Geographical patterns of childhood cancer incidence in Europe, 1988-1997. Report from the Automated Childhood Cancer Information System project.

Data on more than 50,000 registrations in the Automated Childhood Cancer Information System (ACCIS) database were used to present an overview of regional patterns in childhood cancer incidence in Europe during 1988-1997, and to present additional detail on selected carcinomas whose occurrence in childhood is seldom described because of their rarity. Total age-standardised incidence was 138.5 per million for Europe overall, and varied between regions from 131.1 per million in the British Isles to 160.1 per million in Northern Europe. Incidence varied significantly between regions for nearly all diagnostic groups. The greatest range of regional incidence rates was for central nervous system (CNS) tumours, from 27.0 per million in the West to 43.8 per million in the North. Differences in registration practice for non-malignant tumours account for some of this variation. There was a marked excess of carcinoma in Eastern Europe, which was wholly attributable to the high incidence of thyroid carcinoma in Belarus, though there was also evidence of inter-regional variation attributable to differences in registration practice. The geographical heterogeneity of incidence rates for other diagnostic groups seems more likely to reflect variations in underlying risk.

[Mesothelioma incidence and time trend in the worlds]. / Incidenza e variazioni temporali dei mesoteliomi nel mondo.

BACKGROUND: Due to its adaptability to different uses, asbestos was increasingly employed in many working and domestic areas up to the 1970s-1980s, when its aetiological role in the onset of pleural mesothelioma (Mm) was recognized. Since then Mm cases have been continuously increasing and no decline is expected until 2020, despite the fact that most industrialized countries banned asbestos use a few decades ago. OBJECTIVES: The aim of this study was to analyse Mm incidence in the World during the last ten years, also considering asbestos consumption in diferent areas. METHODS: Incidence age-standardized rates (ASR) from Cancer Registries included in Cancer Incidence in Five Continents, Vol. VII and VIII, and, when appropriate, standardized rate ratio (SRR) with confidence interval were estimated. RESULTS: The highest incidence rates among males were observed in Liguria and Australia. After Liguria, Maastricht and Scotland in Europe, North East Regions and Piedmont in Italy showed high rates. Among females, the highest incidence rates were observed in Liguria, among black women in New Orleans and in the province of Varese. SRRs revealed increased rates, not always significant, in almost all areas among males and in about 50% of the areas among females, although the variation was significant only in Varese. CONCLUSIONS: These results confirmed a relationship between Mm risk and asbestos use, revealing high incidence rates in Australia (mining), Italy (shipyards, building, goods handling, heavy industries and sea trade) and Great Britain (shipyards). Mm cases increased in areas with elevated incidence rates, suggesting that larger amounts of asbestos were probably used for a longer period. Finally, no Mm cases were registered in some areas, which probably signifies a lack (or a delay) of risk referred to the investigated period.

Epidemiologic surveillance for primary prevention of malignant mesothelioma: the Italian experience.

BACKGROUND: The Italian National Mesothelioma Registry (ReNaM) was set up at the National Institute for Occupational Safety and Health (ISPESL) to estimate Italian incidence of malignant mesothelioma (MM), define modalities of asbestos exposures, assess impact and diffusion of MM, identify underestimated sources of environmental contamination. OBJECTIVES: To describe ReNaM activity, database dimension and epidemiological characteristics of the caselist. METHODS: Regional Operating Centers (COR) in 16 Italian regions were set up to identify and investigate all cases of MM diagnosed in each region, applying national guidelines. COR collect cases in health care institutions. Occupational history, lifestyle and residence are obtained by direct interview using a standard questionnaire. Exposure modalities are classified by industrial hygienists, evaluating whether work, private life or any particular environmental condition could have involved asbestos exposure. RESULTS: Data refer to 3,446 cases collected in 9 Italian regions during 1993-2001. Pleural mesothelioma affected 94% cases, pleural/peritoneal ratio was 16:1. Gender ratio (M/F) was 2.7:1 (1.3:1 for peritoneum). There was a variety of occupational exposures, some already known as high risk sectors and others unexpected. The most common exposures occurred in building and construction, metallurgy and steel, shipbuilding, and railway stock. High risk categories were encountered such as bricklayers, plumbers, carpenters, electricians, welders, installers and maintenance workers in metallurgy and the steel industry, general labourers, tool makers and painters in shipbuilding/repair/demolition. CONCLUSIONS: Despite some ReNam's limitations, identification of MM cases and analysis of modality of exposure, with standardized criteria, are a fundamental tool for primary prevention of asbestos related diseases.

[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.

The impact of screening and early diagnosis on survival--results from the Italian cancer registries.

Early diagnosis of neoplastic diseases enjoined large popularity in the last two decades. In many countries or European regions, population-based cancer screening programs for breast, cervical and colorectal cancer are going on. Diagnostic tests, like the PSA test for prostate cancer, are not yet validated in terms of their efficacy in reducing specific mortality, but their spontaneous diffusion is changing the pattern of the disease incidence. In this contribution, we discuss briefly the survival trends for some tumours (breast, cervix, colorectal, melanoma and prostate cancer) for which the occurrence rates are modified by screening and for some of them we evaluate the possible impact of early diagnosis on survival rates.

Survival analysis of childhood tumours: data from the Italian cancer registries.

This study shows the childhood cancer survival rates of 1,315 cases incident in the 1990-1994 period in Italy. The observed survival shows an increase over the previous period in almost all diagnostic groups. In particular, 5-year survival attained 72% overall, 78% for acute lymphatic leukaemia, about 100% for Hodgkin's disease, 70% for non Hodgkin's lymphomas, 64% for central nervous system tumours, 87% for retinoblastoma, 80% for renal tumours, 67% for hepatic tumours, 71% for bone tumours, and 70% for soft tissue sarcomas. Finally, the findings are comparable to those in other countries (USA, Great Britain, Australia, Slovakia) and they show a progressive improvement in survival.

Survival trends of childhood cancer during the period 1978-1994 in Italy: a first report from the Italian cancer registries.

This article shows the survival trends of childhood cancers diagnosed from 1978 to 1994 in Italy. A first analysis presents a survival increase for all the diagnostic categories and in both sexes, with the exception of Hodgkin's disease, for which five-year survival is stable at 97%. The results of this analysis show that five-year survival changes from 54% to 72% for all cancers, from 56% to 70% for non Hodgkin's lymphomas, from 53% to 64% for central nervous system tumours, from 59% to 78% for acute lymphatic leukaemia, from 18% to 42% for acute non lymphatic leukaemia, from 30% to 62% for neuroblastoma and from 33% to 71% for malignant bone tumours. Concerning international comparisons, the overall Italian rates and their increases are very similar to the USA ones. Instead, if we consider a comparison between survival trends in Italy and survival trends observed in some European countries, like Great Britain, Slovakia and Denmark, it is evident that in Italy there is a faster improvement of prognosis for almost all diagnostic categories.

[Methodological issues and first results of a record linkage between AIDS and Cancer Registries in Italy]. / Incrocio tra i Registri Tumori italiani e il Registro nazionale AIDS: aspetti metodologici e primi risultati.Cancer and AIDS Registry Linkage Study.

We report herein, the first results of a record linkage between the Italian AIDS Registry and 13 population-based Cancer Registries (about 8-million population in 1991). An anonymous linkage process was carried out on about 339,000 cancer notifications and 6,067 AIDS ones reported between 1982 and 1994. Out of 243 Kaposi's sarcomas (KS) below age 50 years recorded at either type of registry, 90 (37%) were reported as such by both. Sixty-eight percent of individuals with KS at Cancer Registries could be identified at the AIDS Registry. Sixty-two percent of individuals with KS and 65% of individuals reported as having non-Hodgkin's lymphoma (NHL) at RAIDS could be also found at Cancer Registries. Among 6,067 persons with AIDS 15-69 years old, observed and expected numbers of cancer and age-standardised incidence ratios (SIR) on a total of 25,759 person-years were computed. Significantly increased SIR was found for Hodgkin's disease (8.9; 95% CI: 4.4-16.0), invasive carcinoma of the cervix uteri (15.5; 95% CI: 4.0-40.1), and non-melanomatous skin cancer (3.0, 95%, CI: 1.3-5.9). As in previous studies, KS and NHL were greatly increased (SIR = 1,300 and 59, respectively). The risk for all cancer types, after exclusion of KS and NHL, was approximately twice the risk of the general population. An increased SIR of Hodgkin's disease in persons with AIDS is thus confirmed, though many-fold smaller than for NHL. An association with invasive carcinoma of the cervix is also shown at a population level. These data indicate the potential of AIDS and Cancer Registries for improving cancer assessment in individuals with HIV/AIDS and elucidating the role of immune system on cancer onset.

Gastric and lung cancer mortality in the Marche region of Italy, 1980-1983.

This paper describes patterns in gastric and lung cancer mortality in the Marche region of Italy and in its 24 Local Health Districts (LHD) over the period 1980-83. Mortality data were obtained from the magnetic tapes provided by the National Institute of Statistics. Linear regressions were tested with the aim to relate the AADRs with the proportion of the agricultural workers in the 1951, 1961 and 1971 census years. The results obtained show that, in the whole Marche region, mortality from lung cancer is first in male cancer mortality. However within the Region itself many LHDs had different patterns. Among the LHDs, gastric cancer rates were the highest in some northern mountain zones, and lung cancer rates in some central coastal zones. Statistical analyses emphasize the inverse relationship between the male 0-64 AADRs relative to gastric cancer and those of lung cancer in the 24 LHDs. Among these, the male gastric cancer 0-64 AADRs are significantly and directly related to the proportion of farm workers in 1971, and the female ones to the proportion of farm workers in all the three periods, which in turn are always inversely related to the 0-64 AADRs male lung cancer. The differences between the observed and expected death frequencies in the several LHDs stress the results obtained in the present study, which generally agree with those obtained in other studies regarding the same and neighbouring areas and with those reported by the international literature.

[Production of coagulase and thermonuclease in 366 strains of staphylococci belonging to different lyogroups]. / Produzione di coagulasi e termonucleasi in 366 ceppi di stafilococchi appartenenti a diversi liogruppi.

366 human staphylococci were tested for the production of coagulase and thermonuclease and were subdivided into lyogroups. 98% of the isolates showed uniformly positive or uniformly negative results for the production of two enzymes. All uniformly positive strains belonged to the species Staphylococcus aureus, whereas coagulase-thermonuclease negative strains were easily subdivided into five lyogroups. Seven strains produced only one of two enzymes and were identified by analysis of their bacteriolytic activity. Two of these strains were identified as Staphylococcus aureus, one was coagulase negative and the other thermonuclease negative.

Cause of death risk in relation to general mortality in zones with different degrees of urbanization.

This investigation deals with the distribution of mortality of four groups of causes (Diseases of the Circulatory System, of the Respiratory System, of the Digestive System, Injuries and Poisonings) in the coastal (urban area), hill (semi-urban area) and mountain (rural area) zones of the Marche (a region of Central Italy) with the aim of evaluating the risk of death from a specific cause in relation to mortality from all causes. Besides the Age Standardized Mortality Rates (ASDR), both the Relative Standardized Mortality Ratios (RSMR) and the Standardized Proportional Mortality Ratios (SPMR) were utilized.--The results obtained showed that the RSMR and the ASDR had the same trend when the urgan area and the rural area were compared--excluding the diseases of the circulatory system--the risk of death from causes was higher in the urban area. On the contrary, comparing the semi-urban area with the urban area and the rural area, dissonant behaviour between the two parameters was revealed.--The results obtained with the RSMR and with the SPMR were almost always similar.--To determine the significance of the deviation between expected number and observed number of deaths, the procedure for estimating the relation of mortality from specific causes to that from all causes (adaptation of Mantel-Haenszel method) was used. The deviation of the observed from expected number of deaths in the mountain zone, taking the coastal zone as control, was statistically significant or very close to significance for each cause with the exception of injuries and poisonings in females and diseases of the circulatory system in both sexes.

Parallelism in the mortality clustering of the most frequent cancer sites in Italy and in the Marche region.

Clusters of selected cancer sites mortality, regarding Italy and the Marche region, were compared. Very similar associations were found both in males and in females, in particular between the alcohol-tobacco-related sites. Many clusters agree with the international literature, while others could constitute a starting point for formulating new hypotheses.

[Urine bacterial flora and chemoantibiotic resistance: observations on ambulatory patients and hospitalized patients at the local health district No. 11 of Fabriano (Ancona)]. / Flora batterica urinaria e chemioantibiotico-resistenza: osservazioni su pazienti ambulatoriali ed ospedalizzati nella U.S.L. 11 di Fabriano (Ancona).

This paper reports the results of a study carried out on 4614 samples of urine from inpatients and outpatients according to the sex. The positive monomicrobic urine specimens were examined and isolated strains were tested against various antimicrobial drugs. Our findings showed that 43.1% of urine specimens examined from inpatients and 38.4% from outpatients proved to be positive. Among the bacterial species more frequently isolated, significant differences among Enterobacter spp. in males and coagulase-negative Staphylococcus spp. in females from general practice, and Pseudomonas spp. in females from the hospital were observed. Statistical analysis reveals that: a) no significant differences were found in antibiotic-resistance among Escherichia coli, Proteus rettgeri, Streptococcus faecalis, Enterobacter spp. and Pseudomonas spp., isolated from inpatients and outpatients as regards males and females; b) Klebsiella spp., Proteus rettgeri and coagulase-negative Staphylococcus strains isolated from females inpatients are more chemo-resistant than those from females outpatients.

Mortality from cancer of the digestive system in Italy: 1950-1975 cross-sectional rates and cohort analysis.

In this study of mortality from cancer of the digestive system in Italy, 1950-1975, both cross-sectional rates and cohort analysis were used. The study found that in both sexes age-standardized rates for cancer of the colon, rectum, liver and biliary tract, and pancreas are increasing whereas the rates for cancer of the stomach are decreasing. Rates for esophagus cancer have remained fairly constant. Cohort analysis showed different trends for selected sites. As to cancer of the stomach, for both sexes, cohorts born up until about 1881 have constant or increasing rates; cohorts born after 1881 have declining rates. For cancer of the esophagus in males the rates reach a peak in the 1896 birth-cohort; cohorts born prior to 1896 show an increase in rates and cohorts born later show a decline. For cancer of the colon, liver and biliary tract, and pancreas, the rates rise constantly for all ages and all cohorts in both sexes. The rates for cancer of the rectum rise after age 75 whereas below that age the rates tend to level off and decline.

[Salmonella isolated in the province of Macerata and their sensitivity to some common chemoantibiotics and to some of recent clinical introduction]. / Salmonelle isolate in provincia di Macerata e loro sensibilità a chemioantibiotici di largo impiego e di recente introduzione clinica.

A study has been carried out in order to evaluate the sensitivity of a group of some 215 Salmonella strains identified in the triennium 1976-1978, in the district of Macerata (Italy), to 16 chemoantibiotics. The average percentage of sensitivity to chemoantibiotics, as a whole, vary from 100% (sisomycin) to 81% (furazolidone). The global sensitivity of different strains, of early diffusion and recent appearance in Italy, by MIC and MBC estimated, progressively increase as follow: A. wien, typhi, typhimurium, infantis, braenderup, paratyphi B, enteritidis, agona, panama.

[Characterization of species of the genus Clostridium by gas chromatographic analysis of the fatty acids produced during metabolism]. / Caratterizzazione di specie del genere Clostridium mediante analisi gas-cromatografica degli acidi grassi prodotti dal metabolismo.

Volatile and non volatile fatty acids deriving from the bacterial metabolism of different sugars were determined by gas-chromatography to better characterize Clostridium tertium and Clostridium ramosum. The data obtained were also used for numerical taxonomic analysis and dendrograms were elaborated to study the taxonomic relationships between the two species.

Tobacco smoking, coffee, cocoa and tea consumption in relation to mortality from urinary bladder cancer in Italy.

This paper examines changes in mortality from urinary bladder cancer in Italy during the years 1950-81 in relation to changes in smoking habits and in coffee, cocoa and tea consumption. The authors found that, in both sexes and for all ages, mortality has been increasing throughout this period, although the rates and relative increase have consistently been much lower and more gradual for women than for men. From the analysis of age-cohort-period variation it seems that bladder cancer mortality can also be influenced by changes in smoking habit patterns and by variation in the quality of diagnoses. The increase in death risk for both sexes in Italy up to cohorts born around 1905-10 can be related to occupational exposures and to high-tar-content tobacco smoking, whereas the tendency for mortality rates to stabilize and decline in cohorts born after 1910 were influenced by changes from high-tar-content and no-filter cigarettes to low-tar-content and filter cigarettes and by prevention measures taken in at-risk working environments. The consumption of coffee, cocoa and tea does not seem to be related to the increase in bladder cancer risk in Italy.

[Sero-epidemiological studies of the anti-rubella immunological status of a sample of the female population]. / Indagine siero-epidemiologica sullo stato immunitario antirubeolico in un campione di popolazione femminile.

A retrospective study on the prevalence and distribution of haemoagglutination inhibiting rubella antibodies in a sample of 4493 women (3150 in pregnancy), showed a low percentage of vaccinated women ( 0.6%) and high share of negative sera (12.6%). The Authors carried on the analysis subdividing the data according to age of the women, their pregnancy's condition or quarter, their residence (Rome and out of Rome) and occupation (housewife and not). The Pearsonian chi-square showed a significant difference between the lower immunization of housewife group and that of non-housewife group. Moreover the seropositivity decreases according to aging.

[Seropositivity to toxoplasma in 3,455 women. Its role in abortion and evaluation of some probable risk factors (author's transl)]. / Sieropositività al toxoplasma; relazioni con alcuni probabili fattori di rischio e con l'aborto.

A retrospective study on 3,455 women showed 60.8% of positive cases to Toxoplasma antibodies. The role in antibody occurrence of raw (or underdone) meat eating was statistically verified. Moreover the findings suggest that Toxoplasma infection may prove to be an significant aetiological factor for abortion.