Breast and colon cancers, more years of life lost in the South and mortality decline at a standstill

The data on mortality from breast cancer and colon cancer split Italy in two. The South records more years of life lost for these two tumors and the low participation in screening for early diagnosis is a handbrake on the decline in deaths: in the South deaths decrease much less than in the North and the Center, and in some cases they even increase. The result is that mortality rates, historically lower in the South than in the North, are now comparable. This is the picture taken by the first report of the Working Group on Equity and Health in the Regions of the Istituto Superiore di Sanità, published today on the ISS website. The low participation in screening, emerges from the report, penalizes the South not only in terms of mortality: it also weighs on the patient flight index, forced to move outside the region to be able to have surgery.

“This report, which will soon be followed by a similar work on cardiovascular diseases, is a further example of what the ISS can do to help the National Health Service,” says the president of the institute Rocco Bellantone, promoter of the working group. “I am sure that the ideas contained in the document will be very useful for developing strategies that can mitigate regional disparities in access to health care, by far the main problem of health care in our country,” he emphasizes.

The authors of the report – explains the ISS – used data on mortality by cause, data on cancer screening coverage (obtained from surveillance systems, in particular from Passi and Passi d’Argento) and data on hospital discharge forms. For breast and colorectal cancers, which represent 40% of all cancer diagnoses in Italy, regional differences in total and premature mortality were analyzed; the impact of screening programs on the reduction of mortality over the last 20 years was evaluated and the capacity of the Regions to take charge was examined through the analysis of extra-regional health mobility.

For both breast and colon cancers, the report shows low levels of patient mobility outside the region in the Center and North of the country. In the South and the Islands, however, mobility levels are significantly higher (about triple) than in the Center-North. And the ISS highlights that where less screening is done, the rate of patient flight also increases.

As for breast cancer, if we look at the correlation between the escape rate and screening, it emerges that regions with higher screening coverage have lower escape rates. “This data – comment the authors of the report – highlights how in regions where mammographic screening reaches a good portion of the target female population, the system is also able to take charge of breast cancer cases that require hospitalization for surgery, while this is not always guaranteed in regions where screening is still far from optimal levels. In this panorama, regions such as Calabria and Molise stand out among those with the lowest levels of mammographic screening coverage and the highest escape rate”.

Also for colon cancer, regions with high levels of screening coverage tend to present low levels of the escape index, although there are some regions that go against the trend (Puglia and Campania, with low coverage and low escape index). However, the coexistence of high escape indexes and low levels of screening coverage is confirmed for regions such as Calabria and Molise.