Cancer screening is primarily a matter of the Member States

The Employment, Social Policy, Health and Consumer Affairs Council (EPSCO) adopted the new Council Recommendations on Cancer Screening on 9 December. This gives the European Union (EU) a new framework for the systematic detaction for early stage cancers. The recommendation is not legally binding.

In five EPSCO meetings, the European Commission's proposal text has been finalised. The amendments relate both to the proposals to develop the established programmes on breast, colorectal and cervical cancer and to transfer the screening approach to other cancers such as prostate, lung and stomach cancer. What the ministers adopted in EPSCO, with explicit reference to Article 168, paragraph 7 Treaty on the Functioning of the European Union (TFEU) and their competence now leans more towards what is practially feasible.

Major differences in cancer screening

This is because the Member States are at different stages of implementation of organised cancer screening. Population-based cancer screening programmes have neither been introduced nor fully implemented in all Member States in 2020. There are also great inequalities. For example, target group coverage for breast cancer screening varied between 6 and 90 per cent and for cervical cancer screening between about 25 and 80 per cent. This can be read in Europe’s Beating Cancer Plan.

Considering available resources

Against this backdrop, negotiations have been hard-fought over the target called for in the Beating Cancer Plan of offering screening to at least 90 per cent of the target population for breast, colorectal and cervical cancer by 2025. In the end, it was nevertheless reflected in the Council recommendations. However, with regard to the monitoring of their implementation, Member States have made it clear that this can only be done taking into account capacities as well as financial and human resources. Healthcare systems should not be unnecessarily burdened with bureaucracy.

Checking cost-effectiveness by Member States

Furthermore, the cost-benefit ratio of any programme must be balanced. The Member States have emphasised that cost-benefit assessment must be carried out as an integral part of the implementation of screening programmes at the national level. This would depend on a number of factors, besides the epidemiology, also on the organisation and implementation of the programmes as well as a sufficiently high participation of the target group. In the implementation, the available diagnostic, treatment and aftercare services should also be taken into account.

European Commission not entirely satisfied

The European Commission has welcomed in principle the adoption of the Council Recommendations on cancer screening. But it would have liked more. In a protocol note , it criticises the fact that the scope of recommended preventive medical check-ups has been restricted by the Member States. In particular, it would have been better to retain the wider age range for breast cancer screening and the reference to the level of effectiveness of lung and prostate cancer screening. However, Member States could only agree to recommend the applicable age range for women from 50 to 69 years of age for breast cancer screening tests. The Member States are of the opinion that the necessary evidence is limited for the effectiveness of screening for lung and prostate cancer and, in certain circumstances, for stomach cancer.