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Brussels, 3 February 2011
Q&A: European guidelines for quality assurance in colorectal cancer screening and diagnosis
Today, the European Commission published new European guidelines on quality assurance in colorectal cancer screening. Similar guidelines have already been developed for breast and cervical cancer screening to promote safe, equitable, reliable and cost-effective services which maximise benefits to those attending screening whilst, at the same time, minimising adverse effects. The new EU Guidelines for colorectal screening and diagnosis will provide similar standards for colorectal screening. They provide guiding principles and evidence-based recommendations for quality assurance that should be followed when implementing screening in the Member States. Experience has shown that success of the screening exercise depends on the quality of the services provided at each step in the screening process.
What is the current burden of cancer in the EU?
Every year, around 2.5 million EU citizens are diagnosed with cancer, which is also the second most common cause of death in the EU.
The burden of cancer is increasing as the European population ages. In addition to the serious implications for health, cancer also represents a heavy economic burden on society.
Colorectal cancer is the second most common newly diagnosed cancer in the EU. It is the second most common cause of cancer death in the EU, accounting for one out of seven new cancers and one out of eight cancer deaths. Around 330 000 new cases and 150 000 deaths occur each year.
Why colorectal cancer screening?
Many deaths from colorectal cancer could be avoided through early detection, by making effective use of screening tests followed by appropriate treatment. Early treatment can be more effective and generally less detrimental for quality of life than later, when symptoms appear. Furthermore, treatment of pre-cancerous lesions detected in screening prevents the development of the disease by stopping it from progressing to cancer.
Why is the EU publishing such guidelines on colorectal cancer screening?
In December 2003, EU Health Ministers unanimously adopted a Council Recommendation on cancer screening which sets out principles of best practice in the early detection of cancer. Member States are invited to implement nationwide population-based screening programs for breast, cervical and colorectal cancer, with appropriate quality assurance. European Guidelines on screening are produced as benchmarks to assist the Member States to do this in the most effective way possible.
What is the recommended test and who is it for?
The faecal occult blood test (FOBT) for men and women aged 50–74 years is the recommended test for colorectal screening programmes in the EU. Currently over 135 million men and women in the EU are in the age range recommended for colorectal cancer screening. Although endoscopic screening methods are being used in some programmes, the vast majority of colorectal cancer screening performed in the EU uses the evidence-based test recommended by EU Health Ministers.
What is an organised, population-based screening programme?
Organised screening programmes are recommended because they include public health organisations responsible for programme implementation, quality assurance and evaluation. Population-based programmes generally require a high degree of organisation in order to identify and personally invite each person in the eligible target population. Personal invitation provides equal chances of benefiting from screening, thereby helping to reduce health inequalities.
Why is quality assurance so important?
Quality assurance in cancer screening is highly important due to the sheer number of people who do not have detectable cancer taking part in screening programmes. Only those with pre-cancerous lesions, or early cancer, can benefit directly from early detection. All others are exposed to the risks a screening test can entail – such as unnecessary examinations, treatment or anxiety resulting from false-positive screening tests. Although the risks of high-quality screening are slight, they must be kept to an absolute minimum and the benefits must be maximised.
European quality assurance guidelines for breast and cervical cancer screening have been developed by experts and published by the EU with the aim of promoting safe, equitable, reliable and cost-effective services which maximise benefits for those attending screening, whilst minimising adverse effects. The new EU Guidelines for colorectal screening and diagnosis now provide similar standards for colorectal screening.
How do you implement screening programmes in line with the Guidelines?
Setting up a screening programme which fulfils the principles and standards recommended in the EU guidelines requires careful preparation, with coordinated activities and decisions of the responsible authorities. This takes time - often successful implementation of such a programme nationwide may take 10 years or more.
The same high levels of quality must be achieved all over the country or region of the programme. Implementing the programme requires careful planning of each and every step in the screening process.
It begins with an invitation for each eligible person to be screened, and is followed up with testing and diagnosis and, where required, treatment of lesions detected and follow-up surveillance.
During the planning phase, studies should be carried out to check that the chosen approach to implementing the Guidelines is feasible. After adjusting the plans to fit the circumstances, piloting of the screening programme can begin. During the pilot phase, the quality and reliability of all parts of the programme (including training, documentation, monitoring and evaluation), are tested. Rollout of the programme to other regions of the country can begin once lessons have been learned from the pilot phase.
Throughout the entire process, the advice and assistance of experts familiar with the process in other countries are essential to avoid common pitfalls and unnecessary delays in achieving high quality.
Background on EU Action on Cancer
The Council of Ministers adopted a Recommendation on cancer screening in December 2003. Five years later, the European Commission issued a Report on the Implementation of this Recommendation on cancer screening revealing that further efforts were still needed to fully implement the Recommendation.
Furthermore, the European Partnership for Action Against Cancer was launched in September 2009 with the aim of supporting Member States in tackling cancer more efficiently. By the end of the Partnership, all Member States should have integrated cancer plans. This should contribute to achieving the long-term aim which is to reduce the incidence of cancer by 15% by 2020.
For further information
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