title: Cancer burden trends in Umbria region using a joinpoint regression.
abstract: BACKGROUND
  The analysis of the epidemiological data on cancer is an important tool to control and evaluate the outcomes of primary and secondary prevention, the effectiveness of health care and, in general, all cancer control activities.
  
  
  METHODS
  The aim of the this paper is to analyze the cancer mortality in the Umbria region from 1978 to 2009 and incidence from 1994-2008. Sex and site-specific trends for standardized rates were analyzed by "joinpoint regression", using the surveillance epidemiology and end results (SEER) software.
  
  
  RESULTS
  Applying the jointpoint analyses by sex and cancer site, to incidence spanning from 1994 to 2008 and mortality from 1978 to 2009 for all sites, both in males and females, a significant joinpoint for mortality was found; moreover the trend shape was similar and the joinpoint years were very close. In males standardized rate significantly increased up to 1989 by 1.23% per year and significantly decreased thereafter by -1.31%; among females the mortality rate increased in average of 0.78% (not significant) per year till 1988 and afterward significantly decreased by -0.92% per year. Incidence rate showed different trends among sexes. In males was practically constant over the period studied (not significant increase 0.14% per year), in females significantly increased by 1.49% per year up to 2001 and afterward slowly decreased (-0.71% n.s. estimated annual percent change - EAPC).
  
  
  CONCLUSIONS
  For all sites combined trends for mortality decreased since late '80s, both in males and females; such behaviour is in line with national and European Union data. This work shows that, even compared to health systems that invest more resources, the Umbria public health system achieved good health outcomes.
authors.affiliation: Sezione di Sanità Pubblica, Dipartimento di Medicina Sperimentale, Università degli Studi di Perugia, Perugia, Italy.
authors.forename: Giuseppe Michele
authors.initials: GM
authors.lastname: Masanotti
authors.affiliation: Sezione di Sanità Pubblica, Dipartimento di Medicina Sperimentale, Università degli Studi di Perugia, Perugia, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Cioccoloni
authors.affiliation: Sezione di Sanità Pubblica, Dipartimento di Medicina Sperimentale, Università degli Studi di Perugia, Perugia, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Stracci
authors.affiliation: Sezione di Sanità Pubblica, Dipartimento di Medicina Sperimentale, Università degli Studi di Perugia, Perugia, Italy.
authors.forename: Fortunato
authors.initials: F
authors.lastname: Bianconi
authors.affiliation: Dipartimento Salute, Regione Umbria, Perugia, Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Duca
authors.affiliation: Sezione di Sanità Pubblica, Dipartimento di Medicina Sperimentale, Università degli Studi di Perugia, Perugia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: La Rosa
mesh_terms: D000328:Adult; D017281:Cost of Illness; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D009369:Neoplasms / Q000453:epidemiology* / Q000401:mortality; D011159:Population Surveillance; D012044:Regression Analysis; D012737:Sex Factors