title: HPV prevalence and risk of pre-cancer and cancer in regular immigrants in Italy: results from HPV DNA test-based screening pilot programs.
abstract: ᅟ: Immigrants from low- and medium-income countries have a higher risk of cervical cancer due both to barriers in access to screening and to higher human papillomavirus (HPV) prevalence. In the near future many screening programmes in industrialised countries will replace Pap test with HPV as primary test. In order to plan future interventions, it is essential to understand how the HPV screening performs in immigrant women.
  
  
  METHODS
  We conducted a survey on the main performance indicators from some of the HPV DNA-based pilot programmes in Italy, comparing regular immigrant women, identified as women resident in Italy who were born abroad, with women who were born in Italy. All the programmes applied the same protocol, with HPV as stand-alone test starting for women of 25 or 35 to 64 years of age. Cytology triage is performed for positive women; those ASC-US or more severe are referred directly to colposcopy; negative women are referred to repeat HPV after one year.
  
  
  RESULTS
  Overall, 162,829 women were invited, of whom 22,814 were born abroad. Participation was higher for Italy-born than born abroad (52.2% vs. 43.6%), particularly for women over 45 years. HPV positivity rate was higher in immigrants: 7.8% vs. 6.1%, age-adjusted Relative Risk (age-adj RR) 1.18, 95% confidence interval (95% CI) 1.13-1.22. The proportion of women with positive cytology triage was similar in the two groups (42%). Cervical Intraepithelial Neoplasia (CIN) grade 2 or more severe detection rate was higher for born abroad (age-adj RR 1.65, 95% CI 1.45-1.89). The difference was stronger when considering only CIN3 or more severe (age-adj RR 2.29, 95% CI 1.90-2.75). Both HPV positivity and CIN2 or more severe detection rate had a different age curve in born abroad compared with Italy-born: in the former, the risk was almost flat, while in the latter it declined rapidly with age.
  
  
  CONCLUSIONS
  Compliance with HPV screening is lower for migrant women, who are affected by higher HPV positivity and CIN3 cancer detection rates.
authors.affiliation: Staff Programmazione e Controllo, AUSL, Reggio Emilia, Italy ; IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Campari
authors.affiliation: Coordinamento regionale screening oncologici, Regione Veneto, Venezia, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Fedato
authors.affiliation: INMP Istituto Nazionale per la promozione della salute delle popolazioni Migranti ed il contrasto delle malattie della Povertà, Rome, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Petrelli
authors.affiliation: Registro Tumori del Veneto, Regione Veneto, Padova, Italy.
authors.forename: Manuel
authors.initials: M
authors.lastname: Zorzi
authors.affiliation: Registro Tumori del Veneto, Regione Veneto, Padova, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Cogo
authors.affiliation: Unità di Epidemiologia - CPO Piemonte, Torino, Italy.
authors.forename: Adele
authors.initials: A
authors.lastname: Caprioglio
authors.affiliation: Unità di Epidemiologia - CPO Piemonte, Torino, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Gallo
authors.affiliation: Unità di Epidemiologia - CPO Piemonte, Torino, Italy.
authors.forename: Livia
authors.initials: L
authors.lastname: Giordano
authors.affiliation: ASL Valle Camonica Sebino, Breno, BS Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Domenighini
authors.affiliation: ASL Valle Camonica Sebino, Breno, BS Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Pasquale
authors.affiliation: Patologia IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
authors.forename: Sonia
authors.initials: S
authors.lastname: Prandi
authors.affiliation: ISPO - Istituto per lo Studio e la Prevenzione Oncologica, Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Zappa
authors.affiliation: IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy ; Servizio Interaziendale di Epidemiologia, AUSL, Reggio Emilia, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Giorgi Rossi