Population breast-cancer screening.
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Breast Neoplasms↗
Biomedical subjects
E Paci
Publications and source records attributed to E Paci.
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↗
[Magnetic resonance arthrography in chondral disease of the knee].
The clinical usefulness of Magnetic Resonance Imaging (MRI) of the knee in the depiction of meniscal, ligament and tendon lesions is well known. In contrast, the role MRI plays in the diagnosis of chondromalacia remains debated, the gold standard being arthroscopy. A new technique, i.e., MR arthrography (MRA), has been recently proposed which consists of the intraarticular injection of a paramagnetic contrast agent (Gd-DTPA) during MRI. Thirty-one patients with clinically suspected chondromalacia of the knee were examined with MRA. The exams were performed with a 1T superconductive magnet and a dedicated coil. All the patients were examined before (baseline scans) and after paramagnetic contrast agent injection. MRA results were compared with arthrographic findings. Baseline MRI had 25% sensitivity, 77.9% specificity and 83% diagnostic confidence in the diagnosis of chondromalacia; these figures increased to 93%, 97.6% and 91.5% after contrast agent injection. This preliminary experience confirms MRA to be a useful tool in the diagnosis of chondral knee conditions.
Adult↗
Population-based breast cancer survival. Mammographic screening activities in central Italy.
BACKGROUND: The aim of this study was to evaluate the effect on 5-year survival of patients with invasive breast cancer relative to demographic and clinical variables (age, residence, and disease diffusion) and to early diagnostic procedures performed in the area. METHODS: The observed (Kaplan-Meier method) and relative 5-year survival in 1263 patients with invasive breast cancer in the Province of Florence, Italy, between 1985-1986 (source: Tuscany Cancer Registry) are presented. The results were compared with those of other European areas and of the Surveillance, Epidemiology, and End Results Program. The Cox model is used to evaluate the effects of age at diagnosis (5-year age groups), disease diffusion (localized, regional, distant, unspecified), residence (Municipality of Florence, screening area, other municipalities), and source of diagnosis (Center for the Study and Prevention of Cancer, hospitals) on observed survival. RESULTS: Observed 5-year survival was 68.4% (Kaplan-Meier method) and relative 5-year survival was 75.4%. Relative survival for patients younger than age 35 at diagnosis was high (82.3%); it decreased slowly from 80.5% in the group of patients 35-44 years of age, to 74.0% in those 65-74 years of age, and steeply decreased to 68.1% in those 75 years of age and older. Relative 5-year survival in Florence was lower only than that observed in Switzerland (Geneva) and in the USA (whites). Five-year prognosis was worse in women 70 years of age or older, in advanced stages, in residents of municipalities not involved in the screening program, and in cases diagnosed in hospitals. The gain in survival may be explained partially by lead-time effect and by length bias due to early diagnosis both in self-referred women and in screening-detected cases. In these cases, though, the better prognosis, although attenuated, persisted after adjustment by disease diffusion. CONCLUSIONS: The results suggest that the early diagnosis of breast cancer in self-referred women affects prognosis, at least concerning 5-year survival. Moreover, although lead-time effect and length bias cannot be excluded in this study, screening by personal invitation may reduce the disadvantage in the survival of patients with breast cancer often observed in rural areas.
Adult↗
What do Italian hospital physicians know about quality of life assessment in oncology?
AIMS: To assess the current level of information and use of quality of life assessment instruments by Italian physicians involved in oncologic patient care. METHODS: Specifically trained scientific representatives of a pharmaceutical company interviewed 2237 hospital physicians all over Italy. RESULTS: A total of 1390 physicians (62.1%) had some knowledge of quality of life assessment tools in oncology, but 364 of them (26.2%) were unable to recall the name of any instruments. The one that was most frequently recalled by the 1026 physicians who knew of the existence of one or more instruments was the Karnofsky Performance Status (KPS) (91%) followed by the Eastern Cooperative Oncology Group performance scale (ECOG) (35.5%) whereas the Quality of Life Index and Visual Analogue Scale were at the very bottom of the list (5.9% and 3.7%, respectively). Physician age and type of department were found to be strong predictors of knowledge of the instruments, which was greater among young physicians and those working in oncological departments. Of the physicians aware of the KPS, 56.6% used it, whereas the percentage of physicians using ECOG was higher (69.5%). CONCLUSIONS: The collected data indicate a poor knowledge of quality of life assessment instruments in Italian physicians. Most physicians tend to use so-called << objective >> instruments where the assessment is made by the physician and not by the patient (KPS, ECOG Quality of Life index), are practically unaware of the new generation of "subjective" self-rating instruments. The use of such instruments in particular might provide greater insights into the impact of the disease and related treatments on the quality of life of cancer patients.
Adult↗
Design and preliminary results of the Florence Breast Cancer Screening Programme (Progetto Firenze Donna).
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Age Factors↗
Breast cancer early diagnosis experience in Florence: can a self referral policy achieve the results of service screening?
STUDY OBJECTIVE: To assess the impact of a breast clinic on a specific target population and evaluate early diagnosis performance indicators for breast cancer in the presence of a self referral policy. DESIGN: Women living in Florence between 1980 and 1989 who had undergone mammography at a self referral breast clinic were studied. Main outcome measures were the use of mammography in relation to age, symptoms, and the interval between two subsequent tests, and early diagnosis performance indicators were the detection rate (DR), the prevalence/incidence ratio, and the proportion of early detected cancers. Performance indicators were compared with those from formal screening programmes. SETTING: Florence, Italy. PATIENTS: All mammograms performed at the clinic from 1980-89 in 40-69 year old women living in Florence were examined (n = 42,226). Records included the date of birth and of the examination, the reason for testing (asymptomatic/presence of pain/presence of symptoms other than pain), and the TNM classification for breast cancer cases. MAIN RESULTS: The total number of mammograms performed per annum increased by 70% over the decade, but much of this was routine repeat mammography (54.1% in 1989). Rates of first examinations in asymptomatic women increased in the second half of the decade from 17 per 1000 in 1985 to 31 per 1000 in 1989. Mammographic coverage decreased with increasing age from 12.6% in 40-49 year olds to 6.0% in 60-69 years old. Performance indicators of the activity in asymptomatic women were comparable with those expected in service screening. The proportion of not advanced cancers detected in asymptomatic women was 62.3% with a DR of 5.3 per 1000, and the average prevalence/incidence ratio was 2.9. CONCLUSIONS: High quality mammography performed in a breast clinic in self referred asymptomatic women can achieve as good results as a formal invitation screening service. Only a few of these women will benefit, but those who do are likely to be younger (40-49 year old women).
Adult↗
MR imaging of hepatic masses: diagnostic significance of wedge-shaped areas of increased signal intensity surrounding the lesion.
OBJECTIVE: Wedge-shaped areas of increased signal intensity surrounding focal hepatic lesions on T2-weighted images have been described as an occasional finding in patients with hepatic metastases. We reviewed MR images of patients with benign and malignant focal hepatic lesions to determine the prevalence and diagnostic significance of this finding, and in particular to determine if these wedge-shaped areas are characteristic of cancer. MATERIALS AND METHODS: One hundred twenty-one patients with focal hepatic lesions (65 patients with metastases, 14 patients with hepatocellular carcinoma, and 42 patients with benign conditions) underwent MR imaging of the liver at 1.0 T. Axial spin-echo T1-weighted and spin-echo and turbo spin-echo T2-weighted MR images were obtained. The MR images were retrospectively evaluated: the number and size of the lesions and the presence of wedge-shaped areas surrounding the lesions were recorded; in patients with cancer, follow-up MR images and a clinical course were used to study the evolution of the lesions and the adjacent wedge-shaped areas. The final diagnosis in patients with cancer was proved by clinical course (54 patients) or fine-needle aspiration biopsy (25 patients); in patients with benign lesions, the findings on various other imaging techniques were accepted as conclusive. RESULTS: The wedge-shaped areas were noted on T2-weighted images in 16 (25%) of 65 patients with metastases, in 3 (21%) of 14 patients with hepatocellular carcinoma, and in 5 (12%) of 42 patients with benign lesions. In 11 of the 16 patients with metastases and wedge-shaped areas of increased signal intensity, a metastatic lesion within the wedge-shaped area was detectable; in the remaining five patients, a metastatic lesion appeared during the subsequent clinical course. In some instances, the wedge-shaped area obscured the lesion. In patients with benign conditions, the wedge-shaped area was frequently seen in association with hemangiomas (4 of 13, 31%). CONCLUSION: Our results show that wedge-shaped areas of increased signal intensity surrounding lesions on T2-weighted MR images are a common finding in patients with focal hepatic lesions. The wedge-shaped areas cannot be considered pathognomonic of malignant lesions because they are also seen in patients with benign conditions (hemangioma, abscess). However, the appearance of these wedge-shaped areas in a patient with cancer should suggest a metastasis. The possibility that hepatic lesions could be obscured by these wedge-shaped areas also should be considered when response to treatment is being evaluated.
Adult↗
[Turbo-Spin-Echo sequences in focal liver diseases].
Turbo Spin-Echo (Turbo SE) pulse sequences represent a new type of fast sequences characterized by a dramatic reduction in acquisition time with similar intrinsic contrast to that of conventional Spin-Echo (SE) pulse sequences. For a preliminary clinical comparison of turbo SE and SE sequences, a consecutive series of 25 patients with focal liver lesions was investigated by means of MRI at 1.0 T. The patients were selected on the basis of US or CT positive liver scans for focal lesions. All patients underwent MRI following the same protocol: axial T1-weighted (T1W) gradient echo (GE) sequences (TR/TE = 110/6 ms) with the "breath-hold" technique, T2-weighted (T2W) SE sequences (TR/TE = 1730/90 ms; FL = 60, M = 128 x 256, 2 AC, TA = 7 min 26 sec) and turbo SE sequences (TR/TE = 5100/112 ms, M = 240 x 256, 2 AC, TA = 2 min 48 sec). Slice thickness was 10 mm with a 1-mm gap in all cases. Qualitative (number, size and definition of the lesions) and quantitative (contrast-to-noise ratio (CNR) and relative CNR) variables were considered. SE and turbo SE sequences demonstrated the same number of lesions; the smallest lesion (3 mm) was identified by turbo SE sequences. Turbo SE sequences better depicted lesion margins than SE sequences. In all cystic conditions, CNR was higher in turbo SE than in SE sequences, while it was lower in all the extant conditions. This preliminary experience proves turbo SE pulse sequences to be a valuable tool in liver MRI, which calls for further clinical trials.
Adult↗
MRI appearances in amoebic granulomatous hepatitis: a case report.
Amoebiasis is a common cause of liver disease usually presenting as single large or multiple smaller abscesses. Cases with granulomatous hepatitis have rarely been described. We report the case of a 7-year-old girl with amoebic granulomatous hepatitis in which multiple liver abscesses were demonstrated by MRI. A total of 14 abscesses were identified, ranging from 5 mm to 3 cm in diameter. The largest lesions appeared to T2-weighted images as heterogeneous, low-intensity areas surrounded by a double-layered wall, the inner layer of which was hyperintense and the outer layer hypointense. These signs, which have never been described in classic amoebic abscess, represent, we believe, a pattern of hepatic granulomatous amoebiasis lesions. We suggest that MRI should always be performed in cases of amoebic infection.
Child↗
Quality-of-life assessment in a home care program for advanced cancer patients: a study using the Symptom Distress Scale.
Quality-of-life assessment in advanced cancer patients should include the study of physical function, psychological status, social interactions, and symptoms. "Symptom distress" relates to the degree of discomfort caused by specific symptoms. A Symptom Distress Scale, which has been developed by McCorkle and Young, is a self-rating instrument that evaluates 13 symptoms. In the present study, the Italian version of the Symptom Distress Scale (SDS) was used to assess the quality of life in advanced cancer patients. The internal consistency of this version was found to be good (Cronbach's coefficient alpha = 0.78). A sample group of 43 patients treated in a home care program was asked to fill out the SDS on a weekly basis. The scores showed a reduction in symptom distress, which was primarily due to improvement in pain, nausea, and bowel pattern. Home care was less effective in improving concentration and, more generally, psychological aspects. This study confirms the validity of a quality-of-life monitoring system that uses a patient self-rating symptom assessment instrument.
Aged↗
Occupation and cancers of the lung and bladder: a case-control study in Bombay.
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Case-Control Studies↗
Pleural malignant mesothelioma in Tuscany, Italy (1970-1988): II. Identification of occupational exposure to asbestos.
Following the finding of an unexpected cluster of mesotheliomas in textile workers, a surveillance system of malignant mesotheliomas was implemented in the region of Tuscany, Italy. This article reports on the investigation of 124 cases of mesothelioma diagnosed and reviewed by the Institutes of Morbid Anatomy and Histopathology at the Universities of Florence, Pisa, and Siena between 1970 and 1988. A complete occupational and asbestos exposure history was assessed through a semi-structured questionnaire directly administered to resident cases of Tuscany or, if deceased, to their closest living relatives, for a total of 100 interviews. The hypothesis of past occupational asbestos exposure was verified and documented. Seventy-two cases have been classified as occupationally exposed to asbestos; four were classified in the category of "possible domestic" exposure to asbestos. For two others, the role of other risk factors was stressed, and for 22 cases, either no asbestos exposure was found or the available data were not adequate to define it. The present study allowed identification of some unknown or scarcely known occupational asbestos exposures in the study area.
Adult↗
Assessment of validity and clinical application of an Italian version of the Rotterdam Symptom Checklist.
An Italian version of the Rotterdam Symptom Checklist (RSCL) has been validated in a sample of 147 healthy women and 61 breast cancer outpatients. The structure of the RSCL has been analysed by factor analysis reproducing results of the English version, and the psychological and physical subscales showed a good internal reliability (Chronbach's alpha 0.91; 0.87). The State-Trait Anxiety Inventory questionnaire and the RSCL were compared in the healthy women sample. A Pearson correlation coefficient (PCC) of 0.74 (p < 0.01) was found between the trait anxiety and RSCL psychological scores. Psychological (mean: 17.5; SD: +/- 5.4) and physical (mean: 37.8; SD: +/- 8.6) subscale scores were correlated in healthy women (PCC: 0.68; p < 0.01) and related to a general wellbeing item (PCC: 0.44; p < 0.01). The breast cancer outpatients showed scores for psychological and physical subscales similar to those in the healthy women sample. The Italian version of the RSCL seems comparable to the English version and could be useful in clinical research. Its use in longitudinal studies should be tested.
Aged↗
What healthy women think, feel and do about cancer, prevention and breast cancer screening in Italy.
In preparation for a major campaign to encourage participation in a breast screening programme for all women between 50-70 years old in Florence, Italy, an in-depth study of 200 women's attitudes and practices regarding cancer and its prevention was undertaken. 72% participated in semistructured interviews, and inclination to participate was analysed in terms of Yes (39%), Uncertain (36%), and No (20%) (5% were unspecified). Age (P = 0.03), area of birth (P = 0.01), education level of husband (P = 0.04) and prior Pap smear (P = 0.00) or mammography (P = 0.00) were among the variables statistically associated with inclination to participate. While the women shared more or less common images of cancer, concern for health, and belief in the importance of God and destiny, those less inclined to participate felt less personally vulnerable, had less faith in medicine's ability to cure or prevent cancer, were more distant from the medical system and culture in general and regarded information about health or illness more as unnecessary or dangerous than beneficial. Understanding and consideration of both "popular" and "medical" cultures need to be encouraged.
Aged↗
Further evidence of an excess of risk of pleural malignant mesothelioma in textile workers in Prato (Italy).
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Asbestos↗