Country: Italy

Name of the programme: "PREVENZIONE SERENA" TURIN - PIEDMONT - Mammographic screening programme of the region VALLE D'AOSTA

Turin, with a population of close to 1 million inhabitants, has an organised population breast screening programme in place since January 1992, started at one fixed Screening Unit. Two additional fixed Units started their activity respectively in 1995 and 1998. It is a centralised system with personal invitation to women 50-69 (n=135,000) due to access to individual population data. In order to facilitate an informed participation a frequently updated and detailed information leaflet is enclosed to all the invitation letters. General practitioners (GPs) are involved by signing the invitation letter and counselling the women. The programme conducts two-yearly mammography with two-views and double reading. All three screening Units run dedicated assessment clinics and are located in Hospitals with treatment facilities where women requiring surgery, chemotherapy or radiotherapy are referred.
In 1996 the Piedmont Regional Health Authorities decided to extend the screening programme to all the regional area, with an overall target of 580,000 women aged 50-69 years. In addition to the Turin one, eight new programmes, with a total of Nine Inter-Departmental Screening programmes have been created for this purpose. In 1998 one more programme has been implemented in the neighbouring Region, Valle d'Aosta, which covers a population of 15,155 women aged 50-69. Oncology services in the two Regions are organised within the same Network. CPO-Piemonte and the Turin programme serve as Reference Centre for monitoring and evaluation.
A training and permanent education programme directed to technicians, specialist medical doctors and clerks operating in the regional programme is on going. Since 1998 more than 800 persons have attended 15 introductory courses, 23 specialist courses, 8 workshops and several stages (update october 2002).
The Piedmont Cancer Registry, which is based in Turin at CPO-Piemonte, has been in place since 1985. It contributes data to Cancer Incidence in Five Continents, a publication of the International Agency for Research on Cancer, and participates in screening evaluation.

In 2001 the results of main performance indicators are:

	Piedmont Region	Turin Project	Valle d'Aosta Region
Invited (2001)	149,315	64,622	5,896
Examined (2001)	80,321	37,438	3,993
Participation rate	53.8 %	57.9 %	67.7 %
Recall rate first exam	5.9 %	7.8 %	5.2%
Recall rate repeated exam	3.1 %	3,2 %	2.5%
Detection rate first exam	8.2 ‰	8.2 ‰	6.4‰
Detection rate repeated exam	5.5 ‰	6.2‰	3.5‰
Detection rate (Cancer <= 10 mm) first exam	2.3 ‰	2,1 ‰	2.9‰
Detection rate (Cancer <= 10 mm) repeated exam	2.2 ‰	2.5 ‰	1.6‰
Proportion of not invasive cancers at first exam	11.2 %	21.0 %	10.0%
Proportion of not invasive cancers at repeated exam	15.3 %	16.7 %	10.0%
Proportion of pre-operative diagnosis in cancers (suspicious or positive pre-operative diagnosis)	79.4%	82.6%	95.8%
Proportion of pre-operative diagnosis in cancers (positive pre-operative diagnosis only)	60.5%	65.6%	83.3%
Breast conservation surgery in invasive cancers pT1	89.9%	90.0%	80.0%

For more information visit www.cspo.it or contact Dr. Nereo Segnan (programme director) at nereo.segnan@cpo.it or Dr. Alfonso Frigerio (reference radiologist) at alffri@tin.it. For Valle d'Aosta contact Dr. Teodoro Meloni at screening_ao@uslaosta.com