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Open Access Research article

Time trends of cancer mortality among elderly in Italy, 1970–2008: an observational study

Ettore Bidoli1*, Lucia Fratino2, Silvia Bruzzone3, Marilena Pappagallo3, Paolo De Paoli4, Umberto Tirelli5 and Diego Serraino1

Author Affiliations

1 Unit of Epidemiology and Biostatistics, Centro di Riferimento Oncologico, IRCCS, via Franco Gallini 2, 33081 Aviano, PN, Italy

2 Division of Medical Oncology A, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy

3 Direzione Centrale per le Statistiche e le Indagini Sulle Istituzioni Sociali, Servizio Sanità e Assistenza, National Institute of Statistics, Rome, Italy

4 Direzione Scientifica, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy

5 Department of Medical Oncology, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy

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BMC Cancer 2012, 12:443  doi:10.1186/1471-2407-12-443

Published: 2 October 2012

Abstract

Background

The aging of the Italian population will unavoidably lead to a growing number of persons diagnosed and living with cancer. A comprehensive description of the burden of cancer mortality among Italian elderly (65-84 years of age) in the last four decades has not been carried out yet. Cancer mortality rates were used to describe time trends between 1970-2008.

Methods

Mortality counts, provided by the Italian National Institute of Statistics, were grouped according to data availability: in quinquennia from 1970-74 through 1995-99, and in 2000-03 and 2006-08 groups. Age-standardized rates (world population) were computed by calendar periods while annual percent changes (APCs) were computed for elderly and middle aged (35-64 years) people for the period 1995-2008.

Results

The number of cancer deaths in elderly nearly doubled between 1970-74 (31,400 deaths/year in men, and 24,000 in women) and 2006-08 (63,000 deaths/year in men, and 42,000 in women). Overall cancer mortality rates peaked during the quinquennia 1985-89 and 1990-94 (about 1,500/100,000 in men and 680 in women) and declined thereafter. Throughout 1995-2008 cancer mortality rates decreased by -1.6%/year in men and -0.9%/year in women. These decreases were mainly driven by cancers of the stomach, bladder, prostate, and lung (APC = -3.3%, -2.7%, -2.5%, -2.2%, respectively) in men, and by cancers of the stomach, bladder, and breast (APC = -3.5%, -1.9%, -1.1%, respectively) in women. Conversely, increases in mortality rates between 1995 and 2008 were recorded for lung cancer (APC = +0.6%) in women, cutaneous melanoma (APC = +1.7%) in men, and pancreatic cancer (APC = +0.6% in men and +0.9% in women).

Conclusions

Overall favorable trends in cancer mortality were observed among Italian elderly between 1995 and 2008. Early diagnosis, improved efficacy of anti-cancer treatments and management of comorbidities are the most likely explanations of these positive observations. However, enduring preventive interventions against the most common risk factor (e.g. cigarette smoking), early diagnosis, and access to care should be reconsidered and extended to match the reductions of cancer mortality recorded in the elderly with those in the middle aged.

Keywords:
Cancer mortality; Time trends; Elderly; Italy