More than 50,000 cancers in Italy slipped under the radar for cancer screening 'snubbed' by citizens

More than 50,000 cancers and pre-cancerous lesions have slipped under the radar due to citizens' non-adherence to the free screening offered by the National Health Service on breast, cervix and colorectum. With the obvious distortion between the daily complaints of endless waiting lists in the public health service and the missed prevention appointments that would be necessary to intercept some of the major big-killers in oncology. A paradox paid for dearly in terms of both health and costs for the national health service.

And that photographs for the umpteenth time the gulf between the North and South of the country, with the Autonomous Province of Trento coming first on breast and cervix and second on colorectal, while at the opposite extreme is Calabria, last on all three screening classes.

Drawing the balance on the 2023 data of the National Screening Observatory is the Gimbe Foundation, according to which in the year considered "millions of citizens did not receive or, much more often, ignored the invitation to undergo free cancer screening, especially in the southern regions". And "if on the one hand," explains president Nino Cartabellotta, "the Observatory's data referring to 2023 show a growing trend in both invitations and population coverage, we are still a long way from the target set in 2022 by the European Council: to guarantee cancer screening coverage to at least 90% of the population by 2025. It is true that many people declare that they undergo periodic check-ups on a 'spontaneous initiative', as revealed by the Passi survey of the Istituto Superiore di Sanità, but for these examinations there is no data either on the cancer detection rate or on the percentage of positives who then undergo more in-depth checks, nor standardised checks on the quality of the tests. So everything that is done privately is in a grey area that cannot be evaluated.

The data remain of the current ineffectiveness of the screening tool, even though it is extremely valuable in its gratuitousness and its theoretical capacity to do prevention by having the actual pulse of the oncological health of Italians. But why is it not adhered to? According to Cartabellotta, 'the screening adherence rate is an indicator that summarises the overall performance of regional health services on organised screening. It reflects the ability to keep the target population's biographical data up-to-date, to schedule and dispatch invitations, to promote public awareness campaigns, and to guarantee the delivery of screening tests'. So much so that, in general, the positioning of each region with respect to adherence is fairly homogeneous on the three screenings, "reflecting the greater or lesser organisational capacity of the regional health systems, albeit with some exceptions".

'Prevention and health promotion,' Cartabellotta continues, 'are the pillars for reducing the incidence of disease and contributing to the sustainability of the SSN. But today the paradox is obvious: on the one hand citizens are on waiting lists for diagnostic examinations that are not always appropriate, and on the other there are millions who do not adhere to organised screening programmes. It is clear that on the invitation front many regions, particularly in the South, need to improve their organisational capacities. But the main critical issue remains the low adherence to screening: more information, effective communication strategies, and active involvement of citizens are needed. Because adherence to organised screening means early diagnosis, timely treatment of pre-cancerous lesions, a higher number of definitive cures, less suffering for patients, lower costs for the NHS, and, above all, fewer deaths from cancer'.