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September 2023

Improving cancer screening in the European Union

Organised cancer screening programmes save lives. The earlier a cancer is diagnosed, the greater the chances of treating it successfully and straightforwardly.

Improving existing screening

Many European countries already have screening programmes for cervical, breast and colorectal cancer. The evidence indicates some ways in which these existing screening programmes can be improved:

  • Cervical cancer: Conventional smear tests (cytology) should be replaced with testing for HPV, the virus that causes cervical cancer, as a first line of screening. HPV testing is needed less often than cytology and can be easily done at home, which improves access. By combining these improvements with widespread HPV vaccination, especially among teenagers, we may eventually be able to eradicate cervical cancer in Europe.
  • Colorectal cancer: Screening should be improved by optimising how frequently people are screened, depending on age, sex, and results of previous tests.
  • Breast cancer: Screening should be extended to women in their mid-40s, and MRI scans should be considered for women with dense breast tissue, for whom mammography is less effective.

New screening programmes

  • Lung cancer: There is a strong scientific basis for introducing lung screening for current and ex-smokers using the latest technologies, such as low-dose CT scanning. This should be combined with ongoing programmes to help people give up smoking.
  • Prostate cancer: There is strong scientific evidence for the benefits of organised prostate cancer screening using blood tests, particularly combined with follow-up MRI scans for men who have a positive blood test result.

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 we should be prepared to introduce new methods, especially in high-risk populations.

How to implement screening programmes

Clinical trials are valuable, but they cannot tell us exactly what will happen when a nationwide screening programme is implemented in the real world. So any new programme should be rolled out gradually, using local small-scale pilots.

Once a programme is running, it needs to be continually monitored and adjusted to maintain quality. Standards, guidelines and screening criteria should be continually updated to take advantage of emerging evidence and new technologies, and the EU has a role in coordinating this. This would also allow countries to share experience and data, and to optimise the use of resources.

The EU also has a role in supporting public awareness campaigns, and in creating large-scale biobanks to improve future research.

Meanwhile, offering opportunistic screening tests outside of organised programmes — and to people with no symptoms — leads to poor quality and unequal access. This should be avoided.

Scientific advice

Requested by

Delivery date

7 September 2023

Supports EU mission

Cancer

Supports UN sustainable development goals

Good health and wellbeing

Resources

The Group of Chief Scientific Advisors responds to the request for advice from the European Commission.

Their policy recommendations are based on the best available scientific evidence.

Cancer screening SO cover
Bibliographic information
DOI
10.2777/867180
ISBN
9789276456032
Licence
Copyright
Cite as
European Commission, Directorate-General for Research and Innovation, Group of Chief Scientific Advisors, (2022). Cancer screening in the European Union, Publications Office of the European Union.
The Scientific Opinion is written jointly by the Group of Chief Scientific Advisors. Former Advisors (‘alumni’) may also contribute.
Portrait of Janusz Bujnicki

Janusz Bujnicki

Alumnus
Portrait of Nicole Grobert

Nicole Grobert

Advisor
Portrait of Éva Kondorosi

Éva Kondorosi

Advisor
Portrait of Maarja Kruusmaa

Maarja Kruusmaa

Advisor
Portrait of Eric Lambin

Eric Lambin

Advisor
Portrait of Alberto Melloni

Alberto Melloni

Advisor
Portrait of Nebojša Nakićenović

Nebojša Nakićenović

Advisor
Portrait of Eva Zažímalová

Eva Zažímalová

Advisor

Events

12 April 2023
Time to screen! Implementing new EU screening recommendations
In-person event
The event’s focus is the implementation of the updated European screening recommendations and strengthening cancer prevention through early detection.
29 September 2022
Integrating research for new cancer screening programmes
Hybrid event
A debate on cancer screening at the EU R&I Days event 2022.
19 May 2022
Conference on improving cancer screening in the EU
In-person event
This event is co-organised by SAPEA and the Hungarian Academy of Sciences .
16 May 2022
Ciência 2022
In-person event with streaming
We presented our cancer screening advice during the session “Cancro: avanços e desafios”.
13 May to 
14 May 2022
7th congress of preventive medicine
In-person event
This conference is organised by the Slovenian Medical Association.

Impact

This advice became a key element of the new EU-Supported Cancer Screening Scheme, which is one of the flagship initiatives of Europe’s Beating Cancer Plan, a key pillar of the European Health Union promised by the president of the European Commission in 2020. Our advice was taken up with minor modifications in the proposal for a Council Recommendation on Strengthening prevention through early detection: A new approach on cancer screening, which was published in September 2022. On 9 December 2022, the Council of the European Union presented its amendments and adopted the proposal.

The contribution of our advice is particularly reflected in the recommendation to extend the screening for breast, colorectal and cervical cancers to other cancers such as lung, prostate and gastric cancer. Furthermore, for cancers that already have screening programmes, such as breast cancer, the advice demonstrated the need to reduce the target age range for screening to women under 50. This recommendation has already been taken up at national level, as in Portugal for instance. In the case of colorectal cancer, our advice underlined the necessity to use the faecal immunochemical test as the preferred screening method. Both points are now reflected in the final Council's recommendations document.

This advice has also been cited in scientific journals such as The Lancet Oncology and Cancers. It has also been featured in media outlets like La Vanguardia (Spain), Delo and SiolNET (Slovenia), and Politico Pro. Additionally, specialised organisations such as the European Federation of Pharmaceutical Industries and Associations, Sciensano (Belgium), and Onkologisk Tidskrift (Denmark) have referenced the advice.

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Media coverage
2024
Egeszsegkalauz: Daganat: mivel lehetne csökkenteni a rák miatti elhalálozást?
Hungary (in Hungarian)
Morote J.; Picola N.; Muñoz-Rodriguez J.; Paesano N.; Rui... (2024). The Role of Digital Rectal Examination Prostate Volume Category in the Early Detection of Prostate Cancer: Its Correlation with the Magnetic Resonance Imaging Prostate Volume. World Journal of Men's Health.
Leja M. (2024). Where are we with gastric cancer screening in Europe in 2024?. Gut.
Bongaerts T.H.G.; Büchner F.L.; Nierkens V.; Crone M.R.; ... (2024). Perceptions and beliefs of general practitioners on their role in the cancer screening programmes in the Netherlands: a mixed-methods study. BMC Primary Care.
Bartolomé-Moreno C.; Melús-Palazón E.; Vela-Vallespín C.;... (2024). Cancer prevention recommendations: Update 2024; [Recomendaciones de prevención del cáncer. Actualización 2024]. Atencion Primaria.
Policy impact
2024
European Commission follow-up to European Parliament requests 2022-2024
Ola I.; Cardoso R.; Hoffmeister M.; Brenner H. (2024). Utilization of colorectal cancer screening tests across European countries: a cross-sectional analysis of the European health interview survey 2018–2020. The Lancet Regional Health - Europe.
de Nijs K.; ten Haaf K.; van der Aalst C.; de Koning H.J. (2024). Projected effectiveness of lung cancer screening and concurrent smoking cessation support in the Netherlands. eClinicalMedicine.
Guerreiro T.; Aguiar P.; Araújo A. (2024). Current Evidence for a Lung Cancer Screening Program; [Evidência atual para um programa de rastreio ao cancro do pulmão]. Portuguese Journal of Public Health.
Josefsson A.; Månsson M.; Kohestani K.; Spyratou V.; Wall... (2024). Performance of 4Kscore as a Reflex Test to Prostate-specific Antigen in the GÖTEBORG-2 Prostate Cancer Screening Trial. European Urology.
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