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BMC Cancer

, 18:169 | Cite as

Characteristics of people living in Italy after a cancer diagnosis in 2010 and projections to 2020

  • Stefano Guzzinati
  • Saverio Virdone
  • Roberta De Angelis
  • Chiara Panato
  • Carlotta Buzzoni
  • Riccardo Capocaccia
  • Silvia Francisci
  • Anna Gigli
  • Manuel Zorzi
  • Giovanna Tagliabue
  • Diego Serraino
  • Fabio Falcini
  • Claudia Casella
  • Antonio Giampiero Russo
  • Fabrizio Stracci
  • Bianca Caruso
  • Maria Michiara
  • Anna Luisa Caiazzo
  • Marine Castaing
  • Stefano Ferretti
  • Lucia Mangone
  • Giuseppa Rudisi
  • Flavio Sensi
  • Guido Mazzoleni
  • Fabio Pannozzo
  • Rosario Tumino
  • Mario Fusco
  • Paolo Ricci
  • Gemma Gola
  • Adriano Giacomin
  • Francesco Tisano
  • Giuseppa Candela
  • Anna Clara Fanetti
  • Filomena Pala
  • Antonella Sutera Sardo
  • Massimo Rugge
  • Laura Botta
  • Luigino Dal Maso
Open Access
Research article
Part of the following topical collections:
  1. Epidemiology, prevention and public health

Abstract

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.

Keywords

Cancer prevalence Projections Survivors Italy 

Background

Estimates of cancer prevalence are widely based on limited duration prevalence, including only patients living after a cancer diagnosis made in the previous 5 years [1, 2]. Prevalence, regardless of the time since diagnosis (i.e., complete prevalence), is less frequently estimated than limited duration prevalence [3, 4, 5, 6, 7, 8, 9]. Overall age-standardized cancer incidence and mortality rates have declined over the past 10 years in the majority of high income countries, whereas the complete prevalence has been consistently increasing in the early 2000s [3, 4, 6, 8, 10, 11]. Complete prevalence is generally measured in absolute numbers and proportions, i.e., not age-standardized. Thus, improved survival [12, 13] and population ageing (increasing absolute number of new cancer diagnoses) imply a progressive increase in tumour prevalence.

Cancer prevalence includes patients currently treated for cancer; those who have become cancer free, but still have a measurable excess risk of recurrence or death; and, finally, patients having death rates similar to those of the general population who can be considered “cured patients” [14]. Many of these individuals are possibly affected by physical, cognitive, and/or psychosocial limitations [15].

The aim of this study was to provide a description of the number of people living in Italy at January 1, 2010 after a cancer diagnosis, for all cancers combined and for a selection of cancer types by sex, age, and time since diagnosis. In addition, projections of cancer prevalence in Italy are presented up to the year 2020. Estimates and projections of complete tumour prevalence and characteristics of prevalent patients are necessary to help clinicians and health care planners in improving long-term care of patients and in allocating appropriately health care resources. Moreover, they may provide helpful information to a growing number of cancer patients or former patients.

Methods

Study design and data sources

This is a descriptive analysis of individual data collected during the period 1976-2009 from 27 population-based Italian cancer registries (i.e., 32% of the entire Italian population in 2010), which agreed to participate in the study and were able to provide at least 7 years of cancer registration as of December 31, 2009 (Appendix 1) and follow-up of vital status as of December 31, 2013. The Italian legislation identifies Cancer Registries as collectors of personal data for surveillance purposes without explicit individual consent. The approval of a research ethic committee is not required, since this descriptive study was conducted without any direct or indirect intervention on patients.

Prevalence for all malignant tumours (ICD-10: C00-C43, C45-C96) and 34 cancer types or their combinations were estimated and presented in this study for all age groups. Urinary bladder cancers with benign or uncertain behaviour, and in situ tumours were also included. Only non melanoma skin cancers (ICD-10 C44) were excluded. ICD-O-3 morphology codes were used to define specific subtypes.

Statistical methods

The clinical and demographic characteristics of the persons registered with a diagnosis of cancers in the Italian CRs were used to estimate: 1) how many of them were still alive at January 1, 2010 regardless of time since diagnosis -i.e., complete prevalence count- by cancer type, sex, and age group; 2) the prevalence proportion in Italy at 2010 for each cancer type, by sex, and age; 3) the complete prevalence (count and proportion) at 1st January 2015 and 2020, overall and by time since diagnosis; and 4) describe the changing over time of these estimates.

For each cancer registry we computed the limited duration prevalence, i.e. the number of patients diagnosed in the period of the registration activity (between 7 and 34 years) at January 1, 2010, using the counting method implemented in SEER*Stat software [16]. This maximum limited duration prevalence was corrected, using the COMPREV software [17], by means of completeness index [18, 19], to estimate the total number of cancer patients alive, regardless of when they were diagnosed. Completeness indices were estimated by cancer type, sex, age, and time since diagnosis. Prevalence was computed as an absolute number, as well as a proportion per 100,000 residents people by cancer type, sex, age group, area of residence, and years since diagnosis. Patients with more than one primary cancer were included in the computation of prevalence for each cancer type or combination. In the analyses for all types combined, only the first cancer was considered. Completeness indices were obtained by statistical regression models of incidence and survival using data from 8 long-term registries (Appendix 1) with an available observation period of at least 18 years before 2010 [20, 21]. Relative survival and incidence functions were estimated by means of parametric models within the period 1985-2011 for survival and 1985-2009 for incidence. The survival model was a parametric cure model assuming that a proportion of individuals with cancer were bound to die (fatal cases) with a survival following a Weibull distribution, while the remaining proportion (cured fraction) had the same mortality rate as that of the general population with the same age and gender stratification [14, 20]. The parameters of the survival model were estimated by cancer type, sex, and age class (0-14, 15-44, 45-54, 55-64, 65-74, 75+ years) through the SAS procedure NLIN. A period effect was included on the hazard of dying of cancer. Incidence data were categorised according to cancer type, sex, five-year age group, and birth cohort (< 1899, 1900-1904,…, 2005-2009). A sixth degree polynomial age-cohort model of crude incidence rates was fitted through the SAS LOGISTIC procedure for each cancer type and sex [21].

Complete prevalence proportions were projected to 2020 by cancer type, sex, age, and registry, assuming that complete prevalence will follow a linear function, based on the trend of the last three calendar years (i.e., 2007-2009). This simplified assumption (linear and constant trend) may not be valid for long-term projections, but it is reasonable for short or medium-term (e.g., 10-year) ones. Other assumptions (e.g., log-linear models) were explored [4, 6], showing consistent results for common cancer types, but unstable projections for the rarest.

The absolute number of prevalent cases in Italy was obtained using proportions of prevalence estimates (age-, sex-, and cancer type-specific) from CRs included in this study, multiplied by the Italian national population by sex and age observed at January 1, 2010. Proportions projected to 2020 were thus multiplied to Italian population forecasted at January 1, 2020 [22].

Results

Prevalence estimates at 2010

In Italy in 2010, 2,637,975 persons were alive after a cancer diagnosis, corresponding to 4.6% of all the Italian population (Appendix 2). Prevalence proportions increase with age: 3.1% at age 45-54 years, 6.6% at 55-64 years, 12.1% at 65-74 years, and nearly 17% after age 75 years (Appendix 2) with differences by sex (Tables 1 and 2).
Table 1

Complete cancer prevalence by cancer type and age in Italian men at January 1, 2010

Cancer type

Prevalent cases

Prevalence proportion per 100,000 men

All ages

%

00-14

15-44

45-54

55-64

65-74

75-84

85+

All ages

00-14

15-44

45-54

55-64

65-74

75-84

85+

All types but skin non-melanoma

1,194,033

 

4844

84,172

87,091

198,505

363,932

357,051

98,439

4250

111

732

2079

5715

13,029

20,534

21,955

Upper aero-digestive tract

26,745

2.2%

19

1654

3320

6536

8063

5786

1367

100

0

15

84

199

311

337

313

Esophagus

3067

0.3%

0

54

252

722

1105

781

153

12

0

1

7

23

45

51

40

Stomach

45,970

3.8%

2

764

2583

6661

13,618

16,538

5802

158

0

6

58

180

470

926

1268

Small intestine

3384

0.3%

0

221

350

760

987

850

216

13

0

2

8

23

38

52

46

Colon, rectum, anus

185,532

15.5%

3

2718

8722

29,332

59,931

63,698

21,130

654

0

23

210

840

2108

3618

4682

Liver

17,454

1.5%

57

317

1539

3831

6347

4752

610

63

2

3

37

110

228

280

142

Biliary tract

4251

0.4%

0

70

238

713

1365

1443

421

15

0

0

6

20

47

80

103

Pancreas

5856

0.5%

3

198

598

1383

1876

1462

336

21

0

2

14

39

69

84

75

Larynx

44,810

3.8%

0

236

2105

8399

15,082

14,819

4169

160

0

2

51

240

540

854

965

Lung

63,048

5.3%

16

804

2771

11,014

22,765

21,682

3996

219

0

7

64

306

787

1229

890

Thymus, heart, mediastinum

2290

0.2%

42

384

435

548

516

331

33

7

1

3

9

14

18

18

9

Bone

4808

0.4%

152

1910

924

771

596

418

37

16

3

16

20

21

19

22

10

Skin melanoma

44,977

3.8%

21

6730

7411

9817

11,117

7867

2014

165

0

61

181

291

408

470

488

Mesothelioma

2090

0.2%

0

72

127

457

913

466

54

8

0

1

3

13

34

27

12

Kaposi sarcoma

5611

0.5%

3

567

658

864

1255

1498

766

21

0

5

17

26

46

90

174

Connective tissue

11,757

1.0%

226

2685

1696

2043

2459

2002

647

41

6

23

41

59

87

111

144

Penis

4285

0.4%

0

91

413

795

1309

1255

422

14

0

1

9

22

45

68

84

Prostate

305,044

25.5%

3

438

3387

34,764

112,958

122,376

31,118

1112

0

5

88

1048

4138

7143

6878

Testis

37,937

3.2%

86

17,116

8495

5349

3317

2389

1187

133

2

149

197

152

128

133

243

Kidney

62,815

5.3%

314

2842

5609

12,652

19,613

17,524

4262

226

7

25

134

364

703

1030

984

Bladder

192,611

16.1%

25

2802

8582

28,948

59,204

70,749

22,302

686

0

26

204

821

2104

4074

5053

Choroidal melanoma

1801

0.2%

0

115

209

365

484

519

109

7

0

1

6

11

18

30

25

Brain and central nervous system

16,110

1.3%

568

5391

2881

2930

2525

1423

391

54

13

46

65

81

82

78

66

Thyroid

25,512

2.1%

31

6428

5811

5876

4665

2351

349

89

1

56

137

165

166

136

80

Hodgkin lymphoma

27,821

2.3%

165

9685

5488

5229

4133

2684

437

95

4

83

129

139

141

148

99

Non-Hodgkin lymphoma

56,808

4.8%

629

8344

8754

11,691

13,802

11,185

2403

203

14

72

206

339

501

655

574

Leukemias

36,105

3.0%

1939

7620

4086

5656

8050

6703

2051

124

43

65

94

158

276

373

444

Multiple myeloma (plasma cell)

12,787

1.1%

0

326

1158

2636

4050

3680

938

45

0

3

27

75

143

215

207

Table 2

Complete cancer prevalence by cancer type and age in Italian women at January 1, 2010

Cancer type

Prevalent cases

Prevalence proportion per 100,000 women

All ages

%

00-14

15-44

45-54

55-64

65-74

75-84

85+

All ages

00-14

15-44

45-54

55-64

65-74

75-84

85+

All types but skin non-melanoma

1,443,942

 

3903

112,527

176,656

277,374

363,646

357,146

152,690

4836

93

988

4095

7496

11,243

13,994

14,500

Upper aero-digestive tract

15,433

1.1%

19

1562

1687

3156

3696

3624

1688

54

0

14

41

87

123

148

158

Esophagus

1125

0.1%

0

17

102

199

348

358

101

4

0

0

3

6

13

16

11

Stomach

35,537

2.5%

0

651

1896

3992

8619

12,953

7426

117

0

5

41

104

254

497

698

Small intestine

2597

0.2%

0

136

277

495

688

752

250

9

0

1

6

14

21

29

28

Colon, rectum, anus

171,847

11.9%

12

2754

8640

24,517

45,322

59,479

31,123

571

0

24

204

658

1377

2287

2901

Liver

7331

0.5%

61

258

371

943

2182

2926

589

25

1

2

9

25

68

114

58

Biliary tract

5565

0.4%

3

60

286

836

1517

1932

931

18

0

0

6

22

44

72

84

Pancreas

6271

0.4%

0

326

495

1239

1699

1733

780

21

0

3

11

33

55

68

69

Larynx

4407

0.3%

2

68

364

898

1211

1358

508

16

0

1

8

26

41

55

52

Lung

23,721

1.6%

5

611

2373

4933

7158

6662

1980

80

0

6

53

133

224

268

186

Thymus, heart, mediastinum

2212

0.2%

61

514

406

410

443

306

72

7

2

4

9

9

12

11

7

Bone

9124

0.6%

100

2259

2163

1950

1306

973

374

28

3

19

43

47

38

38

32

Skin melanoma

57,515

4.0%

30

10,718

9929

10,950

11,657

9953

4278

198

1

98

237

302

372

404

432

Mesothelioma

674

0.0%

0

18

68

148

224

174

42

2

0

0

2

4

8

8

5

Kaposi sarcoma

1990

0.1%

0

105

60

197

349

750

528

7

0

1

2

6

12

30

49

Connective tissue

9917

0.7%

203

1893

1399

1812

1890

1791

929

34

5

17

32

49

62

71

91

Breast

604,841

41.9%

0

26,663

82,068

128,514

165,456

142,658

59,483

2046

0

236

1906

3516

5164

5643

5751

Vagina and vulva

9689

0.7%

17

256

557

982

2377

3570

1931

32

0

2

13

27

71

137

183

Cervix uteri

58,879

4.1%

4

4321

8073

10,569

13,177

15,641

7093

193

0

38

184

280

397

591

675

Corpus uteri (endometrium)

103,321

7.2%

0

1490

5745

21,047

31,548

31,158

12,333

342

0

13

135

553

964

1198

1147

Ovary

45,620

3.2%

65

4058

6617

10,544

11,399

9729

3209

149

1

34

154

276

352

372

291

Kidney

35,250

2.4%

411

2369

2841

5290

9461

10,650

4229

122

9

21

68

149

293

436

418

Bladder

47,822

3.3%

6

1362

2562

6101

11,410

16,786

9594

164

0

12

62

172

359

676

897

Choroidal melanoma

1713

0.1%

0

149

210

294

445

414

202

6

0

1

4

9

14

18

21

Brain and central nervous system

23,145

1.6%

501

6210

3661

3565

3875

3978

1355

72

12

52

82

96

114

133

105

Thyroid

93,341

6.5%

68

22,813

21,805

21,597

16,956

8578

1524

307

2

199

498

571

521

356

153

Hodgkin lymphoma

20,433

1.4%

102

9116

3990

3104

2222

1401

498

67

2

79

93

84

67

58

43

Non-Hodgkin lymphoma

53,907

3.7%

262

5635

6626

10,917

13,615

12,731

4120

181

6

49

153

290

422

505

407

Leukemias

31,196

2.2%

1450

7445

3465

4400

5626

6067

2742

101

34

64

78

115

166

235

256

Multiple myeloma (plasma cell)

12,278

0.9%

0

217

887

2367

3611

3814

1382

41

0

2

22

64

112

150

124

Men living in Italy after a cancer diagnosis in 2010 were 1,194,033, corresponding to 4.3% (4250/100,000) of all Italian male population (Table 1). This proportion increased from less than 1% below the age of 45 years, to > 20% for men aged ≥75 years. The most frequent tumours in terms of prevalence were prostate (305,044 of prevalent cases at January, 1st 2010) representing 25.5% of all cases or 1.1% of all Italian men, followed by bladder (192,611 men, 16.1%) and colorectal (185,532 men, 15.5%) tumours.

Italian women living after a cancer diagnosis were 1,443,942 (Table 2), corresponding to 4.8% of all Italian women. Breast cancer represented 41.9% of all cancers (604,841), followed by colorectal cancers (171,847, 11.9% of all female prevalent cases, 0.6% of all Italian women) and by endometrial cancers (103,321, 7.2% and 0.3%, respectively). Notably, the fourth most frequent cancer type diagnosed in Italian prevalent women is thyroid (93,341 women, 6.5% of all female prevalent cases). Prevalent women were younger than men. Women aged 15-44 years living after a diagnosis represented 1% of the whole Italian population, they were 4% at ages 45-54 years, 7% at ages 55-64 years, 11% at ages 65-74 years, and 14% for women aged ≥75 years (Table 2).

More than 1.5 million people (i.e., 2.7% of all Italian residents) were alive after ≥5 years since diagnosis. They were 60% of all prevalent cases, 64% of women and 55% of men. The distribution of prevalent cases by time since diagnosis depends on cancer type (Fig. 1). The percentage of prevalent cases diagnosed since less than 2 years varied from 39% for lung cancer patients to 15% for female breast and 7% for cervical cancer patients. Conversely, the percentage of prevalent cases diagnosed ≥15 years before was 59% for cervical cancer, 35% for stomach cancer and 31% for endometrial cancer, but only 4% for prostate and 13% for lung cancer patients. Notably, patients diagnosed ≥15 years before were 21% of all prevalent cases (16% among men and 25% among women).
Fig. 1

Complete prevalence by time since diagnosis for selected cancer types* in Italy at January 1, 2010. *Cancer types diagnosed in > 50,000 persons, sorted by number of cases

Prevalence projections for 2020

In 2020, there will be 3.6 million prevalent cancer cases in Italy (Table 3), 1.9 million women and 1.7 million men, with a 10-year increase of 37% (41 and 33% in men and women, respectively). In 2020, 2.6% of all Italian women (0.8 millions) will be alive after a breast cancer diagnosis and more than half a million patients (2.1% of all men) will be alive after a prostate cancer diagnosis (Table 3). The largest 10-year increases are foreseen for prostate (+ 85%) and for thyroid cancers (+ 79%, 212,863 cases), which will become the third most frequent prevalent cancer types among Italian women. A more than 50% increases are also expected in 2020 for prevalence after diagnosis of testicular cancer (63,395 patients) or skin melanoma (169,900). A limited change in prevalence (variations < 10%) is expected for ovary, larynx, and stomach, with cervical cancer being the only cancer type showing a decline in prevalence (− 13%) (Table 3).
Table 3

Projected complete prevalence (cases) at January 1,  2020 by sex and 10-year variations in Italy

 

Prevalent cases

Variation (%)

 

2020

10-year period

Cancer Typea

Men

Women

Total

Men

Women

Total

All types but skin non-melanoma

1687,049

1,922,086

3,609,135

41.3%

33.1%

36.8%

Upper aero-digestive tract

36,081

21,831

57,911

34.9%

41.5%

37.3%

Stomach

50,327

32,033

82,360

9.5%

−9.9%

1.0%

Colon, Rectum, Anus

280,277

233,245

513,522

51.1%

35.7%

43.7%

Liver

25,234

8531

33,765

44.6%

16.4%

36.2%

Larynx

47,015

6006

53,020

4.9%

36.3%

7.7%

Lung

77,159

40,657

117,816

22.4%

71.4%

35.8%

Skin Melanoma

80,069

89,831

169,900

78.0%

56.2%

65.8%

Connective Tissue

17,040

11,815

28,855

44.9%

19.1%

33.1%

Female Breast

 

834,154

834,154

 

37.9%

37.9%

Cervix Uteri

 

51,136

51,136

 

−13.2%

−13.2%

Corpus Uteri (endometrium)

 

122,553

122,553

 

18.6%

18.6%

Ovary

 

49,807

49,807

 

9.2%

9.2%

Prostate

563,960

 

563,960

84.9%

 

84.9%

Testis

63,395

 

63,395

67.1%

 

67.1%

Kidney

97,249

47,151

144,400

54.8%

33.8%

47.2%

Bladder

255,015

58,608

313,624

32.4%

22.6%

30.4%

Brain and central nervous system

23,505

29,314

52,819

45.9%

26.7%

34.6%

Thyroid

45,949

166,914

212,863

80.1%

78.8%

79.1%

Hodgkin Lymphoma

37,692

29,314

67,006

35.5%

43.5%

38.9%

Non- Hodgkin Lymphoma

82,780

73,584

156,364

45.7%

36.5%

41.2%

Leukaemias

45,880

39,100

84,980

27.1%

25.3%

26.3%

Multiple Myeloma

19,472

17,159

36,631

52.3%

39.8%

46.1%

a Cancer types with more than 20,000 prevalent cases at 2010

Table 4

Projected complete prevalence at January 1, 2020 by sex and age groups in Italy a

SEX, Cancer type

Prevalent cases

Prevalence proportion per 100,000

All ages

%

00-44

45-74

75+

All ages

00-44

45-74

75+

MEN and WOMEN

 All types but skin non-melanoma

3,609,135

100.0%

228,145

1,897,543

1,483,448

5731

726

16,383

21,657

 Colon, rectum, anus

513,522

14.2%

4954

231,800

276,767

808

15

2080

3952

 Skin melanoma

169,900

4.7%

24,038

101,180

44,682

271

76

857

673

 Female breast

834,154

23.1%

29,758

498,614

305,781

2622

201

8215

7297

 Corpus uteri (endometrium)

122,553

3.4%

1707

65,765

55,081

379

10

1104

1269

 Prostate

563,960

15.6%

1174

255,514

307,272

2056

12

5634

12,343

 Bladder

313,624

8.7%

4130

128,332

181,162

563

15

1323

2836

 Thyroid

212,863

5.9%

41,112

145,562

26,189

309

127

1084

379

 Non-Hodgkin lymphoma

156,364

4.3%

14,948

87,255

54,161

247

47

739

789

MEN

 All types but skin non-melanoma

1687,049

100%

95,056

834,967

757,026

5444

615

15,678

28,728

 Colon, rectum, anus

280,277

16.6%

2250

135,206

142,821

902

13

2573

5267

 Skin melanoma

80,069

4.7%

8760

50,437

20,872

256

57

898

815

 Prostate

563,960

33.4%

1174

255,514

307,272

2056

12

5634

12,343

 Bladder

255,015

15.1%

2636

106,086

146,294

958

20

2323

5932

 Thyroid

45,949

2.7%

9141

31,444

5364

142

59

490

209

 Non-Hodgkin lymphoma

82,780

4.9%

8959

49,513

24,309

271

58

871

946

WOMEN

 All types but skin non-melanoma

1,922,086

100%

133,089

1,062,575

726,422

5992

888

17,374

17,007

 Colon, rectum, anus

233,245

12.1%

2704

96,594

133,947

720

17

1633

3105

 Skin melanoma

89,831

4.7%

15,278

50,742

23,811

284

102

822

581

 Breast

834,154

43.4%

29,758

498,614

305,781

2622

201

8215

7297

 Corpus uteri (endometrium)

122,553

6.4%

1707

65,765

55,081

379

10

1104

1269

 Bladder

58,608

3.0%

1494

22,246

34,868

195

10

405

859

 Thyroid

166,914

8.7%

31,971

114,119

20,825

508

218

1761

516

 Non-Hodgkin lymphoma

73,584

3.8%

5989

37,743

29,852

225

37

618

688

a Most frequent cancer types are shown: Cancer types or combinations with > 100,000 prevalent cases

Nearly 22% (21,657/100,000) of population aged ≥75 years in 2020 will have had a previous cancer diagnosis (Table 4). Below 45 years of age, prevalent cases will be 228,145 (i.e., 0.8% of all cases, 726/100,000) and, in both sexes, the most frequent cancer type will be thyroid cancer, experienced by 31,971 women and 9141 men.

Prevalent cases diagnosed within 2 years were the only group showing a negligible increase from 2010 to 2020 (+ 3% in the examined period), while a 19% increase was observed for cases diagnosed between 2 and 5 years before, 30-34% for cases diagnosed between 5 and 20 years earlier, and 45% increased for long-term survivors diagnosed ≥20 years before (Fig. 2).
Fig. 2

Complete cancer prevalence (proportions) in Italy from 2006 to 2020 by years since diagnosis. *Data for 2006 obtained from ref. 21. Filled symbols (e.g., •) represent estimated values, empty symbols (e.g., ο) represent projected values

Discussion

In 2010, 2.6 million people were living in Italy after a cancer diagnosis and this number will reach 3.6 million in 2020, increasing from 4.6% to 5.7% (i.e., one out of 17 Italians) of the overall population. The estimated overall trend in the present decade in Italy (+ 3.2% per year) is comparable to that estimated in the same period in the USA (+ 2.8% per year) [5], UK (+ 3.3%) [4], and Switzerland (+ 2.5%) [6].

The expected 37% increase in the present decade in Italy will be more marked (i.e., nearly + 50%) among long-term survivors diagnosed ≥20 years before; they will be more than half a million in Italy (519,356), 14% of all prevalent cases (11% in men and 18% in women). Most of them can be considered as cured since they had already reached a similar life expectancy (i.e., death rates) of the corresponding general population [14].

A higher proportion of women (55%) than that of men emerged among prevalent cancer cases at 2010 in the present Italian study, in agreement with findings from most studies conducted in other countries [4, 5, 6, 9] but France (where 53% were men, 6.4% of the French population) [8]. In Italy, female breast cancer cases represented 23% of all prevalent cases, and affected the distribution of cancer prevalence by age. The thyroid cancer epidemic in Italy also contributed to an excess in females, below age 45 years thyroid cancer was the most frequent prevalent type in 2010 (29,340 men and women), and this number will substantially increase to more than 41,000 in 2020. It should be noted, however, that a large proportion of thyroid cancer incidence and prevalence may be affected by overdiagnosis; i.e., the detection of cancer cases that would not otherwise result in causing symptoms or deaths [23, 24].

An important role on variation of cancer prevalence is played by screening programmes, inducing a reduction of cervical and colorectal prevalent cancers cases, while early detection of breast and prostate cancers may inflate number of prevalent cases [25]. In particular, screening can prevent cervical cancer, with a consequent major effect on prevalence reduction, i.e., − 13% in 10 years in the present study.

Distribution of cancer prevalence by age is also noteworthy. In 2010, 37% of prevalent patients were 75 years or older (38% in men, 35% in women). In this age group, they will reach 41% in 2020, with more than 20% of men and 14% of women will have experienced a previous cancer diagnosis. These proportions were similar to those reported by other studies, showing also that elderly cancer patients had more severe comorbidity conditions than non cancer patients [26].

At the opposite end of the age spectrum, 8% of Italian prevalent cases were younger than 44 years of age and 10% were aged 45–54 years. It has been recently estimated that 44,135 persons living in Italy in 2010 had had a cancer diagnosis during childhood [27]; they represented 0.07% of the Italian population and 1.7% of prevalent cases diagnosed at any age. In similar studies conducted in the USA [28], a substantial proportion of morbidities emerged in childhood cancer patients several years after diagnosis, and there is growing awareness on potentially long-term risks affecting the survivors’ future physical, cognitive, and/or psychosocial health [29]. The impact of a cancer diagnosis is rather different between younger and older survivors, the first facing more pronounced socio-economic consequences [30, 31], as well as psychosocial impairments in fertility and sexuality [32, 33].

We acknowledge the several limitations of our analyses. First, data from Italian cancer registries (AIRTUM) included one third of the Italian population in 2010 and the representativeness for the national prevalence estimates may be questionable [34]. To overcome this issue, we adjusted estimated proportions in cancer registry areas for the age distribution of the whole Italian population. Moreover, since cancer registries have been active in Italy from a relatively recent time period, the complete prevalence has been estimated through statistical models. Notably, the validation of complete prevalence estimation by means of COMPREV method in Italy and elsewhere [19] is reasonably reassuring. In particular, the validation of COMPREV method shows negligible (i.e., < 5%) differences, when comparing observed prevalence for cancer registries with ≥30 years of observation and estimated prevalence using complete indexes applied to the same registries and truncated data [21, page 34].

On the other hand, the strengths of this population-based study are represented by the size of the study population, which included nearly 1.7 million incident cancer cases, and its long-term follow-up, more than a half of these cases were followed-up for > 20 years post diagnosis. In addition, data and period used were updated in the present study (see Appendix 1), including an additional number of years of observation and follow-up, in comparison with previous studies on the same topic [21].

The accuracy of future projections of prevalence is necessarily uncertain and lies on statistical models based on assumptions reflecting unknown evolution of incidence, survival, and demographic changes. This may also affect comparisons with trends reported in other countries, obtained using different assumptions and statistical models [4, 6, 26]. In our medium-term projections, the hypothesis that complete prevalence at 2020 can be predicted by a linear function of calendar year as regressor variable is supported by empirical evidence, at least for all cancer types combined and for most frequent cancer types, consistently showing an approximate linear trend in recent years [5, 21]. Notably, the use of a longer period (5 calendar years) to estimate linear slope did not materially modify the estimates.

Detailed estimates and projections of numbers of persons living after different cancer diagnoses are particularly relevant for policy makers to better plan health care resource allocation and meet cancer patients needs, including not only initial treatment, but also rehabilitation and long-term surveillance. However, to date, guidelines pertaining to survivorship care have been largely based on consensus rather than on empirical evidence [35, 36, 37].

In the USA, the main driver of cancer costs growth is population ageing, with an overall increase of 27% by the year 2020 from 2010 levels [38]. The largest increase in expenditures is attributable to the continuing phase of care (i.e., > 1-year post-diagnosis and > 1 year from death) for prostate and female breast cancer, with 42 and 32% increase respectively [38]. Although health care costs in the continuing phase of care is lower than in the first course of treatment (first year since diagnosis) and in the last year of life, the large number of survivors in the continuing phase of care is driving most of healthcare resources. Similar findings, on the distribution of cancer burden by phase of care, are expected in Italy [39].

Conclusions

The availability of reliable and accurate estimates of complete prevalence and predictions of the rising tide of people living after cancer diagnosis may be helpful not only to epidemiologists and health-care planners, but also to clinicians in developing guidelines to enhance and standardize the long-term follow-up of cancer survivors. Furthermore, these estimates are intended for patients to help recovering social activities and supporting rehabilitation demands.

Notes

Acknowledgements

The authors thank Mrs. Luigina Mei for editorial assistance.

Funding

The study was funded by the Italian Association for Cancer Research (AIRC) (grant no. 16921). Role of funding source: The funding sources had no role in study design, collection, analysis or interpretation of data, the writing of the report, or the decision to submit the article for publication.

Availability of data and materials

Dataset supporting our findings is available, according to AIRTUM guidelines, at the following website: www.registri-tumori.it.

Authors’ contributions

SG and LDM drafted the study protocol, designed the study, and drafted the manuscript with the support of RDA. All authors (SG, SV, RDA, CP, CB, RC, SiF, AnG, MZ, GT, DS, FF, CC, AGR, FaS, BC, MM, ALC, MC, StF, LM, GR, FlS, GM, FaP, MF, RT, PR, GG, AdG, FT, GC, ACF, FiP, ASS, MR, LB, LDM) and AIRTUM Working Group revised the study protocol, collected data, prepared raw data for the study database, and corrected data after quality controls. SG did the statistical analyses with the support of SV, CP, LB and LDM. DS, RC, SiF, AG specifically supported LDM in the interpretation and clinical implication of study results. All authors revised the preliminary results and the report, and contributed to data interpretation, report writing, and reviewed and approved the final version.

Ethics approval and consent to participate

The Italian legislation identifies Cancer Registries as collectors of personal data for surveillance purposes without explicit individual consent. The approval of a research ethic committee is not required, since this study is a descriptive analysis of individual data without any direct or indirect intervention on patients (Decreto del Presidente del Consiglio dei Ministri, 3/3/2017, Identificazione dei sistemi di sorveglianza e dei registri di mortalità, di tumori e di altre patologie, 17A03142, GU Serie Generale n.109 del 12-05-2017 (Available at: http://www.gazzettaufficiale.it/eli/id/2017/05/12/17A03142/sg, last access: 31/01/2018).

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors and Affiliations

  • Stefano Guzzinati
    • 1
  • Saverio Virdone
    • 2
  • Roberta De Angelis
    • 3
  • Chiara Panato
    • 2
  • Carlotta Buzzoni
    • 4
    • 5
  • Riccardo Capocaccia
    • 6
  • Silvia Francisci
    • 3
  • Anna Gigli
    • 7
  • Manuel Zorzi
    • 1
  • Giovanna Tagliabue
    • 8
  • Diego Serraino
    • 2
  • Fabio Falcini
    • 9
  • Claudia Casella
    • 10
  • Antonio Giampiero Russo
    • 11
  • Fabrizio Stracci
    • 12
  • Bianca Caruso
    • 13
  • Maria Michiara
    • 14
  • Anna Luisa Caiazzo
    • 15
  • Marine Castaing
    • 16
  • Stefano Ferretti
    • 17
  • Lucia Mangone
    • 18
  • Giuseppa Rudisi
    • 19
  • Flavio Sensi
    • 20
  • Guido Mazzoleni
    • 21
  • Fabio Pannozzo
    • 22
  • Rosario Tumino
    • 23
  • Mario Fusco
    • 24
  • Paolo Ricci
    • 25
  • Gemma Gola
    • 26
  • Adriano Giacomin
    • 27
  • Francesco Tisano
    • 28
  • Giuseppa Candela
    • 29
  • Anna Clara Fanetti
    • 30
  • Filomena Pala
    • 31
  • Antonella Sutera Sardo
    • 32
  • Massimo Rugge
    • 1
    • 33
  • Laura Botta
    • 6
  • Luigino Dal Maso
    • 2
  1. 1.Veneto Tumor RegistryPadovaItaly
  2. 2.Cancer Epidemiology Unit, CRO Aviano National Cancer Institute IRCCSAvianoItaly
  3. 3.Istituto Superiore di Sanità (ISS)RomeItaly
  4. 4.Tuscany Cancer Registry, Clinical and Descriptive Epidemiology Unit, Cancer Prevention and Research Institute (ISPO)FlorenceItaly
  5. 5.AIRTUM DatabaseFlorenceItaly
  6. 6.Dipartimento di Ricerca Epidemiologica e Medicina Molecolare (DREaMM)Fondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
  7. 7.Institute for Research on Population and Social Policies, National Research CouncilRomeItaly
  8. 8.Lombardy Cancer Registry, Varese Province, Cancer Registry Unit, Department of ResearchFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
  9. 9.Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (Forlì), Italy-Azienda Usl della RomagnaForlìItaly
  10. 10.Registro Tumori Ligure, Epidemiologia Clinica, Ospedale Policlinico San Martino IRCCSGenovaItaly
  11. 11.Cancer Registry of Milan, Epidemiology Unit, Agency for Health Protection of MilanMilanItaly
  12. 12.Public Health Section, Department of Experimental MedicineUniversity of PerugiaPerugiaItaly
  13. 13.Modena Cancer Registry, Public Health DepartmentAUSL ModenaModenaItaly
  14. 14.Parma Cancer Registry, Oncology UnitAzienda Ospedaliera Universitaria di ParmaParmaItaly
  15. 15.Cancer Registry of Salerno ProvinceSalernoItaly
  16. 16.Registro Tumori Integrato Catania-Messina-Siracusa-EnnaUniversità degli Studi di CataniaCataniaItaly
  17. 17.Ferrara Cancer Registry, Ferrara Local Health BoardUniversity of Ferrara, USL FerraraFerraraItaly
  18. 18.Reggio Emilia Cancer Registry, Epidemiology unitAUSL ASMN-IRCCS, Azienda USL di Reggio EmiliaReggio EmiliaItaly
  19. 19.Palermo and Province Cancer Registry, Clinical Epidemiology UnitAzienda Ospedaliera Universitaria Policlinico “Paolo Giaccone”PalermoItaly
  20. 20.North Sardinia Cancer Registry, Azienda Regionale per la Tutela della SaluteSassariItaly
  21. 21.Sudtyrol Cancer RegistryBolzanoItaly
  22. 22.Cancer Registry of Latina Province, AUSL LatinaLatinaItaly
  23. 23.Cancer Registry ASP RagusaRagusaItaly
  24. 24.Cancer Registry of ASL Napoli 3 SudNapoliItaly
  25. 25.Mantova Cancer Registry, Epidemilogy Unit, Agenzia di Tutela della Salute (ATS) della Val PadanaMantovaItaly
  26. 26.Como Cancer Registry, ATS InsubriaVareseItaly
  27. 27.Registro Tumori Piemonte, Provincia di Biella CPOBiellaItaly
  28. 28.Cancer Registry of of the Province of Siracusa, Local Health Unit of SiracusaSiracusaItaly
  29. 29.Trapani Cancer Registry, Dipartimento di Prevenzione della SaluteTrapaniItaly
  30. 30.Sondrio Cancer Registry, Health Protection AgencySondrioItaly
  31. 31.Nuoro Cancer Registry, RT Nuoro, ASSL Nuoro/ATS SardegnaNuoroItaly
  32. 32.Catanzaro Cancer Registry, Azienda Sanitaria 7CatanzaroItaly
  33. 33.Department of Medicine (DIMED)University of PaduaPaduaItaly

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