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Pasquale L, Rossi PG, Carozzi F, Domenighini S, Ruggeri C, Cecconami L, Morana C, Chiaramonte M, Chiudinelli D, Piccolomini M, Marchione R, Confortini M. HPV screening performance indicators in women who previously tested HPV-negative: The second round of Vallecamonica screening programme, Northern Italy. J Med Screen 2020; 27:207-214. [PMID: 32102618 DOI: 10.1177/0969141320905325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To present performance indicators from the second round of the Vallecamonica-Sebino HPV screening programme in women who had tested negative about four years earlier (mean 45 months). METHODS From 2010 to 2012, the target female population (aged 25-64) was invited to the first HPV screening round. In 2013-2017, women were rescreened for the second round. HPV-negative women at the first round were initially rescreened after three years. The interval was gradually increased to five years. HPV-positive women underwent cytology triage: positives were referred to colposcopy and negatives to repeat testing after one year. If HPV was persistently positive, women were referred to colposcopy, if negative, to normal interval rescreening. RESULTS In the second round, of 13,824 previously HPV-negative women, 598 were HPV-positive (4.3%), of whom 297 were positive at cytology triage. Of those referred to one-year HPV test, 291 complied (98.0%), 133 (50.2%) of whom were persistently positive. Total referral was 3.1% compared with 6.6% in the first round (age-adjusted relative referral 0.59, 95% CI: 0.53-0.65). There were 24 cervical intraepithelial neoplasia 2+ (three cervical intraepithelial neoplasia 3+). Detection was 0.17%, compared with 0.9% in the first round. Age-adjusted relative detections were 0.25 (95% CI: 0.16-0.39) and 0.18 (95% CI: 0.05-0.61) for cervical intraepithelial neoplasia 2+ and cervical intraepithelial neoplasia 3+, respectively. Positive predictive value was 5.7%, compared with 14.6% in the first round. CONCLUSIONS At second round, referral was half that at first round, while cervical intraepithelial neoplasia 2+ detection decreased nine-fold. Consequently, positive predictive value decreased dramatically. Rescreening four years after an HPV-negative test makes the process inefficient due to the low prevalence of lesions.
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Affiliation(s)
- Luigi Pasquale
- Former responsible for screening ex ASL Vallecamonica-Sebino, Regione Lombardia, Breno, Italy
| | - Paolo G Rossi
- Epidemiology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Carozzi
- S.C. Laboratorio di Prevenzione Oncologica, Istituto per lo Studio e la Prevenzione Oncologica, Firenze, Italy
| | | | | | | | | | | | | | | | | | - Massimo Confortini
- S.C. Laboratorio di Prevenzione Oncologica, Istituto per lo Studio e la Prevenzione Oncologica, Firenze, Italy
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2
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Thomsen LT, Kjær SK, Munk C, Frederiksen K, Ørnskov D, Waldstrøm M. Clinical Performance of Human Papillomavirus (HPV) Testing versus Cytology for Cervical Cancer Screening: Results of a Large Danish Implementation Study. Clin Epidemiol 2020; 12:203-213. [PMID: 32110112 PMCID: PMC7041597 DOI: 10.2147/clep.s243546] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 02/05/2020] [Indexed: 12/26/2022] Open
Abstract
Background Human papillomavirus (HPV) testing is increasingly used as the primary cervical cancer screening test. In a large pilot implementation, we compared participation, referrals and detection of high-grade cervical intraepithelial neoplasia (CIN) in HPV- versus cytology-based cervical cancer screening. Methods The implementation was embedded into the routine screening program at Lillebaelt Hospital, Department of Pathology, Vejle, Denmark. Based on the area of residence, women aged 30–59 years were screened by either HPV testing (with HPV16/18 genotyping and cytology triage) or cytology (with HPV triage for minor abnormalities). Our analysis includes women invited or screened during May 2017–May 2018 (invited: n=35,081; screened: n=28,352) with 6 months of follow-up. Information on screening results and sociodemographic characteristics were obtained from registers. Using logistic regression, we estimated odds ratios (ORs) with 95% confidence intervals (CIs) of participation, referral and CIN3+-detection in HPV- versus cytology-based screening, adjusting for sociodemographic characteristics. Results Participation was virtually identical in the HPV- and cytology group (58.4% vs 58.8%; ORadjusted=0.97, 95% CI, 0.93–1.01). Referral to colposcopy was more common in the HPV- than cytology group (3.8% vs 2.1%; ORadjusted=1.88, 95% CI, 1.63–2.17). More cases of CIN3+ were detected in the HPV- than cytology group (1.0% vs 0.7%, ORadjusted=1.47; 95% CI, 1.13–1.91). Conclusion Participation did not differ between HPV- and cytology-based screening. HPV-based screening detected more cases of CIN3+, but in this initial screening round also led to more colposcopies than cytology-based screening.
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Affiliation(s)
- Louise T Thomsen
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne K Kjær
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Gynecology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Christian Munk
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kirsten Frederiksen
- Unit of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Dorthe Ørnskov
- Department of Pathology, Vejle Hospital, Lillebaelt Hospital, Region of Southern Denmark, Vejle, Denmark
| | - Marianne Waldstrøm
- Department of Pathology, Vejle Hospital, Lillebaelt Hospital, Region of Southern Denmark, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Rebolj M, Rimmer J, Denton K, Tidy J, Mathews C, Ellis K, Smith J, Evans C, Giles T, Frew V, Tyler X, Sargent A, Parker J, Holbrook M, Hunt K, Tidbury P, Levine T, Smith D, Patnick J, Stubbs R, Moss S, Kitchener H. Primary cervical screening with high risk human papillomavirus testing: observational study. BMJ 2019; 364:l240. [PMID: 30728133 PMCID: PMC6364146 DOI: 10.1136/bmj.l240] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/01/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To provide the first report on the main outcomes from the prevalence and incidence rounds of a large pilot of routine primary high risk human papillomavirus (hrHPV) testing in England, compared with contemporaneous primary liquid based cytology screening. DESIGN Observational study. SETTING The English Cervical Screening Programme. PARTICIPANTS 578 547 women undergoing cervical screening in primary care between May 2013 and December 2014, with follow-up until May 2017; 183 970 (32%) were screened with hrHPV testing. INTERVENTIONS Routine cervical screening with hrHPV testing with liquid based cytology triage and two early recalls for women who were hrHPV positive and cytology negative, following the national screening age and interval recommendations. MAIN OUTCOME MEASURES Frequency of referral for a colposcopy; adherence to early recall; and relative detection of cervical intraepithelial neoplasia grade 2 or worse from hrHPV testing compared with liquid based cytology in two consecutive screening rounds. RESULTS Baseline hrHPV testing and early recall required approximately 80% more colposcopies, (adjusted odds ratio 1.77, 95% confidence interval 1.73 to 1.82), but detected substantially more cervical intraepithelial neoplasia than liquid based cytology (1.49 for cervical intraepithelial neoplasia grade 2 or worse, 1.43 to 1.55; 1.44 for cervical intraepithelial neoplasia grade 3 or worse, 1.36 to 1.51) and for cervical cancer (1.27, 0.99 to 1.63). Attendance at early recall and colposcopy referral were 80% and 95%, respectively. At the incidence screen, the 33 506 women screened with hrHPV testing had substantially less cervical intraepithelial neoplasia grade 3 or worse than the 77 017 women screened with liquid based cytology (0.14, 0.09 to 0.23). CONCLUSIONS In England, routine primary hrHPV screening increased the detection of cervical intraepithelial neoplasia grade 3 or worse and cervical cancer by approximately 40% and 30%, respectively, compared with liquid based cytology. The very low incidence of cervical intraepithelial neoplasia grade 3 or worse after three years supports extending the screening interval.
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Affiliation(s)
- Matejka Rebolj
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London SE1 9RT, UK
| | - Janet Rimmer
- Young Person and Adult Screening Programmes, Public Health England, Sheffield, UK
| | - Karin Denton
- PHE Screening Quality Assurance Service South, Public Health England, Bristol, UK
- Severn Pathology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - John Tidy
- Department of Gynaecological Oncology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Christopher Mathews
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London SE1 9RT, UK
| | - Kay Ellis
- Cytology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - John Smith
- Cytology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Chris Evans
- NHS Liverpool Clinical Laboratories, Royal Liverpool University Hospital, Liverpool, UK
| | - Thomas Giles
- NHS Liverpool Clinical Laboratories, Royal Liverpool University Hospital, Liverpool, UK
| | - Viki Frew
- Department of Cellular Pathology, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Xenia Tyler
- Department of Cellular Pathology, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Alexandra Sargent
- Clinical Virology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Janet Parker
- Cellular Pathology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Miles Holbrook
- Cellular Pathology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Katherine Hunt
- Severn Pathology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Penny Tidbury
- Severn Pathology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Tanya Levine
- Department of Cellular Pathology, Northwick Park Hospital, London, UK
| | - David Smith
- Department of Cellular Pathology, Northwick Park Hospital, London, UK
| | - Julietta Patnick
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ruth Stubbs
- Young Person and Adult Screening Programmes, Public Health England, Sheffield, UK
| | - Sue Moss
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Henry Kitchener
- Division of Cancer Sciences, University of Manchester and Manchester NIHR BRC, Manchester, UK
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Passamonti B, Gustinucci D, Giorgi Rossi P, Cesarini E, Bulletti S, Carlani A, Martinelli N, Broccolini M, D'Angelo V, D'Amico MR, Di Dato E, Galeazzi P, Malaspina M, Spita N, Tintori B, Giaimo MD. Cervical human papilloma virus (HPV) DNA primary screening test: Results of a population-based screening programme in central Italy. J Med Screen 2016; 24:153-162. [PMID: 27614992 DOI: 10.1177/0969141316663580] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To present the results of the first and second round human papilloma virus (HPV)-based screening programme in the Umbria region after three years. Methods From August 2010 to November 2011, the entire female population aged 35-64 in a local health district was invited for HPV testing (HPV-DNA cobas4800 on a liquid-based cytology sample). HPV-negative women were re-invited after three years. For HPV-positive women, a slide was prepared and interpreted. Positive cytologies were referred to colposcopy; negatives were referred to repeat HPV after one year. If HPV was persistently positive, women were referred to colposcopy; if negative, to normal screening. Indicators of the first and second round are compared with those of cytology screening in the same area in the preceding three years. Results Participation was 56.5%, the same as cytology (56.6%). HPV-positivity was 6.4% (396/6272), cytology triage positivity was 35.6%; 251 cytology negative women were referred to one-year HPV retesting, 84.1% complied, and 55.5% were positive. Total colposcopy referral was 4.1%, and for cytology 1%. The detection rate for cervical intraepithelial neoplasia grade 2 or more severe was 10‰, compared with 3.7‰ using cytology. After three years, HPV-positivity was 3.4% (129/3831), overall colposcopy referral was 2.3% (most at one-year follow-up), and detection rate was 0.5/1000. Conclusions The first round detection rate was more than twice that of cytology screening, while colposcopy referral increased fourfold. At the second round, the detection rate decreased dramatically, showing that longer interval and more conservative protocols are needed.
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Affiliation(s)
- Basilio Passamonti
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Daniela Gustinucci
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Paolo Giorgi Rossi
- 2 Servizio Interaziendale di Epidemiologia, AUSL Reggio Emilia, Italy
- 3 Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Elena Cesarini
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Simonetta Bulletti
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Angela Carlani
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Nadia Martinelli
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Massimo Broccolini
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Valentina D'Angelo
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | | | - Eugenio Di Dato
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Paola Galeazzi
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Morena Malaspina
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Nicoletta Spita
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Beatrice Tintori
- 1 Azienda USL Umbria 1 Perugia, Laboratorio Unico di Screening, Perugia, Italy
| | - Maria Donata Giaimo
- 4 Regione Umbria, Responsabile Servizio Prevenzione, Sanità Veterinaria e Sicurezza Alimentare
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5
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Screening women for cervical cancer carcinoma with a HPV mRNA test: first results from the Venice pilot program. Br J Cancer 2016; 115:525-32. [PMID: 27490801 PMCID: PMC4997543 DOI: 10.1038/bjc.2016.216] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/24/2016] [Accepted: 06/26/2016] [Indexed: 12/02/2022] Open
Abstract
Background: HPV DNA-based screening is more effective than a Pap test in preventing cervical cancer, but the test is less specific. New HPV tests have been proposed for primary screening. The HPV mRNA test showed a similar or slightly lower sensitivity than the HPV DNA tests but with a higher specificity. We report the results of an organised HPV mRNA-based screening pilot program in Venice, Italy. Methods: From October 2011 to May 2014, women aged 25–64 years were invited to undergo a HPV mRNA test (Aptima). Those testing positive underwent cytological triage. Women with positive cytology were referred to colposcopy, whereas those with negative cytology were referred to repeat the HPV mRNA test 1 year later. The results of the HPV mRNA test program were compared with both the local historical cytology-based program and with four neighbouring DNA HPV-based pilot projects. Results: Overall, 23 211 women underwent a HPV mRNA test. The age-standardised positivity rate was 7.0%, higher than in HPV DNA programs (6.8% relative rate (RR) 1.11, 95% confidence interval (CI) 1.05–1.17). The total colposcopy referral was 5.1%, double than with cytology (2.6% RR 2.02, 95% CI 1.82–2.25) but similar to the HPV DNA programs (4.8% RR 1.02; 95% CI 0.96–1.08). The cervical intraepithelial neoplasia grade 2+ detection rate with HPV mRNA was greater than in the HPV DNA programs at baseline (RR 1.50; 95% CI 1.19–1.88) and not significantly lower at the 1-year repeat (RR 0.70; 95% CI 0.40–1.16). The overall RR was 1.29 (95% CI 1.05–1.59), which was much higher than with cytology (detection rate 5.5‰ vs 2.1‰ RR 2.50, 95% CI 1.76–3.62). Conclusions: A screening programme based on the HPV mRNA obtained results similar to those observed with the HPV DNA test. In routine screening programmes, even a limited increase in HPV prevalence may conceal the advantage represented by the higher specificity of HPV mRNA.
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Gustinucci D, Giorgi Rossi P, Cesarini E, Broccolini M, Bulletti S, Carlani A, D'angelo V, D'amico MR, Di Dato E, Galeazzi P, Malaspina M, Martinelli N, Spita N, Tintori B, Giaimo MD, Passamonti B. Use of Cytology, E6/E7 mRNA, and p16INK4a-Ki-67 to Define the Management of Human Papillomavirus (HPV)-Positive Women in Cervical Cancer Screening. Am J Clin Pathol 2016; 145:35-45. [PMID: 26712869 DOI: 10.1093/ajcp/aqv019] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES We measured the accuracy of p16(INK4a)-Ki67 (CINtec PLUS, Roche, Mannheim, Germany), and E6/E7mRNA (types 16/18/31/33/45 NucliSENS easyQ, bioMérieux, Boxtel, The Netherlands) as triage test, alone and combined with cytology. METHODS Six thousand two hundred and seventy two women were recruited in a population-based screening using HPV DNA as primary test; 396 were positive and were tested for cytology and biomarkers. All tests were performed on the same sample. Cytology-positive women were referred to colposcopy; cytology-negative women were referred to one-year HPV re-testing. The endpoint was CIN2+ at baseline or follow up. RESULTS Sensitivity was 77.6% (95% confidence interval (CI) 65.3-86.7) and 53.2% (95%CI: 40.3-65.4) for cytology at atypical squamous cells of undetermined significance (ASC-US) and high-grade threshold, and 87.6% (95%CI:75.7-93.6), and 80.8% (95%CI: 67.6-89.8) for p16INK4a-Ki67, and E6/E7mRNA, respectively. Colposcopy referral was 36% (95%CI: 31.2-40.9) and 11.2% (95%CI: 7.8-14.1) for cytology at ASC-US and high-grade threshold, respectively, and 36.0% (95%CI: 29.9-29.6), and 47.5% (95%CI: 32.5-42.4) for p16(INK4a)-Ki67, and E6/E7mRNA, respectively. Strategies referring high-grade cytology or biomarker positive women to colposcopy reached sensitivity close to 100%, with modest increase in colposcopy referral. CONCLUSIONS The high sensitivity of combined strategies probably allows longer intervals in HPV-positive, triage-negative women.
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Affiliation(s)
- Daniela Gustinucci
- From Azienda USL Umbria 1 Perugia, Laboratorio Unico Di Screening, Perugia, Italy
| | - Paolo Giorgi Rossi
- Servizio Interaziendale Di Epidemiologia, AUSL Reggio Emilia, Italy, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy,
| | - Elena Cesarini
- Beneficiaria Di Un Aiuto Individuale per La Realizzazione Di Progetti Di Ricerca Co-Finanziato Dal Fondo Sociale Europeo (FSE) Nell'ambito Del Programma Operativo Regionale (POR) Umbria, FSE "Obiettivo Competitività Regionale E Occupazione" 2007-2013
| | - Massimo Broccolini
- From Azienda USL Umbria 1 Perugia, Laboratorio Unico Di Screening, Perugia, Italy
| | - Simonetta Bulletti
- From Azienda USL Umbria 1 Perugia, Laboratorio Unico Di Screening, Perugia, Italy
| | - Angela Carlani
- From Azienda USL Umbria 1 Perugia, Laboratorio Unico Di Screening, Perugia, Italy
| | - Valentina D'angelo
- From Azienda USL Umbria 1 Perugia, Laboratorio Unico Di Screening, Perugia, Italy
| | | | - Eugenio Di Dato
- From Azienda USL Umbria 1 Perugia, Laboratorio Unico Di Screening, Perugia, Italy
| | - Paola Galeazzi
- From Azienda USL Umbria 1 Perugia, Laboratorio Unico Di Screening, Perugia, Italy
| | - Morena Malaspina
- From Azienda USL Umbria 1 Perugia, Laboratorio Unico Di Screening, Perugia, Italy
| | - Nadia Martinelli
- From Azienda USL Umbria 1 Perugia, Laboratorio Unico Di Screening, Perugia, Italy
| | - Nicoletta Spita
- From Azienda USL Umbria 1 Perugia, Laboratorio Unico Di Screening, Perugia, Italy
| | - Beatrice Tintori
- From Azienda USL Umbria 1 Perugia, Laboratorio Unico Di Screening, Perugia, Italy
| | - Maria Donata Giaimo
- Sanità Veterinaria E Sicurezza Alimentare Regione Umbria, Servizio Prevenzione, Perugia, Italy
| | - Basilio Passamonti
- From Azienda USL Umbria 1 Perugia, Laboratorio Unico Di Screening, Perugia, Italy
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7
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Campari C, Fedato C, Petrelli A, Zorzi M, Cogo C, Caprioglio A, Gallo F, Giordano L, Domenighini S, Pasquale L, Prandi S, Zappa M, Rossi PG. HPV prevalence and risk of pre-cancer and cancer in regular immigrants in Italy: results from HPV DNA test-based screening pilot programs. Infect Agent Cancer 2015; 10:14. [PMID: 25969693 PMCID: PMC4427984 DOI: 10.1186/s13027-015-0009-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 04/21/2015] [Indexed: 11/25/2022] Open
Abstract
UNLABELLED ᅟ: Immigrants from low- and medium-income countries have a higher risk of cervical cancer due both to barriers in access to screening and to higher human papillomavirus (HPV) prevalence. In the near future many screening programmes in industrialised countries will replace Pap test with HPV as primary test. In order to plan future interventions, it is essential to understand how the HPV screening performs in immigrant women. METHODS We conducted a survey on the main performance indicators from some of the HPV DNA-based pilot programmes in Italy, comparing regular immigrant women, identified as women resident in Italy who were born abroad, with women who were born in Italy. All the programmes applied the same protocol, with HPV as stand-alone test starting for women of 25 or 35 to 64 years of age. Cytology triage is performed for positive women; those ASC-US or more severe are referred directly to colposcopy; negative women are referred to repeat HPV after one year. RESULTS Overall, 162,829 women were invited, of whom 22,814 were born abroad. Participation was higher for Italy-born than born abroad (52.2% vs. 43.6%), particularly for women over 45 years. HPV positivity rate was higher in immigrants: 7.8% vs. 6.1%, age-adjusted Relative Risk (age-adj RR) 1.18, 95% confidence interval (95% CI) 1.13-1.22. The proportion of women with positive cytology triage was similar in the two groups (42%). Cervical Intraepithelial Neoplasia (CIN) grade 2 or more severe detection rate was higher for born abroad (age-adj RR 1.65, 95% CI 1.45-1.89). The difference was stronger when considering only CIN3 or more severe (age-adj RR 2.29, 95% CI 1.90-2.75). Both HPV positivity and CIN2 or more severe detection rate had a different age curve in born abroad compared with Italy-born: in the former, the risk was almost flat, while in the latter it declined rapidly with age. CONCLUSION Compliance with HPV screening is lower for migrant women, who are affected by higher HPV positivity and CIN3 cancer detection rates.
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Affiliation(s)
- Cinzia Campari
- />Staff Programmazione e Controllo, AUSL, Reggio Emilia, Italy
- />IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Chiara Fedato
- />Coordinamento regionale screening oncologici, Regione Veneto, Venezia, Italy
| | - Alessio Petrelli
- />INMP Istituto Nazionale per la promozione della salute delle popolazioni Migranti ed il contrasto delle malattie della Povertà, Rome, Italy
| | - Manuel Zorzi
- />Registro Tumori del Veneto, Regione Veneto, Padova, Italy
| | - Carla Cogo
- />Registro Tumori del Veneto, Regione Veneto, Padova, Italy
| | | | | | | | | | | | - Sonia Prandi
- />Patologia IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Marco Zappa
- />ISPO – Istituto per lo Studio e la Prevenzione Oncologica, Florence, Italy
| | - Paolo Giorgi Rossi
- />IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
- />Servizio Interaziendale di Epidemiologia, AUSL, Reggio Emilia, Italy
| | - the GISCi Migrant Working Group
- />Staff Programmazione e Controllo, AUSL, Reggio Emilia, Italy
- />IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
- />Coordinamento regionale screening oncologici, Regione Veneto, Venezia, Italy
- />INMP Istituto Nazionale per la promozione della salute delle popolazioni Migranti ed il contrasto delle malattie della Povertà, Rome, Italy
- />Registro Tumori del Veneto, Regione Veneto, Padova, Italy
- />Unità di Epidemiologia - CPO Piemonte, Torino, Italy
- />ASL Valle Camonica Sebino, Breno, BS Italy
- />Patologia IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
- />ISPO – Istituto per lo Studio e la Prevenzione Oncologica, Florence, Italy
- />Servizio Interaziendale di Epidemiologia, AUSL, Reggio Emilia, Italy
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8
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Giorgi Rossi P, Fortunato C, Barbarino P, Boveri S, Caroli S, Del Mistro A, Ferro A, Giammaria C, Manfredi M, Moretto T, Pasquini A, Sideri M, Tufi MC, Cogo C, Altobelli E. Self-sampling to increase participation in cervical cancer screening: an RCT comparing home mailing, distribution in pharmacies, and recall letter. Br J Cancer 2015; 112:667-75. [PMID: 25633037 PMCID: PMC4333501 DOI: 10.1038/bjc.2015.11] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/19/2014] [Accepted: 12/25/2014] [Indexed: 01/23/2023] Open
Abstract
Background: We performed a multicentre randomised controlled trial to evaluate the effect on participation in organised screening programmes of a self-sampling device mailed home or picked up at a pharmacy compared with the standard recall letter. Methods: Women aged 30–64 non-responding to screening invitation were eligible. Response rate to first invitation ranged from 30% to 60% between centres. The control was the standard reminder letter to undergo the test used by the programme (Pap test in three centres and HPV DNA test in three other centres). Home mailing of the self-sampler was preceded by a letter with a leaflet about HPV. The analysis was intention-to-treat. Results: In all, 14 041 women were randomised and recruited: 5012 in the control arm, 4516 to receive the self-sampler at home, and 4513 to pick up the self-sampler at a pharmacy. Participation was 11.9% in the control, 21.6% (relative participation: 1.75; 95% CI 1.60–1.93) in home, and 12.0% (relative participation: 0.96; 95% CI 0.86–1.07) in the pharmacy arms, respectively. The heterogeneity between centres was high (excess heterogeneity of that expected due to chance, i.e., I2, 94.9% and 94.1% for home and pharmacy arm, respectively). The estimated impact on the overall coverage was +4.3% for home mail self-sampling compared with +2.2% for standard reminder. Conclusions: Home mailing of self-sampler proved to be an effective way to increase participation in screening programmes, even in those with HPV as primary testing. Picking up at pharmacies showed effects varying from centre to centre.
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Affiliation(s)
- P Giorgi Rossi
- 1] Servizio Interaziendale di Epidemiologia, Azienda Unità Sanitaria Locale, via Amendola 2, Reggio Emilia 42122, Italy [2] IRCCS-Arcispedale S. Maria Nuova, 42122 Reggio Emilia, Italy
| | - C Fortunato
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Viale San Salvatore, Edificio Delta 6, 67100 L'Aquila, Italy
| | - P Barbarino
- UOC Screening e prevenzione ASL Roma G, 00019 Tivoli (Rome), Italy
| | - S Boveri
- Preventive Gynaecology Unit, European Institute of Oncology, 20141 Milano, Italy
| | - S Caroli
- 1] Servizio Interaziendale di Epidemiologia, Azienda Unità Sanitaria Locale, via Amendola 2, Reggio Emilia 42122, Italy [2] IRCCS-Arcispedale S. Maria Nuova, 42122 Reggio Emilia, Italy
| | - A Del Mistro
- Istituto Oncologico Veneto IOV-IRCCS, 35128 Padova, Italy
| | - A Ferro
- Dipartimento di Prevenzione Azienda ULSS 17, 35042 Este-Monselice (PD), Italy
| | - C Giammaria
- UOC Ginecologia e Ostetricia, Screening Oncologici Regionali Ospedale Cardarelli, 86100 Campobasso (CB), Italy
| | - M Manfredi
- Programma Screening Oncologici AUSL di Bologna, 40068 San Lazzaro di Savena (BO), Italy
| | - T Moretto
- Dipartimento di Prevenzione Azienda ULSS 7 Pieve di Soligo - Conegliano, 31053 Pieve di Soligo (TV), Italy
| | - A Pasquini
- Programma Screening Oncologici AUSL di Bologna, 40068 San Lazzaro di Savena (BO), Italy
| | - M Sideri
- Preventive Gynaecology Unit, European Institute of Oncology, 20141 Milano, Italy
| | - M C Tufi
- UOC Screening e prevenzione ASL Roma G, 00019 Tivoli (Rome), Italy
| | - C Cogo
- Registro tumori del Veneto, 35131 Padova, Italy
| | - E Altobelli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Viale San Salvatore, Edificio Delta 6, 67100 L'Aquila, Italy
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9
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Pasquale L, Giorgi Rossi P, Carozzi F, Pedretti C, Ruggeri C, Scalvinoni V, Cotti Cottini M, Tosini A, Morana C, Chiaramonte M, Sacristani M, Cirelli R, Chiudinelli D, Piccolomini M, Marchione R, Romano L, Domenighini S, Pieracci G, Confortini M. Cervical cancer screening with HPV testing in the Valcamonica (Italy) screening programme. J Med Screen 2014; 22:38-48. [PMID: 25431452 DOI: 10.1177/0969141314561707] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We present the results of the first screening round and the first year of the second round of the Valcamonica Human Papillomavirus (HPV) pilot screening project. SETTING From 2010 to 2012, the entire target female population (aged 25-64) was invited to the first HPV screening round in an area where Pap test screening had been active since 2002. METHODS For HPV-negative women, the interval was three years. For HPV-positive women, a cytological smear was stained and interpreted. Positive cytologies were referred to colposcopy; negatives were referred to repeat HPV after one year. If HPV was persistently positive, women were referred to colposcopy; if negative, to normal screening. RESULTS In 2010-12 18728 women were screened, slightly higher participation than with Pap test (18233 64.7%); 1633 were HPV-positive (8.7%); 843 were positive at cytology triage (referral rate at baseline 4.5%). Of those referred at the one year HPV test, 84% complied (660/780); 356 were persistently positive (1.9%). The total referral rate was 6.4% compared with 3.7% for the Pap test. The detection rate was 9.2/1000 compared with 5.0% for the Pap test. The HPV positivity rate during the second round in women previously negative was 3.9% and the detection rate in HPV-positive cytology-positive women was 0.8/1000. CONCLUSIONS HPV-based screening increases colposcopies at the first round, but also strongly increases the detection rate. At the second round, HPV prevalence was much lower and the detection rate also fell, corroborating the need for longer screening intervals in HPV-negative women.
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Affiliation(s)
- L Pasquale
- ASL Vallecamonica-Sebino, Regione Lombardia
| | - Paolo Giorgi Rossi
- Servizio Interaziendale di Epidemiologia, AUSL Reggio Emilia IRCCS - Arcispedale Santa Maria Nuova, Reggio Emilia
| | - F Carozzi
- S.C. Laboratorio di Prevenzione Oncologica, Istituto per lo Studio e la Prevenzione Oncologica, Firenze
| | - C Pedretti
- ASL Vallecamonica-Sebino, Regione Lombardia
| | - C Ruggeri
- ASL Vallecamonica-Sebino, Regione Lombardia
| | | | | | - A Tosini
- ASL Vallecamonica-Sebino, Regione Lombardia
| | - C Morana
- ASL Vallecamonica-Sebino, Regione Lombardia
| | | | | | - R Cirelli
- ASL Vallecamonica-Sebino, Regione Lombardia
| | | | | | | | - L Romano
- ASL Vallecamonica-Sebino, Regione Lombardia
| | | | - G Pieracci
- ASL Vallecamonica-Sebino, Regione Lombardia
| | - M Confortini
- S.C. Laboratorio di Prevenzione Oncologica, Istituto per lo Studio e la Prevenzione Oncologica, Firenze
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10
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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] [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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11
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Mistro AD, Frayle H, Ferro A, Callegaro S, Sole AD, Stomeo A, Cirillo E, Fedato C, Pagni S, Barzon L, Zorzi M. Cervical cancer screening by high risk HPV testing in routine practice: results at one year recall of high risk HPV-positive and cytology-negative women. J Med Screen 2014; 21:30-7. [DOI: 10.1177/0969141314522219] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Cervical cancer screening by human papillomavirus (HPV) testing requires the use of additional triage and follow-up analyses. We evaluated women’s compliance with and the performance of this strategy in a routine setting. Setting Five cervical service screening programmes in North-East Italy. Methods Eligible women aged 25-64 invited for a new screening episode underwent HPV testing for high risk types (hrHPV by Hybrid Capture 2) and cytology triage. Women with positive HPV and cytology results were referred for colposcopy; women with positive HPV but negative cytology results were referred to 1-year repeat hrHPV testing. Results Of 46,694 women screened by HPV testing up to December 2011, 3,211 (6.9%) tested hrHPV positive; 45% of these had a positive triage cytology. Those with negative cytology were invited for 1-yr repeat testing. Compliance with invitation was 61.6% at baseline and 85.3% at 1-yr repeat. Rate of persistent hrHPV positivity was 58% (830/1,435). Colposcopy performed in women with a positive hrHPV test at 1-yr repeat accounted for 36% of all colposcopies performed within the screening programmes. Cumulatively, a histological high-grade lesion was detected in 276 women (5.9‰ detection rate), 234 at baseline (85%), and 42 (15%) at 1-yr repeat. Conclusions Compliance with hrHPV-based screening programmes was high both at baseline and at 1-yr repeat. Compared with the randomized trials, a higher proportion of triage cytology was read as positive, and only a small number of high-grade lesions were detected among the group of hrHPV positive cytology negative women who repeated testing 1-yr after baseline.
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Affiliation(s)
- Annarosa Del Mistro
- Immunology and Molecular Oncology Unit, Veneto Oncology Institute IOV IRCCS, Padova, Italy
| | - Helena Frayle
- Immunology and Molecular Oncology Unit, Veneto Oncology Institute IOV IRCCS, Padova, Italy
| | - Antonio Ferro
- Department of Prevention; Local Health Unit 17 Este-Monselice, Italy
| | | | | | - Anna Stomeo
- Department of Prevention; Local Health Unit 18 Rovigo, Italy
| | | | | | - Silvana Pagni
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Luisa Barzon
- Department of Molecular Medicine, University of Padova, Padova, Italy
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12
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Zorzi M, Del Mistro A, Farruggio A, de' Bartolomeis L, Frayle-Salamanca H, Baboci L, Bertazzo A, Cocco P, Fedato C, Gennaro M, Marchi N, Penon MG, Cogo C, Ferro A. Use of a high-risk human papillomavirus DNA test as the primary test in a cervical cancer screening programme: a population-based cohort study. BJOG 2013; 120:1260-7; discussion 1267-8. [DOI: 10.1111/1471-0528.12272] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2013] [Indexed: 11/28/2022]
Affiliation(s)
- M Zorzi
- Veneto Tumour Registry; Istituto Oncologico Veneto IRCCS; Padua Italy
| | - A Del Mistro
- Immunology and Molecular Oncology Unit; Istituto Oncologico Veneto IRCCS; Padua Italy
| | - A Farruggio
- Department of Pathology; Local Health Unit; Monselice Italy
| | - L de' Bartolomeis
- Department of Obstetrics and Gynaecology; Local Health Unit; Monselice Italy
| | - H Frayle-Salamanca
- Immunology and Molecular Oncology Unit; Istituto Oncologico Veneto IRCCS; Padua Italy
| | - L Baboci
- Immunology and Molecular Oncology Unit; Istituto Oncologico Veneto IRCCS; Padua Italy
| | - A Bertazzo
- Department of Prevention; Local Health Unit; Monselice Italy
| | - P Cocco
- Department of Pathology; Local Health Unit; Monselice Italy
| | - C Fedato
- Veneto Tumour Registry; Istituto Oncologico Veneto IRCCS; Padua Italy
| | - M Gennaro
- Department of Prevention; Local Health Unit; Monselice Italy
| | - N Marchi
- Department of Pathology; Local Health Unit; Monselice Italy
| | - MG Penon
- Department of Prevention; Local Health Unit; Monselice Italy
| | - C Cogo
- Veneto Tumour Registry; Istituto Oncologico Veneto IRCCS; Padua Italy
| | - A Ferro
- Department of Prevention; Local Health Unit; Monselice Italy
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