1. CANCER EXCESSES IN THE CLINICAL COHORT OF THE RAMAZZINI INSTITUTE
Ramazzini Days
October 27, Carpi
Angela Guaragna, MD
Director of the Cancer Clinical Center of the Ramazzini Institute, Bologna

2. Cancer in Italy in 2016
366,000 new diagnoses of cancer every year, 55% among men, 45 % among women.
and 176,000 deaths due to cancer
6,000-16,000 (?) estimated new diagnoses of occupational cancers ( %, probably understimated)

3. Cancer in Italy in 2016 Incidence of cancer in Italy by age: 0-49 11 %% % %
Incidence and the type of tumor changes in different age groups.

4. Cancer in Italy in 2016
Rank
Males
Females 1°
Prostate (19%)
Breast (30%) 2°
Lung (15%)
Colorectal (13%) 3°
Lung (6%) 4°
Bladder (11%)
Body of uterus (5%) 5°
Stomach (4%)
Thyroid (5%)
Top five most frequently diagnosed cancers by sex. Pool Airtum Cancer in Italy Airtum 2016.

5. Cancer in Italy in 2016
Rank
Males
Females 1°
Lung (26%)
Breast (17%) 2°
Colorectal (10%)
Colorectal (12%) 3°
Prostate (8%)
Lung (11%) 4°
Liver (7%)
Pancreas (7%) 5°
Stomach (6%)
Top five most frequent causes of cancer death by sex. Pool Airtum Cancer in Italy Airtum 2016.

6. Cancer in Italy in 2016 Survival
The survival rate at 5 years has increased significantly for both men and women:
Men: 57%
Women: 63%
It was 39% for men and 53% for women between
Pool Airtum Cancer in Italy Airtum 2016.

7. Cancer in Italy in 2016 Survival
The improvement in 5 year survival rate is marked in frequent tumors such as:
Prostate cancer: 91% survival
Breast cancer: 87%
Colorectal cancer: 64% for men and 63% for women
Type of cancers for which early detection may be effective.
Pool Airtum Cancer in Italy Airtum 2016.

8. What are the annual costs for
Cancer in Italy
What are the annual costs for
oncological disease?
Total healthcare cost (1): € 112 bn
Oncological healthcare cost (2): € 7.5 bn (6.7% of total healthcare cost).
Future: increase in costs (more specific but more expensive treatments) and prevalence (aging population, increased survival).
(1) ISTAT
(2) Economist Intelligence Unit

9. Manca da Ralph
Cancer is not a single disease with a single cause or treatment (multifactorial disease). It develops when cells in the body grow in an uncontrolled and abnormal way.
An individual’s risk of developing a cancer is influenced by a combination of factor including personal habits such as smoking and alcohol consumption, exposure to carcinogens in the general and occupational environment, genetics, sex, ethnicity, age, and so on.

10. To fight cancer, as a major public health problem, we need to revise the present control strategies, reinforcing:
Primary prevention: identification of carcinogenic agents
Secondary prevention: early detection of oncological lesions of certain types of tumor

11. Primary prevention: with the Cesare Maltoni Cancer Research Center.
For more than 30 years the Ramazzini Institute has pursued this strategy for:
Primary prevention: with the Cesare Maltoni Cancer Research Center.
This Center, with over 200 compounds studies, is the second largest program in the world for the experimental identification of carcinogens.

12. Secondary prevention: with the Clinical Center for Cancer Prevention.

13. The aims of this presentation are:
To illustrate the Ramazzini Institute Clinical activity for early detection of oncological lesions
To show if the various types of tumors detected among unselected patients, referring to our Clinical Center are affected by the type of occupational activity – administrative/managerial (white collar) or workers (blue collar) – and
To show if there are some occupationally-related types of tumor

14. Ramazzini Institute, Bologna Structures and Activity
Clinical Center for Cancer Prevention
Ramazzini Institute, Bologna
Structures and Activity

15. Clinical Center for Cancer Prevention
The Clinical Center for Cancer Prevention at the Ramazzini Institute was opened in Bologna in June 2002.
The aim of the Center is the EARLY DETECTION of oncological lesions among people particularly at risk of developing cancer by age and/or by occupation.

16. Clinical Center for Cancer Prevention
THE STRUCTURE
The Center has:
five surgeries for specialistic visits
a digital mammography unit
a bone densitometry (DEXA) unit
a ultrasonography unit
a cytopathology laboratory
blood tests and lab analysis

17. Clinical Center for Cancer Prevention
For each patient questionnaire data are collected: demographics data and family history, occupational activity, lifestyle, noteworthy symptoms, past pathologies.
This enables stratification of people at risk of developing oncological lesions.

18. Clinical Center for Cancer Prevention
On the basis of the data collected select basic diagnostic investigations are recommended, if necessary, for cancer screening and prevention, such as ultrasound-scan, mammography, fecal occult blood test and cytological examinations (sputum, breast fine needle aspiration and secretions, urine and cervical tests).

19. Clinical Center for Cancer Prevention
After making a precise record of job details (type of job performed, duration, exposure to potential carcinogens, type and duration of exposure), we divide the people in blue collar and white collar.
All are examinated following a standardized and systematic protocol.

20. Clinical Center for Cancer Prevention: Results

21. Clinical Center for Cancer Prevention
Clinical Cohort
Sex
Blue collar
White collar
Total
Males
1.531
706
2.237
Females
3.109
2.654
5.763
4.640
3.360
8.000

22. Clinical Center for Cancer Prevention Clinical Cohort performed from June 2002 to December 2016, by sex and age

23. Cancer Clinical Center
The Ramazzini Institute, with the support of members, through various initiatives, can guarantee a free oncological check for people over sixty-five, as well as free follow-up for patients with neoplastic disease. Meaning 11% of our examinations are free

24. Asymptomatic tumors are in most cases completely curable!
Total malignant tumors observed from June 2002 to December 2016, distributed by sex and symptoms
Malignant tumours
Males
Females
Total
Asymptomatic 89
164 %
Symptomatic 39
167 %
128
331 %
Asymptomatic tumors are in most cases completely curable!

25. Total malignant tumors observed from June 2002 to December 2016, distributed by site and by sex
Syte
Males
Females
Total
Prostate 43
Breast
250
252
Skin_no Mel 24 21 45
Colorectal 16
Skin_Melanoma 15
Cervix 8 31
Bladder 10 7 23
Kidney 9
Uterus 6
Other sytes 11
Tyroid
TOTAL
128 5 12
331 19
459

26. Total malignant tumors observed from June 2002 to December 2016, distributed by working categories, sex and age group
BLUE: Total 267 of which 88 (33%) Males and 179 (67%) Females
WHITE: Totale 192 di cui 40 (21%) Males and 152 (79%) Females
TOTAL: 459 cases of which 128 (28%) Males and 331 (72%) Females

27. Comparison of the incidence of some types of tumor among blue or white collar
Blue Collar
White Collar
Male
1531
706
Female
3109
2654
TOTAL
4640
3360
Syte
(%)
Prostate 34
(2.0) 9
(1.0)
Skin Non-Mel 14 10
Colon 2
(0.3)
Bladder 7
(0.4) 3
Melanoma 5
Kidney 4
(0.2)
Breast
139
(4.0) 97
Skin Non -Mel 12
(0.1) 13
(0.5)
Cervix
Uterus

28. Case report showing the consistency of the approch
S. R. M 73 years old
Carcinogens : asbestos, railway
tobacco smoke
Entered follow-up at the R.I. Clinical Cancer Prevention Center from the age of 59
60 years: bladder cancer in early stage, diagnosed by cytological examination of urine sediment (trans-uretral bladder resection)
68 years: left kidney cancer, diagnosed by abdominal ultrasonography (lumpectomy)
70 years: left kidney cancer, diagnosed by abdominal ultrasonography (lumpectomy)
This case shows the importance of early detection by cancer surveillance

29. Conclusion
The small number of cases in our clinical cohort does not allow us to draw definitive conclusions regarding some cancers excesses:
However it is interesting to note the incidence of cases of melanoma among white collar males and females. At the moment and on the basis of the data available, no specific explanation is possible.

30. Conclusion
Collection of information on occupational cancers is of primary importance in planning targeted prevention programs.
Occupational cancers are of major concern in terms of mortality and lost economic productivity.
Some occupational cancers are often preventable and, if detected in early stages (often asymptomatic), completely curable
Preventive campaigns to evaluate ongoing risk and current exposure are strongly recommended to health policy-makers.

31. Most types of cancer are not caused by bad luck!
Conclusion
Our experience once more highlights the importance of cancer surveillance during the development of neoplastic disease. This lowers mortality rates for cancer, significantly increasing survival and improving the quality of life.
However the first goal is to decrease the incidence of cancer through the reducing and remedying environmental carcinogens and correcting the risk factors related to lifestyle.
Most types of cancer are not caused by bad luck!