Mammography screening in Italy: 2004 survey and 2005 preliminary data.

In 2004 regions were required to provide the ONS (Osservatorio Nazionale Screening, National Centre for Screening Monitoring) with data on screening activity. Previously, GISMa (Gruppo Italiano Screening Mammografico) had for several years carried out a yearly survey to collect process indicators of mammography screening and compare them, using standard values agreed on at a national and international level. In 2006, an updated version of the operative report of process indicators was published by GISMa and ONS. Data for the survey came from several different programmes that may have changed over time, and may have different settings of organisation and management. The year 2004 can be considered almost exhaustive of the situation of Italian mammography screening; data were provided by 117 programmes from 18 different regions. In ten regions, the individual programmes are part of a comprehensive regional project. In 2004, about 1,870,000 women aged 50-69 years were invited to have a screening mammography, and over 1,050,000 were screened. Theoretical extension was 71.9%, while 52% of the target population received an invitation to screening. An imbalance in coverage is still present when comparing Northern (more than 80%) and Central Italy (almost 100%) to Southern Italy, that only has a 40% coverage by organised screening. The national crude attendance rate was 55.6%, slightly lower than the previous year. A decreasing trend was evident from the North to the Centre to the South of Italy: 60.2%, 51.8%, and 39.1%, respectively. Referral rates of 8.8% at first screening and 4.2% at repeat screening were recorded. Direct standardised detection rate was 6.6 x 1000 at the first test and 5.0 at repeat test, while benign to malignant ratio for first and repeat screening was 0.34 and 0.20, 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. Preliminary data for the year 2005 shows a further increase in screening coverage: 76.4 % of the Italian target population was enrolled in screening programmes, and 50.3% received an invitation to have a mammography. Imbalance in coverage still exists between Northern and Central Italy and the South: figures are 92.4%, 98.6%, and 39.3%. The national crude attendance rate was 5 7.8%.