Cervical Cancer Screening

Cervical cancer screening

Cervical cancer screening is ongoing all over the Region since year 2000. Till 2013 all women 25-64 have been invited to Pap test every three years. As for breast cancer screening, organizational and diagnostic protocols refer to European guidelines for Cervical Cancer Screening. In 2013 Tuscany Region approved the implementation of HPV test as primary screening test for women 34-64 years old. HPV positive tests are triaged by cytology and if it raises an abnormal results (ASCUS +) women are appointed to an assessment colposcopy. Women with a negative cytology are requested to repeat HPV test after one year: if it persists positive women are invited to a colposcopy. In tables 1 (here are also reported standards from Italian group for cervical cancer screening – GISCi) and 2 most recently Tuscany Pap test and HPV test surveys are summarized.

Table 1 – Main indicators of cervical screening programmes performance in Tuscany Region and standard proposed by GISCi – Years 2014- 2016

 

Years

Standard GISCI

Indicators

2014§^

2015^

2016^

desirable

acceptable

Adjusted extension (%)

99.6

94.5

104.0

 

Adjusted participation (%)

55.8

58.7

56.6

 

Inadequate Pap tests (%)

 

1.3

1.4

1.4

< 5%

< 7%

Recommendation to repeat cytology (%)

1.8

1.9

2.0

 

Compliance to recommendation to repeat cytology (%)

70.5

65.6

n.a.

Referral rate (%)

2.3

2.5

2.7

Compliance with assessment for ASCUS+ (%)

89.1

87.6

76.3

≥ 90%

≥ 80%

Compliance with assessment for HSIL+ (%)

92.2

91.8

87.6

≥ 95%

≥ 90%

 

Crude detection rate (per 1.000) for histologically confirmed lesions CIN2+

4.5

4.5

 

 

 

Crude detection rate (per 1.000) for histologically confirmed lesions CIN1

4.7

5.0

 

 

PPV of Pap test for CIN2+ among women referred to colposcopy for ASCUS+(%)

22

20.7

13.5

 

PPV of Pap test for CIN2+ among women referred to colposcopy for HSIL+ (%)

78.8

70.6

66.9

≥ 85%

≥ 65%

§ = Local Health Unit 12 Viareggio did not provide full data

^= Since 2014 3 Local Health Unit (LHU - Firenze, Grosseto and Viareggio) begun to invite 34-64 women to HPV test as primary screening test. In 2017 the 3 LHU reached all the targeted population. Except adjusted extenxion and participation all the figures reported are referred to Pap test as the primary screening test.

 

Table 2 – Main indicators of HPV test cervical screening programmes performance in Tuscany Region–Both baseline and 1 year recall - Years 2014- 2016

 

Years

Indicators

2013/14§

55-64*

2014/15§

Grosseto 34-64* Firenze 45-64*

2015/16

34-64*

Referral rate to colposcopy among all screened women (%)

2,2

3,9

4,5§

Compliance with assessment (%)

95,1

94,3

93,2§

PPV of HPV test for CIN2+ among women referred to colposcopy (%)

13,7

20,5

20,4§

Crude detection rate for histologically confirmed lesions CIN2+ among all screened women (‰)

2,8

7,5

8,5§

Referral rate to colposcopy among HPV + women (%)

69,1

63,8

64,4§

Crude detection rate for histologically confirmed lesions CIN2+ among HPV+ women (‰)

9,0

12,3

12,3§

§ = Local Health Unit 12 Viareggio did not provide full data

*= according to the Regional HPV test Protocol women have been progressively invited beginning from older age (55-64)