{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T06:31:15Z","timestamp":1786343475084,"version":"build-2736575974"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Extending Italy\u2019s mammography screening programme to women aged 45\u201349 and 70\u201374 could markedly improve breast-cancer prevention, lowering mortality and optimizing healthcare resources. Using a decision-tree model based on national epidemiological data, we compared the current screening coverage scenario, characterized by a partial regional adoption, with a nationwide optimal coverage extension. Under the current screening coverage scenario, the screening programme covers 1,995,876 eligible women, with a per-patient cost of \u20ac9.52. The model estimates 55,663 annual incident cases across the total eligible women, with approximately 13,975 diagnosed at an early stage and 41,688 at an advanced stage. Average disease-management costs amount to \u20ac135.84 per patient, resulting in a total per-patient expenditure (screening plus management) of approximately \u20ac145.36. The optimal screening coverage scenario extends coverage to the full eligible population of 3,930,936 women, increasing the per-patient cost to \u20ac18.75. Extended screening shifts stage distribution toward earlier detection, with approximately 19,430 early-stage cases and 36,233 advanced-stage cases. Per-patient disease-management costs fall to \u20ac126.05, for a total per-patient expenditure of approximately \u20ac144.80. The near-perfect equivalence between the two scenarios confirms that the intervention is essentially resource-neutral: the additional screening expenditure is almost entirely offset by savings in disease-management costs driven by earlier diagnosis, while enabling the identification of approximately 5,454 additional early-stage cases. Overall, full national extension would require additional investment, almost entirely offsetting costs for the Italian National Health Service (NHS) while improving equity and long-term sustainability through wider access to early diagnosis. Strategies to increase adherence, reduce regional inequalities, and integrate innovative technologies remain crucial, and inclusion of the programme in the Essential Levels of Care (LEA) would guarantee long-term equity and sustainability beyond cost savings.<\/jats:p>","DOI":"10.3389\/fmed.2026.1648666","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T06:18:10Z","timestamp":1786342690000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Extension of the mammographic screening programme in Italy: cost-benefit analysis of early diagnosis in the 45\u201349 and 70\u201374 age groups"],"prefix":"10.3389","volume":"13","author":[{"given":"Eugenio","family":"Di Brino","sequence":"first","affiliation":[{"name":"ALTEMS Advisory, Universit\u00e0 Cattolica Del Sacro Cuore","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena Maria","family":"Calosci","sequence":"additional","affiliation":[{"name":"ALTEMS Advisory, Universit\u00e0 Cattolica Del Sacro Cuore","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Basile","sequence":"additional","affiliation":[{"name":"ALTEMS Advisory, Universit\u00e0 Cattolica Del Sacro Cuore","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo","family":"Rumi","sequence":"additional","affiliation":[{"name":"ALTEMS Advisory, Universit\u00e0 Cattolica Del Sacro Cuore","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debora","family":"Antonini","sequence":"additional","affiliation":[{"name":"ALTEMS Advisory, Universit\u00e0 Cattolica Del Sacro Cuore","place":["Rome, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"B1","unstructured":"I numeri Del Cancro In Italia 2024.\n          \n          2024"},{"key":"B2","doi-asserted-by":"crossref","unstructured":"Harbeck\n              N\n            \n            \n              Penault-Llorca\n              F\n            \n            \n              Cortes\n              J\n            \n            \n              Gnant\n              M\n            \n            \n              Houssami\n              N\n            \n            \n              Poortmans\n              P.\n            \n          \n          Breast cancer. Nat Rev Dis Primer [Internet].\n          \n          2019","DOI":"10.1038\/s41572-019-0111-2"},{"key":"B3","first-page":"637","article-title":"Metastatic patterns of invasive lobular versus invasive ductal carcinoma of the breast.","volume":"114","author":"Borst","year":"1993","journal-title":"Surgery."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3310\/hta24550","article-title":"Annual mammographic screening to reduce breast cancer mortality in women from age 40 years: long-term follow-up of the UK Age RCT.","volume":"24","author":"Duffy","year":"2020","journal-title":"Health Technol Assess Winch Engl."},{"key":"B5","unstructured":"Breast cancer - Symptoms and causes [Internet].\n          \n          2024"},{"key":"B6","doi-asserted-by":"publisher","first-page":"2379","DOI":"10.1002\/cncr.32887","article-title":"Breast cancer early detection: a phased approach to implementation.","volume":"126","author":"Ginsburg","year":"2020","journal-title":"Cancer."},{"key":"B7","doi-asserted-by":"crossref","DOI":"10.1093\/oso\/9780198529446.001.0001","volume-title":"Methods for The Economic Evaluation Of Health Care Programmes.","author":"Drummond","year":"2005"},{"key":"B8","doi-asserted-by":"publisher","first-page":"15","DOI":"10.53225\/ben_083","article-title":"Programmi di screening oncologico organizzati in italia: differenze tra macroaree da un\u2019indagine su regioni e province autonome (2023).","volume":"5","author":"Timelli","year":"2024","journal-title":"Boll Epidemiol Naz."},{"key":"B9","unstructured":"La Diffusione Degli Screening Oncologici in Italia Nel 2024 - Screening mammografico - Anno 2024.\n          \n          2024"},{"key":"B10","unstructured":"Osservatorio Nazionale Screening (ONS).\n          \n          \n            \n              Paci\n              E\n            \n            \n              Puliti\n              D\n            \n          \n          How the Epidemiology of Breast Cancer Is Changing in Italy: Results of the IMPATTO Project on Mammography Screening Programs. ISPO \u2013 Istituto per lo Studio e la Prevenzione Oncologica\n          \n          2011"},{"key":"B11","unstructured":"Internet.\n          \n          2024"},{"key":"B12","unstructured":"National Tariffs For Services Provided By The National Health Service (SSN)"},{"key":"B13","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1007\/s41669-024-00543-1","article-title":"Burden of disease of breast cancer in italy: a real-world data analysis.","volume":"9","author":"Mennini","year":"2025","journal-title":"Pharmacoecon Open."},{"key":"B14","volume-title":"National Cancer Plan (Piano Oncologico Nazionale): Planning And Guidance Document For Cancer Prevention And Control 2023\u20132027 [Internet].","year":"2023"},{"key":"B15","doi-asserted-by":"publisher","first-page":"f2618","DOI":"10.1136\/bmj.f2618","article-title":"Cost effectiveness of the NHS breast screening programme: life table model.","volume":"346","author":"Pharoah","year":"2013","journal-title":"BMJ."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1918","DOI":"10.1001\/jama.2024.5534","article-title":"Screening for breast cancer: USPSTF recommendation statement.","volume":"331","year":"2024","journal-title":"JAMA."},{"key":"B17","doi-asserted-by":"publisher","first-page":"e2452821","DOI":"10.1001\/jamanetworkopen.2024.52821","article-title":"Cost-effectiveness of breast cancer screening using digital mammography in Canada.","volume":"8","author":"Wilkinson","year":"2025","journal-title":"JAMA Netw Open."},{"key":"B18","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1186\/s13561-025-00628-5","article-title":"Cost-effectiveness of expanding the target population of biennial screening for breast cancer from ages 50\u201369 to 45 and\/or 74: a cohort modelling study in the Finnish setting.","volume":"15","author":"Siegfrids","year":"2025","journal-title":"Health Econ Rev."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1648666\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T06:18:12Z","timestamp":1786342692000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1648666\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,10]]},"references-count":18,"alternative-id":["10.3389\/fmed.2026.1648666"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1648666","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,10]]},"article-number":"1648666"}}