Qual è l’indicatore principale prodotto dai Registri Tumori di Popolazione? 1.La sopravvivenza 2.La mortalità 3.L’incidenza EdiVoteStartEdiVoteStop 000.

Qual è l’indicatore principale prodotto dai Registri Tumori di Popolazione? 1.La sopravvivenza 2.La mortalità 3.L’incidenza EdiVoteStartEdiVoteStop 000 Standard 010

Qual è la caratteristica peculiare della casistica rilevata da Registri Tumori di Popolazione? 1.E’ costituita dai pazienti oncologici trattati nei principali ospedali del territorio 2.E’ costituita da tutte le nuove neoplasie insorgenti nell’intera popolazione residente nell’area sorvegliata 3.E’ costituita da tutti i pazienti oncologici residenti e non residenti nell’area sorvegliata 33% EdiVoteStartEdiVoteStop 000 Standard 010

Valerio Ramazzotti SC Epidemiologia “Long term survivors and second primary cancer”

Cancer incidence in Italy All sites: annual incidence 812,4 cases/100.000 men; 622,0 cases/ 100.000 women (2003-2005, AIRTUM area, Italy) All sites (except skin,non-melanoma cancers) annual cases exstimated: 2011: 416.486; 2020: 465.003; 2030: 522.861

Epidemiological criteria for the study of Multiple primary cancers (MP) “Since tumours are relatively rare and MP may be diagnosed only in cancers patients, its necessary to follow a huge cohort of cancer patients to identify some MP” From: “Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456 We have two possible approaches: –The population-based approach (cancer registries) –The hospital-based approach (clinical series)

Population-based study

Multiple primary cancer incidence in Italy E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. Europen Journal of Cancer 37 (2001) 2449-2456 Data collected from eleven Italian population-based cancer registries (overall population 7,200,000 inhabitants) were used to compute the incidence of second independent cancers in a cohort of cancer patients aged 15 years or more; Overall, 240,111 patients have been followed for 544,438 person-years; During the follow-up 8,766 second primary cancers were diagnosed; Restricting the analysis to metachronous cancers there were 6974 second primary cancers diagnosed among 198,303 patients during 508,648 person-years.

IARC/IACR RULES TO DEFINE MULTIPLE INDEPENDENT PRIMARY CANCERS (MP) MP are two or more tumours arising in different sites (defined by the first three digits of the ICD for Oncology; or At the same site when histology is different according to Berg; Only one tumour can be counted in paired organs or for systemic diseases unless the histology differs; Basal and squamous cell cancers of the skin were considered as MP

Synchronous/metachronous events Synchonous cancers were defined as those diagnosed within the first 2 months after the first cancer; then Metachronous cancers were those diagnosed after the first 2 months after the first cancer. From: “Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456 (modified)

SIR (standardized incidence rates) The observed second primary cancers were compared with those expected by standardized incidence rates (SIR) The expected number of second primary cancers was calculated by multiplying the age, gender, 5-year period, site and registry-specific incidence rates by the same categories of person-years The measure of observed and of expected second primary cancers was a mean of the different registries contribution weighted by the person-years of each registry From: “Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456

From: “Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456 (modified)

“When all cancers, both synchronous and metachronous, were included not only was there a very high SIR during the first two months, but also the result for the whole follow-up period showed an approximately 10% increased risk” From: “Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456

“When only second metachronous cancers were considered, the cohort experienced a reduced risk of approximately 10% of developing further cancers in comparison with the general population” From: “Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456

“The changes of risk for all Multiple Cancers over time since diagnosis of the first primary was similar to the theoretical trend of the incidence rate after a screening test with a strong increase at time zero, when prevalent cases are identified through anticipation of diagnosis, followed by a decrease due to the lack of diagnosis of cancers…” From: “Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456 (modified)

SIRs of metachronous second cancers according to the site of first cancer and to gender, for all the second sites with significantly increased SIR

From: “Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. Europen Journal of Cancer 37 (2001) 2449-2456 (modified)

From: “Multiple primary cancer Incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456 (modified)

From: ”Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456 (modified)

From: “Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456 modified)

From “:Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456 (modified)

“Some of the evidenced associations between the cancer sites may be due to the effect of the same risk factor” Tobacco smoking and alcohol Cancers of upper aero-digestive system: oral cavity, oesophagus, larynx and lung. Cervical cancer and oral cavity, urinary bladder and lung cancers. Hormonal and dietary factors Associations beteween cancers of colon, rectum, female breast and ovary; corpus uteri and female breast; female breast and colon; colon and corpus uteri; corpus uteri and ovary. Radioterapy or chemoterapy Increased risk of leukaemia after Hodgkin’s lymphoma or ovary cancer; urinary bladder after cervix uteri; bone and connective tissue Increased site-specific medical surveillance Skin melanoma and non-melanoma skin cancers Immunnedeficiency Skin non melanoma and Non-Hodgkin’s lymphoma (immunedeficiency induced by ultraviolet light) From: “Multiple primary cancer incidence in Italy. E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456

Unexplained associations Pancreas and female breast Connective tissue and oral cavity and pharynx Urinary bladder and connective tissue Thyroid and pancreas Considering the high number of comparisons these findings may be due to chance alone From: “Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456

SIR significantly lower than 1 “ It is unlikely that cancer patients are biologically protected against other cancers unless the “protection” is related to the treatment for first cancer: corpus uteri cancers among patients with surgical removal for cervical cancer or because of a bias due to less intensive medical surveillance in patients older then 65 years” From: “Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456

“The identification of strong site-specific associations may be useful for clinicians when following-up patients” From: “Multiple primary cancer incidence in Italy” E. Crocetti, E. Buiatti, P. Falini, The Italian Multiple Cancer Working Group. European Journal of Cancer 37 (2001) 2449-2456

Clinical series

Risk of second malignacies in long-term survivors of childhood cancer”. MC Cardous-bink, RC Heinen et al. European Journal of Cancer 43 (2007) 351-362 Between 1966 and 1996, 2603 children (aged 0-18 years) were treated for a first primary cancer in the EKZ/AMC in Amsterdam. All patients who survived for at least five years were included in the study cohort. Survivors were identified using the Childhood Cancer Registry of the EKZ/AMC (Hospital-based cancer registry contains data on all patients admitted with respect to diagnosis, treatment and follow- up). In total, 1368 5-year survivors were identified; 79 second and 7 subsequent malignancies were observed 5 years or more after the diagnosis of the primary childhood cancer. A comparison was made between second cancer incidence in the survivor of childhood cancer and cancer incidence in the Dutch population a

Risk of second malignacies in long-term survivors of childhood cancer”. MC Cardous-bink, RC Heinen et al. European Journal of Cancer 43 (2007) 351-362 Mutually exclusive treatment groups were compared to assess the effects of treatment on the risk of developing a second cancer. Two treatment eras (before and after October 1984) were defined for stratified analysis, because at this time the prophylactic cranio-spinal radiation in leukaemia patients without central nervous system involvement was abolished b

From: “Risk of second malignacies in long-term survivors of childhood cancer”. MC Cardous-bink, RC Heinen et al. European Journal of Cancer 43 (2007) 351-362 (modified)

Overall, including meningioma,the risk of second malignancy was 11.2 fold increased in comparison with cacner risk in the general population. Soft tissue sarcoma, CNS tumours and meningiona contributed most to the excess risk of second solid cancers. From: “Risk of second malignacies in long-term survivors of childhood cancer”. MC Cardous-bink, RC Heinen et al. European Journal of Cancer 43 (2007) 351-362

“Radioteraphy appears to be a strong risk factor for developing second cancers”. “”However, chemotherapy only was also associated with a significantly increased risk”. From: “Risk of second malignacies in long-term survivors of childhood cancer”. MC Cardous-bink, RC Heinen et al. European Journal of Cancer 43 (2007) 351-362

“The SIR was highest in the 5-9 year follow-up interval (19.2) and stabilized at 9-fold incresed risk after 10 years of follow-up without a further decrease till at least 30 years of follow-up”. From: “Risk of second malignacies in long-term survivors of childhood cancer”. MC Cardous-bink, RC Heinen et al. European Journal of Cancer 43 (2007) 351-362

“While the SIR decreased till survivors attained the age of 25-30 years, it appeared to stabilize in those survivors who had reached the oldest age group (>=30). This suggests that excess second cancer risk may persist trough life”. From: “Risk of second malignacies in long-term survivors of childhood cancer”. MC Cardous-bink, RC Heinen et al. European Journal of Cancer 43 (2007) 351-362 (modified)

From: “Risk of second malignacies in long-term survivors of childhood cancer”. MC Cardous-Ubbink, RC Heinen et al. European Journal of Cancer 43 (2007) 351-362 (modified)

Qual è l’indicatore principale prodotto dai Registri Tumori di Popolazione? 1.La sopravvivenza 2.La mortalità 3.L’incidenza EdiVoteStartEdiVoteStop 000 Standard 010

Qual è la caratteristica peculiare della casistica rilevata da Registri Tumori di Popolazione? 1.E’ costituita dai pazienti oncologici trattati nei principali ospedali del territorio 2.E’ costituita da tutte le nuove neoplasie insorgenti nell’intera popolazione residente nell’area sorvegliata 3.E’ costituita da tutti i pazienti oncologici residenti e non residenti nell’area sorvegliata 33% EdiVoteStartEdiVoteStop 000 Standard 010

Qual è l’indicatore principale prodotto dai Registri Tumori di Popolazione? 1.La sopravvivenza 2.La mortalità 3.L’incidenza EdiVoteStartEdiVoteStop 000.

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Qual è l’indicatore principale prodotto dai Registri Tumori di Popolazione? 1.La sopravvivenza 2.La mortalità 3.L’incidenza EdiVoteStartEdiVoteStop 000.

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Presentation on theme: "Qual è l’indicatore principale prodotto dai Registri Tumori di Popolazione? 1.La sopravvivenza 2.La mortalità 3.L’incidenza EdiVoteStartEdiVoteStop 000."— Presentation transcript:

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