Sustainable implementation

Tasks in the final phase of the implementation:

• Long-term evaluation
• Accurate communication
• Safeguard sustainability
• Continuous quality improvement
• Prospective evaluation of new methods
• Modification or stopping as indicated

Monitoring and evaluation reports must be published regularly to inform the public and decisionmakers and to permit timely modification of programme policy, if necessary. Indicators for equity in participation and health outcomes need also to be included in the routine quality assurance capabilities of population-based screening programmes.

Because of the importance of acceptance of the programme by society, the results must be communicated to the public on a regular basis. Collaboration between countries in monitoring and evaluating routine programmes will ensure better comparability of results and may encourage higher standards in all aspects of quality assurance.

Modifications of established, well-functioning programmes may be needed to reflect developments in screening, diagnostic and treatment methods, or because of developments in complementary primary prevention (such as changes in cervical cancer screening policy in HPV vaccinated populations). There need to be criteria also for stopping a programme, if it has been proven to be ineffective.

Further reading

Lönnberg S, Šekerija M, Malila N, Sarkeala T, Leja M, Májek O, Zappa M, Heijnsdijk E, Heinävaara S, de Koning H, Anttila A. Chapter 4. Cancer screening: policy recommendations on governance, organization and evaluation of cancer screening. In: Albreht T, Kiasuwa R, Van den Bulcke M, eds. European Guide on Quality Improvement in Comprehensive Cancer Control. National Institute of Public Health, Ljubljana, Slovenia 2018.

Lynge E, Törnberg S, Von Karsa L, Segnan N, Van Delden JJM. Determinants of successful implementation of population-based cancer screening programmes. Eur J Cancer. 2012;48(5):743–8.

The European guidelines for quality assurance in breast, cervical and colorectal screening:

Perry N et al., eds. European guidelines for quality assurance in breast cancer screening and diagnosis. Luxembourg, Office for Official Publications of the European Communities; 2006.

Perry N et al., eds. European guidelines for quality assurance in breast cancer screening and diagnosis, 4th edn, Supplements. Luxembourg, Office for Official Publications of the European Union; 2013.

Guidelines on breast cancer screening and diagnosis (ECIBC) https://healthcare-quality.jrc.ec.europa.eu/ecibc/european-breast-cancer-guidelines

Arbyn M et al., eds. European guidelines for quality assurance in cervical cancer screening, 2nd ed. Luxembourg, Office for Official Publications of the European Communities; 2008.

Anttila A et al., eds. European guidelines for quality assurance in cervical cancer screening, 2^nd edition, Supplements. Luxembourg, Office for Official Publications of the European Union; 2015.

Segnan N, Patnick J, von Karsa L, eds. European guidelines for quality assurance in colorectal cancer screening and diagnosis. Luxembourg, Office for Official Publications of the European Union; 2010.Andermann A et al. Revisiting Wilson and Jungner in the genomic age: a review of screening criteria over the past 40 years. Bulletin of the World Health Organization, 2008;86:317–331.

Developments in screening criteria:

Dobrow MJ, Hagens V, Chafe R, Sullivan T, Rabeneck L. Consolidated principles for screening based on a systematic review and consensus process. CMAJ 2018 April 9;190:E422-9. doi: 10.1503/cmaj.171154.

Schünemann H, Brożek J, Guyatt G, Oxman A, eds. GRADE Handbook. Introduction to GRADE Handbook. Handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach. Updated October 2013. https://gdt.gradepro.org/app/handbook/handbook.html.

Májek O, Anttila A, Arbyn M, van Veen EB, Engesæter B, Lönnberg S. The legal framework for European cervical cancer screening programmes. Eur J Public Health 2019; 29: 345-350.

Anttila A, Singh D, Lipponen S, et al. New openings of cancer screening in Europe. https://www.ipaac.eu/res/file/outputs/wp5/new-openings-cancer-screening-europe.pdf