Epidemiology and Biostatistics Unit, Centro di Riferimento Oncologico, Aviano (PN) 33081, Italy.
Eur J Obstet Gynecol Reprod Biol. 2010 Oct;152(2):200-4. doi: 10.1016/j.ejogrb.2010.06.005. Epub 2010 Jul 27.
To describe screening histories of women with invasive cervical cancer (ICC) in Friuli Venezia Giulia, after the introduction of organized screening, in order to identify possible reasons undermining prevention of ICC. To investigate associations between screening histories in relation to women's survival and tumor characteristics, with a focus on organized and opportunistic screenings.
438 women, diagnosed with ICC between 1999 and 2005, were identified using the regional Cancer Registry. Cytological and histopathological information were obtained through regional health databases. Associations between different screening histories and characteristics of women and their tumors were evaluated by means of odds ratios (OR) and corresponding 95% confidence intervals (CI), through multinomial logistic regression models adjusted for age; death risks were estimated by computing hazard ratios (HR) with 95% CI, using Cox models adjusted for age, tumor stage, and histology.
165 (38%) women with ICC had no Pap smears: 71 (16%) never attended the organized screening despite invitation; 69 (16%) were never invited because they were above 64 years of age; and 25 (6%) were yet to be invited. Conversely, 273 (62%) women underwent screening: 141 women (32%) had opportunistic screening; 132 (30%) women attended the organized program. A total of 193 (44%) women had ICC detected at screening. Compared to women with ICC who had never been screened, those screened within the organized program were more often at stage IA (46%), were seldom at stage II or higher (OR=0.3, 95% CI: 0.1-0.6, vs. IB), and showed a lower risk of death (HR=0.6, 95% CI: 0.3-1.0).
In Friuli Venezia Giulia, the lack of screening among older women and of compliance with organized programs among women in the target population are the main limitations in cervical cancer secondary prevention. Our findings indicate that participation in organized screening has a beneficial effect in terms of down-staging and improved survival as compared to both absence of screening and opportunistic screening.
描述在引入有组织筛查后，弗留利-威尼斯朱利亚（意大利东北部的一个自治区）浸润性宫颈癌（ICC）患者的筛查史，以确定可能破坏 ICC 预防的原因。研究筛查史与女性生存和肿瘤特征之间的关联，重点关注有组织和机会性筛查。
通过区域癌症登记处确定了 1999 年至 2005 年间诊断为 ICC 的 438 名女性。通过区域健康数据库获取细胞学和组织病理学信息。通过多变量逻辑回归模型，使用调整后的年龄比值比（OR）及其 95%置信区间（CI）评估不同筛查史与女性及其肿瘤特征之间的关系；使用 Cox 模型计算调整后的年龄、肿瘤分期和组织学后的死亡风险比（HR）及其 95%CI。
165 名（38%）ICC 患者未进行巴氏涂片检查：71 名（16%）从未参加过有组织筛查，尽管有邀请；69 名（16%）因年龄超过 64 岁而从未被邀请；25 名（6%）尚未被邀请。相反，273 名（62%）女性接受了筛查：141 名（32%）接受了机会性筛查；132 名（30%）女性参加了有组织的项目。共有 193 名（44%）女性在筛查中发现了 ICC。与从未接受过筛查的 ICC 患者相比，在有组织计划中接受筛查的患者更常处于 IA 期（46%），很少处于 II 期或更高期（OR=0.3，95%CI：0.1-0.6，与 IB 相比），且死亡风险较低（HR=0.6，95%CI：0.3-1.0）。
在弗留利-威尼斯朱利亚，老年女性缺乏筛查以及目标人群中女性对有组织计划的遵守是宫颈癌二级预防的主要局限性。我们的研究结果表明，与未接受筛查和机会性筛查相比，参加有组织筛查在降期和提高生存率方面具有有益的效果。
