Population-based method for investigating adherence to international recommendations for pathology reporting of primary cutaneous melanoma: Results of a EUROCARE-5 high resolution study.

AIM: Our study aim was to investigate the degree of adherence to international recommendations for cutaneous melanoma pathology reports at the population level by a EUROCARE high resolution study. METHODS: The availability of nine characteristics - predominant cell type, tumour-infiltrating lymphocytes, mitotic index, histological subtype, growth phase, Clark level, Breslow thickness, ulceration, and sentinel-node biopsy - was examined on pathology reports of a random sample of 636 cases diagnosed in 2003-2005 in seven Italian cancer registries: Biella, Ferrara, Firenze, Latina, Ragusa, Reggio Emilia, Romagna. The odds of having (versus not having) information for all four core characteristics (last four listed above) were estimated. RESULTS: Sentinel node biopsy was available most often, followed by Clark level, Breslow thickness, histological subtype and ulceration. Information on all nine characteristics was more often available in Biella and Ferrara (northern Italy) than elsewhere. Information on all four core items was available for 78% of cases. Odds of four-core-item availability were higher (than mean) in Biella and lower in Latina (centre) and Ragusa (south). CONCLUSIONS: The availability of information important for staging and management was good overall on pathology reports, but varied with geography. It is likely to be improved by wider dissemination of reporting guidelines and adoption of a standardised synoptic reporting system.

Regional inequalities in cancer care persist in Italy and can influence survival.

BACKGROUND: Population-based cancer registry studies of care patterns can help elucidate reasons for the marked geographic variation in cancer survival across Italy. The article provides a snapshot of the care delivered to cancer patients in Italy. METHODS: Random samples of adult patients with skin melanoma, breast, colon and non-small cell lung cancers diagnosed in 2003-2005 were selected from 14 Italian cancer registries. Logistic models estimated odds of receiving standard care (conservative surgery plus radiotherapy for early breast cancer; surgery plus chemotherapy for Dukes C colon cancer; surgery for lung cancer; sentinel node biopsy for >1mm melanoma, vs. other treatment) in each registry compared to the entire sample (reference). RESULTS: Stage at diagnosis for breast, colon and melanoma was earlier in north/central than southern registries. Odds of receiving standard care were lower than reference in Sassari (0.68, 95%CI 0.51-0.90) and Napoli (0.48, 95%CI 0.35-0.67) for breast cancer; did not differ across registries for Dukes C colon cancer; were higher in Romagna (3.77, 95%CI 1.67-8.50) and lower in Biella (0.38, 95%CI 0.18-0.82) for lung cancer; and were higher in Reggio Emilia (2.37, 95%CI 1.12-5.02) and lower in Ragusa (0.27, 95%CI 0.14-0.54) for melanoma. CONCLUSIONS: Notwithstanding limitations due to variations in the availability of clinical information and differences in stage distribution between north/central and southern registries, our study shows that important disparities in cancer care persist across Italy. Thus the public health priority of reducing cancer survival disparities will not be achieved in the immediate future.

[Skin cancer risk factors in childhood: findings of a survey in an Italian area characterized by atypical migration]. / Infanzia e fattori di rischio per tumori della cute: risultati di un'indagine in un'area italiana oggetto di una migrazione atipica.

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: 35412 children attending primary schools in the provinces of Latina and Rome, located in the Lazio region (Italy), in the 1998-2001 time period. MAIN OUTCOME MEASURES: Odds Ratios (ORs) and their relative 95% Confidence Intervals (95% CI) computed through univariate and multivariate logistic regression models. RESULTS: "FOTO positive" phenotype, a proxy variable of the fair phenotype, was directly and significantly 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), 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) and the use of sunscreens (OR 1.70; 95% CI 1.55-1.88). An inverse association was observed 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) and the ability to tan (OR 0.38; 95% CI 0.34-0.42). CONCLUSION: These findings confirmed that fairness of phenotype is associated in children with other skin cancer risk factors as well as ethnicity and parents' sun protection behavior.