According to the bar chart comparing screening rates in 2019 with those in 2024 across EU countries (plus Switzerland, Iceland, and Norway), Italy shows a sharp decline. This negative trend is shared by ten other countries, including Netherlands, France, Ireland, and especially Malta, where the decl…
According to the bar chart comparing screening rates in 2019 with those in 2024 across EU countries (plus Switzerland, Iceland, and Norway), Italy shows a sharp decline. This negative trend is shared by ten other countries, including Netherlands, France, Ireland, and especially Malta, where the decline can be described as a veritable collapse — from a rate nearing 70% in 2019 to less than 50% in 2024.
I was, however, surprised by the Italian data. I often write about these topics, and I didn't recall noticing a deterioration in the organization of services or widespread reluctance to undergo mammography. On the contrary, I remembered that in recent years the historical discrepancy in service availability and participation between the Center-North and the South and Islands had also narrowed, albeit not entirely.
In fact, data from the National Screening Observatory show that — compared to the 2018-2019 period, when the national average coverage rate for the mammography program was 46% — the figure had improved significantly by 2024, reaching the 50% threshold for the first time. Then, in 2025, a year not yet covered by Eurostat data, the proportion of women aged 50-69 years in Italy who underwent a mammogram through the National Health Service [Italy's publicly funded health system] rose to 53.1%.
The figures reported above are those from the Nuovo Sistema di Garanzia [NSG, Italy's national system for monitoring the performance of essential health services], specifically indicator P15C, which measures the proportion of resident women who accept the invitation relative to the total number of women eligible for screening under the Livelli Essenziali di Assistenza [LEA, the package of health services that Italy's national health system must guarantee nationwide], net of exclusions prior to the invitation. These include, for example, women who have recently been diagnosed with breast cancer or who have recently undergone a mammogram due to a clinical suspicion. Compared to other evaluation criteria (the percentage of women invited out of the total or the participation rate among those invited), this indicator is preferable because it combines the healthcare system's capacity to provide the service on the one hand and citizens' willingness to participate on the other. The values exceeding 60% reported in the European document for 2018 and 2019 — which fell to 55.4% in 2023 and 53.8% in 2024 — thus refer to the screening participation rate among women who had actually received an invitation. This indicator is therefore different from that of the NSG, which instead considers participation relative to the entire eligible population.
One possible explanation is the increase in screening availability following the pandemic, which led to investments primarily in the most disadvantaged regions. In 2018, 84% of women between ages 50 and 69 in Italy were invited for mammography screening, but this average stemmed from the nearly total coverage already achieved in the North and Central regions and from only 59% of women invited for screening in the South and on the islands. In 2024, however, the coverage rate (that is, the ratio of invited individuals to those eligible, excluding those excluded prior to the invitation) had reached 97.3% nationwide. This means nearly all women in the age group covered by LEA were invited for screening, thanks to the improvement in the South and the Islands, where the invitation rate rose to 87.5%.
Finally, it is important to note that these statistics pertain only to mammograms performed as part of national screening programs. With the widespread adoption of individual prevention and check-up plans (often provided as part of corporate wellness programs) and the decision by many women to undergo testing privately (outside the screening program), it is reasonable to assume that the number of women who undergo regular screening to detect breast cancer at an early stage is higher than that indicated by Eurostat's figures.
According to information collected by the PASSI Project [Progressi delle Aziende Sanitarie per la Salute in Italia, a national surveillance system based on recurring population surveys], which monitors the health of Italians over time through successive sample surveys, between 2023 and 2024, 3 out of 4 women between ages 50 and 69 had undergone a screening mammogram. This 75% figure is reached taking into account that nearly 20% of women residing in Italy undergo private screening, either on their own initiative or upon their doctor's recommendation.
Public vs Private One might wonder why someone would choose to pay for a service offered for free by the National Health Service. There are several possible reasons: Often, as mentioned above, the exam itself does not incur an additional cost but is covered by an insurance or welfare plan; at other times, it is because their doctor recommends more frequent screenings than those recommended (often annually) even in the absence of specific risk factors; and finally, because some women are convinced that exams at private centers are conducted more thoroughly, with more modern equipment, in a pleasant environment, and with appointments that fit their own schedules. In addition, there is the benefit of receiving results more quickly, without the long wait required by the national program to find out whether one falls into the approximately 6% of cases that will be recalled due to a suspicious finding.
However, the programs organized by the National Health Service offer other advantages in addition to equity. First and foremost is the guarantee that the exam is performed by trained technicians using calibrated equipment. Moreover, mammograms are always independently reviewed by two radiologists. These quality controls, as well as the double review, are guarantees that not all private centers can consistently provide. In addition, in case of doubt, the woman is recalled and referred to follow the next steps for the necessary diagnostic investigations and, if needed, for treatment, all within the same program.
For those entering the system from outside, however, the process may be less straightforward. Finally, the National Health Service program establishes age groups and intervals between screenings based on the most robust scientific data. More frequent screenings or those outside the recommended age range — driven in good faith by a doctor's desire to be more vigilant, or, less in good faith, by the financial interests of private facilities — increase the rate of false positives, the need for biopsies and other unnecessary tests, and exposure to an excessive dose of radiation relative to the expected benefit.
