Cancer Incidence in Ferrara Province (1998-2002)

Italy, Ferrara Province: REGISTRATION AREA: The province of Ferrara is located in the northwest of Emilia-Romagna Region and is mainly agricultural. It lies close to sea level (maximum altitude 22 m) and it is bordered to the north by the Po river, to the east by the Adriatic sea, to the south by the provinces of Bologna and Ravenna and to the west by those of Modena and Mantova. The population (348 651 in 2000) is fairly stable and it is characterized by elevated aging (24% over 65 years) with a crude annual birth rate at the lowest levels in Italy (6.1/1000 inhabitants in 2000). Among the 26 municipalities of the province, the only one with a popolation >100 000 is Ferrara (132 085 inhabitants in 2000). The prevalence of non-Caucasians is low, and the most widespread religion in Chistian Catholic. The number of immigrants is lower than in other regional provinces, but the proportion increased in size from the late 1990s (from 0.52% in 1995 to 2.43% in 2004). A majority (54.5%) of them comes from five countries (Morocco, Ukraine, Albania, Romania and Pakistan), and females/males ratio is 1.23. The level of employment was 47.8% (35.6% industry, 9.4% agriculture, 55.0% trade and services). Mechanical and chemical industries are present in the province, and they represent the main source of water and air pollution, together with animal breeding, traffic, heating plants and agriculture chemical treatments. In 2000 the average temperature was 13.3°C (monthly average from –0.5°C in January to 23.8°C in August) and the overall rainfall was 443mm. In the period 1998–2002 the population showed a progressive decrease due to a fall in births and low migration rates from other areas. CANCER CARE FACILITIES: In 2000 the province had a network of three care districts with 5 general hospitals (1851 beds). These provided cancer surgery units, haematology, radiotherapy and chemotherapy services. Cervix uteri and breast cancer organized screening programmes started in 1996 and 1997 respectively, as a part of a whole regional project. Colorectal cancer screening started in 2005. PSA testing is widespread among the adult male population, expecially in most recent years. In 2003, 14.6% of patients were treated outside the Registry area. REGISTRY STRUCTURE AND METHODS: The Registry is supported by the Emilia-Romagna regional Health Care Service since 1994, and it has also been funded by the Health Care Units of Ferrara province. It is located in the Pathology Department of Ferrara University and it has a staff of three clerks and a director. The main sources of information are discharge diagnoses from all national hospitals and the database of the Pathology Department (covering all pathological diagnostic activity in the province). Additional information is provided by direct contact with care services (medical records) and general practitioners. Mortality data for all causes are provided by public health services to identify DCN and DCO cases and for follow-up purposes. Data collection is performed both actively and passively. Personal identifying data are protected in compliance with current Italian law. Regular maintenance is carried out on the computerized database. Checks for duplicates, errors and consistency are performed using the IARCcrg and DEPedits tools. Completeness and accuracy evaluations are performed using death certificates, record-linkage with pathological archives and checking of site-specific changes in incidence over time. INTERPRETING THE RESULTS: The high prevalence of old-aged population has a great effect on crude incidence rates of many sites. In the area covered by the Registry, lung cancer is traditionally the most common male malignant tumor. The rate of cigarette smoking in the Province (32.6% over 14 years old in 1996) is the highest in the Region (average 26.3%) and one of the highest in Italy. About 42% of children have at least one smoker parent. Air pollution from the aforementioned sources and fog also add further risk for lung cancer. Dietary risks are also remarkable, due to high meat, cold cut and saturated fats intake, compared with low vegetable consumption. The province shows also high incidence rates for colorectal, gallbladder, soft tissues, endometrial, brain tumors and multiple myeloma. The very high incidence of breast cancer and of cervix uteri is explained by the population-based screenings started in 1996–97. Prostate and thyroid cancers also increased in the period, the former as a result of PSA diffusion, the latter of diagnostic ecography improvement. DCN and “final” DCO were 1.1% and 1% respectively. The proportion of cancer deaths necropsied in 1998–2002 was low (<1%). USE OF THE DATA: The Registry is involved in local and regional cancer care networks and it publishes periodic reports on cancer incidence, prevalence and survival. The impact of screening on incidence, mortality and therapy and cancer care needs in the covered population are its main purposes. It is also involved in several studies on multiple tumors, prognostic and predictive power of biological assessment in breast cancer, social inequalities and cancer care access. The Registry joins in the Italian Association of Tumor Registries (AIRTum). Several studies on cancer descripitve epidemiology and breast cancer screening in Italy are now in progress. Further activities on registration and coding techniques are also being carried out.