Breast cancer screening: differences between Swiss cantons

Around 370 new breast cancer diagnoses are recorded in Ticino every year. In 2024, participation in the screening programme stood at around 60%, according to the Council of State's report. In October, the month dedicated to prevention, these figures draw attention back to early diagnosis and to the obstacles that still keep many women away from check-ups.

Maria Luisa Gasparri, professor and head of gynaecology and senology at the Ente ospedaliero cantonale, spoke about this on RSI's programme Il Faro. According to the data she presented, screening reduces the risk of dying from breast cancer by around 20%. The chance of recovery depends on the biology of the disease and the stage at diagnosis: early diagnosis can make a difference on this second factor. In cantons with organised programmes, tumours are often detected when they are smaller and less likely to involve the lymph nodes, which can also mean less burdensome treatment. A small lesion may allow for limited surgery, while a more advanced disease may require more extensive surgery or chemotherapy before the operation, with fatigue that builds up even before reaching the operating theatre.

Programmes vary from canton to canton

In Switzerland, the availability of organised screening remains uneven. Zurich, Obwalden and Nidwalden are among the cantons without an organised mammography programme, while Lucerne and Aargau plan to introduce one this year. The absence of a programme does not mean mammograms cannot be carried out, but it does point to a difference in how prevention is organised. For Gasparri, the issue is guaranteeing equal opportunities: where someone lives should not determine different chances of detecting the disease early.

The debate over the age at which check-ups should start also remains open. Over a lifetime, around one woman in eight develops breast cancer; incidence rises after the age of 50, but around 18% of diagnoses concern younger women. This is behind the Swiss Society of Gynaecology's call to bring the start of screening forward from 50 to 45. Choices vary from country to country: in Sweden screening starts at 40, while in Lombardy the threshold is 45. The comparison involves benefits, costs and the additional examinations required, since before the age of 50 breast tissue is often denser and reading a mammogram may call for further checks such as an ultrasound. Gasparri notes, however, that treating a disease found early can also reduce treatment costs.

Among the reasons for not taking part, the specialist points to lack of time, fear of radiation and fear of being called back for further examination. On radiation, she suggests weighing the risk against the benefits of screening: "Se noi consideriamo la dose di radiazioni di una mammografia digitale, questa dose corrisponde a zero quattro millisievert (mSv), l'unità di misura che equivale all'esposizione di radiazioni dell'ambiente di una donna in un quartiere di Manhattan per sette settimane" (if we consider the radiation dose of a digital mammogram, that dose corresponds to 0.4 millisieverts (mSv), the unit of measurement equivalent to the environmental radiation exposure of a woman in a Manhattan neighbourhood over seven weeks). Recalls affect around 10% of first mammograms; among recalled women, one in five is later diagnosed with cancer, while for the others further examination does not confirm the disease. A woman who understands these steps, Gasparri concludes, can approach prevention with less fear.