As national cancer survival estimates in Italy date back to 2011, we provided updated figures using population-based cancer registries. Analyses by age and sex included 1.418.044 cancers diagnosed between 2013 and 2017 from 34 registries covering 48 million residents. The 2008-2017 period, with 20 registries covering 24 million residents, was used for trends and regional comparisons. Net survival was estimated by Pohar-Perme method with life tables by year, sex, residence and calculated using the international standard distribution. Five-year age-standardized net survival for all cancers combined was 66.7 % in females and 62.2 % in males. Females had better survival than males for most cancers, notably acute lymphatic leukaemia (+9 % points (pp)), upper respiratory/digestive (+9 pp), lung (+6 pp), CNS (+5 pp), and stomach (+4 pp). Males had a higher survival for bladder (+4 pp), kidney (+2 pp), and urinary cancers (+5 pp). Best outcomes (>75 %) were documented for prostate, testicular, breast, endometrial, thyroid, melanoma, Hodgkin lymphoma, bladder, and chronic lymphatic leukaemia. Poorest prognosis (<30 %) was for CNS, liver, lung, pancreas, and acute myeloid leukaemias. Survival was age-dependent, highest in younger and lowest in older patients, with > 40 % points gaps in some haematological cancers. From 2008-2017, net survival arose from 65.7 % to 70.7 % in men and from 69.9 % to 74.1 % in women. Improvements were seen for pancreas, lung, and acute leukaemias, mainly in women, while decreases affected bladder, cervical, chronic lymphatic leukaemia in men. Geographical disparities persisted, with higher survival in Northern-Central Italy (64.0 % for men and 68.3 % for women) than in Southern-Islands (58.1 % for men and 63.7 %, for women). Our findings confirmed a better prognosis for younger patients and females than male patients. Survival has continued to improve over time, even at a higher improving rate in the considered period than the past.

BACKGROUND:Cervical cancer (CC) incidence in Italy has declined due to organized screening and HPV vaccination programs. However, disparities persist among vulnerable populations, including foreign-born women. This study aims to retrieve and synthesize evidence from population-based studies focusing on CC incidence among foreign-born women in Italy. METHODS:A systematic review was conducted to identify population-based epidemiological studies on CC in Italy. A comprehensive and systematic search was performed in PubMed, CINAHL, and Scopus. Studies were included if they reported data comparing foreign-born and Italian-born women in Italy and were based on cancer registry records. Due to heterogeneity in study designs and data, we used a descriptive and comparative approach rather than a meta-analysis. RESULTS:A total of five pertinent articles were identified and included in the review. Findings consistently indicate a higher incidence or relative risk of CC among foreign-born women in Italy, with estimates ranging from a modest increase to more than double the risk compared with Italian-born women. Higher incidence of both invasive cervical cancer and high-grade pre-malignant lesions was observed across multiple regions, particularly among women originating from countries with high HPV prevalence and high migratory pressure. CONCLUSION:These findings highlight persistent inequalities in cervical cancer risk between foreign-born and Italian-born women in Italy. Differences by country of origin may be associated with unequal access to timely and adequate care and with cultural barriers faced by specific immigrant women. Targeted policies and culturally sensitive interventions are needed to increase awareness, accessibility, healthcare navigation ability, and participation in cervical cancer screening, while addressing structural, linguistic, and informational barriers among high-risk migrant groups.

BACKGROUND:Stage at diagnosis, histologic grade, and molecular subtypes are established prognostic indicators for women with breast cancer (BC), but their impact on population-based survival estimates is poorly documented. This study assessed long-term BC survival trends according to these factors. METHODS:We identified women aged <75 years diagnosed with stage I-IV invasive BC between 2004 and 2014 from the Friuli Venezia Giulia (North Eastern Italy) Cancer Registry (N = 10,476). Follow-up through 2023 was used to estimate overall and net survival (NS) according to combinations of prognostic factors. RESULTS:The highest 10-year NS (10-NS) was observed in women with stage I HR+/HER2- subtype (98.8%), while it was 35.1% for stage III triple-negative (TN) subtype. Among women with stage IV BC, 10-NS was 18.9% for those HR-/HER2+, 11.5% for those HR+/HER2+, 8.3% for HR+/HER2-, and 6.7% for TN. For each stage, NS decreased with increasing grade. Comparing period of diagnosis (2004-2009 vs 2010-2014), 10-NS remained >90% for women with stage I BC, but improved for stage III and aggressive subtypes (HR-/HER2+ and TN). In women with stage III HR-/HER2+ BC, 10-NS increased from 48.6% to 87.9% (+39 percentage points), while when diagnosis was stage III TN BC it rose from 28.8% to 42.3. CONCLUSION:Population-based estimates of long-term BC survival by combined stage, grade, and molecular subtype can inform the interpretation of evolving therapeutic strategies and improve risk stratification for patient follow-up.

OBJECTIVES:We forecasted the incidence of malignant tumours in Italy in 2025, using the most representative estimates of incidence rates and recent trends in cancer incidence available. A comparison with estimates for 2025 obtained using different assumptions and data sets is also presented. METHODS:34 cancer registries (81 % of the Italian population) were used to estimate incidence rate trends in 2013-2017, by cancer types, sex, and age. The stratified incidence rates were projected until 2025 by applying trends in the same strata, using a linear regression model with the calendar year as an independent variable. RESULTS:We estimated 362,100 new cancer cases in Italy in 2025 (182,300 in men, 179,800 in women). Prostate is the most frequent cancer site in men (31,200 cases; age-standardised incidence rates-ASR=92.3 per 100,000), followed by lung (27,100, ASR=80.9), bladder, and colon-rectum (23,000 cases each; ASR=69.0). 55,900 women were estimated to be diagnosed with breast cancer (ASR=159.0 per 100,000), 18,900 with colorectal (ASR=47.0) and 16,400 with lung cancers (ASR=41.0). CONCLUSIONS:Our estimates were slightly lower than those based on other assumptions and/or different datasets (i.e., ECIS/GLOBOCAN ones). More effective anti-smoking campaigns are needed to halt the predicted increase in smoking-related cancers among women.

In the last five decades, the epidemiology of cancer in Italy has been characterised by a north-south gradient in cancer incidence, mortality, and survival. Recently, this pattern has been changing, making it important to analyse the three indicators together to understand the underlying dynamics and to identify successes and failures in cancer control. Herein, data from 20 accredited Italian population-based cancer registries were used to examine age-standardised trends in incidence, five-year net survival, and mortality rates, for all cancers and 18 major cancer types, between 2008 and 2017. Data from the national pool were compared with macro-areas ones from north-centre and south-islands. We classified trends according to a 5-category model, ranging from 'Optimal Progress' (decreasing incidence and mortality, increasing survival) to 'Worsening' (increase of both incidence and mortality). At the national level we found progress in all indicators for all cancers combined: incidence and mortality rates declined, on average, by 2.5% and 5.5% annually, while survival increased by 2.5 % points. Similar optimal progress was shown, in men, by all cancers and lung cancer and, in both sexes, by liver cancer, and non-Hodgkin lymphoma. Conversely, evidence of worsening emerged for lung cancer in women, with incidence and mortality rates increasing, on average, by 6.5% and 4% annually. Contrasting trends emerged from north to south for colorectal, pancreatic, and kidney cancers. Trends were homogeneous, but improvements were stronger in the north-centre for all cancers, all cancers in men, male lung, prostate and bladder cancers, non-Hodgkin lymphoma, and for breast cancer mortality. For female lung cancer and breast cancer incidence, we documented a stronger burden increase in the south-islands. The advantage in cancer incidence and mortality risk shown decades ago by the south-islands macro area is being lost, and, if these trends remain stable, in near future the north-south gradient is expected to be reversed for many cancers.

BACKGROUND:This study aims to estimate the long-term risk of metastatic recurrence (MR) among Italian women with breast cancer (BC) by period, age, stage, and surrogate molecular profile. METHODS:Data on 59,968 women below age 75 years diagnosed in 1997-2017 with stage I-III BC from 7 population-based Italian cancer registries were analyzed. We used a novel modeling method, based on an illness-death process coupled with a mixture cure model, to estimate relative survival and MR risks up to 15 years after BC diagnosis according to calendar period, age, stage, and profile. RESULTS:The risk of MR for the entire cohort at 15 years decreased from 20.6% in 1997-2006 to 12.3% in 2007-2017, when MR risk within 15 years was 3.0% for stage I, 16.0% for stage II, and 42.7% for stage III. The conditional risk of MR decreased with time since diagnosis, with stage I-III triple-negative BC having a higher risk of developing MR in the first 5 years regardless of age (16.0% at age 15-54 years and 18.3% at 55-74 years), but < 1% once they survived for 5 years without recurrence. In contrast, hormone receptor-positive BC had a lower but persisting risk of MR of about 6% for both age groups in the first 10 years, halving to about 3% in the following 5 years after diagnosis. CONCLUSIONS:This study provides a population-based estimate of the long-term risk of MR for women with BC by major prognostic factors. These findings may help in tailoring follow-up strategies through informative risk stratification.

Background and Purpose: Head and Neck Squamous Cell Cancer (HNSCC) originates from the oral cavity, oropharynx, hypopharynx and larynx, and it ranks sixth among global cancers. Despite modest 5-year survival gains, the integration of molecular personalization lags behind and there is an urgent need to develop novel therapies and biomarkers. Material and Methods: This study outlined the somatic mutational profile of 15 HNSCC-enriched genes in a case series from North-eastern Italy, the region with the highest national HNSCC incidence. We conducted a comparative analysis with prior case studies and assessed the prognostic implications of the mutations that we found in these genes. Results: Consistent with previous studies, oral cavity tumours showed a lower gene mutation frequency. We highlighted a significant enrichment of somatic AJUBA mutations in the hypopharyngeal region, linked to a poorer prognosis. Moreover, KMT2C mutations co-occurring with CDKN2A or NOTCH1 mutations were associated with a worse prognosis. At the same time, only 7 % of the cases exhibited mutations that are predictive biomarker in HNSCC according to compelling clinical evidence but that need further investigation in a clinical trial setting. Conclusion: Our findings underlined novel differences in somatic gene mutations among the four anatomic sites. However, at present, the identified mutations cannot yet be considered predictive biomarkers either for the lack of supporting clinical findings or for the lack of approved targeted therapies in HNSCC. This underscores the imperative for continued investigation into the biology of HNSCC to unveil novel vulnerabilities that can be leveraged to enhance patient treatment strategies.

The cancer risk of people with HIV (PWH) enrolled in the Italian COhort of Naives to Antiretrovirals (ICONA) with HIV diagnosis occurred between 01/1997 and 12/2023 has been compared to that of the corresponding general population of Italy. Incident cancers were grouped according to their association with viral infections. Standardized incidence ratios (SIRs) were estimated as the ratio between the observed number of cancers among PWH and the expected ones among the general population. Competing risks cumulative incidence curves and Gray's test were used to compare incidence between groups (gender and CD4+ T-cells values at diagnosis) with death as a competing risk. Overall, 17,298 PWH (79.1% males) contributing to 133,851 person-years of follow-up were included; 763 (4.4%) developed > = 1 incident cancers, the most frequent cancers being KS (N = 204), NHL (N = 127) and lung-trachea-bronchus (N = 66). PWH were at 1.6-times higher risk for all cancers compared to the general population (SIR = 1.6, 95% CI: 1.5-1.8), with significantly increased SIR for almost all virus-related cancers, including KS (SIR = 145), NHL (SIR = 5.8), ICC (SIR = 6.0), anal cancer (SIR = 21.0) and Hodgkin lymphoma (SIR = 10.0). Apart from lung cancer risk (SIR = 1.3), none of the non-virus-related cancers turned out to be more frequent among PWH. PWH with CD4 + <200 cells/mm3 at cART initiation showed the highest cancer incidence, 5% after 5 years, versus 3% for CD4+ 200-349 and 2% for CD4+ >350 (p < .001). These findings underscore the need to continue prevention efforts in PWH, including behavioral risk reduction, early cART initiation, screening, and vaccination.

ABSTRACTPrevious reports have indicated that during the era of combination antiretroviral therapy, the major causes of morbidity and mortality in people living with HIV (PLWH) were not solely linked to HIV‐related opportunistic infections but also to cancers that were difficult to manage due to HIV‐related immunodeficiency. We investigated whether PLWH who underwent autologous hematopoietic stem cell transplantation (ASCT) for lymphomas experienced significant morbidity over the past thirty years following HIV infection. We conducted a retrospective follow‐up study of 49 PLWH over a 10‐year period following ASCT. We collected survival data, examined the occurrence of long‐term events, assessed CD4 + T‐cell immune recovery, and analysed the correlation between immune recovery and the events experienced by these patients. The data confirmed the significant long‐term effectiveness of ASCT, with an overall survival rate of 78% at 10 years post‐ASCT. Opportunistic infections, which occurred soon after ASCT and were associated with lower CD4 + T‐cell counts, were successfully managed. However, lymphoma relapse, secondary malignancies, cardiovascular disease, and bone disease, which developed years after ASCT, were major causes of morbidity and mortality in this population. Our findings highlight the need for the development and validation of specific tests to predict risk and guide effective interventions for metabolic diseases, secondary malignancies, and lymphoma relapses in PLWH treated with ASCT for lymphoma.

We outline the history and role of cancer registration in Italy. Since the '70s, local population-based registries were established, representing up to nowadays a valuable national surveillance network. In this framework, the Italian Association of Cancer Registries (AIRTUM) has been playing a central role, ensuring high data quality standards and supporting cancer registry-based research. Over the years, difficulties for cancer registration arose due to a strict and non-uniform application of data protection rules, to the gap in digitalization of health data primary sources, which feed population-based cancer registries (PBCRs), and, more recently, to the impact of COVID-19 pandemic. Indeed, the COVID-19 pandemic in Italy affected not only cancer surveillance but also cancer screening and access to care. Despite the above-mentioned limitations, an unprecedented coverage of cancer surveillance on the Italian population (about 80 %) was reached for the present study, representing a substantial contribution in the perspective of the long-lasting establishment of a national cancer registry. This commentary introduces a series of manuscripts updating the landscape of descriptive cancer epidemiology, highlighting at the same time the challenges of cancer registration, in Italy.

Lung cancer is the leading cause of cancer-related mortality worldwide, and understanding its pathological patterns and trends is of interest for clinical and public health interventions. This study investigates the trends in lung cancer incidence rates from 1995 to 2021 in the Friuli Venezia Giulia (FVG) region in northeastern Italy, focusing on histological subtypes and sex-specific differences. Data were obtained from the population-based FVG Cancer Registry. Data on histological types of lung cancer were analyzed. Using census-based population estimates, age-standardized incidence rates (ASIRs) were calculated for three calendar periods (1995–2003, 2004–2012, 2013–2021). Joinpoint regression analysis was used to assess significant changes in trends, estimating annual percent change and average annual percent change (AAPC). A total of 24 519 lung cancer cases were recorded between 1995 and 2021, 70% in males. During 2013–2021, ASIRs were 31.9/100 000 males and 16.9/100 000 females. Adenocarcinoma accounted for the highest ASIRs in both sexes (15.2/100 000 males and 9.9/100 000 females). Over the 1995–2021 period, the overall incidence of lung cancer decreased in males (AAPC: −3.2%), whereas it increased in females (AAPC: +1.0%). Trends in adenocarcinoma were inconsistent for males but continued to rise in females. Squamous and small cell lung cancer incidence declined in males, while both increased in females. These trends underscore the importance of targeted prevention strategies, especially addressing smoking cessation in middle-aged females.

Background: Prostate cancer (PCa) trends have evolved due to changing screening practices. This study assessed long-term trends in PCa incidence and survival according to Gleason score (GS) in Friuli Venezia Giulia, northeastern Italy. Methods: A population-based study was conducted, encompassing 21,571 PCa cases from the regional Cancer Registry, diagnosed between 2000 and 2020. Age-standardized incidence rates and 5-year overall (OS) and net survival (NS) were assessed by GS (2–6, 7, 8–10) and age group (<65, 65–74, ≥75). Trends were analyzed using Joinpoint regression. Results: PCa incidence increased from 2000 to 2007 (Annual Percent Change, APC = +1.8%), then declined sharply until 2010 (APC = −7.6%) and remained stable thereafter. Incidence of low-grade cancers (GS 2–6) decreased across all age groups, especially in men aged ≥75 years (APC = −8.1%). The incidence of GS 7 rose until 2007 and then stabilized. High-grade cancers (GS 8–10) showed a stable incidence, but their proportion increased from 20% to 29%, mainly in older men. Survival improved across all GS groups. For GS 2–6, OS increased from 81.4% to 88.2%; for GS 7, from 78.1% to 88.1%. GS 8–10 had smaller gains, but NS reached 82% in recent years. Among men aged ≥75 years, OS for GS 7 rose from 51.9% to 78.1%, and for GS 8–10, from 43.9% to 54.4%. NS remained high for GS ≤ 7. Conclusions: While overall outcomes improved, the increasing proportion of high-grade PCa, despite a stable incidence, raises concerns, particularly in older men, and calls for tailored clinical strategies.

Objective: To evaluate short-term (2008-2017) cancer incidence trends in Italy for individuals aged 20-49 years by sex and cancer type.Methods: Observational study from population-based data collected by 20 Italian Cancer Registries, covering 33% of the Italian population. The age-standardized incidence rates (ASRs), overall and stratified by area, sex, cancer site or type, and major age groups (i.e., 20-39, 40-49), were computed.Results: In 2008-2017, cancer incidence rates were almost two times higher in Italian women aged 20-49 than in age-corresponding men (202.2 vs 112.4 per 100,000) on account of elevated rates of breast and thyroid cancers. Contrasting trends emerged according to cancer sites/types. ASRs for female breast cancer increased steadily from 2008 (82.4) to 2014 (86.2) and remained unchanged thereafter (i.e., 86.5 in 2017). During the study period, there was an increase for testicular cancer, skin melanoma in both sexes, and thyroid cancer until 2013 (followed by a slight decrease from 2014 to 2017). Conversely, ASRs consistently declined for colorectal cancer and were substantially stable or slightly decreasing for cervix uteri (from 8.1 to 7.7), ovary (from 7.5 to 6.9) and non-Hodgkin lymphoma (from 8.3 to 7.6 in men and from 5.9 to 5.5 in women).Conclusions: Study findings do not support a unique temporal pattern for the incidence of early-onset cancer in Italy until 2017, as reported in other countries. Increases in incidence documented in both sexes for some tumor sites was counterbalanced by a decrease in other sites. The importance of supporting prevention strategies from the youngest of ages must be emphasized, and the role of anticipated screening should be carefully addressed.

Background: A cholesterol-lowering diet score was previously developed for epidemiological studies; its association with serum lipid profile was not confirmed yet. Methods: The score was developed as an adaptation of the dietary portfolio for cholesterol reduction, assigning one point for adherence to seven dietary indicators and ranging from 0 (null adherence) to 7 (highest adherence). The score was calculated for breast cancer patients enrolled in the DEDiCa study using a 7-day food record; serum lipid profile, including total and low-density lipoprotein cholesterol (LDL-C), was evaluated in serum at baseline. Results: Patients with the highest adherence to the cholesterol-lowering diet (i.e., score ≥ 4) reported lower LDL-C level than women with score 0–1 (median: 107 mg/dL and 122 mg/dL, respectively; p < 0.01). The proportion of women with LDL-C above the recommended limit of 116 mg/dL was 60.0% with score 0–1 and 42.6% with score ≥4. Although the score directly correlates with consumption of foods from vegetal sources, it was mildly associated with the healthful plant-based diet index (r-Spearman = 0.51) and the Mediterranean Diet Adherence Screener (r-Spearman = 0.30) Conclusions: These results provide experimental evidence that the cholesterol-lowering diet score is capable of detecting a specific plant-based dietary pattern that affects circulating cholesterol levels.

BACKGROUND:Head and neck cancer (HNC) incidence is on the rise, often diagnosed at late stage and associated with poor prognoses. Risk prediction tools have a potential role in prevention and early detection. METHODS:The IARC-ARCAGE European case-control study was used as the model development dataset. A clinical HNC risk prediction model using behavioral and demographic predictors was developed via multivariable logistic regression analyses. The model was then externally validated in the UK Biobank cohort. Model performance was tested using discrimination and calibration metrics. RESULTS:1926 HNC cases and 2043 controls were used for the development of the model. The development dataset model including sociodemographic, smoking, and alcohol variables had moderate discrimination, with an area under curve (AUC) value of 0.75 (95% CI, 0.74-0.77); the calibration slope (0.75) and tests were suggestive of good calibration. 384 616 UK Biobank participants (with 1177 HNC cases) were available for external validation of the model. Upon external validation, the model had an AUC of 0.62 (95% CI, 0.61-0.64). CONCLUSION:We developed and externally validated a HNC risk prediction model using the ARCAGE and UK Biobank studies, respectively. This model had moderate performance in the development population and acceptable performance in the validation dataset. Demographics and risk behaviors are strong predictors of HNC, and this model may be a helpful tool in primary dental care settings to promote prevention and determine recall intervals for dental examination. Future addition of HPV serology or genetic factors could further enhance individual risk prediction.

OBJECTIVE To provide a baseline comparative assessment of the main epidemiological features of prostate cancer in European populations as background for the proposed EU screening initiatives. DESIGN Population based study. SETTING 26 European countries, 19 in the EU, 1980-2017. National or subnational incidence data were extracted from population based cancer registries from the International Agency for Research on Cancer's Global Cancer Observatory, and mortality data from the World Health Organization. POPULATION Men aged 35-84 years from 26 eligible countries RESULTS Over the past decades, incidence rates for prostate cancer varied markedly in both magnitude and rate of change, in parallel with temporal variations in prostate specific antigen testing. The variation in incidence across countries was largest around the mid-2000s, with rates spanning from 46 (Ukraine) to 336 (France) per 100 000 men. Thereafter, incidence started to decline in several countries, but with the latest rates nevertheless remaining raised and increasing again in the most recent quinquennium in several countries. Mortality rates during 1980-2020 were much lower and less variable than incidence rates, with steady declines in most countries and lesser temporal differences between countries. Overall, the up to 20-fold variation in prostate cancer incidence contrasts with a corresponding fivefold variation in mortality. Also, the inverse U-shape of the age specific curves for incidence contrasted with the mortality pattern, which increased progressively with age. The difference between the highest and lowest incidence rates across countries ranged from 89.6 per 100 000 men in 1985 to 385.8 per 100 000 men in 2007, while mortality rates across countries ranged from 23.7 per 100 000 men in 1983 to 35.6 per 100 000 men in 2006. CONCLUSIONS The epidemiological features of prostate cancer presented here are indicative of overdiagnosis varying over time and across populations. Although the results are ecological in nature and must be interpreted with caution, they do support previous recommendations that any future implementation of prostate cancer screening must be carefully designed with an emphasis on minimising the harms of overdiagnosis.

Evidence on the relationship between legume consumption and risk of specific cancer sites is inconclusive. We used data from a series of case-controls studies, conducted in Italy and in the Swiss Canton of Vaud between 1991 and 2009 to quantify the association between legume consumption and several cancer sites including oral cavity, esophagus, larynx, stomach, colorectum, breast, endometrium, ovary, prostate and kidney. Multiple logistic regression models controlled for sex, age, education, smoking, alcohol, body mass index, physical activity, comorbidities, and consumption of fruit, vegetables, processed meat and total calorie intake were used to estimate the odds ratios (OR) for different cancer sites and their corresponding 95% confidence intervals(CI). For female hormone-related cancers, the models also included adjustments for age at menarche, menopausal status and parity. Although most of the estimates were below unity, suggesting a protective effect, only colorectal cancer showed a significant association. Compared to no consumption, the OR for consuming at least one portion of legumes was 0.79 (95% CI: 0.68–0.91), the OR for consuming two or more portions was 0.68 (95% CI: 0.57–0.82) and the estimate for an increment of one portion per week was 0.87 (95% CI: 0.81–0.93). The inverse association between legume consumption and colorectal cancer suggests a possible role of legumes in preventing cancer risk.