Neoplasie e Fattori Di Rischio
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Transcript of Neoplasie e Fattori Di Rischio
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MGC\DBPIG G EBZZCVI JI VIP@OIC 8
WM’IMJBKIMG PZBZIPZI@B
@crsc8 \rcfbfiditiì g stbtisti`b
B.B. 6
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PCNNBVIC
IMZVCJWXICMG…………………………………………………...0JBZBPGZ ………………………………………………………………………...0
ZWNCVG BD @CDCM VGZZC GJ CFGPIZB’……………………..:
WM \C’ JI KVBEI@I…………………………………………………………….:
@CMEVCMZC @BWPB-GEEGZZC @CM KVBEI@C B DIMGG………………..7
ZBFGDDB JGI JBZI………………………………………………………………5
VGKVGPPICMG DIMGBVG G BMBDIPI JGI VGPIJWI…………………………….;
ZGPZ JI ACDNCKCVCU-PNIVMCEE…………………………………………9
ZWNCVG BDDB \VCPZBZB GJ GZMIB JI \VCUGMIGMXB……22
WM \C’ JI KVBEI@I…………………………………………………………..22
@CMEVCMZC @BWPB-GEEGZZC @CM KVBEI@C B DIMGG………………22
ZBFGDDB JGI JBZI……………………………………………………………..20
VGKVGPPICMG DIMGBVG………………………………………………………2:
ZGPZ @OI RWBJVBZC JI IMJI\GMJGMXB………………………………….2:
ZWNCVG BI \CDNCMI G EWNC……………………………….25
WM \C’ JI KVBEI@I…………………………………………………………..25
@CMEVCMZC @BWPB-GEEGZZC @CM KVBEI@C B DIMGG………………2?
@VGBXICMG JI WM NCJGDDC FIUBVIBZC………………………………..2?
ZBFGDDB JGI JBZI……………………………………………………………..29
VGKVGPPICMG DIMGBVG FIUBVIBZB………………………………………...6<
VGKVGPPICMG DIMGBVG WMIUBVIBZB G BMBDIPI JGI VGPIJWI…………..66
ZGPZ JI POB\IVC [IDA………………………………………………………..67
IMZGVUBDDC JI \VGJIXICMG \GV DB VIP\CPZB EWZWVB………………...6;
@CM@DWPICMG………………………………………………….6?
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IMZVCJWXICMG
Mgdd’bnfitc jgd prckgttc dgkbtc bd `crsc ji \rcfbfiditì g Ptbtisti`b jgdd’B.B. 6
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ZWNCVG BD @CDCM VGZZC GJ CFGPIZB’
Dc s`cpc ji qugstb sgzicmg ï imjbkbrg su qubmtc im`ijb d’cfgsitì sud ris`oic ji `cmtrbrrg um
tuncrg bd `cdcm rgttc. Pi `cmsijgrb cfgsc um ucnc qubmjc id suc FNI (Fcjy Nbss Imjgx,
rbppcrtc pgsc/bdtgzzb) ï nbkkicrg ji 00
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Zbssc ji im`ijgmzb ji tuncrg bd `cdcm-rgttc ckmi 2
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Pudd’bssg jgddg bs`issg bffibnc jispcstc kdi stbti bngri`bmi, ngmtrg dg crjimbtg imji`bmc mgd
`bsc jgddb dimgb rcssb id mungrc ji pgrscmg ckmi 2
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\gmmsydvbmib 0
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beeijbrg `cm si`urgzzb bd ncjgddc dimgbrg, tuttbvib ritgmibnc ji mcm pctgr trbs`urbrg um `grtc
dgkbng trb db vbribfidg ji imkrgssc g db vbribfidg ji us`itb. Kubrjbmjc id krbei`c, imebtti,
pcssibnc mctbrg `cng db muvcdb ji pumti si bjjgmsi imtcrmc bddb rgttb ji rgkrgssicmg
bs`gmjgmtg.
Jgeimibnc i rgsijui `cng dg jieegrgmzg trb i vbdcri geegttivi jgddb vbribfidg ji us`itb Y g i vbdcri
bttgsi, `icï id vbdcrg `og db vbribfidg Y bssungrgffg sg sgkuissg gsbttbngmtg db rgdbzicmg
dimgbrg.
Id mcrnbd prcfbfidity pdct ï umb tg`mi`b krbei`b `og pgrngttg ji visubdizzbrg sikmiei`btivi
jis`cstbngmti jbddb jistrifuzicmg mcrnbdg. Pudd’bssg x vi scmc i rgsijui jispcsti im crjimg
`rgs`gmtg, sudd’bssg y i qubmtidi jgddb mcrnbdg stbmjbrj `bd`cdbti b pbrtirg jbddb eumzicmg ji
ripbrtizicmg gnpiri`b. Pg id krbei`c `og mg risudtb bsscnikdib bj umb rgttb b `cgeei`igmtg
bmkcdbrg pcsitivc, bddcrb id `bnpicmg cssgrvbtc si bvvi`imb bddb mcrnbditì. Bddcmtbmbngmti
jbddb rgttb c jgecrnbzicmi sikmiei`bmc `og id `bnpicmg mcm puö gssgrg `cmsijgrbtc mcrnbdg.
Mgd mcstrc `bsc i rgsijui si jispcmkcmc bpprcssinbtivbngmtg su umb rgttb, bm`og sg mgd tgrzc
qubjrbmtg i pumti si jispgrjcmc.
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ZGPZ JI ACDNCKCVCU PNIVMCEE \GV DB MCVNBDIZÌ JGI VGPIJWI
Jcpc bvgr cssgrvbtc db jistrifuzicmg jgi rgsijui `cm id Mcrnbd \rcfbfidity \dct, bmjibnc b
tgstbrg d’ ipctgsi `og qugsti sibmc jistrifuiti mcrnbdngmtg `cm ngjib " ukubdg bddb ngjib
`bnpicmbrib jgi rgsijui g `cm vbribmzb !6 pbri bd rbppcrtc
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Zbfgddb jgd tgst ji Acdnckcrcv-Pnirmcv
Ptbtc Vgsijui Vgsijui stj h/m (h-2)/m EJV tgcri`b |E(x)-h/m| |E(x)-(h-2)/m|Bdbfbnb -0,9:
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ZWNCVG BDDB \VCPZBZB GJ GZMIB JI \VCUGMIGMXB
Im qugstc ncjudc si prcpcmg d’cssgrvbzicmg jgd dgkbng trb ebttcri kgmgti`i jcvuti bdd’gtmib ji
um imjivijuc g db jivgrsb im`ijgmzb ji bd`umg ecrng tuncrbdi.
Bvgmjc cssgrvbtc umb gvijgmtg bmbdckib trb db jistrifuzicmg jgddb nimcrbmzb
bercbngri`bmb mgi jivgrsi stbti jgdd’Wmicmg g id tbssc ngjic ji im`ijgmzb jgd `bm`rc bddbprcstbtb suddb pcpcdbzicmg, `i prcpcmibnc im qugstb sgjg ji bpprcecmjirg tbdg ipctgti`c
dgkbng cssgrvbmjcmg db `crrgdbzicmg.
B tbdg s`cpc geegttugrgnc um tgst ji imjipgmjgmzb g bmbdizzgrgnc id dgkbng dimgbrg trb db
`busb(bppbrtgmgmzb bdd’gtmib bercbngri`bmb) g d’geegttc(nbkkicrg im`ijgmzb jgd `bm`rc
bddb prcstbtb).
Wm pc’ ji krbei`i@cmercmtc `busb-geegttc `cm krbei`c b dimgg
Pudd’bssg jgddg bs`issg bffibnc imsgritc i mcni jgkdi stbti bngri`bmi, ngmtrg suddg crjimbtg ï
prgsgmtg db pgr`gmtubdg ji bercbngri`bmi stbtc pgr stbtc(dimgb rcssb), db ngjib mbzicmbdg ji
bercbngri`bmi sud tctbdg jgddb pcpcdbzicmg (dimgb vicdb), g id mungrc ji `bsi ji `bm`rc bddb
prcstbtb ckmi 2
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Jistrifuzicmg jgddb pcpcdbzicmg bercbngri`bmb mgkdi Ptbti Wmiti
Mgd krbei`c scvrbstbmtg si mctb `cng db pcpcdbzicmg bercbngri`bmb sib nbkkicrngmtg
prgsgmtg bj gst, bj g``gzicmg jgd Mgw Obnpsoirg, Nbimg g Ugrncmt, `cm umb `cm
`cm`gmtrbzicmg pbrti`cdbrngmtg gdgvbtb mgddb zcmb ngrijicmbdg.
Zbssc ji im`ijgmzb suddb pcpcdbzicmg bngri`bmb jgd `bm`rc bddb prcstbtb
Im qugstc sg`cmjb nbppb vgjibnc `og db zcmb suj-gst ob umb pgr`gmtubdg nbkkicrg ji
imjivijui `og obmmc `cmtrbttc id `bm`rc bddb prcstbtb, im dimgb `cm db `brtimb prg`gjgmtg im
`ui mgddb ngjgsinb zcmb ̀ ’ï umb nbkkicr ̀ cm`gmtrbzicmg ji pcpcdbzicmg bercbngri`bmb.
Imcdtrg mgddg brgg im `ui db pgr`gmtubdg ji bercbngri`bmi ï mctgvcdngmtg imegricrg, `’ï um
tbssc ji im`ijgmzb jgd tuncrg rgdbtivbngmtg fbssc.
Mcm pcssibnc pgrö ritgmgrg `cnpdgtbngmtg vbdijb db `cmkgtturb rikubrjc bd dgkbng trb idebttcrg kgmgti`c g db `cmtrbzicmg jgd `bm`rc pci`oé ncdti stbti (bj gsgnpic Wtbo g Edcrijb)
mcm sgkucmc qugstc trgmj.
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Zbfgddb jgi jbti
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5%/* G P:@NBD/4> "&*) "*# "*''&$#
A:BB:0D3B>77B "&*) (*+ "*)"#&+
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F1814:C1 "%*+ %*" "*"(+&"
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Z>22BO85:2/: "%*' ""*# )*#('$#
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F:8/6142/: "$*' '*' ,)*#'+(%
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9>4@127 "$*$ )*- ,)*))&)"
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@cmsijgrbtc um `bnpicmg cnckgmgc ̀ og tgmkb ̀ cmtc jgdd’im`ijgmzb jgddb nbdbttib sui
jivgrsi kruppi gtmi`i g db pgr`gmtubdg ji imjivijui bppbrtgmgmti bi qubttrc nb`rckruppi
`cmsijgrbti, db tbfgddb ribssumtivb jgddg cssgrvbzicmi sbrì8
Uckdibnc tgstbrg8
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ZWNCVG BI \CDNCMI G EWNC
Id eunc ji sikbrgttb ï db prim`ipbdg `busb ji nbdbttig ncrtbdi mgkdi Ptbti Wmiti, bj gssc scmcjcvuti :?
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Zbssc ji im`ijgmzb ji tuncrg b pcdncmi g frcm`oi ckmi 2
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@cmercmtc `busb-geegttc `cm krbei`c b dimgg
Pudd’bssg jgddg bs`issg bffibnc jispcstc kdi stbti bngri`bmi, ngmtrg dg crjimbtg imji`bmc mgd
`bsc jgddb dimgb rcssb id mungrc ji pgrscmg ckmi 2
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0%).&&% 8:G:4> #)*) #"*( '%*$
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9>4@127 )*( "-*" '&*(
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VGKVGPPICMG DIMGBVG FIUBVIBZBZbfgddb 2
!"#"$%"$ ()**# +),+)%%$-.) /#*-+)
[ @387/N81 )*-"$"+#'(#
[ :8 ]3:C4:71 )*+$$-)#&-#
[ :8 ]3:C4:71 0144>771 )*+#')%+&
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mungrc ji `bsi ji `bm`rc bi pcdncmi ckmi 2 6 -
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Zbfgddb jgi jbti suddb rgdbzicmg trb pgr`gmtubdg ji eunbtcri g `bm`rc bi pcdncmi
6+%+* I H2$%+"#* B?;*07/037 "(*" '#*" &$*($'$ ,+*$'$(
L>8:G:4> #"*( '%*$ '$*%(() ,)*+#$)
L/B74/07 16 F183@=/: #)*+ &&*+ '"*&("# &*(("#
Y814/C: "-*$ '"*) &+*$-%- ,#*')&"
M>142730HO #-*) +)*" (+*-$&" ,"*"'%-
J13/B/:2: #&*( '-*+ ("*-%(# #*"%(#
A:/2> ##*+ '-*# '&*+)'$ ,$*$-$(
A:4O8:2C "-*" &'*( &(*-("% "*#("%
A:BB:0D3B>77B "+*# &&*+ &'*)'&' )*#'&'
A/0D/G A>X/01 #"*& '#*# '$*)&$& )*+&$&
E>G I14H "+*" '"*' &&*+&$+ ,&*(%'#
E147D F:418/2: #"*+ '+*% '$*'+++ ,%*(""#
E147D L:H17: #"*- &+*' '$*-))& &*$))&
_D/1 #&*" '+*' ()*'('( #*)('(
_H8:D1@: #'*" ()*# (#*(-%# #*&-%#
_4>22BO85:2/: ##*% ''*" '%*-&-$ ,"*"%)(
[D1C> VB8:2C #)*) '$*# &-*+((# ,$*$##+
.137D F:418/2: #$*" '&*$ ''*%%"' "*"%"'
.137D L:H17: #$*) '(*) ''*##-+ ,)*(()#
U>22>BB>> #$*) '%*+ ''*##-+ "*%#-+
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##
Vgkrgssicmg dimgbrg umivbribtb g bmbdisi jgi rgsijui
Im qugstc krbei`c si ipctizzb d’gsistgmzb ji um dgkbng dimgbrg trb pgr`gmtubdg ji eunbtcri g
im`ijgmzb jgd `bm`rc bi pcdncmi mgi simkcdi stbti.
Ckmumc ji gssi ï rbpprgsgmtbtc jb um pumtc \8
• D’bs`issb jgd pumtc x(\) rbpprgsgmtb db pgr`gmtubdg ji eunbtcri mgddc Ptbtc
rbpprgsgmtbtc jb \
• D’crjimbtb jgd pumtc y(\) rbpprgsgmtb id tbssc ji im`ijgmzb jgddb ecrnb tuncrbdg
im qugsticmg su um tctbdg ji 2
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Vgsijui@i bspgttibnc `og i rgsijui bffibmc bpprcssinbtivbngmtg ngjib muddb .
6+%+* O./*07/037 ,+*$'$()"&''
L>8:G:4> ,)*+##-++$)$
L/B74/07 16 F183@=/: &*(("#"--(#
Y814/C: ,#*')&)--&("
M>14 ,$*$-$'+($)&
A:4O8:2C "*#("$-""&(
A:BB:0D3B>77B )*#'&&--%$#
A/0D/G P:@NBD/4> ,"*)-$$%%-$%
E>G K>4B>O ,&*%-+-'&%(%
E>G A>X/01 )*+&$&)#%#&
E>G I14H ,&*(%'"&)%
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E147D L:H17: &*$)))-()
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Cncs`ogjbstì itì jgi rgsijui
Pudd’bssg jgddg bs`issg vi ï db pgr`gmtubdg ji eunbtcri mgkdi stbti bngri`bmi, ngmtrg sudd’bssg
jgddg crjimbtg vi scmc id vbdcrg jgi rgsijui.
Mctibnc `og i rgsijui mcm sgkucmc um bmjbngmtc mctgvcdg, id `og `i eb fgm spgrbrg
rikubrjc db dcrc mcrnbditì, im qubmtc db jieegrgmzb jbd vbdcrg bttgsc (sg`cmjc db rgkrgssicmg
dimgbrg) jgd vbdcrg geegttivc rgkistrbtc mcm ncstrb umb jipgmjgmzb inngjibtbngmtg visifidg
jbd vbdcrg jgddb vbribfidg ji imkrgssc _.
D'cncs`ogjbsti`itì ï umb `cmjizicmg ijgbdg mgddb qubdg si trcvb umb eumzicmg ji jbtirbpprgsgmtbfidi krbei`bngmtg `cng jispgrsi im nbmigrb bffbstbmzb cnckgmgb bd ji scprb
cj bd ji scttc ji umb dimgb rgttb.
Db muvcdb jgi rgsijui rispgttb db jgeimizicmg scvrbstbmtg pci`oé si jistrifuis`g piuttcstc
cnckgmgbngmtg sudd’brgb jgd krbei`c.
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I pumti si jispcmkcmc `cm fucmb bpprcssinbzicmg bttcrmc bj umb rgttb pbssbmtg pgr
d’crikimg, g``gzicm ebttb ji bd`umi pumti `cm vbdcri ncdtc bdti c fbssi8 pcssibnc quimji
bssungrg `og i rgsijui sgkubmc umb jistrifuzicmg mcrnbdg ji ngjib " # $ ! # #$
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Pg db tbkdib m jgd `bnpicmg ï pbri `cmsijgrgrgnc n>m/6, im `bsc ji jispbritì n>(m-2)/6.
Id vbdcrg ji n `i sgrvirì crb pgr `bd`cdbrg db stbtisti`b tgst.
Jgeimitc f `cng8
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jcvg i vbdcri bi scmc `cgeei`igmti vbribfidi b sg`cmjb jgd vbdcrg ji m, db stbtisti`b tgst [ sbrì
ukubdg b8
[>f6/PP
I vbdcri jgddb stbtisti`b tgst ji Pobpirc-[ida scmc `cnprgsi trb < g 2 g vgmkcmc `cmercmtbti `cm
dg tbvcdg bppcsitbngmtg `cstruitg pgr id tgst.
Bppbrg gvijgmtg `og, sg `cmsijgribnc id `bnpicmg crjimbtc `rgs`gmtgngmtg, im `bsc ji m
jispbri, gssgmjc f db scnnb pgsbtb(`ci `cgeei`igmti bi) jgddg jieegrgmzg trb i tgrnimi jgd`bnpicmg gquijistbmti jbddb ngjibmb, mcm vgrrì utidizzbtc, mgd `bd`cdc ji f, id vbdcrg jgddb
ngjibmb stgssb.
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ZBFGDDB VIG\IDCKBZIUB JGD ZGPZ JI POB\IVC-[IDA
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Pcstitugmjc bddb vbribmzb id suc stinbtcrg!!"
#!! pcssibnc `cstruirg um imtgrvbddc jgddb ecrnb
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