Baili Paolo, De Angelis Roberta, Casella Ilaria, Grande Enrico, Inghelmann Riccardo, Francisci Silvia, Verdecchia Arduino, Capocaccia Riccardo, Meneghini Elisabetta, Micheli Andrea
Unità di Epidemiologia Descrittiva e Programmazione Sanitaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Tumori. 2007 Jul-Aug;93(4):398-407. doi: 10.1177/030089160709300412.
Cancer burden estimates in Italian regions are available for the period 1970-2010 as a result of the project "I TUMORI IN ITALIA" connected with EUROCHIP, the European project on cancer control. The Italian health-care system is organized at a regional level, so regional estimates of cancer indicators are useful to identify priorities for cancer plans. We compared cancer site-specific epidemiological estimates by 3 macro-areas (obtained by grouping regions) to suggest priorities for Italian cancer control plans, both at national and regional levels.
Mortality and incidence estimates for all cancers combined and for stomach, colorectal, lung, breast and prostate cancers were downloaded from the website www.tumori.net and aggregated in broad age classes (0-54, 55-74 and 75-84 years) and macro-areas (northern, central and southern Italy).
Historically, Southern Italy had a lower cancer risk than the Center and North. After 2000 this epidemiological picture disappeared and the incidence and mortality rates in the Center are reaching those of the North. Also the weight of various cancer sites on all cancers has changed in Italy in the last decades. Lung cancer is still the most frequent cancer in the male population in the South, while in the Center-North it has been surpassed by prostate cancer and colorectal cancer. The lung cancer weight on all cancer deaths is increasing in women. Prostate cancer has become the most frequent male cancer in the Center-North in the age class 55-84. Breast cancer is the most frequent cancer in the female population and its incidence rates in the North are higher than those in the Center-South for all age classes. Colorectal cancer incidence rates have dramatically increased in men and colorectal cancer is nowadays the second cancer diagnosed in women in all age classes and macro-areas.
From the epidemiological data here presented we derived the following suggestions and observations for cancer control plans: (a) tobacco prevention should focus on the male population in the South, and on female populations in the country as a whole; (b) prevention concerning diet and physical activity (risk factors for colorectal cancer) should be considered mainly for men at a national level; (c) the coverage of breast cancer screening programs should be increased in the Center-South; (d) colorectal cancer screening should be promoted at a national level; (e) PSA testing (that is not actually included among the screening programs recommended) for prostate cancer is probably more widespread in the Center-North, resulting in an increased incidence without any evident decline in mortality as yet.
由于与欧洲癌症控制项目EUROCHIP相关的“意大利的肿瘤”项目，现已获得意大利各地区1970 - 2010年期间的癌症负担估计数据。意大利的医疗保健系统按地区组织，因此癌症指标的地区估计有助于确定癌症计划的优先事项。我们比较了3个宏观区域（通过对地区进行分组获得）特定癌症部位的流行病学估计，以提出意大利国家和地区层面癌症控制计划的优先事项。
从网站www.tumori.net下载了所有癌症以及胃癌、结直肠癌、肺癌、乳腺癌和前列腺癌的死亡率和发病率估计数据，并汇总为宽泛的年龄组（0 - 54岁、55 - 74岁和75 - 84岁）和宏观区域（意大利北部、中部和南部）。
从历史上看，意大利南部的癌症风险低于中部和北部。2000年后，这种流行病学情况消失，中部的发病率和死亡率正在接近北部。在过去几十年中，意大利各种癌症部位在所有癌症中的占比也发生了变化。肺癌仍是南部男性人群中最常见的癌症，而在中北部，它已被前列腺癌和结直肠癌超越。肺癌在所有癌症死亡中的占比在女性中正在增加。前列腺癌已成为中北部55 - 84岁年龄组男性中最常见的癌症。乳腺癌是女性人群中最常见的癌症，其在北部所有年龄组中的发病率均高于中南部。男性结直肠癌发病率大幅上升，如今在所有年龄组和宏观区域中，结直肠癌是女性中第二常见的诊断癌症。
根据此处呈现的流行病学数据，我们对癌症控制计划得出以下建议和观察结果：（a）烟草预防应侧重于南部的男性人群以及全国的女性人群；（b）关于饮食和身体活动（结直肠癌的风险因素）的预防在国家层面应主要针对男性；（c）应提高中南部乳腺癌筛查项目的覆盖范围；（d）应在国家层面推广结直肠癌筛查；（e）前列腺癌的PSA检测（实际上未包含在推荐的筛查项目中）在中北部可能更为普遍，导致发病率上升，但死亡率尚未明显下降。
