Cancer burden estimates and forecasts: uses and cautions

Incidence, prevalence and mortality indicators, as provided in this monographic issue for each of the Italian regions and for the major cancers (stomach, colorectal, lung, breast, uterine cervix, prostate cancer and skin melanoma), provide necessary information for cancer control activities. In Italy, these activities are mainly organized on a regional level. Incidence depends on the distribution of risk factors in the population and is monitored to assess the efficacy of primary prevention programs as well as to measure the effect of screening activities. Mortality is a summary indicator incorporating the effects of both occurrence and survival. Finally, the prevalence of people with a diagnosis of cancer within a population is a direct measure of the demand for health care and social services. When taken separately, each of these indicators provides a partial view of the cancer phenomenon and should therefore be interpreted with caution. In this paper we give some examples of the uses of these indicators, and also of the interpretation difficulties by relating the regional cancer incidence to tobacco use, overweight and residence in polluted sites. We comment on the observed mortality trends in terms of their contribution to incidence and survival. We associate the estimated trends in cancer prevalence from 1990 to 2015 with the gross domestic product, an indicator of the resources available in Italy. The simultaneous consideration of all three indicators, as was done throughout this monograph by means of a unique methodology, is suggested for public health use.