Screening programmes vary substantially between countries and in most long-term effectiveness of screening has not yet been assessed. In 2015 the EU-TOPIA project has started. The objective of EU-TOPIA is to systematically evaluate and quantify the harms and benefits of the screening programmes for cervical, breast, and colorectal cancer in all European countries, and identify ways to improve health outcomes and equity for citizens. We will present an overview of the first result of this important EU funded project, focusing on the results for cervical cancer prevention.
First, we have harmonized key quality indicators across cancer sites and prioritized key indicators for the harms and benefits of screening. Second, we systematically evaluated literature on the effects (in terms of mortality or incidence reduction) of cancer screening across the European countries. This information will be used to validate decision models which will be used to find the optimal screening strategy. Third, we started constructing state-of-the-art decision models of the natural history of the cancers (based on the well-known microsimulation model MISCAN), using country-specific data. Fourth, a CATWOE (‘Customers, Actors, Transformation, Weltanschauung, Owner, Environment’) analysis tool was developed to identify barriers hindering implementation of optimal screening programs. This tool was filled in for six EU countries representing four European region (North, East, South and West). Fifth, the first workshop on monitoring screening programmes in a series of four workshops is planned. The aim of the workshops is to build capacity to conduct cancer screening evaluation independently.
We prioritized a set of 17 key quality indicators (7 benefits and 10 harms), harmonized across cancer sites. The literature search provided evidence that cervical cancer screening is proven to reduce mortality across Northern and Western Europe. However, no studies have been performed evaluating the direct effect of screening on mortality in other European regions. The CATWOE analysis identified the most important barriers and different levels of the screening programme in six exemplary countries. It was found that many barriers occur in each country/region, but also many specific to each country/region. Finally, the first workshop will be held in September 2017. Currently, already 60 persons (researchers and policymakers) registered from 25 different countries. In conclusion, important progress have been made within the EU-TOPIA project.