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The impact of the COVID-19 pandemic on Italian population-based cancer screening activities and test coverage: Results from national cross-sectional repeated surveys in 2020

doi: 10.7554/eLife.81804. The impact of the COVID-19 pandemic on Italian population-based cancer screening activities and test coverage: Results from national cross-sectional repeated surveys in 2020 Giuliano Carrozzi², Patrizia Falini³, Letizia Sampaolo², Giuseppe Gorini³, Manuel Zorzi⁴, Paola Armaroli⁵, Carlo Senore⁵, Priscilla Sassoli de Bianchi⁶, Maria Masocco⁷, Marco Zappa⁸, Francesca Battisti³, Paola Mantellini^{3 8}

Affiliations

¹ Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy.
² Azienda Unità Sanitaria Locale Di Modena, Modena, Italy.
³ Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy.
⁴ Registro Tumori del Veneto, Azienda Zero, Padua, Italy.
⁵ Centro di Prevenzione Oncologica, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy.
⁶ Servizio Prevenzione Collettiva e Sanità Pubblica, Direzione Generale Cura della Persona, Salute e Welfare, Regione Emilia-Romagna, Bologna, Italy.
⁷ Istituto Superiore di Sanita, Rome, Italy.
⁸ Osservatorio Nazionale Screening, Florence, Italy.

PMID: 36734526
PMCID: PMC9934859
DOI: 10.7554/eLife.81804

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The impact of the COVID-19 pandemic on Italian population-based cancer screening activities and test coverage: Results from national cross-sectional repeated surveys in 2020

Paolo Giorgi Rossi et al. Elife. 2023.

doi: 10.7554/eLife.81804. Authors Paolo Giorgi Rossi¹, Giuliano Carrozzi², Patrizia Falini³, Letizia Sampaolo², Giuseppe Gorini³, Manuel Zorzi⁴, Paola Armaroli⁵, Carlo Senore⁵, Priscilla Sassoli de Bianchi⁶, Maria Masocco⁷, Marco Zappa⁸, Francesca Battisti³, Paola Mantellini^{3 8} Affiliations

¹ Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy.
² Azienda Unità Sanitaria Locale Di Modena, Modena, Italy.
³ Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy.
⁴ Registro Tumori del Veneto, Azienda Zero, Padua, Italy.
⁵ Centro di Prevenzione Oncologica, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy.
⁶ Servizio Prevenzione Collettiva e Sanità Pubblica, Direzione Generale Cura della Persona, Salute e Welfare, Regione Emilia-Romagna, Bologna, Italy.
⁷ Istituto Superiore di Sanita, Rome, Italy.
⁸ Osservatorio Nazionale Screening, Florence, Italy.

PMID: 36734526
PMCID: PMC9934859
DOI: 10.7554/eLife.81804

Item in Clipboard

Abstract

Background: In Italy, regions have the mandate to implement population-based screening programs for breast, cervical, and colorectal cancer. From March to May 2020, a severe lockdown was imposed due to the COVID-19 pandemic by the Italian Ministry of Health, with the suspension of screening programs. This paper describes the impact of the pandemic on Italian screening activities and test coverage in 2020 overall and by socioeconomic characteristics.

Methods: The regional number of subjects invited and of screening tests performed in 2020 were compared with those in 2019. Invitation and examination coverage were also calculated. PASSI surveillance system, through telephone interviews, collects information about screening test uptake by test provider (public screening and private opportunistic). Test coverage and test uptake in the last year were computed by educational attainment, perceived economic difficulties, and citizenship.

Results: A reduction of subjects invited and tests performed, with differences between periods and geographical macro areas, was observed in 2020 vs. 2019. The reduction in examination coverage was larger than that in invitation coverage for all screening programs. From the second half of 2020, the trend for test coverage showed a decrease in all the macro areas for all the screening programs. Compared with the pre-pandemic period, there was a greater difference according to the level of education in the odds of having had a test last year vs. never having been screened or not being up to date with screening tests.

Conclusions: The lockdown and the ongoing COVID-19 emergency caused an important delay in screening activities. This increased the preexisting individual and geographical inequalities in access. The opportunistic screening did not mitigate the impact of the pandemic.

Funding: This study was partially supported by Italian Ministry of Health - Ricerca Corrente Annual Program 2023 and by the Emilian Region DGR 839/22.

Keywords: COVID 19 pandemic; Italy; cancer screening; early detection of cancer; epidemiology; global health; none; survey.

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Conflict of interest statement

PG, GC, PF, LS, GG, MZ, PA, CS, PS, MM, MZ, FB, PM No competing interests declared

Figures
Figure 1.. Cumulative incidence (left) and mortality…

Figure 1.. Cumulative incidence (left) and mortality (right) rates in the first (upper panel, March–June…
Figure 1.. Cumulative incidence (left) and mortality (right) rates in the first (upper panel, March–June 2020) and second COVID-19 wave (lower panel, July–December 2020) per 100,000 inhabitants.

Mortality is referred to the date of incidence. Rates are computed by province, bold lines define the macro areas, North, Center, and South, and Islands. Data from the National Institute of Health, Italy, 2020.

Figure 2.. Invitation and examination coverage for…

Figure 2.. Invitation and examination coverage for cervical, breast, and colorectal cancer screening in Italy,…
Figure 2.. Invitation and examination coverage for cervical, breast, and colorectal cancer screening in Italy, by year and geographical macro area.

The invitation coverage (right panel) is computed as the number of invitations sent during the year divided by the expected target population to be invited in 1 year. Test coverage (right panel) is computed as the number of tests performed during the year divided by the expected target population in that year. For breast and colorectal cancer, the target population is expected to be invited in 2 years, for cervical cancer the target population is expected to be invited in 3 years if the last test was a Pap test and every 5 years if the last test was an HPV test.

Figure 3.. Changes in the number of…

Figure 3.. Changes in the number of invitations sent (left panel) and screening tests (right…
Figure 3.. Changes in the number of invitations sent (left panel) and screening tests (right panel) performed by screening programs in 2020–2021 compared to the same months in 2019, by period and geographic macro area.

Data from ONS survey.

Figure 4.. Trends of the proportion of…

Figure 4.. Trends of the proportion of the screening target population who declared to have…
Figure 4.. Trends of the proportion of the screening target population who declared to have had a test in due time, overall, and by the setting of the last test.

Data from the PASSI interviews. For breast cancer, we considered as being eligible the female population aged 50–69 years and those who reported as having had a mammogram in the last 2 years as up to date with screening; for cervical cancer, we considered as being eligible the female population aged 25–64 years and those having had a Pap test in the last 3 years or an HPV-DNA test in the last 5 years as up to date with screening; for colorectal cancer, we considered as being eligible males and females aged 50–69 years and those who reported as having had a fecal occult blood test (FOBT) in the last 2 years or a colonoscopy or sigmoidoscopy in the last 5 years as up to date with screening.

Figure 5.. Trends of the proportion of…

Figure 5.. Trends of the proportion of the screening target population who declared to have…
Figure 5.. Trends of the proportion of the screening target population who declared to have had a test in due time, by geographical macro area.

Data from the PASSI interviews. For breast cancer, we considered as being eligible the female population aged 50–69 years and those who reported as having had a mammogram in the last 2 years as up to date with screening; for cervical cancer, we considered as being eligible the female population aged 25–64 years and those having had a Pap test in the last 3 years or an HPV-DNA test in the last 5 years as up to date with screening; for colorectal cancer, we considered as being eligible males and females aged 50–69 years and those who reported having had a fecal occult blood test (FOBT) in the last 2 years or a colonoscopy or sigmoidoscopy in the last 5 years as up to date with screening.

Figure 6.. Trends of the proportion of…

Figure 6.. Trends of the proportion of the screening target population who declared to have…
Figure 6.. Trends of the proportion of the screening target population who declared to have had a test in due time, by education.

Figure 7.. Trends of the proportion of…

Figure 7.. Trends of the proportion of the screening target population who declared to have…
Figure 7.. Trends of the proportion of the screening target population who declared to have had a test in due time, by economic difficulties, Data from the PASSI interviews.

For breast cancer, we considered as being eligible the female population aged 50–69 years and those who reported as having had a mammogram in the last 2 years as up to date with screening; for cervical cancer, we considered as being eligible the female population aged 25–64 years and those having had a Pap test in the last 3 years or an HPV-DNA test in the last 5 years as up to date with screening; for colorectal cancer, we considered as being eligible males and females aged 50–69 years and those who reported as having had a fecal occult blood test (FOBT) in the last 2 years or a colonoscopy or sigmoidoscopy in the last 5 years as up to date with screening. Economic difficulties are classified into three categories: many economic difficulties; some economic difficulties; no economic difficulties.

Figure 8.. Proportion of the target population…

Figure 8.. Proportion of the target population who declared having had the screening test in…
Figure 8.. Proportion of the target population who declared having had the screening test in the last year, by year and setting where the test was last performed.

Data from the PASSI interviews.