Serraino Diego, Gini Andrea, Taborelli Martina, Ronco Guglielmo, Giorgi-Rossi Paolo, Zappa Marco, Crocetti Emanuele, Franzo Antonella, Falcini Fabio, Visioli Carmen Beatriz, Stracci Fabrizio, Zorzi Manuel, Federico Massimo, Michiara Maria, Fusco Mario, Ferretti Stefano, Pannozzo Fabio, Tisano Francesco, Zanetti Roberto, Zucchetto Antonella
Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, Aviano, Italy.
Center for Cancer Epidemiology and Prevention, City of Health and Science Hospital, Torino, Italy.
Prev Med. 2015 Jun;75:56-63. doi: 10.1016/j.ypmed.2015.01.034. Epub 2015 Mar 27.
To quantify the impact of organized cervical screening programs (OCSPs) on the incidence of invasive cervical cancer (ICC), comparing rates before and after activation of OCSPs.
This population-based investigation, using individual data from cancer registries and OCSPs, included 3557 women diagnosed with ICC at age 25-74years in 1995-2008. The year of full-activation of each OCSP was defined as the year when at least 40% of target women had been invited. Incidence rate ratios (IRRs) with 95% confidence intervals (95% CIs) were calculated as the ratios between age-standardized incidence rates observed in periods after full-activation of OCSPs vs those observed in the preceding quinquennium.
ICC incidence rates diminished with time since OCSPs full-activation: after 6-8years, the IRR was 0.75 (95% CI: 0.67-0.85). The reduction was higher for stages IB-IV (IRR=0.68, 95% CI: 0.58-0.80), squamous cell ICCs (IRR=0.74, 95% CI: 0.64-0.84), and particularly evident among women aged 45-74years. Conversely, incidence rates of micro-invasive (stage IA) ICCs increased, though not significantly, among women aged 25-44years (IRR=1.34, 95% CI: 0.91-1.96). Following full-activation of OCSPs, micro-invasive ICCs were mainly and increasingly diagnosed within OCSPs (up to 72%).
CONCLUSION(S): Within few years from activation, organized screening positively impacted the already low ICC incidence in Italy and favored down-staging.
通过比较组织性宫颈筛查项目（OCSPs）启动前后的发病率，量化其对浸润性宫颈癌（ICC）发病率的影响。
这项基于人群的调查使用了癌症登记处和OCSPs的个体数据，纳入了1995年至2008年期间诊断为ICC的3557名25至74岁的女性。每个OCSP的全面启动年份定义为至少40%的目标女性被邀请的年份。发病率比（IRRs）及其95%置信区间（95% CIs）通过OCSPs全面启动后各时期观察到的年龄标准化发病率与前一个五年期观察到的发病率之比来计算。
自OCSPs全面启动以来，ICC发病率随时间下降：6至8年后，IRR为0.75（95% CI：0.67 - 0.85）。IB-IV期（IRR = 0.68，95% CI：0.58 - 0.80）、鳞状细胞ICC（IRR = 0.74，95% CI：0.64 - 0.84）的下降幅度更大，在45至74岁女性中尤为明显。相反，在25至44岁女性中，微浸润（IA期）ICC的发病率虽未显著增加，但有所上升（IRR = 1.34，95% CI：0.91 - 1.96）。OCSPs全面启动后，微浸润ICC主要且越来越多地在OCSPs内被诊断出来（高达72%）。
在启动后的几年内，组织性筛查对意大利本就较低的ICC发病率产生了积极影响，并有利于疾病分期的降低。
