Giordano Livia, Giorgi Daniela, Piccini Paola, Ventura Leonardo, Stefanini Valeria, Senore Carlo, Paci Eugenio, Segnan Nereo
CPO Piemonte, Torino.
Epidemiol Prev. 2007 Mar-Jun;31(2-3 Suppl 2):21-32.
Since 1990, the Italian Group for Mammography Screening (GISMa) has been promoting the development of new organised programmes and performing a yearly systematic survey of data activity. The screening extension has increased over time, reaching an overall 76.4% of coverage in 2005. The geographical extension is still heterogeneous, with a higher distribution in Northern and Central Italy compared with Southern and Insular Italy, where the screening activity was implemented only recently. Notwithstanding the continuity in implementation, the actual coverage reached only 50.3% of the target population, due to a reduced flow of invitations over time as a consequence of a chronic lack of invested resources and of well-plannedpolicies. The overall Italian rate for crude attendance was above the acceptable 50% standard even though a North-South trend is still confirmed; in Southern/Insular Italy participation was still inadequate (<40%) and did not reach the standard considered acceptable. Participation was higher in centralised programmes compared with those without regional coordination (+5-8%). The time trends for the other key performance indicators showed good average performance: the benign/malignant surgical biopsy ratio (B/M ratio) progressively decreased, reaching an 0.25 ratio (both for first and subsequent screening) in 2004; overall detection rate, detection rate for in situ and small cancers (< or =10 mm) showed a good trend, reaching 6.7% per hundred, 0.7% per hundred, and 1.6% per hundred, respectively, for the first screening, and 5.1% per hundred, 0.9% per hundred, and 1.7% per hundred for the subsequent screening in 2004. The only exception was the referral rate (RR) at first screening, which exceeded standards (> 7% in 2002-2004). Data comparing activity volume and programme duration were also analysed. In programmes with greater activity (average test number: 22,506) the referral rate for the first screening was higher, but still within acceptable standards. 6.3% per hundred; RR: 1.01 (0.98-1.04). This performance is compensated by better specificity and sensitivity: Positive Predictive Value (PPV). 12.8; RR:1.16 (1.05-1.27); overall detection rate: 8.1% per hundred, RR 1.19 (1.07-1.31). An improvement in quality with the increase of programme experience is evident. programmes with more than 6 years of activity, compared with newer programmes, show a recall rate in first screening of 6.5%; RR. 0.87 (0.84-0.89), a PPV of 1.7, RR:1.61 (1.48-1.75) andan overall detection rate of 7.6% per hundred, RR:1.41 (1.29-1.55). These results are consistent with those observed in other European programmes and encourage to explore new analysis strategies. The website of the National Centre for Screening Monitoring (ONS) is http://www.osservatorionazionalescreening.it.
自1990年以来，意大利乳腺钼靶筛查小组（GISMa）一直在推动新的有组织筛查项目的开展，并对数据活动进行年度系统调查。筛查范围随时间不断扩大，到2005年总体覆盖率达到76.4%。地域分布仍不均衡，意大利北部和中部的筛查覆盖率高于南部和岛屿地区，后者的筛查活动直到最近才开展。尽管筛查工作持续进行，但由于长期缺乏投入资源和规划政策，导致邀请人数随时间减少，实际覆盖率仅达到目标人群的50.3%。意大利的总体粗参与率高于可接受的50%标准，尽管南北差异仍然存在；在意大利南部/岛屿地区，参与率仍然不足（<40%），未达到可接受标准。与没有区域协调的项目相比，集中式项目的参与率更高（高出5 - 8%）。其他关键绩效指标的时间趋势显示出良好的平均表现：良性/恶性手术活检率（B/M比）逐渐下降，2004年达到0.25（首次筛查和后续筛查均如此）；总体检出率、原位癌和小癌症（≤10毫米）的检出率呈良好趋势，首次筛查分别达到每百人6.7%、0.7%和1.6%，2004年后续筛查分别为每百人5.1%、0.9%和1.7%。唯一的例外是首次筛查的转诊率（RR），超过了标准（2002 - 2004年>7%）。还分析了活动量与项目持续时间的数据对比。在活动量较大的项目中（平均检测次数：22,506次），首次筛查的转诊率更高，但仍在可接受标准范围内。每百人6.3%；RR：1.01（0.98 - 1.0４）。这种表现通过更好的特异性和敏感性得到了弥补：阳性预测值（PPV）。12.8；RR：1.16（1.05 - 1.27）；总体检出率：每百人8.1%，RR 1.19（1.07 - 1.31）。随着项目经验的增加，质量有所提高是显而易见的。与新项目相比，活动超过6年的项目首次筛查召回率为6.5%；RR。0.87（0.84 - 0.89），PPV为1.7，RR：1.61（1.48 - 1.75），总体检出率为每百人7.6%，RR：1.41（1.29 - 1.55）。这些结果与其他欧洲项目的观察结果一致，并鼓励探索新的分析策略。国家筛查监测中心（ONS）的网站是http://www.osservatorionazionalescreening.it 。
