title: Breast cancer mortality trends in Italy by region and screening programme, 1980-2008.
abstract: OBJECTIVE
  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.
authors.affiliation: Cancer Prevention and Research Institute (ISPO), via delle Oblate 2, 50141, Florence, Italy g.gorini@ispo.toscana.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gorini
authors.affiliation: Cancer Prevention and Research Institute (ISPO), via delle Oblate 2, 50141, Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Zappa
authors.affiliation: Cancer Prevention and Research Institute (ISPO), via delle Oblate 2, 50141, Florence, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Cortini
authors.affiliation: Cancer Prevention and Research Institute (ISPO), via delle Oblate 2, 50141, Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Martini
authors.affiliation: Cancer Prevention and Research Institute (ISPO), via delle Oblate 2, 50141, Florence, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Mantellini
authors.affiliation: Cancer Prevention and Research Institute (ISPO), via delle Oblate 2, 50141, Florence, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Ventura
authors.affiliation: Cancer Prevention and Research Institute (ISPO), via delle Oblate 2, 50141, Florence, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Carreras
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality*; D055088:Early Detection of Cancer / Q000379:methods; D005006:Ethnicity; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008403:Mass Screening / Q000458:organization & administration; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D013997:Time Factors
keywords: Breast cancer mortality; Italy; mammography screening