Long-term survival, prevalence, and cure of cancer: a population-based estimation for 818 902 Italian patients and 26 cancer types.

BACKGROUND: Persons living after a cancer diagnosis represent 4% of the whole population in high-income countries. The aim of the study was to provide estimates of indicators of long-term survival and cure for 26 cancer types, presently lacking. PATIENTS AND METHODS: Data on 818 902 Italian cancer patients diagnosed at age 15-74 years in 1985-2005 were included. Proportions of patients with the same death rates of the general population (cure fractions) and those of prevalent patients who were not at risk of dying as a result of cancer (cure prevalence) were calculated, using validated mixture cure models, by cancer type, sex, and age group. We also estimated complete prevalence, conditional relative survival (CRS), time to reach 5- and 10-year CRS >95%, and proportion of patients living longer than those thresholds. RESULTS: The cure fractions ranged from >90% for patients aged <45 years with thyroid and testis cancers to <10% for liver and pancreatic cancers of all ages. Five- or 10-year CRS >95% were both reached in <10 years by patients with cancers of the stomach, colon-rectum, pancreas, corpus and cervix uteri, brain, and Hodgkin lymphoma. For breast cancer patients, 5- and 10-year CRSs reached >95% after 19 and 25 years, respectively, and in 15 and 18 years for prostate cancer patients. Five-year CRS remained <95% for >25 years after cancer diagnosis in patients with liver and larynx cancers, non-Hodgkin lymphoma, myeloma, and leukaemia. Overall, the cure prevalence was 67% for men and 77% for women. Therefore, 21% of male and 31% of female patients had already reached 5-year CRS >95%, whereas 18% and 25% had reached 10-year CRS >95%. CONCLUSIONS: A quarter of Italian cancer patients can be considered cured. This observation has a high potential impact on health planning, clinical practice, and patients' perspective.

Incidence of thyroid cancer in Italy, 1991-2005: time trends and age-period-cohort effects.

BACKGROUND: In Italy, some of the highest incidence rates (IRs) of thyroid cancer (TC) worldwide have been reported. PATIENTS AND METHODS: TC cases <85 years of age reported to Italian cancer registries during 1991-2005 were included. Age-standardized IRs were computed for all TC and age-period-cohort effects were estimated for papillary TC. RESULTS: IRs of TC were twofold higher in 2001-2005 than in 1991-1995 (18 and 8 per 100,000 women, 6 and 3 per 100,000 men, respectively). Increases were similar in the two sexes and nearly exclusively due to papillary TC. Increases of papillary TC by birth cohort were found in both sexes and among all age groups between 20 and 79 years. Age-period-cohort models showed a strong period effect in both sexes (rate ratio for 2001-2009 versus 1991-1995 = 2.5 in women and 2.3 in men), although IRs peaked at an earlier age in women (45-49 years) than men (65-69 years). CONCLUSION: The strength of the period effect in both sexes and the earlier onset in women than men strongly implicated increased medical surveillance in the upward trends of papillary TC incidence in Italy. The consequences of the current intense search for TC on morbidity and possible overtreatment, especially among young women, should be carefully evaluated.

Pattern of cancer risk in persons with AIDS in Italy in the HAART era.

A record-linkage study was carried out between the Italian AIDS Registry and 24 Italian cancer registries to compare cancer excess among persons with HIV/AIDS (PWHA) before and after the introduction of highly active antiretroviral therapy (HAART) in 1996. Standardised incidence ratios (SIR) were computed in 21951 AIDS cases aged 16-69 years reported between 1986 and 2005. Of 101 669 person-years available, 45 026 were after 1996. SIR for Kaposi sarcoma (KS) and non-Hodgkin lymphoma greatly decreased in 1997-2004 compared with 1986-1996, but high SIRs for KS persisted in the increasingly large fraction of PWHA who had an interval of <1 year between first HIV-positive test and AIDS diagnosis. A significant excess of liver cancer (SIR=6.4) emerged in 1997-2004, whereas the SIRs for cancer of the cervix (41.5), anus (44.0), lung (4.1), brain (3.2), skin (non-melanoma, 1.8), Hodgkin lymphoma (20.7), myeloma (3.9), and non-AIDS-defining cancers (2.2) were similarly elevated in the two periods. The excess of some potentially preventable cancers in PWHA suggests that HAART use must be accompanied by cancer-prevention strategies, notably antismoking and cervical cancer screening programmes. Improvements in the timely identification of HIV-positive individuals are also a priority in Italy to avoid the adverse consequences of delayed HAART use.

Regional indices of socio-economic and health inequalities: a tool for public health programming.

OBJECTIVES: The aim was to provide an affordable method of computing socio-economic (SE) deprivation indices at the regional level, in order to reveal the specific aspects of the relationship between SE inequalities and health outcomes. The Umbria Region Socio-Health Index (USHI) was computed and compared with the Italian National Deprivation Index at the Umbria regional level (NDI-U). METHODS: The USHI was computed by applying factor analysis to census tract SE variables correlated with general mortality and validated through comparison with the NDI-U. RESULTS: Overall mortality presented linear positive trends in USHI, while trends in NDI-U proved non-linear or non-significant. Similar results were obtained with regard to specific causes of death according to deprivation groups, gender and age. CONCLUSIONS: The USHI better describes a local population in terms of health-related SE status. Policy-makers could therefore adopt this method in order to obtain a better picture of SE-associated health conditions in regional populations and to target strategies for reducing health inequalities.

Decline in pneumonia and acute otitis media after the introduction of childhood pneumococcal vaccination in Liguria, Italy.

The effect of the pneumococcal conjugate vaccine immunization programme on pneumococcal-associated or potentially pneumococcal-associated hospital admissions in the Italian region of Liguria was assessed. Hospital admission rates were compared in subjects belonging to birth cohorts before and after the introduction of widespread immunization for 0 - 2-year old children with a seven-valent conjugate vaccine (PCV7). Significant reductions in hospitalization rates for all-cause and pneumococcal pneumonia and for acute otitis media were observed in subjects born after widespread uptake of the vaccine. The preventive fraction (a measure of vaccine effectiveness) ranged from 15.2% for all cause pneumonia to 70.5% for pneumococcal pneumonia. This study contributes to the growing body of information that supports the beneficial effect of PCV7 vaccination.

The local Socio-Economic Health Deprivation Index: methods and results.

INTRODUCTION: A socio-economic (SE) deprivation index is a measure that aims to provide an indication of SE hardship and disadvantage in the population. Our aim was constructing 10 Socio-Economonic and Health Deprivation Indexes (SEHDI) by means of the same method. This particular method enables these indexes to be used to investigate the relationships between SE inequalities and aspects of health and prevention in the population. MATERIALS AND METHODS: Data on the demographic and SE situation of the populations were taken from the 2011 Census at the Census Tract (CT) level (2001 for Rome municipality). To construct the SEHDIs, variables displaying a statistically significant correlation with the SMRs of overall mortality were subjected to a tolerance test of linearity, in order to eliminate collinear variables. The variables selected underwent PCA factor analysis, in order to obtain the factors to be linearly combined into the SEHDI. The final values were scaled from minimum to maximum deprivation, and the quantitative scale was converted into five ordinal normalized population groups. The SEHDIs were validated at the SE level by comparing them with the trends of the main SE indexes used in the 2011 Census (2001 for Rome municipality), and at the health level by comparing them with the trends of some causes of death. Both comparisons were made by means of ANOVA. RESULTS: The 10 areas considered were: the municipalities of Cagliari, Ferrara, Florence, Foggia, Genoa, Rome, Palermo, Sassari, Siena, and the ULSS 7 Veneto area. For each one, a specific SEHDI was computed and the different variables comprising each index focused on particular aspects of SE and health deprivation at the area level. The SEHDIs showed good percentages of explained variance (from 72.2% to 49.1%) and a linear distribution of the main statistical SE indices and of overall mortality in each area; these findings were in line with the literature on the relationship between the SE condition and health status of the population. The distribution of cause-specific mortality across the SEHDIs deprivation clusters is analyzed in other articles, which deal with the findings of the study in each area. CONCLUSIONS: The SEHDIs showed good ability to identify the elements of SE inequalities that impact on the health conditions of populations; to depict the distribution of causes of death that are sensitive to SE differences concerning aspects of the social and family support structure. From a public health perspective, these results are relevant because they enable interventions of health promotion and prevention to be implemented on the basis of the characteristics that define deprivation groups.

Influenza vaccination coverage and deprivation among the elderly in the municipality of Cagliari: results and perspectives.

INTRODUCTION: The elderly are among the main targets of influenza vaccination campaigns. Previous studies have shown that socio-economic status influences compliance with influenza vaccination, particularly in the elderly. Deprivation indexes can therefore be useful in identifying population groups with lower vaccination uptake and guide targeted intervention to improve vaccination coverage. We analysed the correlation between influenza vaccination coverage and levels of socio-economic and health deprivation among the population of Cagliari, by means of an Index of Socio-Economic and Health Deprivation (SEHDI) specifically tailored to the city, in order to identify population subgroups needing specific intervention to improve vaccination coverage. METHODS: A combination of linear regression, factor analysis and cluster analysis was adopted in order to build the SEHDI at the Census Tract (CT) level; data were taken from the 2011 Italian Census. Mortality among subjects aged ≥ 65 years in Cagliari in the period 2013-2015 was used to select the SEHDI variables. On the basis of the SEHDI, his population was classified into five normalised deprivation groups. Information on vaccination coverage was provided by general practitioners and Local Health Units. Cause-specific mortality and information on vaccination coverage in the deprivation groups were analysed by means of ANOVA (F test at p < 0.05). RESULTS: Around 20% of the Cagliari population was seen to be living in disadvantaged conditions. The trends in Standard Mortality Rates (SMRs) for all causes and for respiratory diseases, chronic obstructive pulmonary diseases (COPD), influenza and pneumonia were analysed across the deprivation groups. Pneumonia and flu mortality rates displayed a non-linear trend in men and a positive linear trend in women. Flu vaccination uptake rates were low: 27%. Coverage proved to be lower in the two extreme categories and higher in the medium deprivation ones. CONCLUSIONS: The correlation between low vaccination coverage and socio-economic deprivation not only underlines the important role of vaccination in safeguarding health, but also the fact that it can be considered a factor in ensuring the system's equality, thanks to its role in limiting health impacts on those living in the most problematic or disadvantaged circumstances. It also stresses the characteristics which contribute to low compliance. Therefore, this finding should be taken into account in the organization of vaccination campaigns and should prompt differentiated interventions in each local area.

Analysis of influenza vaccination coverage among the elderly in Genoa (Italy) based on a deprivation index, 2009-2013.

INTRODUCTION: The elderly suffer the most influenza-related complications, and 90% of deaths due to influenza occur in older subjects. Consequently, the elderly are among the main targets of influenza vaccination campaigns. The use of deprivation indexes can help to identify subgroups with lower vaccination uptake. This study analyzed influenza vaccination coverage in elderly persons living in Genoa (Italy) in relation to a local Index of Socio-Economic and Health Deprivation (SEHDI) in order to identify population subgroups needing specific intervention to improve vaccination coverage. METHODS: The study targeted subjects aged ≥ 65 years living in Genoa in the period 2009-2013. Information on vaccination coverage was provided by general practitioners and Local Health Units. A combination of linear regression, factor analysis and cluster analysis was used to construct the SEHDI at Census Tract (CT) level, on the basis of data from the 2011 Italian census. RESULTS: In 2011, people aged ≥ 65 years accounted for the 27.7% of the population of Genoa. Most elderly subjects were assigned to either the medium (45.3%) or medium-high (32%) deprivation groups, while the percentages in the extreme tails were low (3.6% high deprivation; 1.3% low deprivation). Significant, non-linear (p < 0.05 NL) relationships were observed in both sexes with regard to mortality due to all respiratory diseases (RD) and chronic obstructive pulmonary disease (COPD), with the highest Standardized Mortality Ratio (SMR) values in women in the high deprivation group of women (1.81, p < 0.05 RD; 1.79, p < 0.05 COPD). The SMRs for influenza and pneumonia showed a positive linear trend in women (p < 0.05) with the highest value in the high deprivation group (1.97, p < 0.05), while in men the trend was NL (p < 0.05). A positive linear trend (p < 0.05) was found with regard to vaccination coverage, which grew weakly as deprivation increased, up to the medium-high deprived group (from 34.6% to 44.4%). However, the high deprivation group showed the lowest value (33.3%). CONCLUSIONS: The results revealed a relationship between deprivation and influenza vaccination coverage in the elderly. This finding should be taken into account in the organization of vaccination campaigns and should prompt differentiated intervention in each local area.

Prostate cancer incidence and mortality trends among elderly and adult Europeans.

Prostate cancer is a common malignancy primarily of elderly men, with incidence rates rapidly increasing, owing to the population ageing and the introduction of more sensitive diagnostic procedures. Although the effectiveness of a screening test remains controversial, the decreasing mortality rates, which recently emerged in the USA, may be partly attributable to the changes of patterns of care, thus suggesting a potential effect of preventive measure. The object of this study is to examine time trends in incidence and mortality from prostate cancer in European Union (EU) countries, with particular attention to possible differences between the elderly (65 years old or over) and younger or middle age adults (35-64 years old). EUROCIM, the data base created by the European Network of Cancer Registries, provided the incidence and mortality data for the 12 EU Countries analysed (namely: Finland, Denmark, Scotland, England and Wales, Ireland and The Netherlands in Northern Europe; Austria, Germany and France in Central Europe; Italy, Spain and Portugal in Southern Europe), for the 1978-1994 period. Incidence and mortality time trends, expressed as mean difference per cent (MD%) per year, were estimated by a Poisson log-linear regression model. Higher resolution analyses were also carried out to check differences in time trends by age class within the two groups under study. Upward mortality trends occurred in several countries, excepting Ireland, Austria and Southern Europe, but only for younger and middle aged adults. Rates increased more rapidly in older age groups; a clear north-south gradient appeared both in the elderly and in younger adults; for the elderly, MD% higher than +1.5 for most countries of Northern Europe, MD% around +1 for Central Europe, and MD% less than +1 for Southern Europe were registered, with lower values for younger people. Incidence rates rose across the period considered, almost in all countries both for elderly and for younger and middle age adults, increasing more rapidly in younger age. Incidence trends showed a less clear geographic pattern than for mortality. In the younger group, high MD%, ranging in Northern Europe from +3.2 in Finland and England and Wales to +5.7 in The Netherlands, were observed, while in the South values ranged between +4.2 and +5.0. In Central Europe, very high MD%, ranging between +8.4 in France and +16.6 in Austria, were noted. No significant trends were observed for Denmark, Ireland and Portugal. For the elderly the increase was generally lower and no significant trend was observed in Germany and Portugal. Interaction between age and calendar period in the older group was observed for most of the considered countries. With reference to mortality, the MD% showed a tendency to rise, with increasing age, while no consistent pattern emerged for incidence. The observed incidence trends are probably a consequence of the different times in which the more recent detection methods were introduced in each country, and of the different policies adopted by each health care system towards the elderly. A comparison with the USA data suggests that in the next future a favourable downward mortality trend could be expected also in some EU Countries and, particularly, for younger age groups, even though prostatic cancer in old patients will remain a great burden, which National Health Care Systems will have to face in the next decades.

Relative survival in elderly European cancer patients: evidence for health care inequalities. The EUROCARE Working Group.

This paper examines the survival of elderly European cancer patients, on the basis of the EUROCARE II results. Using Hakulinen and Abeywickrama's method, the relative survival rates at 1 and 5 years from diagnosis were computed by sex and quinquennial age group for the elderly (65-99 years old). Age-standardised rates for the whole elderly group were also calculated. The analysis covered: all malignancies combined, stomach, colon, rectum, pancreas, lung, melanoma, bladder, kidney and non-Hodgkin's lymphomas for both sexes; prostate and larynx for men; and breast, ovary, uterine cervix and corpus for women. Data relating to 701521 cancer patients came from 44 population-based cancer registries in 16 European countries. The relative risks of death (RRs) of older patients (65-99) with respect to middle-aged adults (55-64) were computed by sex and country, for all malignancies only. The most prominent finding was the decrease in survival rates with increasing age for almost all cancer sites. The age-curves of survival rates at 1 year from diagnosis usually had a steeper slope than those at 5 years, particularly in women. This suggests that disease stage at presentation plays an important role in determining survival, particularly in the elderly. Thus, all factors which influence timing diagnosis in the elderly and cause a delay in tumour detection, such as psycho-social factors, access to care, co-morbidities and other clinical features affecting performance status, are very important predictors of prognosis. Very large geographic variations in relative survival rates were found among European countries. The ordering of countries was similar for almost all cancer sites. Western and Central Europe generally had the best survival, followed by Northern countries and by Southern ones (the latter with survival around the European average: 39% in men, 47% in women). The UK had survival rates unexpectedly lower than rates of nearest nations, often below the European average. Eastern countries usually had the lowest rates. In the very elderly patients (over 85 years), an apparent rise in the survival rates was noted, particularly at 5 years from diagnosis and in men. This 'too good' survival is unlikely to be due to real better prognosis, but rather to a selection bias. Countries with this unusual rise are also those registering a high proportion of DCO cases (those cases retrieved by death certificate only) (around 10%) or DCO unavailable. Another 'natural' bias has also to be taken into account: in elderly patients with a very bad prognosis, who are often suffering from other serious co-morbid conditions, cancer diagnoses could be under-notified and not reach at all the data sources commonly monitored by cancer registries.

The mortality rate of the province of birth as a risk indicator for lung and stomach cancer mortality among Genoa residents born in other Italian provinces.

This study analyses the relationship between migration and mortality for lung and stomach cancer, these diseases being those considered susceptible to changes in environmental conditions and individual habits that usually follow migration. Mortality rate of the province of birth was used as the index of risk related to migration. Data were analysed using the Poisson regression model for grouped data. Results indicate that migration determines modifications in the mortality rates of the migrant populations for the diseases under study. For lung cancer, the analysis showed a greater risk for migrants originating from areas with high rates and that migrants had a reduced risk in comparison with natives of Genoa. With regard to stomach cancer, the study revealed that migrants originating from high risk areas had higher relative risks than the Genoa natives, even if these were lower than expected when compared to the risks of the populations in the regions from which the migrants originated.

Differences in the epidemic rise and decrease of prostate cancer among geographical areas in Southern Europe. an analysis of differential trends in incidence and mortality in France, Italy and Spain.

This is a population-based study aimed at evaluating incidence and mortality trends for prostate cancer in France, Italy and Spain, during the prostate-specific antigen (PSA) era, considering elderly people aged 70 years and over and younger adults aged between 40 and 69 years. Trends were estimated by a log-linear Poisson regression model and expressed as an Estimated Annual Percent Change (EAPC). Incidence increased sharply in almost all areas. Spain showed the lowest increases. Incidence started to rise around 1985 in France and after 1990 in Italy and Spain. Mortality increased until the late 1980s in all countries, then declined in France and Italy (-2.5% in 40-69 year age group), but not in Spain. Younger people showed a much higher rise in incidence than the elderly, while mortality decreased mainly in the younger adults. The decrease in mortality was more marked in those areas and the younger age group where the rise in incidence was higher and started earlier, i.e. in France and in younger people, suggesting that the PSA test may have had a positive effect on mortality, although other clinical advances also have to be taken into account.

Relative survival in elderly cancer patients in Europe. EUROCARE Working Group.

In this paper different patterns of survival by age and gender are presented for 17 European countries which participated in the EUROCARE II programme. Survival data were available for 701,521 patients aged between 65 and 99 years from 44 population-based cancer registries. Age-standardised relative survival rates at 1 and 5 years from diagnosis were computed. Relative risks (RRs) of death for those aged between 65 and 99 years compared with those aged between 55 and 64 years were estimated by gender and country. In general, the elderly had a large survival disadvantage, particularly 1 year after diagnosis and in women. Poorer survival rates in the elderly were observed for patients from Eastern European countries for almost all sites. However, relative survival of the elderly with respect to younger patients was similar in the different geographic areas. The results are in agreement with other population-based studies, confirming a worse prognosis for the elderly in both sexes. This may be explained by changes in biology and the natural history of the tumour and the occurrence of severe comorbidities, potentially affecting preventive, diagnostic and therapeutic strategies. The lack of equality in providing adequate treatment to elderly cancer patients should be addressed as a matter of urgency by health-care providers.

Mortality among shipyard workers in Genoa, Italy.

The dockyards of Genoa are exposed to many known or suspect carcinogenic agents, namely, asbestos, silica, polycyclic aromatic hydrocarbons, and halogenated hydrocarbons; other possibly harmful substances are trace amounts of aromatic amines, welding smokes, paints, and lipid-removing solvents. A cohort study of causes of death of 2190 dockyard workers in Genoa was conducted between January 1, 1960 and December 31, 1975. Mortality rates were calculated for 20 different occupational categories, for which there exist different levels of exposure to noxious substances. Two control groups were selected: the general male population of Genoa and all male employees (462) of San Martino Hospital, Genoa for the same period of time. Causes of death that demonstrated significant excesses for both control groups were: cancer of the colon, excluding the rectum; cancer of the larynx; cancer of the lung, bronchus, and trachea; cancer of the kidney, urinary bladder, and other urinary organs; respiratory diseases; and cirrhosis of the liver. The data obtained from these 20 job categories revealed different types and levels of risk for various carcinogenic agents.

Cancer Incidence and Mortality in the Elderly: Profile of the Italian Problem.

In Italy, 28% of all deaths are due to cancer. Of the 15% of the population that is 65 years or older, 65% of cancer deaths occur in men and 69.5% in women. The proportional mortality and incidence of cancer in Italy varies with increasing age. All patients over 65 years are found to be at increased risk for intestinal cancers. In older men, the proportion of lung and urinary tract cancers decreases, while prostate, intestinal and gastric cancers increases. Prostate cancer predominates in men over 85 years and intestinal and gastric cancers are relatively more common than lung cancer. In women over age 74, intestinal cancer is most common. Breast, genital and lung cancers decrease rapidly with age, while stomach, liver, gallbladder and pancreatic cancers increase with age. The ratio of incidence to mortality for all cancers studied is shown to equalize with increased age, the probable result of lower hospitalization rates and less adequate cancer therapy for the elderly.

Prostate cancer in Italy before and during the 'PSA era': survival trend and prognostic determinants.

The aim of the study was to investigate the variations in prostate cancer prognosis during a period of major diagnostic change, such as the introduction of the prostate-specific antigen (PSA) test. Data were provided by 14 Italian cancer registries (CRs). Incidence and follow-up information was collected for patients diagnosed from 1978 to 1994. Relative survival was computed taking into account incidence period, age, tumour stage and grade at diagnosis. A multivariate analysis was carried out to evaluate the independent simultaneous effect on survival of some prognostic determinants. A large geographical variability was observed: in 1993-1994 Italian survival rates ranged from 76% to 52%, with a north-south gradient. A striking prognostic improvement (up to +27 percentage points) between the late 1980s and the early 1990s occurred in almost all CRs, particularly with regard to younger patients. Multivariate analysis showed a strong influence of incidence period on survival, also after correction by tumour stage. The slowdown of metastatic cancers suggests that the survival improvement could be due both to the introduction of an effective opportunistic screening and to a quantitative change in the application of clinical treatment, even if the effect of the lead-time bias phenomenon has to be taken into account.

Cancer patient survival in the elderly in Italy. ITACARE Working Group.

AIMS AND BACKGROUND: Italy, like most western populations, is sharply aging and changing its age structure with a striking increase in the oldest segment of the elderly. Since age is related to an exponential growth of cancer incidence rates and to a worsening of prognosis, the progressive aging of the population will constitute, in the future, an issue increasingly more important for public health. The present study is the first effort to present and analyze survival rates in italian elderly cancer patients in order to provide a starting point for the development of better clinical strategies addressed to the aged. MATERIALS AND METHODS: The presented data come from a large data set consisting of survival data relating to 25,798 men and 20,479 women, aged 65-84 years at diagnosis, collected by Italian cancer registries participating in the ITACARE project. Relative survival rates of patients have been calculated by sex, quinquennial age classes and the considered entire age class for overall malignant neoplasms and the 10 most frequent cancer sites in the elderly. RESULTS: When all Italian data for all cancers in the 65-84 year age group were pooled, survival rates at 5 years from the diagnosis was 27% and 39% in men and women, respectively. As regards specific sites, survival rates below 50% were observed for lung, stomach and ovary cancer at 1 year from diagnosis. At 5 years from diagnosis, the rates were less than 50% for colon, prostate, cervix, multiple myeloma, non-Hodgkin's lymphoma and melanoma (only in men). The best survival at 5 years from diagnosis (above 50%) was in women for melanoma and corpus uteri and breast cancer. For all cancers, the prognosis for women was better in each considered age group even though a dramatic decrease in survival with age was observed in both sexes. In general, a similar decline in survival with increasing age characterized all considered specific sites. However, at closer observation, the patterns of a decrease revealed some differences. The ratio between the survival rates of 55-64 vs 65-84 year age class indicated that the sites with the greatest advantage of survival for younger patients (ratio > 1.5) were ovary, lung and melanoma (only in men), whereas the least advantage was observed for colon, corpus uteri, breast and prostate. By calendar periods, excluding non-Hodgkin's lymphoma for women, an increase in survival was observed for all considered sites, improving an encouraging successful trend in diagnostic and therapeutic progresses.

Cancer prevalence in the elderly. ITAPREVAL Working Group.

AIMS AND BACKGROUND: To describe the cancer prevalence in elderly Italian people and analyze the differences, if any, with the prevalence among younger subjects. METHODS & STUDY DESIGN: The cancer prevalence among elderly patients (65 years and over), the three age classes encompassing elderly age (65-74 years, 75-84 years, 85 years and over) and younger patients (0-64 years) was computed using the PREVAL method on the basis of the incident cases over the period 1976-1992 followed up to 31 December 1992 (prevalence reference date). Data were collected by 11 Italian cancer registries. RESULTS: The observed prevalence figures for all cancers (except skin epitheliomas), both sexes combined and considering the whole elderly group, were 1,090 and 3,601 cases per 100,000 one and five years since diagnosis, respectively; the prevalence increased up to the 75-84 age group and showed a slight decrease after age 85. With regard to specific cancer sites, in men bladder and prostate had the highest prevalence 5 years from diagnosis (more than 800 cases per 100,000), followed by colon and lung (about 500 cases per 100,000) stomach and rectum (about 300 cases per 100,000); in women breast cancer ranked first (more than 1,000 cases per 100,000), followed by colon (about 350 cases per 100,000), corpus uteri, stomach and rectum cancers (between 150 and 200 cases per 100,000). For all malignancies and the two sexes combined the prevalence figures were about six times higher in the older than in the younger age group. CONCLUSIONS: These figures confirm the important role of aging in determining the increase in cancer prevalence. The resulting prevalence figures clearly indicate the cancer burden placed on health care services; moreover, the figures will probably increase in the next decades due to a possible improvement in survival and to the dramatic aging of the population, assuming a stable trend for incidence rates. This picture will represent a major challenge for politicians and those dealing with health care planning and social policies in general, especially in the light of the reduction of the available financial resources and the specific features of medical and social needs in the elderly.

Mortality among dock-yard workers in Genoa, Italy.

The causes of death among the dock-yard workers of Genoa from December 31, 1959 to January 1, 1970, have been investigated. These workers, mainly assigned to ship repair, refitting and construction, are exposed to several noxious substances, such as: asbestos, silica, paint solvents, welding smoke and volatile products of petroleum. Two different control groups were selected: the male population of Genoa and the staff of the San Martino Hospital in Genoa. Causes of death showing a significant increase were: gastric cancer (only in comparison with the hospital staff), cancer of colon excluding rectum, lung cancer, cancer of kidney, urinary bladder and other urinary organs, respiratory diseases, cirrhosis of the liver, cardiovascular diseases (only in comparison with the hospital staff).

A cohort study of workers employed in a refractory brick plant.

A mortality study was carried out on a cohort of workers who were exposed to silica dust in a refractory brick plant. The cohort was divided into two groups: workers with and without silicosis, and their mortality was contrasted with the death rate of Genova from 1960 to 1979. Results show an increased risk for laryngeal tumors (3 obs., 0.44 exp., SMR = 682), nonmalignant respiratory disease (16 obs., 3.2 exp., SMR = 500), and cardiovascular diseases (19 obs., 11 exp., SMR = 173) among silicotics. The mortality rate for lung cancer showed an increase for the cohort of workers as a whole (11 obs., 6 exp., SMR = 183). The almost double overall mortality observed in silicotic subjects raises some doubts about the validity of other proportional mortality studies that showed no excesses for workers in these industries.