HPV prevalence and risk of pre-cancer and cancer in regular immigrants in Italy: Results from HPV DNA test-based screening pilot programs

Cinzia Campari, Chiara Fedato, Alessio Petrelli, Manuel Zorzi, Carla Cogo, Adele Caprioglio, Federica Gallo, Livia Giordano, Serena Domenighini, Luigi Pasquale, Sonia Prandi, Marco Zappa, Paolo Giorgi Rossi

Research output: Contribution to journalArticle

Abstract

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. Methods: 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. Results: 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. Conclusion: Compliance with HPV screening is lower for migrant women, who are affected by higher HPV positivity and CIN3 cancer detection rates.

Original languageEnglish
Article number14
JournalInfectious Agents and Cancer
Volume10
Issue number1
DOIs
Publication statusPublished - May 7 2015

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Human Papillomavirus DNA Tests
Italy
Neoplasms
Triage
Confidence Intervals
Cell Biology
Papanicolaou Test
Colposcopy
Cervical Intraepithelial Neoplasia
Developed Countries
Uterine Cervical Neoplasms

ASJC Scopus subject areas

  • Infectious Diseases
  • Oncology
  • Epidemiology
  • Cancer Research

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HPV prevalence and risk of pre-cancer and cancer in regular immigrants in Italy : Results from HPV DNA test-based screening pilot programs. / Campari, Cinzia; Fedato, Chiara; Petrelli, Alessio; Zorzi, Manuel; Cogo, Carla; Caprioglio, Adele; Gallo, Federica; Giordano, Livia; Domenighini, Serena; Pasquale, Luigi; Prandi, Sonia; Zappa, Marco; Rossi, Paolo Giorgi.

In: Infectious Agents and Cancer, Vol. 10, No. 1, 14, 07.05.2015.

Research output: Contribution to journalArticle

Campari, C, Fedato, C, Petrelli, A, Zorzi, M, Cogo, C, Caprioglio, A, Gallo, F, Giordano, L, Domenighini, S, Pasquale, L, Prandi, S, Zappa, M & Rossi, PG 2015, 'HPV prevalence and risk of pre-cancer and cancer in regular immigrants in Italy: Results from HPV DNA test-based screening pilot programs', Infectious Agents and Cancer, vol. 10, no. 1, 14. https://doi.org/10.1186/s13027-015-0009-x
Campari, Cinzia ; Fedato, Chiara ; Petrelli, Alessio ; Zorzi, Manuel ; Cogo, Carla ; Caprioglio, Adele ; Gallo, Federica ; Giordano, Livia ; Domenighini, Serena ; Pasquale, Luigi ; Prandi, Sonia ; Zappa, Marco ; Rossi, Paolo Giorgi. / HPV prevalence and risk of pre-cancer and cancer in regular immigrants in Italy : Results from HPV DNA test-based screening pilot programs. In: Infectious Agents and Cancer. 2015 ; Vol. 10, No. 1.
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title = "HPV prevalence and risk of pre-cancer and cancer in regular immigrants in Italy: Results from HPV DNA test-based screening pilot programs",
abstract = "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. Methods: 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. Results: 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. Conclusion: Compliance with HPV screening is lower for migrant women, who are affected by higher HPV positivity and CIN3 cancer detection rates.",
author = "Cinzia Campari and Chiara Fedato and Alessio Petrelli and Manuel Zorzi and Carla Cogo and Adele Caprioglio and Federica Gallo and Livia Giordano and Serena Domenighini and Luigi Pasquale and Sonia Prandi and Marco Zappa and Rossi, {Paolo Giorgi}",
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T2 - Results from HPV DNA test-based screening pilot programs

AU - Campari, Cinzia

AU - Fedato, Chiara

AU - Petrelli, Alessio

AU - Zorzi, Manuel

AU - Cogo, Carla

AU - Caprioglio, Adele

AU - Gallo, Federica

AU - Giordano, Livia

AU - Domenighini, Serena

AU - Pasquale, Luigi

AU - Prandi, Sonia

AU - Zappa, Marco

AU - Rossi, Paolo Giorgi

PY - 2015/5/7

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N2 - 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. Methods: 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. Results: 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. Conclusion: Compliance with HPV screening is lower for migrant women, who are affected by higher HPV positivity and CIN3 cancer detection rates.

AB - 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. Methods: 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. Results: 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. Conclusion: Compliance with HPV screening is lower for migrant women, who are affected by higher HPV positivity and CIN3 cancer detection rates.

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