Immigration, screening, and cervical cancer incidence: an application of Age–Period–Cohort analysis

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.

Perceptions about cancer and barriers towards cancer screening among ethnic minority women in a deprived area in Denmark – a qualitative study

“…As a group, ethnic minority women in deprived areas are characterised by lower employment, lower disposable income and education, as well as higher incidence of some cancers compared to the native population [5,6]. Studies from Denmark and other countries show that ethnic minority women are less likely to participate in screening programmes for cervical cancer [7][8][9][10], breast cancer [11,12] and colorectal cancer [13,14] than the native population. There may be different complex factors influencing ethnic minority women's screening participation.…”

Incidence and mortality of cervical cancer in Vietnam and South Korea (1999-2017)

“…For instance, since Finland initiated a nationwide cervical cancer screening program for women aged from 30 to 50 in 1960s, an 80% drop of incidence and mortality rates for cervical cancer in all age groups was observed from 1965 to 2003 [ 37 ]. In Italy, which implemented population-based screening for cervical cancer in 1996, a stably decreasing trend in cervical cancer incidence was observed 17 years later, with a decline by 2.7% per year (1994-2013) [ 38 ].…”

Clinicopathological characteristics and prognostic risk factors of cervical cancer patients aged ≤35 years old

“…According to previous studies, [3,4] the pathological type, stage, and lymph node metastasis of tumors are all factors influencing the prognosis of cervical cancer patients. Currently, 20 to 40% of cervical cancer patients are aged ≤35 years, [5] but there are few studies on the factors influencing the prognosis of these patients. Moreover, the boundary age of young patients with cervical cancer is 35 years in the Chinese literature.…”