All.Can and the EFPIA Oncology Platform (EOP) started a collaboration in April 2023 to promote a constructive and evidence-based dialogue on the implementation of the EU Cancer Screening Recommendation in four EU countries – Belgium, Italy, Romania and Spain – as a further step towards greater efficiency in cancer care and better health outcomes.

Through high-level roundtables and policy dialogues held in these four countries, the national All.Can community, exchanging with key stakeholders and decision-makers, has been raising awareness on the value of cancer screening programmes and on concrete routes for country-level implementation. Key country activities executed during the second half of 2023 and the first quarter of 2024 focused on:

• Awareness raising and communications activities
• Policy research to support multistakeholder events, such as stakeholder survey; white paper; policy recommendations
• High-level Roundtables (in person and virtual) organized in accordance with political context and developments
• 1:1 stakeholder engagement.

In November 2023, All.Can Belgium launched the multi-stakeholder Lung Cancer Working Group (LCWG) to address critical needs within the lung cancer care pathway, including the implementation of screening programmes. Despite the focus on lung cancer, explicit reference is made to the EU Cancer Screening Recommendation, used as a background against which lung cancer screening can be specifically addressed. An important part of the discussion in Belgium revolves around the feasibility of population-based lung cancer screening and the cost-effectiveness of such a programme. In that regard, an advice of KCE (Knowledge Center Belgium) and the HGR/CSS (High Health Council) was published in April 2024[1]. It highlights that lung cancer screening has been shown to reduce lung cancer mortality and overall mortality among the screened high-risk individuals. It suggests that lung cancer screening can be cost-effective if the government's willingness to pay is between €20.000 and €30.000 per QALY gained. The roundtable hosted by All.Can Belgium, as part of the collaboration with the EFPIA Oncology Platform, on 10 July involved key stakeholders and highlighted sensitivities and challenges still related to the topic of lung cancer screening[2]. Following the event, a number of recommendations were agreed and will be included in a White Paper to be published by All.Can Belgium later in the Summer.

In Italy, All.Can facilitated a high-level conference held at the Ministry of Health (MoH) in February 2024 and involved representatives of patient associations and scientific societies. The MoH will continue focusing on improving screening adherence across Italian regions. In addition, it will partner with several regions to pilot screening programs, e.g. for prostate cancer, with the aim  to collect and analyze the data to assess the full-scale implementation of other programmes for different cancer types. A challenge remains in aligning national and regional decision-making and funding, with some northern regions being more advanced than others. However, a bottom-up approach that enables to share learnings and best practice across regions could accelerate implementation across the country in a more equitable way and, at the same time, help the government to align regional initiatives.

In Romania, screening for preventable cancers is still in its early stages of development, delivered opportunistically rather than through a more effective population-based approach. The only active screening programme funded by the Ministry of Health is for cervical cancer, which sees low participation rates and limited geographic coverage. For breast cancer and colorectal cancer, pilot programmes have been conducted at regional level. The All.Can-EOP supported webinar held at the end of November 2023 provided the latest updates in EU cancer screening guidelines and their implications for Romania. Despite the clear benefits, the path to implementing effective cancer screening programmes in Eastern Europe has many challenges, including financial constraints, lack of infrastructure, and low health literacy. Overcoming these obstacles requires strong political will, investment in healthcare, and collaboration with international organisations and experts. Romanian officials, academia, civil society, patient organisations, medical institutions, and tech & innovation sectors expressed strong support for the EU's new cancer screening recommendations. Commitment from Romanian authorities, including funding allocation and effective monitoring, is going to be crucial. Quality control, well-equipped facilities, and adequate treatment capacities are essential for programmes’ success.

All.Can Spain and its partners were able to successfully set an agenda highlighting recommendations on screening programmes’ implementation, opening a communication channel with different government levels and continuing to strengthen its presence as a key platform for overcoming inefficiencies in cancer care in Spain. A multi-stakeholder roundtable, key activity of the All Can Spain – EOP collaboration on cancer screening, was held in February 2024 at the EU representation in Madrid. It included two panel discussions with 1) technical experts and 2) policymakers including representatives from MoH and the regions. As highlighted during the debates, all the key stakeholders took the opportunity to urge decision-makers to continue working on the implementation of pilots as a first step towards their wide-spread adoption in the National Health System. The considerations shared by experts and patients were welcomed by the public decision-makers, who highlighted the importance of these screenings in reducing cancer mortality, increasing the quality of life of patients and families and the sustainability of the NHS, although they stressed that they are complex programmes whose evaluation must be exhaustive.

Key learnings to date across the 4 countries confirm the positive impact of the initiative and illustrate the way forward:

• Urgent and sustained policy leadership and collaborative actions at all levels are crucial to strengthen cancer control and build efficiency in cancer care, aligning evidence-based policies, practices, technologies, data systems, organisational frameworks, and incentives.
• Appropriate funding for screening programmes both for infrastructure and human resources should be made available as a matter of priority.
• Comprehensive public education and awareness campaigns about the importance of screening and early diagnosis of cancer have to be executed, ensuring the involvement of GPs and employing appropriate digital tools.
• Screening programmes have to be continuously monitored and evaluated to inform evidence-based improvements and policy development.

[1] https://kce.fgov.be/en/lung-cancer-screening-in-a-high-risk-population

[2] The Flemish federation of GP’s ( Domus Medica) did an appeal in the media against lung cancer screening https://www.hln.be/medisch/vlaamse-huisartsenfederatie-roept-op-om-minder-snel-op-longkanker-te-screenen-waarom~ac4c0106/