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Eugenio Paci

Publications and source records attributed to Eugenio Paci.

At least 37 records · Page 2Linked to original sources
PubMed2002

Stage-specific incidence of breast cancer before the beginning of organized screening programs in Italy.

OBJECTIVE: To measure stage-specific geographic and time variability of breast cancer in seven Italian areas before the onset of organized screening programs. METHODS: All invasive cancers (8689 cases) arising in women aged 40-79 years during the pre-screening period 1985-1997, were considered. Multiple Poisson regression analysis was performed. RESULTS: About 39% of the cases were classified as "early," 52% as "advanced," and 9% as "unspecified" stage. Age-adjusted incidence rates showed a significant geographic variation for early but not for advanced cancers (range: 58-103 cases/100,000 and 104-125 cases/100,000, respectively). The result was confirmed in the multiple regression analysis after adjustment for year of diagnosis and age. Early breast cancer risk adjusted for age and registry showed a significant increase over time (+3.9% per year for all ages, and +6.2% per year for age category 50-79). In contrast, a decreasing time trend was observed for advanced cancer of 3 cm or over in women aged less than 60. CONCLUSIONS: In our study, early breast cancer incidence varied both by geographic area and time before the commencement of screening. The differences in early-stage incidence may well be related to differences in availability of "spontaneous" mammography. Late-stage incidence decreased over time in younger women and for very advanced cases, but not in the older ones, nor for cancers less than 3 cm. Early detection outside organized screening was only partially efficient in reducing advanced breast cancer incidence. The trend of incidence of advanced disease, as previously proposed, is confirmed to be a valid early indicator of effectiveness of screening.

Adult↗
PubMedDate not supplied

What is hidden behind urban and semiurban cancer incidence and mortality differences in central Italy?

AIMS AND BACKGROUND: To analyze differences in cancer incidence and mortality between urban and semiurban municipalities in central Italy. METHODS AND STUDY DESIGN: Population-based survey in the provinces of Florence and Prato in Central Italy involving cancer patients diagnosed between 1985 to 1997 and cancer deaths from 1985 to 1998. RESULTS: Urban-semiurban incidence ratios were significantly high in both genders for all cancer sites combined (males 1.06, females 1.09), lung (1.11 and 1.37), Kaposi's sarcoma (1.96 and 2.39) and urinary bladder (1.23 and 1.44) and significantly low for stomach cancer (0.76 and 0.84). Among females, urban incidence excesses were present for breast, cervix uteri and skin melanoma and among males for prostate, Hodgkin disease, non-Hodgkin lymphomas and mesotheliomas. Most of the cancer mortality rate ratios corresponded to the incidence rate ratios. CONCLUSIONS: We found that cancer risks and deaths were not homogeneously distributed in the analyzed area, but an urban gradient was present. Part of the differences can probably be attributed to environmental exposures and lifestyle.

Adult↗
PubMedDate not supplied

Incidence and survival cancer trends in children and adolescents in the Provinces of Florence and Prato (Central Italy), 1985-1997.

AIMS AND BACKGROUND: The incidence of childhood and adolescent cancers has been increasing during the last decades in most Western countries. Improvements in cancer survival rates have also been observed according to the availability of more efficient therapies. METHODS AND STUDY DESIGN: A total of 518 cancer cases (age, 0-19 years) incident in the period 1985-1997 in the Tuscany Cancer Registry area, corresponding to the Provinces of Florence and Prato (Central Italy), were analyzed. Incidence rates and estimated annual percentage change were computed according to sex, 5-year age groups and diagnostic groups of the International Classification for Childhood Cancer. All patients were actively followed at 31.12.1998, and 5-year survival rates were computed for cases diagnosed in 1985-1990 and 1991-1997. RESULTS: Overall age-standardized incidence rates were 186.7/10(6) for males and 175.4 for females. In 1991-1997, standardized incident rates were 50.8 for leukemias, 44.6 for lymphomas, and 34.3 for CNS tumors. There was a marked increasing trend for lymphomas that grew at a yearly rate of +12.1% and less evident increasing tendency for leukemias, CNS tumors and carcinomas. The overall survival rate was 88% at one year, 78% at 3 years, and 74% at 5 years. A slight improving tendency in survival was evident over time. CONCLUSIONS: The study pointed out that in the examined area, during 1985-1997, there was a significant increasing incidence trend for lymphomas. Survival rates were as high as in other Western countries - evidence of the high level of diagnostic and treatment services in the area.

Adolescent↗
PubMedDate not supplied

Benign breast diseases in breast cancer screening programs in Italy (2000-2001).

AIMS AND BACKGROUND: Screening mammography has been shown to be effective in reducing breast cancer mortality in several randomized clinical trials. One major side effect of screening is the diagnosis of benign breast disease (BBD), which is considered as a nonprogressive lesion, except for a small percentage of lesions considered at high risk. We present data referring to service screening programs active in Italy in 2000 and 2001 and participating in the national survey carried out by the Italian Group for Mammography Screening (GISMa). METHODS: To all centers participating in the GISMa National Survey, we submitted a questionnaire regarding the service screening protocol and main indicators of performance of the local program in the years 2000 and 2001. RESULTS: A total of 657 detected BBD cases, registered by 23 Italian breast cancer screening centers in women 50 to 69 years of age, are included in this study. The BBD detection rate was 2.5 per 1000 at the first screening test and 1.05 per 1000 at repeated tests. The benign/malignant ratio was 0.34 at the first and 0.22 at the repeated test. CONCLUSIONS: Detection of BBD occurred frequently in breast screening programs, and prognostic implications should be further investigated. Women should be individually informed at screening, and with greater detail at the moment of the recall for assessment, of the implications of BBD detection and receive the necessary, also psychological, counseling to avoid the possible harm related to breast cancer screening.

Aged↗
PubMedDate not supplied

National estimates of cancer patients survival in Italy: a model-based method.

AIMS AND BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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).

Adolescent↗
PubMedDate not supplied

What gender differences in cancer incidence changed during the last 10 years in central Italy?

AIMS AND BACKGROUND: We have investigated whether gender differences in cancer incidence have changed during the mid 1980s to late 1990s, and whether certain changes could be clues for gender-specific modifications in carcinogenic exposures. METHODS: We used the incidence data from the Tuscany Cancer Registry and computed the standardized (on the European standard population) male-to-female incidence rate ratios (IRR) for two periods, 1986-87 and 1996-97, with corresponding 95% confidence intervals. Such statistics were calculated for two age groups, 0-59 years and 60 years and over. RESULTS: Among younger subjects there was a remarkable reduction in the IRR for smoking-related cancer sites such as oral cavity (IRR from 4.3 to 2.2), esophagus (IRR from 6.2 to 4.2), larynx (IRR from 13.3 to 5.7), and lung (IRR from 6.5 to 3.3). Less evident changes were observed among subjects aged 60 and over, eg for lung the IRR fell from 8.1 to 6.2. CONCLUSIONS: Most of the differences examined were probably due to changes in tobacco smoking which were different between genders during the last decade, with a decreasing prevalence of smokers among males and an increasing trend among females.

Adolescent↗
PubMedDate not supplied

[Estimates of cancer incidence in Tuscany, year 2000. Between method accuracy and communication appropriateness].

This study applies a method for the estimation and temporal projection of cancer incidence. The estimates are disaggregated to the Local Health Units; they refer to Tuscany for the year 2000 and to the incidence of cancer at three specific sites (lung, breast, prostate). The mortality data derive from the Regional Mortality Registry and the incidence data from the Tuscan Cancer Registry, which includes two provinces: Florence and Prato. The choice of method is discussed and a validation of the estimates obtained, using the incidence data observed in the province of Prato. The estimates and the temporal projections are required for accurate health planning, and they present the means to overcome health planning based on the historical data of medical care only. We suggest that appropriate communication of these estimates should address their limits, due to the uncertainty of the temporal prediction on the one hand and the possibility (only partially verifiable) of the violation of the assumptions on which any method for the estimation of cancer incidence is based.

Adult↗
PubMedDate not supplied

Female breast cancer.

Breast cancer represents, among females, the most important cancer site, in terms of incidence and mortality. Temporal trends have been computed in the database of the Italian Network of Cancer Registries (pool AIRT) including 58,862 cases and 20,659 deaths during the period 1986-1997. Incidence was increasing and standardised rates increase by, on average, 1.7% every year. Such increase may be partially due to the implementation of organised screening programmes. Mortality was increasing up to 1989, then it statistically significantly decreased.

Adult↗
PubMedDate not supplied

[Automatic coding of pathologic cancer variables by the search of strings of text in the pathology reports. The experience of the Tuscany Cancer Registry].

The present study evaluates the application of an automatic system for variables coding by means of strings reading in the text of the pathology reports, in the database of the Tuscany Cancer Registry. Incidence data for the years 2000 (n. 6297) and 2001 (n. 6291) for subjects for whom computerised pathology reports were available were included. The system is based on Queries (SQL language) linked to Functions (Visual Basic for Applications) that work on Windows Access. The agreement between original data inputted by the registrars and variables coded by means of automatic reading has been evaluated by means of Cohen's kappa. The following variables were analysed: cancer site (kappa = 0.87 between "manual" and automatic coding, for cases incident in the year 2001), morphology (kappa=0.75), Berg's morphology groups (kappa=0.87), behaviour (kappa=0.70), grading (kappa=0.90), Gleason (kappa=0.90), focality (kappa=0.86), lateralily (kappa=0.36), pT (kappa=0.92), pN (kappa=0.76), pM (kappa=0.28), number of lymph nodes (kappa=0.69), number of positive lymph nodes (kappa=0.70), Breslow thickness (kappa=0.94), Clark level (kappa=0.91), Dukes (kappa=0.74). The system of automatic reading of strings allows to collect a very huge amount of reliable information and its use should be implemented by the Registries.

Catchment Area, Health↗
PubMedDate not supplied

[Process indicators and standards for the evaluation of breast cancer screening programmes].

In order to obtain the maximum benefit from breast cancer screening it is essential for every programme to reach high levels of sensitivity and specificity. This can only be achieved if skill and a comprehensive quality assurance system is applied to the entire process, involving each individual part of the programme. Monitoring of outcomes and continuous evaluation of the entire screening process are key operational objectives for a successful population screening programme. The aim of this document, born in the framework of the Italian Group for Mammography Screening (GISMa), is to propose a unique methodology for collecting and reporting screening data using commonly agreed terminology, definitions and classifications. The indicators considered are those referred to the entire screening process and its sequelae, such as organizational, logistic and performance indicators. The indicators are provided under form of a synthetic and easy to use card. Every card is structured in short sections: definition, aim of the indicator, the data necessary to build it, the summarizing formula, possible problems of interpretation, the acceptable and desirable standards (derived both from the experience of national and European breast cancer screening programmes).

Breast Neoplasms↗