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Latina province

Latina province. Unusual north-south migration of 60 000 people from Veneto, Friuli and Emilia Romagna to Latina province area during the 1930s.

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Latina province

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  1. Latina province

  2. Unusual north-south migration of 60 000 people from Veneto, Friuli and Emilia Romagna to Latina province area during the 1930s People were mainly manual workers, farmers and their families involved in land reclamation that drained the marsh area extending from the southern boundaries of Rome to Terracina From: Tumori, 80: 101-105, 1994

  3. Pool of Italian Cancer Registries(AIRTUM) http://www.registri-tumori.it/cms/

  4. Number of subjects to be followed until the age of 84 years to detect one incident cancer, by site and sex. Pool of Italian Cancer Registries. Period 2005-2007 • From: “I numeri del cancro in Italia 2011”. www.registritumori.it/PDF/AIOM2011/I_numeri_del_cancro_2011.pdf (modified)

  5. Number of subjects to be followed until the age of 84 years to observe one death by cancer site and sex. Pool of Italian Cancer Registries. Period 2005-2007 • From: “I numeri del cancro in Italia 2011”. www.registritumori.it/PDF/AIOM2011/I_numeri_del_cancro_2011.pdf (modified)

  6. Five most frequently diagnosed cancer and percentage on the overall number of cases (excl. non-melanoma skin cancer). Pool of Italian cancer registries. Period 2005-2007, by gender and age-classes From: http://www.registri-tumori.it/cms/node/2172. (modified)

  7. Melanoma: Italy. Incidence rates (Eu. Stand. Per 100 000) by geographical area and sex. Pool of Italian Cancer Registries. 2005-2007 From: www.registri-tumori.it/PDF/AIOM2011/I_numeri_del_cancro_2011_+_errata_corrige.pdf (modified)

  8. Skin melanoma. Relative survival (%), 2000-2004. Male & female. Pool of 31 cancer registries. Italy From: Epidemiol Prev 2011; 35 (5-6) suppl 3: 1-200 (Modified)

  9. Incidence and mortality cancer trends, 1998-2005. Annual percent change. Pool of Italian cancer registries From: www.registri-tumori.it/PDF/AIRTUM2009Trend/E&P33_4-5S1_19_trend.pdf (modified)

  10. Prevalence, Italy, 01.01.2006. Number of subjects by cancer site. Male & female. Pool ofItalianCancerRegistries. *cancer site with N. subjects ≥ 50 000) From: www.registri-tumori.it/cms/?q=Rapp2010 (Modified)

  11. World burden of skin cancers: summary results for the year 2000 *disability-adjusted life year From: www.who.int/uv/publications/solaradgbd/en/index.html

  12. Risk Factors for cutaneous melanoma Constitutional features Behavioural features Sun exposure (Intermittent, Chronic) Sun exposure (In childhood, In Adulthood) Use of indoor tanning equipment • Phototype (I, II, III) • Hair colour (Red, Blond, Light Brown) • Skin colour (Light colour) • Eye colour (Blue, Green, Hazel) • Naevi (Atypical naevi, number of naevi) • Freckles (High density) Personal history • Actinic damage indicators • Family history

  13. Melanoma preventionpractices • Seekingshade • Wearingbroadspectrumsunscreen • Covering up with a shirt and/or a hat • Wearingsunglasses

  14. Early detection pratices • Skinself-examinations • Examinationsbymedicalprofessionals

  15. Skin cancer risk factors in childhood: findings of a survey in an Italian area characterized by an atypical migration (A) From: Ramazzotti V et al. Epidemiol Prev. 2009 Jan-Apr;33(1-2):45-50. (Modified)

  16. Skin cancer risk factors in childhood: findings of a survey in an Italian area characterized by an atypical migration (B) From: Ramazzotti V et al. Epidemiol Prev. 2009 Jan-Apr;33(1-2):45-50. (Modified)

  17. Sun protection behavior in primary school children: comparison between pre- and post-intervention results. Valencia, Spain; 2007 - 2008

  18. CDKN2A • 5% - 10% ofallmelanomas are hereditary • Ofthose Up to 40% are explainedbymutations in the Cyclin-dependentkinaseinhibitor 2° CDKN2A Cancer Epidemiol Biomarkers Prev. 2013 Apr;22(4):607-14

  19. In USA individuals positive for a mutation in CDKN2A have a 76% estimatedlifetimerisk ofdeveloping melanoma (lifetimerisk in the generalpopulation: 2%) Cancer Epidemiol Biomarkers Prev. 2013 Apr;22(4):607-14

  20. MC1R Variants in melanocortin- 1 receptor (MC1R) gene conferriskof melanoma (to a lesserdegreeof a mutation in CDKN2A) RiskbyMC1R isgreater in individualswith darker hair hyes skin color Cancer Epidemiol Biomarkers Prev. 2013 Apr;22(4):607-14

  21. Use of genetic testing and counseling for melanoma risk: effects (a) Will individuals who test positive for genetic mutations increase their sun avoidance and skin examination behaviors? Cancer Epidemiol Biomarkers Prev. 2013 Apr;22(4):607-14

  22. Use of genetic testing and counseling for melanoma risk: effects (b) Will individuals who test negative (or inconclusive) for mutations be less vigilant because of a reassurance effect? Cancer Epidemiol Biomarkers Prev. 2013 Apr;22(4):607-14

  23. Aspinwall LG et al. CDKN2A genetic test reporting improves early detection intentions and practices in high-risk melanoma families. • Total body skin examinations by medical professional • Skin self-examinations In n. 77 individuals with: • CDKN2A (+) and personal history of melanoma; • CDKN2A (+) and no personal history of melanoma; • CDKN2A (-); This group reported a significant increase in monthly skin self- examination intentions and behaviors at follow up Cancer Epidemiol Biomarkers Prev 2008; 17(6): 1510 - 1519

  24. Bergernmar M et al. Family members’perceptions of genetic testing for malignant melanoma – A prospective interview study. In 11 unaffected members of melanoma-prone families Measurement of: • Anxiety and depression • Risk perception • Sun-related habits • Before • At disclosure • Six months after disclosure CDKN2A Genetic test Results • On year post-disclosure Disclosure of genetic test results did not change perceived risk for melanoma Eur J Oncol 2002; 3(11): 653-654

  25. Glanz KL et al. Melanoma Genetic Testing, Counseling, and Adherence to Skin Cancer Prevention and Detection Behaviors (A) Randomized control trial Two groups of individuals (73 adults) in hereditary melanoma families • Individuals enrolled in melanoma families (a. three or more cases of melanoma on the same side of family; b. two or more cases in first degree relatives) • All participants completed a full body skin examination of moles and provided a blood and/or buccal swab sample for CDKN2A and MC1R genotyping • Intervention group: offering genetic counseling and test results (35 individuals) • Control group: not offering genetic counseling and test results (38 individuals) • Baseline Survey (see specific items) • Genetic counseling session with a genetic counselor • Follow-up survey (for months after) Cancer Epidemiol Biomarkers Prev. 2013 Apr;22(4):607-14

  26. Glanz KL et al. Melanoma Genetic Testing, Counseling, and Adherence to Skin Cancer Prevention and Detection Behaviors (B) Aims: to investigate the effect of offering genetic counseling and testing on: • Behavior • Attitudes • Perceived risk of melanoma • Current and intended sun avoidance/protection • Skin examination behaviors Cancer Epidemiol Biomarkers Prev. 2013 Apr;22(4):607-14

  27. Differences between intervention and control groups at baseline p-value Age NS % High risk NS % Previously diagnosed melanoma NS % Ever getting genetic testing NS % With a family member who had ever had genetic testing NS __________________________________________________________________ I C % Female 80.0 57.9 0.04 % BMI overweight/obese 40.0 65.8 0.03 % Family history of melanoma (other than self) 25.7 52.6 0.03 % Very good or excellent self rated health 88.5 52.7 0.01 Cancer Epidemiol Biomarkers Prev. 2013 Apr;22(4):607-14

  28. Changes in Behaviors in Behaviors and Attitudes from Baseline to Follow-Up (1 a) Prevention & Detection Behaviors p-value _______________________________________________________________ Sun Protection Habits NS Wear Sunscreen NS Wear Sunglasses NS Seek Shade NS Wear a Hat NS Limit Hours in the Sun NS Skin Examination by a Medical Professional NS Sun Exposure: Weekday NS Sun exposure: Weekend NS Sunburn Frequency NS Cancer Epidemiol Biomarkers Prev. 2013 Apr;22(4):607-14

  29. Changes in Behaviors in Behaviors and Attitudes from Baseline to Follow-Up (2) Perceptions and Beliefs p-value ______________________________________________________________ Perceived Skin Cancer Risk NS Perceived Benefits of Sun Protection NS Perceived Barriers to Sun Protection NS Awareness of Genetic Counseling NS Perceived Benefits of Genetic Counseling NS Cancer Epidemiol Biomarkers Prev. 2013 Apr;22(4):607-14

  30. Changes in Behaviors and Attitudes from Baseline to Follow-Up (1 b) Prevention & Detection Behaviors Score Mean SD p-value I C ______________________________________________________________ a)Wear Shirt (1-4) Baseline 2.80 3.00 Follow-up 2.60 2.39 0.047 _____________________________________________________________________ b)Skin Self - Examination (1-4) Baseline 1.89 1.71 Follow-up 1.23 1.84 0.002 _____________________________________________________________________ • Higher scores = greater frequency of the behavior • Lower scores = more recent self examination Cancer Epidemiol Biomarkers Prev. 2013 Apr;22(4):607-14

  31. Conclusions Feedback of CDKN2A and MC1R genotype “does not appear to decrease sun protection behaviors” also among families without known pathogenic CDKN2A mutations Cancer Epidemiol Biomarkers Prev. 2013 Apr;22(4):607-14

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