Mammography screening in Italy: 2003-2004 survey.

: GISMa performs a yearly survey to collect process indicators of mammography screening and compare them, using standard values agreed on a national and international basis. This survey is highly representative of the Italian situation, providing summary data stratified by region and by age group. Data come from several different programmes that may have changed over time, and may have different model of organisation and management. Eighty-eight programmes from 15 different regions (out of 21) provided data for 2003. In nine regions individual programmes are part of a comprehensive regional project. During this year about 1,480,000 women aged 50-69 years were invited to have a screening mammogram, and over 843,000 were screened. Theoretical coverage was 56.2%, while 41.4% of the target population received an invitation to screening. An imbalance in coverage can be seen when comparing Northern and Central Italy, where over 3/4 of the population is covered, to Southern Italy, with only a 10.6% coverage by organised screening. National crude attendance rate was 58.3%. A decreasing trend was evident from the North to the Centre to the South of Italy: 61.2%. 56.2%, and 38.1% respectively. Referral rates of 7.8% at first screening and 4.5% at repeat screening were recorded. Direct standardised detection rate was 6.9 x 1000 at first test and 4.8 at repeat test, while benign to malignant ratio for first and repeat screening was 0.33 and 0.23 respectively. Detection rate of "small" cancers (< or =10 mm in size) was 1.5 and 1.4 x 1000 for first and repeat test. Indicators by 5-year age groups 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. The year 2004 was the first in which regions were required to provide data on screening activity to the ONS; data were provided by 120 programmes from 18 regions. Preliminary data showed a coverage rate of 69.4%, while 51.1% of the target population received an invitation to screening. Although a substantial increase in coverage was observed also in Southern Italy. a major imbalance in coverage still exists between Northern-Central and Southern Italy: 82.3%, 98.2% and 30.5% respectively. National crude attendance rate was 55.8%.