Europe wants member states to screen more people for more types of cancer. In Flanders there are not many reasons to change much. ‘The GP can determine whether an examination is useful.’
The more cancers detected at an early stage, the better the patient’s chances of survival. The European Commission presented ideas this week to improve early detection. By 2025, it wants 90% of eligible people to be offered effective cancer screening for breast, cervical and colon cancers. Screening should also be expanded to include prostate, lung and stomach cancer.
An inter-cabinet working group met on Friday morning, including attendees from the Public Health domain. This included the position of the Agency for Care and Health, together with that of the Center for Cancer Detection.
breast cancer
A more notable European suggestion was to expand the target group of women for breast cancer screening to 45-74 years, from the current 50-69 years.
‘That is a large group and if you were to screen there, it would result in a large extra cost. There is no objection to this in itself, but there is no evidence that it is useful,’ says oncologist Erik Van Limbergen (KU Leuven). ‘Breast cancer in patients under the age of 50 is often seen in familial high-risk groups. They are already well monitored. The number of cancer cases is very limited in the rest of the younger population.’
Expanding to a higher age group is more useful, although this should not be done via a large population survey. ‘In specific cases, the general practitioner could determine whether an examination is useful, for those who still have a good life expectancy of, for example, fifteen years’, says Van Limbergen.
lung cancer
There is currently no general screening for lung cancer in our country, although specialists certainly see benefits for heavy smokers. There too, Europe proposes to subject high-risk groups – heavy smokers – to preventive examinations. In concrete terms, it concerns smokers with more than thirty ‘pack years’ on the counter. This means that you have smoked twenty cigarettes a day for thirty years.
‘That must be investigated, especially if smoking cessation counseling is also used, because prevention is always better than cure,’ says director of the Center for Cancer Detection Patrick Martens. ‘Work has been going on for some time on such a screening, but that is not evident from the point of view of population screening. For example, you do not know who smoked that amount. You have to collect that information in a certain way, in a privacy-friendly way. You have to evaluate something like this step by step.’
Other cancers
Europe wants an earlier screening for prostate cancer, but the scientists point out that in our country prostate cancer is very often detected at an early stage (1 or 2). The five-year survival rate is 98 percent. That is already very good. Does systematic screening still offer much benefit? There is a high risk of overdiagnosis and overtreatment. About a third of prostate cancers progress so slowly that you will never have them. The treatment does have potential drawbacks such as impotence and incontinence, but no benefits.’
There is also the advice to switch for cervical cancer from the traditional PAP smear to a specific HPV test every five years from the age of 30. ‘Self-sampling is also possible there, which is not possible with the PAP test. This has already been started, but here too it is important that we first develop the entire screening process qualitatively from invitation, accessible correct information, test, result, registration and follow-up.’
Europe is also proposing to increase screening for colorectal cancer from 55 to 50 years of age, although this is already happening in our country.
For the time being, the vision from Flanders is a point of view that ultimately has to be viewed by the member states via a federal advice at European level. Only then will a concrete plan be proposed from Europe.