Work Package 6 Screening and Early Detection European Partnership for Action Against Cancer SC Meeting, Brussels 8.December 2010 Work Package 6 Screening and Early Detection Package Leader: Ahti Anttila, Finnish Cancer Registry, Helsinki Package Co-leader, Focal point & Technical Support: Dr Lawrence von Karsa & Maria Fernan, IARC, Lyon Associated Partners (7): FCR / FCS: Finnish Cancer Registry / Finnish Cancer Society NEN: Netherlands Standards Organization CSISP: Centro Superior de Investigación en Salud Pública, Valencia VAZG: Flemish Agency on Care and Health SEF: NHS Sefton AOSGB&CPO: San Giovanni Battista University Hospital of Turin CPO IOL: Institute of Oncology, Ljubljana

WP6 Collaborating partners (37) WHO: World Health Organization HQ WHO: World Health Organization EURO, Denmark IARC: International Agency for Research on Cancer German National Association of Statutory Health Insurance Physicians, Germany EUGF: United European Gastroenterology Federation, Ireland VWS: Netherlands Ministry of Health, Welfare and Sport / RIVM, the Netherlands ESPEN: European Society of Clinical Nutrition and Metabolism, United Kingdom English Department of Health, United Kingdom National Cancer Screening Service, Ireland (CEO), Ireland Spanish Cancer Screening Network , Spain Servei d’Avaluació i Epidemiologia Clínica, Spain Public Association for Healthy People, Hungary Malta National Breast Screening Centre (Ministry of Health, the Elderly and Community Care), Malta Malta Breast Screening Centre, (Ministry of Health, the Elderly and Community Care), Malta LRCB University of Neijmegen, the Netherlands CANEPID: Division of Epidemiology & Cancer Prevention, Cancer Center & Institute of Oncology, Poland Institutul Oncologic "I.Chiricuta" , Romania Karolinska University Hospital, Stockholm Cancer Screening Program, Sweden University of Oxford, United Kingdom EDMA: European Diagnostic Manufacturers Association, Belgium ELPA: European Liver Patients Association, Belgium ECCO: European Cancer Organization, Belgium ECL: European Cancer Leagues, Belgiu, INCa: Institut National du Cancer, France Aprémas (Coordinating Center for Cancer Screening), France European Institute of Women's Health, Ireland Europa Uomo, Italy Instituto Tumori, Milan, Italy Ministry of Health, Italy Cancerworld, European School of Oncology, Italy Ministry of Health, Portugal Institute of Oncology, Barcelona, Spain Europacolon, United Kingdom ECPC: European Cancer Patient Coalition, United Kingdom Lynn's Bowel Cancer Movement, United Kingdom Department of Diagnostic Radiology, University of Turku, Finland National Health Information Centre, Slovakia

Rationale: cancer screening Improved implementation of the Council Recommendation on Cancer Screening continuously needed; included capacity building, evidence-based implementation modalities, and monitoring and evaluation To be made accessible to all citizens who may benefit

CERVICAL Cancer Screening Programme Implementation in the EU Estimated targeted proportion of 30-60-year-old women in the EU by programme type and implementation status of Member States in 2007 2% Excluded <1% no prog. Population-based Non population-based nationwide 47% 41 nationwide 7 regional 22% 29% Rollout complete Rollout ongoing 20% Nationwide Planning / Piloting 7% Nationwide Regional 2% Karsa et al., 2008

Estimated number of Persons attending Breast, Cervical and CRC Screening Programmes in the EU by Target Cancer and Programme Type in 2007 Estimates corrected for programmes in rollout phase and for missing data in Austria, Latvia, Greece, and Slovak Republic (all programmes) and in Denmark, France and Spain for cervical screening; and in Bulgaria for CRC screening. Karsa et al., 2008

Rationale: early detection Further added value will be created by promoting synergy between cancer screening and other areas of early detection Health checks and periodic health examinations can range from early diagnosis to life style and primary prevention; dealing also with many other chronic diseases and health risks than cancer For many of the health checks, the evidence base is lacking; and many other long established quality criteria for screening are not met aspects pertaining to early detection and prevention of cancer

Work Package 6 Screening and Early Detection The main aims Improving screening programme implementation Reducing inequalities in screening Regional workshops Exchange of experience and initial consensus on quality criteria for health checks

ESSM (A.Anttila, FCR/FCS) (1) Planning and initiation of a network of European Schools of Screening Management (ESSM) dedicated to capacity building for implementation and improvement of population-based cancer screening programmes A two-week course curriculum will be developed by experts from key universities and research institutes and from internationally recognized centres of excellence in primary and secondary prevention of cancer. The course will be piloted in 2012

ESSM (FCR/FCS) (2) The planning within the ESSM process include a full audit of one regional or national cervical cancer screening programme The course will be piloted by training at least 15 competitively selected participants from national and regional screening management units. A criterium of selection will be the likelihood that the participant will constructively work on implementation or improvement of cancer screening programmes in the next few years This, along with piloting of population-based programmes and with networking in order to develop certification in the framework within the ECN, will promote sustainability of the results

Inequalities (R.Peiro & D.Salas, CSISP, Valencia) The literature of inequalities in participation and compliance in screening programmes will be reviewed A survey addressed to the national or regional screening managers will focus on two main dimensions: collection of data suitable to describing and analyzing the existence of inequalities related to related to screening compliance and what kind of interventions have developed to reduce inequalities

Regions (S.Wallyn, VAZG; C.White, SEF; EUREGHA) To support regions seeking to implement or improve cancer screening programmes as recommended by the Council of the EU, workshops will be held in the UK, Belgium and Italy The workshops will bring screening experts across the EU together with regional stakeholders and responsible authorities. The focus will be on best practices, raising awareness and the obstacles to implementation

Quality criteria for health checks (M.Bijlsma, NEN, The Netherlands) For the health checks, the experience emerged in the Netherlands in developing quality criteria for health checks will be exchanged with other member states and initial consensus on pan-European quality criteria for health checks will be developed This aims to develop a coherent strategy to improve and maintain quality of such services - without recommending premature actions which, for lack of evidence, may be counterproductive

Further collaborations The WP will establish links with the European Science Advisory Network for Health, European Network for Health Technology Assessment, and with the European Network on Cancer Screening and Prevention Programmes and will create new platforms for collaborations

About the activities and deliverables Meetings, audio/teleconferences and networking among partners, collaborating partners, stakeholders, ministries and other authorities, and experts Pilot the first European course on Screening Management Seven reports/surveys [D04-D13]

Planned activities in the first year… Kick-off teleconferences and meetings, establishing the teams, recruit experts, start networking ESSM: start activities of the School with the partners Plan, perform and report of a full audit of one regional screening programme Plan the first international course Inequalities: Accomplish the literature review Regions: First regional workshop Quality criteria for health checks A report on the Dutch criteria Survey on the European level