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Micheli A. [Wars, atomic risk, our journal Epidemiologia&Prevenzione]. Epidemiol Prev 2022; 46:306-307. [PMID: 36628638 DOI: 10.19191/ep22.5-6.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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2
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Vozzi F, Dimitri GM, Piacenti M, Zucchelli G, Solarino G, Nesti M, Pieragnoli P, Gallicchio C, Persiani E, Morales MA, Micheli A. Artificial intelligence algorithms for the recognition of Brugada type 1 pattern on standard 12-leads ECG. Europace 2022. [DOI: 10.1093/europace/euac053.558] [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: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This research project is funded by Tuscany Region
Background/Introduction
Electrocardiograms (ECGs) are rapidly moving from analog to digital versions. Consequently, a series of automatic analyses of standard 12-lead ECGs are attracting interest for their ability to support clinicians in the automatic recognition of specific features associated with different cardiac diseases [2]. Artificial Intelligence applications and Machine Learning (ML) algorithms have gained much attention in the last years for their ability to figure out patterns from data independently, without being explicitly taught rules. Peculiar features define the ECGs of patients with Brugada Syndrome (BrS); however, ambiguities still exist for the correct diagnosis of BrS and discrimination with respect to other pathologies.
Purpose
The BrAID (Brugada syndrome and Artificial Intelligence applications to Diagnosis) project aims to develop an innovative system for diagnosing Type 1 BrS based on ECG pattern recognition through the application of ML algorithms. In this work, an application of Echo State Networks (ESN), a type of Recurrent Neural Network (RNN), for the diagnosis of BrS from ECG is presented.
Methods
After approval from the Local Ethical Committees, 12-lead ECGs were obtained in patients enrolled in 5 Centers diagnosed with typical spontaneous Type 1 pattern (coved) (group A, 81 patients). Baseline ECG was also collected in patients undergoing the ajmaline test, classified as positive (group B, 37 patients) or negative (group C, 14 patients) according to test results. 174 patients with no clinical and familial history of arrhythmias were considered controls (group D). Data were collected from 4 beats extracted from the ECGs as input to the ESN. The datasets obtained in the different groups were used for the ESN model’s training and assessment (testing) through a double cross-validation approach.
Results
As shown in Table 1, the performances using three leads (V1, V2, V3) or V2 only were compared.
The algorithm performance was assessed in all the datasets (group A+B+C+D) and in spontaneous BrS (group A) and controls (group D). A good accuracy (79.21%) was seen when the three leads were considered for groups A and D only; the best test set accuracy (80.20%) was obtained in the case in which V2 only was used as input in all the datasets.
Conclusion(s)
In this work, a novel system for diagnosing Type 1 BrS using an ESN approach was developed. Our preliminary results show that this ML model is able to detect ECG patterns associated with Type 1 BrS with good and comparable accuracy both when three leads (79.21% ) or V2 only (80.20%) were analyzed. The future availability of larger datasets could improve the model performance, increasing the ESN potentialities as a clinical support system tool to be used in everyday clinical practice.
Table 1. The accuracy, specificity, and sensitivity reported for each dataset group are obtained through double cross-validation.
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Affiliation(s)
- F Vozzi
- National Council of Research, Pisa, Italy
| | - GM Dimitri
- University of Pisa, Department of Computer Science, Pisa, Italy
| | - M Piacenti
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - G Zucchelli
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - M Nesti
- San Donato Hospital of Arezzo, Arezzo, Italy
| | | | - C Gallicchio
- University of Pisa, Department of Computer Science, Pisa, Italy
| | - E Persiani
- National Council of Research, Pisa, Italy
| | - MA Morales
- National Council of Research, Pisa, Italy
| | - A Micheli
- University of Pisa, Department of Computer Science, Pisa, Italy
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Gigante N, Micheli A, Montanari A, Scala E. Decidability and Complexity of Action-Based Temporal Planning over Dense Time. ARTIF INTELL 2022. [DOI: 10.1016/j.artint.2022.103686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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4
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Micheli A, Forastiere F, Candela S, Richiardi L. [Like an atomic wind]. Epidemiol Prev 2021; 45:438-440. [PMID: 35001585 DOI: 10.19191/ep21.6.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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5
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Forastiere F, Micheli A. [Face masks and COVID-19: a methodological debate about decision-making in public health]. Epidemiol Prev 2020; 44:322-324. [PMID: 33706480 DOI: 10.19191/ep20.5-6.p322.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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6
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Micheli A, Forastiere F, Richiardi L. [COVID-19. A turning point for Italian society?]. Epidemiol Prev 2020; 44:15-16. [PMID: 33412785 DOI: 10.19191/ep20.5-6.s2.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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7
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Forastiere F, Micheli A, Salmaso S, Vineis P. [Epidemiology and Covid-19 in Italy. Accessing and sharing data to foster collaboration]. Epidemiol Prev 2020; 44:112-113. [PMID: 32631009 DOI: 10.19191/ep20.2-3.p112.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
| | | | - Stefania Salmaso
- Ex direttrice del Centro nazionale di epidemiologia, sorveglianza e promozione della salute dell'Istituto superiore di sanità, Roma
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8
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Inghelmann R, Grande E, Francisci S, De Angelis R, Micheli A, Verdecchia A, Ferretti S, Vercelli M, Ramazzotti V, Pannelli F, Federico M, De Lisi V, Tumino R, Falcini F, Budroni M, Zanetti R, Paci E, Crosignani P, Zambon P, Capocaccia R. National Estimates of Cancer Patients Survival in Italy: A Model-Based Method. Tumori 2019; 91:109-15. [PMID: 15948535 DOI: 10.1177/030089160509100201] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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 To provide model-based estimates of all cancers patient survival in Italy and in Italian large geographical areas (North-West, North-East, Center, South), where only partial coverage of cancer registries data is available, and to describe them in terms of time trends. Moreover, to measure the degree of representativeness of cancer patient survival obtained from Italian cancer registries data. Methods Relative survival in the four main Italian geographical areas was estimated by a parametric mixture model belonging to the class of “cure” survival models. Data used are from Italian cancer registries, stratified by sex, period of diagnosis and age. The Italian national survival was obtained as a weighted average of these area-specific estimates, with weights proportional to the number of estimated incident cases in every area. The model takes into account also differences in survival temporal trends between the areas. Results Relative survival for all cancers combined in Italian patients diagnosed in 1990-1994 was estimated to be higher in women (53%) than in men (38%) at 5 years from the diagnosis. The survival trend is increasing by period and decreasing creasing by age, both for men and women. The greatest gain in terms of survival was obtained by the elderly, with annual mean growth rates in the period 1978-1994 equal to 3.5% and 3.2% for men and women, respectively. More than 50% of the youngest cancer patients were “cured”, whereas for the elderly this proportion dropped to 15% and 25% for men and women, respectively. The South of Italy had the lowest survival and the North the most pronounced increase. Conclusions The obtained national survival estimates are similar, but not identical, to previously published estimates, in which Italian registries’ data were pooled without any adjustment for geographical representativeness. The four Italian areas have different survival levels and trends, showing variability within the country. The differences in survival between men and women may be explained by the different proportion of lethal cancers. Among males, most cases had a poor prognosis (lung and stomach cancers), whereas among females the largest proportion was made up of curable and less lethal cancers (breast cancer).
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Affiliation(s)
- Riccardo Inghelmann
- Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Reparto di Epidemiologia dei Tumori, Istituto Superiore di Sanità, Rome, Italy.
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9
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Forastiere F, Micheli A. [Migrants, health and healthcare: the new epidemiology we need]. Epidemiol Prev 2019; 42:6. [PMID: 29506351 DOI: 10.19191/ep18.1.p006.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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10
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Micheli A, Forastiere F. [Epidemiologists' responsibility in our society]. Epidemiol Prev 2019; 43:114-115. [PMID: 31293123 DOI: 10.19191/ep19.2-3.p114.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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11
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Micheli A, Verdecchia A, Capocaccia R, De Angelis G, Gatta G, Sant M, Valente F, Berrino F. Estimated Incidence and Prevalence of Female Breast Cancer in Italian Regions. Tumori 2018; 78:13-21. [PMID: 1609453 DOI: 10.1177/030089169207800104] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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
Female breast cancer incidence and prevalence in Italy have been estimated by region and vast areas from population-based survival data of breast cancer patients and 1970–1987 specific mortality data using a mathematical model. Italian age-standardized incidence rates (ASR) for 1987 range from 70 to 90 per 100,000 women-year in the Northern regions, 55 to 73 in the Center, and 45 to 72 in the South. Overall, the ASR is about 80 in the North, 70 in the Center and 60 in the South. In the absence of competitive mortality, breast cancer cumulative risk in the 0–74 years life span is about 7 women out of 100 in the North, 6 in the Center and 5 in the South. The decreasing risk pattern from North to Center then South appears less evident when under 45 age-specific rates are considered. Very high levels for young age-groups are present both in the North (Liguria and Emilia Romagna) and South (Sardinia and Apulia). The incidence pattern by age differs from region to region and over the considered period, suggesting that a birth-cohort effect is crossing the whole country. Using to model, it can be estimated that the risk by cohort increases from the generations born at the beginning of the century to those born in the 40s, after which, for subsequent generations, it has been decreasing in all the considered areas and is similar in the North and South. We can infer that for the whole country the incidence will increase up to the years 2000–2010 when those birth-cohorts at higher risk will also be at higher risk for age. In 1987, about 250,000 Italian women had a present or past history of breast cancer: for the 1970–1987 period, prevalence has increased by approximately 5,500 cases per year.
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Affiliation(s)
- A Micheli
- Divisione di Epidemiologia, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
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12
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Abstract
The basic descriptive epidemiologic data on stomach cancer occurrence in Italian regions are presented and discussed. Incidence and prevalence were estimated from official mortality and survival data provided by four population-based Italian cancer registries. Age-adjusted mortality, incidence, and prevalence rates are presented by region for the year 1990. Time trends of incidence and their projection for the year 2000 are also presented by region and three broad age classes. Althrough the occurence of stomach cancer has been decreasing in Italy and most western countries over the last decades, a substantial slowing down of this decrease was evidenced in Italy, especially for women under 65 and for the regions of southern Italy. A marked tendency towards a reduction of geographic heterogeneity in stomach cancer occurrence was also shown. Such a phenomenon is consistent with the observed changes of dietary habits in Italian regions. The regions of Umbria and The Marches seem to emerge as new areas at relatively high risk of stomach cancer incidence and mortality. About 45,000 prevalent cases were estimated in Italy by 1990, half of which have been diagnosed before 1984.
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Affiliation(s)
- R De Angelis
- Laboratorio di Epidemiologia e Biostatistica, Istituto Superiore di Sanità, Rome, Italy
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13
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Abstract
Aims and background Breast cancer is the most important malignant neoplasm affecting women in Western countries. An increasing number of women undergo regular medical checkups, especially during the first years following the diagnosis. Therefore, from the health planning point of view, it is essential to have prevalence measures to furnish estimates for the demands that the health care system could possibly undergo. Methods By means of PREVAL, a computerized program, breast cancer prevalence has been measured in the Varese province using incidence and follow-up data from the Lombardy Cancer Registry (LCR). Results During the 1986–1988 period, breast cancer prevalence for patients alive within 10 years from diagnosis was about 625 per 100,000 resident women. Of these, 54% were over 60 years and 9% were under 45 years of age. Patients alive within 2 years from diagnosis were about 200 per 100,000 residents; considering the 1978–1980 period, patients alive within 2 years from diagnosis were just 140 per 100,000 residents. This dramatic increase in breast cancer prevalence is present also for long-term survivors (i.e. patients alive at 10–13 years from the diagnosis). Extrapolating breast cancer prevalence measured in the Varese province to the whole Lombardy region, the expected number of prevalent cases alive within 10 years of the diagnosis, presently living in Lombardy, would be 27,500. LCR's breast cancer prevalence figures were compatible with available data provided by the Finnish Cancer Registry. Conclusion Owing to aging of the population, the improvement in survival and the increasing incidence, the number of prevalent cases will increase. This phenomenon has and will have great importance for the health planning.
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Affiliation(s)
- A Micheli
- Division of Epidemiology, National Cancer Institute, Milan, Italy
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14
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Abstract
Objective To provide estimates and projections of cancer incidence and prevalence for those Italian regions whose population is partially covered by a cancer registry (CR) and to determine to what extent local CRs can be considered representative of the region, thus improving the potential of the information provided by CRs. Methods A statistical method, MIAMOD (mortality-incidence analysis model), was used to estimate regional cancer incidence and prevalence from regional cancer mortality data and patient survival data recorded by the cancer registries. Estimates of the cancer incidence and prevalence in the various regions have thus been obtained for a number of major cancer sites. A first and important step in validating the regional estimates has been the comparison of the MIAMOD estimates in the areas covered by the cancer registries with empirical incidence and prevalence observed by CRs, in order to assess the consistency in data, methods and assumptions. Empirical prevalence has been calculated by counting patients with a diagnosis of cancer who were alive on the reference date by PREVAL method. A correction factor has been applied to include patients diagnosed before the period of activity of the registry. Results General consistency was found between empirical and estimated (by MIAMOD) incidence and prevalence in the registry areas, which is indicative of the quality and the completeness of all data involved as well as the appropriateness of model choices. The prevalence of all cancers combined for Italian regions with CRs was estimated and projected to the year 2000 as ranging between 1,240 per 100,000 in Sicilia and 2,781 in Emilia-Romagna for men, while for women these figures were 1,765 in Sicilia and 4,019 in Liguria. Comparison of cancer prevalence in CR areas with regional estimates shows quite good consistency for Piemonte, Liguria and Lombardia, which means that the local CRs (of Torino, Genova and Varese, respectively) are representative of their respective regions. Prevalence in Emilia-Romagna appears to be rather well represented by only one, the Parma CR, of the three local CRs. The southern Italian registries of Latina and Ragusa recorded a lower cancer prevalence than was actually estimated in their respective regions. Discussion Cancer registries with a longer period of activity showed better agreement between empirical and estimated figures due to the more precise information provided, particularly regarding survival and incidence trends. In conclusion, this work shows the potential of the cancer registries not only to represent their population with respect to cancer morbidity but also as an invaluable tool to extrapolate this information to the larger areas they represent.
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Affiliation(s)
- A Mariotto
- Superior Institute of Health, Rome, Italy.
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15
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Di Salvo F, Baili P, Vicentini M, Tumino R, Vercelli M, Pirino D, Contiero P, Foschi R, Minicozzi P, Rossi PG, de Lorenzo F, Micheli A, Marani E, Orengo MA, Rossi PG, Mangone L, Pellegri C, Di Felice E, Cascone G, Cilia S, Morana G, Nicita C, Rollo C, Sigona A, Spata E, Spata G, Budroni M, Cesaraccio R, Contiero P, Maghini A, Tagliabue G, De Lorenzo F, Del Campo L, Polacchi F, Aurora F, Vittone D, Compagni A, Fattore G, Casella I, Cifalà A, Sant M, Gatta G, Trama A, Anselmi V, Casoli C. Cancer Rehabilitation Services: An Italian Population-based Cohort Study. Tumori Journal 2018. [DOI: 10.1177/1578.17224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Francesca Di Salvo
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Paolo Baili
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | | | | | - Marina Vercelli
- Liguria Region Cancer Registry, IRCCS AOU S Martino - Istituto Nazionale per la Ricerca sul Cancro, Genoa
- Department of Health Sciences, University of Genoa, Genoa
| | | | | | - Roberto Foschi
- Evaluation Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Paolo Giorgi Rossi
- Servizio Interaziendale di Epidemiologia, AUSL Reggio Emilia, Reggio Emilia
| | | | - Andrea Micheli
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Abstract
Aim To present data on cancer prevalence for the areas covered by Italian cancer registries, by using a standardized set of data collection and elaboration criteria, and a single method of data analysis. Subjects and Methods Data on over 250,000 patients with cancer, diagnosed between 1978 and 1992, from 11 Italian cancer registries covering about 12% of the Italian population were collected, validated and analyzed according to the unified protocol of the ITAPREVAL project. The method implemented in the PREVAL computer program was used to provide prevalence estimates for the period covered by cancer registration. The total prevalence for each registry and for the pool of all registries was then estimated by correcting for incomplete observations due to the period in which the registration was not yet activated. All prevalence estimates were for 1992. Results Prevalence figures are presented by cancer site, age, sex, years from diagnosis and registry area. For all malignancies combined, total prevalence ranged from 1,350 per 100,000 inhabitants in Ragusa to 3,650 per 100,000 inhabitants in Romagna, the ratio between these two extremes being 2.7. For the pool of the areas covered by registration cancer prevalence was 3,100 per 100,000 females and 2,250 per 100,000 males. About a third of the total female cases and about half the male cases were diagnosed in the previous five years. Among those aged over 75 years, total prevalence was higher for males than for females: 11,300 versus 8,900 per 100,000 respectively. Conclusions This is the first large-scale estimate of the burden of cancer in Italy. It is also one of the first studies in the world which was aimed to study cancer prevalence in detail. These data are necessary for predicting health service needs and help in the evaluation of differences in health service demand by sex, age and Italian regions.
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Affiliation(s)
- A Micheli
- Divisione di Epidemiologia, Istituto Nazionale Tumori, Milan, Italy
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17
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Abstract
Aims and Background Cancer prevalence in a population, defined as the proportion – or the number – of people who were diagnosed with a cancer during their lives and are still alive at a given date, is a crucial indicator for heath care planning and resource allocation. Long-term population-based cancer registries (CR) are the appropriate tools to produce prevalence figures, which, however, are scarcely available. This paper contains a review up to 1999 of the published data world-wide (reports and articles) on cancer prevalence: including measured and estimated figures. Materials and Methods Data on cancer prevalence from CRs are available for the Nordic countries, Connecticut, and Italy. In addition, electronic data are available for the European Union (EU). Data for the Nordic countries were first published in the mid-seventies, reporting the prevalence for 1970. The first data from Connecticut were available 10 years later. Estimates for all EU countries were published by the International Agency for Research on Cancer (IARC) in 1997. In Italy, observed and estimated data on the prevalence of respiratory and digestive tract cancer and breast cancer have been published during the nineties, followed by a systematic analysis for all cancers in 1999. By using information obtained from CRs, cancer prevalence data were calculated directly (observed prevalence) by means of incidence and follow-up information on individual cancer patients, or indirectly (estimated prevalence) by means of mathematical models, which generally use epidemiological information at the aggregate level. Results Cancer prevalence for all cancers combined (proportions per 100,000 inhabitants) showed values of less than 700 in males and less than 800 in females in 1970 (Finland) to over 2,300 in males and over 3,000 in females in 1992 (Italian registries). With few exceptions, in each country and period considered the cancer sites contributing most to cancer prevalence are lung, colon-rectum, prostate and bladder in males, colon-rectum, breast, uterus (both cervix and corpus) and ovary in females. At present, comparison of measurements from different areas is difficult because there exists no standardized mode of presentation. Conclusions In spite of their being potentially useful for health care planning, prevalence data have been produced inconsistently and late by cancer registries, at least in comparison with the systematic availability of incidence and survival statistics. The available data can be compared only to a limited extent due to differences in completeness, in the choice of indicators, in the standard populations, and in the frequency of publication. It would be desirable that in the future data will be produced systematically, with a higher level of standardization compared to the past, and, most importantly, on the same geographic and administrative scale as health-care decision-making.
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Affiliation(s)
- R Zanetti
- Piedmont Cancer Registry, Turin, Italy
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18
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Affiliation(s)
- Andrea Micheli
- Divisione di Epidemiologia, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
| | - Franco Berrino
- Divisione di Epidemiologia, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
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Abstract
Rationale Survival figures from a population-based study incorporate the overall practice in diagnosis, cure and clinical follow-up for a specific disease within a given health care system. Being the outcome of a number of individual, social and economical aspects, population-based survival may be thought as index for measuring the level of a country's development. Data The EUROCARE project, a European Cancer Registries (CR) concerted action, provided reliable information on survival for more than 800,000 cancer patients from 11 European countries. A great deal of epidemiologic information has derived from EUROCARE. Women had a longer survival than men for all studied tumour sites, except for the colon. European survival variability was fairly high for several cancers, but it was lower for cancers with a relatively good prognosis and those sensitive to treatment. The ranking of populations of cancer survival tended to be fairly stable for many cancers: CR of Switzerland and Finland ranked high and Polish CR low. Denmark, Italian and France CR did not substantially differ from the European survival average. For most cancers, prognosis improved during the studied period (years of diagnosis: 1978–1985). Survival figures for colon (r = 0.74, males; r = 0.73, women) and female breast cancer (r = 0.57) well correlated with the national health expenditure of different participating countries. The ITACARE study, a new Italian Cancer Registries collaborative project involving more than 100,000 cancer patients, was set up to study survival differences within the country. Survival of cancer patients was not homogeneous in 7 studied Italian regions (the estimated 5-year relative survival for all malignant neoplasms combined ranked from 37.8% in CR of Sicily to 42.1% in those of Emilia-Romagna). The lowest levels of regional health expenditures were accompanied by the lowest levels of prognosis for overall cancers. However, a relatively low correlation among patient cancer survival and the regional health expenditure (r = 0.21) was found, suggesting that other factors such as different efficiency in managing cancer may play a role in explaining the intracountry differences. Conclusions Population-based survival figures may be used to study epidemiologic aspects, comparing different health systems, and may be interpreted as indexes for discussing inequalities in health in different populations.
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Affiliation(s)
- A Micheli
- Divisione di Epidemiologia, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.
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20
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Affiliation(s)
- Gemma Gatta
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Università degli Studi, Napoli
| | - Illaria Malvezzi
- Lega Italiana per la Lotta Contro i Tumori, Milan, Università degli Studi, Napoli
| | - Milena Sant
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Università degli Studi, Napoli
| | - Andrea Micheli
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Università degli Studi, Napoli
| | - Salvatore Panico
- Istituto di Medicina Interna e Malattie Dismetaboliche, IIa Facoltà di Medicina, Università degli Studi, Napoli
| | - Gianni Ravasi
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Università degli Studi, Napoli
| | - Franco Berrino
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Università degli Studi, Napoli
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21
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Abstract
Since 1990 a concerted action between European population-based cancer registries (the EUROCARE project) has been carried out with the aims of establishing whether there are differences in cancer patient survival in Europe, and the reasons for such differences. Survival differences actually exist for cancer sites for which the stage of disease at diagnosis is the major prognostic factor (such as breast, stomach and colon cancer). However, for most cancer sites, survival increases over time and the survival rates of different countries tend to converge towards higher values. Interpreting survival differences and trends is not an easy task. Longer survival may be achieved by postponing death through better treatment or by anticipating diagnosis. However, an earlier diagnosis may or may not make a treatment more effective in postponing death. The computation of stage-specific or stage-adjusted survival is not sufficient for interpretation of survival differences, because staging procedures change over time and may vary in different hospitals and countries. In addition to an early diagnosis and more effective treatment, a number of factors may bias survival estimates. They may be classified into factors that can be controlled in the analysis (at least partially), such as mortality from other causes, demographic factors, epoch of diagnosis, different statistical methodology, and factors depending on the validity of cancer registry data, such as definition of the illness, exhaustiveness and quality of registration, completeness of follow-up, definition of the date of diagnosis, and definition of disease stage including the diagnostic procedure used to establish stage. To help disentangle the effects of early diagnosis and better treatment, several statistical approaches are being developed: multivariate analysis on relative survival data, new modeling analysis to separately estimate the proportion of cured patients and the length of survival for those patients destined to die, and the standardized collection of information on stage at diagnosis and staging procedures.
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Affiliation(s)
- F Berrino
- Divisione di Epidemiologia, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.
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Micheli A. [Precarious workers, precarious research, precarious epidemiology]. Epidemiol Prev 2018; 42:10-11. [PMID: 29506355 DOI: 10.19191/ep18.1.p010.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Micheli A, Apicella B. [Give voice to different cultures for a stronger idea of prevention]. Epidemiol Prev 2018; 42:86-87. [PMID: 29506369 DOI: 10.19191/ep18.1.p086.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Micheli A. [Epidemiologists and legal professionals: notes for a debate]. Epidemiol Prev 2018; 42:118-120. [PMID: 29774707 DOI: 10.19191/ep18.2.p119.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Abstract
Aims and background Breast cancer is the most common cancer and the leading cause of cancer death among women. Knowledge of the present and future burden of the disease at a regional and national scale is a major issue in Italy, where the frequency and coverage of screening programs vary considerably across the country. This study presents estimates and projections of the female breast cancer incidence, prevalence and mortality for Italy and all Italian regions in the period 1970-2010. Methods The estimates were obtained by applying the MIAMOD method, a statistical back-calculation approach to derive incidence and prevalence figures from mortality and relative survival data. Published data from the Italian cancer registries were modelled to obtain regional and national estimates of breast cancer survival. Results Breast cancer mortality has been declining from the late 1980s in the northern-central regions and from the mid 1990s in the southern regions Puglia, Sicilia and Sardegna. Stable mortality rates are estimated for the other southern regions in the 2000's first decade. The incidence rate in Italy is estimated as increasing until the late 1990s, and stable thereafter (93 per 100,000). The incidence curve is also estimated to flatten in many northern-central regions from the late 1990s or later. Rising incidence trends are estimated in all southern regions, with the exception of Puglia. About 8,500 deaths, 37,000 new diagnoses and 416,000 prevalent cases for breast cancer are estimated among Italian women in 2005. In the same year, the proportion of prevalent cases in the northern area (1,221 per 100,000) is about twice that estimated in the South (685 per 100,000). Discussion The geographical variation in female breast cancer burden can be explained by the unequal distribution of screening. A more widespread screening activity in the southern regions would help to bridge the gap between northern-central and southern regions. Continuous monitoring of regional epidemiological indicators for breast cancer is crucial to evaluate the effect of different health measures taken to control breast cancer in Italy.
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Affiliation(s)
- Enrico Grande
- Reparto di Epidemiologia dei Tumori, Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy.
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Micheli A, Sanz N, Mwangi-Powell F, Coleman MP, Neal C, Ullrich A, Travado L, Santini LA, Grassi L, De Lorenzo F, Costa A, Dangou JM, Bisanti L, Costantini AS, Abu-Rmeileh N, Kamal M, Federico M, Saracci R, Rennert G, Stefanini A, Cavalli F, Cazap E, Redmond K, O?Reilly S, Muti P, Casali P, Gatta G, Ferrari A, Koifman S, Bah E, Pastore G, Barr R, Lombardo C, Frazzingaro C, Ciampichini R, Baili P. International collaborations in cancer control and the Third International Cancer Control Congress. Tumori 2018; 95:579-96. [DOI: 10.1177/030089160909500502] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Over the past few decades, there has been growing support for the idea that cancer needs an interdisciplinary approach. Therefore, the international cancer community has developed several strategies as outlined in the WHO non-communicable diseases Action Plan (which includes cancer control) as the World Health Assembly and the UICC World Cancer Declaration, which both include primary prevention, early diagnosis, treatment, and palliative care. This paper highlights experiences/ideas in cancer control for international collaborations between low, middle, and high income countries, including collaborations between the European Union (EU) and African Union (AU) Member States, the Latin-American and Caribbean countries, and the Eastern Mediterranean countries. These proposals are presented within the context of the global vision on cancer control set forth by WHO in partnership with the International Union Against Cancer (UICC), in addition to issues that should be considered for collaborations at the global level: cancer survival (similar to the project CONCORD), cancer control for youth and adaptation of Clinical Practice Guidelines. Since cancer control is given lower priority on the health agenda of low and middle income countries and is less represented in global health efforts in those countries, EU and AU cancer stakeholders are working to put cancer control on the agenda of the EU-AU treaty for collaborations, and are proposing to consider palliative care, population-based cancer registration, and training and education focusing on primary prevention as core tools. A Community of Practice, such as the Third International Cancer Control Congress (ICCC-3), is an ideal place to share new proposals, learn from other experiences, and formulate new ideas. The aim of the ICCC-3 is to foster new international collaborations to promote cancer control actions in low and middle income countries. The development of supranational collaborations has been hindered by the fact that cancer control is not part of the objectives of the Millennium Development Goals (MGGs). As a consequence, less resources of development aids are allocated to control NCDs including cancer.
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Affiliation(s)
- Andrea Micheli
- Descriptive studies and health planning unit, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | - Natalia Sanz
- Descriptive studies and health planning unit, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | | | - Michel P Coleman
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Andreas Ullrich
- Diseases and Health Promotion, World Health Organization (WHO), Geneva, Switzerland
| | - Luzia Travado
- National Coordination for Oncology Diseases, High Commission for Health, Lisbon, Portugal
| | | | - Luigi Grassi
- Section of Psychiatry, University of Ferrara, Italy
| | | | | | | | - Luigi Bisanti
- Epidemiology Unit, Local Health Authority of Milan, Milan, Italy
| | - Adele Seniori Costantini
- Occupational and Environmental Epidemiology Unit, ISPO Cancer Prevention and Research Institute, Florence, Italy
| | - Niveen Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University West Bank, Palestinian Authority
| | - Mostafa Kamal
- Egyptian Smoking Prevention Research Institute, Cairo, Egypt
| | | | | | - Gad Rennert
- National Israeli Breast and Colorectal Cancer Detection Programs Ministry of Health and Israel Cancer Association, Department of Community Medicine and Epidemiology Carmel Medical Center and B. Rappaport Faculty of Medicine, Technion, Israel
| | - Angelo Stefanini
- Office of Development Cooperation, Consulate General of Italy, Jerusalem (on leave from the University of Bologna, Italy), Jerusalem, Israel
| | - Franco Cavalli
- International Union Against Cancer (UICC), Geneva, Switzerland
| | - Eduardo Cazap
- Latino American and Caribbean Society of Medical Oncology (SLACOM), Buenos Aires, Argentina
| | - Kathy Redmond
- Cancer World Magazine and Media Program, European School of Oncology, Milan, Italy
| | - Susan O?Reilly
- British Columbia Cancer Agency, Division of Medical Oncology Department of Medicine at the University of British Columbia, Vancouver, Canada
| | - Paola Muti
- Italian National Cancer Institute “Regina Elena”, Rome, Italy
| | - Paolo Casali
- Oncology Medicine Unit, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | - Gemma Gatta
- Evaluation Epidemiology Unit, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | - Andrea Ferrari
- Paedriatic Oncology Unit, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | | | - Ebrima Bah
- International Agency for Cancer Research (IARC), Banjul, Gambia
| | | | | | - Claudio Lombardo
- National Institute for Cancer Research of Genoa, Genoa, and Alleanza Contro il Cancro, Rome
| | - Cristina Frazzingaro
- Descriptive studies and health planning unit, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | - Roberta Ciampichini
- Descriptive studies and health planning unit, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | - Paolo Baili
- Descriptive studies and health planning unit, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
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Arbyn M, Antoine J, Valerianova Z, Mägi M, Stengrevics A, Smailyte G, Suteu O, Micheli A. Trends in Cervical Cancer Incidence and Mortality in Bulgaria, Estonia, Latvia, Lithuania and Romania. Tumori 2018; 96:517-23. [DOI: 10.1177/030089161009600402] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective The burden of cervical cancer varies considerably in the European Union. In this paper, we describe trends in incidence of and mortality from this cancer in the five most affected member states. Methods Data on number of deaths from uterine cancers and the size of the female population of Estonia, Latvia, Lithuania, Bulgaria and Romania were extracted from the WHO mortality database. Mortality rates were corrected for inaccuracies in the death certification of not otherwise specified uterine cancer. Incidence data were obtained from the national cancer registries. Joinpoint regression was used to study the annual variation of corrected and standardized incidence and mortality rates. Changes by birth cohort were assessed for specific age groups and subsequently synthesized by computing standardized cohort incidence/mortality ratios. Results Joinpoint regression revealed rising trends of incidence (in Lithuania, Bulgaria and Romania) and of mortality (in Latvia, Lithuania, Bulgaria and Romania). In Estonia, rates were rather stable. Women born between 1940 and 1960 were at continuously increasing risk of both incidence of and mortality from cervical cancer. Conclusions Rising trends of cervical cancer in the most affected EU member states reveal a worrying pattern that warrants urgent introduction of effective preventive actions as described in the European guidelines.
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Affiliation(s)
- Marc Arbyn
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
| | - Jerome Antoine
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
| | | | | | | | | | - Ofelia Suteu
- I. Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Institute of Oncology, Cluj, Romania
| | - Andrea Micheli
- Descriptive Studies and Health Planning Unit, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
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Baili P, De Angelis R, Casella I, Grande E, Inghelmann R, Francisci S, Verdecchia A, Capocaccia R, Meneghini E, Micheli A. Italian Cancer Burden by Broad Geographical Area. Tumori 2018; 93:398-407. [PMID: 17899872 DOI: 10.1177/030089160709300412] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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 and background Cancer burden estimates in Italian regions are available for the period 1970-2010 as a result of the project “I TUMORI IN ITALIA” connected with EUROCHIP, the European project on cancer control. The Italian health-care system is organized at a regional level, so regional estimates of cancer indicators are useful to identify priorities for cancer plans. We compared cancer site-specific epidemiological estimates by 3 macro-areas (obtained by grouping regions) to suggest priorities for Italian cancer control plans, both at national and regional levels. Methods Mortality and incidence estimates for all cancers combined and for stomach, colorectal, lung, breast and prostate cancers were downloaded from the website www.tumori.net and aggregated in broad age classes (0-54, 55-74 and 75-84 years) and macro-areas (northern, central and southern Italy). Results Historically, Southern Italy had a lower cancer risk than the Center and North. After 2000 this epidemiological picture disappeared and the incidence and mortality rates in the Center are reaching those of the North. Also the weight of various cancer sites on all cancers has changed in Italy in the last decades. Lung cancer is still the most frequent cancer in the male population in the South, while in the Center-North it has been surpassed by prostate cancer and colorectal cancer. The lung cancer weight on all cancer deaths is increasing in women. Prostate cancer has become the most frequent male cancer in the Center-North in the age class 55-84. Breast cancer is the most frequent cancer in the female population and its incidence rates in the North are higher than those in the Center-South for all age classes. Colorectal cancer incidence rates have dramatically increased in men and colorectal cancer is nowadays the second cancer diagnosed in women in all age classes and macro-areas. Discussion From the epidemiological data here presented we derived the following suggestions and observations for cancer control plans: a) tobacco prevention should focus on the male population in the South, and on female populations in the country as a whole; b) prevention concerning diet and physical activity (risk factors for colorectal cancer) should be considered mainly for men at a national level; c) the coverage of breast cancer screening programs should be increased in the Center-South; d) colorectal cancer screening should be promoted at a national level; e) PSA testing (that is not actually included among the screening programs recommended) for prostate cancer is probably more widespread in the Center-North, resulting in an increased incidence without any evident decline in mortality as yet.
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Affiliation(s)
- Paolo Baili
- Unità di Epidemiologia Descrittiva e Programmazione Sanitaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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Abstract
Aims and background Stomach cancer still remains one of the most frequent tumors in Italy and Europe. The aim of this paper is to present estimates for stomach cancer mortality, incidence and prevalence over the period 1970-2010 for the Italian regions and for Italy as a whole. Methods Estimated figures for incidence, prevalence and mortality were obtained by using the MIAMOD method. Starting from the knowledge of mortality in the period 1970-1999 and of relative survival in the period of diagnosis 1978-1994, we derived incidence and prevalence estimates and projections up to the year 2010 by means of a statistical back-calculation approach. Survival at the regional and national levels was modelled on the basis of published survival data from the Italian cancer registries. Results Incidence and mortality trends for both sexes decrease by about 60% during the estimation period 1970-2010. Both indicators show a 2-fold male/female ratio all over the country, and a similar gender time trend. The incidence and mortality in the North and Center of the country are estimated to be higher and to decrease more steeply than those in the South, both for men and women. A total of around 13,000 incident cases, 57,000 prevalent cases, and 8,000 deaths are estimated to have occurred in Italy in 2005. Conclusions The incidence and mortality trends are estimated to decline during the entire period 1970-2010, with different slopes between northern-central and southern regions. The incidence and mortality are quite similar among Italian regions, showing that the risk of developing the disease diminishes and is becoming more homogeneous than in the past decades all over the country.
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Affiliation(s)
- Riccardo Inghelmann
- Reparto di Epidemiologia dei Tumori, Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy
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De Angelis R, Grande E, Inghelmann R, Francisci S, Micheli A, Baili P, Meneghini E, Capocaccia R, Verdecchia A. Cancer Prevalence Estimates in Italy from 1970 to 2010. Tumori 2018; 93:392-7. [PMID: 17899871 DOI: 10.1177/030089160709300411] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 12/24/2022]
Abstract
Aims and background The growing number of cancer survivors in Italy is expected to continue to increase as a consequence of population aging and survival improvements, but few estimates are currently available, particularly on the national and regional scale. The purpose of this work is to present detailed and updated prevalence estimates in Italy over the period 1970-2010 by cancer site (all cancers combined, stomach, colon and rectum, lung, breast and prostate) and gender. Methods Prevalence was derived with the MIAMOD statistical method, using cancer-specific mortality and relative survival as input data. Survival data from the Italian cancer registries were modeled to derive a national estimate for each cancer site and sex. To estimate prevalence trends, survival was assumed to improve in the future with the same rate observed in the period 1978-1994. A double scenario for survival - increasing or stationary - was considered to decompose the prevalence growth from 1995 to 2005 by its determinants: demographic changes, incidence and survival dynamics. The prevalence estimates were also decomposed by disease duration (2, 5 and 10 years) and by age (0-44, 45-59, 60-74 and 75-99). Results The proportion of cancer survivors in 2010 is expected to be about 4% in women and 3% in men, about twice the values attained in 1990. The highest dynamics was observed for prostate cancer, with a three-fold increase just in the 1995-2005 period (from 212 to 623 per 100,000), whereas in absolute terms breast cancer presented the highest levels (1,700 per 100,000 in 2010). The overall number of cancer prevalent cases is expected to rise by about 48% in the decennium 1995-2005 (from 1,152,000 to 1,709,000), and this growth is mainly attributable to incidence dynamics (+21%), then to survival improvements (+14%) and population aging (13%). In 2005, the 2-year prevalent cases were estimated to be 20% of all cancer survivors, 21% between 2 and 5 years from the diagnosis, 23% between 5 and 10 years, with 36% surviving for more than 10 years. Prevalence proportion was very high in the elderly (12.6% for 75-84 years and 8% for 60-74 years). Conclusions Updated prevalence data with appropriate coverage of the national territory are essential to define priorities in health care management and to develop cancer control programs. Prevalence by disease duration and by age should be the basis for planning research on the quality of life of cancer survivors, as long as cancer continues to become an even more chronic disease.
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Affiliation(s)
- Roberta De Angelis
- Reparto di Epidemiologia dei Tumori, Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy.
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Affiliation(s)
- Andrea Micheli
- Unità di Epidemiologia Descrittiva e
Programmazione Sanitaria, Fondazione IRCCS “Istituto Nazionale dei Tumori”,
Milan
| | - Franco Berrino
- Unità di Epidemiologia Eziologia e
Prevenzione, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan
| | - Eugenio Paci
- Unità di Epidemiologia clinica e
descrittiva, Centro per lo Studio e la Prevenzione Oncologica, CSPO, Florence
| | - Arduino Verdecchia
- Reparto di Epidemiologia dei Tumori,
Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto
Superiore di Sanità, Rome
| | - Marco A Pierotti
- Direzione Scientifica, Fondazione
IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
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Abstract
Aims and background The aim of this paper is to present the Italian regional and national estimates of the mortality, incidence and prevalence over the period 1970-2010 for lung cancer, one of the most common cancers in Italy and Europe, especially among men. Methods The estimates were obtained with the MIAMOD method, a statistical back-calculation approach to derive incidence and prevalence figures using mortality and relative survival data. Published survival data from the Italian cancer registries were appropriately modelled in order to estimate survival at regional and national level. Results For men, the Italian lung cancer mortality and incidence rates reached their maximum values during the late 1980s and steeply decreased thereafter. This pattern is quite uniform across all regions, even though the decrease was delayed and less steep in the South of the country. For women, both indicators appear to be increasing at the national level, even though a certain regional variability in incidence trends remains within the country: some regions (such as Lazio, Umbria, Marche, Campania, Sardegna and Friuli Venezia Giulia) present increasing trends, while in others a clear levelling off is visible. A total of 33,500 incident cases, 72,000 prevalent cases and 28,000 deaths are estimated in Italy in 2005. Conclusions This study produced an up-to-date description of lung cancer epidemiology both at national and regional level. The marked difference in lung cancer figures and trends between sexes suggests that prevention policies have led to changes in smoking habits for men, while for women they were lacking in efficacy. The attention should now focus on women, whose risk trend is the least favorable.
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Affiliation(s)
- Riccardo Inghelmann
- Reparto di Epidemiologia dei Tumori, Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy
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Anttila A, Arbyn M, Veerus P, Viberga I, Kurtinaitiene R, Valerianova Z, Apostol I, Baili P, Micheli A. Barriers in Cervical Cancer Screening Programs in New European Union Member States. Tumori 2018; 96:515-6. [DOI: 10.1177/030089161009600401] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ahti Anttila
- Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
| | - Piret Veerus
- National Institute for Health Development, Tallinn, Estonia
| | - Ilze Viberga
- Riga Stradins University Department of Obstetric and Gynaecology, Riga, Latvia
| | - Ruta Kurtinaitiene
- Vilnius University, Medical Faculty, Obstetric and Gynaecology Clinic, Vilnius, Lithuania
| | | | | | - Paolo Baili
- Descriptive Studies and Health Planning Unit, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | - Andrea Micheli
- Descriptive Studies and Health Planning Unit, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
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Abstract
Aims and background The aim of this paper is to present regional and national estimates of mortality, incidence and prevalence for all cancers in Italy over the period 1970-1999, with projections up to 2010. Methods The estimates were obtained by applying the MIAMOD method, a statistical back-calculation approach, to derive incidence and prevalence starting from mortality and relative survival data. Published data from the Italian Cancer Registries were modeled in order to estimate regional and national cancer survival. Results Cancer time trends resulted more favorable in northern-central regions than in southern regions, both for men and women. Mortality started to decrease in the northern-central area approximately from the mid 1980s, whereas it was expected to slightly decline only after the year 2000 in the southern area. Incidence was estimated to decrease in men from 1995 in northern and central areas only; no incidence reduction is expected for women during the study period. Overall, 130,000 cancer deaths, 250,000 new cancer cases and 1,700,000 prevalent cancer cases are estimated in Italy in the year 2005. Conclusions This up-to-date picture of cancer risk and burden in the Italian regions shows as a relevant epidemiological change is ongoing in Italy. Although a clear geographical variability in mortality and morbidity levels still exists across the country, the historical North-to-South gap appears smaller than in the past. This change is particularly remarkable for men, as a consequence of trends that are favorable in northern-central regions but not yet in southern regions.
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Affiliation(s)
- Enrico Grande
- Reparto di Epidemiologia dei Tumori, Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Rome.
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Micheli A, Di Salvo F, Lombardo C, Ugolini D, Baili P, Pierotti MA. Cancer Research Performance in the European Union: A Study of Published Output from 2000 to 2008. Tumori 2018; 97:683-9. [DOI: 10.1177/030089161109700601] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and Background Although several studies have assessed cancer research performance in individual European countries, comparisons of European Union (EU27) performance with countries of similar population size are not available. Methods We compared cancer research performance in 2000–2008 between EU27 and 11 countries with over 100 million inhabitants. Performance should not have been affected by the 2007–2009 recession. We examined 143 journals considered oncology journals by Journal Citation Reports, accessing them via Scopus. Publications were attributed to countries using a published counting procedure. Results For number of publications, the USA held a clear lead in 2006–2008 (yearly averages: 10,293 USA vs 9,962 EU27), whereas the EU27 held the lead previously. EU27 was also second to the USA for total impact factor. China markedly improved its cancer publications record over the period. Compared to the USA, EU27 and Japan, the other countries (all developing) had a poor publications record. Conclusions Comparative cancer research spending data are not available. However from 2002 to 2007, gross domestic expenditure on research and development (UNESCO data) increased by 34% in North America, 161% in China and only 28% in EU27. Thus the European Union is lagging behind North America and may well be eclipsed by China in research and development spending in the near future. We suggest that these new findings should be considered by policymakers in Europe and other countries when developing policies for cancer control.
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Affiliation(s)
- Andrea Micheli
- Descriptive Studies and Health Planning Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Francesca Di Salvo
- Descriptive Studies and Health Planning Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Claudio Lombardo
- National Institute for Cancer Research of Genoa, Genoa, and Alleanza Contro il Cancro, Rome
| | - Donatella Ugolini
- Epidemiology and Biostatistics Unit of the National Institute for Cancer Research of Genoa and Department of Oncology, Biology and Genetics of the University of Genoa, Genoa
| | - Paolo Baili
- Descriptive Studies and Health Planning Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
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Pierotti MA, Micheli A, Sutcliffe SB. The 3rd International Cancer Control Congress: international collaboration in an era of cancer as a global concern. Tumori 2018; 95:565-7. [DOI: 10.1177/030089160909500507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Marco A Pierotti
- Scientific Direction, Fondazione IRCCS
“Istituto Nazionale dei Tumori”, Milan, Italy
| | - Andrea Micheli
- Descriptive Studies and Health
Planning Unit, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
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Baili P, Micheli A, De Angelis R, Weir HK, Francisci S, Santaquilani M, Hakulinen T, Quaresma M, Coleman MP. Life Tables for World-Wide Comparison of Relative Survival for Cancer (CONCORD Study). Tumori 2018; 94:658-68. [DOI: 10.1177/030089160809400503] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The CONCORD study compares population-based relative survival from cancer using data from cancer registries in five continents. To estimate relative survival, general mortality life tables are required. Available statistics are incomplete, so various approaches are used to construct complete life tables. This article outlines how the life tables were constructed for CONCORD; it compares life expectancy at birth between 101 populations covered by cancer registries in 31 countries and compares the impact of two approaches to the deployment of life tables in relative survival analysis. Methods The CONCORD approach, using specific mathematical methods, produced complete (single-year-of-age) life tables by sex, cancer registry area, calendar year (1990–1999) and race (only in the USA). In order to study the impact of different approaches, we compared relative survival in the USA using the US national life table, centered on the relevant census years, and the CONCORD approach. We estimated relative survival in each American participating cancer registry for patients diagnosed with breast (women), colorectal or prostate cancer during 1990–1994 and followed up to 1999. Results Average life expectancy at birth during 1990–1999 varied in CONCORD cancer registry areas from 64 to 78 years in males and from 71 to 84 years in females. It increased during the 1990s more in men than in women. In the USA, it was lower in blacks than in whites. Relative survival in American populations was lower with the CONCORD approach, which incorporates trends and geographic variation in background mortality, than with the USA census life tables. Conclusions International variation in background mortality by geographic area, calendar time, race, age and sex is wide. We suggest that in international comparisons of cancer relative survival, complete life tables that are specific for cancer registry area, calendar year and race should be used.
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Affiliation(s)
- Paolo Baili
- Descriptive Epidemiology and Health Planning Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Micheli
- Descriptive Epidemiology and Health Planning Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberta De Angelis
- Istituto Superiore di Sanità, National Center of Epidemiology, Surveillance and Health Promotion, Cancer Epidemiology Unit, Rome, Italy
| | - Hannah K Weir
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Silvia Francisci
- Istituto Superiore di Sanità, National Center of Epidemiology, Surveillance and Health Promotion, Cancer Epidemiology Unit, Rome, Italy
| | - Mariano Santaquilani
- Istituto Superiore di Sanità, National Center of Epidemiology, Surveillance and Health Promotion, Cancer Epidemiology Unit, Rome, Italy
| | | | - Manuela Quaresma
- Cancer Research UK Cancer Survival Group, Non-Communicable Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, UK
| | - Michel P Coleman
- Cancer Research UK Cancer Survival Group, Non-Communicable Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, UK
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Abstract
Aims and background In terms of new diagnoses, colorectal cancer is one of the most important cancers in Italy and worldwide. The aim of this paper is to present estimates of the mortality, incidence and prevalence of colorectal cancer in Italy at a national and regional scale over the period 1970-1999, with projections up to 2010. Methods The estimates were obtained by applying the MIAMOD method, a statistical back-calculation approach to derive incidence and prevalence estimates from mortality and relative survival data. Published data from the Italian cancer registries were modelled to obtain regional and national estimates of colorectal cancer survival. Results Different incidence patterns were observed for men and women, especially in the projection period: the national age-standardized rate is estimated to increase throughout the study period 1970-2010 for men from 30 to 70 per 100,000, and to stabilize from the end of the 1990s for women at around 38 per 100,000. A stabilization or a slight decrease in age-standardized incidence rates is expected in most regions for women and in most northern-central regions for men. The most critical situation is estimated among men for southern regions, where the rise in incidence is accompanied by a dramatic increase in mortality. About 46,000 incident cases, 267,000 prevalent cases, and 16,000 deaths from colorectal cancer are estimated in Italy for the year 2005. Conclusions Despite the risk reduction estimated in most northern-central regions among men and in the large majority of regions among women, the colorectal cancer burden in Italy is expected to remain relevant in the next years. Prospects for reducing this burden appear mainly connected to the adoption of prevention policies aimed at increasing the awareness of the risk related to dietary habits and lifestyles and at promoting colorectal cancer screening.
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Affiliation(s)
- Enrico Grande
- Reparto di Epidemiologia dei Tumori, Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy.
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Inghelmann R, Grande E, Francisci S, Verdecchia A, Micheli A, Baili P, Gatta G, Capocaccia R, Valdagni R, De Angelis R. Regional Estimates of Prostate Cancer Burden in Italy. Tumori 2018; 93:380-6. [PMID: 17899869 DOI: 10.1177/030089160709300409] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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 Prostate cancer is one of the most common cancers in developed countries and the most common among men in industrialized countries. The introduction of new diagnostic procedures caused an increase in new diagnoses in Italy starting from the early 1990s, while the prognosis of prostate cancer improved due to the use of hormonal treatments. The aim of this paper is to present estimates of prostate cancer mortality, incidence and prevalence over the period 1970-2005 for the Italian regions and for Italy as a whole, and to assess the changes that opportunistic screening and the diffusion of more effective treatments introduced. Methods Estimated figures for incidence, prevalence and mortality were obtained with the MIAMOD method. Starting from the knowledge of mortality in the period 1970-1999 and of the relative survival in the period of diagnosis 1978-1994, we derived incidence and prevalence estimates up to the year 2005 by means of a statistical back-calculation approach. Survival at regional and national levels was modelled on the basis of published survival data from the Italian cancer registries. Results The incidence trend showed a steep increase all over the country during the entire estimation period 1970-2005 with a more pronounced increase in the Center-North then in the South of Italy. Incidence of northern and central regions was about twice as high as that of southern regions. Mortality trends were however constant or declining in the majority of northern-central regions, while they still increased in the South. A total of around 43,000 incident cases, 174,000 prevalent cases and 9,000 deaths were estimated for Italy in 2005. Discussion The effects of opportunistic screening are reflected in an earlier diagnosis for many patients. The existing North-South gradient in incidence seems to be associated with the different spread of the PSA test in different parts of the country. Prostate cancer remains a great health problem in terms of both incidence and prevalence.
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Affiliation(s)
- Riccardo Inghelmann
- Reparto di Epidemiologia dei Tumori, Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy
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40
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Lillini R, Vercelli M, Quaglia A, Micheli A, Capocaccia R. Use of socio-economic factors and healthcare resources to estimate cancer survival in European countries with partial national cancer registration. Tumori 2018; 97:265-74. [DOI: 10.1177/030089161109700302] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and aims Cancer is a chronic disease whose clinical history has a strong relationship with socio-economic indicators, and it could be defined as a real “social disease”. For this reason, socio-economic factors can be used to project survival rates by means of ecological models. The present study had two main aims: to generalize to all adult patients study of the association between survival and socio-economic and healthcare technologies and related medical resources factors; to provide insights on the possible bias in giving national meaning to survival rates based on pools of regional cancer registries where national coverage is not available. Material and methods The EUROCARE 3 Study provided age-standardized survival rates at 5 years from the diagnosis for 10 major cancer sites collected by 52 cancer registries from 21 European countries for the period 1990–1994. For each area and country, socio-economic and health-related variables were collected for the period 1993–1995. Multiple linear regression models were used to compute predicted survival rates in countries totally covered by registration, starting from the correlation between socio-economic and health-related variables and observed survival rates. For those areas not totally covered by cancer registry activity, a correctional parameter coming from the previous linear regression models was computed in order to estimate survival at a national level also in these countries. Results Predicted survival rates were very close to the observed rates for countries totally covered by cancer registries. The estimates were also good for nations with partial national cancer registration, with less convergence in results for countries where socio-economic differences between the whole territory and the covered area were relevant. Conclusions In the light of these findings, evaluation of the role of socio-economic and health-related factors and the estimation of survival is of utmost importance in order to evaluate healthcare outcomes and to support planners in allocating resources in a more effective and egalitarian way.
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Affiliation(s)
- Roberto Lillini
- Liguria Region Cancer Registry at the Descriptive Epidemiology Unit, National Cancer Research Institute, Genoa
- National Center of Epidemiology, Surveillance and Promotion of Health, National Institute of Health, Rome
- “Vita-Salute”, Ospedale San Raffaele, Milan
| | - Marina Vercelli
- Liguria Region Cancer Registry at the Descriptive Epidemiology Unit, National Cancer Research Institute, Genoa
- Department of Health Sciences, University of Genoa, Genoa
| | - Alberto Quaglia
- Liguria Region Cancer Registry at the Descriptive Epidemiology Unit, National Cancer Research Institute, Genoa
| | - Andrea Micheli
- Descriptive Epidemiology and Public Health Planning Unit, National Cancer Institute, Milan, Italy
| | - Riccardo Capocaccia
- National Center of Epidemiology, Surveillance and Promotion of Health, National Institute of Health, Rome
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Barba M, Cavalleri A, Schünemann HJ, Krogh V, Evangelista A, Secreto G, Micheli A, Zhou Q, Fuhrman B, Teter B, Berrino F, Muti P. Reliability of Urinary 6-sulfatoxymelatonin as a Biomarker in Breast Cancer. Int J Biol Markers 2018; 21:242-5. [PMID: 17177163 DOI: 10.1177/172460080602100408] [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: 11/15/2022]
Abstract
The objective of this study is to evaluate the effect of cryopreservation at different storage temperatures on urinary 6-sulfatoxymelatonin (aMT6s) concentration. Overnight urine from 28 postmenopausal women participating in the ORDET cohort study was filtered and separated into 6 mL aliquots. Urine samples were stored at –80°C and at –30°C for an average of 14 years. Urinary aMT6s concentration was assessed using a competitive immunoassay. Mean aMT6s values of samples stored at –30°C were systematically lower than those of samples stored at –80°C (10.7 ng/mL versus 15.8 ng/mL, p<0.001). Bland Altman plots showed disagreement between determinations at different storage temperatures at the highest levels of the metabolite concentration. The degree of agreement evaluated in terms of intra-class correlation coefficient was 0.68 (95% CI 0.41–0.84, p<0.0001). Pearson's correlation coefficient between aMT6s values of the two differently stored samples was 0.93 (p<0.001), while the Kendal tau coefficient for rank distribution was 0.73 (p<0.001). Our data suggest that storage temperatures might affect degradation of aMT6s during storage. However, individual characterization by melatonin levels does not seem to be affected by cryopreservation conditions.
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Affiliation(s)
- M Barba
- Department of Epidemiology, Regina Elena Cancer Institute, Rome, Italy
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Micheli A, Forastiere F. [Scientific directors' reply to the letter of Paolo D'Argenio et al.]. Epidemiol Prev 2018; 42:4-5. [PMID: 29506349 DOI: 10.19191/ep18.1.p004.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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43
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Micheli A. Disjunctive temporal networks with uncertainty via SMT: Recent results and directions1. IA 2017. [DOI: 10.3233/ia-170112] [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] [Indexed: 11/15/2022]
Affiliation(s)
- A. Micheli
- Embedded Systems Unit, Fondazione Bruno Kessler, Via Sommarive 18, Trento, Italy
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Di Salvo F, Baili P, Mariottini M, Baldini M, Micheli A, Meneghini E. [Excess deaths for haematological tumours in Falconara Marittima (Marche Region, Central Italy): short story from the epidemiological survey up to now]. Epidemiol Prev 2017; 41:243-247. [PMID: 29119757 DOI: 10.19191/ep17.5-6.p243.083] [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: 11/15/2022]
Abstract
API is a company refining petroleum products located in Falconara Marittima (Ancona Province, Marche Region, Central Italy). Thanks to the pressure made by citizens' committees, which considered the plant as a risk source for the population residing in the surroundings municipalities, Marche Region as institution asked for an epidemiological survey. This survey found a significative excess in deaths for haematological tumours in women and in a sub-group of retired and elderly. The results were published in one report and two scientific journals, and were also presented during a public meeting. It was urgent to made public health intervention, which were called for, but up to now nothing has been done. Here, the reconstruction of this affair, from the start of the epidemiological survey up to the more recent development in terms of public health.
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Affiliation(s)
- Francesca Di Salvo
- SSD epidemiologia analitica e impatto sanitario, Fondazione IRCCS Istituto nazionale dei tumori, Milano.
| | - Paolo Baili
- SSD epidemiologia analitica e impatto sanitario, Fondazione IRCCS Istituto nazionale dei tumori, Milano
| | - Mauro Mariottini
- Servizio epidemiologia ambientale, Agenzia regionale per la protezione dell'ambiente delle Marche, Ancona
| | - Marco Baldini
- Servizio epidemiologia ambientale, Agenzia regionale per la protezione dell'ambiente delle Marche, Ancona
| | | | - Elisabetta Meneghini
- SSD epidemiologia analitica e impatto sanitario, Fondazione IRCCS Istituto nazionale dei tumori, Milano
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Micheli A, Barbone F, Biggeri A, Capocaccia R, Davoli M, Pirastu R, Richiardi L, Traversa G, Forastiere F. [Health, public health, research, and participation. Considerations on the Italian ''Vaccination decree'']. Epidemiol Prev 2017; 41:149-151. [PMID: 28929702 DOI: 10.19191/ep17.3-4.p149.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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46
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Micheli A, Forastiere F. [Two new directors: for 40 more years of E&P journal]. Epidemiol Prev 2016; 40:387-388. [PMID: 27919143 DOI: 10.19191/ep16.6.p387.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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48
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Micheli A. [Rare tumours: data are now available, politics has no more excuses]. Epidemiol Prev 2016; 40:6-8. [PMID: 26951692 DOI: 10.19191/ep16.1.p006.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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49
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Baili P, Di Salvo F, de Lorenzo F, Maietta F, Pinto C, Rizzotto V, Vicentini M, Rossi PG, Tumino R, Rollo PC, Tagliabue G, Contiero P, Candela P, Scuderi T, Iannelli E, Cascinu S, Aurora F, Agresti R, Turco A, Sant M, Meneghini E, Micheli A. Out-of-pocket costs for cancer survivors between 5 and 10 years from diagnosis: an Italian population-based study. Support Care Cancer 2015; 24:2225-2233. [DOI: 10.1007/s00520-015-3019-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 11/08/2015] [Indexed: 11/28/2022]
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50
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Baili P, Di Salvo F, Marcos-Gragera R, Siesling S, Mallone S, Santaquilani M, Micheli A, Lillini R, Francisci S. Age and case mix-standardised survival for all cancer patients in Europe 1999-2007: Results of EUROCARE-5, a population-based study. Eur J Cancer 2015; 51:2120-2129. [PMID: 26421816 DOI: 10.1016/j.ejca.2015.07.025] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 07/08/2015] [Accepted: 07/17/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Overall survival after cancer is frequently used when assessing a health care service's performance as a whole. It is mainly used by the public, politicians and the media, and is often dismissed by clinicians because of the heterogeneous mix of different cancers, risk factors and treatment modalities. Here we give survival details for all cancers combined in Europe, correlating it with economic variables to suggest reasons for differences. METHODS We computed age and cancer site case-mix standardised relative survival for all cancers combined (ACRS) for 29 countries participating in the EUROCARE-5 project with data on more than 7.5million cancer cases from 87 population-based cancer registries, using complete and period approach. RESULTS Denmark, United Kingdom (UK) and Eastern European countries had lower survival than neighbouring countries. Five-year ACRS has been increasing throughout Europe, and substantial increases, between 1999-2001 and 2005-2007, have been achieved in countries where survival was lower in the past. Five-year ACRS for men and women are positively correlated with macro-economic variables like the Gross Domestic Product (GDP) and Total National Expenditure on Health (TNEH) (R2 about 70%). Countries with recent larger increases in GDP and TNEH had greater increases in cancer survival. CONCLUSIONS ACRS serves to compare all cancer survival in Europe taking account of the geographical variability in case-mixes. The EUROCARE-5 data on ACRS confirm previous EUROCARE findings. Survival appears to correlate with macro-economic determinants, particularly with investments in the health care system.
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Affiliation(s)
- Paolo Baili
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori", via Venezian 1, 20133 Milan, Italy
| | - Francesca Di Salvo
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori", via Venezian 1, 20133 Milan, Italy.
| | - Rafael Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry (Oncology Coordination Plan). Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona Biomedical Research Institute, Girona, Spain
| | - Sabine Siesling
- Netherlands Comprehensive Cancer Organisation (Department of Research), PO Box 19079, 3501 DB Utrecht, The Netherlands; MIRA Institute of Biomedical Technology and Technical Medicine, University of Twente (Department of Health Technology and Services Research), Enschede, The Netherlands
| | - Sandra Mallone
- National Centre for Epidemiology Surveillance and Health Promotion (CNESPS), National Institute of Health (Istituto Superiore di Sanità), Rome, Italy
| | - Mariano Santaquilani
- Informatics service, National Institute of Health (Istituto Superiore di Sanità), Rome, Italy
| | - Andrea Micheli
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori", via Venezian 1, 20133 Milan, Italy; Department of Health Sciences (DISS), University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Roberto Lillini
- PhD School in Applied Sociology and Methodology of Research, Department of Sociology, University of Milan-Bicocca, Milan, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Silvia Francisci
- National Centre for Epidemiology Surveillance and Health Promotion (CNESPS), National Institute of Health (Istituto Superiore di Sanità), Rome, Italy
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