APH 2008, 66, 109-124:

Cancer screening: EU recommendations and current practice in Belgium

Neyt M, De Laet C, Van de Sande S, Hulstaert F, Paulus D, Van den Bruel A, Mambourg F, Vinck I, Ramaekers D.

Keywords: mass screening, colorectal neoplasms, breast neoplasms, prostatic neoplasms, uterine cervical neoplasms

Background

Several European countries have set up population screening programmes for cancer detection. By definition, screening tests are performed in a population that is not at increased risk. The benefits and harms both before and after programme implementation are to be balanced versus programme costs.

Methods

The Belgian Health Care Knowledge Centre (KCE) has performed four systematic reviews on respectively colorectal, breast, prostate, and cervical cancer screening. This paper presents an overview and discussion of results.

Results

For the guaiac Faecal Occult Blood Test there is high quality evidence from randomised controlled trials that screening reduces colorectal cancer mortality. Its implementation in a real-world setting, however, is not easy. For breast cancer screening, recent reviews raise questions about the balance between benefits and risks and the European recommendations are far from being applied in reality. The Prostate Specific Antigen test is often performed, despite the absence of evidence for its value in population screening. For cervical cancer, the Pap smear is overused in a subgroup of women, whereas 4 out of 10 women in the Belgian target population are not regularly tested.

Conclusions

Current screening programmes are often set up to improve life expectancy and quality of life. However, benefits should be proven before the implementation of widespread screening programmes. Screening programmes without a positive benefit/risk balance or that do not offer value for money should not be organised by governments and paid from public funds. If
screening programmes are implemented, setting up a register is of paramount importance to collect information on participation, test results, subsequent management, harms, and outcomes to evaluate and fine-tune the programmes.