title: Regional inequalities in cancer care persist in Italy and can influence survival.
abstract: BACKGROUND
  Population-based cancer registry studies of care patterns can help elucidate reasons for the marked geographic variation in cancer survival across Italy. The article provides a snapshot of the care delivered to cancer patients in Italy.
  
  
  METHODS
  Random samples of adult patients with skin melanoma, breast, colon and non-small cell lung cancers diagnosed in 2003-2005 were selected from 14 Italian cancer registries. Logistic models estimated odds of receiving standard care (conservative surgery plus radiotherapy for early breast cancer; surgery plus chemotherapy for Dukes C colon cancer; surgery for lung cancer; sentinel node biopsy for >1mm melanoma, vs. other treatment) in each registry compared to the entire sample (reference).
  
  
  RESULTS
  Stage at diagnosis for breast, colon and melanoma was earlier in north/central than southern registries. Odds of receiving standard care were lower than reference in Sassari (0.68, 95%CI 0.51-0.90) and Napoli (0.48, 95%CI 0.35-0.67) for breast cancer; did not differ across registries for Dukes C colon cancer; were higher in Romagna (3.77, 95%CI 1.67-8.50) and lower in Biella (0.38, 95%CI 0.18-0.82) for lung cancer; and were higher in Reggio Emilia (2.37, 95%CI 1.12-5.02) and lower in Ragusa (0.27, 95%CI 0.14-0.54) for melanoma.
  
  
  CONCLUSIONS
  Notwithstanding limitations due to variations in the availability of clinical information and differences in stage distribution between north/central and southern registries, our study shows that important disparities in cancer care persist across Italy. Thus the public health priority of reducing cancer survival disparities will not be achieved in the immediate future.
authors: Descriptive Studies and Health Planning Unit, Department of Preventive and Predictive Medicine, Fondazione IRCSS Istituto Nazionale dei Tumori, Via Venezian 1, Milano, Italy. milena.sant@istitutotumori.mi.it
authors: Milena
authors: M
authors: Sant
authors: Pamela
authors: P
authors: Minicozzi
authors: Claudia
authors: C
authors: Allemani
authors: Claudia
authors: C
authors: Cirilli
authors: Massimo
authors: M
authors: Federico
authors: Riccardo
authors: R
authors: Capocaccia
authors: Mario
authors: M
authors: Budroni
authors: Pina
authors: P
authors: Candela
authors: Emanuele
authors: E
authors: Crocetti
authors: Fabio
authors: F
authors: Falcini
authors: Stefano
authors: S
authors: Ferretti
authors: Mario
authors: M
authors: Fusco
authors: Adriano
authors: A
authors: Giacomin
authors: Francesco
authors: F
authors: La Rosa
authors: Lucia
authors: L
authors: Mangone
authors: Maurilio
authors: M
authors: Natali
authors: Maurizio Ponz De
authors: MP
authors: Leon
authors: Adele
authors: A
authors: Traina
authors: Rosario
authors: R
authors: Tumino
authors: Paola
authors: P
authors: Zambon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D012042:Registries; D012959:Socioeconomic Factors; D016019:Survival Analysis; D055815:Young Adult