ABSTRACT
Background and aim: Because of COVID-19 pandemic several healthcare activities were temporarily ceased during the two epidemic waves. However all urgencies, as well as oncological services, including screening colonoscopy following positive fecal occult blood test (FOBT), were always guaranteed, except in the first phase. The aim of this study is to quantify the impact of COVID-19 pandemic on colonoscopy and colorectal cancer surgical activities, analysing the reduction of screening activity. Materials and methods: We analysed retrospectively colorectal= cancer screening, colonoscopy and colorectal cancer surgical interventions from January to November 2020, compared to the average of the same period in 2018 and 2019. Data was extracted from the regional screening database, hospital discharge records and regional digital archives of outpatient services. ᵪ2 test was used to compare the reduction of screening and non-screening colonoscopies. Results: 453,877 people were invited to participate in the FOBT, within the regional colorectal cancer screening programme, 115,976 fewer than the previous two years (-20.4%), with an adherence rate that dropped from 65.2% to 54.2%. The monthly reduction of screening participants was greater than the reduction of people invited to the screening programme and most marked in April (-86.8%) and May (-81.0%). Colonoscopies fell by 22.2% (67,138 in 2020 Vs. 86,298 for the 2018-2019) and it reached its lowest in April (-70.4%). The reduction was of 13.1% for screening colonoscopies following a positive FOBT, and 24.9% for non-screening colonoscopies (p<0.001). Surgical interventions were strongly reduced as well, from a yearly average of 2,466 to 2,250 colorectal cancer surgical procedures in 2020 (-8.7%), with the lowest rate in April and May, respectively -17.4% and -34.9%. Conclusions: COVID-19 pandemic markedly reduced colorectal cancer screening activity, to the point that regional screening programmes were not able to completely recover the work lost during the first epidemic wave. Following the reduction of FOBT, also colonoscopy and colorectal cancer surgical interventions decreased during the epidemic wave and, up to November 2020, these healthcare services did not completely recover the lost work either. Nevertheless, considering the greater reduction of non-screening compared to screening colonoscopies, colorectal cancer screening seems to play a pivotal role in limiting the decrease of endoscopic and surgical interventions
ABSTRACT
Objective: The detection and treatment of high-grade cervical lesions prevent the development of invasive cervical cancer. Excisional procedures can pose a risk for subsequent pregnancies, thus conservative management of Cervical Intraepithelial Neoplasia grade 2 (CIN2) lesions should be adopted in young women. The aim of our study is to evaluate the ability of viral and cellular biomarkers in predicting regression/progression of CIN2. Methods: Women aged 25 to 45 years, participating to population-based organised cervical cancer screening programmes in the Veneto Region (Italy), diagnosed with a CIN2 lesion and fitting predefined inclusion/exclusion criteria, are invited to take part in a multicentre observational longitudinal cohort study with a follow-up of 24 months. Upon signing an informed consent, women are enrolled in the study and cervical cell samples collected. Treatment is delayed and subsequently performed in the case of lesion progression, or persistence for >12 months. HPV genotyping, p16(INK4A)/ki67 expression and methylation status for L1 viral sequences and FAM19A4/miR124-2 cellular genes are determined at baseline and during follow-up, and evaluated in relation to the clinical outcome. Results: The study, registered on Clinical Trials.gov (ID: NCTo4687267), is currently ongoing. Enrolment of women aged 25-45 years started in 2019, and will continue up to the end of 2021. Discussion: Since February 2020, the Veneto Region has been hit by the COVID-19 pandemic. The enrolment of women in the study was interrupted during an initial two-month lockdown, and slowed down during the subsequent months. The12-month extension of the study period will partially counterbalance this delay.
ABSTRACT
Background: Veneto was one of the Italian regions hit hardest by the early phase of the coronavirus disease (COVID-19) pandemic. Aim: This paper describes the public health response and epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in the Veneto Region from 21 February to 2 April 2020. Methods: Information on the public health response was collected from regional health authorities' official sources. Epidemiological data were extracted from a web-based regional surveillance system. The epidemic curve was represented by date of testing. Characteristics of hospitalised COVID-19 cases were described and compared to those never admitted to hospital. Age- and sex-stratified case fatality ratios (CFRs) were calculated. Results: Key elements of the regional public health response were thorough case-finding and contact tracing, home care for non-severe cases, creation of dedicated COVID-19 healthcare facilities and activation of sub-intensive care units for non-invasive ventilation. As at 2 April 2020, 91,345 individuals were tested for SARS-CoV-2 and 10,457 (11.4%) were positive. Testing and attack rates were 18.6 per 1,000 and 213.2 per 100,000 population, respectively. The epidemic peaked around 20 to 24 March, with case numbers declining thereafter. Hospitalised cases (n=3,623;34.6%) were older and more frequently male compared with never-hospitalised cases. The CFR was 5.6% overall, and was higher among males and people > 60 years of age. Conclusion: In the Veneto Region, the strict social distancing measures imposed by the Italian government were supported by thorough case finding and contact tracing, as well as well-defined roles for different levels of care.
ABSTRACT
BACKGROUND: Cell entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) depends on binding of the viral spike (S) proteins to angiotensin-converting enzyme 2 and on S protein priming by TMPRSS2. Inhibition of TMPRSS2 may work to block or decrease the severity of SARS-CoV-2 infections. Intriguingly, TMPRSS2 is an androgen-regulated gene that is up-regulated in prostate cancer where it supports tumor progression and is involved in a frequent genetic translocation with the ERG gene. First- or second-generation androgen-deprivation therapies (ADTs) decrease the levels of TMPRSS2. Here we put forward the hypothesis that ADTs may protect patients affected by prostate cancer from SARS-CoV-2 infections. MATERIALS AND METHODS: We extracted data regarding 9280 patients (4532 males) with laboratory-confirmed SARS-CoV-2 infection from 68 hospitals in Veneto, one of the Italian regions that was most affected by the coronavirus disease 2019 (COVID-19) pandemic. The parameters used for each COVID-19-positive patient were sex, hospitalization, admission to intensive care unit, death, tumor diagnosis, prostate cancer diagnosis, and ADT. RESULTS: There were evaluable 9280 SARS-CoV-2-positive patients in Veneto on 1 April 2020. Overall, males developed more severe complications, were more frequently hospitalized, and had a worse clinical outcome than females. Considering only the Veneto male population (2.4 million men), 0.2% and 0.3% of non-cancer and cancer patients, respectively, tested positive for SARS-CoV-2. Comparing the total number of SARS-CoV-2-positive cases, prostate cancer patients receiving ADT had a significantly lower risk of SARS-CoV-2 infection compared with patients who did not receive ADT (OR 4.05; 95% CI 1.55-10.59). A greater difference was found comparing prostate cancer patients receiving ADT with patients with any other type of cancer (OR 4.86; 95% CI 1.88-12.56). CONCLUSION: Our data suggest that cancer patients have an increased risk of SARS-CoV-2 infections compared with non-cancer patients. However, prostate cancer patients receiving ADT appear to be partially protected from SARS-CoV-2 infections.