Activity level and process indicators of organised programmes for cervical cancer screening in Italy

The target population of Italian organised cervical screening programmes that were active (that invited at least 1000 women) in 2004 was 10,206,741 women, corresponding to 64% of the Italian female population in the 25-64 year age range. This proportion was 66%, 83% and 49% in Northern, Central, and Southern Italy respectively. Some 27% of this target population was invited during 2004. Among women invited in 2004, 37.7% had cytology within organised programmes up to April 2005 (46.2%, 36.0% and 26.2% in Northern, Central, and Southern Italy respectively). It must be kept in mind that many women have spontaneous tests that are not registered in organised programmes. Further data on women invited in 2003 were collected as aggregated tables, provided by the local screening registration systems. We obtained data from 99 programmes with an overall target population of 8,698,480 women. At least 70% of programmes could provide data for most indicators. Overall, 3.2% of smears were classified as unsatisfactory. At a national level 6.6% of women was advised to repeat cytology and 62.2% of them actually did. However 13/71 programmes recommended repeat cytology to > 10% of screened women. Nationwide, 2.6% of screened women were referred to colposcopy. The Positive Predictive Value (PPV) of detecting a biopsy-proven Cervical Intraepithelial Neoplasia grade 2 (CIN2) or more severe among women referred because of cytology "Atypical Squamous Cells of Undetermined Significance" or more severe was 15.0%. There was however a relevant variability: 9/90 programmes had a referral rate >5%. There was an inverse correlation between referral rate and PPV. Compliance with recommended colposcopy was 86% (91% among women with high-grade cytology). The raw detection rate of biopsy-proven CIN2+ was 2.7 per 1000 screened women (2.8 per 1000 when standardised on the Italian population). In conclusion, during 2004 there was a further increase of active organised programmes, especially in Southern Italy. This is important, as spontaneous activity is known to be low there. Despite this rise, quality indicators were stable. However, in a few programmes, the use of excessively broad criteria in the interpretation of cytology decides an excessively high rate of referrals to colposcopy.