title: The burden of breast cancer in Italy: mastectomies and quadrantectomies performed between 2001 and 2008 based on nationwide hospital discharge records.
abstract: BACKGROUND
  Where population coverage is limited, the exclusive use of Cancer Registries might limit ascertainment of incident cancer cases. We explored the potentials of Nationwide hospital discharge records (NHDRs) to capture incident breast cancer cases in Italy.
  
  
  METHODS
  We analyzed NHDRs for mastectomies and quadrantectomies performed between 2001 and 2008. The average annual percentage change (AAPC) and related 95% Confidence Interval (CI) in the actual number of mastectomies and quadrantectomies performed during the study period were computed for the full sample and for subgroups defined by age, surgical procedure, macro-area and singular Region. Re-admissions of the same patients were separately presented.
  
  
  RESULTS
  The overall number of mastectomies decreased, with an AAPC of -2.1% (-2.3 -1.8). This result was largely driven by the values observed for women in the 45 to 64 and 65 to 74 age subgroups (-3.0%, -3.4 -3.6 and -3.3%, -3.8 -2.8, respectively). We observed no significant reduction in mastectomies for women in the remaining age groups. Quadrantectomies showed an overall +4.7 AAPC (95%CI:4.5-4.9), with no substantial differences by age. Analyses by geographical area showed a remarkable decrease in mastectomies, with inter-regional discrepancies possibly depending upon variability in mammography screening coverage and adherence. Quadrantectomies significantly increased, with Southern Regions presenting the highest average rates. Data on repeat admissions within a year revealed a total number of 46,610 major breast surgeries between 2001 and 2008, with an overall +3.2% AAPC (95%CI:2.8-3.6).
  
  
  CONCLUSIONS
  In Italy, NHDRs might represent a valuable supplemental data source to integrate Cancer Registries in cancer surveillance.
authors.affiliation: Department of Internal Medicine, University of Florence, Viale Pieraccini 18, Florence 50139, Italy.
authors.forename: Prisco
authors.initials: P
authors.lastname: Piscitelli
authors.forename: Maddalena
authors.initials: M
authors.lastname: Barba
authors.forename: Massimo
authors.initials: M
authors.lastname: Crespi
authors.forename: Massimo
authors.initials: M
authors.lastname: Di Maio
authors.forename: Antonio
authors.initials: A
authors.lastname: Santoriello
authors.forename: Massiliamo
authors.initials: M
authors.lastname: D'Aiuto
authors.forename: Alfredo
authors.initials: A
authors.lastname: Fucito
authors.forename: Arturo
authors.initials: A
authors.lastname: Losco
authors.forename: Francesca
authors.initials: F
authors.lastname: Pentimalli
authors.forename: Pasquale
authors.initials: P
authors.lastname: Maranta
authors.forename: Giovanna
authors.initials: G
authors.lastname: Chitano
authors.forename: Alberto
authors.initials: A
authors.lastname: Argentiero
authors.forename: Cosimo
authors.initials: C
authors.lastname: Neglia
authors.forename: Alessandro
authors.initials: A
authors.lastname: Distante
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Di Tanna
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Brandi
authors.forename: Alfredo
authors.initials: A
authors.lastname: Mazza
authors.forename: Ignazio R
authors.initials: IR
authors.lastname: Marino
authors.forename: Antonio
authors.initials: A
authors.lastname: Giordano
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D005260:Female; D006753:Hospital Records; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008327:Mammography; D008408:Mastectomy; D008875:Middle Aged; D010351:Patient Discharge; D015996:Survival Rate