Causes of death in women with breast cancer: a risks and rates study on a population-based cohort.

Introduction: The increasing survival of patients with breast cancer has prompted the assessment of mortality due to all causes of death in these patients. We estimated the absolute risks of death from different causes, useful for health-care planning and clinical prediction, as well as cause-specific hazards, useful for hypothesis generation on etiology and risk factors. Materials and methods: Using data from population-based cancer registries we performed a retrospective study on a cohort of women diagnosed with primary breast cancer. We carried out a competing-cause analysis computing cumulative incidence functions (CIFs) and cause-specific hazards (CSHs) in the whole cohort, separately by age, stage and registry area. Results: The study cohort comprised 12,742 women followed up for six years. Breast cancer showed the highest CIF, 13.71%, and cardiovascular disease was the second leading cause of death with a CIF of 3.60%. The contribution of breast cancer deaths to the CIF for all causes varied widely by age class: 89.25% in women diagnosed at age <50 years, 72.94% in women diagnosed at age 50-69 and 48.25% in women diagnosed at age ≥70. Greater CIF variations were observed according to stage: the contribution of causes other than breast cancer to CIF for all causes was 73.4% in women with stage I disease, 42.9% in stage II-III and only 13.2% in stage IV. CSH computation revealed temporal variations: in women diagnosed at age ≥70 the CSH for breast cancer was equaled by that for cardiovascular disease and "other diseases" in the sixth year following diagnosis, and an early peak for breast cancer was identified in the first year following diagnosis. Among women aged 50-69 we identified an early peak for breast cancer followed by a further peak near the second year of follow-up. Comparison by geographic area highlighted conspicuous variations: the highest CIF for cardiovascular disease was more than 70% higher than the lowest, while for breast cancer the highest CIF doubled the lowest. Conclusion: The integrated interpretation of absolute risks and hazards suggests the need for multidisciplinary surveillance and prevention using community-based, holistic and well-coordinated survivorship care models.

Physical activity and play in kindergarten age children.

PERISCOPE project assesses factors promoting or preventing obesity development in early age. A specific aim is to assess preschool children's physical activity habits in three different European countries. PERISCOPE has been implemented in 1094 children attending kindergartens in Denmark, Italy and Poland. The parents' and children's physical activity habits and attitudes assessed by a questionnaire filled by the parents. Overweight and obesity assessed by Cole's BMI cut-off points. Statistical analysis performed by χ(2) test and the test of proportion. Denmark shows the lowest rate (14.6 %) of overweight, followed by Poland (17.1%), while Italy shows the highest (21.2 %) (p < 0.0001). The Polish families show the highest rate of walking from home to kindergarten and back, followed by the Italians and, lastly, the Danish ones (p < 0.001). Almost all the Danish and Polish children, but only the 50.1 % of the Italians play outside (p < 0.001). During the weekdays, 34.9 % of Polish children, 22.2 % of Italians and 19.8 % of the Danish play outside more than one hour a day (p < 0.0001). During the weekend, 91.1 % of Polish children, 86.7 % of Danish children, but only 54.4 % of Italians play outside more than one hour (p < 0.0001). 53.5 % of Danish children, 31.9 % of Polish children, and 18.2 % of Italian ones practice sport (p < 0.0001). Danish children are the most active, the Polish are in the middle and the Italians are the least active. The difference in infrastructures (safety of walking streets, access to playgrounds/parks, etc.) can play an important role, in addition to cultural and social family characteristics, to the development of overweight.