Descriptive epidemiology of Hodgkin's disease in Italy

Death certification data on Hodgkin's disease in Italy over the period 1955-84 were studied in terms of age-standardized and age-specific national trends, and of geographical variation in mortality. There were substantial declines in death rates from the early 1970's onward, which can be largely attributed to therapeutic improvements. These led to avoidance of about 350 deaths, with a total 950 reported, which is probably the major absolute therapeutic advance identified for any cancer site. The declines started earlier in childhood and young adult age, and were restricted to population below age 60. The age distribution of the disease was different in the two sexes, since the age curve for males showed steady rises up to age 75, whereas that for females was clearly bimodal, with a peak around age 30, and another at oldest age. This divergent pattern is consistent with different exposure to (infectious) agent(s) in children of the two sexes, but also to occupational exposures potentially related to the risk of the disease. Examination of rates in various geographical areas showed generally higher rates in the North, and a few provinces with exceedingly high mortality in the central part of Northern Italy, particularly in a chiefly rural province (Mantua). This excess mortality (and, more in general, the observation that rates for Northern Italy are higher than in any other area of the EEC) could not be explained by obvious diagnostic or classification problems, were evident in both sexes, appeared to be consistent over the last decade and are reflected in available Italian cancer registration data.