Cancer is responsible for more than one in four deaths in Europe, and screening is an essential tool in preventing cancer. In this Recommendation, the Council calls on Member States to implement effective screening programmes with a good scientific basis.
Council Recommendation of 2 December 2003 on cancer screening [Official Journal L 327 of 16.12.2003].
This Recommendation sets out guidelines for best practice in the early detection of breast, colorectal and cervical cancers. It recommends implementing effective and high-quality screening programmes involving the following screening tests:
- mammography screening for breast cancer in women aged 50 to 69;
- faecal occult blood screening for colorectal cancer in men and women aged 50 to 74;
- pap smear screening for cervical abnormalities from the ages of 20 to 30.
Implementation of cancer screening programmes
With regard to the implementation of screening programmes, the Council recommends that Member States:
- offer evidence-based cancer screening through a systematic population-based approach with quality assurance at all appropriate levels;
- implement screening programmes in accordance with European guidelines on best practice and facilitate the further development of best practice for high-quality cancer screening programmes at national and, where appropriate, regional levels;
- ensure that the people participating in a screening programme are fully informed about the benefits and risks;
- ensure that appropriate complementary diagnostic procedures, treatment, psychological support and after-care are provided for those with a positive screening test;
- make available human and financial resources in order to assure appropriate organisation and quality control;
- take decisions on the implementation of a cancer screening programme nationally or regionally depending on the burden the disease represents, the resources available, the side effects and cost-effectiveness of screening, and experience from scientific trials and pilot projects;
- set up a systematic call/recall system, together with an effective and appropriate diagnosis, treatment and after-care service;
- ensure that due regard is paid to data protection legislation, particularly as it applies to personal health data.
Registration and management of screening data
With regard to the registration and management of screening data, Member States are called upon to:
- make available the data systems needed to run the screening programmes;
- ensure that all persons targeted by the screening programme are invited, by means of a call/recall system, to take part in the programme;
- collect, manage and evaluate data on all screening tests, assessments and diagnoses in accordance with relevant legislation on data protection;
- collect, manage and evaluate data in full compliance with the relevant legislation on the protection of personal data.
Monitoring and training
Member States are requested to monitor regularly the process and outcome of organised screening and report these results quickly to the public and the personnel providing the screening. Appropriate training of personnel is also recommended to ensure that they are able to deliver high-quality screening.
The Council recommends that Member States seek a high level of compliance, based on fully informed consent, when screening is offered. The Council also advocates action to ensure equal access to screening, taking account of the possible need to target particular socioeconomic groups.
Introduction of novel screening tests taking into account international research results
Member States are encouraged to:
- implement new cancer screening tests in routine healthcare only after they have been evaluated in randomised controlled trials;
- run trials on subsequent treatment procedures, clinical outcome, side effects, morbidity and quality of life;
- assess level of evidence concerning effects of new methods by pooling trial results from representative settings;
- consider the introduction into routine healthcare of screening tests which are currently being evaluated, provided the evidence is conclusive;
consider the introduction into routine healthcare of potentially promising new modifications of established screening tests, once the effectiveness of the modification has been successfully evaluated, possibly using other epidemiologically validated surrogate endpoints.
Background: cancer in Europe
Cancer is an enormous burden on European society, given that one person in three develops the disease during their lifetime, which is approximately equivalent to 3.2 million European citizens every year. After circulatory disease, cancer was the second cause of death in 2006, accounting for two out of ten deaths in women (approximately 554 000 women) and three out of ten deaths in men (approximately 698 000 men). The health strategy (2008 - 2013) highlights the importance of Community action in sectors such as cancer which provides considerable added value to counter the main health challenges more effectively, thanks to the sharing of information and the exchange of expertise and good practice as demonstrated by the various ‘Europe against cancer’ programmes (from 1987 to 1989, 1990 to 1994 and 1996 to 2002). In order to continue those efforts, the Commission intends to create a European action partnership against cancer during the second half of 2009 in order to unite the stakeholders involved throughout the Union in a collective effort against cancer. This partnership will support Member States in combating cancer more effectively. The target areas for future activities on cancer will include: health information, collection and analysis of comparative data; primary prevention, identification and promotion of good cancer care practices and the priorities for cancer research.
Report from the Commission to the Council, the European Parliament, the Economic and Social Committee and the Committee of the Regions – Implementation of the Council Recommendation of 2 December 2003 on cancer screening (2003/878/EC) [COM(2008) 882 final– Not published in the Official Journal].
This Report is the first assessment of the implementation of Recommendation 2003/878/EC. It is based on:
- the results of a survey of Member States in the second half of 2007;
- information from the European Cancer Network and the European Network for Information on Cancer;
- population statistics obtained from the European Statistical System or national sources.
The Council Recommendation of 2 December 2003 set out six priorities to be implemented by Member States. This Report gives a positive assessment of the implementation of those six priorities. Most of the measures have been implemented satisfactorily. Efforts remain to be made in the field of cancer screening. In this perspective, the European Commission intends to set up a partnership for action against cancer in 2009.
The first point relating to the establishment of screening programmes is reported to be followed by at least 2/3 of the Member States;
The second point relating to the quality of screening programmes is reported to be followed by a large proportion of the Member States;
The third point establishing the necessary basis for quality assurance of screening programmes is followed by only 55% of the Member States;
The fourth point highlighting the importance of training of healthcare staff is a success, in that 20 out of Member States report that screening programme personnel is adequately trained;
The fifth point intended to promote equal access to screening is also largely followed;
The sixth and final point recommending the implementation of novel forms of screening still shows a number of shortcomings, in that only 50% of Member States report adherence. The Report underlines the importance of prevention and the exchange of good practice with a view to controlling and preventing cancer at European level (particularly colorectal, breast and cervical cancer).
Further information on the European Commission public health website