Abstract: In Italy since 2007 vaccination against human papillomavirus (HPV) is offered to 11-year-old females, whereas vaccination for older age groups is still a matter of debate. To assess Italian young women's knowledge, attitudes and practice regarding primary and secondary cervical cancer prevention a cross-sectional study among young women aged 18-26 years was conducted in 2008. The survey collected information on in-depth awareness and knowledge regarding Pap testing, HPV infection, HPV vaccine and cervical cancer. The response rate was 57.7% with a wide range of variability (34-84%) amongst local health units. Among 667 women who participated in the survey poor awareness and various misconceptions regarding HPV and cervical cancer prevention were detected. Overall women were found to be more knowledgeable about Pap smears and cervical cancer than about HPV infection and the HPV vaccine. Respondents pointed to their healthcare providers as their most trusted source for medical information. Understanding women's knowledge on cervical cancer prevention, as well as related factors is important in helping to achieve and maintain adherence to cervical cancer preventive strategies. Moreover in order to minimize cervical cancer risk by improving women's adherence to preventive strategies, appropriate and adequate information dissemination, and guidance from health professionals appear to be crucial elements.
Abstract: We investigated clustering patterns of human papillomavirus (HPV) in a large study, the New Technologies in Cervical Cancer (NTCC) screening study.
Abstract: this article presents a review of evidences about Human Papillomavirus (HPV) and cervical cancer in Italy, highlighting geographical differences.
Abstract: This study compares colposcopy referrals of 2 management strategies: oncogenic human papillomavirus (HPV)-DNA testing (Hybrid Capture 2 assay, Qiagen, Germantown, MD) and repeat cytology. In the New Technology in Cervical Cancer Trial, 22,708 subjects were randomly assigned to undergo both HPV and liquid-based cytologic testing. Women aged 35 to 60 years old with unsatisfactory cytologic findings were directly referred for colposcopy if the HPV test result was positive, and were referred for repeat cytologic examination if the HPV test result was negative; women aged 25 to 35 years old were referred for repeat cytologic examination independent of HPV test results. A positive or a second unsatisfactory cytologic examination referred women for colposcopy. Five hundred sixty women had unsatisfactory cytologic findings. Colposcopy referral was not significant and slightly higher with HPV testing than repeat cytologic test (9.8% vs 6.8%, P = .11). When cytologic testing was repeated 36.8% were unavailable for follow-up and most of the colposcopies were performed in HPV-negative women. For unsatisfactory cytologic findings, HPV triage is a more logical and efficient management strategy than a repeat cytologic test.
Abstract: ABSTRACT: OBJECTIVE: The aim of this study is to describe the prevalence of HPV types in invasive cervical cancers in Italy from 1996 to 2008. METHODS: A pooled analysis of the three largest case series typed to date was performed. HPV typing was performed on paraffin-embedded slices. Molecular analyses were performed in four laboratories. Multivariate analyses were performed to test the associations between calendar time, age, and geographical area and the proportion of types 16/18. RESULTS: Out of 574 cancers, 24 (4.2%) were HPV negative. HPV 16 and 18 were responsible for 74.4% (378/508) and 80.3% (49/61) of the squamous cancers and adenocarcinomas, respectively. Other frequent types were 31 (9.5%), 45 (6.4%), and 58 (3.3%) for squamous cancers and 45 (13.3%), 31, 35, and 58 (5.0%) for adenocarcinomas. The proportion of HPV 16 and/or 18 decreased with age (p-value for trend <0.03), while it increased in cancers diagnosed in more recent years (p-value for trend < 0.005). CONCLUSIONS: The impact of HPV 16/18 vaccine on cervical cancer will be greater for early onset cancers. In vaccinated women, screening could be started at an older age without reducing protection.
Abstract: OBJECTIVE OF THE PROJECT: The introduction of the HPV test as a primary screening test will cause important changes in the screening system based on cytology. The purposes of this report are: to define the best screening policies with HPV-based screening on the basis of the resulting efficacy and of undesired effects; comparing them to cytology-based screening; to identify their best conditions of application; to evaluate economic cost, feasibility and impact on the organisation of services of such policy in the Italian situation.
Abstract: Randomized trials have produced sound evidence about the efficacy of screening with human papillomavirus (HPV) DNA tests in reducing cervical cancer incidence and mortality. We evaluated the clinical performance and reproducibility of the Abbott RealTime High Risk (HR) HPV test compared with that of the HR hybrid capture 2 (HC2) assay as assessed by a noninferiority score test. A random sample of 998 cervical specimens (914 specimens of cervical intraepithelial neoplasia less severe than grade 2 [<CIN2] and 84 specimens of cervical intraepithelial neoplasia grade 2 or more severe lesions [≥CIN2]), collected in the Florence and Catania cervical Cancer Screening Programs from women aged 25 to 64 and already tested by HR HC2, were retested with the Abbott RealTime HR HPV test. Absolute specificity was 92.3% (95% confidence interval [CI], 90.4 to 94.0) and 92.6% (95% CI, 90.7 to 94.2) for the Abbott RealTime HR HPV test and the HR HC2, respectively. Absolute sensitivity was 96.4% (95% CI, 89.9 to 99.3) and 97.6% (95% CI, 91.7 to 99.7) for the Abbott RealTime HR HPV test and the HR HC2, respectively. The noninferiority score test revealed that the clinical sensitivity and specificity of the Abbott RealTime HR HPV test were not inferior (P = 0.004 and 0.009, respectively) to those of HR HC2. Overall agreement between the two assays was 96.5%, with a k value of 0.86 (CI 95%, 0.82 to 0.91). We evaluated the intralaboratory reproducibility by retesting 521 samples at least 4 weeks after the first test; the crude agreement between the first and second test was 98.5%, with an overall k value of 0.97 (CI 95%, 0.95 to 0.99). This test fully satisfies the requirements of a primary cervical cancer screening test. This assay differentiates between HPV16, HPV18, and non-HPV16/18 types in every specimen, but how to use this information in a screening setting still is unclear.
Abstract: In Italy vaccination against human papillomavirus (HPV) was introduced in the national immunization programme in 2007; the primary target for this vaccination is 11-year-old females, whereas vaccination for older age groups is still a matter of debate. This project was carried out in the period 2007-2009 to estimate the acceptance rate among 18-26-year-old, to whom free-of-charge vaccination was actively offered. Socio-demographic factors associated with acceptance were also investigated. A sample of 1159 women was randomly selected from resident population lists of 10 Local Health Units in 6 of Italy's 21 Regions; 1032 women were deemed eligible for the study. Of the eligible women, 580 received at least one vaccine dose for an acceptance rate of 56.2% and 542 received all three vaccine doses (52.6%). The acceptance rate was significantly higher for: residents of northern and central Italy (OR(adj)=2.22, 95%CI 1.64-3.01 and OR(adj)=1.77, 95%CI, 1.20-2.61 respectively), compared to southern Italy; women with a high educational level (OR(adj)=1.41; 95%CI: 1.02-1.93); and students (OR(adj)=1.64; 95%CI: 1.13-2.37). The low immunization rate highlights the difficulties of reaching young adult women, although the current coverage rates observed in the primary target population of HPV vaccination campaign (64%) emphasize that achieving high coverage rates is challenging also in younger age groups. Our results suggest that it would be premature to extend the active free-of-charge offer of HPV vaccination to older women and that efforts should be focused on the priority target, considering that the objective of 95% coverage established for this age group is still far from being attained.
Abstract: Italy was the first European nation to offer free vaccination against human papillomavirus (HPV) types 16 and 18. The vaccination is actively encouraged and is available free of charge to 11-year-old girls. The introduction of new technologies such as HPV DNA testing and HPV vaccination requires cost-effectiveness analysis of cervical cancer strategies in Italy for both vaccinated and unvaccinated women.
