Evaluation of Screening
“The possibilities of screening for diseases are growing rapidly due to technological developments. We aim to quantify the effects of screening for a wide range of diseases to help policymakers, clinicians and individuals make an informed choice about implementation of and participation in screening."
Screening is a popular concept, because early detection of disease has the potential to considerably improve survival and/or quality of life. However, screening can also result in serious harms such as false-positive test results or detection of clinically irrelevant disease, leading to unnecessary interventions. It is therefore important that new screening tests are only implemented if their benefits outweigh their harms. Our research focuses on quantifying these health benefits, unfavorable side-effects, impact on quality of life, and cost consequences, resulting in recommendations for screening policies, both in settings with organized programs and in clinical care.
Highlights
Socio-economic inequality of utilization of cancer testing in Europe
Many countries in Europe have organised screening programs for breast, cervical and colorectal cancer. However, screening programmes are implemented in different ways, and with different levels of participation. We assessed inequalities in the use of screening services by socio-economic status, socio-demographic factors, self-perceived health and smoking behaviour. We found that, in general, factors associated with a lower likelihood of being up to date with cancer screening are: having a low or intermediate educational level, being unemployed, having a low household income, or being born outside a European country. The income-based inequality in breast and colorectal testing was greatest in Southern Europe. For cervical testing, this inequality was greatest in Eastern Europe. There is thus a considerable inequality in the use of cancer testing in Europe and it is of great importance to further examine the reasons for not participating in testing, such that these barriers can be solved.
Studying recruitment approaches for lung cancer screening
Lung cancer is the leading cause of cancer-related mortality among men and women, accounting for 28% of all cancer deaths in Europe. Two large-scale randomized controlled trials have shown computed tomography (CT) lung cancer screening to be efficacious in reducing lung cancer mortality in high-risk populations. However, effective and high-quality implementation of CT lung cancer screening requires important remaining uncertainties to be addressed.
Our Horizon Europe-funded study 4-IN-THE-LUNG-RUN is a multi-centered implementation trial aiming to do exactly that. An important aspect of the trial is to compare a population based (general) recruitment approach with more individually (gender specific) tailored approaches. In this comparison, we will specifically evaluate the impact of these recruitment approaches on inequalities in screening participation.
