Journal of Epidemiology and Community Health

Differential impact of cervical cancer in immigrant women: a decade-long epidemiological study in the Marche Region, Italy

Background Cervical cancer is primarily caused by persistent human papilloma virus (HPV) infections, with significant disparities observed in its burden, especially affecting immigrant populations from high HPV prevalence regions. This study evaluates the incidence and severity of cervical cancer in immigrant women in the Marche region, Italy, from 2010 to 2019. Methods We employed a detailed analysis of population-based data from the Marche Cancer Registry using the age-standardised incidence rates (IRs) and Poisson regression models for in situ cervical cancer (ISCC) and infiltrating cervical cancer (ICC). Results The IRs for ICC and ISCC among immigrant women are alarmingly higher compared with their Italian counterparts; IR for ICC in immigrant women is 26.5 per 100 000 women-years, compared with 7.9 in Italian women. For ISCC, the IR is 55.1 for immigrants versus 29.2 for Italians. Immigrant women showed a median age at diagnosis for ICC of 49 years, almost a decade younger than Italian women, and they were more likely to have squamous cell histology, which is linked to high-risk HPV strains. Conclusions The study reveals a substantially higher incidence of both ISCC and ICC among immigrant women with ICC diagnosed 8 years previously. These findings underscore the pressing need for culturally and linguistically tailored public health interventions, including improved access to screening and vaccination for HPV, to address the elevated risk and earlier onset of cervical cancer in immigrant women in Italy. The study highlights the critical role of preventive measures in reducing health disparities and enhancing the efficacy of public health policies.

Are there any sociodemographic factors associated with non-uptake of HPV vaccination of girls in high-income countries with school-based vaccination programmes? A systematic review

Background Uptake of human papillomavirus (HPV) vaccination is generally high in high-income countries with school-based vaccination programmes; however, lower uptake in certain population subgroups could continue pre-immunisation inequalities in cervical cancer. Methods Six electronic databases were searched for quantitative articles published between 1 September 2006 and 20 February 2023, which were representative of the general population, with individual-level data on routine school-based vaccination (with >50% coverage) and sociodemographic measures. Titles, abstracts and full-text articles were screened for eligibility criteria and assessed for bias. A second independent reviewer randomly screened 20% of articles at each stage. A narrative synthesis summarised findings. Results 24 studies based in eight countries (Australia, Belgium, Canada, New Zealand, Norway, Sweden, Switzerland, UK) were included. Studies reported vaccination uptake by individual-level and area-level socioeconomic status (SES), parental education, religion, ethnicity and/or country of birth. 19 studies reported that more than 70% were vaccinated (range: 50.7%–93.0%). Minority ethnic groups and migrants were more likely to have lower vaccination uptake than White groups and non-migrants (11/11 studies). Lower SES was also associated with lower uptake of vaccination (11/17 studies). Associations with other sociodemographic characteristics, such as parental education and religion, were less clear. Conclusions Even in high-income countries with high coverage school-based vaccination programmes, inequalities are seen. The totality of available evidence suggests girls from lower SES and minority ethnic groups tend to be less likely to be vaccinated. Findings could inform targeted approaches to mop-up vaccination and cervical cancer screening amidst changing HPV epidemiology in a vaccine era. Trial registration number CRD42023399648.

Cost-effectiveness of extending the HPV vaccination to boys: a systematic review

Background Human papillomavirus (HPV) infection can have severe consequences both in women and men. Preadolescent girls are vaccinated against HPV worldwide but a gender-neutral vaccination is being adopted only little by little. This systematic review offers an overview of cost-effectiveness of the gender-neutral HPV vaccination. Methods Economic evaluations of gender-neutral HPV vaccination with a two-dose schedule compared with girls-only strategy were systematically searched in Medline, Embase and WOS up to June 2020. Incremental cost-effectiveness ratios and key parameters were analysed. Results Nine studies met the inclusion criteria. Four studies concluded in favour of the gender-neutral programme, another four found it cost-effective only in alternative scenarios. The most influential parameters are the discount rate of benefits (same as for costs vs reduced), vaccine price (listed vs publicly negotiated) and included health problems (inclusion of oropharyngeal and penile cancers). Sponsorship was not decisive for the final result, but there were differences between industry-funded and independent studies in some cost categories. Conclusions The evidence of the cost-effectiveness of extending HPV vaccination to boys is scarce and ambiguous. Before the adoption of such a strategy, countries should carry out context-specific cost-effectiveness analyses, but the decision should also take into account other criteria, such as gender-related equality.

Green tea consumption, primary treatment outcome and survival after a diagnosis of ovarian cancer

Background Drinking green tea prior to a diagnosis of ovarian cancer has been associated with improved survival; however, research on post-diagnosis consumption is limited. We investigated whether consuming green tea during primary chemotherapy was associated with improved treatment response and whether green tea drinking pre-diagnosis or post-treatment was associated with survival. Methods We used data from the Ovarian Cancer Prognosis and Lifestyle study, an Australian prospective cohort of 958 women with epithelial ovarian cancer. Tea consumption was self-reported at baseline and at 3 monthly intervals following diagnosis. Logistic regression was used to estimate ORs and 95% CIs for the association between green tea consumption during primary treatment and outcome. Flexible parametric survival models were used to estimate HRs and 95% CIs for the associations between green tea pre-diagnosis and post-treatment and survival. Black and herbal tea were included as negative controls. Results No association was seen between green or black tea consumption during chemotherapy and treatment response. There was a suggestion that drinking at least one cup/day of green tea in the pre-diagnosis or post-treatment periods was associated with improved overall survival (pre-diagnosis: HR=0.78, 95%CI=0.60 to 1.00; post-treatment: HR=0.84, 95%CI=0.66 to 1.04), but not progression-free survival. Conversely, herbal tea consumption post-treatment was associated with improved progression-free but not overall survival. Conclusions We confirmed previous results suggesting green tea may be associated with better ovarian cancer survival but cannot rule out the possibility that residual confounding may be influencing these associations. Randomised trials are required to confirm any potential benefit.