EPIC Centres

ITALY

  Background | Follow-up | Scientists | Funding  | Activities 

Background

The EPIC cohort in Italy was originally based in four 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.

Milan: Recruitment was carried out at two hospital centres in the province of Varese between 1992 and 1997. Volunteers were recruited through general practitioners’ records, factories, and schools or through letters sent to their homes. A blood sample was provided by each participant.

Florence: Recruitment of the EPIC-Florence cohort took place between 1993 and 1998. With 13 597 participants (3514 males and 10 083 females), it 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. More information on the EPIC-Florence cohort is available on the dedicated website www.ispo.toscana.it/epic/.

Naples: The research group started its activities on population etiology of chronic disease in the early 1980s, with a special focus on cardiovascular and metabolic diseases. At the beginning of the 1990s, the Progetto ATENA study started. It is a study on the etiology of major chronic diseases in women, and the study data have recently been transformed for incorporation into the EPIC database. Progetto ATENA has been designed to study especially cardiovascular disease and cancer (Panico S et al. Eur J Epidemiol 1992 Jul;8(4):601-8).

Turin: Recruitment took place in 1993—1998 and involved blood donors and other healthy volunteers. The main field of research is molecular and genetic epidemiology. A laboratory is devoted to DNA repair, genome-wide association studies (GWAS), epigenetics, and other activities of molecular epidemiology. Researchers are involved in studies on genome-wide methylation, miRNA expression, and gene mutations (in relation to environmental exposures and disease progression).

Ragusa: The EPIC study is conducted in Ragusa province (in south-eastern Sicily) by personnel of the local population-based cancer registry. Recruitment began between 1992 and 1993, and it was finished in 1997. The EPIC-Ragusa cohort consists of 6404 participants (mainly blood donors and their spouses) with interviews on diet, and 6396 participants with blood samples available.

  Males Females Number of participants Percentage of EPIC cohort
Milan 2554 9525 12 079 2.32%
Florence 3514 10 083 13 597 2.61%
Naples 0 5062 5062 0.97%
Turin 6047 4557 10 604 2.03%
Ragusa 3052 3352 6404 1.23%
Italy 15 167 32 579 47 746 9.16%

Follow-up

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. By the end of 2013, 618 deaths and 1603 new cancer cases had been reported (end of follow-up: 31 December 2009).

Florence: Follow-up procedures include: direct contact with participants by mailing of questionnaires; collaborations with the local Tuscany Cancer Registry and the Regional Mortality Registry (both run by ISPO); linkage with the demographic computerized archives of the area; and linkage with the discharge report database for hospitalized patients. By December 2010, 685 deaths and 2117 newly diagnosed cases of cancer had been identified.

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 2010.

Turin: Cooperation with the local cancer registry and the local health authority allows for access to hospital discharge information and all newly diagnosed cancer cases. In addition, EPIC has taken part in several GWAS (in particular, on lung cancer and hypertension) and is now considering post-GWAS steps on the basis of the findings of the previous wave.
In 2009, a follow-up questionnaire was sent by mail to the entire cohort (excluding deaths), asking for information on current anthropometrical measurements and on chronic diseases, and requesting participants to sign a new informed consent agreement. About 60% of cohort participants responded to the follow-up questionnaire.

Ragusa: Follow-up consists of telephone contacts with the participants and an administered non-dietary questionnaire; follow-up for cancer end-points is made by record linkage with local cancer registry. The main source of vital status information is the local municipal registries; the source of mortality data is the mortality registry of the local health authority. By December 2008, 464 new cases of cancer had been diagnosed, and by December 2011, 318 participants had died.


Scientists

MILAN
Principal Investigator
Dr Vittorio Krogh
Epidemiology and Prevention Unit
Fondazione IRCCS Istituto Nazionale dei Tumori
Milan, Italy
Co-Investigator
Dr Sabina Sieri
Epidemiology and Prevention Unit
Fondazione IRCCS Istituto Nazionale dei Tumori
Milan, Italy
Dr Valeria Pala
Epidemiology and Prevention Unit
Fondazione IRCCS Istituto Nazionale dei Tumori
Milan, Italy
Dr Claudia Agnoli
Epidemiology and Prevention Unit
Fondazione IRCCS Istituto Nazionale dei Tumori
Milan, Italy
Database Manager
Dr Sara Grioni
Epidemiology and Prevention Unit
Fondazione IRCCS Istituto Nazionale dei Tumori
Milan, Italy
FLORENCE
Principal Investigator
Dr Domenico Palli, MD, MPH
Molecular and Nutritional Epidemiology Unit, ISPO
Cancer Prevention and Research Institute
Florence, Italy
Co-Investigator or Study Coordinator
Giovanna Masala, MD, MPH
Molecular and Nutritional Epidemiology Unit, ISPO
Cancer Prevention and Research Institute
Florence, Italy
Calogero Saieva, MD, MPH
Molecular and Nutritional Epidemiology Unit, ISPO
Cancer Prevention and Research Institute
Florence, Italy
Database Manager
Melania Assedi
Molecular and Nutritional Epidemiology Unit, ISPO
Cancer Prevention and Research Institute
Florence, Italy
Other key people
Saverio Caini, MD, MPH
Molecular and Nutritional Epidemiology Unit, ISPO
Cancer Prevention and Research Institute
Florence, Italy
Benedetta Bendinelli, PharmD
Molecular and Nutritional Epidemiology Unit, ISPO
Cancer Prevention and Research Institute
Florence, Italy
NAPLES
Principal Investigator
Salvatore Panico
Professor of Internal Medicine
Dipartimento di Medicina Clinica e Chirurgia
Federico II University
Co-Investigator or Study Coordinator
Amalia Mattiello
Epidemiologist
Dipartimento di Medicina Clinica e Chirurgia
Federico II University
AOU Federico II
Other key people
Maria Santucci de Magistris
Nutritionist
Dipartimento di Medicina Clinica e Chirurgia
Federico II University
AOU Federico II
Paolo Chiodini
Statistician
Department of Mental Health and Preventive Medicine,
Second University of Naples, Italy
Marco Gentile
Biologist
Biobank Technician
Dipartimento di Medicina Clinica e Chirurgia
Federico II University
AOU Federico II

TURIN
Principal Investigator
Dr Carlotta Sacerdote
CPO-Piemonte and
HuGeF Foundation, Torino
Turin, Italy
Co-Investigator or Study Coordinator
Professor Paolo Vineis
Imperial College London and
HuGeF Foundation, Torino
Turin, Italy
Database Manager
Dr Carlotta Sacerdote
CPO-Piemonte and
HuGeF Foundation, Torino
Turin, Italy
Other key people
Professor Giuseppe Matullo
University of Torino and HuGeF Foundation, Torino
Turin, Italy
Dr Alessio Naccarati
HuGeF Foundation, Torino
Turin, Italy
Dr Silvia Polidoro
HuGeF Foundation, Torino
Turin, Italy
RAGUSA
Principal Investigator
Dr Rosario Tumino, MD MSc DLSHTM
Unit of Histopathology and Cancer Registry
Azienda Sanitaria Provinciale (ASP)
Ragusa, Italy

Study Coordinator
Graziella Frasca
Biologist
Cancer Registry
Azienda Sanitaria Provinciale (ASP)
Ragusa, Italy
Maria Concetta Giurdanella
Biologist
Cancer Registry
Azienda Sanitaria Provinciale (ASP)
Ragusa, Italy
Other key people
Caterina Martorana
Interviewer
Cancer Registry
Azienda Sanitaria Provinciale (ASP)
Ragusa, Italy
Maria Grazia Ruggeri
Interviewer
Cancer Registry
Azienda Sanitaria Provinciale (ASP)
Ragusa, Italy
Stefania Vacirca
Interviewer
Cancer Registry
Azienda Sanitaria Provinciale (ASP)
Ragusa, Italy

Funding

MILAN
Financial support is provided by:
  • Italian Association for Research on Cancer
  • National Research Council
  • World Cancer Research Fund
  • Compagnia di San Paolo
  • Italian Ministry of Health

FLORENCE
Financial support is provided by:
  • Italian Association for Research on Cancer

NAPLES
Financial support is provided by:
  • Italian Association for Research on Cancer
  • Compagnia di San Paolo
  • Banco di Napoli
  • Ministry of University
  • Ministry of Health

TURIN
Financial support is provided by:
  • Italian Association for Research on Cancer

RAGUSA
Financial support is provided by:
  • Sicilian Government
  • AIRE – ONLUS Ragusa

Research Activities

MILAN
  • Coordinate the management of dietary and lifestyle data sets.
  • Collaborate with and interface between the Italian centres and the coordinating centre at IARC.
  • Research activities focus on the role of dietary, hormonal, and metabolic factors in the etiology of breast cancer. In particular, the group implements nested case—control studies on the role of endogenous hormone levels, metabolic syndrome, and insulin resistance in breast cancer. For the EPIC project, the group designed and conducted the following studies: a prospective study on fat intake and breast cancer risk in the whole EPIC cohort; and a prospective study on meat, eggs, and dairy intake and breast cancer risk in the whole EPIC cohort.
  • A prospective study on yogurt consumption and colorectal cancer in the Italian EPIC cohort.
  • Research in cardiovascular epidemiology. The Milan group designed and conducted studies on the relation between dietary total antioxidant capacity, glycemic index and glycemic load, dietary patterns, coffee consumption, and risk of cardiovascular and cerebrovascular diseases in the Italian EPIC cohort.
  • A case—cohort study nested in the EPIC centres of Turin, Milan, Naples, and Ragusa on the role of metabolic syndrome, inflammation, and coagulation on four different outcomes: breast cancer, colorectal cancer, myocardial infarction, and stroke. In particular, the following associations have been investigated: PAI-1 and risk of breast cancer, colorectal cancer, myocardial infarction, and stroke; plasma lipids and colorectal cancer risk; and metabolic syndrome and breast cancer risk.
  • Collaboration with other European countries in a study on dietary habits and health status among children.
  • Co-authorship of studies on the association between food consumption, nutrient intake, anthropometric factors, physical activity, metabolic factors, polymorphisms, and cancer risk.

FLORENCE
  • A study on alcohol consumption, at baseline and over a lifetime, and epithelial cancer risk in the Italian EPIC cohort (including the EPIC-Florence cohort).
  • A study on dietary and lifestyle determinants of malondialdehyde—DNA adducts in the EPIC-Florence cohort.
  • A study on dietary and lifestyle determinants of plasma levels of carotenoids in the EPIC-Florence cohort.
  • A case—case study on the biological basis for the association between mammographic breast density and breast cancer risk, including a series of 200 breast cancer cases identified in the framework of the EPIC-Florence cohort (100 with high and 100 with low mammographic breast density) comparing the DNA methylation profile and the individual levels of 27 inflammatory biomarkers in pre-diagnostic blood samples.
  • A study on glycemic index, glycemic load, and mammographic breast density in women from the EPIC-Florence cohort.

NAPLES
  • Cardiovascular disease epidemiology in Italy and Europe, with special reference to women
  • Contribution to the structure of the risk charts for cardiovascular disease in Italy
  • Coordination of the Italian cardiovascular section of EPIC (EPICOR Study)
  • Collaboration with the other Italian EPIC centres.

TURIN
  • Genome-wide methylation of breast and colon cancer
  • Metabolomics in colon cancer
  • Innovative tools for early diagnosis and risk assessment of pancreatic cancer
  • Epigenomics in Parkinson’s disease
  • Risk factors for multiple primary tumours
  • EXPOsOMICS
  • Collaborations with the University of California at Berkeley, IRAS (Utrecht), and Imperial College London.

RAGUSA
  • Studies on local traditional wild edible vegetables.