Qual è l’indicatore principale prodotto dai Registri Tumori di Popolazione?

EdiVoteStart EdiVoteStop Standard Qual è l’indicatore principale prodotto dai Registri Tumori di Popolazione? • La sopravvivenza • La mortalità • L’incidenza 000 010

EdiVoteStart EdiVoteStop Standard Qual è la caratteristica peculiare della casistica rilevata da Registri Tumori di Popolazione? • E’ costituita dai pazienti oncologici trattati nei principali ospedali del territorio • E’ costituita da tutte le nuove neoplasie insorgenti nell’intera popolazione residente nell’area sorvegliata • E’ costituita da tutti i pazienti oncologici residenti e non residenti nell’area sorvegliata 33% 33% 33% 000 010

Valerio Ramazzotti SC Epidemiologia “Long term survivors and second primary cancer”

Cancer incidence in Italy • All sites: annual incidence 812,4 cases/100.000 men; 622,0 cases/ 100.000 women (2003-2005, AIRTUM area, Italy) • All sites (except skin,non-melanoma cancers) annual cases exstimated: 2011: 416.486; 2020: 465.003; 2030: 522.861

Epidemiological criteria for the study of Multiple primary cancers (MP) • “Since tumours are relatively rare and MP may be diagnosed only in cancers patients, its necessary to follow a huge cohort of cancer patients to identify some MP” From: “Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456 • We have two possible approaches: • The population-based approach (cancer registries) • The hospital-based approach (clinical series)

Population-based study

Data collected from eleven Italian population-based cancer registries (overall population 7,200,000 inhabitants) were used to compute the incidence of second independent cancers in a cohort of cancer patients aged 15 years or more; Overall, 240,111 patients have been followed for 544,438 person-years; During the follow-up 8,766 second primary cancers were diagnosed; Restricting the analysis to metachronous cancers there were 6974 second primary cancers diagnosed among 198,303 patients during 508,648 person-years. Multiple primary cancer incidence in ItalyE. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. Europen Journal of Cancer 37 (2001) 2449-2456

IARC/IACR RULES TO DEFINE MULTIPLE INDEPENDENT PRIMARY CANCERS (MP) • MP are two or more tumours arising in different sites (defined by the first three digits of the ICD for Oncology; • or • At the same site when histology is different according to Berg; • Only one tumour can be counted in paired organs or for systemic diseases unless the histology differs; • Basal and squamous cell cancers of the skin were considered as MP

Synchronous/metachronous events • Synchonous cancers were defined as those diagnosed within the first 2 months after the first cancer; • then • Metachronous cancers were those diagnosed after the first 2 months after the first cancer. From: “Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456 (modified)

SIR (standardized incidence rates) • The observed second primary cancers were compared with those expected by standardized incidence rates (SIR) • The expected number of second primary cancers was calculated by multiplying the age, gender, 5-year period, site and registry-specific incidence rates by the same categories of person-years • The measure of observed and of expected second primary cancers was a mean of the different registries contribution weighted by the person-years of each registry From: “Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456

From: “Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456 (modified)

“When all cancers, both synchronous and metachronous, were included not only was there a very high SIR during the first two months, but also the result for the whole follow-up period showed an approximately 10% increased risk” From: “Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456

“When only second metachronous cancers were considered, the cohort experienced a reduced risk of approximately 10% of developing further cancers in comparison with the general population” From: “Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456

“The changes of risk for all Multiple Cancers over time since diagnosis of the first primary was similar to the theoretical trend of the incidence rate after a screening test with a strong increase at time zero, when prevalent cases are identified through anticipation of diagnosis, followed by a decrease due to the lack of diagnosis of cancers…” From: “Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456 (modified)

SIRs of metachronous second cancers according to the site of first cancer and to gender, for all the second sites with significantly increased SIR

From: “Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. Europen Journal of Cancer 37 (2001) 2449-2456 (modified)

From: “Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456 (modified)

From: “Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456 (modified)

From: “Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456 (modified)

From: “Multiple primary cancer Incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456 (modified)

From: “Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456 (modified)

From: ”Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456 (modified)

From: “Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456 modified)

From “:Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456 (modified)

“Some of the evidenced associations between the cancer sites may be due to the effect of the same risk factor” • Tobacco smoking and alcohol Cancers of upper aero-digestive system: oral cavity, oesophagus, larynx and lung. Cervical cancer and oral cavity, urinary bladder and lung cancers. • Hormonal and dietary factors Associations beteween cancers of colon, rectum, female breast and ovary; corpus uteri and female breast; female breast and colon; colon and corpus uteri; corpus uteri and ovary. • Radioterapy or chemoterapy Increased risk of leukaemia after Hodgkin’s lymphoma or ovary cancer; urinary bladder after cervix uteri; bone and connective tissue • Increased site-specific medical surveillance Skin melanoma and non-melanoma skin cancers • Immunnedeficiency Skin non melanoma and Non-Hodgkin’s lymphoma (immunedeficiency induced by ultraviolet light) From: “Multiple primary cancer incidence in Italy. E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456

Unexplained associations • Pancreas and female breast • Connective tissue and oral cavity and pharynx • Urinary bladder and connective tissue • Thyroid and pancreas Considering the high number of comparisons these findings may be due to chance alone From: “Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456

SIR significantly lower than 1 “It is unlikely that cancer patients are biologically protected against other cancers unless the “protection” is related to the treatment for first cancer: corpus uteri cancers among patients with surgical removal for cervical cancer or because of a bias due to less intensive medical surveillance in patients older then 65 years” From: “Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456

“The identification of strong site-specific associations may be useful for clinicians when following-up patients” From: “Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456

Clinical series

Risk of second malignacies in long-term survivors of childhood cancer”. MC Cardous-bink, RC Heinen et al. European Journal of Cancer 43 (2007) 351-362 a • Between 1966 and 1996, 2603 children (aged 0-18 years) were treated for a first primary cancer in the EKZ/AMC in Amsterdam. • All patients who survived for at least five years were included in the study cohort. • Survivors were identified using the Childhood Cancer Registry of the EKZ/AMC (Hospital-based cancer registry contains data on all patients admitted with respect to diagnosis, treatment and follow-up). • In total, 1368 5-year survivors were identified; 79 second and 7 subsequent malignancies were observed 5 years or more after the diagnosis of the primary childhood cancer. • A comparison was made between second cancer incidence in the survivor of childhood cancer and cancer incidence in the Dutch population

Risk of second malignacies in long-term survivors of childhood cancer”. MC Cardous-bink, RC Heinen et al. European Journal of Cancer 43 (2007) 351-362 b • Mutually exclusive treatment groups were compared to assess the effects of treatment on the risk of developing a second cancer. • Two treatment eras (before and after October 1984) were defined for stratified analysis, because at this time the prophylactic cranio-spinal radiation in leukaemia patients without central nervous system involvement was abolished

From: “Risk of second malignacies in long-term survivors of childhood cancer”. MC Cardous-bink, RC Heinen et al. European Journal of Cancer 43 (2007) 351-362 (modified)

Qual è l’indicatore principale prodotto dai Registri Tumori di Popolazione?

Qual è l’indicatore principale prodotto dai Registri Tumori di Popolazione?

Presentation Transcript