Mammography screening in Italy: 2009 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 2009, an increase in theoretical extension was recorded; however, this was not followed by an increase in actual extension, which remained stable. Currently, all Italian regions have implemented screening programmes. In 2009, almost 2,522,000 women aged 50-69 years were invited to have a screening mammogram, and more than 1,362,000 were screened. Theoretical extension was 93.8%, while actual extension was 69.5%. An imbalance in coverage is still present when comparing northern and central Italy to southern Italy, which only has a 78% coverage by organised screening. The Italian mean value (78.5%) of two-year extension (period 2008-2009) suggests that, at full capacity, Italian programmes are able to invite only three quarters of the target population. The percentage of women screened during 2009 accounted for 36.5% 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 8% at first screening and 4.6% at repeat screening were recorded. Direct standardised detection rate was 6.2 x 1,000 at first screening and 4.4 x 1,000 at repeat screening, while benign to malignant ratio for first and repeat screening was 0.25 and 0.12, respectively. Detection rate of invasive cancers ≤ 10 mm was 1.34 x 1,000 at first screening and 1.51 x 1.000 at repeat screening; the proportion of in situ carcinomas was 14.1% and 14.4% for first and repeat screening, respectively. Indicators by 5-year age group confirm greater diagnostic problems at younger ages (50-54 years), 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.