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Survival of 12,051 cancer patients was investigated in incident cases registered in an ad hoc survey in the Umbria region for the period 1978-82. Death certificate only cases were excluded. The follow-up was carried out by an automatic link with the RENCAM (nominative register of causes of death) and verified at the Registrar's Offices of the various towns of the region. Both observed and relative survival rates according to sex and selected time periods (1, 5 and 10 years) were calculated. Generally, the relative survival rate for all tumour sites at 5 years was 0.35 in males and 0.53 in females (P < 0.01), and 0.31 and 0.49, respectively, at 10 years. 5-year relative survival rates greater than 0.50 were found for only three tumour sites in men (bladder, larynx, colon), accounting for approximately 21% of all men included in the study, but for six sites in females (breast, uterus, kidney, bladder, rectum, colon), accounting for more than 50% of the female cases. The 5-year age-adjusted relative survival rates in Umbria were higher than in other Italian and European registries for selected sites (stomach, colon, rectum, lung). High survival in Umbria could probably be related to the availability of specialist care and to the easy access to a network of oncological services.

We analyzed the 10-year survival of 1,512 women with breast cancer in relation to age at diagnosis. The incident cases were from an ad hoc investigation in Umbria, a region of central Italy, for the period 1978-1982. The follow-up was carried out by an automatic link with the RENCAM (Nominative register of causes of death) and verified at the Register's Offices of the various towns of the region. Observed survival at 1 year was 0.89, at 3 years 0.75, at 5 years 0.64 and at 10 years 0.47. Median survival was 9.0 years. Relative survival at 1, 3, 5, 10 years was respectively 0.91, 0.79, 0.71 and 0.59. Women < 35 years of age had a better prognosis both at 5 (0.83) and 10 years (0.69) from diagnosis. Thereafter, survival decreased with increasing age. The exception to this trend was women in the 45-49 and 60-64 year age ranges, for which survival was greater than the previous age range classes by 6% and 13%, respectively, at 5 years from diagnosis and 6% and 14% at 10 years. Comparison of data from Umbria and Italian and European Registries shows that the prognosis for Umbrian women with breast cancer is quite good.

With the aim of strengthening epidemiological knowledge on breast cancer, the authors analyze the geographical and temporal distribution of mortality and incidence of the neoplasy in Italy and other countries in the world; attention is focused on recent years and on the influence that the year of birth, the period and age of death have on Italian mortality trend. Analysis of the latest available data confirm the great variability in distribution of breast cancer in different countries of the world, with greater frequency in economically advanced western countries, urbanized and industrilized areas, white women and in higher socio-economic classes. The incidence of breast cancer in the world shows a continuous increases which is more evident and rapid in the countries and among the ethnic groups that were until now in lower risk categories. In Italy, during the period between 1950-88, there is a steady increase in the mortality rate, more evident in the first 20 years. The cumulative rates 25-49 years and 50-75 years demonstrates that the essential contribution to the trends is due to the mortality of elderly women. It is plausible that this trend is influenced by the increased survival, although a different cohort effect due to the exposure to different risk factors is possible. The cohort analysis of mortality shows a sharp cohort effect: the mortality increases in an evident way for all cohorts until those born in 1925, afterwhich we find a tendency towards reduction. The identification of specific reasons that are the basis of the observations can contribute to the knowledge of breast cancer eziology.