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Basso Basset F, Rota MB, Beccaceci M, Krieger TM, Buchinger Q, Neuwirth J, Huet H, Stroj S, Covre da Silva SF, Ronco G, Schimpf C, Höfling S, Huber-Loyola T, Rastelli A, Trotta R. Signatures of the Optical Stark Effect on Entangled Photon Pairs from Resonantly Pumped Quantum Dots. Phys Rev Lett 2023; 131:166901. [PMID: 37925701 DOI: 10.1103/physrevlett.131.166901] [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] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/05/2023] [Accepted: 08/02/2023] [Indexed: 11/07/2023]
Abstract
Two-photon resonant excitation of the biexciton-exciton cascade in a quantum dot generates highly polarization-entangled photon pairs in a near-deterministic way. However, the ultimate level of achievable entanglement is still debated. Here, we observe the impact of the laser-induced ac-Stark effect on the quantum dot emission spectra and on entanglement. For increasing pulse-duration-to-lifetime ratios and pump powers, decreasing values of concurrence are recorded. Nonetheless, additional contributions are still required to fully account for the observed below-unity concurrence.
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Affiliation(s)
- F Basso Basset
- Department of Physics, Sapienza University of Rome, 00185 Rome, Italy
| | - M B Rota
- Department of Physics, Sapienza University of Rome, 00185 Rome, Italy
| | - M Beccaceci
- Department of Physics, Sapienza University of Rome, 00185 Rome, Italy
| | - T M Krieger
- Institute of Semiconductor and Solid State Physics, Johannes Kepler University, 4040 Linz, Austria
| | - Q Buchinger
- Technical Physics, University of Würzburg, 97074 Würzburg, Germany
| | - J Neuwirth
- Department of Physics, Sapienza University of Rome, 00185 Rome, Italy
| | - H Huet
- Department of Physics, Sapienza University of Rome, 00185 Rome, Italy
| | - S Stroj
- Forschungszentrum Mikrotechnik, FH Vorarlberg, 6850 Dornbirn, Austria
| | - S F Covre da Silva
- Institute of Semiconductor and Solid State Physics, Johannes Kepler University, 4040 Linz, Austria
| | - G Ronco
- Department of Physics, Sapienza University of Rome, 00185 Rome, Italy
| | - C Schimpf
- Institute of Semiconductor and Solid State Physics, Johannes Kepler University, 4040 Linz, Austria
| | - S Höfling
- Technical Physics, University of Würzburg, 97074 Würzburg, Germany
| | - T Huber-Loyola
- Technical Physics, University of Würzburg, 97074 Würzburg, Germany
| | - A Rastelli
- Institute of Semiconductor and Solid State Physics, Johannes Kepler University, 4040 Linz, Austria
| | - R Trotta
- Department of Physics, Sapienza University of Rome, 00185 Rome, Italy
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2
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Giorgi Rossi P, Ronco G, Mancuso P, Carozzi F, Allia E, Bisanzi S, Gillio-Tos A, De Marco L, Rizzolo R, Gustinucci D, Del Mistro A, Frayle H, Confortini M, Iossa A, Cesarini E, Bulletti S, Passamonti B, Gori S, Toniolo L, Barca A, Bonvicini L, Venturelli F, Benevolo M. Performance of HPV E6/E7 mRNA Assay as Primary Screening Test. Results from the NTCC2 Trial. Int J Cancer 2022; 151:1047-1058. [PMID: 35579975 DOI: 10.1002/ijc.34120] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/17/2022] [Accepted: 04/23/2022] [Indexed: 11/11/2022]
Abstract
As the primary screening test, E6/E7 mRNA has shown similar sensitivity for CIN3+ and lower positivity rate than the HPV DNA test. Nevertheless, the overall mRNA positivity is too high for immediate colposcopy, making a triage test necessary. The aim was to estimate the mRNA performance as a primary test with different triage strategies. All HPV DNA-positives were tested for mRNA, cytology and p16/ki67. A sample of HPV DNA-negatives were also tested for mRNA to estimate test specificity. We included all CIN3+ histologically diagnosed within 24 months since recruitment. Of the 41127 participants, 7.7% were HPV DNA-positive, of which 66.4% were mRNA-positive. Among the HPV DNA-negatives, 10/1108 (0.9%) were mRNA-positive. Overall, 97 CIN3+ were found. If mRNA was used as the primary test, it would miss about 3% of all CIN3+ with a 22% reduction of positivity compared to HPV DNA. The weighted specificity estimate for <CIN2 was 94.5% (95% CI=93.9%-94.9%) and sensitivity for CIN3+ was 96.9% (95% CI=91.3%-99.1%). If all the weighted estimated 6.0% mRNA-positive women had been referred to colposcopy, PPV for CIN3+ would have been 4.2%. Cytology or p16/ki67 triage would decrease immediate referral to 1.7% and 2.0%, increasing PPV to 11.2% and 11.7%, respectively; total colposcopy referral would be 4.0% and 3.9%, respectively. As the primary screening test, the mRNA assay showed a positivity rate lower than that of HPV DNA, with a small number of CIN3+ missed. Triage with cytology or p16/ki67 would only marginally decrease overall colposcopy referral.
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Affiliation(s)
- Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Guglielmo Ronco
- Center for Cancer Epidemiology and Prevention (CPO), Turin, Italy
| | - Pamela Mancuso
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Francesca Carozzi
- Institute for cancer research, prevention and clinical network (ISPRO), Florence, Italy
| | - Elena Allia
- Centre for Cervical Cancer Screening, City of Health and Science Hospital, Turin, Italy
| | - Simonetta Bisanzi
- Institute for cancer research, prevention and clinical network (ISPRO), Florence, Italy
| | - Anna Gillio-Tos
- Centre for Cervical Cancer Screening, City of Health and Science Hospital, Turin, Italy
| | - Laura De Marco
- Centre for Cervical Cancer Screening, City of Health and Science Hospital, Turin, Italy.,Unit of Cancer Epidemiology and Center for Cancer Prevention (CPO), City of Health and Science Hospital, Turin, Italy
| | | | | | | | - Helena Frayle
- Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy
| | - Massimo Confortini
- Institute for cancer research, prevention and clinical network (ISPRO), Florence, Italy
| | - Anna Iossa
- ISPRO Oncological Network, Prevention and Research Institute, Screening Unit, Florence, Italy
| | - Elena Cesarini
- Laboratorio Unico di Screening USL Umbria1, Perugia, Italy
| | | | | | - Silvia Gori
- Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy
| | | | | | - Laura Bonvicini
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Francesco Venturelli
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Maria Benevolo
- IRCCS - Regina Elena National Cancer Institute, Rome, Italy
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3
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Giorgi Rossi P, Carozzi F, Ronco G, Allia E, Bisanzi S, Gillio-Tos A, De Marco L, Rizzolo R, Gustinucci D, Del Mistro A, Frayle H, Confortini M, Iossa A, Cesarini E, Bulletti S, Passamonti B, Gori S, Toniolo L, Barca A, Bonvicini L, Mancuso P, Venturelli F, Benevolo M. p16/ki67 and E6/E7 mRNA Accuracy and Prognostic Value in Triaging HPV DNA-Positive Women. J Natl Cancer Inst 2021; 113:292-300. [PMID: 32745170 PMCID: PMC7936054 DOI: 10.1093/jnci/djaa105] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 06/12/2020] [Accepted: 07/23/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The study presents cross-sectional accuracy of E6 and E7 (E6/E7) mRNA detection and p16/ki67 dual staining, alone or in combination with cytology and human papillomavirus (HPV)16/18 genotyping, as a triage test in HPV DNA-positive women and their impact on cervical intraepithelial neoplasia (CIN2+) overdiagnosis. METHODS Women aged 25-64 years were recruited. HPV DNA-positive women were triaged with cytology and tested for E6/E7 mRNA and p16/ki67. Cytology positive women were referred to colposcopy, and negatives were randomly assigned to immediate colposcopy or to 1-year HPV retesting. Lesions found within 24 months since recruitment were included. All P values were 2-sided. RESULTS 40 509 women were recruited, and 3147 (7.8%) tested HPV DNA positive; 174 CIN2+ were found: sensitivity was 61.0% (95% confidence interval [CI] = 53.6 to 68.0), 94.4% (95% CI = 89.1 to 97.3), and 75.2% (95% CI = 68.1 to 81.6) for cytology, E6/E7 mRNA, and p16/ki67, respectively. Immediate referral was 25.6%, 66.8%, and 28.3%, respectively. Overall referral was 65.3%, 78.3%, and 63.3%, respectively. Cytology or p16/ki67, when combined with HPV16/18 typing, reached higher sensitivity with a small impact on referral. Among the 2306 HPV DNA-positive and cytology-negative women, relative CIN2+ detection in those randomly assigned at 1-year retesting vs immediate colposcopy suggests a -28% CIN2+ regression (95% CI = -57% to +20%); regression was higher in E6/E7 mRNA-negatives (Pinteraction = .29). HPV clearance at 1 year in E6/E7 mRNA and in p16/ki67 negative women was about 2 times higher than in positive women (Pinteraction < .001 for both). CONCLUSIONS p16/ki67 showed good performance as a triage test. E6/E7 mRNA showed the highest sensitivity, at the price of too high a positivity rate to be efficient for triage. However, when negative, it showed a good prognostic value for clearance and CIN2+ regression.
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Affiliation(s)
- Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Carozzi
- ISPRO Oncological Network, Prevention and Research Institute, Regional Laboratory of Cancer Prevention Unit, Florence, Italy
| | - Guglielmo Ronco
- International Agency for Research on Cancer, Lyon, France
- Unit of Cancer Epidemiology and Center for Cancer Prevention (CPO), City of Health and Science Hospital, Turin, Italy
| | - Elena Allia
- Center for Cervical Cancer Screening, City of Health and Science Hospital, Turin, Italy
| | - Simonetta Bisanzi
- ISPRO Oncological Network, Prevention and Research Institute, Regional Laboratory of Cancer Prevention Unit, Florence, Italy
| | - Anna Gillio-Tos
- Unit of Cancer Epidemiology and Center for Cancer Prevention (CPO), City of Health and Science Hospital, Turin, Italy
| | - Laura De Marco
- Center for Cervical Cancer Screening, City of Health and Science Hospital, Turin, Italy
- Unit of Cancer Epidemiology and Center for Cancer Prevention (CPO), City of Health and Science Hospital, Turin, Italy
| | - Raffaella Rizzolo
- Unit of Cancer Epidemiology and Center for Cancer Prevention (CPO), City of Health and Science Hospital, Turin, Italy
| | - Daniela Gustinucci
- Laboratorio Unico di Screening, Unità Sanitaria Locale Umbria1, Perugia, Italy
| | | | | | - Massimo Confortini
- ISPRO Oncological Network, Prevention and Research Institute, Regional Laboratory of Cancer Prevention Unit, Florence, Italy
| | - Anna Iossa
- ISPRO Oncological Network, Prevention and Research Institute, Screening Unit, Florence, Italy
| | - Elena Cesarini
- Laboratorio Unico di Screening, Unità Sanitaria Locale Umbria1, Perugia, Italy
| | - Simonetta Bulletti
- Laboratorio Unico di Screening, Unità Sanitaria Locale Umbria1, Perugia, Italy
| | - Basilio Passamonti
- Laboratorio Unico di Screening, Unità Sanitaria Locale Umbria1, Perugia, Italy
| | - Silvia Gori
- Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Laura Toniolo
- Azienda Unità Locale Socio Sanitaria 6, Este, Padua, Italy
| | | | - Laura Bonvicini
- Epidemiology Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pamela Mancuso
- Epidemiology Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Venturelli
- Epidemiology Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Benevolo
- IRCCS-Regina Elena National Cancer Institute, Rome, Italy
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Inturrisi F, Lissenberg‐Witte BI, Veldhuijzen NJ, Bogaards JA, Ronco G, Meijer CJLM, Berkhof J. Estimating the direct effect of human papillomavirus vaccination on the lifetime risk of screen-detected cervical precancer. Int J Cancer 2021; 148:320-328. [PMID: 32663316 PMCID: PMC7754437 DOI: 10.1002/ijc.33207] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 11/15/2019] [Revised: 06/17/2020] [Accepted: 06/29/2020] [Indexed: 01/26/2023]
Abstract
Birth cohorts vaccinated against human papillomavirus (HPV) are now entering cervical cancer screening. Assessment of (pre)cancer (CIN3+) risk is needed to assess the residual screening need in vaccinated women. We estimated the lifetime (screen-detected) CIN3+ risk under five-yearly primary HPV screening between age 30 and 60, using HPV genotyping and histology data of 21,287 women participating in a screening trial with two HPV-based screening rounds, 5 years apart. The maximum follow-up after an HPV-positive test was 9 years. We re-estimated the CIN3+ risk after projecting direct vaccine efficacy for the bivalent and the nonavalent HPV vaccines, assuming life-long protection. The lifetime CIN3+ risk was 4.1% (95% confidence interval 3.5-4.9) and declined by 53.5% and 70.5% after bivalent vaccination without and with cross-protection, respectively, translating into a residual lifetime CIN3+ risk of 1.9% (1.4-2.4) and 1.2% (0.9-1.5). The CIN3+ risk declined by 88.5% after nonavalent vaccination, translating into a residual lifetime CIN3+ risk of 0.5% (0.2-0.7). The latter risk increased to 1.6% when vaccine protection only lasted until the first screening round at age 30. Among HPV-positive women with abnormal adjunct cytology, the nine-year CIN3+ risk was 16.9% (8.7-32.4) after nonavalent vaccination. In conclusion, HPV vaccination will lead to a strong decline in the lifetime CIN3+ risk and the remaining absolute CIN3+ risk will be very low. Primary HPV testing combined with adjunct cytology at five-year intervals still seems feasible even after nonavalent vaccination, although unlikely to be cost-effective. Our results support a de-intensification of screening programs in settings with high vaccination coverage.
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Affiliation(s)
- Federica Inturrisi
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam Public HealthAmsterdamThe Netherlands
| | - Birgit I. Lissenberg‐Witte
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam Public HealthAmsterdamThe Netherlands
| | - Nienke J. Veldhuijzen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam Public HealthAmsterdamThe Netherlands
- The Leprosy Research InitiativeAmsterdamThe Netherlands
| | - Johannes A. Bogaards
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam Public HealthAmsterdamThe Netherlands
- Centre for Infectious Disease ControlNational Institute for Public Health and the EnvironmentBilthovenThe Netherlands
| | | | - Chris J. L. M. Meijer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center AmsterdamAmsterdamThe Netherlands
| | - Johannes Berkhof
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam Public HealthAmsterdamThe Netherlands
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Cuzick J, Adcock R, Carozzi F, Gillio-Tos A, De Marco L, Del Mistro A, Frayle H, Girlando S, Sani C, Confortini M, Zorzi M, Giorgi-Rossi P, Rizzolo R, Ronco G. Combined use of cytology, p16 immunostaining and genotyping for triage of women positive for high-risk human papillomavirus at primary screening. Int J Cancer 2020; 147:1864-1873. [PMID: 32170961 DOI: 10.1002/ijc.32973] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/07/2020] [Accepted: 02/28/2020] [Indexed: 12/22/2022]
Abstract
Human papillomavirus (HPV) testing is very sensitive for primary cervical screening but has low specificity. Triage tests that improve specificity but maintain high sensitivity are needed. Women enrolled in the experimental arm of Phase 2 of the New Technologies for Cervical Cancer randomized controlled cervical screening trial were tested for high-risk HPV (hrHPV) and referred to colposcopy if positive. hrHPV-positive women also had HPV genotyping (by polymerase chain reaction with GP5+/GP6+ primers and reverse line blotting), immunostaining for p16 overexpression and cytology. We computed sensitivity, specificity and positive predictive value (PPV) for different combinations of tests and determined potential hierarchical ordering of triage tests. A number of 1,091 HPV-positive women had valid tests for cytology, p16 and genotyping. Ninety-two of them had cervical intraepithelial neoplasia grade 2+ (CIN2+) histology and 40 of them had CIN grade 3+ (CIN3+) histology. The PPV for CIN2+ was >10% in hrHPV-positive women with positive high-grade squamous intraepithelial lesion (61.3%), positive low-grade squamous intraepithelial lesion (LSIL+) (18.3%) and positive atypical squamous cells of undetermined significance (14.8%) cytology, p16 positive (16.7%) and, hierarchically, for infections by HPV33, 16, 35, 59, 31 and 52 (in decreasing order). Referral of women positive for either p16 or LSIL+ cytology had 97.8% sensitivity for CIN2+ and women negative for both of these had a 3-year CIN3+ risk of 0.2%. Similar results were seen for women being either p16 or HPV16/33 positive. hrHPV-positive women who were negative for p16 and cytology (LSIL threshold) had a very low CIN3+ rate in the following 3 years. Recalling them after that interval and referring those positive for either test to immediate colposcopy seem to be an efficient triage strategy. The same applies to p16 and HPV16.
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Affiliation(s)
- Jack Cuzick
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Rachael Adcock
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Francesca Carozzi
- Regional Cancer Prevention Laboratory, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Anna Gillio-Tos
- Cancer Epidemiology Unit, Department of Medical Sciences, C.E.R.M.S, University of Turin, Turin, Italy
| | - Laura De Marco
- Cancer Epidemiology Unit, Department of Medical Sciences, C.E.R.M.S, University of Turin, Turin, Italy
| | - Annarosa Del Mistro
- Immunology and Diagnostic Molecular Oncology Unit, Veneto Institute of Oncology IOV IRCCS, Padua, Italy
| | - Helena Frayle
- Immunology and Diagnostic Molecular Oncology Unit, Veneto Institute of Oncology IOV IRCCS, Padua, Italy
| | | | - Cristina Sani
- Regional Cancer Prevention Laboratory, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Massimo Confortini
- Regional Cancer Prevention Laboratory, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Manuel Zorzi
- Veneto Tumour Registry, Azienda Zero, Padua, Italy
| | - Paolo Giorgi-Rossi
- Epidemiology Unit, Azienda USL, IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Raffaella Rizzolo
- Centre for Cancer Prevention, AOU Città della Salute e della Scienza, Torino, Italy
| | - Guglielmo Ronco
- Centre for Cancer Prevention, AOU Città della Salute e della Scienza, Torino, Italy
- International Agency for Research on Cancer (IARC), Lyon, France
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Ponti A, Basu P, Ritchie D, Anttila A, Carvalho AL, Senore C, Mallafré-Larrosa M, Piccinelli C, Ronco G, Soerjomataram I, Primic-Žakelj M, Dillner J, Elfström MK, Lönnberg S, Vale DB, Tomatis M, Armaroli P, Giordano L, Sankaranarayanan R, Segnan N. Key issues that need to be considered while revising the current annex of the European Council Recommendation (2003) on cancer screening. Int J Cancer 2020; 147:9-13. [PMID: 31970768 DOI: 10.1002/ijc.32885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Received: 10/03/2019] [Revised: 11/26/2019] [Accepted: 01/09/2020] [Indexed: 01/09/2023]
Abstract
The 2003 European Council recommendation urging the Member States to introduce or scale up breast, cervical and colorectal cancer screening through an organized population-based approach has had a remarkable impact. We argue that the recommendation needs to be updated for at least two sets of reasons. First, some of the current clinical guidelines include new tests or protocols that were not available at the time of the Council document. Some have already been adopted by organized screening programs, such as newly defined age ranges for mammography screening, Human Papillomavirus (HPV)-based cervical cancer screening, fecal immunochemical test (FIT) and sigmoidoscopy for colorectal cancer screening. Second, the outcomes of randomized trials evaluating screening for lung and prostate cancer have been published recently and the balance between harms and benefits needs to be pragmatically assessed. In the European Union, research collaboration and networking to exchange and develop best practices should be regularly supported by the European Commission. Integration between primary and secondary preventive strategies through comprehensive approaches is necessary not only to maximize the reduction in cancer burden but also to control the rising trend of other noncommunicable diseases sharing the same risk factors.
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Affiliation(s)
- Antonio Ponti
- CPO, University Hospital 'Città Della Salute e Della Scienza', Turin, Italy
| | - Partha Basu
- Screening Group, International Agency for Research on Cancer, Lyon, France
| | - David Ritchie
- Association of European Cancer Leagues, Brussels, Belgium
| | - Ahti Anttila
- Mass Screening Registry/Finnish Cancer Registry, Helsinki, Finland
| | - Andre L Carvalho
- Screening Group, International Agency for Research on Cancer, Lyon, France
| | - Carlo Senore
- CPO, University Hospital 'Città Della Salute e Della Scienza', Turin, Italy
| | | | | | - Guglielmo Ronco
- CPO, University Hospital 'Città Della Salute e Della Scienza', Turin, Italy
- Infections and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | | | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Pathology/Cytology, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
| | | | - Stefan Lönnberg
- Mass Screening Registry/Finnish Cancer Registry, Helsinki, Finland
| | - Diama B Vale
- Departamento de Tocoginecologia, Divisão de Oncologia, Universidade Estadual de Campinas, Brazil
| | - Mariano Tomatis
- CPO, University Hospital 'Città Della Salute e Della Scienza', Turin, Italy
| | - Paola Armaroli
- CPO, University Hospital 'Città Della Salute e Della Scienza', Turin, Italy
| | - Livia Giordano
- CPO, University Hospital 'Città Della Salute e Della Scienza', Turin, Italy
| | | | - Nereo Segnan
- CPO, University Hospital 'Città Della Salute e Della Scienza', Turin, Italy
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7
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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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8
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Vale DB, Anttila A, Ponti A, Senore C, Sankaranaryanan R, Ronco G, Segnan N, Tomatis M, Žakelj MP, Elfström KM, Lönnberg S, Dillner J, Basu P. Response to the author: invitation to cancer screening: putting the car before the horse? Eur J Cancer Prev 2019; 28:458-459. [PMID: 31385844 DOI: 10.1097/cej.0000000000000474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Diama B Vale
- Departamento de Tocoginecologia, Divisão de Oncologia, Universidade Estadual de Campinas, Brazil
| | | | - Antonio Ponti
- CPO Piemonte and University Hospital 'Cittàdella Salute e dellaScienza', Turin, Italy
| | - Carlo Senore
- CPO Piemonte and University Hospital 'Cittàdella Salute e dellaScienza', Turin, Italy
| | | | - Guglielmo Ronco
- CPO Piemonte and University Hospital 'Cittàdella Salute e dellaScienza', Turin, Italy
| | - Nereo Segnan
- CPO Piemonte and University Hospital 'Cittàdella Salute e dellaScienza', Turin, Italy
| | - Mariano Tomatis
- CPO Piemonte and University Hospital 'Cittàdella Salute e dellaScienza', Turin, Italy
| | - Maja P Žakelj
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | - Stefan Lönnberg
- Cancer Registry of Norway, Oslo, Norway, Finnish Cancer Registry, Helsinki, Finland
| | | | - Partha Basu
- International Agency for Research on Cancer, Lyon, France
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9
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Ponti A, Ronco G, Lynge E, Tomatis M, Anttila A, Ascunce N, Broeders M, Bulliard JL, Castellano I, Fitzpatrick P, Frigerio A, Hofvind S, Májek O, Segnan N, Taplin S. Low-grade screen-detected ductal carcinoma in situ progresses more slowly than high-grade lesions: evidence from an international multi-centre study. Breast Cancer Res Treat 2019; 177:761-765. [PMID: 31250357 DOI: 10.1007/s10549-019-05333-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 05/08/2019] [Accepted: 06/18/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE Nuclear grade is an important indicator of the biological behaviour of ductal carcinoma in situ (DCIS). De-escalation of treatment has been suggested for low-grade DCIS. Our aim is to estimate the relative rate of progression of DCIS by nuclear grade by analysing the distribution of nuclear grade by detection at initial or subsequent screening. METHODS We asked International Cancer Screening Network sites to complete, based on their screening and clinical databases, an aggregated data file on DCIS detection, diagnosis and treatment. RESULTS Eleven screening programs reported 5068 screen-detected pure DCIS in nearly 7 million screening tests in women 50-69 years of age. For all programs combined, low-grade DCIS were 20.1% (range 11.4-31.8%) of graded DCIS, intermediate grade 31.0% and high grade 48.9%. Detection rates decreased more steeply from initial to subsequent screening in low compared to high-grade DCIS: the ratios of subsequent to initial detection rates were 0.39 for low grade, 0.51 for intermediate grade, and 0.75 for high grade (p < 0.001). CONCLUSIONS These results suggest that the duration of the preclinical detectable phase is longer for low than for high-grade DCIS. The findings from this large multi-centre, international study emphasize that the management of low-grade DCIS should be carefully scrutinized in order to minimize overtreatment of screen-detected slow-growing or indolent lesions. The high variation by site in the proportion of low grade suggests that further pathology standardization and training would be beneficial.
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Affiliation(s)
- Antonio Ponti
- CPO Piemonte, AOU Città della Salute e della Scienza, Via Cavour 31, 10123, Torino, Italy.
| | - Guglielmo Ronco
- CPO Piemonte, AOU Città della Salute e della Scienza, Via Cavour 31, 10123, Torino, Italy
| | - Elsebeth Lynge
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mariano Tomatis
- CPO Piemonte, AOU Città della Salute e della Scienza, Via Cavour 31, 10123, Torino, Italy
| | - Ahti Anttila
- Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland
| | - Nieves Ascunce
- Breast Cancer Screening Program, Public Health and Labour Institute of Navarra, Pamplona, Spain
| | - Mireille Broeders
- Dutch Expert Centre for Screening and Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jean-Luc Bulliard
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Isabella Castellano
- Unit of Pathology, Department of Medical Sciences, University of Torino, Torino, Italy
| | | | - Alfonso Frigerio
- Breast Cancer Screening Reference Centre, AOU Città della Salute e della Scienza, Torino, Italy
| | | | - Ondřej Májek
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Nereo Segnan
- CPO Piemonte, AOU Città della Salute e della Scienza, Via Cavour 31, 10123, Torino, Italy
| | - Stephen Taplin
- Centre for Global Health, National Cancer Institute, Rockville, MD, USA
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10
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Vale DB, Anttila A, Ponti A, Senore C, Sankaranaryanan R, Ronco G, Segnan N, Tomatis M, Žakelj MP, Elfström KM, Lönnberg S, Dillner J, Basu P. Invitation strategies and coverage in the population-based cancer screening programmes in the European Union. Eur J Cancer Prev 2019; 28:131-140. [PMID: 29570103 DOI: 10.1097/cej.0000000000000426] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The aim of this study was to describe the compliance of the population-based cancer screening programmes in the European Union Member States to the invitation strategies enumerated in the European Guidelines and the impact of such strategies on the invitational coverage. Experts in screening programme monitoring from the respective countries provided data. Coverage by invitation was calculated as the proportion of individuals in the target age range receiving a screening invitation over the total number of annualized eligible population. The invitation strategies of 30 breasts, 25 cervical and 27 colorectal national or regional population-based screening programmes are described. Individual mail invitations are sent by 28 breasts, 20 cervical and 25 colorectal screening programmes. Faecal occult blood test kits are sent by post in 17 of the colorectal cancer screening programmes. The majority of programmes claimed to have a population registry, although some use health insurance data as the database for sending invitations. At least 95% invitation coverage was reached by 16 breast, six cervical and five colorectal screening programmes. Majority of the programmes comply with the invitation strategies enumerated in the European guidelines, although there is still scope for improvements. Coverage by invitation is below the desirable level in many population-based cancer screening programmes in European Union.
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Affiliation(s)
- Diama B Vale
- Department of Obstetrics and Gynecology, State University of Campinas (Unicamp), Campinas, Brazil
| | | | - Antonio Ponti
- CPO Piemonte and University Hospital 'Cittàdella Salute e dellaScienza', Turin, Italy
| | - Carlo Senore
- CPO Piemonte and University Hospital 'Cittàdella Salute e dellaScienza', Turin, Italy
| | | | - Guglielmo Ronco
- CPO Piemonte and University Hospital 'Cittàdella Salute e dellaScienza', Turin, Italy
| | - Nereo Segnan
- CPO Piemonte and University Hospital 'Cittàdella Salute e dellaScienza', Turin, Italy
| | - Mariano Tomatis
- CPO Piemonte and University Hospital 'Cittàdella Salute e dellaScienza', Turin, Italy
| | - Maja P Žakelj
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | - Stefan Lönnberg
- Finnish Cancer Registry, Helsinki, Finland
- Cancer Registry of Norway, Oslo, Norway
| | | | - Partha Basu
- Screening Group, International Agency for Research on Cancer, Lyon, France
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11
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Basu P, Ponti A, Anttila A, Ronco G, Senore C, Vale DB, Segnan N, Tomatis M, Soerjomataram I, Žakelj MP, Dillner J, Elfström KM, Lönnberg S, Sankaranarayanan R. Author's reply to: Implementation and organization of cancer screening in France. Int J Cancer 2018; 143:3035. [PMID: 29943811 DOI: 10.1002/ijc.31629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 05/17/2018] [Accepted: 05/17/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Partha Basu
- Screening Group, International Agency for Research on Cancer, Lyon, France
| | - Antonio Ponti
- CPO Piemonte and University Hospital "Città della Salute e della Scienza", Turin, Italy
| | - Ahti Anttila
- Mass Screening Registry/Finnish Cancer Registry, Helsinki, Finland
| | - Guglielmo Ronco
- CPO Piemonte and University Hospital "Città della Salute e della Scienza", Turin, Italy
| | - Carlo Senore
- CPO Piemonte and University Hospital "Città della Salute e della Scienza", Turin, Italy
| | - Diama Bhadra Vale
- Departamento de Tocoginecologia, Divisão de Oncologia, Universidade Estadual de Campinas, Brazil
| | - Nereo Segnan
- CPO Piemonte and University Hospital "Città della Salute e della Scienza", Turin, Italy
| | - Mariano Tomatis
- CPO Piemonte and University Hospital "Città della Salute e della Scienza", Turin, Italy
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | | | | | | | - Stefan Lönnberg
- Cancer Registry of Norway, Oslo, Norway
- Finnish Cancer Registry, Helsinki, Finland
| | - Rengaswamy Sankaranarayanan
- Research Triangle Institute, International-India, Commercial Tower, Pullman Hotel Aerocity, New Delhi, India
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12
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Baussano I, Lazzarato F, Ronco G, Franceschi S. Impacts of human papillomavirus vaccination for different populations: A modeling study. Int J Cancer 2018; 143:1086-1092. [PMID: 29603224 PMCID: PMC6099330 DOI: 10.1002/ijc.31409] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 11/16/2017] [Revised: 03/13/2018] [Accepted: 03/21/2018] [Indexed: 12/31/2022]
Abstract
International variations in the prevalence of HPV infection derive from differences in sexual behaviors, which are also a key factor of the basic reproductive number (R0 ) of HPV infection in different populations. R0 affects the strength of herd protection and hence the impact of a vaccination program. Similar vaccination programs may therefore generate different levels of impact depending upon the population's pre-vaccination HPV prevalence. We used IARC's transmission model to estimate (i) the overall effectiveness of vaccination versus no vaccination in women aged 15-34 years measured as percent prevalence reduction (%PR) of HPV16 and (ii) the corresponding herd protection in populations with gender-equal or traditional sexual behavior and with different levels of sexual activity, corresponding to pre-vaccination HPV16 prevalence from 1 to 8% as observed worldwide. Between populations with different levels of gender-equal sexual activity, the highest difference in %PR under girls-only vaccination is observed at 40% coverage (91%PR vs. 48%PR for 1% and 8% pre-vaccination prevalence, respectively). HPV16 elimination is obtained with 55 and 97% coverage, respectively. To achieve desirable levels of HPV16 prevalence after vaccination, different levels of coverage are required in populations with different levels of pre-vaccination HPV16 prevalence, for example, in populations with gender-equal sexual behavior a decrease to 1/1000 HPV16 from pre-vaccination prevalence of 1 and 8% would require coverages of 37 and 96%, respectively. In traditional populations, corresponding coverages would need to be 28 and 93%, respectively. In conclusion, pre-vaccination HPV prevalence strongly influences herd immunity and helps predict the overall effectiveness of HPV vaccination.
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Affiliation(s)
| | - Fulvio Lazzarato
- International Agency for Research on CancerLyonFrance
- Unit of Cancer Epidemiology, AOU Città della Salute e della Scienza, Hospital of TurinTurinItaly
| | - Guglielmo Ronco
- Department of Cancer ScreeningCentre for Epidemiology and Prevention in OncologyTurinItaly
| | - Silvia Franceschi
- Cancer Epidemiology Unit, Aviano National Cancer Institute IRCCSAvianoItaly
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13
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Cuschieri K, Ronco G, Lorincz A, Smith L, Ogilvie G, Mirabello L, Carozzi F, Cubie H, Wentzensen N, Snijders P, Arbyn M, Monsonego J, Franceschi S. Eurogin roadmap 2017: Triage strategies for the management of HPV-positive women in cervical screening programs. Int J Cancer 2018; 143:735-745. [PMID: 29341110 DOI: 10.1002/ijc.31261] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [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] [Received: 11/07/2017] [Revised: 12/20/2017] [Accepted: 01/03/2018] [Indexed: 01/04/2023]
Abstract
Cervical cancer screening will rely, increasingly, on HPV testing as a primary screen. The requirement for triage tests which can delineate clinically significant infection is thus prescient. In this EUROGIN 2017 roadmap, justification behind the most evidenced triages is outlined, as are challenges for implementation. Cytology is the triage with the most follow-up data; the existence of an HR-HPV-positive, cytology-negative group presents a challenge and retesting intervals for this group (and choice of retest) require careful consideration. Furthermore, cytology relies on subjective skills and while adjunctive dual-staining with p16/Ki67 can mitigate inter-operator/-site disparities, clinician-taken samples are required. Comparatively, genotyping and methylation markers are objective and are applicable to self-taken samples, offering logistical advantages including in low and middle income settings. However, genotyping may have diminishing returns in immunised populations and type(s) included must balance absolute risk for disease to avoid low specificity. While viral and cellular methylation markers show promise, more prospective data are needed in addition to refinements in automation. Looking forward, systems that detect multiple targets concurrently such as next generation sequencing platforms will inform the development of triage tools. Additionally, multistep triage strategies may be beneficial provided they do not create complex, unmanageable pathways. Inevitably, the balance of risk to cost(s) will be key in decision making, although defining an acceptable risk will likely differ between settings. Finally, given the significant changes to cervical screening and the variety of triage strategies, appropriate education of both health care providers and the public is essential.
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Affiliation(s)
- Kate Cuschieri
- Scottish HPV Reference Laboratory, Department of Laboratory Medicine, NHS Lothian, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, United Kingdom
| | - Guglielmo Ronco
- Centre for Cancer Prevention (CPO), AOU Città della Salute e della Scienza via Cavour 39, Torino, 10123, Italy
| | - Attila Lorincz
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, United Kingdom
| | - Laurie Smith
- University of British Columbia and BC Women's Hospital and Health Centre, 4500 Oak Street, Vancouver, British Columbia, V6H 3N1, Canada
| | - Gina Ogilvie
- Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Lisa Mirabello
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Francesca Carozzi
- Cancer Prevention Regional Laboratory, ISPO, Cancer Prevention and Research Institute, Florence, Italy
| | - Heather Cubie
- Global Health Academy, University of Edinburgh, Teviot Quad, Edinburgh, EH8 9PG, United Kingdom
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Peter Snijders
- Department of Pathology, VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium
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14
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Basu P, Ponti A, Anttila A, Ronco G, Senore C, Vale DB, Segnan N, Tomatis M, Soerjomataram I, Primic Žakelj M, Dillner J, Elfström KM, Lönnberg S, Sankaranarayanan R. Author's reply to: Cancer screening policy in Hungary. Int J Cancer 2018; 143:1005. [PMID: 29524204 DOI: 10.1002/ijc.31371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/21/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Partha Basu
- Screening Group, International Agency for Research on Cancer, Lyon, France
| | - Antonio Ponti
- CPO Piemonte and University Hospital "Città della Salute e della Scienza,", Turin, Italy
| | - Ahti Anttila
- Mass Screening Registry/Finnish Cancer Registry, Helsinki, Finland
| | - Guglielmo Ronco
- CPO Piemonte and University Hospital "Città della Salute e della Scienza,", Turin, Italy
| | - Carlo Senore
- CPO Piemonte and University Hospital "Città della Salute e della Scienza,", Turin, Italy
| | - Diama Bhadra Vale
- Departamento de Tocoginecologia, Divisão de Oncologia, Universidade Estadual de Campinas, Brazil
| | - Nereo Segnan
- CPO Piemonte and University Hospital "Città della Salute e della Scienza,", Turin, Italy
| | - Mariano Tomatis
- CPO Piemonte and University Hospital "Città della Salute e della Scienza,", Turin, Italy
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | | | | | | | - Stefan Lönnberg
- Cancer Registry of Norway, Oslo, Norway; Finnish Cancer Registry, Helsinki, Finland
| | - Rengaswamy Sankaranarayanan
- Research Triangle Institute, International-India, Commercial Tower, Pullman Hotel Aerocity, New Delhi, India
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15
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Del Mistro A, Adcock R, Carozzi F, Gillio‐Tos A, De Marco L, Girlando S, Rizzolo R, Frayle H, Trevisan M, Sani C, Burroni E, Giorgi Rossi P, Cuzick J, Ronco G. Human papilloma virus genotyping for the cross-sectional and longitudinal probability of developing cervical intraepithelial neoplasia grade 2 or more. Int J Cancer 2018; 143:333-342. [PMID: 29453769 PMCID: PMC6099271 DOI: 10.1002/ijc.31326] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 09/11/2017] [Revised: 01/16/2018] [Accepted: 02/06/2018] [Indexed: 11/07/2022]
Abstract
Human papilloma virus (HPV) testing is more sensitive but less specific than cytology. We evaluated stand-alone genotyping as a possible triage method. During a multicentre randomised controlled trial comparing HPV testing to conventional cytology, HPV-positive women were referred to colposcopy and followed up if no high-grade lesion was detected. HPV-positive samples were genotyped by GP5+/GP6+ primed polymerase chain reaction followed by reverse line blot. Genotypes were hierarchically ordered by positive predictive value (PPV) for CIN grade 2 or more (CIN2+), and grouped by cluster analysis into three groups (A, B and C in decreasing order). Receiver operating characteristic curves were computed. Among 2,255 HPV-positive women with genotyping, 239 CIN2+ (including 113 CIN3+) were detected at baseline or during a 3-year follow-up. HPV33 had the highest PPV with CIN2+ and CIN3+ as the endpoint and when considering lesions detected at baseline or also during follow-up. HPV16 and HPV35 were the second and third, respectively. Cross-sectional sensitivity for CIN2+ at baseline was 67.3% (95% CI 59.7-74.2), 91.8% (95% CI 86.6-95.5) and 94.7% (95% CI 90.2-97.6), respectively, when considering as "positive" any of the HPV types in group A (33, 16 and 35), A or B (31, 52, 18, 59 and 58) and A or B or C (39, 51, 56, 45 and 68). The corresponding cross-sectional PPVs for CIN2+ were 15.8% 95% (CI 13.2-18.7), 12.0% (95% CI 10.3-13.9) and 9.6% (95% CI 8.2-11.1), respectively. HPV33, 16 and 35 confer a high probability of CIN2+ but this rapidly decreases when adding other genotypes.
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Affiliation(s)
| | - Rachael Adcock
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of LondonLondonUK
| | | | | | | | | | | | | | | | - Cristina Sani
- Institute for Cancer Study and Prevention (ISPO)FlorenceItaly
| | - Elena Burroni
- Institute for Cancer Study and Prevention (ISPO)FlorenceItaly
| | | | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of LondonLondonUK
| | - Guglielmo Ronco
- Center for Cancer Epidemiology and Prevention (CPO)TurinItaly
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Pardini B, De Maria D, Francavilla A, Di Gaetano C, Ronco G, Naccarati A. MicroRNAs as markers of progression in cervical cancer: a systematic review. BMC Cancer 2018; 18:696. [PMID: 29945565 PMCID: PMC6020348 DOI: 10.1186/s12885-018-4590-4] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [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: 08/08/2017] [Accepted: 06/13/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Invasive cervical cancer (ICC) is caused by high-risk human papillomavirus types (HR-HPVs) and is usually preceded by a long phase of intraepithelial neoplasia (CIN). Before invasion, (epi) genetic changes, potentially applicable as molecular markers within cervical screening, occur in HPV host cells. Epigenetic alterations, such as dysregulation of microRNA (miRNA) expression, are frequently observed in ICC. The mechanisms and role of miRNA dysregulation in cervical carcinogenesis are still largely unknown. METHODS We provide an overview of the studies investigating miRNA expression in relation to ICC progression, highlighting their common outcomes and their weaknesses/strengths. To achieve this, we systematically searched through Pubmed database all articles between January 2010 and December 2017. RESULTS From the 24 studies retrieved, miR-29a and miR-21 are the most frequently down- and up-regulated in ICC progression, respectively. Microarray-based studies show a small overlap, with miR-10a, miR-20b, miR-9, miR-16 and miR-106 found repeatedly dysregulated. miR-34a, miR-125 and miR-375 were also found dysregulated in cervical exfoliated cells in relation to cancer progression. CONCLUSIONS The pivotal role of miRNAs in ICC progression and initial development is becoming more and more relevant. Available studies are essentially based on convenience material, entailing possible selection bias, and frequently of small size: all these points still represent a limitation to a wide comprehension of miRNAs relevant for ICC. The targeted approach instead of a genome-wide investigation still precludes the identification of all the relevant miRNAs in the process. The implementation of deep sequencing on large scale population-based studies will help to discover and validate the relation between altered miRNA expression and CC progression for the identification of biomarkers. Optimally, once explored on a miRNome scale, small specific miRNA signatures maybe used in the context of screening.
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Affiliation(s)
- Barbara Pardini
- Italian Institute for Genomic Medicine (IIGM), Via Nizza 52, 10126, Turin, Italy.,Department of Medical Sciences, University of Turin, Via Santena 19, 10126, Turin, Italy
| | - Daniela De Maria
- Italian Institute for Genomic Medicine (IIGM), Via Nizza 52, 10126, Turin, Italy
| | - Antonio Francavilla
- Italian Institute for Genomic Medicine (IIGM), Via Nizza 52, 10126, Turin, Italy
| | - Cornelia Di Gaetano
- Italian Institute for Genomic Medicine (IIGM), Via Nizza 52, 10126, Turin, Italy.,Department of Medical Sciences, University of Turin, Via Santena 19, 10126, Turin, Italy
| | - Guglielmo Ronco
- Center for Cancer Epidemiology and Prevention, AO City of Health and Science, Via Cavour, 31 10123, Turin, Italy
| | - Alessio Naccarati
- Italian Institute for Genomic Medicine (IIGM), Via Nizza 52, 10126, Turin, Italy.
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Di Stefano F, Giorgi Rossi P, Carozzi F, Ronco G, Cacciani L, Vecchi S, Naldoni C, Segnan N. [Implementation of DNA-HPV primary screening in Italian cervical cancer screening programmes. Results of the MIDDIR Project]. Epidemiol Prev 2018. [PMID: 28627153 DOI: 10.19191/ep17.2.p116.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES to obtain data on conversion paths to HPV testing as part of screening programmes and to harmonize the introduction of HPV testing in primary cervical cancer screening protocols of Italian programmes. DESIGN survey by questionnaire on strategies adopted by screening programmes for transition to primary HPV testing; systematic review of the literature; discussion among experts. SETTING AND PARTICIPANT S: managers of Italian Regions' cervical cancer screening programmes. MAIN OUTCOME MEASURES transition planning; activity volumes; modalities of centralization; criteria for dismissal; staff training; communication initiatives. RESULTS nine cervical screening programmes responded to the survey. Most of them chose to schedule a transition of a few years to allow for adjustment of the volume of activity in the passage from the three-year screening interval to the five-year one. To select women to be given precedence, 7 programmes use the age, starting from the oldest. The liquid base is the choice by far preferred both for HPV test and for Pap test. The reading of HPV test "born" already centralized, but a centralization process is in place also for cytology. CONCLUSIONS the survey on conversion strategies to primary HPV testing showed the opportunity to schedule a transition phase. For HPV test, cost, organization, and quality benefits of centralization are clear, thus the central organization should be preferred and managed immediately. Moreover, the need for a centralization of cytology is evident. The tariff scheme should be based on the whole process rather than on single performances. Dismissal strategies have to be tailored on peculiarities of single services, but some typologies can be outlined.
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Affiliation(s)
- Francesca Di Stefano
- Centro di riferimento per l'epidemiologia e la prevenzione oncologica in Piemonte, SC Epidemiologia, screening e registro tumori; CPO, AOU Città della salute e della scienza di Torino.
| | - Paolo Giorgi Rossi
- Servizio interaziendale di epidemiologia e comunicazione del rischio, AUSL Reggio Emilia e Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia
| | | | - Guglielmo Ronco
- Centro di riferimento per l'epidemiologia e la prevenzione oncologica in Piemonte, SC Epidemiologia, screening e registro tumori; CPO, AOU Città della salute e della scienza di Torino
| | - Laura Cacciani
- Dipartimento di epidemiologia del Servizio sanitario regionale del Lazio, Regione Lazio, Roma
| | - Simona Vecchi
- Dipartimento di epidemiologia del Servizio sanitario regionale del Lazio, Regione Lazio, Roma
| | - Carlo Naldoni
- Centro di riferimento e coordinamento screening in oncologia, Assessorato alle politiche per la salute, Regione Emilia-Romagna, Bologna
| | - Nereo Segnan
- Centro di riferimento per l'epidemiologia e la prevenzione oncologica in Piemonte, SC Epidemiologia, screening e registro tumori; CPO, AOU Città della salute e della scienza di Torino
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18
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Vineis P, Ronco G, Ciccone G, Vernero E, Troia B, D'Incalci T, Gogliani F. Prevention of Exposure of Young Children to Parental Tobacco Smoke: Effectiveness of an Educational Program. Tumori 2018; 79:183-6. [PMID: 8236500 DOI: 10.1177/030089169307900304] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Aims and Background We conducted a population-based trial to evaluate the efficacy of an intervention aimed at preventing exposure of young children to parental tobacco smoke. Methods Of the 1142 eligible couples (parents of newborn babies), 1015 were recruited; the intervention was offered to 402 and not to 613 families. Results A strong association was found between social class and smoking behavior, in particular smoking during meals at home. The intervention itself had limited effectiveness In decreasing the number of smokers. The effect was stronger in mothers and in higher social groups. Among the «white-collar» families belonging to the intervention group, the proportion of mothers who stopped smoking was 3 times higher than in the control group (not statistically significant). Conclusions Educational interventions against smoking should be planned taking into account the difference in efficacy according to social class.
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Affiliation(s)
- P Vineis
- Unit of Cancer Epidemiology, Ospedale Maggiore di S. Giovanni Battista, Torino, Italy
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19
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Segnan N, Senore C, Giordano L, Ponti A, Ronco G. Promoting Participation in a Population Screening Program for Breast and Cervical Cancer: A Randomized Trial of Different Invitation Strategies. Tumori 2018; 84:348-53. [PMID: 9678615 DOI: 10.1177/030089169808400307] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background Attendance level has been identified as a major determinant of cost-effectiveness of organized screening programs. We tested the effectiveness of 4 different invitation systems in the context of an organized population screening program for cervical and breast cancer. Methods Women eligible for invitation - 8385 for cervical and 8069 for breast cancer screening - listed in the rosters of 43 and 105 general practitioners (GP), respectively, who had accepted to collaborate in the program, were randomized to 4 invitation groups: Group A - letter signed by the GP, with a prefixed appointment; Group B - open-ended invitation, signed by the GP, prompting women to contact the screening center to arrange an appointment; Group C - letter (same as for group A), signed by the program coordinator, with a prefixed appointment; Group D - extended letter (highlighting the benefits of early cancer detection) signed by the GP, with a prefixed appointment. Assignment to the interventions was based on a randomized block design (block=GP). Results Assuming Group A as the reference, the overall compliance with cervical cancer screening was reduced by 39% in Group B (RR=0.61; 95% CI, 0.56-0.68) and by 14% in Group C (RR=0.86; 95% CI, 0.78-0.93); no difference was observed for Group D (RR=1.03; 95% CI, 0.95-1.1). The response pattern was similar for breast screening (Group B: RR=0.71; 95% CI, 0.65-0.76; Group C: RR=0.87; 95% CI, 0.81-0.94; Group D: RR=1.01; 95% CI, 0.94-1.08). Conclusions Personal invitation letters signed by the woman's GP, with preallocated appointments, induce a significant increase in compliance with screening. Efficiency can be ensured through the adoption of overbooking, provided that attendance levels are regularly monitored.
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Affiliation(s)
- N Segnan
- C.P.O. Piemonte, Dipartimento di Oncologia, Ospedale S. Giovanni AS, Azienda USLI, Torino, Italy
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20
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Abstract
We studied the practice of screening for breast and uterine cervix cancer in Torino where, currently, no kind of organized program exists and two projects of population screening programs, based on pap smear and mammography, have been developed. Fifty-two percent (95% confidence limits (C.L.): 47%-58%) of women 18-69 years old had had a pap test or colposcopy in the absence of symptoms during their lifetime. Among them 50% had had their last pap test within 18 months of the interview, 77% within 3 and 1/2 years, and only 14% was screened 5 and 1/2 years before or earlier. Thirty percent of never-screened women (95% C.L.: 25-35%) would not accept any of the proposed modalities for screening. Overall, 15% of women had had a mammography for screening purposes. Among women 50 to 59 years old, 23% (95% C.L.: 17-30%) had had at least one mammography for screening purposes in their lifetime, but only 18% (95% C.L.: 13-24%) had had at least 1 screening test at age 50 or after. Half of ever-screened women age 50-69 years had had the last mammography within 2 and 1/2 years. Among all respondents in the same age group this figure was 11% (95% C.L.: 7-15%). Forty-one percent of respondents reported to currently practice BSE (95% C.L.: 36-45%), but this proportion dropped to 10% in the age group 19-39 years and to 4% among women 40-69 years old when only those who had 10-13 examinations each year and judged their performance to be good were considered. Thirty-nine percent (95% C.L.: 34-44%) had had a physical examination of the breast performed by a medical doctor in the absence of symptoms within the last 18 months. Thirty-five percent (95% C.L.: 31-38%) of all women had never had a mammography, did not practice BSE, and had never consulted a physician for control in the absence of symptoms. Analysis by age, birth cohort, education, marital status and place of birth is presented.
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Affiliation(s)
- N Segnan
- Area di Epidemiologia USSL Torino I, Italy
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21
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Ronco G, Iossa A, Naldoni C, Pilutti S, Anghinoni E, Zappa M, Dalla Palma P, Ciatto S, Segnan N. A First Survey of Organized Cervical Cancer Screening Programs in Italy. Tumori 2018; 84:624-30. [PMID: 10080665 DOI: 10.1177/030089169808400602] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In Italy, where no national screening program for cervical cancer exists, organized programs have developed on a local basis. We performed the first survey of existing organized programs by mailing a standard questionnaire to a large network of possibly involved services. For the present survey, a program was defined as organized if personal invitations were sent. We identified 29 already active organized programs and 4 others in a starting phase. The target population of active programs included 2,074,820 women in the age range 25-64 years, corresponding to 13.5% of the Italian female population of the same age. The situation is rapidly evolving since many regional programs are being implemented. Most programs followed Italian and European recommendations as regards the age limits, interval between screening rounds, presence of a fail-safe system for women referred for colposcopy, presence of protocols for diagnostic workup and treatment, and presence of referral centers for such phases. However, many programs did not meet national guidelines as regards the size of laboratories interpreting smears, which were frequently small. Second-level referral centers also frequently had a very small activity. The average (weighted for size of the invited population) compliance to invitation and coverage (proportion of women with at least one test in the last 3 years) was 32.6% and 66.0%, respectively, therefore needing to be improved. Compliance to colposcopy (weighted for number of referred women) was 81.4%. We found a very high variability in the proportion of women referred for colposcopy that could only be partly explained by different referral protocols and could depend on different criteria of smear interpretation: the average (weighted for number of tested women) was 2.01%. A need for improvement in the process of evaluation and for homogenization of criteria of cytology interpretation was identified: work in this regard is on-going.
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Affiliation(s)
- G Ronco
- Department of Oncology, ASL TOI, Center for Cancer Epidemiology and Prevention (CPO), Regione Piemonte, Torino, Italy
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22
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Affiliation(s)
- Guglielmo Ronco
- From City of Health and Science, Turin, Italy, and International Agency for Research on Cancer, Lyon, France
| | - Silvia Franceschi
- From City of Health and Science, Turin, Italy, and International Agency for Research on Cancer, Lyon, France
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23
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Basu P, Ponti A, Anttila A, Ronco G, Senore C, Vale DB, Segnan N, Tomatis M, Soerjomataram I, Primic Žakelj M, Dillner J, Elfström KM, Lönnberg S, Sankaranarayanan R. Status of implementation and organization of cancer screening in The European Union Member States-Summary results from the second European screening report. Int J Cancer 2018; 142:44-56. [PMID: 28940326 DOI: 10.1002/ijc.31043] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [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] [Received: 06/28/2017] [Revised: 08/10/2017] [Accepted: 08/30/2017] [Indexed: 12/16/2022]
Abstract
The second report on the implementation status of cancer screening in European Union (EU) was published in 2017. The report described the implementation status, protocols and organization (updated till 2016) and invitation coverage (for index year 2013) of breast, cervical and colorectal cancer screening in the EU. Experts in screening programme monitoring (N = 80) from the EU Member States having access to requisite information in their respective countries provided data on breast, cervical and colorectal cancer screening through online questionnaires. Data was collected for screening performed in the framework of publicly mandated programmes only. Filled in questionnaires were received from 26 Member States for all three sites and from one Member State for breast cancer only. Substantial improvement in screening implementation using population-based approach was documented. Among the age-eligible women, 94.7% were residents of Member States implementing or planning population-based breast cancer screening in 2016, compared to 91.6% in 2007. The corresponding figures for cervical cancer screening were 72.3 and 51.3% in 2016 and 2007, respectively. Most significant improvement was documented for colorectal cancer screening with roll-out ongoing or completed in 17 Member States in 2016, compared to only five in 2007. So the access to population-based screening increased to 72.4% of the age-eligible populations in 2016 as opposed to only 42.6% in 2007. The invitation coverage was highly variable, ranging from 0.2-111% for breast cancer, 7.6-105% for cervical cancer and 1.8-127% for colorectal cancer in the target populations. In spite of the considerable progress, much work remains to be done to achieve optimal effectiveness. Continued monitoring, regular feedbacks and periodic reporting are needed to ensure the desired impacts of the programmes.
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Affiliation(s)
- Partha Basu
- Screening Group, International Agency for Research on Cancer, Lyon, France
| | - Antonio Ponti
- CPO Piemonte and University Hospital "Città della Salute e della Scienza", Turin, Italy
| | - Ahti Anttila
- Mass Screening Registry/Finnish Cancer Registry, Helsinki, Finland
| | - Guglielmo Ronco
- CPO Piemonte and University Hospital "Città della Salute e della Scienza", Turin, Italy
| | - Carlo Senore
- CPO Piemonte and University Hospital "Città della Salute e della Scienza", Turin, Italy
| | - Diama Bhadra Vale
- Departamento de Tocoginecologia, Divisão de Oncologia, Universidade Estadual de Campinas, Brazil
| | - Nereo Segnan
- CPO Piemonte and University Hospital "Città della Salute e della Scienza", Turin, Italy
| | - Mariano Tomatis
- CPO Piemonte and University Hospital "Città della Salute e della Scienza", Turin, Italy
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | | | | | | | - Stefan Lönnberg
- Cancer Registry of Norway, Oslo, Norway; Finnish Cancer Registry, Helsinki, Finland
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Ronco G, Giorgi Rossi P. Role of HPV DNA testing in modern gynaecological practice. Best Pract Res Clin Obstet Gynaecol 2017; 47:107-118. [PMID: 28918099 DOI: 10.1016/j.bpobgyn.2017.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 07/31/2017] [Accepted: 08/02/2017] [Indexed: 11/28/2022]
Abstract
The identification of some types of human papillomavirus (HPV) as necessary, but not sufficient, cause of cervical cancer has suggested the use of HPV testing in cervical cancer prevention. A large number of studies has provided evidence supporting its application (1) as primary screening test, (2) for triaging borderline cytology, (3) for follow-up after positive primary test but no abnormal histology and (4) as a test of cure. They also allowed a reasonably good definition of the appropriate policies and protocols, leading to the delivery of evidence-based guidelines resulting from a systematic review of the literature. In this chapter, we present a critical analysis of the recommendations of the main European and North American guidelines relative to industrialised countries.
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Affiliation(s)
- Guglielmo Ronco
- Centre for Epidemiology and Prevention in Oncology, (CPO), Città della Salute e della Scienza, Torino, Italy.
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25
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Gallo F, Caprioglio A, Castagno R, Ronco G, Segnan N, Giordano L. Inequalities in cervical cancer screening utilisation and results: A comparison between Italian natives and immigrants from disadvantaged countries. Health Policy 2017; 121:1072-1078. [PMID: 28843514 DOI: 10.1016/j.healthpol.2017.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 09/07/2016] [Revised: 01/04/2017] [Accepted: 08/03/2017] [Indexed: 11/28/2022]
Abstract
Cervical cancer screening underutilisation is documented among immigrants from poor countries and it is associated to an augmented risk for severe lesions. In a cohort of 1,410,364 Italian women and 200,491 immigrants from poor countries differences in screening participation and results were investigated. Participation rate was lower for immigrants than for Italians: 43.98% versus 48.59% (chi(1): p<0.001). This gap increased with age (ptrend<0.0001). Some socio-demographic factors negatively influenced immigrants' participation. Illiteracy (OR=0.75) versus secondary school, being single (OR=0.71) versus attached, first screens (OR=0.67) versus subsequent ones. Although the interaction between educational and professional levels showed that graduated immigrant women conducting an intellectual job have a higher inclination towards screening than their Italian peers (OR=1.43 vs OR=1.04). The Standardised Detection Ratio (SDR) suggested a frequency of severe lesions nearly double among immigrants in first screens (SDR=1.94; 95% CI: 1.82-2.08) and even higher (SDR=2.53; 95% CI: 2.35-2.73) for Central/Eastern Europeans. Multi-component interventions involving both patients and providers offer the greatest potential to increase cervical cancer screening uptake within foreign-born populations. So immigrant-specific interventions are needed for some immigrant groups, like Central/Eastern Europeans who are at higher risk of cervical lesions and, together with Asians and Africans, showed a poor attitude towards cancer prevention.
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Affiliation(s)
- Federica Gallo
- CPO Piemonte, Centre for Cancer Prevention, Unit of Epidemiology, Screening and Cancer Registry, AOU Città della Salute e della Scienza, Turin, Italy.
| | - Adele Caprioglio
- CPO Piemonte, Centre for Cancer Prevention, Unit of Epidemiology, Screening and Cancer Registry, AOU Città della Salute e della Scienza, Turin, Italy.
| | - Roberta Castagno
- CPO Piemonte, Centre for Cancer Prevention, Unit of Epidemiology, Screening and Cancer Registry, AOU Città della Salute e della Scienza, Turin, Italy.
| | - Guglielmo Ronco
- CPO Piemonte, Centre for Cancer Prevention, Unit of Epidemiology, Screening and Cancer Registry, AOU Città della Salute e della Scienza, Turin, Italy.
| | - Nereo Segnan
- CPO Piemonte, Centre for Cancer Prevention, Unit of Epidemiology, Screening and Cancer Registry, AOU Città della Salute e della Scienza, Turin, Italy.
| | - Livia Giordano
- CPO Piemonte, Centre for Cancer Prevention, Unit of Epidemiology, Screening and Cancer Registry, AOU Città della Salute e della Scienza, Turin, Italy.
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Baussano I, Lazzarato F, Ronco G, Lehtinen M, Dillner J, Franceschi S. Different Challenges in Eliminating HPV16 Compared to Other Types: A Modeling Study. J Infect Dis 2017; 216:336-344. [PMID: 28859431 PMCID: PMC5853887 DOI: 10.1093/infdis/jix299] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 04/11/2017] [Accepted: 06/30/2017] [Indexed: 12/31/2022] Open
Abstract
Background Human papillomavirus (HPV) vaccination is still not reaching many high-risk populations. HPV16/18 vaccines offer cross-protection against other types, for example, HPV45. Both direct vaccine efficacy and indirect herd protection contribute to vaccination effectiveness. Methods We used a dynamic transmission model, calibrated to cervical screening data from Italy, to estimate vaccination effectiveness against HPV16 and HPV45 infection, assuming for HPV45 either 95% or lower cross-protection. Results Basic reproductive number was smaller (2.1 vs 4.0) and hence vaccine effectiveness and herd protection stronger for HPV45 than for HPV16. The largest difference in the reduction of infection prevalence in women <35 years old was found at 70% coverage in girls-only vaccination programs (99% vs 83% for total protection for HPV45 and HPV16, respectively, mainly owing to stronger herd protection, ie, 37% vs 16%). In gender-neutral vaccination, the largest difference was at 40% coverage (herd protection, 54% vs 28% for HPV16 and HPV45, respectively). With ≥80% coverage, even 50% cross-protection would reduce HPV45 by ≥94%. Conclusions The characteristics of individual high-risk HPV types strongly influence herd protection and determine the level of coverage and cross-protection required to reduce or eliminate the infection through HPV vaccination. HPV16 infection and related cancers are the most difficult to eliminate.
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Affiliation(s)
| | - Fulvio Lazzarato
- International Agency for Research on Cancer, Lyon, France
- Unit of Cancer Epidemiology, AOU Città della Salute e della Scienza, Hospital of Turin
| | - Guglielmo Ronco
- Department of Cancer Screening, Centre for Epidemiology and Prevention in Oncology, Turin, Italy
| | - Matti Lehtinen
- University of Tampere, Finland
- Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden
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27
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Giorgi Rossi P, Carozzi F, Federici A, Ronco G, Zappa M, Franceschi S. Cervical cancer screening in women vaccinated against human papillomavirus infection: Recommendations from a consensus conference. Prev Med 2017; 98:21-30. [PMID: 27894910 DOI: 10.1016/j.ypmed.2016.11.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 11/14/2016] [Accepted: 11/24/2016] [Indexed: 10/20/2022]
Abstract
In Italy, the cohorts of women who were offered Human papillomavirus (HPV) vaccination in 2007/08 will reach the age (25years) for cervical cancer (CC) screening from 2017. The simultaneous shift from cytology-based screening to HPV test-based screening gives the opportunity for unprecedented reorganisation of CC prevention. The ONS (National Screening Monitoring Centre) Directive and the GISCi (Italian Group for Cervical Screening) identified the consensus conference as the most suitable method for addressing this topic. A summary of consensus recommendations is reported here. The main objective was to define the best screening methods in girls vaccinated against HPV and the knowledge required for defining evidence-based screening strategies. A Jury made recommendations about questions and proposals formulated by a panel of experts representative of Italian scientific societies involved in CC prevention and based on systematic reviews of literature and evidence. The Jury considered changing the screening protocols for girls vaccinated in their twelfth year as appropriate. Tailored screening protocols based on vaccination status could be replaced by "one size fits all" protocols only when a herd immunity effect has been reached. Vaccinated women should start screening at age 30, instead of 25, with HPV test. Furthermore, there is a strong rationale for applying longer intervals for re-screening HPV negative women than the currently recommended 5years, but research is needed to determine the optimal screening time points. For non-vaccinated women and for women vaccinated in their fifteenth year or later, the current protocol should be kept.
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Affiliation(s)
- Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale, Via Amendola 2, 42122, Reggio Emilia, Italy; Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico - IRCCS, Reggio Emilia, Italy.
| | - Francesca Carozzi
- Cancer Prevention Regional Laboratory, ISPO, Cancer Prevention and Research Institute, Florence, Italy.
| | | | - Guglielmo Ronco
- Center for Cancer Epidemiology and Prevention, AO City of Health and Science, Turin, Italy.
| | - Marco Zappa
- Unit of Clinical and Descriptive Epidemiology, ISPO, Florence, Italy.
| | - Silvia Franceschi
- International Agency for Research on Cancer, 69372 Lyon Cedex 08, France.
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Ronco G, Baussano I. Causal system modelling of cervical cancer screening. Lancet Public Health 2017; 2:e61-e62. [PMID: 29253393 DOI: 10.1016/s2468-2667(17)30013-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/12/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Guglielmo Ronco
- Unit of Epidemiology, Cancer Registry and Screening, Centre for Cancer Prevention, Turin 10123, Italy.
| | - Iacopo Baussano
- Infection and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France
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Benevolo M, Allia E, Gustinucci D, Rollo F, Bulletti S, Cesarini E, Passamonti B, Giovagnoli MR, Carico E, Carozzi FM, Mongia A, Fantacci G, Confortini M, Rubino T, Fodero C, Prandi S, Marchi N, Farruggio A, Coccia A, Macrì L, Ghiringhello B, Ronco G, Bragantini E, Polla E, Maccallini V, Negri G, Giorgi Rossi P. Interobserver reproducibility of cytologic p16 INK4a /Ki-67 dual immunostaining in human papillomavirus-positive women. Cancer Cytopathol 2016; 125:212-220. [PMID: 27926800 DOI: 10.1002/cncy.21800] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/14/2016] [Accepted: 10/17/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND The accumulation of cyclin-dependent kinase inhibitor 2A (p16ink4a ) protein in a cell is associated with neoplastic progression in precancerous cervical lesions. Dual staining for p16ink4a and Ki-67 has been proposed as a triage test in cervical cancer screening for women who test positive for human papillomavirus DNA. In this study, interobserver reproducibility of the interpretation of this test was assessed. METHODS Forty-two immunostained, liquid-based cytology slides were divided into 2 sets and were interpreted by 17 to 21 readers from 9 different laboratories, yielding a total of 816 reports. Immunostaining results were classified as positive, negative, inconclusive, or inadequate. After evaluation of the first set of slides and before circulation of the second set, the results were discussed in a plenary meeting. The 10 slides with the most discordant results were evaluated again by selected expert cytopathologists. RESULTS The overall κ value was 0.612 (95% confidence interval [CI], 0.523-0.701), it was higher for the positive and negative categories (κ = 0.692 and κ = 0.641, respectively), and it was almost null for the inconclusive category (κ = 0.058). Considering only readers from laboratories with documented experience, the κ value was higher (κ = 0.747; 95% CI, 0.643-0.839) compared with nonexperienced centers (κ = 0.498; 95% CI, 0.388-0.616). The results were similar in both sets of slides (κ = 0.505 [95% CI, 0.358-0.642] and κ = 0.521 [95% CI, 0.240-0.698] for the first and second sets, respectively). Reinterpretation of the slides with the most discordant results did not provide any improvement (first evaluation, κ = 0.616 [95% CI, 0.384-0.866]; second evaluation, κ = 0.403 [95% CI, 0.182-0.643]). CONCLUSIONS Dual staining for p16 ink4a and Ki-67 demonstrated good reproducibility, confirming its robustness, which is a necessary prerequisite for its adoption as a triage test in cervical cancer screening programs that use human papillomavirus DNA as a primary test. Cancer Cytopathol 2017;125:212-220. © 2016 American Cancer Society.
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Affiliation(s)
| | - Elena Allia
- Central Cervicovaginal Screening Unit and Center for Cancer Epidemiology and Prevention, Turin, Italy
| | - Daniela Gustinucci
- Laboratory Screening Unit, Local Health Authority-Umbria 1, Perugia, Italy
| | | | - Simonetta Bulletti
- Laboratory Screening Unit, Local Health Authority-Umbria 1, Perugia, Italy
| | - Elena Cesarini
- Laboratory Screening Unit, Local Health Authority-Umbria 1, Perugia, Italy
| | - Basilio Passamonti
- Laboratory Screening Unit, Local Health Authority-Umbria 1, Perugia, Italy
| | | | - Elisabetta Carico
- Cytopathology Unit, St Andrea Hospital, "Sapienza" University, Rome, Italy
| | - Francesca M Carozzi
- Human Papillomavirus Laboratory and Molecular Oncology Unit, Regional Cancer Prevention Laboratory, Institute for Cancer Study and Prevention, Florence, Italy
| | - Alessandra Mongia
- Human Papillomavirus Laboratory and Molecular Oncology Unit, Regional Cancer Prevention Laboratory, Institute for Cancer Study and Prevention, Florence, Italy
| | - Giulia Fantacci
- Human Papillomavirus Laboratory and Molecular Oncology Unit, Regional Cancer Prevention Laboratory, Institute for Cancer Study and Prevention, Florence, Italy
| | - Massimo Confortini
- Human Papillomavirus Laboratory and Molecular Oncology Unit, Regional Cancer Prevention Laboratory, Institute for Cancer Study and Prevention, Florence, Italy
| | - Teresa Rubino
- Institute for Research and Health Care (IRCCS), "Arcispedale S. Maria Nuova" Hospital, Reggio Emilia, Italy
| | - Cristina Fodero
- Institute for Research and Health Care (IRCCS), "Arcispedale S. Maria Nuova" Hospital, Reggio Emilia, Italy
| | - Sonia Prandi
- Institute for Research and Health Care (IRCCS), "Arcispedale S. Maria Nuova" Hospital, Reggio Emilia, Italy
| | - Natalina Marchi
- Unit 17, Local Health and Social Care Facility, Este Monselice, Italy
| | - Angelo Farruggio
- Unit 17, Local Health and Social Care Facility, Este Monselice, Italy
| | - Anna Coccia
- Central Cervicovaginal Screening Unit and Center for Cancer Epidemiology and Prevention, Turin, Italy
| | - Luigia Macrì
- Central Cervicovaginal Screening Unit and Center for Cancer Epidemiology and Prevention, Turin, Italy
| | - Bruno Ghiringhello
- Central Cervicovaginal Screening Unit and Center for Cancer Epidemiology and Prevention, Turin, Italy
| | - Guglielmo Ronco
- Central Cervicovaginal Screening Unit and Center for Cancer Epidemiology and Prevention, Turin, Italy
| | | | - Enzo Polla
- Provincial Health Care Service, Trento, Italy
| | - Vincenzo Maccallini
- Department of Pathology, Avezzano, Sulmona, and L'Aquila Local Health Trust-Abruzzo, Avezzano, Italy
| | - Giovanni Negri
- Department of Pathology, Bolzano Central Hospital, Bolzano, Italy
| | - Paolo Giorgi Rossi
- Institute for Research and Health Care (IRCCS), "Arcispedale S. Maria Nuova" Hospital, Reggio Emilia, Italy.,Interinstitutional Epidemiology Unit, Reggio Emilia Local Health Trust, Reggio Emilia, Italy
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Ronco G, Zappa M, Franceschi S, Tunesi S, Caprioglio A, Confortini M, Del Mistro A, Carozzi F, Segnan N, Zorzi M, Giorgi-Rossi P. Impact of variations in triage cytology interpretation on human papillomavirus-based cervical screening and implications for screening algorithms. Eur J Cancer 2016; 68:148-155. [PMID: 27755998 DOI: 10.1016/j.ejca.2016.09.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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] [Received: 06/23/2016] [Revised: 08/24/2016] [Accepted: 09/02/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Women positive to human papillomavirus (HPV+) testing at cervical screening need triage, typically cytology and immediate colposcopy in case of atypical squamous cells of undetermined significance (ASCUS) or worse (ASCUS+) or, in cytology-normal HPV+ women, HPV test repeat after 1 year and colposcopy referral if still HPV+. Our hypothesis was that substantial variations in triage positivity and sensitivity may produce little variation in overall referral to colposcopy and on sensitivity of the entire screening process. METHODS Centre- and age-aggregated data from 72,869 women aged 35-64 years were derived from 10 organised screening programmes which have piloted HPV screening in Italy since 2012. Overall colposcopy referral was evaluated as a function of immediate colposcopy referral and overall CIN2+ detection as a function of the proportion of all CIN2+ detected by immediate referral (a proxy of cytology's sensitivity). We fitted additive regression models, adjusted for centre, age, compliance to HPV retesting and to colposcopy, by generalised estimation equations. RESULTS The proportion of HPV+ women directly referred to colposcopy varied across programmes (20-57%; average 37%) and so did CIN2+ detection (49-94%; average 77%). Overall, 63% (range 41-75%) of HPV+ were referred to colposcopy either immediately or at HPV repeat. An absolute 10% increase in immediate colposcopy referral resulted in 4.2% (95% CI: 3.3-5.1%) increase in overall referral. An absolute 10% increase in cytology's sensitivity resulted in a 1.1% (95% CI: 0.1-2.0%) increase in overall CIN2+ detection. CONCLUSIONS Repeat HPV testing limits the effect of subjectivity of cytology interpretation on overall referral and sensitivity. These will change only slightly when replacing cytology with another test if the interval to HPV repeat remains unchanged.
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Affiliation(s)
- Guglielmo Ronco
- Center for Cancer Epidemiology and Prevention (CPO), University Hospital "Città della Salute e della Scienza di Torino", Turin, Italy.
| | - Marco Zappa
- Institute for Cancer Study and Prevention (ISPO), Florence, Italy
| | | | - Sara Tunesi
- Center for Cancer Epidemiology and Prevention (CPO), University Hospital "Città della Salute e della Scienza di Torino", Turin, Italy; Department of Translational Medicine, Unit of Medical Statistics and Cancer Epidemiology, University of Piemonte Orientale, Novara, Italy
| | - Adele Caprioglio
- Center for Cancer Epidemiology and Prevention (CPO), University Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
| | | | | | | | - Nereo Segnan
- Center for Cancer Epidemiology and Prevention (CPO), University Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Manuel Zorzi
- Registro Tumori del Veneto, Regione Veneto, Padova, Italy
| | - Paolo Giorgi-Rossi
- Servizio Interaziendale di Epidemiologia, AUSL Reggio Emilia, Italy; Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy
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Bosch FX, Robles C, Díaz M, Arbyn M, Baussano I, Clavel C, Ronco G, Dillner J, Lehtinen M, Petry KU, Poljak M, Kjaer SK, Meijer CJLM, Garland SM, Salmerón J, Castellsagué X, Bruni L, de Sanjosé S, Cuzick J. HPV-FASTER: broadening the scope for prevention of HPV-related cancer. Nat Rev Clin Oncol 2016; 13:119-32. [PMID: 26323382 DOI: 10.1038/nrclinonc.2015.146] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Human papillomavirus (HPV)-related screening technologies and HPV vaccination offer enormous potential for cancer prevention, notably prevention of cervical cancer. The effectiveness of these approaches is, however, suboptimal owing to limited implementation of screening programmes and restricted indications for HPV vaccination. Trials of HPV vaccination in women aged up to 55 years have shown almost 90% protection from cervical precancer caused by HPV16/18 among HPV16/18-DNA-negative women. We propose extending routine vaccination programmes to women of up to 30 years of age (and to the 45-50-year age groups in some settings), paired with at least one HPV-screening test at age 30 years or older. Expanding the indications for HPV vaccination and much greater use of HPV testing in screening programmes has the potential to accelerate the decline in cervical cancer incidence. Such a combined protocol would represent an attractive approach for many health-care systems, in particular, countries in Central and Eastern Europe, Latin America, Asia, and some more-developed parts of Africa. The role of vaccination in women aged >30 years and the optimal number of HPV-screening tests required in vaccinated women remain important research issues. Cost-effectiveness models will help determine the optimal combination of HPV vaccination and screening in public health programmes, and to estimate the effects of such approaches in different populations.
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Affiliation(s)
- F Xavier Bosch
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme, Institut Catala d' Oncologia-Catalan Institute of Oncology, IDIBELL, Avenida Gran Via 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Claudia Robles
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme, Institut Catala d' Oncologia-Catalan Institute of Oncology, IDIBELL, Avenida Gran Via 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Mireia Díaz
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme, Institut Catala d' Oncologia-Catalan Institute of Oncology, IDIBELL, Avenida Gran Via 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
| | | | - Christine Clavel
- Centre Hospitalier Universitaire (CHU) Reims, Université de Reims Champagne-Ardenne and Institut National de la Santé et de la Recherche Médicale UMR-S 903, Reims, France
| | - Guglielmo Ronco
- Unit of Cancer Epidemiology, Centre for Cancer Prevention (CPO), Torino, Italy
| | - Joakim Dillner
- Departments of Laboratory Medicine, Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Matti Lehtinen
- University of Tampere, School of Health Sciences, Tampere, Finland
| | - Karl-Ulrich Petry
- Department of Obstetrics and Gynaecology, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Susanne K Kjaer
- Virus, Lifestyle &Genes, Danish Cancer Society Research Centre; and Department of Gynaecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Chris J L M Meijer
- Department of Pathology, VU University Medical Centre (VUmc), Amsterdam, Netherlands
| | - Suzanne M Garland
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital; Murdoch Childrens Research Institute; and Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Jorge Salmerón
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Xavier Castellsagué
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme, Institut Catala d' Oncologia-Catalan Institute of Oncology, IDIBELL, Avenida Gran Via 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Laia Bruni
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme, Institut Catala d' Oncologia-Catalan Institute of Oncology, IDIBELL, Avenida Gran Via 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Silvia de Sanjosé
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Programme, Institut Catala d' Oncologia-Catalan Institute of Oncology, IDIBELL, Avenida Gran Via 199-203, L'Hospitalet de Llobregat, 08908 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
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von Karsa L, Arbyn M, De Vuyst H, Dillner J, Dillner L, Franceschi S, Patnick J, Ronco G, Segnan N, Suonio E, Törnberg S, Anttila A. European guidelines for quality assurance in cervical cancer screening. Summary of the supplements on HPV screening and vaccination. Papillomavirus Research 2015. [PMCID: PMC5886856 DOI: 10.1016/j.pvr.2015.06.006] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
In a project coordinated by the International Agency for Research on Cancer (IARC) 31 experts from 11 European countries and IARC have developed supplements to the current European guidelines for quality assurance in cervical cancer screening. The supplements take into account the potential of primary testing for human papillomavirus (HPV) and vaccination against HPV infection to improve cervical cancer prevention and control and will be published by the European Commission in book format. They include 62 recommendations or conclusions for which the strength of the evidence and the respective recommendations is graded. While acknowledging the available evidence for more efficacious screening using HPV primary testing compared to screening based on cytology, the authors and editors of the supplements emphasize that appropriate policy and programme organization remain essential to achieve an acceptable balance between benefit and harm of any screening or vaccination programme. A summary of the supplements and all of the graded recommendations are presented here in journal format to make key aspects of the updated and expanded guidelines known to a wider professional and scientific community.
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Affiliation(s)
- Lawrence von Karsa
- Quality Assurance Group, Section of Early Detection and Prevention, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
- Corresponding author. Tel.: +33 4 72 73 84 85; fax: +33 4 72 73 85 75.
| | - Marc Arbyn
- Belgian Cancer Centre / Unit of Cancer Epidemiology, Scientific Institute of Public Health, J. Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Hugo De Vuyst
- Prevention and Implementation Group, Section of Early Detection and Prevention International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Joakim Dillner
- Department of Laboratory Medicine and the Department of Medical Epidemiology and Biostatistics, Huddinge campus F56, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Lena Dillner
- Department of Clinical Microbiology, Karolinska University Hospital, Solna, 17176 Stockholm, Sweden
| | - Silvia Franceschi
- Infections and Cancer Epidemiology Group, Section of Infections, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Julietta Patnick
- NHS Cancer Screening Programmes, Directorate of Health and Wellbeing, Public Health England, Fulwood House, Old Fulwood Rd, Sheffield S10 3TH, United Kingdom
| | - Guglielmo Ronco
- Department of Cancer Screening and Unit of Cancer Epidemiology, Center for Epidemiology and Prevention in Oncology, CPO Piedmont, University Hospital Città della Salute e della Scienza, via S. Francesco da Paola 31, 10123 Turin, Italy
| | - Nereo Segnan
- Department of Cancer Screening and Unit of Cancer Epidemiology, Center for Epidemiology and Prevention in Oncology, CPO Piedmont, University Hospital Città della Salute e della Scienza, via S. Francesco da Paola 31, 10123 Turin, Italy
| | - Eero Suonio
- Quality Assurance Group, Section of Early Detection and Prevention, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Sven Törnberg
- Department of Cancer Screening, Stockholm Regional Cancer Centre, PO Box 6909, 10239 Stockholm, Sweden
| | - Ahti Anttila
- Mass Screening Registry, Finnish Cancer Registry, Unioninkatu 22, FI-00130 Helsinki, Finland
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Rossi PG, Ronco G, Dillner J, Elfström KM, Snijders PJF, Arbyn M, Berkhof J, Carozzi F, Del Mistro A, De Sanjosè S, Bosch X, Petry KU, Poljak M, Naldoni C, Meijer CJLM. Why follow-back studies should be interpreted cautiously: The case of an HPV-negative cervical lesion. Cancer Cytopathol 2015; 124:66-7. [PMID: 26356132 DOI: 10.1002/cncy.21622] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 07/27/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Paolo Giorgi Rossi
- Interinstitutional Epidemiology Unit, Azienda Unita Sanitaria Locale di Reggio Emilia, Reggio Emilia, Italy, Arcispedale S. Maria Nuova, National Institute for Research and Treatment, Reggio Emilia, Italy
| | - Guglielmo Ronco
- Center for Cancer Epidemiology and Prevention, AO City of Health and Science, Turin, Italy
| | | | | | - Peter J F Snijders
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - Marc Arbyn
- Belgian Cancer Center, Scientific Institute of Public Health, Brussels, Belgium
| | - Johannes Berkhof
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - Francesca Carozzi
- S. C. Laboratory for the Prevention of Cancer, Institute for the Study and Prevention of Cancer, Florence, Italy
| | - Annarosa Del Mistro
- Veneto Institute of Oncology, National Institute for Research and Treatment, Padua, Italy
| | - Silvia De Sanjosè
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, Barcelona, Spain
| | - Xavier Bosch
- Cancer Epidemiology Research Program, Catalan Institute of Oncology, Barcelona, Spain
| | - Karl Ulrich Petry
- Department of Obstetrics and Gynecology, Wolfsburg Hospital, Wolfsburg, Germany
| | - Mario Poljak
- Institute of Microbiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Chris J L M Meijer
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
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Gallo F, Giubilato P, Larato C, Caprioglio A, Tomatis M, Calcagno M, Casella D, Di Leo A, Ponti A, Ronco G, Segnan N, Giordano L. [Introduction of a centralised system (Service) for collecting clinical data in cancer screening programmes in Piedmont (Northern Italy): a pre-post assessment of a hub&spoke model]. Epidemiol Prev 2015; 39:243-250. [PMID: 26499237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES evaluation of a centralised collection of clinical data (Service) within cancer screening programmes in Piedmont based on a hub&spoke model and its impact on process indicators. DESIGN assessment of an organisational intervention, through a non-controlled pre-post design. SETTING AND PARTICIPANTS organised screening programmes within the Piedmont Region, divided into 9 departments. MAIN OUTCOME MEASURES clinical data (extracted from medical charts for mammography screening and from excision histology reports for cervical screening) obtained through the Service were quantified and their completeness was assessed. The Service impact on the detection rate (DR) was evaluated, comparing the DR pre- (2005-2008) and post-Service (2009- 2012) within breast screening; the DR was computed through histological diagnosis made during colposcopy (pre-Service method) or through the worst diagnosis between the latter and that reported from excision histology (post-Service method) within cervical screening (data available for department 1, year 2013). Some hints on human resources employed in pre- and post-Service periods were reported. RESULTS within mammography screening, the Service obtained 53.1% of extra-department medical charts and 45.8% of extra-region ones; the percentage of missing diagnoses changed from 5.5% (pre- Service) to 3.7% (post-Service). The age standardised DR for malignant tumours in the post-Service period is 1.3 times the DR of the pre-Service period per 1,000 screening tests. Within cervical screening, 51.7% of histological reports was recorded. Crude DR for high-grade lesions changed from 3.9 (pre-Service) to 4.7 (post-Service) per 1,000 screened women. The system centralisation did not imply an increase in the dedicated personnel. CONCLUSION the Service is an operational core which coordinates the collection of clinical data, impacting on process indicators without an increase in human resources at departmental level.
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Affiliation(s)
- Federica Gallo
- Centro di riferimento per l'epidemiologia e la prevenzione oncologica in Piemonte e Azienda ospedaliero universitaria "Città della salute e della scienza", Torino.
| | - Pamela Giubilato
- Centro di riferimento per l'epidemiologia e la prevenzione oncologica in Piemonte e Azienda ospedaliero universitaria "Città della salute e della scienza", Torino
| | - Cristina Larato
- Centro di riferimento per l'epidemiologia e la prevenzione oncologica in Piemonte e Azienda ospedaliero universitaria "Città della salute e della scienza", Torino
| | - Adele Caprioglio
- Centro di riferimento per l'epidemiologia e la prevenzione oncologica in Piemonte e Azienda ospedaliero universitaria "Città della salute e della scienza", Torino
| | - Mariano Tomatis
- Centro di riferimento per l'epidemiologia e la prevenzione oncologica in Piemonte e Azienda ospedaliero universitaria "Città della salute e della scienza", Torino
| | - Marco Calcagno
- Centro di riferimento per l'epidemiologia e la prevenzione oncologica in Piemonte e Azienda ospedaliero universitaria "Città della salute e della scienza", Torino
| | - Denise Casella
- Centro di riferimento per l'epidemiologia e la prevenzione oncologica in Piemonte e Azienda ospedaliero universitaria "Città della salute e della scienza", Torino
| | - Aurora Di Leo
- Centro di riferimento per l'epidemiologia e la prevenzione oncologica in Piemonte e Azienda ospedaliero universitaria "Città della salute e della scienza", Torino
| | - Antonio Ponti
- Centro di riferimento per l'epidemiologia e la prevenzione oncologica in Piemonte e Azienda ospedaliero universitaria "Città della salute e della scienza", Torino
| | - Guglielmo Ronco
- Centro di riferimento per l'epidemiologia e la prevenzione oncologica in Piemonte e Azienda ospedaliero universitaria "Città della salute e della scienza", Torino
| | - Nereo Segnan
- Centro di riferimento per l'epidemiologia e la prevenzione oncologica in Piemonte e Azienda ospedaliero universitaria "Città della salute e della scienza", Torino
| | - Livia Giordano
- Centro di riferimento per l'epidemiologia e la prevenzione oncologica in Piemonte e Azienda ospedaliero universitaria "Città della salute e della scienza", Torino
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Serraino D, Gini A, Taborelli M, Ronco G, Giorgi-Rossi P, Zappa M, Crocetti E, Franzo A, Falcini F, Visioli CB, Stracci F, Zorzi M, Federico M, Michiara M, Fusco M, Ferretti S, Pannozzo F, Tisano F, Zanetti R, Zucchetto A. Changes in cervical cancer incidence following the introduction of organized screening in Italy. Prev Med 2015; 75:56-63. [PMID: 25818232 DOI: 10.1016/j.ypmed.2015.01.034] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 01/13/2015] [Accepted: 01/18/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To quantify the impact of organized cervical screening programs (OCSPs) on the incidence of invasive cervical cancer (ICC), comparing rates before and after activation of OCSPs. METHODS This population-based investigation, using individual data from cancer registries and OCSPs, included 3557 women diagnosed with ICC at age 25-74years in 1995-2008. The year of full-activation of each OCSP was defined as the year when at least 40% of target women had been invited. Incidence rate ratios (IRRs) with 95% confidence intervals (95% CIs) were calculated as the ratios between age-standardized incidence rates observed in periods after full-activation of OCSPs vs those observed in the preceding quinquennium. RESULTS ICC incidence rates diminished with time since OCSPs full-activation: after 6-8years, the IRR was 0.75 (95% CI: 0.67-0.85). The reduction was higher for stages IB-IV (IRR=0.68, 95% CI: 0.58-0.80), squamous cell ICCs (IRR=0.74, 95% CI: 0.64-0.84), and particularly evident among women aged 45-74years. Conversely, incidence rates of micro-invasive (stage IA) ICCs increased, though not significantly, among women aged 25-44years (IRR=1.34, 95% CI: 0.91-1.96). Following full-activation of OCSPs, micro-invasive ICCs were mainly and increasingly diagnosed within OCSPs (up to 72%). CONCLUSION(S) Within few years from activation, organized screening positively impacted the already low ICC incidence in Italy and favored down-staging.
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Affiliation(s)
- Diego Serraino
- Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Andrea Gini
- Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Martina Taborelli
- Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Guglielmo Ronco
- Center for Cancer Epidemiology and Prevention, City of Health and Science Hospital, Torino, Italy
| | - Paolo Giorgi-Rossi
- Interinstitutional Epidemiology Unit, Local Health Unit, Reggio Emilia, Italy; IRCCS Santa Maria Nuova Hospital, Reggio Emilia, Italy
| | - Marco Zappa
- Cancer Prevention and Research Institute, Firenze, Italy
| | | | | | - Fabio Falcini
- Romagna Cancer Registry, IRCCS "Istituto scientifico romagnolo per lo studio e la cura dei tumori" Institute, Meldola, Italy
| | | | - Fabrizio Stracci
- Department of Medical and Surgical Specialties and Public Health, Perugia University, Perugia, Italy
| | - Manuel Zorzi
- Veneto Tumour Registry, Veneto Region, Padova, Italy
| | - Massimo Federico
- Department of Oncology, Hematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Mario Fusco
- Napoli 3 South Local Health Unit, Brusciano, Italy
| | - Stefano Ferretti
- Ferrara University and Ferrara Local Health Unit, Ferrara, Italy
| | | | | | - Roberto Zanetti
- Center for Cancer Epidemiology and Prevention, City of Health and Science Hospital, Torino, Italy
| | - Antonella Zucchetto
- Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, Aviano, Italy.
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Ronco G, Giorgi Rossi P, Giubilato P, Del Mistro A, Zappa M, Carozzi F. A first survey of HPV-based screening in routine cervical cancer screening in Italy. Epidemiol Prev 2015; 39:77-83. [PMID: 26405779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Pilot HPV-based cervical screening programmes have recently started in Italy, partly on the strength of a large randomized trial. The Ministry of Health recommended that regions shift toward HPV-based screening in early 2013 and provided guidelines for its application (stand-alone HPV testing by validated methods, cytological triage of HPV positives, beginning at age 30-35, 5-year intervals). A first survey on the 2012 activity was conducted in 2013. In 2012, 19 Italian organized cervical screening programmes from 10 regional programmes invited 311,856 women (8.0%of all women invited for cervical screening in 2012 in Italy) for HPV-based screening; 41.5% complied, with a decreasing North-South trend. Among screened women, 7.9% (range 4.3%-13.9%) were HPV positive, decreasing to 6.6% (range 4.0%-12.4%) when considering women aged 35-64 years. Among HPV positive women, 34.8%(with high variability between programmes: range 11.1%-59.3%) were judged to have ASC-US or more severe cytology (5.3%ASC-US, 26.6%L-SIL, 5.2% H-SIL). Out of all screened women, those referred to colposcopy based on HPV and cytology results were 2.9% (range 0.6%-4.8%), whereas they were 2.0% when considering only women aged 35-64 years.
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Affiliation(s)
- Guglielmo Ronco
- AOU Città della salute e della scienza, CPO Piemonte, Torino.
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Carozzi FM, Iossa A, Scalisi A, Sideri M, Andersson KL, Confortini M, Del Mistro A, Maina G, Ronco G, Raggi P, Schiboni ML, Zappa M, Giorgi Rossi P. hr-HPV testing in the management of women with ASC-US+ and in the follow-up of women with cytological abnormalities and negative colposcopy. Recommendations of the Italian group for cervical cancer screening (GISCi). Epidemiol Prev 2015; 39:84-90. [PMID: 26405780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Compared to spontaneous screening, an organized screening programme is characterized by the presence of protocols and recommendations for all stages including follow-up. Despite the availability of well-functioning screening programmes throughout the country, the follow-up protocol after an abnormal Pap test and negative colposcopy is not clearly defined in Italy, and there is no uniformity of indications. HPV testing for oncogenic human papillomavirus (hr-HPV) has a high negative predictive value (NPV) and high positive predictive value (PPV) for CIN2+ and its employment can reduce follow-up assessments. In order to provide indications about the management of women with ASC-US+ and the follow-up of women with cytological abnormalities and negative colposcopy, a literature analysis was carried out, taking into consideration European and American guidelines and good practice recommendations from the most important scientific associations and regulatory agencies. GISCi (Italian Group for Cervical Screening) drafted recommendations for the management of women with ASC-US, L-SIL, ASC-H, AGC, and H-SIL until their return to the routine screening interval. This protocol can be applied not only in the management of abnormal Pap smears in cytology-based programmes, but also in the management of abnormal Pap test triage after HPV positive test when HPV is the primary screening test. The protocols approved within the screening programmes must have an extensive consensus among all involved professionals, including any that women might meet outside the programme.
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Ronco G, Giubilato P, Carozzi F, Maia G, Giorgi Rossi P, Zappa M. Extension of organized cervical cancer screening programmes in Italy and their process indicators, 2011-2012 activity. Epidemiol Prev 2015; 39:61-76. [PMID: 26405778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Italian national guidelines recommend regional implementation of organized screening programmes for cervical cancer. As we have been doing since 1998, we collected aggregated tables of data from Italian organized cervical screening programmes in order to centrally compute process indicators. Data on women invited during 2011 and 2012 and screened up to April of the subsequent year were considered. In 2012, the target population of Italian organized screening programmes included 14,497,207 women, corresponding to 87.3% of Italian women aged 25-64 years. Compliance to invitation was 41.2%in 2011 and 40.8%in 2012, with a strong decreasing North-South trend. However, it should be considered that many women are screened outside any organized programmes. In 2012, of the women screened, 3.5% were referred for repeat cytology and 71.1% of them complied; 2.4% of screened women were referred to colposcopy. Compliance with colposcopy referral was 85.3%among women referred because of ASC-US or more severe cytology and 90.4% among those referred because of HSIL or more severe cytology. The positive predictive value (PPV) of referral because of ASC-US or more severe cytology for CIN2 or more severe histology was 16.9%. The unadjusted detection rate of CIN2 or more severe histology was 3.4 per 1,000 screened women (3.6 standardized on the Italian population, truncated 25-64). CIN2 or more severe histology was detected in 64.6% of colposcopies classified as grade 2 or higher. Of all colposcopies during which a CIN2 or more severe histology was obtained, 33.6% were classified as grade 2 or higher. Follow-up only was recommended to 81.7% of women with CIN1. Excision by radio-frequency device was the most common treatment for women with CIN2 (52.8%) and CIN3 (57.0%). However 0.4% of all CIN2 and 2.3% of all CIN3 had hysterectomy.
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Affiliation(s)
- Guglielmo Ronco
- AOU Città della salute e della scienza, CPO Piemonte, Torino.
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Bergeron C, Giorgi-Rossi P, Cas F, Schiboni ML, Ghiringhello B, Dalla Palma P, Minucci D, Rosso S, Zorzi M, Naldoni C, Segnan N, Confortini M, Ronco G. Informed cytology for triaging HPV-positive women: substudy nested in the NTCC randomized controlled trial. J Natl Cancer Inst 2015; 107:dju423. [PMID: 25568167 PMCID: PMC4339260 DOI: 10.1093/jnci/dju423] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [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] [Indexed: 01/16/2023] Open
Abstract
Background: Human papillomavirus (HPV)–based screening needs triage. In most randomized controlled trials (RCTs) on HPV testing with cytological triage, cytology interpretation has been blind to HPV status. Methods: Women age 25 to 60 years enrolled in the New Technology in Cervical Cancer (NTCC) RCT comparing HPV testing with cytology were referred to colposcopy if HPV positive and, if no cervical intraepithelial neoplasia (CIN) was detected, followed up until HPV negativity. Cytological slides taken at the first colposcopy were retrieved and independently interpreted by an external laboratory, which was only aware of patients’ HPV positivity. Sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values were computed for histologically proven CIN2+ with HPV status–informed cytology for women with a determination of atypical squamous cells of undetermined significance (ASCUS) or more severe. All statistical tests were two-sided. Results: Among HPV-positive women, informed cytology had cross-sectional sensitivity, specificity, PPV and 1-NPV for CIN2+ of 85.6% (95% confidence interval [CI] = 76.6 to 92.1), 65.9% (95% CI = 63.1 to 68.6), 16.2% (95% CI = 13.0 to 19.8), and 1.7 (95% CI = 0.9 to 2.8), respectively. Cytology was also associated with subsequent risk of newly diagnosed CIN2+ and CIN3+. The cross-sectional relative sensitivity for CIN2+ vs blind cytology obtained by referring to colposcopy and following up only HPV positive women who had HPV status–informed cytology greater than or equal to ASCUS was 1.58 (95% CI = 1.22 to 2.01), while the corresponding relative referral to colposcopy was 0.95 (95% CI = 0.86 to 1.04). Conclusions: Cytology informed of HPV positivity is more sensitive than blind cytology and could allow longer intervals before retesting HPV-positive, cytology-negative women.
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Affiliation(s)
- Christine Bergeron
- Department of Pathology, Laboratoire Cerba, Cergy Pontoise France (CB, FC); Servizio Interaziendale Epidemiologia, AUSL Reggio Emilia, Italy (PGR); Department of Pathology, S. Giovanni Hospital, Rome, Italy (MLS); Laboratory Department University Hospital "Città della Salute e della Scienza di Torino," Turin, Italy (BG); Department of Pathology, S. Chiara Hospital, Trento, Italy (PDP); Women's Health Department, University Hospital, Padua, Italy (DM); Veneto Oncology Institute IRCCS, Padua, Italy (MZ); Emilia-Romagna Region, Bologna, Italy (CN); Laboratory of Preventive Oncology, Institute for Cancer Study and Prevention (ISPO), Florence (MC); Department of Cancer Screening, Center for Epidemiology and Prevention in Oncology (CPO), University Hospital "Città della Salute e della Scienza di Torino," Turin, Italy (GR, NS, SR)
| | - Paolo Giorgi-Rossi
- Department of Pathology, Laboratoire Cerba, Cergy Pontoise France (CB, FC); Servizio Interaziendale Epidemiologia, AUSL Reggio Emilia, Italy (PGR); Department of Pathology, S. Giovanni Hospital, Rome, Italy (MLS); Laboratory Department University Hospital "Città della Salute e della Scienza di Torino," Turin, Italy (BG); Department of Pathology, S. Chiara Hospital, Trento, Italy (PDP); Women's Health Department, University Hospital, Padua, Italy (DM); Veneto Oncology Institute IRCCS, Padua, Italy (MZ); Emilia-Romagna Region, Bologna, Italy (CN); Laboratory of Preventive Oncology, Institute for Cancer Study and Prevention (ISPO), Florence (MC); Department of Cancer Screening, Center for Epidemiology and Prevention in Oncology (CPO), University Hospital "Città della Salute e della Scienza di Torino," Turin, Italy (GR, NS, SR)
| | - Frederic Cas
- Department of Pathology, Laboratoire Cerba, Cergy Pontoise France (CB, FC); Servizio Interaziendale Epidemiologia, AUSL Reggio Emilia, Italy (PGR); Department of Pathology, S. Giovanni Hospital, Rome, Italy (MLS); Laboratory Department University Hospital "Città della Salute e della Scienza di Torino," Turin, Italy (BG); Department of Pathology, S. Chiara Hospital, Trento, Italy (PDP); Women's Health Department, University Hospital, Padua, Italy (DM); Veneto Oncology Institute IRCCS, Padua, Italy (MZ); Emilia-Romagna Region, Bologna, Italy (CN); Laboratory of Preventive Oncology, Institute for Cancer Study and Prevention (ISPO), Florence (MC); Department of Cancer Screening, Center for Epidemiology and Prevention in Oncology (CPO), University Hospital "Città della Salute e della Scienza di Torino," Turin, Italy (GR, NS, SR)
| | - Maria Luisa Schiboni
- Department of Pathology, Laboratoire Cerba, Cergy Pontoise France (CB, FC); Servizio Interaziendale Epidemiologia, AUSL Reggio Emilia, Italy (PGR); Department of Pathology, S. Giovanni Hospital, Rome, Italy (MLS); Laboratory Department University Hospital "Città della Salute e della Scienza di Torino," Turin, Italy (BG); Department of Pathology, S. Chiara Hospital, Trento, Italy (PDP); Women's Health Department, University Hospital, Padua, Italy (DM); Veneto Oncology Institute IRCCS, Padua, Italy (MZ); Emilia-Romagna Region, Bologna, Italy (CN); Laboratory of Preventive Oncology, Institute for Cancer Study and Prevention (ISPO), Florence (MC); Department of Cancer Screening, Center for Epidemiology and Prevention in Oncology (CPO), University Hospital "Città della Salute e della Scienza di Torino," Turin, Italy (GR, NS, SR)
| | - Bruno Ghiringhello
- Department of Pathology, Laboratoire Cerba, Cergy Pontoise France (CB, FC); Servizio Interaziendale Epidemiologia, AUSL Reggio Emilia, Italy (PGR); Department of Pathology, S. Giovanni Hospital, Rome, Italy (MLS); Laboratory Department University Hospital "Città della Salute e della Scienza di Torino," Turin, Italy (BG); Department of Pathology, S. Chiara Hospital, Trento, Italy (PDP); Women's Health Department, University Hospital, Padua, Italy (DM); Veneto Oncology Institute IRCCS, Padua, Italy (MZ); Emilia-Romagna Region, Bologna, Italy (CN); Laboratory of Preventive Oncology, Institute for Cancer Study and Prevention (ISPO), Florence (MC); Department of Cancer Screening, Center for Epidemiology and Prevention in Oncology (CPO), University Hospital "Città della Salute e della Scienza di Torino," Turin, Italy (GR, NS, SR)
| | - Paolo Dalla Palma
- Department of Pathology, Laboratoire Cerba, Cergy Pontoise France (CB, FC); Servizio Interaziendale Epidemiologia, AUSL Reggio Emilia, Italy (PGR); Department of Pathology, S. Giovanni Hospital, Rome, Italy (MLS); Laboratory Department University Hospital "Città della Salute e della Scienza di Torino," Turin, Italy (BG); Department of Pathology, S. Chiara Hospital, Trento, Italy (PDP); Women's Health Department, University Hospital, Padua, Italy (DM); Veneto Oncology Institute IRCCS, Padua, Italy (MZ); Emilia-Romagna Region, Bologna, Italy (CN); Laboratory of Preventive Oncology, Institute for Cancer Study and Prevention (ISPO), Florence (MC); Department of Cancer Screening, Center for Epidemiology and Prevention in Oncology (CPO), University Hospital "Città della Salute e della Scienza di Torino," Turin, Italy (GR, NS, SR)
| | - Daria Minucci
- Department of Pathology, Laboratoire Cerba, Cergy Pontoise France (CB, FC); Servizio Interaziendale Epidemiologia, AUSL Reggio Emilia, Italy (PGR); Department of Pathology, S. Giovanni Hospital, Rome, Italy (MLS); Laboratory Department University Hospital "Città della Salute e della Scienza di Torino," Turin, Italy (BG); Department of Pathology, S. Chiara Hospital, Trento, Italy (PDP); Women's Health Department, University Hospital, Padua, Italy (DM); Veneto Oncology Institute IRCCS, Padua, Italy (MZ); Emilia-Romagna Region, Bologna, Italy (CN); Laboratory of Preventive Oncology, Institute for Cancer Study and Prevention (ISPO), Florence (MC); Department of Cancer Screening, Center for Epidemiology and Prevention in Oncology (CPO), University Hospital "Città della Salute e della Scienza di Torino," Turin, Italy (GR, NS, SR)
| | - Stefano Rosso
- Department of Pathology, Laboratoire Cerba, Cergy Pontoise France (CB, FC); Servizio Interaziendale Epidemiologia, AUSL Reggio Emilia, Italy (PGR); Department of Pathology, S. Giovanni Hospital, Rome, Italy (MLS); Laboratory Department University Hospital "Città della Salute e della Scienza di Torino," Turin, Italy (BG); Department of Pathology, S. Chiara Hospital, Trento, Italy (PDP); Women's Health Department, University Hospital, Padua, Italy (DM); Veneto Oncology Institute IRCCS, Padua, Italy (MZ); Emilia-Romagna Region, Bologna, Italy (CN); Laboratory of Preventive Oncology, Institute for Cancer Study and Prevention (ISPO), Florence (MC); Department of Cancer Screening, Center for Epidemiology and Prevention in Oncology (CPO), University Hospital "Città della Salute e della Scienza di Torino," Turin, Italy (GR, NS, SR)
| | - Manuel Zorzi
- Department of Pathology, Laboratoire Cerba, Cergy Pontoise France (CB, FC); Servizio Interaziendale Epidemiologia, AUSL Reggio Emilia, Italy (PGR); Department of Pathology, S. Giovanni Hospital, Rome, Italy (MLS); Laboratory Department University Hospital "Città della Salute e della Scienza di Torino," Turin, Italy (BG); Department of Pathology, S. Chiara Hospital, Trento, Italy (PDP); Women's Health Department, University Hospital, Padua, Italy (DM); Veneto Oncology Institute IRCCS, Padua, Italy (MZ); Emilia-Romagna Region, Bologna, Italy (CN); Laboratory of Preventive Oncology, Institute for Cancer Study and Prevention (ISPO), Florence (MC); Department of Cancer Screening, Center for Epidemiology and Prevention in Oncology (CPO), University Hospital "Città della Salute e della Scienza di Torino," Turin, Italy (GR, NS, SR)
| | - Carlo Naldoni
- Department of Pathology, Laboratoire Cerba, Cergy Pontoise France (CB, FC); Servizio Interaziendale Epidemiologia, AUSL Reggio Emilia, Italy (PGR); Department of Pathology, S. Giovanni Hospital, Rome, Italy (MLS); Laboratory Department University Hospital "Città della Salute e della Scienza di Torino," Turin, Italy (BG); Department of Pathology, S. Chiara Hospital, Trento, Italy (PDP); Women's Health Department, University Hospital, Padua, Italy (DM); Veneto Oncology Institute IRCCS, Padua, Italy (MZ); Emilia-Romagna Region, Bologna, Italy (CN); Laboratory of Preventive Oncology, Institute for Cancer Study and Prevention (ISPO), Florence (MC); Department of Cancer Screening, Center for Epidemiology and Prevention in Oncology (CPO), University Hospital "Città della Salute e della Scienza di Torino," Turin, Italy (GR, NS, SR)
| | - Nereo Segnan
- Department of Pathology, Laboratoire Cerba, Cergy Pontoise France (CB, FC); Servizio Interaziendale Epidemiologia, AUSL Reggio Emilia, Italy (PGR); Department of Pathology, S. Giovanni Hospital, Rome, Italy (MLS); Laboratory Department University Hospital "Città della Salute e della Scienza di Torino," Turin, Italy (BG); Department of Pathology, S. Chiara Hospital, Trento, Italy (PDP); Women's Health Department, University Hospital, Padua, Italy (DM); Veneto Oncology Institute IRCCS, Padua, Italy (MZ); Emilia-Romagna Region, Bologna, Italy (CN); Laboratory of Preventive Oncology, Institute for Cancer Study and Prevention (ISPO), Florence (MC); Department of Cancer Screening, Center for Epidemiology and Prevention in Oncology (CPO), University Hospital "Città della Salute e della Scienza di Torino," Turin, Italy (GR, NS, SR)
| | - Massimo Confortini
- Department of Pathology, Laboratoire Cerba, Cergy Pontoise France (CB, FC); Servizio Interaziendale Epidemiologia, AUSL Reggio Emilia, Italy (PGR); Department of Pathology, S. Giovanni Hospital, Rome, Italy (MLS); Laboratory Department University Hospital "Città della Salute e della Scienza di Torino," Turin, Italy (BG); Department of Pathology, S. Chiara Hospital, Trento, Italy (PDP); Women's Health Department, University Hospital, Padua, Italy (DM); Veneto Oncology Institute IRCCS, Padua, Italy (MZ); Emilia-Romagna Region, Bologna, Italy (CN); Laboratory of Preventive Oncology, Institute for Cancer Study and Prevention (ISPO), Florence (MC); Department of Cancer Screening, Center for Epidemiology and Prevention in Oncology (CPO), University Hospital "Città della Salute e della Scienza di Torino," Turin, Italy (GR, NS, SR)
| | - Guglielmo Ronco
- Department of Pathology, Laboratoire Cerba, Cergy Pontoise France (CB, FC); Servizio Interaziendale Epidemiologia, AUSL Reggio Emilia, Italy (PGR); Department of Pathology, S. Giovanni Hospital, Rome, Italy (MLS); Laboratory Department University Hospital "Città della Salute e della Scienza di Torino," Turin, Italy (BG); Department of Pathology, S. Chiara Hospital, Trento, Italy (PDP); Women's Health Department, University Hospital, Padua, Italy (DM); Veneto Oncology Institute IRCCS, Padua, Italy (MZ); Emilia-Romagna Region, Bologna, Italy (CN); Laboratory of Preventive Oncology, Institute for Cancer Study and Prevention (ISPO), Florence (MC); Department of Cancer Screening, Center for Epidemiology and Prevention in Oncology (CPO), University Hospital "Città della Salute e della Scienza di Torino," Turin, Italy (GR, NS, SR).
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Allia E, Ronco G, Coccia A, Luparia P, Macrì L, Fiorito C, Maletta F, Deambrogio C, Tunesi S, De Marco L, Gillio-Tos A, Sapino A, Ghiringhello B. Interpretation of p16(INK4a) /Ki-67 dual immunostaining for the triage of human papillomavirus-positive women by experts and nonexperts in cervical cytology. Cancer Cytopathol 2014; 123:212-8. [PMID: 25534957 DOI: 10.1002/cncy.21511] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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: 10/21/2014] [Revised: 11/25/2014] [Accepted: 12/01/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND The triage of human papillomavirus (HPV)-positive women is needed to avoid overreferral to colposcopy. p16(INK4a) immunostaining is an efficient triage method. p16(INK4a) /Ki-67 dual staining was introduced mainly to increase reproducibility and specificity compared with stand-alone p16(INK4a) staining. METHODS Within a pilot project, HPV-positive women were referred to colposcopy if cytology was abnormal or unsatisfactory or HPV testing was still positive after 1 year. For 500 consecutive women, a slide obtained during colposcopy was immunostained for p16(INK4a) /Ki-67 and independently interpreted by 7 readers without previous experience with dual staining. Four of these readers were experts in cervical pathology and 3 were not. Kappa values for multiple raters, sensitivity, and specificity for cervical intraepithelial neoplasia type 2-positive histology were computed. Because women with normal cytology were underrepresented, estimates for all HPV-positive women were obtained as weighted means of cytology-specific estimates. RESULTS The overall kappa for HPV-positive women was 0.70 (95% confidence interval [95% CI], 0.60-0.77). Kappa values were not found to be significantly different between expert and nonexpert readers with regard to cervical cytology but were significantly increased (P =. 0066) after consensus discussion. The overall specificity estimate for HPV-positive women was 64.0% (95% CI, 57.4%-70.2%): 66.7% (95% CI, 59.8%-73.0%) for experts and 60.5% (95% CI, 59.8%-73.0%) for nonexperts. Among women with abnormal cytology, the sensitivity was 85.5% (95% CI, 77.9%-90.8%): 85.8% (95% CI, 77.9%-91.2%) for experts and 85.1% (95% CI, 76.6%-90.9%) for nonexperts. CONCLUSIONS p16(INK4a) /Ki-67 immunostaining demonstrated good reproducibility and specificity when triaging HPV-positive women. Dual-staining interpretation can be performed, after short training, even by staff who are not experts in cervical cytology. This allows HPV-based screening with triage to be performed in settings in which such expert staff is not available.
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Affiliation(s)
- Elena Allia
- Center for Cervical Cancer Screening, AO City of Health and Science, Turin, Italy
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Veldhuijzen NJ, Berkhof J, Gillio-Tos A, De Marco L, Carozzi F, Del Mistro A, Snijders PJF, Meijer CJLM, Ronco G. The age distribution of type-specific high-risk human papillomavirus incidence in two population-based screening trials. Cancer Epidemiol Biomarkers Prev 2014; 24:111-8. [PMID: 25300476 DOI: 10.1158/1055-9965.epi-14-0628] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Age- and type-specific high-risk human papillomavirus (hrHPV) incidence estimates in screen-eligible women are relevant from a public health perspective because they provide an indication of the effect of vaccination on the occurrence of screen-positives in HPV-based screening. However, limited data from women over 25 years of age are available. METHODS In 24,105 hrHPV-negative women participating in Dutch (Population-Based Screening Study Amsterdam: POBASCAM) and Italian (New Technologies for Cervical Cancer: NTCC) population-based randomized controlled screening trials the age- and type-specific distribution of incident hrHPV infections detected at the next screening round was assessed. HPV types were grouped into vaccine (bivalent: HPV16/18; polyvalent HPV16/18/31/33/45/52/58) and nonvaccine types. RESULTS The incidence of screen-detected hrHPV among women ages 29 to 56 years was 2.54% (95% confidence interval, 2.30-2.78) in POBASCAM and 2.77% (2.36-3.19) in NTCC. In both studies, the incidence of bivalent, polyvalent, and nonpolyvalent infections decreased with age (P < 0.0001). Among women with incident infection(s), vaccine-type positivity changed quadratically with age, in particular for the polyvalent vaccine (P values: POBASCAM: bivalent 0.264, polyvalent 0.038; NTCC bivalent 0.039, polyvalent 0.005). However, more than 20% and 50% of women with incident hrHPV were positive for bivalent and polyvalent vaccine types, respectively, in all ages in both studies. CONCLUSIONS We observed decreasing age trends of hrHPV vaccine and nonvaccine type incidences and age-related differences in the vaccine-type positivity among women with incident infections. Most importantly, hrHPV infections continued to be detected in all ages and the contribution of vaccine types remained substantial. IMPACT Our results indicate a considerable reduction of new hrHPV infections in vaccinated cohorts, ensuing revision of screening guidelines.
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Affiliation(s)
- Nienke J Veldhuijzen
- Department of Epidemiology & Biostatistics, VU University Medical Centre, Amsterdam, the Netherlands.
| | - Johannes Berkhof
- Department of Epidemiology & Biostatistics, VU University Medical Centre, Amsterdam, the Netherlands
| | - Anna Gillio-Tos
- Cancer Epidemiology Unit, CERMS, University of Turin, Turin, Italy
| | - Laura De Marco
- Cancer Epidemiology Unit, CERMS, University of Turin, Turin, Italy
| | | | | | - Peter J F Snijders
- Department of Pathology, VU University Medical Centre (VUmc), Amsterdam, the Netherlands
| | - Chris J L M Meijer
- Department of Pathology, VU University Medical Centre (VUmc), Amsterdam, the Netherlands
| | - Guglielmo Ronco
- Center for Cancer Epidemiology and Prevention, AO City of Health and Science, Turin, Italy
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Carozzi F, De Marco L, Gillio-Tos A, Del Mistro A, Girlando S, Baboci L, Trevisan M, Burroni E, Grasso S, Rossi PG, Ronco G. Age and geographic variability of human papillomavirus high-risk genotype distribution in a large unvaccinated population and of vaccination impact on HPV prevalence. J Clin Virol 2014; 60:257-63. [DOI: 10.1016/j.jcv.2014.04.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 03/11/2014] [Accepted: 04/10/2014] [Indexed: 12/29/2022]
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Bergeron C, Ronco G, Reuschenbach M, Wentzensen N, Arbyn M, Stoler M, von Knebel Doeberitz M. The clinical impact of using p16(INK4a) immunochemistry in cervical histopathology and cytology: an update of recent developments. Int J Cancer 2014; 136:2741-51. [PMID: 24740700 DOI: 10.1002/ijc.28900] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [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: 01/04/2014] [Revised: 03/07/2014] [Accepted: 03/11/2014] [Indexed: 02/02/2023]
Abstract
Cervical cancer screening test performance has been hampered by either lack of sensitivity of Pap cytology or lack of specificity of Human Papillomavirus (HPV) testing. This uncertainty can lead to unnecessary referral and treatment, which is disturbing for patients and increases costs for health care providers. The identification of p16(INK4a) as a marker for neoplastic transformation of cervical squamous epithelial cells by HPVs allows the identification of HPV-transformed cells in histopathology or cytopathology specimens. Diagnostic studies have demonstrated that the use of p16(INK4a) immunohistochemistry substantially improves the reproducibility and diagnostic accuracy of histopathologic diagnoses. p16(INK4a) cytology has substantially higher sensitivity for detection of cervical precancer in comparison to conventional Pap tests. Compared to HPV DNA tests, immunochemical detection of p16(INK4a) -stained cells demonstrates a significantly improved specificity with remarkably good sensitivity. About 15 years after the initial observation that p16(INK4a) is overexpressed in HPV-transformed cells we review the accumulated clinical evidence suggesting that p16(INK4a) can serve as a useful biomarker in the routine diagnostic work up of patients with HPV infections and associated lesions of the female anogenital tract.
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Affiliation(s)
- Guglielmo Ronco
- Unit of Cancer Epidemiology, Center for Cancer Epidemiology and Prevention, AO City of Health and Science, 10123 Torino, Italy.
| | | | - Nereo Segnan
- Unit of Cancer Epidemiology, Center for Cancer Epidemiology and Prevention, AO City of Health and Science, 10123 Torino, Italy
| | | | | | - Julian Peto
- London School of Hygiene & Tropical Medicine, London, UK
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Giorgi Rossi P, Baldacchini F, Ronco G. The Possible Effects on Socio-Economic Inequalities of Introducing HPV Testing as Primary Test in Cervical Cancer Screening Programs. Front Oncol 2014; 4:20. [PMID: 24575388 PMCID: PMC3919018 DOI: 10.3389/fonc.2014.00020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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: 11/30/2013] [Accepted: 01/24/2014] [Indexed: 11/13/2022] Open
Abstract
Background: Screening with HPV is more effective than Pap test in preventing cervical cancer. HPV as primary test will imply longer intervals and a triage test for HPV positive women. It will also permit the development of self-sampling devices. These innovations may affect population coverage, participation, and compliance to protocols, and likely in a different way for less educated, poorer, and disadvantaged women. Aim: To describe the impact on inequalities, actual or presumed, of the introduction of HPV-based screening. Methods: The putative HPV-based screening algorithm has been analyzed to identify critical points for inequalities. A systematic review of the literature has been conducted searching PubMed on HPV screening coverage, participation, and compliance. Results were summarized in a narrative synthesis. Results: Knowledge about HPV and cervical cancer was lower in women with low socio-economic status and in disadvantaged groups. A correct communication can reduce differences. Longer intervals will make it easier to achieve high-population coverage, but higher cost of the test in private providers could reduce the use of opportunistic screening by disadvantaged women. There are some evidences that inviting for HPV test instead of Pap increases participation, but there are no data on social differences. Self-sampling devices are effective in increasing participation and coverage. Some studies showed that the acceptability of self-sampling is higher in more educated women, but there is also an effect on hard-to-reach women. Communication of HPV positivity may increase anxiety and impact on sexual behaviors, the effect is stronger in low educated and disadvantaged women. Finally, many studies found indirect evidence that unvaccinated women are or will be more probably under-screened. Conclusion: The introduction of HPV test may increase population coverage, but non-compliance to protocols and interaction with opportunistic screening can increase the existing inequalities.
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Affiliation(s)
- Paolo Giorgi Rossi
- Servizio Interaziendale di Epidemiologia, Azienda Unità Sanitaria Locale di Reggio Emilia , Reggio Emilia , Italy
| | - Flavia Baldacchini
- Servizio Interaziendale di Epidemiologia, Azienda Unità Sanitaria Locale di Reggio Emilia , Reggio Emilia , Italy
| | - Guglielmo Ronco
- Unit of Cancer Epidemiology II, Center for Cancer Epidemiology and Prevention (CPO) , Turin , Italy
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Ronco G, Dillner J, Elfström KM, Tunesi S, Snijders PJF, Arbyn M, Kitchener H, Segnan N, Gilham C, Giorgi-Rossi P, Berkhof J, Peto J, Meijer CJLM. Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials. Lancet 2014; 383:524-32. [PMID: 24192252 DOI: 10.1016/s0140-6736(13)62218-7] [Citation(s) in RCA: 1078] [Impact Index Per Article: 107.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND In four randomised trials, human papillomavirus (HPV)-based screening for cervical cancer was compared with cytology-based cervical screening, and precursors of cancer were the endpoint in every trial. However, direct estimates are missing of the relative efficacy of HPV-based versus cytology-based screening for prevention of invasive cancer in women who undergo regular screening, of modifiers (eg, age) of this relative efficacy, and of the duration of protection. We did a follow-up study of the four randomised trials to investigate these outcomes. METHODS 176,464 women aged 20-64 years were randomly assigned to HPV-based (experimental arm) or cytology-based (control arm) screening in Sweden (Swedescreen), the Netherlands (POBASCAM), England (ARTISTIC), and Italy (NTCC). We followed up these women for a median of 6·5 years (1,214,415 person-years) and identified 107 invasive cervical carcinomas by linkage with screening, pathology, and cancer registries, by masked review of histological specimens, or from reports. Cumulative and study-adjusted rate ratios (experimental vs control) were calculated for incidence of invasive cervical carcinoma. FINDINGS The rate ratio for invasive cervical carcinoma among all women from recruitment to end of follow-up was 0·60 (95% CI 0·40-0·89), with no heterogeneity between studies (p=0·52). Detection of invasive cervical carcinoma was similar between screening methods during the first 2·5 years of follow-up (0·79, 0·46-1·36) but was significantly lower in the experimental arm thereafter (0·45, 0·25-0·81). In women with a negative screening test at entry, the rate ratio was 0·30 (0·15-0·60). The cumulative incidence of invasive cervical carcinoma in women with negative entry tests was 4·6 per 10(5) (1·1-12·1) and 8·7 per 10(5) (3·3-18·6) at 3·5 and 5·5 years, respectively, in the experimental arm, and 15·4 per 10(5) (7·9-27·0) and 36·0 per 10(5) (23·2-53·5), respectively, in the control arm. Rate ratios did not differ by cancer stage, but were lower for adenocarcinoma (0·31, 0·14-0·69) than for squamous-cell carcinoma (0·78, 0·49-1·25). The rate ratio was lowest in women aged 30-34 years (0·36, 0·14-0·94). INTERPRETATION HPV-based screening provides 60-70% greater protection against invasive cervical carcinomas compared with cytology. Data of large-scale randomised trials support initiation of HPV-based screening from age 30 years and extension of screening intervals to at least 5 years. FUNDING European Union, Belgian Foundation Against Cancer, KCE-Centre d'Expertise, IARC, The Netherlands Organisation for Health Research and Development, the Italian Ministry of Health.
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Affiliation(s)
- Guglielmo Ronco
- Center for Cancer Epidemiology and Prevention, AO City of Health and Science, Turin, Italy.
| | | | | | - Sara Tunesi
- Center for Cancer Epidemiology and Prevention, AO City of Health and Science, Turin, Italy
| | | | - Marc Arbyn
- Scientific Institute of Public Health, Brussels, Belgium
| | - Henry Kitchener
- Institute of Cancer Sciences, University of Manchester, Manchester, UK
| | - Nereo Segnan
- Center for Cancer Epidemiology and Prevention, AO City of Health and Science, Turin, Italy; International Agency for Research on Cancer (IARC), Lyon, France
| | - Clare Gilham
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Julian Peto
- London School of Hygiene and Tropical Medicine, London, UK
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Baussano I, Dillner J, Lazzarato F, Ronco G, Franceschi S. Upscaling human papillomavirus vaccination in high-income countries: impact assessment based on transmission model. Infect Agent Cancer 2014; 9:4. [PMID: 24438317 PMCID: PMC3901332 DOI: 10.1186/1750-9378-9-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 01/03/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The decrease in human papillomavirus (HPV) vaccine prices may allow upscale already started vaccination programmes but the advantages of different options are unclear. METHODS Using a mathematical model of HPV16 and 18 transmission and data on vaccination coverage from Italy, we compared 3 options to upscale an already started programme targeting 11-year old girls (coverage 65%): a) coverage improvement (from 65% to 90%); b) addition of 11-year-old boys (coverage 65%); or c) 1-year catch-up of older girls (coverage 50%). RESULTS The reduction of cervical HPV16/18 infection as compared to no vaccination (i.e. effectiveness against HPV16/18) increased from 76% to 98% with coverage improvement in girls and to 90% with the addition of boys. With higher coverage in girls, HPV16/18 infection cumulative probability by age 35 decreased from 25% to 8% with a 38% increase in vaccine number. The addition of boys decreased the cumulative probability to 18% with a 100% increase in the number of vaccinees. For any coverage in girls, the number of vaccinees to prevent 1 woman from being infected by HPV16/18 by age 35 was 1.5, whereas it was 2.7 for the addition of boys. Catch-up of older girls only moved forward the vaccination effectiveness by 2-5 years. CONCLUSIONS Increasing vaccination coverage among girls is the most effective option for decreasing HPV16/18. If not achievable, vaccinating boys is justifiable if vaccine cost has at least halved, because this option would almost double the number of vaccinees.
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Affiliation(s)
- Iacopo Baussano
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon cedex 08, France
| | - Joakim Dillner
- Karolinska Institutet, Nobels väg 12A, 17177 Stockholm, Sweden
| | - Fulvio Lazzarato
- Department of Medical Sciences, Unit of Cancer Epidemiology, University of Turin, Via Santena 7, 10126 Turin, Italy
| | - Guglielmo Ronco
- Centre for Cancer Prevention, Via San Francesco da Paola 31, 10123 Turin, Italy
| | - Silvia Franceschi
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon cedex 08, France
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Arbyn M, Ronco G, Anttila A, Meijer CJ, Poljak M, Ogilvie G, Koliopoulos G, Naucler P, Sankaranarayanan R, Peto J. Erratum to: “Evidence Regarding Human Papillomavirus Testing in Secondary Prevention of Cervical Cancer” [Vaccine 30S5 (2012) F88–F99]. Vaccine 2013. [DOI: 10.1016/j.vaccine.2013.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Baussano I, Elfström KM, Lazzarato F, Gillio-Tos A, De Marco L, Carozzi F, Del Mistro A, Dillner J, Franceschi S, Ronco G. Type-specific human papillomavirus biological features: validated model-based estimates. PLoS One 2013; 8:e81171. [PMID: 24400036 PMCID: PMC3882251 DOI: 10.1371/journal.pone.0081171] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 10/09/2013] [Indexed: 11/19/2022] Open
Abstract
Infection with high-risk (hr) human papillomavirus (HPV) is considered the necessary cause of cervical cancer. Vaccination against HPV16 and 18 types, which are responsible of about 75% of cervical cancer worldwide, is expected to have a major global impact on cervical cancer occurrence. Valid estimates of the parameters that regulate the natural history of hrHPV infections are crucial to draw reliable projections of the impact of vaccination. We devised a mathematical model to estimate the probability of infection transmission, the rate of clearance, and the patterns of immune response following the clearance of infection of 13 hrHPV types. To test the validity of our estimates, we fitted the same transmission model to two large independent datasets from Italy and Sweden and assessed finding consistency. The two populations, both unvaccinated, differed substantially by sexual behaviour, age distribution, and study setting (screening for cervical cancer or Chlamydia trachomatis infection). Estimated transmission probability of hrHPV types (80% for HPV16, 73%-82% for HPV18, and above 50% for most other types); clearance rates decreasing as a function of time since infection; and partial protection against re-infection with the same hrHPV type (approximately 20% for HPV16 and 50% for the other types) were similar in the two countries. The model could accurately predict the HPV16 prevalence observed in Italy among women who were not infected three years before. In conclusion, our models inform on biological parameters that cannot at the moment be measured directly from any empirical data but are essential to forecast the impact of HPV vaccination programmes.
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Affiliation(s)
| | - K. Miriam Elfström
- Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Fulvio Lazzarato
- Unit of Cancer Epidemiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Anna Gillio-Tos
- Unit of Cancer Epidemiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Laura De Marco
- Unit of Cancer Epidemiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Annarosa Del Mistro
- Molecular Oncological and Diagnostic Immunology, Venetian Oncology Institute (IOV), Padova, Italy
| | - Joakim Dillner
- Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - Guglielmo Ronco
- Unit of Cancer Epidemiology, Centre for Cancer Prevention, Turin, Italy
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Zucchetto A, Ronco G, Giorgi Rossi P, Zappa M, Serraino D. Re: lead time and down-staging in the survival of cervical cancer cases detected by screening. Prev Med 2013; 57:404-5. [PMID: 23954188 DOI: 10.1016/j.ypmed.2013.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 08/04/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Antonella Zucchetto
- Epidemiology and Biostatistics Unit, Aviano National Cancer Institute (CRO), Via Gallini 2, 33081 Aviano (PN), Italy; Clinical Sciences and Community Health, Milan University, Via Vanzetti 5, 20133 Milano, Italy.
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