Neoadjuvant therapy for breast cancer

Objective: To evaluate the frequency of neoadjuvant therapy (NT) in women with stage I–III breast cancer in Italy and whether it is influenced by biological characteristics, screening history, and geographic area. Methods: Data from the High Resolution Study conducted in 7 Italian cancer registries were used; they are a representative sample of incident cancers in the study period (2009–2013). Included were 3546 women aged <85 years (groups <50, 50–69, 70–64, and 75+) with stage I–III breast cancer at diagnosis who underwent surgery. Women were classified as receiving NT if they received chemotherapy, target therapy, and/or hormone therapy before the first surgical treatment. Logistic models were built to test the association with biological and contextual variables. Results: Only 8.2% of women (290 cases) underwent NT; the treatment decreases with increasing age (14.5% in age <50 and 2.2% in age 75+), is more frequent in women with negative receptors (14.8%), HER2-positive (15.7%), and triple-negative (15.6%). The multivariable analysis showed the probability of receiving NT is higher in stage III (odds ratio [OR] 3.83; 95% confidence interval [CI] 2.83–5.18), luminal B (OR 1.87; 95% CI 1.27–2.76), triple-negatives (OR 1.88; 95% CI 1.15–3.08), and in symptomatic cancers (OR 1.98; 95% CI 1.13–3.48). Use of NT varied among geographic areas: Reggio Emilia had the highest rates (OR 2.29; 95% CI 1.37–3.82) while Palermo had the lowest (OR 0.41; 95% CI 0.24–0.68). Conclusions: The use of NT in Italy is limited and variable. There are no signs of greater use in hospitals with more advanced care

Physical activity and risk of cancers of the colon and rectum: an Italian case-control study

We investigated the relationships between risk of colon and rectal cancers and physical activity in both sexes at different ages by a case-control study conducted between 1991 and 1996 in six Italian centres. Cases were 1225 patients (688 men, 537 women) below the age of 75 with colon cancer and the controls included 4154 patients (2073 men, 2081 women) admitted to hospital for acute, non-neoplastic conditions. We also analysed 722 cases of rectal cancer. Compared with the lowest level of occupational physical activity at 30–39 years old the odds ratios (OR) for the highest level were 0.64 (95% confidence interval, CI 0.44–0.93) in men and 0.49 (95% CI 0.33–0.72) in women. The inverse association in both sexes was similar at 15–19 and 50–59 years old. No association was found in either sex for leisure-time physical activity. For both sexes the inverse relationship between occupational physical activity at 30–39 years old and colon cancer risk was not significantly heterogeneous across strata of selected covariates, and for ascending, transverse, descending and sigmoid colon. Rectal cancer risk was not associated with any measure of physical activity (OR = 1.32 for men and 0.88 for women for the highest level of occupational physical activity at 30–39 years old compared with the lowest). This study confirms that occupational physical activity is protective against colon, but not against rectal cancer. © 1999 Cancer Research Campaig

Rilevazione sui consumi finali di prodotti energetici delle imprese

Nella pubblicazione viene descritta la metodologia e vengono riportati i risultati dell'indagine campionaria sui consumi di prodotti energetici delle imprese industriali e del terziario (CoEn), realizzata da Istat ed ENEA. Il lavoro si origina da una collaborazione tra ENEA e Ministero dello Sviluppo Economico e da un successivo accordo tra ENEA ed Istat: tale cooperazione è stata finalizzata al rafforzamento del sistema delle statistiche energetiche nazionali, necessario al policy making e promosso dall'Unione Europea, che ha rappresentato il riferimento normativo delle attività svolte. Si ritiene utile trasferire metodologia ed esiti di questa esperienza di lavoro congiunto tra soggetti istituzionali, da considerarsi quale primo passo verso l'evoluzione del sistema statistico energetico nazionale

Hormone replacement treatment and breast cancer risk: a cooperative Italian study.

The relationship between hormone replacement treatment (HRT) and breast cancer risk was analysed using data from a case-control study conducted between June 1991 and February 1994 in six Italian centres on 2569 patients aged below 75 with histologically confirmed breast cancer and 2588 controls admitted to hospital for a wide spectrum of acute, non-neoplastic, non hormone-related diseases. Ever HRT use was reported by 7.5% of cases and 7.5% of controls, corresponding to a multivariate odds ratio (OR) of 1.2 [95% confidence interval (CI), 0.9-1.5]. The risk increased with increasing duration of use: the ORs were 1.0 for use lasting less than 1 year, 1.3 for 1-4 years and 1.5 for 5 years or more. There was no clear pattern of risk with reference to time since starting use, but the OR was significantly elevated (OR = 2.0, 95% CI 1.3-2.9) for women who had stopped HRT within the last 10 years. No association was observed in those who had stopped HRT more than 10 years ago (OR = 1.0). The increased OR for women who had stopped HRT within the last 10 years was consistent across strata of identified covariates, and was significantly related to duration of use. This study confirms the absence of a strong association between HRT and breast cancer risk, although the risk estimate was above unity for women who had used HRT for 5 years or longer. However, the risk was significantly elevated in the short to medium term after use, particularly for long-term use. This short-term increased risk is consistent with an effect of HRT on one of the later stages of the process of breast carcinogenesis. The flattening of risk with increasing time since stopping, and hence the absence of a long-term cumulative excess in breast cancer risk after stopping HRT exposure, has relevant implications on individual risk assessment and public health

Situaciones problemáticas en el aprendizaje significativo de biología celular en la carrera de Odontología

Ponencia presentada en la II Muestra Nacional de Innovaciones en la Enseñanza de la Odontología y IV Muestra Institucional de Innovaciones en la Enseñanza de la Odontología. Córdoba, 13 y 14 de septiembre de 2012.En la formación de un odontólogo generalista, la Biología Celular comprende la adquisición de los conocimientos que son necesarios para el abordaje de la problemática de la tríada salud- enfermedad- atención en todos sus aspectos preventivos, terapéuticos y epidemiológicos.Fil: Zárate, A. M. Universidad Nacional de Córdoba. Facultad de Odontología. Departamento de Biología Bucal. Cátedra A de Biología Celular; Argentina.Fil: Cismondi, A. Universidad Nacional de Córdoba. Facultad de Odontología. Departamento de Biología Bucal. Cátedra A de Biología Celular; Argentina.Fil: Kohan, R. Universidad Nacional de Córdoba. Facultad de Odontología. Departamento de Biología Bucal. Cátedra A de Biología Celular; Argentina.Fil: Llanes, M. Universidad Nacional de Córdoba. Facultad de Odontología. Departamento de Biología Bucal. Cátedra A de Biología Celular; Argentina.Fil: Filiberti, A. M. Universidad Nacional de Córdoba. Facultad de Odontología. Departamento de Biología Bucal. Cátedra A de Biología Celular; Argentina.Fil: Scherma, M. E. Universidad Nacional de Córdoba. Facultad de Odontología. Departamento de Biología Bucal. Cátedra A de Biología Celular; Argentina.Fil: Brunotto, M. Universidad Nacional de Córdoba. Facultad de Odontología. Departamento de Biología Bucal. Cátedra A de Biología Celular; Argentina

The role of CEA, CYFRA21-1 and NSE in monitoring tumor response to Nivolumab in advanced non-small cell lung cancer (NSCLC) patients

Background: CEA, CYFRA21-1 and NSE are tumor markers used for monitoring the response to chemotherapy in advanced adenocarcinoma, squamous cell carcinoma and small-cell lung cancer, respectively. Their role in cancer immunotherapy needs to be elucidated. Methods: Patients with advanced non-small cell lung cancer (NSCLC) were treated with nivolumab 3 mg/kg every 2 weeks within the Italian Nivolumab Expanded Access Program. Blood samples were collected at baseline, at each cycle up to cycle 5 and then every two cycles until patient's withdrawn from the study. All patients underwent a CT-scan after every 4 cycles of treatment and responses were classified according to RECIST 1.1. The biomarkers serum levels were measured with a chemiluminescent microparticle immunoassay for CEA and with an immuno radiometric assay for CYFRA21-1 and NSE. The markers values at baseline and after 4 cycles were used to analyze the relationship between their variation over baseline and the tumor response, evaluated as disease control rate (DCR: CR + PR + SD), and survival (PFS and OS). Results: A total of 70 patients were evaluable for the analysis. Overall, a disease control was obtained in 24 patients (35.8%, 4 PR + 20 SD). After 4 cycles of nivolumab a CEA or CYFRA21-1 reduction 65 20% over the baseline was significantly associated with DCR (CEA, p = 0.021; CYFRA21-1, p < 0.001), PFS (CEA, p = 0.028; CYFRA21-1, p < 0.001) and OS (CEA, p = 0.026; CYFRA21-1, p = 0.019). Multivariate analysis confirmed the ability of CYFRA21-1 reduction 65 20% to predict DCR (p = 0.002) and PFS (p < 0.001). Conclusion: The reduction in serum level of CYFRA21-1 or CEA might be a reliable biomarker to predict immunotherapy efficacy in NSCLC patients. NSE was not significant for monitoring the efficacy of nivolumab

Cross-cultural adaptation and patients' judgments of a Question Prompt List for Italian-speaking cancer patients

<p>Abstract</p> <p>Background</p> <p>Question Prompt Lists (QPLs) have proven very effective in encouraging cancer patients to ask questions, allowing them to take up a more active role during visits with the oncologist. As no such tool has yet been validated for Italian-speaking users, we carried out the cross-cultural adaptation and evaluation of an existing Australian Question Prompt List.</p> <p>Methods</p> <p>Cross-cultural adaptation was performed in accordance with the five steps described by Guillemin and Beaton. Forward and back translations of the original tool were carried out, and the products discussed by an Expert Committee who agreed on a prefinal version of the Italian QPL, which was submitted to 30 volunteer patients for evaluation. They rated each question's adequacy of content, clarity of wording, usefulness, and generated anxiety, on a 3-point Likert scale. Based on the analysis of patient ratings, the final version of the Italian QPL was produced.</p> <p>Results</p> <p>Few discrepancies between the two back translations and the original version of the instrument were noted, indicating that the Italian translation (synthesis of the 2 forward translations) was substantially accurate. Most volunteer patients felt that the questionnaire was adequate, easy to understand and useful. Only a few minor criticisms were expressed. Certain questions on diagnosis and prognosis generated the highest level of anxiety. Patient comments and ratings on clarity highlighted the need to clarify common health care terms which are not widely used by the public (i.e. guideline, multidisciplinary team and clinical trial)</p> <p>Conclusions</p> <p>This cross-cultural adaptation has produced an Italian Question Prompt List that is now available for multi-center international studies and can be safely used with Italian-speaking cancer patients.</p

Treatment challenges in and outside a specialist network setting: Pancreatic neuroendocrine tumours

Pancreatic Neuroendocrine Neoplasms comprise a group of rare tumours with special biology, an often indolent behaviour and particular diagnostic and therapeutic requirements. The specialized biochemical tests and radiological investigations, the complexity of surgical options and the variety of medical treatments that require individual tailoring, mandate a multidisciplinary approach that can be optimally achieved through an organized network. The present study describes currents concepts in the management of these tumours as well as an insight into the challenges of delivering the pathway in and outside a Network

Effects of different doses of erythropoietin in patients with myelodysplastic syndromes: A propensity score-matched analysis

Erythropoiesis-stimulating agents effectively improve the hemoglobin levels in a fraction of anemic patients with myelodysplastic syndromes (MDS). Higher doses (HD) of recombinant human erythropoietin (rhEPO) have been proposed to overcome suboptimal response rates observed in MDS patients treated with lower "standard doses" (SD) of rhEPO. However, a direct comparison between the different doses of rhEPO is lacking