Changes in cervical cancer incidence following the introduction of organized screening in Italy

Serraino, Diego; Gini, Andrea; Taborelli, Martina; Ronco, Guglielmo; Rossi, Paolo Giorgi; Zappa, Marco; Crocetti, Emanuele; Franzo, Antonella; Falcini, Fabio; Visioli, Carmen Beatriz; Stracci, Fabrizio; Zorzi, Manuel; Federico, Massimo; Michiara, Maria; Fusco, Mario; Ferretti, Stefano; Pannozzo, Fabio; Tisano, F.; Zanetti, Roberto; Zucchetto, Antonella; Zanier, Loris; Clagnan, Elena; Virdone, Saverio; Birri, Silvia; Naldoni, Carlo; Mancini, Silvia; Vattiato, Rosa; Monticelli, Chiara Lucrezio; Vitali, B; Caldarella, Adele; Manneschi, Gianfranco; Intrieri, Teresa; Rosa, Francesco La; Bianconi, Fortunato; Spita, Nicoletta; Martinelli, Nadia; Vinti, G.; Baracco, Susanna; Baracco, Maddalena; Bovo, Emanuela; Turrin, Anna; Cin, Antonella Dal; Iachetta, Francesco; Crimi, Claudia; Bozzani, F; Sgargi, Paolo; Lombardozzi, Lorella; Vitale, M.F.; Fusco, Maria Alice; Panico, Maria Grazia; Maione, Carmela; Togni, Aldo De; Marzola, L; Migliari, E; Carletti, N; Carpanelli, M.C.; Bellardini, P.; Frateloreto, F.; Macci, L; Busco, Susanna; Malignaggi, S.; Giubilato, Pamela; Patriarca, S; Campari, Cinzia; Caroli, Stefania; Felice, Enza Di; Prandi, Sonia; Marani, Enza; Casella, Claudia; Puppo, Antonella; Bonelli, Luigina; Piffer, Silvano; Gentilini, M; Cappelletti, M; Biavati, Patrizia; Collina, Natalina; Petrucci, Cristina; Pandolfi, Pier Paolo; Manfredi, Marilena; Seghini, Pietro; Borciani, E; Castaing, Marine; Sciacca, Salvatore; Sciacchitano, Salvatore; Benedetto, G; Fidelbo, M; Scuderi, T.; Pala, Funda Sibel; Sini, Giovanna; Canu, Letizia; Pintori, Nicholas

doi:10.1016/j.ypmed.2015.01.034

Cited by 35 publications

(26 citation statements)

References 21 publications

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“…Our results should also be compared to those of a previous multiregional Italian study of changes in CC incidence following the introduction of organised screening, authored by Serraino et al ., that covered part of the Emilia‐Romagna Region . The reported incidence reduction was 25%, considerably less than the one resulting from our estimate.…”

Section: Discussioncontrasting

confidence: 72%

“…A key issue to consider is that its implementation was accompanied by a substantial decrease in spontaneous screening activities, that are known to be more expensive and less effective . In the first half of the 1990s, based on national estimates, the proportion of women aged ≥25 years who had ever undergone a Pap smear spontaneously was certainly above 50% . Currently, the proportion of women aged 25–64 years who spontaneously undergo a Pap smear every 3 years is 23% .…”

Section: Discussionmentioning

confidence: 99%

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Estimating the impact of an organised screening programme on cervical cancer incidence: A 26‐year study from northern Italy

Bucchi

Baldacchini

Mancini

et al. 2018

Intl Journal of Cancer

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The impact of the organised cervical cancer (CC) screening programmes implemented in Europe since the 1990s has been insufficiently evaluated. We investigated the changes in CC incidence following the introduction of a screening programme in the Emilia-Romagna Region (northern Italy). The study period was 1988-2013. The programme, targeting women aged 25-64 years (1,219,000 in 2018), started in 1998. The annual incidence rates that would be expected in 1998-2013 in the absence of screening were estimated, first, by analysing the annual rates in 1988-1997 with a log-linear model and, second, by analysing the annual rates in 1988-2013 with an age-period model in which the period effect was enforced to be linear. Cervical adenocarcinoma incidence trend over the entire period was used to validate both estimates. Observed annual rates were compared to the two series of expected ones with the incidence rate ratio (IRR). Incidence remained stable during 1988-1997, peaked in 1998 and then decreased until 2007, when it stabilised. The two series of expected rates were virtually coincident and their trends roughly paralleled the stable adenocarcinoma incidence trend. After 2007, the median IRR was 0.60 (95% confidence interval, 0.45-0.81) based on the log-linear model and 0.58 (95% confidence interval, 0.34-0.97) based on the age-period model. Thirty-six to seventy-five CC cases were prevented annually for an average annual frequency of 6.5 per 100,000 women in the target population. In summary, consistent circumstantial evidences were obtained that the organised screening programme brought about a 40% reduction in annual CC incidence after 10 years.

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Section: Discussioncontrasting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Estimating the impact of an organised screening programme on cervical cancer incidence: A 26‐year study from northern Italy

Bucchi

Baldacchini

Mancini

et al. 2018

Intl Journal of Cancer

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“…Organised cancer screening using evidence‐based tests has considerable potential to improve the health of the target population, provided that programmes are implemented cost‐effectively and with high quality (Veerus, Arbyn, Amati, & Paolo, ). A recent study on the impact of organised screening in Italy showed that, in line with other international experiences, invasive cervical cancer incidence rates have been decreasing since its full activation, especially among women aged 45–74 years (Serraino et al., ). A similar trend was observed also in Apulia since 2011.…”

Section: Discussionmentioning

confidence: 64%

Cervical cancer prevention: An Italian scenario between organised screening and human papillomaviruses vaccination

et al. 2018

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We aimed to assess the cervical cancer burden and performance of screening programme over the last decade in Apulia, Italy. Data from Hospital Discharge, Causes of Death and of Outpatient Services registries were analysed to estimate the disease burden, and data collected by the screening information system were used to evaluate the performance of the programme. We computed annual hospitalisation, incidence and mortality rates and number of outpatient services prescriptions for the follow‐up of preneoplastic/neoplastic lesions. Indicators as proposed by the National Centre for Screening Monitoring were computed to describe the screening performance. Hospitalisation rates declined from 47 in 2001 to 28 per 100,000 in 2014, incidence from 10.3 in 2004 to 6.0 per 100,000 in 2014 and mortality from 1.4 in 2001 to 1.0 per 100,000 in 2010. Prescriptions increased from 3,333 in 2006 to 4,968 in 2010, then decreased to 3,634/year in 2012–2014. Actual extension of screening increased from 10.8% in 2007 to 62% in 2014; compliance with the invitation was 32%/year. In the last decade, we observed a reduction in the cervical cancer burden as early effect of screening implementation.

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“…Cervical screening performed in the framework of organized population-based programs has reduced cervical carcinoma incidence and mortality [1]. Key strategic elements for effective screening include a high coverage of the target population and the use of and adherence to validated protocols.…”

Section: Introductionmentioning

confidence: 99%

Methylation analysis and HPV genotyping of self-collected cervical samples from women not responding to screening invitation and review of the literature

et al. 2017

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Aim of the studyTo assess the feasibility of partial HPV genotyping and methylation analysis of CADM1, MAL, and miR124-2 genes as triage tests in assaying self-collected cervical samples positive for high-risk HPV on primary screening, and to review the literature regarding host cellular gene methylation analysis of self-collected cervical samples.Material and methodsWomen residing in North-East Italy who had failed to respond to the invitation to participate in an organized population-based program were invited to provide a self-sample. Their stored baseline (self-collected) and follow-up (clinician-collected) cervical samples were included in the study. DNA was extracted from HPV-positive (Qiagen’s Hybrid Capture 2, HC2) samples. Partial genotyping with separate detection of HPV types 16 and 18 was performed with a hybrid capture-based method and a quantitative PCR assay. Methylation was assayed with a quantitative methylation-specific PCR.ResultsHigh-risk HPV infection was detected in 48% of baseline and 71% of follow-up HC2-positive samples. Methylation was demonstrated respectively in 15% and 23.5% of baseline and follow-up samples and chiefly involved a single gene (miR124-2). Invalid quantitative PCR results were recorded in 5% of self-collected samples. The specificity of miR124-1, MAL, and CADM1 methylation was 84%, 94%, and 98%, respectively, and the specificity of the three markers combined was 84%. Sensitivity was not estimated due to the lack of CIN2+ samples. The systematic review showed that different methylation assays yield different accuracy values.ConclusionSelf-collected samples are suitable for methylation assays included in reflex triage testing. The reproducibility and accuracy of the methylation tests described in the literature should be improved.

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Changes in cervical cancer incidence following the introduction of organized screening in Italy

Cited by 35 publications

References 21 publications

Estimating the impact of an organised screening programme on cervical cancer incidence: A 26‐year study from northern Italy

Estimating the impact of an organised screening programme on cervical cancer incidence: A 26‐year study from northern Italy

Cervical cancer prevention: An Italian scenario between organised screening and human papillomaviruses vaccination

Methylation analysis and HPV genotyping of self-collected cervical samples from women not responding to screening invitation and review of the literature

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