Background: The number and projections of cancer survivors are necessary to meet the healthcare needs of patients, while data on cure prevalence, that is, the percentage of patients who will not die of cancer by time since diagnosis, are lacking. Materials and methods: Data from Italian cancer registries (duration of registration ranged from 9 to 40 years, with a median of 22 years) covering 47% of the population were used to calculate the limited-duration prevalence, the complete prevalence in 2018, projections to 2030, and cure prevalence, by cancer type, sex, age, and time since diagnosis. Results: A total of 3 347 809 people were alive in Italy in 2018 after a cancer diagnosis, corresponding to 5.6% of the resident population. They will increase by 1.5% per year to 4 012 376 in 2030, corresponding to 6.9% of the resident population, 7.6% of women and similar to 22% after age 75 years. In 2030, more than one-half of all prevalent cases (2 million) will have been diagnosed by >= 10 years. Those with breast (1.05 million), prostate (0.56 million), or colorectal cancers (0.47 million) will be 52% of all prevalent patients. Cure prevalence was 86% for all patients alive in 2018 (87% for patients with breast cancer and 99% for patients with thyroid or testicular cancer), increasing with time since diagnosis to 93% for patients alive after 5 years and 96% after 10 years. Among patients who survived at least 5 years, the excess risk of death (1 - cure prevalence) was <5% for patients with most cancer types except for those with cancers of the breast (8.3%), lung (11.1%), kidney (13.2%), and bladder (15.5%). Conclusions: Study findings encourage the implementation of evidence-based policies aimed at improving long-term clinical follow-up and rehabilitation of people living after cancer diagnosis throughout the course of the disease. Updated estimates of complete prevalence are important to enhance data-driven cancer control planning.

Background Survival is a key metric of the effectiveness of a health system in managing cancer. We set out to provide a comprehensive examination of worldwide variation and trends in survival from brain tumors in adults, by histology. Methods We analyzed individual data for adults (15-99 years) diagnosed with a brain tumor (ICD-O-3 topography code C71) during 2000-2014, regardless of tumor behavior. Data underwent a 3-phase quality control as part of CONCORD-3. We estimated net survival for 11 histology groups, using the unbiased nonparametric Pohar Perme estimator. Results The study included 556,237 adults. In 2010-2014, the global range in age-standardized 5-year net survival for the most common sub-types was broad: in the range 20%-38% for diffuse and anaplastic astrocytoma, from 4% to 17% for glioblastoma, and between 32% and 69% for oligodendroglioma. For patients with glioblastoma, the largest gains in survival occurred between 2000-2004 and 2005-2009. These improvements were more noticeable among adults diagnosed aged 40-70 years than among younger adults. Conclusions To the best of our knowledge, this study provides the largest account to date of global trends in population-based survival for brain tumors by histology in adults. We have highlighted remarkable gains in 5-year survival from glioblastoma since 2005, providing large-scale empirical evidence on the uptake of chemoradiation at population level. Worldwide, survival improvements have been extensive, but some countries still lag behind. Our findings may help clinicians involved in national and international tumor pathway boards to promote initiatives aimed at more extensive implementation of clinical guidelines.

Introduction: The number of patients living after a cancer diagnosis is increasing, especially after hemolymphopoietic and thyroid cancer (TC). This study aims at evaluating both the risk of a second hemolymphopoietic cancer in TC patients and the risk of TC as a second cancer. Methods: Two population-based cohorts of cancer patients aged up to 84 years were identified from 28 Italian cancer registries in the 1998–2012. The first included TC patients and the second hemolymphopoietic cancers patients with cancers. Standardized incidence ratios (SIR) of SPC were stratified by sex, age, and time since first cancer. SPC diagnosed within 2 months since first are not included in the computation of cancer-specific SIRs. Results: 38,535 TC patients and 154,820 patients with hemolymphopoietic cancers were included. Overall SIR for hemolymphopoietic cancer in TC patients was significantly increased (SIR=1.5 in women and 1.3 in men), as well as for most of the hemolymphopoietic subtypes (SIR=2.7 for acute lymphoid leukemia, 1.6 for follicular non-Hodgkin lymphomas, 1.5 for chronic lymphoid leukemia, and 1.4 for myelomas for both sexes). The overall SIR for hemolymphopoietic cancer in TC patients was significantly higher in all three age groups (0-34 years: 2.0, 35-54: 1.4 and 55+: 1.4 for both sexes). The risk of TC cancer was significantly increased after Acute Lymphoid Leukemia (10 cases, SIR=6.1), Hodgkin lymphomas (38, 2.8), and all hemolymphopoietic neoplasms (183, 1.8). The risk of TC after any hemolymphopoietic cancer was particularly higher for the age groups 0-34 and 35-54 (SIR 4.3 and 1.8 respectively). Conclusions: TC patients have both an increased risk of developing a second hemolymphopoietic cancer as TC to be a second cancer. An elevated risk of second primary tumors from the use of radioactive iodine (RAI) therapy in TC patients, in particular in pediatric and young adult patients, may explain the elevated incidence of acute lymphoid leukaemias and hemolymphoiectic neoplasms overall. The present finding may help in designing surveillance programs for hemolymphopoietic cancers in TC patients and vice versa keeping into consideration the possibility of overdiagnosis of TC. Keywords: Prevention and Cancer Interception No conflicts of interests pertinent to the abstract.

INTRODUCTION Global variations in survival for brain tumours are very wide when all histological types are considered together. Appraisal of international differences should be informed by the distribution of histology, but little is known beyond Europe and North America. PATIENTS AND METHODS The source for the analysis was the CONCORD data base, a programme of global surveillance of cancer survival trends, which includes the tumour records of individual patients from more than 300 population-based cancer registries. We considered all patients aged 0-99 years who were diagnosed with a primary brain tumour during 2000-2014, whether malignant or non-malignant. We presented the histology distribution of these tumours, for patients diagnosed during 2000-2004, 2005-2009, and 2010-2014. RESULTS Records were submitted from 60 countries on five continents, 67,331 for children and 671,085 for adults. After exclusion of irrelevant morphology codes, the final study population comprised 60,783 children and 602,112 adults. Only 59 of 60 countries covered in CONCORD-3 were included, because none of the Mexican records were eligible. We defined 12 histology groups for children, and 11 histology groups for adults. In children (0-14 years), the proportion of low-grade astrocytomas ranged between 6% and 50%. Medulloblastoma was the most common sub-type in countries where low-grade astrocytoma was less commonly reported. In adults (15-99 years), the proportion of glioblastomas varied between 9% and 69%. International comparisons were made difficult by wide differences in the proportion of tumours with unspecified histology, which accounted for up to 52% of diagnoses in children and up to 65% in adults. CONCLUSIONS To our knowledge, this is the first account of the global histology distribution of brain tumours, in children and adults. Our findings provide insights into the practices and the quality of cancer registration worldwide.

Abstract Background Respond to alarms for possible cancer cluster is a public health problem, but the management of these alarms is difficult and sometime conflictual. Methods We reviewed the guidelines on the management of disease clusters developed in various countries and the approaches used in previous disease cluster episodes in Tuscany. Statistical approaches for cluster detection were also reviewed. We performed a clustering analysis (spatio or spatio-temporal when appropriate) on childhood leukemia using data from Tuscany Cancer Registry (RTT). We used spatial hierarchical Bayesian model on aggregate data at municipality level. We performed test for general clustering and cluster detection on individual data. Results More than 100 tests for clustering analysis has been identified in the literature. Bayesian analysis on aggregate data did not show areas at higher risk with the exception of the city of Florence for childhood cancer among males. We did not found clusters for leukemia. In previous studies on disease clusters in Tuscany, most investigations have been started from community concerns and in the majority of situations a multidisciplinary approach was used. In some case an increase of incidence rate was observed, but rarely specific cluster cancer tests were used. Conclusions Hierarchical Bayesian models to aggregate data provided useful to identify long range geographical patterns while clustering analysis on individual data is a useful tool for small scale patterns. Both represent important tools for epidemiological surveillance studies particularly on childhood cancer. The best test for all situations doesn't exist, but the choice is determined by the type of question being asked from the data, by different situations and by different approaches. The Tuscany cancer clusters survey and the review of the guidelines on the management of clusters developed in different countries, give us the opportunity to formulate some suggestions for the health agencies. Key messages Respond to alarms for cluster of cancer and suggest recommendations for epidemiological and statistical standardized approaches is a public health issue. Tuscany cancer clusters survey and the review of the guidelines on the management of clusters developed in different countries, give the opportunity to formulate some suggestions for health agencies.

Objective The impact of a screening programme on colorectal cancer (CRC) incidence in its target population depends on several variables, including coverage with invitations, participation rate, positivity rate of the screening test, compliance with an invitation to second-level assessment and endoscopists' sensitivity. We propose a synthetic indicator that may account for all the variables influencing the potential impact of a screening programme on CRC incidence. Design We defined the 'rate of advanced adenoma on the target population' (AA-TAP) as the rate of patients who received a diagnosis of advanced adenoma within a screening programme, divided by the programme target population. We computed the AA-TAP for the CRC Italian screening programmes (biennial faecal immunochemical test, target population 50-69 year olds) using the data of the Italian National Survey from 2003 to 2016, overall and by region, and assessed the association between AA-TAP and CRC incidence fitting a linear regression between the trend of regional CRC incidence rates in 50-74 year old subjects and the cumulative AA-TAP. Results In 2016, the AA-TAP at a national level was 105x100 000, whereas significant differences were observed between the northern and central regions (respectively 126 and 149x100 000) and the South and Islands (36x100 000). The cumulative AA-TAP from 2004 to 2012 was significantly correlated with the difference between CRC incidence rates in 2013-2014 and those in 2003-2004 (p=0.009). Conclusion The AA-TAP summarises into a single indicator the potential impact of a screening programme in reducing CRC incidence rates.

Objective: To evaluate the trends of colorectal cancer (CRC) incidence and mortality rates from 2003 to 2014 in Italy by age groups and regions. Methods: We used the data of 48 cancer registries from 17 Italian regions to estimate standardized incidence and mortality rates overall and by sex, age groups (<50, 50-69, 70+ years), and geographic area (northwest, northeast, center, south, and islands). Time trends were expressed as annual percent change in rates (APC) with 95% confidence intervals (95% CI). Results: Incidence rates decreased from 104.3 (2003) to 89.9 x 100,000 (2014) in men and from 64.3 to 58.4 x 100,000 in women. Among men, incidence decreased during 2007-2010 (APC -4.0, 95% CI -6.0 to -1.9) and 2010-2014 (APC -0.7, 95% CI -1.4 to 0.0), while in women it linearly decreased during the whole period (APC -1.1, 95% CI -1.4 to -0.8). Mortality rates showed a linear reduction both in men (APC -0.7, 95% CI -1.0 to -0.3) and women (APC -0.9, 95% CI -1.2 to -0.6) and decreased respectively from 41.1 to 39.2 x 100,000 and from 24.6 to 23.1 x 100,000. In the 50- to 69-year-old range (screening target age), incidence showed a prescreening increase, followed by a peak after screening started, and a decline thereafter. Incidence and mortality rates significantly decreased in all areas but in the south and islands, where incidence increased and mortality remained stable. Conclusions: A renewed commitment by all regional health systems to invest in primary (i.e., lifestyle) and secondary (i.e., screening programs) prevention is of utmost importance.

整体而言,皮肤癌是一种最常见的癌症形式。有若干类型,最常见的是非黑色素瘤皮肤癌,包括基底细胞癌(BCC)和鳞状细胞癌(SCC)。在英国,每年诊断超过 10 万例新发非黑色素瘤皮肤癌病例。皮肤附属器肿瘤 (CAC) 是罕见肿瘤,通常难以诊断。这项来自意大利的研究旨在评估人群中的 CAC 数量随时间推移如何变化,和确定存在 CAC 和 SCC 发生风险之间的关系。分析了来自 Tuscany 癌症注册 (TCR) 1985 至 2010 年间 25 年中的数据。从这一时间段中鉴定出了 242 名患者,CAC 患者的数量从 1985 ‐ 1987 年的 2.5 例/百万人增长至 2009 ‐2010 年的 19 例/百万人。在 1997 到 2010 年,人群中的 CAC 患病率增高了 159%。还发现,CAC 患者在晚年发生 SCC 的可能性比无 CAC 的患者高 34 倍,提示这是一个显著的风险因素。此研究的作者预测,由于正在衰老的人群,CAC 患者的数量可能继续增多。这一点加上 CAC 和 SCC 之间的联系强调了需要在未来改进 CAC 的诊断。

Globally, skin cancer is one of most common forms of cancer. There are several types, the most common being non‐melanoma skin cancer, which includes basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). In the UK, more than 100,000 new cases of non‐melanoma skin cancers are diagnosed every year. Cutaneous adnexal carcinomas (CACs) are rare tumors which are often difficult to diagnose. This study, from Italy, aimed to evaluate how the number of CACs in the population has changed over time and identify if there is a link between CAC presence and the risk of developing SCC. Data was analysed from the Tuscany Cancer Registry (TCR) from a 25‐year time period between 1985 and 2010. 242 patients with CACs were identified from this period with the number of patients with CACs growing from 2.5 per million in 1985‐87 to 19 per million in 2009‐10. Between 1997 and 2010, CAC presence in the population increased by 159%. It was also found that patients with CAC were 34 times more likely to develop SCC later in life than those without CAC, suggesting that this is a significant risk factor. The authors of this study predict that the number of patients with CAC is likely to continue to increase, due to an ageing population. This combined with the link between CAC and SCC highlights the need to improve diagnosis of CACs in the future.

BACKGROUND:Recent studies have shown an increasing incidence of cutaneous adnexal carcinomas (CACs).OBJECTIVES:The aim of our study was to evaluate incidence and survival for cases of CACs and investigate their association with other skin neoplasms.METHODS:We conducted a population-based study. Data on incident cases of CACs were obtained from the Tuscany Cancer Registry between 1985 and 2010. In order to determine whether the occurrence of squamous cell carcinoma (SCC) among patients with CAC is higher or lower than expected in the general population, the standardized incidence ratio (SIR) was calculated.RESULTS:A total of 242 patients with CAC were observed; the age-standardized incidence rate was 3·8 cases per million person-years. From 1997 to 2010 crude incidence rates increased by 159%. Age-specific incidence was higher in men over 80 years old than in women of the same age and younger individuals. Carcinomas of sweat gland origin prevailed; the most common histotype was porocarcinoma and the most frequently affected site was the head/neck. Overall, 88% of CACs were diagnosed at a localized stage. The 5-year overall survival and disease-specific survival rates were 59% [95% confidence interval (CI) 53-65] and 94% (95% CI 91-98), respectively. In the observation cohort, the number of SCCs was significantly higher than expected as the SIR was calculated to be 33·7 (P < 0·001).CONCLUSIONS:Increasing incidence warrants awareness and early diagnosis of CACs. Increased SCC incidence among patients with these tumours highlights the relevance of careful skin examination and follow-up.

INTRODUCTION:In 2009, the American Joint Committee on Cancer (AJCC) incorporated the tumor mitotic rate in the melanoma pathological TNM staging system. To investigate the effect of this change on the pT1 substaging of primary cutaneous melanomas, we reclassified the cases collected by a cancer registry according to the 6th and the 7th editions of AJCC melanoma staging. METHODS:Patients with pathological T1 melanoma diagnosed in the period 2000-2008 were selected from Tuscan Cancer Registry. The histological reports were reviewed and pT1 melanomas classified according to both the 6th and the 7th editions of the AJCC staging system. The shift of melanomas between pT1 substages was analyzed. RESULTS:Among the 242 pT1 melanomas collected in the study period and with mitotic index available, there were 202 (83 % of all pT1) and 175 (72 %) pT1a, according to the 6th and the 7th editions of the AJCC melanoma staging, respectively. When the 7th edition was used, 20 % of all pT1a melanomas shifted to pT1b, and 32 % of all pT1b melanomas shifted to pT1a. A poor level agreement between the two TNM staging systems, measured by the Cohen's kappa coefficient, was found (K = 0.37). CONCLUSIONS:The addition of mitotic activity to the pathological staging resulted in an increase in pT1b proportion and in a change in the classification of some cases. This modification could influence the clinical approach, with a different use of the sentinel lymph node biopsy, and underlines the role of mitosis evaluation in the management of thin melanoma patients.

Original, population-based estimates of indicators of long-term survival and cure in cancer patients are provided. More than a quarter of cancer patients in Italy have reached death rates similar to those of the general population. Nearly three quarters of them will not die as a result of cancer. These estimates are potentially helpful to health-care planners, clinicians, and patients.Persons living after a cancer diagnosis represent 4% of the whole population in high-income countries. The aim of the study was to provide estimates of indicators of long-term survival and cure for 26 cancer types, presently lacking.Data on 818 902 Italian cancer patients diagnosed at age 15-74 years in 1985-2005 were included. Proportions of patients with the same death rates of the general population (cure fractions) and those of prevalent patients who were not at risk of dying as a result of cancer (cure prevalence) were calculated, using validated mixture cure models, by cancer type, sex, and age group. We also estimated complete prevalence, conditional relative survival (CRS), time to reach 5- and 10-year CRS > 95%, and proportion of patients living longer than those thresholds.The cure fractions ranged from > 90% for patients aged < 45 years with thyroid and testis cancers to < 10% for liver and pancreatic cancers of all ages. Five- or 10-year CRS > 95% were both reached in < 10 years by patients with cancers of the stomach, colon-rectum, pancreas, corpus and cervix uteri, brain, and Hodgkin lymphoma. For breast cancer patients, 5- and 10-year CRSs reached > 95% after 19 and 25 years, respectively, and in 15 and 18 years for prostate cancer patients. Five-year CRS remained < 95% for > 25 years after cancer diagnosis in patients with liver and larynx cancers, non-Hodgkin lymphoma, myeloma, and leukaemia. Overall, the cure prevalence was 67% for men and 77% for women. Therefore, 21% of male and 31% of female patients had already reached 5-year CRS > 95%, whereas 18% and 25% had reached 10-year CRS > 95%.A quarter of Italian cancer patients can be considered cured. This observation has a high potential impact on health planning, clinical practice, and patients' perspective.

The special types of breast cancer seem to have not only distinct morphological features but also distinct biological features.

In a population-based screening program, a percentage of tumors remain undetected; these tumors comprise a heterogeneous group, and they are more likely to have adverse prognostic features. The aim of this study was to identify differences in biological characteristics of screen-detected versus interval breast cancers in a population-based screening program according to molecular subtypes.

Conflicting results on the shift of right–left ratio in colon cancer incidence have been reported. We examine incidence trends by subsite in a population-based study.

INTRODUCTION:Penile cancer is a rare neoplasm in Western countries, and detailed studies on trends in population-based survival of penile cancer have never been published before. We examined population-based trends in survival in Europe and the United States of America (USA). METHODS:Data from 3297 European and 1820 American penile cancer patients, contributed by 12 European cancer registries and the Surveillance, Epidemiology, and End Results (SEER) Program of the USA were included in this study. Period analysis techniques were used to examine relative survival trends overall, as well as for four geographic regions in Europe, and for the age groups 15-54, 55-64, 65-74 and 75+ for both populations between 1990-1995 and 2002-2007. Survival trends were assessed in a multiple regression model of relative excess risk including period of diagnosis, age and continent. RESULTS:The 5-year relative survival of penile cancer patients increased statistically non-significantly from 65% to 70% in Europe and decreased (significantly) from 72% to 63% in the USA. Trends in age-specific 5-year relative survival did not find any significant improvement in either Europe or the USA. The multiple regression analysis confirmed the lack of survival trend, and found significantly higher relative excess risk with age, and, apparently due to lower survival before 2002-2007, higher risk in Europe. CONCLUSION:Survival for penile cancer patients has not improved in either Europe or the USA since at least 1990. The reasons for the decrease of survival in the USA remain unknown and to be explored. Stronger international cooperation in clinical research may be important to facilitate clinical progress in treatment and thereby improvement of survival of this rare malignancy.