Tuttavia il risultato non è poi così male, sottolineano i ricercatori di Epidemiologia e Prevenzione. Soprattutto in tempo di crisi. Grazie ai 4,3 milioni di screening effettuati sono stati identificati e trattati più di 6 mila cancri alla mammella e altre migliaia di tumori. Il vero problema resta però il divario tra Nord e Sud.
Si chiamava “Lo screening al tempo della crisi”, il convegno nazionale in cui quest’anno sono stati presentati per la prima volta i dati relativi all’accesso agli screening oncologici, pubblicati nell’ultimo numero diEpidemiologia e Prevenzione, rivista specializzata pubblicata col supporto del Ministero della Salute: la consapevolezza del peso della situazione economica, spiegano gli autori nell’introduzione dello studio che analizza in particolare il cancro al colon-retto, quello alla mammella e quello alla cervice uterina, deriva dal fatto che “se la grave crisi che attraversa il nostro Paese ha dei riflessi su tutte le politiche sanitarie pubbliche, ha dunque effetto anche sui programmi di screening”. Ma gli autori precisano: “Considerando questo scenario di fondo, i risultati dell’attività 2010 si possono giudicare positivi, anche se permane il differenziale fra Centro-Nord e Sud”.
Dai dati – relativi all’anno 2010 – emerge infatti che complessivamente in un anno quasi 9,5 milioni di persone sono state invitate a un esame di screening (3.450.000, 2.496,000 e 3.464.000, rispettivamente per lo screening cervicale, mammografico e colorettale). Delle persone invitate, oltre 4.300.000 hanno accettato l’invito (1.375.000, 1.382.000 e 1.582.000 rispettivamente); questa attività ha portato all’identificazione e al trattamento di 6.015 cancri mammari (31% dei tumori della mammella incidenti in Italia fra i 50 e i 69 anni, secondo le più recenti stime), 4.597 lesioni CIN2+, 2.916 cancri colorettali (15% dei cancri colorettali incidenti nella fascia di età 50-69) e 15.049 adenomi avanzati.
Rispetto all’anno precedente è stata registrata una lieve diminuzione per lo screening cervicale e mammografico, mentre si registra un aumento per lo screening colo rettale: una parziale spiegazione per la diminuzione dello screening mammografico deriverebbe dal sovraccarico registratosi in due Regioni (Emilia-Romagna e Piemonte) dovuto all’estensione dell’invito alle donne nella fascia di età fra i 45 e i 49 anni, che ha determinato una parziale diminuzione degli inviti sopra i 50 anni.
Un quadro dunque non del tutto negativo, per quanto riguarda la prevenzione, ma che fa emergere chiara la distribuzione a macchia di leopardo sul territorio nazionale, quando si parla di screening. Ad esempio, se l’estensione nominale dello screening per il cancro cervicale (ovverosia la percentuale di donne in età target residenti in un’area dove un programma di screening è attivo) è leggermente aumentata rispetto al 2009, raggiungendo l’80% della popolazione target con una distribuzione non dissimile sulle macroaree del Paese, è anche vero che due Regioni del Nord Italia (Lombardia e Liguria) hanno deciso di non implementare tale screening su tutto il proprio territorio. Per questo l’estensione reale (la percentuale di donne in età target 25-64 che ricevono regolarmente una lettera di invito) è diminuita raggiungendo nel 2010 il 65% della popolazione target, quando nel 2009 era arrivata al 67%. Tuttavia, è incoraggiante notare come 5-6 anni fa la copertura effettiva fosse intorno al 50% in Italia complessivamente e intorno al 40% nel Sud Italia.
Per quanto riguarda lo screening mammografico: l’estensione nominale è circa il 92%, dato che corrisponde a un’attivazione totale secondo i criteri europei, ma in leggero calo rispetto al 2009, ma le differenze fra le aree geografiche si fanno più evidenti quando si considera l’estensione reale. Anche in questo caso vediamo un lieve calo rispetto al 2009 (69,5%), ma il dato più importante è che la distanza fra il CentroNord e il Sud rimane rilevante: infatti se per il secondo valore si raggiunge il 89% al Nord e il 77% al Centro, la percentuale scende a meno del 38% al Sud.
La leggera diminuzione nel primo valore, invece, deriverebbe secondo gli esperti solo dalla temporanea chiusura di alcuni programmi nel Sud Italia, dato che evidenzia ancora di più la disomogeneità fra le aree del Paese. “Infatti la diffusione nel Centro-Nord è completa, mentre nel Sud e nell’Italia insulare si ferma al 75%”, scrivono gli autori. “È comunque da rimarcare che nel Sud 6 anni fa si raggiungeva solo il 10%”.
Per quanto concerne lo screening colorettale, invece, considerando entrambe le politiche di screening adottate in Italia, nel corso del 2010 l’estensione nominale ha raggiunto il 66% del territorio nazionale, un risultato importante sia nel confronto con le altre esperienze europee che in confronto alla diffusione nei 5 anni precedenti: in Italia la diffusione fino a metà degli anni Duemila erano infatti presenti solo pochi programmi pilota.
Anche in questo caso, le differenze fra il Nord e il Sud del Paese sono piuttosto marcate. L’estensione nominale è vicina al 90% nel Nord, uguale all’80% nel Centro e solo di poco superiore al 30% al Sud, anche se qualcosa si sta muovendo in quell’area. Ma le differenze si acuiscono ancor più quando si considera l’estensione reale: questo parametro infatti risulta pari rispettivamente al 78% al Nord, al 45% al Centro, mentre arriva addirittura solo all’8% al Sud.
Nonostante il quadro poco omogeneo, gli esperti sembrano piuttosto ottimisti, seppure la strada da fare sia ancora tanta. “Questa panoramica sulla diffusione dei programmi di screening in Italia illustra una situazione di lenta espansione che riesce molto parzialmente a superare le distanze esistenti fra CentroNord e Sud”, scrivono gli autori in conclusione allo studio. “La mancata copertura di alcune aree e, in alcuni casi, la bassa partecipazione, non sono l’unico ostacolo che i programmi di screening oncologici si trovano ad affrontare. Esistono anche problemi concernenti la qualità di alcuni programmi, che monitoraggi come questo tentano di mettere in luce: lo scopo della sorveglianza è il miglioramento continuo della qualità; mettendo in evidenza i punti deboli (quando vi sono) dei singoli programmi, offre la possibilità di mettere in campo azioni positive per risolverli”.
Fonte: “Quotidiano.it” – 02 gennaio 2013
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