Epidemiology of HPV-related female cancers in the Umbria region of Italy: pre-vaccination period.

The authors describe the incidence and mortality rates of human papillomavirus (HPV)-related female cancers in Umbria (Italy) in the pre-vaccination period from 1978-2008. Joinpoint regression was applied on age-adjusted incidence and mortality rates to evaluate temporal trends. Mouth and pharynx cancers incidence and mortality trends decreased about three percent per year. For anus and anal canal cancer, incidence and mortality trends presented a non-significant decrease. For malignant neoplasm of vulva, a significant change was found in incidence trend: the annual percentage change decreased from 2001 (- 1.8%). Mortality trend showed a non-significant decrease. Incidence and mortality rates from vaginal cancer were non-significantly decreased. For malignant neoplasm of cervix uteri, incidence rates showed a significant decrease by 2.1% per year. Mortality rates decreased as well, although non-significantly. HPV-related cancers consistently decreased in Umbria. This trend may be a consequence of safer sexual behavior. For cervical cancer, a combination of opportunistic and programmed screening led to a much-reduced disease burden. It is expected that the implementation of vaccination in the future will lead to a further decrease of HPV-related cancer incidence and mortality.

Risk of multiple primary cancers following melanoma and non-melanoma skin cancer.

BACKGROUND: The relationship between cutaneous malignancies and successive primary cancers has been studied since several years, but it still remains controversial. OBJECTIVE: The aim of this study was to evaluate the excess risk of multiple primary cancer among the population of Umbria, Italy, that survived a skin cancer. METHODS: The data registered in the Umbrian Population Cancer Registry from 1994 to 2006 were collected, recorded, and analysed in accordance to the standard methods recommended for cancer registries. Among skin cancer patients, those with multiple cutaneous and non-cutaneous cancers were selected. Only sites with a frequency of more than five cases were considered. The expected number of cases was obtained from indirect standardization with regional incidence rates in several sites that incurred in the overall period. The significance of the observed/expected ratios and the corresponding 95% CI were based on the Poisson distribution. RESULTS: In men, a significant standardized incidence ratio (SIR) was found for melanoma (2.21), non-melanoma skin cancers (1.86), Hodgkin's (4.95) and non-Hodgkin lymphoma (1.82), and tongue/mouth cancer (2.47). In women, melanoma, non-melanoma skin and breast cancer showed a significant high SIRs (4.13, 1.55 and 1.28 respectively). All other cancers showed a non-significant SIR. Considering all sites combined and all sites except skin cancers, the analysis showed a significant excess in men, whereas a significant risk was observed in women only when also skin cancers were considered. CONCLUSIONS: Data from the whole of Umbrian population revealed that skin cancer patients experience marked excess risk of further primary cancers. The main risk in both genders is skin melanoma and other skin cancers. The excess of lymphomas and tongue/mouth cancers is also significant in men, and breast cancer in women. These observations prompt us to include a screening for these cancers in the follow-up of our patients surviving a skin malignancy.

Recent trends in incidence, mortality and survival after cancer of the female breast and reproductive organs. Umbria, Italy: 1978-2005.

This study analyzed the incidence, mortality and survival after cancer of the female breast and reproductive organs in the Umbria region of Italy with the aim of generating hypotheses to explain trends. Mortality data were supplied by ISTAT (1978-1993) and ReNCaM (1994-2005) and incidence (1994-2005) and survival (at 12/31/2007) data by RTUP. Joinpoint regression was applied to evaluate temporal trends of the age-adjusted incidence and mortality rates. Mortality, incidence and relative survival rates were compared with national and international data. The incidence of breast cancer increased up to 2001 and afterwards significantly decreased; mortality rates significantly decreased after 1994. Uterine corpus incidence was practically stable, and decreased over the study period; mortality from all uterine subsites significantly decreased from 1978 onwards. Trends in ovarian cancer incidence and mortality (after 1985) were constant. Trends in occurrence of breast and cervical cancer were linked to population screening of Umbrian women, noting a low compliance by younger females with cervical cancer screening and emphasizing the opportunity of starting breast cancer screening at a younger age. Trends in the incidence of cancer of the uterus and ovary, though unsteady, were probably related to modifications in risk factor exposure. Survival was better for breast and cervical cancers than in the 1978-1982 period and might be due to early diagnosis and progress in therapy.

Incidence of multiple primary malignancies in women diagnosed with breast cancer.

Using data from the Umbrian Population Cancer Registry (RTUP) we tested the hypothesis of relationships between several subsequent cancer sites in women who had had breast cancer. New patients (7,840) were collected from the RTUP between 01/01/1994 and 31/12/2006; 24 DCO cases were excluded; 332 successive multiple cancers in 320 patients were recorded. Including all second cancers, metachronous contralateral breast cancer, the observed/expected ratio (SIR) was non-significant. Excluding these cases, SIR was significantly lower whether with or without second skin carcinomas. SIR of all second metachronous contralateral cancers, excluding skin carcinomas, was non-significant. Significantly lower risk involved the colorectum, stomach, pancreas and metachronous breast with different histology. A significant excess was found of melanoma and total second breast cancers, including the contralateral. The excessive skin melanoma in breast cancer survivors was attributed to the relationship with BRCA2 and CDKN2A mutation-positive patients. The excess risk due to the CDKN2A mutation should also include pancreatic cancer which, in the present study, presented a significantly lower risk.

[Decrease of frequency of male lung cancer in Umbria region. 1978-1982 and 1994-1999]. / Diminuzione della frequenza del tumore polmonare nei maschi umbri. 1978-1982 e 1994-1999.

In Umbria, region of Central Italy, lung cancer is the leading cause of death due to cancer in males. The aim of this work is to highlight decrease of mortality from lung cancer in males in Umbria, in the last 20 years and to describe relationship among incidence, mortality and survival of this cancer. The incidence data derived from an ad hoc survey carried out over the period 1978-1982 and for 1994-1999 from the Umbrian Population Cancer Registry (RTUP). The mortality data were derived from official publications of the Italian Central Institute for Statistics (ISTAT) and covered the entire period 1978-1999. Estimated annual percent change (EAPC) was calculated by joinpoint regression analysis. Decrease of mortality from male lung cancer in Umbria began in the 1990-ies due to reduced quantity of tar in cigarettes, decreasing consumption of tobacco and increasing of survival derived from the quality and the effectiveness of the oncological health care system.