2023-12-12 11:36:47
by Health Editorial Staff
Screening in decline: in Northern Italy mammography coverage decreased from 63% to 54% and colorectal testing from 45% to 38%. In the female population, deaths from lung cancer are rising: 16% more than expected
In 2023, new cancer diagnoses in Italy will be 395 thousand: 208 thousand in men and 187 thousand in women. In 2020 there were 376 thousand: three years later, and with the Covid pandemic in the middle, there are almost 20 thousand more cancer cases in our country. Not only. Over the next two decades the number of new oncological diagnoses will increase, on average (each year) by 1.3% in men and by 0.6% in women. Oncology is making enormous progress and cancer is increasingly a curable disease: in 13 years, from 2007 to 2019, 268,471 deaths were avoided. Many patients recover and return to their previous lives, thanks also to the law on oncological oblivion which was definitively approved by the Senate a few days ago. However, there are black holes, areas in which no improvements are recorded: tumors caused by cigarette smoking in women and pancreatic cancer in both sexes.
The photograph taken in the volume The numbers of cancer in Italy 2023, presented at the Istituto Superiore di Sanit. the 13th edition of the official census dedicated to the diagnosis and treatment of neoplasms, carried out by the Italian Association of Medical Oncology (Aiom), the Italian Association of Tumor Registries (Airtum), the Aiom Foundation, the National Screening Observatory (Ons), Passi (Progress of the Health Authorities for Health in Italy), Passi d’Argento and the Italian Society of Pathological Anatomy and Diagnostic Cytology (Siapec-Iap).
Bad habits
The most frequently diagnosed cancer in 2023 is breast cancer (55,900 cases), followed by colorectal (50,500), lung (44,000), prostate (41,100) and bladder (29,700). In men, prostate cancer is the most frequent cancer (19.8% of all male cancers), followed by lung cancer (29,800 new cases in 2023), colorectal cancer (26,800) and bladder cancer (23,700). Breast cancer is the most frequent in women (30% of all female cancers), followed by colorectal-anal cancer (23,700 new cases), lung (14,000) and endometrial cancer (10,200). Numbers that make us understand how it is necessary to commit more to prevention. 24% of Italian adults smoke, 29% are sedentary, 33% are overweight and 10% obese, 17% consume alcohol in quantities that are risky for their health. Furthermore, at a national level, there is a 3% drop in the coverage of mammography and colorectal screening (2022 data). The decrease is drastic in the North, where compliance with mammography went from 63% in 2021 to 54% in 2022 and compliance with colorectal screening from 45% to 38%.
It is necessary to continue working to strengthen the culture of primary and secondary prevention, starting from the youngest – writes the Minister of Health Orazio Schillaci in the preface of the book -: from the adoption of healthy lifestyles to reduce individual risk factors to the promotion of screening, increasing coverage levels, reducing territorial heterogeneity and opening up the prospect of extending them to tumors currently not included in national programmes.
Cure innovative
It is essential to guarantee all patients the increasingly innovative treatments that scientific research makes available – adds Saverio Cinieri, president of the Aiom Foundation -. Some clinical situations, for which up until a decade ago the therapeutic options were very limited, today involve a sequence of several lines of treatment. Suffice it to mention kidney cancer, prostate cancer or hepatocellular carcinoma. Molecular characterization, in addition to the classic histological diagnosis, is necessary in all cases for which targeted therapies are available in clinical practice. However, progress in diagnosis is not always implemented with the same timeliness in all centres. We must commit ourselves to continuing to keep the level of the National Health System high, which remains one of the best in the world, and to further consolidate the collaboration between institutions, clinicians and patients, so that the differences in healthcare that still exist today in various areas of the world are overcome. our country.
Lung cancer
Progress in treatment translates into a reduction in mortality. In both sexes, the number of deaths caused by all tumors was lower than the expected number every year, from 2007 to 2019 – underline Fabrizio Stracci, president of Airtum, and Diego Serraino, director of Oncological Epidemiology and Tumor Registry of Friuli Venezia Giulia, Centro of Oncology Reference IRCCS, Aviano —. The most striking data concerns mortality from lung cancer, caused in more than 80% of cases by tobacco smoking. In men, 36.6% of cancer deaths avoided in the period 2007-2019 linked to the progress made in the fight against smoking, as well as to improved diagnostic-therapeutic-care practices. In women, with equal diagnosis and treatment opportunities, an excess of 16,036 deaths from lung cancer was documented, 16% more than expected. A picture that reflects gender diversity in the spread of the habit of smoking over time and which suggests the opportunity to forcefully continue the fight against smoking.
Risk factors
Not only. In both sexes, the number of deaths from pancreatic cancer or melanoma remained consistently higher than expected. A situation which partly reflects the increased incidence attributable to individual risk factors: tobacco smoking, overweight, obesity and diabetes for pancreatic cancer and exposure to sunlight for melanoma.
The smoking habit is more frequent among men, among the youngest, in the Center-South and is strongly associated with social disadvantage, because it is more widespread among people with many economic difficulties or less educated – says Maria Masocco, scientific manager of the surveillance systems Passi and Passi D’Argento, coordinated by the Istituto Superiore di Sanit -. Sedentary lifestyle is more frequent among women, increases with age and draws a clear geographical difference to the detriment of the Southern Regions (42% compared to 17% in the North). This bad habit has increased significantly, going from 23% in 2008 to 29% in 2022. Even excess weight, which affects more than 4 out of 10 adults, has the highest values in the Southern Regions. One in 6 citizens consumes alcohol risky levels for health, due to quantity or method of intake. Unlike other risk factors, alcohol consumption is more frequent among the wealthier social classes, without economic difficulties or with high levels of education.
Screening cervicale
The challenge of secondary prevention also remains open. The data updated to 2022 show, as regards mammographic and colorectal screening, a considerable and generalized difficulty in maintaining the performances observed in 2021. In many cases it can be said that the effects of the pandemic will also have repercussions in 2022 – explains Paola Mantellini, director of the National Screening Observatory —. Cervical screening shows a slightly different trend, with overall pre-pandemic values around 39%, a decline to 23% in 2020, a coverage level of 35% in 2021 and a further advance of 41% in 2022. In 2022, the improvement in coverage compared to 2021 is, at least in part, due to the greater extension of invitations to the population with a simultaneous transition from Pap tests to HPV tests starting from 30 years of age.
Pollution and tumors
We have an important challenge ahead: by 2025, screening must be offered to at least 90% of those eligible throughout the European Community – concludes Francesco Perrone, president of Aiom -. Unfortunately we don’t have much time and without a major advance from the South we will not be able to reach this goal. For screening to be effective, it is necessary for the population to participate: it is more necessary than ever to adopt permanent awareness campaigns combined with a widespread and usable offer. Prevention also includes actions to combat air pollution. There are more and more studies demonstrating the link between poor air quality and tumors. Italy, in particular the Po Valley, has the highest levels of particulate pollution in Europe. Unfortunately, political sensitivity on these issues in our country still seems to be very limited.
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December 12, 2023 (modified December 12, 2023 | 10:37)
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