Abstract
I first met Stefano Ciatto more than 20 years ago, when we were doing a seminar tour visiting the important Italian cancer screening research centres. I remember Stefano being busy in his radiological office in Florence, but when debating issues around cancer screening later that day he was as active and enthusiastic as you can imagine – which he remained throughout his life.
Stefano, born and raised in Florence, obtained his Medical degree at Florence University in 1973 and specialized in radiology in 1977. He was a member of the Radiology Department at Florence University from 1974 to 1985, where he became an associate professor, and acquired a reputation as one of the most influential screening radiologists in Italy and abroad. For almost 25 years, he served as the head of the Diagnostic Imaging Department of the now well-known CSPO (Centro per lo Studio e la Prevenzione Oncologica) in Florence. With an extremely skillful team, the CSPO had become a reference centre on cancer screening evaluation in Italy, on cervical cancer screening, breast cancer screening, and colorectal and prostate cancer screening. Stefano was the clinical expert who managed to gain insights into one type of cancer and, as the evolutionary scientist, transferred that fundamental knowledge to the other emerging cancer screening fields. There were never any doubts about his scientific wisdom; everybody was always keen to hear to what Stefano had to say. His publication record now reports more than 700 national and international papers.
His skills became well-known internationally too. He was a founder of the European Breast Cancer Screening Group, a member of the European Community for Cervical Cancer Screening, an adviser for the Scientific Committee of Europe Against Cancer, a member of the European Society of Mastology and he held a variety of similar important posts in Italian medical societies. He contributed greatly to the development of organized screening programmes in Italy.
His pièce de résistance was undoubtedly the European Randomised Study of Screening for Prostate Cancer (ERSPC) trial, in which the Italian centre was the fourth largest, with 14,517 men randomized to either prostate-specific antigen (PSA) screening or the control arm. Stefano was the principal investigator in the Italian centre, and chaired the international quality control committee. He was the perfect person for that post: on the basis of empirical data and experience, he ensured that both patients and healthy men received the highest possible standard of care. He could be provocative if he felt it served a purpose. Prostate cancer screening was the field where his concerns were most needed. His call for a scientific evaluation of both the benefits and the many harms attributable to PSA testing was certainly heeded. Aware of the delicate balance between the public health and individual care, Stefano was invariably sceptical about debates on whether more biopsies should be taken. The ERSPC trial, praised as ‘the most important study for men's health in history’ in the New York Times, has been published twice in the New England Journal of Medicine, and I am proud that we have been able to dedicate the latest paper on the harms and benefits of PSA testing to his legacy.
Stefano's non-scientific work was important to him. He wrote with Daniele Corradetti a couple of mystery novels set in London in the 17th century during the plague (the name of the main character ‘the investigator’ was Ulysses). Stefano was highly committed to a voluntary theatre group dedicated to elderly people. He loved to sing for them and often on a Sunday he used what little spare time he had to do just that. He cherished this experience and considered it a great honour to be able to work for people he felt were wiser and more competent than he considered himself to be, because of their advanced age and life experience.
Stefano liked cats, but every time we met or emailed each other he would ask about my dogs. He was always cheerful, personal and kind, with the ability to switch to the necessary professionalism in science. In 2009 he officially retired and moved to Verona, to enjoy the excellent wine in the region, and live there quietly with his wife Liana. In spite of this, Stefano remained active, for example as a consulting radiologist and esteemed screening expert, delivering more than 800 lectures worldwide. After his retirement he also continued his research. In particular, he conducted original studies on the use of tomosynthesis within breast cancer screening. He was curious about all scientific news, but also shrewdly challenged propagandist claims.
His final day involved passing his expertise to others, and running home to his lovely wife Liana. His tragic death is a huge loss to the scientific screening world, to his friends and to countless other people – including many patients. Perhaps the best compliment we could pay Stefano is that he was not only a clinical epidemiologist and a public health doctor, but also simply the most thoughtful clinician ever seen.
We will all miss ‘the Italian cancer screening man’ dearly.