Country: Italy

Name of the programme: Progetto Firenze Donna

The mammography screening programme - Progetto Firenze Donna- has been implemented in 1990 as an extension of the previous pilot project on-going in the Florence District since 1970. The programme is now inviting over 100,000 women aged 50-69 every two years. In 1999, the Tuscany Region Health Authorities decided to extend progressively the screening programme to all the 12 Health Units of the Region, with an overall target of 513,130 women aged 50 - 69 yrs.
The screening programme is centralised and, in the Florence area, uses 2 mobile units for the 25 cities and villages of the district and 2 mobile units for the Florence town. Screening films are centrally processed and read by two radiologists. Women with a screen-detected lesion are recalled for assessment at the Florence fixed unit.
At initial screening two views are taken, whilst at subsequent screening only one oblique view is taken in 60% of the women with breast density < 25% (N1-P1 Wolfe's patterns).
The Florence project is now a Reference Centre for Tuscany Region and is charged to monitor the quality of the 12 Screening programmes.
The main results of main performance indicators are:

	Tuscany Region	Florence Project
Invited (2002)	163,164	38,921 %
Examined (2002)	98,388	27,946 %
Participation rate	60.3 %	71,8 %
Recall rate first exam	6 %	8,2 %
Recall rate repeated exam	4 %	4,5 %
Detection rate first exam	5.7 %°	7,5 %
Detection rate repeated exam	4.0 %°	4.6 %
Detection rate (Cancer < 11 mm) first exam	1.9 %°	2,04 %°
Detection rate (Cancer < 11 mm) repeated exam	1.2 %°	1,2 %°
Proportion of not invasive cancers at first exam	9.0 %	9,1 %
Proportion of not invasive cancers at repeated exam	16.3 %	6,5 %

A recent evaluation of the effect of the mammography screening programme (1990-1996) on fatal breast cancers in the Florence area (BJC,2002,87 (1), 65-69) has shown that the Incidence-based mortality was significantly lower (50%) in 1990-96 compared to 1985-86. This reduction was more evident in the women invited to screening (55%) compared to non invited (41%).
Excluding prevalent cases , the rate of stage II+ breast cancers was 42% lower in screened women compared to non-invited.
We also have observed -from 1990 to 1996- a significant increase in breast conserving surgery and a significant decline in rates of radical surgery i. e. mastectomy rates decline from 1.08%° in 1990 to 0.62 in 1996 (BMJ 2002).

Homepage: www.cspo.it

Name of the Authors:
Marco Rosselli Del Turco, Screening Unit CSPO
Eugenio Paci, Epidemiology Unit CSPO

For more information please contact:
m.rosselli@cspo.it