Role of P16(INK4a) expression in identifying CIN2 or more severe lesions among HPV-positive patients referred for colposcopy after abnormal cytology.

Background: p16 is strongly overexpressed in dysplastic cervical cells because of the transforming activity of the E7 oncogene of all high-risk human papillomavirus (HR-HPV) types and may be easily revealed by immunochemistry: p16 may, therefore, be considered a surrogate marker for the activated oncogene expression of HR-HPV in dysplastic cervical cells.

Methods: HPV and p16(INK4a) testing were performed in a consecutive series of 283 patients with abnormal cytology referred to colposcopy assessment or follow-up. Triage of patients to colposcopy by HPV or HPV and p16 testing was simulated, and the relative sensitivity, specificity, and positive predictive value (PPV) of HPV and p16 testing for > CIN2 lesions was determined as well as the cost balance of the two triage types.

Measuring interval cancers in population-based screening using different assays of fecal occult blood testing: the District of Florence experience.

The fecal occult blood test (FOBT) has demonstrated its efficacy in reducing mortality from colorectal cancer (CRC). The guaiac-based FOBT has been criticized for its low sensitivity. In this study, two different assays for FOBT (guaiac or an immunochemical test based on reversed passive hemagglutination [RPHA]) were tested for comparison within a population-based screening program for colorectal cancer in the province of Florence (Italy).

Disclosure practices and cultural narratives: understanding concealment and silence around cancer in Tuscany, Italy.

Disclosure practices are embedded in and enact personal, professional, and societal narratives. These narratives are not given but contested and evolving. The medical arena constitutes an important social space in which this contestation, reproduction and change take place.

Study design of randomized controlled clinical trials of breast cancer screening.

Evaluation of population screening must be based on a randomized clinical trial (RCT) with the study population randomized into two arms: an intervention group invited to screening and a control group not invited to screening. Reduced mortality in the intervention group is evidence of a benefit from screening. Individual randomization is the ideal, but cluster randomization is often used for logistical and ethical reasons.

Linkage between AIDS surveillance system and population-based cancer registry data in Italy: a pilot study in Florence, 1985-90.

The role of the Tuscany population-based Cancer Registry (TCR) in the assessment of cancer incidence in AIDS patients, and the completeness of cancer reporting to the Italian AIDS surveillance system (RAIDS) was evaluated through a linkage between the TCR and the RAIDS in the period 1985-90. In the Province of Florence, the incidence of Kaposi's sarcoma in AIDS cases was underestimated by 24% (95% CI; 9.8%-47%; 6/25 cases) by RAIDS in comparison with the TCR.

Measurement of the costs in two mammographic screening programmes in the province of Florence, Italy.

Objectives: To estimate and to compare the cost per woman examined and per breast cancer detected in two mammographic screening programmes in the province of Florence.

Setting: Two ongoing, population based, mammographic screening programmes in the province of Florence. The first (district project) was started in the seventies in a rural area, whereas the second (city project) was started in the city at the end of 1990.

A model-based prediction of the impact on reduction in mortality by a breast cancer screening programme in the city of Florence, Italy.

The efficacy of breast cancer screening for women older than 50 years has been shown in several studies. Service screening is now ongoing or planned in several countries in Europe. MISCAN, a computer simulation programme, has been used to analyse data from the Florence District Programme (FDP) breast cancer experience.

Cancer mortality in Italian migrants and their offspring in Canada.

Studies on the offspring of migrants provide important information on the contribution of environmental and genetic factors in the etiology of various cancers. The aim of the present study is to analyze the cancer risk in Italian-migrants (Canadian residents born in Italy) and their offspring compared with the host population. Odds ratios (OR) and 95 percent confidence intervals (CI) by site and birthplace categories (migrants, pure and mixed Italian-parentage Canadians) were calculated by means of a case-control study using the 'other cancer deaths' as controls and taking the host population as the reference category.

Population-based breast cancer survival. Mammographic screening activities in central Italy.

Background: The aim of this study was to evaluate the effect on 5-year survival of patients with invasive breast cancer relative to demographic and clinical variables (age, residence, and disease diffusion) and to early diagnostic procedures performed in the area.

Methods: The observed (Kaplan-Meier method) and relative 5-year survival in 1263 patients with invasive breast cancer in the Province of Florence, Italy, between 1985-1986 (source: Tuscany Cancer Registry) are presented. The results were compared with those of other European areas and of the Surveillance, Epidemiology, and End Results Program.

Radial scars of the breast: review of 38 consecutive mammographic diagnoses.

The authors report 38 consecutive cases of histologically proved breast radial scars (RSs) detected at mammography. In a retrospective review of mammograms in 30 matched cases of nonpalpable RS and nonpalpable scirrhous cancer, the characteristic mammographic features of RS were confirmed: (a) the absence of a central opacity, often substituted by a radiolucent area; (b) the presence of multiple elongated thin spicules radiating from the center of the lesion; (c) the infrequency of any palpable finding, even for superficial lesions of relatively large size. Microcalcifications with aspecific structure were found in the lesions on mammograms of 14 of the 38 cases and in 24 of the histologic specimens.

Modelling the analysis of breast cancer screening programmes: sensitivity, lead time and predictive value in the Florence District Programme (1975-1986).

Statistical indicators of early efficacy were estimated in the Florence District Programme where breast cancer screening has been carried out since 1970. Analysis of screen-detected and interval cancer data by means of statistical modelling using GLIM allowed us to estimate the mean sojourn time (1.91 and 3.

"Nonclassic" cytologic signs of cervical condyloma. A case-control study.

The association between "nonclassic" cytologic signs of condyloma and human papillomavirus (HPV) infection in women with negative Papanicolaou smears was analyzed via a case-control study. The cytologic signs considered were mild koilocytosis, mild dyskeratosis, binucleation or multinucleation, cleared cytoplasm and nuclear hyperchromatism. The Papanicolaou smears of 166 cases that showed colposcopic and histologic evidence of HPV infection (but whose smears lacked the classic cytologic signs of condyloma) and 166 controls that were negative colposcopically were randomly admixed and blindly reviewed by a panel of cytologists.

Routine colposcopic survey of patients with squamous atypia. A method for identifying cases with false-negative smears.

Routine colposcopy was performed on 376 women with cervical squamous atypia (originally reported as "inflammatory atypia"). Colposcopy showed no abnormalities in 240 cases and a lesion in 136 cases; the latter were sampled by colposcopy-guided biopsy. The biopsy samples showed evidence of human papillomavirus (HPV) infection and/or grade I cervical intraepithelial neoplasia (CIN I) in 42 cases (11.

Embodying illness, embodying cancer.

Individuals and societies embody illnesses in different ways, in part determined by the way a person knows and lives his or her diagnosis and prognosis. Based on research in Northern Italy, on the experiences and meanings of cancer and on the practice of nondisclosure of the diagnosis, we find nondisclosure reflects a world divided--life/death, good/bad, mind/body--with the unwanted converted to "other." The strong association of cancer with death, suffering, and hopelessness in much of Italy, coupled with the tremendous power attributed to naming and "sentencing" makes nondisclosure a major mechanism for keeping the "condemned" in this social world, and keeping death, decay, and suffering in the "other.

Positive predictive value of fine needle aspiration cytology of breast lesions.

The predictive value of fine needle aspiration (FNA) was assessed in 1,181 consecutive cases of breast lesions in which cytologic abnormalities were reported. The positive predictive value (PPV) of an FNA cytologic report of atypia, suspicious or positive was 0.49, 0.

Urethral cytology of Cytobrush specimens. A new technique for detecting subclinical human papillomavirus infection in men.

Cytologic examination of urethral smears prepared with the Cytobrush and colposcopic examination of the penis were performed in 53 male partners of women with cervical human papillomavirus (HPV) infections and in 14 healthy controls. A diagnosis of HPV infection was recorded in 28 subjects (52.8%).