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Gatta G.,Evaluative Epidemiology Unit | Rossi S.,Italian National Institute of Health | Capocaccia R.,Italian National Institute of Health
Tumori | Year: 2013

Incidence, prevalence and mortality indicators, as provided in this monographic issue for each of the Italian regions and for the major cancers (stomach, colorectal, lung, breast, uterine cervix, prostate cancer and skin melanoma), provide necessary information for cancer control activities. In Italy, these activities are mainly organized on a regional level. Incidence depends on the distribution of risk factors in the population and is monitored to assess the efficacy of primary prevention programs as well as to measure the effect of screening activities. Mortality is a summary indicator incorporating the effects of both occurrence and survival. Finally, the prevalence of people with a diagnosis of cancer within a population is a direct measure of the demand for health care and social services. When taken separately, each of these indicators provides a partial view of the cancer phenomenon and should therefore be interpreted with caution. In this paper we give some examples of the uses of these indicators, and also of the interpretation difficulties by relating the regional cancer incidence to tobacco use, overweight and residence in polluted sites. We comment on the observed mortality trends in terms of their contribution to incidence and survival. We associate the estimated trends in cancer prevalence from 1990 to 2015 with the gross domestic product, an indicator of the resources available in Italy. The simultaneous consideration of all three indicators, as was done throughout this monograph by means of a unique methodology, is suggested for public health use.


Fusco M.,Campania Cancer Registry at ASL NA3 Sud | De Angelis R.,Italian National Institute of Health | Senatore G.,Cancer Registry of the Salerno Province | Zigon G.,Evaluative Epidemiology Unit | Rossi S.,Italian National Institute of Health
Tumori | Year: 2013

Aims and background. In Campania two cancer registries have been operating since 1996, covering part of the province of Naples and the province of Salerno, and amounting to 29% of the regional population. The aim of this paper is to provide estimates of the incidence, mortality and prevalence of seven major cancers for the entire Campania region. Methods. The estimates were obtained by applying the MIAMOD method, a statistical back-calculation approach to derive incidence and prevalence figures starting from mortality and relative survival data. Survival was modeled on the basis of published data from the Italian cancer registries. Results. In 2012 the most frequent cancers were colorectal, breast and lung cancer with 3,969, 3,675 and 3,629 new diagnosed cases, respectively. The cancers with increasing incidence trends were breast cancer, lung cancer and skin melanoma in women, and colorectal cancer and skin melanoma in men. By contrast, the incidence rates of uterine cervix cancer and stomach cancer were decreasing. In men the lung and prostate cancer incidence rates increased, reaching a peak in different periods, and then decreased and stabilized, respectively. Prevalence was increasing for all considered cancers with the exception of cervical cancer. The highest values in 2012 were estimated for breast and colorectal cancer (34,000 and 22,000 prevalent cases, respectively). In the final period under study there was a decline in mortality for all cancers except female lung cancer. The highest crude mortality rates in 2012 were estimated for lung cancer in men and breast cancer in women: 80 and 31 per 100,000, respectively. Conclusion. This paper provides a description of the burden of the major cancers in Campania until 2015. The estimates highlight the need to reinforce organized screening, especially for breast and colorectal cancer, and to support evidence-based prevention campaigns against female smoking. All these aspects require continuous and updated monitoring of the main epidemiological indicators in the Campania population.


Oddone E.,University of Pavia | Modonesi C.,University of Parma | Gatta G.,Evaluative Epidemiology Unit
World Journal of Gastroenterology | Year: 2014

A traditional belief widespread across the biomedical community was that dietary habits and genetic predisposition were the basic factors causing colorectal cancer. In more recent times, however, a growing evidence has shown that other determinants can be very important in increasing (or reducing) incidence of this malignancy. The hypothesis that environmental and occupational risk factors are associated with colorectal cancer is gaining ground, and high risks of colorectal cancer have been reported among workers in some industrial branches. The aim of this study was to investigate the epidemiologic relationship between colorectal cancer and occupational exposures to several industrial activities, by means of a scientific literature review and meta-analysis. This work pointed out increased risks of colorectal cancer for labourers occupied in industries with a wide use of chemical compounds, such as leather (RR = 1.70, 95%CI: 1.24-2.34), basic metals (RR = 1.32, 95%CI: 1.07-1.65), plastic and rubber manufacturing (RR = 1.30, 95%CI: 0.98-1.71 and RR = 1.27, 95%CI: 0.92-1.76, respectively), besides workers in the sector of repair and installation of machinery exposed to asbestos (RR = 1.40, 95%CI: 1.07-1.84). Based on our results, the estimated crude excess risk fraction attributable to occupational exposure ranged from about 11% to about 15%. However, homogeneous pattern of association between colorectal cancer and industrial branches did not emerge from this review. © 2014 Baishideng Publishing Group Inc. All rights reserved.


Stracci F.,University of Perugia | Ciampichini R.,Evaluative Epidemiology Unit | Tavilla A.,Italian National Institute of Health | Foschi R.,Evaluative Epidemiology Unit
Tumori | Year: 2013

Aims and background. Model-based estimates and projections of epidemiological indicators related to cancer are important tools to support public health policies and planning. The aim of the present study is to produce projections of cancer incidence, mortality and prevalence for the Umbria region (900,000 inhabitants) in central Italy. Methods. The estimations were obtained by applying the MIAMOD method, a statistical back-calculation approach to derive incidence and prevalence figures starting from mortality and relative survival data. Published data from the Italian cancer registries were modeled in order to estimate regional cancer survival. Estimated incidence rates were validated with observed incidence rates obtained from the Umbria regional cancer registry. Results. The most frequent cancer sites estimated were colon-rectum, prostate and breast in women, with 970, 615 and 729 new diagnoses, respectively, in 2012. The incidence rates were increasing for female lung cancer, male colorectal cancer, and melanoma. By contrast, the rates have been declining for cervix and stomach cancer. For lung cancer and prostate cancer in men and colorectal cancer in women the rates increased, reaching a peak in different periods, and then decreased. The incidence rates of breast cancer rose, reaching a plateau in the mid 2010s. Favorable mortality trends were predicted for all cancers except skin melanoma and lung cancer in women. The prevalence of cancer was increasing with the only exception of cervical cancer in women and lung cancer in men in the most recent estimation period. Conclusion. The scenario found for cancer incidence and prevalence was largely influenced by screening activities, so that increasing or stable incidence rates may reflect active preventive efforts. Aging, screening, and more complex and costly treatments pose a problem of sustainability and selection of interventions to the regional oncology system. Evaluation of effectiveness of intervention and cost-benefit analyses will be important to ensure cancer control in the future.


Trama A.,Evaluative Epidemiology Unit | Botta L.,Evaluative Epidemiology Unit | Foschi R.,Evaluative Epidemiology Unit | Ferrari A.,Paediatric Oncology Unit | And 6 more authors.
The Lancet Oncology | Year: 2016

Background: Data from EUROCARE have consistently shown lower survival for adolescents and young adults (AYAs; aged 15-24 years) than for children (0-14 years) for most cancers that affect both groups, and modest survival improvements up to 2000-02. AYAs have longer survival than that of adults for most cancers. We used the latest definition of AYAs (aged 15-39 years) and provided estimates of 5-year relative survival for European AYAs with cancer diagnosed in 2000-07, compared with children and adults (40-69 years) with cancer, and assessed survival improvements over time. Methods: We analysed data from population-based cancer registries of 27 European countries participating in EUROCARE-5. We used the so-called complete method to estimate 5-year, population-weighted relative survival for 19 cancers affecting AYAs and children, and for 27 cancers affecting AYAs and adults. We assessed relative-survival differences between children versus AYAs, and between AYAs versus adults, using the Z test. We used the period approach to estimate 5-year relative survival over time for children and AYAs, and used a generalised linear model to model survival time trends (1999-2007) and to assess the significance of changes over time. Findings: We analysed 56 505 cancer diagnoses in children, 312 483 in AYAs, and 3 567 383 in adults. For all cancers combined, survival improved over time for AYAs (from 79% [95% CI 78·1-80·5] in 1999-2002 to 82% [81·1-83·3] in 2005-07; p<0·0001) and children (from 76% [74·7-77·1] to 79% [77·2-79·4]; p<0·0001). Survival improved significantly in children and AYAs for acute lymphoid leukaemia (p<0·0001) and non-Hodgkin lymphoma (p<0·0001 in AYAs and p=0·023 in children). Survival improved significantly in AYAs only for CNS tumours (p=0·0046), astrocytomas (p=0·040), and malignant melanomas (p<0·0001). Survival remained significantly worse in AYAs than in children for eight important cancers: acute lymphoid leukaemias, acute myeloid leukaemias, Hodgkin's lymphomas, non-Hodgkin lymphomas, astrocytomas, Ewing's sarcomas, and rhabdomyosarcomas (p<0·0001 in all cases), and osteosarcomas (p=0·011). Interpretation: Notwithstanding the encouraging results for some cancers, and overall, we showed poorer survival in AYAs than in children for the eight important cancers. Recent European initiatives to improve outcomes in AYAs might reduce the survival gap between children and AYAs, but this reduction can only be verified by future population-based studies. Funding: Italian Ministry of Health, European Commission. © 2016 Elsevier Ltd.

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