Aiom 2025 report: cancer mortality down 9% in Italy, but prevention and inequalities remain crucial challenges

The degree of efficiency of screening and the health mobility that contributes to the heavy financial burden of cancer for patients and their families - recalled by the president of the Aiom Foundation Francesco Perrone as a phenomenon "in constant growth over the last 30 years and as transversal to all Italian macro-regions but heavier in the Centre and South" - draw the same trends: not because of a cause-effect relationship but because the quality of healthcare provision has different parameters that go hand in hand in the individual regions.

An emblematic example is travel in the case of breast cancer: "The analysis of healthcare mobility between regions to undergo surgery for the treatment of breast cancer can provide important elements for assessing the ability of regional healthcare systems to take care of patients with this neoplasm in the post-diagnosis phase," concludes Massimo Di Maio. "Between 2010 and 2023, the share of mobile operations at the national level remained substantially stable, with values of around 8%. The analysis of escape indices by territorial macro-areas shows that in the South passive mobility is three times higher than in the Centre-North. Lombardy, Friuli Venezia Giulia and Lazio present the lowest levels of flight, with values around 1.5%, 2.5% and 4% respectively. All the Southern Regions show higher escape rates than the national average, with Calabria, Basilicata and Molise presenting the highest levels, reaching almost 50% of surgeries performed outside the Region in the case of Calabria. The Southern Regions with high levels of leakage are also those with the lowest levels of total screening coverage"

The habit of tobacco smoking remains more frequent among men (28%) than women (20%) and is strongly associated with social disadvantage, involving much more people with economic difficulties (36%) than those who say they have none (21%). "Another risk factor is being overweight," explains Rossana Berardi, President-elect of Aiom. Excess weight affects 43% of adults in Italy. Since 2008, temporal analyses show an increase in weight excess at national level, supported by a contained but statistically significant increase in obesity in the North, compared with a reduction that began in more recent years in the South. The geographical gradient of excess weight remains against the South and in some regions, such as Campania, Puglia and Molise, half of the adult population is overweight. Problems with the scales are often associated with a lack of physical activity. In this case, however, there is a trend reversal. In fact, after more than ten years of constant and significant increase, the sedentary trend has changed direction after 2020, showing a progressive and continuous reduction of 5 percentage points in just 4 years, from 32% in 2020 to 27% in 2024. A reduction in obesity would improve public health, reducing new cancer diagnoses and recurrences and enhancing response to treatment. Acting on weight and lifestyle is a concrete tool for cancer prevention and treatment, in line with the One Health approach

"Ultimately," explained Maria Masocco of the Istituto Superiore di Sanità ("Passi" and "Passi d'Argento" projects), "there is no substantial improvement in lifestyles: gender differences are maintained and indeed women are reducing their historical advantage over smoking and alcohol, while young people are also more exposed to alcohol and smoking. Moreover, the key to interpretation in terms of social determinants is important: the most vulnerable people are also the most exposed to behavioural risk factors and social disadvantage is accompanied by lower participation in screening with a territorial difference that actually exacerbates the social gradient. The result is that equity of access to diagnosis and treatment is still not guaranteed throughout the country', is the summary

The element that makes the difference on the drop in mortality, however, is the figure for men. "In the coming years, the absolute number of new diagnoses in Italy could stabilise or begin to fall," is the comment of Diego Serraino, epidemiologist consultant at Alleanza Contro il Cancro. "It is a hypothesis supported not only by the constant demographic decrease in the Italian population, but also by the decrease in cases in men. A representative example of the different temporal trends, in Italy, of incidence rates in the male and female population is offered by lung cancer. In men, between 2003 and 2017, new diagnoses of this neoplasm decreased by 16.7%, while among women they increased by 84.3%."

In the lung, there is also a component related to a significant improvement in therapies in the last 5-10 years: with the same diagnosis, people are living longer thanks to molecularly targeted drugs and immunotherapy.

There remains the issue of the scarce forces in the field, which Aiom would like to emphasise by stressing the need to adequately support the National Health Service: with the same number of patients, the complexity of care is sometimes greater because patients even with advanced disease live longer and have access to more lines of therapy than before. This translates into a greater commitment on the part of the SSN both in terms of duration and resources per patient, between instrumental examinations and number of visits, as well as for operators to be involved in care pathways. Today, a patient with metastatic lung cancer receives a much longer and more complex treatment than years ago, and this is excellent news, but it also means having to guarantee in a fair and timely manner a series of services that would otherwise be difficult to offer. This is why Aiom is also focusing on prevention: a key parameter in this bet is the system's ability to reduce cases by boosting primary prevention (lifestyles) and secondary prevention, which, thanks to screening, translates (eventually) on average into a disease that can be treated sooner and definitively with a cure. "If we bet on prevention, we are obviously also investing in the sustainability of the system, but having said that, there will always be those who fall ill in the context of a population that continues to age: inevitably, cancers, which are diseases also linked to ageing, will be more and more numerous, so in order to treat those who fall ill well, we will also have to have adequate resources for the National Health Service. The data on the decline in mortality reported by the EU Commission are proof that a country with a universal health service can guarantee a good average outcome, guaranteeing access to the best care regardless of income. This is proof of the need to safeguard the public health service, and we hope that it will do even better with the extension of coverage to interventions of proven effectiveness in reducing mortality, such as the inclusion of lung screening for those at risk in the Essential Levels of Care. Ditto,' he concludes, 'for hereditary cancer surveillance of patients with a hereditary tumour, estimated at around 1.2 million in our country'.