Daniela Giorgi - Academia.edu (original) (raw)
Papers by Daniela Giorgi
Tumori
Quality of care is today a major issue in oncology, and much attention is given to research on th... more Quality of care is today a major issue in oncology, and much attention is given to research on the outcome of breast cancer care. Too little attention has been devoted in the scientific literature to the consequences of treatment in long-term survivors, and in particular to the possible side effects. The specific aim of this contribution is to present population-based data about the long-term impact of breast cancer care in women who had an incident cancer in 1985/1986. The cases are 476 breast cancers incident in the City of Florence in 1985-86. Women still living 5 years later were invited to have an interview and a physical examination. Lymphedema, peripheral nerve lesions and damage to the shoulder were assessed. Of the 346 5-year survivors, 238 accepted our invitation: 35.2% of the women reported some early postoperative sequelae, 30.2% had a chronic lymphedema and 18.9% a shoulder deficit. Comparing breast-conserving surgery with radical mastectomy, the risk of chronic lymphed...
Annali dell'Istituto superiore di sanita
In Italy, due to increasing healthcare budget and staff shortages, the recently created regional ... more In Italy, due to increasing healthcare budget and staff shortages, the recently created regional mammography screening programmes were established under worse radiology practice quality criteria than the previously created programmes. Using available data from a national questionnaire survey conducted at the end of 2013 and involving 222 responder radiologists, we compared the main professional quality standards of radiologists working in the screening programmes established during the period 2000-2012 with those working in the screening programmes created from 1990 to 1999. The former reported more years of clinical experience in breast imaging and a greater clinical mammogram reading volume than the latter. Conversely, they dedicated less working time to breast imaging, were less likely to participate in the diagnostic assessment of screen-detected lesions, to work in large-staffed screening centres, and to have a screening and a total mammogram reading volume (SMRV and TMRV) ≥ 50...
Breast Cancer Research, 2000
The Swedish Two-County Trial is a randomized controlled study of invitation to breast cancer scre... more The Swedish Two-County Trial is a randomized controlled study of invitation to breast cancer screening. It was initiated in late 1977. The follow-up to the end of 1998 provides results at approximately the twentieth anniversary of the trial. A significant decrease in breast cancer death among women invited to screening was published 7-8 years after randomization and at 20-year follow up there is a significant 32% reduction in mortality associated with invitation to screening. The advent of screen-film mammographic screening with the ability to detect potentially fatal tumors at an early stage provides an opportunity to study the natural history of breast cancer at an earlier phase in its development than was possible in the past. Our findings show that breast cancer is not a systemic disease at its inception, but is a progressive disease and its development can be arrested by screening. Detection of < 15 mm and lymph node negative invasive tumors will save lives and confer an opportunity for less radical treatment.
Journal of Medical Screening, 1995
Objectives – To estimate and to compare the cost per woman examined and per breast cancer detecte... more Objectives – To estimate and to compare the cost per woman examined and per breast cancer detected in two mammographic screening programmes in the province of Florence. Setting –Two ongoing, population based, mammographic screening programmes in the province of Florence. The first (district project) was started in the seventies in a rural area, whereas the second (city project) was started in the city at the end of 1990. Methods –All relevant resources consumed by the programmes (costs) were listed and measured. The costs are related to 1993. The unit cost for each phase (recruitment, screening, assessment) of the screening process was estimated by dividing the total cost of the phase by the number of women examined. The cost per cancer detected was obtained by dividing the total cost of the programme by the number of cancers detected at screening. Results –The costs per woman examined were 38.1and38.1 and 38.1and41.1 in the district and city programmes respectively. The cost per breast cancer ...
La Radiologia medica, Jan 31, 2016
Screening mammogram reading volume (SMRV) and total (screening and clinical) mammogram reading vo... more Screening mammogram reading volume (SMRV) and total (screening and clinical) mammogram reading volume (TMRV) per year are strongly associated with the radiologist's diagnostic performance in breast cancer screening. The current article reports the prevalence and correlates of a SMRV and a TMRV ≥5000 among Italian breast screening radiologists. A questionnaire survey was carried out in 2013-2014 by the Italian Group for Mammography Screening (GISMa). The questionnaire included items of information for radiologist's experience-related characteristics and for facility-level factors supposedly associated with SMRV and TMRV. Multivariate analysis was performed using backward stepwise multiple logistic regression models. Data for 235 radiologists from 51 local screening programmes were received. Of the 222 radiologists who were eligible, 133 (59.9 %) reported a SMRV ≥5000 and 163 (73.4 %) a TMRV ≥5000. Multivariate factors positively associated with both characteristics included: ...
* pesato per la composizione per età della popolazione esaminata dai diversi programmi RR: rischi... more * pesato per la composizione per età della popolazione esaminata dai diversi programmi RR: rischio relativo; VPP: valore predittivo positivo; 95% CI: intervallo di confidenza al 95%.
Epidemiologia e prevenzione
In this position paper, a self-convened team of experts from the Italian Group for Mammography Sc... more In this position paper, a self-convened team of experts from the Italian Group for Mammography Screening (Gruppo italiano screening mammografico, GISMa) pointed out the problems that increasingly hamper the feasibility and validity of the estimate of the proportional incidence of interval breast cancer (IBC) in Italy, suggested potential solutions and an agenda for research, and proposed that the question of the sensitivity of mammography be viewed in a larger perspective, with a greater attention to radiological review activities and breast radiology quality assurance programmes. The main problems are as follows: the coverage of cancer registration is incomplete; the robustness of using the pre-screening incidence rates as underlying rates decreases with time since the start of screening; the intermediate mammograms performed for early detection purposes may cause an overrepresentation of IBCs; the classification of many borderline screening histories is prone to subjectivity; and,...
Epidemiologia e prevenzione
This report is an update of similar previous papers that have been published by the ONS (Osservat... more This report is an update of similar previous papers that have been published by the ONS (Osservatorio nazionale screening, National Centre for Screening Monitoring) since 2002. Data for the survey come from several different programmes that may have changed over time, and may have different settings of organisation and management. During 2010, the first slight decrease in theoretical extension was recorded. Currently, all Italian regions have implemented screening programmes. In 2010, almost 2,496,000 women aged 50-69 years were invited to have a screening mammogram, and more than 1,382,000 were screened. Theoretical extension was 91.7%, while actual extension was 69.1%. An imbalance in extension is still present when comparing northern and central Italy to southern Italy, which only has a 75% coverage by organised screening. The Italian mean value (69%) of two-year extension (period 2009-2010) suggests that, at full capacity, Italian programmes are able to invite only three quarter...
Epidemiologia e prevenzione
This report is an update of similar previous papers that have been published by the ONS (Osservat... more This report is an update of similar previous papers that have been published by the ONS (Osservatorio Nazionale Screening, National Centre for Screening Monitoring) since 2002. Data for the survey come from several different programmes that may have changed over time, and may have different settings of organisation and management. During 2007, a further increase in screening activity was recorded, with the inclusion of all Northern and Central Italian Regions, and a further development in the Southern Regions and Islands, so today all Italian Regions have implemented screening programmes. In 2008, almost 2,509,000 women aged 50-69 years were invited to have a screening mammogram, and more than 1,361,000 were screened. Theoretical extension was 89.9%, while actual extension increased from 62.3% in 2007 to 69.4%in 2008. An imbalance in coverage is still present when comparing Northern and Central Italy to Southern Italy, which only has a 69% coverage by organised screening. The Italia...
Epidemiologia e prevenzione
This report is an update of similar previous papers that have been published by the ONS (Osservat... more This report is an update of similar previous papers that have been published by the ONS (Osservatorio Nazionale Screening, National Centre for Screening Monitoring) since 2002. Data for the survey come from several different programmes that may have changed over time, and may have different settings of organisation and management. During 2007, a further increase in screening activity was recorded, with the inclusion of all Northern and Central Italian Regions, and a further development in the Southern Regions and Islands. In 2007, screening activity also started in Puglia, so today all Italian Regions have implemented screening programmes. In 2007, almost 2,210,000 women aged 50-69 years were invited to have a screening mammogram, and over 1,225,000 were screened. Theoretical extension was 81.4%, while actual extension increased from 57.2% in 2006 to 62.3% in 2007, finally rising over the critical value of about 50% registered during the last years. An imbalance in coverage is still...
Epidemiologia e prevenzione
Mammography screening programmes in Italy have been implemented since the early 90's. Over th... more Mammography screening programmes in Italy have been implemented since the early 90's. Over the last ten years, national and international institutions have strongly supported screening programme implementation with several laws. Since 2004, the Italian Ministry of Health, together with the Commission of Regions and Self-governing Provinces Health Officials, has officially entrusted the ONS (Osservatorio Nazionale Screening, National Centre for Screening Monitoring) with monitoring and promoting nationwide screening programmes. Previously, for several years, GISMa (Gruppo Italiano per lo Screening Mammografico) carried out a yearly survey to collect process indicators of mammography screening and compare them, using national and international standard values as reference. In 2006, an updated version of the operative report of process indicators was published by GISMa, and in November 2006 the updated national screening guidelines, prepared by the workgroups on oncological screeni...
Epidemiologia e prevenzione
Since 1990, the Italian Group for Mammography Screening (GISMa) has been promoting the developmen... more Since 1990, the Italian Group for Mammography Screening (GISMa) has been promoting the development of new organised programmes and performing a yearly systematic survey of data activity. The screening extension has increased over time, reaching an overall 76.4% of coverage in 2005. The geographical extension is still heterogeneous, with a higher distribution in Northern and Central Italy compared with Southern and Insular Italy, where the screening activity was implemented only recently. Notwithstanding the continuity in implementation, the actual coverage reached only 50.3% of the target population, due to a reduced flow of invitations over time as a consequence of a chronic lack of invested resources and of well-plannedpolicies. The overall Italian rate for crude attendance was above the acceptable 50% standard even though a North-South trend is still confirmed; in Southern/Insular Italy participation was still inadequate (<40%) and did not reach the standard considered accepta...
Epidemiologia e prevenzione
In 2004 regions were required to provide the ONS (Osservatorio Nazionale Screening, National Cent... more In 2004 regions were required to provide the ONS (Osservatorio Nazionale Screening, National Centre for Screening Monitoring) with data on screening activity. Previously, GISMa (Gruppo Italiano Screening Mammografico) had for several years carried out a yearly survey to collect process indicators of mammography screening and compare them, using standard values agreed on at a national and international level. In 2006, an updated version of the operative report of process indicators was published by GISMa and ONS. Data for the survey came from several different programmes that may have changed over time, and may have different settings of organisation and management. The year 2004 can be considered almost exhaustive of the situation of Italian mammography screening; data were provided by 117 programmes from 18 different regions. In ten regions, the individual programmes are part of a comprehensive regional project. In 2004, about 1,870,000 women aged 50-69 years were invited to have a...
Epidemiologia e prevenzione
Since 1992, the Italian Group for Mammography Screening (GISMa) has been performing a yearly syst... more Since 1992, the Italian Group for Mammography Screening (GISMa) has been performing a yearly systematic survey of ongoing activities. The screening extension increased from 1996, reaching an overall 68.7% coverage in 2004. This progression has been more evident in Central-Northern Italy while in Southern Italy a real, but still limited (30%), increase has been recorded only recently. Despite this geographical extension, the actual coverage reached only 5 1.1% of the target population, due to a reduced flow of invitations over time as a consequence of a chronic lack of invested resources and of well planned political actions. The time trends for the key performance indicators show a good average performance: crude attendance rate exceeds over the years the acceptable 50% standard; BIM ratio is progressively decreasing, reaching a ratio of 0.7:1 (both for first/subsequent screening) in 2003; overall detection rate, detection rate for in situ and small cancers (< or =10 mm) show a g...
Epidemiologia e prevenzione
GISMa performs a yearly survey to collect process indicators of mammography screening and compare... more GISMa performs a yearly survey to collect process indicators of mammography screening and compare them, using standard values agreed on a national and international basis. This survey is highly representative of the Italian situation, providing summary data stratified by region and by age group. Data come from several different programmes that may have changed over time, and may have different model of organisation and management. Eighty-eight programmes from 15 different regions (out of 21) provided data for 2003. In nine regions individual programmes are part of a comprehensive regional project. During this year about 1,480,000 women aged 50-69 years were invited to have a screening mammogram, and over 843,000 were screened. Theoretical coverage was 56.2%, while 41.4% of the target population received an invitation to screening. An imbalance in coverage can be seen when comparing Northern and Central Italy, where over 3/4 of the population is covered, to Southern Italy, with only ...
British journal of cancer, 2002
Breast cancer cases diagnosed in women aged 50-69 since 1990 to 1996 in the City of Florence were... more Breast cancer cases diagnosed in women aged 50-69 since 1990 to 1996 in the City of Florence were partitioned into those who had been invited to screening prior to diagnosis and those who had not. All cases were followed up for vital status until 31 December 1999. The cumulative number of breast cancer deaths among the cases were divided by screening and invitation status, to give the rates of cancers proving fatal within a period of 8 years of observation (incidence-based mortality). We used the incidence-based mortality rates for two periods (1985-86, 1990-96), pre and during screening. The incidence-based mortality ratio comparing 1990-96 and 1985-86 was 0.50 (95% CI : 0.38-0.66), a significant 50% reduction. For noninvited women, compared to 1985-86, there was a 41% significant mortality reduction (RR=0.59, 95% CI : 0.42-0.82). The comparable reduction in those invited was a significant 55% (RR=0.45, 95% CI : 0.32-0.61). The incidence ratio of rates of cancers stage II or worse ...
Tumori
To compare the impact of different modalities of general practitioner (GP) involvement, including... more To compare the impact of different modalities of general practitioner (GP) involvement, including the introduction of target payments, on the attendance rate of organized population-based screening programs for breast cancer in Italy. The study was conducted between 1994 and 1996 in four Italian cities where mammographic screening programs are active: Caltanissetta (CL), Firenze (FI), Modena (MO) and Torino (TO). The impact on attendance rate of different invitation strategies based on active GP involvement was tested in each center. The additional effect of economic incentives was also assessed. The incentives were proportional to the level of compliance attained by each GP and weighted by the size of his eligible patients' list. In the Firenze project, an invitation signed by the GP and the project co-ordinator attained a statistically significant higher participation (difference: 4.2%, chi2 = 7.42, P = 0.006). In Caltanissetta and Torino there was a significant increase of ab...
Cancer causes & control : CCC, 1999
The study analyzes the relationship between the incidence trends of breast carcinoma in situ (CIS... more The study analyzes the relationship between the incidence trends of breast carcinoma in situ (CIS) and the spread of mammography screening in the Italian area of Florence (about 608,000 female residents). In this area, since the seventies, a mammographic screening by personal invitation was performed by the Center for Cancer Prevention (CSPO) in some rural municipalities. After 1990, the municipality of Florence and other municipalities were involved in the screening. The study included all cases of female breast carcinomas in situ reported to the population-based Tuscany Cancer Registry between 1985 and 1995. On the basis of information from the CSPO files, the cases were categorized into: "screen-detected", "self-referrals", and "other" (CSPO cases diagnosed in symptomatic women or at periodic check up after breast cancer plus hospital cases). Overall, 332 women with breast carcinoma in situ (CIS) were registered between 1985 and 1995. The CIS inciden...
Tumori
In 1990, GISMa (Italian Group for planning and evaluating Mammographic Screening - Gruppo Italian... more In 1990, GISMa (Italian Group for planning and evaluating Mammographic Screening - Gruppo Italiano per la pianificazione e la valutazione dei programmi di Screening Mammografico), a working group of operators (radiographers, radiologists, epidemiologists, clinicians, surgeons) involved in screening programmes ongoing in Italy, was created within the Italian School of Senology. The aim of this study is to illustrate data, presented at the GISMa meeting held in April 1994, concerning the characteristics of each programme and some early indicators of effectiveness. To assess these parameters (concerning compliance level, recall rate, benign/malignant biopsy ratio, detection rate, stage distribution, nodal involvement and number of cancers with a diameter under 1 cm, rate of cancer, etc.), 'acceptable' and 'desirable' standards obtained from Italian and North-European cancer screening experiences have been adopted. Most programmes have shown an acceptable standard for mo...
Epidemiologia e prevenzione
In order to obtain the maximum benefit from breast cancer screening it is essential for every pro... more In order to obtain the maximum benefit from breast cancer screening it is essential for every programme to reach high levels of sensitivity and specificity. This can only be achieved if skill and a comprehensive quality assurance system is applied to the entire process, involving each individual part of the programme. Monitoring of outcomes and continuous evaluation of the entire screening process are key operational objectives for a successful population screening programme. The aim of this document, born in the framework of the Italian Group for Mammography Screening (GISMa), is to propose a unique methodology for collecting and reporting screening data using commonly agreed terminology, definitions and classifications. The indicators considered are those referred to the entire screening process and its sequelae, such as organizational, logistic and performance indicators. The indicators are provided under form of a synthetic and easy to use card. Every card is structured in short...
Tumori
Quality of care is today a major issue in oncology, and much attention is given to research on th... more Quality of care is today a major issue in oncology, and much attention is given to research on the outcome of breast cancer care. Too little attention has been devoted in the scientific literature to the consequences of treatment in long-term survivors, and in particular to the possible side effects. The specific aim of this contribution is to present population-based data about the long-term impact of breast cancer care in women who had an incident cancer in 1985/1986. The cases are 476 breast cancers incident in the City of Florence in 1985-86. Women still living 5 years later were invited to have an interview and a physical examination. Lymphedema, peripheral nerve lesions and damage to the shoulder were assessed. Of the 346 5-year survivors, 238 accepted our invitation: 35.2% of the women reported some early postoperative sequelae, 30.2% had a chronic lymphedema and 18.9% a shoulder deficit. Comparing breast-conserving surgery with radical mastectomy, the risk of chronic lymphed...
Annali dell'Istituto superiore di sanita
In Italy, due to increasing healthcare budget and staff shortages, the recently created regional ... more In Italy, due to increasing healthcare budget and staff shortages, the recently created regional mammography screening programmes were established under worse radiology practice quality criteria than the previously created programmes. Using available data from a national questionnaire survey conducted at the end of 2013 and involving 222 responder radiologists, we compared the main professional quality standards of radiologists working in the screening programmes established during the period 2000-2012 with those working in the screening programmes created from 1990 to 1999. The former reported more years of clinical experience in breast imaging and a greater clinical mammogram reading volume than the latter. Conversely, they dedicated less working time to breast imaging, were less likely to participate in the diagnostic assessment of screen-detected lesions, to work in large-staffed screening centres, and to have a screening and a total mammogram reading volume (SMRV and TMRV) ≥ 50...
Breast Cancer Research, 2000
The Swedish Two-County Trial is a randomized controlled study of invitation to breast cancer scre... more The Swedish Two-County Trial is a randomized controlled study of invitation to breast cancer screening. It was initiated in late 1977. The follow-up to the end of 1998 provides results at approximately the twentieth anniversary of the trial. A significant decrease in breast cancer death among women invited to screening was published 7-8 years after randomization and at 20-year follow up there is a significant 32% reduction in mortality associated with invitation to screening. The advent of screen-film mammographic screening with the ability to detect potentially fatal tumors at an early stage provides an opportunity to study the natural history of breast cancer at an earlier phase in its development than was possible in the past. Our findings show that breast cancer is not a systemic disease at its inception, but is a progressive disease and its development can be arrested by screening. Detection of < 15 mm and lymph node negative invasive tumors will save lives and confer an opportunity for less radical treatment.
Journal of Medical Screening, 1995
Objectives – To estimate and to compare the cost per woman examined and per breast cancer detecte... more Objectives – To estimate and to compare the cost per woman examined and per breast cancer detected in two mammographic screening programmes in the province of Florence. Setting –Two ongoing, population based, mammographic screening programmes in the province of Florence. The first (district project) was started in the seventies in a rural area, whereas the second (city project) was started in the city at the end of 1990. Methods –All relevant resources consumed by the programmes (costs) were listed and measured. The costs are related to 1993. The unit cost for each phase (recruitment, screening, assessment) of the screening process was estimated by dividing the total cost of the phase by the number of women examined. The cost per cancer detected was obtained by dividing the total cost of the programme by the number of cancers detected at screening. Results –The costs per woman examined were 38.1and38.1 and 38.1and41.1 in the district and city programmes respectively. The cost per breast cancer ...
La Radiologia medica, Jan 31, 2016
Screening mammogram reading volume (SMRV) and total (screening and clinical) mammogram reading vo... more Screening mammogram reading volume (SMRV) and total (screening and clinical) mammogram reading volume (TMRV) per year are strongly associated with the radiologist's diagnostic performance in breast cancer screening. The current article reports the prevalence and correlates of a SMRV and a TMRV ≥5000 among Italian breast screening radiologists. A questionnaire survey was carried out in 2013-2014 by the Italian Group for Mammography Screening (GISMa). The questionnaire included items of information for radiologist's experience-related characteristics and for facility-level factors supposedly associated with SMRV and TMRV. Multivariate analysis was performed using backward stepwise multiple logistic regression models. Data for 235 radiologists from 51 local screening programmes were received. Of the 222 radiologists who were eligible, 133 (59.9 %) reported a SMRV ≥5000 and 163 (73.4 %) a TMRV ≥5000. Multivariate factors positively associated with both characteristics included: ...
* pesato per la composizione per età della popolazione esaminata dai diversi programmi RR: rischi... more * pesato per la composizione per età della popolazione esaminata dai diversi programmi RR: rischio relativo; VPP: valore predittivo positivo; 95% CI: intervallo di confidenza al 95%.
Epidemiologia e prevenzione
In this position paper, a self-convened team of experts from the Italian Group for Mammography Sc... more In this position paper, a self-convened team of experts from the Italian Group for Mammography Screening (Gruppo italiano screening mammografico, GISMa) pointed out the problems that increasingly hamper the feasibility and validity of the estimate of the proportional incidence of interval breast cancer (IBC) in Italy, suggested potential solutions and an agenda for research, and proposed that the question of the sensitivity of mammography be viewed in a larger perspective, with a greater attention to radiological review activities and breast radiology quality assurance programmes. The main problems are as follows: the coverage of cancer registration is incomplete; the robustness of using the pre-screening incidence rates as underlying rates decreases with time since the start of screening; the intermediate mammograms performed for early detection purposes may cause an overrepresentation of IBCs; the classification of many borderline screening histories is prone to subjectivity; and,...
Epidemiologia e prevenzione
This report is an update of similar previous papers that have been published by the ONS (Osservat... more This report is an update of similar previous papers that have been published by the ONS (Osservatorio nazionale screening, National Centre for Screening Monitoring) since 2002. Data for the survey come from several different programmes that may have changed over time, and may have different settings of organisation and management. During 2010, the first slight decrease in theoretical extension was recorded. Currently, all Italian regions have implemented screening programmes. In 2010, almost 2,496,000 women aged 50-69 years were invited to have a screening mammogram, and more than 1,382,000 were screened. Theoretical extension was 91.7%, while actual extension was 69.1%. An imbalance in extension is still present when comparing northern and central Italy to southern Italy, which only has a 75% coverage by organised screening. The Italian mean value (69%) of two-year extension (period 2009-2010) suggests that, at full capacity, Italian programmes are able to invite only three quarter...
Epidemiologia e prevenzione
This report is an update of similar previous papers that have been published by the ONS (Osservat... more This report is an update of similar previous papers that have been published by the ONS (Osservatorio Nazionale Screening, National Centre for Screening Monitoring) since 2002. Data for the survey come from several different programmes that may have changed over time, and may have different settings of organisation and management. During 2007, a further increase in screening activity was recorded, with the inclusion of all Northern and Central Italian Regions, and a further development in the Southern Regions and Islands, so today all Italian Regions have implemented screening programmes. In 2008, almost 2,509,000 women aged 50-69 years were invited to have a screening mammogram, and more than 1,361,000 were screened. Theoretical extension was 89.9%, while actual extension increased from 62.3% in 2007 to 69.4%in 2008. An imbalance in coverage is still present when comparing Northern and Central Italy to Southern Italy, which only has a 69% coverage by organised screening. The Italia...
Epidemiologia e prevenzione
This report is an update of similar previous papers that have been published by the ONS (Osservat... more This report is an update of similar previous papers that have been published by the ONS (Osservatorio Nazionale Screening, National Centre for Screening Monitoring) since 2002. Data for the survey come from several different programmes that may have changed over time, and may have different settings of organisation and management. During 2007, a further increase in screening activity was recorded, with the inclusion of all Northern and Central Italian Regions, and a further development in the Southern Regions and Islands. In 2007, screening activity also started in Puglia, so today all Italian Regions have implemented screening programmes. In 2007, almost 2,210,000 women aged 50-69 years were invited to have a screening mammogram, and over 1,225,000 were screened. Theoretical extension was 81.4%, while actual extension increased from 57.2% in 2006 to 62.3% in 2007, finally rising over the critical value of about 50% registered during the last years. An imbalance in coverage is still...
Epidemiologia e prevenzione
Mammography screening programmes in Italy have been implemented since the early 90's. Over th... more Mammography screening programmes in Italy have been implemented since the early 90's. Over the last ten years, national and international institutions have strongly supported screening programme implementation with several laws. Since 2004, the Italian Ministry of Health, together with the Commission of Regions and Self-governing Provinces Health Officials, has officially entrusted the ONS (Osservatorio Nazionale Screening, National Centre for Screening Monitoring) with monitoring and promoting nationwide screening programmes. Previously, for several years, GISMa (Gruppo Italiano per lo Screening Mammografico) carried out a yearly survey to collect process indicators of mammography screening and compare them, using national and international standard values as reference. In 2006, an updated version of the operative report of process indicators was published by GISMa, and in November 2006 the updated national screening guidelines, prepared by the workgroups on oncological screeni...
Epidemiologia e prevenzione
Since 1990, the Italian Group for Mammography Screening (GISMa) has been promoting the developmen... more Since 1990, the Italian Group for Mammography Screening (GISMa) has been promoting the development of new organised programmes and performing a yearly systematic survey of data activity. The screening extension has increased over time, reaching an overall 76.4% of coverage in 2005. The geographical extension is still heterogeneous, with a higher distribution in Northern and Central Italy compared with Southern and Insular Italy, where the screening activity was implemented only recently. Notwithstanding the continuity in implementation, the actual coverage reached only 50.3% of the target population, due to a reduced flow of invitations over time as a consequence of a chronic lack of invested resources and of well-plannedpolicies. The overall Italian rate for crude attendance was above the acceptable 50% standard even though a North-South trend is still confirmed; in Southern/Insular Italy participation was still inadequate (<40%) and did not reach the standard considered accepta...
Epidemiologia e prevenzione
In 2004 regions were required to provide the ONS (Osservatorio Nazionale Screening, National Cent... more In 2004 regions were required to provide the ONS (Osservatorio Nazionale Screening, National Centre for Screening Monitoring) with data on screening activity. Previously, GISMa (Gruppo Italiano Screening Mammografico) had for several years carried out a yearly survey to collect process indicators of mammography screening and compare them, using standard values agreed on at a national and international level. In 2006, an updated version of the operative report of process indicators was published by GISMa and ONS. Data for the survey came from several different programmes that may have changed over time, and may have different settings of organisation and management. The year 2004 can be considered almost exhaustive of the situation of Italian mammography screening; data were provided by 117 programmes from 18 different regions. In ten regions, the individual programmes are part of a comprehensive regional project. In 2004, about 1,870,000 women aged 50-69 years were invited to have a...
Epidemiologia e prevenzione
Since 1992, the Italian Group for Mammography Screening (GISMa) has been performing a yearly syst... more Since 1992, the Italian Group for Mammography Screening (GISMa) has been performing a yearly systematic survey of ongoing activities. The screening extension increased from 1996, reaching an overall 68.7% coverage in 2004. This progression has been more evident in Central-Northern Italy while in Southern Italy a real, but still limited (30%), increase has been recorded only recently. Despite this geographical extension, the actual coverage reached only 5 1.1% of the target population, due to a reduced flow of invitations over time as a consequence of a chronic lack of invested resources and of well planned political actions. The time trends for the key performance indicators show a good average performance: crude attendance rate exceeds over the years the acceptable 50% standard; BIM ratio is progressively decreasing, reaching a ratio of 0.7:1 (both for first/subsequent screening) in 2003; overall detection rate, detection rate for in situ and small cancers (< or =10 mm) show a g...
Epidemiologia e prevenzione
GISMa performs a yearly survey to collect process indicators of mammography screening and compare... more GISMa performs a yearly survey to collect process indicators of mammography screening and compare them, using standard values agreed on a national and international basis. This survey is highly representative of the Italian situation, providing summary data stratified by region and by age group. Data come from several different programmes that may have changed over time, and may have different model of organisation and management. Eighty-eight programmes from 15 different regions (out of 21) provided data for 2003. In nine regions individual programmes are part of a comprehensive regional project. During this year about 1,480,000 women aged 50-69 years were invited to have a screening mammogram, and over 843,000 were screened. Theoretical coverage was 56.2%, while 41.4% of the target population received an invitation to screening. An imbalance in coverage can be seen when comparing Northern and Central Italy, where over 3/4 of the population is covered, to Southern Italy, with only ...
British journal of cancer, 2002
Breast cancer cases diagnosed in women aged 50-69 since 1990 to 1996 in the City of Florence were... more Breast cancer cases diagnosed in women aged 50-69 since 1990 to 1996 in the City of Florence were partitioned into those who had been invited to screening prior to diagnosis and those who had not. All cases were followed up for vital status until 31 December 1999. The cumulative number of breast cancer deaths among the cases were divided by screening and invitation status, to give the rates of cancers proving fatal within a period of 8 years of observation (incidence-based mortality). We used the incidence-based mortality rates for two periods (1985-86, 1990-96), pre and during screening. The incidence-based mortality ratio comparing 1990-96 and 1985-86 was 0.50 (95% CI : 0.38-0.66), a significant 50% reduction. For noninvited women, compared to 1985-86, there was a 41% significant mortality reduction (RR=0.59, 95% CI : 0.42-0.82). The comparable reduction in those invited was a significant 55% (RR=0.45, 95% CI : 0.32-0.61). The incidence ratio of rates of cancers stage II or worse ...
Tumori
To compare the impact of different modalities of general practitioner (GP) involvement, including... more To compare the impact of different modalities of general practitioner (GP) involvement, including the introduction of target payments, on the attendance rate of organized population-based screening programs for breast cancer in Italy. The study was conducted between 1994 and 1996 in four Italian cities where mammographic screening programs are active: Caltanissetta (CL), Firenze (FI), Modena (MO) and Torino (TO). The impact on attendance rate of different invitation strategies based on active GP involvement was tested in each center. The additional effect of economic incentives was also assessed. The incentives were proportional to the level of compliance attained by each GP and weighted by the size of his eligible patients' list. In the Firenze project, an invitation signed by the GP and the project co-ordinator attained a statistically significant higher participation (difference: 4.2%, chi2 = 7.42, P = 0.006). In Caltanissetta and Torino there was a significant increase of ab...
Cancer causes & control : CCC, 1999
The study analyzes the relationship between the incidence trends of breast carcinoma in situ (CIS... more The study analyzes the relationship between the incidence trends of breast carcinoma in situ (CIS) and the spread of mammography screening in the Italian area of Florence (about 608,000 female residents). In this area, since the seventies, a mammographic screening by personal invitation was performed by the Center for Cancer Prevention (CSPO) in some rural municipalities. After 1990, the municipality of Florence and other municipalities were involved in the screening. The study included all cases of female breast carcinomas in situ reported to the population-based Tuscany Cancer Registry between 1985 and 1995. On the basis of information from the CSPO files, the cases were categorized into: "screen-detected", "self-referrals", and "other" (CSPO cases diagnosed in symptomatic women or at periodic check up after breast cancer plus hospital cases). Overall, 332 women with breast carcinoma in situ (CIS) were registered between 1985 and 1995. The CIS inciden...
Tumori
In 1990, GISMa (Italian Group for planning and evaluating Mammographic Screening - Gruppo Italian... more In 1990, GISMa (Italian Group for planning and evaluating Mammographic Screening - Gruppo Italiano per la pianificazione e la valutazione dei programmi di Screening Mammografico), a working group of operators (radiographers, radiologists, epidemiologists, clinicians, surgeons) involved in screening programmes ongoing in Italy, was created within the Italian School of Senology. The aim of this study is to illustrate data, presented at the GISMa meeting held in April 1994, concerning the characteristics of each programme and some early indicators of effectiveness. To assess these parameters (concerning compliance level, recall rate, benign/malignant biopsy ratio, detection rate, stage distribution, nodal involvement and number of cancers with a diameter under 1 cm, rate of cancer, etc.), 'acceptable' and 'desirable' standards obtained from Italian and North-European cancer screening experiences have been adopted. Most programmes have shown an acceptable standard for mo...
Epidemiologia e prevenzione
In order to obtain the maximum benefit from breast cancer screening it is essential for every pro... more In order to obtain the maximum benefit from breast cancer screening it is essential for every programme to reach high levels of sensitivity and specificity. This can only be achieved if skill and a comprehensive quality assurance system is applied to the entire process, involving each individual part of the programme. Monitoring of outcomes and continuous evaluation of the entire screening process are key operational objectives for a successful population screening programme. The aim of this document, born in the framework of the Italian Group for Mammography Screening (GISMa), is to propose a unique methodology for collecting and reporting screening data using commonly agreed terminology, definitions and classifications. The indicators considered are those referred to the entire screening process and its sequelae, such as organizational, logistic and performance indicators. The indicators are provided under form of a synthetic and easy to use card. Every card is structured in short...