European Code against Cancer, 4th Edition: Cancer screening

Abstract

In order to update the previous version of the European Code against Cancer and formulate evidence-based recommendations, a systematic search of the literature was performed according to the methodology agreed by the Code Working Groups. Based on the review, the 4th edition of the European Code against Cancer recommends: "Take part in organized cancer screening programmes for: Bowel cancer (men and women); Breast cancer (women); Cervical cancer (women)." Organized screening programs are preferable because they provide better conditions to ensure that the Guidelines for Quality Assurance in Screening are followed in order to achieve the greatest benefit with the least harm. Screening is recommended only for those cancers where a demonstrated life-saving effect substantially outweighs the potential harm of examining very large numbers of people who may otherwise never have, or suffer from, these cancers, and when an adequate quality of the screening is achieved. EU citizens are recommended to participate in cancer screening each time an invitation from the national or regional screening program is received and after having read the information materials provided and carefully considered the potential benefits and harms of screening. Screening programs in the European Union vary with respect to the age groups invited and to the interval between invitations, depending on each country's cancer burden, local resources, and the type of screening test used For colorectal cancer, most programs in the EU invite men and women starting at the age of 50-60 years, and from then on every 2 years if the screening test is the guaiac-based fecal occult blood test or fecal immunochemical test, or every 10 years or more if the screening test is flexible sigmoidoscopy or total colonoscopy. Most programs continue sending invitations to screening up to the age of 70-75 years. For breast cancer, most programs in the EU invite women starting at the age of 50 years, and not before the age of 40 years, and from then on every 2 years until the age of 70-75 years. For cervical cancer, if cytology (Pap) testing is used for screening, most programs in the EU invite women starting at the age of 25-30 years and from then on every 3 or 5 years. If human papillomavirus testing is used for screening, most women are invited starting at the age of 35 years (usually not before age 30 years) and from then on every 5 years or more. Irrespective of the test used, women continue participating in screening until the age of 60 or 65 years, and continue beyond this age unless the most recent test results are normal.

Status of implementation and organization of cancer screening in The European Union Member States—Summary results from the second European screening report

“…2,3 The EU Council in a series of recommendations published in 2003, urged the Member States to introduce or scale up breast, cervical and colorectal cancer screening through systematic population-based approach with quality assurance at all levels. 4 The first report on the implementation of the Council recommendations prepared by the International Agency for Research on Cancer (IARC) concluded that the number of individuals having access to population-based screening in the year 2007 was much lower than the desired level and substantial opportunistic screening was ongoing in the Member States, targeting nearly 100 million men and women.…”

Performance of colorectal cancer screening in the European Union Member States: data from the second European screening report

“…There is convincing evidence that screening can significantly reduce both colorectal cancer (CRC) incidence and mortality,1 and results from modelling studies suggest that CRC screening is a cost-effective intervention 2. Based on this evidence, several institutions and scientific organisations recommend the implementation of CRC screening to reduce the burden of disease.…”

Personalised informed choice on evidence and controversy on mammography screening: study protocol for a randomized controlled trial

“…In 2003, the European Council Recommendation promoted the implementation of screening programs in Europe, for breast, bowel and cervical cancer. This decision was confirmed, after assessment of the available evidence, in the recently released European code against cancer [1]. …”