title: Cancer screening uptake: association with individual characteristics, geographic distribution, and time trends in Italy.
abstract: BACKGROUND
  In Italy, organized screening programmes invite the vast majority of the population for cervical and breast cancer, and about one half of the population for colorectal cancer. Programme activity and quality are closely monitored. Nevertheless, there is a vast spontaneous activity, both public and private, for which information on service and coverage is missing. To estimate actual population coverage for the three types of screening the extent of spontaneous screening needs to be known.
  
  
  METHODS
  PASSI is a national telephone-interview surveillance system that continuously collects information about behavioural health risk factors and the diffusion of preventive health interventions. From 2010 to 2013, more than 151,000 18- to 69-year-olds were interviewed. During 2013, 136 out of 147 Italian local health authorities participated in the survey. Information about screening includes: test uptake (Pap smear, HPV, mammography, faecal occult blood test, colonoscopy), date of the last test, provider of the last test (whether paid or for free, proxy of the organized screening programme), reason for not participating in screening, and screening promotion/recommendation received. Individual information on socio-economic characteristics is available.
  
  
  RESULTS
  Seventy-seven percent of the 25-64 year-old women interviewed said they had undergone a Pap smear or HPV test in the three years before the interview, 40%within the screening programme, 37% spontaneously and paying. Seventy percent of the 50-69 year-old women interviewed reported having had a mammography in the two years before the interview, 51% within the screening programme, 19% spontaneously and paying. Thirty-eight percent of the 50-69 year olds interviewed reported having undergone colorectal screening in the two years before the interview, 31% within the screening programme, 7% spontaneously and paying. All three screening programmes showed a decreasing North-South trend in coverage. From 2010 to 2013, coverage increased for all types of screening; the trend was stronger in the South; the increase was mostly due to the tests performed within the organized programmes. People with low education, economic problems, and immigrants from high migration pressure countries had lower coverage levels. In regions with well-implemented organized screening programmes, test coverage was higher and differences for socio-economic factors were smaller than in regions with incomplete programme activation.
authors.affiliation: Dipartimento di sanità pubblica, AUSL Modena. g.carrozzi@ausl.mo.it.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Carrozzi
authors.forename: Letizia
authors.initials: L
authors.lastname: Sampaolo
authors.forename: Lara
authors.initials: L
authors.lastname: Bolognesi
authors.forename: Laura
authors.initials: L
authors.lastname: Sardonini
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Bertozzi
authors.forename: Paolo
authors.initials: P
authors.lastname: Giorgi Rossi
authors.forename: Marco
authors.initials: M
authors.lastname: Zappa
authors.forename: Sandro
authors.initials: S
authors.lastname: Baldissera
authors.forename: Stefano
authors.initials: S
authors.lastname: Campostrini
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Ferrante
authors.forename: Maria
authors.initials: M
authors.lastname: Masocco
authors.forename: Valentina
authors.initials: V
authors.lastname: Minardi
authors.forename: Angelo
authors.initials: A
authors.lastname: D'Argenzio
authors.forename: Pirous Fateh
authors.initials: PF
authors.lastname: Moghadam
authors.forename: Elisa
authors.initials: E
authors.lastname: Quarchioni
authors.forename: Mauro
authors.initials: M
authors.lastname: Ramigni
authors.forename: Massimo Oddone
authors.initials: MO
authors.lastname: Trinito
authors.forename: Stefania
authors.initials: S
authors.lastname: Salmaso
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D003113:Colonoscopy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D055088:Early Detection of Cancer; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008327:Mammography / Q000706:statistics & numerical data; D008403:Mass Screening; D008875:Middle Aged; D009780:Occult Blood; D065006:Papanicolaou Test / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology