Trends in invasive and in situ (CIN 3) cervical cancer incidence and mortality in Umbria, Italy: 1994-2008

AIM To analyze trends in invasive cancer incidence and mortality and CIN 3 in an Italian region (Umbria) in the period from 1994 to 2008. MATERIALS AND METHODS Joinpoint regression was applied to evaluate temporal trends of the incidence and mortality rates (EP standard) [1]. Relative survival rates were calculated with the Hakulinen method [2]. RESULTS The incidence and mortality rates in the period considered decrease (EAPC respectively of -1.5 (95% IC -4.0;1.1) and -4.1 (95% IC -9.0;1.1). In 2008, probably as a consequence of the increased number of foreign residents, accounting for 24.4% of invasive and 28.6% of CIN 3 incident cases, the incidence rate increased (7.2) and also the mortality rate (1.4). CIN 3 incidence rates significantly increased by 6.7 per year (95% IC 4.9; 8.5). Survival rates remain stable but for 1998-2001 cases a peak was observed with the first round of the organized screening. DISCUSSION The introduction of an opportunistic screening strategy first (1980) and the regional screening program (1999) after, are linked to the changes in trends [3,4]. The growth of CIN 3 incidence is caused by the screening program but also by immigrants from countries with high prevalence of HPV-related lesions [5,6]. Higher survival rates for the first round of organized screening could result from the early diagnosis of infiltrating lesions (e.g. pT1a1). BIBLIOGRAPHY Kim HJ,et al. Permutation tests for joinpoint regression with application to cancer rates. Stat. Med 2000; 19, 335. Correction: 2001, 20, 655. Karim-Kos HE, et al. Recent trends of cancer in Europe: a combined approach of incidence, survival and mortality for 17 cancer sites since the 1990s. Eur J Cancer 2008; 44(10):1345-89. De Kok IM, et al.Trends in cervical cancer in the Netherlands until 2007: Has the bottom been reached? Int J Cancer. 2011;128:2174-2181. Arbyn M, et al. The challenges of organising cervical screening programmes in the 15 old member states of the European Union”, Eur J Cancer.2009;45:2671-8. Sjoeborg KD, et al. HPV genotype distribution according to severity of cervical neoplasia Gynecol Oncol. 2010 Jul;118(1):29-34. Epub 2010 Apr 20 Arbyn M, et al. Trends in cervical cancer incidence and mortality in the Baltic countries, Bulgaria and Romania. Int J Cancer. 2011 ;128:1899-907. Zucchetto A, et al. Screening history of women with invasive cervical cancer in north-east Italy. Eur J Obstet Gynecol Reprod Biol 2010 ; 152(2):200-4.