Introduction The IMPATTO-CERVICE is a population-based study aiming at evaluating the effects of organized cervical screening programs (CSPs -i.e., free cytology every 3 years to women aged 25-64 years) in Italy. Objectives To analyze incidence rate trend of cervical cancer, in Italian areas covered by the 20 participating cancer registries (CRs), according to stage at diagnosis and women’s screening history within CSPs. Materials and Methods We included 4289 women (25-64 years) diagnosed with invasive cervical cancer (ICC) and 12773 with CIN3/AIS in the period 1995-2007. Screen-detected (SD) cases were those with a positive cytology in CSPs, otherwise, they were non screen-detected in CSPs (NSD). Annual percent change (APC) of age-standardized (Europe) incidence rates, and 95% confidence intervals (CI), were estimated by Joinpoint. Results In the period 1995-2007, the incidence rates of ICC among women aged 25-64 years were decreasing (APC=-3.7, CI 95% -5.1, -2.3), especially for fully-invasive stages (FIGO IA2-IB: APC=-4.7, CI 95% -7.0, -2.4; II-IV: APC=-4.1, CI 95% -6.0, -2.1). Conversely, the incidence rates of CIN3/AIS increased during the same period (APC=+4.8, CI 95% +2.5, +7.2). Among women with micro-invasive ICC (IA1-IA), the incidence SD cases was higher compared to NSD cases throughout the study period, whereas, the opposite emerged among women with fully-invasive ICCs. Also among women with CIN3/AIS, SD cases were the majority and reported an increasing incidence trend, while the incidence of NSD cases remained almost stable. Discussion and Conclusions This study showed a decreasing trend for ICC and an increasing trend for CIN3/AIS incidence among women in CSP’s target. SD cases were mostly micro-invasive or CIN3/AIS. The trend of NSD CIN3/AIS cases -proxy of opportunistic screening- was stable. These results, despite the hard interpretation due to the heterogeneity of CSPs starting periods, suggest a positive impact of CSPs in Italy.
Incidence trend of cervical cancer for stage at diagnosis and screening history : an Italian collaborative study / A. Zucchetto, A. Gini, M. Taborelli, G. Ronco, P. Giorgi Rossi, M. Zappa, A. Franzo, S. Ferretti, F. Falcini, F. La Rosa, C. Beatriz Visioli, M. Federico, C. Campari, M. Vercelli, R. Zanetti, A. De Togni, P. Biavati, M. Michiara, S. Baracco, P. Seghini, M. Fusco, S. Piffer, F.P.F. Tisano, M. Castaing, G. Candela, M. Usala, D. Serraino. ((Intervento presentato al 38. convegno Ascensione Reunion: Group of Registry and Epidemiology of cancer in latin speaking countries (GRELL) tenutosi a SIRACUSA nel 2013.
Incidence trend of cervical cancer for stage at diagnosis and screening history : an Italian collaborative study
A. ZucchettoPrimo
;
2013
Abstract
Introduction The IMPATTO-CERVICE is a population-based study aiming at evaluating the effects of organized cervical screening programs (CSPs -i.e., free cytology every 3 years to women aged 25-64 years) in Italy. Objectives To analyze incidence rate trend of cervical cancer, in Italian areas covered by the 20 participating cancer registries (CRs), according to stage at diagnosis and women’s screening history within CSPs. Materials and Methods We included 4289 women (25-64 years) diagnosed with invasive cervical cancer (ICC) and 12773 with CIN3/AIS in the period 1995-2007. Screen-detected (SD) cases were those with a positive cytology in CSPs, otherwise, they were non screen-detected in CSPs (NSD). Annual percent change (APC) of age-standardized (Europe) incidence rates, and 95% confidence intervals (CI), were estimated by Joinpoint. Results In the period 1995-2007, the incidence rates of ICC among women aged 25-64 years were decreasing (APC=-3.7, CI 95% -5.1, -2.3), especially for fully-invasive stages (FIGO IA2-IB: APC=-4.7, CI 95% -7.0, -2.4; II-IV: APC=-4.1, CI 95% -6.0, -2.1). Conversely, the incidence rates of CIN3/AIS increased during the same period (APC=+4.8, CI 95% +2.5, +7.2). Among women with micro-invasive ICC (IA1-IA), the incidence SD cases was higher compared to NSD cases throughout the study period, whereas, the opposite emerged among women with fully-invasive ICCs. Also among women with CIN3/AIS, SD cases were the majority and reported an increasing incidence trend, while the incidence of NSD cases remained almost stable. Discussion and Conclusions This study showed a decreasing trend for ICC and an increasing trend for CIN3/AIS incidence among women in CSP’s target. SD cases were mostly micro-invasive or CIN3/AIS. The trend of NSD CIN3/AIS cases -proxy of opportunistic screening- was stable. These results, despite the hard interpretation due to the heterogeneity of CSPs starting periods, suggest a positive impact of CSPs in Italy.
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