Breast Cancer in Italy: A Look at Progress, Disparities, and the Road Ahead

In Italy today, breast cancer remains the most commonly diagnosed cancer among women, accounting for 31% of all female cancer cases. While Italy’s overall cancer mortality is 6% lower than the EU average, and its cancer survival outcomes are among the best in Europe, the picture is far from uniform across the country.

A Strong Public Health System—with Uneven Access

Italy’s National Health Service provides comprehensive cancer care free of charge, a major distinction from the U.S. healthcare model, where access often hinges on insurance coverage. Yet access in Italy is not entirely equitable. Regional disparities are pronounced, especially between the wealthier north and the south and islands. Northern regions boast better access to radiotherapy, higher screening rates, and more consistent adoption of genetic testing (e.g., for BRCA mutations), while southern areas lag in both infrastructure and participation.

Screening and Early Detection: A Work in Progress

Population-based breast cancer screening is offered to women ages 50–69 (with some regions expanding to 45–74), but only about 54–56% of eligible women participated in 2022—below pre-pandemic levels. Participation varies widely by region: in Calabria, fewer than 12% of eligible women took part, while northern regions approach near-universal coverage. Opportunistic (non-programmed) screening is higher in underserved areas, but this introduces inconsistencies in quality and follow-up.

Importantly, Italy is working to implement genetic screening pathways for those at high risk of hereditary breast cancer. The goal is to make BRCA testing available nationwide by the end of 2025, aligning with Europe’s Beating Cancer Plan.

What Influences Breast Cancer Risk in Italy?

Italy performs better than most EU countries on several modifiable risk factors for cancer. The Mediterranean diet—rich in vegetables, fruits, legumes, and olive oil—combined with relatively low alcohol consumption and lower obesity rates, contributes to Italy’s favorable breast cancer outcomes. In fact:

• Adult obesity in Italy is the lowest in the EU.

• Overweight and obesity are more common in lower-income and southern populations, highlighting health equity concerns.

• Alcohol consumption is 20% lower than the EU average.

• Daily fruit and vegetable intake is high by European standards.

  
  

However, there are concerning trends:

• Air pollution remains a major issue, with Italy ranking in the highest quartile among EU nations for exposure to PM2.5 particles—an environmental risk factor increasingly linked to breast cancer.

• Teen smoking and binge drinking rates are on the rise, especially among girls, potentially foreshadowing future increases in cancer incidence.

• HPV vaccination coverage remains inconsistent across regions, though national recovery plans are underway.

  
  

Survivorship and Quality of Life

Italy has one of the highest five-year cancer prevalence rates in Europe—about 6% higher than the EU average. This reflects the country’s aging population, earlier detection, and relatively strong survival outcomes. However, support for survivors varies, and gaps persist in psychological support and rehabilitation services—particularly in regions with fewer resources.

Is Treatment Different from the U.S.?

Yes and no. Italy and the U.S. both employ evidence-based approaches to breast cancer treatment, including surgery, radiation, chemotherapy, targeted therapies, and hormone therapies. However, differences emerge in delivery:

• Access and equity: In the U.S., out-of-pocket costs and insurance gaps often limit access. In Italy, treatment is universally covered—but regional inequities affect access to timely, specialized care.

• Genetic testing: While both countries are expanding BRCA testing, the U.S. has broader commercial availability, whereas Italy is standardizing access through its public health plan.

• Screening uptake: The U.S. has higher mammography rates overall, though often linked to opportunistic screening rather than structured programs.

  
  

What’s Next?

Italy’s National Oncology Plan 2023–2027 is a bold effort to close these gaps. It aims to expand screening, increase HPV vaccination rates, implement BRCA testing across all regions, and improve the quality of survivorship care. However, delays in implementation and uneven regional commitment pose challenges. A new national Steering Committee was announced in 2024 to help accelerate progress.

As Italy continues to advance in cancer care, ensuring equitable access across its diverse regions—and addressing environmental and behavioral risk factors—will be key to shaping a future where all individuals receive the timely, high-quality care they need.