Written by 1:56 pm EU Investment

Commission proposes updated cancer screening recommendations – EURACTIV.com

Health commissioner Stella Kyriakides presented a proposal for an update to the two-decade-old EU Council recommendation on cancer screening on Tuesday (20 September), with the aim of including more cancer types in national screening programmes.

The proposal includes prostate, lung and gastric cancer testing in the recommendation, in addition to adjustments to the already existing recommendations on breast, colorectal and cervical cancer testing.

“We aim to ensure that we deliver on our ambitious commitment under the Cancer plan to ensure that 90% of people in the EU who qualify for breast, cervical and colorectal screenings are offered such screening by 2025,” Kyriakides said during the presentation.

“We are proposing a step-by-step approach […] With these updates, we are covering six cancer sites that together account for almost 55% of all new cancer estimated to be diagnosed in the EU every year and which causes over 50% of deaths related to cancer,” the health commissioner added.

Concretely, the proposal suggests that breast cancer screening should be expanded to include women aged 45 to 74 and that magnetic resonance imaging (MRI) should be offered for those with very dense breasts.

For cervical cancer, the Commission proposes a change from PAP smear screening to Human Papillomavirus (HPV) testing instead, which should be offered every five years or more to women aged 30 to 65.

To improve testing for colorectal cancer, they suggest triage testing in people aged 50-74 through faecal immunochemical testing to determine whether to follow up by performing a colonoscopy.

For the newly included cancer types, lung cancer screening should be offered to ex-smokers and current heavy smokers between 50-75 years of age.

The Commission also recommends prostate-specific antigen testing for prostate cancer in men up to 70 years old available with MRI for follow-up. Lastly, they suggest screening for gastric cancer be made available in places with high incidence and mortality.

According to Kyriakides, 1.3 million EU citizens lost their lives to cancer in 2020, which is almost three times as many who died from COVID-19 during the same year.

She stressed that the COVID-19 pandemic has made action even more urgent, as the response and restrictions seriously affected cancer screening programmes.

“An estimated 100 million cancer screening tests were not performed in Europe during the pandemic,” Kyriakides said, warning that “cancer will become the leading cause of death in the EU by 2035” if we do not take action now.

EU member states are expected to adopt the new EU Council Recommendation by December 2022.

Health Brief: Nipping cancer in the bud

Updating the 2003 Council recommendation on cancer screening is a high priority for the current Czech EU Presidency, which is hoping to see results on more preventative actions to reduce the occurrence of Europe’s second-worst killer.

Will require investments

Implementing new cancer screening programmes will of course require investments from the EU member states.

During the unveiling of the proposal, Kyriakides said that €100 million will be made available from the ambitious EU4Health programme set in response to the COVID-19 pandemic and the research budget Horizon Europe to be spent on different actions for screening.

She also promised a proposal for additional funding under the 2023 EU4Health programme.

On top of that, member states will be able to use funds under the Cohesion Policy — the Regional Development Fund and European Social Fund Plus specifically — to help finance investments.

“Cancer screening saves lives. We can speak of cure following early detection. It is additionally an investment as will it lead to lower health costs,” Kyriakides said.

Stakeholders: positive development

The initial reactions from stakeholders towards the suggested update of the recommendations were largely positive.

“Since 2003, the world of screening and early detection has advanced considerably. This includes targeting more cancers, the introduction of new technologies and practices, and the improvement of validated risk prediction models in cancer screening,” said Isabel Rubio, co-chair of the European Cancer Organisation’s Prevention, Early Detection and Screening Network.

“It is welcome news that new recommendations to the EU member states reflect these changes and encourage all countries to bring their cancer screening approaches up to date with the latest evidence. The challenge now is ensuring a robust implementation and monitoring framework to turn words into action,” she added.

Some, however, remain sceptical of what Kyriakides called a “step-by-step” approach as it could potentially be used as a loophole for delaying the introduction of screening.

“If we are to take a ‘step-wise approach’ to screening, they need to be big steps. We hope that evidence-based medicine and investment in health systems are the main drivers to implementation of lung cancer screening and bureaucratic hurdles embedded in this recommendation do not impede the introduction of this life-saving measure,” said the president of the European Respiratory Society, Carlos Robalo.

[Edited by Gerardo Fortuna/Nathalie Weatherald]

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