Time trends of process and impact indicators in Italian breast screening programmes (1999-2009).

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 from 1999-2009 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 centralised management is more established or complete, the participation rate was higher compared to areas without such characteristics, with differences from 5% in 2005 (reaching 22% in 2008) to 10% in 2009. The time trends of the other parameters included in the analysis showed, in 2009, a good average performance. For example, benign/malignant surgical biopsy ratio (B/M ratio) reached 0.21 at first screening and 0.08 at subsequent screening; detection rate for in situ and small cancers (≤10 mm) showed a good trend, reaching 0.9‰, and 1.5‰, respectively, for first screening, and 0.9‰, and 1.4‰ for subsequent screening. On the contrary, excess referral rate at first screening persisted, and the overall detection rate presented a negative trend in the last period (8.9% and 5.7‰, respectively). Although further analyses are needed to better interpret these trends, results continue to be consistent with those achieved by other European programmes, and are reassuring for all Italian mammography screening professionals.