Anna Maria Petrinelli

Ten-year survival and age at diagnosis of women with breast cancer from a population-based study in Umbria, Italy.

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 Registrars 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.

Incidence, Mortality and Long–Term Survival from Prostate Cancer in Umbria, Italy, 1978–1994

Objectives and Methods: Incidence, mortality and long–term survival from prostate cancer were examined in the Umbria region of Italy, for the period 1978–1994. Incidence rates were derived from an ad hoc survey carried out over the period 1978–1982 and from 1994 cancer registry records. The mortality over the period derived from data of the official publications and the survival rates, at 15 years, were calculated starting from the ad hoc survey incident cases.Results: In the Umbria region, over the period 1978–1994, crude incidence rates from prostate cancer increased from 31.2 to 81.9 per 100,000 and mortality rates from 22.7 to 31.9 per 100,000. The rates were from 30.5 to 61.2 for age–adjusted incidence while standardized mortality remained constant (from 22.6 to 22.7 per 100,000). Survival in Umbria, compared with rates from other European Cancer Registries, is low both at 5– and 10–year follow–up.Conclusion: The great incidence increase observed over the study period could depend on a lesser completeness achieved by the 1978–1982 ad hoc survey with respect to the 1994 cancer registry data and/or from the screening campaign carried out in a large part of the region in 1994. Different elements support these hypotheses. However the above hypotheses can be verified over the next years when further incidence and survival data from the cancer registry will be available.

Long term survival of upper aerodigestive tract cancer in male patients in the Umbria region (Italy)

The aim of this work was to make a study of the whole population of a central Italian region, the Umbria region – cancer survival rates for the upper aerodigestive tract, which includes cancers of the head and neck (tongue, oral cavity, pharynx), oesophagus and larynx. In Italy cancer survival rates do not cover entire regions but single municipalities or provinces. Cases of incidence were derived from an ‘ad hoc’ survey carried out during the period 1978–1982. Starting from the nominative data, we studied up to 15 years 245 head and neck, 87 oesophagus and 321 larynx cases of cancer in males. Data for female cases were not considered because of the small number. Cancer cases were followed up mainly by verification at the Registry Office of several municipalities, the Regional Death Registry and the list of persons under the Regional Health Service. Observed survival rates for head and neck cancer were 0.63, 0.29, 0.17 and 0.12 at 1, 5, 10 and 15 years of follow-up respectively; rates for cancers of the oesophagus and larynx were 0.30, 0.08, 0.06, 0.03 and 0.79, 0.54, 0.41, 0.30 respectively. Relative survival rates were 0.65, 0.34, 0.24, 0.23 for cancer of the head and neck, 0.31, 0.10, 0.09, 0.08 for cancer of the oesophagus, and 0.81, 0.63, 0.59, 0.56 for cancer of the larynx, at 1, 5, 10 and 15 years of follow-up. The worst survival rates were observed for oesophagus and hypopharynx. Overall survival values for Umbrian patients were relatively good, being higher than survival data reported for a similar period by Italian Cancer Registries. They were also strikingly similar to survival rates for England and Scotland.

Cancer survival from incident cases of a population-based study in the Umbria Region, Italy

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 Registrars 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.

Ten-year survival of patients with cancer of the digestive tract in Umbria, Italy.

Survival statistics of 4135 incident cases of digestive system cancers in the Umbria region of Italy are reported. The original data are derived from an ad hoc survey carried out in the period 1978--1982. Observed and relative rates at 1, 5 and 10 years are presented separately by sex and age (< 60 and ≥ 60 years). In both sexes there are very short survival rates for liver, bile duct and pancreas cancers, whereas about 50% of colon and rectum cancer patients survived at five years. About 20% stomach cancer patients survived at the same time. In males the survival rate for oesophagus cancer is close to 10%. The rates at ten years confirm the trend. Comparisons between sexes show that there is no significant differences in age at first diagnosis. Survival values are higher in females only for rectum cancers. In both sexes, for stomach, colon and rectum sites younger patients had a significantly longer survival than older ones.

Urinary Organ Cancer Survival in the Umbria Region (Italy): Follow-Up at Ten Years

Objectives and Methods: Survival of 687 urinary bladder and 217 kidney cancer patients was investigated using incident cases registered in an ad hoc survey in the Umbria region for the period 1978–1982. Death certificate only cases were excluded. The follow-up was carried out through the General Nominative Register of Causes of Death and verified at the Registrar’s Offices of the various towns of the Region. Results: At 10 years about one third of all bladder cancer patients were still alive while for kidney cancer the rate was 0.41 for females and 0.26 for males. Observed survival rates, at 1 year time intervals, never differed significantly in the two sexes even if, for kidney cancer, both observed and relative survival rates were somewhat higher in females than in males and, for bladder cancer, higher in males than in females. From survival rates by age groups both observed and relative rates decreased with age in males. In females the trend was unsteady due to the low survival in the first age group (15–44 years) for the two sites and a lower rate for kidney cancers in the 55–64 years age group compared to the next age groups. This trend was also probably due to the small number of cases. Conclusions: Comparison of survivals in Umbria with those of European registries shows higher rates for bladder cancer in both sexes and for kidney cancer in females in Umbria, while the value for kidney cancer survival in males was intermediate.

Tobacco smoking, coffee, cocoa and tea consumption in relation to mortality from urinary bladder cancer in Italy

This paper examines changes in mortality from urinary bladder cancer in Italy during the years 1950-81 in relation to changes in smoking habits and in coffee, cocoa and tea consumption. The authors found that, in both sexes and for all ages, mortality has been increasing throughout this period, although the rates and relative increase have consistently been much lower and more gradual for women than for men.From the analysis of age-cohort-period variation it seems that bladder cancer mortality can also be influenced by changes in smoking habit patterns and by variation in the quality of diagnoses. The increase in death risk for both sexes in Italy up to cohorts born around 1905-10 can be related to occupational exposures and to high-tar-content tobacco smoking, whereas the tendency for mortality rates to stabilize and decline in cohorts born after 1910 were influenced by changes from high-tar-content and no-filter cigarettes to low-tar-content and filter cigarettes and by prevention measures taken in at-risk working environments.The consumption of coffee, cocoa and tea does not seem to be related to the increase in bladder cancer risk in Italy.

Urban-rural differences in male cancer incidence and mortality in the Umbria region of Italy

Background: The aim of this study is to verify the existence of different rates of cancer incidence and mortality in males in the urban and rural populations of Umbria and to formulate hypotheses as to why this occurs. Methods: Directly age-adjusted incidence rates (AAIR) and age-adjusted death rates (AADR) were calculated for 1998-2002 and the expected number of rural cases (standardized incidence ratios-SIRs and standardized mortality ratios-SMRs) was determined by indirect standardization using urban incidence and mortality. Results: Urban zones have higher AAIR’s for the most common cancer sites. Significantly lower SIRs, in rural areas, were shown for skin melanoma, prostate and bladder cancers and a significantly lower SIR was also determined for the combination of all cancer sites. Lower AADRs in rural areas were demonstrated for the most common cancer sites and significant low SMRs were shown for lung cancer and skin melanoma. Prostate cancer incidence is significantly higher in urban areas whereas the mortality rate is slightly higher in rural municipalities probably due to the effects of the opportunistic screening widely available in Umbria, particularly in zones near diagnostic services. A very similar pattern was found for urinary bladder cancer; this could be related to the association between prostate and bladder cancer sites. Both incidence and mortality from melanoma are significantly lower in rural areas, this may be due to the difficulty in accessing diagnostic services or/and to different occupational exposure patterns. Conclusion: It would appear in Umbria that differences in health services utilization continue to exist. In particular, our results are compatible with a lower diffusion of preventive activities for prostate cancer and skin melanoma in rural areas.

Trends of mortality from external causes in the Umbria region of Italy: 1994-2004

The aim of the present paper is to analyse the mortality from external causes in the Umbria region, from 1994 to 2004, in order to have an indication of the effectiveness of primary prevention interventions. Sex and cause-specific AADR (the age-adjusted death rates) and YPLL rates (the age-adjusted rates of years of potential life lost up to 74 yrs) time trends were analysed by means of joinpoint regression utilising SEER software. The expected annual percent change and its significance were also calculated. The cause groups examined were: all external causes, transport accidents, falls, accidental poisoning and exposure to noxious substances, intentional self-harm and assault. The age-adjusted death rates from the selected external causes showed, in both sexes, a decreasing trend. The joinpoint regression of AADR indicated that all statistically significant variations are declining. For the AADR cause group significant decreases were found in all external combined and poisoning causes for both sexes, transport accidents and falls for females. Among males the age-adjusted YPLL rates showed significant decreases for all external causes combined (EACP = -2.8%). This analysis provides a useful tool to evaluate the effectiveness of interventions performed in the last decade and indicates that further assessment and monitoring are needed.