Italian Cancer Registries Research Articles

Regional Estimates of Prostate Cancer Burden in Italy

Prostate cancer is one of the most common cancers in developed countries and the most common among men in industrialized countries. The introduction of new diagnostic procedures caused an increase in new diagnoses in Italy starting from the early 1990s, while the prognosis of prostate cancer improved due to the use of hormonal treatments. The aim of this paper is to present estimates of prostate cancer mortality, incidence and prevalence over the period 1970-2005 for the Italian regions and for Italy as a whole, and to assess the changes that opportunistic screening and the diffusion of more effective treatments introduced. Estimated figures for incidence, prevalence and mortality were obtained with the MIAMOD method. Starting from the knowledge of mortality in the period 1970-1999 and of the relative survival in the period of diagnosis 1978-1994, we derived incidence and prevalence estimates up to the year 2005 by means of a statistical back-calculation approach. Survival at regional and national levels was modelled on the basis of published survival data from the Italian cancer registries. The incidence trend showed a steep increase all over the country during the entire estimation period 1970-2005 with a more pronounced increase in the Center-North then in the South of Italy. Incidence of northern and central regions was about twice as high as that of southern regions. Mortality trends were however constant or declining in the majority of northern-central regions, while they still increased in the South. A total of around 43,000 incident cases, 174,000 prevalent cases and 9,000 deaths were estimated for Italy in 2005. The effects of opportunistic screening are reflected in an earlier diagnosis for many patients. The existing North-South gradient in incidence seems to be associated with the different spread of the PSA test in different parts of the country. Prostate cancer remains a great health problem in terms of both incidence and prevalence.

Regional Estimates of Lung Cancer Burden in Italy

The aim of this paper is to present the Italian regional and national estimates of the mortality, incidence and prevalence over the period 1970-2010 for lung cancer, one of the most common cancers in Italy and Europe, especially among men. The estimates were obtained with the MIAMOD method, a statistical back-calculation approach to derive incidence and prevalence figures using mortality and relative survival data. Published survival data from the Italian cancer registries were appropriately modelled in order to estimate survival at regional and national level. For men, the Italian lung cancer mortality and incidence rates reached their maximum values during the late 1980s and steeply decreased thereafter. This pattern is quite uniform across all regions, even though the decrease was delayed and less steep in the South of the country. For women, both indicators appear to be increasing at the national level, even though a certain regional variability in incidence trends remains within the country: some regions (such as Lazio, Umbria, Marche, Campania, Sardegna and Friuli Venezia Giulia) present increasing trends, while in others a clear levelling off is visible. A total of 33,500 incident cases, 72,000 prevalent cases and 28,000 deaths are estimated in Italy in 2005. This study produced an up-to-date description of lung cancer epidemiology both at national and regional level. The marked difference in lung cancer figures and trends between sexes suggests that prevention policies have led to changes in smoking habits for men, while for women they were lacking in efficacy. The attention should now focus on women, whose risk trend is the least favorable.

Regional Estimates of Breast Cancer Burden in Italy

Breast cancer is the most common cancer and the leading cause of cancer death among women. Knowledge of the present and future burden of the disease at a regional and national scale is a major issue in Italy, where the frequency and coverage of screening programs vary considerably across the country. This study presents estimates and projections of the female breast cancer incidence, prevalence and mortality for Italy and all Italian regions in the period 1970-2010. The estimates were obtained by applying the MIAMOD method, a statistical back-calculation approach to derive incidence and prevalence figures from mortality and relative survival data. Published data from the Italian cancer registries were modelled to obtain regional and national estimates of breast cancer survival. Breast cancer mortality has been declining from the late 1980s in the northern-central regions and from the mid 1990s in the southern regions Puglia, Sicilia and Sardegna. Stable mortality rates are estimated for the other southern regions in the 2000's first decade. The incidence rate in Italy is estimated as increasing until the late 1990s, and stable thereafter (93 per 100,000). The incidence curve is also estimated to flatten in many northern-central regions from the late 1990s or later. Rising incidence trends are estimated in all southern regions, with the exception of Puglia. About 8,500 deaths, 37,000 new diagnoses and 416,000 prevalent cases for breast cancer are estimated among Italian women in 2005. In the same year, the proportion of prevalent cases in the northern area (1221 per 100,000) is about twice that estimated in the South (685 per 100,000). The geographical variation in female breast cancer burden can be explained by the unequal distribution of screening. A more widespread screening activity in the southern regions would help to bridge the gap between northern-central and southern regions. Continuous monitoring of regional epidemiological indicators for breast cancer is crucial to evaluate the effect of different health measures taken to control breast cancer in Italy.

Epidemiology of Colorectal Cancer in the Umbria Region of Italy: Prescreening Period

The epidemiology of colorectal cancer in Umbria, Italy, was evaluated, and data were analyzed in the pre-screening period to better understand the etiology of the disease and to develop screening strategies. Incident data were collected by the Umbrian Population Cancer Registry and mortality data by the Nominative Regional Mortality Registry from 1994 to 2002. The survival rates relative to Italian cancer registries were derived from the Italian Associations of Cancer Registries publications. Time trends were analyzed by joinpoint regression. The follow-up for survival rates referred to December 31, 2005. The trend of colorectal cancer age-adjusted incidence showed a slight, constant, but non significant increase over time. The mortality trend showed a slight, constant, but non-significant decrease. Age at diagnosis remained constant in males, whereas in females it showed a significant increase of about 1.5 years. In the last period, all incidence rates increased with age, but in males they presented a rapid increase in the 55-74 age group, levelled and declined up to 84 and after again reached, which could be a consequence of opportunistic screening practice, probably undergone by males. Mortality in both sexes increased with age, whereas survival rates fell. Comparison of survival rates in some Italian cancer registries showed that the Umbria region, in the 1994-1996 period, was the zone with the highest relative survival; in the 1996-1999 period, the rate stopped, differently from other Italian zones. In the last period, the highest survival rates were recorded by registries covering zones with active screening programs. The present reduction of mortality in Umbria, as in other Italian areas, is dependent on the natural behavior of the disease, which is linked to a birth cohort-related effect of stabilization and decrease in exposure to risk factors.

Gail Model for Prediction of Absolute Risk of Invasive Breast Cancer: Independent Evaluation in the Florence–European Prospective Investigation Into Cancer and Nutrition Cohort

The Gail model 2 (GM) for predicting the absolute risk of invasive breast cancer has been used for counseling and to design intervention studies. Although the GM has been validated in US populations, its performance in other populations is unclear because of the wide variation in international breast cancer rates. We used data from a multicenter case-control study in Italy and from Italian cancer registries to develop a model (IT-GM) that uses the same risk factors as the GM. We evaluated the accuracy of the IT-GM and the GM using independent data from the Florence-European Prospective Investigation Into Cancer and Nutrition (EPIC) cohort. To assess model calibration (i.e., how well the model predicts the observed numbers of events in subsets of the population), we compared the number of expected incident breast cancers (E) predicted by these models with the number of observed incident breast cancers (O), and we computed the concordance statistic to measure discriminatory accuracy. The overall E/O ratios were 0.96 (95% confidence interval [CI] = 0.84 to 1.11) and 0.93 (95% CI = 0.81 to 1.08) for the IT-GM and the GM, respectively. The IT-GM was somewhat better calibrated than GM in women younger than 50 years, but the GM was better calibrated when age at first live birth categories were considered (e.g., 20- to 24-year age-at-first-birth category E/O = 0.68, 95% CI = 0.53 to 0.94 for the IT-GM and E/O = 0.75, 95% CI = 0.58 to 1.03 for the GM). The concordance statistic was approximately 59% for both models, with 95% confidence intervals indicating that the models perform statistically significantly better than pure chance (concordance statistic of 50%). There was no statistically significant evidence of miscalibration overall for either the IT-GM or the GM, and the models had equivalent discriminatory accuracy. The good performance of the IT-GM when applied on the independent data from the Florence-EPIC cohort indicates that GM can be improved for use in populations other than US populations. Our findings suggest that the Italian data may be useful for revising the GM to include additional risk factors for breast cancer.

Comparison of Female Breast Cancer Registration in the City and Province of Palermo With Other Italian Cancer Registries

: The aim of this study was to assess the incidence of breast cancer in women from the city and province of Palermo (Sicily) in 5 yr, 1999–2003, using a population based cancer registry approach. In the last years, a sharp increase of breast cancer incidence has been observed worldwide. Overall, direct age-standardized incidence rates were 89.3 per 100,000 person-yr, being markedly higher in Palermo City (101.0) than in Palermo Province (75.0). Results show a highly significant difference in breast cancer incidence in different areas of Sicily, particularly in the older (>50 yr) age groups and a profound difference between the metropolitan area of Palermo and the surrounding areas. The evidence of the different rates of breast cancer incidence in Palermo City and in the other small municipalities of the Palermo Province suggests a different pattern of breast cancer risk as a consequence of different lifestyle and diet modifications in the urban population of Palermo City.

The Italian surveillance system for occupational cancers: Characteristics, initial results, and future prospects

Occupational cancer monitoring is important for cancer prevention and public health protection. A surveillance system for identifying occupational cancer risks and cancer cases in Italy that are likely to be of occupational origin using information available in the Italian Social Security archives was created and assessed. Persons employed in the private sector, the employing company, its industrial sector, and years of employment are available in these archives. A method to find known occupational hazards was first tested using a case-control approach. Cases were from six Italian cancer registries (CRs) and controls were sampled from source populations and as "exposure" the economic sector of the employing company was used. The potential of using hospital discharge records as case sources was subsequently assessed: these cover larger populations and are available more quickly than CR case series. In the CR-based study many known occupational cancer risks related to specific industrial sectors were identified. By using cases from hospital discharge records many industries at risk were identified, as well as cases of recent diagnosis likely to be of occupational origin. However, for some industrial sectors (e.g., the chemical industry) the approach was unable to detect any excess risk. Furthermore, information on employees in important areas like agriculture, self-employment, and the public sector is not available in the Social Security archives. This approach appears to be a promising low-cost method for occupational cancer surveillance, at least for some industries, and can be easily implemented in other countries.

National Estimates of Cancer Patients Survival in Italy: A Model-Based Method

To provide model-based estimates of all cancers patient survival in Italy and in Italian large geographical areas (North-West, North-East, Center, South), where only partial coverage of cancer registries data is available, and to describe them in terms of time trends. Moreover, to measure the degree of representativeness of cancer patient survival obtained from Italian cancer registries data. Relative survival in the four main Italian geographical areas was estimated by a parametric mixture model belonging to the class of "cure" survival models. Data used are from Italian cancer registries, stratified by sex, period of diagnosis and age. The Italian national survival was obtained as a weighted average of these area-specific estimates, with weights proportional to the number of estimated incident cases in every area. The model takes into account also differences in survival temporal trends between the areas. Relative survival for all cancers combined in Italian patients diagnosed in 1990-1994 was estimated to be higher in women (53%) than in men (38%) at 5 years from the diagnosis. The survival trend is increasing by period and decreasing by age, both for men and women. The greatest gain in terms of survival was obtained by the elderly, with annual mean growth rates in the period 1978-1994 equal to 3.5% and 3.2% for men and women, respectively. More than 50% of the youngest cancer patients were "cured", whereas for the elderly this proportion dropped to 15% and 25% for men and women, respectively. The South of Italy had the lowest survival and the North the most pronounced increase. The obtained national survival estimates are similar, but not identical, to previously published estimates, in which Italian registries' data were pooled without any adjustment for geographical representativeness. The four Italian areas have different survival levels and trends, showing variability within the country. The differences in survival between men and women may be explained by the different proportion of lethal cancers. Among males, most cases had a poor prognosis (lung and stomach cancers), whereas among females the largest proportion was made up of curable and less lethal cancers (breast cancer).

Population-based incidence and mortality cancer trends (1986–1997) from the network of Italian cancer registries

The objective of this study was to analyse incidence and mortality cancer trends in the Italian Network of Cancer Registries (about 8,000,000 inhabitants) during the period 1986-1997. Included were 525,645 newly diagnosed cancers and 269,902 cancer deaths (subjects > 14 years). Joinpoints (points in time where trend significantly changes from linearity) were found and estimated annual percentage changes (EAPC) used to summarize tendencies. Overall cancer incidence increased in both sexes and cancer mortality significantly decreased (since 1991 among men). Lung cancer showed significantly decreasing incidence (EAPC = -1.4%) and mortality (EAPC = -1.6%) among men and increasing trends among women. In women, breast cancer incidence significantly increased (EAPC= +1.7%) and mortality decreased since 1989 (EAPC= -2.0%). Stomach cancer incidence and mortality decreased in both sexes. Prostate incidence sharply increased since 1991 and mortality decreased. Colon cancer incidence increased and rectum mortality decreased significantly in both sexes. Significant increases in incidence were also found for kidney (up to 1991 among men), urinary bladder, skin epithelioma, melanoma, liver (up to 1993 among men), pancreas, mesothelioma, Kaposi's sarcoma (up to 1995 among men), testis, thyroid, non-Hodgkin's lymphomas and multiple myeloma. Mortality significantly decreased for cancers of the oral cavity and pharynx, oesophagus, liver (women), larynx (men), bone, cervix (since 1990), central nervous system, urinary bladder, thyroid, Hodgkin's lymphomas and leukaemias (men). Non-Hodgkin's lymphoma mortality increased in both sexes. In conclusion, most of the changes seen can be explained as the effect of changes in smoking habits and of the extension of secondary prevention activities. The Italian health care system will also have to cope with growing cancer diagnostic and therapeutic needs due to population ageing.

Lung cancer in persons with AIDS in Italy, 1985–1998

The Italian Cancer and AIDS Registries Linkage Study was used to compare the incidence of lung cancer in persons with HIV/AIDS (PWA) before and after the introduction of highly active antiretroviral therapy (HAART). Twenty-one lung cancers were identified in 12 104 PWA. Incidence rates of lung cancer in PWA exceeded those in the general population, but no increase emerged after HAART. Population-based studies with long follow-up are needed to monitor trends in non-AIDS defining cancer in PWA.

Prostate cancer in Italy before and during the 'PSA era': survival trend and prognostic determinants.

The aim of the study was to investigate the variations in prostate cancer prognosis during a period of major diagnostic change, such as the introduction of the prostate-specific antigen (PSA) test. Data were provided by 14 Italian cancer registries (CRs). Incidence and follow-up information was collected for patients diagnosed from 1978 to 1994. Relative survival was computed taking into account incidence period, age, tumour stage and grade at diagnosis. A multivariate analysis was carried out to evaluate the independent simultaneous effect on survival of some prognostic determinants. A large geographical variability was observed: in 1993-1994 Italian survival rates ranged from 76% to 52%, with a north-south gradient. A striking prognostic improvement (up to +27 percentage points) between the late 1980s and the early 1990s occurred in almost all CRs, particularly with regard to younger patients. Multivariate analysis showed a strong influence of incidence period on survival, also after correction by tumour stage. The slowdown of metastatic cancers suggests that the survival improvement could be due both to the introduction of an effective opportunistic screening and to a quantitative change in the application of clinical treatment, even if the effect of the lead-time bias phenomenon has to be taken into account.

Multiple primary cancer incidence in Italy

Data collected from eleven Italian population-based cancer registries (overall population 7 200 000 inhabitants) were used to compute the incidence of second independent cancers (MP) in a cohort of cancer patients aged 15 years or more. Overall, 240 111 patients have been followed for 544 438 person-years during which 8766 second primary cancers were diagnosed leading to an observed to expected ratio (SIR) of MP of 1.08 (95% Confidence Interval (CI): 1.05–1.12). Restricting the analysis to metachronous cancers, there were 6974 second primary cancers diagnosed among 198 303 patients during 508,648 person-years with an SIR of 0.93 (95% CI: 0.90–0.96). According to the time since first cancer diagnosis, the SIR was significantly higher than expected during the first 2 months, then the overall risk was slightly lower than 1 up to 10 years after diagnosis. No differences were observed according to gender. The SIR significantly differed among the age groups with consistent excess risks in subjects younger than 65 years in comparison with older ones. Overall, significantly elevated SIR for metachronous cancers were evidenced for oral cavity and pharynx, larynx, connective, skin non-melanoma, ovary and kidney cancers. For each cancer site, the site-specific risk of further MP has been evaluated. The identification of strong site-specific associations may be useful for clinicians when following-up patients.

Risk of nonmelanoma skin cancer in Italian organ transplant recipients. A registry-based study.

Organ transplant recipients are at an increased risk of nonmelanoma skin cancer. Few data concern heart transplantation and populations from southern Europe. A total of 1,329 patients who received their first kidney (1,062 subjects) or heart allograft (267 subjects) were included in a partly retrospective cohort study to evaluate the risk of skin cancer. The incidence rate per 1,000 person-years and the cumulative incidence were computed. Standardized morbidity ratio was estimated by comparison with Italian cancer registry data. To analyze the role of potential prognostic factors, Cox's regression method was used. The overall incidence rate of nonmelanoma skin cancer was 10.0 cases per 1,000 posttransplant person-years (95% confidence interval 8.2-11.7). This estimate was far higher than expected in the general population. The overall risk of developing skin cancer increased from a cumulative incidence of 5.8% after 5 posttransplant years to an incidence of 10.8% after 10 years of graft survival. In a Cox proportional hazard risk model, the most important factors that appeared to favor the development of skin cancer were age at transplantation and sex. After adjustment for age at transplantation and sex, no definite increased risk was documented among heart as compared with kindney transplant recipients. Our study confirms the increased risk of nonmelanoma skin cancer among organ transplant recipients in a southern European population.

Soft tissue sarcomas in the general population living near a chemical plant in Northern Italy.

After the notification by a general practitioner of a high frequency of soft tissue sarcomas among subjects living close to the industrial area of the city of Mantua (northern Italy), the local Medical Association carried out a formal epidemiologic investigation to corroborate or falsify the hypothesized excess. Several industrial activities of the area were hypothesized to be a source of environmental pollution that might cause soft tissue sarcomas. All general practitioners working in the area were requested to report the cases of soft tissue sarcoma diagnosed in the study area. Person-years of observation were computed for all subjects who ever resided in the area between 1984 and 1997. Expected incidence was computed from the cancer registry covering a nearby province (Varese) and from the pool of Italian cancer registries. Peripheral soft tissue sarcoma and visceral sarcomas were included in the analysis. Overall, 20 cases were observed in a 13-year period, 8.87 were expected from the Varese province cancer registry and 7.72 from the pool of Italian registries. The corresponding standardized morbidity ratios were 2.25 (95% confidence interval, 1.34-3.47) and 2.6 (95% confidence interval, 1.6-4.0), respectively. A significant excess persisted after excluding 5 cases that had been the object of the original notification. We hypothesize that the soft tissue sarcoma excess may have resulted from environmental pollution by industrial toxic emissions, which likely included 2,3,7,8-tetrachloro-dibenzo-dioxin.

Results from a historical survey of the survival of cancer patients given Di Bella Multitherapy

BACKGROUND The Italian media have given wide coverage to a number of successes in treating cancer patients with an alternative therapy developed by Dr. Luigi Di Bella, a physician in Modena, Italy. In 1998, the Ministry of Health, under considerable pressure from the public, decided to promote studies to evaluate its efficacy. METHODS Follow-up was conducted for cancer patients previously treated during the years 1971−1997 by Dr. Di Bella and registered in his archive. Identified cases were searched in cancer registries for diagnostic confirmation, date of diagnosis, and follow-up. Survival was compared with that in individually matched cancer cases derived from a pool of Italian cancer registries (the ITACARE data base). Kaplan−Meier survival curves were produced for all adult cancer patients as well as for children with leukemia and, in the matched analysis, for patients with cancer at the major anatomic sites and for all cancer patients combined. The homogeneity of survival curves between the two groups was tested by means of the log rank test. RESULTS After several exclusions, 314 patients were entered into the study. Follow-up was completed for 79%. Only four patients received Di Bella Multitherapy (MDB) as their only anticancer therapy. Of these, only 1 is still alive 2 years after diagnosis. Five-year survival rates for children with leukemia and adult cancer patients were both 29.4%. Five-year survival was significantly lower in comparison with ITACARE cases for patients with childhood leukemia, breast carcinoma, and adult leukemia, and for all cancer patients combined. Twenty-seven MDB patients survived 10 years or longer after diagnosis. In only three cases was this long survival unexpected. CONCLUSIONS The results for this series did not give any evidence that MDB improved the survival of the cancer patients. [See editorial on pages 1887−9 and commentaries on pages 1900−2 and 1903−11 this issue.] Cancer 1999;86:2143–9. © 1999 American Cancer Society.

Results from a historical survey of the survival of cancer patients given Di Bella Multitherapy

The Italian media have given wide coverage to a number of successes in treating cancer patients with an alternative therapy developed by Dr. Luigi Di Bella, a physician in Modena, Italy. In 1998, the Ministry of Health, under considerable pressure from the public, decided to promote studies to evaluate its efficacy. Follow-up was conducted for cancer patients previously treated during the years 1971-1997 by Dr. Di Bella and registered in his archive. Identified cases were searched in cancer registries for diagnostic confirmation, date of diagnosis, and follow-up. Survival was compared with that in individually matched cancer cases derived from a pool of Italian cancer registries (the ITACARE data base). Kaplan-Meier survival curves were produced for all adult cancer patients as well as for children with leukemia and, in the matched analysis, for patients with cancer at the major anatomic sites and for all cancer patients combined. The homogeneity of survival curves between the two groups was tested by means of the log rank test. After several exclusions, 314 patients were entered into the study. Follow-up was completed for 79%. Only four patients received Di Bella Multitherapy (MDB) as their only anticancer therapy. Of these, only 1 is still alive 2 years after diagnosis. Five-year survival rates for children with leukemia and adult cancer patients were both 29.4%. Five-year survival was significantly lower in comparison with ITACARE cases for patients with childhood leukemia, breast carcinoma, and adult leukemia, and for all cancer patients combined. Twenty-seven MDB patients survived 10 years or longer after diagnosis. In only three cases was this long survival unexpected. The results for this series did not give any evidence that MDB improved the survival of the cancer patients. [See editorial on pages 1887-9 and commentaries on pages 1900-2 and 1903-11 this issue.]

Cancer prevalence in Italian cancer registry areas: the ITAPREVAL study. ITAPREVAL Working Group.

To present data on cancer prevalence for the areas covered by Italian cancer registries, by using a standardized set of data collection and elaboration criteria, and a single method of data analysis. Data on over 250,000 patients with cancer, diagnosed between 1978 and 1992, from 11 Italian cancer registries covering about 12% of the Italian population were collected, validated and analyzed according to the unified protocol of the ITAPREVAL project. The method implemented in the PREVAL computer program was used to provide prevalence estimates for the period covered by cancer registration. The total prevalence for each registry and for the pool of all registries was then estimated by correcting for incomplete observations due to the period in which the registration was not yet activated. All prevalence estimates were for 1992. Prevalence figures are presented by cancer site, age, sex, years from diagnosis and registry area. For all malignancies combined, total prevalence ranged from 1,350 per 100,000 inhabitants in Ragusa to 3,650 per 100,000 inhabitants in Romagna, the ratio between these two extremes being 2.7. For the pool of the areas covered by registration cancer prevalence was 3,100 per 100,000 females and 2,250 per 100,000 males. About a third of the total female cases and about half the male cases were diagnosed in the previous five years. Among those aged over 75 years, total prevalence was higher for males than for females: 11,300 versus 8,900 per 100,000 respectively. This is the first large-scale estimate of the burden of cancer in Italy. It is also one of the first studies in the world which was aimed to study cancer prevalence in detail. These data are necessary for predicting health service needs and help in the evaluation of differences in health service demand by sex, age and Italian regions.

The prevalence of tumors of the breast and female genital tract in Italy.

Data from 10 Italian population-based cancer registries were used to estimate the prevalence of female tumors of the breast and genital tract. The total prevalence, expressed in number per 100,000, was highest for breast cancer (1,117), followed by cancer of the corpus (264) and cervix uteri (146), ovary (110), and vagina and vulva (23). For all tumors the prevalence increased with age at diagnosis. The cancer prevalence was divided into intervals from diagnosis, expressing different health needs in terms of therapy and intensity of clinical follow-up. For all tumors considered, 1-year prevalence was higher than 1-2-year prevalence, reflecting a high death risk due to perioperative mortality and to the proportion of patients diagnosed at advanced stages. The prevalence decreased in the following intervals considered. Noticeable geographic variability was observed in the prevalence across Italy, with higher proportions being registered in the northern-central regions than in the South. The two extreme 0-5-year prevalence figures (per 100,000) were: for breast cancer 568 (Genova) and 259 (Ragusa); for corpus uteri cancer 94 (Romagna) and 21 (Latina); for cervix uteri cancer 63 (Romagna) and 26 (Latina); for ovarian cancer 49 (Parma) and 21 (Latina); for cancer of the vagina and vulva 17 (Genova) and 5 (Ragusa). This variability depends mainly on incidence and on the proportion of elderly in the general population. From 1987 to 1992 there was an increase in the prevalence of tumors of the breast, ovary and vagina and vulva, especially in the elderly. The prevalence of corpus uteri cancer decreased slightly in the elderly only, whereas that of cervix uteri cancer decreased at all ages.

Cancer Prevalence in the Elderly

To describe the cancer prevalence in elderly Italian people and analyze the differences, if any, with the prevalence among younger subjects. The cancer prevalence among elderly patients (65 years and over), the three age classes encompassing elderly age (65-74 years, 75-84 years, 85 years and over) and younger patients (0-64 years) was computed using the PREVAL method on the basis of the incident cases over the period 1976-1992 followed up to 31 December 1992 (prevalence reference date). Data were collected by 11 Italian cancer registries. The observed prevalence figures for all cancers (except skin epitheliomas), both sexes combined and considering the whole elderly group, were 1,090 and 3,601 cases per 100,000 one and five years since diagnosis, respectively; the prevalence increased up to the 75-84 age group and showed a slight decrease after age 85. With regard to specific cancer sites, in men bladder and prostate had the highest prevalence 5 years from diagnosis (more than 800 cases per 100,000), followed by colon and lung (about 500 cases per 100,000) stomach and rectum (about 300 cases per 100,000); in women breast cancer ranked first (more than 1,000 cases per 100,000), followed by colon (about 350 cases per 100,000), corpus uteri, stomach and rectum cancers (between 150 and 200 cases per 100,000). For all malignancies and the two sexes combined the prevalence figures were about six times higher in the older than in the younger age group. These figures confirm the important role of aging in determining the increase in cancer prevalence. The resulting prevalence figures clearly indicate the cancer burden placed on health care services; moreover, the figures will probably increase in the next decades due to a possible improvement in survival and to the dramatic aging of the population, assuming a stable trend for incidence rates. This picture will represent a major challenge for politicians and those dealing with health care planning and social policies in general, especially in the light of the reduction of the available financial resources and the specific features of medical and social needs in the elderly.

The Role of Cancer Registration for Programming Health Services

The Italian National Health Plan 1998-2000 indicates quantitative and qualitative goals in the fight against cancer. This approach stresses the need of reliable and updated descriptive data to evaluate, at a population level, the burden of neoplastic disease, the results of primary and secondary preventive actions, and the efforts towards a more equal distribution of diagnostic and therapeutic services. The aims of this paper is to evaluate the use of descriptive data to quantify the burden of neoplastic disease, using the data provided by the network of Italian cancer registries (the most reliable source of information on neoplastic disease in Italy). Crude rates are the most adequate for describing the "burden" of cancer patients who are expected in a certain period and will need specific diagnostic or therapeutic activities. Incidence, prevalence and mortality rates provide information on different phenomena (i.e., patients requiring diagnostic and therapeutic activities related with the first definition and treatment of the disease; patients requiring periodic follow-up or treatment of disease relapse; need palliative care). The use of these measures combined is highly informative in relation with the different objectives of health planners (i.e., patients requiring diagnostic and therapeutic activities related with the first definition and treatment of the disease; patients requiring periodic follow-up or treatment of disease relapse; need palliative care).