The EPIC cohort in Italy was originally based in 4 areas based on cancer registries: the provinces of Florence, Ragusa and Varese and the city of Turin. An additional centre, the city of Naples, later became associated with EPIC through the Progetto ATENA study (see Naples below). Recruitment in Italy was started in 1993 and completed by 1998. Blood was collected from nearly 100% of the participants.
Florence: Recruitment took place between 1993 and 1998 with 13,597 participants (3,514 males and 10,083 females) is the largest Italian EPIC cohort. Each participant provided a fasting blood sample, and a repeat sample is available from 100 participants. Florence is the only Italian EPIC centre located in Central Italy, an area characterized by a high consumption of fresh and cured meats, wine and olive oil.
Milan: Recruitment was carried out at two hospital centres in Varese province between 1992 and 1997. Volunteers were recruited through general practitioners’ records, factories, schools or through letters sent at home. A blood sample was provided by each participant.
Ragusa: After a pilot study in 1989-92 EPIC started in Ragusa in 1993 and has been carried out by the local population-based cancer registry. The study population was mostly based on local blood donors and their spouses; recruitment finished in July 1997.
Turin: Recruitment took place in 1993-1998 and involved blood donors and other healthy volunteers. Co-operation with the local cancer registry and the local health authority allows for access to hospital discharge information and all newly diagnosed cancer cases.
Naples: Data from the Progetto ATENA, a study on the etiology of major chronic diseases in women, has been transformed for incorporation into the EPIC database. Progetto ATENA has been designed also to study cardiovascular disease (S. Panico et al. Eur J Epidemiol 1992 Jul;8(4):601-8).

Identification of cancer cases is possible by access to local cancer registries. All deaths and causes of death are confirmed by death certificate. The description of follow-up procedures is the same, in practice, for Florence, Varese, Torino and Ragusa cohorts; the follow up procedures and the sources of information on vital and health status are actually very similar between all centers except Naples where a more active search of information on current health status is necessary.
Florence: Follow-up procedures include collaboration with the local Cancer Registry and the Regional Mortality Registry (both run by ISPO), linkages with the demographic computerized archives of the area, and the discharge report database for hospitalised patients; 438 deaths have been reported at December 2007 and almost 1430 newly diagnosed cases of cancer at December 2006.
Milan: Follow-up started in 1998, including collaboration with the local cancer registry, the regional population database of the National Health Service, the mortality database of Varese province and the discharge report database for hospital patients. 415 deaths and 1150 new cancer cases had been reported by the end of 2009 (end of follow-up: December 31st, 2006).
Ragusa: Follow-up procedures started early in 1998 and report current vital status of participants, cancer diagnoses, deaths and cause of death according to the EPIC protocol. Other end-points have been added: CVD, diabetis and selected neurological diseases. Follow-up is updated each 3 years: last updates are 2009 for life status and 2006 for cancer incidence.
Turin: Follow-up started in 1998, including collaboration with the local cancer registry, the demographic computerized archives of the Torino area and the discharge report database for hospital patients. 342 deaths and 773 newly diagnosed cases of cancer (all cancer sites except skin) had been reported by December 2006.
Naples: Progetto ATENA has an active follow-up on major chronic diseases based on participants, family doctors, participants' best-friends, and linkage with hospital and death certificate archives. The follow-up has been updated until December 2006.