Early cancer detection through screening programmes is to be modernised and expanded

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

The 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

New 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.