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

Nel futuro i professionisti sanitari della prevenzione saranno sempre più chiamati in prima persona nella gestione di situazioni critiche e appare chiaro che oggi più che mai è necessario che assumano il ruolo previsto nei profili professionali, ma per farlo nel modo migliore dobbiamo pensare alla loro formazione in modo sempre più incisivo e collegato alle necessità reali. Different strategies are available to fight cancer, as related to the natural history of the disease and to its stage. Primary prevention aims at avoiding cancer initiation and promotion both by minimizing exposures to carcinogenic agents and by favouring the intake of protective factors either with the diet and/or with pharmacological agents. Secondary prevention involves the early detection of the disease either by diagnosing cancer in selected individuals at an early stage or by implementing programs of oncological screenings in broad population strata. When a neoplastic disease becomes clinically manifest, the most suitable therapeutic protocols are followed by tertiary prevention measures in the framework of the management of cancer patients. Such a strategy is designed in order to prevent local relapses, invasion of the blood and lymph streams by malignant cells and metastasis in distant organs. All the above strategies have the common goal to decrease cancer mortality. However, such a goal is pursued via differentiated tools that are intrinsic in the nature of the intervention approach. Thus, reduction of cancer mortality by primary prevention, which is the only strategy addressed to healthy (or apparently healthy) individuals, is achieved by lowering the incidence of the disease. An objective of this type has already been shown to be feasible on a large scale either through risk assessment and risk management approaches (e.g., in the case of lung cancer) or through unintentional measures (e.g., in the case of gastric cancer, whose decline has been defined as an "unplanned triumph of medicine"). Obviously, the decrease in cancer incidence will also result in a decrease of cancer prevalence with years. On the other hand, both therapy and tertiary prevention will attenuate cancer mortality by decreasing its fatality thereby improving survival, which will also result in a greater cancer prevalence. As to oncological screenings, in principle these interventions tend to increase cancer incidence because they are designed in order to detect a greater number of cancer cases at an early stage, when they are more easily curable. This results in a greater survival and in an increased prevalence of the disease. For instance, extensive gastroscopy campaigns have been carried out in the Japanese and Korean populations for the detection of so-called "early gastric cancer", which resulted in an increase in the number of the diagnosed cases but also in a lower mortality and in a greater prevalence of gastric cancer. In some cases, an oncological screening may result in an excessive detection of cancer cases that, besides the risk of false positives, may involve the application of distressing treatments of cancer cases that would never have been detected during lifetime. This overdiagnosis problem has been emphasized several times regarding the elevations in PSA levels in the blood for the diagnosis of prostate cancer. In the case of breast cancer, during the 2003-2018 period there was in Italy a slight trend for an increase in the incidence, accompanied by a slight decrease i