Abstract: Since its establishment in 1990, one of the main tasks of the Italian Group for Mammography Screening (GISMa) has been that of collecting, as systematically and thoroughly as possible, data on the activity of the various mammography screening programmes implemented in Italy. Data are collected in an aggregated way and gathered through a standardised form to calculate process and impact parameters. Analysis of data collected in the period 1996-2006 shows that the number of Italian women involved in mammography screening has constantly increased over time. In 2006, almost 8 out of 10 Italian women in the 50-69 year age range lived in areas where an organised screening activity had been implemented. The geographical distribution of the screening activity in Italy continues to present differences between Northern and Central Italy, where the coverage ranges from 95.7% to 89.6%, and Southern Italy and the Islands, where this value is still lower (45.9%). The discrepancy between annual theoretical coverage and actual coverage still persists (21%). Throughout the period, crude attendance rate reached the acceptable 50% standard, presenting the same North-South trend as the coverage rate distribution. In areas where the centralised management is more established or complete, the participation rate was higher compared with areas without such characteristics, with differences of about 4-9%. The time trends of the other parameters included in the analysis showed a good average performance. For example, benignant/malignant surgical biopsy ratio (B/M ratio) continued to progressively decrease, reaching 0.24 at first screening and 0.14 at subsequent screening in 2005; overall detection rate, detection rate for in situ and small cancers (< or =10 mm) showed a good trend, reaching 6.0 per thousand, 0.7 per thousand, and 1.3 per thousand, respectively, for first screening, and 5.2 per thousand, 0.8 per thousand, and 1.6 per thousand for subsequent screening in 2005. On the contrary, excess referral rate at first screening persists over time. Data comparing activity volume and programme duration were also considered. In programmes with greater activity volume (average test number: 24,596) the referral rate for first screening was higher if compared with programmes with lower activity volume, but still within acceptable standards. Nevertheless, this performance is compensated by better specificity and sensitivity. An improvement in quality with the increase of programmes experience continues to be evident: compared with new programmes, programmes with more than 6 years of activity showed lower recall rates and higher positive predictive values and overall detection rates in first screening. Outcomes related to subsequent screening present analogous performances. These results continue to be consistent with those achieved by other European programmes and reassuring for all Italian mammography screening professionals.
Abstract: Mammography screening programmes in Italy have been implemented since the early 90's. Over the last ten years, national and international institutions have strongly supported screening programme implementation with several laws. Since 2004, the Italian Ministry of Health, together with the Commission of Regions and Self-governing Provinces Health Officials, has officially entrusted the ONS (Osservatorio Nazionale Screening, National Centre for Screening Monitoring) with monitoring and promoting nationwide screening programmes. Previously, for several years, GISMa (Gruppo Italiano per lo Screening Mammografico) carried out a yearly survey to collect process indicators of mammography screening and compare them, using national and international standard values as reference. In 2006, an updated version of the operative report of process indicators was published by GISMa, and in November 2006 the updated national screening guidelines, prepared by the workgroups on oncological screening set up by the Ministry, was published. This report is an update of similar previous papers published by the ONS since 2002. Data for the survey come from several different programmes that may have changed over time, and may have different settings of organisation and management. During 2005, an increase in screening activity was recorded with the inclusion of all Northern and Central Italian Regions, and 2006 showed a further development n the Southern Regions and Islands. Only one Region is missing (Puglia), but it started its activity in 2007; so starting from 2007, all Italian Regions have implemented screening programmes. In 2006, more than 2 million women aged 50-69 years were invited to have a screening mammogram, and over 1,150,000 were screened. Theoretical extension was 76.4% in 2005 and 78.2% in 2006. This year shows an important increase in actual extension, improving from 50.3% in 2005 to 57.2% in 2006 and finally rising over the critical value of about 50% registered during the last years. An imbalance in coverage is still present when comparing Northern and Central Italy (more than 90%) to Southern Italy, which only has a 46% coverage by organised screening. The percentage of women screened during 2005 accounted for 28.6% of the national target population, and increased up to 31.8% in 2006. During the three-year period 2004-2006, participation rates were substantially stable around 55-57% for crude rate, and 59-60% for adjusted rate, respectively. A decreasing trend towards the South of Italy is evident for this parameter, too, but in 2005-2006 the Central Regions registered the highest increase in attendance: crude and adjusted participations rose from 52-54% in 2004 to 56-58% in 2005-2006. Many programmes work with low volumes of activity (below 10,000 or even 5,000 examinations per year), and no regional mean value surpassed the desirable level of at least 20,000 examinations for each programme. Referral rates of 8.3% at first screening and 4.5% at repeat screening were recorded. Direct standardised detection rate was 5.7 x 1,000 at first test and 4.6 at repeat test, while benign to malignant ratio for first and repeat screening was 0.28 and 0.21, respectively. Detection rate of invasive cancers < or =10 mm was 1.44 x 1,000 at first test and 1.58 at repeat test; the proportion of in situ carcinomas was 12.9% and 14.7% for first and repeat test, respectively. Indicators by 5-year age group confirm greater diagnostic problems at younger ages, with higher referral rates, higher frequency of surgical procedures with benign outcome (B/M ratio), and a substantially lower detection rate as compared to older age groups.
Abstract: We used the Tuscan Cancer Registry archives to retrieve records of 2,896 patients with a histological diagnosis of lung tumor from January 1996 to December 2000. Of 2,410 patients with non-small-cell lung cancer, 767 (31.8%) underwent complete resection. The following variables were analyzed for their influence on survival in the 157 patients with pathologic N1 status: sex, age, cell type, pathologic tumor status, number and level of involved lymph nodes, tumor grade, and type of surgery. Overall 5-year survival rates were 43.9% for 417 patients with pN0 disease, 10.8% for 176 with pN2 disease, and 31.6% for those with pN1 disease. In pN1 disease, the overall 5-year survival rates for patients with hilar and non-hilar lymph node involvement were 27.4% and 39.6%, respectively. Univariate analysis demonstrated that pathological T status and level of N1 involvement were significant prognostic factors. Cox proportional hazards analysis indicated that hilar lymph node involvement was an independent prognostic factor. N1 lymph node status was identified as an independent prognostic factor in a combination of subgroups with different prognoses.
Abstract: OBJECTIVE: To estimate survival in patients in whom uveal melanoma was diagnosed between January 1, 1983, and December 31, 1994, in Europe. METHODS: Survival analysis of data from 32 cancer registries in 16 European countries adhering to the European Cancer Registry for 5788 patients with uveal melanoma diagnosed between January 1, 1983, and December 31, 1994, with follow-up to 1999. RESULTS: Five-year relative survival was 68.9% overall and remained stable with the period of diagnosis. Relative excess risk of death was 2.45 (95% confidence interval [CI], 2.10-2.86) in patients aged 75 years or older compared with patients aged 54 years or younger and was slightly higher in male patients (relative excess risk, 1.10; 95% CI, 1.02-1.19) than in female patients. Survival was similar in Nordic countries (relative excess risk, 1.03; 95% CI, 0.87-1.21) compared with the United Kingdom (reference country) and was lower in eastern and western European countries (1.26; 1.05-1.52, and 1.25; 0.90-1.60, respectively) compared with the reference country. CONCLUSIONS: In this large series of patients with uveal melanoma, 5-year relative survival remained stable with the introduction of conservative treatment in individuals in whom uveal melanoma was diagnosed between 1983 and 1994. We found differences in survival between sexes and in European areas that should be investigated in studies that consider tumor characteristics at the individual level.
Abstract: OBJECTIVE: The aim of this study was to assess the misclassification of cause of death for breast cancer cases, and to evaluate the differential misclassification between cases detected in an organized screening program and cases found in current clinical practice. METHODS: All deaths occurring between 1999 and 2002 within breast cancer cases were linked to hospital discharge records. Death certificates and latest available hospital discharge notes were classified into various categories. We created a classification algorithm defining which combinations of categories (of death certificates and hospital discharge notes) suggested the probability of misclassification and the need for an in-depth diagnostic review. Questionable cases were reviewed by a team of experts in order to reach a consensus on cause of death. Based on our algorithmic classification and diagnostic review results, the agreement between original cause of death and that resulting from the assessment process was analyzed stratifying for every variable of interest. RESULTS: According to death certificates, breast cancer was the cause of death in 66.9% of subjects, and after assessment this figure changed to 65.7%. The misclassification rate was 4.3% and did not differ significantly between screen-detected (4.7%) and non-screen-detected (4.3%) cases. Higher misclassification rates in favor of false positivity (cause of death wrongly attributed to breast cancer in death certificates) was observed for subjects with multiple cancers (6.5% vs. 1.9%), with no admission in the year before death (4.6% vs. 2.4%) and with an unknown cancer stage (4.9% vs 2.4% or 2.3%). CONCLUSIONS: The cause of death misclassification rate is modest, causing a slight overestimate of deaths attributed to breast cancer, and is not affected by modality of diagnosis. The study confirmed the validity of using cause-specific mortality for service screening evaluation.
