Update of the recommendation on cancer screening: ECDA position

ECDA fully supports the update of the 2003 guidance, which should allow to improve the early detection of cancer and potential complications across Europe; and support implementation of screening guidelines and cost-effective and evidence-based solutions for early diagnosis.

Improvements in cancer screening and diagnosis are critical to effectively enhance cancer management and survival in Europe; and prevent or address early-on cancer co-morbidities as well as cancer-related complications, which present a significant challenge.

Extension of screening to other types of cancer

The update of the recommendations and extension of screening to other types of cancer should be based on new, solid scientific evidence and good practice screening policies in Europe. The 2020 WHO report on cancer provides related guidance. ECDA supports the extension of screening notably to liver, lung and gastric cancer.

  • Liver cancer is the sixth-most common cancer and the third-most frequent cause of cancer-related death globally. Detection of liver cancer at an early stage could reduce mortality to a maximum of 5 years of life lost relative to the general population. Chronic liver diseases caused by viral hepatitis, alcohol or fatty liver disease are the most important risk factors for developing liver cancer. Extending the Recommendation to liver cancer for high-risk population groups living with chronic liver diseases makes sense and is endorsed by all clinical stakeholders. These patients are identifiable, have a high risk of liver cancer, and can be offered curative treatment if their liver cancer is diagnosed early. Furthermore, liver cancer detection tools are easily available and affordable.
  • Concerning lung cancer, there is compelling international scientific evidence demonstrating that Low Dose Computed Tomography (LDCT) for lung cancer screening is effective, beneficial and feasible. More specifically, evidence shows that national screening programs using LDCT in asymptomatic high-risk Europeans could detect cancer at an early stage when treatment is most likely to be successful. Such screening programmes would save lives and improve the survival and quality of life of Europeans. In addition, LDCT for lung cancer screening satisfies all the criteria on the introduction of screening set out in point 6 of the current Council recommendations on cancer screening and is in accord with the WHO principles of early disease detection.
  • As for gastric cancer, although rates are lower in Europe and tend to decline, around 136,000 Europeans are diagnosed with gastric cancer every year. Approximately 90% of all gastric cancers are related to H. pylori infection. According to latest studies around 40% reduction in mortality is achieved by eradicating H. pylori among healthy individuals. Well-designed H.pylori screen and treat implementation strategies should be recommended with thorough monitoring and outcome data collection. Population-based screening for H. pylori does not seem appropriate for all European countries. However, it should be considered in the countries with higher incidence of gastric cancer and in all other countries in the individuals considered at increased risk for gastric cancer.

Improving participation in screening

The initiative should help improve the participation to screening programmes. Harmonisation of protocols and research on finding the most appropriate target populations would be very beneficial.

Taking a bold vision on cancer screening

Further, other major chronic diseases can be risk factors for certain types of cancer, or enhance disease progression. The interactions between cancer and other chronic diseases require to establish protocols for the screening and management of complications on the long term, as these may occur only after several years in patients. The earlier detection and state-of-the-art management of other major chronic diseases that cause cancer should be integral to strategies to detect and control cancer.

ECDA’s response to the public consultation on the update of the cancer screening recommendations is available here.