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

Eroina e asma bronchiale

Il broncospasmo da eroina, di recente individuazione, è di raro riscontro probabilmente perché poco conosciuto o non adeguatamente indagato. L’eroina, principalmente attraverso un meccanismo di istamino-liberazione, induce ostruzione bronchiale che appare più grave negli asmatici cronici e negli atopici manifestandosi pochi minuti dopo l’inalazione della sostanza. Il narcotico può determinare: a) broncospasmo con insufficienza respiratoria che può richiedere cure intensive con ricorso alla ventilazione meccanica; b) depressione del centro bulbare del respiro; c) sintomatologia sistemica; d) sindrome da astinenza, che si può presentare poco dopo la risoluzione dell’episodio acuto. Un rapporto empatico con il paziente può agevolare il percorso diagnostico; infatti, la sua reticenza a svelare l’abitudine voluttuaria ritarda l’individuazione dell’esposizione alla sostanza. Ciò può comportare un trattamento terapeutico ritardato, con conseguente aggravamento della condizione clinica a possibile evoluzione infausta.Bronchospasm caused by inhaled heroin has recently been identified. The condition has been rarely identified and/or not sufficiently investigated. Through the reaction mediated by histamine, heroin causes a bronchial obstruction that seems more severe in chronic asthmatic and atopic individuals, immediately after inhalating the substance. Heroin can reveal: a) bronchospasm with respiratory failure that may require intensive care up to mechanical ventilation; b) depression of the bulbar center of breath; c) systemic symptoms; d) withdrawal syndrome that may be evident after an acute clinical event. Even though an empathic relationship between the patient and the doctor can facilitate the diagnostic process, a lack of early identification of exposure to the substance, due to the patient’s hesitation to disclose his/her behavior, may cause a delay in the treatment and a worsening of clinical conditions with unfavourable development

ETS exposure and PAH body burden in nonsmoking Italian adults

Active smoking is associated with increased body burden of polycyclic aromatic hydrocarbons (PAHs); the aim of this study was to assess whether environmental tobacco smoking (ETS) increases the internal dose of PAHs. In 344 nonsmoking Italian adults, out of 497 individuals selected as representative of the population of the town of Modena, ETS exposure was evaluated by a self-administered questionnaire and by the measurement of urinary cotinine (COT-U). PAH exposure was assessed by the measurement of urinary 1-hydroxypyrene (1-OHPYR) and of ten urinary PAHs. In all subjects, median (5th-95th percentile) COT-U was 0.47 (<0.1-3.91) mu g/L. While 58 subjects reported to be ETS exposed (ETSQUEST), 38 individuals were identified as ETS exposed on the basis of a COT-U value of 1.78 (90% confidence interval 1.75-1.80) mu g/L, previously derived as an upper reference value in not ETS exposed Italian adults (ETSCOT). Median COT-U levels were 1.38 (<0.1-9.06) and 3.63 (1.80-17.39) mu g/L in ETSQUEST and in ETSCOT subjects, respectively. Significant correlations between COT-U and 1-OHPYR, and urinary anthracene, fluoranthene, pyrene, and chrysene were found among all subjects. Significantly higher levels of 1-OHPYR, and urinary fluorene, anthracene, and pyrene were found in ETSCOT individuals. The results of multiple linear regression analyses, taking into consideration diet and other sources of PAHs exposures such as the residence area/characteristics and traffic, confirmed that 1-OHPYR and urinary fluorene were affected by ETS exposure, even if ETS played a minor role

Migrant health in Italy: a better health status difficult to maintain-country of origin and assimilation effects studied from the Italian risk factor surveillance data

Many studies on migrant health have focused on aspects of morbidity and mortality, but very few approach the relevant issues of migrants' health considering behavioral risk factors. Previous studies have often been limited methodologically because of sample size or lack of information on migrant country of origin. Information about risk factors is fundamental to direct any intervention, particularly with regard to non-communicable diseases that are leading causes of death and disease. Thus, the main focus of our analysis is the influence of country of origin and the assimilation process

Linee guida di prevenzione oncologica - Tabagismo

Linee guida sulla prevenzione oncologica predisposte dal Consiglio sanitario regionale toscano

Risk of thyroid as a first or second primary cancer. A population-based study in Italy, 1998–2012

Background: The number of patients living after a cancer diagnosis is increasing, especially after thyroid cancer (TC). This study aims at evaluating both the risk of a second primary cancer (SPC) in TC patients and the risk of TC as a SPC. Methods: We analyzed two population-based cohorts of individuals with TC or other neoplasms diagnosed between 1998 and 2012, in 28 Italian areas covered by population-based cancer registries. Standardized incidence ratios (SIRs) of SPC were stratified by sex, age, and time since first cancer. Results: A total of 38,535 TC patients and 1,329,624 patients with other primary cancers were included. The overall SIR was 1.16 (95% CI: 1.12–1.21) for SPC in TC patients, though no increase was shown for people with follicular (1.06) and medullary (0.95) TC. SPC with significantly increased SIRs was bone/soft tissue (2.0), breast (1.2), prostate (1.4), kidney (2.2), and hemolymphopoietic (1.4) cancers. The overall SIR for TC as a SPC was 1.49 (95% CI: 1.42–1.55), similar for all TC subtypes, and it was significantly increased for people diagnosed with head and neck (2.1), colon–rectum (1.4), lung (1.8), melanoma (2.0), bone/soft tissue (2.8), breast (1.3), corpus uteri (1.4), prostate (1.5), kidney (3.2), central nervous system (2.3), and hemolymphopoietic (1.8) cancers. Conclusions: The increased risk of TC after many other neoplasms and of few SPC after TC questions the best way to follow-up cancer patients, avoiding overdiagnosis and overtreatment for TC and, possibly, for other malignancies