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Biggeri A, Stoppa G, Facciolo L, Fin G, Mancini S, Manno V, Minelli G, Zamagni F, Zamboni M, Catelan D, Bucchi L. All-cause, cardiovascular disease and cancer mortality in the population of a large Italian area contaminated by perfluoroalkyl and polyfluoroalkyl substances (1980-2018). Environ Health 2024; 23:42. [PMID: 38627679 PMCID: PMC11022451 DOI: 10.1186/s12940-024-01074-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/20/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFAS) are associated with many adverse health conditions. Among the main effects is carcinogenicity in humans, which deserves to be further clarified. An evident association has been reported for kidney cancer and testicular cancer. In 2013, a large episode of surface, ground and drinking water contamination with PFAS was uncovered in three provinces of the Veneto Region (northern Italy) involving 30 municipalities and a population of about 150,000. We report on the temporal evolution of all-cause mortality and selected cause-specific mortality by calendar period and birth cohort in the local population between 1980 and 2018. METHODS The Italian National Institute of Health pre-processed and made available anonymous data from the Italian National Institute of Statistics death certificate archives for residents of the provinces of Vicenza, Padua and Verona (males, n = 29,629; females, n = 29,518) who died between 1980 and 2018. Calendar period analysis was done by calculating standardised mortality ratios using the total population of the three provinces in the same calendar period as reference. The birth cohort analysis was performed using 20-84 years cumulative standardised mortality ratios. Exposure was defined as being resident in one of the 30 municipalities of the Red area, where the aqueduct supplying drinking water was fed by the contaminated groundwater. RESULTS During the 34 years between 1985 (assumed as beginning date of water contamination) and 2018 (last year of availability of cause-specific mortality data), in the resident population of the Red area we observed 51,621 deaths vs. 47,731 expected (age- and sex-SMR: 108; 90% CI: 107-109). We found evidence of raised mortality from cardiovascular disease (in particular, heart diseases and ischemic heart disease) and malignant neoplastic diseases, including kidney cancer and testicular cancer. CONCLUSIONS For the first time, an association of PFAS exposure with mortality from cardiovascular disease was formally demonstrated. The evidence regarding kidney cancer and testicular cancer is consistent with previously reported data.
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Affiliation(s)
- Annibale Biggeri
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua, Padua, Italy
| | - Giorgia Stoppa
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua, Padua, Italy.
| | | | - Giuliano Fin
- Comitato mamme NO-PFAS, Vicenza, Padua, Verona, Italy
| | - Silvia Mancini
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Valerio Manno
- Statistical Service, Istituto Superiore di Sanità, Rome, Italy
| | - Giada Minelli
- Statistical Service, Istituto Superiore di Sanità, Rome, Italy
| | - Federica Zamagni
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | | | - Dolores Catelan
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua, Padua, Italy
| | - Lauro Bucchi
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
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Crocetti E, Ravaioli A, Falcini F, Vattiato R, Mancini S, Baldacchini F, Zamagni F, Vitali B, Balducci C, Bucchi L, Giuliani O. How many Italian cancer patients are eligible for, and may respond to, Italian Medicines Agency-approved immune checkpoint inhibitors? Tumori 2024; 110:109-115. [PMID: 38372036 PMCID: PMC11005312 DOI: 10.1177/03008916241229649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/11/2023] [Accepted: 01/11/2024] [Indexed: 02/20/2024]
Abstract
INTRODUCTION This cross-sectional study was aimed at estimating the number of Italian incident cancer patients in 2020 eligible for, and respondent to, immune checkpoint inhibitors (ICI). METHODS The study is based on publicly available data: the ICI approved until August 2022 by the Italian Medicines Agency (AIFA) with their specific indications and overall observed responses, rther details can be found in the Online Supplementary Materi cancer incidence estimates at 2020 and observed cancer deaths, and published papers with estimates on the frequency of different cancer stage/histology/markers etc. corresponding to AIFA authorizations. RESULTS In the analyzed period, a total of seven ICI were authorized in Italy for 20 cancer types. The estimated number of ICI-eligible patients in 2020 was 48,400, 14.3% of those tumors (including skin epitheliomas) that may fit AIFA-indications, and 10.5% of all the incident malignant tumors, including skin epitheliomas. The number of patients who may benefit from ICI therapy was 24,052, 49.7% of the ICI-eligible ones, or 5.2% of the overall estimated incident cancers in 2020. CONCLUSIONS In conclusion, although the number of ICI-eligible patients is a relatively small proportion of the yearly burden of cancers, about half of them may respond to ICI-treatment.
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Affiliation(s)
- Emanuele Crocetti
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Alessandra Ravaioli
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Fabio Falcini
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
- Local Health Authority, Cancer Prevention Unit, Forlì, Italy
| | - Rosa Vattiato
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Silvia Mancini
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Flavia Baldacchini
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Federica Zamagni
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Benedetta Vitali
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Chiara Balducci
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Lauro Bucchi
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Orietta Giuliani
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
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Dal Maso L, Toffolutti F, De Paoli A, Giudici F, Francisci S, Bucchi L, Zorzi M, Fusco M, Caldarella A, Rossi S, De Angelis R, Botta L, Ravaioli A, Casella C, Musolino A, Vitale MF, Mangone L, Fanetti AC, Carpin E, Burgio Lo Monaco MG, Migliore E, Gambino ML, Ferrante M, Stracci F, Gasparotti C, Carrozzi G, Cavallo R, Mazzucco W, Ballotari P, Ferretti S, Sampietro G, Rizzello RV, Boschetti L, Cascone G, Mian M, Pesce MT, Piras D, Galasso R, Bella F, Seghini P, Pinna P, Crocetti E, Serraino D, Guzzinati S. Cure indicators and prevalence by stage at diagnosis for breast and colorectal cancer patients: A population-based study in Italy. Int J Cancer 2024. [PMID: 38520231 DOI: 10.1002/ijc.34923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/15/2024] [Accepted: 02/20/2024] [Indexed: 03/25/2024]
Abstract
People alive many years after breast (BC) or colorectal cancer (CRC) diagnoses are increasing. This paper aimed to estimate the indicators of cancer cure and complete prevalence for Italian patients with BC and CRC by stage and age. A total of 31 Italian Cancer Registries (47% of the population) data until 2017 were included. Mixture cure models allowed estimation of net survival (NS); cure fraction (CF); time to cure (TTC, 5-year conditional NS >95%); cure prevalence (who will not die of cancer); and already cured (prevalent patients living longer than TTC). 2.6% of all Italian women (806,410) were alive in 2018 after BC and 88% will not die of BC. For those diagnosed in 2010, CF was 73%, 99% when diagnosed at stage I, 81% at stage II, and 36% at stages III-IV. For all stages combined, TTC was >10 years under 45 and over 65 years and for women with advanced stages, but ≤1 year for all BC patients at stage I. The proportion of already cured prevalent BC women was 75% (94% at stage I). Prevalent CRC cases were 422,407 (0.7% of the Italian population), 90% will not die of CRC. For CRC patients, CF was 56%, 92% at stage I, 71% at stage II, and 35% at stages III-IV. TTC was ≤10 years for all age groups and stages. Already cured were 59% of all prevalent CRC patients (93% at stage I). Cancer cure indicators by stage may contribute to appropriate follow-up in the years after diagnosis, thus avoiding patients' discrimination.
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Affiliation(s)
- Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Federica Toffolutti
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | | | - Fabiola Giudici
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Silvia Francisci
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Lauro Bucchi
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Manuel Zorzi
- Epidemiological Department, Azienda Zero, Padua, Italy
| | - Mario Fusco
- Registro Tumori ASL Napoli 3 Sud, Napoli, Italy
| | - Adele Caldarella
- Tuscany Cancer Registry, Institute for Cancer Research, Prevention and Clinical Network, Florence, Italy
| | - Silvia Rossi
- Department of Oncology and Molecular Medicine, National Institute of Health, Rome, Italy
| | - Roberta De Angelis
- Department of Oncology and Molecular Medicine, National Institute of Health, Rome, Italy
| | - Laura Botta
- Evaluative Epidemiology Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandra Ravaioli
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Claudia Casella
- Liguria Cancer Registry, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Antonino Musolino
- Emilia-Romagna Cancer Registry, Parma Unit, Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | - Lucia Mangone
- Emilia-Romagna Cancer Registry, Reggio Emilia Unit, Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Anna Clara Fanetti
- Sondrio Cancer Registry, Agenzia di Tutela della Salute della Montagna, Sondrio, Italy
| | - Eva Carpin
- Epidemiological Department, Azienda Zero, Padua, Italy
| | - Maria Giovanna Burgio Lo Monaco
- Coordination Centre of the Cancer Registry of Puglia-Strategic Regional Agency for Health and Social Care (AReSS), Bari, Italy
| | - Enrica Migliore
- Piedmont Cancer Registry, Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica (CPO) Piemonte and University of Turin, Turin, Italy
| | - Maria Letizia Gambino
- Registro tumori ATS Insubria (Provincia di Como e Varese) S.S. Epidemiologia Registri Specializzati e Reti di Patologia, Varese, Italy
| | - Margherita Ferrante
- Registro Tumori Integrato di Catania-Messina-Enna, Igiene Ospedaliera, Azienda Ospedaliero-Universitaria Policlinico G. Rodolico-San Marco, Catania, Italy
| | - Fabrizio Stracci
- Umbria Cancer Registry, Public Health Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Cinzia Gasparotti
- Registro tumori ATS Brescia, Struttura Semplice Epidemiologia, ATS, Brescia, Italy
| | - Giuliano Carrozzi
- Emilia-Romagna Cancer Registry, Modena Unit, Public Health Department, Local Health Authority, Modena, Italy
| | - Rossella Cavallo
- Cancer Registry Azienda Sanitaria Locale (ASL) Salerno, Dipartimento di Prevenzione, Salerno, Italy
| | - Walter Mazzucco
- Clinical Epidemiology and Cancer Registry Unit, Azienda Ospedaliera Universitaria Policlinico (AOUP) di Palermo, Palermo, Italy
| | | | - Stefano Ferretti
- Emilia-Romagna Cancer Registry, Ferrara Unit, Local Health Authority, Ferrara, University of Ferrara, Ferrara, Italy
| | - Giuseppe Sampietro
- Bergamo Cancer Registry, Epidemiological Service, Agenzia di Tutela della Salute, Bergamo, Italy
| | | | | | - Giuseppe Cascone
- Azienda Sanitaria Provinciale (ASP) Ragusa-Dipartimento di Prevenzione-Registro Tumori, Ragusa, Italy
| | - Michael Mian
- Innovation, Research and Teaching Service (SABES-ASDAA), Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Bolzano-Bozen, Italy
| | - Maria Teresa Pesce
- Monitoraggio Rischio Ambientale e Registro Tumori ASL Caserta, Caserta, Italy
| | | | - Rocco Galasso
- Unit of Regional Cancer Registry, Clinical Epidemiology and Biostatistics, IRCCS Centro di Riferimento Oncologico di Basilicata (CROB), Rionero in Vulture, Italy
| | - Francesca Bella
- Siracusa Cancer Registry, Provincial Health Authority of Siracusa, Siracusa, Italy
| | - Pietro Seghini
- Emilia-Romagna Cancer Registry, Piacenza Unit, Public Health Department, AUSL Piacenza, Piacenza, Italy
| | - Pasquala Pinna
- Nuoro Cancer Registry, RT Nuoro, Servizio Igiene e Sanità Pubblica, ASL Nuoro, Nuoro, Italy
| | - Emanuele Crocetti
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
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Gennaro G, Bucchi L, Ravaioli A, Zorzi M, Falcini F, Russo F, Caumo F. The risk-based breast screening (RIBBS) study protocol: a personalized screening model for young women. Radiol Med 2024:10.1007/s11547-024-01797-9. [PMID: 38512619 DOI: 10.1007/s11547-024-01797-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/02/2024] [Indexed: 03/23/2024]
Abstract
The optimal mammography screening strategy for women aged 45-49 years is a matter of debate. We present the RIBBS study protocol, a quasi-experimental, prospective, population-based study comparing a risk- and breast density-stratified screening model (interventional cohort) with annual digital mammography (DM) screening (observational control cohort) in a real-world setting. The interventional cohort consists of 10,269 women aged 45 years enrolled between 2020 and 2021 from two provinces of the Veneto Region (northen Italy). At baseline, participants underwent two-view digital breast tomosynthesis (DBT) and completed the Tyrer-Cuzick risk prediction model. Volumetric breast density (VBD) was calculated from DBT and the lifetime risk (LTR) was estimated by including VBD among the risk factors. Based on VBD and LTR, women were classified into five subgroups with specific screening protocols for subsequent screening rounds: (1) LTR ≤ 17% and nondense breast: biennial DBT; (2) LTR ≤ 17% and dense breast: biennial DBT and ultrasound; (3) LTR 17-30% or LTR > 30% without family history of BC, and nondense breast: annual DBT; (4) LTR 17-30% or > 30% without family history of BC, and dense breast: annual DBT and ultrasound; and (5) LTR > 30% and family history of BC: annual DBT and breast MRI. The interventional cohort is still ongoing. An observational, nonequivalent control cohort of 43,000 women aged 45 years participating in an annual DM screening programme was recruited in three provinces of the neighbouring Emilia-Romagna Region. Cumulative incidence rates of advanced BC at three, five, and ten years between the two cohorts will be compared, adjusting for the incidence difference at baseline.Trial registration This study is registered on Clinicaltrials.gov (NCT05675085).
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Affiliation(s)
| | - Lauro Bucchi
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy.
| | - Alessandra Ravaioli
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Manuel Zorzi
- SER - Servizio Epidemiologico Regionale e Registri, Azienda Zero, Padua, Italy
| | - Fabio Falcini
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
- Cancer Prevention Unit, Local Health Authority, Forlì, Italy
| | - Francesca Russo
- Direzione Prevenzione, Sicurezza Alimentare, Veterinaria, Regione del Veneto, Venice, Italy
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Bucchi L, Mancini S, Crocetti E, Dal Maso L, Baldacchini F, Vattiato R, Giuliani O, Ravaioli A, Zamagni F, Bella F, Bidoli E, Caldarella A, Candela G, Carone S, Carrozzi G, Cavallo R, Ferrante M, Ferretti S, Filiberti RA, Fusco M, Gatti L, Gili A, Iacovacci S, Magoni M, Mangone L, Mazzoleni G, Michiara M, Musolino A, Piffer S, Piras D, Rizzello RV, Rosso S, Rugge M, Scala U, Stracci F, Tagliabue G, Toffolutti F, Tumino R, Biggeri A, Masini C, Ridolfi L, Villani S, Palmieri G, Stanganelli I, Falcini F. The descriptive epidemiology of melanoma in Italy has changed - for the better. Ital J Dermatol Venerol 2023; 158:483-492. [PMID: 38015485 DOI: 10.23736/s2784-8671.23.07653-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
A recent research project using data from a total of 40 cancer registries has provided new epidemiologic insights into the results of efforts for melanoma control in Italy between the 1990s and the last decade. In this article, the authors present a summary and a commentary of their findings. Incidence increased significantly throughout the study period in both sexes. However, the rates showed a stabilization or a decrease in men and women aged below 35 years. The risk of disease increased for successive cohorts born until 1973 (women) and 1975 (men) while subsequently tending to decline. The trend towards decreasing tumor thickness and increasing survival has continued, but a novel favorable prognostic factor has emerged since 2013 for patients - particularly for males - with thick melanoma, most likely represented by molecular targeted therapies and immune checkpoint inhibitors. Due to this, the survival gap between males and females has been filled out. In the meanwhile, and despite the incidence increase, dermatologists have not lowered their threshold to perform skin biopsy. Skin biopsy rate has increased because of the increasingly greater volume of dermatologic office visits, but the proportion of skin biopsies out of dermatologic office visits has remained constant. In summary, an important breakthrough in melanoma control in Italy has taken place. Effective interventions have been implemented across the full scope of care, which involve many large local populations - virtually the whole national population. The strategies adopted during the last three decades represent a valuable basis for further steps ahead in melanoma control in Italy.
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Affiliation(s)
- Lauro Bucchi
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
| | - Silvia Mancini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy -
| | - Emanuele Crocetti
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
| | - Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Pordenone, Italy
| | - Flavia Baldacchini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
| | - Rosa Vattiato
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
| | - Orietta Giuliani
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
| | - Alessandra Ravaioli
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
| | - Federica Zamagni
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
| | - Francesca Bella
- Siracusa Cancer Registry, Azienda Sanitaria Provinciale (ASP), Siracusa, Italy
| | - Ettore Bidoli
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Pordenone, Italy
| | - Adele Caldarella
- Tuscany Cancer Registry, Clinical and Descriptive Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Giuseppa Candela
- Trapani Cancer Registry, Department of Prevention, Servizio Sanitario Regionale Sicilia, Azienda Sanitaria Provinciale (ASP), Trapani, Italy
| | - Simona Carone
- Taranto Cancer Registry, Unit of Statistics and Epidemiology, ASL Taranto, Taranto, Italy
| | | | | | - Margherita Ferrante
- Integrated Cancer Registry of Catania-Messina-Enna, Rodolico-San Marco Polyclinic University Hospital, Catania, Italy
| | - Stefano Ferretti
- Romagna Cancer Registry - Section of Ferrara, ASL Ferrara, University of Ferrara, Ferrara, Italy
| | - Rosa A Filiberti
- Liguria Cancer Registry, San Martino Polyclinic Hospital IRCCS, Genoa, Italy
| | | | - Luciana Gatti
- Mantova Cancer Registry, Epidemiology Unit, Agenzia di Tutela della Salute (ATS) della Val Padana, Mantua, Italy
| | - Alessio Gili
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | | | - Michele Magoni
- Registry of Brescia Province, Epidemiology Unit, Brescia Health Protection Agency, Brescia, Italy
| | - Lucia Mangone
- Epidemiology Unit, AUSL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Maria Michiara
- Parma Cancer Registry, Medical Oncology Unit, Parma University Hospital, Parma, Italy
| | - Antonino Musolino
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Medical Oncology Unit and Cancer Registry, Parma University Hospital, Parma, Italy
| | - Silvano Piffer
- Trento Province Cancer Registry, Unit of Clinical Epidemiology, Trento, Italy
| | - Daniela Piras
- Sassari Cancer Registry, Azienda Regionale per la Tutela della Salute (ATS), Sassari, Italy
| | - Roberto V Rizzello
- Trento Province Cancer Registry, Unit of Clinical Epidemiology, Trento, Italy
| | - Stefano Rosso
- Piedmont Cancer Registry, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | - Fabrizio Stracci
- Umbria Cancer Registry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Giovanna Tagliabue
- Lombardy Cancer Registry of Varese Province, Cancer Registry Unit, Department of Research, National Cancer Institute IRCCS Foundation, Milan, Italy
| | - Federica Toffolutti
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Pordenone, Italy
| | - Rosario Tumino
- Cancer Registry, Department of Histopathology, Provincial Health Authority (ASP), Ragusa, Italy
| | - Annibale Biggeri
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Carla Masini
- Unit of Oncological Pharmacy, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
| | - Laura Ridolfi
- Department of Immunotherapy, Cell Therapy and Biobank, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
| | - Simona Villani
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | - Giuseppe Palmieri
- Department of Immuno-oncology and Targeted Oncologic Biotherapies, University of Sassari, Sassari, Italy
- Unit of Tumor Genetics, IRGB-CNR, Sassari, Italy
| | - Ignazio Stanganelli
- Skin Cancer Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
- Cancer Prevention Unit, ASL Forlì, Forlì-Cesena, Italy
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Catelan D, Biggeri A, Bucchi L, Manno V, Pappagallo M, Stoppa G, Grippo F, Frova L, Zamagni F, Crialesi R, Minelli G. Epidemiologic transition of lung cancer mortality in Italy by sex, province of residence and birth cohort (1920-1929 to 1960-1969). Int J Cancer 2023; 153:1746-1757. [PMID: 37486208 DOI: 10.1002/ijc.34657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/05/2023] [Accepted: 05/30/2023] [Indexed: 07/25/2023]
Abstract
Space-time analysis of mortality risk is useful to evaluate the epidemiologic transitions at the subnational level. In our study, we analysed the death certificate records for lung cancer in Italy in 1995-2016, obtained from the Italian National Institute of Statistics. Our objective was to investigate the spatial-temporal evolution of lung cancer mortality by sex and province of residence (n = 107) using the birth cohort as relevant time axis. We built Bayesian space-time models with space-time interactions. Among males (n = 554 829), mortality peaked in the 1920-1929 cohort, followed by a generalised decline. Among females (n = 158 619), we found novel original evidence for a peak in the 1955-1964 cohort, equivalent to a 35-year delay, with a downward trend being observed thereafter. Over time, the documented north-south decreasing mortality gradient has been replaced by a west-east decreasing gradient. Naples has become the province at highest risk in Italy, both among males and females. This pattern is consistent with an epidemiologic transition of risk factors for lung cancer to the south-west of the country and raises concern, because 5-year age-standardised net survival from the disease in this geographic area is lower than in northern and central Italy. The variability of mortality rates among provinces has changed over time, with an increasing homogeneity for males and an opposite trend for females in the more recent birth cohorts. These unprecedented observations provide evidence for a profound spatio-temporal transition of lung cancer mortality in Italy.
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Affiliation(s)
- Dolores Catelan
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Annibale Biggeri
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Lauro Bucchi
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Valerio Manno
- Statistical Service, Istituto Superiore di Sanità, Rome, Italy
| | - Marilena Pappagallo
- Integrated System for Health, Social Assistance and Welfare, Italian National Institute of Statistics, Rome, Italy
| | - Giorgia Stoppa
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Francesco Grippo
- Integrated System for Health, Social Assistance and Welfare, Italian National Institute of Statistics, Rome, Italy
| | - Luisa Frova
- Integrated System for Health, Social Assistance and Welfare, Italian National Institute of Statistics, Rome, Italy
| | - Federica Zamagni
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Roberta Crialesi
- Integrated System for Health, Social Assistance and Welfare, Italian National Institute of Statistics, Rome, Italy
| | - Giada Minelli
- Statistical Service, Istituto Superiore di Sanità, Rome, Italy
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7
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Mancini S, Biggeri A, Giuliani O, Vattiato R, Baldacchini F, Ravaioli A, Zamagni F, Falcini F, Bucchi L. Applying competing risks analysis to recurrences of primary breast cancer. Epidemiol Prev 2023; 47:363-373. [PMID: 38318787 DOI: 10.19191/ep23.6.a600.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
INTRODUCTION in time-to-event analysis, competing risks are observed when a subject is at risk of multiple types of events. A competing risk is an event that prevents the event of interest from happening or modifies its chance to occur. OBJECTIVES the purposes of this article are to provide an overview of competing risks analysis and to illustrate its application to the follow-up of breast cancer patients in order to estimate the risk of disease recurrence. DESIGN cohort study. SETTING AND PARTICIPANTS population-based random sample of patients with stage I-III primary female breast cancer diagnosed in 2000-2013, aged 15 years or older, resident in the Forlì health care district (northern Italy), treated surgically and with available information regarding disease laterality. MAIN OUTCOME MEASURES subhazard ratio, hazard ratio and cumulative incidence function for loco-regional recurrences and distant metastasis during 10 years of follow-up. METHODS breast cancer recurrences were evaluated taking into account death from any cause and occurrence of a second primary breast cancer as competing risks. Recent developments in competing risks methodology were used. The results obtained were compared with those from the Cox regression model, in which the competing risks were not accounted for. CONCLUSIONS estimating the risk of recurrence without accounting for the competing risks resulted in a divergence of the hazard/subhazard functions. Competing risks analysis is preferable when the statistical assumption of independence of end-points may be violated.
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Affiliation(s)
- Silvia Mancini
- Emilia-Romagna Cancer Registry, Romagna Unit, Romagna cancer institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì (Italy)
| | - Annibale Biggeri
- Unit of biostatistics, epidemiology and public health, Department of cardiac, thoracic, vascular sciences and public health, University of Padua, Padua (Italy)
| | - Orietta Giuliani
- Emilia-Romagna Cancer Registry, Romagna Unit, Romagna cancer institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì (Italy)
| | - Rosa Vattiato
- Emilia-Romagna Cancer Registry, Romagna Unit, Romagna cancer institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì (Italy)
| | - Flavia Baldacchini
- Emilia-Romagna Cancer Registry, Romagna Unit, Romagna cancer institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì (Italy)
| | - Alessandra Ravaioli
- Emilia-Romagna Cancer Registry, Romagna Unit, Romagna cancer institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì (Italy)
| | - Federica Zamagni
- Emilia-Romagna Cancer Registry, Romagna Unit, Romagna cancer institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì (Italy);
| | - Fabio Falcini
- Emilia-Romagna Cancer Registry, Romagna Unit, Romagna cancer institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì (Italy)
- Cancer prevention unit, Local health authority, Forlì (Italy)
| | - Lauro Bucchi
- Emilia-Romagna Cancer Registry, Romagna Unit, Romagna cancer institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì (Italy)
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8
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D’Antona R, Deandrea S, Sestini E, Pau L, Ferrè F, Angiolini C, Bortul M, Bucchi L, Caumo F, Fortunato L, Giordano L, Giordano M, Mantellini P, Martelli I, Melucci G, Naldoni C, Paci E, Saguatti G, Tinterri C, Vainieri M, Cataliotti L. Presence and Role of Associations of Cancer Patients and Volunteers in Specialist Breast Centres: An Italian National Survey of Breast Centres Associated with Senonetwork. Curr Oncol 2023; 30:8186-8195. [PMID: 37754509 PMCID: PMC10529214 DOI: 10.3390/curroncol30090594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/25/2023] [Accepted: 08/30/2023] [Indexed: 09/28/2023] Open
Abstract
This article aims to present the results of a national, cross-sectional, voluntary, online survey on the presence and roles of associations of breast cancer patients and volunteers in Italian specialist breast centres. The survey was developed according to standard methods. The questionnaire was pre-tested by a random sample of three breast centres, loaded onto the SurveyMonkey platform, and piloted by one volunteer breast centre. The breast centre clinical leads were invited to participate via email. A link to the online instrument was provided. No financial incentives were offered. The results were reported using standard descriptive statistics. The response rate was 82/128 (65%). Members of associations were routinely present in 70% Italian breast centres. Breast centres most often reporting their presence were those certified by the European Society of Breast Cancer Specialists. Patient support (reception and information, listening, identification of needs, and psychological support) was the primary area where associations were reported to offer services. The magnitude of this phenomenon warrants a study to investigate the impact of the activities of associations on the quality of life of patients and on the cost-benefit ratio of the service, and the modes of their interactions with the nursing staff and the medical staff.
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Affiliation(s)
- Rosanna D’Antona
- Europa Donna Italia, 20122 Milan, Italy; (R.D.); (E.S.); (L.P.); (C.N.)
| | - Silvia Deandrea
- Environmental Health Unit, Agency for Health Protection, 27100 Pavia, Italy;
| | | | - Loredana Pau
- Europa Donna Italia, 20122 Milan, Italy; (R.D.); (E.S.); (L.P.); (C.N.)
| | - Francesca Ferrè
- Management and Health Laboratory, Institute of Management, Department EMbeDS, Sant’Anna School of Advanced Studies, 56127 Pisa, Italy; (F.F.); (I.M.); (M.V.)
| | - Catia Angiolini
- SOD Oncologia Della Mammella, Breast Unit, DAI Oncologico, Azienda Ospedaliero-Universitaria Careggi, 50134 Firenze, Italy;
| | - Marina Bortul
- Breast Unit, Division of General Surgery, Azienda Sanitaria Universitaria Giuliano Isontina, Hospital of Cattinara, 34149 Trieste, Italy;
| | - Lauro Bucchi
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, 47014 Meldola, Italy
| | - Francesca Caumo
- Department of Breast Radiology, Veneto Institute of Oncology, IRCCS, 35128 Padova, Italy;
| | - Lucio Fortunato
- Breast Centre, San Giovanni-Addolorata Hospital, 00184 Rome, Italy;
| | - Livia Giordano
- CPO Piedmont, AOU Cittá della Salute e della Scienza, 10126 Torino, Italy;
| | - Monica Giordano
- Medical Oncology Department, Azienda Socio Sanitaria Territoriale Lariana, 22100 Como, Italy;
| | - Paola Mantellini
- Screening Unit, ISPRO—Oncological Network, Prevention and Research Institute, 50139 Firenze, Italy;
| | - Irene Martelli
- Management and Health Laboratory, Institute of Management, Department EMbeDS, Sant’Anna School of Advanced Studies, 56127 Pisa, Italy; (F.F.); (I.M.); (M.V.)
| | - Giuseppe Melucci
- SS Radiologia Senologica, ASL ‘SS. Annunziata’, 74100 Taranto, Italy;
| | - Carlo Naldoni
- Europa Donna Italia, 20122 Milan, Italy; (R.D.); (E.S.); (L.P.); (C.N.)
| | - Eugenio Paci
- Italian Group for Mammography Screening, 50131 Firenze, Italy;
| | - Gianni Saguatti
- Senology Unit, Local Health Authority, 40139 Bologna, Italy;
| | - Corrado Tinterri
- Breast Unit, Humanitas Cancer Centre, Rozzano, 20089 Milan, Italy;
| | - Milena Vainieri
- Management and Health Laboratory, Institute of Management, Department EMbeDS, Sant’Anna School of Advanced Studies, 56127 Pisa, Italy; (F.F.); (I.M.); (M.V.)
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9
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Crocetti E, Ravaioli A, Giuliani O, Bucchi L, Vattiato R, Mancini S, Zamagni F, Vitali B, Balducci C, Baldacchini F, Falcini F. Female breast cancer subtypes in the Romagna Unit of the Emilia-Romagna cancer registry, and estimated incident cases by subtypes and age in Italy in 2020. J Cancer Res Clin Oncol 2023; 149:7299-7304. [PMID: 36922443 PMCID: PMC10374783 DOI: 10.1007/s00432-023-04593-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/18/2023] [Indexed: 03/17/2023]
Abstract
PURPOSE The aim of this study was to estimate the Italian burden of incident breast cancer (BC) by subtypes, according to the distribution of hormonal receptor (HR) status and expression of human epidermal growth factor 2 (HER2). METHODS Female breast cancers incidence in the Romagna Unit of the Emilia-Romagna registry (n. 10,711) were grouped into: HR+ /HER2-, HR+ /HER2+ , HR-/HER2+ , HR-/HER2- and missing, and by age: < 50, 50-69 and 70+ years. Data were compared with other published Italian population-bases series before using them for national estimates. We used national and regional numbers of expected breast cancers published by the Italian network of cancer registries considering the age- and geographic-specific variation of the Italian population. RESULTS Overall, 70.7% of incident BC cases are expected to be HR+ /HER2-, 8.5% HR+ /HER2+ , 7.5% HR-/HER2-, 4.1% HR-/HER2+ and 9.3% missing. The global ranking is similar across age-groups but with age-specific differences. The proportion of missing was around 3-times lower than in the other Italian published population-based series and similar to the SEER one. In Italy, are estimated 38,841 HR+ /HER2- breast cancer cases, 4665 HR+ /HER2+ , 4098 HR-/HER2-, 2281 HR-/HER2+ , and 5092 not specified. Numbers by age-group were provided. CONCLUSIONS The present estimates relied on high-quality population-based data and provide a clinically relevant information on the burden of breast cancer subtypes. These data will support the planning of therapy needs for oncologists, decision-makers, and all other stakeholders.
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Affiliation(s)
- Emanuele Crocetti
- Romagna Unit of the Emilia-Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Forlì, Meldola, Italy.
| | - Alessandra Ravaioli
- Romagna Unit of the Emilia-Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Forlì, Meldola, Italy.
| | - Orietta Giuliani
- Romagna Unit of the Emilia-Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Forlì, Meldola, Italy
| | - Lauro Bucchi
- Romagna Unit of the Emilia-Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Forlì, Meldola, Italy
| | - Rosa Vattiato
- Romagna Unit of the Emilia-Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Forlì, Meldola, Italy
| | - Silvia Mancini
- Romagna Unit of the Emilia-Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Forlì, Meldola, Italy
| | - Federica Zamagni
- Romagna Unit of the Emilia-Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Forlì, Meldola, Italy
| | - Benedetta Vitali
- Romagna Unit of the Emilia-Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Forlì, Meldola, Italy
| | - Chiara Balducci
- Romagna Unit of the Emilia-Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Forlì, Meldola, Italy
| | - Flavia Baldacchini
- Romagna Unit of the Emilia-Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Forlì, Meldola, Italy
| | - Fabio Falcini
- Romagna Unit of the Emilia-Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Forlì, Meldola, Italy
- Local Health Authority, Cancer Prevention Unit, Forlì, Italy
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10
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Bucchi L. [Extending the target age of mammography screening or the scope of senology?]. Epidemiol Prev 2023; 47:In press. [PMID: 37337941 DOI: 10.19191/ep23.3.a634.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
In Italy, the extension of the age range eligible for mammography screening to 45-74 years was accepted by national guidelines in 2006, much earlier than elsewhere in Europe. The ultimate rationale was to increase the modest proportion of screen-detected cancers out of total incident breast cancers in the general female population. This comment aims to emphasize that extending the reach of the mammography age boundaries to include younger and older women is not the only way to enlarge the protection of screening upon the female population. Another, and complementary, option is to extend to specialist breast centres some of the main cornerstones of the theory of mammography screening, that is, the adherence to evidence-based guidelines, the monitoring and publication of results of breast cancer control at the population level, the taking of responsibility for the observed failures, and the adoption of proper actions.
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Affiliation(s)
- Lauro Bucchi
- Registro tumori dell'Emilia-Romagna, Unità della Romagna, IRCCS Istituto romagnolo per lo studio dei tumori (IRST) Dino Amadori, Meldola (FC);
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11
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Bucchi L, Ravaioli A, Dal Maso L, Falcini F, Mangone L, Massarut S, Schirosi L, Crispo A, Vici P, Franceschi S. De-Implementation of Axillary Staging and Radiotherapy in Low-Risk Breast Cancer Patients Aged 70-79 Years from Six Italian Cancer Institutes. Curr Oncol 2023; 30:4177-4184. [PMID: 37185431 PMCID: PMC10137373 DOI: 10.3390/curroncol30040318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023] Open
Abstract
In women aged ≥70 with low-risk breast cancer (BrC), some major international guidelines recommend against sentinel lymph node biopsy (for example, those from the Society of Surgical Oncology, U.S.) and post-lumpectomy radiotherapy (for example, those from the National Comprehensive Cancer Network, U.S.). We assessed the frequency of both procedures in six National Cancer Institutes (IRCCSs) in the North, the Centre, and the South of Italy. Data on tumour characteristics and treatment were obtained from each centre. Patients aged 70-79 years diagnosed with a pT1-pT2, clinically axillary lymph node-negative, oestrogen and/or progesterone receptor-positive, and human epidermal growth factor receptor 2-negative BrC between 2015 and 2020 were eligible for the study. Factors associated with the omission of the two procedures were evaluated using binary penalised logistic regression models. Axillary staging was omitted in 33/1000 (3.3%) women. After simultaneous adjustment for the centre of treatment and all other key variables, axillary staging was omitted more often in 2015-2016 vs. 2017-2020 (odds ratio (OR): 2.7; 95% CI: 1.0-7.5), in women aged 75-79 vs. 70-74 years (OR: 2.3; 95% CI: 1.1-4.9), and in those who had mastectomy vs. breast-conserving surgery (OR: 3.3; 95% CI: 1.2-9.0). The higher the histological grade was, the less frequent were the omissions (OR for grade 3 vs. grade 1: 0.2; 95% CI: 0.0-0.7). Post-lumpectomy radiotherapy was omitted in 56/651 (8.6%) women with no significant association with age, period, tumour stage, and tumour grade. In conclusion, the omission of axillary staging and post-lumpectomy radiotherapy in low-risk older BrC patients was rare in the Italian IRCCSs. Although women included in the study cannot be considered a nationally representative sample of BrC patients in Italy, our findings can serve as a baseline to monitor the impact of future guidelines. To do that, the recording and storage of hospital-based information should be improved.
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Affiliation(s)
- Lauro Bucchi
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, 47014 Meldola, Forlì, Italy
| | - Alessandra Ravaioli
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, 47014 Meldola, Forlì, Italy
| | - Luigino Dal Maso
- SOC Epidemiologia Oncologica, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Fabio Falcini
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, 47014 Meldola, Forlì, Italy
| | - Lucia Mangone
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Samuele Massarut
- SOC di Chirurgia Oncologica del Seno, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Laura Schirosi
- U.O.C. Anatomia Patologica, IRCCS Istituto Tumori "Giovanni Paolo II", 70124 Bari, Italy
| | - Anna Crispo
- SOC Epidemiologia e Biostatistica, Istituto Nazionale dei Tumori-IRCCS Fondazione G. Pascale, 80131 Napoli, Italy
| | - Patrizia Vici
- UOSD Sperimentazioni di FASE IV, IRCCS Istituto Nazionale Tumori Regina Elena, 00128 Roma, Italy
| | - Silvia Franceschi
- Direzione Scientifica, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
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12
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Mancini S, Bucchi L, Zamagni F, Baldacchini F, Crocetti E, Giuliani O, Ravaioli A, Vattiato R, Preti M, Tumino R, Ferretti S, Biggeri A, Ballotari P, Boschetti L, Brustolin A, Caldarella A, Cavallo R, Cirilli C, Citarella A, Contrino ML, Dal Maso L, Filiberti RA, Fusco M, Galasso R, Lotti FL, Magoni M, Mangone L, Masanotti G, Mazzoleni G, Mazzucco W, Melcarne A, Michiara M, Pesce P, Pinto A, Piras D, Rizzello RV, Rognoni M, Rosso S, Rugge M, Sampietro G, Scalzi S, Scuderi T, Tagliabue G, Toffolutti F, Vitarelli S, Falcini F. Trends in Net Survival from Vulvar Squamous Cell Carcinoma in Italy (1990–2015). J Clin Med 2023; 12:jcm12062172. [PMID: 36983173 PMCID: PMC10054662 DOI: 10.3390/jcm12062172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 03/14/2023] Open
Abstract
(1) Objective: In many Western countries, survival from vulvar squamous cell carcinoma (VSCC) has been stagnating for decades or has increased insufficiently from a clinical perspective. In Italy, previous studies on cancer survival have not taken vulvar cancer into consideration or have pooled patients with vulvar and vaginal cancer. To bridge this knowledge gap, we report the trend in survival from vulvar cancer between 1990 and 2015. (2) Methods: Thirty-eight local cancer registries covering 49% of the national female population contributed the records of 6274 patients. Study endpoints included 1- and 2-year net survival (NS) calculated using the Pohar-Perme estimator and 5-year NS conditional on having survived two years (5|2-year CNS). The significance of survival trends was assessed with the Wald test on the coefficient of the period of diagnosis, entered as a continuous regressor in a Poisson regression model. (3) Results: The median patient age was stable at 76 years. One-year NS decreased from 83.9% in 1990–2001 to 81.9% in 2009–2015 and 2-year NS from 72.2% to 70.5%. Five|2-year CNS increased from 85.7% to 86.7%. These trends were not significant. In the age stratum 70–79 years, a weakly significant decrease in 2-year NS from 71.4% to 65.7% occurred. Multivariate analysis adjusting for age group at diagnosis and geographic area showed an excess risk of death at 5|2-years, of borderline significance, in 2003–2015 versus 1990–2002. (4) Conclusions: One- and 2-year NS and 5|2-year CNS showed no improvements. Current strategies for VSCC control need to be revised both in Italy and at the global level.
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Affiliation(s)
- Silvia Mancini
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (S.M.); (L.B.); (F.B.); (E.C.); (O.G.); (A.R.); (R.V.); (F.F.)
| | - Lauro Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (S.M.); (L.B.); (F.B.); (E.C.); (O.G.); (A.R.); (R.V.); (F.F.)
| | - Federica Zamagni
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (S.M.); (L.B.); (F.B.); (E.C.); (O.G.); (A.R.); (R.V.); (F.F.)
- Correspondence:
| | - Flavia Baldacchini
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (S.M.); (L.B.); (F.B.); (E.C.); (O.G.); (A.R.); (R.V.); (F.F.)
| | - Emanuele Crocetti
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (S.M.); (L.B.); (F.B.); (E.C.); (O.G.); (A.R.); (R.V.); (F.F.)
| | - Orietta Giuliani
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (S.M.); (L.B.); (F.B.); (E.C.); (O.G.); (A.R.); (R.V.); (F.F.)
| | - Alessandra Ravaioli
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (S.M.); (L.B.); (F.B.); (E.C.); (O.G.); (A.R.); (R.V.); (F.F.)
| | - Rosa Vattiato
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (S.M.); (L.B.); (F.B.); (E.C.); (O.G.); (A.R.); (R.V.); (F.F.)
| | - Mario Preti
- Department of Obstetrics and Gynaecology, University of Torino, 10124 Torino, Italy;
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, Provincial Health Authority (ASP), 97100 Ragusa, Italy;
| | - Stefano Ferretti
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Local Health Authority, 44121 Ferrara, Italy;
| | - Annibale Biggeri
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy;
| | - Paola Ballotari
- Mantova & Cremona Cancer Registry, Epidemiology Unit, Val Padana Health Protection Agency, 46100 Mantova, Italy;
| | - Lorenza Boschetti
- Pavia Cancer Registry, Public Health Agency of Pavia, 27100 Pavia, Italy;
| | - Angelita Brustolin
- Unit of Epidemiology and Cancer Registry, Local Health Authority, 01100 Viterbo, Italy
| | - Adele Caldarella
- Tuscany Cancer Registry, Clinical and Descriptive Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139 Florence, Italy;
| | - Rossella Cavallo
- Cancer Registry of Local Health Authority Salerno, 84124 Salerno, Italy;
| | - Claudia Cirilli
- Modena Cancer Registry, Public Health Department, Local Health Authority, 41126 Modena, Italy;
| | - Annarita Citarella
- Cancer Registry, Department of Prevention, Unit of Epidemiology, Local Health Authority, 82100 Benevento, Italy;
| | | | - Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy; (L.D.M.); (F.T.)
| | - Rosa A. Filiberti
- Liguria Cancer Registry, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
| | - Mario Fusco
- Napoli 3 Sud Cancer Registry, 80031 Napoli, Italy;
| | - Rocco Galasso
- Unit of Regional Cancer Registry, Clinical Epidemiology and Biostatistics, IRCCS-CROB, Basilicata, 85028 Rionero in Vulture, Italy;
| | - Fernanda L. Lotti
- Brindisi Cancer Registry, Local Health Authority, 72100 Brindisi, Italy;
| | - Michele Magoni
- Cancer Registry of Brescia Province, Epidemiology Unit, Brescia Health Protection Agency, 25124 Brescia, Italy;
| | - Lucia Mangone
- Epidemiology Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy;
| | - Giuseppe Masanotti
- Section of Public Health and RTUP Register, Department of Experimental Medicine, University of Perugia, 06123 Perugia, Italy;
| | | | - Walter Mazzucco
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90131 Palermo, Italy;
| | | | - Maria Michiara
- Parma Cancer Registry, Medical Oncology Unit, University Hospital of Parma, 43126 Parma, Italy;
| | - Paola Pesce
- Catania, Messina and Enna Cancer Registry, 95123 Catania, Italy;
| | - Angela Pinto
- Barletta, Andria, Trani Cancer Registry, BAT Province, 76121 Barletta, Italy;
| | - Daniela Piras
- Sassari Cancer Registry, Azienda Regionale per la Tutela della Salute-ATS, 7100 Sassari, Italy;
| | - Roberto V. Rizzello
- Trento Province Cancer Registry, Unit of Clinical Epidemiology, Azienda Provinciale per i Servizi Sanitari (APSS), 38123 Trento, Italy;
| | - Magda Rognoni
- Epidemiology Unit, Cancer Registry of ATS Brianza, Health Protection Agency, 20900 Monza, Italy;
| | - Stefano Rosso
- Piedmont Cancer Registry, A.O.U. Città della Salute e della Scienza di Torino, 10123 Turin, Italy;
| | - Massimo Rugge
- Veneto Tumour Registry, Azienda Zero, University of Padova-DIMED, 35132 Padova, Italy;
| | | | - Santo Scalzi
- Catanzaro ASP Cancer Registry, 88100 Catanzaro, Italy;
| | - Tiziana Scuderi
- Trapani and Agrigento Cancer Registry, 91100 Trapani, Italy;
| | - Giovanna Tagliabue
- Lombardy Cancer Registry-Varese Province, Cancer Registry Unit, Department of Research, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy;
| | - Federica Toffolutti
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy; (L.D.M.); (F.T.)
| | - Susanna Vitarelli
- Macerata Province Cancer Registry, University of Camerino, 62032 Camerino, Italy;
| | - Fabio Falcini
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (S.M.); (L.B.); (F.B.); (E.C.); (O.G.); (A.R.); (R.V.); (F.F.)
- Cancer Prevention Unit, Local Health Authority, 47121 Forlì, Italy
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13
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Bucchi L, Mancini S, Zamagni F, Crocetti E, Dal Maso L, Ferretti S, Baldacchini F, Giuliani O, Ravaioli A, Vattiato R, Brustolin A, Candela G, Carone S, Carrozzi G, Cavallo R, Dinaro YM, Ferrante M, Iacovacci S, Mazzoleni G, Musolino A, Rizzello RV, Serraino D, Biggeri A, Stanganelli I, Falcini F. Patient presentation, skin biopsy utilization and cutaneous malignant melanoma incidence and mortality in northern Italy: Trends and correlations. J Eur Acad Dermatol Venereol 2023; 37:293-302. [PMID: 36181283 PMCID: PMC10092783 DOI: 10.1111/jdv.18635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/14/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND The global increase in incidence of cutaneous malignant melanoma (CMM) occurring in the past decades has been partly attributed to increased diagnostic scrutiny of early lesions, with a potential phenomenon of overdiagnosis. The reported positive linear relation between skin biopsy rate and incidence of early CMM is compatible with this hypothesis. OBJECTIVES We explored the ecological association between the trends in annual dermatologic office visit rates, skin biopsy rates, incidence rates of in situ and invasive CMM by tumour thickness category, and CMM mortality rates in the Emilia-Romagna Region (northern Italy). METHODS Four cancer registries covering a population of 2,696,000 provided CMM incidence data for the years 2003-2017. Dermatologic office visit rates and skin biopsy rates were calculated using the Regional outpatient care database. All rates were age-standardized. Trends were described with the estimated average annual per cent change (EAAPC). Correlations were tested with the Spearman correlation coefficient. RESULTS Incidence increased significantly. The increase was steeper for in situ CMM (EAAPC: men, 10.2; women, 6.9) followed by CMM <0.8 mm thick (9.1; 5.2), but the rates grew significantly for most subgroups of CMMs ≥0.8 mm thick. Mortality decreased significantly among women (-2.3) and non-significantly among men. For dermatologic office visit rate and skin biopsy rate the EAAPC were, respectively, 1.7 and 1.8 for men and 1.2 and 0.9 for women. Annual dermatologic office visit rate correlated with skin biopsy rate in both sexes. However, the proportion of skin biopsies out of dermatologic office visits was constant across the years (range: men, 0.182-0.216; women, 0.157-0.191). CONCLUSIONS In Italy, the increasing CMM incidence trend is, at least in part, genuine. Overdiagnosis-if any-is due to an increased patient presentation at dermatologic offices and not to a lower dermatologic threshold to perform biopsy.
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Affiliation(s)
- Lauro Bucchi
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Silvia Mancini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Federica Zamagni
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Emanuele Crocetti
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Stefano Ferretti
- Romagna Cancer Registry, section of Ferrara, Local Health Authority and University of Ferrara, Ferrara, Italy
| | - Flavia Baldacchini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Orietta Giuliani
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Alessandra Ravaioli
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Rosa Vattiato
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Angelita Brustolin
- UOSD Epidemiologia e Registro Tumori (Dip. di Prevenzione ASL VT) c/o Cittadella della Salute, Viterbo, Italy
| | - Giuseppa Candela
- Trapani Cancer Registry, Dipartimento di Prevenzione della Salute, Servizio Sanitario Regionale Sicilia, Azienda Sanitaria Provinciale (ASP), Trapani, Italy
| | - Simona Carone
- Registro Tumori di Taranto, Unità Operativa Complessa di Statistica ed Epidemiologia, Azienda Sanitaria Locale, Taranto, Italy
| | - Giuliano Carrozzi
- Modena Cancer Registry, Public Health Department, Local Health Authority, Modena, Italy
| | | | | | - Margherita Ferrante
- Integrated Cancer Registry of Catania-Messina-Enna, Azienda Ospedaliero-Universitaria Policlinico "Rodolico-San Marco", Catania, Italy
| | | | | | - Antonino Musolino
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Medical Oncology Unit and Cancer Registry, University Hospital of Parma, Parma, Italy
| | - Roberto Vito Rizzello
- Trento Province Cancer Registry, Unit of Clinical Epidemiology, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Annibale Biggeri
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Ignazio Stanganelli
- Skin Cancer Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy.,Department of Dermatology, University of Parma, Parma, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy.,Local Health Authority, Cancer Prevention Unit, Forlì, Italy
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14
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Baldacchini F, Bucchi L, Giuliani O, Mancini S, Ravaioli A, Vattiato R, Zamagni F, Giorgi Rossi P, Mangone L, Campari C, Sassatelli R, Trande P, Esposito P, Rossi F, Carrozzi G, Triossi O, Fabbri C, Strocchi E, Giovanardi M, Canuti D, Sassoli de Bianchi P, Ferretti S, Falcini F. Effects of Attendance to an Organized Fecal Immunochemical Test Screening Program on the Risk of Colorectal Cancer: An Observational Cohort Study. Clin Gastroenterol Hepatol 2022; 20:2373-2382. [PMID: 35144023 DOI: 10.1016/j.cgh.2022.01.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS This cohort study compared colorectal cancer (CRC) incidence and mortality between people who participated in an Italian regional biennial fecal immunochemical test (FIT) screening program and people who did not. METHODS The program started in 2005. The target population included over 1,000,000 people aged 50 to 69 years. The FIT was a one-sample OC-Sensor (Eiken Chemical Co, Tokyo, Japan) (cutoff, ≥20 μg hemoglobin/g feces). The average annual response rate to invitation was 51.4%. The records of people invited up to June 2016 were extracted from the screening data warehouse. Attenders were subjects who responded to the first 2 invitations or to the single invitation sent them before they became ineligible. Non-attenders were subjects who did not respond to any of these invitations. The records were linked with the regional CRC registry. People registered up to December 2016 were identified. Self-selection-adjusted incidence rate ratios (IRRs) and incidence-based CRC mortality rate ratios (MRRs) for attenders to non-attenders, with 95% confidence intervals (CIs), were calculated. RESULTS The cohort generated 2,622,131 man-years and 2,887,845 woman-years at risk with 4490 and 3309 CRC cases, respectively. The cohort of attenders was associated with an IRR of 0.65 (95% CI, 0.61-0.69) for men, 0.75 (95% CI, 0.70-0.80) for women and 0.69 (95% CI, 0.66-0.72) for both sexes combined. The self-selection-adjusted IRR was 0.67 (95% CI, 0.62-0.72) for men and 0.79 (95% CI, 0.72-0.88) for women. The IRR for stage I, II, III, and IV CRC was 1.35 (95% CI, 1.20-1.50), 0.61 (95% CI, 0.53-0.69), 0.60 (95% CI, 0.53-0.68) and 0.28 (95% CI, 0.24-0.32) for men and 1.64 (95% CI, 1.43-1.89), 0.60 (95% CI, 0.52-0.69), 0.73 (95% CI, 0.63-0.85) and 0.35 (95% CI, 0.30-0.42) for women. The overall incidence-based CRC MRR was 0.32 (95% CI, 0.28-0.37) for men, 0.40 (95% CI, 0.34-0.47) for women and 0.35 (95% CI, 0.31-0.39) for both sexes combined. The adjusted MRR was 0.35 (95% CI, 0.29-0.41) for men and 0.46 (95% CI, 0.37-0.58) for women. CONCLUSIONS Attendance to a FIT screening program is associated with a CRC incidence reduction of 33% among men and 21% among women, and a CRC mortality reduction of 65% and 54%, respectively.
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Affiliation(s)
- Flavia Baldacchini
- Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì, Italy
| | - Lauro Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì, Italy.
| | - Orietta Giuliani
- Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì, Italy
| | - Silvia Mancini
- Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì, Italy
| | - Alessandra Ravaioli
- Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì, Italy
| | - Rosa Vattiato
- Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì, Italy
| | - Federica Zamagni
- Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lucia Mangone
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cinzia Campari
- Screening Coordinating Centre, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Romano Sassatelli
- Unit of Gastroenterology and Digestive Endoscopy, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Paolo Trande
- Struttura Semplice Dipartimentale Screening del Colon-Retto, AUSL di Modena, Modena, Italy
| | | | - Federica Rossi
- Cancer Screening Unit, Public Health Department, AUSL Modena, Modena, Italy
| | - Giuliano Carrozzi
- Modena Cancer Registry, Public Health Department, AUSL Modena, Modena, Italy
| | - Omero Triossi
- Gastroenterology Unit, Local Health Authority, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì and Cesena Hospitals, AUSL Romagna, Forlì, Italy
| | - Enrico Strocchi
- Gastroenterology and Digestive Endoscopy Unit, Local Health Authority, Cesena, Italy
| | - Mauro Giovanardi
- Gastroenterology and Digestive Endoscopy Unit, Local Health Authority, Rimini, Italy
| | - Debora Canuti
- Department of Health, Regional Administration, Emilia-Romagna Region, Bologna, Italy
| | | | - Stefano Ferretti
- University of Ferrara and Local Health Authority, Ferrara, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì, Italy; Cancer Prevention Unit, Local Health Authority, Forlì, Italy
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15
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Ravaioli A, Crocetti E, Bucchi L, Guzzinati S, Casella C, Falcini F, Ferretti S, Giuliani O, Mancini S, Puppo A, Toffolutti F, Zamagni F, Zorzi M, Dal Maso L, Serraino D. [Update of survival of cancer patients in Italy: geographical comparisons and focus on patients with cancers targeted by screening programmes, childhood cancers, and smoking-associated cancers]. Epidemiol Prev 2022; 46:356-366. [PMID: 36458516 DOI: 10.19191/ep22.5-6.a489.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES to update the Italian estimates of survival for patients with a paediatric cancer, tobacco smoke-associated cancers, and cancers targeted by screening; to assess geographical differences. DESIGN population-based descriptive study. SETTING AND PARTICIPANTS incident cancer cases diagnosed in 2010-2014, with follow-up to 2018, from 17 Italian cancer registries (covering 31% of the national population; 43% of the population residing in the North-Centre of the country and 8% of the population living in the South and Islands). MAIN OUTCOME MEASURES age-standardized 5-year net survival (NS) by cancer site or type, sex, age, and geographical area. RESULTS NS of patients aged ≥15 years with breast, prostate, colorectal, and lung cancers was higher in the North-Centre than in the South and Islands. The overall survival of people diagnosed with cancer in childhood (0-14 years) was 84.3%, with similar values among the geographical macro-areas and between males and females. Women with breast cancer within the current target age of the screening programmes and those in the younger age groups (45-49 years) show similar survival values; the same is true for women with colorectal cancer. In both cases, survival decreased in the age groups after the age of cessation of screening programmes. Survival of patients with tobacco smoke-associated cancers varies according to cancer site (from 11.1% for patients with pancreatic cancer to 79.7% for those with bladder cancer). For most cancer sites, women have higher survival than men. CONCLUSIONS for adults, a geographical survival gap persists. The results may contribute to the debate on extending the target age for screening programmes and to support initiatives to encourage tobacco smoking cessation even after cancer diagnosis. For patients who receive a cancer diagnosis in childhood, survival similar to highest values internationally.
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Affiliation(s)
- Alessandra Ravaioli
- Registro tumori della Regione Emilia-Romagna, Unità funzionale della Romagna, IRCCS Istituto romagnolo per lo studio dei tumori (IRST) "Dino Amadori", Meldola (FC)
| | - Emanuele Crocetti
- Registro tumori della Regione Emilia-Romagna, Unità funzionale della Romagna, IRCCS Istituto romagnolo per lo studio dei tumori (IRST) "Dino Amadori", Meldola (FC)
| | - Lauro Bucchi
- Registro tumori della Regione Emilia-Romagna, Unità funzionale della Romagna, IRCCS Istituto romagnolo per lo studio dei tumori (IRST) "Dino Amadori", Meldola (FC)
| | | | | | - Fabio Falcini
- Registro tumori della Regione Emilia-Romagna, Unità funzionale della Romagna, IRCCS Istituto romagnolo per lo studio dei tumori (IRST) "Dino Amadori", Meldola (FC).,Azienda USL della Romagna, Forlì
| | - Stefano Ferretti
- Registro tumori dell'Emilia-Romagna, Unità funzionale di Ferrara, Università di Ferrara, Azienda USL Ferrara
| | - Orietta Giuliani
- Registro tumori della Regione Emilia-Romagna, Unità funzionale della Romagna, IRCCS Istituto romagnolo per lo studio dei tumori (IRST) "Dino Amadori", Meldola (FC)
| | - Silvia Mancini
- Registro tumori della Regione Emilia-Romagna, Unità funzionale della Romagna, IRCCS Istituto romagnolo per lo studio dei tumori (IRST) "Dino Amadori", Meldola (FC)
| | | | - Federica Toffolutti
- SOC Epidemiologia oncologica, Centro di riferimento oncologico di Aviano (CRO) IRCCS, Aviano (PN)
| | - Federica Zamagni
- Registro tumori della Regione Emilia-Romagna, Unità funzionale della Romagna, IRCCS Istituto romagnolo per lo studio dei tumori (IRST) "Dino Amadori", Meldola (FC)
| | - Manuel Zorzi
- Registro tumori del Veneto, Azienda Zero, Padova
| | - Luigino Dal Maso
- SOC Epidemiologia oncologica, Centro di riferimento oncologico di Aviano (CRO) IRCCS, Aviano (PN);
| | - Diego Serraino
- SOC Epidemiologia oncologica, Centro di riferimento oncologico di Aviano (CRO) IRCCS, Aviano (PN)
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16
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Zamagni F, Bucchi L, Mancini S, Crocetti E, Dal Maso L, Ferretti S, Biggeri A, Villani S, Baldacchini F, Giuliani O, Ravaioli A, Vattiato R, Brustolin A, Candela G, Carone S, Carrozzi G, Cavallo R, Dinaro YM, Ferrante M, Iacovacci S, Mazzoleni G, Musolino A, Rizzello RV, Serraino D, Stracci F, Tumino R, Masini C, Ridolfi L, Palmieri G, Stanganelli I, Falcini F. The relative contribution of the decreasing trend in tumour thickness to the 2010s increase in net survival from cutaneous malignant melanoma in Italy: a population-based investigation. Br J Dermatol 2022; 187:52-63. [PMID: 35253204 PMCID: PMC9542017 DOI: 10.1111/bjd.21051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/03/2022] [Accepted: 02/06/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The long-term increase in survival from cutaneous malignant melanoma (CMM) is generally attributed to the decreasing trend in tumour thickness, the single most important prognostic factor. OBJECTIVES To determine the relative contribution of decreased tumour thickness to the favourable trend in survival from CMM in Italy. METHODS Eleven local cancer registries covering a population of 8 056 608 (13.4% of the Italian population in 2010) provided records for people with primary CMM registered between 2003 and 2017. Age-standardized 5-year net survival was calculated. Multivariate analysis of 5-year net survival was undertaken by calculating the relative excess risk (RER) of death. The relative contribution of the decrease in tumour thickness to the RER of death was evaluated using a forward stepwise flexible parametric survival model including the available prognostic factors. RESULTS Over the study period, tumour thickness was inversely associated with 5-year net survival and multivariate RER in both sexes. The median thickness was 0.90 mm in 2003-2007, 0.85 mm in 2008-2012 and 0.75 mm in 2013-2017 among male patients, and 0.78 mm, 0.77 mm and 0.68 mm among female patients, respectively. The 5-year net survival was 86.8%, 89.2% and 93.2% in male patients, and 91.4%, 92.0% and 93.4% in female patients, respectively. In 2013-2017, male patients exhibited the same survival as female patients despite having thicker lesions. For them, the increasing survival trend was more pronounced with increasing thickness, and the inclusion of thickness in the forward stepwise model made the RER in 2013-2017 vs. 2003-2007 increase from 0.64 [95% confidence interval (CI) 0.51-0.80] to 0.70 (95% CI 0.57-0.86). This indicates that the thickness trend accounted for less than 20% of the survival increase. For female patients, the results were not significant but, with multiple imputation of missing thickness values, the RER rose from 0.74 (95% CI 0.58-0.93) to 0.82 (95% CI 0.66-1.02) in 2013-2017. CONCLUSIONS For male patients in particular, decrease in tumour thickness accounted for a small part of the improvement in survival observed in 2013-2017. The introduction of targeted therapies and immune checkpoint inhibitors in 2013 is most likely to account for the remaining improvement.
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Affiliation(s)
- Federica Zamagni
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Lauro Bucchi
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Silvia Mancini
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Emanuele Crocetti
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Luigino Dal Maso
- Cancer Epidemiology UnitCentro di Riferimento Oncologico di Aviano (CRO) IRCCSAvianoItaly
| | - Stefano Ferretti
- Romagna Cancer Registry, Section of FerraraLocal Health Authority and University of FerraraFerraraItaly
| | - Annibale Biggeri
- Department of Statistics, Computer Science, Applications G. ParentiUniversity of FlorenceFlorenceItaly
| | - Simona Villani
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical EpidemiologyUniversity of PaviaPaviaItaly
| | - Flavia Baldacchini
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Orietta Giuliani
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Alessandra Ravaioli
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Rosa Vattiato
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Angelita Brustolin
- UOSD Epidemiologia e Registro Tumori (Dip. di Prevenzione ASL VT) c/o Cittadella della SaluteViterboItaly
| | - Giuseppa Candela
- Trapani Cancer Registry, Dipartimento di Prevenzione della SaluteServizio Sanitario Regionale Sicilia, Azienda Sanitaria Provinciale (ASP)TrapaniItaly
| | - Simona Carone
- Registro tumori di TarantoUnità operativa complessa di statistica ed epidemiologiaAzienda sanitaria locale TarantoItaly
| | - Giuliano Carrozzi
- Modena Cancer Registry, Public Health DepartmentLocal Health AuthorityModenaItaly
| | | | | | - Margherita Ferrante
- Integrated Cancer Registry of Catania‐Messina‐EnnaAzienda Ospedaliero‐Universitaria Policlinico ‘Rodolico‐San Marco’CataniaItaly
| | | | | | - Antonino Musolino
- Department of Medicine and SurgeryUniversity of Parma; Medical Oncology Unit and Cancer Registry, University Hospital of ParmaParmaItaly
| | - Roberto Vito Rizzello
- Trento Province Cancer Registry, Unit of Clinical EpidemiologyAzienda Provinciale per i Servizi Sanitari (APSS) TrentoItaly
| | - Diego Serraino
- Cancer Epidemiology UnitCentro di Riferimento Oncologico di Aviano (CRO) IRCCSAvianoItaly
| | - Fabrizio Stracci
- Department of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
| | - Rosario Tumino
- Former Director Cancer RegistryProvincial Health Authority (ASP)RagusaItaly
| | - Carla Masini
- Unit of Oncological PharmacyIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Laura Ridolfi
- Immunotherapy, Cell Therapy and BiobankIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Giuseppe Palmieri
- Institute of Research on Genetics and Biomedicine (IRGB), National Research Council (CNR)SardegnaSassariItaly
| | - Ignazio Stanganelli
- Skin Cancer UnitIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
- Department of DermatologyUniversity of ParmaParmaItaly
| | - Fabio Falcini
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
- Cancer Prevention UnitLocal Health AuthorityForlìItaly
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Deandrea S, Ferrè F, D’Antona R, Angiolini C, Bortul M, Bucchi L, Caumo F, Fortunato L, Giordano L, Giordano M, Mantellini P, Martelli I, Melucci G, Naldoni C, Paci E, Pau L, Saguatti G, Sestini E, Tinterri C, Vainieri M, Cataliotti L. Integrating mammography screening programmes into specialist breast centres in Italy: insights from a national survey of Senonetwork breast centres. BMC Health Serv Res 2022; 22:723. [PMID: 35641985 PMCID: PMC9153866 DOI: 10.1186/s12913-022-08111-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/13/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Despite recommendations, mammography screening is often insufficiently integrated into specialist breast centres. A national, cross-sectional, voluntary, online survey on this issue was carried out among the Italian breast centres associated with Senonetwork, the Italian network of breast cancer services.
Methods
A 73-item questionnaire was created, pre-tested and piloted. Centres integrating and not integrating a screening programme were compared using the unified theory of acceptance and use of technology (UTAUT) model. Centres’ clustering was performed using the Gower’s distance metric. Groups and clusters were compared with the equality-of-means test.
Results
The response rate was 82/128 (65%). Overall, 84% (69/82) breast centres reported a collaboration with a screening programme in performing and/or reading mammograms and in the diagnostic work-up of women with abnormal screening results. The same proportion was observed among those centres responding to all questions (62/74). Performance expectancies (or the perceived usefulness of integration in terms of clinical quality, patient convenience, ease of job, and professional growth), satisfaction and motivation were higher in those centres collaborating with the screening programme. Effort expectancy indicators (or the degree to which the respondents believe that the integration is easy to implement) and those concerning the existence of facilitating conditions were lower both in centres collaborating and not collaborating with the screening programme. Among the former, six clusters of centres, distributed from ‘no integration’ to ‘high’, were identified. In cluster analysis, the highest level of integration was associated with higher agreement that integration eases the job, offers better opportunities for professional growth, and makes the working environment more satisfactory. The least integrated cluster assigned the lowest score to the statement that local health authority made available the resources needed.
Conclusions
While confirming the positive effects of integrating screening programmes into breast centres, this survey has brought to light specific difficulties that must be faced. The results provide insights into the importance of integration focusing on the perspectives of professional career and motivation. The deficiency of facilitating conditions to integration is modifiable. Screening professionals’ societies may have a role as initiators of the integration. Other supporting actions may be included in health laws at the national and regional level.
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Bucchi L, Costa S, Mancini S, Baldacchini F, Giuliani O, Ravaioli A, Vattiato R, Zamagni F, Giorgi Rossi P, Campari C, Canuti D, Sassoli de Bianchi P, Ferretti S, Falcini F. Clinical Epidemiology of Microinvasive Cervical Carcinoma in an Italian Population Targeted by a Screening Programme. Cancers (Basel) 2022; 14:cancers14092093. [PMID: 35565224 PMCID: PMC9103092 DOI: 10.3390/cancers14092093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/29/2022] [Accepted: 04/15/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary According to this population-based study, 3750 patients living in the Emilia-Romagna Region (northern Italy) were registered with cervical carcinoma between 1995–2016, including 2942 eligible patients. The likelihood of stage IA cervical carcinoma (n = 876, 29.8%) did not change over time, decreased with increasing patient age, and was lower for patients with adenocarcinoma and grade 3–4 disease. Three hundred and fifty (40.0%) patients had a conservative treatment, 317 (36.2%) had hysterectomy, 197 (22.5%) had hysterectomy with lymph node dissection (LND), and 12 (1.4%) had a conservative treatment with LND. The proportion of hysterectomy decreased from 70.6% in 1995–1999 to 46.9% in 2011–2016. The likelihood of hysterectomy increased above the age of 40. Among screening-aged (25–64 years) patients, the likelihood of hysterectomy did not differ between screen-detected and non-screen-detected ones. Hysterectomy was increasingly combined with LND. High tumour grade was the strongest determinant of LND during hysterectomy. Abstract (1) Background: This population-based study aimed at identifying the factors associated with the likelihood of detection of stage IA cervical carcinoma—versus the detection of stage IB through IV cervical carcinoma—and the patterns of surgical treatment. (2) Methods: Between 1995–2016, 3750 patients living in the Emilia-Romagna Region (northern Italy) were registered with cervical carcinoma, including 2942 eligible patients (median age, 53). Multivariate analysis was performed using binary logistic regression models. (3) Results: The likelihood of stage IA cervical carcinoma (n = 876, 29.8%) did not change over time, decreased with increasing patient age, and was lower for patients with adenocarcinoma and grade 3–4 disease. Three hundred and fifty (40.0%) patients had a conservative treatment, 317 (36.2%) had hysterectomy, 197 (22.5%) had hysterectomy with lymph node dissection (LND), and 12 (1.4%) had a conservative treatment with LND. The proportion of hysterectomy decreased from 70.6% in 1995–1999 to 46.9% in 2011–2016. The likelihood of hysterectomy increased above the age of 40. Among screening-aged (25–64 years) patients, the likelihood of hysterectomy did not differ between screen-detected and non-screen-detected ones. Hysterectomy was increasingly combined with LND. High tumour grade was the strongest determinant of LND during hysterectomy. (4) Conclusions: This study provided a multifaceted overview of stage IA cervical carcinoma over the last decades.
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Affiliation(s)
- Lauro Bucchi
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (L.B.); (F.B.); (O.G.); (A.R.); (R.V.); (F.Z.); (F.F.)
| | - Silvano Costa
- Department of Gynaecology, Madre Fortunata Toniolo Hospital, 40141 Bologna, Italy;
| | - Silvia Mancini
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (L.B.); (F.B.); (O.G.); (A.R.); (R.V.); (F.Z.); (F.F.)
- Correspondence:
| | - Flavia Baldacchini
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (L.B.); (F.B.); (O.G.); (A.R.); (R.V.); (F.Z.); (F.F.)
| | - Orietta Giuliani
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (L.B.); (F.B.); (O.G.); (A.R.); (R.V.); (F.Z.); (F.F.)
| | - Alessandra Ravaioli
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (L.B.); (F.B.); (O.G.); (A.R.); (R.V.); (F.Z.); (F.F.)
| | - Rosa Vattiato
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (L.B.); (F.B.); (O.G.); (A.R.); (R.V.); (F.Z.); (F.F.)
| | - Federica Zamagni
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (L.B.); (F.B.); (O.G.); (A.R.); (R.V.); (F.Z.); (F.F.)
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Cinzia Campari
- Cancer Screening Unit, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Debora Canuti
- Department of Health, Emilia-Romagna Region, 40127 Bologna, Italy; (D.C.); (P.S.d.B.)
| | | | - Stefano Ferretti
- Department of Translational Medicine, University of Ferrara and Local Health Authority, 44121 Ferrara, Italy;
| | - Fabio Falcini
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (L.B.); (F.B.); (O.G.); (A.R.); (R.V.); (F.Z.); (F.F.)
- Local Health Authority, 47121 Forlì, Italy
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Bucchi L, Mancini S, Baldacchini F, Ravaioli A, Giuliani O, Vattiato R, Zamagni F, Giorgi Rossi P, Campari C, Canuti D, Di Felice E, Sassoli de Bianchi P, Ferretti S, Bertozzi N, Biggeri A, Falcini F. How a faecal immunochemical test screening programme changes annual colorectal cancer incidence rates: an Italian intention-to-screen study. Br J Cancer 2022; 127:541-548. [PMID: 35444286 PMCID: PMC9345854 DOI: 10.1038/s41416-022-01813-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 03/17/2022] [Accepted: 03/31/2022] [Indexed: 02/06/2023] Open
Abstract
Background This study aimed to evaluate the effectiveness of a biennial faecal immunochemical test (FIT) screening programme in reducing annual colorectal cancer (CRC) incidence in its dynamic target population. Methods The target population included over 1,000,000 persons aged 50–69 living in a region of northern Italy. The average annual response rate to invitation was 51.4%. Each observed annual age-standardised (Europe) rate per 100,000 persons between 2005, the year of introduction of the programme, and 2016 was compared with each expected annual rate as estimated with age-period-cohort (men) and age-period (women) models. Results For both sexes, the rates observed in 1997–2004 and those expected in 2005–2016 were stable. Observed rates increased in 2005, peaked in 2006 (the first full year of screening), dropped significantly below the expected level in 2009, and continued to decrease until 2013 (the eighth full year), after which no further significant changes occurred. In the pooled years 2013–2016, the observed incidence rate per 100,000 persons was 102.2 [95% CI: 97.4, 107.1] for men, 75.6 [95% CI: 71.6, 79.7] for women and 88.4 [95% CI: 85.3, 91.5] for both sexes combined, with an observed:expected incidence rate ratio of 0.68 [95% CI: 0.65, 0.71], 0.79 [95% CI: 0.76, 0.82] and 0.72 [95% CI: 0.66, 0.81], respectively. Discussion The study provided multiple consistent proofs of a causal relationship between the introduction of screening and a stable 28% decrease in annual CRC incidence after eight years. ![]()
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Affiliation(s)
- Lauro Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì, Italy
| | - Silvia Mancini
- Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì, Italy.
| | - Flavia Baldacchini
- Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì, Italy
| | - Alessandra Ravaioli
- Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì, Italy
| | - Orietta Giuliani
- Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì, Italy
| | - Rosa Vattiato
- Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì, Italy
| | - Federica Zamagni
- Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cinzia Campari
- Cancer Screening Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Debora Canuti
- Cancer Screening Unit, Local Health Authority, Rimini, Italy
| | - Enza Di Felice
- Department of Health, Regional Administration, Emilia-Romagna Region, Bologna, Italy
| | | | - Stefano Ferretti
- University of Ferrara and Local Health Authority, Ferrara, Italy
| | - Nicoletta Bertozzi
- Department of Health, Regional Administration, Emilia-Romagna Region, Bologna, Italy
| | - Annibale Biggeri
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì, Italy.,Cancer Prevention Unit, Local Health Authority, Forlì, Italy
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Deandrea S, Sardanelli F, Calabrese M, Ferré F, Vainieri M, Sestini E, Caumo F, Saguatti G, Bucchi L, Cataliotti L. Provision of follow-up care for women with a history of breast cancer following the 2016 position paper by the Italian Group for Mammographic Screening and the Italian College of Breast Radiologists by SIRM: a survey of Senonetwork Italian breast centres. Radiol Med 2022; 127:484-489. [PMID: 35347582 PMCID: PMC8960092 DOI: 10.1007/s11547-022-01485-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/10/2022] [Indexed: 11/06/2022]
Abstract
Introduction In 2016, the Italian Group for Mammography Screening and the Italian College of Breast Radiologists by the Italian Society of Medical and Interventional Radiology recommended that screening programmes and specialist breast centres actively invite women with a history of breast cancer to follow-up imaging. Objective A survey of breast centres associated with Senonetwork, the Italian network of breast cancer services, has offered the opportunity to assess the implementation of this recommendation. Methods A national, cross-sectional, voluntary, online survey was developed, pre-tested, and administered during the months July–October 2020. Five of the 73 questionnaire items concerned breast cancer follow-up. Results The response rate was 82/128 (65%). Of the 82 respondent centres, 69 (84%) were involved in a screening programme. Fifty-six (68%) reported the presence of a programme of active invitation to breast cancer follow-up targeted at patients living in their catchment area, with a significant north-to-south gradient. Four centres (5%) reported that the screening programme was responsible for actively initiating follow-up during the 10-year period since diagnosis. Only after 10 years did the proportion increase moderately. Conclusion Screening programmes have still a marginal role in active breast cancer follow-up.
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Affiliation(s)
- Silvia Deandrea
- Environmental Health Unit, Agency for Health Protection, Pavia, Italy
| | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy.,Department of Biomedical Sciences for Health, Università Degli Studi di Milano, San Donato Milanese, Italy
| | - Massimo Calabrese
- UOC Radiologia Senologica, IRCCS-Policlinico San Martino, Genoa, Italy
| | - Francesca Ferré
- Management and Health Laboratory, Department EMbeDS, Institute of Management, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Milena Vainieri
- Management and Health Laboratory, Department EMbeDS, Institute of Management, Sant'Anna School of Advanced Studies, Pisa, Italy
| | | | - Francesca Caumo
- Department of Breast Radiology, Veneto Institute of Oncology, IRCCS, Padua, Italy
| | | | - Lauro Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy.
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Galli V, Pini M, De Metrio D, de Bianchi PS, Bucchi L. An image quality review programme in a population-based mammography screening service. J Med Radiat Sci 2021; 68:253-259. [PMID: 34085397 PMCID: PMC8424329 DOI: 10.1002/jmrs.487] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 04/20/2021] [Accepted: 05/05/2021] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Mammography is one of the most technically demanding radiographic processes, and mammography quality assurance initiatives are priorities in the implementation of public health screening services. In the optimisation of image quality (IQ), radiographers play a major role. Between 1998 and 2009, the steering committee for mammography of a large population-based screening service in northern Italy undertook several audit checks of the imaging facilities. In 2009, the target age range of the screening service was extended. The mammogram volume was projected to increase steeply but with no substantial increase in the radiographer workforce. METHODS In view of the potential impact on mammographic IQ, the passive audit approach was abandoned in favour of an active radiographer-oriented IQ review programme. Its technical basis consists of regularly repeated rounds of review of random samples of digital mammograms performed by each first-level radiographer and by more experienced local reference radiographers, with IQ classification, followed by a training effort and a monitoring work. RESULTS The mammogram volume grew from 140,822 in 2008 to 319,394 in 2014 (+127%) and then stabilised. In 2012, the proportion of mammograms with a poor IQ rose from 0.6% to 19.3%, paralleled by a substantial decrease of mammograms interpreted to have a moderate and perfect IQ. Conversely, a generalised improvement occurred in both rounds of 2016 and in the first round of 2018. CONCLUSION In the new challenging scenario, the programme proved to be effective. A successful IQ review initiative is one that encourages radiographers to participate with a positive and confident attitude.
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Affiliation(s)
- Vania Galli
- Mammography Screening CentreLocal Health AuthorityModenaItaly
| | - Monica Pini
- Mammography Screening CentreLocal Health AuthorityModenaItaly
| | - Daniele De Metrio
- Mammography Screening CentreSt. Anna University HospitalFerraraItaly
| | | | - Lauro Bucchi
- Romagna Cancer RegistryRomagna Cancer Institute (Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori”, IRST, IRCCS)Meldola, ForlìItaly
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Bucchi L, Ravaioli A, Baldacchini F, Giuliani O, Mancini S, Vattiato R, Rossi PG, Campari C, Canuti D, Di Felice E, de Bianchi PS, Ferretti S, Bertozzi N, Falcini F. Five-year annual incidence and clinico-molecular features of breast cancer after the last negative screening mammography at age 68-69. Eur Radiol 2021; 32:834-841. [PMID: 34363132 DOI: 10.1007/s00330-021-08129-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/17/2021] [Accepted: 05/30/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The European Commission Initiative on Breast Cancer recommendation for triennial screening of women aged 70-74 is based on very weak evidence. A cohort of Italian women who had their last biennial screening mammography at age 68-69 was followed up for 5 years, assumed to represent the interval to another hypothetical screening mammography, in order to determine the annual proportional incidence of interval breast cancer. METHODS The cohort included 118,370 women. They had their last mammography between 1997 and 2008. Incident breast cancers were identified by record-linking the cohort with the regional breast cancer registry. The expected incidence in the age range 65-74 was estimated with an age-period-cohort model. The number of interval cancers was divided by the expected number to obtain their proportional incidence. RESULTS Overall, there were 298,658 woman-years at risk with 371 interval cancers versus 988.8 expected. In the first, second, third, fourth, and fifth interval year, the proportional incidence was 0.09 (95% confidence interval, 0.06-0.13), 0.32 (0.25-0.39), 0.60 (0.49-0.73), 0.75 (0.60-0.92), and 0.81 (0.60-1.07), respectively. Between the second and the fifth year, tumour stage and molecular subtype did not change significantly. CONCLUSION Though not supported by these findings, the proposal of triennial screening for women aged 70-74 merits further research, because the 95% confidence interval of the third-year proportional incidence of interval cancer included 0.50-the maximum limit considered acceptable for women aged 50-69. KEY POINTS • The third-year incidence of breast cancer relative to the expected one was 0.60 (95% confidence interval, 0.49-0.73). • Between the second and the fifth year, tumour stage and molecular subtype did not change significantly (p >0.10). • The proposal of a 3-year screening interval at age 70-74 merits further evaluation.
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Affiliation(s)
- Lauro Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori"), Meldola, Forlì, Italy
| | - Alessandra Ravaioli
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori"), Meldola, Forlì, Italy.
| | - Flavia Baldacchini
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori"), Meldola, Forlì, Italy
| | - Orietta Giuliani
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori"), Meldola, Forlì, Italy
| | - Silvia Mancini
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori"), Meldola, Forlì, Italy
| | - Rosa Vattiato
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori"), Meldola, Forlì, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cinzia Campari
- Cancer Screening Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Debora Canuti
- Department of Health, Regional Administration, Emilia-Romagna Region, Bologna, Italy
| | - Enza Di Felice
- Department of Health, Regional Administration, Emilia-Romagna Region, Bologna, Italy
| | | | - Stefano Ferretti
- University of Ferrara and Local Health Authority, Ferrara, Italy
| | - Nicoletta Bertozzi
- Department of Health, Regional Administration, Emilia-Romagna Region, Bologna, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori"), Meldola, Forlì, Italy
- Local Health Authority, Forlì, Italy
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Deandrea S, Cavazzana L, Principi N, Luconi E, Campoleoni M, Bastiampillai AJ, Bracchi L, Bucchi L, Pedilarco S, Piscitelli A, Sfondrini MS, Silvestri AR, Castaldi S. Screening of women with aesthetic prostheses in dedicated sessions of a population-based breast cancer screening programme. Radiol Med 2021; 126:946-955. [PMID: 33954896 PMCID: PMC8206050 DOI: 10.1007/s11547-021-01357-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 04/14/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Women with aesthetic prostheses must be included in the target population of mammography screening programmes. Breast implants are radiopaque and partially obscure the breast tissue. This can be avoided with the use of the Eklund technique, which causes an increased radiation exposure. In this study, augmented women undergoing a dedicated protocol within a population-based screening programme were compared according to selected indicators with the standard screening population. Essential dosimetric parameters and their time trend were also assessed. MATERIALS AND METHODS The study was conducted in a screening centre in Milan in the years 2009-2016. The screening protocol for women with breast implants included a double-read mammography with the Eklund views, ultrasound and clinical breast examination. RESULTS A total of 28,794 women were enrolled, including 588 (2%) women with breast implants and 28,206 (98%) undergoing the standard screening protocol. The invasive assessment rate was 9.0‰ for women with breast implants vs. 15‰ in the standard cohort. The surgical referral rate was 2.2% vs. 0.9%. The detection rate was similar in the two groups (4.0 and 4.5‰, respectively). There were significant differences in the average glandular dose according to the mammography equipment. The use of the Eklund views increased over time. CONCLUSIONS Screening of augmented women according to a specific protocol in the contexts of population-based programmes is feasible. Observed differences in screening indicators relative to the standard screening population require further research. The increasing use of Eklund views probably results from quality assurance measures associated with screening programmes.
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Affiliation(s)
- Silvia Deandrea
- Health Protection Agency Metropolitan City of Milan, Milan, Italy
| | - Laura Cavazzana
- Post Graduate School of Public Health, University of Milan, Milan, Italy.
| | - Niccolò Principi
- Post Graduate School of Public Health, University of Milan, Milan, Italy
| | - Ester Luconi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mauro Campoleoni
- Medical Physics Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Lucia Bracchi
- Medical Physics Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lauro Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori, IRST, "Dino Amadori"), Meldola, Forlì, Italy
| | - Stella Pedilarco
- Division of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Piscitelli
- Post Graduate School of Public Health, University of Milan, Milan, Italy
| | - Maria Silvia Sfondrini
- Division of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Silvana Castaldi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Quality Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Giudici F, Bortul M, Clagnan E, Del Zotto S, Franzo A, Giordano L, Gobbato M, Puliti D, Serraino D, Zucchetto A, Zanier L, Zanconati F, Bucchi L. [Early effects of attendance to the Friuli Venezia Giulia (Northern Italy) mammography screening programme on the incidence of advanced-stage breast cancer: a cohort study]. Epidemiol Prev 2021; 44:145-153. [PMID: 32631014 DOI: 10.19191/ep20.2-3.p145.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES to evaluate the incidence of advanced-stage breast cancer (BC) - an early surrogate indicator of effectiveness of mammography screening - among women who attended the Friuli Venezia Giulia (FVG) Region (Northern Italy) screening programme compared to women who did not attend. DESIGN retrospective cohort study. Women invited to the first screening round (2006-2007) were identified from the database of the programme. The cohort was record-linked to the archive of women invited to the second round (2008-2009). The definition of attendance to screening was based on attendance to at least one of the two rounds. The incidence of BC was assessed through record linkage with the FVG cancer registry using an anonymous univocal identifier (end of follow-up: 31st December 2013). Three distinct definitions of advanced stage were used: pT2 or greater (pT2+), positive lymph nodes (pN+), and TNM stage II or greater (stage II+). SETTING AND PARTICIPANTS organized mammography screening programme for women aged 50-69 years in the five regional healthcare districts. MAIN OUTCOME MEASURES incidence rate ratio (IRR) between attenders and non-attenders, adjusted for age and deprivation index, with 95% confidence interval (95%CI). RESULTS the cohort included 104,488 attenders and 49,839 non-attenders. During follow-up (median duration 84 months), 2,717 invasive BCs were diagnosed among attenders and 1,149 among non-attenders. Total incidence rate was 13% higher among attenders (IRR 1.13; 95%CI 1.05-1.21). These, conversely, had a 36% lower rate of pT2+ BC (IRR 0.64; 95%CI 0.56-0.72), a 13% lower rate of pN+ BC (IRR 0.87; 95%CI 0.78-0.98), a 22% lower rate of stage II+ BC (IRR 0.78; 95%CI 0.70-0.87), and a 32% lower rate of mastectomy (IRR 0.68; 95%CI 0.60-0.78). CONCLUSIONS attenders had lower incidence rates of advanced-stage BC. This early effect is suggestive of a future impact of the screening programme on BC mortality.
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Affiliation(s)
- Fabiola Giudici
- Unità di biostatistica, epidemiologia e sanità pubblica, Università di Padova.,Unità di biostatistica, Dipartimento di scienze mediche, Università degli Studi di Trieste
| | - Marina Bortul
- Dipartimento di scienze mediche, Università degli Studi di Trieste.,Dipartimento di chirurgia generale, Azienda sanitaria universitaria integrata di Trieste
| | - Elena Clagnan
- Servizio epidemiologico e flussi informativi, Azienda regionale di coordinamento per la salute, Regione autonoma Friuli Venezia Giulia, Udine
| | - Stefania Del Zotto
- Registro tumori del Friuli Venezia Giulia, Struttura operativa complessa (SOC) di epidemiologia oncologica, Centro di riferimento oncologico di Aviano (CRO) IRCCS, Aviano
| | - Antonella Franzo
- Area promozione della salute e prevenzione, Direzione centrale salute, politiche sociali e disabilità, Regione autonoma Friuli Venezia Giulia, Udine
| | - Livia Giordano
- Unità di epidemiologia dei tumori, Centro di riferimento per l'epidemiologia e la prevenzione oncologica in Piemonte, Torino
| | - Michele Gobbato
- Registro tumori del Friuli Venezia Giulia, Struttura operativa complessa (SOC) di epidemiologia oncologica, Centro di riferimento oncologico di Aviano (CRO) IRCCS, Aviano
| | - Donella Puliti
- Unità di epidemiologia clinica, Istituto per lo studio, la prevenzione e la rete oncologica (ISPRO), Firenze
| | - Diego Serraino
- Registro tumori del Friuli Venezia Giulia, Struttura operativa complessa (SOC) di epidemiologia oncologica, Centro di riferimento oncologico di Aviano (CRO) IRCCS, Aviano
| | - Antonella Zucchetto
- Registro tumori del Friuli Venezia Giulia, Struttura operativa complessa (SOC) di epidemiologia oncologica, Centro di riferimento oncologico di Aviano (CRO) IRCCS, Aviano
| | - Loris Zanier
- Servizio epidemiologico e flussi informativi, Azienda regionale di coordinamento per la salute, Regione autonoma Friuli Venezia Giulia, Udine
| | - Fabrizio Zanconati
- Dipartimento di scienze mediche, Università degli Studi di Trieste.,Anatomia e istologia patologica, Azienda sanitaria universitaria integrata di Trieste
| | - Lauro Bucchi
- Registro tumori della Romagna, Istituto scientifico romagnolo per lo studio e la cura dei tumori (IRST) IRCCS, Meldola, Forlì;
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25
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Bucchi L, Mancini S, Crocetti E, Dal Maso L, Baldacchini F, Vattiato R, Giuliani O, Ravaioli A, Caldarella A, Carrozzi G, Ferretti S, Filiberti RA, Fusco M, Gatti L, Gili A, Magoni M, Mangone L, Mazzoleni G, Michiara M, Panato C, Piffer S, Piras D, Rosso S, Rugge M, Scala U, Tagliabue G, Tumino R, Stanganelli I, Falcini F. Mid-term trends and recent birth-cohort-dependent changes in incidence rates of cutaneous malignant melanoma in Italy. Int J Cancer 2020; 148:835-844. [PMID: 33405292 DOI: 10.1002/ijc.33259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/21/2020] [Accepted: 07/28/2020] [Indexed: 01/12/2023]
Abstract
In Oceania, North America and north-western Europe, after decades of increase, cutaneous malignant melanoma (CMM) rates began to stabilise or decline before 2000. Anecdotal evidence suggests that the reversal of the incidence trend is extending to southern Europe. To obtain a formal confirmation, this nationwide study from Italy investigated the incidence trends by birth cohort. Twenty-one local cancer registries covering a population of 15 814 455 provided incidence data for primary CMM registered between 1994 and 2013. Trends in age-standardised rates were analysed using joinpoint regression models and age-period-cohort models. Age-standardised incidence showed a consistent increase throughout the period (estimated annual percent change, 3.6 [95% confidence interval, 3.2-4.0] among men and 2.5 [2.0-3.1] among women). This pattern was confirmed by a sensitivity analysis with removal of low-risk populations of southern Italy. The rates, however, showed a stabilisation or a decrease in men and women aged below 35. Using the cohort of 1949-the median cohort with respect to the number of cases for both genders-as a reference, the incidence rate ratio increased for successive cohorts born until 1973 (women) and 1975 (men), and subsequently tended to decline. For the most recent cohorts in both genders, the risk of disease returned to the level of the cohort of 1949. The changes observed in the latest generations can be interpreted as the earliest manifestations of a birth-cohort-dependent incidence decrease. Our study adds to previous data indicating that the reversal of the long-term upward incidence trend of CMM is extending to southern Europe.
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Affiliation(s)
- Lauro Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlì, Italy
| | - Silvia Mancini
- Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlì, Italy
| | - Emanuele Crocetti
- Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlì, Italy
| | - Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Flavia Baldacchini
- Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlì, Italy
| | - Rosa Vattiato
- Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlì, Italy
| | - Orietta Giuliani
- Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlì, Italy
| | - Alessandra Ravaioli
- Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlì, Italy
| | - Adele Caldarella
- Tuscany Cancer Registry, Clinical and Descriptive Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Giuliano Carrozzi
- Modena Cancer Registry, Public Health Department, Local Health Authority, Modena, Italy
| | - Stefano Ferretti
- Romagna Cancer Registry, section of Ferrara, Local Health Authority, and University of Ferrara, Ferrara, Italy
| | | | | | - Luciana Gatti
- Mantova Cancer Registry, Epidemiology Unit, Agenzia di Tutela della Salute (ATS) della Val Padana, Mantova, Italy
| | - Alessio Gili
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Michele Magoni
- Registry of Brescia Province, Epidemiology Unit, Brescia Health Protection Agency, Brescia, Italy
| | - Lucia Mangone
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Maria Michiara
- Parma Cancer Registry, Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Chiara Panato
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Silvano Piffer
- Trento Province Cancer Registry, Unit of Clinical Epidemiology, Trento, Italy
| | - Daniela Piras
- Sassari Cancer Registry, Azienda Regionale per la Tutela della Salute - ATS, Sassari, Italy
| | - Stefano Rosso
- Piedmont Cancer Registry, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | - Giovanna Tagliabue
- Lombardy Cancer Registry-Varese Province, Cancer Registry Unit, Department of Research, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, Provincial Health Authority (ASP), Ragusa, Italy
| | - Ignazio Stanganelli
- Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlì, Italy.,Department of Dermatology, University of Parma, Parma, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlì, Italy.,Cancer Prevention Unit, Local Health Authority, Forlì, Italy
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26
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Bucchi L, Ravaioli A, Baldacchini F, Giuliani O, Mancini S, Vattiato R, de Bianchi PS, Ferretti S, Falcini F. Incidence of interval breast cancer among women aged 45-49 in an organised mammography screening setting. J Med Screen 2020; 28:207-209. [PMID: 32842856 DOI: 10.1177/0969141320946059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To estimate the proportional incidence (PI) of first- and second-year interval breast cancer among women aged 45-49. METHODS In the Emilia-Romagna Region (northern Italy), women aged 45-49 are invited to mammography screening annually, and women aged 50-74 biennially. For younger ones, the proportional incidence of interval cancer in the first and unique interval year was calculated using standard methods. For the second, hypothetical year, it was estimated using two different estimates of the ratio between the second- and the first-year proportional incidence observed among women aged 50-54. Overall, 567,151 negative mammography records were used. RESULTS In the first interval year, the observed proportional incidence of interval cancer among women aged 45-49 was 0.27 (95% confidence interval (CI), 0.22-0.33), within the European limit considered desirable for women aged 50-69 (<0.30). In the second, hypothetical interval year, the estimated proportional incidence ranged from 0.61 (95% CI, 0.43-0.86) to 0.48 (95% CI, 0.31-0.76) depending on whether the estimate was based on data from the pre-digital or digital era, respectively. CONCLUSION The more up-to-date estimate of 0.48, slightly below the maximum limit considered acceptable for women aged 50-69 (<0.50), suggests that a screening interval of two years may also be an acceptable option for women aged 45-49.
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Affiliation(s)
- Lauro Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS), Meldola, Forlì, Italy
| | - Alessandra Ravaioli
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS), Meldola, Forlì, Italy
| | - Flavia Baldacchini
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS), Meldola, Forlì, Italy
| | - Orietta Giuliani
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS), Meldola, Forlì, Italy
| | - Silvia Mancini
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS), Meldola, Forlì, Italy
| | - Rosa Vattiato
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS), Meldola, Forlì, Italy
| | | | - Stefano Ferretti
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara and Local Health Authority, Ferrara, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS), Meldola, Forlì, Italy.,Cancer Prevention Unit, Local Health Authority, Forlì, Italy
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27
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Altini M, Solinas L, Bucchi L, Gentili N, Gallegati D, Balzi W, Falcini F, Massa I. Assessment of Cancer Care Costs in Disease-Specific Cancer Care Pathways. Int J Environ Res Public Health 2020; 17:ijerph17134765. [PMID: 32630745 PMCID: PMC7369964 DOI: 10.3390/ijerph17134765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 01/04/2023]
Abstract
In view of an efficient use of the Italian National Health Service-funded healthcare resources, a novel data-processing strategy combining information from multiple sources was developed in a regional cancer network of northern Italy. The goal was to calculate the annual overall cost of care pathways of six disease groups in 10,486 patients. The evaluation was conceived as a population-based cost description from the perspective of the Italian National Health Service. Costs occurred during a defined time period for a cross-section of patients at varying stages of their disease were measured. The total cancer care cost was €81,170,121 (11.1% of total local health expenditure), with a cost per patient of €7741.17 and a cost per capita of €204.62. Surgical, inpatient and day-hospital medical admissions, radiotherapy, drugs, outpatient care, emergency admissions, and home and hospice care accounted for 21.2%, 24.1%, 6.2%, 28.2%, 14.0%, 0.9%, and 5.4% of the total cost, respectively. The highest cost items included drugs (cost per capita, €22.95; 11.2% of total cost) and medical admissions (€14.51; 7.1%) for blood cancer, and surgical (€14.56; 7.1%) and medical admissions (€13.60; 6.6%) for gastrointestinal cancer. The information extracted allows multidisciplinary cancer care teams to be more aware of the costs of their clinical decisions.
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Affiliation(s)
- Mattia Altini
- Healthcare Administration, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (M.A.); (W.B.)
| | - Laura Solinas
- Management and Accounting Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (L.S.); (D.G.)
| | - Lauro Bucchi
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy;
- Correspondence: ; Tel.: +39-0543-739-455; Fax: +39-0543-739-459
| | - Nicola Gentili
- Information Technology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy;
| | - Davide Gallegati
- Management and Accounting Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (L.S.); (D.G.)
| | - William Balzi
- Healthcare Administration, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (M.A.); (W.B.)
| | - Fabio Falcini
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy;
- Cancer Prevention Unit, Morgagni-Pierantoni Hospital, 47121 Forlì, Italy
| | - Ilaria Massa
- Unit of Biostatistic and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy;
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28
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Rimini M, Casadei-Gardini A, Ravaioli A, Rovesti G, Conti F, Borghi A, Dall’Aglio AC, Bedogni G, Domenicali M, Giacomoni P, Tiribelli C, Bucchi L, Falcini F, Foschi FG. Could Inflammatory Indices and Metabolic Syndrome Predict the Risk of Cancer Development? Analysis from the Bagnacavallo Population Study. J Clin Med 2020; 9:jcm9041177. [PMID: 32325965 PMCID: PMC7231063 DOI: 10.3390/jcm9041177] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/08/2020] [Accepted: 04/10/2020] [Indexed: 02/07/2023] Open
Abstract
Background: Despite the robust data available on inflammatory indices (neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and systemic immune-inflammation index (SII)) and clinical outcome in oncological patients, their utility as a predictor of cancer incidence in the general population has not been reported in literature. Methods: The Bagnacavallo study was performed between October 2005 and March 2009. All citizens of Bagnacavallo (Ravenna, Emilia-Romagna, Italy) aged 30–60 years as of January 2005 were eligible and were invited by written letter to participate to the study. All participants underwent a detailed clinical history and physical examination following the model of the Dionysos Study. All blood values included in the analysis were obtained the day of physical examination. Cancer incidence data were obtained from the population-based Romagna Cancer Registry, which operates according to standard methods. The aim of this analysis was to examine the association between metabolic syndrome and baseline SII, NLR, and PLR levels, and the diagnosis of an invasive cancer in the Bagnacavallo study cohort. Results: At univariate analysis, metabolic syndrome was not associated with an increase of cancer incidence (HR 1.30; p = 0.155). High glucose (HR 1.49; p = 0.0.16), NLR HR 1.54, p = 0.002), PLR (HR 1.58, p = 0.001), and SII (HR 1.47, p = 0.006) were associated with an increase of cancer incidence. After adjusting for clinical covariates (smoking, physical activity, education, age, and gender) SII, PLR, and NLR remained independent prognostic factors for the prediction of cancer incidence. Conclusions: Inflammatory indices are promising, easy to perform, and inexpensive tools for identifying patients with higher risk of cancer in cancer-free population.
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Affiliation(s)
- Margherita Rimini
- Department of Oncology and Hematology, Division of Oncology, University Hospital Modena, 73828 Modena, Italy; (M.R.); (G.R.)
| | - Andrea Casadei-Gardini
- Department of Oncology and Hematology, Division of Oncology, University Hospital Modena, 73828 Modena, Italy; (M.R.); (G.R.)
- Correspondence:
| | - Alessandra Ravaioli
- Romagna Cancer Registry-Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.R.); (L.B.); (F.F.)
| | - Giulia Rovesti
- Department of Oncology and Hematology, Division of Oncology, University Hospital Modena, 73828 Modena, Italy; (M.R.); (G.R.)
| | - Fabio Conti
- Department of Internal Medicine, Degli Infermi Hospital, 48018 Faenza, Italy; (F.C.); (A.C.D.); (F.G.F.)
| | - Alberto Borghi
- Centro di Ricerca Biomedica Applicata (CRBA), Azienda Ospedaliero-Universitaria Policlinico S. Orsola-Malpighi e Università di Bologna, 40121 Bologna, Italy;
| | - Anna Chiara Dall’Aglio
- Department of Internal Medicine, Degli Infermi Hospital, 48018 Faenza, Italy; (F.C.); (A.C.D.); (F.G.F.)
| | - Giorgio Bedogni
- Liver Research Center, Italian Liver Foundation, Basovizza, 34121 Trieste, Italy; (G.B.); (C.T.)
| | - Marco Domenicali
- Department of Medical and Surgical Sciences-DIMEC, S. Orsola-Malpighi Hospital, Alma Mater Studiorum-University of Bologna, 40121 Bologna, Italy;
| | - Pierluigi Giacomoni
- Department of Internal Medicine, Ospedale di Lugo, AUSL Romagna, 48022 Lugo, Italy;
| | - Claudio Tiribelli
- Liver Research Center, Italian Liver Foundation, Basovizza, 34121 Trieste, Italy; (G.B.); (C.T.)
| | - Lauro Bucchi
- Romagna Cancer Registry-Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.R.); (L.B.); (F.F.)
| | - Fabio Falcini
- Romagna Cancer Registry-Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy; (A.R.); (L.B.); (F.F.)
| | - Francesco Giuseppe Foschi
- Department of Internal Medicine, Degli Infermi Hospital, 48018 Faenza, Italy; (F.C.); (A.C.D.); (F.G.F.)
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29
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Mancini S, Bucchi L, Baldacchini F, Giuliani O, Ravaioli A, Vattiato R, Preti M, Tumino R, Ferretti S, Biggeri A, Brustolin A, Boschetti L, Caiazzo AL, Caldarella A, Cesaraccio R, Cirilli C, Citarella A, Filiberti RA, Fusco M, Galasso R, Gatti L, Lotti FL, Magoni M, Mangone L, Masanotti G, Mazzoleni G, Mazzucco W, Melcarne A, Michiara M, Pesce P, Piffer S, Pinto A, Rognoni M, Rosso S, Rugge M, Sampietro G, Scalzi S, Scuderi T, Tagliabue G, Tisano F, Toffolutti F, Vitarelli S, Falcini F. Incidence trends of vulvar squamous cell carcinoma in Italy from 1990 to 2015. Gynecol Oncol 2020; 157:656-663. [PMID: 32273199 DOI: 10.1016/j.ygyno.2020.03.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/08/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The incidence of vulvar squamous cell carcinoma has increased for decades in most Western countries - a trend virtually restricted to women aged <50 or 60 years. In southern Europe, conversely, the trends have been insufficiently studied. This article reports a study from Italy. METHOD Thirty-eight local cancer registries, currently covering 15,274,070 women, equivalent to 49.2% of the Italian national female population, participated. Invasive cancers registered between 1990 and 2015 with an International Classification of Diseases for Oncology, 3rd revision, topography code C51 and morphology codes compatible with vulvar squamous cell carcinoma (n = 6294) were eligible. Incidence trends were analysed using joinpoint regression models, with calculation of the estimated annual percent change (EAPC), and age-period-cohort models. RESULTS Total incidence showed a regular and significant decreasing trend (EAPC, -0.96; 95% confidence interval (CI), -1.43 to -0.48). This was entirely accounted for by women aged ≥60 years (EAPC, -1.34; 95% CI, -1.86 to -0.81). For younger women, the EAPC between 1990 and 2012 was 1.20 (95% CI, 0.34 to 2.06) with a non-significant acceleration thereafter. This pattern did not vary substantially in a sensitivity analysis for the effect of geographic area and duration of the registry. The age-period-cohort analysis revealed a risk decrease in cohorts born between 1905 and 1940 and a new increase in cohorts born since 1945. CONCLUSIONS The decreasing trend observed among older women and the resulting decrease in total rate are at variance with reports from most Western countries. Age-period-cohort analysis confirmed a decreasing trend for earliest birth cohorts and an opposite one for recent ones.
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Affiliation(s)
- Silvia Mancini
- Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlì, Italy
| | - Lauro Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlì, Italy
| | - Flavia Baldacchini
- Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlì, Italy
| | - Orietta Giuliani
- Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlì, Italy
| | - Alessandra Ravaioli
- Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlì, Italy.
| | - Rosa Vattiato
- Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlì, Italy
| | - Mario Preti
- Department of Obstetrics and Gynaecology, University of Torino, Torino, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, Provincial Health Authority (ASP), Ragusa, Italy
| | | | - Annibale Biggeri
- Department of Statistics, Computer Science, Applications G. Parenti, University of Florence, Florence, Italy
| | - Angelita Brustolin
- Unit of Epidemiology and Cancer Registry, Local Health Authority, Viterbo, Italy
| | | | - Anna L Caiazzo
- Cancer Registry of Local Health Authority Salerno, Salerno, Italy
| | - Adele Caldarella
- Tuscany Cancer Registry, Clinical and Descriptive Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Rosaria Cesaraccio
- Sassari Cancer Registry, Azienda Regionale per la Tutela della Salute - ATS, Sassari, Italy
| | - Claudia Cirilli
- Modena Cancer Registry, Public Health Department, Local Health Authority, Modena, Italy
| | - Annarita Citarella
- Cancer Registry, Department of Prevention, Unit of Epidemiology, Local Health Authority, Benevento, Italy
| | - Rosa A Filiberti
- Liguria Cancer Registry, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Rocco Galasso
- Unit of Regional Cancer Registry, Clinical Epidemiology and Biostatistics, IRCCS-CROB, Basilicata, Rionero in Vulture, Italy
| | - Luciana Gatti
- Mantova Cancer Registry, Epidemiology Unit, Agenzia di Tutela della Salute (ATS) della Val Padana, Mantova, Italy
| | - Fernanda L Lotti
- Brindisi Cancer Registry, Local Health Authority, Brindisi, Italy
| | - Michele Magoni
- Cancer Registry of Brescia Province, Epidemiology Unit, Brescia Health Protection Agency, Brescia, Italy
| | - Lucia Mangone
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Giuseppe Masanotti
- Section of Public Health and RTUP Register, Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | | | - Walter Mazzucco
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | | | - Maria Michiara
- Parma Cancer Registry, Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Paola Pesce
- Catania, Messina, and Enna Cancer Registry, Catania, Italy
| | - Silvano Piffer
- Trento Province Cancer Registry, Unit of Clinical Epidemiology, Trento, Italy
| | - Angela Pinto
- Barletta, Andria, Trani Cancer Registry, BAT Province, Barletta, Italy
| | - Magda Rognoni
- Epidemiology Unit, Cancer Registry of ATS Brianza, Health Protection Agency, Monza, Italy
| | - Stefano Rosso
- Piedmont Cancer Registry, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Massimo Rugge
- Veneto Tumour Registry, Azienda Zero, University of Padova-DIMED, Padova, Italy
| | | | | | | | - Giovanna Tagliabue
- Lombardy Cancer Registry-Varese Province, Cancer Registry Unit, Department of Research, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Federica Toffolutti
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Susanna Vitarelli
- Macerata Province Cancer Registry, University of Camerino, Camerino, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlì, Italy; Cancer Prevention Unit, Local Health Authority, Forlì, Italy
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Mancini S, Bucchi L, Giuliani O, Ravaioli A, Vattiato R, Baldacchini F, Ferretti S, Sassoli de Bianchi P, Mezzetti F, Triossi O, Serafini M, Ricci E, Palazzi M, Imolesi C, Giovanardi M, Canuti D, Voci C, Altini M, Falcini F. Proportional incidence of interval colorectal cancer in a large population-based faecal immunochemical test screening programme. Dig Liver Dis 2020; 52:452-456. [PMID: 32165075 DOI: 10.1016/j.dld.2020.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/23/2020] [Accepted: 02/14/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The European guidelines for quality assurance in colorectal cancer (CRC) screening recommend that interval cancer rate be expressed as a proportion of background incidence rate. AIM To determine the crude and adjusted proportional incidence of interval CRC in an Italian regional two-yearly faecal immunochemical test (FIT) screening programme. METHODS The programme (year of implementation, 2005) is targeted at over 1,000,000 people aged 50-69 years. The test is a one-sample OC-Sensor (Eiken Chemical Co., Tokyo, Japan). The study covered one-third of the regional area. Excerpts of 434,295 eligible negative FIT records dated 2005-2012 from 193,193 subjects were retrieved from the regional CRC screening data warehouse. By 31 December 2013, the cohort accumulated 198,302 man-years and 235,370 woman-years. Interval CRCs were identified by record-linkage with the local population-based cancer registry. Their number was divided by the expected number, estimated with age-period-cohort models, to obtain the proportional incidence. RESULTS The proportional incidence of interval CRC for men and women was, respectively, 0.06 (95% confidence interval (CI), 0.04-0.09) and 0.17 (95% CI, 0.13-0.23) in the first interval year, and 0.21 (95% CI, 0.16-0.26) and 0.28 (95% CI, 0.22-0.36) in the second year. CONCLUSIONS The results were acceptable and in line with previous studies.
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Affiliation(s)
- Silvia Mancini
- Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS, Meldola, Italy
| | - Lauro Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS, Meldola, Italy.
| | - Orietta Giuliani
- Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS, Meldola, Italy
| | - Alessandra Ravaioli
- Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS, Meldola, Italy
| | - Rosa Vattiato
- Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS, Meldola, Italy
| | - Flavia Baldacchini
- Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS, Meldola, Italy
| | - Stefano Ferretti
- University of Ferrara and Local Health Authority, Ferrara, Italy
| | | | - Francesca Mezzetti
- Department of Health, Emilia-Romagna Regional Administration, Bologna, Italy
| | - Omero Triossi
- Cancer Screening Unit, Local Health Authority, Ravenna, Italy
| | - Monica Serafini
- Cancer Screening Unit, Local Health Authority, Ravenna, Italy
| | - Enrico Ricci
- Department of Gastroenterology and Digestive Endoscopy, Local Health Authority, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Mauro Palazzi
- Cancer Screening Unit, Local Health Authority, Cesena, Italy
| | - Claudia Imolesi
- Cancer Screening Unit, Local Health Authority, Cesena, Italy
| | | | - Debora Canuti
- Cancer Screening Unit, Local Health Authority, Rimini, Italy
| | - Claudio Voci
- Servizio ICT, Tecnologie e Strutture Sanitarie, Department of Health, Emilia-Romagna Regional Administration, Bologna, Italy
| | - Mattia Altini
- Healthcare Administration, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS, Meldola, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS, Meldola, Italy; Cancer Prevention Unit, Local Health Authority, Forlì, Italy
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Mancini S, Crocetti E, Bucchi L, Pimpinelli N, Vattiato R, Giuliani O, Ravaioli A, Baldacchini F, Stanganelli I, Falcini F. Time trends and age-period-cohort analysis of cutaneous malignant melanoma incidence rates in the Romagna Region (northern Italy), 1986-2014. Melanoma Res 2020; 30:198-205. [PMID: 30615011 DOI: 10.1097/cmr.0000000000000570] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
After a long-term increase, the incidence of cutaneous malignant melanoma has stabilized recently or even decreased in several populations of North-western Europe, USA, Canada, Australia and New Zealand, but not in southern Europe. The incidence trends of primary invasive cutaneous malignant melanoma (International Classification of Diseases, 10th revision, codes C43.0-C43.9) in the Romagna Region (northern Italy, 1.2 million inhabitants) for the period 1986-2014 were analysed with an age-period-cohort modelling approach. The series included 2466 men and 2481 women, a total of 4947 patients. Using the method of model building, the best-fitting models were found to be an age-drift model for men and an age-period model for women. Among men, the age-specific incidence rates increased in each successive cohort born between 1916 and 1981 with an attenuation of the trend for younger ones in the last cohorts. Among younger women, a slight decrease occurred for the cohorts born after 1961. For men, the quasi-parallel appearance of incidence curves by age group and cohort on a log scale suggested that the observed change was explained by a linear cohort effect. For women, the curves tended to overlap, suggesting an interaction between age and cohort that could be explained as a nonlinear period effect. In conclusion, the long-term upward incidence trend in the study area is stabilizing among women and an attenuation of the increasing trend is occurring among younger men in the most recent cohorts. These observations need to be confirmed with longer-term studies.
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Affiliation(s)
- Silvia Mancini
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
| | - Emanuele Crocetti
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
| | - Lauro Bucchi
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
| | - Nicola Pimpinelli
- Dermatology Unit, Department of Surgery and Translational Medicine, University of Florence Medical School, Florence, Italy
| | - Rosa Vattiato
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
| | - Orietta Giuliani
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
| | - Alessandra Ravaioli
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
| | - Flavia Baldacchini
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
| | - Ignazio Stanganelli
- Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
- University of Parma, Parma
| | - Fabio Falcini
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
- Romagna Local Health Authority, Forlì, Italy
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Bucchi L, Ravaioli A, Mancini S, Baldacchini F, Giuliani O, Vattiato R, Falcini F. Detection by screening introduces biases into survival estimates for luminal A‐like breast cancer patients. Int J Cancer 2020; 146:1764-1766. [DOI: 10.1002/ijc.32697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 09/11/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Lauro Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS) Meldola Forlì Italy
| | - Alessandra Ravaioli
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS) Meldola Forlì Italy
| | - Silvia Mancini
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS) Meldola Forlì Italy
| | - Flavia Baldacchini
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS) Meldola Forlì Italy
| | - Orietta Giuliani
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS) Meldola Forlì Italy
| | - Rosa Vattiato
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS) Meldola Forlì Italy
| | - Fabio Falcini
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS) Meldola Forlì Italy
- Local Health Authority Forlì Italy
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Cortesi L, Baldassarri B, Ferretti S, Razzaboni E, Bella M, Bucchi L, Canuti D, De Iaco P, De Santis G, Falcini F, Galli V, Godino L, Leoni M, Perrone AM, Pignatti M, Saguatti G, Santini D, Sassoli de'Bianchi P, Sebastiani F, Taffurelli M, Tazzioli G, Turchetti D, Zamagni C, Naldoni C. A regional population-based hereditary breast cancer screening tool in Italy: First 5-year results. Cancer Med 2020; 9:2579-2589. [PMID: 32045136 PMCID: PMC7131858 DOI: 10.1002/cam4.2824] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 12/16/2019] [Accepted: 12/20/2019] [Indexed: 12/19/2022] Open
Abstract
Background Up to 10% of individuals with breast cancer (BC) belong to families with hereditary syndromes. The aim of this study was to develop an instrument to identify individuals/families at high‐hereditary risk for BC and offer dedicated surveillance programs according to different risks. Methods The instrument consisted of a primary questionnaire collecting history of BC and ovarian cancer (OC). This questionnaire was applied to women enrolled in the Emilia‐Romagna Breast Cancer Screening Program. General practitioners (GPs) and specialists could propose the same questionnaire too. Women with a score of ≥ 2, were invited to complete an oncogenetic counseling. According to the Tyrer‐Cuzick evaluation, women considered at high risk were invited to involve the most representative alive individual of the family affected with BC/OC for BRCA1/2 genetic testing. Results Since January 2012 and December 2016, 660 040 women were evaluated by the regional screening program, of which 22 289 (3.5%) were invited to the Spoke evaluation, but only 5615 accepted (25.2%). Totally, also considering women sent by GPs and specialists, 11 667 were assessed and 5554 were sent to the Hub evaluation. Finally, 2342 (42.8%) women fulfilled the criteria for genetic testing, and 544 (23.2%) resulted BRCA1/2 mutation carriers. Conclusions To our knowledge, this is the first regional population‐based multistep model that is aimed to identify individuals with BRCA1/2 mutations and to offer an intensive surveillance program for hereditary‐high risk women. This tool is feasible and effective, even if more efforts must be performed to increase the acceptance of multiple assessments by the study population.
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Affiliation(s)
- Laura Cortesi
- Department of Oncology and Haematology, Azienda Ospedaliero, Universitaria di Modena Ospedale Civile di Baggiovara, Modena, Italy
| | - Bruna Baldassarri
- Department of Health and Welfare, Emilia-Romagna Region, Bologna, Italy
| | - Stefano Ferretti
- Department of Health and Welfare, Emilia-Romagna Region, Bologna, Italy
| | - Elisabetta Razzaboni
- Department of Oncology and Haematology, Azienda Ospedaliero, Universitaria di Modena Ospedale Civile di Baggiovara, Modena, Italy
| | - Mariangela Bella
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Lauro Bucchi
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Debora Canuti
- Cancer Screening Unit, Local Health Agency of Romagna, Rimini, Italy
| | - Pierandrea De Iaco
- Unit of Oncologic Gynecology, Department of Obstetrics and Gynecology, University of Bologna, Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Giorgio De Santis
- Division of Plastic Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.,Azienda Usl della Romagna, Forlì, Italy
| | - Vania Galli
- AUSL Modena, Mammography Screening Centre, Modena, Italy
| | - Lea Godino
- Department of Medical and Surgical Sciences, University of Bologna, Hospital of Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Maurizio Leoni
- Oncology Unit, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - Anna Myriam Perrone
- Unit of Oncologic Gynecology, Department of Obstetrics and Gynecology, University of Bologna, Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Marco Pignatti
- Division of Plastic Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Gianni Saguatti
- Senology Unit, Bellaria Carlo Alberto Pizzardi Hospital, Bologna, Italy
| | - Donatella Santini
- Sant'Orsola-Malpighi Polyclinic, University of Bologna, Hospital of Bologna, Bologna, Italy
| | | | - Federica Sebastiani
- Department of Oncology and Haematology, Azienda Ospedaliero, Universitaria di Modena Ospedale Civile di Baggiovara, Modena, Italy
| | - Mario Taffurelli
- Department of the Health of Woman, Child and Urological Diseases, University of Bologna, Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Giovanni Tazzioli
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Daniela Turchetti
- Department of Medical and Surgical Sciences, University of Bologna, Hospital of Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Claudio Zamagni
- Department of Hematology and Oncology, University of Bologna, Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Carlo Naldoni
- Department of Health and Welfare, Emilia-Romagna Region, Bologna, Italy
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Crocetti E, Giuliani O, Mancini S, Bucchi L, Falcini F. Colorectal cancer incidence trends among Italian individuals aged younger than 50 years are decreasing. Cancer 2020; 126:453. [DOI: 10.1002/cncr.32537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 09/04/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Emanuele Crocetti
- Romagna Cancer Registry Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS Meldola Forlì-Cesena Italy
| | - Orietta Giuliani
- Romagna Cancer Registry Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS Meldola Forlì-Cesena Italy
| | - Silvia Mancini
- Romagna Cancer Registry Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS Meldola Forlì-Cesena Italy
| | - Lauro Bucchi
- Romagna Cancer Registry Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS Meldola Forlì-Cesena Italy
| | - Fabio Falcini
- Romagna Cancer Registry Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS Meldola Forlì-Cesena Italy
- Romagna Local Health Authority Forlì Forlì-Cesena Italy
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Ravaioli A, Crocetti E, Mancini S, Baldacchini F, Giuliani O, Vattiato R, Bucchi L, Falcini F. Suicide death among cancer patients: new data from northern Italy, systematic review of the last 22 years and meta-analysis. Eur J Cancer 2020; 125:104-113. [DOI: 10.1016/j.ejca.2019.08.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/13/2019] [Accepted: 08/15/2019] [Indexed: 10/25/2022]
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Serra P, Katabalo DM, Masalu N, Amadori D, Bugingo S, Foca F, Bravaccini S, Donati C, Bucchi L, Masini C. Evaluating the appropriateness of chemotherapy in a low-resource cancer centre in sub-Saharan Africa. Cancer Med 2019; 9:133-140. [PMID: 31721474 PMCID: PMC6943087 DOI: 10.1002/cam4.2672] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/16/2019] [Accepted: 10/18/2019] [Indexed: 01/08/2023] Open
Abstract
Background To evaluate the appropriateness of chemotherapy use at the Oncology Department of the Bugando Medical Centre of Mwanza, Tanzania. Methods The study was an observational prevalence‐based study designed to evaluate a single‐chemotherapy cycle during a defined time period for a cross‐section of patients at varying stages of their clinical history. The sample included 103 consecutive subjects who were treated during January‐March 2017 and had at least one previous cycle. Chemotherapy treatment omissions, cycle delays, and dose reductions and their causes were recorded using a standard form that included demographic, anthropometric, and clinical items. The data were analyzed descriptively. Results There were 59 males (57.3%) and 44 females (42.7%). Ninety‐four patients were aged ≥18 years. Considering cancer type/site, there were 23 distinct groups of patients. The recorded number of drugs in the chemotherapy regimens varied between one and five. The median cycle number was three (range: 2‐11). Sixty‐eight (66.0%) patients were treated in a standard fashion. For the remaining, cycle delay and dose reduction were the most common cause for nonstandard treatment. Hematologic toxicity was responsible for the greater part of cycle delays, whereas dose reductions were accounted for by a larger spectrum of causes. Overall, toxicity explained 21/35 (60.0%) patients receiving nonstandard treatment. The distribution of toxic events was skewed toward grade 1 and grade 2. Conclusions The observed level of appropriateness of chemotherapy was encouraging. The proportion of patients experiencing severe toxic effects was lower than expected.
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Affiliation(s)
- Patrizia Serra
- Biostatistics and Clinical Trials Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Nestory Masalu
- Oncology Department, Bugando Medical Centre, Mwanza, Tanzania
| | | | | | - Flavia Foca
- Biostatistics and Clinical Trials Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sara Bravaccini
- Gerobiomics Unit, Bioscience Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Caterina Donati
- Oncology Pharmacy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Lauro Bucchi
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Carla Masini
- Oncology Pharmacy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Bucchi L, Mancini S, Baldacchini F, Giuliani O, Ravaioli A, Vattiato R, Falcini F, Giorgi Rossi P, Campari C, Canuti D, Di Felice E, de Bianchi PS, Ferretti S. Changes in the incidence of cervical tumours by disease stage in a cytology-based screening programme. J Med Screen 2019; 27:96-104. [PMID: 31690178 DOI: 10.1177/0969141319885989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To report changes in incidence of cervical tumours by disease stage, following the introduction of an organized cytology-based screening programme. METHODS An intention-to-screen study of a cytology-based screening programme targeting 1,219,000 women aged 25-64 in northern Italy was carried out. Based on the previously reported trend in total incidence of cervical cancer, the study period 1995-2014 was divided into 1995-1996 (pre-screening, or reference, years), 1997-1998 (screening implementation phase), 1999-2006 (transition phase, when incidence decreased), and 2007-2014 (steady-state phase, when incidence stabilized again). Tumour stage was categorized as preinvasive (cervical intraepithelial neoplasia grade 3 (CIN3) and adenocarcinoma in situ), early (pT1a), advanced (pT1b or greater, ypT), and unknown (pT1 not otherwise specified, pTx, missing information). Average annual incidence rates observed in each phase were compared with the expected (reference) rates, using the incidence rate ratio, calculated with a Poisson regression model. RESULTS In the steady-state phase, incidence rate ratios were: CIN3, 1.55 (95% confidence interval, 1.41-1.70); early-stage squamous carcinoma, 0.49 (0.36-0.67); advanced-stage squamous carcinoma, 0.44 (0.33-0.57); unknown-stage squamous carcinoma, 0.69 (0.48-0.99); adenocarcinoma in situ, 1.44 (0.72-2.88); early-stage adenocarcinoma, 2.65 (0.82-8.53); advanced-stage adenocarcinoma, 1.03 (0.56-1.91); and unknown-stage adenocarcinoma, 0.46 (0.23-0.92). CONCLUSIONS After stabilization, changes in incidence by tumour stage included a 55% increase for CIN3 and a 50-55% decrease both for early- and advanced-stage squamous carcinoma, but no significant changes for glandular tumours. These data will serve to quantify the incremental impact of the implementation of human papillomavirus-based screening, introduced in 2015.
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Affiliation(s)
- Lauro Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Forlì, Italy
| | - Silvia Mancini
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Forlì, Italy
| | - Flavia Baldacchini
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Forlì, Italy
| | - Orietta Giuliani
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Forlì, Italy
| | - Alessandra Ravaioli
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Forlì, Italy
| | - Rosa Vattiato
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Forlì, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Forlì, Italy
- Local Health Authority, Forlì, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cinzia Campari
- Cancer Screening Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Enza Di Felice
- Department of Health, Emilia-Romagna Region, Bologna, Italy
| | | | - Stefano Ferretti
- University of Ferrara and Local Health Authority, Ferrara, Italy
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Bravaccini S, Bucchi L, Puccetti M, Ravaioli S, Tumedei MM, Serra P, Masini C, Kahima J, Masalu N, Amadori D. Explaining the aggressiveness of breast cancer in sub-Saharan African patients. J Clin Pathol 2019; 72:723-724. [PMID: 31409610 DOI: 10.1136/jclinpath-2019-206071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Sara Bravaccini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Lauro Bucchi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Sara Ravaioli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Maria Maddalena Tumedei
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Patrizia Serra
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Carla Masini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Jackson Kahima
- Bugando Medical Center, Mwanza, United Republic of Tanzania
| | - Nestory Masalu
- Bugando Medical Center, Mwanza, United Republic of Tanzania
| | - Dino Amadori
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Preti M, Micheletti L, Privitera S, Radici G, Gallio N, Benedetto C, Bucchi L. Vulvar Lichen Planus: A Risk Factor for Vulvar High-Grade Squamous Intraepithelial Lesion Recurrence? J Low Genit Tract Dis 2019; 22:264-265. [PMID: 29933292 DOI: 10.1097/lgt.0000000000000398] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Mario Preti
- Department of Obstetrics and Gynecology, University of Torino, Torino, Italy ; Department of Obstetrics and Gynecology, University of Torino, Torino, Italy; Department of Pathology, and Cytology of Female Cancer, Childhood Cancer and Rare Cancers, AOU Città della Salute e della Scienza, Torino, Italy Department of Obstetrics and Gynecology, University of Torino, Torino, Italy Romagna Cancer Registry,Romagna Cancer Institute, Meldola, Forlì, Italy
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Mancini S, Crocetti E, Bucchi L, Pimpinelli N, Vattiato R, Giuliani O, Ravaioli A, Baldacchini F, Balducci C, Stanganelli I, Falcini F. Melanoma survival with Classification and Regression Trees Analysis: a complement for the communication of prognosis to patients. Ital J Dermatol Venerol 2019; 156:460-466. [PMID: 31210469 DOI: 10.23736/s2784-8671.19.06402-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Prognostic factors in cutaneous melanoma are commonly evaluated by the Cox proportional hazard model. However, the interpretation of the effect of multiple variables is not straightforward. Classification and Regression Trees Analysis (CART), which allows a more friendly data evaluation, could be a valid integration of the message from Cox model. METHODS The CART algorithm splits up data, creating a "tree" of groups of patients with different profiles for the risk of death. Results are easy to interpret in clinical practice. A total of 2692 patients with invasive cutaneous melanoma registered in Romagna (northern Italy) between 1993-2012 and followed-up until the end of 2013 were included. The Cox model and CART analysis were applied to sex, patient age, histological subtype, Breslow's tumor thickness, ulceration, site of disease, and Clark level. RESULTS The CART analysis identified 15 categories which were collapsed into five classes with statistically different survival. The best prognostic group (10-year observed survival, 99.1%) included subjects with Breslow thickness ≤0.78 mm and age 16-81 years. The worst prognostic group (10-year observed survival, 35.8%) comprised subjects with thickness ≥3.75 mm and age 16-96 years. According to the Cox model, patient age, histological subtype, Breslow thickness, ulceration, and site of disease had a significant independent prognostic value. CONCLUSIONS CART and Cox models provided consistent results. CART seemed friendlier in its interpretation and it could facilitate the communication of risk.
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Affiliation(s)
- Silvia Mancini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì-Cesena, Italy
| | - Emanuele Crocetti
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì-Cesena, Italy
| | - Lauro Bucchi
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì-Cesena, Italy
| | - Nicola Pimpinelli
- Unit of Dermatology, Department of Health Sciences, University of Florence Medical School, Florence, Italy
| | - Rosa Vattiato
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì-Cesena, Italy
| | - Orietta Giuliani
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì-Cesena, Italy
| | - Alessandra Ravaioli
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì-Cesena, Italy
| | - Flavia Baldacchini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì-Cesena, Italy -
| | - Chiara Balducci
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì-Cesena, Italy
| | - Ignazio Stanganelli
- Unit of Skin Cancer, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì-Cesena, Italy.,University of Parma, Parma, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì-Cesena, Italy.,Romagna Local Health Authority, Forlì, Forlì-Cesena, Italy
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Mancini S, Crocetti E, Bucchi L, Pimpinelli N, Vattiato R, Giuliani O, Ravaioli A, Baldacchini F, Balducci C, Stanganelli I, Falcini F. Melanoma survival with Classification and Regression Trees Analysis: a complement for the communication of prognosis to patients. Ital J Dermatol Venerol 2019. [PMID: 31210469 DOI: 10.23736/s0392-0488.19.06402-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Prognostic factors in cutaneous melanoma are commonly evaluated by the Cox proportional hazard model. However, the interpretation of the effect of multiple variables is not straightforward. Classification and Regression Trees Analysis (CART), which allows a more friendly data evaluation, could be a valid integration of the message from Cox model. METHODS The CART algorithm splits up data, creating a "tree" of groups of patients with different profiles for the risk of death. Results are easy to interpret in clinical practice. A total of 2692 patients with invasive cutaneous melanoma registered in Romagna (northern Italy) between 1993-2012 and followed-up until the end of 2013 were included. The Cox model and CART analysis were applied to sex, patient age, histological subtype, Breslow's tumor thickness, ulceration, site of disease, and Clark level. RESULTS The CART analysis identified 15 categories which were collapsed into five classes with statistically different survival. The best prognostic group (10-year observed survival, 99.1%) included subjects with Breslow thickness ≤0.78 mm and age 16-81 years. The worst prognostic group (10-year observed survival, 35.8%) comprised subjects with thickness ≥3.75 mm and age 16-96 years. According to the Cox model, patient age, histological subtype, Breslow thickness, ulceration, and site of disease had a significant independent prognostic value. CONCLUSIONS CART and Cox models provided consistent results. CART seemed friendlier in its interpretation and it could facilitate the communication of risk.
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Affiliation(s)
- Silvia Mancini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì-Cesena, Italy
| | - Emanuele Crocetti
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì-Cesena, Italy
| | - Lauro Bucchi
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì-Cesena, Italy
| | - Nicola Pimpinelli
- Unit of Dermatology, Department of Health Sciences, University of Florence Medical School, Florence, Italy
| | - Rosa Vattiato
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì-Cesena, Italy
| | - Orietta Giuliani
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì-Cesena, Italy
| | - Alessandra Ravaioli
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì-Cesena, Italy
| | - Flavia Baldacchini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì-Cesena, Italy -
| | - Chiara Balducci
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì-Cesena, Italy
| | - Ignazio Stanganelli
- Unit of Skin Cancer, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì-Cesena, Italy.,University of Parma, Parma, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Forlì-Cesena, Italy.,Romagna Local Health Authority, Forlì, Forlì-Cesena, Italy
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Bucchi L, Baldacchini F, Mancini S, Ravaioli A, Giuliani O, Vattiato R, Falcini F, Giorgi Rossi P, Campari C, Canuti D, Di Felice E, Sassoli de Bianchi P, Ferretti S, Bertozzi N, Biggeri A. Estimating the impact of an organised screening programme on cervical cancer incidence: A 26-year study from northern Italy. Int J Cancer 2018; 144:1017-1026. [PMID: 30120770 DOI: 10.1002/ijc.31806] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/26/2018] [Accepted: 08/01/2018] [Indexed: 11/09/2022]
Abstract
The impact of the organised cervical cancer (CC) screening programmes implemented in Europe since the 1990s has been insufficiently evaluated. We investigated the changes in CC incidence following the introduction of a screening programme in the Emilia-Romagna Region (northern Italy). The study period was 1988-2013. The programme, targeting women aged 25-64 years (1,219,000 in 2018), started in 1998. The annual incidence rates that would be expected in 1998-2013 in the absence of screening were estimated, first, by analysing the annual rates in 1988-1997 with a log-linear model and, second, by analysing the annual rates in 1988-2013 with an age-period model in which the period effect was enforced to be linear. Cervical adenocarcinoma incidence trend over the entire period was used to validate both estimates. Observed annual rates were compared to the two series of expected ones with the incidence rate ratio (IRR). Incidence remained stable during 1988-1997, peaked in 1998 and then decreased until 2007, when it stabilised. The two series of expected rates were virtually coincident and their trends roughly paralleled the stable adenocarcinoma incidence trend. After 2007, the median IRR was 0.60 (95% confidence interval, 0.45-0.81) based on the log-linear model and 0.58 (95% confidence interval, 0.34-0.97) based on the age-period model. Thirty-six to seventy-five CC cases were prevented annually for an average annual frequency of 6.5 per 100,000 women in the target population. In summary, consistent circumstantial evidences were obtained that the organised screening programme brought about a 40% reduction in annual CC incidence after 10 years.
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Affiliation(s)
- Lauro Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Meldola, Forlì, Italy
| | - Flavia Baldacchini
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Meldola, Forlì, Italy
| | - Silvia Mancini
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Meldola, Forlì, Italy
| | - Alessandra Ravaioli
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Meldola, Forlì, Italy
| | - Orietta Giuliani
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Meldola, Forlì, Italy
| | - Rosa Vattiato
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Meldola, Forlì, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Meldola, Forlì, Italy.,Cancer Prevention Unit, Local Health Authority, Forlì, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Local Health Authority and Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Cinzia Campari
- Cancer Screening Unit, Local Health Authority and Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Debora Canuti
- Cancer Screening Unit, Local Health Authority, Rimini, Italy
| | - Enza Di Felice
- Department of Health, Regional Administration, Emilia-Romagna Region, Bologna, Italy
| | | | - Stefano Ferretti
- Department of Health, Regional Administration, Emilia-Romagna Region, Bologna, Italy
| | - Nicoletta Bertozzi
- Department of Health, Regional Administration, Emilia-Romagna Region, Bologna, Italy
| | - Annibale Biggeri
- Department of Statistics, Computer Science, and Applications "G. Parenti", University of Florence, Florence, Italy
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Stanganelli I, Raccagni AA, Baldassari L, Calista D, Serafini M, Bucchi L. Analysis of Breslow Tumor Thickness Distribution of Skin Melanoma in the Italian Region of Romagna, 1986–1991. Tumori 2018; 80:416-21. [PMID: 7900229 DOI: 10.1177/030089169408000602] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and Background In southern European countries, the availability of epidemiologic data on cutaneous malignant melanoma is limited. A descriptive analysis was performed on melanoma cases diagnosed in the Italian region of Romagna (population 600,000), 1986-91. Methods The main end point was the proportion of cases less than 1.5 mm thick by sex, age, and site. Results A total of 297 incident cases was evaluated. The average annual age-standardized (World) incidence rates were 6.2 (95% CI 5.2–7.2) per 100,000 females and 4.5 (95% CI 3.6–5.3) per 100,000 males. Females presented with significantly thinner melanomas than males. The proportion of cases less than 1.5 mm thick decreased significantly with increasing age in both sexes, with the most pronounced decrease (approximately from 2/3 to 1/3) being observed above 60 years for females and above 40 for males. Comparing sexes by 10-year age groups, a significant F:M advantage in thickness distribution was found only at age 40–49 and 50–59 years. Among females under 60, melanomas of the legs and those of the trunk showed no difference in thickness distribution, in both sexes, incidence appeared to increase progressively with age. No apparent elevation in incidence rates was observed in the age groups with the highest frequency of thin melanomas. Conclusions The major implication of these data is that in public education programs specific messages should be aimed at those subgroups that show the poorest levels of self-surveillance.
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Affiliation(s)
- I Stanganelli
- Dermatology Department, Health Care District 35, Ravenna, Italy
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Broeders MJM, Allgood P, Duffy SW, Hofvind S, Nagtegaal ID, Paci E, Moss SM, Bucchi L. The impact of mammography screening programmes on incidence of advanced breast cancer in Europe: a literature review. BMC Cancer 2018; 18:860. [PMID: 30176813 PMCID: PMC6122725 DOI: 10.1186/s12885-018-4666-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 07/11/2018] [Indexed: 11/30/2022] Open
Abstract
Background Observational studies have reported conflicting results on the impact of mammography service screening programmes on the advanced breast cancer rate (ABCR), a correlation that was firmly established in randomized controlled trials. We reviewed and summarized studies of the effect of service screening programmes in the European Union on ABCR and discussed their limitations. Methods The PubMed database was searched for English language studies published between 01-01-2000 and 01–06-2018. After inspection of titles and abstracts, 220 of the 8644 potentially eligible papers were considered relevant. Their abstracts were reviewed by groups of two authors using predefined criteria. Fifty studies were selected for full paper review, and 22 of these were eligible. A theoretical framework for their review was developed. Review was performed using a ten-point checklist of the methodological caveats in the analysis of studies of ABCR and a standardised assessment form designed to extract quantitative and qualitative information. Results Most of the evaluable studies support a reduction in ABCR following the introduction of screening. However, all studies were challenged by issues of design and analysis which could at least potentially cause bias, and showed considerable variation in the estimated effect. Problems were observed in duration of follow-up time, availability of reliable reference ABCR, definition of advanced stage, temporal variation in the proportion of unknown-stage cancers, and statistical approach. Conclusions We conclude that much of the current controversy on the impact of service screening programmes on ABCR is due to observational data that were gathered and/or analysed with methodological approaches which could not capture stage effects in full. Future research on this important early indicator of screening effectiveness should focus on establishing consensus in the correct methodology. Electronic supplementary material The online version of this article (10.1186/s12885-018-4666-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M J M Broeders
- Radboud Institute for Health Sciences, Radboud university medical center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands. .,Dutch Expert Centre for Screening, Nijmegen, The Netherlands.
| | - P Allgood
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - S W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - S Hofvind
- Cancer Registry of Norway, Oslo, Norway
| | - I D Nagtegaal
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - E Paci
- Retired, Clinical and Descriptive Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Florence, Italy
| | - S M Moss
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - L Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Meldola, Forli, Italy
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Ravaioli A, Bucchi L. [Cancer and risk of suicide: follow-up and multidisciplinarity may offer opportunities for prevention.]. Recenti Prog Med 2018; 109:322-323. [PMID: 29968859 DOI: 10.1701/2932.29485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Suicide rate is two-fold higher among cancer patients than in the general population. General and cancer-related risk factors for suicide are easily identified by caregivers interacting with patients, but with the exception of depression - the strongest one. This hampers the feasibility of screening of patients by the treating personnel. While new treatments tend to make cancer a chronic disease, which exposes patients to prolonged periods of uncertainty about recurrences, two recent advances have improved the possibility to prevent suicide. On the one hand, the emerging concept of cancer survivorship care has placed the identification of long-term consequences of cancer and its treatments, including an increased risk for suicide, among the objectives of patient follow-up. On the other hand, models of multidisciplinary team care have been implemented in several areas of cancer management. Although the psycho-oncologist has a complementary role, a clear definition of its relationship with the multidisciplinary teams facilitates the adoption of screening programmes for the detection of conditions of increased risk for suicide in cancer care facilities.
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Affiliation(s)
- Alessandra Ravaioli
- Registro Tumori della Romagna, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlì
| | - Lauro Bucchi
- Registro Tumori della Romagna, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlì
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Abstract
The distribution of Breslow's thickness by sex, age and site of 95 of the 103 cases of primary cutaneous malignant melanoma (CMM) diagnosed in 1981–1990 in the Ravenna Health District (a low-incidence area in northern Italy) was studied. The median patient age was 57 years. The median tumor thickness was 1.33 mm in females and 2.15 mm in males (two-tailed Wilcoxon rank sum test, p = 0.153). Significantly thinner lesions were found among women up to the median age than among men of the same age group (1.05 mm vs. 1.80 mm, p = 0.034) and older women (2.20 mm, p = 0.035). The difference between males aged under 57 years and older than 57 was not significant (1.80 mm vs. 2.20 mm, p = 0.828). As a consequence, younger women compared favorably with the rest of the population as a whole (2.20 mm, p = 0.011). No significant differences in site-specific median tumor thickness were found between the sexes or between young and older males, whereas CMMs of the legs among females were thinner in the younger age group (0.67 mm vs. 2.20 mm, p = 0.007). The prevalence of younger women in the recognition of early CMM was entirely accounted for by a substantial shift observed in the most recent 5-year period (from 2.40 mm to 0.70 mm, p = 0.006). Specific educational activities have never been carried out in Ravenna.
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Affiliation(s)
- L Bucchi
- Cancer Prevention Centre, S. Maria delle Croci Hospital, Ravenna, Italy
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Abstract
Aims and Background In the field of breast cancer control, obtaining population-based data on spontaneous mammography (MG) screening should be a priority. This study focuses on the breast cancer incidence and stage distribution in relation to MG use in Ravenna (Italy), 1987-88. Methods We estimated the MG rates, expected (E) incidence based on mortality data, observed (O) incidence, predicted excess incidence based on MG rates, observed excess incidence, and stage distribution according to the MG history. Results The highest MG rate (37%) was found among residents aged 40-44 but none of these had a T1a-bN0 breast cancer diagnosed nor was the predicted excess incidence demonstrated. Between 45 and 64 years, 80% of self-selected screenees had repeat (“incidence”) MG and the O:E incidence ratio was 1.32 (95% Cl 1.09-1.58). The observed excess incidence was 3.8-fold (95% Cl 2.56-5.16) greater than that predicted. Advanced (T2+ and/or N1+) cases accounted for 42% of patients diagnosed within 3 years of their last MG, for 55% of those diagnosed more than 3 years after their last MG, and for 70% of those with no previous MG. Above age 70, a significant worsening of stage at diagnosis was associated with a clear-cut drop in the proportion of breast cancer patients with previous self-referral for MG. Conclusions The results indicate that self-selection and its implications are major features of spontaneous screening practice.
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Affiliation(s)
- L Bucchi
- Romagna Cancer Registry, Morgagni-Pierantoni Hospital, Forli, Italy
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Morini N, Bucchi L, Naldoni C, Schincaglia P, Capacci N, Fantozzi V, Buzzi G. Effects of the Bethesda System on the Rate of Unsatisfactory Pap Smears in Spontaneous Cervical Screening. Tumori 2018; 82:437-40. [PMID: 9063518 DOI: 10.1177/030089169608200504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims In 1990, The Bethesda System (TBS) was introduced into spontaneous cervical screening practice in Ravenna, Italy. Negative/benign reports with the recommendation for early repeat smears (RERS) due to some limitation in sample adequacy were considered no longer acceptable. A monitoring program for the rate of unsatisfactory smears (UNS) was implemented. The aim of the present study was to evaluate the effects of such changes in the screening procedure. Methods The frequency of UNS in 1990 was compared with that of UNS+RERS in 1988 (assumed as a baseline year) by the calculation of the standardized rate ratio with the 95% confidence interval (CI). The trend in the standardized rate of UNS from 1990 to 1994 was evaluated by the calculation of the average annual variation with the 95% CI. Results The immediate effect of TBS (1990:1988 comparison) was a significant increase in the rate of UNS attributable to scant cellularity, poor fixation and thick areas (rate ratio, 2.35; 95% CI, 2.18 to 2.53) and to the absence of endocervical component (1.45; 95% CI, 1.30 to 1.60). The rate of UNS attributable to the presence of cytolysis, inflammation, blood and foreign material decreased by about 6 times (0.16; 95% CI, 0.13 to 0.19). The midterm effect of TBS (trend from 1990 to 1994) was a decrease in the total rate of UNS by an average of 2.3% per year. The downward trend was significant for smears showing scant cellularity, poor fixation and thick areas (-1.5% per year) and the absence of endocervical component (-0.7% per year). UNS attributable to the presence of cytolysis, inflammation, blood and foreign material stabilized. Conclusions TBS led to a substantial change in the type of information provided by the cytology report (Immediate effect). The monitoring program according to TBS led to a reduction in UNS attributable to sample taker (midterm effect).
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Affiliation(s)
- N Morini
- Department of Prevention, Ravenna Health Care District, Italy
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Schincaglia P, Brondelli L, Cicognani A, Buzzi G, Orsini LF, Bovicelli L, Jasonni VM, Bucchi L. A Feasibility Study of Ovarian Cancer Screening: Does Fine-Needle Aspiration Improve Ultrasound Specificity? Tumori 2018; 80:181-7. [PMID: 8053074 DOI: 10.1177/030089169408000304] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background The prognosis for ovarian cancer patients depends on the stage at diagnosis. As a prerequisite for any proposed procedure for ovarian cancer screening, high levels of specificity should be obtained using combinations of tests. Based on preliminary data from an ongoing feasibility study, this report is focused on the possible gain in specificity provided by fine-needle aspiration of occult ovarian masses detected by ultrasound. Methods Ultrasonography was used as a basic test, and fine-needle aspiration was obtained from selected patients. Those with (a) positive aspiration cytology or histology, (b) complex or solid masses showing volume increase, (c) complex or irregular masses and inadequate samples, and (d) recurrent cystic lesions were operated on. Results A total of 3541 asymptomatic patients 50-69 years of age underwent ultrasonography, and 98 were selected for fine-needle aspiration. Of these, 19 (positivity rate 19/3541 or 0.5%) were operated on. Two ovarian cancer cases (FIGO Stage II and III) were detected (detection rate 2/3541 or 0.6 × 1,000; positive predictive value 2/19 or 10.5%). Specificity was 3443/3539 or 97.3% for ultrasound alone and 3522/3539 or 99.5% for the procedure as a whole. Surgical exploration for relapses of benign cysts reduced by some 50% the potential gain in positive predictive value provided by aspiration cytology compared with ultrasound alone. Conclusions Although fine-needle aspiration has improved the performance of ultrasound, this 2-levei procedure does not appear to achieve acceptable levels of specificity.
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Abstract
Cytologic and colposcopic histories of cases of invasive cervical cancer and cervical intraepithelial neoplasia grade III (CIN III) registered in Ravenna (northern Italy) between 1986 and 1990 were evaluated. During the 5 years prior to diagnosis, 10/49 invasive cancer patients and 25/61 CIN III patients had had at least one pap smear reported as negative. At the time of the most recent false-negative report, 9/10 and 17/25 of these cases had been recommended for a repeat smear within 2 to 6 months. Of the 9 patients with invasive cancer, 5 had also undergone an inconclusive colposcopy (with biopsy unperformed). Among invasive cancer patients aged under 50, half of incident cases (7/14) and most of those with some cytologic experience (7/8) had had a false-negative report; each of these patients (7/7) had been recommended for an early repeat smear. For invasive cancer patients as well as for CIN III patients, the suggested intervals for the early repeat were largely exceeded. Median delay in diagnosis was about 2 years. Although the frequency of negative reports recommending repeat smears within a few months was estimated to be some 10 % of total screening patients, current concepts in cervical cytology suggest that cancer cases with such false-negative reports should be regarded as follow-up failures rather than laboratory errors. In fact, they passed quite unnoticed. In unplanned (spontaneous) cervical screening practice, sensitivity needs to be maximized, but even the occurrence of false-negative cases is not monitored. The present study points out what may result from such a contradiction.
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Affiliation(s)
- L Bucchi
- Cancer Prevention Centre, Ravenna, Italy
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