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The debate on truth telling is at the core of contemporary biomedical ethics. Differences in truth telling arise from the delicate interplay between autonomy and beneficence in medicine, under the influence of cultural variables. Recently, a trend toward evolution of truth-telling practices has been noticed in countries previously known for non-disclosure. Italy is among them. This article analyzes in detail the different factors that have been influential in the Italian context, focusing on cancer patients. Medical profession, public discourse, medical deontology and legislators played an important role in Italy's shift toward the western autonomy predicament. A review of the scanty published data on informed consent and truth telling in Italy, however, consistently shows that partial or non-disclosure are still present. This seems to represent a general trend in nations traditionally centered on family and community values. The article explores these issues to achieve a better understanding of the specific Italian cultural context, while avoiding common stereotyping. The subject treated contributes to the growing debate on cultural diversity in medicine and in oncology.