leonardo Ventura

Background: the knowledge of sojourn time (the duration of the preclinical screen-detectable period) and screening test sensitivity is crucial for understanding the disease progression and the effectiveness of screening programmes. For this purpose a model of the natural history of the disease is needed. The aim of this work is to provide an illustration of the application of multistate Markov models for breast cancer progression to the data of the Florentine screening programme, in order to estimate the sojourn time and sensitivity for breast cancer screening. MeThods: three different multi-state Markov models of increasing complexity were used with three different estimation procedures based on non-linear least squares, maximum likelihood, and on a Bayesian approach. all the models produced estimates for screening sensitivity and mean sojourn time. The data used in our application seem to lead to a non-identifiability problem, since the estimation procedures for both the Maximum L...

OBJECTIVES to describe the course of Italian organized cancer screening programmes during the COVID-19 emergency; to provide estimates of the diagnosis of malignant or pre-malignant lesions that will face a diagnostic delay due to the slowing down of screening activities. DESIGN quantitative survey of aggregated data for each Region and overall for Italy relating to screening tests carried out in the period January-May 2020 compared to those of the same period of 2019; estimate of diagnostic delays starting from the calculation of the average detection rate of the last 3 years available (specific by Region). SETTING AND PARTICIPANTS Italian mass screening programmes. Data on the tests carried out in the target population of the breast (women 50-69 years old), cervix (women 25-64 years old), and colorectal (women and men 50-69 years old) cancer screening. MAIN OUTCOME MEASURES the cumulative delay (in absolute numbers and as a percentage) in the period January-May 2020 compared to th...

Colorectal cancer (CRC) dominants in incidence and mortality among all malignant tumors, it is observed both globally and different regions of Russia. The results of analytical epidemiological study «case-control» on the impact of the colorectal cancer risk factors are presented. Considered risk factors were associated with the sources of water consumption and the some features of diet in Permski Krai. Questionnaire surveys of 200 patients with CRC and 200 healthy individuals were performed. Observation and control groups were spread evenly by sex, age and ethnicity. It was determined following risk factors: consumption of municipal unboiled water and well water, sour cream intake, high concentration of salt in the food, fat, fried and spicy meal as well. There were protective factors such us consumption of municipal boiled water and intake of total dairy products more than 1000 g per week.

Poly(vinylidene fluoride)-based dielectric materials are prospective candidates for high power density electric storage applications because of their ferroelectric nature, high dielectric breakdown strength and superior processability. However, obtaining a polar phase with relaxor-like behavior in poly(vinylidene fluoride), as required for high energy storage density, is a major challenge. To date, this has been achieved using complex and expensive synthesis of copolymers and terpolymers or via irradiation with high-energy electron-beam or γ-ray radiations. Herein, a facile process of pressing-and-folding is proposed to produce β-poly(vinylidene fluoride) (β-phase content: ~98%) with relaxor-like behavior observed in poly(vinylidene fluoride) with high molecular weight > 534 kg mol−1, without the need of any hazardous gases, solvents, electrical or chemical treatments. An ultra-high energy density (35 J cm−3) with a high efficiency (74%) is achieved in a pressed-and-folded poly(v...

We evaluated the association between volumetric breast density (BD) and risk of advanced cancers after a negative screening episode. A cohort of 16,752 women aged 49-54 years at their first screening mammography in the Florence screening programme was followed for breast cancer (BC) incidence until the second screening round. Volumetric BD was measured using fully automated software. The cumulative incidence of advanced cancer after a negative screening episode (including stage II or more severe cancer during the screening interval - on average 28 months - and at the subsequent round) was calculated separately for Volpara density grade (VDG) categories. BC incidence gradually increased with the increas in BD: 3.7‰, 5.1‰, 5.4‰ and 9.1‰ in the VDG categories 1-4, respectively (p trend < 0.001). The risk of advanced cancers after a negative screening episode was 1.0‰, 1.3‰, 1.1‰, and 4.2‰ (p trend = 0.003). The highest BD category, compared with the other three together, has double ...

In Italy, due to increasing healthcare budget and staff shortages, the recently created regional mammography screening programmes were established under worse radiology practice quality criteria than the previously created programmes. Using available data from a national questionnaire survey conducted at the end of 2013 and involving 222 responder radiologists, we compared the main professional quality standards of radiologists working in the screening programmes established during the period 2000-2012 with those working in the screening programmes created from 1990 to 1999. The former reported more years of clinical experience in breast imaging and a greater clinical mammogram reading volume than the latter. Conversely, they dedicated less working time to breast imaging, were less likely to participate in the diagnostic assessment of screen-detected lesions, to work in large-staffed screening centres, and to have a screening and a total mammogram reading volume (SMRV and TMRV) ≥ 50...

e11522 Background: TNBC are characterized by the lack of both hormonal receptors expression and overexpression of human epidermal receptor type-2 (HER2), and represents around of 15% of all invasive breast cancers in our population. Our aim was to describe demographic and clinical characteristics, response to neoadjuvant treatment and survival rates. METHODS We realized a retrospective review of 90 patients diagnosed with TNBC and treated with neoadjuvant chemotherapy at the Instituto Nacional de Enfermedades Neoplásicas during 2002-2008. The main clinicopathological and demographic variables were evaluated to determine risk factors for outcome, pathological response rates, progression free survival (PFS) and overall survival (OS). RESULTS The median age at diagnosis was 39 years, 15% were nulliparous, 66% had overweight or were obese, 44% had early menarche, 77% were premenopausal, 96% had locally advanced clinical stages, and 97% had infiltrating ductal histology. Different neoadjuvant chemotherapy regimens were used. Adriamycin-cyclophosphamide/paclitaxel was the most frequent (58.8%). Thirthy four patients (37.8%) also received additional neoadjuvant radiotherapy. A total of 32 patients (35%) progressed to neoadjuvant treatment. 64 patients undergone surgery, 11 (17.2%) patients achieved pathologic complete response (pCR) and 53 had residual disease (82.8%). We found significant differences between age and response to therapy (mean of 35.1 years to pCR and 41.3 years to residual disease; P=0.001); number of births (nulliparous or 1 birth VS > 2 births, RR = 3.9; P<0.012); age at first pregnancy (< 30 VS ≥ 30 years old; RR= 0.2; P=0.002). 26 patients (28%) had recurrent disease. Median of Follow-up was 3.4 years. The 3 years-OS was 52.4% and 3 years-PFS was 59.0%. The 3 years-OS for patients who achieved pCR was 100% and 63.0% for patients with residual disease (P = 0.034).The 3 years-PFS for patients who achieved pCR was 90.9% and 51.7% for patients with residual disease (P = 0.036). CONCLUSIONS TNBC in our institution showed pCR similar to those found in other international series. Age at diagnostic, number of births and age at first pregnancy were identified as risk factors for response to therapy.

Aspirin has been associated with reduced incidence and mortality of colorectal and a few other cancers. The aim of our paper was to study the effect of low-dose aspirin intake on cancer mortality in a population-based cohort study. The study included inhabitants of the Florence district (Italy) at the beginning of 2007. We considered two cohorts: patients who received prescriptions of low-dose aspirin for the whole year and patients who did not have any prescriptions over the same period. We followed the two cohorts until 31 December 2013. By linking with the Tuscany Mortality Registry, we analysed cause-specific mortality. We used a Cox semiparametric model to compare the mortality of the two cohorts. There was an 18% higher probability [hazard ratio (HR)=1.18, 95% confidence interval (CI): 1.12-1.23] for all causes of death among the cohort of aspirin users, almost completely caused by cardiovascular diseases (CVDs) (HR=1.39, 95% CI: 1.29-1.49). Colorectal cancer mortality was reduced by almost 30% (HR=0.71, 95% CI: 0.52-0.97). Death caused by major bleeding was 11% higher (HR=1.11, 95% CI: 0.86-1.44), but not statistically significant. Our results support the hypothesis that the use of low-dose aspirin for CVD prevention reduces colorectal cancer mortality. Given the growing ability to identify subgroups of individuals with an increased risk of developing cancer, further studies are needed to study the effectiveness of different cancer screening strategies tailored to these specific subgroups. Our study suggests the importance of focusing on this issue from the opposite perspective, that is, considering subgroups of individuals at decreased risk, such as the subgroup of individuals who take low-dose aspirin for CVD prevention. Thus, further assessments are needed to possibly identify subgroup-specific screening strategies that would be more effective than those developed for average-risk individuals.

The aim of this study was to evaluate the participation and yield of the faecal immunochemical test (FIT) in nonattendees for computed tomography colonography (CTC) or optical colonoscopy (OC) screening, in the setting of a randomized trial. In the SAVE trial, 16087 individuals were randomly assigned and invited to one of four interventions for colorectal cancer screening: (i) biennial FIT for three rounds; (ii) reduced-preparation CTC; (iii) full-preparation CTC; and (iv) OC. Nonattendees of reduced-preparation CTC, full-preparation CTC and OC groups were invited to FIT. Here, we analysed the participation rate and the detection rate for cancer or advanced adenoma (advanced neoplasia) of FIT among nonattendees for reduced-preparation CTC, full-preparation CTC and OC. Nonattendees were 1721 of 2395 (71.9%) eligible invitees in the reduced-preparation CTC group, 1818 of 2430 (74.8%) in the full-preparation CTC group and 883 of 1036 (85.2%) in the OC group. Participation rates for FIT...

Haemoglobin (Hb) stability in faecal samples is an important issue in colorectal cancer screening by the faecal immunochemical test (FIT) for Hb. This study evaluated the performance of the FIT-Hb (OC-Sensor Eiken) used in the Florence screening programme by comparing two different formulations of the buffer, both in an analytical and in a clinical setting. In the laboratory simulation, six faecal pools (three in each buffer type) were stored at different temperatures and analysed eight times in 10 replicates over 21 days. In the clinical setting, 7695 screenees returned two samples, using both the old and the new specimen collection device (SCD). In the laboratory simulation, 5 days from sample preparation with the buffer of the old SCD, the Hb concentration decreased by 40% at room temperature (25°C, range 22-28°C) and up to 60% at outside temperature (29°C, range 16-39°C), whereas with the new one, Hb concentration decreased by 10%. In the clinical setting, a higher mean Hb conce...

Screening mammogram reading volume (SMRV) and total (screening and clinical) mammogram reading volume (TMRV) per year are strongly associated with the radiologist's diagnostic performance in breast cancer screening. The current article reports the prevalence and correlates of a SMRV and a TMRV ≥5000 among Italian breast screening radiologists. A questionnaire survey was carried out in 2013-2014 by the Italian Group for Mammography Screening (GISMa). The questionnaire included items of information for radiologist's experience-related characteristics and for facility-level factors supposedly associated with SMRV and TMRV. Multivariate analysis was performed using backward stepwise multiple logistic regression models. Data for 235 radiologists from 51 local screening programmes were received. Of the 222 radiologists who were eligible, 133 (59.9 %) reported a SMRV ≥5000 and 163 (73.4 %) a TMRV ≥5000. Multivariate factors positively associated with both characteristics included: ...

Background: the knowledge of sojourn time (the duration of the preclinical screen-detectable period) and screening test sensitivity is crucial for understanding the disease progression and the effectiveness of screening programmes. For this purpose a model of the natural history of the disease is needed. The aim of this work is to provide an illustration of the application of multistate Markov models for breast cancer progression to the data of the Florentine screening programme, in order to estimate the sojourn time and sensitivity for breast cancer screening. Methods: three different multi-state Markov models of increasing complexity were used with three different estimation procedures based on non-linear least squares, maximum likelihood, and on a Bayesian approach. All the models produced estimates for screening sensitivity and mean sojourn time. The data used in our application seem to lead to a non-identifiability problem, since the estimation procedures for both the Maximum Likelihood and Non-Linear Least Squares gave estimates that changed with the parameters’ initial values or difficultly converged. In order to take this problem into account we used the Bayesian Approach by incorporating prior information on all the parameters. Results: the mean sojourn time varied between 2-7 years and 3-5 years for women aged 50-59 and 60-69, respectively. When the model complexity was increased a higher variability in estimates was observed among the estimation procedures. The results of the screening sensitivity estimates were highly variable, both among estimation techniques and models - varying between 63% and 100%, and between 77% and 100% for women aged 50-59 and 60-69, respectively. Conclusions: results are in accord with the literature; those obtained through the Bayesian Approach seem to be more reliable.

This report is an update of a number of papers that have been published by the ONS (Osservatorio nazionale screening, National centre for screening monitoring) since 2002. Data for the survey come from several programmes that may have changed over time, and may have different settings of organization and management. During 2011-2012, a slight increase in actual extension was recorded compared to the previous years. Currently, all Italian regions have implemented screening programmes. In 2011-2012, almost 5,300,000 women aged 50-69 years were invited to have a screening mammogram, and almost 3,000,000 were screened.While potential extension was 94.4%, actual extension was 73.3%. An imbalance in extension is still present when comparing northern and central Italy, that have an actual screening extension of 94% and 86% respectively, to southern Italy, that has less than 40%. During the last few years, participation rates have been substantially stable, at around 56%for crude rate, and ...

Together with the National centre for screening monitoring (ONS), GISMa supports annual collection of data on national breast screening activities. Aggregated data on implementation and performance are gathered through a standardized form to calculate process and impact indicators. Analyzed data belong to 153 local programmes in the period 2006-2011 (2006-2012 for participation rate only). During the whole period, Italian crude participation rate exceeded GISMa's acceptable standard (50%), even though a higher participation in northern and central Italy compared to southern Italy and Islands was observed. Time trend analysis of diagnostic indicators confirmed in 2011 an adequate quality of breast screening performance, especially at subsequent screening. Recall rate at initial screening did not reach the acceptable standard (<7%) and rose slightly over the period. On the contrary, a good performance was achieved at subsequent screening. The same trend was followed by the over...

This report is an update of similar previous papers that have been published by the ONS (Osservatorio nazionale screening, National Centre for Screening Monitoring) since 2002. Data for the survey come from several different programmes that may have changed over time, and may have different settings of organisation and management. During 2010, the first slight decrease in theoretical extension was recorded. Currently, all Italian regions have implemented screening programmes. In 2010, almost 2,496,000 women aged 50-69 years were invited to have a screening mammogram, and more than 1,382,000 were screened. Theoretical extension was 91.7%, while actual extension was 69.1%. An imbalance in extension is still present when comparing northern and central Italy to southern Italy, which only has a 75% coverage by organised screening. The Italian mean value (69%) of two-year extension (period 2009-2010) suggests that, at full capacity, Italian programmes are able to invite only three quarter...

This report is an update of similar previous papers that have been published by the ONS (Osservatorio nazionale screening, National Centre for Screening Monitoring) since 2002. Data for the survey come from several different programmes that may have changed over time, and may have different settings of organisation and management. During 2009, an increase in theoretical extension was recorded; however, this was not followed by an increase in actual extension, which remained stable. Currently, all Italian regions have implemented screening programmes. In 2009, almost 2,522,000 women aged 50-69 years were invited to have a screening mammogram, and more than 1,362,000 were screened. Theoretical extension was 93.8%, while actual extension was 69.5%. An imbalance in coverage is still present when comparing northern and central Italy to southern Italy, which only has a 78% coverage by organised screening. The Italian mean value (78.5%) of two-year extension (period 2008-2009) suggests tha...

This report is an update of similar previous papers that have been published by the ONS (Osservatorio Nazionale Screening, National Centre for Screening Monitoring) since 2002. Data for the survey come from several different programmes that may have changed over time, and may have different settings of organisation and management. During 2007, a further increase in screening activity was recorded, with the inclusion of all Northern and Central Italian Regions, and a further development in the Southern Regions and Islands, so today all Italian Regions have implemented screening programmes. In 2008, almost 2,509,000 women aged 50-69 years were invited to have a screening mammogram, and more than 1,361,000 were screened. Theoretical extension was 89.9%, while actual extension increased from 62.3% in 2007 to 69.4%in 2008. An imbalance in coverage is still present when comparing Northern and Central Italy to Southern Italy, which only has a 69% coverage by organised screening. The Italia...

This report is an update of similar previous papers that have been published by the ONS (Osservatorio Nazionale Screening, National Centre for Screening Monitoring) since 2002. Data for the survey come from several different programmes that may have changed over time, and may have different settings of organisation and management. During 2007, a further increase in screening activity was recorded, with the inclusion of all Northern and Central Italian Regions, and a further development in the Southern Regions and Islands. In 2007, screening activity also started in Puglia, so today all Italian Regions have implemented screening programmes. In 2007, almost 2,210,000 women aged 50-69 years were invited to have a screening mammogram, and over 1,225,000 were screened. Theoretical extension was 81.4%, while actual extension increased from 57.2% in 2006 to 62.3% in 2007, finally rising over the critical value of about 50% registered during the last years. An imbalance in coverage is still...

Since 1990, the Italian Group for Mammography Screening (GISMa) has been promoting the development of new organised programmes and performing a yearly systematic survey of data activity. The screening extension has increased over time, reaching an overall 76.4% of coverage in 2005. The geographical extension is still heterogeneous, with a higher distribution in Northern and Central Italy compared with Southern and Insular Italy, where the screening activity was implemented only recently. Notwithstanding the continuity in implementation, the actual coverage reached only 50.3% of the target population, due to a reduced flow of invitations over time as a consequence of a chronic lack of invested resources and of well-plannedpolicies. The overall Italian rate for crude attendance was above the acceptable 50% standard even though a North-South trend is still confirmed; in Southern/Insular Italy participation was still inadequate (<40%) and did not reach the standard considered accepta...

In 2004 regions were required to provide the ONS (Osservatorio Nazionale Screening, National Centre for Screening Monitoring) with data on screening activity. Previously, GISMa (Gruppo Italiano Screening Mammografico) had for several years carried out a yearly survey to collect process indicators of mammography screening and compare them, using standard values agreed on at a national and international level. In 2006, an updated version of the operative report of process indicators was published by GISMa and ONS. Data for the survey came from several different programmes that may have changed over time, and may have different settings of organisation and management. The year 2004 can be considered almost exhaustive of the situation of Italian mammography screening; data were provided by 117 programmes from 18 different regions. In ten regions, the individual programmes are part of a comprehensive regional project. In 2004, about 1,870,000 women aged 50-69 years were invited to have a...

GISMa performs a yearly survey to collect process indicators of mammography screening and compare them, using standard values agreed on a national and international basis. This survey is highly representative of the Italian situation, providing summary data stratified by region and by age group. Data come from several different programmes that may have changed over time, and may have different model of organisation and management. Eighty-eight programmes from 15 different regions (out of 21) provided data for 2003. In nine regions individual programmes are part of a comprehensive regional project. During this year about 1,480,000 women aged 50-69 years were invited to have a screening mammogram, and over 843,000 were screened. Theoretical coverage was 56.2%, while 41.4% of the target population received an invitation to screening. An imbalance in coverage can be seen when comparing Northern and Central Italy, where over 3/4 of the population is covered, to Southern Italy, with only ...

The MIAMOD method has been widely applied to derive regional and national cancer burden estimates. The method is based on a back-calculation approach using cancer-specific mortality and relative survival to derive expected incident and prevalent cases. Multiple tumors occurring in the same site for the same person (for example colon-colon) can be estimated just once. This has little effect on cancer-specific estimates, whereas it limits all cancers-combined estimates, where only cancer cases, rather than cancer diagnoses, can be accounted for by the method. The aim of this article is to present a specific strategy of application of the MIAMOD method to all cancers sites, which better approximates an estimate of 'cancer diagnoses'. The strategy consists of breaking down the estimation process in separate applications to the most frequent cancer sites and to a 'remainder-site', given by all malignant sites except the previous ones. The separate estimates are then summe...

The best screening strategy for colorectal cancer is still debated. We simulated two screening strategies, namely flexible sigmoidoscopy (single episode) and immunological fecal occult blood test (FOBT) (five biennial rounds) and comparing their results as regards advanced adenomas and colorectal cancer detection. A Markov model was developed to estimate the number of advanced adenomas and colorectal cancer detected with the two compared screening strategies. Two different scenarios, namely a) where the same compliance (50%) at both flexible sigmoidoscopy and immunological FOBT invitation is applied, and b) where the actual compliance observed at a national level (immunological FOBT, 45%; flexible sigmoidoscopy, 30%) is applied. In scenario a), immunological FOBT would detect a total of 20,573 adenomas and 3,952 colorectal cancers, performing 74,507 total colonoscopies compared to 20,939 and 2,511, respectively, detected by flexible sigmoidoscopy, with 17,985 total colonoscopies. In...

The Tuscan cancer registry has been operating since 1985, providing cancer incidence and survival data in Tuscany; it covers about 33% of the regional population. The purpose of this paper is to provide incidence, prevalence and mortality estimates for the major cancers in the whole Tuscany region for the period 1970-2015. The estimated figures were obtained by applying the MIAMOD method. Starting from mortality and survival data, incidence and prevalence were derived using a statistical back-calculation approach. Survival was modeled on the basis of published data from the Italian cancer registries. According to the estimates, the most frequent cancer sites were colon-rectum in both genders, prostate in men and breast in women, with 4,188, 3,082 and 3,092 new diagnoses, respectively, in 2012. The incidence rates were steadily increasing for lung cancer in women and melanoma in both sexes, while they were decreasing for uterine cervix cancer in women, lung cancer in men and stomach ...

Objectives To describe trends in breast cancer mortality in 14 Italian regions representing 90% of the Italian population, and in the country overall, in relation to the diffusion of organized or opportunistic breast cancer screening programmes. Settings: Breast cancer mortality figures from 1980–2008 in Italy and 14 Italian regions were retrieved from the National Statistics Institute. Methods Estimated annual percent change (EAPC) was calculated for three time-periods (1980–1989, 1990–1999, 2000–2008). To estimate the age-adjusted and age-specific EAPC, trends in mortality based on annual data were examined using a log-linear regression model, and the year of death as a regressor variable. Results In the period 1980–1989 an increasing trend was observed in Italy overall (EAPC = +1.1%; 95% confidence interval [95%CI]: + 0.9%; + 1.3%) and in the 14 regions. In the second decade a decreasing trend was recorded both overall in Italy (EAPC = −1.6%; 95CI:−1.8%;−1.4%) and in all the regi...

Background Colorectal cancer (CRC) is the most frequent cancer in Europe. Randomized clinical trials demonstrated that screening with fecal occult blood test (FOBT) reduces mortality from CRC. Accordingly, the European Community currently recommends population-based screening with FOBT. Other screening tests, such as computed tomography colonography (CTC) and optical colonoscopy (OC), are highly accurate for examining the entire colon for adenomas and CRC. Acceptability represents a critical determinant of the impact of a screening program. We designed a randomized controlled trial to compare participation rate and diagnostic yield of FOBT, CTC with computer-aided diagnosis, and OC as primary tests for population-based screening. Methods/Design A total of 14,000 subjects aged 55 to 64 years, living in the Florence district and never screened for CRC, will be randomized in three arms: group 1 (5,000 persons) invited to undergo CTC (divided into: subgroup 1A with reduced cathartic pre...

... FTIR spectra were recorded as a KBr disc or in solution (CHCl 3 ), on a PerkinElmer 1750 series grating. Only major or important absorptions are given. The UV–vis spectrum was recorded in solution (CHCl 3 ) on a Hitachi U-2000 spectrophotometer. ...

A novel poly (p-xylylene), PPX, derivative bearing phenyl side groups was electrochemically synthesized in 85% yield. The polymer, poly (2-phenyl-p-xylylene)(PPPX), presented a major fraction (88%) soluble in common organic solvents. It showed to be thermally ...

The efficacy of colorectal cancer screening based on faecal immunochemical test, in terms of reduction of colorectal cancer incidence, is under debate. In the district of Florence, an organized screening programme based on faecal immunochemical test has been running since the early 1990s. The aim of this study was to compare the risk of developing colorectal cancer for subjects undergoing faecal immunochemical test with those who did not undergo the test in the same period. Two cohorts were analyzed: subjects who underwent an initial faecal immunochemical test between 1993 and 1999 ("attenders"), and unscreened residents in the same municipalities invited to perform the faecal immunochemical test in the same period ("non-attenders"). Kaplan-Meier and Cox regression analysis were performed to evaluate the risk of developing colorectal cancer. The attenders' and non-attenders' cohorts included 6961 and 26,285 subjects, respectively. Cox analysis showed a reduction in colorectal cancer incidence of 22% in the…

Riassunto L'incidenza del tumore della mammella e l'implementazione dei programmi di screening mammografico (tempi di avvio e copertura di popolazione) non sono omogenei sul territorio italiano. Per valutare l'entità della variabilità geografica nella mortalità, sono ...

Introduzione Programmi di screening mammografico sul terri-torio nazionale sono presenti sin dagli inizi degli anni '90. Fin da allora, nell'ambito del GISMa (Gruppo Italiano Screening Mammografico) sono stati condotti censimenti annuali sull'attivazione dei programmi in ...