The Early Detection of Breast Cancer for Women in Bologna (IT) after the Offer Reorganization

In Italy, the establishment in 1978 of a National Health Service (NHS) providing universal coverage for comprehensive and essential healthcare services marked a clear step forward in social policies and the concrete assertion of the safeguard of health. In addition to the universality of access, the system guarantees equality of access to healthcare services and envisages financial contribution from individuals determined solely on the basis of their ability to contribute. This study intends to present the implications for regularity of checks, quality of services (and costs) of early detection of breast cancer of the solutions adopted after 2010 to deal with the problems of waiting lists and the control of spending for the services of early detection of breast cancer, redirecting the services toward the screening of public health. The data (2002-2016) from the Regional Health Service of Emilia-Romagna (SSR) on the access to the mammography services in the AUSLs of the region allowed to identify the different paths for the early detection of breast cancer undertaken by the women in Bologna and in the other AUSLs in Emilia-Romagna after these solutions. In 2002, Bologna was associated with “NO screening”, although not as strongly as other AUSLs in the region. In 2016, Bologna is associated with “YES screening”, although not as strongly as other AUSLs in the region. The young women choose “YES screening”, but the older women have not completely abandoned the spontaneous access to mammography services via the general practitioner's prescription. The effectiveness of early detection of breast cancer lies in the latest generation mammograms, in breast pathologists dedicated to the reading of mammograms. In addition, the effectiveness lies in maintaining the recommended regular intervals for mammograms and other diagnostic investigations. With the data made available by the SSR, it is possible to define now different behavior profiles at least with respect to the intervals and regularity of the mammograms received and the quality of the mammography service which is accessed for the different age groups of women. An evaluation of the cost (of the service) and effectiveness of the different “chosen” diagnostic paths is therefore presented.