The European Commission’s proposal for an updated Council recommendation on cancer screening sets out an ambitious, patient-centric approach to early detection, which will (re-) position the European Union (EU) as a world leader in screening. The proposal is a clear illustration of the EU’s commitment to execute on its Europe’s Beating Cancer Plan ambitions. The proposal is based on scientific evidence. Whilst the next step will be for the EU Council to negotiate a final recommendation, we must work together to ensure its full implementation by all Member States.

Organised screening programmes “directly save lives”[1]: this is the unambiguous message delivered by the Group of Chief Scientific Advisors and SAPEA in their independent reports from March 2022. Implementing successful screening programmes is a long process, as we have seen over the last couple of decades in Europe, but the upcoming update to the 2003 Council recommendation on cancer screening is a giant leap forward.

Adopted nearly 20 years ago, the first recommendation was instrumental in the development of comprehensive, organised screening programmes across Member States[2]. However, a series of challenges have meant that patient access to screening programmes remains sub-optimal:

• The implementation of recommendations has varied widely across EU countries – with coverage of the target population for breast cancer screening ranging country-to-country from 6% to 90%, and from 25% to 80% for cervical cancer screening[3].
• Despite successful implementation of programmes in some countries, uptake tends to be an issue with low levels of participation, exacerbated further by COVID-19[4]^,[5].
• New scientific and technological developments could translate into millions of additional patients benefitting from improved existing screening programmes, and expansion to new cancers[6].

The Commission’s proposal aims to tackle these issues, including a goal to ensure that 90% of the EU population who qualify for breast, cervical and colorectal cancer screenings are offered screening by 2025. EFPIA’s Oncology Platform welcomes these bold ambitions as they are in line with industry initiatives advocating for proactive and early intervention in eligible patients[7]. Whilst updating existing diagnostic guidelines is essential for more efficient and targeted detection in already included cancers, we applaud the Commission’s addition of lung, gastric and prostate cancers, thereby providing many Europeans with the opportunity to access screening programmes, receive diagnoses at an early stage and improve their chances for better outcomes. Traditionally, questions around cost-effectiveness for these programmes have been raised. Novel approaches to risk-based cancer screening now allow for better harm-benefit ratios and the EU’s move towards risk-stratification is not only bold, but also an example for the world. The example of risk-adapted screening for prostate cancer, rather than reliance on PSA screening alone, illustrates how risk stratification can effectively avoid over 50% of biopsies and unnecessary radical surgery[8].

Way forward: turning the words of the Europe’s Beating Cancer Plan into action

While the journey to effective screening is long, the updated Council recommendation is an important first step in the right direction. We will all need to continue working together to ensure patients truly benefit from the opportunity for screening and early detection of cancers. Importantly, continuous monitoring and evaluation for quality assurance will be needed, not only at Member State level as outlined by the Commission’s proposal, but also at the EU level. Every Day Counts[9] for cancer patients, therefore we call on Member States to act with urgency and ambition in implementing the Council recommendation on cancer screening. We will collaborate across the EU to help the consistent expansion of projects like the European Commission Initiative on Breast and Colorectal Cancer. Regular evaluations of programme implementation will be needed to ensure we are moving forward as a true European Health Union in a harmonised way.

In addition, regular scientific evidence reviews should be encouraged, as soon as positive harm-benefit ratios, cost-effectiveness and feasibility are proven for new approaches. The pace of scientific and technological development differs significantly from policymaking processes. A spirit of continuous improvement will be needed to adapt and update guidelines as we continue to build on scientific insights. 

It is now up to the Council to move forward as swiftly as possible to ensure the Commission’s science-led proposal is enshrined in a new recommendation. Establishing effective, patient-centric screening programmes in an equitable manner across all Member States will not be accomplished overnight – it can only be achieved successfully with the right guidance and support from the EU over the years to come. In the end, all these efforts mean that more patients will benefit from equitable access to care, earlier diagnosis and improved outcomes. We as industry are committed partners in this mission to make the EU a true leader in early diagnosis – turning the words of the Europe’s Beating Cancer Plan into action.

[1] European Commission, Directorate-General for Research and Innovation, Group of Chief Scientific Advisors, (2022). Cancer screening in the European Union, Publications Office. https://data.europa.eu/doi/10.2777/867180

[2] European Commission, Directorate-General for Health and Food Safety (2017). Cancer Screening in the European Union (2017). https://health.ec.europa.eu/system/files/2017-05/2017_cancerscreening_2ndreportimplementation_en_0.pdf

[3] European Commission, Directorate-General for Research and Innovation, Group of Chief Scientific Advisors, (2022). Cancer screening in the European Union, Publications Office. https://data.europa.eu/doi/10.2777/867180

[4] EFPIA (2021). Every Day Counts: the impact of COVID-19 on Patient Access to Cancer Care in Europe.  https://www.efpia.eu/media/602636/every-day-counts-covid19-addendum.pdf

[5] European Cancer Organisation. Leave no one behind – delivering innovation in lung cancer care. Action report from the Community 365 Roundtable Meeting on Lung Cancer, 7 December 2020. https://www.europeancancer.org/europeancancer.org/2-standard/187-lung-cancer-early-detection-and-screening

[6] European Commission, Directorate-General for Research and Innovation, Group of Chief Scientific Advisors, (2022). Cancer screening in the European Union, Publications Office. https://data.europa.eu/doi/10.2777/867180

[7] Amgen EU (2020). Predict and Prevent Healthcare System. https://www.amgen.eu/amgen-media-release/our-perspective/predict-and-prevent-approach

[8] European Cancer Organisation. Community 365 roundtable meeting early detection and screening. 22 June 2021. https://www.europeancancer.org/index.php?option=com_attachments&task=download&id=586:ECO_Early-Detection--Screening-Roundtable_June2021

[9] EFPIA (2020). Every Day Counts: Improving time to patient access to innovative oncology therapies in Europe. https://www.efpia.eu/publications/downloads/efpia/every-day-counts-improving-time-to-patient-access-to-innovative-oncology-therapies-in-europe/