Mammography screening in Italy: 2005 survey and 2006 preliminary data.

Mammography screening programmes in Italy have been implemented since the early 90's. Over the last ten years, national and international institutions have strongly supported screening programme implementation with several laws. Since 2004, the Italian Ministry of Health, together with the Commission of Regions and Self-governing Provinces Health Officials, has officially entrusted the ONS (Osservatorio Nazionale Screening, National Centre for Screening Monitoring) with monitoring and promoting nationwide screening programmes. Previously, for several years, GISMa (Gruppo Italiano per lo Screening Mammografico) carried out a yearly survey to collect process indicators of mammography screening and compare them, using national and international standard values as reference. In 2006, an updated version of the operative report of process indicators was published by GISMa, and in November 2006 the updated national screening guidelines, prepared by the workgroups on oncological screening set up by the Ministry, was published. This report is an update of similar previous papers published by the ONS 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 2005, an increase in screening activity was recorded with the inclusion of all Northern and Central Italian Regions, and 2006 showed a further development n the Southern Regions and Islands. Only one Region is missing (Puglia), but it started its activity in 2007; so starting from 2007, all Italian Regions have implemented screening programmes. In 2006, more than 2 million women aged 50-69 years were invited to have a screening mammogram, and over 1,150,000 were screened. Theoretical extension was 76.4% in 2005 and 78.2% in 2006. This year shows an important increase in actual extension, improving from 50.3% in 2005 to 57.2% in 2006 and finally rising over the critical value of about 50% registered during the last years. An imbalance in coverage is still present when comparing Northern and Central Italy (more than 90%) to Southern Italy, which only has a 46% coverage by organised screening. The percentage of women screened during 2005 accounted for 28.6% of the national target population, and increased up to 31.8% in 2006. During the three-year period 2004-2006, participation rates were substantially stable around 55-57% for crude rate, and 59-60% for adjusted rate, respectively. A decreasing trend towards the South of Italy is evident for this parameter, too, but in 2005-2006 the Central Regions registered the highest increase in attendance: crude and adjusted participations rose from 52-54% in 2004 to 56-58% in 2005-2006. Many programmes work with low volumes of activity (below 10,000 or even 5,000 examinations per year), and no regional mean value surpassed the desirable level of at least 20,000 examinations for each programme. Referral rates of 8.3% at first screening and 4.5% at repeat screening were recorded. Direct standardised detection rate was 5.7 x 1,000 at first test and 4.6 at repeat test, while benign to malignant ratio for first and repeat screening was 0.28 and 0.21, respectively. Detection rate of invasive cancers < or =10 mm was 1.44 x 1,000 at first test and 1.58 at repeat test; the proportion of in situ carcinomas was 12.9% and 14.7% 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.