title: Screening patterns within organized programs and survival of Italian women with invasive cervical cancer.
abstract: OBJECTIVE
  To evaluate screening patterns within organized cervical screening programs (OCSPs) and survival of women with invasive cervical cancer (ICC).
  
  
  METHODS
  A population-based study was conducted in Italian areas covered by cancer registries and OCSPs. The study included all women aged 25-65 years diagnosed with ICC between 1995 and 2008, and their screening histories within OCSPs were retrieved. Hazard ratios (HR) of death and 95% confidence intervals (CI) were computed according to screening pattern, using Cox models adjusted for age, ICC stage, and major confounders.
  
  
  RESULTS
  Among 3268 women with ICC, 20% were never-invited to OCSP, 36% were never-compliant with OCSP's invitation, 33% were compliant and had a screen-detected ICC within OCSP (i.e., after a positive cytology), and 11% were compliant but had a non-screen-detected ICC. Screen-detected ICCs were more frequently micro-invasive (42%) compared to non-screen-detected ones (14%). Compared to women with screen-detected ICC, the adjusted HRs of death were 1.9 (95% CI 1.5-2.4) for those never-invited, 2.0 (95% CI 1.6-2.5) for never-compliant, and 1.7 (95% CI 1.3-2.4) for compliant women having non-screen-detected ICC.
  
  
  CONCLUSIONS
  Prolonged survival, beyond down-staging, of women with ICC detected within OCSPs in Italy, further calls for improvements of OCSPs' invitational coverage and participation.
authors.affiliation: Epidemiology and Biostatistics Unit, Aviano National Cancer Institute Centro di riferimento oncologico, Via Gallini 2, 33081 Aviano (PN), Italy. zucchetto.epi@cro.it
authors.forename: Antonella
authors.initials: A
authors.lastname: Zucchetto
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Ronco
authors.forename: Paolo
authors.initials: P
authors.lastname: Giorgi Rossi
authors.forename: Marco
authors.initials: M
authors.lastname: Zappa
authors.forename: Stefano
authors.initials: S
authors.lastname: Ferretti
authors.forename: Antonella
authors.initials: A
authors.lastname: Franzo
authors.forename: Fabio
authors.initials: F
authors.lastname: Falcini
authors.forename: Carmen Beatriz
authors.initials: CB
authors.lastname: Visioli
authors.forename: Roberto
authors.initials: R
authors.lastname: Zanetti
authors.forename: Patrizia
authors.initials: P
authors.lastname: Biavati
authors.forename: Francesco
authors.initials: F
authors.lastname: La Rosa
authors.forename: Susanna
authors.initials: S
authors.lastname: Baracco
authors.forename: Massimo
authors.initials: M
authors.lastname: Federico
authors.forename: Cinzia
authors.initials: C
authors.lastname: Campari
authors.forename: Aldo
authors.initials: A
authors.lastname: De Togni
authors.forename: Silvano
authors.initials: S
authors.lastname: Piffer
authors.forename: Fabio
authors.initials: F
authors.lastname: Pannozzo
authors.forename: Mario
authors.initials: M
authors.lastname: Fusco
authors.forename: Maria
authors.initials: M
authors.lastname: Michiara
authors.forename: Marine
authors.initials: M
authors.lastname: Castaing
authors.forename: Pietro
authors.initials: P
authors.lastname: Seghini
authors.forename: Francesco
authors.initials: F
authors.lastname: Tisano
authors.forename: Diego
authors.initials: D
authors.lastname: Serraino
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007558:Italy; D008403:Mass Screening / Q000458:organization & administration*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010342:Patient Acceptance of Health Care; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D014626:Vaginal Smears
keywords: CI; CR; Cancer Registry; Cervical cancer; Cytology; FIGO; HR; ICC; ICD; International Classification of Diseases; International Federation of Gynecology and Obstetrics; NOS; OCSP; OR; Organized screening program; Screening history; WHO; World Health Organization; confidence interval; hazard ratio; invasive cervical cancer; not otherwise specified; odds ratio; organized cervical screening program