title: Cancer mortality trends between 1988 and 2009 in the metropolitan area of Naples and Caserta, Southern Italy: Results from a joinpoint regression analysis.
abstract: Mortality data by geographic area and trend-based surveillance are particularly relevant in orienting public health decisions targeting specific populations. We analyzed overall and site-specific cancer mortality between 1988 and 2009 in the metropolitan area of Naples and Caserta in southern Italy. Age-standardized mortality rates (SMR) were computed for each 5-y age group, by gender, primitive cancer site and specific Province in the overall population and age-defined subgroups. Cancer mortality trends were quantified by annual percent change (APC) and 95% confidence interval (CI). From Naples and Caserta, the reduction observed between 1988 and 2009 in SMR in males, but not in females, was significantly lower compared with the decrease reported at a national level (-11.4% and -28.4%, respectively). In elderly men, differences between local and national SMR were more pronounced (+13.6% compared with -2.7%). In males, the joinpoint regression analysis showed the following APC and 95% CI: -0.9%/year (-1.2; -0.7) and -0.6%/year (-1.0; -0.2) for Naples and Caserta, respectively. In females, estimates were -0.6%/year (-0.8; -0.5) and -0.7%/year (-1.2; -0.3). The overall orientation toward declining cancer mortality trends appeared in antithesis with the slight, but significant, increase for some tumors (e.g., pancreatic cancer in both genders). A complex mixture of heterogeneous factors concurs to explain the evidence observed including lifestyle, access to screening procedures, advancements in cancer diagnosis and treatment. Further details might eventually derive from biomonitoring studies for ascertaining the causal link between exposure to potential contaminants in air, water, and soil and cancer-related outcomes in the area of interest.
authors.affiliation: Epidemiology Unit; National Cancer Institute G. Pascale Foundation; Naples, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Crispo
authors.affiliation: Medical Oncology B-Scientific Direction; Regina Elena National Cancer Institute; Rome, Italy.
authors.forename: Maddalena
authors.initials: M
authors.lastname: Barba
authors.affiliation: Department of Epidemiology; Mario Negri Institute; Milan, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Malvezzi
authors.affiliation: Department of Oncology and Experimental-Clinical Endocrinology; Federico II University of Naples; Naples, Italy.
authors.forename: Grazia
authors.initials: G
authors.lastname: Arpino
authors.affiliation: Epidemiology Unit; National Cancer Institute G. Pascale Foundation; Naples, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Grimaldi
authors.affiliation: Department of Epidemiology; Mario Negri Institute; Milan, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Rosso
authors.affiliation: Epidemiology Unit; National Cancer Institute G. Pascale Foundation; Naples, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Esposito
authors.affiliation: Medical Oncology B; Regina Elena National Cancer Institute; Rome, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Sergi
authors.affiliation: Scientific Director; Cancer Institute G. Pascale Foundation; Naples, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Ciliberto
authors.affiliation: Sbarro Institute for Cancer Research and Molecular Medicine and Center of Biotechnology; College of Science and Technology; Temple University; Philadelphia, PA USA; Department of Pathology & Oncology; University of Siena; Siena, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Giordano
authors.affiliation: Epidemiology Unit; National Cancer Institute G. Pascale Foundation; Naples, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Montella
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D009369:Neoplasms / Q000401:mortality*; D012044:Regression Analysis
keywords: Naples; analysis; cancer mortality; joinpoint; metropolitan area; southern Italy; time trends
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