Epidemiologia & Prevenzione最新文献

Objectives: to describe the frequency of prostate biopsy and its determinants, as well as the incidence of prostate cancer, in a cohort of asymptomatic residents of the Agency for Health Protection of the Metropolitan Area of Milan (ATS Milano) who underwent total prostate-specific antigen (PSA) testing.

Design: cohort study of resident men aged 30-84 years who underwent at least one PSA test (index test) in 2018-2019 and 2021-2023, with follow-up until December 2024.

Setting and participants: from the administrative and healthcare databases of ATS Milano, 414,731 residents who underwent at least one PSA test during the study period, presumably for screening purposes, were identified.

Main outcome measures: frequency of specific follow-up procedures (repeat PSA testing, urological consultation, ultrasound, magnetic resonance imaging), with particular focus on prostate biopsy, and cumulative incidence at 3, 6, and 12 months after the index test. Logistic regression analysis of the probability of undergoing prostate biopsy within 6 months of the index test.

Results: overall, 1.6% of subjects underwent a prostate biopsy within one year (N. 6,598). This proportion increased markedly with higher initial PSA values (13.8% among those with PSA >=6 ng/mL). On average, 11.7% of biopsies were the first procedure after the index test, 22.4% followed one of the procedures considered, 33.7% followed two procedures, 24.9% followed after three procedures, and 7.3% followed four procedures. Prostate cancers diagnosed were 1,157 at 3 months and 3,219 at 1 year, compared by means of the observed-to-expected ratio, to the incidence of the general population. The biopsy-to-cancer ratio was approximately 2. At 6 months, prostate biopsy was positively associated with age (up to 70-79 years), strongly associated with PSA level (>=6 ng/mL, OR: 28.7) and with Italian citizenship, while a lower risk was observed in the presence of comorbidities. The observed-to-expected ratio was greater than 1 for initial PSA values >=3 ng/mL and increased progressively with higher PSA levels.

Conclusions: among residents of the ATS Milano area, a PSA level equal to or greater than 3 ng/mL identifies an early increased risk of prostate carcinoma. To ensure the timely identification of all clinically significant cases, biopsy should be integrated into a multimodal diagnostic pathway including advanced imaging, which was not always available in the analysed cohort.

The web of causation of the upper airways cancers (UAC) is complex and, at present, only partially defined; certainly, a wide range of airborne viruses and chemicals is therein (with varying degrees of evidence) involved. Within the perspective of subsequent formal studies about this topic, a small case-series pilot has been performed, searching Epstein-Barr Virus (EBV), Human Cytomegalovirus (HCMV), Human Papilloma Virus (HPV) 18 and 16 markers in a set of tumour samples from 53 patients diagnosed with different types of primary epithelial UAC. Overall, the prevalence of positive tests for EBV, HCMV, and HPV18 was 24.5%, 5.5% and 5.5%, respectively. EBV tested positive in 10 nasopharyngeal carcinomas (including 1 adenocarcinoma), 2 nasal carcinomas (including 1 adenocarcinoma), and 2 sinus carcinomas (both adenocarcinomas); HCMV tested positive in 3 nasal carcinomas (including 2 adenocarcinomas); HPV18 tested positive in 1 nasal adeno carcinoma and 2 sinus adenocarcinomas. Future studies are warranted to shed light on the complex aetiology of UAC, by integrating the best pathological evidence and systematic acquisition of standardized anamnestic data, meanwhile taking in consideration both the viral presence in the cancer tissues and the patients' self-referred exposures to particles and vapours.

Objectives: to update the health profile of the residents in the national priority contaminated sites (SIN) in Sicily Region (Southern Italy), through a description of mortality and hospitalisation by causes, as implementation of the epidemiological surveillance included in the Programme of health intervention in these populations and in the new Regional Prevention Plan.

Design: ecological study which uses two levels of comparison for each SIN: a local level including the populations of SIN neighbouring areas and a regional level including people residing in Sicily.

Setting and participants: the population in the study is residents in the municipalities included in the following SIN: Augusta-Priolo (presence of industrial areas); Gela (presence of industrial areas); Milazzo (presence of industrial areas); Biancavilla (presence of natural asbestos-like material).

Main outcome measures: using the information from the mortality registry for the mortality index, the hospital discharge data for the morbidity index, the standardised mortality ratio (SMR), and the standardised hospitalisation ratio (SHR) with the corresponding 95% confidence intervals were calculated.

Results: in the local comparison, an excess of hospitalisation in both sexes is reported in Augusta-Priolo for liver cirrhosis, mental disorders, and digestive tract disease, and an excess of mortality for leukaemia in women and prostate cancer in men. In the SIN of Gela, there is an excess of hospitalisation in both sexes for blood and haematopoietic diseases, circulatory and nervous system diseases, sustained by the same excess of mortality. There are also excesses of hospitalisation and mortality of stomach tumours in men and hospitalisation of lung cancer in women. The area of ​​Milazzo is characterised by an excess of hospitalisation and mortality for melanoma in men. In the municipality of Biancavilla, there is evidence of an excess of hospitalisation for respiratory diseases and endocrine glands diseases in both sexes, while a mortality excess for circulatory system diseases.

Conclusions: the data derived from the new surveillance system help to define the health profile in the SINs of Sicily. Even by using the local level of comparison that was added to the traditional approach in geographic studies in the national priority contaminated sites for the reclamation available until today, the particular impact of some chronic diseases in these populations has also been confirmed in recent years.

Synthetic data are artificially generated information with the aim of imitating real data. They are designed to preserve the statistical characteristics of the original population while ensuring high levels of privacy, which makes them particularly useful in contexts where confidentiality is crucial. Measuring the value of synthetic data means assessing the similarity with the original data, the ability to produce results comparable to those obtained with real data, and the potential risks of privacy breaches. However, some risks remain, including the possible re-identification of individuals, the danger of amplification of biases already present in the original data, and the difficulty in validating the quality of synthetically generated data. At present, synthetic data represent an emerging and promising technology in various fields, however their use in epidemiology, particularly in observational settings, is still debated and requires further investigation and evaluation.

Objectives: to assess the frequency of total prostate-specific antigen (PSA) testing in the absence of clinical conditions in the Agency for Health Protection of the Metropolitan Area of Milan (ATS Milan), prior to the launch of the Lombardy regional prostate cancer screening programme.

Design: the study included all men aged 30-84 years residing in the ATS Milan area who underwent at least one PSA test during the years 2018-2019 and 2021-2023. The absence of prostate-related clinical conditions was verified using local health records and the cancer registry of the ATS Milan.

Setting and participants: the study used data from administrative and healthcare databases of ATS Milan. Among the 466,616 citizens with at least one PSA tests recorded during the study period, 414,731 had the test presumably conducted for screening purposes.

Main outcome measures: at least one PSA test in the period.

Results: screening tests accounted for approximately 80% of total PSA tests. On average, 35.6% of male residents underwent at least one preventive PSA test, with low uptake among those under 50, 48.9% in those aged 50-69 years, 60.8% among men in their seventies, and 51.8% in the 80-84 age group. The mean number of PSA test per individual over the study period was 2.3. Testing decreased in 2021-2022, but increased again in 2023. A significant and increasing proportion of individuals undergoing PSA testing had three or more comorbidities. Among the 414,731 initial tests, 47.3% had PSA values <1 ng/mL, 35.4% between 1 and 3, 11.0% between 3 and 6 and 6.3% >=6.

Conclusions: the high frequency of testing among the elderly, the frequent repeat testing, and the growing involvement of individuals with multiple comorbidities highlight the need to transition to an organized screening programme capable of balancing benefits and risks.