San Marino does not know with precision how widespread oncological diseases are among its citizens. This was the admission made before Commission IV by the Director of Health and Social-Health Activities, Alessandro Bertolini, responding to Francesca Civerchia of the PDCS, who had asked whether it might be possible to build a more structured database on the real spread of disease within the population. The answer revealed a declared gap: organic epidemiological data is lacking, and the cancer registry has in fact been at a standstill since 2014.
Work is now underway to reactivate it, but Bertolini warned against a recurring temptation when discussing health matters in a country of 35,000 inhabitants: the small size of the population makes it difficult to draw statistically sound conclusions, since a handful of cases more or less can dramatically shift percentages. “Before we can attempt statistical inference, we need at least a solid descriptive epidemiology,” he observed, pointing to the registry itself as the first step toward a reliable picture of San Marino residents’ health.
The issue is far from abstract. Director General Claudio Vagnini flagged the growing burden of oncological and cardiovascular diseases even among relatively young age groups, while Guerrino Zanotti of Libera asked what might be driving the emergence of certain illnesses among younger segments of the population — without an updated registry, however, such answers remain little more than impressions.
The Institute’s own activity figures tell the story of a system that generates vast amounts of data without yet being able to read it in a coherent way. In 2025, for a population of roughly 35,000 people, Vagnini reported around 450,000 specialist visits, 1.2 million laboratory tests and 90,000 radiological exams. These figures prompted the Commission to reflect on the appropriateness of prescriptions: on the corrective front, Bertolini reported a roughly 3% reduction in radiological services and a contained 0.6% rise in laboratory tests, compared with a previously more pronounced growth trend.
