Mammographic screening effectiveness in reducing breast cancer mortality in Sicily, Italy, 2008–2023

Background

Breast cancer is the leading cause of cancer death among women globally. In Italy, approximately 55,900 new cases and 15,500 deaths were recorded in 2022–2023. In Sicily, mammographic screening (MS) adherence persistently falls below national and European targets, creating a health equity gap. In detail, organised screening participation declined by 10% in the Southern while increasing by 6.6% in the Northern [1]. Barriers including limited health literacy, geographic disparities and socioeconomic factors continue to undermine screening effectiveness in Southern regions.

Methods

An ecological study was conducted among women aged 50–69 in Sicily (2008–2023). MS participation rates were derived from the PASSI surveillance system; breast cancer mortality data from the Sicilian Regional Cancer Mortality Registry. A multivariate logistic regression analysis evaluated the association between annual screening adherence and mortality, adjusting for cohabitation, educational level, and marital status.

Results

Higher MS adherence was independently associated with reduced breast cancer mortality (OR = 1.04; 95% CI: 1.01–1.08; p = 0.043), after adjusting for all sociodemographic covariates. Calendar year was also significant (OR = 1.15; 95% CI: 1.03–1.29; p = 0.016), reflecting secular improvements in treatment. Sociodemographic covariates were non-significant suggesting the screening effect is not confounded.

Conclusions

Organised screening reduces breast cancer mortality in historically underserved Mediterranean regions, independent of sociodemographic factors. Our findings are concordant with EUROSCREEN estimates of 25–31% mortality reduction among invited women [2], and European ecological studies showing 1.5–8.1% annual reductions after organised programme implementation [3]. Structural and social barriers to equitable access must become a political priority, consistent with the European Cancer Beating Plan target of 15% mortality reduction by 2030.

Key messages

• The mammographic screening adherence reduces breast mortality cancer.

• The effectiveness of mammographic screening should be a key factor in increasing screening adherence.