Cancer screening: 7.6 million people ‘missed’ and 50,300 cases remain undetected
Focus on breast, cervical and colorectal screening provided free of charge by the National Health Service: of the 54 per cent of the target population who ‘fall through the net’, the majority choose not to take part, and the South continues to lag behind
Key points
In 2024, 54 per cent of the target population – over 7.6 million people – were not covered by the free cancer screening programmes – for breast, cervical and colorectal cancer – particularly in the South: partly because they did not receive an invitation, but much more often because they did not take part. “The toll is extremely heavy: over 50,300 cases not detected by the organised screening programmes”, notes the Gimbe Foundation, which analysed the strengths and weaknesses of the three prevention programmes offered as part of the Essential Levels of Care (LEA) of the National Health Service, based on data from the 2024 Report by the National Screening Observatory (ONS).
EU targets still a long way off
“Take-up rates are still too low and there are significant regional disparities,” says President Nino Cartabellotta, “which undermine the effectiveness of the most suitable tool for the early detection of cancers and precancerous lesions. ‘The 2024 National Health Service (ONS) data,’ he adds, ‘show an increase in both the number of invitations issued and population coverage. However, Italia remains a long way from the target set in 2022 by the Council of the European Union: to ensure that, by 2025, cancer screening covers at least 90 per cent of the target population. The 2026–2031 National Prevention Plan, recently approved by the State-Regions Conference, sets this target for 2029, with interim targets of at least 70 per cent in 2027 and 80 per cent in 2028.”
Disparities between tests and between regions
“Excluding those not covered by the target,” Cartabellotta continues, “in 2024, over 14.1 million people were invited to take a screening test, but fewer than 6.5 million (6,481,002) took part. This figure masks significant differences not only between the three programmes, but above all between the regions and geographical areas of the country.” In detail, at national level, 50 per cent of the women invited took part in mammography screening, with marked regional differences: from 74 per cent in the Autonomous Province of Trento to 15.2 per cent in Calabria. The whole of the South, except for Basilicata, recorded participation levels below the national average. As for cervical screening, 51 per cent of invited women took part, with significant regional differences: ranging from 90.3 per cent in the Autonomous Province of Trento to 12.2 per cent in Calabria. Finally, colorectal cancer screening: nationally, only 33.3 per cent of those invited took part, with figures ranging from 64.1 per cent in Valle d’Aosta to 4.5 per cent in Calabria.
Estimating ‘missed’ cancers
By setting a target of 90 per cent coverage of the target population and taking into account both those who were not invited or who did not participate, as well as the cancer detection rate, it is possible to estimate how many cancers and precancerous lesions ‘escaped’ the NHS screening tests. “In 2024,” summarises Cartabellotta, “it is estimated that the failure to achieve 90 per cent coverage meant that over 11,000 breast cancers were not identified, of which more than 2,300 were small invasive tumours; almost 9,700 precancerous lesions of the cervix; 4,700 colorectal cancers and almost 25,000 advanced adenomas. Overall, this amounts to over 50,300 cancers and lesions that the organised screening programmes could have detected, enabling timely diagnostic investigations and, where necessary, specific treatment to be initiated.’
“The sample survey carried out by the Passi surveillance system of the Istituto Superiore di Sanità,” explains Cartabellotta, “shows that many people report undergoing regular screening ‘on their own initiative’. For these tests, however, there are no objective indicators available – such as the cancer detection rate and the percentage of people with positive results who undergo second-level testing – nor are there any standardised quality controls for the tests. Furthermore, there is no certainty that, in the event of a positive result, an appropriate diagnostic and treatment pathway will be initiated. Finally, whilst a sample survey provides relevant information on risk factors and socio-economic determinants, it does not allow for the verification of cancer screening coverage for ‘spontaneous initiative’.”
