Transcript Diapositiva 1

Latina province
Unusual north-south migration of 60 000 people from Veneto, Friuli and
Emilia Romagna to Latina province area during the 1930s
People were mainly manual workers, farmers and their families involved
in land reclamation that drained the marsh area extending from the
southern boundaries of Rome to Terracina
From: Tumori, 80: 101-105, 1994
Pool of Italian Cancer Registries
(AIRTUM)
http://www.registri-tumori.it/cms/
Latina province cancer registry. Male1 born in northern Italy: observed vs
expected cases, standardized incidence ratio (SIR), 95% confidence interval
(CI) by site. 1983-87
Site
Observed Expected SIR
CI
Mouth, pharynx
15
9.45 159
89-262
Esophagus
3
2.70 111
22-324
Stomach
24
17.61 136
87-203
Colon
14
13.76 102
55-171
Rectum
9
8.99 100
46-190
Liver
11
6.63 166
83-297
Biliary tract
2
3.08
65
7-234
Pancreas
8
5.16 155
67-305
Larynx
11
7.55 146
72-260
Lung
93
60.37 154 124-189 A
Bone
0
0.33
0
0-1125
Connective tissue
2
1.78 112
12-405
Skin (melanomas)
2
1.79 111
12-403
Skin (carcinomas)
52
35.03 148 111-195 B
Prostate
26
13.81 188 123-276 C
Testis
0
0.47
0
0-785
Bladder
31
26.05 119
81-169
Kidney, urinary tract
6
3.71 162
59-352
Central nervous system
6
2.95 303
74-442
Thyroid
1
0.36 281
4-1562
Unspecified site, metastases
8
4.30 186
80-366
Unknown origin
3
2.72 110
22-322
Non-Hodgkin lymphomas
6
5.08 118
43-257
Hodgkin’s lymphoma
2
1.47 136
15-491
Multiple mieloma
1
1.63
61
1-342
Leukaemias
12
6.53 184
95-321
All site
354
249.36 142 127-157 d
1
Age ≥55 years
p<0.05; b p<0.01; c p<0.005; d p<0.001.
From: Tumori, 80: 101-105, 1994
a
Number of subjects to be followed until the age of 84 years to detect one
incident cancer, by site and sex. Pool of Italian Cancer Registries. Period
2005-2007
SITE
Upper respiratory and digestive tract cancers
Stomach
Colorectum
Liver
Pancreas
Lung
Melanoma of skin
Non melanoma skin cancer
Breast
Corpus uteri
Ovary
Prostate
Kidney and other urinary cancer
Bladder
Thyroid
Non-Hodgkin lymphoma
All cancers except non melanoma skin cancer
MALE
From: “I numeri del cancro in Italia 2011”.
www.registritumori.it/PDF/AIOM2011/I_numeri_del_cancro_2011.pdf (modified)
FEMALE
36
28
10
34
51
9
43
9
553
7
36
13
152
45
2
166
57
17
95
64
35
58
15
8
47
74
84
69
56
61
2
Number of subjects to be followed until the age of 84 years to observe one
death by cancer site and sex. Pool of Italian Cancer Registries. Period 20052007
SITE
Upper respiratory and digestive tract cancers
Stomach
Colorectum
Liver
Pancreas
Lung
Melanoma of skin
Breast
Corpus uteri
Ovary
Prostate
Kidney and other urinary cancer
Bladder
Thyroid
Hodgkin’s lymphoma
All cancers except non melanoma skin cancer
MALE
From: “I numeri del cancro in Italia 2011”.
www.registritumori.it/PDF/AIOM2011/I_numeri_del_cancro_2011.pdf (modified)
FEMALE
71
38
25
40
50
10
269
33
94
51
1184
110
3
344
82
45
112
67
44
513
32
897
104
244
306
897
152
6
Five most frequently diagnosed cancer and percentage on the overall
number of cases (excl. non-melanoma skin cancer). Pool of Italian cancer
registries. Period 2005-2007, by gender and age-classes
Males
1°
2°
3°
4°
5°
Females
0-49
50-69
70+
0-49
50-69
70+
Testis
(11%)
Melanoma
(10%)
Colorectum
(8%)
Non-Hodgkin
lymphoma
(8%)
Thyroid
(6%)
Prostate
(22%)
Colorectum
(15%)
Lung
(14%)
Bladder
(10%)
Prostate
(21%)
Lung
(17%)
Colorectum
(15%)
Bladder
(11%)
Breast
(40%)
Thyroid
(13%)
Melanoma
(8%)
Cervix uteri
(6%)
Breast
(35%)
Colorectum
(13%)
Corpus uteri
(7%)
Lung
(6%)
Breast
(20%)
Colorectum
(17%)
Lung
(7%)
Stomach
(6%)
Upper respiratory
and digestive tract
(5%)
Stomach
(6%)
Colorectum
(5%)
Thyroid
(4%)
Pancreas
(5%)
From: http://www.registri-tumori.it/cms/node/2172. (modified)
Melanoma: Italy. Incidence rates (Eu. Stand. Per 100 000) by geographical
area and sex. Pool of Italian Cancer Registries. 2005-2007
14.31
13.54
12.27
12.18
6.44
Nord
Center
Males
6.11
South
Females
From: www.registri-tumori.it/PDF/AIOM2011/I_numeri_del_cancro_2011_+_errata_corrige.pdf (modified)
Skin melanoma. Relative survival (%), 2000-2004. Male & female. Pool of 31
cancer registries. Italy
96
89
85
1 year
3 years
From: Epidemiol Prev 2011; 35 (5-6) suppl 3: 1-200 (Modified)
5 years
Incidence and mortality cancer trends, 1998-2005. Annual percent change. Pool of Italian cancer registries
Site
Upper respiratory and digestive tract cancers
Oesophagus
Stomach
Colorectum
Liver
Gallbladder
Pancreas
Lung
Melanoma of skin
Non melanoma skin cancer
Mesothelioma
Soft tissue cancer
Kaposi’s sarcoma
Breast
Cervix uteri
Corpus uteri
Ovary
Prostate
Testis
Kidney and other urinary cancer
Bladder
Brain
Thyroid
Hodgkin’s lymphoma
Non-Hodgkin lymphoma
Multiple myeloma
Leukaemia
All cancers except non melanoma skin cancer
Males
Incidence
Mortality
Females
Incidence
Mortality
-3.2
-3.4
+1.4
+1.4
-1.9
-2.5
-0.1
+1.0
-3.3
-3.5
-3.5
+0.8
a) -2.1
b) -8.2
-0.5
+0.6
-1.4
-0.7
-1.2
-1.0
-1.3
-0.2
+03
-2.0
-0.2
+0.3
-0.1
+0.3
-2.6
-2.3
c) +2.1
d) -0.2
+1.3
+3.8
+2.6
+1.9
-0.3
-0.7
+0.8
-0.1
+5.7
+1.1
+2.9
+1.5
+1.3
-1.4
-4.8
+0.1
-1.1
-6.0
e) +3.4
f) -0.4
-3.4
-1.0
+0.9
+0.3
-1.2
-1.4
+0.5
-3.8
a) +7.3
b) +3.4
+4.5
-1.7
+1.6
+0.3
-0.4
+1.1
-0.8
-1.9
-0.4
-1.6
-0.3
+0.1
+0.7
+1.0
c) +10.0
d) + 4.2
+1.1
-0.9
+7.1
-3.4
-0.3
+2.1
-2.1
e) +4.2
f) -1.1
-2.0
-3.2
-0.2
-2.2
-0.6
-0.9
-0.3
-2.9
-1.9
-1.4
-0.4
+0.3
-1.7
+0.3
-0.8
Statistically significant increase of the estimated annual percent change
Statistically significant decrease of the estimated annual percent change
Years: a)1998-2003, b)2003-2005; c)1998-2001, d)2001-2005; e)1998-2000, f)2000-2005.
From: www.registri-tumori.it/PDF/AIRTUM2009Trend/E&P33_4-5S1_19_trend.pdf (modified)
Prevalence, Italy, 01.01.2006. Number of subjects by cancer site. Male &
female. Pool of Italian Cancer Registries.
Female breast
522235
Colon and rectum
296687
Bladder
223533
Prostate
216716
Head and neck
106727
Non-Hodgkin Lymphoma
95250
Corpus uteri
91689
Kidney and other urinary organ
84413
Thyroid
81131
SKIN MELANOMA
80802
Trachea, bronchus and lung
75365
Stomach
69225
Larynx
54650
Cervix uteri
53361
Leukaemias
51378
*cancer site with N. subjects ≥ 50 000)
From: www.registri-tumori.it/cms/?q=Rapp2010 (Modified)
World burden of skin cancers: summary results for the year 2000
Disease
*DALYs (000)
Incident cases
Deaths
Melanoma
690.248
65 161
211 921
Squamous cell carcinoma
161.892
13 534
2 883 037
57.983
3245
10 532 711
910.123
81 940
13 627 669
Basal cell carcinoma
Total
*disability-adjusted life year
From: www.who.int/uv/publications/solaradgbd/en/index.html
Risk Factors for cutaneous melanoma
Constitutional features
Behavioural features





Phototype (I, II, III)
Hair colour (Red, Blond, Light Brown)
Skin colour (Light colour)
Eye colour (Blue, Green, Hazel)
Naevi (Atypical naevi, number of
naevi)
 Freckles (High density)
 Sun exposure (Intermittent, Chronic)
 Sun exposure (In childhood, In
Adulthood)
 Use of indoor tanning equipment
Personal history
 Actinic damage indicators
 Family history
Melanoma prevention practices
•
•
•
•
Seeking shade
Wearing broad spectrum sunscreen
Covering up with a shirt and/or a hat
Wearing sunglasses
Early detection pratices
• Skin self-examinations
• Examinations by medical professionals
Skin cancer risk factors in childhood: findings of a
survey in an Italian area characterized by an atypical
migration (A)
Objective: to evaluate the association of different phenotypes
with sun sensitivity factors, sun protection behavior and
ethnicity in school-age children.
Design: cross sectional study in the framework of a survey of
children using a self-administered questionnaire.
Setting and participants: 35 412 children attending primary
schools in the provinces of Latina and Rome, located in the Lazio
region (Italy), in the 1998-2001 time period.
From: Ramazzotti V et al. Epidemiol Prev. 2009 Jan-Apr;33(1-2):45-50. (Modified)
Skin cancer risk factors in childhood: findings of a
survey in an Italian area characterized by an atypical
migration (B)
Results
«FOTO positive» phenotype was directly associated with:
•the tendency to sunburn (OR 4.64; 95% CI 4.39-4.89)
•the presence of freckles on the face (OR 1.65; 95% CI 1.55-1.77)
•the presence of naevi on the left forearm (OR 1.18; 95% CI 1.12-1.25)
•the number of grandparents born in northern areas (OR 1.54; 95% CI 1.15-2.07, for
four northern grandparents versus none)
•the residence in Latina Province (OR 1.13; 95% CI 1.07-1.20)
•the use of sunscreens (OR 1.70; 95% CI 1.55-1.88)
«FOTO positive» phenotype was inversely associated with
•the male sex (OR 0.91; 95% CI 0.86-0.96)
•the increase of school-class level (OR 0.66; 95% CI 0.61-0.72, for the highest versus
the lowest school-class level)
•the ability to tan (OR 0.38; 95% CI 0.34-0.42)
From: Ramazzotti V et al. Epidemiol Prev. 2009 Jan-Apr;33(1-2):45-50. (Modified)
Sun protection behavior in primary school children: comparison between pre- and
post-intervention results. Valencia, Spain; 2007 - 2008
_______________________________________________________________________________________
Characteristics
Baseline (%)
Post-intervention (%)
p value
_______________________________________________________________________________________
Sun avoidance at midday
Never/rarely/sometimes
65
80
0.01
Often/always
35
20
Sunscreens
Sometimes/often
31
28
0.61
Always
69
72
High-SPF sunscreens
Rarely/sometimes/often
28
23
0.80
Always
72
77
High-SPF, all days
Rarely/sometimes/often
47
43
0.99
Always
53
57
Timing sunscreens
20 min before sun exposure
63
70
0.42
At/during exposure
37
30
Sunscreen re-application
Rarely/sometimes
47
37
0.28
Often/always
53
63
Hats
Never/rarely/sometimes
37
45
0.23
Often/always
63
55
T-Shirt
Never/rarely/sometimes
39
47
0.99
Often/always
61
52
Sunglasses
Never
45
36
0.69
Rarely/sometimes/often/always
55
64
Sunburns in the last summer
No
81
91
0.15
Yes
19
9
____________________________________________________________________________________
Cercato MC, Nagore E, Ramazzotti V, Sperduti I, Guillén C. Improving sun-safe knowledge, attitude and
behaviour in parents of primary school children: a pilot study. J Cancer Educ. 2013 Mar;28(1):151-7
CDKN2A
• 5% - 10% of all melanomas are hereditary
– Of those
Up to 40% are explained by mutations in the
Cyclin-dependent kinase inhibitor 2°
CDKN2A
Cancer Epidemiol Biomarkers Prev. 2013 Apr;22(4):607-14
In USA individuals positive for a mutation in
CDKN2A have a
76% estimated lifetime risk
of developing melanoma
(lifetime risk in the general population: 2%)
Cancer Epidemiol Biomarkers Prev. 2013 Apr;22(4):607-14
MC1R
Variants in
melanocortin- 1 receptor (MC1R) gene
confer risk of melanoma
(to a lesser degree of a mutation in CDKN2A)
Risk by MC1R is greater in individuals with
darker
hair
hyes
skin color
Cancer Epidemiol Biomarkers Prev. 2013 Apr;22(4):607-14
Use of genetic testing and counseling
for melanoma risk: effects (a)
Will individuals who test positive for genetic
mutations increase their sun avoidance and
skin examination behaviors?
Cancer Epidemiol Biomarkers Prev. 2013 Apr;22(4):607-14
Use of genetic testing and counseling
for melanoma risk: effects (b)
Will individuals who test negative (or
inconclusive) for mutations be less vigilant
because of a reassurance effect?
Cancer Epidemiol Biomarkers Prev. 2013 Apr;22(4):607-14
Aspinwall LG et al. CDKN2A genetic test reporting improves
early detection intentions and practices in high-risk
melanoma families.
•
•
Total body skin examinations by medical professional
Skin self-examinations
In n. 77 individuals with:
 CDKN2A (+) and personal history of melanoma;
 CDKN2A (+) and no personal history of melanoma;
 CDKN2A (-);
This group reported a significant increase in monthly skin selfexamination intentions and behaviors at follow up
Cancer Epidemiol Biomarkers Prev 2008; 17(6): 1510 - 1519
Bergernmar M et al. Family members’perceptions of genetic testing
for malignant melanoma – A prospective interview study.
In 11 unaffected members of melanoma-prone families
Measurement of:



1.
2.
3.
4.
Anxiety and depression
Risk perception
Sun-related habits
Before
At disclosure
Six months after disclosure
On year post-disclosure
CDKN2A Genetic test Results
Disclosure of genetic test results did not change perceived risk for
melanoma
Eur J Oncol 2002; 3(11): 653-654
Glanz KL et al. Melanoma Genetic Testing, Counseling, and
Adherence to Skin Cancer Prevention and Detection Behaviors (A)
Randomized control trial
Two groups of individuals (73 adults) in hereditary melanoma families
A.
B.


Individuals enrolled in melanoma families (a. three or more cases of melanoma on the
same side of family; b. two or more cases in first degree relatives)
All participants completed a full body skin examination of moles and provided a blood
and/or buccal swab sample for CDKN2A and MC1R genotyping
Intervention group: offering genetic counseling and test results (35 individuals)
Control group: not offering genetic counseling and test results (38 individuals)
1.
Baseline Survey (see specific items)
2.
Genetic counseling session with a genetic counselor
3.
Follow-up survey (for months after)
Cancer Epidemiol Biomarkers Prev. 2013 Apr;22(4):607-14
Glanz KL et al. Melanoma Genetic Testing, Counseling, and Adherence to
Skin Cancer Prevention and Detection Behaviors (B)
Aims: to investigate the effect of offering genetic counseling and
testing on:
 Behavior
 Attitudes
 Perceived risk of melanoma
 Current and intended sun avoidance/protection
 Skin examination behaviors
Cancer Epidemiol Biomarkers Prev. 2013 Apr;22(4):607-14
Differences between intervention and control groups
at baseline
p-value
Age
NS
% High risk
NS
% Previously diagnosed melanoma
NS
% Ever getting genetic testing
NS
% With a family member who had ever had genetic testing
NS
__________________________________________________________________
I
C
% Female
80.0
57.9
0.04
% BMI overweight/obese
40.0
65.8
0.03
% Family history of melanoma (other than self)
25.7
52.6
0.03
% Very good or excellent self rated health
88.5
52.7
0.01
Cancer Epidemiol Biomarkers Prev. 2013 Apr;22(4):607-14
Changes in Behaviors in Behaviors and Attitudes from
Baseline to Follow-Up (1 a)
Prevention & Detection Behaviors
p-value
_______________________________________________________________
Sun Protection Habits
NS
Wear Sunscreen
NS
Wear Sunglasses
NS
Seek Shade
NS
Wear a Hat
NS
Limit Hours in the Sun
NS
Skin Examination by a Medical Professional
NS
Sun Exposure: Weekday
NS
Sun exposure: Weekend
NS
Sunburn Frequency
NS
Cancer Epidemiol Biomarkers Prev. 2013 Apr;22(4):607-14
Changes in Behaviors in Behaviors and Attitudes from
Baseline to Follow-Up (2)
Perceptions and Beliefs
p-value
______________________________________________________________
Perceived Skin Cancer Risk
NS
Perceived Benefits of Sun Protection
NS
Perceived Barriers to Sun Protection
NS
Awareness of Genetic Counseling
NS
Perceived Benefits of Genetic Counseling
NS
Cancer Epidemiol Biomarkers Prev. 2013 Apr;22(4):607-14
Changes in Behaviors and Attitudes from Baseline to
Follow-Up (1 b)
Prevention &
Detection Behaviors Score
Mean SD
p-value
I
C
______________________________________________________________
a)Wear Shirt
(1-4)
Baseline
2.80
3.00
Follow-up 2.60
2.39
0.047
_____________________________________________________________________
b)Skin Self - Examination (1-4)
Baseline 1.89
1.71
Follow-up 1.23
1.84
0.002
_____________________________________________________________________
a) Higher scores = greater frequency of the behavior
b) Lower scores = more recent self examination
Cancer Epidemiol Biomarkers Prev. 2013 Apr;22(4):607-14
Conclusions
Feedback of CDKN2A and MC1R genotype
“does not appear to decrease sun protection
behaviors”
also among families without known pathogenic
CDKN2A mutations
Cancer Epidemiol Biomarkers Prev. 2013 Apr;22(4):607-14