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Transcript of International Agency for Research on Cancer Lyon, France National Centre for Screening Monitoring...
International Agency for Research on Cancer
Lyon, France
National Centre for Screening Monitoring andItalian Colorectal Cancer Screening Group
European Guidelines Workshop
Colorectal Cancer Screening in Europe
Lawrence von KarsaQuality Assurance Group
Section of Early Detection and Prevention
Overview topics
1. Collaborative effort in developing the EU CRC screening Guidelines
2. CRC screening programmes in Europe
3. Future directions in colorectal cancer screening in Europe and worldwide.
THE COUNCIL OF THE EUROPEAN UNIONRecommendation on Cancer Screening of
2 December 2003
1. Implementation of cancer screening programmes
(a) Offer evidence-based cancer screening through a systematic population-based approach with quality assurance at all appropriate levels. The tests which should be considered in this context are listed in the Annex;
(b) Implement screening programmes in accordance with European guidelines on best practice where they exist and facilitate the further development of best practice for high quality cancer screening programmes on a national and, where appropriate, regional level;
EU CRC Screening GuidelinesLiterature group leadChapter lead authors
Silvia Minozzi Literature Group
Iris Vogelaar Introduction
Nea Mallila Organisation
Sue Moss Evaluation
Stephen HalloranFaecal occult blood testing
Roland Valori Endoscopy
Phil Quirke Pathology
Wendy Atkin Surveillance
Joan Austoker Communication
Robert Steele Training and management of lesions detected in screening
EU CRC Screening Guidelines
Italian experts
Editor (Methodology, Public Health, Chs 1-3, 10): Nereo Segnan
Literature group: Silvia Minozzi, Paola Armaroli, Rita Banzi,Cristina Bellisario Carlo Senore, Luca Vignatelli, Nereo Segnan
Authors: (Ch 2) Carlo Senore, Paola Armaroli (Ch 4) Marco Zappa, (Ch 5) Carlo Senore, Giorgio Minoli (Ch7) Mauro Risio (Ch 8) Giorgio Minoli (Ch 9) Carlo Senore, Nereo Segnan (Ch 10) Livia GiordanoLivia Giordano
Reviewer: (Ch 6) Guido Costamagna
Colorectal Cancer Screening Programmes in the EU 1/2011
Population-based
FOBT/FS-based
FOBT/CS-based
CS-basedItaly
Poland
AustriaBelgiumCyprusCzech Rep.DenmarkGermanyGreeceSlovak Rep.
BulgariaFranceFinlandHungaryIrelandLatviaLithuania MaltaNetherlands PortugalRomaniaSloveniaSpainSwedenUK
No programme
FOBT-based
Non population-based
EstoniaLuxembourg
Belgium *CyprusDenmark*FinlandFrance*HungaryIreland*ItalyLithuania*Malta*Netherlands* Portugal*RomaniaSlovenia*Spain*Sweden*UK*
AustriaBulgariaCzech Rep.*GermanyGreeceLatviaPolandSlovak Rep.
No programmeEstoniaLuxembourg
Sources:Karsa, Anttila, Ronco et al. 2008,European Commission, IARC, ECN and EUNICE;IDCA/IARC/UEGF Survey 11/2009-2011
Financial supportof EU Public Health Programme
THE COUNCIL OF THE EUROPEAN UNIONRecommendation on Cancer Screening of
2 December 2003
HEREBY INVITES THE COMMISSION:7. To report on the implementation of cancer screening
programmes, on the basis of the information provided by Member States, not later than the end of the fourth year after the date of adoption of this Recommendation, to consider the extent to which the proposed measures are working effectively, and to consider the need for further action.
ANNEX:• pap smear screening for cervical cancer precursors starting
not before the age of 20 and not later than the age of 30;• mammography screening for breast cancer in women aged
50 to 69 in accordance with European guidelines on quality assurance in mammography;
• faecal occult blood screening for colorectal cancer in men and women aged 50 to 74.
Future directions in colorectal cancer screening
Implementing the EU Guidelines
• Technical and scientific support
Regional funds
European Schools of Screening Management
External QA schemes
• Pan-European collaboration in
Monitoring and evaluation
Accreditation
Future directions in colorectal cancer screening
Systematic updating of the EU Guidelines and the annex of recommended evidence-based screening tests in the Council Recommendation with special attention to:
• Screening by flexible sigmoidoscopy
• CT colonography in assessment
• Nurse practitioners
• Family risk (evidence)
Research Agenda Evaluation of screening protocols with different
testing options (eg FOBT and/or FS or CS; newer technologies, etc.)
Linkage of screening data and cancer registry data in routine monitoring
Impact of screening on symptomatic care
Testing surveillance protocols for CRC screening
Integrating effective primary and secondary prevention interventions control of colorectal cancer
Improving the process of programme implementation
Economic impact of population-based screening
Estimated proportion of breast, cervix and colorectal cancer deaths worldwide (left) and in the EU-27
(right) in 2008.
Source: Ferlay J et al. (2010), GLOBOCAN 2008, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10 [Internet]. IARC, Lyon,France
Sequence of Steps in Quality-controlled
Implementation of Screening Programmes*
1. Comprehensive planning of screening process: feasibility of screening models, professional performance, organisation and financing, quality assurance (QA)
2. Preparation of all components of screening process to perform at requisite high level (including feasibility testing)
3. Expert verification of adequacy of preparations
4. Piloting and modification, if necessary, of all screening systems and components, including QA, in routine settings
5. Expert verification of adequacy of pilot performance
6. Transition of pilot to service screening and geographicallyphased programme rollout in other regions of the country
7. Intensive monitoring of programme rollout for early detectionand correction of quality problems *Source: L. von Karsa, Quality Assurance
Group, Prevention and Early Detection Section, International Agency for Research on Cancer
Programme implementation - Key requirements
Involvement of civil society• Engagement in discussion of benefits and harm of
screening Cancer registration
• Accurate assessment of cancer burden for effective monitoring and evaluation
Good governance• Long-term political commitment• Adequate, sustainable resources• Competent oversight (standards)
Autonomous programme management• Coordination of numerous stakeholders and activities• Organisational development• Control of resources (dedicated budget and staff)
International collaboration*Source: L. von Karsa, Quality Assurance Group, Prevention and Early Detection Section, International Agency for Research on Cancer
Thank you for your attention