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Environmental health effects vary considerably with regard to their severity, type of disease, and duration. Integrated measures of population health, such as environmental burden of disease (EBD), are useful for setting priorities in environmental health policies and research. This review is a summary of the full Environmental Burden of Disease in European countries (EBoDE) project report. The EBoDE project was set up to provide assessments for nine environmental risk factors relevant in selected European countries (Belgium, Finland, France, Germany, Italy, and the Netherlands). Disability-adjusted life years (DALYs) were estimated for benzene, dioxins, secondhand smoke, formaldehyde, lead, traffic noise, ozone, particulate matter (PM2.5), and radon, using primarily World Health Organization data on burden of disease, (inter)national exposure data, and epidemiological or toxicological risk estimates. Results are presented here without discounting or age-weighting. About 3-7% of the annual burden of disease in the participating countries is associated with the included environmental risk factors. Airborne particulate matter (diameter ≤ 2.5 μm; PM2.5) is the leading risk factor associated with 6,000-10,000 DALYs/year and 1 million people. Secondhand smoke, traffic noise (including road, rail, and air traffic noise), and radon had overlapping estimate ranges (600-1,200 DALYs/million people). Some of the EBD estimates, especially for dioxins and formaldehyde, contain substantial uncertainties that could be only partly quantified. However, overall ranking of the estimates seems relatively robust. With current methods and data, environmental burden of disease estimates support meaningful policy evaluation and resource allocation, including identification of susceptible groups and targets for efficient exposure reduction. International exposure monitoring standards would enhance data quality and improve comparability.

Background Estimates of cancer prevalence are widely based on limited duration, often including patients living after a cancer diagnosis made in the previous 5 years and less frequently on complete prevalence (i.e., including all patients regardless of the time elapsed since diagnosis). This study aims to provide estimates of complete cancer prevalence in Italy by sex, age, and time since diagnosis for all cancers combined, and for selected cancer types. Projections were made up to 2020, overall and by time since diagnosis. Methods Data were from 27 Italian population-based cancer registries, covering 32% of the Italian population, able to provide at least 7 years of registration as of December 2009 and follow-up of vital status as of December 2013. The data were used to compute the limited-duration prevalence, in order to estimate the complete prevalence by means of the COMPREV software. Results In 2010, 2,637,975 persons were estimated to live in Italy after a cancer diagnosis, 1.2 million men and 1.4 million women, or 4.6% of the Italian population. A quarter of male prevalent cases had prostate cancer ( n  = 305,044), while 42% of prevalent women had breast cancer ( n  = 604,841). More than 1.5 million people (2.7% of Italians) were alive since 5 or more years after diagnosis and 20% since ≥15 years. It is projected that, in 2020 in Italy, there will be 3.6 million prevalent cancer cases (+ 37% vs 2010). The largest 10-year increases are foreseen for prostate (+ 85%) and for thyroid cancers (+ 79%), and for long-term survivors diagnosed since 20 or more years (+ 45%). Among the population aged ≥75 years, 22% will have had a previous cancer diagnosis. Conclusions The number of persons living after a cancer diagnosis is estimated to rise of approximately 3% per year in Italy. The availability of detailed estimates and projections of the complete prevalence are intended to help the implementation of guidelines aimed to enhance the long-term follow-up of cancer survivors and to contribute their rehabilitation needs.

Background This study aims to estimate the long‐term risk of metastatic recurrence (MR) among Italian women with breast cancer (BC) by period, age, stage, and surrogate molecular profile. Methods Data on 59,968 women below age 75 years diagnosed in 1997–2017 with stage I‐III BC from 7 population‐based Italian cancer registries were analyzed. We used a novel modeling method, based on an illness–death process coupled with a mixture cure model, to estimate relative survival and MR risks up to 15 years after BC diagnosis according to calendar period, age, stage, and profile. Results The risk of MR for the entire cohort at 15 years decreased from 20.6% in 1997–2006 to 12.3% in 2007–2017, when MR risk within 15 years was 3.0% for stage I, 16.0% for stage II, and 42.7% for stage III. The conditional risk of MR decreased with time since diagnosis, with stage I–III triple‐negative BC having a higher risk of developing MR in the first 5 years regardless of age (16.0% at age 15–54 years and 18.3% at 55–74 years), but < 1% once they survived for 5 years without recurrence. In contrast, hormone receptor‐positive BC had a lower but persisting risk of MR of about 6% for both age groups in the first 10 years, halving to about 3% in the following 5 years after diagnosis. Conclusions This study provides a population‐based estimate of the long‐term risk of MR for women with BC by major prognostic factors. These findings may help in tailoring follow‐up strategies through informative risk stratification.

Background Increasing evidence of cure for some neoplasms has emerged in recent years. The study aimed to estimate population‐based indicators of cancer cure. Methods Information on more than half a million cancer patients aged 15‐74 years collected by population‐based Italian cancer registries and mixture cure models were used to estimate the life expectancy of fatal tumors (LEFT), proportions of patients with similar death rates of the general population (cure fraction), and time to reach 5‐year conditional relative survival (CRS) >90% or 95% (time to cure). Results Between 1990 and 2000, the median LEFT increased >1 year for breast (from 8.1 to 9.4 years) and prostate cancers (from 5.2 to 7.4 years). Median LEFT in 1990 was >5 years for testicular cancers (5.8) and Hodgkin lymphoma (6.3) below 45 years of age. In both sexes, it was ≤0.5 years for pancreatic cancers and NHL in 1990 and in 2000. The cure fraction showed a 10% increase between 1990 and 2000. It was 95% for thyroid cancer in women, 94% for testis, 75% for prostate, 67% for breast cancers, and <20% for liver, lung, and pancreatic cancers. Time to 5‐year CRS >95% was <10 years for testis, thyroid, colon cancers, and melanoma. For breast and prostate cancers, the 5‐year CRS >90% was reached in <10 years but a small excess remained for >15 years. Conclusions The study findings confirmed that several cancer types are curable. Became aware of the possibility of cancer cure has relevant clinical and social impacts. The study provides further evidence on the possibility of cancer cure, for some cancer types, within a short‐ or long‐time span. Recognizing some cancer patients as cured may have relevant clinical and social impacts, and represents an opportunity to improve the quality of life in “former” patients.

The EUROCARE-5 study revealed disparities in childhood cancer survival among European countries, giving rise to important initiatives across Europe to reduce the gap. Extending its representativeness through increased coverage of eastern European countries, the EUROCARE-6 study aimed to update survival progress across countries and years of diagnosis and provide new analytical perspectives on estimates of long-term survival and the cured fraction of patients with childhood cancer. In this population-based study, we analysed 135 847 children (aged 0–14 years) diagnosed during 2000–13 and followed up to the end of 2014, recruited from 80 population-based cancer registries in 31 European countries. We calculated age-adjusted 5-year survival differences by country and over time using period analysis, for all cancers combined and for major cancer types. We applied a variant of standard mixture cure models for survival data to estimate the cure fraction of patients by childhood cancer and to estimate projected 15-year survival. 5-year survival for all childhood cancer combined in Europe in 2010–14 was 81% (95% CI 81–82), showing an increase of three percentage points compared with 2004–06. Significant progress over time was observed for almost all cancers. Survival remained stable for osteosarcomas, Ewing sarcoma, Burkitt lymphoma, non-Hodgkin lymphomas, and rhabdomyoscarcomas. For all cancers combined, inequalities still persisted among European countries (with age-adjusted 5-year survival ranging from 71% [95% CI 60–79] to 87% [77–93]). The 15-year survival projection for all patients with childhood cancer diagnosed in 2010–13 was 78%. We estimated the yearly long-term mortality rate due to causes other than the diagnosed cancer to be around 2 per 1000 patients for all childhood cancer combined, but to approach zero for retinoblastoma. The cure fraction for patients with childhood cancer increased over time from 74% (95% CI 73–75) in 1998–2001 to 80% (79–81) in 2010–13. In the latter cohort, the cure fraction rate ranged from 99% (95% CI 74–100) for retinoblastoma to 60% (58–63) for CNS tumours and reached 90% (95% CI 87–93) for lymphoid leukaemia and 70% (67–73) for acute myeloid leukaemia. Childhood cancer survival is increasing over time in Europe but there are still some differences among countries. Regular monitoring of childhood cancer survival and estimation of the cure fraction through population-based registry data are crucial for evaluating advances in paediatric cancer care. European Commission.

Cancer survivors—people living with and beyond cancer—are a growing population with different health needs depending on prognosis and time since diagnosis. Despite being increasingly necessary, complete information on cancer prevalence is not systematically available in all European countries. We aimed to fill this gap by analysing population-based cancer registry data from the EUROCARE-6 study. In this population-based study, using incidence and follow-up data up to Jan 1, 2013, from 61 cancer registries, complete and limited-duration prevalence by cancer type, sex, and age were estimated for 29 European countries and the 27 countries in the EU (EU27; represented by 22 member states that contributed registry data) using the completeness index method. We focused on 32 malignant cancers defined according to the third edition of the International Classification of Diseases for Oncology, and only the first primary tumour was considered when estimating the prevalence. Prevalence measures are expressed in terms of absolute number of prevalent cases, crude prevalence proportion (reported as percentage or cases per 100 000 resident people), and age-standardised prevalence proportion based on the European Standard Population 2013. We made projections of cancer prevalence proportions up to Jan 1, 2020, using linear regression. In 2020, 23 711 thousand (95% CI 23 565–23 857) people (5·0% of the population) were estimated to be alive after a cancer diagnosis in Europe, and 22 347 thousand (95% CI 22 210–22 483) in EU27. Cancer survivors were more frequently female (12 818 thousand [95% CI 12 720–12 917]) than male (10 892 thousand [10 785–11 000]). The five leading tumours in female survivors were breast cancer, colorectal cancer, corpus uterine cancer, skin melanoma, and thyroid cancer (crude prevalence proportion from 2270 [95%CI 2248–2292] per 100 000 to 301 [297–305] per 100 000). Prostate cancer, colorectal cancer, urinary bladder cancer, skin melanoma, and kidney cancer were the most common tumours in male survivors (from 1714 [95% CI 1686–1741] per 100 000 to 255 [249–260] per 100 000). The differences in prevalence between countries were large (from 2 to 10 times depending on cancer type), in line with the demographic structure, incidence, and survival patterns. Between 2010 and 2020, the number of prevalent cases increased by 3·5% per year (41% overall), partly due to an ageing population. In 2020, 14 850 thousand (95% CI 14 681–15 018) people were estimated to be alive more than 5 years after diagnosis and 9099 thousand (8909–9288) people were estimated to be alive more than 10 years after diagnosis, representing an increasing proportion of the cancer survivor population. Our findings are useful at the country level in Europe to support evidence-based policies to improve the quality of life, care, and rehabilitation of patients with cancer throughout the disease pathway. Future work includes estimating time to cure by stage at diagnosis in prevalent cases. European Commission.

Management of lymphoid malignancies requires substantial health system resources. Total national health expenditure might influence population-based lymphoid malignancy survival. We studied the long-term survival of patients with 12 lymphoid malignancy types and examined whether different levels of national health expenditure might explain differences in lymphoid malignancy prognosis between European countries and regions. For this observational, retrospective, population-based study, we analysed the EUROCARE-6 dataset of patients aged 15 or older diagnosed between 2001 and 2013 with one of 12 lymphoid malignancies defined according to International Classification of Disease for Oncology (third edition) and WHO classification, and followed up to 2014 (Jan 1, 2001–Dec 31, 2014). Countries were classified according to their mean total national health expenditure quartile in 2001–13. For each lymphoid malignancy, 5-year and 10-year age-standardised relative survival (ASRS) was calculated using the period approach. Generalised linear models indicated the effects of age at diagnosis, gender, and total national health expenditure on the relative excess risk of death (RER). 82 cancer registries (61 regional and 21 national) from 27 European countries provided data eligible for 10-year survival estimates comprising 890 730 lymphoid malignancy cases diagnosed in 2001–13. Median follow-up time was 13 years (IQR 13–14). Of the 12 lymphoid malignancies, the 10-year ASRS in Europe was highest for hairy cell leukaemia (82·6% [95% CI 78·9–86·5) and Hodgkin lymphoma (79·3% [78·6–79·9]) and lowest for plasma cell neoplasms (29·5% [28·9–30·0]). RER increased with age at diagnosis, particularly from 55–64 years to 75 years or older, for all lymphoid malignancies. Women had higher ASRS than men for all lymphoid malignancies, except for precursor B, T, or natural killer cell, or not-otherwise specified lymphoblastic lymphoma or leukaemia. 10-year ASRS for each lymphoid malignancy was higher (and the RER lower) in countries in the highest national health expenditure quartile than in countries in the lowest quartile, with a decreasing pattern through quartiles for many lymphoid malignancies. 10-year ASRS for non-Hodgkin lymphoma, the most representative class for lymphoid malignancies based on the number of incident cases, was 59·3% (95% CI 58·7–60·0) in the first quartile, 57·6% (55·2–58·7) in the second quartile, 55·4% (54·3–56·5) in the third quartile, and 44·7% (43·6–45·8) in the fourth quartile; with reference to the European mean, the RER was 0·80 (95% CI 0·79–0·82) in the first, 0·91 (0·90–0·93) in the second, 0·94 (0·92–0·96) in the third, and 1·45 (1·42–1·48) in the fourth quartiles. Total national health expenditure is associated with geographical inequalities in lymphoid malignancy prognosis. Policy decisions on allocating economic resources and implementing evidence-based models of care are needed to reduce these differences. Italian Ministry of Health, European Commission, Estonian Research Council.

Clinically relevant survival outcomes, including cure fraction estimates, and long-term survival outcomes of paediatric CNS tumours from large-scale databases have not been reported for Europe. Moreover, various biases hinder direct geographical comparisons, thereby limiting the effective translation of population-based findings into cancer care, surveillance, and research. We aimed to estimate these survival outcomes across Europe through the EUROCARE database. In this population-based study, we analysed survival data from the EUROCARE-6 database from children younger than 15 years with a CNS tumour across 31 European countries. For the period 2008–13, we estimated observed survival via the actuarial method, and 5-year observed survival was reported at the European level and national level for four major CNS tumour groups. For the period 1998–2013, cure fraction was estimated through a mixture cure model assuming constant long-term mortality from other causes. Additionally, model-based 10-year and 15-year survival were estimated. For observed survival analyses, 13 782 tumour cases were included. 5-year observed survival was 72% (95% CI 68 to 75) for ependymomas, 92% (91 to 93) for low-grade gliomas, 47% (45 to 49) for high-grade gliomas, 24% (21 to 27) for high-grade gliomas excluding glioma not otherwise specified, and 64% (62 to 67) for medulloblastomas. A total of 30 392 children were included in the cure fraction analysis. During the study period, the largest absolute increase in cure fraction was observed for ependymomas from 65% (57 to 73) in 1998–2001 to 79% (69 to 89) in 2010–13, whereas low-grade gliomas increased from from 89% (85 to 94) to 95% (89 to 100), high-grade gliomas had a 6 percentage point change increase (2 to 10), and medulloblastomas increased from 52% (49 to 55) to 56% (51 to 60). The estimated 10-year and 15-year survival rates were highest for low-grade gliomas at 90·6% (89·4 to 91·7) at 10 years and 88·5% (87·2 to 89·8) at 15 years, whereas the lowest survival rates were observed for high-grade gliomas excluding glioma not otherwise specified at 20·5% (17·0 to 24·1) and 19·0% (15·6 to 22·5). This study is the first to report a comprehensive evaluation of survival parameters for paediatric CNS tumour patients in Europe. These outcomes are important to evaluate advances in care for children with a CNS tumour. Princess Máxima Center for Pediatric Oncology and Associazione Italiana per la Ricerca sul Cancro.

Cancer incidence and mortality trends represent epidemiological indicators of fundamental importance for public health systems. The study's aim is to present recent (2013–2017) short-term cancer incidence and mortality trends in Italy, including 80 % of the Italian population, for different cancer sites by sex, age group, and areas. Joinpoint Regression models were employed. A significantly decreasing trend in the incidence of all cancers was observed for men in Italy (-1.9 % per year), particularly for cancers of the lung (-2.5 %), liver (-3.9 %), stomach (-2.8 %), colorectal (-2.2 %), prostate (-3.4 %), and leukaemias (-3.2 %). The only significant increase was seen for skin melanoma (+5.2 % per year). Among women, overall cancer incidence remained stable, with a decrease in the North (-0.6 %) and an increase in the South and Islands (+0.9 %). Decreasing trends were observed for colorectal (-1.9 %), stomach (-3.5 %), liver (-4.0 %%), and leukaemias (-2.0 %) cancers, while incidence increased for skin melanoma (+6.0 % per year), and lung cancer (2.3 %). Cancer mortality declined consistently in both sexes (-1.8 % per year in men and −0.6 % in women), across different areas, and age groups. The observed trends in men and women partly reflect the impact of risk factors affecting both sexes at different times, mainly in the case of tobacco and lung cancer. Also, some trends may be linked to organized screening initiatives (e.g. colorectal) or the decrease in opportunistic screening (e.g. prostate). The snapshot of cancer trends in Italy may highlight new opportunities for strengthening prevention activities and advancing research on early detection and target treatments. [Display omitted] •We observed decreasing incidence and mortality trends in men and stable incidence and decreasing mortality trends in women.•Skin melanoma incidence increased in both sexes, while lung cancer increased in women and decreased in men.•Stomach, colorectal, liver and leukaemias incidence decreased in both sexes.•We highlighted the need to improve cancer prevention initiatives and research in diagnostic and treatments in Italy

Paediatric cancers are rare, yet, Italy has previously shown some of the highest incidence rates in Europe as a leading cause of death in children and adolescents. This study updates data from Italy for 2008–2017, analyses trends from 1998, and compares findings with other European regions. A population-based approach was used, leveraging data from the Italian Association of Cancer Registries (AIRTUM). Thirty-one cancer registries covering 77 % of the Italian paediatric population contributed data on tumour type, age, sex, residence, and diagnosis date. Cancers were classified using the International Classification of Childhood Cancer, Third Edition (ICCC-3). Age-specific (IR) and age-standardized incidence rates (ASR) were computed, while trends were analysed with Joinpoint regression to estimate annual (APC) and average annual percentage change (AAPC). From 2008–2017, 17,322 malignant paediatric cancer cases were reported in Italy. The age-standardized incidence rate (ASR) was 166.8 per million for ages 0–14 and 294.3 per million for adolescents 15–19. Over the study period, incidence rates were generally stable, but a significant increase was observed for bone tumours in children and thyroid and melanoma in adolescents. Central Italy showed higher incidence rates compared to other Italian regions. Italy still shows one of the highest incidence rates in Europe. While the study confirms overall stable incidence trends in Italy, it also highlights an increase in specific cancers such as melanoma and thyroid tumours in adolescents. Central Italy exhibited higher incidence rates, potentially due to environmental and/or diagnostic factors. Continuous monitoring and further research are needed to clarify regional variations and evaluate the impact of early diagnosis and environmental exposures. •17,322 paediatric cancer cases recorded in Italy (2008–2017).•ASR: 166.8/million in children; IR: 294.3/million in adolescents.•Central Italy had highest incidence, esp. melanoma and epithelial tumours.•Italy shows higher paediatric cancer rates than other European regions.•Stable trends; increased bone tumours (children), thyroid and melanoma (adolescents).