Research Groups

Early Detection and Prevention - Quality Assurance Group

Current Research Topics:

European Cancer Network (ECN) for Screening and Prevention

The primary objective of the European Cancer Network (ECN) for Screening and Prevention is to promote best practice in screening and complementary methods of primary cancer prevention in Europe through pan-European and international cooperation and collaboration in development and implementation of quality assurance guidelines. The network is coor¬dinated by the Quality Assurance Group at IARC.

In 2005 and 2006 the European breast and cervical cancer screening networks established under the Europe Against Cancer programmes, and the new EU network for development of guidelines on quality assurance of colorectal cancer screening were consolidated under the umbrella of the ECN - providing a single multidisciplinary network for cooperation and collaboration across different tumor sites. Through network meetings and collaborative projects, the EU member states which acceded to the EU after 2003 and EU applicant countries were brought into the mainstream of European efforts toward continuous improvement of best practice in cancer screening. Activities of the network were initially co-financed by the EU Public Health Programme (grant agreement no. 2004309). IARC was the main partner of respective EU grant agreement. Associate partners were: EUROPA DONNA - the European Breast Cancer Coalition in Milan, Italy; the Public Association for Healthy People (PAHP), in Budapest, Hungary; and the Scientific Institute of Public Health (IPH), in Brussels, Belgium.

Key achievements in 2006 were completion of preparations for publication of the 4th expanded and updated edition of the European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis, as well as the launching of a pan-European project, including experts from Israel, Japan, Switzerland, Norway and the USA, to develop the first European Quality Assurance Guidelines in Colorectal Cancer Screening. This initiative has subsequently been supported by a grant from the European Commission under the current EU Health Programme (no. 2005317).

In 2007 and 2008, activities in the ECN were extended to include complementary cancer prevention, particularly integration of recommendations on HPV vaccination into the EU cervical cancer screening guidelines. Initial efforts focused on the final editing of the updated and substantially expanded 2nd edition of the European Guidelines for Quality Assurance in Cervical Cancer Screening, as well as preparation of the first report on the implementation of the Council Recommendation on Cancer Screening of 2 December 2003. Support for the latter activities was also provided through another project which was integrated into the ECN and co-funded by the EU Health Programme (European Network for Information on Cancer - EUNICE). After completion of the initial ECN contract (no. 2004309), Financial support for continuation of scientific reporting on the status of cancer screening programmes in the EU was provided through a project under the current EU Health Programme (no. 2006322) which also deals with updating and expanding the current editions of the EU guidelines for quality assurance in breast and cervical cancer screening.

In 2009, status reporting and development and updating of the EU guidelines on breast, cervical and colorectal cancer screening has continued with increasing interest and involvement of the new EU member states and applicant countries as well as countries from Africa, Asia, the Middle East, North and South America and the Pacific region (Argentina, Australia, Bahrain, Brazil, Canada, China, India, Israel, Japan, Jordan, Korea, Kuwait, Libya, Mexico, the Russian Federation, Saudi Arabia, Serbia, the Ukraine and the United States).

Development of European Guidelines for Quality Assurance of Colorectal Cancer Screening

This project is funded under the EU Health Programme (CRC Screening, grant no. 2005317). The main objective is to develop EU guidelines on best practice in colorectal cancer screening. The com¬pre¬hen¬sive guidelines will be based on available evidence and previous experience in testing and quality assurance of CRC screening. They will cover the entire screening process from invitation to manage¬ment of screen-detected lesions and will include recommendations for standardized proce¬dures, moni¬toring and evaluation, as well as recommendations on future perspectives for CRC screening.

The methods applied in the project include:
  • A multidisciplinary editorial board structure with writing and review groups appointed by the co-chairmen of the editorial board who have extensive experience in development of best practice guidelines, in evaluation of strategies for CRC screening and in screening programme management
  • Consultation of experts, client/patient groups in meetings and via web
  • Literature searches and data analysis
  • Pan-European network building with well-planned, multidisciplinary conferences to involve national/local screening coordinators, scientific societies, client and patient representatives and to ensure geographic representation and wide-spread acceptance of the developed standards and recommendations.
  • Supplemental dissemination through advocacy
Screening experts, clinicians (for assessment and management of screening-detected lesions), public health specialists and epidemiologists, administrators and client and patient representatives in all of the EU member states will play an active role in editing and reviewing the comprehensive CRC best practice guidelines.

It is expected that the best practice guidelines developed in the project will receive the same high recognition and acceptance throughout the Community which is currently the case with the European guidelines on breast and cervical cancer screening. This, in turn will help to achieve the general goals of the project, e.g.: to build on previous, highly successful efforts to improve control of common cancer in the European Union through secondary prevention, to promote cooperation between member states in guideline development and implementation, to make available to all member states expertise in high quality colorectal cancer screening and to facilitate implementation of effective colorectal cancer screening programmes in interested member states through networking.

Main partner: IARC
Associated partners:
  • University of Oxford, United Kingdom
  • Azienda Ospedalliera San Giovanni Battista and CPO, Torino, Italy
  • Public Association for Healthy People, Budapest, Hungary
  • European Cancer Patient Coalition (ECPC), Utrecht, The Netherlands.
  • Quality Assurance Group, Early Detection and Prevention Section, IARC

European Cooperation on Development and Implementation of Cancer Screening and Prevention Guidelines (ECCG-ECN, project no. 2006322)

  1. General objectives
    The project aims to develop urgently needed supplements to the current EU guidelines in order to take into account new developments and improve prevention of cervical cancer through HPV vaccination and testing.

  2. Strategic relevance
    Guidelines for breast and cervical cancer screening have been developed by the former cancer screening networks established under the 'Europe against cancer' (EAC) programme. The Council of the European Union has recommended screening based on these guidelines (COM(2003) 230 final). The project will generate significant added value in coming years by assuring that relevant, state-of-the-art quality assurance guidelines are available when most of the new EU Member States, which have not yet implemented the Council recommendation on screening, are ready to expand cancer control efforts through secondary prevention. Since the fundamental principles of quality assurance on which the guidelines are based are valid in all resource settings, the experience gained in updating the European screening guidelines is also relevant to efforts to implement and improve cancer screening in other regions of the world.

  3. Methods and means
    The priority for currently identified guideline topics has been identified in working group meetings in breast and cervical cancer screening held at the 2006 meeting of the European cancer network which was attended by experts from 23 EU Member States. Multidisciplinary editorial boards will provide professional supervision of the guideline development process. Experts and clients, and patient groups will be consulted to assure wide professional and lay input to guideline development. Empirical measurements will be conducted on breast imaging and viewing equipment and technical accessories to develop and test validity and practicability of physico-technical standards. Literature reviews and data analysis will identify those references which need to be added or updated to the relevant chapters in the breast and cervical cancer guidelines.

  4. Expected outcomes
    Maintenance of the relevance and comprehensiveness of EU guidelines for quality assurance on cancer screening by the preparation of print-ready supplements on specific topics. Extension of the scope of the screening guidelines by inclusion of HPV vaccination for the prevention of cervical cancer. Maintenance of an EU forum for cooperation in cancer screening and guideline development. Description of the current epidemiology of breast and cervical cancer in the EU. Participation of experts outside the EU.

Main partner: IARC
Associated partners:
  • ARCADES, France
  • EUROPA DONNA, The European Breast Cancer Coalition, Italy
  • Stichting Landelijk Referentie Centrum voor Bevolkingsonderzoek, (LRCB-EUREF), The Netherlands
  • Queen Mary & Westfield College, United Kingdom
  • Scientific Institute of Public Health, Belgium
  • Royal Surrey County Hospital NHS Trust, United Kingdom
  • Quality Assurance Group, Early Detection and Prevention Section, IARC

Europe against Cancer: Optimisation of the Use of Registries for Scientific Excellence in research (EUROCOURSE)

In work package 5: "Interface of cancer registries with cancer screening programmes", the QAS group has collaborated with experts in quality assurance of population-based cancer screening programmes in Europe to develop recommendations on items related to screening to be used in a European data set for comprehensive cancer monitoring and reporting in Europe.

The recommended data items take into account that the purpose of screening for cancer is to prevent mortality from the disease. In addition, cancer incidence and quality-of-life will be affected. It is essential that when providing screening for cancer, a well-organised population-based approach is utilised with systematic quality assurance at all appropriate levels.

The purpose of the recommendations on information on cancer screening is to outline procedures, data items and coding structures for a systematic individual-level registration of cancer screening programmes, provide a set of aggregated key performance indicators for the European level based on the European quality assurance guidelines for cancer screening, and illustrate how to compute the key performance indicators. The recommendations are developed in the context of monitoring and evaluation which are essential to quality assurance of cancer screening.

There is a clear need to promote availability of standardised screening registration and respective data classification systems in the population-based cancer screening programmes across Europe. Effective utilisation of screening registers includes, but is not limited to systematic and comprehensive linkages with cancer, cause-of-death and other relevant registers in the health care system. Basic requirements for these linkages in quality assurance and evaluation of cancer screening programmes are also included in the presently proposed data descriptions. These recommendations have importance also in developing accreditation of cancer screening programmes.

The final recommendations are documented and explained in a separate document (Anttila A, Ponti A, Ronco G, Lönnberg S, Malila N, Chil A, Fracheboud J, Törnberg S, Zakelj M, von Karsa L (2012) Recommendations on screening related items in European data set. Goto: