Artificial intelligence in population-based cancer screening: evidence from a national survey of Italian...

Artificial Intelligence (AI) is increasingly proposed to enhance population-based cancer screening. While several applications are under evaluation, there is limited evidence on professional and organisational perspectives regarding their value, risks, and implementation challenges.

We conducted a web-based survey targeting coordinators and reference professionals of Italian cancer screening programmes. The survey comprised 39 questions and explored prior experience with AI, perceived benefits and risks, organisational and legal barriers, and willingness to invest in AI applications. Recruitment combined a cascade procedure through regional and sub-regional coordinators with distribution via the mailing list of the Federation of Oncology Screening Associations (FASO). Descriptive analyses summarised responses, while multiple linear regression assessed determinants of willingness to invest in AI applications.

A total of 305 professionals responded, representing all but one Italian region. About one-third reported AI experience, most frequently in colorectal polyp detection and breast imaging support. Overall, 74.8% expressed a strong interest in adopting AI applications, particularly for risk prediction and diagnostic support. The most valued benefits were improved diagnostic accuracy, workflow optimisation, and shorter reporting times. Concerns focused on legal liability (72.8%), lack of transparency and algorithmic bias (67.2%), and professional de-skilling (46.2%). Organisational barriers included inadequate IT infrastructure (77.0%), absence of guidelines (75.7%), and limited financial resources (77.4%). Regression confirmed that higher perceived benefits were positively associated with willingness to invest in AI applications, whereas risks were negatively associated.

Italian screening professionals generally support the adoption of AI but emphasise the need for robust evidence, clear regulatory frameworks, and sustained investment in digital infrastructure to ensure its safe and effective implementation.