Estimating the impact of an organised screening programme on cervical cancer incidence: A 26‐year study from northern Italy

Abstract

The impact of the organised cervical cancer (CC) screening programmes implemented in Europe since the 1990s has been insufficiently evaluated. We investigated the changes in CC incidence following the introduction of a screening programme in the Emilia-Romagna Region (northern Italy). The study period was 1988-2013. The programme, targeting women aged 25-64 years (1,219,000 in 2018), started in 1998. The annual incidence rates that would be expected in 1998-2013 in the absence of screening were estimated, first, by analysing the annual rates in 1988-1997 with a log-linear model and, second, by analysing the annual rates in 1988-2013 with an age-period model in which the period effect was enforced to be linear. Cervical adenocarcinoma incidence trend over the entire period was used to validate both estimates. Observed annual rates were compared to the two series of expected ones with the incidence rate ratio (IRR). Incidence remained stable during 1988-1997, peaked in 1998 and then decreased until 2007, when it stabilised. The two series of expected rates were virtually coincident and their trends roughly paralleled the stable adenocarcinoma incidence trend. After 2007, the median IRR was 0.60 (95% confidence interval, 0.45-0.81) based on the log-linear model and 0.58 (95% confidence interval, 0.34-0.97) based on the age-period model. Thirty-six to seventy-five CC cases were prevented annually for an average annual frequency of 6.5 per 100,000 women in the target population. In summary, consistent circumstantial evidences were obtained that the organised screening programme brought about a 40% reduction in annual CC incidence after 10 years.

The artificial intelligence‐assisted cytology diagnostic system in large‐scale cervical cancer screening: A population‐based cohort study of 0.7 million women

“…Cervical cytology has been used for cervical cancer screening for decades, and reduced the burden of cervical cancer worldwide. [1][2][3] Cytology-based cervical cancer screening is mostly performed through microscopic observation of cervical cell morphology by cytotechnologists or cytologists. [2][3][4] Cytology-based screening strategy is recommended for population-based cervical cancer screening in many guidelines.…”

“…[1][2][3] Cytology-based cervical cancer screening is mostly performed through microscopic observation of cervical cell morphology by cytotechnologists or cytologists. [2][3][4] Cytology-based screening strategy is recommended for population-based cervical cancer screening in many guidelines. [5][6][7] Recently, human papillomavirus (HPV) test has being recommended for cervical cancer primary screening because of a slightly higher sensitivity, [5][6][7] and some countries are moving toward HPV test as primary screening or co-testing.…”

Comments on: Limitations of HPV DNA Testing in Screening of Cervical Adenocarcinomas

“…The incidence of endocervical adenocarcinomas has been proportionally increasing due to expansion of screening, particularly in population-based programs. 2 In the study by Stolnicu et al 3 , HPV-negative adenocarcinomas were diagnosed in more advanced stages than squamous carcinomas. Further studies are needed to clarify if this was due to later detection or a more aggressive behavior of the tumor.…”

“…An international cross-sectional study found that 38% of adenocarcinomas were not HPV-related. 2 A recently proposed histologic classification of endocervical adenocarcinoma, known as International Endocervical Adenocarcinoma Criteria and Classification (IECC), 3 uses the presence of HPVrelated disease to histologically classify cervical adenocarcinomas. Among nonhuman papillomavirus-associated adenocarcinoma (NHPVA), the authors identify the following histological types: endometrial, gastric-type, minimal deviation, serous, clear-cell and mesonephric.…”

The Application of Log-Linear Model to Selected Poison Patients

“…Recent studies of log-linear models in health analysis include Bucchi et al, (2019), Voumard et al, (2019), Gautam et al, (2019, Kamranrad et al, (2019), Lin et al (2019) and Wiseman et al, (2019). The last two have some relevance to poisoning: Mercury for Wiseman et al, (2019) and Asbestos for Lin et al, (2019).…”