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Suicide rate is two-fold higher among cancer patients than in the general population. General and cancer-related risk factors for suicide are easily identified by caregivers interacting with patients, but with the exception of depression... more
Suicide rate is two-fold higher among cancer patients than in the general population. General and cancer-related risk factors for suicide are easily identified by caregivers interacting with patients, but with the exception of depression - the strongest one. This hampers the feasibility of screening of patients by the treating personnel. While new treatments tend to make cancer a chronic disease, which exposes patients to prolonged periods of uncertainty about recurrences, two recent advances have improved the possibility to prevent suicide. On the one hand, the emerging concept of cancer survivorship care has placed the identification of long-term consequences of cancer and its treatments, including an increased risk for suicide, among the objectives of patient follow-up. On the other hand, models of multidisciplinary team care have been implemented in several areas of cancer management. Although the psycho-oncologist has a complementary role, a clear definition of its relationship with the multidisciplinary teams facilitates the adoption of screening programmes for the detection of conditions of increased risk for suicide in cancer care facilities.
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This article analyses the mortality data used for the calculation of relative survival, within the survival study of the cases incident in 1990-1994. The mortality data used in the 14 cancer registries come from ISTAT or other official... more
This article analyses the mortality data used for the calculation of relative survival, within the survival study of the cases incident in 1990-1994. The mortality data used in the 14 cancer registries come from ISTAT or other official sources. Results show higher death risk for all causes of death in men and lower in women. Risk increases with age, values are generally higher in the North and lower in the Centre and the South of the country. Consistently with mortality trends, the difference between observed and relative survival is higher in older age groups, and in men rather than women, with an increasing difference the further from the date of diagnosis.
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BACKGROUND Prognostic factors in cutaneous melanoma are commonly evaluated by the Cox proportional hazard model. However, the interpretation of the effect of multiple variables is not straightforward. Classification and Regression Trees... more
BACKGROUND Prognostic factors in cutaneous melanoma are commonly evaluated by the Cox proportional hazard model. However, the interpretation of the effect of multiple variables is not straightforward. Classification and Regression Trees Analysis (CART), which allows a more friendly data evaluation, could be a valid integration of the message from Cox model. METHODS The CART algorithm splits up data, creating a "tree" of groups of patients with different profiles for risk of death. Results are easy to interpret in clinical practice. A total of 2,692 patients with invasive cutaneous melanoma registered in Romagna (northern Italy) between 1993-2012 and followed-up until the end of 2013 were included. The Cox model and CART analysis were applied to sex, patient age, histological subtype, Breslow's tumour thickness, ulceration, site of disease, and Clark level. RESULTS The CART analysis identified 15 categories which were collapsed into five classes with statistically different survival. The best prognostic group (10-year observed survival, 99.1%) included subjects with Breslow's thickness ≤ 0.78 mm and age 16-81 years. The worst prognostic group (10-year observed survival, 35.8%) comprised subjects with thickness ≥ 3.75 mm and age 16-96 years. According to the Cox model, patient age, histological subtype, Breslow thickness, ulceration, and site of disease had a significant independent prognostic value. CONCLUSIONS CART and Cox models provided consistent results. CART seemed friendlier in its interpretation and it could facilitate the communication of risk.
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• Growing difficulties in calculating the proportional incidence of interval breast cancers are emerging in screening programmes.
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In 1990, The Bethesda System (TBS) was introduced into spontaneous cervical screening practice in Ravenna, Italy. Negative/benign reports with the recommendation for early repeat smears (RERS) due to some limitation in sample adequacy... more
In 1990, The Bethesda System (TBS) was introduced into spontaneous cervical screening practice in Ravenna, Italy. Negative/benign reports with the recommendation for early repeat smears (RERS) due to some limitation in sample adequacy were considered no longer acceptable. A monitoring program for the rate of unsatisfactory smears (UNS) was implemented. The aim of the present study was to evaluate the effects of such changes in the screening procedure. The frequency of UNS in 1990 was compared with that of UNS+RERS in 1988 (assumed as a baseline year) by the calculation of the standardized rate ratio with the 95% confidence interval (CI). The trend in the standardized rate of UNS from 1990 to 1994 was evaluated by the calculation of the average annual variation with the 95% CI. The immediate effect of TBS (1990; 1988 comparison) was a significant increase in the rate of UNS attributable to scant cellularity, poor fixation and thick areas (rate ratio, 2.35; 95% CI, 2.18 to 2.53) and to the absence of endocervical component (1.45; 95% CI, 1.30 to 1.60). The rate of UNS attributable to the presence of cytolysis, inflammation, blood and foreign material decreased by about 6 times (0.16; 95% CI, 0.13 to 0.19). The midterm effect of TBS (trend from 1990 to 1994) was a decrease in the total rate of UNS by an average of 2.3% per year. The downward trend was significant for smears showing scant cellularity, poor fixation and thick areas (-1.5% per year) and the absence of endocervical component (-0.7% per year). UNS attributable to the presence of cytolysis, inflammation, blood and foreign material stabilized. TBS led to a substantial change in the type of information provided by the cytology report (immediate effect). The monitoring program according to TBS led to a reduction in UNS attributable to sample taker (midterm effect).
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BACKGROUND & AIMS This cohort study compared colorectal cancer (CRC) incidence and mortality between people who participated in an Italian regional biennial fecal immunochemical test (FIT) screening program and people who did not.... more
BACKGROUND & AIMS This cohort study compared colorectal cancer (CRC) incidence and mortality between people who participated in an Italian regional biennial fecal immunochemical test (FIT) screening program and people who did not. METHODS The program started in 2005. The target population included over 1,000,000 people aged 50-69 years. The FIT was a one-sample OC-Sensor (Eiken Chemical Co., Tokyo, Japan) (cut-off, ≥20 μg hemoglobin/g feces). The average annual response rate to invitation was 51.4%. The records of people invited up to June 2016 were extracted from the screening data warehouse. Attenders were subjects who responded to the first 2 invitations or to the single invitation sent them before they became ineligible. Non-attenders were subjects who did not respond to any of these invitations. The records were linked with the regional CRC registry. People registered up to December 2016 were identified. Self-selection-adjusted incidence rate ratios (IRR) and incidence-based CRC mortality rate ratios (MRR) for attenders to non-attenders, with 95% confidence intervals (CI), were calculated. RESULTS The cohort generated 2,622,131 man-years and 2,887,845 woman-years at risk with 4,490 and 3,309 CRC cases, respectively. The cohort of attenders was associated with an IRR of 0.65 (95% CI, 0.61-0.69) for men, 0.75 (0.70-0.80) for women, and 0.69 (0.66-0.72) for both sexes combined. The self-selection-adjusted IRR was 0.67 (95% CI, 0.62-0.72) for men, and 0.79 (0.72-0.88) for women. The IRR for stage I, II, III and IV CRC was 1.35 (95% CI, 1.20-1.50), 0.61 (0.53-0.69), 0.60 (0.53-0.68) and 0.28 (0.24-0.32) for men and 1.64 (1.43-1.89), 0.60 (0.52-0.69), 0.73 (0.63-0.85), and 0.35 (0.30-0.42) for women. The overall incidence-based CRC MRR was 0.32 (95% CI, 0.28-0.37) for men, 0.40 (0.34-0.47) for women and 0.35 (0.31-0.39) for both sexes combined. The adjusted MRR was 0.35 (95% CI, 0.29-0.41) for men and 0.46 (95% CI, 0.37-0.58) for women. CONCLUSIONS Attendance to a FIT screening program is associated with a CRC incidence reduction of 33% among men and 21% among women, and a CRC mortality reduction of 65% and 54%, respectively.
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Research Interests: Medicine, Humans, Female, Pubmed, Melanoma, and 6 moreMale, Clinical Sciences, Middle Aged, Sex Factors, Age Factors, and Skin Neoplasms
Research Interests: Demography, Incidence Geometry, Adolescent, Medicine, Italy, and 15 moreHumans, Child, Female, Melanoma, Male, Incidence, Clinical Sciences, Aged, Middle Aged, Adult, Trunk, Age Groups, Skin Neoplasms, Tumori, and Age distribution
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Objectives: to evaluate the incidence of advanced-stage breast cancer (BC) - an early surrogate indicator of effectiveness of mammography screening - among women who attended the Friuli Venezia Giulia (FVG) Region (Northern Italy)... more
Objectives: to evaluate the incidence of advanced-stage breast cancer (BC) - an early surrogate indicator of effectiveness of mammography screening - among women who attended the Friuli Venezia Giulia (FVG) Region (Northern Italy) screening programme compared to women who did not attend. Design: retrospective cohort study. Women invited to the first screening round (2006-2007) were identified from the database of the programme. The cohort was record-linked to the archive of women invited to the second round (2008-2009). The definition of attendance to screening was based on attendance to at least one of the two rounds. The incidence of BC was assessed through record linkage with the FVG cancer registry using an anonymous univocal identifier (end of follow-up: 31st December 2013). Three distinct definitions of advanced stage were used: pT2 or greater (pT2+), positive lymph nodes (pN+), and TNM stage II or greater (stage II+). Setting and participants: organized mammography screening programme for women aged 50-69 years in the five regional healthcare districts. Main outcome measures: incidence rate ratio (IRR) between attenders and non-attenders, adjusted for age and deprivation index, with 95% confidence interval (95%CI). Results: the cohort included 104,488 attenders and 49,839 non-attenders. During follow-up (median duration 84 months), 2,717 invasive BCs were diagnosed among attenders and 1,149 among non-attenders. Total incidence rate was 13% higher among attenders (IRR 1.13; 95%CI 1.05-1.21). These, conversely, had a 36% lower rate of pT2+ BC (IRR 0.64; 95%CI 0.56-0.72), a 13% lower rate of pN+ BC (IRR 0.87; 95%CI 0.78-0.98), a 22% lower rate of stage II+ BC (IRR 0.78; 95%CI 0.70-0.87), and a 32% lower rate of mastectomy (IRR 0.68; 95%CI 0.60-0.78). Conclusions: attenders had lower incidence rates of advanced-stage BC. This early effect is suggestive of a future impact of the screening programme on BC mortality.
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... AMADORI, A.*; GENTILINI, P.; BUCCHI, L.; INNOCENTI, MP; FALCINI, F.; MARTINI, M.; FABBRI, M.; LIVERANI, M.; DANESI, S.; PIANTINI, B.; MILANDRI, C.; SARAGONI, L.§; AMADORI, D.. Article Outline. Collapse Box Author... more
... AMADORI, A.*; GENTILINI, P.; BUCCHI, L.; INNOCENTI, MP; FALCINI, F.; MARTINI, M.; FABBRI, M.; LIVERANI, M.; DANESI, S.; PIANTINI, B.; MILANDRI, C.; SARAGONI, L.§; AMADORI, D.. Article Outline. Collapse Box Author Information. ... Glenn Benoit et al. ...
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Background: An acceptable level of reliability is a prerequisite for the introduction of epiluminescence microscopy (ELM) into the diagnosis of pigmented skin lesions. Objective: To assess the effects of a training program on the... more
Background: An acceptable level of reliability is a prerequisite for the introduction of epiluminescence microscopy (ELM) into the diagnosis of pigmented skin lesions. Objective: To assess the effects of a training program on the reproducibility and accuracy of ELM as compared to clinical evaluation. Methods: Before and after the program, 48 clinical images and their ELM counterparts were independently evaluated by seven participants. Reproducibility was measured by the κ index, accuracy by the rate of exact diagnoses (RED) assuming histology as a reference. Results: We observed (i) no effect of training on clinical reproducibility, (II) an improved reproducibility of ELM diagnoses of nonmelanocytic lesions (NML) and melanomas but not of melanocytic nevi (MN), (iii) a greater increase in the clinical RED of NML and melanomas compared with MN and (iv) a similar though more pronounced increase in the RED on ELM. Conclusions: The effects of training were greater for ELM as compared to clinical diagnosis, and for NML and melanomas as compared to MN.
Research Interests: Education, Microscopy, Dermatology, Medicine, Humans, and 15 moreSkin Lesion Diagnosis, Switzerland, Skin Diseases, Clinical Sciences, Medical Diagnosis, Skin Pigmentation, Venereology, Observer Variation, Reproducibility, Reproducibility of Results, Indexation, Sensitivity and Specificity, Training Program, Clinical Diagnosis, and Clinical evaluation
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Research Interests: Radiology, Breast Cancer, Cell Biology, Medicine, Biopsy, and 15 moreItaly, Humans, Female, Breast, Mammography, Laboratories, Clinical Sciences, Fine needle aspiration cytology, Aged, Middle Aged, Adult, Retrospective Studies, Sensitivity and Specificity, Predictive value of tests, and Breast Neoplasms
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In an external quality assurance (EQA) scheme, 110 selected cervical smears were independently reported by seven cytology laboratories using the 1988 Bethesda System. In one of these, a random sample of 60 study smears was independently... more
In an external quality assurance (EQA) scheme, 110 selected cervical smears were independently reported by seven cytology laboratories using the 1988 Bethesda System. In one of these, a random sample of 60 study smears was independently classified by five cytologists before undergoing joint examination according to EQA protocol. Internal agreement (i.e., among these cytologists) was compared with external agreement (between these cytologists and the other six laboratories) and with interlaboratory agreement (among these laboratories). The kappa value for internal agreement on sample adequacy (0.57) was considerably greater than those for external (0.16) and interlaboratory agreement (0.10). For interpretation of epithelial abnormalities, internal kappa was excellent (0.80) but not substantially greater compared with external kappa (0.66) and interlaboratory kappa (0.70). Calculation of class-specific kappa values revealed (a) that superiority of internal agreement on sample adequacy was restricted to the notations of "less than optimal" and of "satisfactory," and (b) that internal increase in agreement on cytologic abnormalities was substantial for the diagnosis of "atypical cells of undetermined significance."
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"OBJECTIVES: to evaluate the effectiveness of the regional law No.1035 enacted in 2009 by the local government of the Emilia- Romagna Region (Northern Italy) with the purpose of revising the rules of access to breast-care services. The... more
"OBJECTIVES: to evaluate the effectiveness of the regional law No.1035 enacted in 2009 by the local government of the Emilia- Romagna Region (Northern Italy) with the purpose of revising the rules of access to breast-care services. The law dictated the extension of the organised mammography screening programme to women aged 45-49 and 70-74 years in order to decrease their spontaneous screening rates and, thus, the waiting times for the access to diagnostic mammography by women of all ages. Design: study of time trends (joinpoint regression analysis and before/ after analysis) in annual percent mammography rates and in waiting times for access to clinical radiology facilities (2006-2014) among resident women. The information was taken from the regional Department of Health. Setting: public and accredited private radiology facilities. Main outcome measures: age-specific and waiting-time-specific (months) percent rates of organised screening mammography, spontaneous screening mammography, and diagnostic mammography. Results: following the regional law No.1035, screening rates among women aged 45-49 and 70-74 years reached levels comparable to those attained by women aged 50-69 years. Spontaneous screening rates dropped and waiting times for spontaneous screening mammography (women aged 40-44 years) were cut. For diagnostic mammography, the rates remained stable, except for a decrease among women aged 35-39 and 45-49 years, and waiting times decreased in a constant manner over the study period. Conclusions: the above-mentioned law met most of its goals. Comprehensive programmes regulating mammography practice at the population level can be effective."
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This study addressed the independent association of past and recent sun exposure indicators and other host factors with the prevalence of major digital epiluminescence microscopy (D-ELM) features such as the pigment network (PN), brown... more
This study addressed the independent association of past and recent sun exposure indicators and other host factors with the prevalence of major digital epiluminescence microscopy (D-ELM) features such as the pigment network (PN), brown globules (BGs), and pigment dots (PDs) in acquired melanocytic naevi. In a consecutive series of 189 patients (median age 28 years; range 10-73 years) with one or more naevi as diagnosed on D-ELM, we evaluated 35 solitary lesions and one naevus randomly selected from each of the 154 patients with multiple lesions. D-ELM images were classified for the presence or absence of PN, BGs and PDs on two blind readings. Data analysis was based on multiple logistic regression. Patient age was positively associated with PN and inversely associated with BGs. The probability of PN increased with more than 110 days since last exposure to the sun, whereas a rapid decrease for BGs and PDs was observed after approximately 1 month. PDs were significantly more likely among lesions with 6-10 h/day of recent exposure. Sex, total lifetime hours of exposure, sunbed use, skin type and colour of hair exerted no effect. In conclusion, major D-ELM features appeared to differ in their relationship with sun exposure indicators.
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The distribution of Breslow's thickness by sex, age and site of 95 of the 103 cases of primary cutaneous malignant melanoma (CMM) diagnosed in 1981-1990 in the Ravenna Health District (a low-incidence area in northern Italy) was... more
The distribution of Breslow's thickness by sex, age and site of 95 of the 103 cases of primary cutaneous malignant melanoma (CMM) diagnosed in 1981-1990 in the Ravenna Health District (a low-incidence area in northern Italy) was studied. The median patient age was 57 years. The median tumor thickness was 1.33 mm in females and 2.15 mm in males (two-tailed Wilcoxon rank sum test, p = 0.153). Significantly thinner lesions were found among women up to the median age than among men of the same age group (1.05 mm vs. 1.80 mm, p = 0.034) and older women (2.20 mm, p = 0.035). The difference between males aged under 57 years and older than 57 was not significant (1.80 mm vs. 2.20 mm, p = 0.828). As a consequence, younger women compared favorably with the rest of the population as a whole (2.20 mm, p = 0.011). No significant differences in site-specific median tumor thickness were found between the sexes or between young and older males, whereas CMMs of the legs among females were thinner in the younger age group (0.67 mm vs. 2.20 mm, p = 0.007). The prevalence of younger women in the recognition of early CMM was entirely accounted for by a substantial shift observed in the most recent 5-year period (from 2.40 mm to 0.70 mm, p = 0.006). Specific educational activities have never been carried out in Ravenna.
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To evaluate the diagnostic agreement between seven cervical/vaginal cytology laboratories participating in the first external quality assurance (EQA) scheme developed in Italy. Between 1991 and 1993, 110 cytologic smears were selected and... more
To evaluate the diagnostic agreement between seven cervical/vaginal cytology laboratories participating in the first external quality assurance (EQA) scheme developed in Italy. Between 1991 and 1993, 110 cytologic smears were selected and classified by a committee and circulated and reported on by the laboratories according to the 1988 Bethesda System. Agreement was evaluated with the kappa statistic. Systematic disagreement was assessed by means of the Wilcoxon signed rank test. Interlaboratory kappa values varied between .01 and .29 (group score, .11) for sample adequacy and between .53 and .78 (group score, .67) for epithelial abnormalities. The lowest specific kappa values were observed for the three classes of sample adequacy (unsatisfactory, .07; less than optimal [LTO], .10; satisfactory [SAT], .14) and for the class of atypical cells of undetermined significance (ACUS), (.29). As compared with the study committee, 5/7 laboratories showed a systematic (P<.01) tendency to undercall sample adequacy. Agreement on epithelial abnormalities was also analyzed according to the pattern of adequacy reported by paired laboratories (LTO/LTO, LTO/SAT, SAT/SAT). As compared with smears designated SAT/SAT, those classified as LTO/SAT were associated with lower specific kappa values for agreement on the presence of carcinoma and ACUS and with equal or greater values for agreement on the other classes, suggesting an arbitrary use of notations of LTO inversely related to the severity of epithelial lesions. EQA schemes, as applied to cervical/vaginal cytology, can shed light on major deficiencies in specific diagnostic areas.
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Space-time analysis of mortality risk is useful to evaluate the epidemiologic transitions at the subnational level. In this study, we analysed the death certificate records for lung cancer in Italy in 1995-2016, obtained from the Italian... more
Space-time analysis of mortality risk is useful to evaluate the epidemiologic transitions at the subnational level. In this study, we analysed the death certificate records for lung cancer in Italy in 1995-2016, obtained from the Italian National Statistics Institute. Our objective was to investigate the spatio-temporal evolution of lung cancer mortality by sex and province of residence (n = 107) using the birth cohort as relevant time axis. We built space-time Bayesian models with space-time interactions. Among men (n = 554,829), mortality peaked in the 1920-1929 cohort, followed by a generalised decline. Among women (n = 158,619), we found novel original evidence for a peak in the 1955-1964 cohort, equivalent to a 35-year delay, with a downward trend being observed thereafter. Over time, the documented north-south decreasing mortality gradient has been replaced by a west-east decreasing gradient. Naples has become the province at highest risk in Italy, both among men and women. Th...
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Objectives: to update the Italian estimates of survival for patients with a paediatric cancer, tobacco smoke-associated cancers, and cancers targeted by screening; to assess geographical differences. Design: population-based descriptive... more
Objectives: to update the Italian estimates of survival for patients with a paediatric cancer, tobacco smoke-associated cancers, and cancers targeted by screening; to assess geographical differences. Design: population-based descriptive study. Setting and participants: incident cancer cases diagnosed in 2010-2014, with follow-up to 2018, from 17 Italian cancer registries (covering 31% of the national population; 43% of the population residing in the North-Centre of the country and 8% of the population living in the South and Islands). Main outcome measures: age-standardized 5-year net survival (NS) by cancer site or type, sex, age, and geographical area. Results: NS of patients aged ≥15 years with breast, prostate, colorectal, and lung cancers was higher in the North-Centre than in the South and Islands. The overall survival of people diagnosed with cancer in childhood (0-14 years) was 84.3%, with similar values among the geographical macro-areas and between males and females. Women with breast cancer within the current target age of the screening programmes and those in the younger age groups (45-49 years) show similar survival values; the same is true for women with colorectal cancer. In both cases, survival decreased in the age groups after the age of cessation of screening programmes. Survival of patients with tobacco smoke-associated cancers varies according to cancer site (from 11.1% for patients with pancreatic cancer to 79.7% for those with bladder cancer). For most cancer sites, women have higher survival than men. Conclusions: for adults, a geographical survival gap persists. The results may contribute to the debate on extending the target age for screening programmes and to support initiatives to encourage tobacco smoking cessation even after cancer diagnosis. For patients who receive a cancer diagnosis in childhood, survival similar to highest values internationally.
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BackgroundThe global increase in incidence of cutaneous malignant melanoma (CMM) occurring in the past decades has been partly attributed to increased diagnostic scrutiny of early lesions, with a potential phenomenon of overdiagnosis. The... more
BackgroundThe global increase in incidence of cutaneous malignant melanoma (CMM) occurring in the past decades has been partly attributed to increased diagnostic scrutiny of early lesions, with a potential phenomenon of overdiagnosis. The reported positive linear relation between skin biopsy rate and incidence of early CMM is compatible with this hypothesis.ObjectivesWe explored the ecological association between the trends in annual dermatologic office visit rates, skin biopsy rates, incidence rates of in situ and invasive CMM by tumour thickness category, and CMM mortality rates in the Emilia‐Romagna Region (northern Italy).MethodsFour cancer registries covering a population of 2,696,000 provided CMM incidence data for the years 2003–2017. Dermatologic office visit rates and skin biopsy rates were calculated using the Regional outpatient care database. All rates were age‐standardized. Trends were described with the estimated average annual per cent change (EAAPC). Correlations wer...
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BACKGROUND We determined the relative contribution of decreased tumour thickness to the favourable trend in survival from cutaneous malignant melanoma (CMM) in Italy. METHODS Eleven local cancer registries covering a population of 8 056... more
BACKGROUND We determined the relative contribution of decreased tumour thickness to the favourable trend in survival from cutaneous malignant melanoma (CMM) in Italy. METHODS Eleven local cancer registries covering a population of 8 056 608 (13.4% of the Italian population in 2010) provided the records of primary CMM cases registered between 2003 and 2017. Age standardized 5-year net survival (NS) was calculated. Multivariate analysis of 5-year NS was done by calculating the relative excess risk of death (RER). The relative contribution of the decrease in tumour thickness to the RER was evaluated using a forward stepwise flexible parametric survival model including the available prognostic factors. RESULTS Over the study period, tumour thickness was inversely associated with 5-year NS and multivariate RER in both sexes. The median thickness was 0.90 mm in 2003-2007, 0.85 mm in 2008-2012 and 0.75 mm in 2013-2017 among men, and 0.78 mm, 0.77 mm and 0.68 mm among women, respectively. The 5-year NS was 86.8%, 89.2% and 93.2% (men), and 91.4%, 92.0%, and 93.4% (women). In 2013-2017, thus, men exhibited the same survival as women despite still having thicker lesions. For them, the increasing survival trend was more pronounced with increasing thickness, and the inclusion of thickness into the forward stepwise model made the RER in 2013-2017 versus 2003-2007 to increase from 0.64 (95% confidence interval, 0.51-0.80) to 0.70 (0.57-0.86). This indicates that thickness trend accounted for less than 20% of the survival increase. For women, the results were not significant but, with multiple imputation of missing thickness values, the RER rose from 0.74 (0.58-0.93) to 0.82 (0.66-1.02). CONCLUSIONS Especially for men, the decrease in tumour thickness accounted for a lesser part of the improvement in survival observed in 2013-2017. The introduction of targeted therapies and immune checkpoint inhibitors in 2013 is most likely to account for the remaining component.
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: Suicide rate is two-fold higher among cancer patients than in the general population. General and cancer-related risk factors for suicide are easily identified by caregivers interacting with patients, but with the exception of... more
: Suicide rate is two-fold higher among cancer patients than in the general population. General and cancer-related risk factors for suicide are easily identified by caregivers interacting with patients, but with the exception of depression - the strongest one. This hampers the feasibility of screening of patients by the treating personnel. While new treatments tend to make cancer a chronic disease, which exposes patients to prolonged periods of uncertainty about recurrences, two recent advances have improved the possibility to prevent suicide. On the one hand, the emerging concept of cancer survivorship care has placed the identification of long-term consequences of cancer and its treatments, including an increased risk for suicide, among the objectives of patient follow-up. On the other hand, models of multidisciplinary team care have been implemented in several areas of cancer management. Although the psycho-oncologist has a complementary role, a clear definition of its relationship with the multidisciplinary teams facilitates the adoption of screening programmes for the detection of conditions of increased risk for suicide in cancer care facilities.
Research Interests:
OBJECTIVES to evaluate the incidence of advanced-stage breast cancer (BC) - an early surrogate indicator of effectiveness of mammography screening - among women who attended the Friuli Venezia Giulia (FVG) Region (Northern Italy)... more
OBJECTIVES to evaluate the incidence of advanced-stage breast cancer (BC) - an early surrogate indicator of effectiveness of mammography screening - among women who attended the Friuli Venezia Giulia (FVG) Region (Northern Italy) screening programme compared to women who did not attend. DESIGN retrospective cohort study. Women invited to the first screening round (2006-2007) were identified from the database of the programme. The cohort was record-linked to the archive of women invited to the second round (2008-2009). The definition of attendance to screening was based on attendance to at least one of the two rounds. The incidence of BC was assessed through record linkage with the FVG cancer registry using an anonymous univocal identifier (end of follow-up: 31st December 2013). Three distinct definitions of advanced stage were used: pT2 or greater (pT2+), positive lymph nodes (pN+), and TNM stage II or greater (stage II+). SETTING AND PARTICIPANTS organized mammography screening pro...
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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... more
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
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The European Commission Initiative on Breast Cancer recommendation for triennial screening of women aged 70–74 is based on very weak evidence. A cohort of Italian women who had their last biennial screening mammography at age 68–69 was... more
The European Commission Initiative on Breast Cancer recommendation for triennial screening of women aged 70–74 is based on very weak evidence. A cohort of Italian women who had their last biennial screening mammography at age 68–69 was followed up for 5 years, assumed to represent the interval to another hypothetical screening mammography, in order to determine the annual proportional incidence of interval breast cancer. The cohort included 118,370 women. They had their last mammography between 1997 and 2008. Incident breast cancers were identified by record-linking the cohort with the regional breast cancer registry. The expected incidence in the age range 65–74 was estimated with an age-period-cohort model. The number of interval cancers was divided by the expected number to obtain their proportional incidence. Overall, there were 298,658 woman-years at risk with 371 interval cancers versus 988.8 expected. In the first, second, third, fourth, and fifth interval year, the proportional incidence was 0.09 (95% confidence interval, 0.06–0.13), 0.32 (0.25–0.39), 0.60 (0.49–0.73), 0.75 (0.60–0.92), and 0.81 (0.60–1.07), respectively. Between the second and the fifth year, tumour stage and molecular subtype did not change significantly. Though not supported by these findings, the proposal of triennial screening for women aged 70–74 merits further research, because the 95% confidence interval of the third-year proportional incidence of interval cancer included 0.50—the maximum limit considered acceptable for women aged 50–69. • The third-year incidence of breast cancer relative to the expected one was 0.60 (95% confidence interval, 0.49–0.73). • Between the second and the fifth year, tumour stage and molecular subtype did not change significantly (p >0.10). • The proposal of a 3-year screening interval at age 70–74 merits further evaluation.
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Prognostic factors in cutaneous melanoma are commonly evaluated by the Cox proportional hazard model. However, the interpretation of the effect of multiple variables is not straightforward. Classification and Regression Trees Analysis... more
Prognostic factors in cutaneous melanoma are commonly evaluated by the Cox proportional hazard model. However, the interpretation of the effect of multiple variables is not straightforward. Classification and Regression Trees Analysis (CART), which allows a more friendly data evaluation, could be a valid integration of the message from Cox model. The CART algorithm splits up data, creating a "tree" of groups of patients with different profiles for risk of death. Results are easy to interpret in clinical practice. A total of 2,692 patients with invasive cutaneous melanoma registered in Romagna (northern Italy) between 1993-2012 and followed-up until the end of 2013 were included. The Cox model and CART analysis were applied to sex, patient age, histological subtype, Breslow's tumour thickness, ulceration, site of disease, and Clark level. The CART analysis identified 15 categories which were collapsed into five classes with statistically different survival. The best prognostic group (10-year observed survival, 99.1%) included subjects with Breslow's thickness ≤ 0.78 mm and age 16-81 years. The worst prognostic group (10-year observed survival, 35.8%) comprised subjects with thickness ≥ 3.75 mm and age 16-96 years. According to the Cox model, patient age, histological subtype, Breslow thickness, ulceration, and site of disease had a significant independent prognostic value. CART and Cox models provided consistent results. CART seemed friendlier in its interpretation and it could facilitate the communication of risk.
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Objective To estimate the proportional incidence (PI) of first- and second-year interval breast cancer among women aged 45–49. Methods In the Emilia-Romagna Region (northern Italy), women aged 45–49 are invited to mammography screening... more
Objective To estimate the proportional incidence (PI) of first- and second-year interval breast cancer among women aged 45–49. Methods In the Emilia-Romagna Region (northern Italy), women aged 45–49 are invited to mammography screening annually, and women aged 50–74 biennially. For younger ones, the proportional incidence of interval cancer in the first and unique interval year was calculated using standard methods. For the second, hypothetical year, it was estimated using two different estimates of the ratio between the second- and the first-year proportional incidence observed among women aged 50–54. Overall, 567,151 negative mammography records were used. Results In the first interval year, the observed proportional incidence of interval cancer among women aged 45–49 was 0.27 (95% confidence interval (CI), 0.22–0.33), within the European limit considered desirable for women aged 50–69 (<0.30). In the second, hypothetical interval year, the estimated proportional incidence rang...