Giorgi Daniela, Giordano Livia, Ventura Leonardo, Frigerio Alfonso, Paci Eugenio, Zappa Marco
UO Epidemiologia, ASL 2 Lucca, Istituto tumori toscano.
Epidemiol Prev. 2011 Sep-Dec;35(5-6 Suppl 5):9-27.
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.
本报告是对国家筛查监测中心（ONS）自2002年以来发表的类似先前论文的更新。调查数据来自几个不同的项目，这些项目可能随时间发生了变化，并且可能有不同的组织和管理设置。2009年，理论推广范围有所增加；然而，实际推广范围并未随之增加，而是保持稳定。目前，意大利所有地区都实施了筛查项目。2009年，近252.2万名50至69岁的女性被邀请进行乳房X光筛查，超过136.2万人接受了筛查。理论推广率为93.8%，而实际推广率为69.5%。将意大利北部和中部与南部进行比较时，覆盖范围仍存在不平衡，南部通过有组织筛查的覆盖率仅为78%。意大利2008 - 2009年两年的推广平均值（78.5%）表明，在满负荷情况下，意大利的项目只能邀请到目标人群的四分之三。2009年接受筛查的女性比例占全国目标人群的36.5%。在过去几年中，参与率基本稳定，粗率分别约为55 - 57%，调整率分别约为59 - 61%。在这个参数上，意大利南部也明显呈现出下降趋势。许多项目的工作量较低（每年低于10000次甚至5000次检查），只有一个地区每个项目超过了理想的至少20000次检查的水平。首次筛查的转诊率为8%，重复筛查的转诊率为4.6%。首次筛查的直接标准化检测率为每1000人中有6.2例，重复筛查为每1000人中有4.4例，而首次和重复筛查的良性与恶性比例分别为0.25和0.12。首次筛查时浸润性癌≤10毫米的检测率为每1000人中有1.34例，重复筛查为每1000人中有1.51例；首次和重复筛查中原位癌的比例分别为14.1%和14.4%。按5岁年龄组划分的指标证实，较年轻年龄组（50 - 54岁）存在更大的诊断问题，转诊率更高，良性结果手术程序的频率更高（B/M比），与较年长年龄组相比检测率大幅降低。
