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Carozzi F, Burroni E, Confortini M, Pompeo G, Bisanzi S, Cellai F, Paganini I, Mantellini P, Iossa A, Lelli L, Di Pierro C, Matucci M, Cannistrà S, Rosati R, Mongia A, Visioli CB, Gorini G, Sani C, The Tuscany Hpv-Based Screening Working Group. Implementation of a centralized HPV-based cervical cancer screening programme in Tuscany: First round results and comparison with the foregoing Pap-based screening programme. J Med Screen 2022; 29:110-122. [PMID: 35038279 DOI: 10.1177/09691413211067922] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate performance of the first round of HPV-based screening in Tuscany region and compare it with the prior round of Pap-based screening. SETTING Tuscany region of Italy, where HPV-based cervical cancer screening started in 2013, with a strong level of centralization screening tests at the Regional Laboratory for Cancer Prevention (ISPRO). METHODS The transition from Pap- to HPV-based screening was initiated for older women and at 3 out of 12 Tuscany Local Health Units (LHUs). Data from the Florence and Grosseto LHUs (about 300,000 women) were analysed and performance screening indicators estimated. RESULTS HPV-based indicators recorded good performance, with increased compliance vs. the Pap-based programme. We registered a substantial decrease in waiting times from sampling to test reporting, probably related to the centralization strategy. Since the screening protocol was the same and conducted at a single laboratory, we could hypothesize that the difference in HPV positivity (6.8% in Florence vs. 8.4% in Grosseto) was due to a real difference in HPV prevalence among women of the two LHUs. The transition to HPV-based screening led to a significant increase both in colposcopy referral rate (4.3% vs. 1.2%) and CIN2+ detection rate (8.3‰ vs. 3.4‰). CONCLUSIONS HPV-based is more effective in detecting high-grade precancerous and cancerous lesions than Pap-based screening and is characterized by an "anticipatory effect" in the detection of CIN2+ lesions. The transition from Pap-based to HPV-based screening programme should include increased resources dedicated to colposcopy services. Centralization in a laboratory with long experience in this field promotes efficiency of the screening process.
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Affiliation(s)
- Francesca Carozzi
- 9366Institute for cancer research, prevention and oncological network (ISPRO), Florence, Italy
| | - Elena Burroni
- 9366Institute for cancer research, prevention and oncological network (ISPRO), Florence, Italy
| | - Massimo Confortini
- 9366Institute for cancer research, prevention and oncological network (ISPRO), Florence, Italy
| | - Giampaolo Pompeo
- 9366Institute for cancer research, prevention and oncological network (ISPRO), Florence, Italy
| | - Simonetta Bisanzi
- 9366Institute for cancer research, prevention and oncological network (ISPRO), Florence, Italy
| | - Filippo Cellai
- 9366Institute for cancer research, prevention and oncological network (ISPRO), Florence, Italy
| | - Irene Paganini
- 9366Institute for cancer research, prevention and oncological network (ISPRO), Florence, Italy
| | - Paola Mantellini
- 9366Institute for cancer research, prevention and oncological network (ISPRO), Florence, Italy
| | - Anna Iossa
- 9366Institute for cancer research, prevention and oncological network (ISPRO), Florence, Italy
| | - Lisa Lelli
- 9366Institute for cancer research, prevention and oncological network (ISPRO), Florence, Italy
| | - Carmelina Di Pierro
- 9366Institute for cancer research, prevention and oncological network (ISPRO), Florence, Italy
| | - Marzia Matucci
- 9366Institute for cancer research, prevention and oncological network (ISPRO), Florence, Italy
| | - Stefania Cannistrà
- 9366Institute for cancer research, prevention and oncological network (ISPRO), Florence, Italy
| | - Roberta Rosati
- Southeast Tuscany Local Health - Grosseto Hospital, Grosseto, Italy
| | | | - Carmen Beatriz Visioli
- 9366Institute for cancer research, prevention and oncological network (ISPRO), Florence, Italy
| | - Giuseppe Gorini
- 9366Institute for cancer research, prevention and oncological network (ISPRO), Florence, Italy
| | - Cristina Sani
- 9366Institute for cancer research, prevention and oncological network (ISPRO), Florence, Italy
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Thomsen LT, Kjaer SK, Munk C, Ørnskov D, Waldstrøm M. Benefits and potential harms of human papillomavirus (HPV)-based cervical cancer screening: A real-world comparison of HPV testing versus cytology. Acta Obstet Gynecol Scand 2021; 100:394-402. [PMID: 33566361 DOI: 10.1111/aogs.14121] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Human papillomavirus (HPV) testing as the primary cervical cancer screening method is implemented in several countries. We report data from the first round of a large Danish pilot implementation of HPV-based screening. Our aim was to compare colposcopy referrals, detection of high-grade cervical intraepithelial neoplasia (CIN) and cervical cancer, and positive predictive value (PPV) of colposcopy referral in HPV vs cytology-based screening. MATERIAL AND METHODS From May 2017 to October 2018, women aged 30-59 years attending cervical cancer screening in the uptake area of the Department of Pathology, Vejle Hospital, Region of Southern Denmark were screened by primary HPV testing (n = 16 067) or primary cytology (n = 23 981) depending on municipality of residence. In the HPV group, women with HPV16/18, or other high-risk HPV types and abnormal cytology, were referred to immediate colposcopy. Women with other high-risk HPV types and normal cytology were invited for repeat screening with HPV test and cytology after 12 months. From a nationwide pathology register, we obtained information on screening results and subsequent histological diagnoses during up to 2.9 years after the first screen. PPVs included diagnoses within 1 year after referral. RESULTS In the HPV group, 3.7% were referred to immediate colposcopy and 2.8% were referred at the 12-month repeat screening. The total referral to colposcopy was higher in the HPV (6.6%) than cytology group (2.1%) (age-adjusted relative referral = 3.05, 95% confidence interval [CI] 2.75-3.38). The detection of CIN3+ was higher in the HPV (1.5%) than the cytology group (0.8%) (age-adjusted relative detection = 1.88, 95% CI 1.56-2.28). The probability of CIN3+ among women referred to colposcopy (= PPV) was lower in the HPV (21.1%; 95% CI 18.7%-23.7%) than the cytology group (34.6%; 95% CI 30.7%-38.9%). In the HPV group, the PPV was lower among women referred at repeat screening (12.1%) than among women referred immediately (27.8%). CONCLUSIONS Compared with cytology-based screening, HPV-based screening provided a 90% increased CIN3+ detection at the cost of a threefold increase in colposcopy referrals, when considering complete data from the prevalence round. Our findings support implementation of HPV-based screening in Denmark, but modifications of screening algorithms may be warranted to decrease unnecessary colposcopy referrals.
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Affiliation(s)
- Louise T Thomsen
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Gynecology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Christian Munk
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Dorthe Ørnskov
- Department of Pathology, Vejle Hospital, Lillebaelt Hospital, Region of Southern Denmark, Vejle, Denmark
| | - Marianne Waldstrøm
- Department of Pathology, Vejle Hospital, Lillebaelt Hospital, Region of Southern Denmark, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Aitken CA, Kaljouw S, Siebers AG, Bron M, Morssink A, van Kemenade FJ, de Kok IMCM. Investigating the decrease in participation in the Dutch cervical cancer screening programme: The role of personal and organisational characteristics. Prev Med Rep 2021; 22:101328. [PMID: 33680719 DOI: 10.1016/j.pmedr.2021.101328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/04/2020] [Accepted: 01/23/2021] [Indexed: 11/22/2022] Open
Abstract
Declining attendance in the Dutch cervical cancer screening programme was recently observed, coinciding with preparations for implementing primary hrHPV-based screening, which was implemented in January 2017. We aimed to investigate which factors were related to decreased attendance. We conducted a population-based cohort study including all women aged 30 to 60 years who were eligible for screening between 2014 and 2018. Attendance was defined as participation in the screening programme within 15 months of the start of the invitation-eligible year. We used data from the Dutch pathology archive (PALGA) linked with data from Statistics Netherlands to investigate population characteristics (position in the household, household income, socio-economic status, number of people in the household, migration background, age) and data from the five Dutch screening organisations (SO) to investigate the effect of cessing self-inviting GP's ('inviting organisation'). SO's were termed SO 1 to 5. Higher attendance rates were observed in women who were employed (60.8%), married (62.9%), Dutch (61.2%), in the highest income bracket (63.4%), living in households with four persons (65.3%) and women who were invited by their GP (69.8%). Differences in personal characteristics did not explain the decline in attendance rates. By adjusting for whether the GP or the SO sent the invitation, the differences in attendance rates between 2014 and 2015 and 2016 and between 2014 and 2015 and 2017-2018 were explained in some screening organisations. Removing the possibility for GPs to send invitations explains some of the decline in participation, although this did not account for the total change in attendance.
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Inturrisi F, Bogaards JA, Heideman DAM, Meijer CJLM, Berkhof J. Risk of Cervical Intraepithelial Neoplasia Grade 3 or Worse in HPV-Positive Women with Normal Cytology and Five-Year Type Concordance: A Randomized Comparison. Cancer Epidemiol Biomarkers Prev 2020; 30:485-491. [PMID: 33293342 DOI: 10.1158/1055-9965.epi-20-1336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/17/2020] [Accepted: 12/04/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In human papillomavirus (HPV)-based cervical screening programs, management of HPV-positive women with normal cytology is debated. Longitudinal information on HPV type persistence may be employed for risk stratification. METHODS We assessed the risk of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) after repeatedly testing positive for the same HPV type(s) in the randomized population-based screening study Amsterdam (POBASCAM). We compared 18-month CIN3+ risks in HPV-positive women (intervention, n = 1,066) to those in HPV-positive/cytology-negative women who tested HPV-positive in the next screening round (control, n = 111) five years later, stratified for HPV type concordance. RESULTS The 18-month CIN3+ risk was 15% in HPV-positive women in the intervention group, 40% in the control group after two-round type concordance (relative risk 2.6, 95% confidence interval 1.9-3.4), and 20% in the control group after a type switch (1.3, 0.5-3.2). The relative increase in CIN3+ risk after two-round type concordance was similar in <35-year-old (3.0, 2.0-4.4) and older women (2.2, 1.4-3.5), and was high in high-risk HPV-positive women who were HPV16/18/31/33/45-negative in both rounds (9.9, 4.4-21.9). CONCLUSIONS Five-year HPV type concordance signals high CIN3+ risk and warrants referral for colposcopy without additional cytology triage. IMPACT HPV screening programs become highly efficient when HPV-positive women with negative triage testing at baseline are offered repeat HPV genotyping after five years.
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Affiliation(s)
- Federica Inturrisi
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam Public Health, Amsterdam, the Netherlands.
| | - Johannes A Bogaards
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam Public Health, Amsterdam, the Netherlands.,Amsterdam UMC, University of Amsterdam, Epidemiology and Data Science, Academic Medical Centre, Amsterdam, the Netherlands
| | - Daniëlle A M Heideman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Chris J L M Meijer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Johannes Berkhof
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam Public Health, Amsterdam, the Netherlands
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Pasquale L, Rossi PG, Carozzi F, Domenighini S, Ruggeri C, Cecconami L, Morana C, Chiaramonte M, Chiudinelli D, Piccolomini M, Marchione R, Confortini M. HPV screening performance indicators in women who previously tested HPV-negative: The second round of Vallecamonica screening programme, Northern Italy. J Med Screen 2020; 27:207-214. [PMID: 32102618 DOI: 10.1177/0969141320905325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To present performance indicators from the second round of the Vallecamonica-Sebino HPV screening programme in women who had tested negative about four years earlier (mean 45 months). METHODS From 2010 to 2012, the target female population (aged 25-64) was invited to the first HPV screening round. In 2013-2017, women were rescreened for the second round. HPV-negative women at the first round were initially rescreened after three years. The interval was gradually increased to five years. HPV-positive women underwent cytology triage: positives were referred to colposcopy and negatives to repeat testing after one year. If HPV was persistently positive, women were referred to colposcopy, if negative, to normal interval rescreening. RESULTS In the second round, of 13,824 previously HPV-negative women, 598 were HPV-positive (4.3%), of whom 297 were positive at cytology triage. Of those referred to one-year HPV test, 291 complied (98.0%), 133 (50.2%) of whom were persistently positive. Total referral was 3.1% compared with 6.6% in the first round (age-adjusted relative referral 0.59, 95% CI: 0.53-0.65). There were 24 cervical intraepithelial neoplasia 2+ (three cervical intraepithelial neoplasia 3+). Detection was 0.17%, compared with 0.9% in the first round. Age-adjusted relative detections were 0.25 (95% CI: 0.16-0.39) and 0.18 (95% CI: 0.05-0.61) for cervical intraepithelial neoplasia 2+ and cervical intraepithelial neoplasia 3+, respectively. Positive predictive value was 5.7%, compared with 14.6% in the first round. CONCLUSIONS At second round, referral was half that at first round, while cervical intraepithelial neoplasia 2+ detection decreased nine-fold. Consequently, positive predictive value decreased dramatically. Rescreening four years after an HPV-negative test makes the process inefficient due to the low prevalence of lesions.
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Affiliation(s)
- Luigi Pasquale
- Former responsible for screening ex ASL Vallecamonica-Sebino, Regione Lombardia, Breno, Italy
| | - Paolo G Rossi
- Epidemiology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Carozzi
- S.C. Laboratorio di Prevenzione Oncologica, Istituto per lo Studio e la Prevenzione Oncologica, Firenze, Italy
| | | | | | | | | | | | | | | | | | - Massimo Confortini
- S.C. Laboratorio di Prevenzione Oncologica, Istituto per lo Studio e la Prevenzione Oncologica, Firenze, Italy
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Thomsen LT, Kjær SK, Munk C, Frederiksen K, Ørnskov D, Waldstrøm M. Clinical Performance of Human Papillomavirus (HPV) Testing versus Cytology for Cervical Cancer Screening: Results of a Large Danish Implementation Study. Clin Epidemiol 2020; 12:203-213. [PMID: 32110112 PMCID: PMC7041597 DOI: 10.2147/clep.s243546] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 02/05/2020] [Indexed: 12/26/2022] Open
Abstract
Background Human papillomavirus (HPV) testing is increasingly used as the primary cervical cancer screening test. In a large pilot implementation, we compared participation, referrals and detection of high-grade cervical intraepithelial neoplasia (CIN) in HPV- versus cytology-based cervical cancer screening. Methods The implementation was embedded into the routine screening program at Lillebaelt Hospital, Department of Pathology, Vejle, Denmark. Based on the area of residence, women aged 30–59 years were screened by either HPV testing (with HPV16/18 genotyping and cytology triage) or cytology (with HPV triage for minor abnormalities). Our analysis includes women invited or screened during May 2017–May 2018 (invited: n=35,081; screened: n=28,352) with 6 months of follow-up. Information on screening results and sociodemographic characteristics were obtained from registers. Using logistic regression, we estimated odds ratios (ORs) with 95% confidence intervals (CIs) of participation, referral and CIN3+-detection in HPV- versus cytology-based screening, adjusting for sociodemographic characteristics. Results Participation was virtually identical in the HPV- and cytology group (58.4% vs 58.8%; ORadjusted=0.97, 95% CI, 0.93–1.01). Referral to colposcopy was more common in the HPV- than cytology group (3.8% vs 2.1%; ORadjusted=1.88, 95% CI, 1.63–2.17). More cases of CIN3+ were detected in the HPV- than cytology group (1.0% vs 0.7%, ORadjusted=1.47; 95% CI, 1.13–1.91). Conclusion Participation did not differ between HPV- and cytology-based screening. HPV-based screening detected more cases of CIN3+, but in this initial screening round also led to more colposcopies than cytology-based screening.
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Affiliation(s)
- Louise T Thomsen
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne K Kjær
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Gynecology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Christian Munk
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kirsten Frederiksen
- Unit of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Dorthe Ørnskov
- Department of Pathology, Vejle Hospital, Lillebaelt Hospital, Region of Southern Denmark, Vejle, Denmark
| | - Marianne Waldstrøm
- Department of Pathology, Vejle Hospital, Lillebaelt Hospital, Region of Southern Denmark, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Del Mistro A, Giorgi Rossi P, Frayle H, Pasquale L, Campari C, Ronco G, Zorzi M. Five-year risk of CIN3 after short-term HPV-DNA negativity in cytology-negative women: a population-based cohort study. BJOG 2019; 126:1365-1371. [PMID: 31356722 DOI: 10.1111/1471-0528.15893] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the 5-year risk of high-grade lesions in women with a transient high-risk HPV infection. DESIGN Population-based cohort study. SETTING HPV primary testing within population-based organised cervical cancer screening programmes. POPULATION Italian women enrolled in seven pilot projects and attending the second round. METHODS On the basis of the cytology triage performed on HPV-positive women, immediate colposcopy or HPV repeat at 12 months was recommended. Data were collected at the subsequent round 3-4 years after HPV infection clearance. MAIN OUTCOME MEASURES Rates of HPV infection, CIN2+ and CIN3+ detection at subsequent round after HPV clearance, and relative risks (RR) in comparison with HPV-negative women (with 95% confidence interval). RESULTS Data on 1230 women (1027 aged 25-64 years and 203 aged 35-64 years) have been analysed. Overall compliance with repeat HPV testing was 84%. In comparison with HPV-negative women, those with a transient HPV infection had higher proportions of HPV positivity (15% versus 3.7%) and of CIN2+ lesions (0.87% versus 0.23%) in round two; most of these (7/10) were CIN2; no cancers were detected, and CIN3 occurred in 3/1230 (0.24%). CONCLUSIONS HPV-based protocols for cervical cancer screening allow long intervals for HPV-negative women; it is important to monitor the clinical outcome in the women with transient high-risk HPV infection. CIN3 detection is similar to that observed in routine European cytology-based screening programmes (CIN3+: 2.7‰); 5-year intervals may provide reasonable protection but longer intervals are not recommended. TWEETABLE ABSTRACT A screening interval of 5 years (but no longer) appears safe in women with transient HPV detection.
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Affiliation(s)
- A Del Mistro
- Immunology and Diagnostic Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - P Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - H Frayle
- Immunology and Diagnostic Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - L Pasquale
- Ex-ASL Vallecamonica-Sebino, Regione Lombardia, Sulzano, Italy
| | - C Campari
- Cancer Screening Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - G Ronco
- International Agency for Research on Cancer, Infection and Cancer Epidemiology Unit, Lyon, France
| | - M Zorzi
- Veneto Tumour Registry, Azienda Zero, Padova, Italy
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Gago J, Paolino M, Arrossi S. Factors associated with low adherence to cervical cancer follow-up retest among HPV+/ cytology negative women: a study in programmatic context in a low-income population in Argentina. BMC Cancer 2019; 19:367. [PMID: 31014287 PMCID: PMC6480915 DOI: 10.1186/s12885-019-5583-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 04/05/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cervical Cancer is still a major public health challenge in low and middle-income countries. HPV testing has been an innovative approach, which was introduced in Argentina for women aged 30+ through the Jujuy Demonstration Project (JDP) carried out between 2012 and 2014. After a positive HPV-test, cytology is used as triage method. Under this protocol, the group of women with HPV+ and normal cytology are recommended to repeat the test within 12-18 months. Studies have shown that this group has increased risk of CIN2+, however, assuring high levels of repeating test among these women is difficult to achieve. We analyze those factors associated with lower re-test attendance among HPV+/ cytology negative women at a programmatic level in low-middle income settings. METHODS We used data of women aged 30+ HPV-tested in the JDP and followed until 2018 (n = 49,565). We performed a set of different adjusted logistic regression models. Primary outcomes were re-test attendance and re-test attendance within recommended timeframe. We assessed as covariates age, health insurance status, year of HPV-testing, Pap testing in the past 3 years, HPV-testing modality (clinician-collected (CC) tests/self-collected (SC) tests), and span between HPV-test collection and report of results. RESULTS Forty nine thousand five hundred sixty five women were HPV-tested and 6742 had a positive HPV-test. Among HPV+ women, a total of 4522 were HPV+/Cytology negative (67.1%). In total, 3172 HPV+/Cytology negative women (70.1%) had a record of a second HPV test as of March 2018. Only 1196 women (26%) completed the second test within the timeframe. Women with no record of a previous Pap (OR: 0.46, 95% CI: 0.4-0.53, p < 0.001), aged 64+ (OR: 0.46, 95% CI: 0.31-0.68, p < 0.001) were less likely to be retested; while women with clinician-collected samples had higher odds of being re-tested (OR: 1.42, 95% CI: 1.06-1.91, p < 0.001). CONCLUSIONS Low re-test rates were found in HPV +/ normal cytology women. Tailored interventions are needed to increase the effectiveness of the screening in this group, especially for those women with characteristics associated to lower attendance.
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Affiliation(s)
- Juan Gago
- Programa Nacional de Prevención de Cancer Cervicouterino/Instituto Nacional del Cáncer (Argentina), Julio A. Roca 781, Piso 7, Buenos Aires, Argentina
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, Buenos Aires, Argentina
| | - Melisa Paolino
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, Buenos Aires, Argentina
| | - Silvina Arrossi
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, Buenos Aires, Argentina
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Rebolj M, Rimmer J, Denton K, Tidy J, Mathews C, Ellis K, Smith J, Evans C, Giles T, Frew V, Tyler X, Sargent A, Parker J, Holbrook M, Hunt K, Tidbury P, Levine T, Smith D, Patnick J, Stubbs R, Moss S, Kitchener H. Primary cervical screening with high risk human papillomavirus testing: observational study. BMJ 2019; 364:l240. [PMID: 30728133 PMCID: PMC6364146 DOI: 10.1136/bmj.l240] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/01/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To provide the first report on the main outcomes from the prevalence and incidence rounds of a large pilot of routine primary high risk human papillomavirus (hrHPV) testing in England, compared with contemporaneous primary liquid based cytology screening. DESIGN Observational study. SETTING The English Cervical Screening Programme. PARTICIPANTS 578 547 women undergoing cervical screening in primary care between May 2013 and December 2014, with follow-up until May 2017; 183 970 (32%) were screened with hrHPV testing. INTERVENTIONS Routine cervical screening with hrHPV testing with liquid based cytology triage and two early recalls for women who were hrHPV positive and cytology negative, following the national screening age and interval recommendations. MAIN OUTCOME MEASURES Frequency of referral for a colposcopy; adherence to early recall; and relative detection of cervical intraepithelial neoplasia grade 2 or worse from hrHPV testing compared with liquid based cytology in two consecutive screening rounds. RESULTS Baseline hrHPV testing and early recall required approximately 80% more colposcopies, (adjusted odds ratio 1.77, 95% confidence interval 1.73 to 1.82), but detected substantially more cervical intraepithelial neoplasia than liquid based cytology (1.49 for cervical intraepithelial neoplasia grade 2 or worse, 1.43 to 1.55; 1.44 for cervical intraepithelial neoplasia grade 3 or worse, 1.36 to 1.51) and for cervical cancer (1.27, 0.99 to 1.63). Attendance at early recall and colposcopy referral were 80% and 95%, respectively. At the incidence screen, the 33 506 women screened with hrHPV testing had substantially less cervical intraepithelial neoplasia grade 3 or worse than the 77 017 women screened with liquid based cytology (0.14, 0.09 to 0.23). CONCLUSIONS In England, routine primary hrHPV screening increased the detection of cervical intraepithelial neoplasia grade 3 or worse and cervical cancer by approximately 40% and 30%, respectively, compared with liquid based cytology. The very low incidence of cervical intraepithelial neoplasia grade 3 or worse after three years supports extending the screening interval.
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Affiliation(s)
- Matejka Rebolj
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London SE1 9RT, UK
| | - Janet Rimmer
- Young Person and Adult Screening Programmes, Public Health England, Sheffield, UK
| | - Karin Denton
- PHE Screening Quality Assurance Service South, Public Health England, Bristol, UK
- Severn Pathology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - John Tidy
- Department of Gynaecological Oncology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Christopher Mathews
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London SE1 9RT, UK
| | - Kay Ellis
- Cytology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - John Smith
- Cytology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Chris Evans
- NHS Liverpool Clinical Laboratories, Royal Liverpool University Hospital, Liverpool, UK
| | - Thomas Giles
- NHS Liverpool Clinical Laboratories, Royal Liverpool University Hospital, Liverpool, UK
| | - Viki Frew
- Department of Cellular Pathology, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Xenia Tyler
- Department of Cellular Pathology, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Alexandra Sargent
- Clinical Virology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Janet Parker
- Cellular Pathology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Miles Holbrook
- Cellular Pathology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Katherine Hunt
- Severn Pathology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Penny Tidbury
- Severn Pathology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Tanya Levine
- Department of Cellular Pathology, Northwick Park Hospital, London, UK
| | - David Smith
- Department of Cellular Pathology, Northwick Park Hospital, London, UK
| | - Julietta Patnick
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ruth Stubbs
- Young Person and Adult Screening Programmes, Public Health England, Sheffield, UK
| | - Sue Moss
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Henry Kitchener
- Division of Cancer Sciences, University of Manchester and Manchester NIHR BRC, Manchester, UK
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10
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Chrysostomou AC, Stylianou DC, Constantinidou A, Kostrikis LG. Cervical Cancer Screening Programs in Europe: The Transition Towards HPV Vaccination and Population-Based HPV Testing. Viruses 2018; 10:E729. [PMID: 30572620 DOI: 10.3390/v10120729] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/12/2018] [Accepted: 12/15/2018] [Indexed: 12/25/2022] Open
Abstract
Cervical cancer is the fourth most frequently occurring cancer in women around the world and can affect them during their reproductive years. Since the development of the Papanicolaou (Pap) test, screening has been essential in identifying cervical cancer at a treatable stage. With the identification of the human papillomavirus (HPV) as the causative agent of essentially all cervical cancer cases, HPV molecular screening tests and HPV vaccines for primary prevention against the virus have been developed. Accordingly, comparative studies were designed to assess the performance of cervical cancer screening methods in order to devise the best screening strategy possible. This review critically assesses the current cervical cancer screening methods as well as the implementation of HPV vaccination in Europe. The most recent European Guidelines and recommendations for organized population-based programs with HPV testing as the primary screening method are also presented. Lastly, the current landscape of cervical cancer screening programs is assessed for both European Union member states and some associated countries, in regard to the transition towards population-based screening programs with primary HPV testing.
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11
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Zorzi M, Frayle H, Rizzi M, Fedato C, Rugge M, Penon MG, Bertazzo A, Callegaro S, Campagnolo M, Ortu F, Del Mistro A. A 3-year interval is too short for re-screening women testing negative for human papillomavirus: a population-based cohort study. BJOG 2017; 124:1585-1593. [DOI: 10.1111/1471-0528.14575] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2016] [Indexed: 11/30/2022]
Affiliation(s)
- M Zorzi
- Veneto Tumour Registry; Veneto Region; Padova Italy
| | - H Frayle
- Immunologia Diagnostica Molecolare Oncologica; Istituto Oncologico Veneto IOV-IRCCS; Padova Italy
| | - M Rizzi
- Immunologia Diagnostica Molecolare Oncologica; Istituto Oncologico Veneto IOV-IRCCS; Padova Italy
| | - C Fedato
- Organizational Unit Prevention and Public Health; Veneto Region; Venezia Italy
| | - M Rugge
- Veneto Tumour Registry; Veneto Region; Padova Italy
- Department of Medicine DIMED Pathology and Cytopathology Unit; University of Padova; Padova Italy
| | - MG Penon
- Department of Prevention; Local Health Unit 17 Monselice; Este Italy
| | - A Bertazzo
- Department of Prevention; Local Health Unit 17 Monselice; Este Italy
| | - S Callegaro
- Department of Prevention; Local Health Unit 15 Alta Padovana; Camposampiero Italy
| | - M Campagnolo
- Department of Prevention; Local Health Unit 15 Alta Padovana; Camposampiero Italy
| | - F Ortu
- Department of Prevention; Local Health Unit 15 Alta Padovana; Camposampiero Italy
| | - A Del Mistro
- Immunologia Diagnostica Molecolare Oncologica; Istituto Oncologico Veneto IOV-IRCCS; Padova Italy
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12
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Passamonti B, Gustinucci D, Giorgi Rossi P, Cesarini E, Bulletti S, Carlani A, Martinelli N, Broccolini M, D'Angelo V, D'Amico MR, Di Dato E, Galeazzi P, Malaspina M, Spita N, Tintori B, Giaimo MD. Cervical human papilloma virus (HPV) DNA primary screening test: Results of a population-based screening programme in central Italy. J Med Screen 2016; 24:153-162. [PMID: 27614992 DOI: 10.1177/0969141316663580] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To present the results of the first and second round human papilloma virus (HPV)-based screening programme in the Umbria region after three years. Methods From August 2010 to November 2011, the entire female population aged 35-64 in a local health district was invited for HPV testing (HPV-DNA cobas4800 on a liquid-based cytology sample). HPV-negative women were re-invited after three years. For HPV-positive women, a slide was prepared and interpreted. Positive cytologies were referred to colposcopy; negatives were referred to repeat HPV after one year. If HPV was persistently positive, women were referred to colposcopy; if negative, to normal screening. Indicators of the first and second round are compared with those of cytology screening in the same area in the preceding three years. Results Participation was 56.5%, the same as cytology (56.6%). HPV-positivity was 6.4% (396/6272), cytology triage positivity was 35.6%; 251 cytology negative women were referred to one-year HPV retesting, 84.1% complied, and 55.5% were positive. Total colposcopy referral was 4.1%, and for cytology 1%. The detection rate for cervical intraepithelial neoplasia grade 2 or more severe was 10‰, compared with 3.7‰ using cytology. After three years, HPV-positivity was 3.4% (129/3831), overall colposcopy referral was 2.3% (most at one-year follow-up), and detection rate was 0.5/1000. Conclusions The first round detection rate was more than twice that of cytology screening, while colposcopy referral increased fourfold. At the second round, the detection rate decreased dramatically, showing that longer interval and more conservative protocols are needed.
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Affiliation(s)
- Basilio Passamonti
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Daniela Gustinucci
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Paolo Giorgi Rossi
- 2 Servizio Interaziendale di Epidemiologia, AUSL Reggio Emilia, Italy
- 3 Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Elena Cesarini
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Simonetta Bulletti
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Angela Carlani
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Nadia Martinelli
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Massimo Broccolini
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Valentina D'Angelo
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | | | - Eugenio Di Dato
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Paola Galeazzi
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Morena Malaspina
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Nicoletta Spita
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Beatrice Tintori
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Maria Donata Giaimo
- 4 Regione Umbria, Responsabile Servizio Prevenzione, Sanità Veterinaria e Sicurezza Alimentare
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13
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Maggino T, Sciarrone R, Murer B, Dei Rossi MR, Fedato C, Maran M, Lorio M, Soldà M, Zago F, Giorgi Rossi P, Zorzi M. Screening women for cervical cancer carcinoma with a HPV mRNA test: first results from the Venice pilot program. Br J Cancer 2016; 115:525-32. [PMID: 27490801 DOI: 10.1038/bjc.2016.216] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/24/2016] [Accepted: 06/26/2016] [Indexed: 12/02/2022] Open
Abstract
Background: HPV DNA-based screening is more effective than a Pap test in preventing cervical cancer, but the test is less specific. New HPV tests have been proposed for primary screening. The HPV mRNA test showed a similar or slightly lower sensitivity than the HPV DNA tests but with a higher specificity. We report the results of an organised HPV mRNA-based screening pilot program in Venice, Italy. Methods: From October 2011 to May 2014, women aged 25–64 years were invited to undergo a HPV mRNA test (Aptima). Those testing positive underwent cytological triage. Women with positive cytology were referred to colposcopy, whereas those with negative cytology were referred to repeat the HPV mRNA test 1 year later. The results of the HPV mRNA test program were compared with both the local historical cytology-based program and with four neighbouring DNA HPV-based pilot projects. Results: Overall, 23 211 women underwent a HPV mRNA test. The age-standardised positivity rate was 7.0%, higher than in HPV DNA programs (6.8% relative rate (RR) 1.11, 95% confidence interval (CI) 1.05–1.17). The total colposcopy referral was 5.1%, double than with cytology (2.6% RR 2.02, 95% CI 1.82–2.25) but similar to the HPV DNA programs (4.8% RR 1.02; 95% CI 0.96–1.08). The cervical intraepithelial neoplasia grade 2+ detection rate with HPV mRNA was greater than in the HPV DNA programs at baseline (RR 1.50; 95% CI 1.19–1.88) and not significantly lower at the 1-year repeat (RR 0.70; 95% CI 0.40–1.16). The overall RR was 1.29 (95% CI 1.05–1.59), which was much higher than with cytology (detection rate 5.5‰ vs 2.1‰ RR 2.50, 95% CI 1.76–3.62). Conclusions: A screening programme based on the HPV mRNA obtained results similar to those observed with the HPV DNA test. In routine screening programmes, even a limited increase in HPV prevalence may conceal the advantage represented by the higher specificity of HPV mRNA.
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14
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Popadiuk C, Gauvreau CL, Bhavsar M, Nadeau C, Asakawa K, Flanagan WM, Wolfson MC, Coldman AJ, Memon S, Fitzgerald N, Lacombe J, Miller AB. Using the Cancer Risk Management Model to evaluate the health and economic impacts of cytology compared with human papillomavirus DNA testing for primary cervical cancer screening in Canada. ACTA ACUST UNITED AC 2016; 23:S56-63. [PMID: 26985148 DOI: 10.3747/co.23.2991] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In Canada, discussion about changing from cytology to human papillomavirus (hpv) dna testing for primary screening in cervical cancer is ongoing. However, the Canadian Task Force on Preventive Health Care has not yet made a recommendation, concluding that the evidence is insufficient. METHODS We used the cervical cancer and hpv transmission models of the Cancer Risk Management Model to study the health and economic outcomes of primary cytology compared with hpv dna testing in 14 screening scenarios with varying screening modalities and intervals. Projected cervical cancer cases, deaths, colposcopies, screens, costs, and incremental cost-effectiveness were evaluated. We performed sensitivity analyses for hpv dna test costs. RESULTS Compared with triennial cytology from age 25, 5-yearly hpv dna screening alone from age 30 resulted in equivalent incident cases and deaths, but 55% (82,000) fewer colposcopies and 43% (1,195,000) fewer screens. At hpv dna screening intervals of 3 years, whether alone or in an age-based sequence with cytology, screening costs are greater, but at intervals of more than 5 years, they are lower. Scenarios on the cost-effectiveness frontier were hpv dna testing alone every 10, 7.5, 5, or 3 years, and triennial cytology starting at age 21 or 25 when combined with hpv dna testing every 3 years. CONCLUSIONS Changing from cytology to hpv dna testing as the primary screening test for cervical cancer would be an acceptable strategy in Canada with respect to incidence, mortality, screening and diagnostic test volumes.
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Affiliation(s)
- C Popadiuk
- Department of Women's Health, Memorial University, St. John's, NL
| | - C L Gauvreau
- Canadian Partnership Against Cancer, Toronto, ON
| | - M Bhavsar
- Canadian Partnership Against Cancer, Toronto, ON
| | | | | | | | | | - A J Coldman
- Canadian Partnership Against Cancer, Toronto, ON
| | - S Memon
- Canadian Partnership Against Cancer, Toronto, ON
| | - N Fitzgerald
- Canadian Partnership Against Cancer, Toronto, ON
| | - J Lacombe
- Canadian Partnership Against Cancer, Toronto, ON
| | - A B Miller
- Dalla Lana School of Public Health, Toronto, ON
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15
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Del Mistro A. HPV Genotyping in the Prevention of Cervical Cancer-How and When Can It Be a Useful Marker? Cancer Epidemiol Biomarkers Prev 2015; 24:1302-3. [PMID: 26088704 DOI: 10.1158/1055-9965.epi-15-0591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/09/2015] [Indexed: 11/16/2022] Open
Affiliation(s)
- Annarosa Del Mistro
- Veneto Institute of Oncology IOV IRCCS, Padua, Italy. Immunologia Diagnostica Molecolare Oncologica Unit, Padova, Italy.
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16
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Campari C, Fedato C, Petrelli A, Zorzi M, Cogo C, Caprioglio A, Gallo F, Giordano L, Domenighini S, Pasquale L, Prandi S, Zappa M, Rossi PG. HPV prevalence and risk of pre-cancer and cancer in regular immigrants in Italy: results from HPV DNA test-based screening pilot programs. Infect Agent Cancer 2015; 10:14. [PMID: 25969693 PMCID: PMC4427984 DOI: 10.1186/s13027-015-0009-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 04/21/2015] [Indexed: 11/25/2022] Open
Abstract
UNLABELLED ᅟ: Immigrants from low- and medium-income countries have a higher risk of cervical cancer due both to barriers in access to screening and to higher human papillomavirus (HPV) prevalence. In the near future many screening programmes in industrialised countries will replace Pap test with HPV as primary test. In order to plan future interventions, it is essential to understand how the HPV screening performs in immigrant women. METHODS We conducted a survey on the main performance indicators from some of the HPV DNA-based pilot programmes in Italy, comparing regular immigrant women, identified as women resident in Italy who were born abroad, with women who were born in Italy. All the programmes applied the same protocol, with HPV as stand-alone test starting for women of 25 or 35 to 64 years of age. Cytology triage is performed for positive women; those ASC-US or more severe are referred directly to colposcopy; negative women are referred to repeat HPV after one year. RESULTS Overall, 162,829 women were invited, of whom 22,814 were born abroad. Participation was higher for Italy-born than born abroad (52.2% vs. 43.6%), particularly for women over 45 years. HPV positivity rate was higher in immigrants: 7.8% vs. 6.1%, age-adjusted Relative Risk (age-adj RR) 1.18, 95% confidence interval (95% CI) 1.13-1.22. The proportion of women with positive cytology triage was similar in the two groups (42%). Cervical Intraepithelial Neoplasia (CIN) grade 2 or more severe detection rate was higher for born abroad (age-adj RR 1.65, 95% CI 1.45-1.89). The difference was stronger when considering only CIN3 or more severe (age-adj RR 2.29, 95% CI 1.90-2.75). Both HPV positivity and CIN2 or more severe detection rate had a different age curve in born abroad compared with Italy-born: in the former, the risk was almost flat, while in the latter it declined rapidly with age. CONCLUSION Compliance with HPV screening is lower for migrant women, who are affected by higher HPV positivity and CIN3 cancer detection rates.
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Affiliation(s)
- Cinzia Campari
- />Staff Programmazione e Controllo, AUSL, Reggio Emilia, Italy
- />IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Chiara Fedato
- />Coordinamento regionale screening oncologici, Regione Veneto, Venezia, Italy
| | - Alessio Petrelli
- />INMP Istituto Nazionale per la promozione della salute delle popolazioni Migranti ed il contrasto delle malattie della Povertà, Rome, Italy
| | - Manuel Zorzi
- />Registro Tumori del Veneto, Regione Veneto, Padova, Italy
| | - Carla Cogo
- />Registro Tumori del Veneto, Regione Veneto, Padova, Italy
| | | | | | | | | | | | - Sonia Prandi
- />Patologia IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Marco Zappa
- />ISPO – Istituto per lo Studio e la Prevenzione Oncologica, Florence, Italy
| | - Paolo Giorgi Rossi
- />IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
- />Servizio Interaziendale di Epidemiologia, AUSL, Reggio Emilia, Italy
| | - the GISCi Migrant Working Group
- />Staff Programmazione e Controllo, AUSL, Reggio Emilia, Italy
- />IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
- />Coordinamento regionale screening oncologici, Regione Veneto, Venezia, Italy
- />INMP Istituto Nazionale per la promozione della salute delle popolazioni Migranti ed il contrasto delle malattie della Povertà, Rome, Italy
- />Registro Tumori del Veneto, Regione Veneto, Padova, Italy
- />Unità di Epidemiologia - CPO Piemonte, Torino, Italy
- />ASL Valle Camonica Sebino, Breno, BS Italy
- />Patologia IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
- />ISPO – Istituto per lo Studio e la Prevenzione Oncologica, Florence, Italy
- />Servizio Interaziendale di Epidemiologia, AUSL, Reggio Emilia, Italy
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