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.
Metrics
-
- 463
- views
-
- 77
- downloads
-
- 7
- citations
Views, downloads and citations are aggregated across all versions of this paper published by eLife.
Download links
A two-part list of links to download the article, or parts of the article, in various formats.
Downloads (link to download the article as PDF)
Open citations (links to open the citations from this article in various online reference manager services)
Cite this article (links to download the citations from this article in formats compatible with various reference manager tools)
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
Further reading
-
- Epidemiology and Global Health
- Medicine
- Microbiology and Infectious Disease
eLife has published the following articles on SARS-CoV-2 and COVID-19.
-
- Epidemiology and Global Health
- Genetics and Genomics
Alzheimer’s disease (AD) is a complex degenerative disease of the central nervous system, and elucidating its pathogenesis remains challenging. In this study, we used the inverse-variance weighted (IVW) model as the major analysis method to perform hypothesis-free Mendelian randomization (MR) analysis on the data from MRC IEU OpenGWAS (18,097 exposure traits and 16 AD outcome traits), and conducted sensitivity analysis with six models, to assess the robustness of the IVW results, to identify various classes of risk or protective factors for AD, early-onset AD, and late-onset AD. We generated 400,274 data entries in total, among which the major analysis method of the IVW model consists of 73,129 records with 4840 exposure traits, which fall into 10 categories: Disease, Medical laboratory science, Imaging, Anthropometric, Treatment, Molecular trait, Gut microbiota, Past history, Family history, and Lifestyle trait. More importantly, a freely accessed online platform called MRAD (https://gwasmrad.com/mrad/) has been developed using the Shiny package with MR analysis results. Additionally, novel potential AD therapeutic targets (CD33, TBCA, VPS29, GNAI3, PSME1) are identified, among which CD33 was positively associated with the main outcome traits of AD, as well as with both EOAD and LOAD. TBCA and VPS29 were negatively associated with the main outcome traits of AD, as well as with both EOAD and LOAD. GNAI3 and PSME1 were negatively associated with the main outcome traits of AD, as well as with LOAD, but had no significant causal association with EOAD. The findings of our research advance our understanding of the etiology of AD.
