The aim of this study was to analyze and describe the epidemiological characteristics and trends of breast cancer in Sassari province (Sardinia, Italy) in the period 1992 2010. Data were obtained from the local tumor registry which makes part of a wider registry web, coordinated today by the Italian Association for Tumor Registries. The overall number of breast cancer cases registered was 5,483 (46 males and 5,437 females). The mean age was 64.8 years for males and 60.4 years for females. The standardized incidence rates were 1/100,000 and 106.2/100,000 and the standardized mortality rates 0.3/100,000 and 23.2/100,000 for males and females respectively. An increasing trend in incidence and mortality rates of breast cancer in Sassari province was evidenced in the years under investigation. Relative survival at 5 years from diagnosis was 78.2% (73.1% for males and 78.3% for females

Attene, Federico

Budroni, Mario

Cossu, Antonio

Paliogiannis, Panagiotis

Palmieri, Giuseppe

Scognamillo, Fabrizio

Sechi, Ornelia

Tanda, Francesco

Torre, Carlo

English

UnissResearch

BREAST CANCER INCIDENCE AND MORTALITY IN NORTH SARDINIA IN THE PERIOD 1992 -
2010 
ANTONIO COSSU*, PANAGIOTIS PALIOGIANNIS*, FEDERICO ATTENE*, GIUSEPPE PALMIERI**, MARIO BUDRONI***, ORNELIA
SECHI***, CARLO TORRE*, FRANCESCO TANDA*, FABRIZIO SCOGNAMILLO*
*Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Italy - **Institute of Biomolecular Chemistry,
Cancer Genetics Unit, C.N.R., Sassari, Italy - ***Service of Epidemiology, A.S.L. 1, Sassari, Italy
[Incidenza e mortalità del cancro della mammella nel nord Sardegna nel periodo 1992 -2010]
Introduction
Breast cancer is one of the most common neo-
plastic diseases in the world with more than
1,380,000 cases among females estimated in 2008(1).
It is the first most incident neoplastic disease and the
first neoplastic cause of death in women(1). An
increase in breast cancer incidence in women was
registered worldwide in the last decades; given the
current incidence trends it is estimated that in 2030
there will be approximately 2.7 million cases of
breast cancer in the world(2). This increase may
reflect technological improvements in modern diag-
nostic methods, changes in reproductive and oral
contraceptive use patterns and continuous improve-
ment of the expectancy of life, especially in coun-
tries that until recently had low rates of the disease(3).
Conversely, a reduction in mortality rates was regis-
tered in developed countries in recent years, proba-
bly because of the progressive adoption of screening
programs, useful to identify individuals with pre-
symptomatic neoplastic lesions, and advances in the
oncological management of breast cancer(2,4). These
trends were observed also in Italy in recent years(5).     
The aim of this population-based study was to
analyze and describe the epidemiological character-
istics and trends of breast cancer in the province of
Sassari (Sardinia, Italy), in the period 1992-2010. 
Materials and methods 
The epidemiological data presented in this
article were obtained from the “Registry of the
tumors of the Province of Sassari”. This registry
was created in 1992 by the local health agency for
the epidemiological surveillance of tumors in the
province. In 1999 it became part of a wider web of
tumor registries, coordinated today by the Italian
Association for Tumor Registries (Associazione
Italiana Registri Tumori, AIRTUM). The associa-
Acta Medica Mediterranea, 2013, 29: 235
ABSTRACT
The aim of this study was to analyze and describe the epidemiological characteristics and trends of breast cancer in Sassari
province (Sardinia, Italy) in the period 1992–2010. Data were obtained from the local tumor registry which makes part of a wider
registry web, coordinated today by the Italian Association for Tumor Registries. The overall number of breast cancer cases regis-
tered was 5,483 (46 males and 5,437 females). The mean age was 64.8 years for males and 60.4 years for females. The standard-
ized incidence rates were 1/100,000 and 106.2/100,000 and the standardized mortality rates 0.3/100,000 and 23.2/100,000 for
males and females respectively. An increasing trend in incidence and mortality rates of breast cancer in Sassari province was evi-
denced in the years under investigation. Relative survival at 5 years from diagnosis was 78.2% (73.1% for males and 78.3% for
females). 
Key words: Breast cancer, ductal, lobular, screening, Sassari, Italy.  
Received March 05, 2013; Accepted April 17, 2013
tion coordinates 34 registries in the country, collects
and publishes data, and collaborates with interna-
tional organizations in the field. 
Every registry collects data on tumoral dis-
eases affecting inhabitants in the territory of juris-
diction through the local hospitals and health care
services, as with other registries (e.g., death reg-
istries). Demographic, clinical, pathological and
prognostic data are collected for each case of can-
cer and are registered in a digital database. This
database was the data source for the present popula-
tion-based report. 
The demographic characteristics of the
patients affected by breast cancer were collected.
Crude incidence and mortality rates per 100,000
inhabitants per year were calculated, as were stan-
dardized rates adjusted for European population
standards. A comparison between incidence and
mortality in the province of Sassari and those in
other Italian provinces was performed.
Additionally, the cumulative risk of developing the
disease and of dying between zero and 74 years of
age was estimated. The age class distribution and
time trends of incidence, mortality, and histology
were also evaluated. Finally, relative 5-year sur-
vival was calculated. 
Results
The overall number of cases of breast cancer
registered in the period under investigation was
5,483. Diagnosis was obtained by histological or
cytological reports in 5,268 cases (96%) and using
other information sources (clinical reports, radio-
logical referrals, death certifications, etc) in 201
cases (3.7%). The modality of diagnosis was not
known in 14 cases (0.3%). Among the 5,483 cases
registered, 46 occurred in males (0.8%) and 5,437
(99.2%) in females. The mean age was 64.8 years
for males and 60.4 years for females. The cumula-
tive risk of developing the disease was 0.07% for
males and 8.46% for females. 
As regards the anatomical distribution of the
tumors 338 (6.2%) were sited in the nipple, 84
(1.5%) in the central quadrant, 2035 (37.1%) in the
upper-outer quadrant, 515 (9.4%) in the upper-inner
quadrant, 320 (5.8%) in the lower-inner quadrant
and 391 (7.1%) in the lower-outer quadrant, while
876 (16%) lesions involved more than one quad-
rant. In 924 (16.9%) cases the anatomical site of
origin was not known. Among the 5,268 tumors
that had a histological or cytological diagnosis,
66.5% were ductal carcinomas, 10.9% lobular car-
cinomas, and 20.7% other histotypes. In 102 cases
(1.9%) the exact histologic type was not known. 
The crude incidence of breast malignancies in
the period under investigation was 1.1/100,000 for
men and 128/100,000 for women. Standardized
incidence rates were 1/100,000 for males and
106.2/100,000 for females. 
Table 1 shows the distribution of incidence in
relation to age in percentages, while Table 2 shows
the distribution of incidence rates in relation to age.
Peak incidence occurred at 80-84 years for males
and 70-74 years for females. Incidence rates were
also calculated for the following three time periods:
1992-1998, 1999-2004 and 2005-2010. There was a
progressive increase in incidence rate in males,
from 0.43/100,000 in the first period, to
1.05/100,000 in the second period and 1.45/100,000
in the last period. The corresponding figures for
females were 87.28/100,000, 105.33/100,000 and
128.76/100,000, respectively (Figure 1). A steady
increase in incidence occurred between 1992 and
2010 in both sexes. Furthermore a consistent
increase in the diagnosis of ductal carcinomas was
observed in both sexes in the same years (Figure 2). 
Table 3 shows the comparison of the incidence
and mortality rates in females in the province of
Sassari with those in other Italian provinces. There
were 1,358 deaths in the period under investigation
(15 males and 1,343 females). Crude overall mor-
tality was 0.4/100,000 for males and 31.6/100,000
for females. Mean age at death was 68.1 years in
males and 67.9 years in females.
236 A. Cossu, P. Paliogiannis et Al
Age (years) Males (Incidence %) Females (Incidence %)
0-14 0 0
15-29 0 0.63
30-44 8.69 14.27
45-59 26.09 33.07
60-74 36.96 34.04
75+ 28.26 17.99
Table 1: Age-class incidence distribution.
Breast cancer incidence and mortality in North Sardinia in the period 1992 - 2010 237
Age (years) Incidence/100,000 Mortality/100,000
Males Females Males Females
0-4 0 0 0 0
5-9 0 0 0 0
10-14 0 0 0 0
15-19 0 0 0 0
20-24 0 0.7 0 0
25-29 0 9.9 0 0
30-34 0 27.3 0 3.5
35-39 0 68.3 0 8.1
40-44 1.3 143.4 0 12.9
45-49 1.4 201.1 0.3 27.6
50-54 2.2 210.5 0.4 38.1
55-59 0.8 246.1 0.8 42
60-64 2.2 251.8 0.9 57.2
65-69 4.2 300.8 1 82.8
70-74 2.6 308.4 1.3 92
75-79 6.4 297.6 2.8 113.3
80-84 7.2 295.8 1.4 129.2
85+ 2 235.9 2 182.9
Total 1.1 128 0.4 31.6
Table 2: Age-class incidence and mortality rates.
Figure 1: Incidence and mortality rates trends in females
(1992 - 2010).
Figure 2: Trends of  the principal histological types
(1992 - 2010).
Province Incidence Mortality
Alto Adige 99.4 25.3
Biella 111.9 27.1
Ferrara 136 30.9
Firenze 116.5 22.9
Friuli VG 119.8 29.4
Genova 116.4 26.7
Macerata 89.6 27
Modena 133 26.4
Napoli 81 21.4
Parma 129.9 26.2
Ragusa 83 23.5
Reggio E 129.7 26.6
Romagna 123.6 23.1
Salerno 79.3 20.9
Sassari 106 23.2
Torino 120.2 29.2
Trento 107.6 29.7
Umbria 107.7 22.5
Varese 124.9 24.2
Veneto 118.7 28.7
Table 3: Comparison of incidence and mortality rates in
females with those of other Italian provinces.
Standardized mortality rates were 0.3/100,000
for males and 23.2/100,000 for females. The cumu-
lative risk of death was low in men (0.02%) and
significantly higher in women (1.8%). Table 2
shows the age-class distribution of mortality rates.
There was a relevant increase in mortality rates
after the seventh decade of life. Figure 1 shows the
time trend of female mortality between 1992 and
2010: a significant increase was registered. Finally,
relative survival at 5 years from diagnosis was
78.2% (73.1% for males and 78.3% for females). 
Discussion
Breast cancer is the most incident neoplastic
disease in women in the world, with more than
1,380,00 cases estimated in 2008(1). World popula-
tion age-standardized incidence in women calculat-
ed for the same year was 38.9/100,000, while
cumulative risk was 4.13(1). Breast cancer is also the
most frequent cause of neoplastic death in women,
with more than 450,000 deaths in the world in
2008(1). Large part of these figures seems to involve
the most developed countries worldwide. In the
European Union more than 420,000 cases of breast
cancer were estimated in 2008, with a standardized
incidence of 66.7/100,000 inhabitants. There were
approximately 130,000 deaths, with a standardized
mortality rate of 16.9/100,000 cases. The highest
figures are observed in northern and western
European countries(1). 
Italy is the country with higher incidence rates
in South Europe. In 2008, more than 47,000 cases
were observed in the country and standardized inci-
dence and mortality rates were 86.3/100,000 and
16.1/100,000 respectively(1). In the same year more
than 11,000 deaths for breast cancer were estimated
in the country(1). In Italy, breast cancer comprises
approximately one third of the overall female can-
cers, with relevant variations in incidence between
northern (127.2/100,000), central (100.1/100,000)
and southern regions (91.6/100,000)(5). This hetero-
geneity may be due to a different diffusion of risk
factors and organized screening programs in the ter-
ritory. Given the continuous increment of the
expectancy of life, an increase in incidence of
breast cancer in Italy is estimated, with more than
50,000 expected in 2020(5). Conversely, a slight but
steady reduction of mortality rates was observed in
the last two decades (-1,7%/year) in the country(5).     
Standardized incidence rates in the province of
Sassari were similar than those estimated for the
central Italian regions. Comparisons of the inci-
dence rates with those of other Italian provinces
place our province between those with low rates,
such as Salerno and Napoli. Provinces with higher
incidences, like Ferrara e Modena, were indeed
northern ones (Table 3).     
Considering the distribution of the disease in
relation to age, less than 1% of the cases occurred
in individuals ≤30 years, while more than 50%
occurred between 45 and 75 years of age. Peak
incidence occurred at 80-84 years for males and 70-
74 years for females.  
The time trends analysis showed a steady
increase in incidence in Sassari province in the
period under investigation. This trend is common to
numerous national and international geographical
areas. It is not clear whether this is a real increase
in incidence or whether it reflects a general advanc-
ing in the technological means employed for diag-
nosis and a progressively wider adoption of surveil-
lance programs in developing countries.
Furthermore, a continuous increase in breast cancer
incidence rates in Sassari province in the last 35
years is evidenced, taking into account previous
epidemiological surveys reporting data obtained in
the periods 1974-1985 and 1992-2002; figures for
crude incidence were 43.4/100,000 and
106/100,000 respectively(6,7). Our data evidenced an
increase in crude incidence to 128.8/100,000 in the
period 2005-2010.    
As regards histology, a relevant increase of
ductal carcinomas was observed from 1992 to
2010. Considering previous reports, the percentage
of ductal carcinomas was globally reduced in the
last 35 years, as it accounted for 82% of all cases in
the period 1974-1985, 65.2% in the period 1992 -
2002, and 58.8% in the period 2005 - 2010(6,7). A
slight increment of lobular and other malignancies
was, furthermore, evidenced in the last 18 years.      
Concerning mortality, 1,358 (15 males and
1,343 females) deaths occurred in the 18 years we
studied. Standardized mortality rates were globally
lower to those observed in most provinces in Italy,
but higher than some recent European and world
estimates(1). Considering the age-class mortality
trend, a natural increase in relation to age was
observed in both sexes, with peaks after the eighth
decade of life. Time trend analysis evidenced an
increase in mortality rates in the period under
investigation, despite the existence of an organized
screening program in the area. This suggests that
surveillance, clinical and oncological health care
238 A. Cossu, P. Paliogiannis et Al
services must be further improved in order to obtain
reduction of mortality in breast cancer patients in
North Sardinia.   
Conclusions
Our data showed an increasing trend in inci-
dence of breast cancer in Sassari province in the
last decades. Furthermore, an increase in mortality
rates was observed, as opposed to national figures.
This suggests that surveillance, clinical and onco-
logical health care services must be improved in
order to obtain reduction of mortality in breast can-
cer patients in North Sardinia.   
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_______
Request reprints from:
Dr. PANAGIOTIS PALIOGIANNIS MD.
Department of Surgical, Microsurgical and Medical Sciences  
University of Sassari
(Italy)
Breast cancer incidence and mortality in North Sardinia in the period 1992 - 2010 239


5) I numeri del cancro in Italia

Carcinoma of the breast in the period 1974-1985 in the province of Sassari.

Epidemiology of breast cancer in Europe and Africa.

Epidemiology of malignant breast tumors in the province of Sassari (Sardinia, Italy) in the period 1992-2002.

Global burden of breast cancer.

Gynaecol Oncol 2005; 26: 505-8. _______ Request reprints from: Dr.

Regional estimates of breast cancer burden in Italy. Tumori

Breast cancer incidence and mortality in North Sardinia in the period 1992–2010

Breast cancer incidence and mortality in North Sardinia in the period 1992–2010

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