Campari Cinzia, Fedato Chiara, Petrelli Alessio, Zorzi Manuel, Cogo Carla, Caprioglio Adele, Gallo Federica, Giordano Livia, Domenighini Serena, Pasquale Luigi, Prandi Sonia, Zappa Marco, Giorgi Rossi Paolo
Staff Programmazione e Controllo, AUSL, Reggio Emilia, Italy ; IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
Coordinamento regionale screening oncologici, Regione Veneto, Venezia, Italy.
Infect Agent Cancer. 2015 May 7;10:14. doi: 10.1186/s13027-015-0009-x. eCollection 2015.
ᅟ: Immigrants from low- and medium-income countries have a higher risk of cervical cancer due both to barriers in access to screening and to higher human papillomavirus (HPV) prevalence. In the near future many screening programmes in industrialised countries will replace Pap test with HPV as primary test. In order to plan future interventions, it is essential to understand how the HPV screening performs in immigrant women.
We conducted a survey on the main performance indicators from some of the HPV DNA-based pilot programmes in Italy, comparing regular immigrant women, identified as women resident in Italy who were born abroad, with women who were born in Italy. All the programmes applied the same protocol, with HPV as stand-alone test starting for women of 25 or 35 to 64 years of age. Cytology triage is performed for positive women; those ASC-US or more severe are referred directly to colposcopy; negative women are referred to repeat HPV after one year.
Overall, 162,829 women were invited, of whom 22,814 were born abroad. Participation was higher for Italy-born than born abroad (52.2% vs. 43.6%), particularly for women over 45 years. HPV positivity rate was higher in immigrants: 7.8% vs. 6.1%, age-adjusted Relative Risk (age-adj RR) 1.18, 95% confidence interval (95% CI) 1.13-1.22. The proportion of women with positive cytology triage was similar in the two groups (42%). Cervical Intraepithelial Neoplasia (CIN) grade 2 or more severe detection rate was higher for born abroad (age-adj RR 1.65, 95% CI 1.45-1.89). The difference was stronger when considering only CIN3 or more severe (age-adj RR 2.29, 95% CI 1.90-2.75). Both HPV positivity and CIN2 or more severe detection rate had a different age curve in born abroad compared with Italy-born: in the former, the risk was almost flat, while in the latter it declined rapidly with age.
Compliance with HPV screening is lower for migrant women, who are affected by higher HPV positivity and CIN3 cancer detection rates.
来自低收入和中等收入国家的移民患宫颈癌的风险较高，这既是由于筛查机会存在障碍，也是由于人乳头瘤病毒（HPV）感染率较高。在不久的将来，许多工业化国家的筛查项目将用HPV检测取代巴氏试验作为主要检测方法。为了规划未来的干预措施，了解HPV筛查在移民女性中的表现至关重要。
我们对意大利一些基于HPV DNA的试点项目的主要性能指标进行了调查，将被确定为出生在国外但居住在意大利的正规移民女性与出生在意大利的女性进行比较。所有项目都采用相同的方案，25岁或35至64岁的女性开始单独进行HPV检测。对检测结果呈阳性的女性进行细胞学分流；那些非典型鳞状细胞意义不明确（ASC-US）或更严重的女性直接转诊至阴道镜检查；检测结果为阴性的女性在一年后再次进行HPV检测。
总体而言，共邀请了162,829名女性，其中22,814名出生在国外。出生在意大利的女性参与率高于出生在国外的女性（52.2%对43.6%），尤其是45岁以上的女性。移民中的HPV阳性率更高：分别为7.8%和6.1%，年龄调整相对风险（age-adj RR）为1.18，95%置信区间（95%CI）为1.13 - 1.22。两组中细胞学分流呈阳性的女性比例相似（42%）。出生在国外的女性中宫颈上皮内瘤变（CIN）2级或更严重病变的检出率更高（年龄调整RR为1.65，95%CI为1.45 - 1.89）。仅考虑CIN3或更严重病变时差异更为明显（年龄调整RR为2.29，95%CI为1.90 - 2.75）。与出生在意大利的女性相比，出生在国外的女性中HPV阳性率和CIN2或更严重病变的检出率具有不同的年龄曲线：在前者中，风险几乎呈平稳状态，而在后者中，风险随年龄迅速下降。
移民女性对HPV筛查的依从性较低，她们受到较高的HPV阳性率和CIN3癌症检出率的影响。
