ITALIAN CANCER FIGURES - REPORT 2015: The burden of rare cancers in Italy = I TUMORI IN ITALIA - RAPPORTO 2015: I tumori rari in Italia

OBJECTIVES: This collaborative study, based on data collected by the network of Italian Cancer Registries (AIRTUM), describes the burden of rare cancers in Italy. Estimated number of new rare cancer cases yearly diagnosed (incidence), proportion of patients alive after diagnosis (survival), and estimated number of people still alive after a new cancer diagnosis (prevalence) are provided for about 200 different cancer entities. MATERIALS AND METHODS: Data herein presented were provided by AIRTUM population- based cancer registries (CRs), covering nowadays 52% of the Italian population. This monograph uses the AIRTUM database (January 2015), which includes all malignant cancer cases diagnosed between 1976 and 2010. All cases are coded according to the International Classification of Diseases for Oncology (ICD-O-3). Data underwent standard quality checks (described in the AIRTUM data management protocol) and were checked against rare-cancer specific quality indicators proposed and published by RARECARE and HAEMACARE (www.rarecarenet.eu; www.haemacare.eu). The definition and list of rare cancers proposed by the RARECAREnet "Information Network on Rare Cancers" project were adopted: rare cancers are entities (defined as a combination of topographical and morphological codes of the ICD-O-3) having an incidence rate of less than 6 per 100,000 per year in the European population. This monograph presents 198 rare cancers grouped in 14 major groups. Crude incidence rates were estimated as the number of all new cancers occurring in 2000-2010 divided by the overall population at risk, for males and females (also for gender-specific tumours).The proportion of rare cancers out of the total cancers (rare and common) by site was also calculated. Incidence rates by sex and age are reported. The expected number of new cases in 2015 in Italy was estimated assuming the incidence in Italy to be the same as in the AIRTUM area. One- and 5-year relative survival estimates of cases aged 0-99 years diagnosed between 2000 and 2008 in the AIRTUM database, and followed up to 31 December 2009, were calculated using complete cohort survival analysis. To estimate the observed prevalence in Italy, incidence and follow-up data from 11 CRs for the period 1992-2006 were used, with a prevalence index date of 1 January 2007. Observed prevalence in the general population was disentangled by time prior to the reference date (≤2 years, 2-5 years, ≤15 years). To calculate the complete prevalence proportion at 1 January 2007 in Italy, the 15-year observed prevalence was corrected by the completeness index, in order to account for those cancer survivors diagnosed before the cancer registry activity started. The completeness index by cancer and age was obtained by means of statistical regression models, using incidence and survival data available in the European RARECAREnet data. RESULTS: In total, 339,403 tumours were included in the incidence analysis. The annual incidence rate (IR) of all 198 rare cancers in the period 2000-2010 was 147 per 100,000 per year, corresponding to about 89,000 new diagnoses in Italy each year, accounting for 25% of all cancer. Five cancers, rare at European level, were not rare in Italy because their IR was higher than 6 per 100,000; these tumours were: diffuse large B-cell lymphoma and squamous cell carcinoma of larynx (whose IRs in Italy were 7 per 100,000), multiple myeloma (IR: 8 per 100,000), hepatocellular carcinoma (IR: 9 per 100,000) and carcinoma of thyroid gland (IR: 14 per 100,000). Among the remaining 193 rare cancers, more than two thirds (No. 139) had an annual IR <0.5 per 100,000, accounting for about 7,100 new cancers cases; for 25 cancer types, the IR ranged between 0.5 and 1 per 100,000, accounting for about 10,000 new diagnoses; while for 29 cancer types the IR was between 1 and 6 per 100,000, accounting for about 41,000 new cancer cases. Among all rare cancers diagnosed in Italy, 7% were rare haematological diseases (IR: 41 per 100,000), 18% were solid rare cancers. Among the latter, the rare epithelial tumours of the digestive system were the most common (23%, IR: 26 per 100,000), followed by epithelial tumours of head and neck (17%, IR: 19) and rare cancers of the female genital system (17%, IR: 17), endocrine tumours (13% including thyroid carcinomas and less than 1% with an IR of 0.4 excluding thyroid carcinomas), sarcomas (8%, IR: 9 per 100,000), central nervous system tumours and rare epithelial tumours of the thoracic cavity (5%with an IR equal to 6 and 5 per 100,000, respectively). The remaining (rare male genital tumours, IR: 4 per 100,000; tumours of eye, IR: 0.7 per 100,000; neuroendocrine tumours, IR: 4 per 100,000; embryonal tumours, IR: 0.4 per 100,000; rare skin tumours and malignant melanoma of mucosae, IR: 0.8 per 100,000) each constituted <4% of all solid rare cancers. Patients with rare cancers were on average younger than those with common cancers. Essentially, all childhood cancers were rare, while after age 40 years, the common cancers (breast, prostate, colon, rectum, and lung) became increasingly more frequent. For 254,821 rare cancers diagnosed in 2000-2008, 5-year RS was on average 55%, lower than the corresponding figures for patients with common cancers (68%). RS was lower for rare cancers than for common cancers at 1 year and continued to diverge up to 3 years, while the gap remained constant from 3 to 5 years after diagnosis. For rare and common cancers, survival decreased with increasing age. Five-year RS was similar and high for both rare and common cancers up to 54 years; it decreased with age, especially after 54 years, with the elderly (75+ years) having a 37% and 20% lower survival than those aged 55-64 years for rare and common cancers, respectively. We estimated that about 900,000 people were alive in Italy with a previous diagnosis of a rare cancer in 2010 (prevalence). The highest prevalence was observed for rare haematological diseases (278 per 100,000) and rare tumours of the female genital system (265 per 100,000). Very low prevalence (<10 prt 100,000) was observed for rare epithelial skin cancers, for rare epithelial tumours of the digestive system and rare epithelial tumours of the thoracic cavity. COMMENTS: One in four cancers cases diagnosed in Italy is a rare cancer, in agreement with estimates of 24% calculated in Europe overall. In Italy, the group of all rare cancers combined, include 5 cancer types with an IR>6 per 100,000 in Italy, in particular thyroid cancer (IR: 14 per 100,000).The exclusion of thyroid carcinoma from rare cancers reduces the proportion of them in Italy in 2010 to 22%. Differences in incidence across population can be due to the different distribution of risk factors (whether environmental, lifestyle, occupational, or genetic), heterogeneous diagnostic intensity activity, as well as different diagnostic capacity; moreover heterogeneity in accuracy of registration may determine some minor differences in the account of rare cancers. Rare cancers had worse prognosis than common cancers at 1, 3, and 5 years from diagnosis. Differences between rare and common cancers were small 1 year after diagnosis, but survival for rare cancers declined more markedly thereafter, consistent with the idea that treatments for rare cancers are less effective than those for common cancers. However, differences in stage at diagnosis could not be excluded, as 1- and 3-year RS for rare cancers was lower than the corresponding figures for common cancers. Moreover, rare cancers include many cancer entities with a bad prognosis (5-year RS <50%): cancer of head and neck, oesophagus, small intestine, ovary, brain, biliary tract, liver, pleura, multiple myeloma, acute myeloid and lymphatic leukaemia; in contrast, most common cancer cases are breast, prostate, and colorectal cancers, which have a good prognosis. The high prevalence observed for rare haematological diseases and rare tumours of the female genital system is due to their high incidence (the majority of haematological diseases are rare and gynaecological cancers added up to fairly high incidence rates) and relatively good prognosis. The low prevalence of rare epithelial tumours of the digestive system was due to the low survival rates of the majority of tumours included in this group (oesophagus, stomach, small intestine, pancreas, and liver), regardless of the high incidence rate of rare epithelial cancers of these sites. This AIRTUM study confirms that rare cancers are a major public health problem in Italy and provides quantitative estimations, for the first time in Italy, to a problem long known to exist. This monograph provides detailed epidemiologic indicators for almost 200 rare cancers, the majority of which (72%) are very rare (IR<0.5 per 100,000). These data are of major interest for different stakeholders. Health care planners can find useful information herein to properly plan and think of how to reorganise health care services. Researchers now have numbers to design clinical trials considering alternative study designs and statistical approaches. Population-based cancer registries with good quality data are the best source of information to describe the rare cancer burden in a population

Quale identità per la storia dell'educazione?

Questo numero monografico degli “Annali on-line della Didattica e della Forma¬zione docente” raccoglie i lavori di due convegni svoltisi su due tematiche distinte, ma tra loro strettamente connesse, perché riconducibili ad una stessa domanda: che cos’è e come si sviluppa la ricerca in ambito storico-educativo. Il primo di questi convegni si è svolto a Ferrara nei giorni 6 e 7 maggio 2013, sotto l’egida del CIRSE, ossia del Centro Italiano per la Ricerca Storico-Educativa, mentre il secondo si è tenuto a Pisa nel giugno del 2013, sotto il pa-trocinio della Società di Politica, Educazione e Storia (SPES) per ricordare l’o¬pera di Tina Tomasi, insigne studiosa di Storia della scuola e dell’educazione, già docente alla Facoltà di Magistero dell’ateneo fiorentino, a cento anni dalla sua nascita. Il primo dei due incontri ha avuto come tema una domanda generale e cru¬ciale per gli studi cui mi riferisco, vale a dire “Quale identità per la Storia dell’educazione?”. Nel raccogliere i contributi di entrambe la iniziative, mi è parso opportuno scegliere questa domanda per dare un titolo significativo ed immediatamente comprensibile al numero monografico di questa rivista. Se, infatti, a tutta prima, essa pare riferirsi solo all’incontro ferrarese, di fatto tale domanda ha accompagnato anche le giornate di studio dedicate a Tina Tomasi. Durante queste giornate gli interventi si sono divisi tra una riconsidera¬zione delle opere della Tomasi ed il ricordo della sua attività di insegnante e una riflessione su due aspetti – quello della relazione tra educazione e politica e della centralità del soggetto nella dimensione della storia e della vita civile – cari alla stessa Tomasi e punto nodale in tutta la sua produzione scientifica. Nell’affrontare questi aspetti specifici come nel prendere in esame, a più di vent’anni dalla sua scomparsa, i lavori della studiosa, il centro (implicito, eppure evidente) degli interventi ha finito per vertere sul significato ed il senso della ricerca storico-educativa. Perciò, il presente numero monografico, sebbene diviso in due parti, al fondo, va letto e pensato come un lavoro unitario su un tema complesso – come quello dell’identità della Storia dell’educazione – attraverso una riflessione teo¬rica e la definizione di alcuni ambiti specifici di sua pertinenza (nella prima parte) e, quindi, attraverso l’analisi di alcuni momenti o di alcuni temi partico¬lari, in cui si applica il metodo storiografico descritto, appunto, nella medesima prima parte. La se¬conda parte del presente numero, dunque, va pensata e considerata non come un’appendice della prima parte, bensì, piuttosto, come un suo necessario e le-gittimo complemento. Senza scendere nel merito dei vari interventi e per non togliere al lettore che abbia voglia e tempo di addentrarsi nel percorso teorico-metodologico che que¬ste pagine disegnano, il gusto della scoperta, mi siano tuttavia concesse tre notazioni: una sugli inter¬venti qui riuniti; e due di carattere più generale. Partiamo dalla prima. Ai due incontri hanno partecipato studiosi di varie università, oltre ovvia¬mente a chi scrive ed ai colleghi ferraresi. Ciò ha consentito di costruire un di¬scorso articolato: si tratta di voci che rendono conto dell’attuale stato dell’arte in questo specifico ambito di ricerca e che ne mettono in luce anche le diverse sfaccettature. Ed eccoci alle notazioni più generali e attinenti strettamente al numero che sto presentando. Innanzitutto, chiediamoci perché, visto l’attuale rigoglio della saggistica sto¬rico-educativa ed una crescente apertura dei suoi confini ad ambiti e tematiche solo alcuni decenni fa impensabili per questi studi, il CIRSE e gli organizzatori abbiano ritenuto interessante riproporre la domanda sull’identità di questi studi. Come si evince dagli interventi della prima parte, la diffusione dei lavori pubblicati non corrisponde sempre ad una chiarezza circa i fondamenti episte-mologici o a un rigore metodologico altrettanto condiviso e ben distinguibile da quello della ricerca meramente documentaria o capace di interrogarsi sull’uso ed il significato di strumenti e fonti documentarie legate a forme nuove di comunicazione e di diffusione delle notizie. Lo attestano gli interventi di Bellatalla, Genovesi, Grassi e Todaro. E, come se ciò non bastasse, non man¬cano, come emerge dagli interventi di Barbieri, Callegari e Cantatore, alcuni sotto-settori della ricerca storico-educativa, quali l’Educazione comparata o la Letteratura per l’infanzia, che si configurano non solo in maniera complessa, ma mostrano anche degli spazi di definizione, sia a livello teorico sia a livello di contenuti da indagare, ancora aperti e non sempre facili da cogliere e da distin¬guere rispetto ad approcci ora sociologici ora letterari ora meramente politici. Inoltre, e questo è più evidente nella seconda parte del presente numero, non manca una apertura interdisciplinare. In questo modo la ricerca storico-educa¬tiva può dialogare – e il saggio di Bitossi ne è un esempio chiaro – con la storia generale o, come mostra l’intervento di Catarci, con questioni concrete, che ri¬mandano a problemi d’ordine sociale, ossia a questioni legate alla formazione civile ed alla contemporaneità. Un modo, questo, per sottolineare, se mai ce ne fosse bisogno, che se lo sto¬rico, in generale, e quello dell’educazione, in particolare, si muovono per lo più in archivio ed in mezzo a fonti documentarie attinenti il passato, ad ogni buon conto, le motivazioni della loro indagine partono sempre e necessariamente da domande che si pongono sulla contemporaneità e su quanto li circonda e che la loro indagine mira a costruire, come in una sorta di puzzle, le relazioni (dialettiche e costruttive) tra passato, presente e futuro. Una tensione verso il futuro che dà il senso della contemporanea tensione verso il non-ancora o verso un legame con lo spirito dell’utopia, che consente di pensare alla ricerca storica come ad un laboratorio dell’educazione e ad un crogiuolo di civiltà e di culture. Infine, il rilievo conclusivo. Perché queste pagine hanno trovato ospitalità in una rivista che, nata dalla costola della “gloriosa” Scuola di Specializzazione per l’Insegnamento Secon¬dario ferrarese, si dedica programmaticamente a questioni legate alla didattica ed alla formazione dei docenti? Non da ora, ma ogni volta che mi sono interro¬gata sul corredo delle competenze del futuro insegnante ho esplicitamente so¬stenuto che il primo, ineludibile requisito per affrontare l’attività docente è la cultura generale, affiancata e arricchita da una preparazione disciplinare su cui vanno ad innestarsi le imprescindibili competenze negli ambiti della Scienza dell’educazione e della Didattica generale. Se l’insegnamento ha come compito precipuo quello di far acquisire agli alunni, attraverso informazioni e contenuti specifici, capacità logico-argomen¬tative, autonomia di giudizio, senso critico, disponibilità a continuare ad apprendere anche in assenza di un maestro; se, in una parola, l’insegnamento ha per compito precipuo quello di far imparare a pensare, allora è innegabile che la conoscenza di una disciplina – la cultura specifica della materia professata – non può e non deve limitarsi al riepilogo di una serie di contenuti o non è e non deve coincidere con una erudizione enciclopedica in un dato ambito. In quanto ricercatore, un insegnante deve abituarsi a condividere con tutti i ricercatori l’abito mentale del dubbio e un atteggiamento anti-dogmatico ed ipotetico. Ciò, ne sono convinta, si acquisisce prima di tutto interrogandosi sui fondamenti logici, epistemologici e metodologici di un dato sapere. Un punto di forza della (immotivatamente e violentemente) defunta SSIS stava proprio nello spazio riservato ai fondamenti storico-epistemologici delle varie discipline comprese nelle diverse classi di abilitazione. Così non accade nel Tirocinio Formativo Attivo, in cui i tempi contingentati e lo spazio ridotto degli insegnamenti teorici a vantaggio delle didattiche disciplinari, impedisce un approfondimento degli aspetti storico-epistemologici. Alla luce di queste considerazioni non meraviglierà, dunque, se le testimonianze delle giornate di studio, organizzate rispettivamente dal CIRSE e dalla SPES, hanno trovato ospitalità su questa rivista: queste pagine, infatti, sono indirizzate certamente, prima di tutto, agli addetti ai lavori, impegnati nel dibattito sui problemi in esse agitati, ma si rivolgono anche, e non meno direttamente, agli insegnanti della Classe di abilitazione A036 in servizio, ai tutor impegnati nel TFA ed agli specializzandi, che si stanno formando per entrare attivamente nella scuola. A tutti questi, confidiamo di offrire un volume corale suggestivo, capace di sollecitarli a riflettere, mentre informa sullo stato dell’arte, e perfino stimolante per progettare percorsi didattici di Storia dell’educazione (in tutte le sue declinazioni)

New incidence and mortality data. 2003-2005

In Italy cancer incidence and mortality rates are similar to those in northern European countries and in USA among males, but they are still lower than women

[Italian cancer figures, report 2010: Cancer prevalence in Italy. Patients living with cancer, long-term survivors and cured patients]

OBJECTIVES: the aim of the present monograph is to update the estimation of the number of people living with cancer in Italy, to describe geographic variability, and estimate the number of long-term survivors, i.e., people living five years or more after a cancer diagnosis. MATERIALS AND METHODS: the study included the data of the AIRTUMdatabase. Twenty-four Cancer Registries (CRs) (covering 27% of the Italian population) collected information on the incidence and vital status of 1,275,353 cases diagnosed between 1978 and 2005. For each CR, the observed prevalence was calculated up to the maximum observable duration. To estimate the complete prevalence (all living patients, independently from time since diagnosis) and the prevalence for lengths of time exceeding the CR maximum duration of registration, the observed prevalence was corrected through a completeness index. Completeness indices, gender, age and site specific, were estimated by means of statistical regression models using cancer incidence and survival data available from CRs with more than 15 years of observation. As of 1 January 2006, the prevalence was estimated (as absolute numbers and as a proportion per 100,000 inhabitants) for 46 cancer sites, by gender, age class, years since diagnosis and geographic areas. RESULTS: as of 2006, 2,244,000 persons (4%of the Italian population) were alive with a cancer diagnosis. A relevant geographic variability emerged, with proportions between 4%-5% among CRs in the Centre and North of Italy, and proportions between 2%-3% in the South. Forty-four percent of prevalent subjects (988,000) were males and 56% (1,256,000) females. Fifty-seven percent (1,285,680 people, 2.2% of total population) of these patients was represented by long-term survivors. In patients aged 75 years or more, the proportions of prevalent cases were 19%in males and 13%in females, and 10%between 60 and 75 years of age in both genders.More than half a million Italian women were alive with a breast cancer diagnosis (42%of women with a neoplasm), followed by women with cancers of the colonrectum (12%), corpus uteri (7%), thyroid (5%), and cervix uteri (4%). In men, 22%of prevalent cases (216,716) included patients with prostate cancer, 18% with bladder cancer, and 15%with colon-rectum cancer. Percentages of long-term survivors higher than 70% were reported for cancers of the cervix uteri (82% at five years, and 55% at 15 years from diagnosis), Hodgkin lymphoma, testis, brain and central nervous system, bone and connective tissue. Many patients with these types of cancers (often occurring in young people) can be considered "cured", i.e., with a life expectancy overlapping that of the general population.The estimated proportions of prevalent cases emerging from this study in Italy were quite similar to those reported in Northern Europe, but at least 15%lower than those in the United States. CONCLUSIONS: in 2006, the number of prevalent cases nearly doubled compared to 1992. The increase over time in the proportion of elderly patients, related to population ageing, requires adequate health policies. Knowing the number of people alive many years after cancer diagnosis (either cured or long-term survivors) provides the scientific bases for the definition of health policies focusing on them. Furthermore, it promotes the conduction of studies aimed at improving the present knowledge on the quality of life of these patients during and after the active phase of treatments, in addition to studies on the long-term effects of treatments

Italian cancer figures, report 2010: Cancer prevalence in Italy. Patients living with cancer, long-term survivors and cured patients

OBJECTIVES: the aim of the present monograph is to update the estimation of the number of people living with cancer in Italy, to describe geographic variability, and estimate the number of long-term survivors, i.e., people living five years or more after a cancer diagnosis. MATERIALS AND METHODS: the study included the data of the AIRTUMdatabase. Twenty-four Cancer Registries (CRs) (covering 27% of the Italian population) collected information on the incidence and vital status of 1,275,353 cases diagnosed between 1978 and 2005. For each CR, the observed prevalence was calculated up to the maximum observable duration. To estimate the complete prevalence (all living patients, independently from time since diagnosis) and the prevalence for lengths of time exceeding the CR maximum duration of registration, the observed prevalence was corrected through a completeness index. Completeness indices, gender, age and site specific, were estimated by means of statistical regression models using cancer incidence and survival data available from CRs with more than 15 years of observation. As of 1 January 2006, the prevalence was estimated (as absolute numbers and as a proportion per 100,000 inhabitants) for 46 cancer sites, by gender, age class, years since diagnosis and geographic areas. RESULTS: as of 2006, 2,244,000 persons (4%of the Italian population) were alive with a cancer diagnosis. A relevant geographic variability emerged, with proportions between 4%-5% among CRs in the Centre and North of Italy, and proportions between 2%-3% in the South. Forty-four percent of prevalent subjects (988,000) were males and 56% (1,256,000) females. Fifty-seven percent (1,285,680 people, 2.2% of total population) of these patients was represented by long-term survivors. In patients aged 75 years or more, the proportions of prevalent cases were 19%in males and 13%in females, and 10%between 60 and 75 years of age in both genders.More than half a million Italian women were alive with a breast cancer diagnosis (42%of women with a neoplasm), followed by women with cancers of the colonrectum (12%), corpus uteri (7%), thyroid (5%), and cervix uteri (4%). In men, 22%of prevalent cases (216,716) included patients with prostate cancer, 18% with bladder cancer, and 15%with colon-rectum cancer. Percentages of long-term survivors higher than 70% were reported for cancers of the cervix uteri (82% at five years, and 55% at 15 years from diagnosis), Hodgkin lymphoma, testis, brain and central nervous system, bone and connective tissue. Many patients with these types of cancers (often occurring in young people) can be considered "cured", i.e., with a life expectancy overlapping that of the general population.The estimated proportions of prevalent cases emerging from this study in Italy were quite similar to those reported in Northern Europe, but at least 15%lower than those in the United States. CONCLUSIONS: in 2006, the number of prevalent cases nearly doubled compared to 1992. The increase over time in the proportion of elderly patients, related to population ageing, requires adequate health policies. Knowing the number of people alive many years after cancer diagnosis (either cured or long-term survivors) provides the scientific bases for the definition of health policies focusing on them. Furthermore, it promotes the conduction of studies aimed at improving the present knowledge on the quality of life of these patients during and after the active phase of treatments, in addition to studies on the long-term effects of treatments