What is hidden behind urban and semiurban cancer incidence and mortality differences in central Italy?

Our plain-English summary of What is hidden behind urban and semiurban cancer incidence and mortality differences in central Italy?, by E. Crocetti, G. Miccinesi, E. Paci, et al (Tumori, 2002).

The study

• Authors: E. Crocetti, G. Miccinesi, E. Paci, C. Cislaghi
• Journal: Tumori
• Published: 2002;88(4):257-61
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aims And Background: To analyze differences in cancer incidence and mortality between urban and semiurban municipalities in central Italy.

Methods And Study Design: Population-based survey in the provinces of Florence and Prato in Central Italy involving cancer patients diagnosed between 1985 to 1997 and cancer deaths from 1985 to 1998.

Results: Urban-semiurban incidence ratios were significantly high in both genders for all cancer sites combined (males 1.06, females 1.09), lung (1.11 and 1.37), Kaposi's sarcoma (1.96 and 2.39) and urinary bladder (1.23 and 1.44) and significantly low for stomach cancer (0.76 and 0.84). Among females, urban incidence excesses were present for breast, cervix uteri and skin melanoma and among males for prostate, Hodgkin disease, non-Hodgkin lymphomas and mesotheliomas. Most of the cancer mortality rate ratios corresponded to the incidence rate ratios.

Conclusions: We found that cancer risks and deaths were not homogeneously distributed in the analyzed area, but an urban gradient was present. Part of the differences can probably be attributed to environmental exposures and lifestyle.

In plain English

This population-based study compared cancer rates in urban and semiurban municipalities of the provinces of Florence and Prato, central Italy. The authors used Tuscany Cancer Registry cases diagnosed from 1985 to 1997 and regional death records from 1985 to 1998 for 50 municipalities. Under a national statistics classification, 9 were urban, including Florence and Prato, and 41 were semiurban. The authors compared age-adjusted rates as urban-to-semiurban ratios. The study compared places of residence, not individual exposures. Overall cancer incidence was higher in urban areas for males (1.06, 95% CI 1.04-1.08) and females (1.09, 95% CI 1.07-1.12). Among males, the urban-to-semiurban mesothelioma incidence ratio was 2.07 (1.24-3.46). The male mesothelioma mortality ratio, 1.15 (0.79-1.68), was not statistically significant. Urban excesses were also seen in both sexes for lung cancer, bladder cancer and Kaposi's sarcoma. Stomach cancer was more common in semiurban areas. The authors suggested the male urban mesothelioma excess may be due to professional exposure to asbestos. They concluded that cancer was not evenly distributed and that an urban gradient was present.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Population-based descriptive study comparing cancer incidence and mortality rates (age-adjusted rate ratios) between urban and semiurban municipalities
• Who was studied: Residents of 50 municipalities in the provinces of Florence and Prato, central Italy, covered by the Tuscany Cancer Registry (9 urban, 41 semiurban; 1,184,681 residents in 1991). Cancer cases were diagnosed 1985-1997 and cancer deaths occurred 1985-1998.
• Exposure: Residence in an urban versus a semiurban municipality, defined by the national statistics institute's classification of municipalities based on 13 variables from the 1981 census. No individual exposures, including asbestos, were measured.
• Main results:
  • Overall cancer incidence was higher in urban than semiurban municipalities. The incidence rate ratio was 1.06 (95% CI 1.04-1.08) for males and 1.09 (95% CI 1.07-1.12) for females.
  • Among males, the urban-to-semiurban incidence rate ratio for mesothelioma was 2.07 (95% CI 1.24-3.46), a statistically significant urban excess (1985-1997).
  • Among males, the urban-to-semiurban mortality rate ratio for mesothelioma was 1.15 (0.79-1.68), not statistically significant (1985-1998, from Table 1).
  • Among females, the urban-to-semiurban incidence rate ratio for mesothelioma was 1.35 (0.68-2.69), not statistically significant (from Table 1).
  • Significant urban incidence excesses were found in both sexes for three cancers: lung (males 1.11, females 1.37), urinary bladder (males 1.23, females 1.44) and Kaposi's sarcoma (males 1.96, females 2.39).
  • Stomach cancer was the only site with a significant semiurban incidence excess (urban-to-semiurban ratio: males 0.76, females 0.84).
  • The authors suggested that the urban mesothelioma excess among males may be due to professional exposure to asbestos. This is their interpretation; the study did not measure exposure.
• The authors' conclusion: The authors concluded that cancer risks and deaths were not evenly distributed in the area and that an urban gradient was present. They attributed part of the differences to lifestyle and probably to environmental exposures.
• Limitations the authors state:
  • Some differences may have been due to selective case or death ascertainment and errors in residence definition, although the authors considered this unlikely for these registries.
  • Population density varied widely within the urban group, especially once Florence and Prato were excluded.
  • Urbanization and deprivation were significantly correlated, so the authors did not fit a regression model including both.

Topics

Medical terms in this study, explained in our Lexicon: Sarcoma, Stomach Cancer, Mesothelioma, rate ratio, Incidence, Environmental Exposure.

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