Papers by Francesco Giusti
Frontiers in Oncology, Jul 17, 2023
Ontologies can provide a valuable role in the work of cancer registration, particularly as a tool... more Ontologies can provide a valuable role in the work of cancer registration, particularly as a tool for managing and navigating the various classification systems and coding rules. Further advantages accrue from the ability to formalise the coding rule base using description logics and thereby benefit from the associated automatic reasoning functionality. Drawing from earlier work that showed the viability of applying ontologies in the data validation tasks of cancer registries, an ontology was created using a modular approach to handle the specific checks for childhood cancers. The ontology was able to handle successfully the various inter-variable checks using the axiomatic constructs of the web ontology language. Application of an ontological approach for data validation can greatly simplify the maintenance of the coding rules and facilitate the federation of any centralised validation process to the local level. It also provides an improved means of visualising the rule interdependencies from different perspectives. Performance of the automatic reasoning process can be a limiting issue for very large datasets and will be a focus for future work. Results are provided showing how the ontology is able to validate cancer case records typical for childhood tumours.
Biomedical Engineering
To conform to FAIR principles, data should be findable, accessible, interoperable, and reusable. ... more To conform to FAIR principles, data should be findable, accessible, interoperable, and reusable. Whereas tools exist for making data findable and accessible, interoperability is not straightforward and can limit data reusability. Most interoperability-based solutions address semantic description and metadata linkage, but these alone are not sufficient for the requirements of inter-comparison of population-based cancer data, where strict adherence to data-rules is of paramount importance. Ontologies, and more importantly their formalism in description logics, can play a key role in the automation of data-harmonization processes predominantly via the formalization of the data validation rules within the data-domain model. This in turn leads to a potential quality metric allowing users or agents to determine the limitations in the interpretation and comparability of the data. An approach is described for cancer-registry data with practical examples of how the validation rules can be mo...
Frontiers in Oncology
Population-based Cancer Registries (PBCRs) are tasked with collecting high-quality data, importan... more Population-based Cancer Registries (PBCRs) are tasked with collecting high-quality data, important for monitoring cancer burden and its trends, planning and evaluating cancer control activities, clinical and epidemiological research and development of health policies. The main indicators to measure data quality are validity, completeness, comparability and timeliness. The aim of this article is to evaluate the quality of PBCRs data collected in the first ENCR-JRC data call, dated 2015.MethodsAll malignant tumours, except skin non-melanoma, and in situ and uncertain behaviour of bladder were obtained from 130 European general PBCRs for patients older than 19 years. Proportion of cases with death certificate only (DCO%), proportion of cases with unknown primary site (PSU%), proportion of microscopically verified cases (MV%), mortality to incidence (M:I) ratio, proportion of cases with unspecified morphology (UM%) and the median of the difference between the registration date and the i...
Frontiers in oncology, Feb 20, 2024
Background: Gastric and oesophageal cancers pose a serious public health concern. In 2020 a total... more Background: Gastric and oesophageal cancers pose a serious public health concern. In 2020 a total of 189,031 incident cases (136,038 stomach, 52,993 oesophagus) and 142,508 deaths (96,997 stomach, 45,511 oesophagus) were estimated in Europe. Oesophago-gastric cancers are a heterogeneous disease, with different aetiology and epidemiology for the various topographic subsites and main histopathological types. Topography subsite and morphology is key information to allow differentiating oesophago-gastric cancers. Correct registration and coding of such variables are fundamental in allowing proper description of the epidemiology of different subsites and histopathological types of oesophago-gastric cancers. The aim of this article is to highlight geographical and temporal variability in topography and morphology of oesophago-gastric cancers observed in Europe in the considered period. Methods: Data collected in the framework of the ENCR-JRC (European Commission's Joint Research Centre) data call and feeding the European Cancer Information System (ECIS) were used to assess the variability of topography and morphology registration of gastric and oesophageal cancer in Europe in the period 1995-2014. Malignant cancers of the stomach and the oesophagus were selected following, respectively, topography codes C16 and C15 of the International Classification of Diseases for Oncology, third edition (ICD-O-3). Analyses were performed by subsite, morphology group, year, sex, and European region.
Frontiers in Oncology
Population-based cancer registries are responsible for collecting incidence and survival data on ... more Population-based cancer registries are responsible for collecting incidence and survival data on all reportable neoplasms within a defined geographical area. During the last decades, the role of cancer registries has evolved beyond monitoring epidemiological indicators, as they are expanding their activities to studies on cancer aetiology, prevention, and quality of care. This expansion relies also on the collection of additional clinical data, such as stage at diagnosis and cancer treatment. While the collection of data on stage, according to international reference classification, is consolidated almost everywhere, data collection on treatment is still very heterogeneous in Europe. This article combines data from a literature review and conference proceedings together with data from 125 European cancer registries contributing to the 2015 ENCR-JRC data call to provide an overview of the status of using and reporting treatment data in population-based cancer registries. The literatu...
Lungo-sopravviventi e guariti per patologia oncologica: implicazioni in temini di sanità pubblica, sociali ed economici
European Journal of Public Health, 2020
Background Up-to-date cancer burden indicators are essential to support political decision making... more Background Up-to-date cancer burden indicators are essential to support political decision making, to enable epidemiological research and as an information source for citizens. Nevertheless, observed cancer incidence and mortality suffer from an endemic registration delay in the data production workflow. To overcome this, the European Commission's Joint Research Centre in collaboration with the WHO's International Agency for Research on Cancer have computed estimates of cancer incidence and mortality, for the year 2020 and for European countries, in the framework of the European Cancer Information System (ECIS). Methods Predicted values for the year 2020 are based on the incidence data of more than 150 European population-based cancer registries included in the ECIS, and on the WHO mortality database. According to previously developed and applied methodology, the estimates of 2020 cancer incidence and mortality rates were produced for 40 European countries, on the basis of t...
European Journal of Public Health, 2020
Cancer has important impacts on the EU's health systems and economies, with around 3 million ... more Cancer has important impacts on the EU's health systems and economies, with around 3 million new patients diagnosed each year. However, up to 40% of cancers are attributed to preventable causes. For these reasons, cancer is one of the main priorities of the EC in the health domain. The new Europe's Beating Cancer Plan of the EC, to be launched at the end of 2020, aims to support EU Member States to improve cancer control and care, by proposing actions at every key stage of the disease: prevention (lifestyle, pollution, vaccination), diagnosis, treatment and survivorship. Reliable cancer statistics are essential to propel both epidemiological research and political decision making, and provide the supporting evidence to allow assessment of best practices in all those key stages. To this purpose, the European Cancer Information System (ECIS), built on European population-based cancer registries' data, provides the latest information on indicators that quantify the burden o...
European Journal of Public Health, 2018
There is considerable variation among countries in how public health organizations address the gr... more There is considerable variation among countries in how public health organizations address the growing threat of AMR. Only few countries have developed national AMR action plans. Relevant policies, such as banning over-the-counter sales of antimicrobials and the use of antimicrobials as growthpromoters in animals, are poorly enforced. Weak linkages exist between public health organizations from the top to lower levels (regional or local) and between public health organizations across sectors. Few countries have taken targeted actions in the veterinary sector. The input of public health organizations in devising policies (where they exist) is frequently small, with relevant agencies rarely taking a leading role in putting the issue on the agenda and formulating appropriate policies; their role is often limited to data provision or monitoring. Conclusions: Public health organizations are so far insufficiently involved in addressing AMR in Europe. There is an overall lack of national coordination which could connect fragmented national initiatives and programmes. Clearer linkages between public health institutions at different levels, as well as clarity on roles and responsibilities, could strengthen the involvement of public health organizations in addressing AMR.
European Journal of Public Health, 2018
European Journal of Public Health, 2016
International Journal of Epidemiology, 2020
Background Few studies have estimated the probability of being cured for cancer patients. This st... more Background Few studies have estimated the probability of being cured for cancer patients. This study aims to estimate population-based indicators of cancer cure in Europe by type, sex, age and period. Methods 7.2 million cancer patients (42 population-based cancer registries in 17 European countries) diagnosed at ages 15–74 years in 1990–2007 with follow-up to 2008 were selected from the EUROCARE-5 dataset. Mixture-cure models were used to estimate: (i) life expectancy of fatal cases (LEF); (ii) cure fraction (CF) as proportion of patients with same death rates as the general population; (iii) time to cure (TTC) as time to reach 5-year conditional relative survival (CRS) >95%. Results LEF ranged from 10 years for chronic lymphocytic leukaemia patients to <6 months for those with liver, pancreas, brain, gallbladder and lung cancers. It was 7.7 years for patients with prostate cancer at age 65–74 years and >5 years for women with breast cancer. The CF was 94% for testis, 87% ...
Journal of the European Radon Association, 2022
Exposure to radon over time has significant detrimental effects on human health. Approximately 22... more Exposure to radon over time has significant detrimental effects on human health. Approximately 226,000 annual radon-related deaths have been reported from 66 countries (1). Many countries have a radon action plan, in order to reduce the harmful effects of radon exposure on the general public. Maps are routinely used to assist with mitigation strategies and delineate areas of priority regulation. Standard regulations in the European Union include the requirement for workplaces to test and the requirement to have reduction methods in newly built homes. Such laws are assigned systematically to areas that are understood to have high values of indoor radon. This article demonstrates that the boundaries of radon priority areas may vary, depending on the data set and methods used. We propose a table and a decision matrix to assist in choosing the most appropriate visual aid according to the purpose for which the map is to be used. We conclude that no single radon map is suitable to fit all...
Journal of Biomedical Semantics, 2022
Background Population-based cancer registries are a critical reference source for the surveillanc... more Background Population-based cancer registries are a critical reference source for the surveillance and control of cancer. Cancer registries work extensively with the internationally recognised TNM classification system used to stage solid tumours, but the system is complex and compounded by the different TNM editions in concurrent use. TNM ontologies exist but the design requirements are different for the needs of the clinical and cancer-registry domains. Two TNM ontologies developed specifically for cancer registries were designed for different purposes and have limitations for serving wider application. A unified ontology is proposed to serve the various cancer registry TNM-related tasks and reduce the multiplication effects of different ontologies serving specific tasks. The ontology is comprehensive of the rules for TNM edition 7 as required by cancer registries and designed on a modular basis to allow extension to other TNM editions. Results A unified ontology was developed bui...
The European Journal of Health Economics, 2021
Objectives To identify and provide lists of procedures and drugs related to diagnosis and treatme... more Objectives To identify and provide lists of procedures and drugs related to diagnosis and treatment of breast cancer. These lists can be used for the estimation of the cost of illness. Methods The method consists of identifying lists of procedures/interventions/drugs related to the tumour of interest, drawn by a panel of expert clinicians and oncologists on the basis of clinical guidelines and current practice. The lists are applied to data referring to breast cancer female patients, collected by population-based Cancer Registries and linked at individual level with information on health care treatments. A comparison with lists obtained via the matched control method is implemented. Results The distribution of administered procedures and drug prescriptions is coherent with the patient clinical pathway: surgery is the main cause of hospitalization in the first year since diagnosis, diagnostic and monitoring interventions are more frequent in the following years (recurrences detection...
European Journal of Public Health, 2018
Nicotine & Tobacco Research, 2019
Background Changes in smoking habits and predictors of smoking cessation were examined in the ran... more Background Changes in smoking habits and predictors of smoking cessation were examined in the randomized ITALUNG lung cancer screening trial. Methods In three centers, eligible smokers or ex-smokers (55–69 years, ≥20 pack-years in the last 10 years) were randomized to receive annual invitation for low-dose computed tomography for 4 years or usual care. At invitation, subjects received written information for a free smoking cessation program. Quitting outcome was assessed at year 4. Results Among participants who completed baseline assessments and year 4 screening, higher quitting (20.8% vs. 16.7%, p = .029) and lower relapse (6.41% vs. 7.56%, p = .50) rates were observed in the active screening group as compared to the usual-care control group. Corresponding figures in the intention-to-treat analysis were as follows: 16.04% versus 14.64% (p = .059) and 4.88% versus 6.43% (p = .26). Quitting smoking was significantly associated to male gender, lower pack-years, and having pulmonary n...
The International Journal of Biological Markers, 2019
Background: Breast cancer is the most common cancer and the leading cause of cancer-related death... more Background: Breast cancer is the most common cancer and the leading cause of cancer-related death in females, with a large societal and economic impact. Decisions regarding its treatment are largely affected by the categorization into different subtypes with hormone receptor status and HER2 status being the most important predictive factors. Other biological markers play an important role for prognostic and predictive reasons. The data collection and harmonization of cancer cases are performed by cancer registries whose collection of parameters largely differs, partially including results from biomarker testing. Methods: This systematic literature review consisting of a total of 729 reports determined whether information about biomarker testing in breast cancer cases is collected and published by cancer registries worldwide. Results: The number of publications using breast cancer biomarker data from registries steeply rose with the beginning of the 21st century and some hospital-bas...
European Journal of Public Health, 2018
understandings for conceptualisations of subjective and objective wellbeing. Methods: Qualitative... more understandings for conceptualisations of subjective and objective wellbeing. Methods: Qualitative phenomenological approach with a purposive sample of six participants drawn from professional services and academic staff at a Higher Education Institution (HEI) in England. Open-ended in-depth phenomenological interviews were undertaken. These were transcribed and analysed using phenomenological descriptive method. Results: Several distinct emphases emerged from participant descriptions about their individual understanding of wellbeing that highlight the multidimensional nature of wellbeing and points to some distinct emphases. These included human connection, the impacts of being with others on wellbeing, relationship with pets, access to natural environments and having a purpose and meaning in life. In the context of wellbeing and working in an HEI, the physical environment, teamwork, workload and stress were all described as contributors to wellbeing. Conclusions: Wellbeing is understood as a multidimensional experience with personal dimensions that seem to be very important. These new insights about the complexity of the human experience of wellbeing go beyond perceptions that wellbeing is merely the absence of illness. Better understanding of wellbeing as an everyday experience that can inform public health policy and interventions has potential to improve health and its perception in populations. Key messages: The complexity of wellbeing requires appropriate methods for its measurement at different ages, ethnic groups, genders and contexts to further new understandings which can inform public health. New perspectives of wellbeing highlight the problem of defining wellbeing as only the absence of illness and point to the need to understand what wellbeing is in the context of long term conditions.
Hematological Oncology, 2017
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Papers by Francesco Giusti