New study on incidence of breast cancer in Italy

A new study on the incidence of breast cancer in Italy has been published in the International Journal of Experimental and Clinical Cancer Research. The authors belong to a multidisciplinary Italian-American team led by Prof. Antonio Giordano, Director of the Sbarro Institute for Cancer Research and Molecular Medicine College of Science and Technology Temple University of Philadelphia, USA.

"Cancer is also a matter of numbers," says Giordano , internationally renowned oncologist engaged for years in the fight against cancer, who recently launched an appeal — signed by over 500 researchers — to protect the environment from the irresponsible dumping of toxic wastes, carcinogenic waste. "The identification of the precise number of cancer cases at a population level and by geographical area is crucial to orient public health strategies towards cancer prevention and early diagnosis."

In this study, the researchers focused on breast cancer, the most common cancer and leading cause of cancer death in women. Based on data provided by the Italian National Institute of Statistics, 12,195 women died of breast cancer in 2009, compared to 11,476 in 2006. The authors analyzed the national archive of hospital discharge records to estimate the number of interventions, for mastectomy (en bloc removal of the breast) and quadrantectomies (partial removal) performed in Italy for a principal diagnosis of breast cancer from 2001 to 2008.

"Compared to our previous work in 2009, the present study not only expands the timeframe of interest, but it also excludes re-operations performed on the same patient throughout the considered timeframe. In this way, we have enhanced our ability to detect newly diagnosed cases while excluding previously diagnosed cases" — says Dr. Prisco Piscitelli, coordinator of the study.

The data showed that from 2001 to 2008 a total number of 328.888 mastectomies and quadrantectomies were performed (117.762 and 211.126, respectively). The overall number of mastectomies decreased in the time window considered (from 15.754 in 2001 to 14.197 in 2008). However, when analyzing data by age groups, the reduction occurred in women between 45 and 74 years, whereas the number of mastectomies did not significantly change in women between 25 and 44 years. Furthermore, the total number of quadrantectomies increased significantly across all the classes of age considered (from 22.140 in 2001 to 30.800 in 2008).

The analysis by macroareas (ie Northern Italy, Central and Southern) confirmed the reduction of mastectomies, although there were inter-regional discrepancies possibly due to differences in coverage and adherence to screening programs. The quadrantectomies increased significantly, with the highest values in Southern Italy (from 3.812 in 2001 to 6.538 in 2008). The number of surgeries repeated within the same year increased from 4.682 in 2001 to 5.909 in 2008.

According to the report of the Italian Association of Cancer Registries (AIRTUM) 2010: "By the age of eighty-four, on average, 1 man out of 2 and 1 woman out of 2 will be affected by cancer in their lifetime; 1 man out of 3 and 1 woman out of 6 will die for the disease." In this scenario, the development of a cancer surveillance program is crucial to the national and international health policy. In Italy, cancer surveillance mostly relies on the valuable support of Cancer Registries. "Currently, the Italian net of Cancer Registries covers approximately 34% of the national population with significant discrepancies among macroareas (i.e. 50.2%, 25.5% and 17.9%, for Northern, Central and Southern Italy, respectively). On this basis, the exclusive use of cancer registries might limit the ascertainment of the real cancer burden" says Dr. Maddalena Barba, senior researcher at the Regina Elena Cancer Institute in Rome.

"This study aims to develop new tools able to complement the activity of cancer registries in the health surveillance of neoplastic diseases. Our results encourage the use of the data from the archive of the national hospital discharge records for the identification of breast cancer patients who underwent surgery (quadrantectomy and/or mastectomy). This is consistent with what happens in the United States, where, similarly to Italy, there is a need to integrate the health monitoring activities carried out by the SEER (Surveillance, Epidemiology and End Results Program) with the use of additional databases." clarifies and concludes Prof. Antonio Giordano, creator of this study project.