Incidence rates of lymphomas and environmental measurements of phenoxy herbicides: ecological analysis and case-control study.

The authors conducted an ecological study of the distribution of malignant lymphomas in a rice-growing area in northern Italy. They considered data on concentrations of phenoxy herbicides in soil and water and found the highest incidence of non-Hodgkin's lymphoma in subjects who lived in an area where 2,4-dichlorophenoxyacetic acid and 2,4,5-trichlorophenoxyacetic acid existed in very high concentrations. During 1985-1988, the incidence of non-Hodgkin's lymphoma in males in the most-polluted municipalities was twice as high as was noted for the remaining less-polluted territories. During 1991-1993, non-Hodgkin's lymphoma was higher by 60%. The authors also conducted a population-based case-control study. They found an association between employment of women in rice-growing jobs (particularly as rice weeders) and risk of non-Hodgkin's lymphoma (odds ratio=1.9; 95% confidence interval=0.6, 6.0). Work in rice fields was correlated strongly with residence in polluted areas. The authors did not detect an association between area of residence or occupation and incidence of Hodgkin's disease.

Incidence rates of leukemias, lymphomas and myelomas in Italy: geographic distribution and NHL histotypes.

The annual incidence of non-Hodgkin's lymphomas is increasing by 3 to 4% in different parts of the developed world, while rates for Hodgkin's disease, myelomas and leukemias are more stable. In the case of this group of malignancies, hypothesis generation on risk factors has been limited by the use of the ICD classification in mortality and incidence statistics. We have computed incidence rates in different Italian areas after careful re-classification of diagnoses, and considering specific histotypes (Working Formulation for NHL, Rye's classification for HD). While no particularly interesting pattern is suggested for Hodgkin's disease (even after considering specific Rye subgroups), multiple myeloma and leukemias, for non-Hodgkin's lymphomas the high rate in one agricultural area (Forli) was mainly due to the A sub-group in the Working Formulation (low-grade). In a heavily industrialized area (Varese), the high incidence rate was at least partly explained by a higher proportion of cases classified in the G sub-group (intermediate grade). Excesses of non-Hodgkin's lymphomas have been observed in populations exposed to phenoxy-acetic-acid herbicides, to insecticides and to organic solvents. One can hypothesize that different risk factors act on different stem cells and induce lymphoid malignancies belonging to different histologic sub-types.

[Epidemiology of malignant liver tumors]. / Epidemiologia dei tumori maligni del fegato.

Interpretation of descriptive statistics on liver cancer is affected by misclassification problems, evolving diagnostic procedures and changes in international classifications. Chronic infection with virus B and aflatoxin are major determinants for liver cancer in high-risk areas. In low and intermediate risk areas, including Italy, alcohol and cirrhosis are the most important risk factors. Preventive measures are neonatal vaccination against hepatitis B, reduction in aflatoxin contamination of foods, alcohol and tobacco consumption. Screening programs cannot be recommended as a measure of public health, particularly in western countries.

Diagnostic accuracy of primary liver cancer: implications for cancer registration.

AIMS AND BACKGROUND: We evaluated some standardized criteria for classifying incident cases of liver cancer into either primary liver cancer (PLC) or unspecified liver cancer (ULC) on the basis of the diagnostic examinations performed and their results. METHODS: A pilot hospital-based study (98 cases) was carried out in Verona, northern Italy, with the main aim of assessing the feasibility of the method. The same procedures were subsequently applied in a population-based study (349 cases) in Brescia, northern Italy. RESULTS: Diagnosis was made on histologic data in 38.7% and 41.8% of the hospital based and population-based studies, respectively, with a wide variation among different hospitals. The percentage of cases classified as PLC was 78.6% in the hospital-based study and 78.8% in the population-based study. No differences in the proportion of cases attributed to PLC were found according to patients' age and sex or hospital of admission. The repeatibility of the procedure was assessed by a cross-panel review of 198 cases, and concordance was found in 91.9% of them. CONCLUSIONS: An operational method for case definition of PLC based on the results of the diagnostic examinations currently performed and some suggestions for cancer registration are proposed.

Incident cases of primary liver cancer (PLC): proposal for the use of a standardised method in case-definition.

We defined some standardised criteria for classifying incident cases of liver cancer into either Primary Liver Cancer (PLC) or Unspecified Liver Cancer (ULC), on the basis of the diagnostic procedures performed. A pilot hospital-based study (98 cases) was carried out in Verona, northern Italy, in order to assess the feasibility of the method. The same protocol was subsequently applied in a population-based study (349 cases) in Bresica, northern Italy. The percentage of cases with histological verification was 38.7 and 41.8%, respectively, with a wide variation among different hospitals. The percentage of cases we attributed to the PLC category was 78.6% in the hospital-based study and 78.8% in the population-based study. No differences in the proportion of cases attributed to PLC were found according to patients' age, sex or hospital of admission. Repeatability of the method was assessed through a cross-panel review of 198 cases, with a 91.9% interobserver agreement. Implications of this method are discussed and some suggestions for cancer registration and future research are proposed.

pTNM stage distribution in breast cancer: a population-based survey in northern Italy. Collaborative Group of Pathologists for Cancer Registration in Verona.

AIMS AND BACKGROUND: The role of distribution by stage at diagnosis in breast cancer has been considered in many studies, with particular regard to evaluation of prognosis, impact of screening programs and quality of care. Nevertheless, international comparisons of descriptive data can be hampered by lack of homogeneity in staging methods. The TNM is presently the most common staging system used all over the world, although some criticism have been raised recently against its pragmatic value. The present study reports a population-based survey of pathologic TNM distribution in incident cases of female breast cancer in the Verona province, a geographical area of northern Italy covered by cancer registration. METHODS: All histologically proven incident cases of breast cancer were identified in the study period 1988-1990 and classified as for tumor size and nodal involvement according to the pathological TNM criteria. The type of surgical treatment was also registered for all cases diagnosed in 1990. RESULTS: one thousand two hundreds and fifty-four invasive and in situ breast cancers were observed and pT1 cases accounted for 44.4%. Nodal involvement was present in 41.5% of invasive cancers. A surgical treatment was performed in 1213 patients (96.7%). Axillary dissection was reported in 1080 cases, 820 of them (76.6%) having 10 or more lymph nodes examined. Radical mastectomy accounted for 74% of the 458 breast cancers diagnosed in 1990 and 31.6% of the eligible cases were conservatively treated. CONCLUSIONS: Cancer registries should be encouraged to report data on stage distribution in breast cancer (and in other malignancies). This practice could improve international comparisons and give an essential contribution to studies on survival, screening programs and quality of care.

Cancer registration: a feasibility study in northern Italy. The Collaborative Group of Pathologists for Cancer Registration in Verona.

A pilot study was carried out in the province of Verona, in the north-east of Italy, in order to assess the feasibility of establishing a population-based cancer registry in the area. The quality of routinely collected data, particularly histological diagnoses and hospital discharge codes, was evaluated for the year 1988. All the histologically confirmed incident cancers observed in the pathology departments of the study area were registered and compared to the expected cases. Moreover, computerised discharge codes were tested for accuracy in identifying hospitalised patients with cancer. Finally, the sensitivity of the two sources combined was measured (90.3%). This study could provide helpful information to cancer registries which intend to assess the quality of specific sources of data both for planning and periodical evaluation purposes.