[Time trends of process and impact indicators in Italian breast screening programmes (2000-2010)].

Since its establishment in 1990, one of the main tasks of the Italian group for breast cancer screening (GISMa) is the systematic data collection on the activity of the organised breast cancer screening programmes implemented in Italy. Data are collected in an aggregated way and gathered through a standardised form to calculate process and impact parameters. Data analysis from 2000-2010 shows that crude attendance rate reached the acceptable 50% standard, presenting a higher level of participation in Northern and Central Italy compared to Southern Italy/Islands, where attendance rates are still inadequate and do not reach the acceptable standard. In areas where a more complete regional extension (referring frequently to a more centralised management) exists, the participation rate was higher compared to those with partial regional extension and no centralised management. The differences range from 5% in 2005 to 22% in 2010. The time trends of the other analysed parameters showed, in 2010, a good overall quality of the performance. For example, benign/malignant surgical biopsy ratio (B/M ratio) reached 0.19 at first screening and 0.11 at subsequent screening; detection rate for in situ and small cancers (≤10 mm) showed a good trend, reaching 0.9‰ and 1.2‰, respectively, at first screening, and 0.6‰, and 1.5‰ for subsequent screening, respectively. On the contrary, excess referral rate at first screening persisted (9.2%) in the year 2010, while RR is improved at subsequent screening (from 4.2% in 2009 to 3.9% in 2010). The overall detection rate is improved both at first and subsequent screening (5.2‰ in 2010 vs. 5.7‰ in 2009 and 4.7‰ in 2010 vs. 5.7‰ in 2009, respectively). Although further analyses are needed to better interpret these trends, results continue to be consistent with those achieved by other European programmes, and they are reassuring for all Italian breast cancer screening professionals.