Indicators of cure for women living after uterine and ovarian cancers: a population-based study.

This study aims to estimate long-term survival, cancer prevalence, and several cure indicators for Italian women with gynaecological cancers. Thirty-one cancer registries, representing 47% of the Italian female population, were included. Mixture cure models were used to estimate Net Survival (NS), Cure Fraction, Time To Cure (5-year conditional NS>95%), Cure Prevalence (women who will not die of cancer), and Already Cured (living longer than Time to Cure). In 2018, 0.4% (121,704) of Italian women were alive after corpus uteri cancer, 0.2% (52,551) after cervical, and 0.2% (52,153) after ovarian cancer. More than 90% of patients with uterine cancers and 83% with ovarian cancer will not die from their neoplasm (Cure Prevalence). Women with gynaecological cancers have a residual excess risk of death <5% after 5 years since diagnosis. The Cure Fraction was 69% for corpus uteri, 32% for ovarian, and 58% for cervical cancer patients. Time To Cure was ≤10 years for women with gynaecological cancers aged <55 years. 74% of patients with cervical cancer, 63% with corpus uteri cancer, and 55% with ovarian cancer were Already Cured. These results will contribute to improving follow-up programs for women with gynaecological cancers and supporting efforts against discrimination of already cured ones.

[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]. / Aggiornamento della sopravvivenza dei pazienti con tumore in Italia: confronti geografici e focus su pazienti con tumori oggetto di screening, pediatrici e associati al fumo.

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.

Dietary inflammatory index before diagnosis and survival in an Italian cohort of women with breast cancer.

The dietary inflammatory indexTM (DII) has been shown to correlate with concentrations of several inflammatory markers and a variety of chronic disease endpoints, including cancers of various anatomic sites. We investigated whether the DII was associated with the risk for death among women with breast cancer (BrCa). This retrospective cohort study included 1453 women with BrCa, diagnosed between 1990 and 1994, and previously enrolled in a case-control study in northern Italy. With a median follow-up of 12·6 years, we observed 503 deaths, among which 398 were due to BrCa. The usual diet was assessed at BrCa diagnosis using a validated FFQ. DII scores were calculated using thirty-one foods/nutrients. Hazard ratios (HR) of death from all causes or from BrCa, with corresponding 95 % CI, were calculated using the Cox models, adjusted for age at diagnosis, tumour stage, oestrogen/progesterone receptor status and other potential confounders. The median DII score of the study women was -1·23, with a relatively narrow range (interquartile range -2·24 to -0·11), indicating a mainly anti-inflammatory diet. There was no difference in survival according to DII tertiles, neither considering all-cause mortality (HRtertile III v. I 1·00; 95 % CI 0·78, 1·28) nor BrCa-specific mortality (HRtertile III v. I 0·97; 95 % CI 0·73, 1·27). Study findings did not suggest an association between the inflammatory potential of diet, measured by the DII, and the survival of BrCa women. However, further studies are needed in populations reporting higher DII scores and a broader range of variability in the scores.

Lifestyle factors and risk of leukemia and non-Hodgkin's lymphoma: a case-control study.

PURPOSE: Risk factors for leukemia and lymphomas in adults are largely unknown. This study was aimed at evaluating the association between lifestyle factors and the risk of hematological malignancies in an adult population. METHODS: Data were drawn from a population-based case-control study carried out in Italy and included 294 cases (199 lymphoid and 95 myeloid) and 279 controls. Analyses were performed using standard multivariable logistic regression. RESULTS: Hair dye use for at least 15 years was associated with a higher risk of lymphoid malignancies among females (OR 2.3, 95 % CI 1.0-4.9, p = 0.036, test for trend). Furthermore, a protective effect of a moderate to heavy tea consumption on the risk of myeloid malignancies was observed (OR 0.4, 95 % CI 0.2-0.9, p = 0.017). No association was found for the use of alcoholic beverages and tobacco smoking. CONCLUSIONS: Our results confirm the potential carcinogenic effect of prolonged hair dye use observed in previous investigations. The excess risk could be explained by exposure to a higher concentration of toxic compounds in hair products used in the past. The protective effect of regular tea consumption observed in an area with a very high prevalence of black tea consumers deserves further investigation.

Chronic diseases, medical history and familial cancer, and risk of leukemia and non-Hodgkin's lymphoma in an adult population: a case-control study.

PURPOSE: This investigation was aimed at evaluating the association between chronic diseases, medical history and familial cancer, and the risk of developing hematological malignancies. METHODS: Data were drawn from a population-based case-control study carried out to assess the risk of non-Hodgkin's lymphoma and leukemia in an adult population exposed to environmental air pollution in Northern Italy. Each case was classified according to the WHO ICD-O-3 classification. Statistical analyses were performed by multivariable unconditional logistic regression in 573 interviewed subjects (199 lymphoid cases, 95 myeloid cases, and 279 healthy controls). RESULTS: Lymphoid malignancies were associated with a history of gastroduodenal ulcer (OR 2.1, 95 % CI 1.2-3.6), rheumatoid arthritis (OR 4.4, 95 % CI 1.3-19.0), anemia (OR 3.3, 95 % CI 1.2-9.3), cholecystectomy (OR 2.9, 95 % CI 1.0-8.0), heavy diagnostic X-ray exposure (OR 2.1, 95 % CI 1.3-3.7), and a familial risk of non-Hodgkin's lymphoma (OR 10.1, 95 % CI 1.3-458). Myeloid malignancies were associated with non-neoplastic thyroid diseases (OR 6.2, 95 % CI 1.7-35.6) and anemia (OR 6.8, 95 % CI 2.0-23.1). Subgroup analysis highlighted an excess risk of MALT in patients with gastroduodenal ulcer (OR 5.3, 95 % CI 1.04-23.7) and of AML in patients with rheumatoid arthritis (OR 6.9, 95 % CI 1.2-38.1), and of MDS in subjects exposed to heavy diagnostic X-ray (OR 3.4, 95 % CI 1.03-11.2) when the analysis was restricted to irradiation of pelvis, abdomen, or thorax. CONCLUSIONS: Most observed associations confirm results from previous studies. The higher risk of lymphoid malignancies among patients with a history of cholecystectomy needs further investigations.

Risk of leukaemia and residential exposure to air pollution in an industrial area in Northern Italy: a case-control study.

Leukaemia risk in adult populations exposed to environmental air pollution is poorly investigated. We have carried out a population-based case-control study in an area that included a fossil fuel power plant, a coke oven and two big chemical industries. Information on residential history and several risk factors for leukaemia was obtained from 164 cases, diagnosed between 2002 and 2005, and 279 controls. A higher risk for subjects residing in polluted areas was observed, but statistical significance was not reached (adjusted OR = 1.11 and 1.56 for subjects living in moderately and in heavily polluted zones, respectively, p = 0.190). Results suggest a possible aetiological role of residential air pollution from industrial sites on the risk of developing leukaemia in adult populations. However, the proportion of eligible subjects excluded from the study and the lack of any measure of air pollution prevent definitive conclusions from being drawn.

Screening for colorectal cancer in Italy: 2011-2012 survey.

We utilised the IMPATTO study's archives to describe the 2000-2008 colorectal cancer (CRC) incidence rate trends in Italy, once screening programmes based on the faecal immunochemical test were implemented in different areas. Data on CRCs diagnosed in Italy from 2000 to 2008 in subjects aged 40-79 years were collected by 23 cancer registries. Incidence rate trends were evaluated as a whole and by macro-area (North-Centre and South-Islands), presence of a screening programme, sex, ten-year age class, anatomic site, stage at diagnosis, and pattern of diagnosis (screen-detected, non-screen-detected). The annual percent change (APC) of incidence rate trends, with 95% confidence intervals (95%CI), were computed. The study included 46,857 CRCs diagnosed in subjects aged 40-79 years, of which 2,806 were screen-detected. The incidence rates in the North-Centre were higher than in the South and on the Islands. During the study period, screening programmes had been implemented only in the North-Centre and had a significant effect on incidence rates, with an initial sharp increase in incidence, followed by a decrease that started in the 3rd-4th years of screening. These incidence rate trends were exclusively due to modifications in the rates of stage I cases. After screening programmes started, incidence increased in all anatomic sites, particularly in the distal colon. The differential figures introduced by the implementation of screening programmes warrant a continuous surveillance of CRC incidence and mortality trends to monitor the impact of screening at a national level.

Complete prevalence and indicators of cancer cure: enhanced methods and validation in Italian population-based cancer registries.

Objectives: To describe the procedures to derive complete prevalence and several indicators of cancer cure from population-based cancer registries. Materials and methods: Cancer registry data (47% of the Italian population) were used to calculate limited duration prevalence for 62 cancer types by sex and registry. The incidence and survival models, needed to calculate the completeness index (R) and complete prevalence, were evaluated by likelihood ratio tests and by visual comparison. A sensitivity analysis was conducted to explore the effect on the complete prevalence of using different R indexes. Mixture cure models were used to estimate net survival (NS); life expectancy of fatal (LEF) cases; cure fraction (CF); time to cure (TTC); cure prevalence, prevalent patients who were not at risk of dying as a result of cancer; and already cured patients, those living longer than TTC at a specific point in time. CF was also compared with long-term NS since, for patients diagnosed after a certain age, CF (representing asymptotical values of NS) is reached far beyond the patient's life expectancy. Results: For the most frequent cancer types, the Weibull survival model stratified by sex and age showed a very good fit with observed survival. For men diagnosed with any cancer type at age 65-74 years, CF was 41%, while the NS was 49% until age 100 and 50% until age 90. In women, similar differences emerged for patients with any cancer type or with breast cancer. Among patients alive in 2018 with colorectal cancer at age 55-64 years, 48% were already cured (had reached their specific TTC), while the cure prevalence (lifelong probability to be cured from cancer) was 89%. Cure prevalence became 97.5% (2.5% will die because of their neoplasm) for patients alive >5 years after diagnosis. Conclusions: This study represents an addition to the current knowledge on the topic providing a detailed description of available indicators of prevalence and cancer cure, highlighting the links among them, and illustrating their interpretation. Indicators may be relevant for patients and clinical practice; they are unambiguously defined, measurable, and reproducible in different countries where population-based cancer registries are active.

Molecular Subtypes, Metastatic Pattern and Patient Age in Breast Cancer: An Analysis of Italian Network of Cancer Registries (AIRTUM) Data.

Breast cancer stage at diagnosis, patient age and molecular tumor subtype influence disease progression. The aim of this study was to analyze the relationships between these factors and survival in breast cancer patients among the Italian population using data from the AIRTUM national database. We enrolled women with primary breast cancer from 17 population-based cancer registries. Patients were subdivided into older (>69 years), middle (50-69 years) and younger age groups (<50 years) and their primary tumors categorized into four molecular subtypes based on hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status. There were 8831 patients diagnosed between 2010 and 2012 included. The most represented age group was 50-69 years (41.7%). In 5735 cases the molecular subtype was identified: HER2-/HR+ was the most frequent (66.2%) and HER2+/HR- the least (6.2%). Of the 390 women with metastases at diagnosis, 38% had simultaneous involvement of multiple sites, independent of age and molecular profile. In women with a single metastatic site, bone (20% of cases), liver (11%), lung (7%) and brain (3%) were the most frequent. In the studied age groups with different receptor expression profiles, the tumor metastasized to target organs with differing frequencies, affecting survival. Five-year survival was lowest in women with triple-negative (HER2-/HR-) tumors and women with brain metastases at diagnosis.

Cancer incidence in people with AIDS in Italy.

People with HIV/AIDS (PWHA) have increased risk of some cancers. The introduction of highly active antiretroviral therapies (HAART) has improved their life expectancy, exposing them to the combined consequences of aging and of a prolonged exposure to cancer risk factors. The aim of this study was to estimate incidence rates (IR) in PWHA in Italy, before and after the introduction of HAART, after adjusting for sex and age through direct standardization. An anonymous record linkage between Italian AIDS Registry (21,951 cases) and Cancer Registries (17.3 million, 30% of Italian population) was performed. In PWHA, crude IR, sex- and age-standardized IR and age-specific IR were estimated. The standardized IR for Kaposi sarcoma and non-Hodgkin lymphoma greatly declined in the HAART period. Although the crude IR for all non-AIDS-defining cancers increased in the HAART period, standardized IR did not significantly differ in the 2 periods (352 and 379/100,000, respectively). Increases were seen only for cancer of the liver (IR ratio = 4.6, 95% CI: 1.3-17.0) and lung (IR ratio = 1.8, 95% CI: 1.0-3.2). Age-specific IRs for liver and lung cancers, however, largely overlapped in the 2 periods pointing to the strong influence of the shift in the age distribution of PWHA on the observed upward trends. In conclusion, standardized IRs for non-AIDS-defining cancers have not risen in the HAART period, even if crude IRs of these cancers increased. This scenario calls, however, for the intensification of cancer-prevention strategies, notably smoking cessation and screening programs, in middle-aged HIV-patients.

Adherence to the Mediterranean Diet and Mortality after Breast Cancer.

Adherence to Mediterranean diet has been consistently associated with a reduced mortality in the general population, but evidence for women with breast cancer is scanty. METHODS: A cohort of 1453 women with breast cancer diagnosed between 1991 and 1994 in northern Italy was followed-up for vital status for 15 years after diagnosis. The pre-diagnostic habitual diet was assessed through a structured questionnaire and adherence to the Mediterranean diet was evaluated through the Mediterranean Diet Score. Hazard ratios (HR) of death with confidence intervals (CI) were estimated using Cox model, adjusting for potential confounders. RESULTS: Compared to women who scarcely adhere to the Mediterranean diet (n = 332, 22.8%), those highly adherent (n = 500, 34.4%) reported higher intakes of carbohydrates, mono-unsaturated and poly-unsaturated fatty acids, vitamins, folate, and carotenoids, and lower intakes of cholesterol and animal proteins. Adherence to the Mediterranean diet was associated with a better prognosis: 15-year overall survival of 63.1% for high and 53.6% for low adherence, respectively (p = 0.013). HR for all-cause mortality was 0.72 (95% CI: 0.57-0.92) and HR for breast cancer mortality was 0.65 (95% CI: 0.43-0.98) for women 55 years and older. No significant association emerged for breast cancer mortality in the total cohort. CONCLUSIONS: Although dietary habits may have changed after breast cancer diagnosis, these findings indicate that women who ate according to the Mediterranean dietary pattern prior to their diagnosis may have greater chance of a favorable prognosis after breast cancer diagnosis compared to those who did not.

Prostate cancer changes in clinical presentation and treatments in two decades: an Italian population-based study.

INTRODUCTION: The incidence of prostate cancer is on the rise in many industrialised countries, including Italy, most likely because of the spread of PSA testing. In Italy, prostate cancer mortality has been dropping since 2000, but it is difficult to understand whether PSA testing is the main reason, considering the role of treatment in prognosis. The objectives of this study were: (1) to describe Italian trends of prostate cancer risk categories and corresponding changes in treatment patterns and (2) to interpret changes in survival over time. METHODS: We made a retrospective observational study using population-based cancer registries. We examined two periods, 1996-1999 and 2005-2007, analysing the distribution of patients among risk groups and treatment changes in those intervals. We estimated 7- and 15-year relative survival with the cohort approach, Ederer II method. We analysed 4635 cases. RESULTS: There was downward risk migration from the first to the second period. In patients younger than 75 years, there was an increase in radical prostatectomy but not radiotherapy; patients older than 75 years rarely had treatment with radical intent. We noted an improvement of prostate cancer survival in the high-risk group. CONCLUSION: These findings raise several questions: the possible overtreatment of low-risk patients undergoing radical treatment; the utility of more aggressive treatment for elderly patients with high-risk disease; and the importance of a multidisciplinary clinical approach to ensure multiple and alternative treatment options. The increase in survival, with the decrease in mortality, suggests an effect of radical treatments on prognosis.

Lung cancer in an urban area in Northern Italy near a coke oven plant.

Coke ovens are well-known sources of potentially carcinogenic air pollutants, but studies on resident populations are still poor. This study investigates the incidence of lung cancer near a coke oven in Cornigliano, a district of the Genoa municipality in Northern Italy. Genoa proper and one district similar to Cornigliano as regards socio-economic deprivation were selected as referents. Incidence data were drawn from the Ligurian Cancer Registry for 1986-1997 calendar period. Concentrations of pollutants related to the industrial activity (namely benzene, benzo[a]pyrene, PM(10), CO, NO(2) and SO(2)) were collected in selected locations before and after the coke oven closing. Spatial trend around the plant was assessed by Stone's test, while the pattern of risk across Cornigliano was evaluated via disease mapping in a Bayesian model. A gradient of air pollutants was observed around the coke oven, which disappeared after its closing. In Cornigliano, 158 lung cancer cases were observed in males and 28 in females. Only a marginal excess risk was observed versus the two selected referents, while a gradient in the areas close to the plant emerged among females. Disease mapping revealed another cluster of risk for both sexes in the Eastern part of the district, where a foundry was operative until the early 1980s. The excess risk for females is consistent with pollution measurements and with other epidemiological evidence. The geographic pattern of incidence suggests a role of industrial air pollution as a risk factor for lung cancer.

[Health conditions of the general population living near a steel plant]. / Stato di salute dei residenti nei pressi di un'acciaieria.

OBJECTIVE: To evaluate the health conditions (period 1986-2003) of the residents in Cornigliano, a district of Genoa (Italy), exposed to air pollution produced by a steel plant with coke-ovens. MATERIALS AND METHODS: Three epidemiological investigations were performed: on all mortality causes; on tumors incidence; on hospitalizations for respiratory diseases. The studies are based on the Regional Mortality Registry, the Ligurian Tumor Registry and the regional hospital discharge records. We calculated both the standardized mortality (SMR) and incidence (SIR) ratios with 95% confidence limits, and we have compared the hospitalization rates in two Cornigliano subareas with different pollution levels; the "rest of Genoa" represents the general reference. RESULTS: In Cornigliano the total mortality is statistically higher among males (SMR 123; n. 1684) and females (SMR 148; n. 2160); in particular all tumours, prostate, brain and emolymphopoietic system were significantly higher among males, while colon-rectum and NOS intestine tumours were higher among females. SMRs were statistically higher in both genders for degenerative illnesses of the nervous central system, brain circulatory disorders and liver cirrhosis; only in males for respiratory tract illnesses and in females for myocardial heart attacks. The incidence has increased to a statistically significant extent among males for all cancer sites (SIR 110; n. 821), and for larynx, brain and emolymphopoietic system tumours. Hospitalizations for respiratory illnesses appear to be higher in the most polluted area among males (age 0-14), and decreased after closing the coke-oven plant (2002). CONCLUSIONS: Results of these studies suggest that air pollution in Cornigliano may have a role on populations health conditions.

Infectious diseases and risk of leukemia and non-Hodgkin's lymphoma: a case-control study.

The aim of this investigation was to evaluate the association between common infectious diseases and the risk of hematological malignancies in an adult population. Data were drawn from a population based case-control study that included 165 cases (125 lymphoid and 40 myeloid neoplasms) and 233 controls. Occurrence of childhood diseases (measles, rubella, chickenpox, mumps, pertussis and scarlet fever) was slightly inversely associated with the risk of both malignancies, but statistical significance was not reached. The data of infections occurring after 14 years of age indicated an increasing risk of lymphoid malignancies (OR=2.9, p<0.05).