Rollout

National rollout ahead! You should be now sure that everything is ready for starting the programme.

Here is the check list for rollout:

• Early evaluation of outcome
• Early evaluation of adverse effects
• Reducing social inequalities
• Reducing barriers
• Training and capacity building
• Modification or stopping as indicated

After the piloting phase, the programme can be rolled out after modifications and corrections deemed necessary based on pilot evaluation. The full implementation of the programme may take several years to achieve coverage and ensure optimal function through the screening chain.

Outcome and adverse effects

To secure the benefits of screening, routine linkage between the registries containing relevant data for defining the population, performance and outcome is essential and can be considered an ethical requirement of screening. Linkage studies provide a powerful tool to assess benefits and harms of the on-going screening programmes. They are also useful in demonstrating cost-effectiveness and whether the expected gains have been realized.

Quality management must include both continuous monitoring of the quality indicators and programme improvement when indicated by monitoring or related evaluation projects. Quality and effectiveness indicators are valuable also for providing feedback, training, and education of professionals.

Communication of benefits and harms should be central to population-based screening programmes. Appropriate balance sheets are useful. Those invited should be provided with the information needed for an informed decision about participation.

Inequalities

Evaluation and regular monitoring of cancer screening should also detect social inequalities and trigger research and interventions on improved equity in health. This needs to be done at every step implementing cancer screening, also in the routine, full implementation phase. Research collaboration has an added value to develop interventions and solutions in the local settings where social barriers and social inequalities in cancer have prevailed.

Social inequalities in access to cancer screening can still be observed within population-based programmes, evident as lower participation in cancer screening programmes by lower socioeconomic status, within minority ethnic groups or in deprived areas. Also, the risk of the disease may vary between population groups.

Participation in and performance and outcome of population-based screening varies remarkably also between countries, indicating large inequalities throughout Europe.

The first studies from the effects of COVID-19 pandemic show that cancer screening services in many European countries were disrupted.