Atti del 52° Congresso Nazionale: Società Italiana di Igiene, Medicina Preventiva e Sanità Pubblica (SItI)

n mortality. As to colorectal cancer, mortality was relatively stable during the same period, whereas an increase in cancer incidence until 2006 was followed by a more evident trend to a decrease. In any case, the fluctuations of cases of can-cers subjected to oncological screenings is not a rule, also because secondary prevention interventions are often coupled with primary prevention measures, such as improvement in lifestyle and hygienic conditions, control of sexually transmitted diseases, etc. In the case of uterine cervix carcinoma, primary prevention by vaccination is predicted to further lower both incidence and mortality for that cancer and other HPV-related cancers as well. In fact, HPV is responsible for the 100% of uterine cervix cancers, notwithstanding the fact that other factors, such as hormonal stimuli, oral contraceptives and cigarette smoking, may represent concausal factors. For the moment, taking into account that progression to invasive cervical cancer requires several decades, HPV vaccination has been shown to be successful in decreasing the incidence of HPV-related cervical intraepithelial neoplasias (CIN). The cancers that in Italy are subjected to oncological screenings as basic health care levels or LEA (essential levels of assistance), including breast cancer, colorectal cancer and uterine cervix cancer, bear a great epidemiological relevance worldwide. According to Globocan data, breast cancer causes the 11.6% of all cancer cases (2,088,849 new cases in 2018) , a figure that is almost equivalent to that of lung cancer. Colorectal cancer ranks 3 rd , with the 10.2% of all diagnosed cancers (1,849 518 new cases in 2018) . Uterine cervix cancer ranks 8 th , with the 3.2% of all cancers (569,847 new cases in 2018). Thus, these 3 cancers represent the 25% of all cancers worldwide. According to AIOM/AIRTUM estimates, the same cancers represent collectively an even greater proportion of all incident cancers in Italy (28.6% of the estimated 373,000 new cases of all cancers). In particular, breast cancer represented in 2018 the 14.2% of all cancer cases (52,800 new cases), colorectal cancer the 13.8% of all diagnosed cancers (51 300 new cases), and uterine cervix cancer the 0.6% of all cancers (2 400 new cases). For the incidence period 2005-2009, survival after 5 years was 87%, 65% and 68%, respectively. The numbers of deaths in 2015 (ISTAT data) were 12 381, 18 935 and 435, respectively, which accounted for a total of 31 751 annual deaths, i.e., the 17.8% of the 178,232 deaths for all cancers in Italy. The high incidence of breast cancer and colorectal cancer, associated with a more than average survival, justifies the high prevalence of these cancers in the population. In fact, there are as many as 799 198 women who are still alive in 2018 after diagnosis of breast cancer, 470 697 people who are still alive after diagnosis of colorectal cancer, and 56,063 women who are still alive after diagnosis of uterine cervix cancer. Therefore, there is a huge number of people (1,326,000 individuals) who are surviving after the diagnosis of these 3 cancers in Italy. These data provide evidence for the outstanding epidemiological importance of those cancers that are subjected to LEA measures in Italy. The strikingly lower incidence of uterine cervix cancer in Italy, as compared with the world situation, is a demonstration of the efficiency of cancer preventive measures.