Implementing cancer screening across the EU (Guest Blog)
The adoption of last year’s updated EU-wide cancer screening recommendation[1], represented an important step forward in cancer prevention as part of Europe’s Beating Cancer Plan[2]. The positive impact this could have on people and health systems requires political commitment from Member States towards its implementation, with support from the cancer community and beyond.
Currently, the implementation as well as the uptake of previous cancer screening programmes vary significantly between and within EU countries. Given that the most recent EU status report is dated from 2017, there’s a need to verify the implementation status for each country to have a solid baseline for measuring progress[3].
The revised Council Recommendation improves and expands existing screening guidelines for breast, cervical and colorectal cancer, and introduces new screening programmes for lung and prostate cancer as well as a prevention programme for gastric cancer.
While for existing screening programmes for breast, colon and cervical cancer, the Recommendation is broadly aligned with the advisory report prepared by SAPEA[4] [5], the characterisation of the advice on both lung cancer and prostate cancer screening as ‘preliminary’ does not align with the SAPEA report[6].
The stepwise approach proposed in the Council Recommendation for lung and prostate cancer screening should not result in countries delaying the preparatory work required for the introduction of new screening programmes. Such work may include the assessment of the best way of including such programmes into general practice, for instance by developing good practice models that can be rolled out across the country. Governments (where possible with the support of EU funding) should start implementing pilots based on available European guidelines for prostate cancer. For lung cancer, governments should consider the wealth of evidence available to guide the implementation of targeted LDCT screening and the experiences of those countries who have already begun implementing national screening programmes – Croatia, Poland and the Czech Republic.
Cost effectiveness and efficiency in cancer care
The SAPEA report highlights cost-effectiveness as an essential consideration when introducing cancer screening programmes, which should follow available guidelines that ensure that cost-effectiveness is optimised. Not doing so - for instance by carrying out more frequent tests than recommended or screening a whole population when stratification for risk is advised - jeopardises patient well-being and cost-effectiveness of programmes, and should be avoided.
For All.Can International[7] making cancer care more efficient, means making use of the human, financial, infrastructural and technological resources available, with a focus on what really matters to people with cancer and to society as a whole[8]. Concretely, this means focusing resources on where they matter most [9], starting with diagnosing cancer as early as possible. Diagnosis delays translate in into poorer outcomes for patients and potentially increased costs[10] .
All.Can and the EFPIA Oncology Platform (EOP) are collaborating to promote a constructive and evidence-based conversation on the implementation of the cancer screening Recommendation in four EU countries – Belgium, Italy, Romania and Spain – recognising the revised EU Recommendation as a further step towards greater efficiency of cancer care and an improvement of public health.
Through roundtables and policy conversation, the national All.Can community and decision-makers in the four countries, will take stock of the local cancer policy framework, and raise awareness on the EU Cancer Screening Recommendation, finding routes for country-level implementation, via, inter alia, potential funding paths.
With this project, we aim to spark dialogue between the All.Can National Initiatives, its partners and EU offices in the countries for a better understanding of the mechanisms to access the EU funding routes. A critical element to be integrated in the implementation of cancer screening in EU Member States is the financial support provided through Europe's Beating Cancer Plan. Specifically for cancer screening an investment of €38.5 million is already committed for projects under the EU4Health Programme, and €60 million under Horizon Europe. Two major projects have already been initiated on lung and prostate cancer (Solace and PRAISE-U). Further support can also be provided from the European regional, cohesion and social funds.
Urgent and sustained policy leadership and collaboration is crucial to strengthen cancer prevention and build efficiency in cancer care, aligning evidence-based policies, practices, technologies, data systems, organisational frameworks, and incentives. The implementation of cancer screening programmes represents one of the policies that can make a meaningful improvement to health outcomes across Europe.
[1] “Recommendation on strengthening prevention through early detection: A new EU approach on cancer screening replacing Council Recommendation 2003/878/EC”.
[2] https://ec.europa.eu/commission/presscorner/detail/en/ip_21_342
[3] Additional information is available in OECD country reports and in the ECIR data tool (data from 2019 for breast, cervical and colorectal screening).
[5] https://sapea.info/topic/cancer-screening/
[6] The SAPEA report states that there is ‘strong scientific evidence for adding low-dose lung cancer CT screening for current and ex-smokers’ and ‘good scientific evidence for organised, population-based, PSA-based prostate cancer screening, particularly in combination with additional MRI scanning as a follow-up test and the use of surveillance rather than immediate treatment’
[8] https://www.all-can.org/all-cans-definition-of-efficient-cancer-care/
[9] https://www.all-can.org/what-we-do/policy-research/building-efficiency-in-cancer-care/#panel-blueprint
[10] European Cancer Organisation. Time To Act: European Cancer Organisation calls for urgent action as one million cancer cases are undiagnosed in Europe due to Covid-19. 2021. Available at https://www.europeancancer.org/timetoact
