title: Changes in cervical cancer incidence following the introduction of organized screening in Italy.
abstract: OBJECTIVE
  To quantify the impact of organized cervical screening programs (OCSPs) on the incidence of invasive cervical cancer (ICC), comparing rates before and after activation of OCSPs.
  
  
  METHODS
  This population-based investigation, using individual data from cancer registries and OCSPs, included 3557 women diagnosed with ICC at age 25-74years in 1995-2008. The year of full-activation of each OCSP was defined as the year when at least 40% of target women had been invited. Incidence rate ratios (IRRs) with 95% confidence intervals (95% CIs) were calculated as the ratios between age-standardized incidence rates observed in periods after full-activation of OCSPs vs those observed in the preceding quinquennium.
  
  
  RESULTS
  ICC incidence rates diminished with time since OCSPs full-activation: after 6-8years, the IRR was 0.75 (95% CI: 0.67-0.85). The reduction was higher for stages IB-IV (IRR=0.68, 95% CI: 0.58-0.80), squamous cell ICCs (IRR=0.74, 95% CI: 0.64-0.84), and particularly evident among women aged 45-74years. Conversely, incidence rates of micro-invasive (stage IA) ICCs increased, though not significantly, among women aged 25-44years (IRR=1.34, 95% CI: 0.91-1.96). Following full-activation of OCSPs, micro-invasive ICCs were mainly and increasingly diagnosed within OCSPs (up to 72%).
  
  
  CONCLUSIONS
  Within few years from activation, organized screening positively impacted the already low ICC incidence in Italy and favored down-staging.
authors.affiliation: Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, Aviano, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Serraino
authors.affiliation: Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, Aviano, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gini
authors.affiliation: Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, Aviano, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Taborelli
authors.affiliation: Center for Cancer Epidemiology and Prevention, City of Health and Science Hospital, Torino, Italy.
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Ronco
authors.affiliation: Interinstitutional Epidemiology Unit, Local Health Unit, Reggio Emilia, Italy; IRCCS Santa Maria Nuova Hospital, Reggio Emilia, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Giorgi-Rossi
authors.affiliation: Cancer Prevention and Research Institute, Firenze, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Zappa
authors.affiliation: Cancer Prevention and Research Institute, Firenze, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Crocetti
authors.affiliation: Friuli Venezia Giulia Central Health Direction, Udine, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Franzo
authors.affiliation: Romagna Cancer Registry, IRCCS "Istituto scientifico romagnolo per lo studio e la cura dei tumori" Institute, Meldola, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Falcini
authors.affiliation: Cancer Prevention and Research Institute, Firenze, Italy.
authors.forename: Carmen Beatriz
authors.initials: CB
authors.lastname: Visioli
authors.affiliation: Department of Medical and Surgical Specialties and Public Health, Perugia University, Perugia, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Stracci
authors.affiliation: Veneto Tumour Registry, Veneto Region, Padova, Italy.
authors.forename: Manuel
authors.initials: M
authors.lastname: Zorzi
authors.affiliation: Department of Oncology, Hematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Federico
authors.affiliation: University Hospital, Parma, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Michiara
authors.affiliation: Napoli 3 South Local Health Unit, Brusciano, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Fusco
authors.affiliation: Ferrara University and Ferrara Local Health Unit, Ferrara, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ferretti
authors.affiliation: Latina Local Health Unit, Latina, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Pannozzo
authors.affiliation: Siracusa Local Health Unit, Siracusa, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Tisano
authors.affiliation: Center for Cancer Epidemiology and Prevention, City of Health and Science Hospital, Torino, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Zanetti
authors.affiliation: Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, Aviano, Italy. Electronic address: zucchetto.epi@cro.it.
authors.forename: Antonella
authors.initials: A
authors.lastname: Zucchetto
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008403:Mass Screening; D008875:Middle Aged; D009367:Neoplasm Staging; D065006:Papanicolaou Test; D012042:Registries; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control
keywords: Cervical cancer; Incidence rate ratio; Organized screening; Pap-smear