European consensus on cancer screening should be applied urgently by health ministers

Editor—In Vienna in November 1999 consensus was reached on European recommendations for cancer screening at a conference organised by the European Commission of experts in research, health care, and cancer screening from all member states of the European Union. Despite this agreement, however, the political authorities concerned have not yet officially validated the recommendations. This lack of a European policy will lead to a continuation of inefficient opportunistic screening in several member states. It will also increase the risk of uncontrolled penetration of new screening methods from commercial lobbying. This issue needs therefore to be high on the agenda of one of the next meetings of the European health ministers, preferably during Belgium's presidency of the European Union (July-December 2001).

The guidelines were published in the European Journal of Cancer and will be included in the updated European Guidelines for Quality Assurance in Mammographic Screening.¹,² They recommend that cancer screening be offered only in organised programmes with quality assurance at all levels, as well as good information about benefits and risks. The benefits of a screening programme are achieved only if coverage is high and standards of rigorous quality assurance are respected. Management and evaluation of the programme require accurate monitoring of data. Opportunistic screening activities should be discouraged as they may not achieve the potential benefits but result in negative side effects.

The guidelines address screening for cervical, breast, and colorectal cancer. Pap smears should be used for cervical screening among a core age group of women aged 30-60, and the screening interval should be three to five years. If resources are available, screening could be offered to a wider age group but not to women younger than 20. Mammography should be used in screening for breast cancer, and only women aged 50-69 should be invited every two to three years. Screening for colorectal cancer by faecal occult blood detection should also be considered a preventive measure, targeting people aged 50-74 every one to two years. Immunological tests and flexible sigmoidoscopy should be evaluated as potential new tests in screening for colorectal cancer.¹,³ Screening is currently not recommended for any other form of cancer.

New technologies can be introduced only after their effectiveness and cost effectiveness have been established. Use of human papillomavirus DNA detection may improve management of women with equivocal Pap smears.⁴ But there is insufficient evidence about the long term effects of primary screening for human papillomavirus.⁵ Resources should be made available to extend current population trials and increase their size, as well as to initiate new trials. European coordination of these initiatives is recommended.