The key points
- The “oncological system” in Italy
- The role of prevention
- The impact of the pandemic on screenings
In Italy a thousand people every day receive a diagnosis of cancer, tumors are the second cause of death only after cardiovascular disease, but they have become the first cause of years of life lost due to disability and premature death. In addition to the high impacts on health, there is also a significant socio-economic burden, which is around 17 billion euros (of which 10.6 billion euros of health expenditure; 1.3 billion euros of social expenditure and 5.2 billions of euros in costs related to the loss of work productivity, both for the cancer patient and for the caregiver).
The “oncological system” in Italy
Despite a very significant socio-economic burden, in our country the “oncological system” as a whole is sustainable: the increase in survival 5 years after diagnosis (which for men from 39% in the years 1990-94 to 54% of years 2005-2009 and for women from 55% to 63%), thanks to prevention, increasingly effective diagnostic techniques and more efficient organizational systems, a proportional increase in expenditure items is not paid. In fact, if we consider the socio-health expenditure of cancer patients at the per capita level, there is an increase in pharmaceutical expenditure (+ 20.7%) over the years, certainly due to increasingly innovative therapies, but there is also a simultaneous reduction both of total social expenditure (-41.1%), that of direct healthcare expenditure (excluding pharmaceuticals) of -53.3% and of costs related to loss of productivity (-4.6%).
In other words, the new oncological drugs have made it possible, on the one hand, to reduce the direct health costs associated with hospitalization, outpatient costs and, on the other hand, to reduce social spending in terms of welfare and social security services, thus allowing cancer patients to live better, with a higher quality of life, reducing the negative impacts on the welfare system.
The role of prevention
In the next twenty years it is estimated that, due to demographic changes and exposure to risk factors (overweight / obesity, low consumption of fresh food, sedentary lifestyle, alcohol and smoking abuse, environmental conditions and genetic factors), the incidence of these pathologies will almost double. Assuming correct behaviors and acting on risk factors is essential in the prevention of cancer. In addition to primary prevention, also secondary prevention, achieved through screening, is of fundamental importance in the fight against cancer. Timeliness of diagnosis is crucial in increasing the chances of surviving the disease. In the last years before the pandemic, adherence to (organized and spontaneous) screening programs in Italy had improved significantly and was among the highest in Europe for all types of cancer.
The impact of the pandemic on screenings
However, the pandemic has seen a dramatic slowdown in screening activities: the monitoring conducted in 2020 shows, for example, a median decline of 45% in the volume of mammography screenings, which corresponded to approximately 3,300 fewer breast cancer diagnoses, and a 7.7% reduction in surgery for priority A breast cancer. This slowdown occurred in all Italian regions, with negative impacts on screening programs and late diagnoses. Analyzing the data, the regions characterized by rates of adherence to screening campaigns above the average before the pandemic tended to record a smaller reduction in screening volumes than the national average, and vice versa.