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Abstract
ᅟImmigrants 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.MethodsWe 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.ResultsOverall, 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.ConclusionCompliance with HPV screening is lower for migrant women, who are affected by higher HPV positivity and CIN3 cancer detection rates.
Highlights
Persistent infection with oncogenic human papillomavirus (HPV) types is the necessary, but not sufficient, cause of cervical cancer [1,2]
Wide differences in cervical cancer incidence and mortality have been observed around the world, with more than 85% of invasive cancers occurring in lowand middle-income countries [3]
Analysis We present the set of the indicators routinely used to evaluate the performance of screening programmes, stratified by country of birth (Italy vs. other countries)
Summary
Persistent infection with oncogenic HPV types is the necessary, but not sufficient, cause of cervical cancer [1,2]. The differences in Several studies have shown that migrant women from low- and medium- income countries have higher risk of cervical cancer [7,8,9,10,11] and usually maintain the same cervical cancer risk as that of their countries of origin for several years [12,13,14,15]. Both of the main determinants of cervical cancer can be related to the differential risk in immigrant women: many countries of origin have high prevalence of HPV infection [16,17]; Pap test coverage in migrant women is lower than in native women because. Most of immigrant women in Italy are in the target age of cervical cancer screening [23,24]
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