Long-term trends in cancer incidence and mortality in Italy: cohort patterns and young-age risks

Background

Cancer incidence and mortality have changed in high-income countries in recent decades, reflecting shifts in risk factor exposure, screening practices, and advances in diagnosis and treatment. We aimed to provide an updated overview in Italy of cancer incidence and mortality trends and to assess generational patterns.

Methods

We used certified cancer mortality data from WHO and ISTAT for 1980-2023, and incidence data from ECIS for 1995-2018. We computed age-standardized mortality and incidence rates using the world standard population. Age-Period-Cohort (APC) analyses were performed using generalized additive models with smooth functions based on cubic regression splines.

Results

Between 2010 and 2023, overall mortality declined by 25.5% in males (to 103.5/100,000) and 13.9% in females (to 71.4/100,000), with major reductions for lung (except for a 15.4% increase in females aged 50+), stomach, and colorectal cancers. Mortality increased for testicular (8.3%), uterine (2.8%), and pancreatic cancer in both (2.0% males, 6.9% females). Among young adults (25-49 years), mortality from all cancers declined by 22.1% in males and 19.2% in females but increased in testicular (36.6%), and uterine cancer (16.6%). APC analyses showed declining risks in cohorts born after 1925 for most cancers, except pancreatic cancer. In females, lung cancer risk increased up to cohorts born around 1960, followed by a decline in more recent cohorts. Between 2008 and 2018, overall cancer incidence decreased by 10.9% in males (to 305.7/100,000) but increased by 2.9% in females (to 273.7/100,000), with rising trends for thyroid (∼25%), skin (∼70%), testicular (24.2%), and lung cancer in females aged 50 + (27.2%). Among young adults, incidence increased in both males (3.6%) and females (10.3%).

Conclusions

Overall cancer incidence and mortality in Italy are declining, but site-specific differences and rising rates in younger adult incidence indicate an evolving epidemiological profile.

Key messages

• Cancer mortality in Italy declined overall, while pancreatic cancer, lung cancer in older females, and cancer incidence in younger adults showed unfavourable trends.

• Long-term trends show cohort effects and a divergence between incidence and mortality.