The Diagnostic-Therapeutic Care Pathway (DTCP) is a useful instrument to rule, improve and make more comfortable for patients, the clinical and organizational processes of a hospital/department.
According to the Legislative Decree of Campania N°36 and N°38 of 2016, Caserta Local Health Authority (LHA) has extended the screening for Breast Cancer (BC), usually provided to women aged 50-69 years, also to women aged 45-49 years, setting as goals a 40% of adherence rate of the total target population for the first year and a 60% of adherence rate at the end of each round (2 years) (5, 6).
After recording the clinical history in the anamnestic section of the Sani.ARP portal, a digital mammography in double projection (mediolateral oblique and craniocaudal) is performed with the Hologic Selenia Dimensions mammography system. The images are examined in double reading by two dedicated radiologists. In discordant cases, a third screening radiologist is consulted.
The patients with doubtful and/or positive mammograms are recalled to perform second-level examinations (tomosynthesis, ultrasound and, if needed, ultrasound-guided fine needle aspiration citology US-FNAC, Vacuum Assisted Breast Biopsy VABB or Magnetic Resonance Imaging MRI).
The outcomes of the performed exams, provided as a structured report with negativity/positivity and BI-RADS classification, are reported in the Sani.ARP web portal (4, 7).
In case of a suspected or positive lesion, as well as in the case of benign pathology worthy of surgery, the patient is referred for a surgical visit within 5 days from the execution of the second level examination.
Surgery is performed within 21-30 days from the pre-hospitalization date at the Breast Surgery Unit of Caserta LHA. (Fig. 2).
A psycho-oncology service is also active at the Department of Diagnostic Senology of DS12 in collaboration with the University of Campania "Luigi Vanvitelli" and the Italian Society of Psycho-Oncology (SIPO): it aims to analyze the cancer experience, not only as regards the individual dimension of the person but also as regards the family and couple relational sphere (8). Diagnosis and treatment for breast cancer have, in fact, important effects on the couple for which it becomes essential to renegotiate roles, functions and responsabilities, dominate feelings of imbalance, break down communication barriers and discover a new intimacy (9, 10). According to this, patients and their partners receive a short psychological counseling intervention of 5-6 meetings, lasting 50 minutes, on a weekly basis.
Finally, patients can be referred, in relation to the district of residence, to one of the four Oncological Services of Caserta LHA located in Aversa, Piedimonte Matese, San Felice A Cancello and Sessa Aurunca, where they can undergo to adjuvant or neo-adjuvant chemotherapy.