Cervical cancer elimination in Italy: Current scenario and future endeavors for a value based prevention

Abstract

BackgroundCervical Cancer (CC) is a vaccine-preventable disease, and it is treatable if diagnosed early and managed properly. However, it is the fourth most common cancer in women worldwide with about 604,127 cases and 341,831 deaths in 2020. In Italy, it represents the fifth most common cancer in women under 50 years of age with about 2,400 new cases in 2020. The CC elimination is today a global public health goal published by the World Health Organization (WHO) in 2020 and a commitment of the European Union that has included it in Europe's Beating Cancer Plan. Therefore, urgent action is needed, at international and national level, to implement value-based interventions regarding vaccination, screening and timely management of the disease. Our study aims to describe the state of the art of Human Papilloma Virus (HPV) prevention in Italy and to get a consensus on indicators for monitoring the progress toward CC elimination at national level.MethodsThe study envisaged the following activities: research and synthesis of the evidence on strategies and actions for CC elimination at regional Italian level; identification of indicators to monitor such strategies/actions; organization of a multi-stakeholder consensus to reach the agreement on main indicators to be used in Italy.ResultsAs for HPV vaccination coverage, the last Italian available data (December 31st, 2020) showed that it was way below the target (95%) with full cycle vaccination coverage ranging from 6 to 61.7% in female adolescents and from 5.4 to 55.4% in male adolescents (2008 birth cohorts). The coverage rate of CC screening is variable with a range of 61.7–89.6%. Furthermore, coverage rates due to organized screening programs (excluding out-of-pocket screening) shows a range from 20.7 to 71.8%. The mapping of the Italian Regions highlighted an important regional heterogeneity in respect to organizational/operational issue of HPV vaccination and CC screening. Indicators for monitoring CC elimination strategies have been drawn from the Australian experience and distinguished by disease outcomes, vaccination coverage, screening participation and treatment uptake. The highest consensus was reached for the following indicators: CC incidence; detection of high-grade cervical disease; CC mortality; full cycle vaccination coverage; screening participation; high-grade cervical disease treatment rates; CC treatment rates.ConclusionsThe assessment of the current status of CC elimination as overarching goal beyond the achievement of vaccine, screening and treatment targets represents the first step for the identification of interventions to be implemented to accelerate the path toward CC elimination. Based on this and following the WHO call, a value-based approach is proposed to untangle the full benefit of HPV-related cancers elimination strategies and identify priority and best practices.

The Role of β1 Integrin/CD29 as a Potential Prognostic Factor for the Risk of Progression to Cervical Carcinoma in HPV-Associated Lesions

“…The use of HPV-based screening has increased the number of patients referred for colposcopy examinations, but it has also increased the number of CIN3+ lesions and cervical malignancies that need to be treated right once. Cytology is primarily utilized as a triage test, while, in certain nations, alternative approaches are being considered [ 40 , 42 ]. As many European nations, particularly those with inadequate opportunistic cytology-based cervical cancer screening programs, require immediate attention, finding additional prognostic factors should increase the sensitivity in finding high-risk patients alongside the increase in colposcopic examinations.…”

Survey of current policies towards widening cervical screening coverage among vulnerable women in 22 European countries

“…Promoting a value-based approach to CC prevention with pragmatic policies ensuring access, equity, quality, performance, efficiency and productivity (optimized allocation of resources) will help European countries minimize the inequalities that currently exist between and within the countries. 37 …”

Cervical cancer — a preventable (?) disease in Poland

“…It assumes achieving: 1) 90% of girls fully vaccinated with HPV vaccine by age 15 years; 2) 70% of women screened with a high-performance test by 35 years of age and again by 45 years of age and 3) 90% of women identified with cervical disease receiving treatment (90% of women with precancer treated, and 90% of women with invasive cancer managed). Some countries [2,3] including Poland [4] elaborated consecutive plans or roadmaps to tackle the burden of CC. However, implementation of required solutions to achieve WHO goals might be a challenge not only for developing but also for some of the more developed countries.…”