Breast cancer, the voice of oncologists: lower the screening age to 45

Increasing the resources earmarked for prevention from the current meagre 5 per cent of healthcare expenditure to 6 per cent: this is one of the proposals for healthcare at the centre of the negotiations now under way on the next budget law. An instance 'blessed' and brought to the Mef by Health Minister Orazio Schillaci, an oncologist who has been repeating the mantra since the beginning of his term of office about the shot in the arm that could come if the population adopted correct lifestyles: in an ideal condition, the benefit would be a -40% reduction in cases.

Today, the reality is quite different: investments in prevention are 'Cinderella' compared to the other items of public health expenditure, which fell by 18.6% between 2022 and 2023 from 10 billion to 8 billion and 453 million, extreme regional variability, and lifestyles including smoking, alcohol consumption, and poor diet that are not improving overall, but rather see a downward alignment between northern and southern Italy. With the result, albeit in a general context of high-level treatment in the country, of one thousand cancer diagnoses per day with 390,100 new cases estimated in 2024. Numbers on which there is ample room for intervention: first of all, with greater awareness among citizens, who still do not adequately 'exploit' the chance of free tests offered by the Essential Levels of Care (LEA) for breast, uterine, and colorectal cancer. The regional scissors are wide, with the Regions in the re-entry plan bound to the Lea (on the age range for breast examinations, for example) but also, and this applies to many territories around Italy, with inadequate organisation of screening.
A reality recalled by Schillaci during the presentation of the Frecciarosa project promoted by the FS Group and the IncontraDonna Foundation with the Aiom Association of Medical Oncologists, on cancer prevention by train aimed precisely at women for "October pink month": "We must increase the percentage of funds for prevention and improve screening campaigns to achieve greater equity of care - warned the minister -: in the adherence there is still too much of a gap between North, Centre and South and this is unacceptable".

Oncologists applaud the announced increase in resources in the manoeuvre. "This would be a very important signal," explains Massimo Di Maio, president-elect of Aiom. As an association, we are certainly constantly committed to diagnosis and treatment, but we are aware that prevention is the most effective weapon, as well as being the most cost-effective. An investment that will clearly have results in the medium to long term, but they will be enormous achievements. Primary prevention to reduce the incidence of the disease through correct lifestyles would bring us considerable benefits, although it is clear,' he points out, 'that a 40 per cent reduction in cancers by cutting out smoking, alcohol, bad diet and promoting a healthy diet is an ideal scenario. Certainly, however, one can aim for a net improvement even if only by convincing half of the Italian population'.

Something has moved on the front of funds for the diagnosis of breast cancer, but it is a drop in the ocean: if the Milleproroghe decree at the beginning of the year allocated one million euros between 2025 (200,000 euros) and 2026 (800,000) to expand the age range for screening from 45 to 74 years, the waiting lists bill has seen the rejection by the Mef of a 'treasury' of 6 million euros to be invested in three years. The road, however, is mapped out by international guidelines, so much so that the EU recommends lowering the age for mammography between 45 and 49 and raising it between 70 and 74.

Endorsing the importance of this measure, which Minister Schillaci himself defends, is Di Maio himself: 'In the face of scientific evidence confirmed by a recommendation,' he explains, 'it is not acceptable for there to be differences between regions based solely on economic criteria. Instead, today many realities are at zero while others have extended screening only partially. Ideally,' she points out, 'the age for free breast screening should start at 45 everywhere. Of course the Regions must have a say on the organisation of screening on the territory and on the modality of the invitation to the test for the citizen, but they cannot contravene scientific evidence'.