Time trends of process and impact indicators in Italian breast screening programmes: 1998-2008.

Since its establishment in 1990, one of the main tasks of the Italian Group for Mammography Screening (GISMa) is the systematic data collection on the activity of the organised mammography 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 referring to the period 1998-2008 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 the centralised management is more established or complete, the participation rate was higher compared with areas without such characteristics, with differences from 5% to 22% (in 2008). The time trends of the other parameters included in the analysis showed, in 2008, a good average performance. For example, benign/malignant surgical biopsy ratio (B/M ratio) reached 0.21 at first screening and 0.11 at subsequent screening; overall detection rate, detection rate for in situ and small cancers (≤10 mm) showed a good trend, reaching 5.7‰, 1.1‰, and 1.4‰, respectively, for first screening, and 5.0‰, 0.7‰, and 1.4‰ for subsequent screening. On the contrary, excess referral rate at first screening persists over time. These results continue to be consistent with those achieved by other European programmes and reassuring for all Italian mammography screening professionals.