Breast cancer mortality trends in Italy by region and screening programme, 1980-2008

Abstract

Objectives: To describe trends in breast cancer mortality in 14 Italian regions representing 90% of the Italian population, and in the country overall, in relation to the diffusion of organized or opportunistic breast cancer screening programmes. Settings : Breast cancer mortality figures from 1980-2008 in Italy and 14 Italian regions were retrieved from the National Statistics Institute.

Methods: Estimated annual percent change (EAPC) was calculated for three time-periods (1980-1989, 1990-1999, 2000-2008). To estimate the age-adjusted and age-specific EAPC, trends in mortality based on annual data were examined using a log-linear regression model, and the year of death as a regressor variable.

Results: In the period 1980-1989 an increasing trend was observed in Italy overall (EAPC = +1.1%; 95% confidence interval [95%CI]: + 0.9%; + 1.3%) and in the 14 regions. In the second decade a decreasing trend was recorded both overall in Italy (EAPC = -1.6%; 95CI:-1.8%;-1.4%) and in all the regions. Between 2000-2008 a slightly decreasing trend was observed in Italy overall (EAPC = -0.8%; 95%CI:-1.0%;-0.5%). A steeper and earlier decrease compared with the rest of Italy was observed in 1990-1999 in Liguria (EAPC = -3.1%; 95%CI:-4.0%,-2.1%), Lombardy (EAPC = -2.3%; 95%CI:-2.8%;-1.9%), and Tuscany (EAPC = -3.0%; 95%CI:-3.7%;-2.2%), mainly due to the 55-64 age-group. There were significant EAPCs between -4.1% and -3.7% in these three regions, 2.5-3.0 times greater than in the rest of Italy (EAPC = -1.4%).

Conclusions: This earlier decline in three Italian regions could be partially attributable to local organized screening programmes implemented earlier than in the rest of Italy, and to opportunistic screening that became more common in 1990s.

Keywords: Breast cancer mortality; Italy; mammography screening.