Andrea Martini

Colorectal Cancer Mortality in Two Areas of Tuscany With Different Screening Exposures

Several randomized trials have demonstrated the efficacy of colorectal cancer screening by the fecal occult blood test in reducing colorectal cancer mortality, but an evaluation of population-based screening programs is still lacking. We compared the colorectal cancer mortality rates (both adjusted rates and 3-year moving average rates) during 1985-2006 for two geographic areas in the provinces of Florence and Prato in the Tuscany region of Italy that began active population-based screening for colorectal cancer at different times: the Empolese-Mugello district, in the early 1980s, and the rest of the Florence and Prato provinces, in early 2000. A log-linear Poisson model was used to estimate the annual percent change in mortality and to examine whether geographic area modified the effect of calendar year on it. The Empolese-Mugello district had a greater decrease in colorectal cancer mortality than the rest of the Florence and Prato provinces (estimated annual percent change in age-adjusted colorectal cancer mortality rate, 2.7% decrease per year [95% confidence interval {CI} = 1.7% to 3.7%] vs 1.3% decrease per year [95% CI = 0.8% to 1.7%], respectively). The interaction between calendar period and area was statistically significant (P < .001). Our results support the hypothesis that the implementation of colorectal cancer screening in the early 1980s in the Empolese-Mugello district, where approximately 17 500 people were tested each year with the fecal occult blood test, was associated with a larger reduction in colorectal cancer mortality than that observed in the rest of Florence and Prato provinces, where screening started 15-20 years later and where approximately 38 000 people were screened each year beginning in 2000.

A school-based peer-led smoking prevention intervention with extracurricular activities: the LILT-LdP cluster randomized controlled trial design and study population.

AIMS AND BACKGROUNDnFew school programs are effective in preventing adolescents tobacco smoking initiation. The Lega contro i Tumori - Luoghi di Prevenzione is a cluster randomized controlled trial designed to evaluate a school-based peer-led smoking prevention intervention with extracurricular activities for students aged 14-15 years. This paper presents the study design and the baseline characteristics of the study population.nnnMETHODS AND STUDY DESIGNnTwenty secondary schools located in the Reggio Emilia province took part in the study. Five schools were excluded because they already participated in smoking prevention interventions. The schools were randomized to control or intervention arms. The study population consisted of students attending the first grade. Components of the intervention included 1) the out-of-school Smoking Prevention Tour (SPT) at the Luoghi di Prevenzione Center, a 4-hour (4 sessions) extracurricular activity; 2) the Smoke-free Schools intervention, combining a life-skills-based peer-led intervention at school, an in-depth lesson on one of the SPT sessions, and enforcement surveillance of the school antismoking policy. Tobacco use was studied through a questionnaire administered before and 6 months after the intervention.nnnRESULTSnEleven high schools and 9 vocational secondary schools took part in the study for a total of 2,476 out of 3,050 eligible students (81.2%). The proportions of respondents in high schools and vocational secondary schools were 90.9% and 64.5%, respectively (P <0.001). Intervention and control arms showed a different distribution of gender and school type, whereas no difference was observed in any tobacco-use characteristic.nnnCONCLUSIONSnThis study is one of the few Italian trials to evaluate the effectiveness of a school-based program for preventing smoking initiation.

Lung cancer mortality patterns in women resident in different urbanization areas in central Italy from 1987-2002.

Aims and background The aim of the study was to evaluate mortality lung cancer trends, as an indicator of female smoking trends, in women resident in different urbanization areas. Methods and study design Data on the 5,782 female lung cancer deaths that occurred in Tuscany, Italy, during the period 1987–2002 were analyzed, using age-period-cohort models by areas at different urbanization levels. Trends were examined with a log-linear regression model, calculating the yearly estimated percent change. Empirical bayesian estimators of the ratios between observed and expected deaths by municipality were calculated for the most recent period and mapped. Results The age-adjusted lung cancer mortality rates increased from 1987 to 2002: estimated percentage change values were equal to 24.5% in the urban areas (P <0.001) and 17.2% in the rural areas (P = 0.023). The age-period-cohort model analyses showed a statistically significant drift and non-linear cohort effects. The higher risk was observed for the birth cohort of women born around 1955 (RR, 5.25; 95% CI, 2.83–9.72). In the rural areas, no significant effects were observed, and the age model showed the best fit. In recent years, the risk appeared concentrated in 9 Tuscan municipalities, accounting more than 35% of the female urban population. Conclusions The observed significant cohort effect in the age-period-cohort analyses for the urban areas reflects the social impact of living in these areas to induce smoking-related disease like lung cancer in women. The risk appeared particularly relevant in more recent and urbanized generations (women born around 1955), thereby suggesting urgent effective campaigns against smoking, gender dedicated, especially in urban areas.

Is cancer overtaking cardiovascular diseases as the killer number one in men in Tuscany

Aims and background For the first time in 2006, cancer became the main cause of death in men in Italy, exceeding cardiovascular disease. The aim of the study was to verify whether the overtaking of cancer male mortality occurred also in Tuscany or in some of its 12 subregional areas and whether there was a geographical trend. Methods Age-standardized mortality rates from the Tuscan Regional Mortality Registry, 1987–2008, were calculated for neoplasms, cardiovascular diseases, and respiratory diseases, considering the whole region and its 12 areas. Joinpoint analyses were carried out to study temporal trend. Results Up to 2008, the number of male deaths for neoplasms (6,786) in Tuscany did not exceed deaths from cardiovascular disease (7,065). Instead, overtaking occurred in some subregional areas from 2004 onwards. When we compared age-standardized mortality rates, cancer became the first cause of death in Tuscany from 2004 onwards (age-standardized mortality rates for cancer 236.5 per 100,000; for cardiovascular disease 227.8 per 100,000). Age-standardized mortality rates for cardiovascular disease recorded an annual 2.4% decrease until 1998, then a 3.5% decrease. Age- standardized mortality rates for all cancers recorded an annual 1.6% decrease in the whole period. Conclusions Our study confirmed a geographical trend in cancer overtaking as the main cause of death in males: from the more urbanized areas in northern Tuscany, where the phenomenon occurred earlier, to the southern part. Free full text available at www.tumorionline.it

Gastric cancer mortality trends in Tuscany, Italy, 1971-2004

Aims, Background, and Methods In Tuscany, Italy, gastric cancer mortality has been decreasing since 1950, although with relevant geographical variability across the region. In Eastern Tuscan areas close to the mountains (high risk areas), gastric cancer mortality has been and is still significantly higher than that recorded in Western coastal areas and in the city of Florence (low risk areas). High-risk areas also showed higher Helicobacter pylori seroprevalence. Aim of this paper is to study gastric cancer mortality trends in high and low-risk areas, during the period 1971–2004, using age-period-cohort models. Results In high-risk areas, gastric cancer mortality rates declined from 61.4 per 100,000 in 1971–74 to 19.8 in 2000–2004 and in low-risk areas from 34.9 to 9.8. Mortality decline in high-risk areas was mainly attributable to a birth cohort effect, whereas in low-risk areas it was due either to a birth cohort effect or a period effect. In low- and high-risk areas, birth-cohort risks of dying decreased over subsequent generations, except for the birth cohorts born around the second world war. Conclusions Gastric cancer mortality in areas with higher H. pylori seroprevalence in Tuscany (high-risk areas) showed a predominant decline by birth cohort, in particular for younger generations, possibly due to the decrease of the infection for improvement of living conditions.

Lung cancer mortality trend by birth cohort in men, Tuscany, 1971-2006.

AIMS AND BACKGROUNDnIn Tuscany, lung cancer mortality in men has shown a decreasing geographical trend over the last 3 decades from the most industrialized north-western coastal areas (Massa-Carrara, Viareggio) to the south-eastern areas (Arezzo, Siena), following the path of the development of industrial activities. The aim of the study was to evaluate lung cancer mortality in males by birth cohort in order to verify whether there was also a decreasing birth cohort trend in male lung cancer mortality rates between north-western and south-eastern Tuscan areas.nnnMETHODSnLung cancer deaths that occurred in men resident in Tuscany, 1971-2006, were analyzed by birth cohort, age group and local health authority area.nnnRESULTSnRates in men >65 years were significantly higher in Viareggio and Massa-Carrara than in the south-eastern areas for all generations, in particular for men born in 1896-1926. Rates for men aged 55-64 years were higher in Massa-Carrara and Viareggio than in south-eastern areas for men born before 1926, whereas for younger generations the rates leveled off. For men aged 45-54 years, rates were similar in all areas only for younger generations (men born around 1951 and 1956), whereas for men aged 35-44 years, rates were similar in all areas for all generations considered.nnnCONCLUSIONSnThe higher lung cancer mortality rates in men aged >65 years and born in 1896-1926 in the north-western areas than in those born in the south-eastern areas may indicate that the tobacco epidemic spread earlier in the north-western areas of Tuscany, following the path of industrialization. However, the higher mortality rates in north-western than in south-eastern areas are at least in part attributable to the high occupational risks for lung cancer experienced by workers in these areas during the first half of 20th century.