North-south disparity in cancer control progress in Italy: a joint analysis of incidence, mortality and survival time trends by geographical area

In the last five decades, the epidemiology of cancer in Italy has been characterised by a north-south gradient in cancer incidence, mortality, and survival. Recently, this pattern has been changing, making it important to analyse the three indicators together to understand the underlying dynamics and to identify successes and failures in cancer control. Herein, data from 20 accredited Italian population-based cancer registries were used to examine age-standardised trends in incidence, five-year net survival, and mortality rates, for all cancers and 18 major cancer types, between 2008 and 2017. Data from the national pool were compared with macro-areas ones from north-centre and south-islands. We classified trends according to a 5-category model, ranging from 'Optimal Progress' (decreasing incidence and mortality, increasing survival) to 'Worsening' (increase of both incidence and mortality). At the national level we found progress in all indicators for all cancers combined: incidence and mortality rates declined, on average, by 2.5% and 5.5% annually, while survival increased by 2.5 % points. Similar optimal progress was shown, in men, by all cancers and lung cancer and, in both sexes, by liver cancer, and non-Hodgkin lymphoma. Conversely, evidence of worsening emerged for lung cancer in women, with incidence and mortality rates increasing, on average, by 6.5% and 4% annually. Contrasting trends emerged from north to south for colorectal, pancreatic, and kidney cancers. Trends were homogeneous, but improvements were stronger in the north-centre for all cancers, all cancers in men, male lung, prostate and bladder cancers, non-Hodgkin lymphoma, and for breast cancer mortality. For female lung cancer and breast cancer incidence, we documented a stronger burden increase in the south-islands. The advantage in cancer incidence and mortality risk shown decades ago by the south-islands macro area is being lost, and, if these trends remain stable, in near future the north-south gradient is expected to be reversed for many cancers.

Authors

Institutions

Publication Details

Journal
Cancer Epidemiology
Published
2026-07-23
DOI
https://doi.org/10.1016/j.canep.2026.103142
Primary Topic
Global Cancer Incidence and Screening
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

North-south disparity in cancer control progress in Italy: a joint analysis of incidence, mortality and survival time trends by geographical area

Cinzia Gasparotti, Gemma Gatta, Anna Clara Fanetti, Sabrina Fabiano et al.
Cancer Epidemiology
Global Cancer Incidence and Screening
article

North-south disparity in cancer control progress in Italy: a joint analysis of incidence, mortality and survival time trends by geographical area

Cinzia Gasparotti, Gemma Gatta, Anna Clara Fanetti, Sabrina Fabiano, Alessandra Sessa, Roberta De Angelis, Lucia Bisceglia, Martina Taborelli, Lorenzo Richiardi, Paola Michelozzi, Giuseppa Candela, William Mantovani, Stefano Marguati, Maurizio Castelli, Alessia Di Prima, Giancarlo D'Orsi, Antonino Ziino Colanino, Rosanna Ortolani, Walter Mazzucco, Maria Teresa Pesce, Valerio Ciullo, Sergio Mazzola, Stefano Guzzinati, Roberta Cerruti, Vincenzo Fronte, Monica Lanzoni, Viviana Perotti, Luciana Del Riccio, Luca Cavalieri d’Oro, T. Scuderi, Rocco Galasso, Luca Boni, Ettore Bidoli, Maurizio Zarcone, Adele Caldarella, Fabrizio Stracci, Rossella Cavallo, Giuseppe Sampietro, Rossella Abbate, Francesca Bella, Maria Francesca Vitale, Pasquala Pinna, Sonia Manasse, Francesco Vitale, Santa Valenti Clemente, Silvia Ghisleni, Federica Manzoni, Silvia Leite, Ermelinda Zollo, Romina Vincenzi, Valerio Napolioni, Marco Villa, Antonietta Minichino, M Ferrante, Maria A. Gentilini, Luigino Dal Maso, Daniela Piras, Valentina Davoli, Enrica Migliore, Diego Serraino, Giulia Bertini, Gaetano Bosso, Mario Fusco, Maria Gambino, Antonela Ipolito
article en

Abstract

In the last five decades, the epidemiology of cancer in Italy has been characterised by a north-south gradient in cancer incidence, mortality, and survival. Recently, this pattern has been changing, making it important to analyse the three indicators together to understand the underlying dynamics and to identify successes and failures in cancer control. Herein, data from 20 accredited Italian population-based cancer registries were used to examine age-standardised trends in incidence, five-year net survival, and mortality rates, for all cancers and 18 major cancer types, between 2008 and 2017. Data from the national pool were compared with macro-areas ones from north-centre and south-islands. We classified trends according to a 5-category model, ranging from 'Optimal Progress' (decreasing incidence and mortality, increasing survival) to 'Worsening' (increase of both incidence and mortality). At the national level we found progress in all indicators for all cancers combined: incidence and mortality rates declined, on average, by 2.5% and 5.5% annually, while survival increased by 2.5 % points. Similar optimal progress was shown, in men, by all cancers and lung cancer and, in both sexes, by liver cancer, and non-Hodgkin lymphoma. Conversely, evidence of worsening emerged for lung cancer in women, with incidence and mortality rates increasing, on average, by 6.5% and 4% annually. Contrasting trends emerged from north to south for colorectal, pancreatic, and kidney cancers. Trends were homogeneous, but improvements were stronger in the north-centre for all cancers, all cancers in men, male lung, prostate and bladder cancers, non-Hodgkin lymphoma, and for breast cancer mortality. For female lung cancer and breast cancer incidence, we documented a stronger burden increase in the south-islands. The advantage in cancer incidence and mortality risk shown decades ago by the south-islands macro area is being lost, and, if these trends remain stable, in near future the north-south gradient is expected to be reversed for many cancers.

Cancer EpidemiologyVol. 104
University of Bergamo (IT), Università di Camerino (IT), Agenzia Regionale per la Protezione Ambientale del Piemonte (IT), University of Insubria (IT), University of Salerno (IT), Provincial Health Services Authority (CA), Local Government Association (GB), Istituto Superiore di Sanità (IT), Regione Campania (IT), Prevention Institute (US), University of Catania (IT), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), Centro di Riferimento Oncologico della Basilicata (IT), Regional Health (US), Provincia Autonoma di Trento (IT), Health Protection Agency (MV), Agenzia Regionale Sanitaria della Puglia (IT), Regione Puglia (IT), National Cancer Registry (IE), Centro di Riferimento Oncologico (IT), Azienda USL della Valle d’Aosta (IT), University of Aosta Valley (IT), Expert System (Italy) (IT), Osservatorio Astronomico della Regione Autonoma Valle d'Aosta (IT), Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone" di Palermo (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Fondazione IRCCS Istituto Nazionale dei Tumori (IT), Azienda Sanitaria Locale Roma 3 (IT), University of Palermo (IT), University for Foreigners Perugia (IT)
Good health and well-being
Openalex Percentile: Top 11%
Global Cancer Incidence and Screening
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.