Giorgi Rossi Paolo, Chini Francesco, Borgia Piero, Guasticchi Gabriella, Carozzi Francesca Maria, Confortini Massimo, Angeloni Claudio, Buzzoni Carlotta, Buonaguro Franco Maria
Agenzia di sanità pubblica della regione Lazio (Laziosanità), Italy.
Epidemiol Prev. 2012 Mar-Apr;36(2):108-19.
this article presents a review of evidences about Human Papillomavirus (HPV) and cervical cancer in Italy, highlighting geographical differences.
two systematic reviews recently published were updated, one collecting studies on the prevalence of HPV types in Italy in the general population and the other collecting prevalence of HPV types in cervical pathologic samples.The search was updated to 31.10.2010 and performed exclusively in MedLine and references in retrieved papers.
the prevalence of HPV types has been related with the incidence of cervical cancer and the spread of Pap tests and screening programs.
the prevalence high risk HPV types is 8%in studies with population-based random sample, with no significant difference between Centre-North and South-Islands, however, the prevalence is slightly higher in the South than the Centre-North for women up to 54 years of age, whereas in older women the ratio is reversed. HPV 16 is the most common type, while HPV 18 is less frequent, 5% and 1% respectively. The average of HPV 16 positivity is 64% and 68% in CIN2/3 and invasive cancer respectively, while the average of HPV 18 is 7% and 11% in CIN2/3 and invasive cancer respectively. There are no significant differences by geographical area.The incidence of invasive cervical cancer in Italy has been decreasing in recent years changing from 9.2 to 7.7 per 100,000 inhabitants in 10 years. The incidence is lower in South-Islands. Pap test coverage is over 80% in Centre-North and less than 60%in South-Islands.
cervical cancer incidence is lower in Southern Italy, while the Pap test coverage is much higher in Centre-Northern Italy. This paradox, until now, has been interpreted as a consequence of a lower HPV prevalence in Southern than Northern regions. Recent studies on HPV prevalence do not confirm this hypothesis. Our interpretation is that in Southern Italy we are facing an epidemiologic scenario in transition where the low cancer incidence is the consequence of a low HPV prevalence in the previous decades, but new generations are experiencing a higher prevalence of HPV and will probably have higher risk of cervical cancer. The consequence may be an epidemic of cervical cancer in the next decades, if adequate screening programs are not implemented.
本文综述了意大利人乳头瘤病毒（HPV）与宫颈癌的相关证据，强调地域差异。
更新了最近发表的两项系统评价，一项收集意大利普通人群中HPV类型流行情况的研究，另一项收集宫颈病理样本中HPV类型的流行情况。检索更新至2010年10月31日，仅在MedLine及检索论文的参考文献中进行。
HPV类型的流行情况与宫颈癌发病率、巴氏试验及筛查项目的推广情况相关。
在基于人群随机抽样的研究中，高危HPV类型的流行率为8%，意大利中北部与南部岛屿之间无显著差异，然而，54岁及以下女性中，南部的流行率略高于中北部，而在老年女性中，这一比例则相反。HPV 16是最常见的类型，而HPV 18较少见，分别为5%和1%。在CIN2/3和浸润性癌中，HPV 16阳性率平均分别为64%和68%，而HPV 18在CIN2/3和浸润性癌中的平均阳性率分别为7%和11%。不同地理区域之间无显著差异。近年来，意大利浸润性宫颈癌的发病率一直在下降，10年间从每10万居民9.2例降至7.7例。南部岛屿的发病率较低。中北部巴氏试验覆盖率超过80%，而南部岛屿低于60%。
意大利南部宫颈癌发病率较低，而意大利中北部巴氏试验覆盖率更高。迄今为止，这一矛盾现象被解释为南部地区HPV流行率低于北部地区的结果。近期关于HPV流行率的研究并未证实这一假设。我们的解释是，在意大利南部，我们正面临一种流行病学转变的情况，即低癌症发病率是过去几十年HPV低流行率的结果，但新一代正经历更高的HPV流行率，可能患宫颈癌的风险也更高。如果不实施适当的筛查项目，未来几十年可能会出现宫颈癌流行。
