BACKGROUND:Malignant mesothelioma (MM) is becoming a prominent health issue due to its low survival and for its increasing incidence in various countries. The objectives of this study were to evaluate epidemiological characteristics and trends of MM in the Umbrian Region for the period 2003-2013.METHODS:All cases of MM reported to Umbrian Population Cancer Registry between 2003 and 2013. Incidence Annual Standardized Rates (ASRs) were analyzed for all histological types of MM. Estimated Annual Percent Change (APC) and joinpoint regression analysis were used to out light the time trend of MM. Geographical distribution of the relative risk for each municipality was calculated by Standardized Incidence Ratios SIRs.RESULTS:191 (156 males) MM cases were recorded in Umbrian residents in the period 2003-2013. Pleural mesothelioma affected 92.1% of the total. Gender ratio M/F was 5.9:1. ASRs for MM was 3.2 among men and 0.6 among women. Joinpoint analysis showed a decrease in females APC -8.4 (95% IC -33.7-26.6) and an increase in males APC 5.8 (95% IC -0.9-13.0). An occupational exposure was identified in 43.7% of females and in 90.7% of males.CONCLUSIONS:The protracted cancer latency and the continued asbestos existence as environmental contaminant in existing buildings, as well as a carcinogenic risk for the workers involved in removing operations of material containing asbestos justifies the investment in a specific surveillance system. Also important would be to implement a national risk communication strategy addressed to the general population, environment surveillance of the high risk areas and guarantee that all workers involved that even may deal with asbestos are always fully equipped and trained, not only for their individual risk but also for the potential risk of non correct disposal.

The authors describe the incidence and mortality rates of human papillomavirus (HPV)-related female cancers in Umbria (Italy) in the pre-vaccination period from 1978-2008. Joinpoint regression was applied on age-adjusted incidence and mortality rates to evaluate temporal trends. Mouth and pharynx cancers incidence and mortality trends decreased about three percent per year. For anus and anal canal cancer, incidence and mortality trends presented a non-significant decrease. For malignant neoplasm of vulva, a significant change was found in incidence trend: the annual percentage change decreased from 2001 (- 1.8%). Mortality trend showed a non-significant decrease. Incidence and mortality rates from vaginal cancer were non-significantly decreased. For malignant neoplasm of cervix uteri, incidence rates showed a significant decrease by 2.1% per year. Mortality rates decreased as well, although non-significantly. HPV-related cancers consistently decreased in Umbria. This trend may be a consequence of safer sexual behavior. For cervical cancer, a combination of opportunistic and programmed screening led to a much-reduced disease burden. It is expected that the implementation of vaccination in the future will lead to a further decrease of HPV-related cancer incidence and mortality.

Background The relationship between cutaneous malignancies and successive primary cancers has been studied since several years, but it still remains controversial. Objective The aim of this study was to evaluate the excess risk of multiple primary cancer among the population of Umbria, Italy, that survived a skin cancer. Methods The data registered in the Umbrian Population Cancer Registry from 1994 to 2006 were collected, recorded, and analysed in accordance to the standard methods recommended for cancer registries. Among skin cancer patients, those with multiple cutaneous and non-cutaneous cancers were selected. Only sites with a frequency of more than five cases were considered. The expected number of cases was obtained from indirect standardization with regional incidence rates in several sites that incurred in the overall period. The significance of the observed/expected ratios and the corresponding 95% CI were based on the Poisson distribution. Results In men, a significant standardized incidence ratio (SIR) was found for melanoma (2.21), non-melanoma skin cancers (1.86), Hodgkins (4.95) and non-Hodgkin lymphoma (1.82), and tongue/mouth cancer (2.47). In women, melanoma, non-melanoma skin and breast cancer showed a significant high SIRs (4.13, 1.55 and 1.28 respectively). All other cancers showed a non-significant SIR. Considering all sites combined and all sites except skin cancers, the analysis showed a significant excess in men, whereas a significant risk was observed in women only when also skin cancers were considered. Conclusions Data from the whole of Umbrian population revealed that skin cancer patients experience marked excess risk of further primary cancers. The main risk in both genders is skin melanoma and other skin cancers. The excess of lymphomas and tongue/mouth cancers is also significant in men, and breast cancer in women. These observations prompt us to include a screening for these cancers in the follow-up of our patients surviving a skin malignancy.

This study analyzed the incidence, mortality and survival after cancer of the female breast and reproductive organs in the Umbria region of Italy with the aim of generating hypotheses to explain trends. Mortality data were supplied by ISTAT (1978-1993) and ReNCaM (1994-2005) and incidence (1994-2005) and survival (at 12/31/2007) data by RTUP. Joinpoint regression was applied to evaluate temporal trends of the age-adjusted incidence and mortality rates. Mortality, incidence and relative survival rates were compared with national and international data. The incidence of breast cancer increased up to 2001 and afterwards significantly decreased; mortality rates significantly decreased after 1994. Uterine corpus incidence was practically stable, and decreased over the study period; mortality from all uterine subsites significantly decreased from 1978 onwards. Trends in ovarian cancer incidence and mortality (after 1985) were constant. Trends in occurrence of breast and cervical cancer were linked to population screening of Umbrian women, noting a low compliance by younger females with cervical cancer screening and emphasizing the opportunity of starting breast cancer screening at a younger age. Trends in the incidence of cancer of the uterus and ovary, though unsteady, were probably related to modifications in risk factor exposure. Survival was better for breast and cervical cancers than in the 1978-1982 period and might be due to early diagnosis and progress in therapy.

The leading causes of death in the Umbria Region (Italy) between 1994-2008 were analysed and a comparison was made between data from three five-year time periods: 1994-1998, 1999-2003 and 2004-2008. Standardized rates of Years of Potential Life Lost (YPLL) at 75 years, by gender and cause of death, were also measured. Mortality data was obtained from the Umbria Registry of causes of death; diagnoses were codified according to the International Classification of Diseases 10th revision (ICD10). Mortality trends over time were analysed by using standardized mortality rates with the 2001 Umbria census data as the reference population . The joinpoint regression program was used to analyze rates calculated by the SEER (Surveillance Epidemiology and End Results) software of the National Cancer Institute (USA). Mortality for all causes, standardised by age, show a significantly decreasing trend from 1994 to 2008 in both genders. Mortality rates for cardiovascular diseases and malignant tumours show a significant constant decline in both genders. Standardised rates of YPLL at 75 years declined by 32% in males and 29% in females between the five-year period 1994-1998 and the period 2004-2008. In conclusion, a generalised decline in mortality and a shift towards older age groups is observed with a consequent decline in YPLL, allowing a positive judgment to be given regarding the efficacy of preventive, therapeutic and rehabilitation interventions implemented by the regional health care system.

BACKGROUND:Spatial clustering of different diseases has received much less attention than single disease mapping. Besides chance or artifact, clustering of different cancers in a given area may depend on exposure to a shared risk factor or to multiple correlated factors (e.g. cigarette smoking and obesity in a deprived area). Models developed so far to investigate co-occurrence of diseases are not well-suited for analyzing many cancers simultaneously. In this paper we propose a simple two-step exploratory method for screening clusters of different cancers in a population. METHODS:Cancer incidence data were derived from the regional cancer registry of Umbria, Italy. A cluster analysis was performed on smoothed and non-smoothed standardized incidence ratios (SIRs) of the 13 most frequent cancers in males. The Besag, York and Mollie model (BYM) and Poisson kriging were used to produce smoothed SIRs. RESULTS:Cluster analysis on non-smoothed SIRs was poorly informative in terms of clustering of different cancers, as only larynx and oral cavity were grouped, and of characteristic patterns of cancer incidence in specific geographical areas. On the other hand BYM and Poisson kriging gave similar results, showing cancers of the oral cavity, larynx, esophagus, stomach and liver formed a main cluster. Lung and urinary bladder cancers clustered together but not with the cancers mentioned above. Both methods, particularly the BYM model, identified distinct geographic clusters of adjacent areas. CONCLUSION:As in single disease mapping, non-smoothed SIRs do not provide reliable estimates of cancer risks because of small area variability. The BYM model produces smooth risk surfaces which, when entered into a cluster analysis, identify well-defined geographical clusters of adjacent areas. It probably enhances or amplifies the signal arising from exposure of more areas (statistical units) to shared risk factors that are associated with different cancers. In Umbria the main clusters were characterized by high risks for cancers with alcohol and tobacco both as risk factors. Tobacco-only related cancers formed a separate cluster to the alcohol- and tobacco-related sites. Joint spatial analysis or investigation of hypothesized exposures might be used for further investigation into interesting geographical clusters.