Improved cancer screening programmes are set to be rolled out across Europe thanks to an EU-funded project that is deploying new tools and techniques to help healthcare systems optimise preventive care, reduce costs and save lives.


© Markus Mainka #101183812 source: 2020

Together, breast, cervical and colorectal cancer are responsible for around 250 000 deaths in the EU every year, accounting for approximately 20 % of all cancer deaths. Diagnosing cancer, while it is still in the early stages, offers the best chance of a person making a full recovery. However, screening programmes vary greatly between countries and even between different populations within countries.

‘These substantial differences may result in inappropriate interventions, excessive screening and over-treatment on the one hand, or under-screening and delayed provision of appropriate treatment on the other,’ says EU-TOPIA project coordinator Harry de Koning of the Erasmus Medical Centre in the Netherlands.

The EU-funded EU-TOPIA project has given all EU Member States the capacity to evaluate the performance of public breast, cervical and colorectal cancer-screening programmes. Policymakers and health authorities can now assess the benefits, cost effectiveness, risks and disadvantages of their programmes and, most importantly, share and adopt improved strategies based on international best practices.

‘This has been a unique and very ambitious project by the end of which many European countries will have their own country-specific roadmaps for actions that will lead to more effective, organised cancer screening. This project is a first, very much needed step towards better healthcare and cost-effective use of healthcare resources,’ de Koning says.

The improved screening programmes expected to emerge from EU-TOPIA have the potential to impact the health and quality of life of millions of Europeans.

The EU-TOPIA researchers have identified countries that screen millions of people too often, given the natural growth rate of some cancer types, such as cervical cancer, which develops much more slowly than breast cancer. A change in policy toward risk-based screening, by using a longer screening interval, would not only lower costs but also minimise the risk of false positive results and reduce anxiety for patients, without affecting quality of care.

On the other hand, some countries still have no screening programmes in place despite EU Council recommendations published in 2003, especially for colorectal cancer, resulting in tens of thousands of cancers not being diagnosed until much more dangerous later stages.

Optimised strategies to save lives

‘A preliminary analysis illustrates that breast cancer screening in Europe has already had a substantial impact by preventing nearly 21 700 breast cancer deaths per year. Through introducing a hypothetical 100 % coverage of screening in target age groups, the number of breast cancer deaths among European women could be further reduced by almost 12 500 per year,’ De Koning says.

By first evaluating the characteristics of different cancer-screening programmes across all EU countries and quantifying their outcomes, the EU-TOPIA partners have been able to identify ways to optimise screening approaches, taking into account country-specific differences, challenges and stakeholders.

The project developed and deployed five tools to enable countries to self-evaluate breast, cervical and colorectal cancer-screening programmes. These include solutions to monitor screening-programme performance, and assess cost-effectiveness, citizen participation and barriers to change, as well as a tool to develop policy roadmaps to implement improvements. The tools have been presented in four workshops attended by researchers, programme coordinators, healthcare providers and policymakers from across Europe.

‘Until now, there was no quantified estimate of the advantages and disadvantages of existing programmes, but such estimates are crucial for policymakers, healthcare providers and citizens themselves,’ De Koning explains. ‘Since almost all EU countries participated in the workshops and deployed the tools we have built capacity to improve screening programmes across Europe. We have also built up an international network to share knowledge and best practices. This will further help improve health outcomes for European citizens, increase cost-effectiveness and ensure greater equality by making the programmes more accessible to more people.’

The EU-TOPIA partners now plan to expand their approach to address screening programmes for other diseases, including lung, prostate and gastric cancers. This will start with a new EU-funded project, 4-IN-THE-LUNG RUN, which will implement novel lung cancer screening techniques in several European countries.