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 in 1992–1997. Volunteers were recruited through general practitioners’ records, factories, and schools or through letters sent to their homes. Each participant provided a blood sample.
Florence: Recruitment of the EPIC-Florence cohort took place in 1993–1998. 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/studio_epic.
Naples: The research group started its activities on population etiology of chronic disease in the final part of the 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 was designed to study especially cardiovascular disease and cancer (Panico et al., 1992).
Turin: Recruitment took place in 1993–1998 and involved blood donors and other healthy volunteers. The main fields of research are social epidemiology, including the study of the biological and lifestyle pathways involved in the association between social and health frailty and gender differences in risk factors, incidence and prognosis of chronic diseases.
Ragusa: The recruitment for the EPIC study in Ragusa province (in south-eastern Sicily) began in 1992–1993 and was completed 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.
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 2012, 861 deaths and 1695 new cancer cases had been reported.
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 2016.
Turin: Follow-up procedures include: direct contact with participants by mailing of questionnaires; collaborations with the local Piedmont Cancer Registry; linkage with the demographic computerized archives of the region; and linkage with the discharge report database for hospitalized patients. An active recall of the cohort participants with new questionnaires and a new biological sample collection has been scheduled for 2024-2025.
Ragusa: Follow-up consisted of telephone contacts with the participants and an administered non-dietary questionnaire; follow-up for cancer end-points is made by record linkage with the 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 2012, 663 new cases of cancer had been diagnosed, and 363 participants had died. Non-dietary telephone follow-up was done from 2007–2013.
Epidemiology and Prevention Unit
Fondazione IRCCS Istituto Nazionale dei Tumori
Milan, Italy
Molecular and Nutritional Epidemiology Unit, ISPO
Cancer Prevention and Research Institute
Florence, Italy
Dipartimento di Medicina Clinica e Chirurgia
Federico II University
A.I.R.E. – ONLUS Ragusa, Italy
Associazione Iblea per la Ricerca Epidemiologica, Ragusa
Organizzazione non lucrativa di utilità sociale
(Hyblean Association for Epidemiology Research, Ragusa
No profit organization)
Other collaborators are involved on a temporary basis with the aim of updating the follow-up for main end-points such as vital status, mortality, and cancer incidence.
Financial support is provided by:
MILAN
FLORENCE
NAPLES
TURIN
RAGUSA