Monday March 4, 2024 occurs there International Day against Human Papilloma Virus (HPV). The anniversary aims to increase awareness of the risks associated with this virus and to spread prevention strategies – for both women and men – aimed at avoid cancer and other diseases related to the virus. Two o’clock too Healthcare companies in Ferrara join the Day illustrating the work of the Services dedicated to the prevention and treatment of this pathology.
Lo screening for cervicocarcinoma and vaccination against papillomavirus they are two sides of the same coin: the Local Health Authority and the Ferrara University Hospital are strongly committed to the fight against the HPV virus, through an integrated and multidisciplinary approach with the aim of eradicating HPV-related pathologies.
LO SCREENING. “HPV (human papillomavirus) – explains Dr. Caterina Palmonari, Director of the Epidemiology Operational Unit, oncology screening, health promotion programs of the Local Health Authority of Ferrara – it is a virus that causes a very frequent infection, which most people contract at least once in their lives. Most lesions heal spontaneously but some, if left untreated, slowly progress to tumor forms. However, it takes many years for the lesions to transform and only very few of the women with papillomavirus infection develop cervical cancer. For a long time, uterine cancer represented the most frequent form of carcinoma for women, but for several years now the situation has changed profoundly thanks to prevention screening and the number of diagnosed deaths due to cervicocarcinoma continues to decrease. On the contrary, where preventive tests are not performed, such as in developing countries, this tumor still exists Today the second leading cause of cancer death in women. Thanks to the prevention screening program in Emilia-Romagna, the incidence of invasive cervical cancer was reduced in the target population by 40% and mortality by 50%”.
Population screening for the prevention of cervical cancer today represents, together with the anti-HPV vaccine, the most effective tool available to prevent women from developing this cancer since, thanks to screening tests, it is possible to detect the presence of the papilloma virus (HPV), the main cause of cervical cancer, and to identify and treat precancerous lesions early, thus preventing the formation of invasive tumors. The regional screening program provides for the free offer to all women aged between 25 and 64 of an HPV test or a PAP test, effective and simple tests which are carried out by midwives at all Consultants active in the provincial territory.
Currently the screening program includes two routes differentiated by age:
– in the 25-29 age group (in women who have not had at least 2 doses of the vaccine before the age of 15): Pap test as a primary screening test every 3 years, i.e. a morphological examination that looks for cellular changes;
– in the 30-64 age group, and women aged 25 to 29 who have received at least 2 doses of the vaccine before the age of 15: HPV test as a primary screening test every 5 years, i.e. a test capable of detecting the presence of virus DNA.
“In 2022 – continues Palmonari – the Oncology Screening Center of Ferrara invited 19.817 donne to participate in the prevention program and the 73% of these performed the screening exam. This important membership allowed us to detect the presence of 758 positive HPV tests and 137 positive Pap tests and the necessary in-depth courses have already been activated for all these women. On average in Ferrara, as in the rest of our region, the prevention screening program detects approximately one precancerous lesion every 132 women and one tumor every 5,000 women who participate. Most of the lesions found are treated with small surgeries, done in the outpatient clinic and with local anesthesia.”
AT THE OBSTETRICS GYNECOLOGY OPERATIONAL UNIT OF THE CONA HOSPITAL second level diagnostic investigations are carried out: Colposcopy. This is an investigation that is carried out on an outpatient basis and is carried out using an optical system at different magnifications (the colposcope). The aim is to identify the anomalous areas at the level of the squamous-columnar junction of the cervix, the most frequent site of precancerous lesions caused by persistent HPV infection, and to perform one or more targeted biopsies on them.
The cervical lesions identified by histological examination are CIN1, CIN2 and CIN3 (Cervical Intraepithelial Neoplasia grades 1, 2 and 3 respectively). CIN1 lesions, also called low-grade, have a high probability of regressing spontaneously, are worthy of cytological follow-up and treated only if persistent; therefore, if the colposcopy is negative or identifies low-grade histological anomalies, referral for follow-up at level I screening is expected. However, there is an indication to treat high-grade lesions as they are precancerous: CIN 2 and CIN 3. Excision of these lesions with a radiofrequency loop is the treatment of choice and is performed on an outpatient basis, under colposcopic guidance, with local anesthesia . Subsequently, the patients remain in the care of the colposcopy clinic for the subsequent checks provided for by the regional protocol.
“At the University Hospital of Ferrara – highlights the prof. Pantaleo Greco, Director of the Operational Unit – in 2023, were performed 1276 colposcopy; were carried out as part of the level II screening process 77 excisional interventions: 49 for CIN2 (64%) and 19 for CIN3 (25%)”.
THE VACCINE. Since 2007 it has been possible to prevent papillomavirus (HPV) infection thanks to an effective vaccine that prevents over 90% of HPV-associated tumors. Preventing infection by the strains of the virus against which they are directed also avoids the formation of precancerous lesions which could progress into a tumor over time. By achieving high levels of vaccination coverage, cervical cancer and other HPV-related cancers would dramatically reduce their incidence. According to the World Health Organization, the goal is to reach vaccination coverage of 90% of girls by 15 years of age by 2030.
Vaccination is actively and free of charge offered to:
– all boys and girls from the age of eleven onwards;
– to girls upon reaching the age of 25, if not previously vaccinated.
Free admission is also available to all women diagnosed with an HPV-related lesion, up to 45 years of age. With the new National and Regional Vaccine Prevention Plans, the vaccine is also offered free of charge up to 45 years of age, without distinction of sex, to subjects falling within the risk categories (MSM, HIV+, subjects undertaking the transition process, sex workers, etc.).
“In the province of Ferrara, during 2021 and 2022 – declares the Dr. Clelia de Sisti, Director of the Public Health Department of the Local Health Authority of Ferrara – a recovery action was carried out for the 2009 and 2010 birth cohorts, not invited during the pandemic period and in 2023 we realigned with the invitation of those born in 2011 and 2012. At the same time, 25 year olds were invited. This recovery action has achieved excellent results, allowing vaccination coverage of a certain level to be achieved. The vaccination campaign underway in 2024 affects those born in 2012 for the second dose and those born in 2013 for the complete cycle”.
On the occasion of World HPV Day, in the week from 4 to 8 March, the Public Hygiene Operational Unit of the Local Health Authority of Ferrara organized dedicated vaccination sessions with the invitation of 25-year-old women born in 1999 who had not previously been vaccinated.
It is important to remember that, given the proven effectiveness of vaccination, the Emilia-Romagna Region has remodulated the cervical cancer screening program and the first call for screening for women vaccinated with at least two doses has been postponed to 30 years for HPV, both administered before the age of 15. Therefore, from 2023 in our Region, 25-year-olds already vaccinated by the age of 15 with at least two doses against the Papilloma virus will have their first test at 30 and no longer at 25.
“It remains indispensable – ends De Sisti – maintain and strengthen the vaccination campaign against HPV, with the active involvement of the local area (in particular open pediatricians, general practitioners and family consultants) and specialists (primarily paediatricians, gynecologists, oncologists) with counseling and promotion of this vaccine, a “shield” against cancers of the uterine cervix, vulva and vagina in women, of the penis in men, of the anus and oral cavity in both sexes”.
THE ILLNESS. HPV infection is very frequent and is mainly transmitted sexually. It is estimated that approximately 80% of women come into contact with HPV in their lifetime, with two peaks in prevalence, at 25 years of age and at 50 years of age. Among the different types of viruses, IARC (International Agency for Research on Carcer) identified 13 genotypes at high oncogenic risk, including HPV 16 and 18, and 12 genotypes at low oncogenic risk, including 6 and 11, the main causes of benign skin lesions such as warts; some of these viruses are among the targets of anti-HPV vaccination. Most viruses cause a transient infection, but the persistence of the viral infection within the cell is the necessary condition for tumor transformation, together with other individual predisposing factors (e.g. immunosuppression and smoking).