The European Commission presented its proposal
for revising the Council's recommendations covering early cancer detection on 20 September. These recommendations date back to 2003 and they have
to be updated. The knowledge accumulated over the last 20 years in terms of
methodology and technology is to be incorporated into the revision with the aim
of increasing participation rates in the established population-based early
detection screening programmes for breast, cervical and colorectal cancer. 90
per cent of eligible people should be offered corresponding screening by 2025.
This will be in line with the targets set in the European plan to fight cancer.
Programme update for breast, cervical and colorectal cancer
methods used and the group of beneficiaries will change somewhat with the
revised Council's recommendations. Breast cancer screening will then be for
women aged 45 to 74 years (today it's 50 to 69 years) using digital mammography
or tomosynthesis. In cervical screening, the examination for human papilloma
viruses will no longer be centred solely on young women between 20 and 30 years
of age as it will then cater for a significantly older age group (30 to 65
years) and it will also take their vaccination status into consideration. With
colorectal cancer screening, immunochemical stool tests will replace occult
blood tests and they will indicate who is to be referred for a subsequent colonoscopy.
New programmes for lung, prostate and stomach cancers
programmes will be gradually researched and developed in order to be able to
include more types of cancer. New screening procedures will only be established
as routine procedures once they have been evaluated in randomised controlled
studies and assessed with regard to their evidence. Subsequently, corresponding
guidelines for the quality assurance of early cancer detection screening
programmes will be developed so that they can be put into practice. A programme
for the early detection of lung cancer appears to be promising. The target
group are current and former smokers aged 50 to 75. Prostate screening based on
PSA examinations combined with supplementary MRI (Magnetic Resonance Imaging)
also appears auspicious. The target group here is: men up to the age of 70. Screening for
Helicobacter pylori is also being considered. This will be limited to regions
that have high incidence and mortality rates from stomach cancer.
DSV took a position on this in February of this
year as part of the exploratory
talks and also expressed an opinion about extending the screening approach to
other types of cancer.
Extending the population-based screening programmes to other types of
cancer seems justified only if there is sufficient
evidence of their benefits in terms of effectiveness, quality and safety as
well as a justified benefit-harm balance. There is support for lung cancer screening that is limited to
heavy smokers, as proposed by the European Commission. It also seems appropriate to limit
stomach cancer screening to regional areas.