Ronco Guglielmo, Giubilato Pamela, Naldoni Carlo, Zorzi Manuel, Anghinoni Emanuela, Scalisi Aurora, Dalla Palma Paolo, Zanier Loris, Federici Antonio, Angeloni Claudio, Prandini Stefania, Maglietta Rocco, Mancini Ettore, Pizzuti Renato, Iossa Anna, Segnan Nereo, Zappa Marco
Centro Prevenzione Oncologica, Torino.
Epidemiol Prev. 2006 Jan-Feb;30(1 Suppl 3):27-40.
The target population of Italian organised cervical screening programmes that were active (that invited at least 1000 women) in 2004 was 10,206,741 women, corresponding to 64% of the Italian female population in the 25-64 year age range. This proportion was 66%, 83% and 49% in Northern, Central, and Southern Italy respectively. Some 27% of this target population was invited during 2004. Among women invited in 2004, 37.7% had cytology within organised programmes up to April 2005 (46.2%, 36.0% and 26.2% in Northern, Central, and Southern Italy respectively). It must be kept in mind that many women have spontaneous tests that are not registered in organised programmes. Further data on women invited in 2003 were collected as aggregated tables, provided by the local screening registration systems. We obtained data from 99 programmes with an overall target population of 8,698,480 women. At least 70% of programmes could provide data for most indicators. Overall, 3.2% of smears were classified as unsatisfactory. At a national level 6.6% of women was advised to repeat cytology and 62.2% of them actually did. However 13/71 programmes recommended repeat cytology to > 10% of screened women. Nationwide, 2.6% of screened women were referred to colposcopy. The Positive Predictive Value (PPV) of detecting a biopsy-proven Cervical Intraepithelial Neoplasia grade 2 (CIN2) or more severe among women referred because of cytology "Atypical Squamous Cells of Undetermined Significance" or more severe was 15.0%. There was however a relevant variability: 9/90 programmes had a referral rate >5%. There was an inverse correlation between referral rate and PPV. Compliance with recommended colposcopy was 86% (91% among women with high-grade cytology). The raw detection rate of biopsy-proven CIN2+ was 2.7 per 1000 screened women (2.8 per 1000 when standardised on the Italian population). In conclusion, during 2004 there was a further increase of active organised programmes, especially in Southern Italy. This is important, as spontaneous activity is known to be low there. Despite this rise, quality indicators were stable. However, in a few programmes, the use of excessively broad criteria in the interpretation of cytology decides an excessively high rate of referrals to colposcopy.
2004年，意大利活跃的（即至少邀请了1000名女性参与）有组织的宫颈癌筛查项目的目标人群为10,206,741名女性，占25 - 64岁年龄段意大利女性人口的64%。在意大利北部、中部和南部分别为66%、83%和49%。2004年约27%的目标人群受到了邀请。在2004年受到邀请的女性中，截至2005年4月，37.7%在有组织的项目中进行了细胞学检查（在意大利北部、中部和南部分别为46.2%、36.0%和26.2%）。必须记住，许多女性进行了自发检查，这些检查未在有组织的项目中登记。关于2003年受邀请女性的更多数据以汇总表格形式收集，由当地筛查登记系统提供。我们从99个项目中获取了数据，总体目标人群为8,698,480名女性。至少70%的项目能够提供大多数指标的数据。总体而言，3.2%的涂片被归类为不满意。在全国范围内，6.6%的女性被建议重复进行细胞学检查，其中62.2%实际进行了复查。然而，71个项目中有13个项目建议超过10%的筛查女性重复进行细胞学检查。在全国范围内，2.6%的筛查女性被转诊至阴道镜检查。因细胞学检查“意义不明确的非典型鳞状细胞”或更严重情况而被转诊的女性中，检测出活检证实的宫颈上皮内瘤变2级（CIN2）或更严重病变的阳性预测值（PPV）为15.0%。然而存在显著差异：90个项目中有9个项目的转诊率>5%。转诊率与PPV之间存在负相关。对推荐的阴道镜检查的依从性为86%（高级别细胞学检查女性中为91%）。活检证实的CIN2+的原始检出率为每1000名筛查女性中有2.7例（按意大利人口标准化后为每1000名中有2.8例）。总之，2004年活跃的有组织项目进一步增加，尤其是在意大利南部。这很重要，因为已知那里的自发筛查活动较低。尽管有这种增长，但质量指标保持稳定。然而，在少数项目中，在细胞学解释中使用过于宽泛的标准导致转诊至阴道镜检查的比例过高。
