Mammography screening in Italy: 2008 survey

This report is an update of similar previous papers that have been published by the ONS (Osservatorio Nazionale Screening, National Centre for Screening Monitoring) since 2002. Data for the survey come from several different programmes that may have changed over time, and may have different settings of organisation and management. During 2007, a further increase in screening activity was recorded, with the inclusion of all Northern and Central Italian Regions, and a further development in the Southern Regions and Islands, so today all Italian Regions have implemented screening programmes. In 2008, almost 2,509,000 women aged 50-69 years were invited to have a screening mammogram, and more than 1,361,000 were screened. Theoretical extension was 89.9%, while actual extension increased from 62.3% in 2007 to 69.4%in 2008. An imbalance in coverage is still present when comparing Northern and Central Italy to Southern Italy, which only has a 69% coverage by organised screening. The Italian mean value (72.8%) of two-year extension (period 2007-2008) suggests that, at full capacity, Italian programmes are able to invite only two thirds of the target population. The percentage of women screened during 2008 accounted for 36.7% of the national target population. During the last few years, participation rates were substantially stable around 55-57% for crude rate, and 59-61% for adjusted rate, respectively. A decreasing trend towards the South of Italy is evident for this parameter, too. Many programmes work with low volumes of activity (below 10,000 or even 5,000 examinations per year), and only one Region surpassed the desirable level of at least 20,000 examinations for each programme. Referral rates of 7.5% at first screening and 4.4% at repeat screening were recorded. Direct standardised detection rate was 6.2x1,000 at first test and 4.2 at repeat test, while benign to malignant ratio for first and repeat screening was 0.25 and 0.15, respectively. Detection rate of invasive cancers ≤10 mm was 1.39x1,000 at first test and 1.44 at repeat test; the proportion of in situ carcinomas was 12.5% and 14.2% for first and repeat test, respectively. Indicators by 5-year age group confirm greater diagnostic problems at younger ages, with higher referral rates, higher frequency of surgical procedures with benign outcome (B/M ratio), and a substantially lower detection rate as compared to older age groups.