Abstract
Cervical cancer (CC) control is based on the implementation of effective screening programs. In the coming years, human papilloma virus vaccination coverage will contribute considerably toward cancer prevention. In Italy, where an organized screening program has been implemented, immigration from low/middle-income countries with a high prevalence of human papilloma virus infections has increased steadily over the last decades. To assess the impact of screening efforts in counteracting background changes, we analyzed the incidence trends of cervical intraepithelial neoplasia grade 3 carcinomas in situ (CIS) and invasive CC from 1994 to 2013 through an Age–Period–Cohort model using data of a regional population-based registry. Moreover, using Joinpoint regression, we compared the incidence of cervical lesions in native women with that observed in foreign-born women, highlighting the differences in age and screening status. The results indicate that the CC incidence trend decreased in Italian women (annual percent change = −2.7*%, 95% confidence interval = −4.3; −1.1), but increased (APC = 12.2*%, 95% confidence interval = 7.6; 17.0) in immigrants. For CIS, incidence rates show a growing trend in both groups, especially in women born abroad. For cancer, no marked changes in period-specific incidence rate ratios were detected until around 2000, when we found a slight decrease, followed by an increase. For CIS, we estimate an important upward trend in cohort-specific risks. The favorable effect of screening in preventing an increase in CC incidence has been counteracted by the progressive increase in immigrants from high-risk countries, where it is of increasing relevance to extend the use of vaccination.
Highlights
IntroductionThere are considerable geographical differences in the global distribution of this disease: the large majority (about 85%) of the global burden occurs in low/middle-income countries, such as South America, Southeast Asia, Western, and Sub-Saharan Africa (Torre et al, 2015)
Cervical cancer (CC) is the fourth most common female tumor worldwide and the fourth most common cause of cancer mortality among women.There are considerable geographical differences in the global distribution of this disease: the large majority of the global burden occurs in low/middle-income countries, such as South America, Southeast Asia, Western, and Sub-Saharan Africa (Torre et al, 2015)
We examined the incidence of cervical lesions in Italian-born women compared with foreign-born women, highlighting the differences in age and screening status
Summary
There are considerable geographical differences in the global distribution of this disease: the large majority (about 85%) of the global burden occurs in low/middle-income countries, such as South America, Southeast Asia, Western, and Sub-Saharan Africa (Torre et al, 2015). The highest HPV prevalence was observed in Sub-Saharan Africa, Eastern Europe, and. South America (Bruni et al, 2010; Bray et al, 2013), paralleled by the highest incidence and mortality for CC
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