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The report
A census of the equipment on which it is based screening mammografico and the diagnosis of breast cancer is Agenas, the National Agency for Regional Health Services, which in recent days published the Report on the state of mammographers – for the year 2019. The dossier reports the number of both digital and analog mammographs , their age and their location in public, private accredited and private non-accredited structures, internal or external to cancer networks. This information is specified for each region, with the exception of Valle D’Aosta and the Autonomous Province of Trento (for which the data were not yet available at the date of extraction).
“It is believed that 10 years is the maximum acceptable age for a mammographer”, confirms Gianni Saguatti, radiologist, director of the Breast Unit of the Bellaria Hospital in Bologna and past president of the Italian Mammographic Screening Group (Gisma): “Obviously it is a convention , but quite reflective of reality, although other countries like the UK replace their equipment every 5 years. However, the age also depends on how much the machines are used. In general, the photograph taken by this survey is quite comforting ”.
How old are mammograms, region by region
In Italy the average age of mammographers is 7.6 years: in no region is it under 5 years, while it exceeds 10 in Molise and in the province of Bolzano. The regions with the most “elderly” mammographs (again as an average age) are then in Basilicata, Calabria, Emilia Romagna, Friuli Venezia Giulia, Lazio, Marche, Puglia and Sicily. The most recent are found in Abruzzo and Umbria.
Overall, 40.5% of mammographers are 1-5 years old, 27% are 6-10 years old and 22.5% – as anticipated – are 10 years or older. It must be said, however, that the picture is not complete, because information on about 10% of equipment is missing.
Digital is better: numbers in public and accredited centers
The numbers should be used to decide where and how to invest in the near future to bridge the technological gaps. Objective: to carry out increasingly accurate mammograms and thus also improve the treatment of the tumor that more than any other affects women, and which counted over 55,000 diagnoses in 2020 alone. But, in the meantime, what indication can we draw from this? It is difficult, if not impossible, for a woman to know the age of the mammograms used and screening programs rarely give the possibility to choose the center where to carry out the examination.
“Some patients ask us generically if the machines we use are modern or up-to-date”, continues Saguatti: “We don’t have data to give precise indications to the population, but knowing if the mammography used is analog or digital is already important information. All screening began in the analog era, but that technology is outdated today. The transition to digital began 15-20 years ago and represented a great diagnostic advantage, because the image is no longer imprinted on film, but can be enlarged and modified to improve contrast and readability, or to fix some problems that may occur while running. Furthermore, it is very easy to recall previous mammograms to the monitor to make comparisons of any possible changes “. The other advantage is of a managerial nature, both for the facility and for the patients: there is no need to keep huge archives or remember to physically bring the previous mammogram to each checkup.
The public centers
Looking at the numbers of this survey, then, it is clear that in the public structures of our health system there is, in general, a clear prevalence of digital mammograms compared to analog ones: they are 81%, while in accredited private structures they represent the 59% “. In absolute numbers, according to the survey, there are 785 digital and 179 analogue mammograms in public facilities, and 492 digital and 339 analogue in accredited private centers. This indirectly also gives information on the obsolescence of machinery, given that the vast majority of equipment that is over 10 years old is analogue (78%) and only 22% is digital.
Beware of regional differences
The report also shows that in the centers that are part of the regional oncological networks the percentages of digital mammographs are very high – in the Hubs it is close to 90% – while in the structures outside the networks they are just over half. Even if the overview is positive, the situation – it must be emphasized – changes a lot from region to region: ranging from 90% of digital mammographs in Abruzzo to 50% in Lazio and Sardinia. In 2019, an average of 8 out of 10 exams were held in the public.
Screening and diagnosis: how much are mammograms used?
The last interesting fact concerns the use of the equipment. It is obvious, for example, that Emilia-Romagna and Campania have the same number of mammographs (about 100), but while the first performed 509 thousand exams in 2019, the second performed 150 thousand. “A possible explanation of this great difference in use involves mammography screening”, comments Saguatti: “It is logical that where the screening on the territory is more active, the machines are used more”.
We must not forget that, when there is breast cancer, mammograms are only the first step in a complex and organized multidisciplinary diagnostic-therapeutic path: “Adhering to mammography screening is not a free mammogram every two years”, concludes Saguatti : “It means being able to take advantage, in case of need, of a structured path of study and care”.
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