Italian Cervical Screening Programme' 17me congrs de la Socit Marocaine de Cancerologie 2325 Avril,

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Italian Cervical Screening Programme. 17ème
congrés de la Société Marocaine de Cancerologie
23-25 Avril, Marrakech

• Marco Zappa
• ISPO, Scientific Institute of Tuscany Region
• Clinical and Descriptive Epidemiology
• Florence - Italy

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The Italian context

• Cancer screening programmes have been developed
  on a voluntary basis till 2000.
• In 2001 cancer screening programs have been
  included in the Basic Healthcare Parameters
• 3 screening programmes are recommended
• ? mammographic screening
• ? cervical screening
• ? colorectal cancer screening
• All examinations are free charged.

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The Italian context

• ? Guidelines are provided by the Minister of
  Health -Department of Prevention (largely based
  on European guidelines)
• ? Regional Governments are responsible for
  organization, management and control of
  screening programmes

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National Centre for Screening Monitoring (Osservat
orio Nazionale Screening)

• ? Founded in 2001 in cooperation with Scientific
  Societies for Breast Cancer, Cervical Cancer and
  Colorectal Cancer.
• ? In 2005 formally charged by the Italian
  Minister of Health of promoting and monitoring
  screening programmes nationwide.
• ? The ONS is located in ISPO Florence

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Aims
Aims

• Monitoring the spreading of screening activities
• Evaluating the impact of screening programmes on
  incidence and mortality
• Training
• Improving quality assurance for each phase of
  screening programmes
• Developing comunication tools to help people to
  make an informed choice

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The Data collection
Monitoring Data Collection

• Data come from several different programmes
  (120), most of them organized at a Regional level
  (20) programmes,
• For every Region, a referent for data collection
  has been identified
• Aggregated data collection by a structured
  questionnaire - referred to the previous year of
  activity

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The questionnaire

• Computerized form ( Excel spreadsheets)
• 1. general information on procedures/participation
  
• 2. performance parameters (initial screening)
• 3. performance parameters (subsequent screening)
• 4. performance parameters (self-registrations)
• Automatic formulas to calculate performance
  indicators
• All data should be provided by age groups and by
  screening test (first vs subsequent)

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Data collection
Data collection

• The feasibility of a National datawarehouse based
  on individual records is going on

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www.osservatorionazionalescreening.it
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Why a monitoring system?

• Identify critical points in the pathway of the
  programme
• Sharing the best experiences
• Benchmarking

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Cervical Screening Calabria Region Referral
Rate to colposcopy by programme
ONS 2008
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Incidence and mortality rates for cervical cancer
Italy 1988-2002- da I Tumori in Italia
Rapporto 2006 AIRT Working Group
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Previous pap test in women affected by Invasive
Cervix Cancer Tuscany Region 2004 -
194 cases
No previous pap
Pap gt 5 years ago
Courtesy of A. Iossa, P. Mantellini, E.Paci,
C.Visioli
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Cervical screening programme in Italy

• Recruitment ? by personal
  letter
• Age ? 25-64
• Screening interval ? 3 years
• Test ? Pap smear
  (HPV in the future? )
• Triage ? for ASCUS
  (new smear or HPV)
• Assessment Phase ? Colposcopy biopsy
  (in case)
  
• Treatment ? Leep etc.
  
• 
  

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of women aged 25-64yrs living in an area where
an organized programme is active
20 Regions 117 programmes 71.8 coverage
3,021,734 invitations 1,217,001 screened woman
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Compliance to invitation
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Compliance to invitation by Region
Lines represent the range between 10th and 90th
centile of programme distrubution within each
Region, n. of programmes in each bar. (no lines
for regions with a single regional programme)
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of recommandation to repeat smear
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of recommendation to repeat smear (and reason)
by Region
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Compliance to Recommendation to repeat citology
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Compliance to recommendation to repeat smear by
Region
Each bar rapresents one Region.Lines represent
the range between 10th and 90th centile of
programme distrubution within each Region, n. of
programmes in each bar. (no lines for regions
with a single regional programme)
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Referral rate to colposcoy
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Referral rate to Colposcopy by Italian Region
Lines represent the range between 10th and 90th
centile of programme distribution within each
Region, n. of programmes in each bar.
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Reason for Referral to colposcopy by Region
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Positive Predictive Value (PPV) for CIN2 of
indication to colposcopy
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Compliance to colposcopy for ASCUS cytology of
programmes with desirable or acceptable level
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(No Transcript)
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CIN2 Detection Rate
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Detection rates of CIN2 lesions by Region
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VPP of cytology ASCUS for histologically
confirmed CIN2
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Conclusion (1)

• Cervical Cancer is almost a preventable cancer by
  a regular pap testing
• Almost 75-80 of Italian women aged 25-64 refer
  to have performed a pap smear in the last 3 years
• Half of them perfom a test within a spontaneous
  activity
• Within an organized activity we can check the
  quality of the whole process from invitation to
  diagnosis and treatment

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Conclusion (2)

• Screening programmes for cervical cancer in
  Italy are widespreading
• Differences between and within Italian Regions
• Room for quality improvement

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In the future?

• HPVs era
• ? HPV as primary test (with pap smear as triage)
  at the moment nine pilot programmes are based
  on such a test
• HPV Vaccination all girls aged 12 years are
  actively invited to vaccination (with different
  policies within Regions in the older age group).