1
|
Clinical performance indicators for monitoring the management of cutaneous melanoma: a population-based perspective. Melanoma Res 2022; 32:353-359. [PMID: 35855661 PMCID: PMC9436025 DOI: 10.1097/cmr.0000000000000841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
The prognosis of cutaneous malignant melanoma (CMM) is based on disease progression. The highly heterogeneous clinical-pathological characteristics of CMM necessitate standardized diagnostic and therapeutic interventions tailored to cancer's stage. This study utilizes clinical performance indicators to assess the quality of CMM care in Veneto (Northeast Italy). This population-based study focuses on all incidences of CMMs registered by the Veneto Cancer Registry in 2015 (1279 patients) and 2017 (1368 patients). An interdisciplinary panel of experts formulated a set of quality-monitoring indicators for diagnostic, therapeutic, and end-of-life clinical interventions for CMM. The quality of clinical care for patients was assessed by comparing the reference thresholds established by experts to the actual values obtained in clinical practice. The prevalence of stage I-CMM decreased significantly from 2015 to 2017 (from 71.8 to 62.4%; P < 0.001), and almost all the pathology reports mentioned the number of nodes dissected during a lymphadenectomy. More than 90% of advanced CMMs were promptly tested for molecular BRAF status, but the proportion of patients given targeted therapies fell short of the desired threshold (61.1%). The proportion of stage I-IIA CMM patients who inappropriately underwent computerized tomography/MRI/PET dropped from 17.4 to 3.3% ( P < 0.001). Less than 2% of patients received medical or surgical anticancer therapies in the month preceding their death. In the investigated regional context, CMM care exhibited both strengths and weaknesses. The evaluated clinical indicators shed essential insight on the clinical procedures requiring corrective action. It is crucial to monitor clinical care indicators to improve care for cancer patients and promote the sustainability of the healthcare system.
Collapse
|
2
|
Buja A, Rugge M, De Luca G, Bovo E, Zorzi M, De Toni C, Cozzolino C, Vecchiato A, Del Fiore P, Spina R, Cinquetti S, Baldo V, Rossi CR, Mocellin S. Cutaneous Melanoma in Alpine Population: Incidence Trends and Clinicopathological Profile. Curr Oncol 2022; 29:2165-2173. [PMID: 35323375 PMCID: PMC8947100 DOI: 10.3390/curroncol29030175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 01/04/2023] Open
Abstract
Previous studies associated high-level exposure to ultraviolet radiation with a greater risk of cutaneous malignant melanoma (CMM). This study focuses on the changing incidence of CMM over time (from 1990 to 2017) in the Veneto region of Northeast Italy, and its Alpine area (the province of Belluno). The clinicopathological profile of CMM by residence is also considered. A joinpoint regression analysis was performed to identify significant changes in the yearly incidence of CMM by sex and age. For each trend, the average annual percent change (AAPC) was also calculated. In the 2017 CMM cohort, the study includes a descriptive analysis of the disease's categorical clinicopathological variables. In the population investigated, the incidence of CMM has increased significantly over the last 30 years. The AAPC in the incidence of CMM was significantly higher among Alpine residents aged 0-49 than for the rest of the region's population (males: 6.9 versus 2.4; females 7.7 versus 2.7, respectively). Among the Alpine residents, the AAPC was 3.35 times greater for females aged 0-49 than for people aged 50+. The clinicopathological profile of CMM was significantly associated with the place of residence. Over three decades, the Veneto population has observed a significant increase in the incidence of CMM, and its AAPC. Both trends have been markedly more pronounced among Alpine residents, particularly younger females. While epidemiology and clinicopathological profiles support the role of UV radiation in CMM, the young age of this CMM-affected female population points to other possible host-related etiological factors. These findings also confirm the importance of primary and secondary prevention strategies.
Collapse
Affiliation(s)
- Alessandra Buja
- Department of Cardiologic, Vascular and Thoracic Sciences and Public Health, University of Padua, 35131 Padua, Italy; (G.D.L.); (V.B.)
| | - Massimo Rugge
- Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua, 35131 Padua, Italy;
- Azienda Zero, Veneto Tumor Registry (RTV), 35131 Padua, Italy; (E.B.); (M.Z.)
| | - Giuseppe De Luca
- Department of Cardiologic, Vascular and Thoracic Sciences and Public Health, University of Padua, 35131 Padua, Italy; (G.D.L.); (V.B.)
| | - Emanuela Bovo
- Azienda Zero, Veneto Tumor Registry (RTV), 35131 Padua, Italy; (E.B.); (M.Z.)
| | - Manuel Zorzi
- Azienda Zero, Veneto Tumor Registry (RTV), 35131 Padua, Italy; (E.B.); (M.Z.)
| | - Chiara De Toni
- Department of Statistical Sciences, University of Padua, 35131 Padua, Italy;
| | - Claudia Cozzolino
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 35131 Padua, Italy; (C.C.); (A.V.); (C.R.R.); (S.M.)
| | - Antonella Vecchiato
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 35131 Padua, Italy; (C.C.); (A.V.); (C.R.R.); (S.M.)
| | - Paolo Del Fiore
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, 35131 Padua, Italy; (P.D.F.); (R.S.)
| | - Romina Spina
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, 35131 Padua, Italy; (P.D.F.); (R.S.)
| | - Sandro Cinquetti
- Hygiene and Public Health Service (SISP), Azienda ULSS 1 Dolomiti, 32100 Belluno, Italy;
| | - Vincenzo Baldo
- Department of Cardiologic, Vascular and Thoracic Sciences and Public Health, University of Padua, 35131 Padua, Italy; (G.D.L.); (V.B.)
| | - Carlo Riccardo Rossi
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 35131 Padua, Italy; (C.C.); (A.V.); (C.R.R.); (S.M.)
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, 35131 Padua, Italy; (P.D.F.); (R.S.)
| | - Simone Mocellin
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 35131 Padua, Italy; (C.C.); (A.V.); (C.R.R.); (S.M.)
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, 35131 Padua, Italy; (P.D.F.); (R.S.)
| |
Collapse
|
3
|
Cancer risk for multiple sclerosis patients treated with azathioprine and disease-modifying therapies: an Italian observational study. Neurol Sci 2021; 42:5157-5163. [PMID: 33791892 DOI: 10.1007/s10072-021-05216-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The risk of malignancy associated with sequential disease-modifying therapies (DMTs) for patients with multiple sclerosis (MS) is uncertain. The aim of this study was to analyze the risk of cancer in patients with MS treated with azathioprine (AZA) and the influence of sequential DMTs on the risk. METHOD We retrospectively enrolled a cohort of AZA-treated MS patients followed in two Italian centers from 1987 to 2019. The ratio between observed and expected cancers in the Italian general population was calculated as standardized incidence ratio (SIR). Associations between AZA and DMTs and cancer were estimated by Cox proportional hazards model. RESULTS We identified 500 AZA-treated MS patients, followed for a median time of 9.7 (0.1-45.7) years: 61.8% of them were treated with DMTs. We found 22 cases of cancer (4.4%). The SIR was 1.14 (95% CI 0.98-1.29), not significantly increased in comparison with the general population. However, the risk was significantly higher in the quintiles of age 32-45, SIR 1.21 (95% CI 1.21-1.42), and 46-51, SIR 1.11 (95% CI 1.11-1.32) than in older cases. Age at AZA treatment onset was the only covariate significantly related to cancer incidence (HR = 1.049, 95% CI 1.007-1.093). The exposure to other DMTs did not modify the risk. CONCLUSION The risk of malignancy in MS patients after AZA was similar to that of the general population and did not change with other DMTs sequential treatments. The increased risk in the younger ages should be considered in treatment assessment.
Collapse
|
4
|
Fancellu A, Zhao XY, Cottu P, Sanna V, Li YP, Zhu Q, Tanda C, Zhang YY, Lai YM, Ginesu GC, Dai SQ, Porcu A. Comparing Clinicopathologic Features and Surgical Treatment of Premenopausal Breast Cancer across Italy and China: Report from a Medical Exchange Program. Breast Care (Basel) 2020; 15:511-518. [PMID: 33223995 DOI: 10.1159/000505448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 12/16/2019] [Indexed: 02/05/2023] Open
Abstract
Background This study investigated the differences in clinicopathologic features and surgical treatment between an Italian and a Chinese cohort of premenopausal women with breast cancer, and highlighted the potential advantages of international medical exchange projects. Methods Premenopausal women who underwent surgical treatment between 2012 and 2016 at one Italian and one Chinese institution participating in a medical exchange program were compared. Factors associated with the probability to receive mastectomy were determined via logistic analysis. Changes in surgical management at the Chinese institution in the period 2018-2019, after the exchange program, were also evaluated. Results A total of 505 patients, 318 from Italy and 187 from China, were evaluated. The Chinese patients had more frequently advanced-stage tumours, large tumour size (30.9 vs. 18.1 mm, p < 0.01), invasive carcinoma (92.5 vs. 83.3%, p < 0.01), positive axillary lymph nodes (54.5 vs. 27.4%, p < 0.01), Her-2 positivity (36.4 vs. 22.0%, p < 0.01), and high proliferative index (55.1 vs. 30.2%, p < 0.01). Positive oestrogen receptor status and rates of triple-negative breast cancer did not differ (77.0 vs. 69.5%, p = 0.09 and 14.2 vs. 16%, p = 0.56, respectively). Mastectomy rates were higher among Chinese women (85 vs. 41%, p < 0.001), whereas use of sentinel node biopsy was more frequent among Italian women (77 vs. 33%, p < 0.001). Chinese women had more than 4-fold higher risk of receiving mastectomy. In the last 2 years, the rates of breast-conserving surgery and sentinel node biopsy at the Chinese institution increased from 15 to 23%, and from 33 to 42%, respectively. Conclusions Tumour features and surgical strategies for premenopausal breast cancer may differ significantly between Italy and China. Since the international exchange program, patients from the Chinese institution have been offered more frequently less invasive surgery. International exchange programs can help in designing epidemiological studies which may be useful for strategies to improve breast cancer management and control.
Collapse
Affiliation(s)
- Alessandro Fancellu
- Unit of General Surgery 2-Clinica Chirurgica, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Xue Yun Zhao
- Department of Thyroid and Breast Surgery, People's Hospital of Leshan, Leshan, China
| | - Pietrina Cottu
- Unit of General Surgery 2-Clinica Chirurgica, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Valeria Sanna
- Division of Medical Oncology, AOU Sassari, Sassari, Italy
| | - Yuan Ping Li
- Department of Thyroid and Breast Surgery, People's Hospital of Leshan, Leshan, China
| | - Qin Zhu
- Department of Thyroid and Breast Surgery, People's Hospital of Leshan, Leshan, China
| | - Cinzia Tanda
- Unit of General Surgery 2-Clinica Chirurgica, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Ying Yi Zhang
- Department of Thyroid and Breast Surgery, People's Hospital of Leshan, Leshan, China
| | - Yan Mei Lai
- Department of Thyroid and Breast Surgery, People's Hospital of Leshan, Leshan, China
| | - Giorgio Carlo Ginesu
- Unit of General Surgery 2-Clinica Chirurgica, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Shu Qin Dai
- Department of Thyroid and Breast Surgery, People's Hospital of Leshan, Leshan, China
| | - Alberto Porcu
- Unit of General Surgery 2-Clinica Chirurgica, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| |
Collapse
|
5
|
Buja A, Rivera M, Girardi G, Vecchiato A, Rebba V, Pizzo E, Sileni VC, Palozzo AC, Montesco M, Zorzi M, Sartor G, Scioni M, Bolzan M, Fiore PD, Bonavina MG, Rugge M, Baldo V, Rossi CR. Cost-effectiveness of a melanoma screening programme using whole disease modelling. J Med Screen 2019; 27:157-167. [PMID: 31711359 DOI: 10.1177/0969141319885998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To assess the potential impact of a melanoma screening programme, compared with usual care, on direct costs and life expectancy in the era of targeted drugs and cancer immunotherapy. METHODS Using a Whole Disease Model approach, a Markov simulation model with a time horizon of 25 years was devised to analyse the cost-effectiveness of a one-time, general practitioner-based melanoma screening strategy in the population aged over 20, compared with no screening. The study considered the most up-to-date drug therapy and was conducted from the perspective of the Veneto regional healthcare system within the Italian National Health Service. Only direct costs were considered. Sensitivity analyses, both one-way and probabilistic, were performed to identify the parameters with the greatest impact on cost-effectiveness, and to assess the robustness of our model. RESULTS Over a 25-year time horizon, the screening intervention dominated usual care. The probabilistic sensitivity analyses confirmed the robustness of these findings. The key drivers of the model were the proportion of melanomas detected by the screening procedure and the adherence of the target population to the screening programme. CONCLUSIONS The screening programme proved to be a dominant option compared with usual care. These findings should prompt serious consideration of the design and implementation of a regional or national melanoma screening strategy within a National Health Service.
Collapse
Affiliation(s)
- Alessandra Buja
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padua, Padua, Italy
| | - Michele Rivera
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Giovanni Girardi
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padua, Padua, Italy
| | - Antonella Vecchiato
- Department of Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Vincenzo Rebba
- Department of Economics and Management 'Marco Fanno', University of Padua, and CRIEP (Interuniversity Research Centre on Public Economics), Padua, Italy
| | - Elena Pizzo
- Department of Applied Health Research, University College London, London, UK
| | | | | | - Maria Montesco
- Department of Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Manuel Zorzi
- Veneto Tumour Registry, Azienda Zero, Padua, Italy
| | - Gino Sartor
- Department of Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Manuela Scioni
- Statistics Department, University of Padua, Padua, Italy
| | - Mario Bolzan
- Statistics Department, University of Padua, Padua, Italy
| | - Paolo Del Fiore
- Department of Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | | | - Vincenzo Baldo
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padua, Padua, Italy
| | - Carlo Riccardo Rossi
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.,Department of Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| |
Collapse
|
6
|
Zorzi M, Dal Maso L, Francisci S, Buzzoni C, Rugge M, Guzzinati S. Trends of colorectal cancer incidence and mortality rates from 2003 to 2014 in Italy. TUMORI JOURNAL 2019; 105:417-426. [PMID: 30917756 DOI: 10.1177/0300891619838336] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the trends of colorectal cancer (CRC) incidence and mortality rates from 2003 to 2014 in Italy by age groups and regions. METHODS We used the data of 48 cancer registries from 17 Italian regions to estimate standardized incidence and mortality rates overall and by sex, age groups (<50, 50-69, 70+ years), and geographic area (northwest, northeast, center, south, and islands). Time trends were expressed as annual percent change in rates (APC) with 95% confidence intervals (95% CI). RESULTS Incidence rates decreased from 104.3 (2003) to 89.9 × 100,000 (2014) in men and from 64.3 to 58.4 × 100,000 in women. Among men, incidence decreased during 2007-2010 (APC -4.0, 95% CI -6.0 to -1.9) and 2010-2014 (APC -0.7, 95% CI -1.4 to 0.0), while in women it linearly decreased during the whole period (APC -1.1, 95% CI -1.4 to -0.8). Mortality rates showed a linear reduction both in men (APC -0.7, 95% CI -1.0 to -0.3) and women (APC -0.9, 95% CI -1.2 to -0.6) and decreased respectively from 41.1 to 39.2 × 100,000 and from 24.6 to 23.1 × 100,000. In the 50- to 69-year-old range (screening target age), incidence showed a prescreening increase, followed by a peak after screening started, and a decline thereafter. Incidence and mortality rates significantly decreased in all areas but in the south and islands, where incidence increased and mortality remained stable. CONCLUSIONS A renewed commitment by all regional health systems to invest in primary (i.e., lifestyle) and secondary (i.e., screening programs) prevention is of utmost importance.
Collapse
Affiliation(s)
- Manuel Zorzi
- Veneto Tumour Registry, Azienda Zero, Padova, Italy
| | - Luigino Dal Maso
- Cancer Epidemiology Unit, CRO Aviano Cancer Institute IRCCS, Aviano, Italy
| | - Silvia Francisci
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Carlotta Buzzoni
- Tuscany Cancer Registry, Institute for Cancer Study and Prevention, Florence, Italy
| | - Massimo Rugge
- Veneto Tumour Registry, Azienda Zero, Padova, Italy.,Department of Medicine, DIMED Pathology and Cytopathology Unit, University of Padova, Italy
| | | | | |
Collapse
|
7
|
Bonaldo G, Vaccheri A, D'Annibali O, Motola D. Safety profile of human papilloma virus vaccines: an analysis of the US Vaccine Adverse Event Reporting System from 2007 to 2017. Br J Clin Pharmacol 2019; 85:634-643. [PMID: 30569481 PMCID: PMC6379209 DOI: 10.1111/bcp.13841] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 11/27/2022] Open
Abstract
AIMS Human papilloma virus (HPV) is the cause of different types of carcinoma. Despite the remarkable effectiveness of the HPV vaccines, there have been many complaints about their risk-benefit profile due to adverse events following immunization (AEFI). The purpose of this study is to analyse the safety profile of the HPV vaccine basing on real-life data derived from reports of suspected AEFIs collected in the US Vaccine Adverse Events Reporting System (VAERS) and assess if the searches on Google overlap with spontaneous reporting. METHODS We collected all the reports in VAERS between January 2007 to December 2017 related to the HPV vaccines. A disproportionality analysis using reporting odds ratio (ROR) with 95% confidence interval was performed. RESULTS Over the 10-year period, 55 356 reports of AEFI related to HPV vaccines were retrieved in VAERS, corresponding to 224 863 vaccine-event pairs. The highest number of reports was related to Gardasil (n = 42 244). The two events more frequently reported and statistically significant for HPV vaccines were dizziness (n = 6259; ROR = 2.60; 95% confidence interval 2.53-2.66) and syncope (n = 6004; ROR = 6.28; 95% confidence interval 6.12-6.44). The trends of spontaneous reporting and Google searches overlap. CONCLUSION The AEFI analysis showed that the events most frequently reported were non-serious and listed in the corresponding summary of product characteristics. Potential safety signals arose regarding less frequent AEFIs that would deserve further investigation. It is extremely important to disseminate correct and evidence-based scientific information.
Collapse
Affiliation(s)
- Giulia Bonaldo
- Unit of Pharmacology, Department of Medical and Surgical SciencesUniversity of Bolognavia Irnerio 4840126BolognaItaly
| | - Alberto Vaccheri
- Unit of Pharmacology, Department of Medical and Surgical SciencesUniversity of Bolognavia Irnerio 4840126BolognaItaly
| | - Ottavio D'Annibali
- Unit of Pharmacology, Department of Medical and Surgical SciencesUniversity of Bolognavia Irnerio 4840126BolognaItaly
| | - Domenico Motola
- Unit of Pharmacology, Department of Medical and Surgical SciencesUniversity of Bolognavia Irnerio 4840126BolognaItaly
| |
Collapse
|
8
|
Does low-dose aspirin use for cardiovascular disease prevention reduce colorectal cancer deaths? A comparison of two cohorts in the Florence district, Italy. Eur J Cancer Prev 2019; 27:134-139. [PMID: 27845951 DOI: 10.1097/cej.0000000000000319] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Aspirin has been associated with reduced incidence and mortality of colorectal and a few other cancers. The aim of our paper was to study the effect of low-dose aspirin intake on cancer mortality in a population-based cohort study. The study included inhabitants of the Florence district (Italy) at the beginning of 2007. We considered two cohorts: patients who received prescriptions of low-dose aspirin for the whole year and patients who did not have any prescriptions over the same period. We followed the two cohorts until 31 December 2013. By linking with the Tuscany Mortality Registry, we analysed cause-specific mortality. We used a Cox semiparametric model to compare the mortality of the two cohorts. There was an 18% higher probability [hazard ratio (HR)=1.18, 95% confidence interval (CI): 1.12-1.23] for all causes of death among the cohort of aspirin users, almost completely caused by cardiovascular diseases (CVDs) (HR=1.39, 95% CI: 1.29-1.49). Colorectal cancer mortality was reduced by almost 30% (HR=0.71, 95% CI: 0.52-0.97). Death caused by major bleeding was 11% higher (HR=1.11, 95% CI: 0.86-1.44), but not statistically significant. Our results support the hypothesis that the use of low-dose aspirin for CVD prevention reduces colorectal cancer mortality. Given the growing ability to identify subgroups of individuals with an increased risk of developing cancer, further studies are needed to study the effectiveness of different cancer screening strategies tailored to these specific subgroups. Our study suggests the importance of focusing on this issue from the opposite perspective, that is, considering subgroups of individuals at decreased risk, such as the subgroup of individuals who take low-dose aspirin for CVD prevention. Thus, further assessments are needed to possibly identify subgroup-specific screening strategies that would be more effective than those developed for average-risk individuals.
Collapse
|
9
|
Galati L, Equestre M, Bruni R, Accardi L, Torti C, Fiorillo MT, Surace G, Barreca GS, Liberto MC, Focà A, Ciccaglione AR, Di Bonito P. Identification of human papillomavirus type 16 variants circulating in the Calabria region by sequencing and phylogenetic analysis of HPV16 from cervical smears. INFECTION GENETICS AND EVOLUTION 2018; 68:185-193. [PMID: 30578936 DOI: 10.1016/j.meegid.2018.12.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 02/04/2023]
Abstract
Sequence analysis of HPV16 isolates reveals the presence of genome variants with characteristic mutations. The HPV16 variants have different geographical distribution and diverge into four phylogenetic lineages (A, B, C and D) and 16 sub-lineages: A1, A2, A3 (previously known as European variants), A4 (Asian variant), B1, B2, B3, B4, C1, C2, C3, and C4 (African variants), D1 (North-American variant), D2, D3 (Asian-American variants) and D4. Population studies showed that infections with viruses belonging to specific HPV16 sublineages confer different risks of viral persistence and cancer. In this study, 39 HPV16-positive cervical smears from European women living in Calabria (Italy) were analyzed for the presence of HPV16 variants. Cervical DNA extracts were processed by PCR to amplify L1, the Long Control Region (LCR), E6 and E7, which were sequenced. The sequences were concatenated and the 3169 nucleotides long fragments were characterized by BLAST and phylogenetic analysis. A total of 96 Single Nucleotide Polymorphism (SNPs) were detected, 29 of which mapping in the L1, 45 in the LCR, 15 in the E6 and 7 in the E7. The most common SNP was the T350G (29/39 samples, 74.4%), causing the L83 V amino acid change in the E6. Most of the HPV16 isolates (89.7%) had 99% of nucleotide (nt) identity to members of the A1 and A2 sublineages, while 4 isolates had 99% nt identity to members of the B2, B4, C1 and D4 sublineages. In conclusion, viruses belonging to the A1, A2, B2, B4, C1 and D4 HPV16 sublineages were found to circulate in the Calabria region.
Collapse
Affiliation(s)
- Luisa Galati
- Department Infectious Diseases, EVOR unit, Istituto Superiore di Sanità, Rome, Italy; Institute of Clinical Microbiology, Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Michele Equestre
- Department Cell Biology and Neurosciences, Istituto Superiore di Sanità, Rome, Italy
| | - Roberto Bruni
- Department Infectious Diseases, EVOR unit, Istituto Superiore di Sanità, Rome, Italy
| | - Luisa Accardi
- Department Infectious Diseases, EVOR unit, Istituto Superiore di Sanità, Rome, Italy
| | - Carlo Torti
- Department of Medical and Surgical Sciences, Unit of Infectious and Tropical Diseases, School of Medicine, University of "Magna Graecia", Catanzaro, Italy
| | - Maria Teresa Fiorillo
- Unit of Microbiology and Virology, Polo Sanitario Nord ASP 5, Reggio Calabria, Italy
| | - Giovanni Surace
- Unit of Microbiology and Virology, Polo Sanitario Nord ASP 5, Reggio Calabria, Italy
| | - Giorgio Settimo Barreca
- Institute of Clinical Microbiology, Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Maria Carla Liberto
- Institute of Clinical Microbiology, Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Alfredo Focà
- Institute of Clinical Microbiology, Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Anna Rita Ciccaglione
- Department Infectious Diseases, EVOR unit, Istituto Superiore di Sanità, Rome, Italy
| | - Paola Di Bonito
- Department Infectious Diseases, EVOR unit, Istituto Superiore di Sanità, Rome, Italy.
| |
Collapse
|
10
|
Cappelli MG, Fortunato F, Tafuri S, Boccalini S, Bonanni P, Prato R, Martinelli D. Cervical cancer prevention: An Italian scenario between organised screening and human papillomaviruses vaccination. Eur J Cancer Care (Engl) 2018; 27:e12905. [PMID: 30178893 PMCID: PMC6175343 DOI: 10.1111/ecc.12905] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 01/15/2018] [Accepted: 07/10/2018] [Indexed: 11/29/2022]
Abstract
We aimed to assess the cervical cancer burden and performance of screening programme over the last decade in Apulia, Italy. Data from Hospital Discharge, Causes of Death and of Outpatient Services registries were analysed to estimate the disease burden, and data collected by the screening information system were used to evaluate the performance of the programme. We computed annual hospitalisation, incidence and mortality rates and number of outpatient services prescriptions for the follow-up of preneoplastic/neoplastic lesions. Indicators as proposed by the National Centre for Screening Monitoring were computed to describe the screening performance. Hospitalisation rates declined from 47 in 2001 to 28 per 100,000 in 2014, incidence from 10.3 in 2004 to 6.0 per 100,000 in 2014 and mortality from 1.4 in 2001 to 1.0 per 100,000 in 2010. Prescriptions increased from 3,333 in 2006 to 4,968 in 2010, then decreased to 3,634/year in 2012-2014. Actual extension of screening increased from 10.8% in 2007 to 62% in 2014; compliance with the invitation was 32%/year. In the last decade, we observed a reduction in the cervical cancer burden as early effect of screening implementation.
Collapse
Affiliation(s)
- Maria G Cappelli
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Francesca Fortunato
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Silvio Tafuri
- Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - Sara Boccalini
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Rosa Prato
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Domenico Martinelli
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| |
Collapse
|
11
|
Gatta G, Rossi S, Capocaccia R. Cancer Burden Estimates and Forecasts: Uses and Cautions. TUMORI JOURNAL 2018; 99:439-43. [DOI: 10.1177/030089161309900320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
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.
Collapse
Affiliation(s)
- Gemma Gatta
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Silvia Rossi
- National Center of Epidemiology, Italian National Institute of Health, Rome, Italy
| | - Riccardo Capocaccia
- National Center of Epidemiology, Italian National Institute of Health, Rome, Italy
| |
Collapse
|
12
|
In vivo bioluminescence-based monitoring of liver metastases from colorectal cancer: An experimental model. J Microsc Ultrastruct 2017. [DOI: 10.1016/j.jmau.2017.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
13
|
Russi A, Damuzzo V, Chiumente M, Pigozzo J, Cesca M, Chiarion-Sileni V, Palozzo AC. Ipilimumab in real-world clinical practice: efficacy and safety data from a multicenter observational study. J Chemother 2017; 29:245-251. [DOI: 10.1080/1120009x.2017.1311444] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Alberto Russi
- Hospital Pharmacy, Veneto Institute of Oncology – IRCCS, Padua, Italy
| | - Vera Damuzzo
- School of Hospital Pharmacy, University of Padua, Padua, Italy
| | - Marco Chiumente
- Italian Society for Clinical Pharmacy and Therapeutics, Milan, Italy
| | - Jacopo Pigozzo
- Melanoma and Esophageal Oncology Unit, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
| | - Marco Cesca
- Hospital Pharmacy, Veneto Institute of Oncology – IRCCS, Padua, Italy
| | - Vanna Chiarion-Sileni
- Melanoma and Esophageal Oncology Unit, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
| | | |
Collapse
|
14
|
Ravaioli A, Mancini S, Naldoni C, Falcini F, Ferretti S, Bucchi L. Coping with problems that flaw the estimate of mammography sensitivity in population-based screening programmes: the Italian perspective. Public Health 2016; 136:178-80. [DOI: 10.1016/j.puhe.2016.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/09/2015] [Accepted: 01/15/2016] [Indexed: 11/26/2022]
|
15
|
Hospital discharge records as data source to monitor epidemiologic indicators of hematologic malignancies in Abruzzo. TUMORI JOURNAL 2016; 2016:258-63. [PMID: 26917409 DOI: 10.5301/tj.5000472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To test the feasibility of using hospital discharge records (HDR) to monitor frequency indicators of hematologic malignancies (HM) in Abruzzo, an Italian region without a cancer registry. METHODS Hospital discharge records contain a primary diagnosis field for principal disease and 5 secondary diagnosis fields for other diseases related or not to the principal diagnosis. In order to build patient indicators of HM-non-Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL), multiple myeloma (MM), and leukemia (acute lymphoblastic leukemia [ALL], chronic lymphoid leukemia [CLL], acute myeloid leukemia [AML], and chronic myeloid leukemia [CML])-residents with first ICD-9-CM code 200-208 in any HDR field, or only in primary field, were identified. RESULTS Among 3,955 patients with first diagnosis of HM registered in primary or secondary fields of HDR in the 2009-2013 period, and never recognized in 2005-2008 (791/year) (60.5/100,000), patients with first HM only in primary field were 2,304 (461/year) (35.2/100,000): 42% were NHL, 34% leukemia, 16% MM, 8% HL. Patient percentage of 461/791/year (58%) (64% among ordinary HDR and 49% in day-hospital HDR) was 35% for CLL (28/81), 47% for MM (74/152), 50% for CML (16/32), 57% for HL (36/63), 62% for NHL (194/314), and 82% for ALL (18/22) and AML (64/78). CONCLUSIONS Applying the cancer registries national rate, expected new diagnoses of HM in Abruzzo are about 620/year (46.4/100,000), compared to HDR estimates of 461 and 791/year (primary/all diagnoses fields: 58%). Since this percentage varies between 35% and 82%, our findings on the 2 methods seem useful for a validation process in the starting Cancer Registry.
Collapse
|
16
|
Incidence of mammary tumors in the canine population living in the Veneto region (Northeastern Italy): Risk factors and similarities to human breast cancer. Prev Vet Med 2016; 126:183-9. [DOI: 10.1016/j.prevetmed.2016.02.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 02/10/2016] [Accepted: 02/27/2016] [Indexed: 12/21/2022]
|
17
|
Capocaccia R, Foschi R, Zucchetto A, Valdagni R, Nicolai N, Maffezzini M, Gatta G. Estimates of prostate cancer burden in Italy. Cancer Epidemiol 2015; 40:166-72. [PMID: 26771313 DOI: 10.1016/j.canep.2015.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/16/2015] [Accepted: 12/09/2015] [Indexed: 11/25/2022]
Abstract
Age-standardized incidence rates of prostate cancer (PC) sharply increased during the period 1990-2005 in Italian areas covered by cancer registries, while corresponding mortality rates remained nearly constant. The latest observations have reported on a reversal of the incidence trend with decreasing values after 2005. We provided incidence, mortality, and prevalence estimates at national and geographical area levels, together with time projections up to the year 2020. We applied the MIAMOD method, using as input national mortality data for the years 1970-2010 and population-based survival data for the period of diagnosis (1985-2002). We assumed relative survival of prostate cancer remained constant after the year of diagnosis (2005). The age-standardized incidence rates of PC were estimated to increase during the period 1984-2005, from 31 per 100,000 in 1984 to 93 per 100,000 in 2005. From 2005 onwards, the estimated rates declined to 71 in 2015 and to 62 in 2020. Age-standardized mortality rates slightly increased from 1970 up to about 19 per 100,000 in 1999 and then started to decrease with an estimated reduction of about 2.3% per year. Mortality projections indicated a continuing reduction, with a predicted age-standardized rate of about 12 per 100,000 in 2020. Prevalence was estimated to continuously increase up to a crude prevalence value of 1.2% in the year 2020. The results indicate that the epidemic peak of PC was reached around the year 2005 followed by declining incidence rates, while a substantial decrease in mortality, starting during the early 2000s, is expected to continue during the 2010s.
Collapse
Affiliation(s)
- R Capocaccia
- Department of Preventive and Predictive Medicine, Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
| | - R Foschi
- Department of Preventive and Predictive Medicine, Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - A Zucchetto
- Epidemiology and Biostatistics Unit, CRO Aviano National Cancer Institute IRCCS, Aviano, Italy
| | - R Valdagni
- Division of Radiation Oncology 1, Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - N Nicolai
- Urological Surgical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - M Maffezzini
- Urological Surgical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - G Gatta
- Department of Preventive and Predictive Medicine, Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| |
Collapse
|
18
|
Roncucci L, Mariani F. Prevention of colorectal cancer: How many tools do we have in our basket? Eur J Intern Med 2015; 26:752-6. [PMID: 26499755 DOI: 10.1016/j.ejim.2015.08.019] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 07/16/2015] [Accepted: 08/07/2015] [Indexed: 12/18/2022]
Abstract
Prevention is the main strategy in order to reduce colorectal cancer incidence and mortality. It can be accomplished through primary prevention, using measures affecting factors known to confer higher risk of colorectal cancer, or through secondary prevention, aimed at early diagnosis of cancer or preneoplastic lesions in groups of subjects at increased risk of cancer. Although primary prevention should be the goal for future years, because it acts on the probable causes of colorectal cancer, at present it seems that secondary prevention is more effective on colorectal cancer survival, and the approaches which have yielded the most satisfying results, in terms of reduced mortality for cancer, are those aimed at detecting preneoplastic lesions, or cancer at an early stage in selected groups of subjects at average or increased risk of colorectal cancer. These groups are subjects aged 50years or older, affected individuals (gene carriers) or family members of hereditary colorectal cancer syndromes (i.e., Lynch syndrome and familial adenomatous polyposis), and patients with inflammatory bowel diseases. The most effective procedures used, though with some drawbacks, are fecal occult blood tests and colonoscopy. Future research should be addressed to find new approaches that will render preventive strategies more acceptable for the population, and more cost-effective.
Collapse
Affiliation(s)
- Luca Roncucci
- Department of Diagnostic and Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Policlinico, Via Del Pozzo 71, Modena 41124, Italy.
| | - Francesco Mariani
- Department of Diagnostic and Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Policlinico, Via Del Pozzo 71, Modena 41124, Italy
| |
Collapse
|
19
|
Zagari RM, Romano M, Ojetti V, Stockbrugger R, Gullini S, Annibale B, Farinati F, Ierardi E, Maconi G, Rugge M, Calabrese C, Di Mario F, Luzza F, Pretolani S, Savio A, Gasbarrini G, Caselli M. Guidelines for the management of Helicobacter pylori infection in Italy: The III Working Group Consensus Report 2015. Dig Liver Dis 2015; 47:903-12. [PMID: 26253555 DOI: 10.1016/j.dld.2015.06.010] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/27/2015] [Accepted: 06/26/2015] [Indexed: 02/08/2023]
Abstract
Knowledge on the role of Helicobacter pylori (HP) infection is continually evolving, and treatment is becoming more challenging due to increasing bacterial resistance. Since the management of HP infection is changing, an update of the national Italian guidelines delivered in 2007 was needed. In the III Working Group Consensus Report 2015, a panel of 17 experts from several Italian regions reviewed current evidence on different topics relating to HP infection. Four working groups examined the following topics: (1) "open questions" on HP diagnosis and treatment (focusing on dyspepsia, gastro-oesophageal reflux disease, non-steroidal anti-inflammatory drugs or aspirin use and extra-gastric diseases); (2) non-invasive and invasive diagnostic tests; (3) treatment of HP infection; (4) role of HP in the prevention of gastric cancer. Statements and recommendations were discussed and a consensus reached in a final plenary session held in February 2015 in Bologna. Recommendations are based on the best current evidence to help physicians manage HP infection in Italy. The guidelines have been endorsed by the Italian Society of Gastroenterology and the Italian Society of Digestive Endoscopy.
Collapse
Affiliation(s)
| | - Marco Romano
- Department of Clinical and Experimental Medicine "F. Magrassi", Second University of Naples, Italy
| | - Veronica Ojetti
- Department of Internal Medicine and Gastroenterology, Catholic University, Rome, Italy
| | | | - Sergio Gullini
- School of Gastroenterology, University of Ferrara, Italy
| | - Bruno Annibale
- Department of Digestive and Liver Disease, University Sapienza, Rome, Italy
| | - Fabio Farinati
- Department of Surgery, Oncology and Gastroenterology, Section of Gastroenterology, University of Padua, Italy
| | - Enzo Ierardi
- Department of Emergency and Organ Transplantation, University of Bari, Italy
| | - Giovanni Maconi
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Milan, Italy
| | - Massimo Rugge
- Department of Medicine, Surgical Pathology and Cytopathology Unit, University of Padua, Italy
| | - Carlo Calabrese
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Francesco Di Mario
- Department of Clinical and Experimental Medicine, University of Parma, Italy
| | - Francesco Luzza
- Department of Health Science, University of Catanzaro "Magna Graecia", Italy
| | | | - Antonella Savio
- Fondazione Poliambulanza, Department of Histopathology, Brescia, Italy
| | - Giovanni Gasbarrini
- Department of Internal Medicine and Gastroenterology, Catholic University, Rome, Italy
| | | |
Collapse
|
20
|
Giambi C, Del Manso M, D’Ancona F, De Mei B, Giovannelli I, Cattaneo C, Possenti V, Declich S. Actions improving HPV vaccination uptake – Results from a national survey in Italy. Vaccine 2015; 33:2425-31. [DOI: 10.1016/j.vaccine.2015.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 03/27/2015] [Accepted: 04/02/2015] [Indexed: 10/23/2022]
|