Risk of metachronous primary cancers in women with cervical tumor--an Italian population-based study.
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Adult↗
Biomedical subjects
E Crocetti
Publications and source records attributed to E Crocetti.
The use of complementary therapies by breast cancer patients attending conventional treatment.
The aim of this study was to measure the proportion and characteristics of complementary therapy (CT) users among female breast cancer patients receiving conventional treatment. 473 women who had received surgical intervention for breast cancer in the year of diagnosis were sent a questionnaire for completion, and 242 responded. CT had been used by 16.5% after cancer diagnosis, only 8.7% before. The most commonly used CTs were homeopathy, manual healing method, herbalism and acupuncture. The main reason for using CTs was physical distress. Only a minority was searching for psychological support. 24 users were satisfied with these treatments, and two-thirds would suggest them. Users were significantly younger, more educated, and previous users of CTs than non-users. Adjusting each variable for the effect of the others, only previous use had an independent effect on increasing the probability of being users after cancer diagnosis.
Acupuncture Therapy↗
High suicide mortality soon after diagnosis among cancer patients in central Italy.
A high suicide mortality risk has been documented among a population-based cohort of 27 123 cancer patients resident in central Italy where the general suicide rate is low. Forty-one suicides were observed (SMR = 2.36) which were only 0.2% of all deaths. However, the highest risk (SMR = 27.7) during the first 6 months after diagnosis, represents a greater contrast with the general population than has been observed in other studies.
Adolescent↗
Re: multiple neoplasias: an oncologic reality.
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Humans↗
Incidence of second primary cancers in three Italian population-based cancer registries.
This is the first population-based study carried out in a southern European region to evaluate the risk of a cohort of cancer patients for developing further cancers. The Tuscany Tumour Registry, the Ragusa Cancer Registry and the Cancer Registry of Romagna, three of the 14 population-based cancer registries active in Italy, were involved in the present study. Overall, 19,252 incident cases of cancer of the female breast, and of the colon, rectum, lung and stomach were followed-up for 48 358.3 person-years. Only second metachronous cancers were considered. Controlateral breast cancers were analysed separately. Multiple primaries (MPs) were defined according to the IACR-IACR rules. The observed (O) numbers of MPs were compared with those expected (E) from age-, sex- and registry-specific incidence rates. Overall, 463 MPs were diagnosed (O/E = 0.87, P < 0.001). The O/E ratios for cancers of the colon (O/E = 0.66), rectum (O/E = 0.72) and all sites combined (O/E = 0.78) in males were significantly lower than expected. The deficit of observed MPs was significant during the first period (2-12 months) and increased over time. Patients over 65 years of age had a significant lower risk of MP, whereas young cancer patients had significantly higher risks for all cancers and for female breast cancer. Male lung cancer patients had a significantly reduced O/E ratio for stomach cancer (O/E = 0.21). Rectal cancer patients had reduced risks of developing stomach cancer and tumours of all sites combined and a 3-fold increased risk of kidney cancers. Colon cancer patients had an overall reduction in risk of MPs, but female colon cancer patients had a significantly increased risk for tumours of the ovary and small intestine; no significant results were found for primary stomach cancers. Female breast cancer patients had a significantly increased risk of rectal cancer (O/E = 1.97), and when synchronous and bilateral breast cancers were considered, significant overall increases in risk were seen for all cancer sites (O/E = 1.6) and for rectal (O/E = 2), and especially for breast cancers (O/E = 3). The cohort analysed had a lower risk of developing further independent tumours than the general population. Several artefacts may have biased these results: the exclusion of synchronous cancers greatly reduced the overall MP risk, and the age-related differences may have been due to reduced medical surveillance and diagnostic aggressiveness. We have confirmed the increased risk for kidney cancers in rectal cancer patients and the association between cancers of the colon and ovary. The significantly increased risk for rectal cancer in female breast cancer patients is probably due to hormonal and dietary factors. For female breast cancer patients, controlateral breast cancer represented the highest risk. The increased risk of cancer of the small intestine in patients with colon cancer may be due to overdiagnosis within increased medical surveillance.
Aged↗
Epidemiology of carcinoid tumours in central Italy.
Between 1985 and 1991, 83 carcinoid tumours were diagnosed in the province of Florence where the Tuscany Tumour Registry is active. There were 44 males and 39 females. The age-adjusted incidence was 0.65 cases/100,000 population/year. The most common location was the lung (30.1%), followed by colorectum (25.2%) and small intestine (22.8%). The 5-year observed and relative survival rates were 70.8% and 78.9% respectively. The relative risk of developing multiple primary cancers was 0.79 (CI 95% 0.28-8.33).
Carcinoid Tumor↗
Gastrointestinal carcinoid tumours. A population-based study.
AIM: The aim of this study was to provide further information on the descriptive epidemiology of gastrointestinal carcinoids. METHODS: Data was drawn from the Tuscany Tumour Registry, a population-based registry active in the province of Florence. All the carcinoid tumours reported for the period 1985-1991 in gastrointestinal organs were analysed. Incidence, mortality and survival data are presented. RESULTS: There were 53 gastrointestinal carcinoid tumours in 29 males and 24 females. The site distribution was: 19 small intestine, 8 colon, 7 appendix, 6 stomach, 6 rectum, 1 large bowel (not specified), and 6 from known metastases. The overall age-adjusted incidence rate was 0.42/100,000. At diagnosis, 33 carcinoids showed evidence of invasion and/or spreading. Seven patients had two independent tumours. As of 31.12.94, nineteen patients had died. The overall observed and relative 5-year survival rates were 66.1% and 75.1%, respectively. CONCLUSIONS: In the province of Florence, the incidence of gastrointestinal carcinoid tumours is low. Probably, this result, is in part due to the low autopsy rate. The overall survival rate is quite good, with the best prognosis seen for appendiceal carcinoids and the worst for colon and stomach carcinoids. 1.9% of the patients had a further tumour diagnosis.
Adolescent↗
Problems related to the coding of multiple primary cancers.
There is growing interest in multiple primary cancers (MPs), but the lack of a universally agreed definition can both modify the results for one series and hamper comparisons among cancer registries. The aim of this study was to compare agreement on the coding of MPs between two cancer registries, the Danish Cancer Registry and the Tuscany Tumour Registry, that adhere to different rules for accepting MPs, and to study whether coding according to common international rules (IACR) would increase the comparability. Data on 200 patients recorded as having more than one cancer were extracted at random from the two registers. The agreement on MP status between coders, one from each registry, using local rules and definitions on MP, was good (kappa value, 0.70). Exclusion of 11 expected discordant cases increased the agreement (kappa = 0.86). The agreement reached with the use of the IACR rules was very high (kappa = 0.80). We conclude that registries should present data according to international rules, in particular for the study of MPs. Registries should at least clearly indicate deviations from the agreed international standards, in order to facilitate comparisons on incidences.
Denmark↗
Colorectal cancer survival--population-based rates in the province of Florence.
This study aimed to evaluate survival in 2,339 colorectal cancer patients diagnosed in 1985-87 in the province of Florence, where the Tuscany Tumour Registry is active. The effect of sex, site (colon, rectum), sub-site, disease diffusion (localized, regional, distant, unspecified), year of diagnosis, place of residence (municipalities involved in the screening programme, Florence, others) and source of diagnosis (Center for the Study and Prevention of Cancer-CSPO, others) were evaluated. Five-year observed and relative survivals were 37.9 and 48.1% respectively. Five-year prognosis was worse in men, in older age groups, in advanced stages and in patients not diagnosed at the CSPO. No differences were shown in residents of municipalities involved in the screening programme. Relative 5-year survival in Florence was among the highest in Europe for cancers of both the colon and the rectum. Sex, age, disease diffusion and source of diagnosis showed an independent prognostic effect. The effect of screening was not evident, probably due to the low compliance during the period under study and to the use of a low sensitivity test.
Adult↗
Small bowel tumours in Tuscany.
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Adolescent↗
A model-based prediction of the impact on reduction in mortality by a breast cancer screening programme in the city of Florence, Italy.
The efficacy of breast cancer screening for women older than 50 years has been shown in several studies. Service screening is now ongoing or planned in several countries in Europe. MISCAN, a computer simulation programme, has been used to analyse data from the Florence District Programme (FDP) breast cancer experience. First, the model was fitted to the screening results for the period 1975-1986. A good correspondence between the model outcomes and the FDP results was achieved. It was then used to predict the impact on mortality of the new starting programme of the city of Florence (63,000 women, 50-69 years old). Assuming a 70% attendance rate, then for the city of Florence, 2563 screen-detected breast cancers are predicted for the period 1991-2020 out of the total number of 9095 breast cancers for all ages (28%). A total of 3720 deaths for breast cancer are expected without screening. An absolute reduction of 472 deaths (13%) is predicted for the whole population. The estimated number of years of life gained by screening until 2020 is 4354. Simulation by MISCAN has previously been a useful support tool for decision-making about screening. The present paper is the first based on a southern European experience. The possibility of applying MISCAN to predict the impact of a national programme in Italy is discussed.
Adult↗
Male breast cancer: incidence, mortality and survival rates from an Italian population-based series.
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Adult↗
[The immigration of Italian patients to foreign countries. Analysis of the Gustave Roussy Institute series].
Most Italian patients who migrate to foreign countries to receive health care, choose France. The Gustave Roussy Institute (IGR) located in Villejuif, a town in the suburbs of Paris, is one of the most important center for cancer diagnosis and treatment in France. The aim of this issue has been to evaluate the admissions of Italian patients in terms of cause of admission, treatment and area of residence of the patients. We analysed the series of Italian patients admitted to IGR from 1988 to 1991; during that period 8159 Italian patients were hospitalized (2.8% younger than 15 years, 84.3% between 15 and 64 years and 12.9% older than 64 years). Most of those patients were resident in the South of Italy (more than 63%) and in particular they came from the region Sicily (27.4%) and Campania (18.8%). A different pattern seems to distinguish patients coming from the Center and the North of Italy from those from the South. In fact the aim of this migration was, for the former, a consultation on the therapy that they had, in large part, already undergone in Italy while the latter wanted to start their treatment there. The admissions related to the three most frequent cancers (breast, lung, lympho-hemopoietic system) have been analysed. The majority of patients were from the South of Italy. Breast cancer patients have migrated to the IGR looking for a post-surgical treatment while lung patients have been in large part treated for the first time at the IGR.
Adolescent↗
Time interval since last test in a breast cancer screening programme: a case-control study in Italy.
STUDY OBJECTIVE: To evaluate a population based screening programme for breast cancer. DESIGN: This was a case-control study of women dying of breast cancer between 1977 and 1987 who had been invited to take part in a screening programme. SETTING: Community based study of women aged between 40 and 70 years (total population about 35,000 at 1981 census), living in 23 small towns near Florence, Italy. PARTICIPANTS: 103 cases were identified from death certification, and 515 living controls (five per case) selected for year of birth and town of residence. MEASUREMENTS AND MAIN RESULTS: Screening history was obtained from computer archive. Sociodemographic information was obtained from town registry offices and directly from relatives of the deceased and from the controls by postal questionnaire, and if necessary telephone or personal interview. Analysis was carried out on two age groups--40-49 years and 50+ years at diagnosis--and considered the number of screening tests and the time interval since the last test, separately and together. In the older age group, women with at least one screening test in the previous 2 1/2 years showed a 50% reduction in risk (odds ratio 0.49, 95% confidence interval [CI] 0.25-0.95). If they had also had another previous negative screen the risk was reduced to one third (odds ratio 0.35, 95% CI 0.14-0.85). There was a significant trend of decreasing risk with increasing number of screens in older women. No clear evidence of a similar protective effect was shown for women in the 40-49 year age group. CONCLUSIONS: A significant protective effect of the screening programme is evident in older women but not in younger ones. The data do not allow an assessment of optimal screening interval because of the small number of previously screened cases.
Adult↗
Prostate cancer: population-based survival rates in central Italy.
AIMS: To evaluate survival in prostate cancer patients in the Province of Florence where the Tuscany Cancer Registry is active. METHODS: The survival of 777 patients with prostate cancer diagnosed in the period 1985-87 was evaluated. The observed and relative survival rates 1, 3 and 5 years after diagnosis were computed. Also the prognostic effect of age, disease extension, tumor grade, histological verification, place of residence and year of diagnosis were evaluated using univariate and multivariate analysis. RESULTS: The observed survival was 73.4% 1 year, 42.5% 3 years and 29.2% 5 years after diagnosis. The relative survival was respectively 78.7%, 53.0% and 43.0%. Significant independent risks were evident when the disease was extended out of the prostate, for patients older than 80 years, for high grade tumors and for patients without histological verification. CONCLUSION: The 5-year relative survival rate in the province of Florence is similar to those from other European Registries and the Latina Registry, but much lower than the one reported by the SEER program in the US. Data on histological verification percentage, availability of information on disease extension, and tumor grade are discussed as indicators of the quality of the diagnostic approach in comparison with other registries.
Aged↗
Agreement estimate among three Italian cancer registries in the coding of multiple primary cancers.
AIMS: The aim of the study was to compare agreement on the coding of multiple primary cancers (MPs) between three italian cancer registries, the Ragusa Cancer Registry (RCR), the Cancer Registry of Romagna (RTRo), and the Tuscany Tumor Registry (RTT), that adhere to different rules for accepting MPs and to study whether coding according to common International rules (IARC-IACR) increased comparability. METHODS: One hundred cases were randomly extracted from the archives of each registry from those recorded as having more than one cancer. For each of the 300 patients, the number of independent cancers was attributed independently by one coder from each registry. The coders coded the series twice: once following the local registry rules and once according to the IARC-IACR rules. The agreement was estimated by couples of coders by means of Cohen's kappa statistics. RESULTS: The agreement on MP status between coders using local rules and definitions was good between the RTT and RCR (kappa = 0.77) and very good between the RTRo and RCR (kappa = 0.81) and the RTT and RTRo (kappa = 0.96). Exclusion of 23 expected discordant cases increased the agreement. The agreement reached with the use of the IARC-IACR rules was very good (RTRo vs RCR, 0.95; RTT vs RTR, 0.94; RTT vs RTRo, 0.95). CONCLUSIONS: The comparison among the RTT, RTRo and RCR confirmed that the number of tumors considered MPs may be modified depending on the rules adopted. There were minor differences between the RTT and the RTRo since their rules were very similar. Most differences in agreement were with the RCR since its classification was conceptually different from the other two. The result on agreement with IARC-IACR rules is encouraging from the point of view of conducting a cooperative study among different registries on the incidence of MPs.
Humans↗
Complementary medicine and oncologists' attitudes: a survey in Italy.
AIMS AND BACKGROUND: There is growing interest in medical practices other than conventional medicine (complementary medicine, CM). CM is widely used by cancer patients. The purpose of the present study was to evaluate the knowledge of and the attitude towards CM in a sample of Italian allopathic oncologists. METHODS: Seventy-six oncologists of the Istituto Nazionale per la Ricerca sul Cancro of Genoa, 80 oncologists working at the Istituto Tumori Fondazione Pascale of Naples, and 100 hospital practitioners of the Province of Sondrio were asked to answer a self-administered structured questionnaire on CM. The level of their knowledge on CM, their opinion on CM and on CM therapists, the sources of information, the use of CM for themselves, the practice of CM and the attitude to refer patients to CM were investigated. RESULTS: Replies were received from 190 oncologists. The response rate was significantly lower for the oncologists of Naples. One-fifth of the physicians replied that they had no knowledge of CM. The main sources of information were newspapers and TV. One-fourth of the physicians had personally used CM. About one-fourth of the physicians had practiced a kind of CM. The percentage of oncologists from Genoa who would refer their cancer patients to CM was significantly higher than the others. The physicians thought that about 84% of their patients used CM. The variables considered were tested in a multivariate model. The oncologists from Genoa showed a significantly increased risk of referring their patients to CM. Oncologists who had personally used CM referred patients to CM 3 times more frequently than the others. CONCLUSIONS: A large percentage of cancer patients used CM according to their physicians. The level and the quality of the knowledge of CM of the oncologists interviewed were low. The oncologists could hardly be helpful for their patients in dealing with therapies different from conventional medicine.
Adult↗
Comparability issues within the ITACARE data base.
AIMS AND BACKGROUND: The aim of the study was to describe the extent of variability among Italian cancer registries in data managing practices that may affect differences in incidence and possibly in survival estimates. METHODS: a self-administered questionnaire was sent to each participating registry. The definitions of the diseases, of the start point and of the end point of survival computation were investigated. Moreover, information on the proportion of histologic confirmation, of ill-defined sites and of DCO (death certificate only) was also considered. RESULTS: There were some differences in cancer registration techniques among Italian cancer registries. As regards disease definition, the most relevant problems arose for urinary bladder. Skin melanoma should also be considered with some caution, due to variability among registries in coding in situ cases. For the CNS and meninges, the proportion of cases that could be differently considered was so limited that no effect on survival is expected. For female breast, colorectum and cervix uteri, the effect of early diagnosis services (which are active only in some areas) may lead to better survival estimates. The variability in incidence date definition was high among registries and sites, but its effect on survival was very limited. There was a wide variability in the proportion of DCOs and of DCIs (initially known from death certificate), which should be considered in survival comparisons. All the registries stated that they carried out an active follow-up of their patients. CONCLUSIONS: In general, quality standards of the registries are good and allow comparability of survival data. The variability of rules adopted by Italian registries may affect geographic survival differences only in a limited number of cancer sites, so that results should be interpreted with caution.
Bias↗