ANNEX

Technical specifications for the cancer screenings listed below, which fulfil the requirements of the Recommendation, will be further specified in European guidelines with quality assurance schemes. Member States are invited to assess their national and regional cancer screening governance arrangements to enable timely and effective implementation of any new or updated European guidelines.

The Annex takes into account the scientific opinion (1) of the Group of Chief Scientific Advisors on improving cancer screening across the EU. The scientific opinion proposes extending the organised screening programmes to lung and prostate cancer, and to gastric cancer in the countries with the highest gastric cancer incidence and death rates. However, further evidence is needed on real-life effectiveness, cost-effectiveness and feasibility of particular screening strategies.

Member States are invited to consider implementation of the following cancer screenings, based on conclusive scientific evidence, while assessing and taking decisions on the national or regional level depending on the disease burden and the healthcare resources available, the harm-benefit balance and cost-effectiveness of cancer screening, and experience from scientific trials and pilot projects. For individuals with increased risk of a particular cancer, Member States should consider specific programmes with extended target populations and intensity, taking into account scientific evidence and local context.

Breast cancer:

Considering the evidence presented in the European guidelines (2), breast cancer screening for women aged 50 to 69 with mammography is recommended. A lower age limit of 45 years and an upper age limit of 74 years is suggested. The use of either digital breast tomosynthesis or digital mammography is suggested. The use of magnetic resonance imaging (MRI) should be considered when medically appropriate.

Cervical cancer:

Testing for human papilloma virus (HPV) using only clinically validated assays as the preferred screening tests for women aged 30 to 65 with an interval of five years or more. Consider adapting ages and intervals to individual risk based on the HPV vaccination history of the individuals and also consider the possibility of offering kits allowing women to take a self-sample, especially for non-responders to screening invitations.

Colorectal cancer:

Quantitative faecal immunochemical testing (FIT) is considered the preferred screening test for referring individuals for follow-up colonoscopy between 50 and 74 years old. Quantitative information from FIT results might be used on the basis of further research with a view to implement risk-tailored strategies, introducing thresholds defined per sex, age and earlier test results. Endoscopy may be adopted as a primary tool to implement combined strategies.

Lung cancer:

Considering the preliminary evidence for screening with use of low-dose computed tomography, and the need for a stepwise approach, countries should explore the feasibility and effectiveness of this programme, for instance by using implementation studies. The programme should integrate primary and secondary prevention approaches, starting with high risk individuals. Special attention should be given to the identification and targeting of high risk profiles, starting with heavy smokers and ex-smokers who used to smoke heavily, and Member States should further research how to reach and invite the target group, as there is no systematic data (documentation) on smoking behaviour. Furthermore, attention should be given to the identification and targeting of other high risk profiles.

Prostate cancer:

Considering the preliminary evidence and the significant amount of ongoing opportunistic screening, countries should consider a stepwise approach, including piloting and further research, to evaluate the feasibility and effectiveness of the implementation of organised programmes (3) aimed at ensuring appropriate management and quality on the basis of prostate-specific antigen (PSA) testing for men, in combination with additional magnetic resonance imaging (MRI) scanning as a follow-up test.

Gastric cancer:

Screen-and-treat strategies for Helicobacter pylori, including implementation studies, should be considered in those countries or regions inside countries with high gastric cancer incidence and death rates. Screening should also address strategies for identification and surveillance of patients with precancerous stomach lesions unrelated to Helicobacter pylori infections.

(1) Scientific opinion of the Group of Chief Scientific Advisors on improving cancer screening across the EU: https://op.europa.eu/en/publication-detail/-/publication/519a9bf4-9f5b-11ec-83e1-01aa75ed71a1

(2) European guidelines on breast cancer screening and diagnosis | ECIBC (europa.eu)

(3) cancer-screening-workshop-report-01.pdf (sapea.info)