Grande Enrico, Inghelmann Riccardo, Francisci Silvia, Verdecchia Arduino, Micheli Andrea, Baili Paolo, Capocaccia Riccardo, De Angelis Roberta
Reparto di Epidemiologia dei Tumori, Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy.
Tumori. 2007 Jul-Aug;93(4):374-9. doi: 10.1177/030089160709300408.
Breast cancer is the most common cancer and the leading cause of cancer death among women. Knowledge of the present and future burden of the disease at a regional and national scale is a major issue in Italy, where the frequency and coverage of screening programs vary considerably across the country. This study presents estimates and projections of the female breast cancer incidence, prevalence and mortality for Italy and all Italian regions in the period 1970-2010.
The estimates were obtained by applying the MIAMOD method, a statistical back-calculation approach to derive incidence and prevalence figures from mortality and relative survival data. Published data from the Italian cancer registries were modelled to obtain regional and national estimates of breast cancer survival.
Breast cancer mortality has been declining from the late 1980s in the northern-central regions and from the mid 1990s in the southern regions Puglia, Sicilia and Sardegna. Stable mortality rates are estimated for the other southern regions in the 2000's first decade. The incidence rate in Italy is estimated as increasing until the late 1990s, and stable thereafter (93 per 100,000). The incidence curve is also estimated to flatten in many northern-central regions from the late 1990s or later. Rising incidence trends are estimated in all southern regions, with the exception of Puglia. About 8,500 deaths, 37,000 new diagnoses and 416,000 prevalent cases for breast cancer are estimated among Italian women in 2005. In the same year, the proportion of prevalent cases in the northern area (1221 per 100,000) is about twice that estimated in the South (685 per 100,000).
The geographical variation in female breast cancer burden can be explained by the unequal distribution of screening. A more widespread screening activity in the southern regions would help to bridge the gap between northern-central and southern regions. Continuous monitoring of regional epidemiological indicators for breast cancer is crucial to evaluate the effect of different health measures taken to control breast cancer in Italy.
乳腺癌是女性中最常见的癌症，也是癌症死亡的主要原因。在意大利，了解该疾病在区域和国家层面当前及未来的负担是一个重大问题，因为该国筛查项目的频率和覆盖范围在全国范围内差异很大。本研究给出了1970 - 2010年期间意大利及所有意大利地区女性乳腺癌发病率、患病率和死亡率的估计值及预测值。
这些估计值是通过应用MIAMOD方法获得的，这是一种从死亡率和相对生存数据推导发病率和患病率数字的统计反向计算方法。对意大利癌症登记处公布的数据进行建模，以获得乳腺癌生存率的区域和国家估计值。
从20世纪80年代末起，意大利中北部地区的乳腺癌死亡率开始下降，而南部地区普利亚、西西里和撒丁岛从20世纪90年代中期起死亡率开始下降。预计在21世纪第一个十年，其他南部地区的死亡率保持稳定。意大利的发病率估计在20世纪90年代末之前呈上升趋势，此后保持稳定（每10万人中有93例）。许多中北部地区的发病率曲线预计从20世纪90年代末或更晚开始趋于平缓。除普利亚外，所有南部地区的发病率都呈上升趋势。2005年，估计意大利女性中有约8500例乳腺癌死亡、37000例新诊断病例和416000例现患病例。同年，北部地区的现患病例比例（每10万人中有1221例）约为南部地区（每10万人中有685例）的两倍。
女性乳腺癌负担的地理差异可以通过筛查分布不均来解释。在南部地区开展更广泛的筛查活动将有助于缩小中北部和南部地区之间的差距。持续监测乳腺癌的区域流行病学指标对于评估意大利为控制乳腺癌而采取的不同健康措施的效果至关重要。
