Showing papers in "Annali dell'Istituto Superiore di Sanità in 1996"

The epidemiology of esophageal cancer.

Abstract: The present paper examines the epidemiological aspects of cancers of the esophagus. Esophageal cancer is the sixth most common cancer in the world. Large geographical and temporal variations in its incidence, even within small areas, suggest that environmental exposure is causally important. Smoking and alcohol consumption are major risk factors for esophageal cancer, and alcohol has been identified as a major cause of this neoplasm in industrialised countries. In addition to smoking and alcohol consumption, dietary habits are important risk determinants of this disease. Epidemiological evidence suggests that nutritional deficiencies and, possibly, ingestion of mycotoxins and nitrosamines are factors for the development of esophageal cancer.

Opioid-immune interactions in autism: behavioural and immunological assessment during a double-blind treatment with naltrexone.

Abstract: The emerging concept of opioid peptides as a new class of chemical messengers of the neuroimmune axis and the presence of a number of immunological abnormalities in infantile autism prompted us to correlate biological (hormonal and immunological) determinations and behavioural performances during treatment with the potent opiate antagonist, naltrexone (NAL). Twelve autistic patients ranging from 7 to 15 years, diagnosed according to DSM-III-R, entered a double-blind crossover study with NAL at the doses of 0.5, 1.0 and 1.5 mg/kg every 48 hours. The behavioural evaluation was conducted using the specific BSE and CARS rating scales NAL treatment produced a significant reduction of the autistic symptomatology in seven ("responders") out of 12 children. The behavioural improvement was accompanied by alterations in the distribution of the major lymphocyte subsets, with a significant increase of the T-helper-inducers (CD4+CD8-) and a significant reduction of the T-cytotoxic-suppressor (CD4-CD8+) resulting in a normalization of the CD4/CD8 ratio. Changes in natural killer cells and activity were inversely related to plasma beta-endorphin levels. It is suggested that the mechanisms underlying opioid-immune interactions are altered in this population of autistic children and that an immunological screening may have prognostic value for the pharmacological therapy with opiate antagonists.

Bladder cancer: a selected review of the epidemiological literature

Abstract: The present contribution reviews the epidemiological literature on the risk factors for bladder cancer in humans, pointing to the new leads from the available knowledge and to suggestions on prevention and research needs. Smoking accounts for about 50% of bladder cancer cases in western countries, occupational exposures are second in importance in bladder cancer development. Exposure to aromatic amines in dyestuff manufacture, in the rubber and textile industry, occupations entailing exposure to paints and solvents, leather dust, inks, some metals, PAH, combustion products and diesel exhausts have been identified as risk factors from epidemiological studies. Other investigations have detected increased risk for bladder cancer in association with dietary factors, specifically fats and cholesterol, and with contamination of drinking water by chlorination by-products.

Biomonitoring and occupational medicine. Possibilities and limitations.

Abstract: In the prevention of occupational diseases, biological monitoring has become very important. Today the individual level of exposure to many toxic substances can be assessed by routinely monitoring their concentrations in blood and urine. The adoption of effective quality control procedures allows reliable analytical results down to the ppt range to be obtained. Limit values such as the biological tolerance values for occupational exposure (BAT) from the Deutsche Forschungsgemeinschaft in Germany and the biological exposure indices (BEI) from the US American Conference of Governmental Industrial Hygienists (ACGIH) help to interpret the analytical results of biological monitoring. In spite of numerous advancements there are some gaps in the field of biological monitoring. Some groups of substances, such as pesticides, are still beyond the possibilities of biological monitoring. With regard to biological and biochemical effect monitoring, large gaps have to be filled and considerable research is needed. The number of limit values evaluated till now is still too small. Politics, however, seems to be the most serious limitation for biological monitoring.

Epidemiology of nonmelanoma skin cancer: a review.

Abstract: The nonmelanoma skin cancers (NMSC), including basal-cell and squamous-cell carcinoma, are the most common type of cancer in white populations. Its incidence has increased has increased worldwide over the last few decades. Mortality from NMSC is low, but the estimated recurrence rate of about 50% at five years and the local invasiveness involve high medical costs and make NMSC a public health concern. Epidemiologic evidence relevant to the effects of UV radiation on the risk of skin cancer comes from both descriptive and analytic studies. More recently, the collaboration between molecular biology and epidemiology has contributed to assess the potential synergism between environmental and genetic factors, such as the capacity of repairing the UV-induced DNA damage, in the etiology of nonmelanoma skin cancer, as by the xeroderma pigmentosum model.

Molecular etiopathogenesis of esophageal cancers.

Abstract: The occurrence and the relevance in squamous cell carcinomas (SCC) and Barrett's adenocarcinomas (ADC) of genetic alterations, namely mutations in the p53 gene, allelic loss at various chromosomal loci and altered expression of genes involved in the regulation of cell proliferation, are described and discussed with reference to the etiology and pathogenesis of esophageal cancers. Mutations in the p53 gene occur in both SSC and ADC with a frequency of up to approximately 80%, although with a strikingly different pattern of mutations. In ADC, a very high frequency of G > A transitions at CpG dinucleotides was observed, whereas in SCC, mutations at A:T base pairs was comparatively high. In addition, in SCC, the frequency of p53 mutations was related to tobacco smoking. These data therefore indicated that such mutation analysis could provide valuable insight into the etiology of this cancer. It is also apparent that the genetic alterations involving genes other than p53 are also present in the natural history of esophageal cancer. The significance of these genetic changes as well as alterations of expression of cell cycle regulatory genes in esophageal carcinogenesis is briefly discussed.

[Distribution of dog ticks (Rhipicephalus sanguineus Latreille, 1806) in Italy: a public health problem].

Abstract: The dog tick, Rhipicephalus sanguineus Latreille, 1806 (Acari: Ixodidae), is a public health problem since it is widely distributed in Italy and because of its role in the transmission of many pathogens to man and dog which is its preferred host. This review deals with the main aspects of the biology and ecology of Rh. sanguineus habitat, developmental time, distribution and seasonality, behaviour and vector competence. Moreover, the preminent role of Rh, sanguineus in the transmission of boutonneuse fever is discussed.

Epidemiology of lung cancer.

Abstract: Primary lung cancer is now the most frequent cancer in the world. Tobacco smoking still represents its predominant cause: a recent estimate attributes 80-85% of lung cancers to smoking and the epidemic of lung cancer mortality is still ongoing, with a major contribution from East European and developing countries. The study of smoking in association with lung cancer has contributed to the understanding of the carcinogenic process in humans, especially since molecular epidemiology techniques have been developed. However, the most probable carcinogenic model, still needs to be more clearly established. Presently, it can be summarised that smoking cessation is beneficial at any age, and more so when early. The contribution of passive smoking to lung cancer risk has been widely documented; its effect in terms of attributable number of cases, however, is not easily estimated at a population level. Some authors suggest that non-smoking-related lung cancer frequency is increasing over time. Exposure to environmental carcinogens with a major emphasis on those deriving from industrial processes, among which asbestos, and on air pollution due to traffic in urban areas has been advocated. Finally, a special interest has grown in the last years on possible protective factors for lung cancer, mainly diet-related (high intake of fresh fruits and vegetables), but results from the first large randomised chemoprevention trial based on alpha-tocopherol and beta-carotene treatment, dealt with "paradoxical" results.

The German external quality assessment scheme in occupational and environmental medicine.

Abstract: According to a technical guideline for dangerous substances (TRGS 410) issued in 1979 by the Ministry of Labour of the Federal Republic of Germany, toxicological analyses in biological materials must be performed under conditions of "statistical quality control". The German Society for Occupational and Environmental Medicine is entrusted with the organization of the German external quality assessment scheme (EQAS). Since 1982 about 100 laboratories regularly take part in each run. Blood and urine samples spiked with two different concentrations (A, B) are distributed to the laboratories. Since 1991 additional samples with environmental exposure levels are also included in the EQAS. A laboratory is certified as successful if both its results (A, B) fall within the tolerance range given by the reference laboratories. The thirteenth (1994) external quality assessment exercise included blood and urine samples containing 21 inorganic and 29 organic substances, besides 8 inorganic and 14 organic analytes within the environmental concentration range.

Biological parameters influencing the immunological response to plasma derived and recombinant hepatitis B vaccines.

Abstract: Personnel (1856 subjects) belonging to local health units (medical and paramedical staff) that have been vaccinated since 1984 against hepatitis B virus (HBV) with HBsAg plasma purified preparations (Hevac-B and H-B-Vax) or recombinant DNA preparation (Engerix-B) were followed in plasma anti-HBs antibody levels. At the end of the protocols, different seroconversion percentages and different anti-HBs levels were reached: the best results were obtained with Engerix-B. Sex and principally age influenced the antibody production: women generally reached highest protective antibody levels and the 21-30 year group was more responsive than other groups. The injection of a supplementary 4th or 5th dose in low or non-responders could restore the specific immunity in the majority of the subjects and increase the anti-HBs level. The time course after the immunization of antibody levels depended on the level reached at the end of vaccination schedule. These data suggest that different antibody level monitorings of vaccinated subjects, planned on the basis of the antibody level reached at the end of vaccination, could prevent a loss of protection against the HBV infection.

Comparison of some European external quality assessment schemes in the field of occupational and environmental medicine.

Abstract: In most European countries an increasing number of external quality assessment schemes (EQAS) are organized, and it seems appropriate to reinforce collaboration at the European level between organizers of EQAS related to occupational and environmental medicine. Since differences between these EQAS have been recognized, a collaborative project was set up focused on the ways the present occupational and environmental medicine EQAS evaluate results obtained by the same pool of laboratories analysing identical control samples for blood lead. The results confirmed that the samples delivered to the laboratories were homogeneous. Considering the performance as judged by five different schemes the study revealed that laboratories were not ranked identically. For laboratories, which either had a very bad or a very good performance, however, the ranking were comparable. The statistical design of the evaluated EQAS poses problems and requires attention.

Biliary tract tumors

Abstract: Biliary tract cancers are rare neoplasms including gallbladder cancer (the commonest), extrahepatic biliary tract cancer and cancer of the ampulla of Vater. Descriptive epidemiology of biliary tract cancers as a whole has two peculiarities: incidence and mortality rates are higher for women than men, and in some specific populations. Mortality rates are highest among New Mexico American Indian women, in Chile and Japan, lowest in Great Britain and Greece. Mortality trends vary widely: the largest increases have been observed in Japan, Hong-Kong and Spain and the largest decreases in the Anglo-Saxon populations. Our knowledge of biliary tract cancer etiology is limited. Defined risks include genetic factors (family history of biliary tract cancers, ethnicity), history of gallbladder disease, and cholelithiasis. Risk factors reported in some studies, on which, however, information is not consistent and which need further study, include overweight, some menstrual and reproductive factors (multiparity, young age at first birth, late menopause), low education, cigarette smoking, selected bacterial infections, some intestinal diseases and diabetes.

Prospects of harmonisation of European external quality assessment schemes in occupational and environmental laboratory medicine.

Abstract: Since 1979, twelve external quality assessment schemes (EQAS) in occupational and environmental laboratory medicine (OELM) have been developed in nine European countries. These schemes cover a broad range of analytes and matrices and have developed differing procedures for the evaluation of laboratories' performances. Collaboration among EQAS in OELM and harmonisation of methods for evaluation of laboratory performance would be advantageous to cope with the demand for assessment of quality of analytical results for an increasing number of analytes and the need to guarantee comparability and consistency of conclusions on health and regulatory issues in different countries and at an international level. This paper compares the different features of the existing EQAS, to highlight critical points for further discussions, and to make some suggestions for possible further collaboration.

Polygenic inheritance of predisposition to lung cancer.

Abstract: Inherited predisposition to lung tumor development appears to be a complex genetic trait, in humans as well as in experimental animals. In humans, tobacco smoking represents the main risk factor for lung tumors. Familial clusterings of lung cancer cases are rare, although affected sib pairs are reported. However, several studies have reported an increased risk of lung cancer in first degree relatives of lung cancer patients, as compared with appropriate controls. Inheritence of particular alleles of genes or phenotypes for drug metabolizing enzymes are also associated with an increased lung cancer risk. In experimental models, murine inbred strains with high genetic predisposition to lung cancer are available, as well as resistant strains. A major locus affecting inherited predisposition to lung cancer in mice has been mapped on chromosome 6, near the Kras2 gene. The locus, pulmonary adenoma susceptibility 1 (Pas1) derives from the A/J strain. Additional "minor" loci have also been mapped. Dominant lung tumor resistance loci have also demonstrated in the mouse genome. Therefore, evidence for polygenic inheritance of predisposition to lung cancer is demonstrated in the mouse model, and it is strongly suggested for human lung cancer.

French external quality assessment schemes for lead in blood and aluminum in plasma and dialysis water.

Abstract: An external quality assessment scheme (EQAS) for lead in blood was established in France in 1992 at the request of the Ministry of Labour and organised by the Drug Bureau. Participation is mandatory for laboratories wishing to obtain ministerial approval for the determination of blood lead levels. In 1994, two interlaboratory comparative exercises were carried out, each involving the analysis of 3 samples of human blood (2 with and 1 without lead supplementation). Out of 66 enrolled laboratories, 58 and 60 participated in the two exercises, respectively. The scattering of results was quite comparable to that observed in other EQAS. The EQAS for plasma aluminium was established in 1983 at the request of the Commission on Trace Elements of the Societe Francaise de Biologie Clinique. Today, 80 laboratories in 22 countries on 4 continents participate in this scheme. Six exercises are carried out each year, each including 3 plasma samples (2 with and 1 without aluminium supplementation), 2 samples of water supplemented with aluminium and a blank (water). The results obtained in this scheme showed an improvement in the quality of the analyses.

The Italian external quality assessment scheme for trace element analysis in body fluids

Abstract: We describe the operative procedures of the Italian external quality assessment scheme (EQAS) for the determination of trace elements in body fluids. The aims of the scheme are both the education of participants and the continuous development and optimization of procedures for collaborative EQA trials. Participation is free of charge. Interlaboratory exercises for EQA are organised every three or four months for the determination of cadmium and lead in blood; aluminium, copper, selenium and zinc in serum; chromium and nickel in urine. Freeze-dried control materials are prepared in the laboratory from animal blood or human urine. In each trial, each participant receives from six to eight samples, chosen from among the pools selected for that occasion using a randomised strategy and including unknown duplicate specimens. Laboratory performances are evaluated on the basis of proximity to target values, differences in results for duplicate samples and comparison with established acceptability limits. The development of dedicated software for the bidirectional transmission of data between the organising centre and the peripheral laboratory gives the participants the chance to verify immediately the quality of their results and take action without delay, if needed.

Molecular epidemiology of bladder cancer.

Abstract: In order to ascertain the role of arylamines in the induction of bladder cancer in smokers, and to assess the contribution of the metabolic phenotype to cancer risk, studies of molecular epidemiology have been conducted. A number of investigations have reported that "slow" acetylators are at higher risk of bladder cancer, especially subgroups occupationally exposed to arylamines. We present the results of studies that investigated markers of both internal dose (hemoglobin adducts, urinary mutagenicity), and genetically determined susceptibility (metabolic polymorphism) among smokers. Levels of ABP-hemoglobin adducts were elevated in smokers of black (air-cured) tobacco compared to smokers of blond tobacco, and "slow" acetylators showed higher levels than "fast" acetylators. Further, a combination of slow acetylator and fast oxidizer phenotype was associated with the highest level of ABP-hemoglobin adduct. Thus the determination of both phenotypes may allow to better predict the risk of bladder cancer than using the "slow" acetylator phenotype alone. Further investigations in this field will consider the occurrence of mutational spectra (hotspots) in relevant genes (e.g.p53 or p16) to ascertain whether tobacco-related carcinogens induce specific mutations.

Genetic alterations in skin cancer.

Abstract: Cancer is a multi-stage process in which the accumulation of genetic changes allows clonal expansion of abnormal cells that will eventually form a tumor. Skin cancer is the most common malignancy affecting human beings. Mutations of the tumor suppressor gene p53 are often found in non-melanoma skin cancer and pre-invasive lesions, like actinic keratosis. The type of mutations detected in the p53 gene strongly indicate UV light as the initiating and promoting agent in skin cancer development. Chromosome instability is also an early event in skin tumor formation. However, despite the huge amount of information available in the literature on molecular markers of skin cancers, much remains to be uncovered about the progression of genetic events that separate normal sun-exposed epidermis from skin cancer. In this paper the following issue will be addressed: how far are we from being able to define a human model for multistage skin carcinogenesis in humans?

I consumi alimentari in Italia in relazione ai tumori dell'apparato digerente

Abstract: Time trends of consumption of the principal food and nutrients in Italy are evaluated in relation with geographic area, using most of the published data. A progressive enrichment was observed for the Italian diet, with an increasing intake of animal proteins, saturated fats and sugars, and a decreasing intake of bread and pasta. Differences of dietary habits among different geographical areas are also decreasing. The main geographical and temporal patterns of digestive sites cancer are in agreement with the above described trends and with the principal hypothesis on nutritional causation of cancer.

Molecular epidemiology of skin cancers: DNA repair and non-melanocytic skin cancer.

Abstract: Exposure to sunlight has been clearly associated with non-melanocytic skin cancer, however individual susceptibility differs considerably. Ethnic origin and pigmentary characteristics are generally accepted as risk factors. Another important defense mechanism is the ability to repair DNA photoproducts. In the inherited disorder xeroderma pigmentosum the inability to repair such DNA damage, associated with a high incidence of skin cancers, suggests an important role for DNA repair capacity in the etiology of this cancer. The development of an in vitro repair assay based on human peripheral blood lymphocytes, has allowed the evaluation of DNA repair capacity as a risk factor in population based studies. This article reviews recent developments in this field.

Determination of chromium and nickel in commercial foam bath products by ETA-AAS.

Abstract: The presence of some inorganic elements, such as Ni and Cr in cosmetic products could be responsible for some skin diseases, such as allergic dermatitis. This paper deals with the determination of these two elements in commercial samples of foam bath products by means of the ETA-AAS technique. Four different analytical procedures for sample digestion are evaluated and discussed. Results indicated that the high-pressure microwave digestion is the best procedure for treatment of the complex matrices considered in the study. Chromium values were in the range of 22-199 micrograms/kg, whereas those of nickel fell within the range 26-287 micrograms/kg. The detection limit (3 sigma) of the whole procedure was 3 micrograms/kg for Cr and 15 micrograms/kg for Ni. The analytical data demonstrated that both Ni and Cr were present in all the samples at very low concentrations, and that foam bath products are a relatively minor source of exposure to these elements.

The Danish external quality assessment scheme.

Abstract: Participation in proficiency testing schemes is generally recognized as an important part of quality control in analytical chemistry. The design and conduct of proficiency testing schemes is therefore a matter of great importance. A proficiency testing scheme should: a) cover a broad concentration range of the substance of interest; b) enable the detection and estimation of each laboratory's systematic errors; c) enable estimation of each laboratory's random error; d) provide each laboratory with a rank or score, and e) present the evaluation of each round to the participating laboratories in a comprehensible way, e.g. in a report with carefully designed text, tables and figures. This paper presents the design of the Danish external quality assessment scheme (DEQAS), which is based on the method evaluation function concept.

Sopravvivenza per tumori del colon e del retto in Italia.

Abstract: In population based from four Italian cancer registries (Varese, Modena, Latina, Ragusa), five-years relative survival was 34% for colon cancer patients (no. = 1864) and 28% from rectum cancer patients (no. = 1117). However, rectum cancer patients showed higher survival rates in the first year of follow-up, which is possibly due to earlier diagnosis for sites more accessible to clinical examination. For colorectal cancer, age was an important prognostic factor, both in univariate and in multivariate analysis, adjusting for competitive mortality, sex, geographical area and year of diagnosis. In the same multivariate analysis, the prognosis was better for women, significantly for colon cancer and the excess death risk was reduced by 25-30% from 1978-79 to 1984-85. No significant differences were found among different geographical areas, possibly because of the low number of patients from some of the participating cancer registries.

Hereditary factors in tumors of the digestive system

Abstract: Gastrointestinal tumours are an excellent model for the investigation of hereditary factors in cancer. Epidemiological studies on high risk population (China, Iran) evidenced a strong familiarity for esophageal cancer with up to 60% of the affected patients reporting a positive familiary history. About 10-15% of gastric cancer patients show a positive familiary history for this neoplasm. The proportion is even higher for the "diffuse" hystological type. Gastric cancer belongs to the neoplastic spectrum of hereditary nonpolyposis colorectal cancer, a genetic disease with an autosomal dominant pattern of inheritance. Familial polyposis coli and hereditary nonpolyposis colorectal cancer are the two main hereditary colon cancer syndromes. Familiar aggregation have been observed in about 10% of colorectal cancer cases. As for pancreatic cancer, anedoctal reports and one case control study have shown an increased risk of pancreatic carcinoma in patients with a positive family history both for all cancers (relative risk, RR, 2), and specific for pancreatic cancer (RR: 5).

FIOH external quality assurance scheme for organic solvent metabolites

Abstract: The scheme consists of analyses for phenol,2,5-hexanedione, and mandelic, trichloroacetic and methylhippuric acids in urine. The present participants are 31 laboratories from 14 countries. Samples are prepared by pooling urine obtained from occupationally exposed workers or by spiking with appropriate pure metabolites. Four sets of samples at two concentration levels for each analyte are distributed annually. The report includes information on the arithmetic means, standard deviations and CVs for overall results and separately for different methods. During the last three years, the CVs have varied rather non systematically, being 21-31% for mandelic acid, 24-26% for trichloroacetic acid, 24-35% for phenol, 55-110% for 2,5-hexanedione and 44-50% for methylhippuric acid.

Basal cell and squamous cell carcinomas. Clinico-histological features

Abstract: Basal cell and squamous cell carcinomas are the most common skin cancers, occurring mainly on sun-damaged skin of old persons. Basal cell carcinoma is a neoplasm of follicular germinative cells which may infiltrate and destroy adjacent tissues, but rarely metastasizes. Five clinico-pathologic types of basal cell carcinomas can be recognized, namely, nodulo-ulcerative, superficial, morpheiform, fibroepithelial, and infundibulo-cystic. Actinic keratosis and Bowen's disease are intrepidermal proliferation of atypical keratinocytes that eventually may progress to become over squamous cell carcinoma. Lesions arising in sites of chronic injury or scarring bear an higher risk of metastases. Keratoacanthoma is a rapidly evolving tumor of keratinocytes that resolves spontaneously. Keratoacanthoma might represent a self-healing type of squamous cell carcinoma.

Genetic alterations in gastric cancer.

Abstract: The aim of this paper is to review the most frequent genetic alterations found in gastric carcinoma, and to focus on the main differences between intestinal and diffuse cancer types. Particular emphasis will be given to tumor suppressor genes, above all to p53. The role of normal and mutated p53 proteins has been studied in depth in a variety of cell types, and p53 alterations have been extensively analysed in many human tumors, including gastric cancer. Accordingly, the paper will report p53 data on this neoplasia, and consider these data in the light of various more general notions.

The Guildford trace elements external quality assessment scheme.

Abstract: An international external quality assessment scheme for trace elements in biological fluids is described. Programmes for aluminium, copper, zinc, selenium, gold, lead, cadmium and mercury in serum, blood, urine, dialysis fluids and water are included with others under development. Preparation of reports is described and assessments of performance based on proximity to assigned values, differences in results between duplicate measurements and recovery of added analyte are given. Performance standards have been introduced to stimulate improvements in the quality of results.

Genetic linkage studies for the identification of cancer-related genes.

Abstract: The most commonly used method for genetic mapping of disease causing loci is the lod-score method, based on maximum likelihood estimation of the recombination fraction. This method is the most powerful one when the mode of inheritance of the disease is known, but is often used also for genetic mapping of complex traits, although in these cases alternative non parametric procedures are often preferable. In those families where cancer segregates as a Mendelian disease, mapping of the corresponding gene can be carried out as for any other genetic disorder. Modelling of the analysis should also consider the possible occurrence of reduced or age dependent penetrance, phenocopies, and genetic heterogeneity. The application of this method has already led to the identification of the genetic location and eventually to the cloning of several cancer-related genes, including FAP, BRCA1, NF1, and more recently AT. Understanding the molecular mechanisms leading to the disease in the Mendelian forms of cancer may prove helpful in unraveling the basis of the other more common forms of cancer.

La sopravvivenza per tumore dell'apparato digerente : dati italiani su base di popolazione e confronti internazionali

Abstract: Survival for malignant tumour of the upper digestive tract, oesophagus, stomach and pancreas are analysed from the data of 5042 cases observed during the period 1976-1985 by the Italian cancer registries (CRs) of Varese, Latina, Ragusa and Florence. Three-year relative survival rates were 42% for patients with tumours of the upper digestive tract and 7% for those tumour of the oesophagus. Five-year relative survival for patients with stomach cancer was 20%. A worse prognosis was found for cases from the Latina and Ragusa CRs. One-year relative survival for patients with pancreatitic cancer was 17%. Younger age, histologic confirmation, period of diagnosis (for upper tract, stomach and pancreatitic cancers), and female gender (for tumours of the upper tract) resulted as positively associated to survival.