Editor—The European Commission recently published the Proposal for a Council Recommendation on Cancer Screening, based on consensus reached by experts.1-3 For breast, cervical, and colorectal cancer sufficient evidence has been accumulated on cost effectiveness and negative effects to recommend screening at a population level. Mammography should be offered every two years to women aged 50-69. Periodic Pap smear testing should start before the age of 30 but not earlier than the age of 20. Faecal occult blood testing should be recommended to men and women aged 50-74.2
New technologies can be introduced only after their effectiveness and cost effectiveness have been established in randomised controlled trials on public health relevant outcomes. The following methods or policies require evaluation: digital mammography, liquid based cervical cytology, human papillomavirus detection, automated screening devices, immunological faecal occult blood tests, primary colonoscopy, as well as extension of mammographic screening in women aged 40-49.
The European Commission recommends that screening be offered in organised programmes, with quality assurance at all levels and good information about benefits and risks. A reduction in mortality and incidence of advanced disease can be achieved only if coverage is high and standards of rigorous quality assurance are respected. Management and evaluation of programmes require accurate monitoring of data. Data transmission and linkage systems must be set up with respect of privacy legislation and ethical rules.
The European Commission has given the network for cancer screening the mandate to work out technical guidelines defining standards and benchmarks for best practice.4 The current proposal still needs endorsement by the ministers of health. We hope this will happen without delay.
Competing interests: None declared.
References
- 1.Commission of the European Communities. Proposal for a council recommendation on cancer screening. 2003/0093 (CNS). Brussels, 5 May, 2003.
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