Variation of Cancer Incidence between and within GRELL Countries.

Variation in cancer incidence between countries and groups of countries has been well studied. However cancer incidence is linked to risk factors that may vary within countries, and may subsist in localized geographic areas. In this study we investigated between- and within-country variation in the incidence of all cancers combined for countries belonging to the Group for Cancer Epidemiology and Registration in Latin Language Countries (GRELL). We hypothesized that investigation at the micro-level (circumscribed regions and local cancer registry areas) would reveal incidence variations not evident at the macro level and allow identification of cancer incidence hotspots for research, public health, and to fight social inequalities. Data for all cancers diagnosed in 2008-2012 were extracted from Cancer Incidence in Five Continents, Vol XI. Incidence variation within a country or region was quantified as r/R, defined as the difference between the highest and lowest incidence rates for cancer registries within a country/region (r), divided by the incidence rate for the entire country/region × 100. We found that the area with the highest male incidence had an ASRw 4.3 times higher than the area with the lowest incidence. The area with the highest female incidence had an ASRw 3.3 times higher than the area with the lowest incidence. Areas with the highest male ASRws were Azores (Portugal), Florianopolis (Brazil), Metropolitan France, north Spain, Belgium, and north-west and north-east Italy. Areas with the highest female ASRws were Florianopolis (Brazil), Belgium, north-west Italy, north-east Italy, central Italy, Switzerland and Metropolitan France. Our analysis has shown that cancer incidence varies markedly across GRELL countries but also within several countries: the presence of several areas with high cancer incidence suggests the presence of area-specific risk factors that deserve further investigation.

A Case-Crossover Study to Investigate the Effects of Atmospheric Particulate Matter Concentrations, Season, and Air Temperature on Accident and Emergency Presentations for Cardiovascular Events in Northern Italy.

Atmospheric particulate matter (PM) has multiple adverse effects on human health, high temperatures are also associated with adverse health outcomes, and the frequency of cardiovascular events (CVEs) varies with season. We investigated a hypothesized increase in PM-related accident and emergency (A&E) presentations for CVE with high temperature, warm season, days of high influenza incidence, and in people with a cancer diagnosis, using a time-stratified case-crossover study design. Outcomes were associations of A&E presentation for CVE with atmospheric PM ≤ 10 µm (PM10), season, and air temperature. PM10 levels in the municipality of residence (exposure variable) were estimated by modeling data from local monitoring stations. Conditional logistic regression models estimated odds ratios (OR) with 95% confidence intervals (CI) for presentations in relation to supposed influencers, adjusting for confounders. Study participants were all who presented at the A&E of a large hospital near Milan, Italy, for a CVE (ICD-9: 390-459) from 1st January 2014 to 31st December 2015. There were 1349 A&E presentations for CVE in 2014-2015 and 5390 control days. Risk of A&E presentation was significantly increased on hot days with OR 1.34 (95%CI 1.05-1.71) per 10 µg/m3 PM10 increment (as mean PM10 on day of presentation, and 1 and 2 days before (lags 0-2)), and (for lag 0) in autumn (OR 1.23, 95%CI 1.09-1.37) and winter (OR 1.18, 95%CI 1.01-1.38). Risks were also significantly increased when PM10 was on lag 1, in people with a cancer diagnosis in the spring and summer months (1.88, 95%CI 1.05-3.37), and on days (lags 0-2) of high influenza incidence (OR 2.34, 95%CI 1.01-5.43). PM10 levels exceeded the 50 µg/m3 "safe" threshold recommended by the WHO and Italian legislation for only 3.8% of days during the warm periods of 2014-2015. Greater risk of A&E presentation for CVE in periods of high PM10 and high temperature suggests that "safe" thresholds for PM10 should be temperature-dependent and that the adverse effects of PM10 will increase as temperatures increase due to climate change.

[Formaldehyde in electronic cigarettes and in heat-not-burn products: let's make the point]. / La formaldeide nelle sigarette elettroniche e nei riscaldatori di tabacco (HnB): facciamo il punto.

The spread of electronic cigarettes (e-cigs) and of the so-called heat-not-burn (HnB), also known as heated tobacco products, presented as a less harmful alternative to traditional cigarettes, required further in-depth studies to demonstrate the real benefits or possible risks linked to this type of habit among smokers and possible new smokers. There are numerous harmful substances produced by these devices, such as metals, organic compounds, and aldehydes. The presence of formaldehyde is particularly worrying: its indoor concentration is 2.7, 1.2, and 40 µg/m3 for HnB, e-cigs, and traditional cigarettes, respectively. The evidence of this substance, which numerous epidemiological studies have already shown to be harmful to health (in particular, the International Agency for Research on Cancer classified it as a group 1 carcinogen), would lead to the need to modify the legislation with more restrictive rules on the use of these devices in public environment and in particular in the presence of more susceptible subjects, such as minors and pregnant women.

Atmospheric fine particulate matter and breast cancer mortality: a population-based cohort study.

OBJECTIVES: Atmospheric fine particulate matter (PM2.5) has multiple adverse effects on human health. Global atmospheric levels of PM2.5 increased by 0.55 µg/m3/year (2.1%/year) from 1998 through 2012. There is evidence of a causal relationship between atmospheric PM2.5 and breast cancer (BC) incidence, but few studies have investigated BC mortality and atmospheric PM2.5. We investigated BC mortality in relation to atmospheric PM2.5 levels among patients living in Varese Province, northern Italy. METHODS: We selected female BC cases, archived in the local population-based cancer registry, diagnosed at age 50-69 years, between 2003 and 2009. The geographic coordinates of each woman's place of residence were identified, and individual PM2.5 exposures were assessed from satellite data. Grade, stage, age at diagnosis, period of diagnosis and participation in BC screening were potential confounders. Kaplan-Meir and Nelson-Aalen methods were used to test for mortality differences in relation to PM2.5 quartiles. Multivariable Cox proportional hazards modelling estimated HRs and 95% CIs of BC death in relation to PM2.5 exposure. RESULTS: Of 2021 BC cases, 325 died during follow-up to 31 December 2013, 246 for BC. Risk of BC death was significantly higher for all three upper quartiles of PM2.5 exposure compared to the lowest, with HRs of death: 1.82 (95% CI 1.15 to 2.89), 1.73 (95% CI 1.12 to 2.67) and 1.72 (95% CI 1.08 to 2.75). CONCLUSIONS: Our study indicates that the risk of BC mortality increases with PM2.5 exposure. Although additional research is required to confirm these findings, they are further evidence that PM2.5 exposure is harmful and indicate an urgent need to improve global air quality.

Female breast cancer and electrical manufacturing: results of a nested case-control study.

BACKGROUND: A previous explorative record-linkage study suggested a putative role of employment in electrical manufacturing in increasing female breast cancer risk in the Province of Milan (Italy). We deepened the understanding of this possible association in a single large electrical manufacturing plant located in Lombardy in the Province of Milan. METHODS: We carried out a nested case-control study within a cohort of women employed in a large electrical manufacturing plant. All incident cases during 2002 to 2009 of female breast cancer in individuals who worked at least a 1 year in the factory and resided in Lombardy, Italy, were selected. Controls were randomly sampled from all women who worked in the same plant and resided in Lombardy as of December 31, 2005. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated using multiple logistic regression models, taking into consideration only female workers as ever/never exposed to physical/chemical agents and their longest occupational period. ORs were adjusted for several potential confounders, namely, other known risk factors. RESULTS: The ORs for female breast cancer were significantly increased for exposure to chlorinated solvents (OR 1.65, 95% CI 1.04-2.62), and there was a twofold increase (OR 2.10, 95% CI 1.21-3.66) among women exposed for at least 10 years. We found no other significantly increased OR by exposure or job title. CONCLUSIONS: Our results suggest an increased risk of breast cancer after exposure to chlorinated solvents among women employed in the electrical manufacturing industry.

[Female breast cancer and occupational sectors: a preliminary study in the provinces of Lombardy, Italy]. / Cancro della mammella e settori occupazionali: studio esplorativo nelle province lombarde.

BACKGROUND: The role of occupational exposures in breast cancer development is still uncertain. A recent paper showed increased risks in some occupational sectors in Lombardy, Italy. We deepened this analysis at the level of single provinces of the same Italian region. METHODS: Based on administrative data, a case-control study was carried out recruiting all incident cases of female breast cancer in the period 2002-2009, aged between 35 and 69 years, residing in Lombardy, Italy. Controls were randomly sampled from all women residing in Lombardy as of December 31, 2005. Occupational histories, including blue collar status, were available from 1974 through record linkage with a social security pension database, and were obtained for 11188 cases and 25329 controls. Adjusted odds ratios (ORs) and corresponding 90% confidence intervals (CIs) were calculated using multiple unconditional logistic regression models. Analyses were performed also by single provinces of Lombardy, Italy. Multiple comparisons were accounted for according to the Benjamini-Hochberg method. RESULTS: The ORs for female breast cancer were modestly but significantly increased for employment in electrical manufacturing (OR 1.12, 90% CI 1.04-121), textile (OR 1.08, 90% CI 1.02-1.15), paper (OR 1.25, 90% CI 1.06-1.46) and rubber (OR 1.26, 90% CI 1.03-1.54) industries. Analysis by province showed significantly increased ORs for electrical manufacturing in the Milano province. After adjustment for multiple comparisons no estimates remained statistically significant, except OR for electrical manufacturing in the Milano province. CONCLUSIONS: Although with several limitations, our results point to a possible role of exposures in electrical manufacturing, textile, paper and rubber industries in the process leading to breast cancer. An in-dept study for the electrical manufacturing industry has been already planned in Milano province.

Occupational brain cancer risks in Umbria (Italy), with a particular focus on steel foundry workers.

OBJECTIVES: As a part of the Occupational Cancer Monitoring (OCCAM) project, a routine analysis based on Umbria region cancer registry (RTUP) database in 2002-2008 was performed. Among other results, the incidental finding of brain cancer increased risk in steel foundry workers in Terni province (Italy), lead us to deepen the analysis, focusing on this specific industrial sector. METHODS: A monitoring study, based on Umbria Regional Cancer Registry data, was recently carried out. Brain cancer cases and controls identified within this preliminary study were selected. Therefore, we considered all incident cases (in Umbria region 2002-2008) of brain cancer occurred among workers occupied for at least one year in private companies since 1974 and controls randomly sampled from the same population. Afterwards, taking in to account results from steel foundry in Terni province, we further deepened our analysis, focusing on this productive sector. Odds ratios (ORs) and corresponding 90% confidence intervals (CIs) were calculated using multiple logistic regression models, adjusted by age at diagnosis or sampling, sex and province of residence, when appropriate. RESULTS: Statistical analyses were carried out on 14913 subjects, 56 cases and 14857 controls. Significantly increased ORs were observed for garment, mechanical manufacturing and chemical industries. Moreover, the risk estimates were strongly correlated with exposures in iron and steel foundries and a cluster of 14 cases in the same foundry in Terni was observed (OR 9.59, 90% CI 2.76-33.34). CONCLUSIONS: Results of this explorative study showed increased ORs of brain cancer in some productive branches, involving possible exposures to chemical compounds and/or solvents. Moreover, our results pointed out a significantly increased risk in Terni foundry workers, determining an interesting brain cancer cluster (14 cases). Further studies on this industrial sector are needed with improved definitions of tasks and exposures.

Female breast cancer in Lombardy, Italy (2002-2009): a case-control study on occupational risks.

BACKGROUND: The role of occupational exposures in breast cancer development is still uncertain and, to our knowledge, no studies have been recently carried out in Italy to provide a comprehensive estimation of this possible risk. METHODS: Based on administrative data, a case-control study was carried out recruiting all incident cases of female breast cancer in the period 2002-2009, aged between 35 and 69 years, residing in Lombardy, Italy. Controls were randomly sampled from all women residing in Lombardy as of December 31, 2005. Occupational histories, including blue-collar status, were available from 1974 through record linkage with a social security pension database, and were obtained for 11,188 cases and 25,329 controls. Adjusted odds ratios (ORs) and corresponding 90% confidence intervals (CIs) were calculated using multiple unconditional logistic regression models, including terms for sectors of longest employment and for duration of employment. Multiple comparisons were accounted for according to the Benjamini-Hochberg method. RESULTS: The ORs for female breast cancer were modestly but significantly increased for employment in electrical manufacturing (OR 1.12, 90%CI 1.04-1.21), textile (OR 1.08, 90%CI 1.02-1.15), paper (OR 1.25, 90%CI 1.06-1.46) and rubber (OR 1.26, 90%CI 1.03-1.54) industries. Analysis by duration of employment within sectors showed significantly increased ORs for electrical manufacturing and rubber industries. After adjustment for multiple comparisons no estimates remained statistically significant. CONCLUSIONS: Although with several limitations, our results point to a possible role of exposures in electrical manufacturing, textile, paper and rubber industries in the process leading to breast cancer. An in-dept study for the electrical manufacturing industry has been already planned.

[Multiple sclerosis and occupational exposures: results of an explorative study]. / Sclerosi multipla e esposizioni occupazionali: risultati di uno studio preliminare.

OBJECTIVES: The aim of the study is to explore possible relationships between occupational exposures and Multiple Sclerosis (MS), whose etiology is not well defined yet. To date, only few literature data are available on this subject. METHODS: We carried out a case-control study, where cases were MS patients included in the MS Register of the Province of Pavia, Northern Italy, and controls, 1:4 matched by sex and age (5 years classes), were randomly selected from the National Health Service population files. The occupational histories were obtained from Italian Institute for Social Security (INPS) archives by automatic linkage using Italian Occupational Cancer Monitoring (OCCAM) method that estimates the risk of specific occupational cancers, by geographic area and industrial sector. OR adjusted for sex and age and corresponding 90% confidence intervals were used to estimate the association between exposure and disease. RESULTS: We included in the study 227 MS patients (130 (57.3%) female, 97 (42.7%) male) and 907 controls (514 (56.7%) female, 393 (43.3%) male). Our results suggest an increased risk for men in mechanical manufacturing industry (OR 1.71, 90% CI 1.03-2.85) and agriculture (OR 2.47, 90% CI 1.03-5.91). Women show an increased risk in mechanical manufacturing industry (OR 2.05, 90% CI 1.22-3.45), agriculture (OR 2.57, 90% CI 1.09-6.09) and leather/shoe industry (OR 2.34, 90% CI 1.06-5.20). CONCLUSIONS: Our preliminary findings indicate that solvent exposures could be related to the risk of MS, as both shoe/leather workers and mechanical manufacturing industry workers are exposed to organic solvents. Interestingly, a major risk of MS was also found among workers engaged in agriculture, suggesting a role of pesticides, whose neurotoxic effect is well known.

Lung cancer risk in the electroplating industry in Lombardy, Italy, using the Italian occupational cancer monitoring (OCCAM) information system.

BACKGROUND: Occupational Cancer Monitoring (OCCAM) is an Italian organization that monitors occupational cancers, by area and industrial sector, by retrieving cases and employment history from official databases. OCCAM previously estimated a relative risk (RR) of lung cancer of about 1.32 among "metal treatment" workers in Lombardy, northern Italy, potentially exposed to chrome and nickel. In the present study, lung cancer risk was estimated among electroplating workers only. METHODS: Lombardy electroplating companies were identified from descriptions in Social Security files. Lung cancer risk was evaluated from 2001 to 2008 incident cases identified from hospital discharge records. RESULTS: The RR for lung cancer among electroplating workers was 2.03 (90% CI 1.33-3.10, 18 cases) for men; 3.00 (90% CI 1.38-9.03, 4 cases) for women. CONCLUSIONS: Electroplaters had higher risks than "metal treatment" workers. Although the risks were due to past exposure, case histories and recent acute effects indicate a present carcinogenic hazard in some Lombardy electroplating factories.

[Study of lung cancer risk in the electroplating industry in Lombardy based on the OCCAM method]. / Studio del rischio cancerogeno per il polmone nell'industria galvanica in Lombardia basato sul metodo OCCAM.

BACKGROUND: The OCCAM method consists of case-control studies aimed at estimating occupational risks by cancer site, by area and by economic sector, using available archives to identify cases and controls; for exposure definition each subject is assigned to the category code of the economic sector or company where he/she worked the longest, obtained by automatic link with the Social Security Institute (INPS) files. The reference category (unexposed) consists of service industry workers. The economic sector is given by the ATECO category that INPS assigns to each firm. OBJECTIVES: In the Lombardy Region, lung cancer risk evaluated for the "metal treatment" industry as a whole was 1.32 (90% CI 1.33-3.10, 67 cases) for males and 1.33 (90% CI 0.51-3.59, 10 cases) for females. The aim of the study was to estimate lung cancer risk among metal electroplating workers only. METHODS: The metal electroplating firms were identified according to the detailed description of production, data which was also contained in INPS files, instead of using the "metal treatment" ATECO code. Lung cancer risk was evaluated using 2001-2008 incident cases identified from hospital discharge records of residents in the Lombardy Region. Controls were a sample from National Health Service files. RESULTS: For the group of firms identified as metal electroplating industries the risk was 2.03 (90% CI 1.69-8.32, 18 cases) for males and 3.75 (90% CI 1.38-9.03, 4 cases) for females. CONCLUSIONS: Focusing on the true electroplating firms increased the risk estimates. Even though these risk were due to past exposures, case histories and recent acute effects indicate that, at least in some factories, a carcinogenic hazard still exists.

[From research on occupational tumors to interventional prevention: use of the OCCAM method at the ASL in Como]. / Dalla ricerca dei casi di tumore professionale agli interventi di prevenzione: l'utilizzo del metodo OCCAM nell'ASL di Como.

In the framework of "Occupational Cancers" project of the Lombardy Region, estimates of cancer risk by site and by economic activity for the incidence period 2001-2004 have been produced in the Local Health Unit of Como. Using these estimates a set of cancer cases with possible occupational origin has been determined. This has been carried out using the OCCAM approach, a case control study where incident cases are identified by hospital discharge records, controls are sampled from health population files and occupational histories are obtained by automatic link with social security archives. This has been integrated with the knowledge of firms and the workers' awareness of other cancer cases in the workforce of the same firms. Among 45 cases with potential occupational origin, 24 were established as due to occupation. These cases were referred for compensation. Moreover, carcinogenic risks still present in some firms were identified and appropriate interventions were carried out.

Confounders and confusion: Dealing with cancer cases of occupational origin.

BACKGROUND: The recognition of occupational cancers is often hampered by confusion between the individual determinants of the disease and effects at the group level. METHODS: Here we propose an approach, based on the evaluation of the attributable risk at the group level, that provides quantitative estimates of the roles of multiple causes in individuals affected of cancer within a population exposed to occupational risk. RESULTS: The estimate of individual probability can be easily obtained computing the attributable risk. This can be often achieved by using the existing information available in the literature. CONCLUSIONS: Dismissing the occupation as a cause of a cancer in an exposed subject on the sole basis of potential confounding is erroneous and should be withdrawn from medical practice.

[The active search for occupational cancers]. / La ricerca attiva dei tumori di origine professionale.

The active search for occupational neoplasms has been implemented only in Italy. This search can be carried out with two modalities: the in-hospital face-to-face interview of selected cancer cases, and the linkage of available information (OCCAM). Both were supported by a special project on occupational carcinogenesis of the Lombardy Region. The active search for occupational neoplasms is a moderate-cost activity and is important for the safeguard of the workforce and of the population as a whole.

[In-progress matrix for occupational cancer recognition]. / Matrice "inprogress" per la consultazione dei dati bibliografici relativi alle neoplasie di sospetta origine professionale.

BACKGROUND: In Italy only a small proportion of all cancers is reported to the national labour insurance board and recognized as having an occupational origin. Cancers with a lower etiological fraction such as lung or bladder cancer have a lower rate of recognition than mesotheliomas or sino-nasal tumours either because of a lack of information obtained via specific occupational anamnesis or because knowledge concerning occupational carcinogens is still uncertain. OBJECTIVES: To interpret findings and advance new working hypotheses, within the framework of an occupational monitoring survey project (OCCAM) we performed an extensive bibliographical search in the scientific literature on occupational cancer. METHODS AND RESULTS: We built an on-line "literature matrix" (www.occam.it) containing positive" results from 685 cohort, case-control and cross-sectional epidemiological studies on occupational cancer, from which 1870 citations were obtained describing risk increases by type of cancer and industry. Production cycles or type of industry (iron foundry, leather and shoe manufacturing, etc.) constitute one axis of the matrix and the other consists of type of cancer by site. CONCLUSIONS: This tool is not only useful for interpretation of evidence arising from occupational cancer surveys but was also intended to be a fast and easy-to-use working tool for occupational physicians, general practitioners and many other specialists to investigate and ascertain the possible occupational origin of a cancer case.

Posterior reconstruction of the rhabdosphincter allows a rapid recovery of continence after transperitoneal videolaparoscopic radical prostatectomy.

OBJECTIVES: Urinary incontinence is one of the major drawbacks of radical retropubic prostatectomy (RRP). One of the possible reasons for this urinary incontinence is a postoperative deficiency of the rhabdosphincter (RS). It has been recently demonstrated that reconstruction of the posterior aspects of the RS allows a rapid recovery of continence after RRP. This study evaluated the application of this technique in videolaparoscopic radical prostatectomy (VLRP), assessing the percentage of continent patients at 3, 30, and 90 d after catheter removal. METHODS: A two-arm prospective comparative trial was carried out with 31 patients recruited for each arm. Group A underwent standard VLRP and group B underwent VLRP with RS reconstruction (VLRP-R). Continence was defined as no pads or one diaper/24h and was assessed 3, 30, and 90 d after the procedure. RESULTS: At catheter removal, 74.2% versus 25% (p=0.0004) of patients were continent with the VLRP-R technique versus VLRP, respectively. A statistically significant difference was present at 30 d (83.8% vs. 32.3%; p=0.0001) At 90 d the difference, although still present, was not statistically significant (92.3% vs. 76.9%; p=0.25). CONCLUSIONS: In this preliminary report, the posterior reconstruction of the RS appears to be an easy and feasible technique even in a laparoscopic setting. Time to continence recovery was significantly shortened.

The Italian surveillance system for occupational cancers: characteristics, initial results, and future prospects.

BACKGROUND: Occupational cancer monitoring is important for cancer prevention and public health protection. A surveillance system for identifying occupational cancer risks and cancer cases in Italy that are likely to be of occupational origin using information available in the Italian Social Security archives was created and assessed. Persons employed in the private sector, the employing company, its industrial sector, and years of employment are available in these archives. METHODS: A method to find known occupational hazards was first tested using a case-control approach. Cases were from six Italian cancer registries (CRs) and controls were sampled from source populations and as "exposure" the economic sector of the employing company was used. The potential of using hospital discharge records as case sources was subsequently assessed: these cover larger populations and are available more quickly than CR case series. RESULTS: In the CR-based study many known occupational cancer risks related to specific industrial sectors were identified. By using cases from hospital discharge records many industries at risk were identified, as well as cases of recent diagnosis likely to be of occupational origin. However, for some industrial sectors (e.g., the chemical industry) the approach was unable to detect any excess risk. Furthermore, information on employees in important areas like agriculture, self-employment, and the public sector is not available in the Social Security archives. CONCLUSIONS: This approach appears to be a promising low-cost method for occupational cancer surveillance, at least for some industries, and can be easily implemented in other countries.

Oncologic outcome and continence recovery after laparoscopic radical prostatectomy: 3 years' follow-up in a "second generation center".

OBJECTIVES: Laparoscopic radical prostatectomy in major centers guarantees oncologic and functional results equal to open procedures. In our institution this operation was introduced in 2001 after an adequate training in laparoscopic surgery. We report the oncologic and functional results after 3 years of experience. METHODS: We considered our first 150 patients that had undergone transperitoneal laparoscopic radical prostatectomy. The following parameters were prospectively collected and analyzed: pathological findings, surgical margins, surgical time, blood loss, hospital stay, catheterization, complications, oncologic follow-up and continence. RESULTS: Single positive surgical margins were observed in 26 patients (17.3%) and multiple positive margins in 15 patients (10%). The rates of positive margins in organ confined tumors (pT2a/b) were 11.3%. Preoperative PSA>10 ng/ml (Chi-square p<0.01), pathological stage>pT2 (Chi-square p<0.001) and Gleason score>6 (Chi-square p<0.01) were significantly correlated with positive margins. Major complications occurred in 16 patients (10.7%). The total recurrence rate is 11.7%. The continence rate at 12 months is 91.7%.with 44.3% of patients completely continent at the moment of catheter removal. CONCLUSIONS: Laparoscopic radical prostatectomy in now a well codified operation that, after an adequate training, could be learned and reproduced safely. Actually this is our first choice surgical approach in patients with localized prostate cancer.

[A monitoring system for occupational cancer]. / Un sistema di monitoraggio per i tumori di origine professionale.

INTRODUCTION: The Italian Occupation and Safety Act (d.lgs 626/94) provided for the establishment of a nationwide occupational cancer registry, under the National Institute for Occupational Health and Safety (ISPESL), with the aim of detecting cancer cases of occupational origin and estimating the influence of occupation in cancer causation. METHODS: Information on cancer cases, drawn from six Italian population-based cancer registries (CRs of Friuli Venezia Giulia Region, Genoa Town and Genoa Province, Macerata Town, Umbria Region, Varese Town, Veneto Region), and on a random sample of population controls selected in each CRs area were linked with data on subjects employed in private enterprises that have been available in electronic form since 1974 at the National Institute for Social Security (INPS). In this way, both for cases and controls, the occupational histories of past employment were collected. A population-based case-control study covering the period 1990-1998 was carried out with the aim of estimating occupational cancer risk in the private sector by site and economic category in each area. Since one of the major drawbacks of this approach is the difficulty in distinguishing true occupational hazards from incidental findings derived from multiple comparisons, an extensive research of occupational literature was carried out, independently of the study results, to compare our results with existing knowledge on occupational risks. RESULTS: Pooled analysis of the most recent incidence data based on 36,379 cases and 29,572 controls was performed; 34 "statistically significant" associations were found for 11 economic categories. Using our literature review, 10 associations were supported by more than 5 publishedpapers, 14 by a number of papers between 1 and 5, and 10 associations had not been previously reported. CONCLUSIONS: This system appears suitable for assessing existing occupational cancer risks and can eventually lead to detecting occupational hazards in many areas of Italy. The system can also provide a list of cases suitable for in-depth search for past occupational exposures.