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1. Molecular epidemiology of a hepatitis C virus epidemic in a haemodialysis unit: outbreak investigation and infection outcome

Author

Lanini Simone, Abbate Isabella, Puro Vincenzo, Soscia Fabrizio, Albertoni Franceso, Battisti Walter, Ruta Amilacare, Capobianchi Maria R, and Ippolito Giuseppe

Subjects
Infectious and parasitic diseases, RC109-216
Abstract

Abstract Background HCV is a leading cause of liver chronic diseases all over the world. In developed countries the highest prevalence of infection is reported among intravenous drug users and haemodialysis (HD) patients. The present report is to identify the pathway of HCV transmission during an outbreak of HCV infection in a privately run haemodialysis (HD) unit in Italy in 2005. Methods Dynamics of the outbreak and infection clinical outcomes were defined through an ambi-directional cohort study. Molecular epidemiology techniques were used to define the relationships between the viral variants infecting the patients and confirm the outbreak. Risk analysis and auditing procedures were carried out to define the transmission pathway(s). Results Of the 50 patients treated in the HD unit 5 were already anti-HCV positive and 13 became positive during the study period (AR = 28.9%). Phylogenic analysis identified that, all the molecularly characterized incident cases (10 out of 13), were infected with the same viral variant of one of the prevalent cases. The multivariate analysis and the auditing procedure disclosed a single event of multi-dose vials heparin contamination as the cause of transmission of the infection in 11 out of the 13 incident cases; 2 additional incident cases occurred possibly as a result of inappropriate risk management. Discussion More than 30% of all HCV infections in developed countries results from poor application of standard precautions during percutaneous procedures. Comprehensive strategy which included: educational programmes, periodical auditing on standard precaution, use of single-dose vials whenever possible, prospective surveillance for blood-borne infections (including a system of prompt notification) and risk assessment/management dedicated staff are the cornerstone to contain and prevent outbreaks in HD Conclusions The outbreak described should serve as a reminder to HD providers that patients undergoing dialysis are at risk for HCV infection and that HCV may be easily transmitted whenever standard precautions are not strictly applied.

Published
2010
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2. Italian cancer figures, report 2011: Survival of cancer patients in Italy

Author

Airtum, Working Group, Fusco, Mario, Buzzoni, Carlotta, Coviello, Enzo, Rashid, Ivan, Bianconi, Fortunato, Cuccaro, Francesco, Castaing, Marine, Angelis, Roberta, Giacomin, Adriano, Guzzinati, Stefano, Mosso, Maria Luisa, Pisani, Paola, Quaglia, Alberto, Randi, Giorgia, Ramazzotti, Valerio, Russo, Antonio, Senatore, Gennaro, Stracci, Fabrizio, Traina, Adele, Vercelli, Marina, Zarcone, Maurizio, Ferretti, Stefano, Mazzoleni, Guido, Bellu, Francesco, Tschugguel, Birgit, Valiere, Elena, Facchinelli, Gerlinde, Falk, Markus, Dal Cappello, Tomas, Vercellino, Pier Carlo, Andreone, Simona, Busato, Anna, Marzola, Laura, Migliari, Elena, Carletti, Nada, Nenci, Italo, Crocetti, Emanuele, Caldarella, Adele, Corbinelli, Antonella, Giusti, Francesco, Intrieri, Teresa, Manneschi, Gianfranco, Nemcova, Libuse, Romeo, Gianpaolo, Sacchettini, Claudio, Zappa, Marco, Paci, Eugenio, Serraino, Diego, Angelin, Tiziana, Bidoli, Ettore, Dal Maso, Luigino, Dottori, Margherita, Paoli, Angela, Santis, Emilia, Forgiarini, Ornella, Lise, Mauro, Zucchetto, Antonella, Zanier, Loris, Orengo, Maria Antonietta, Casella, Claudia, Marani, Enza, Puppo, Antonella, Celesia, Maria Vittoria, Cogno, Roberta, Manenti, Simone, Garrone, Elsa, Pannozzo, Fabio, Busco, Susanna, Maria Cecilia Cercato, Battisti, Walter, Sperduti, Isabella, Macci, Leonarda, Bugliarello, Ester, Bernazza, Edvige, Tamburo, Lucilla, Rossi, Miriana, Curatella, Simonetta, Francesco, Carla, Tamburrino, Silvana, Bisanti, Luigi, Autelitano, Mariangela, Ghilardi, Simona, Leone, Rosanna, Filipazzi, Luisa, Bonini, Annamaria, Giubelli, Cinzia, Federico, Massimo, Artioli, Maria Elisa, Valla, Katia, Braghiroli, Barbara, Cirilli, Claudia, Luminari, Stefano, Pirani, Monica, Ferrari, Lorenza, Bellatalla, Caterina, Fusco, Maria, Panico, Margherita, Perrotta, Carmela, Vassante, Biagio, Vitale, Maria Francesca, Michiara, Maria, Bozzani, Francesco, Sgargi, Paolo, Tumino, Rosario, La Rosa, Maria Guglielmina, Cascone, Giuseppe, Frasca, Graziella, Giurdanella, Maria Concetta, Martorana, Caterina, Morana, Gabriele, Nicita, Carmela, Rollo, Patrizia Concetta, Ruggeri, Maria Grazia, Sigona, Aurora, Spata, Eugenia, Vacirca, Stefania, Mangone, Lucia, Di Felice, Enza, Pezzarossi, Annamaria, Caroli, Stefania, Pellegri, Carlotta, Vicentini, Massimo, Storchi, Cinzia, Cavuto, Silvio, Costa, Jaqueline, Falcini, Fabio, Colamartini, Americo, Bucchi, Lauro, Balducci, Chiara, Ravegnani, Mila, Vitali, Benedetta, Cordaro, Carlo, Caprara, Licia, Giuliani, Orietta, Giorgetti, Stefania, Salvatore, Silvia, Palumbo, Monica, Vattiato, Rosa, Ravaioli, Alessandra, Foca, Flavia, Rinaldi, Elisa, Mancini, Silvia, Tonelli, Chiara, Amadori, Marinella, Cremone, Luigi, Iannelli, Arturo, Zevola, Arrigo, Budroni, Mario, Cesaraccio, Rosaria, Pirino, Daniela, Carboni, Donatella, Fiori, Giovanna, Soddu, Marcella, Mameli, Gianpaolo, Mura, Francesco, Contrino, Maria Lia, Madeddu, Anselmo, Tisano, Francesco, Sciacca, Salvatore, Muni, Angela, Mizzi, Margherita, Russo, Maria, Sacco, Giorgio, Aletta, Paoletta, Colanino Ziino, Antonio, Tessandori, Roberto, Fanetti, Anna Clara, Maspero, Sergio, Annulli, Monica Lucia, Moroni, Elena, Sanoja Gonzalez, Maria Eugenia, Zanetti, Roberto, Rosso, Stefano, Patriarca, Silvia, Prandi, Rossana, Sobrato, Irene, Gilardi, Franca, Busso, Paola, Piffer, Silvano, Gentilini, Maria A., Battisti, Laura, Rizzello, Roberto, Cappelletti, Maddalena, Moser, Marilena, La Rosa, Francesco, D Alo, Daniela, Scheibel, Massimo, Costarelli, Daniela, Spano, Francesco, Rossini, Stefania, Santucci, Cinzia, Petrinelli, Anna Maria, Solimene, Clotilde, Brunori, Valerio, Crosignani, Paolo, Tagliabue, Giovanna, Contiero, Paolo, Preto, Lucia, Tittarelli, Andrea, Maghini, Anna, Codazzi, Tiziana, Frassoldi, Emanuela, Gada, Daniela, Costa, Enrica, Di Grazia, Laura, Zambon, Paola, Baracco, Maddalena, Bovo, Emanuela, Dal Cin, Antonella, Fiore, Anna Rita, Greco, Alessandra, Monetti, Daniele, Rosano, Alberto, Stocco, Carmen, Tognazzo, Sandro, Donato, Francesco, Limina, Rosa Maria, Adorni, Anna, Andreis, Paolo, Zani, Giuseppe, Piovani, Francesco, Salvi, Ornella, Puleio, Maria, Vitarelli, Susanna, Antonini, Silvia, Candela, Giuseppina, Pappalardo, Giuseppe, Scuderi, Tiziana, Lottero, Barbara, Ribaudo, Michele, Ricci, Paolo, Guarda, Linda, Gatti, Luciana, Bozzeda, Annalaura, Dall Acqua, Maria, Pironi, Vanda, Sutera Sardo, Antonella, Mazzei, Adriana, Sirianni, Nicola, Lavecchia, Anna Maria, Mancuso, Pierina, Usala, Mario, Pala, Filomena, Sini, Giovanna Maria, Pintori, Nicolina, Canu, Luisa, Demurtas, Giuliana, Doa, Nina, Ponz Leon, Maurizio, Domati, Federica, Rossi, Giuseppina, Goldoni, Carlo Alberto, Rossi, Federica, Gaetani, Carmela, Benatti, Piero, Roncucci, Luca, Di Gregorio, Carmela, Pedroni, Monica, Pezzi, Annalisa, Maffei, Stefania, Mariani, Francesco, Borsi, Enrica, Carruba, Giuseppe, Cusimano, Rosanna, Amodio, Rosalba, Dolcemascolo, Cecilia, Staiti, Rosalba, Pastore, Guido, Magnani, Corrado, Terracini, Benedetto, Cena, Tiziana, Alessi, Daniela, Baussano, Iacopo, Merletti, Franco, Maule, Milena, Macerata, Vanda, Cocchioni, Mario, Pascucci, Cristiana, Gennaro, Valerio, Lazzarotto, Anna, Benfatto, Lucia, Mazzucco, Giovanna, Montanaro, Fabio, AIRTUM Working Group: [.., Enrica Borsi, and ]

Subjects
Adult, Aged, 80 and over, Male, Adolescent, Age Factors, Infant, Newborn, Infant, Middle Aged, Survival Analysis, CANCER, Survival Rate, Young Adult, Italy, Organ Specificity, Child, Preschool, Neoplasms, Humans, Female, Registries, Child, Aged
Abstract

INTRODUCTION: population-based survival analyses are fundamental to assess the impact of public health interventions and new therapies in cancer control. This monograph updates previous reports on cancer patient survival in Italy up to the year 2007. MATERIAL AND METHODS: we extracted from the Network of Italian Cancer Registries (AIRTUM) database over 1,490,000 records of tumours diagnosed during 1990-2007 and followed up to the end of 2008, including all multiple tumours. We used the Ederer II method to estimate relative survival (RS) for 29 different types of neoplasm. Five-year relative survival rates were analysed by gender and macroarea. Trends in 5-, 10- and 15-year RS were studied by gender over six 3-year diagnostic periods, from 1990 to 2007. Conditional 5-year RS was also computed by gender and macroarea. Hybrid approaches were applied to exploit the recent survival experiences of cases diagnosed up to 2007. Adjustment for age was performed using EUROCARE weights. Additional sections describe cancer patient survival in childhood and in elderly patients and provide a comparison of cancer patient survival rates in Italy with those of other countries. RESULTS: Standardized 5-year RS for all tumours but skin in 52% for men and 61% for women. Patient survival has improved for almost all types of cancer: from 1990 to 2007 5-year RS has increased by 15% for all cancers but skin; the exceptions are some cancers with poor prognosis, where patient survival has remained basically unchanged. In males, RS was usually lower than in females, but trend analysis shows that the gap is narrowing. We also report persisting lower RS in southern Italy: 5-year RS in the South is usually from 4% to 10% lower than in the North and Centre. CONCLUSION: this study provides valuable information for all stakeholders in cancer control, both in Italy and elsewhere. Increasing survival reflects improvements in various areas of cancer control. On the other hand, delayed diagnosis and suboptimal management are consistent with the reported differences in survival within the country.

Published
2011

3. [AIRTUM numbers: 200,000 young Italians live with cancer]

Author

Dal Maso, Luigino, Angelis, Roberta, Guzzinati, Stefano, Airtum, Working Group, Paoli, Angela, Buzzoni, Carlotta, Crocetti, Emanuele, Bucchi, Lauro, Casella, Claudia, Cuccaro, Francesco, Fusco, Mario, Luminari, Stefano, Madeddu, Anselmo, Mangone, Lucia, Patriarca, Silvia, Piffer, Silvano, Stracci, Fabrizio, Tagliabue, Giovanna, Tumino, Rosario, Zappa, Marco, Capocaccia, Riccardo, Ferretti, Stefano, Mazzoleni, Guido, Bellu, Francesco, Tschugguel, Birgit, Valiere, Elena, Facchinelli, Gerlinde, Falk, Markus, Dal Cappello, Tomas, Giacomin, Adriano, Vercellino, Pier Carlo, Andreone, Simona, Busato, Anna, Marzola, Laura, Migliari, Elena, Carletti, Nada, Nenci, Italo, Caldarella, Adele, Corbinelli, Antonella, Giusti, Francesco, Intrieri, Teresa, Manneschi, Gianfranco, Nemcova, Libuse, Romeo, Gianpaolo, Sacchettini, Claudio, Paci, Eugenio, Serraino, Diego, Angelin, Tiziana, Bidoli, Ettore, Dottori, Margherita, Santis, Emilia, Forgiarini, Ornella, Zucchetto, Antonella, Zanier, Loris, Vercelli, Marina, Orengo, Maria Antonietta, Marani, Enza, Puppo, Antonella, Celesia, Maria Vittoria, Cogno, Roberta, Manenti, Simone, Garrone, Elsa, Quaglia, Alberto, Pannozzo, Fabio, Busco, Susanna, Rashid, Ivan, Ramazzotti, Valerio, Cercato, M. Cecilia, Battisti, Walter, Sperduti, Isabella, Macci, Leonarda, Bugliarello, Ester, Bernazza, Edvige, Tamburo, Lucilla, Rossi, Miriana, Curatella, Simonetta, Francesco, Carla, Tamburrino, Silvana, Bisanti, Luigi, Autelitano, Mariangela, Randi, Giorgia, Ghilardi, Simona, Leone, Rosanna, Filipazzi, Luisa, Bonini, Annamaria, Giubelli, Cinzia, Federico, Massimo, Artioli, Maria Elisa, Valla, Katia, Braghiroli, Barbara, Cirilli, Claudia, Pirani, Monica, Ferrari, Lorenza, Bellatalla, Caterina, Fusco, Maria, Panico, Margherita, Perrotta, Carmela, Vassante, Biagio, Traina, Adele, Carruba, Giuseppe, Cusimano, Rosanna, Amodio, Rosalba, Dolcemascolo, Cecilia, Staiti, Rosalba, Zarcone, Maurizio, Michiara, Maria, Bozzani, Francesco, Sgargi, Paolo, Cilia, Sonia, La Rosa, Maria Guglielmina, Cascone, Giuseppe, Frasca, Graziella, Giurdanella, Maria Concetta, Martorana, Caterina, Morana, Gabriele, Nicita, Carmela, Rollo, Patrizia, Ruggeri, Maria Grazia, Sigona, Aurora, Spata, Eugenia, Vacirca, Stefania, Di Felice, Enza, Pezzarossi, Annamaria, Caroli, Stefania, Pellegri, Carlotta, Vicentini, Massimo, Storchi, Cinzia, Cavuto, Silvio, Costa, Jaqueline, Falcini, Fabio, Colamartini, Americo, Balducci, Chiara, Ravegnani, Mila, Vitali, Benedetta, Cordaro, Carlo, Caprara, Licia, Giuliani, Orietta, Giorgetti, Stefania, Salvatore, Silvia, Palumbo, Monica, Vattiato, Rosa, Ravaioli, Alessandra, Foca, Flavia, Rinaldi, Elisa, Donato, Andrea, Iannelli, Arturo, Senatore, Gennaro, Zevola, Arrigo, Budroni, Mario, Cesaraccio, Rosaria, Pirino, Daniela, Carboni, Donatella, Fiori, Giovanna, Soddu, Marcella, Mameli, Gianpaolo, Mura, Francesco, Contrino, Maria Lia, Tisano, Francesco, Sciacca, Salvatore, Muni, Angela, Mizzi, Margherita, Russo, Maria, Tessandori, Roberto, Ardemagni, Giuseppina, Gianola, Luigi, Maspero, Sergio, Annulli, Monica Lucia, Moroni, Elena, Roberto, Guglielmana, Zanetti, Roberto, Rosso, Stefano, Prandi, Rossana, Sobrato, Irene, Gilardi, Franca, Busso, Paola, Franchini, Silva, Gentilini, Maria A., Battisti, Laura, Cappelletti, Maddalena, Moser, Marilena, La Rosa, Francesco, D Alo, Daniela, Scheibel, Massimo, Costarelli, Daniela, Spano, Francesco, Rossini, Stefania, Santucci, Cinzia, Petrinelli, Anna Maria, Solimene, Clotilde, Bianconi, Fortunato, Brunori, Valerio, Crosignani, Paolo, Contiero, Paolo, Preto, Lucia, Tittarelli, Andrea, Maghini, Anna, Codazzi, Tiziana, Frassoldi, Emanuela, Gada, Daniela, Costa, Enrica, Di Grazia, Laura, Zambon, Paola, Baracco, Maddalena, Bovo, Emanuela, Dal Cin, Antonella, Fiore, Anna Rita, Greco, Alessandra, Monetti, Daniele, Rosano, Alberto, Stocco, Carmen, Tognazzo, Sandro, Donato, Francesco, Limina, Rosa Maria, Adorni, Anna, Andreis, Paolo, Zani, Giuseppe, Piovani, Francesco, Salvi, Ornella, Puleio, Maria, Vitarelli, Susanna, Antonini, Silvia, Candela, Giuseppina, Pappalardo, Giuseppe, Scuderi, Tiziana, Lottero, Barbara, Ribaudo, Michele, Ricci, Paolo, Guarda, Linda, Gatti, Luciana, Bozzeda, Annalaura, Dall Acqua, Maria, Pironi, Vanda, Sardo, Antonella Sutera, Mazzei, Adriana, Sirianni, Nicola, Lavecchia, Anna Maria, Mancuso, Pierina, Usala, Mario, Pala, Filomena, Sini, Giovanna Maria, Pintori, Nicolina, Canu, Luisa, Demurtas, Giuliana, Doa, Nina, Pisani, Paola, Pastore, Guido, Magnani, Corrado, Terracini, Benedetto, Cena, Tiziana, Alessi, Daniela, Baussano, Iacopo, Merletti, Franco, Maule, Milena, Mosso, Maria Luisa, Nonnato, Marinella, Rasulo, Assunta, Richiardi, Lorenzo, Zuccolo, Luisa, Pivetta, Emanuele, Dalmasso, Paola, Macerata, Vanda, Leon, Maurizio Ponz, Domati, Federica, Rossi, Giuseppina, Goldoni, Carlo Alberto, Rossi, Federica, Gaetani, Carmela, Benatti, Piero, Roncucci, Luca, Di Gregorio, Carmela, Pezzi, Monica Pedroni Annalisa, Maffei, Stefania, Mariani, Francesco, Enrica Borsi, Cocchioni, Mario, Pascucci, Cristiana, Gennaro, Valerio, Lazzarotto, Anna, Benfatto, Lucia, Mazzucco, Giovanna, and Montanaro, Giovanna

4. Italian cancer figures, report 2013: Multiple tumours

Author

Airtum, Working Group, Adamo, Maria Stella, Alessi, Daniela, Aletta, Paoletta, Amodio, Rosalba, Andreone, Simona, Angelin, Tiziana, Anghinoni, Emanuela, Annulli, Monica Lucia, Antonini, Silvia, Artioli, Maria Elisa, Autelitano, Mariangela, Balducci, Chiara, Balottari, Paola, Baracco, Maddalena, Battisti, Walter, Bella, Francesca, Bellatalla, Caterina, Belluardo, Cristiano, Benatti, Piero, Benedetto, Giovanni, Benfatto, Lucia, Bernazza, Edvige, Bianconi, Fortunato, Biavati, Patrizia, Bidoli, Ettore, Birri, Silvia, Bizzoco, Sabrina, Bonelli, Luigina, Bonini, Annamaria, Borciani, Elisabetta, Bovo, Emanuela, Bozzani, Francesco, Bozzeda, Annalaura, Braghiroli, Barbara, Brucculeri, Maria Angela, Brunori, Valerio, Bucalo, Giovanni, Bucchi, Lauro, Bugliarello, Ester, Bulatko, Andreas, Busco, Susanna, Busso, Paola, Buzzoni, Carlotta, Calabretta, Laura, Caldarella, Adele, Candela, Giuseppina, Canu, Luisa, Cappelletti, Maddalena, Caprara, Licia, Carboni, Donatella, Carletti, Nada, Caroli, Stefania, Carone, Simona, Cascio, Maria Antonietta, Cascone, Giuseppe, Casella, Claudia, Castaing, Marine, Cecconami, Lorella, Celesia, Maria Vittoria, Cena, Tiziana, Cercato, Maria Cecilia, Cesaraccio, Rosaria, Chiesa, Roberta, Cirilli, Claudia, Civaschi, Alessandro, Cocchioni, Mario, Codazzi, Tiziana, Cogno, Roberta, Colamartini, Americo, Colanino Ziino, Antonino, Cometti, Ivan, Contiero, Paolo, Contrino, Maria Lia, Corbinelli, Antonella, Cordaro, Carlo, Corti, Mariangela, Costa, Alessandro, Costarelli, Daniela, Cremone, Luigi, Crocetti, Emanuele, Curatella, Simonetta, Cusimano, Rosanna, D Alo, Daniela, D Angelo, Stefania, Dal Cappello, Tomas, Dal Cin, Antonella, Dal Maso, Luigino, Dall Acqua, Maria, Dalsasso, Fernanda, Davini, Chiara, Dottori, Margherita, Maria, Valentina, Santis, Emilia, Valiere, Elena, Dei Tos, Angelo Paolo, Demurtas, Giuliana, Devigli, Elena, Di Felice, Enza, Di Grazia, Laura, Di Gregorio, Carmela, Di Prima, Alessia, Distefano, Rosalba, Doa, Nina, Domati, Federica, Fabiano, Sabrina, Facchinelli, Gerlinde, Falcini, Fabio, Falk, Markus, Fanetti, Anna Clara, Fattoruso, Silvia, Federico, Massimo, Ferrari, Lorenza, Ferretti, Stefano, Fidelbo, Melchiorre, Filipazzi, Luisa, Fiore, Anna Rita, Fiori, Giovanna, Foca, Flavia, Forgiarini, Ornella, Frasca, Graziella, Frassoldi, Emanuela, Frizza, Jacqueline, Fusco, Maria, Fusco, Mario, Gada, Daniela, Garrone, Elsa, Gasparotti, Cinzia, Gatti, Luciana, Gaudiano, Claudia, Gennaro, Valerio, Gentilini, Maria, Gerevini, Claudia, Ghilardi, Simona, Ghisleni, Silvia, Giacomin, Adriano, Giavazzi, Luisa, Gilardi, Franca, Giorgetti, Stefania, Giubelli, Cinzia, Giuliani, Orietta, Giurdanella, Maria Concetta, Gola, Gemma, Goldoni, Carlo Alberto, Golizia, Maria Grazia, Grandi, Luigi, Greco, Alessandra, Guarda, Linda, Guttadauro, Agnese, Guzzinati, Stefano, Iachetta, Francesco, Iannelli, Arturo, Ieni, Antonio, Intrieri, Teresa, Kaleci, Shaniko, La Rosa, Francesco, Lando, Cecilia, Lavecchia, Anna Maria, Lazzarato, Fulvio, Leone, Anna, Leone, Rosanna, Lonati, Fulvio, Lottero, Barbara, Lucchi, Silvia, Luminari, Stefano, Macci, Leonarda, Macerata, Vanda, Madeddu, Anselmo, Maffei, Stefania, Maghini, Anna, Magnani, Corrado, Magnani, Giulia, Magoni, Michele, Mameli, Gianpaolo, Mancini, Silvia, Mancuso, Pierina, Mangone, Lucia, Manneschi, Gianfranco, Mannino, Rita, Mannino, Salvatore, Marani, Enza, Mariani, Francesco, Martorana, Caterina, Marzola, Laura, Maspero, Sergio, Maule, Milena, Mazzei, Adriana, Mazzoleni, Guido, Mazzucco, Giovanna, Melcarne, Anna, Merletti, Franco, Michiara, Maria, Migliari, Elena, Minerba, Sante, Minicuzzi, Antonia, Mizzi, Margherita, Monetti, Daniele, Morana, Gabriele, Moroni, Elena, Mosso, Maria Luisa, Muni, Angela, Mura, Francesco, Natali, Maurilio, Nemcova, Libuse, Nicita, Carmela, Ocello, Cristina, Paci, Eugenio, Pala, Filomena, Palumbo, Monica, Panico, Margherita, Pannozzo, Fabio, Pascucci, Cristiana, Pastore, Guido, Patriarca, Silvia, Pedroni, Monica, Pellegri, Carlotta, Perrotta, Carmela, Pesce, Paola, Petrinelli, Anna Maria, Petrucci, Chiara, Pezzarossi, Annamaria, Piffer, Silvano, Pintori, Nicolina, Pirani, Monica, Pirino, Daniela, Pironi, Vanda, Ponz Leon, Maurizio, Prandi, Rossana, Prazzoli, Rita, Preto, Lucia, Puleio, Maria, Puppo, Antonella, Quaglia, Alberto, Quarta, Fabrizio, Quattrocchi, Maria, Raho, Anna Maria, Valerio Ramazzotti, Rashid, Ivan, Ravaioli, Alessandra, Ravazzolo, Barbara, Ravegnani, Mila, Reggiani-Bonetti, Luca, Ribaudo, Michele, Rinaldi, Elisa, Ricci, Paolo, Rizzello, Roberto, Rollo, Patrizia Concetta, Roncucci, Luca, Rosano, Alberto, Rossi, Federica, Rossi, Giuseppina, Rossi, Miriana, Rossini, Stefania, Rosso, Stefano, Rudisi, Giuseppa, Ruggeri, Maria Grazia, Russo, Antonio Giampiero, Russo, Maria, Sacchettini, Claudio, Sacco, Giorgio, Sacerdote, Carlotta, Salvatore, Silvia, Salvi, Ornella, Sampietro, Giuseppe, Sandrini, Monica, Santucci, Cinzia, Scheibel, Massimo, Schiacchitano, Salvatore, Sciacca, Salvatore, Sciacchitano, Carlo, Scuderi, Tiziana, Sechi, Ornelia, Seghini, Pietro, Senatore, Gennaro, Serafini, Giuseppina, Serraino, Diego, Sgargi, Paolo, Sigona, Aurora, Sini, Giovanna Maria, Sobrato, Irene, Soddu, Marcella, Solimene, Clotilde, Spano, Francesco, Spata, Eugenia, Sperduti, Isabella, Staiti, Rosalba, Stocco, Carmen, Stracci, Fabrizio, Sunseri, Raffaella, Sardo, Antonella Sutera, Tagliabue, Giovanna, Tamburo, Lucilla, Tamburrino, Silvana, Tanzarella, Margherita, Terracini, Benedetto, Tessandori, Roberto, Tisano, Francesco, Tittarelli, Andrea, Tognazzo, Sandro, Torrisi, Antonietta, Torrisi, Antonina, Traina, Adele, Trapani, Carlo, Tschugguel, Birgit, Tumino, Rosario, Usala, Mario, Vacirca, Stefania, Valerio, Orsola, Valla, Katia, Varvara, Massimo, Vasquez, Enrico, Vassante, Biagio, Vattiato, Rosa, Vercelli, Marina, Vercellino, Pier Carlo, Vicentini, Massimo, Villa, Marco, Vitale, Francesco, Vitale, Maria Francesca, Vitali, Benedetta, Vitarelli, Susanna, Zanchi, Andreina, Zanetti, Roberto, Zani, Giuseppe, Zanier, Loris, Zappa, Marco, Zarcone, Maurizio, Zevola, Arrigo, Zucchetto, Antonella, Zucchi, Alberto, Buzzoni, C, Crocetti, E, Bella, F, Bonelli, L, Caldarella, A, Castaing, M, Cercato, MC, Dal Maso, L, Dei Tos, AP, Ferretti, S, Giacomin, A, Pannozzo, F, Mazzoleni, G, Patriarca, S, Petrucci, S, Pisani, P, Ponz de Leon, P, Quaglia, A, Ramazzotti, V, Tumino, R, Vercelli, M, and Vitale, F

Subjects
Adult, Male, Data Interpretation, cancer incidence, Adolescent, Epidemiology, Settore MED/42 - Igiene Generale E Applicata, Neoplasms, Multiple Primary, Cohort Studies, Young Adult, Multiple Primary, Risk Factors, Neoplasms, 80 and over, Humans, Child, Preschool, Aged, Retrospective Studies, Aged, 80 and over, Incidence, Environmental and Occupational Health, multiple tumour, Infant, Neoplasms, Second Primary, italian cancer, multiple tumours, Statistical, Middle Aged, Multiple primary cancer incidence, Child, Preschool, Data Interpretation, Statistical, Female, Italy, Second Primary, Public Health, Environmental and Occupational Health, Public Health
Abstract

This collaborative study, based on data collected by the network of Italian association of cancer registries (AIRTUM), provides updated estimates on the incidence risk of multiple primary cancer (MP). The objective is to highlight and quantify the bidirectional associations between different oncological diseases. The quantification of the excess or decreased risk of further cancers in cancer patients, in comparison with the general population, may contribute to understand the aetiology of cancer and to address clinical follow-up.Data herein presented were provided by AIRTUM population-based cancer registries, which cover nowadays 48% of the Italian population. This monograph utilizes the AIRTUM database (December 2012), considering all malignant cancer cases diagnosed between 1976 and 2010. All cases are coded according to ICD-O-3. Non-melanoma skin cancer cases, cases based on death certificate only, cases based on autopsy only, and cases with follow-up time equal to zero were excluded. To define multiple primaries, IARC-IACR rules were adopted (http://www.iacr.com.fr/MPrules_july2004.pdf). Data were subjected to standard quality control procedures (described in the AIRTUM data management protocol) and specific quality control checks defined for the present study. A cohort of cancer patients was followed over time from first cancer diagnosis until the date of second cancer diagnosis, death, or the end of follow-up, to evaluate whether the number of observed second cancer cases was greater than expected. Person years at risk (PY) were computed by first cancer site, geographic area (North, Centre, South and Islands), attained age, and attained calendar-year group. All second cancers diagnosed in the cohort's patients were included in the observed numbers of cases. The expected number of cancer cases was computed multiplying the accumulated PY by the expected rates, calculated from the AIRTUM database stratified by cancer site, geographic area, age, and calendar-year group. The Standardized Incidence Ratio (SIR) was calculated as the ratio of observed to expected cancer cases. The Excess Absolute Risk (EAR) beyond the expected amount were calculated subtracting the expected number of subsequent cancers from the observed number of cancer cases; the difference was then divided by the PY and the number of cancer cases in excess (or deficit) was expressed per 1,000 PY. Confidence intervals were stated at 95%. The two months (60 days) after first cancer diagnosis were defined as "synchronicity period", and in the main analysis observed and expected cases during this period were excluded. It was estimated the excess risk in the period after first diagnosis (≥ 0 months), excluding the synchronicity period (≥ 2 months), and during the following periods: 2-11, 12-59, 60-119 and 120 months after diagnosis. First-cancer-site-and-gender-specific sheets are presented, reporting both SIRs and EARs.For 5,979,338 person-years a cohort of 1,635,060 cancer patients (880,361 males and 754,699 females) diagnosed between 1976 and 2010 was followed. The mean follow-up length was 14 years. Overall, 85,399 metachronous (latency ≥2 months) cancers were observed, while 77,813 were expected during the study period: SIR: 1.10 (95%CI 1.09-1.10), EAR: 1.32 x 1,000 person-years (95%CI 1.19 - 1.46). The SIR was 1.08 (95%CI 1.08-1.09) for men (54,518 observed and 50,260 expected) and 1.12 (95%CI 1.11-1.13) for women (30,881/27,553), and the EAR 1.61 (95%CI 1.37-1.84) and 1.08 x 1,000 person-years (95%CI 0.93-1.24), respectively.Moreover, during the first two months after first cancer diagnosis (synchronous period) 14,807 cancers were observed while 3,536 were expected (SIR: 4.16; 95%CI 4.09-4.22); the SIR was 4.08 (95%CI 4.00-4.16) for men and 4.32 (95%CI 4.20-4.45) for women.The mean age of patients at first cancer diagnosis was 67.0 years among males and 65.8 among females.The risk of MP was related to age being higher for younger patients and lower for older ones. In relation to the time of first cancer diagnosis, the SIR was very high at the beginning and then decreased, although remaining constantly over 1, and then rose over time. No strong differences were evident across the different incidence periods, which all showed an increased MP risk.Women had higher SIRs than expected for 18 cancer sites, men for 12. The statistically significantly SIRs lower than 1 were 2 and 8, respectively. Increased overall MP risk was observed for patients of both sexes with a first primary in the oral cavity (SIR men: 1.93; SIR women: 1.48), pharynx (SIR men: 2.13; SIR women: 1.99), larynx (SIR men: 1.57; SIR women: 1.79), oesophagus (SIR men: 1.45; SIR women: 1.41), lung (SIR men: 1.09; SIR women: 1.13), kidney (SIR men: 1.14; SIR women: 1.15), urinary bladder (SIR men: 1.29; SIR women: 1.22), thyroid (SIR: 1.22 in both sexes), Hodgkin lymphoma (SIR men: 1.59; SIR women: 1.94), and non-Hodgkin lymphoma (SIR men: 1.13; SIR women: 1.12), and for the heterogeneous group "other sites" (SIR men: 1.09; SIR women: 1.07). Moreover, men had a higher MP risk if the first cancer was in the testis (SIR: 1.24), while the same was true for women with gallbladder (SIR: 1.21), skin melanoma (SIR: 1.17), bone (SIR: 1.41), breast (SIR: 1.12), cervix uteri (SIR: 1.23) and corpus uteri (SIR: 1.23), and ovarian cancer (SIR: 1.18). On the contrary, a first liver or pancreas cancer were associated with a decreased MP risk in both sexes (liver SIR: 0.86 and 0.81 for men and women, respectively; pancreas SIR: 0.70 and 0.78 for men and women, respectively), as were those of colon (SIR: 0.93), rectum (SIR: 0.83), gallbladder (SIR: 0.80), prostate (SIR: 0.93), mesothelioma (SIR: 0.65), and central nervous system (SIR: 0.82) among men. Among the cancers for which the EAR is statistically significant, those with higher Excess Absolute Risk of MP were those of the oral cavity (EAR: 16.0 x 1,000 person-years in men and 5.4 in women), pharynx (17.6 and 9.1), larynx (11.4 and 8.8), and oesophagus (8.5 and 4.8).This descriptive study provides quantitative information on the risk of developing a second cancer in an Italian population-based cohort of approximately 1.65 million cancer patients, compared to the risk of the general population. During the follow-up time (on average 14 years) cancer patients had an MP risk that was 10% higher in comparison to the general population and an Excess Absolute Risk of 1.32 x 1,000 person-years. Study of MPs and their risk measures are dependent on methods used in the calculation. The definition of MP is not univocal and using different rules can greatly change the number of cancers in a patient with MPs. However, the AIRTUM cancer registries adopt the same recommendations for MP definition. This monograph was therefore made possible by the shared rules and standards used by AIRTUM registries. The cancer site-specific sheets, which represent the core of the monograph, can be useful to highlight and quantify the bidirectional associations among different diseases and therefore provide indications for clinical follow-up. Lifestyle changes in more healthful directions can have a positive effect in the cancer patient population and should always be recommended.

5. [Italian cancer figures, report 2010: Cancer prevalence in Italy. Patients living with cancer, long-term survivors and cured patients]

Author

Airtum, Working Group, Guzzinati, Stefano, Dal Maso, Luigino, Angelis, Roberta, Paoli, Angela, Buzzoni, Carlotta, Crocetti, Emanuele, Bucchi, Lauro, Casella, Claudia, Cuccaro, Francesco, Fusco, Mario, Luminari, Stefano, Madeddu, Anselmo, Mangone, Lucia, Patriarca, Silvia, Piffer, Silvano, Stracci, Fabrizio, Tagliabue, Giovanna, Tumino, Rosario, Zappa, Marco, Capocaccia, Riccardo, Ferretti, Stefano, Mazzoleni, Guido, Bellu, Francesco, Tschugguel, Birgit, Valiere, Elena, Facchinelli, Gerlinde, Falk, Markus, Dal Cappello, Tomas, Giacomin, Adriano, Vercellino, Pier Carlo, Andreone, Simona, Busato, Anna, Marzola, Laura, Migliari, Elena, Carletti, Nada, Nenci, Italo, Caldarella, Adele, Corbinelli, Antonella, Giusti, Francesco, Intrieri, Teresa, Manneschi, Gianfranco, Nemcova, Libuse, Romeo, Gianpaolo, Sacchettini, Claudio, Paci, Eugenio, Serraino, Diego, Angelin, Tiziana, Bidoli, Ettore, Dottori, Margherita, Santis, Emilia, Forgiarini, Ornella, Zucchetto, Antonella, Zanier, Loris, Vercelli, Marina, Orengo, Maria Antonietta, Marani, Enza, Puppo, Antonella, Celesia, Maria Vittoria, Cogno, Roberta, Manenti, Simone, Garrone, Elsa, Quaglia, Alberto, Pannozzo, Fabio, Busco, Susanna, Rashid, Ivan, Ramazzotti, Valerio, Cercato, M. Cecilia, Battisti, Walter, Sperduti, Isabella, Macci, Leonarda, Bugliarello, Ester, Bernazza, Edvige, Tamburo, Lucilla, Rossi, Miriana, Curatella, Simonetta, Francesco, Carla, Tamburrino, Silvana, Bisanti, Luigi, Autelitano, Mariangela, Randi, Giorgia, Ghilardi, Simona, Leone, Rosanna, Filipazzi, Luisa, Bonini, Annamaria, Giubelli, Cinzia, Federico, Massimo, Artioli, Maria Elisa, Valla, Katia, Braghiroli, Barbara, Cirilli, Claudia, Pirani, Monica, Ferrari, Lorenza, Bellatalla, Caterina, Fusco, Maria, Panico, Margherita, Perrotta, Carmela, Vassante, Biagio, Traina, Adele, Carruba, Giuseppe, Cusimano, Rosanna, Amodio, Rosalba, Dolcemascolo, Cecilia, Staiti, Rosalba, Zarcone, Maurizio, Michiara, Maria, Bozzani, Francesco, Sgargi, Paolo, Cilia, Sonia, La Rosa, Maria Guglielmina, Cascone, Giuseppe, Frasca, Graziella, Giurdanella, Maria Concetta, Martorana, Caterina, Morana, Gabriele, Nicita, Carmela, Rollo, Patrizia, Ruggeri, Maria Grazia, Sigona, Aurora, Spata, Eugenia, Vacirca, Stefania, Di Felice, Enza, Pezzarossi, Annamaria, Caroli, Stefania, Pellegri, Carlotta, Vicentini, Massimo, Storchi, Cinzia, Cavuto, Silvio, Costa, Jaqueline, Falcini, Fabio, Colamartini, Americo, Balducci, Chiara, Ravegnani, Mila, Vitali, Benedetta, Cordaro, Carlo, Caprara, Licia, Giuliani, Orietta, Giorgetti, Stefania, Salvatore, Silvia, Palumbo, Monica, Vattiato, Rosa, Ravaioli, Alessandra, Foca, Flavia, Rinaldi, Elisa, Donato, Andrea, Iannelli, Arturo, Senatore, Gennaro, Zevola, Arrigo, Budroni, Mario, Cesaraccio, Rosaria, Pirino, Daniela, Carboni, Donatella, Fiori, Giovanna, Soddu, Marcella, Mameli, Gianpaolo, Mura, Francesco, Contrino, Maria Lia, Tisano, Francesco, Sciacca, Salvatore, Muni, Angela, Mizzi, Margherita, Russo, Maria, Tessandori, Roberto, Ardemagni, Giuseppina, Gianola, Luigi, Maspero, Sergio, Annulli, Monica Lucia, Moroni, Elena, Roberto, Guglielmana, Zanetti, Roberto, Rosso, Stefano, Prandi, Rossana, Sobrato, Irene, Gilardi, Franca, Busso, Paola, Franchini, Silva, Gentilini, Maria A., Battisti, Laura, Cappelletti, Maddalena, Moser, Marilena, La Rosa, Francesco, D Alo, Daniela, Scheibel, Massimo, Costarelli, Daniela, Spano, Francesco, Rossini, Stefania, Santucci, Cinzia, Petrinelli, Anna Maria, Solimene, Clotilde, Bianconi, Fortunato, Brunori, Valerio, Crosignani, Paolo, Contiero, Paolo, Preto, Lucia, Tittarelli, Andrea, Maghini, Anna, Codazzi, Tiziana, Frassoldi, Emanuela, Gada, Daniela, Costa, Enrica, Di Grazia, Laura, Zambon, Paola, Baracco, Maddalena, Bovo, Emanuela, Dal Cin, Antonella, Fiore, Anna Rita, Greco, Alessandra, Monetti, Daniele, Rosano, Alberto, Stocco, Carmen, Tognazzo, Sandro, Donato, Francesco, Limina, Rosa Maria, Adorni, Anna, Andreis, Paolo, Zani, Giuseppe, Piovani, Francesco, Salvi, Ornella, Puleio, Maria, Vitarelli, Susanna, Antonini, Silvia, Candela, Giuseppina, Pappalardo, Giuseppe, Scuderi, Tiziana, Lottero, Barbara, Ribaudo, Michele, Ricci, Paolo, Guarda, Linda, Gatti, Luciana, Bozzeda, Annalaura, Dall Acqua, Maria, Pironi, Vanda, Sutera Sardo, Antonella, Mazzei, Adriana, Sirianni, Nicola, Lavecchia, Anna Maria, Mancuso, Pierina, Usala, Mario, Pala, Filomena, Sini, Giovanna Maria, Pintori, Nicolina, Canu, Luisa, Demurtas, Giuliana, Doa, Nina, Pisani, Paola, Pastore, Guido, Magnani, Corrado, Terracini, Benedetto, Cena, Tiziana, Alessi, Daniela, Baussano, Iacopo, Merletti, Franco, Maule, Milena, Mosso, Maria Luisa, Nonnato, Marinella, Rasulo, Assunta, Richiardi, Lorenzo, Zuccolo, Luisa, Pivetta, Emanuele, Dalmasso, Paola, Macerata, Vanda, Ponz Leon, Maurizio, Domati, Federica, Rossi, Giuseppina, Goldoni, Carlo Alberto, Rossi, Federica, Gaetani, Carmela, Benatti, Piero, Roncucci, Luca, Di Gregorio, Carmela, Pedroni, Monica, Pezzi, Annalisa, Maffei, Stefania, Mariani, Francesco, Enrica Borsi, Cocchioni, Mario, Pascucci, Cristiana, Gennaro, Valerio, Lazzarotto, Anna, Benfatto, Lucia, Mazzucco, Giovanna, Montanaro, Fabio, AIRTUM Working Group […, Enrica, Borsi, and …]

Subjects
Adult, Male, Time Factors, Adolescent, Databases, Factual, Remission Induction, Infant, Middle Aged, CANCER, Cancer prevalence, Italy, Epidemiologic Studies, Young Adult, Child, Preschool, Neoplasms, Prevalence, Humans, Long-term survivors, Female, Registries, Survivors, Child, Aged
Abstract

OBJECTIVES: the aim of the present monograph is to update the estimation of the number of people living with cancer in Italy, to describe geographic variability, and estimate the number of long-term survivors, i.e., people living five years or more after a cancer diagnosis. MATERIALS AND METHODS: the study included the data of the AIRTUMdatabase. Twenty-four Cancer Registries (CRs) (covering 27% of the Italian population) collected information on the incidence and vital status of 1,275,353 cases diagnosed between 1978 and 2005. For each CR, the observed prevalence was calculated up to the maximum observable duration. To estimate the complete prevalence (all living patients, independently from time since diagnosis) and the prevalence for lengths of time exceeding the CR maximum duration of registration, the observed prevalence was corrected through a completeness index. Completeness indices, gender, age and site specific, were estimated by means of statistical regression models using cancer incidence and survival data available from CRs with more than 15 years of observation. As of 1 January 2006, the prevalence was estimated (as absolute numbers and as a proportion per 100,000 inhabitants) for 46 cancer sites, by gender, age class, years since diagnosis and geographic areas. RESULTS: as of 2006, 2,244,000 persons (4%of the Italian population) were alive with a cancer diagnosis. A relevant geographic variability emerged, with proportions between 4%-5% among CRs in the Centre and North of Italy, and proportions between 2%-3% in the South. Forty-four percent of prevalent subjects (988,000) were males and 56% (1,256,000) females. Fifty-seven percent (1,285,680 people, 2.2% of total population) of these patients was represented by long-term survivors. In patients aged 75 years or more, the proportions of prevalent cases were 19%in males and 13%in females, and 10%between 60 and 75 years of age in both genders.More than half a million Italian women were alive with a breast cancer diagnosis (42%of women with a neoplasm), followed by women with cancers of the colonrectum (12%), corpus uteri (7%), thyroid (5%), and cervix uteri (4%). In men, 22%of prevalent cases (216,716) included patients with prostate cancer, 18% with bladder cancer, and 15%with colon-rectum cancer. Percentages of long-term survivors higher than 70% were reported for cancers of the cervix uteri (82% at five years, and 55% at 15 years from diagnosis), Hodgkin lymphoma, testis, brain and central nervous system, bone and connective tissue. Many patients with these types of cancers (often occurring in young people) can be considered "cured", i.e., with a life expectancy overlapping that of the general population.The estimated proportions of prevalent cases emerging from this study in Italy were quite similar to those reported in Northern Europe, but at least 15%lower than those in the United States. CONCLUSIONS: in 2006, the number of prevalent cases nearly doubled compared to 1992. The increase over time in the proportion of elderly patients, related to population ageing, requires adequate health policies. Knowing the number of people alive many years after cancer diagnosis (either cured or long-term survivors) provides the scientific bases for the definition of health policies focusing on them. Furthermore, it promotes the conduction of studies aimed at improving the present knowledge on the quality of life of these patients during and after the active phase of treatments, in addition to studies on the long-term effects of treatments.

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