Epidemiol Prev 2018; 42 (5-6): 76-85

Cancer incidence in children and young adults living in industrially contaminated sites: from the Italian experience to the development of an international surveillance system

  • Ivano Iavarone1

  • Carlotta Buzzoni2

  • Giorgia Stoppa2

  • Eva Steliarova-Foucher3

  • SENTIERI-AIRTUM Working Group4

  1. Department of Environment and Health, Italian National Health Institute, Rome (Italy)
  2. Clinical and Descriptive Epidemiology Unit, Oncological Network, Prevention, and Research Institute (ISPRO), Florence (Italy)
  3. Section of Cancer Surveillance, International Agency for Research on Cancer, World Health Organization, Lyon (France)
  4. SENTIERI-AIRTUM Working Group: Antonino Ardizzone (Registro tumori Brindisi), Alessandro Barchielli (Registro tumori Toscano), Elisabetta Borciani (Registro tumori Piacenza), Lorenza Boschetti (Registro tumori Pavia), Angelita Brustolin (Registro tumori Viterbo), Carlotta Buzzoni (Registro tumori toscano; Istituto per lo studio, la prevenzione e la rete oncologica – ISPRO, Firenze), Maria Caiazzo (Registro tumori Salerno), Giuseppina Candela (Registro tumori Trapani), Giuliano Carrozzi (Registro tumori Modena), Luca Cavalieri D’Oro (Registro tumori Monza Brianza), Rosaria Cesaraccio (Registro tumori Sassari), Paolo Contiero (Istituto nazionale dei tumori, Milano), Maria Lia Contrino (Registro tumori Siracusa), Vincenzo Coviello (Registro tumori Barletta), Fabio Falcini (Registro tumori Romagna), Anna Clara Fanetti (Registro tumori Sondrio), Stefano Ferretti (Registro tumori Ferrara), Rosa Filiberti (Registro tumori Genova), Rocco Galasso (Registro tumori Basilicata), Anna Giorno (Registro tumori Cosenza-Crotone), Iolanda Grappasonni (Registro tumori infantili Marche), Michele Magoni (Registro tumori Brescia), Lucia Mangone (Registro tumori Reggio Emilia), Guido Mazzoleni (Registro tumori Alto Adige), Anna Melcarne (Registro tumori Lecce), Maria Michiara (Registro tumori Parma), Aldo Minerba (Registro tumori Taranto), Fabio Pannozzo (Registro tumori Latina), Silvano Piffer (Registro tumori Trento), Salvatore Pisani (Registro tumori Como), Paolo Ricci (Registro tumori Mantova), Massimo Rugge (Registro tumori Veneto), Antonio Giampiero Russo (Registro tumori Milano), Carlotta Sacerdote (Registro tumori Infantili Piemonte), Giuseppe Sanpietro (Registro tumori Bergamo), Salvatore Sciacca (Registro tumori integrato Catania-Messina-Siracusa-Enna), Giorgia Stoppa (Registro tumori toscano, Istituto per lo studio, la prevenzione e la rete oncologica – ISPRO, Firenze), Fabrizio Stracci (Registro tumori Umbria), Antonella Sutera (Registro tumori Catanzaro), Giovanna Tagliabue (Registro tumori Varese), Rosario Tumino (Registro tumori Ragusa), Mario Usala (Registro tumori Nuoro), Francesco Vitale (Registro tumori Palermo), Zanetti Roberto (Registro tumori del Piemonte, Province di Biella e Vercelli)
Ivano Iavarone -


BACKGROUND: this paper is based upon work from COST Action ICSHNet. Children’s environmental health is on the 2030 Agenda for Sustainable Development. The incidence of childhood cancer is increasing worldwide and in Europe. Yet, the aetiology of most childhood cancers, including the role of environmental carcinogens, is still largely unknown. Contaminated areas, especially of industrial origin, are of high concern due to complex mix of hazardous pollutants and their potential health impacts on human populations, notably in children.
to describe cancer risk in children and young adults (YA) residing in national priority contaminated sites (NPCSs) in Italy and to provide a suitable framework for a development of cancer surveillance in industrially contaminated sites (ICSs) in Europe.
this study is based on a collaborative work of the Italian Institute of Health (ISS) and the Italian Association of Cancer Registries (AIRTUM), in the context of the SENTIERI project (Epidemiological study of residents in National Priority Contaminated Sites). Incidence rates were standardised according to the European standard population. The number of observed cases was compared to the expected cases derived from the age-, sex-, and cancer-specific incidence rates of the national pool of AIRTUM registries for the period 2006-2013. Standardized incidence ratios (SIRs) and 90% confidence intervals (CIs) were computed. The study reports the cancer profile in all combined 28 NPCSs covered by 22 cancer registries.
1,050 cases of malignant tumours (MTs) were recorded among 3,161,786 person-years in people aged 0-29 years in 28 NPCSs (SIR: 1.03; 90%CI 0.98-1.09), with an age-standardised incidence rate of 317 per million. Excess risks were observed for: MT of the central nervous system in the age-group <1 year (SIR: 3.2; 90%CI 1.4-6.3); soft tissue sarcoma in the age-group 0-14 years (SIR: 1.6; 90%CI 1.1-2.3); acute myeloid leukaemia in the agegroup 0-14 years (SIR: 1.7; 90%CI 1.1-2.4); non-Hodgkin lymphoma in the age-group 20-24 years (SIR 1.5; 90%CI 1.1-2.1), and germ cell tumours of male gonads in the age-group 20-29 years (SIR: 1.33; 90%CI 1.1-1.5). A deficit of cases was observed for Hodgkin lymphomas in the age-group 20-29 years (SIR 0.8; 90%CI 0.6-1.0).
this study, which is based on standardized methods and accredited information sources, supports the hypothesis that living in an NPCS increases the risk of some cancer types in children and young adults. Further work will concern groups of NPCSs characterised by common sources of contamination/key carcinogenic pollutants. In fact, in a novel project proposal we aim to monitor the cancer profile in children living in ICSs in Europe. The new project, based on the SENTIERI-AIRTUM methodology, will build on the networking activities of the COST Action on Industrially Contaminated Sites and Health Networking (ICSHNet) and childhood cancer studies coordinated by the International Agency for research on Cancer (IARC).

Keywords: child, young adult, cancer incidence, aetiology, contaminated sites, industry, surveillance


What is already known

  • The overall cancer incidence for all tumours in children aged 0-14 years is increasing worldwide; this increase concerns also high-income Countries. Despite the documented high susceptibility of children to environmental pollutants, the overall evidence linking environmental carcinogens to the incidence of childhood cancer is mostly inadequate.
  • Previous findings of the collaborative work of the Italian Institute of Health (ISS) and the Italian Association of Cancer Registries (AIRTUM), in the context of the SENTIERI project, showed an excess risk in the overall cancer incidence (9% in men and 7% in women), and in particular for several cancer sites in the residents exposed to the national priority contaminated sites (NPCSs).


What this paper adds

  • This paper identifies, for the first time, possible increase in risk of cancer in children and young adults living in NPCSs and paves the way for further assessments and researches to verify specific aetiological hypothesis.
  • A new international framework for the surveillance of cancer incidence in children and young adults living in industrially contaminated areas across Europe based on standardized methodologies and accredited information sources is outlined.