In 1982 a nationwide program of pre-participation screening including 12-lead 
electrocardiography (ECG) was launched in Italy. The aim of this article is to 
examine whether this 25-year screening program should be considered a valid and 
advisable public health strategy. The analysis of data coming from the 
long-running Italian experience indicates that ECG screening has provided 
adequate sensitivity and specificity for detection of potentially lethal 
cardiomyopathy or arrhythmias and has led to substantial reduction of mortality 
of young competitive athletes by approximately 90%. Screening was feasible 
thanks to the Italian Health System, which is developed in terms of health care 
and prevention services, and because of the limited costs of cardiovascular 
evaluation in the setting of a mass program. On the basis of current scientific 
evidence the implementation of a mass-screening program aimed to prevent 
athletic-field sudden cardiac death should be at least carefully considered by 
public health administrators worldwide.