Colorectal cancer incidence and mortality after negative fecal immunochemical tests by age 70: A prospective observational study.

Limited endoscopy capacity usually represents the main barrier to the extension of screening to subjects older than 70, given the high positivity rate in this age group. We assessed CRC incidence and mortality by number of previous negative fecal immunochemical tests (FIT) among subjects turning 70. We selected persons aged 70 years who had received their last screening invitation when they were 68 or 69 years old within the population-based screening program in the Veneto region of Italy. Subjects with a positive FIT were excluded. We calculated 10-year cumulative CRC incidence and mortality in cohorts of subjects having performed zero, one, two or three negative FITs over the last three screening rounds before turning 70. Out of 117 858 subjects included in the study (46.4% men), 33.7% had never participated in screening (zero negative FITs), 23.3% had had one-negative FIT, 20.1% two-negative FITs and 22.9% three negative FITs. The 10-year cumulative CRC incidence was 29.7 per 1000 subjects with zero FITs, and respectively, 14.5, 11.7 and 9.6 per 1000 subjects with one, two and three negative FITs. The corresponding figures for 10-year cumulative mortality were 9.3, 3.5, 2.2 and 2.1 per 1000 in the four study cohorts. Figures were roughly double for men than for women for all the study cohorts. In order to use more efficiently limited endoscopy resources, and to minimize the potential harms related to false positive results in the elderly, screening among people aged 70 to 74 might be restricted to those with zero previous negative FITs.

Quality control on digital cancer registration.

Population-based cancer registration methods are subject to internationally-established rules. To ensure efficient and effective case recording, population-based cancer registries widely adopt digital processing (DP) methods. At the Veneto Tumor Registry (RTV), about 50% of all digitally-identified (putative) cases of cancer are further profiled by means of registrars' assessments (RAs). Taking these RAs for reference, the present study examines how well the registry's DP performs. A series of 1,801 (putative) incident and prevalent cancers identified using DP methods were randomly assigned to two experienced registrars (blinded to the DP output), who independently re-assessed every case. This study focuses on the concordance between the DP output and the RAs as concerns cancer status (incident versus prevalent), topography, and morphology. The RAs confirmed the cancer status emerging from DP for 1,266/1,317 incident cancers (positive predictive value [PPV] = 96.1%) and 460/472 prevalent cancers (PPV = 97.5%). This level of concordance ranks as "optimal", with a Cohen's K value of 0.91. The overall prevalence of false-positive cancer cases identified by DP was 2.9%, and was affected by the number of digital variables available. DP and the RAs were consistent in identifying cancer topography in 88.7% of cases; differences concerned different sites within the same anatomo-functional district (according to the International Agency for Research on Cancer [IARC]) in 9.6% of cases. In short, using DP for cancer case registration suffers from only trivial inconsistencies. The efficiency and reliability of digital cancer registration is influenced by the availability of good-quality clinical information, and the regular interdisciplinary monitoring of a registry's DP performance.

Sarcoma risk and dioxin emissions from incinerators and industrial plants: a population-based case-control study (Italy).

BACKGROUND: It is not clear whether environmental exposure to dioxin affects the general population. The aim of this research is to evaluate sarcoma risk in relation to the environmental pollution caused by dioxin emitted by waste incinerators and industrial sources of airborne dioxin. The study population lives in a part of the Province of Venice (Italy), where a population-based cancer registry (Veneto Tumour Registry--RTV) has been active since 1987. METHODS: Two hundred and five cases of visceral and extravisceral sarcoma, confirmed by microscopic examination, diagnosed from 01.01.1990 to 31.12.1996, were extracted from the RTV database. Diagnoses were revised using the actual pathology reports and clinical records. For each sarcoma case, three controls of the same age and sex were randomly selected from the population files of the Local Health Units (LHUs). The residential history of each subject, whether case or control, was reconstructed, address by address, from 1960 to the date of diagnosis. All waste incinerators and industrial sources of airborne dioxin in the Province of Venice were taken into account, as was one very large municipal waste incinerator outside the area but close to its boundaries. The Industrial Source Complex Model in Long Term mode, version 3 (ISCLT3), was used to assess the level of atmospheric dispersion. A specific value for exposure was calculated for each point (geo-referenced address) and for each calendar year; the exposure value for each subject is expressed as the average of specific time-weighted values. The analysis takes into account 172 cases and 405 controls, aged more than 14 years. RESULTS: The risk of developing a sarcoma is 3.3 times higher (95% Confidence Interval--95% CI: 1.24-8.76) among subjects, both sexes, with the longest exposure period and the highest exposure level ; a significant excess of risk was also observed in women (Odds Ratio OR = 2.41, 95% CI: 1.04-5.59) and for cancers of the connective and other soft tissue (International Classification of Diseases, ninth Revision--ICD-IX 171), both sexes (OR = 3.27, 95% CI: 1.35-7.93). CONCLUSION: Our study supports the association between modelled dioxin exposure and sarcoma risk.

[Malignant mesothelioma in the Veneto Region (north-east of Italy), 1988-2002: incidence, geographical analysis, trends and comparison with mortality]. / L'incidenza del mesotelioma maligno in Regione Veneto nel periodo 1988-2002: analisi geografica, trend e confronto con la mortalità.

OBJECTIVE: The study assesses incidence and trend of malignant mesothelioma (MM), and mortality from primary pleural tumour (PPT) among residents of the Veneto region (North-east of Italy 4,450,000 inhabitants at the last census). The study also aims at identifying areas at high risk, by applying geographical analysis techniques. METHOD: The results have been obtained through the activity ofa Mesothelioma Registry, established in 2001, thus collecting largely retrospective data. Incidence and trends are estimated on MM diagnosed between 1988 and 2002 by means of histological or cytological techniques. Deaths from PPT are derived through the availability of mortality records for the period 1988-1999 (latest year available). Direct age-standardization was applied to provincial rates (7 provinces), whereas standardized mortality and incidence ratios according to Kernel estimates and spatial scan statistics have been used to identify clusters at the municipality level (581 municipalities). RESULTS AND CONCLUSIONS: the incidence of MM in the Veneto region appears similar to that of other northern Italian regions (904 new MM cases from 1988 to 2002, 650 among males, 819 pleural; age-standardized annual incidence rates x 100,000 in the period 1988-1999): 1.75 (IC 95% 1.59-1.91) among males, based on 460 cases, and 0.67 (IC 95% 0.57-0.77) among females, based on 196 cases, and displays an increasing trend among both genders. Among males incidence doubles during the study period. High risks are detected among males in a cluster formed by the city of Venice and surrounding municipalities (Standardized Incidence Ratio, SIR, for pleural mesothelioma, 1988-1999, 2.94 (p = 0.001) for the cluster based on 110 observed cases), and, in addition to Venice, in the province of Padua among females (SIR from pleural mesothelioma, 1988-1999, 1.98 (p = 0.001) for the cluster based on 95 observed cases). Mortality from TPP turns out to be higher than incidence and tends to approach incidence in more recent years; this may be explained by the increasing application of diagnostic procedures, inclusive of histopathological tests, among old patients.