October is Breast Cancer Awareness Month, but attention must not waver for other women’s cancers as well. Adherence to cancer screenings remains essential, even though participation still faces numerous challenges.
Discrepancies: Screening Uptake Figures
We have the tools for cancer prevention, but the turnout is not as effective or proportional to the resources available to the population. Across Italy and Europe, highly specialized centers with cutting-edge equipment for targeted screening for early diagnosis, such as breast cancer—October being dedicated to this—are expanding. Yet they represent valuable opportunities that are often missed: women do not respond proactively and effectively to participate in screenings, with participation trending downward over the years, according to the latest Eurostat data. There are also meaningful gaps between regions and countries.
For example: in 2024, higher uptake is recorded among women aged 50 to 69 who had a mammogram in the previous two years, in Nordic countries such as Denmark (82.1%), Sweden (82.0%), and Finland (81.6%), followed at a short distance by Slovenia (77.8%) and Ireland (71.2%). In contrast, several countries show much lower figures: Hungary (27.2%), Cyprus (29.2%), Poland (33.8%), Latvia (38.2%), and Austria (41.3%), which have the lowest breast cancer screening rates. Italy sits in the middle, with uptake around 53.8%, down sharply from 60.7% in 2019. Overall, compared with 2019, breast cancer screening rates rose in nine EU countries, with the largest increases in Slovakia (+12.5 percentage points), Croatia (+10.0 pp), and Estonia (+9.9 pp). Meanwhile, rates in Sweden and Finland remained stable, while 11 other EU countries saw declines, ranging from -0.4 pp in Ireland to -21.8 pp in Malta.
Nonetheless, the greater availability of mammography services continues. Greece shows 7.6 units per 100,000 inhabitants as the highest availability for mammography equipment, followed by Cyprus with 6.9 units, while Italy stands at 3.7 units (up from 3.45 in 2019). By contrast, Poland, the Czech Republic, Sweden, and Romania report the lowest availability at about 1.1 units per 100,000 people. Compared with 2019, the number of units per 100,000 inhabitants increased in 10 EU countries—Cyprus showing the largest gain (+1.3 units)—and decreased in four, including Sweden (-0.8) and Malta (-0.7). In the remaining six countries, availability remained unchanged.
Institutional Measures
There is also strong attention to promoting preventive care in the workplace. Law Decree 159/2025, enacted as Law 198/2025, strengthens the role of the occupational physician, assigning specific tasks and responsibilities. Among these are the synergistic collaboration with the employer in risk assessment and the definition of prevention measures, promoting health through worker well-being initiatives, screening, and the widespread adoption of healthy lifestyles, as well as the analysis of health data to identify recurring issues and, therefore, to improve working conditions. It also aims to incentivize participation in company programs designed to reduce risks and safeguard long-term health.
Therefore, the occupational physician is no longer limited to simply assessing fitness for a specific job, but engages in active health information and promotion, raising employee awareness—especially in terms of adherence to national cancer screening programs covered by the Essential Levels of Care (ELC)—such as those for breast, colorectal, and cervical cancer. Moreover, the physician supports integrating health surveillance with universal and oncologic prevention and ensures that mandatory health checkups occur during working hours.
Actions on the Ground
Among the early actions tied to Pink October is FrecciaRosa, the breast cancer prevention campaign promoted by the FS Group (Ferrovie dello Stato) and the IncontraDonna Foundation, supported and championed by Hon. Marcello Gemmato, Undersecretary of Health. Prevention has yielded remarkable results in breast cancer: today roughly 88% of women survive five years post-diagnosis, with cure rates approaching 98% when the disease is detected early. These tools enable increasingly effective care, while also contributing to the sustainability of the health system. Nevertheless, it remains crucial not to let guard down and to extend prevention to other conditions affecting women’s health, listening to the body’s signals and undergoing periodic checkups. This includes conditions such as endometriosis and adenomyosis, health issues that many women in Italy contend with.
Recent research has focused on the link between endometriosis, hormonal balance, chronic inflammation, and potential oncologic implications, along with the responsibility that comes with adopting healthier lifestyles—such as an anti-inflammatory diet rich in vegetables and fresh fruit, whole grains, legumes, and omega-3 fatty acids, and low in refined sugars and processed foods—thereby supporting hormonal balance. Diet and lifestyle changes are not cures and do not replace medical therapy, but they constitute an important daily preventive measure to be developed in partnership with expert clinicians, as emphasized by the National Italian Foundation for Endometriosis. There is also a need to defend against cervical cancer, which rests on prevention through vaccination (primary prevention) that protects against Human Papillomavirus (HPV), responsible for about 95% of cases of this cancer.
The vaccination is actively and freely offered by the National Health Service to girls and boys, typically around age 11 (at least 11 years old) and is strongly recommended before the start of sexual activity. It can be administered later as well. A second pillar is screening tests (secondary prevention), including periodic checks to identify and treat precancerous lesions before they progress to cancer.
For young women aged 25 to 29, a Pap test every 3 years is recommended, a cytology exam that analyzes cervical cells, while for ages 30 to 65, the HPV-DNA test every 5 years directly screens for oncogenic viral strains. Screening tests are free, and a positive result leads to second-level follow-up investigations, such as colposcopy. Ovarian cancer remains a challenging disease to screen for, being often subtle and asymptomatic in early stages, and there are currently no universally accepted population-based screening programs. However, some studies suggest that an annual visit to a gynecologist, including bimanual ovarian palpation and transvaginal ultrasound, may facilitate early detection.
While screening programs based on the blood marker CA-125 are not considered reliable or effective due to low specificity and fluctuations that can occur for many reasons, they can be useful to monitor potential disease recurrence in patients previously treated for ovarian cancer. Particular attention is given to women with BRCA1 or BRCA2 gene mutations, which predispose to breast cancer, with established surveillance pathways. It is important to pursue follow-up counseling to discuss options to reduce the risk of developing ovarian (or breast) cancer, including risk-reducing surgical options such as oophorectomy and salpingectomy after age 40.
Ongoing research aims to develop population-based screening tests for early detection, for example by detecting traces of ovarian cancer in Pap tests, with early data emerging from the Humanitas Clinical Institute in Rozzano (Milan). Equally important is colorectal cancer screening, the second most common cancer among women after breast cancer, with approximately 18,900–21,200 new cases annually, accounting for around 10.5% of all female cancers, peaking between ages 60 and 75, though there are modest increases in those under 50 as well.
Hence the importance of participating in free screening programs (with a kit that can be picked up and returned at Italian pharmacies) to increase the likelihood of cure from about 56% to roughly 92% if detected early. In Italy, adherence to the fecal occult blood test and to preventive colonoscopy varies widely by region and is often below expectations, even though it remains the main tool for identifying polyps or early neoplasia.
Finally, lung cancer is rising among women, driven by both traditional cigarette use and newer tobacco products such as e-cigarettes. Today, evidence supports the effectiveness of early detection through screening, reducing mortality from lung cancer. Low-dose CT scans can detect small lung nodules in asymptomatic individuals, increasing the opportunity for curative treatment at an early stage.
The “Deception” Uncovered
Researchers from the University of Liège (Belgium) and the Dana-Farber Cancer Institute (United States) reportedly identified the mechanism by which certain breast cancer cells manage to evade immunotherapy. The culprits appear to be cells with whole-genome doubling (WGD), a condition affecting about 37% of primary solid tumors and up to 56% of metastatic forms.
These cells may develop biological strategies, such as epigenetic changes, that render them invisible to the immune system. The discovery could help explain why some breast tumors initially respond to immune defenses and then become resistant to immunotherapy. If future data confirm this hypothesis, there could be opportunities to study combination therapies that integrate epigenetics and immunotherapy.
Abbonati a Karla Miller
