New EU Guidelines on Breast Cancer Screening and Diagnosis

What are the guidelines?

The European guidelines are a benchmark for quality assurance in breast cancer screening and diagnosis across Europe. They are a manual for health professionals and advocates everywhere, describing best practice evolving from regional and national breast cancer screening programmes based on mammography.

What is breast cancer screening?

Breast cancer screening aims to reduce the numbers of women dying from the disease. Screening is a method of detecting breast cancer at a very early stage, usually at least three years before symptoms would be noticed by the woman. Treatment undertaken at this time is frequently more effective. The first step in screening involves two x-rays of each breast - a mammogram - which is taken while carefully compressing the breast. The mammogram can detect small changes in breast tissue which may indicate cancers which are too small to be felt either by the woman herself or by a doctor. The process requires trained and experienced professionals using up-to-date and specialised equipment. The EU guidelines stipulate, for instance, that free, high quality breast screening should be provided every two years for women aged 50 and over.

Who produces the guidelines?

The guidelines have been developed by the European Breast Cancer Network (EBCN), which was co-financed under the Commission’s Europe against Cancer Programme in 2002. Through the EBCN over 200 scientists, breast cancer specialists, client and patient advocates and other health professionals have contributed to the guidelines. These contributions have come from 18 Member States (the pre-Enlargement 15 Member States, plus Cyprus, Hungary, and Poland), as well as Canada, Israel, Norway, Switzerland and the United States.

Who uses them?

The previous editions of the guidelines have been used as a reference manual by breast cancer professionals and medical practitioners throughout the EU. Advocacy groups also use them to encourage national governments and authorities to improve standards. The last edition of the guidelines was among the top 10 best selling books of the EU bookshop.

What is new in the latest edition?

New chapters in the current fourth edition deal with recent developments in communication in screening, the technical aspects of digital mammography, certification of diagnostic and screening units, multidisciplinary diagnosis, and specialist breast units.

The new chapters and major changes were discussed and approved by the EBCN at its annual meeting of 22-23 September 2005 in Budapest. It is hoped that the new edition will have a significant impact, particularly in raising standards in early detection and diagnosis of breast cancer, as preconditions for effective treatment. According to 2003 statistics from the European Network of Cancer Registries (ENCR), it is estimated that some 32,000 European deaths from breast cancer could be prevented annually if best practice for mammography screening were adopted across the EU.

What has the EU done to mark the new edition?

On World Breast Cancer Day (18 October 2005), the European Commission handed the draft of the guidelines to the European Parliament Breast Cancer Inter Group. The EP group also opened an exhibition on breast cancer on this day, and the Parliament was lit up in pink to pay tribute to breast cancer victims everywhere.

When were the previous editions produced and what impact did they have?

The first edition of the EU guidelines appeared in 1993, followed by updated and expanded editions in 1996, 2001 and now in 2006. The standards of technical quality control set out in previous editions had a profound impact on the quality of mammography equipment and imaging throughout the European Union. A number of Member States implemented or expanded regional or national mammography screening programmes based on the quality standards and recommendations in the guidelines, benefiting thousands of women across the EU. Statistics of the impact of the previous editions are currently being gathered and will be presented in a Commission Communication to be ready by December 2007, (see below).

How many women in the EU develop and die from breast cancer?

Breast cancer is the most frequent cancer in women worldwide. It is responsible for 26.5% of all new cancer cases and 17.5% of cancer deaths among women in Europe. In the enlarged EU, there are around 270,000 new cases of breast cancer each year and 96,000 cancer deaths. Breast cancer prevalence is rising in the EU due to increasing age, and shows no signs of stopping.

What was the Commission’s ‘Europe Against Cancer’ programme?

From 1987-2002, the Commission ran the ‘Europe Against Cancer’ programme, which provided a funding stream for many prevention and public health initiatives. Its last funding cycle ran from 1996 to 2002 with a budget of €90.4 million. Some of the main outcomes of the programme include;

The development of a world-class database on cancer incidence, mortality, prevalence and survival;
The creation of a European Code against Cancer (www.cancercode.org), which had its final revision in 2003. Through Commission and Member States’ partnership in pursuing the public health approach set out in the Code 92,000 cancer deaths were avoided each year in the former EU-15.[1]
Health promotion actions on smoking prevention among young people (a predecessor to the HELP campaign);
Recommendations on screening
Guidelines on training standards for healthcare professionals.

What is the Directorate General for Health and Consumer Protection doing on cancer today?

Projects and campaigns

Through its Public Health Action Plan for 2003-2008 (with an annual budget of €58.9m), the Directorate-General for Health and Consumer Protection supports the work of the European Cancer Network (ECN), and the European Network for Information on Cancer in Europe (EUNICE), through which the Commission endeavours to take forward the Council Recommendation on cancer screening (see below). The European Code against Cancer is further taken forward by other actions, such as promotion of healthy lifestyles, and support to the European Network on Smoking Prevention (ENSP).
The Commission’s new ‘HELP’ campaign against tobacco is investing €72 million into helping citizens avoid or stop smoking – a habit which accounts for over 650,000 deaths in the EU each year.
In addition, the Commission is working continually to encourage the coordination and communication of health data amongst Member states, as information is key to improvement in cancer control. One initiative which could be highlighted is the EU Health Portal, which will be launched in May and will serve as a single access point to EU health related information, with links to all Member States.

Legislation

In December 2003, the Council issued recommendations on high quality cancer screening for the EU[2], stipulating the need to follow EU-wide benchmarks for breast, cervical and colorectal screening, whenever they are available. The Council asked the Commission to report on progress in taking forward these recommendations. The Commission is therefore preparing a Communication, with input from the ECN and the Member States, for December 2007. The Commission is also preparing guidelines for cervical cancer screening to be issued later in 2006, while guidelines for colorectal cancer screening should be produced by 2009.

Where can I find out more?

Over 4,000 copies of the full guideline document will be published by the "Office for Official Publications of the European Communities" and will be available from mid-April. (Copies may be ordered from http://bookshop.europa.eu; ISBN: 92-79-01258-4; Catalogue number: ND-73-06-954-EN-C).
An executive summary of the document is available from the bookshop website: http://bookshop.europa.eu
DG Health and Consumer Protection’s web pages on the Public Health Action Plan 2003-2008: http://ec.europa.eu/health/ph_programme/programme_en.htm

[Graphic in PDF & Word format]

[1] “Measuring progress against cancer in Europe: has the 15% decline targeted for 2000 come about?” P. Boyle et al. Annals of Oncology 14:1312-1325, 2003
[2] Council Recommendation of 2 December 2003 on cancer screening (20003/878/EC)