S. Lönnberg, M. Šekerija, N. Malila, T. Sarkeala, M. Leja, O. Májek, M. Zappa, E. Heijnsdijk, S. Heinävaara, H. de Koning and A. Anttila
- National structures for governance of screening are here identified as important requirements for evidence-based decision-making and for establishing adequate legal, financial and organizational frameworks for effective cancer screening programmes with integrated quality assurance. We recommend transparent, structured and publicly documented decisionmaking, informed political commitment and broad stakeholder involvement in order to build strong professional support for the aims and means of the screening programme. Governance structures recommended here are currently lacking in many European settings, which may contribute substantially to inequalities in cancer prevention outcomes observed both between and within countries.
- Organization for the practical implementation and the continual gradual improvement of population-based cancer screening programmes further requires careful coordination of this multistep process with feedback and corrective modification at each step, plus revolution of the quality circle. Information systems that permit registration and monitoring of process and outcome are crucial for maintaining current levels of quality, and for guiding further improvement.
- Evaluations of the benefit-harm balance and cost-effectiveness of screening are required periodically for existing programmes and prospectively for new screening programmes. The population targeted by screening have an ethically mandated right to clear information on benefits and harms for an informed choice about participation. Indicators for equity in participation and health outcomes need to be included in the routine quality assurance capabilities of population-based screening programmes.
- New screening programmes require step-wise decision-making which includes the establishment of evidence of effectiveness, benefits that outweigh the harms and costeffectiveness. Once evidence exists to support these criteria, implementation research in each country is needed to assess the feasibility of fulfilling the national requirements in practice. In light of currently available evidence, some prostate cancer screening policies may be costeffective but questions remain on the optimal benefit-harm balance. Forthcoming results of European trials are expected to inform policy-making on lung cancer screening in Europe. New trials need to be financed to investigate optimal strategies for gastric cancer screening.