (7.33%) samples, no HPV types were detected. The probability of detecting HC2-targeted types increased with increasing viral load expressed as the relative light unit/positive-control specimen ratio (RLU/PC) (OR for unitary increase of log RLU/PC, 1.35; 95% confidence interval [CI], 1.30 to 1.42) and with STM versus PreservCyt (OR, 1.56; 95% CI, 1.25 to 1.84). If only the samples containing HC2-targeted types tested positive, the positive predictive value (PPV) would have increased from 7.0% (95% CI, 6.1% to 8.0%) to 8.4% (95% CI, 7.3 to 9.6), although 4.9% (95% CI, 2.4% to 8.8%) of cervical intraepithelial neoplasia grade 2+ (CIN2+) cases would have been missed. In conclusion, STM use and an increased cutoff would reduce the HC2 analytical false-positive rate and increase the positive predictive value for high-grade CIN. The gain in clinical sensitivity by detecting non-HC2-targeted HPV types is limited. Copyright © 2013, American Society for Microbiology. All Rights Reserved.


Faustini A.,Regional Health Service of Lazio | Stafoggia M.,Regional Health Service of Lazio | Colais P.,Regional Health Service of Lazio | Berti G.,U.S. Environmental Protection Agency | And 6 more authors.
European Respiratory Journal | Year: 2013

Short-term effects of air pollutants on respiratory mortality and morbidity have been consistently reported but usually studied separately. To more completely assess air pollution effects, we studied hospitalisations for respiratory diseases together with out-of-hospital respiratory deaths. A time-stratified case-crossover study was carried out in six Italian cities from 2001 to 2005. Daily particulate matter (particles with a 50% cut-off aerodynamic diameter of 10 μm (PM10)) and nitrogen dioxide (NO2) associations with hospitalisations for respiratory diseases (n5100 690), chronic obstructive pulmonary disease (COPD) (n538 577), lower respiratory tract infections (LRTI) among COPD patients (n59886) and out-of-hospital respiratory deaths (n55490) were estimated for residents aged o35 years. For an increase of 10 μgm-3 in PM10, we found an immediate 0.59% (lag 01 days) increase in hospitalisations for respiratory diseases and a 0.67% increase for COPD; the 1.91% increase in LRTI hospitalisations lasted longer (lag 03 days) and the 3.95% increase in respiratory mortality lasted 6 days. Effects of NO2 were stronger and lasted longer (lag 05 days). Age, sex and previous ischaemic heart disease acted as effect modifiers for different outcomes. Analysing multiple rather than single respiratory events shows stronger air pollution effects. The temporal relationship between the pollutant increases and hospitalisations or mortality for respiratory diseases differs. Copyright © ERS 2013.


Baussano I.,International Agency for Research on Cancer | Dillner J.,Karolinska Institutet | Lazzarato F.,University of Turin | Ronco G.,Center for Cancer Prevention | Franceschi S.,International Agency for Research on Cancer
Infectious Agents and Cancer | Year: 2014

Background: The decrease in human papillomavirus (HPV) vaccine prices may allow upscale already started vaccination programmes but the advantages of different options are unclear. Methods. Using a mathematical model of HPV16 and 18 transmission and data on vaccination coverage from Italy, we compared 3 options to upscale an already started programme targeting 11-year old girls (coverage 65%): a) coverage improvement (from 65% to 90%); b) addition of 11-year-old boys (coverage 65%); or c) 1-year catch-up of older girls (coverage 50%). Results: The reduction of cervical HPV16/18 infection as compared to no vaccination (i.e. effectiveness against HPV16/18) increased from 76% to 98% with coverage improvement in girls and to 90% with the addition of boys. With higher coverage in girls, HPV16/18 infection cumulative probability by age 35 decreased from 25% to 8% with a 38% increase in vaccine number. The addition of boys decreased the cumulative probability to 18% with a 100% increase in the number of vaccinees. For any coverage in girls, the number of vaccinees to prevent 1 woman from being infected by HPV16/18 by age 35 was 1.5, whereas it was 2.7 for the addition of boys. Catch-up of older girls only moved forward the vaccination effectiveness by 2-5 years. Conclusions: Increasing vaccination coverage among girls is the most effective option for decreasing HPV16/18. If not achievable, vaccinating boys is justifiable if vaccine cost has at least halved, because this option would almost double the number of vaccinees. © 2014 Baussano et al.; licensee BioMed Central Ltd.


Ronco G.,Center for Cancer Prevention | Giorgi-Rossi P.,Agency for Public Health | Carozzi F.,Institute for Cancer Study and Prevention | Confortini M.,Institute for Cancer Study and Prevention | And 14 more authors.
The Lancet Oncology | Year: 2010

Background: Human papillomavirus (HPV) testing is known to be more sensitive, but less specific than cytology for detecting cervical intraepithelial neoplasia (CIN). We assessed the efficacy of cervical-cancer screening policies that are based on HPV testing. Methods: Between March, 2004, and December, 2004, in two separate recruitment phases, women aged 25-60 years were randomly assigned to conventional cytology or to HPV testing in combination with liquid-based cytology (first phase) or alone (second phase). Randomisation was done by computer in two screening centres and by sequential opening of numbered sealed envelopes in the remaining seven centres. During phase one, women who were HPV-positive and aged 35-60 years were referred to colposcopy, whereas women aged 25-34 years were referred to colposcopy only if cytology was also abnormal or HPV testing was persistently positive. During phase two, women in the HPV group were referred for colposcopy if the HPV test was positive. Two rounds of screening occurred in each phase, and all women had cytology testing only at the second round. The primary endpoint was the detection of grade 2 and 3 CIN, and of invasive cervical cancers during the first and second screening rounds. Analysis was done by intention to screen. This trial is registered, number ISRCTN81678807. Findings: In total for both phases, 47 001 women were randomly assigned to the cytology group and 47 369 to HPV testing. 33 851 women from the cytology group and 32 998 from the HPV-testing group had a second round of screening. We also retrieved the histological diagnoses from screening done elsewhere. The detection of invasive cervical cancers was similar for the two groups in the first round of screening (nine in the cytology group vs seven in the HPV group, p=0·62); no cases were detected in the HPV group during round two, compared with nine in the cytology group (p=0·004). Overall, in the two rounds of screening, 18 invasive cancers were detected in the cytology group versus seven in the HPV group (p=0·028). Among women aged 35-60 years, at round one the relative detection (HPV vs cytology) was 2·00 (95% CI 1·44-2·77) for CIN2, 2·08 (1·47-2·95) for CIN3, and 2·03 (1·60-2·57) for CIN2 and 3 together. At round two the relative detection was 0·54 (0·23-1·28) for CIN2, 0·48 (0·21-1·11) for CIN3, and 0·51 (0·28-0·93) for CIN2 and 3 together. Among women aged 25-34 years, there was significant heterogeneity between phases in the relative detection of CIN3. At round one the relative detection was 0·93 (0·52-1·64) in phase one and 3·91 (2·02-7·57) in phase two. At round two the relative detection was 1·34 (0·46-3·84) in phase one and 0·20 (0·04-0·93) in phase two. Pooling both phases, the detection ratio of CIN2 for women aged 25-34 years was 4·09 (2·24-7·48) at round one and 0·64 (0·23-1·27) at round two. Interpretation: HPV-based screening is more effective than cytology in preventing invasive cervical cancer, by detecting persistent high-grade lesions earlier and providing a longer low-risk period. However, in younger women, HPV screening leads to over-diagnosis of regressive CIN2. Funding: European Union, Italian Ministry of Health, Regional Health Administrations of Piemonte, Tuscany, Veneto and Emilia-Romagna, and Public Health Agency of Lazio. © 2010 Elsevier Ltd. All rights reserved.


Stafoggia M.,Rome E Health Authority | Forastiere F.,Rome E Health Authority | Faustini A.,Rome E Health Authority | Biggeri A.,University of Florence | And 9 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2010

Rationale: Acute effects of ozone on mortality have been extensively documented in clinical and epidemiological research. However, only a few studies have focused on subgroups of the population especially vulnerable to these effects. Objectives: To estimate the association between exposure to ozone and cause-specific mortality, and to evaluate whether individual sociodemographic characteristics or chronic conditions confer greater susceptibility to the adverse effects of ozone. Methods: A case-crossover analysis was conducted in 10 Italian cities. Data on mortality were collected for the period 2001 to 2005 (April - September) for 127,860 deceased subjects. Information was retrieved on cause of death, sociodemographic characteristics, chronic conditions from previous hospital admissions, and location of death. Daily ozone concentrations were collected from background fixed monitors. Measurements and Main Results: We estimated a 1.5% (95% confidence interval [CI], 0.9-2.1) increase in total mortality for a 10 μg/m3 increase in ozone (8-h, lag 0-5). The effect lasted several days for total, cardiac and respiratory mortality (lag 0-5), and it was delayed for cerebrovascular deaths (lag 3-5). In the subgroup analysis, the effect was more pronounced in people older than 85 years of age (3.5%; 95% CI, 2.4-4.6) than in 35- to 64-year-old subjects (0.8%; 95% CI,20.8 to 2.5), in women (2.2%; 95% CI, 1.4-3.1) than in men (0.8%; 95% CI, 20.1 to 1.8), and for out-of-hospital deaths (2.1%; 95% CI, 1.0-3.2), especially among patients with diabetes (5.5%; 95% CI, 1.4-9.8). Conclusions:Agreater vulnerability of elderly people and women was indicated; subjects who died at home and had diabetes emerged as especially affected.


Zanetti R.,Center for Cancer Prevention | Tazi M.A.,Directorate of Epidemiology and Control of Diseases | Rosso S.,Center for Cancer Prevention
European Journal of Cancer | Year: 2010

Over the last few years, Cancer Registries in North Africa (Morocco, Algeria, Tunisia, Libya and Egypt) increased in number from one to nine, and now covers 13% of the total regional population. Their data can be considered of good or acceptable quality, according to available indicators. The pattern of risk shown by these Registries is quite unique. The total cancer burden in the North African countries is between one third and one half of what is observed in Europe. The overall incidence rate in men (world age standardised, per 100,000) ranges from 86.3 in Sétif, Algeria, to 156.1 in Garbiah, Egypt. The range is similar in women: from 80.3 in Sétif to 164.0 in Algier, both in Algeria. The case mix and the level of rates are quite homogeneous in the countries considered. The most frequent cancers are the same as in Europe (Lung, Breast and Prostate). This pattern completely differs from that of Central and Southern African countries, where infection-related cancers are predominant. The well-known excess risk for nasopharyngeal carcinoma in this area is confirmed, with rates reaching the level of 5.4 in men and 1.9 in women, which is 10 times higher than that in Europe. © 2009 Elsevier Ltd. All rights reserved.


Ronco G.,Center for Cancer Prevention | Meijer C.J.L.M.,VU University Amsterdam
Current Cancer Therapy Reviews | Year: 2010

Cervical screening based on testing for the DNA of high-risk HPV types as primary screening test detects the precursors of cervical cancers earlier than cytology. This allows longer screening intervals and results in increased effec- tiveness in preventing invasive cervical cancers. Data suggest that protection is similar irrespective whether sole HPV testing or HPV in conjunction with cytology are applied as primary tests. In addition, protection seems similar when di- rectly referring all HPV positive women to colposcopy and when referring only women with abnormal cytology or persis- tent infection (cytological triage). On the other hand, using both tests for primary screening, and especially directly refer- ring to colposcopy all HPV positive women, results in a strong increase of unneeded colposcopies. Therefore stand-alone HPV testing as primary test, at prolonged intervals, with cytological triage is recommendable. With this approach the positive predictive value of colposcopy is similar to that obtained with cytological screening. In younger women HPV based screening could result in large overdiagnosis of regressive lesions and should therefore be avoided. Other triage methods, based on simple HPV test repeat, viral load, p16-INK4A overexpression and testing for the HPV E6/E7 mRNA are under study. Self sampling for HPV is sensitive and specific. Among non-responders to routine screening it obtained higher compliance than regular re-invitation and allowed a relevant yield of CIN2+. 2010 Bentham Science Publishers Ltd.

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