Donato Francesco, Raffetti Elena
Università degli studi di Brescia, Dipartimento di specialità medico-chirurgiche, scienze radiologiche e sanità pubblica, Unità di igiene, epidemiologia e sanità pubblica.
Epidemiol Prev. 2014 Nov-Dec;38(6 Suppl 2):14-8.
A case-study regarding the results of the SENTIERI project on the Brescia-Caffaro NPCS (National Priority Contaminated Site) is reported. This area has been polluted mainly by polychlorinated biphenyls (PCBs), which have been classified recently by the International Agency for Research on Cancer as human carcinogens (group 1), with sufficient evidence for melanoma and limited for non-Hodgkin lymphoma (NHL) and breast cancer. The 3rd report of the SENTIERI project (2014) has shown an excess of cancer incidence with respect to the expected, on the basis of the incidence rates from the pool of Centre-North Italy cancer registries, but a mortality similar to that expected according to the regional rates, for melanoma, NHL and breast cancer. Furthermore, a higher than expected incidence has been found for various cancers which are not associated a priori with PCB exposure. The Brescia Local Health Authority has also carried out an analysis of cancer incidence, which has shown an incidence in the area similar to other ones in North Italy and a cluster of cases centered on Brescia town for melanoma only. A possible explanation of these discrepancies is the use of different reference populations for the comparisons (Region and pool of Centre-North Italy cancer registries), besides possible confounding bias. We discuss here the most critical aspects of modern ecological studies, their potential information content and interpretation limits.
本文报告了一项关于SENTIERI项目在布雷西亚-卡法罗国家重点污染场地（NPCS）研究结果的案例分析。该区域主要受到多氯联苯（PCBs）污染，国际癌症研究机构最近已将其列为人类致癌物（第1组），有充分证据表明其与黑色素瘤有关，与非霍奇金淋巴瘤（NHL）和乳腺癌有关的证据有限。SENTIERI项目的第三份报告（2014年）显示，基于意大利中北部癌症登记处汇总的发病率，黑色素瘤、NHL和乳腺癌的实际发病率高于预期，但死亡率与根据该地区发病率预期的死亡率相似。此外，还发现了一些事先与PCB暴露无关的各种癌症的发病率高于预期。布雷西亚地方卫生当局也对癌症发病率进行了分析，结果显示该地区的发病率与意大利北部其他地区相似，仅黑色素瘤病例集中在布雷西亚镇。除了可能存在的混杂偏倚外，这些差异的一个可能解释是比较时使用了不同的参考人群（该地区和意大利中北部癌症登记处汇总数据）。我们在此讨论现代生态研究的最关键方面、其潜在的信息内容和解释局限性。
