Questions and answers: A new EU approach to cancer screening

Source: European Commission (EC) i, published on Tuesday, September 20 2022.

How does this new approach to cancer screening fit into Europe's Beating Cancer Plan?

Europe's Beating Cancer Plan is a key pillar of a strong European Health Union. It helps create a more secure, resilient, and better-prepared European Union. The EU Cancer Screening Scheme is one of the ten flagship initiatives, which will help Member States turn the tide against cancer. The earlier a cancer is diagnosed, the greater the chances of treating it successfully and straightforwardly. By extension, early detection through population-based screening offers the best chance of beating cancer and saving lives.

Population-based, quality-assured screening programmes have been instrumental in improving cancer screening and ensuring that the vast majority of people in the target age ranges have access to organised screening in the past. However, inequalities continue to persist in terms of access, quality, and diagnostics throughout the EU. The EU Cancer Plan target aims to ensure that 90% of the EU population who qualify for breast, cervical and colorectal cancer screenings are offered screening by 2025. It also announced the intention to consider extending targeted cancer screening beyond breast, colorectal and cervical cancer to include additional cancers, such as prostate, lung and gastric cancer.

Why is there a need for a new approach?

Much has changed in the almost two decades since the previous recommendations. The Commission is therefore proposing to replace the 2003 Council Recommendation to ensure it reflects the latest available scientific evidence and technological advancements, and to improve monitoring and data sharing. This includes updating the breast, cervical and colorectal cancer screening recommendations with new targeting and testing types as well and extending cancer screening programmes to include lung and prostate cancer as well as to gastric cancer in those countries or regions with the highest gastric cancer incidence and death rates. These updates will be accompanied by “living” EU guidelines, which can adapt to changing scientific evidence, and quality assurance schemes for these cancer types.

What are the changes in relation to breast, cervical and colorectal cancer?

  • Extending breast cancer screening from women aged 50 to 69 to include women between 45 and 74 years of age. The Commission also advises Member States to consider specific diagnostic measures, including magnetic resonance imagining (MRI) for women with particularly dense breasts;
  • Prioritising testing for human papilloma virus (HPV) for women aged 30-65, every 5 years or more over pap smear screening and taking account of HPV vaccination status;
  • Recommending faecal immunochemical testing for colorectal cancer in people aged 50 - 74 instead of faecal occult blood screening to see if individuals need referring for follow-up endoscopy/colonoscopy.

What are the new cancer types that have been added and why these three?

The Commission proposes to introduce screening for lung, prostate, and, in certain conditions, gastric cancer.

Lung cancer: the Commission recommends introducing screening for current and ex-smokers who have quit smoking within the previous 15 years, are aged 50 to 75 years and have a smoking history of 30 pack-years (equivalent to smoking 20 cigarettes per day for 30 years).

Prostate cancer: the Commission proposes introducing to prostate-specific antigen (PSA) testing - like a blood test - for men up to 70, in combination with additional magnetic resonance imaging (MRI) scanning as a follow-up test.

Gastric cancer: in countries or regions with higher gastric cancer incidence and death rates, the Commission proposes introducing screening for Helicobacter pylori bacteria, which can cause stomach ulcers, and in some cases lead to stomach cancer. The Commission also recommends screening or pre-cancerous stomach ulcers from other causes.

For other cancers, the evidence does not yet support population-wide screening. New technologies, including multi-cancer blood tests, are not yet ready for routine use — but research is moving fast, and the EU needs to be prepared to introduce new methods, should the evidence support it.

What is the scientific basis for this proposal?

The Group of Chief Scientific Advisors published its scientific opinion on cancer screening in the European Union on 2 March 2022. The aim of this opinion was to examine how the Commission can contribute to improving cancer screening across the Union and to inform the Commission's 2022 proposal to update the 2003 Council Recommendation on cancer screening. The opinion was based on the evidence review report ‘Improving cancer screening in the European Union' by the consortium Science Advice for Policy by European Academies (SAPEA).

How is the EU investing in further research?

The EU Mission on Cancer under the Horizon Europe framework programme for research and innovation (2021-2027) is a major component of the Union's investment in cancer research and innovation. Several of the planned actions, namely on optimised and improved access to existing screening programmes, developing new methods and technologies for screening and early detection, and developing early predictors/tests will directly support the new EU Cancer Screening Scheme and create an important link between Research and Innovation and cancer policies.

Why is investment necessary and which amount is available to help Member States?

Investing in cancer screening can help reduce the burden on healthcare systems - through earlier detection, ensuring a better quality of healthier life years and most importantly by saving lives. Europe's Beating Cancer Plan is supported using the whole range of Commission funding instruments with a total of €4 billion being earmarked for actions addressing cancer. This includes around € 38.5 million committed from the EU4Health programme for screening-related projects and € 60 million under the Horizon Europe. The Commission will propose additional funding for cancer screening under the 2023 EU4Health programme.

EU countries can also use cohesion funding to support cancer screening, by using Regional Development Fund and European Social Fund Plus. Some Member States have already included cancer diagnosis and treatment as part of their national Recovery and Resilience Plans.

The public health benefits and cost efficiency of a screening programme can be achieved if it is implemented gradually, in an organised and systematic way, covers the whole target population and follows evidence-based and up-to-date European guidelines with quality assurance. This includes the appropriate monitoring of the quality of the screening programmes.

How will you monitor progress?

The proposal introduces a systematic monitoring system to follow the way in which EU countries are implementing the cancer screening recommendations.

This outlines how Member States should regularly monitor the process and outcome of organised cancer screening and report to the public and the personnel providing the screening. It also details how EU countries should ensure the appropriate registration, collection, storage and management of data and information using the European cancer information system, including performance and impact indicators.

The EU-funded CanScreen - European Cancer Information System (ECIS) project will help Member States comply with the reporting requirement in the Recommendation and is developing tools to help Member States feed information into the ECIS.

The Recommendation requires Member States to report on how they are implementing the updated approach to EU Cancer Screening within three years of the adoption of the Recommendation and, subsequently, every four years. Based on this, the Commission will further report on the implementation of cancer screening programmes and consider the need for further action.

For More Information

Proposal for a Council Recommendation on Strengthening prevention through early detection: A new approach on cancer screening

Annex to the Proposal

Stakeholder consultation on the proposal

Press release

Factsheet: Europe's Beating Cancer Plan - a new approach to cancer screening

Factsheet: Europe's Beating Cancer Plan - where are we now?

Video on cancer screening

JRC Factsheets

Report: Cancer screening in the EU

EU policy on cancer