Biomedical subjects
G Gatta
Publications and source records attributed to G Gatta.
Health care system, cancer registration and follow-up of cancer patients in Italy.
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Survival of cancer patients in Europe. Guide to tables.
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Time trends of lung and larynx cancers in Italy.
During the period 1970-1989, age-adjusted mortality rates for lung cancer in Italy increased by more than 50%, while rates for larynx cancer in males decreased by approximately 13%. This study aims to interpret this difference, which seems to contradict the finding that cigarette smoking is a common major risk factor for both lung and larynx cancer. To this end, we jointly analyzed the time trends of incidence, survival and mortality. We first examined survival data taken from the population-based Lombardy Cancer Registry (northern Italy). Based on data referring to 880 incident cases of larynx cancer, diagnosed during the period 1976-1987, we estimated a 3% annual increase in relative survival. By contrast, no significant period effect was observed for survival rates of 2,259 incident cases of lung cancer. National incidence rates were estimated using official mortality data and the above-described survival data. Age-adjusted estimated incidence rates increased, from 1970 to 1989, for both cancer sites: +55% for male lung, +56% for female lung, and +22% for male larynx. Moreover, the patterns of birth-cohort effect, which are diverging for mortality, are nearly parallel with regard to incidence. This analysis suggests that a substantial improvement in survival of larynx cancer patients may largely explain the differences in mortality trends for cancer of lung and larynx.
[Trends in cancer incidence as observed by Lombardy cancer registry, Varese Province].
Trends in cancer risk of the Varese province Cancer Registry from 1976 to 1987 have been considered. The analysis has been carried out subdividing the 12 years of observation in three quadriennia. In younger ages (0 to 54) an increase of melanomas, of testicular cancer and, only in females, of tobacco-related cancers (oral cavity, oesophagus, pancreas, larynx, lung, bladder and kidney) has been observed. In younger males, instead, a decrease of tobacco-related cancer risk is already observable. Below age 55 there is no reduction in gastric cancer risk. The increase of breast cancer for youngest women is only observed between the first and the second quadriennium. For older ages (from 55 to 74) tobacco-related cancers continue to increase, in both sexes, but mainly among females. Also increasing, for males, are colon and liver cancer risks. Among the same ages, gastric and cervix (for screened age groups) cancer risks are decreasing. These observations, most in accordance with patterns observed in other western countries, can be used for setting intervention and research priorities.
The effect of cytological screening on cervical neoplasia in the Italian province of Varese.
In the Varese province (409,142 female inhabitants in 1981), which has been covered by a cancer registry since 1976, cytologic screening for cervical cancer began in the early sixties in the municipality of Busto Arsizio (41,818 female inhabitants in 1981) and subsequently spread to the rest of the province. The distribution by age of cytologic smears and of detected in situ cancer reveals a more frequent attitude to be screened for women aged between 25 and 54 years. Overall, the incidence rate (world standardized) for invasive cancer in the province decreased from 10.3/100,000 women-year in the period 1976-81 to 7.5/100,000 in 1982-87. In Busto Arsizio a survey of the hospital archives has been carried out to identify the cases of cervical cancer diagnosed from 1966 to 1985: in this 20-year period, the incidence of cervical cancer decreased markedly, but only in those ages frequently screened. In the rest of the province, for the first period of cancer registration (1976-81), the incidence was significantly higher than in Busto Arsizio, especially for ages 35-64. Subsequently, between 1982-87, the cervical cancer incidence was low in both areas. For the period 1976-87, no difference for carcinoma in situ registration rates was observed between the two populations studied. Actually by 1976, when the Lombardy Cander Registry began its activity, the screening was diffuse throughout the province. These observations are consistent with the preventive effect of screening activity.
Estimated incidence and prevalence of female breast cancer in Italian regions.
Female breast cancer incidence and prevalence in Italy have been estimated by region and vast areas from population-based survival data of breast cancer patients and 1970-1987 specific mortality data using a mathematical model. Italian age-standardized incidence rates (ASR) for 1987 range from 70 to 90 per 100,000 women-year in the Northern regions, 55 to 73 in the Center, and 45 to 72 in the South. Overall, the ASR is about 80 in the North, 70 in the Center and 60 in the South. In the absence of competitive mortality, breast cancer cumulative risk in the 0-74 years life span is about 7 women out of 100 in the North, 6 in the Center and 5 in the South. The decreasing risk pattern from North to Center then South appears less evident when under 45 age-specific rates are considered. Very high levels for young age-groups are present both in the North (Liguria and Emilia Romagna) and South (Sardinia and Apulia). The incidence pattern by age differs from region to region and over the considered period, suggesting that a birth-cohort effect is crossing the whole country. Using to model, it can be estimated that the risk by cohort increases from the generations born at the beginning of the century to those born in the 40s, after which, for subsequent generations, it has been decreasing in all the considered areas and is similar in the North and South. We can infer that for the whole country the incidence will increase up to the years 2000-2010 when those birth-cohorts at higher risk will also be at higher risk for age. In 1987, about 250,000 Italian women had a present or past history of breast cancer: for the 1970-1987 period, prevalence has increased by approximately 5,500 cases per year.
Clinical and pathologic prognostic indicators in colorectal cancer. A population-based study.
The institution of a colorectal Cancer Register in a health care district of Northern Italy gave the authors the opportunity to evaluate the prognostic relevance of several morphologic and clinical variables by univariate and multivariate analyses. Of the 134 patients registered in 1984, 132 were followed up until the end of 1989. Overall 5-year survival was 37%, but the figure increased to 43% when only colorectal cancer-related deaths were considered. Univariate analysis for clinical variables showed that TNM staging and age at diagnosis were significantly related to prognosis, whereas none of the other parameters were indicative of the clinical outcome. With a similar analysis, among the various morphologic variables, pattern of growth (infiltrating versus expanding) and extent of fibrosis (extensive versus little or absent) appeared to be indicators of prognosis. When the variables that were significant (stage, age, pattern of growth, and fibrosis) in the univariate analysis were entered into the Cox model of multivariate analysis, TNM staging was the only parameter that maintained an independent prognostic importance. The authors state that their results confirm the importance of stage in predicting survival for cancer of the large bowel and suggest that the possible prognostic value of clinical and morphologic variables should be investigated within each of the major TNM or Dukes' classes.
Survival for lung cancer in northern Italy.
From the population covered by the Lombardy Cancer Registry (northern Italy), all 2,259 lung cancer patients diagnosed from 1976 to 1981 were followed through 30 November 1989. The length of follow-up ranged from eight to 13 years. A special investigation on long-term survivors showed that a negligible proportion (0.01 percent) of errors occur in determining life status when an active follow-up is adopted. Age, stage, and histotype were found to be statistically significant, independent, prognostic factors in multivariate analysis both by the Cox model and by a model considering the relative survival. Observed survival was 29 percent at one year after diagnosis, 13 percent at two years, eight percent at three years, five percent at five years and two percent at 10 years. Survival decreased with age, but the youngest patients of both sexes showed lower survival compared with immediately subsequent ages. Among morphologically confirmed tumors, epidermoid carcinomas and adenocarcinomas showed the highest survival (38 percent and 33 percent at one year, respectively); small cell carcinomas showed the poorest prognosis (one-year survival, 23 percent). Beyond the second year after diagnosis, differences between histotypes became slighter. Survival according to stage showed a decreasing pattern from limited to advanced tumors, one-year figures being 41 percent for localized tumors, 27 percent for regional metastasis, and three percent for distant metastasis. Relative survival in Varese was compared with that reported by other cancer registries in Western countries: the variability noted could be related to different modalities of registration and to different distribution of clinical and demographic factors.
[Survival in respiratory tract tumors: Italian population-based data and international comparisons].
Population survival studies are usually carried out within population-based cancer registries and are useful mainly for geographical and temporal survival comparisons. Survival studies based on clinical series of patients are traditionally executed to evaluate the efficacy of a given treatment or to analyze the prognostic role of clinical factors. Subjects from a case-control study on incidence of larynx and hypopharynx cancers in Turin, for the period 1979-82, were followed-up in order to study their survival. The analysis was based on 347 cases of larynx cancer (319 males and 28 females) and 48 cases of hypopharynx cancer (47 males and 1 female). For larynx cancer, observed five-years survival was 59% in males and 64% in females. Hypopharynx cancer had a worse prognosis (21%). In males suffering from larynx cancer, older age, extent of spread, birth in Northern Italy, and being unmarried proved to be statistically significant negative prognostic factors. The same variables were also predictive of survival for hypopharynx cancer. The one- and three-year relative survival for larynx cancer in Turin was higher than that reported by other cancer registries. For males, relative five-year survival figures range from 47% to 65%. Survival for hypopharynx cancer is considerably lower, five-year figures ranging from 13% to 35%. The survival study on lung cancer was based on all the incident cases recorded by the Lombardy Cancer Registry (L.C.R.) from 1976 to 1981; during this period there were 2042 cases of primary lung cancers occurred in males and 217 in females. Observed survival at one, three and five years from diagnosis was 29%, 8% and 5%, respectively. Survival decreased with increasing age; no important differences between sexes are evident. Information on tumor stage was available in 1904 cases and histotype was known in 1605. Three-year survival was 17% for localized tumors, 8% for tumors with regional metastasis, and 1% for tumours with distant metastasis. Epidermoid carcinomas had a better prognosis than non-epidermoid carcinomas in the first year of follow-up, survival being 38% and 29%, respectively; among non-epidermoid carcinomas the worst prognosis was for small-cell carcinomas. Comparisons between the LCR relative survival and that reported by other cancer registries did not show important differences, five-year figures ranging from 5% to 10% in males.(ABSTRACT TRUNCATED AT 400 WORDS)
Randomized trial of primary school education against smoking.
Since 1974 an anti-smoking campaign consisting of a one-day educational intervention has been carried out in primary schools in Milan by the Italian League against Cancer (Milan Division). All but two of the 165 schools were randomized to evaluate the intervention effect. A total of 8549 children aged 9-10 were allocated to the intervention group and 8897 to the control group. Four years later a self-administered questionnaire was distributed in order to investigate the children's smoking habits. The proportion of smokers was 8.05% and 8.72% (p = 0.23) respectively for the intervention and control groups. It was concluded that sporadic educational intervention carried out during primary school years has little or no impact in preventing cigarette smoking in teenagers.
Survival and age at diagnosis of breast cancer in a population-based cancer registry.
From the population covered by the Lombardy Cancer Registry, Italy, 1991 female breast cancer patients diagnosed from 1976 to 1981 were followed up until May 1987. Relative survival was 69% at 5 years and 58% at 10 years; median survival was 8.8 years. Ages 40-49 showed the best survival; ages 25-34 were 20% lower. From age 50 onwards, survival decreased progressively, with the exception of age group 65-74. We suggest that the best prognosis for ages 40-49, followed by the survival fall in subsequent ages, could be related to an anticipation of diagnosis in ages near menopause. The death hazard function showed a bimodal pattern, with a first peak in the first years after diagnosis, and a second one between the seventh and eighth years. The death hazard rate decreased by about 1% per year at each subsequent calendar year of diagnosis. When such an estimated calendar effect was taken in account, there were no considerable survival differences among Western countries covered by population-based cancer registries.
Incident lung cancer survival. Long-term follow-up of a population-based study in Italy.
The long-term survival of an incident lung cancer population was evaluated in relation to clinical stage, treatment modalities and other prognostic factors. The survey was carried out among the residents in the Local Sanitary Unit of Saronno, a highly industrialized area of northern Italy, where all the lung cancer cases diagnosed during the years 1976-79 had been identified and clinically studied. The overall survival of the 222 cases included in the analysis was 32% at 1 year, 10% at 3 years and 5% at 5 years; median survival was 7 months. A significantly better prognosis was associated with surgical resection (32% at 5 years; median, 42 mo), clinical stage I (16% at 5 years; median, 15 mo), and squamous cell carcinoma (13% at 5 years; median, 11 mo). Other factors such as age, sex, social class or cancer symptoms did not affect survival when treatment was taken into account. Our data show that surgical resection is the major determinant of survival, and suggest that sub-optimal access to curative treatment, particularly in patients aged 60 to 75 with limited disease, might have compromised the overall survival.
Breast cancer incidence and prevalence estimated from survival and mortality.
Survival probability for female breast cancer patients was used to estimate incidence rates from breast cancer mortality data in Italy. The female breast cancer survival curve from the Lombardy Cancer Registry (LCR) was used to test the method on data from four local cancer registries, covering areas in different regions of Italy. In spite of the well known geographic variability of female breast cancer incidence and mortality, the results support the idea that survival probability does not change across the country and that the survival probability from the LCR is a good estimate of that in the country as a whole. Female breast cancer incidence and prevalence rates were then estimated for Italy, making use of a mathematical model specifically developed for chronic diseases. In 1985, crude incidence and prevalence rates of female breast cancer, for ages up to 74 years, were estimated as 71 and 701 per 100,000 women, respectively. Estimated incidence rates show a complex trend with age, increasing to a temporary pronounced peak at the age of 52. A marked cohort effect was found to increase significantly the risk of the disease from the 1886 to the 1930 birth cohorts by a factor of 2.9. After the 1930 cohort, risks have continued at a constant high level.
[Familial polyposis: epidemiology].
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Energy-rich diet and breast cancer risk.
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A case-control study of brain gliomas and occupational exposure to chemical carcinogens: the risk to farmers.
During 1983 and 1984, 240 newly diagnosed cases of brain glioma and 742 controls (465 non-glioma nervous system tumors and 277 patients with other neurologic diseases) were recruited and interviewed in the neurologic and neurosurgical departments of two hospitals in Milan, Italy. The occupational histories of cases and controls were compared, and relative risk estimates, adjusted for sex, age, residence, and socioeconomic status, were computed using the Mantel-Haenszel method. A statistically significant risk increase was found for farmers (relative risk (RR) = 1.6, p = 0.0025). This risk increase was attributable to those farmers who reported the use of chemicals (insecticides or fungicides, herbicides, and fertilizers). Among the three groups of investigated agrochemicals, only the use of insecticides or fungicides was associated with a significant increase in relative risk (RR = 2.0, p = 0.006). Many farmers exposed to fungicides reported the use of commercial compounds of copper sulfate. Some of these compounds contain methyl urea, which has a specific carcinogenic effect on the nervous system in animals. These data suggest that the occupational exposure of farmers to agrochemicals might be responsible for the observed excess risk of brain glioma in farmers.
Efficacy of screening in preventing invasive cervical cancer: a case-control study in Milan, Italy.
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