title: Clinical features and colorectal cancer survival: an attempt to explain differences between two different Italian regions.
abstract: AIMS OF THE STUDY AND METHODS: Recent studies suggested the existence of significant regional variations, in Italy, for cancer survival. For most neoplasms, survival rates tended to be lower in Southern regions versus Northern areas; for colorectal tumours, 5-year survival was 60% in Northern regions, but ranged between 40% and 50% in the South. Main purpose of the present study was to find out possible reasons which might explain such differences. To reach this objective, we compared the main epidemiological and clinical data in two areas covered by cancer registration: Modena, in the North, and Naples in the South of Italy.
  
  
  RESULTS
  The results of the study suggest that differences in colorectal cancer survival can be mainly attributed to a different stage at diagnosis, which was less favourable in a larger fraction of cases diagnosed in Southern Italy. This could be the consequence of an insufficient diffusion of screening procedures. Type of surgery, medical treatment and follow-up seem to play little or no role. The study also shows that incidence rates of colorectal cancer are significantly higher in the North than in the South of the country, and that the excess of cases seen in Modena is limited to the age group 55-75+ years, while age-specific incidence is virtually identical in the younger age classes.
  
  
  CONCLUSIONS
  This high-resolution study confirms the paramount importance of stage at diagnosis in the management of colorectal cancer, and suggests that social and economic factors are of relevance, even in Western countries, for reducing inequalities in cancer care.
authors.affiliation: Registro Tumori Regione Campania c/o ASL Napoli 4, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Fusco
authors.forename: Annalisa
authors.initials: A
authors.lastname: Pezzi
authors.forename: Piero
authors.initials: P
authors.lastname: Benatti
authors.forename: Luca
authors.initials: L
authors.lastname: Roncucci
authors.forename: Paolo
authors.initials: P
authors.lastname: Chiodini
authors.forename: Gianna
authors.initials: G
authors.lastname: Di Maio
authors.forename: Rosaria
authors.initials: R
authors.lastname: Di Napoli
authors.forename: Maurizio Ponz
authors.initials: MP
authors.lastname: de Leon
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002648:Child; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012737:Sex Factors; D055815:Young Adult