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
- Azienda Sanitaria Unità Locale di Reggio Emilia, Italy
- Azienda Unità Sanitaria Locale di Modena, Italy
- Istituto per lo Studio, la Prevenzione e la rete Oncologica, Italy
- Registro Tumori del Veneto, Azienda Zero, Italy
- Centro di Prevenzione Oncologica, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Italy
- Servizio Prevenzione Collettiva e Sanità Pubblica, Direzione Generale Cura della Persona, Salute e Welfare, Regione Emilia-Romagna, Italy
- Istituto Superiore di Sanita, Italy
- Osservatorio Nazionale Screening, Italy
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 socio-economic 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 geographic 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 pre-existing 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.
Data availability
The study reports the results of mandatory monitoring activities, that are statutary duties of the National Screening Monitoring System (ONS). Although the anonymized dataset is not yet available, ONS is working to make it available as open data on its website.In the PASSI surveillance system, personal data are processed in compliance with the GDPR 2016.Although the anonymized dataset is not yet available, the National Institute of Public Health is working to make it available on request (http://www.epicentro.iss.it/passi/PresPolicy.asp) and the excel sheets with the numbers used to plot the graphs and charts of the manuscript are available and enclosed as supplementary files.
Article and author information
Author details
Paolo Giorgi Rossi
Funding
Ministero della Salute (Ricerca corrente 2023)
- Paolo Giorgi Rossi
The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.
Ethics
Human subjects: Screening activity is monitored by ONS as statutary duties on regular basis, using a standard common set of quality indicators. During the Covid 19 pandemic ONS conducted this analysis as a part of the routine monitoring activity of the programmes performance, pooling anonymous individual data from each programme, based on a common standardised form. Approval from local ethics review boards is not required for monitoring programme activity.Regarding PASSI surveillance system, personal data are processed in compliance with the GDPR 2016. PASSI was approved by the Ethics Committee of the National Institute of Public Health on January 23, 2007. Interviews are transferred anonymously to a national archive via a secure internet connection. Personal Identifiers on paper or computers are subsequently locally destroyed.
Copyright
© 2023, Giorgi Rossi et al.
This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.
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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
eLife 12:e81804.
https://doi.org/10.7554/eLife.81804
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Background:
Biological aging exhibits heterogeneity across multi-organ systems. However, it remains unclear how is lifestyle associated with overall and organ-specific aging and which factors contribute most in Southwest China.
Methods:
This study involved 8396 participants who completed two surveys from the China Multi-Ethnic Cohort (CMEC) study. The healthy lifestyle index (HLI) was developed using five lifestyle factors: smoking, alcohol, diet, exercise, and sleep. The comprehensive and organ-specific biological ages (BAs) were calculated using the Klemera–Doubal method based on longitudinal clinical laboratory measurements, and validation were conducted to select BA reflecting related diseases. Fixed effects model was used to examine the associations between HLI or its components and the acceleration of validated BAs. We further evaluated the relative contribution of lifestyle components to comprehension and organ systems BAs using quantile G-computation.
Results:
About two-thirds of participants changed HLI scores between surveys. After validation, three organ-specific BAs (the cardiopulmonary, metabolic, and liver BAs) were identified as reflective of specific diseases and included in further analyses with the comprehensive BA. The health alterations in HLI showed a protective association with the acceleration of all BAs, with a mean shift of –0.19 (95% CI −0.34, –0.03) in the comprehensive BA acceleration. Diet and smoking were the major contributors to overall negative associations of five lifestyle factors, with the comprehensive BA and metabolic BA accounting for 24% and 55% respectively.
Conclusions:
Healthy lifestyle changes were inversely related to comprehensive and organ-specific biological aging in Southwest China, with diet and smoking contributing most to comprehensive and metabolic BA separately. Our findings highlight the potential of lifestyle interventions to decelerate aging and identify intervention targets to limit organ-specific aging in less-developed regions.
Funding:
This work was primarily supported by the National Natural Science Foundation of China (Grant No. 82273740) and Sichuan Science and Technology Program (Natural Science Foundation of Sichuan Province, Grant No. 2024NSFSC0552). The CMEC study was funded by the National Key Research and Development Program of China (Grant No. 2017YFC0907305, 2017YFC0907300). The sponsors had no role in the design, analysis, interpretation, or writing of this article.
