Overweight, smoking, physical inactivity and alcohol increase the risk and are increasingly widespread. Few compatriots take the (free) exams to find early stage neoplasms and then there is the negative impact of the pandemic
Cases of cancer are increasing in our country (if any have been registered almost 400 thousand in 2022): however, considering that tumors are more frequent pathologies after the age of 65, the growth appears mostly connected to the general aging of the Italian population. And if there is good news regarding the resumption of screening programmes, which have returned to pre-pandemic levels (that is, compatriots have resumed carrying out tests recommended for early diagnosis: breast mammography, tests for the search for occult blood in feces for the colorectal and Pap test or HPV-DNA test for the cervix), there is a front that worries specialists a lot: bad habits. 33% of adults are overweight and 10% obese, 24% smoke and sedentary have increased from 23% in 2008 to 31% in 2021. Unhealthy lifestyles are increasingly widespread and the Italian data is increasingly alarming: more of one in three cancer cases could be avoided and prevented only by avoiding these dangerous behaviors stresses Saverio Cinieripresident of the Italian Association of Medical Oncology (Aiom) during the presentation of Cancer numbers in Italy 2022 at the Ministry of Health.
The most frequent types of cancer
The official census every year photographs the oncological reality in our country and describes the aspects relating to the diagnosis and therapy of neoplasms thanks to the work of Aiom, Airtum (Italian Association of Cancer Registries), the Aiom Foundation, the National Screening Observatory (Ons), Passi (Progressi of healthcare companies for health in Italy), Passi d’argento and the Italian Society of Pathological Anatomy and Diagnostic Cytology (Siapec-Iap). The estimated new cases of cancer in 2022 are 390,700, 205,000 in men (compared to 194,700 cases diagnosed in 2020) e 185,700 in women (181,900 in 2020). In two years, the increase was 14,100 cases. The most frequent tumors are those of the breast (55,700 new cases, an increase of 0.5% compared to 2020), colorectal (48,100 new cases, +1.5% in men and +1.6% in women), lung (43,900 new cases, +1.6% in men and +3.6% in women), prostate (40,500 new cases, +1.5%) e bladder (29,200 new cases, +1.7% in men and +1.0% in women). In men, the most common neoplasms are: prostate (40,500 new diagnoses in 2022), lung (29,300), colorectal (26,000), bladder (23,300) and stomach (8,800). In women, however: breast (55,700 cases), colorectal (22,100), lung (14,600), endometrium (10,200) and thyroid (8,700).
The healed and the right to be forgotten
Recovering from cancer or living with a tumor for years, as happens with other chronic diseases, is now possible. It happens more and more often, even in Italy, where there are over three and a half million (3.6 million, 37% more than ten years earlier) people living after a cancer diagnosis, but only about one million ex cancer patients can be considered cured. The numbers make it possible to measure healing using specific indicators: the risk of death from cancer is highest in the first few years after diagnosis and then progressively decreases. A cured person is defined as having the same life expectancy as people of his or her age and gender who have never had cancer. In short, one is cured when the ex-patient’s chances of dying from the neoplasm are now almost nil and he or she returns to being the same as the rest of the population. In the vast majority of cases, a person free from disease more than ten years after the end of treatment can, in the absence of a recurrence, be considered cured – remember Giordano Beretta, president of the Aiom Foundation -. They are an exception to this rule some tumors in which the healing time is instead longer (for example breast, prostate and bladder, which are among the most frequent) e neoplasms arising in childhood and adolescence, in which five years can be enough to talk about healing. In Italy, recovered cancer patients, however, still risk encountering concrete difficulties when, for example, they try to take out life insurance or apply for a mortgage or bank loan. This is why it is essential to implement, also in Italy, a law on the right to be forgotten, following the example of other European countries.
Screenings for early diagnosis
The successes in healing and the increasing number of compatriots who live with a neoplasm that has become chronic even for many years are due to the new therapies developed thanks to scientific research, but also to the great progress made in early diagnosis. Healing is all the easier the sooner the disease is discovered: a tumor discovered in an early stage, small in size and confined to the organ (without metastases) is more likely to be cured definitively and without too invasive therapies. This is why adherence to screenings is fundamental – he says Paula Mantellini, director of the National Observatory screening -. The goal is not only to make up for the delays induced by the health emergency caused by Covid, but to obtain optimal coverage levels which, in certain areas of the country and for some programmes, were not achieved even before the pandemic. There are still too few Italians who take the exams offered free of charge by the National Health Service, which could save their lives. In fact, the volume shows that the Italian average value of the proportion of women who have undergone mammography compared to those entitled, which in 2020 stood at 30%, in 2021 returns in line (46.3%) with the coverage values of the period 2018-2019. For colorectal screening (search for occult blood in the stool) the overall value was around 30%, to decrease to 17% in 2020 and go back up to 30% in 2021. Cervical screening had pre-pandemic values around 38 -39%, a drop to 23% in 2020 and a coverage level of 35% in 2021.
Lifestyles
During the presentation of the volume to the Ministry of Health in Rome, the experts sounded the alarm for the worrying habits of the Italians: the situation destined to get significantly worse if a barrier to incorrect behavior is not put in place. The ‘Passi’ data on lifestyles confirm the non-optimal adherence of citizens to healthy habits – he clarifies Maria Masocco, scientific manager of the Passi and Passi d’Argento surveillance systems, coordinated by the Higher Institute of Health. From the analysis of the historical series of behavioral risk factors, it emerges that there hasn’t been much improvement in the past 15 years and, with the exception of the habit of cigarette smoking which has continued its slow reduction for over thirty years, risky alcohol consumption, physical inactivity and excess weightoverall, worsen or remain stable. Not only. In the midst of the pandemic, during the two-year period 2020-2021, these trends underwent changes mostly in a pejorative sense. The impact of the pandemic on lifestyles is more visible in 2020 and seems, in part, to return in 2021. But efforts to raise awareness of the importance of primary prevention must not stop.
Smoking and alcohol
In 2021 in Italy 24% of 18-69 year olds smoke and 16% are ex-smokers. Among smokers, one in four (22%) consumes more than a pack of cigarettes a day and smoking is more frequent among men than women, among the youngest, among residents of the Centre-South. Almost one in six adults (or 16% of citizens, especially males, very young people aged 18-24 and residing in the North) alcohol consumption that poses a greater risk to healthby quantity and/or method of intake: 8% for excessive episodic consumption, binge drinking (five or more units of alcohol, Ua, on a single occasion for men and four or more Ua for women), 8% for alcohol consumption exclusively/mainly between meals and 2% for high habitual consumption (three or more average units per day for men and two for women). A sedentary lifestyle also affects a third of citizens: more frequent among women (36% vs 27% among men), increases with age (26% among 18-34 year olds and 35% among 50-69 year olds), draws a clear geographical gradient against the South (43 % in the Southern Regions vs 19% in the North) and social disadvantage of people with greater economic difficulties (among which it reaches 45%) or low level of education. Finally, in 2021 more than four out of ten adults are overweight, obesity is slightly more frequent among men (11% vs 10% among women) and increases significantly with age.
The Covid impact
These numbers cannot but cause concern, if we consider that 40% of cases and 50% of cancer deaths can be avoided by intervening on preventable risk factors, especially on lifestyles – comments the Minister of Health Horace Schillaci —. As far as behavioral risk factors are concerned, the data collected during the two-year period 2020-2021 mark a moment of acceleration mostly in a pejorative sense. Furthermore, as emerges from the analysis, following decades characterized by considerable progress, the Covid-19 pandemic has brought about a setback in the fight against cancer, causing a sharp slowdown in Italy in diagnostic activities in the oncological field, with consequent increase in advanced forms of the disease. These delays will certainly influence the future incidence of neoplastic pathologies. A chapter of the book dedicated toimpact of Covid on cancer patients. In Italy, the pandemic has caused an increase in the mortality of cancer patients, especially in males, in old age, with cancer diagnosed less than two years ago and in hematological malignancies – they conclude Fabrizio Stracci, president of Airtum, and Diego Serraino, director of Oncological Epidemiology and Cancer Registry of Friuli Venezia Giulia, Oncological Reference Center, IRCCS of Aviano —. it is essential that fragile patients, including cancer patients, get vaccinated. In fact, a study of all residents in Friuli Venezia Giulia and in the province of Reggio Emilia has shown that the risk of death among individuals with a history of cancer and positive for Sars-CoV-2 infection is two to three times higher among unvaccinated versus vaccinated.
December 19, 2022 (change December 19, 2022 | 1:32 pm)
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