Cancer screening and health system resilience: Keys to protecting and bolstering preventive services during a financial crisis

Martín-Moreno, José M.; Anttila, Ahti; Karsa, Lawrence von; Jl, Alfonso Sánchez; Gorgojo, Lydia

doi:10.1016/j.ejca.2012.02.060

Cited by 37 publications

(29 citation statements)

References 21 publications

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“…As a result of the current economic crisis, the financing of public health is in danger in many countries, as the long-term benefits of public health interventions are often overlooked [40].…”

Section: Responding To the Economic Crisismentioning

confidence: 99%

Financing Public Health in Europe

Rechel

Brand²

2013

Gesundheitswesen

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Aim: To ascertain the levels and mechanisms of funding public health in Europe.Methods: A review of published and unpublished documents and expenditure data.Results: Expenditure on public health in Europe is difficult to determine, but data from national health accounts suggest that it differs greatly across countries, both as a percentage of total health expenditure and per capita. Better data are urgently needed, given that a lack of sustainable, long-term funding may be the most significant barrier to public health programmes and interventions in Europe. Conclusions:In view of the current economic crisis, it will be essential to safeguard financing for public health and to put it on a more sustainable basis.

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Section: Responding To the Economic Crisismentioning

confidence: 99%

Financing Public Health in Europe

Rechel

Brand²

2013

Gesundheitswesen

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“…A number of criteria for successful implementation of cancer screening programmes have been identified in the chapter on organization [16]. This is an important area in which knowledge is expanding [68][69][70][71] and should be further developed to make effective use of CRC screening as a tool of cancer control. …”

mentioning

confidence: 99%

European guidelines for quality assurance in colorectal cancer screening and diagnosis: Overview and introduction to the full Supplement publication

Karsa¹,

Patnick²,

Segnan³

et al. 2012

Endoscopy

249

187

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Population-based screening for early detection and treatment of colorectal cancer (CRC) and precursor lesions, using evidence-based methods, can be effective in populations with a significant burden of the disease provided the services are of high quality. Multidisciplinary, evidence-based guidelines for quality assurance in CRC screening and diagnosis have been developed by experts in a project co-financed by the European Union. The 450-page guidelines were published in book format by the European Commission in 2010.They include 10 chapters and over 250 recommendations, individually graded according to the strength of the recommendation and the supporting evidence. Adoption of the recommendations can improve and maintain the quality and effectiveness of an entire screening process, including identification and invitation of the target population, diagnosis and management of the disease and appropriate surveillance in people with detected lesions. To make the principles, recommendations and standards in the guidelines known to a wider professional and scientific community and to facilitate their use in the scientific literature, the original content is presented in journal format in an open-access Supplement of Endoscopy. The editors have prepared the present overview to inform readers of the comprehensive scope and content of the guidelines. IntroductionAccording to recent estimates by the International Agency for Research on Cancer [1], colorectal cancer (CRC) is the most common cancer in Europe with 432 000 new cases reported annually in men and women combined. It is the second most common cause of cancer deaths in Europe with 212 000 deaths reported in 2008.Worldwide, CRC ranks third in incidence and fourth in mortality with an estimated 1.2 million cases and 0.6 million deaths annually. In the 27 Member States of the European Union (EU), CRC ranks first in incidence and second in mortality, with approximately 334000 new cases and 149000 deaths estimated in 2008.Even in those Member States in the lower range for age-standardized rates of CRC, the burden of disease is significantly greater when compared with many other HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript regions of the world (see reference [1]). CRC is therefore an important health problem across the EU.Screening can be effective in cancer control in populations with a significant burden of CRC, provided the services are of high quality [2]. The aim of CRC screening is to lower the burden of cancer in the population by discovering disease in its early, latent stages [3]. Evidence-based methods permit treatment that is more effective than if disease is diagnosed later when symptoms have occurred. Early treatment of invasive lesions, for example by endoscopic resection of early CRC, can also be less detrimental for quality of life. The endoscopic removal of pre-malignant lesions also reduces the incidence of CRC by avoiding the progression to cancer. Randomized trials in people of average risk invite...

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“…Three of the most recently published sets of principles showed further evolution. In the context of genetic screening, Andermann and colleagues added a number of subcategorizations to a distinct overarching structure (i.e., laboratory testing, clinical services and program management); 43 Martin-Moreno and colleagues used 4 health system elementsgovernance, finance, resource generation and service deliveryto organize their approach to cancer-screening decisions; 46 and the most recent screening principles from the UK National Screening Committee added a fifth category for implementation criteria. 51 The citation analysis showed many apparent inconsistencies in the evolution of the documented screening principles we identified in the review.…”

Section: Resultsmentioning

confidence: 99%

Consolidated principles for screening based on a systematic review and consensus process

Dobrow

Hagens

Chafe

et al. 2018

CMAJ

238

214

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MethodsWe employed a systematic review to identify, synthesize and consolidate existing principles of screening, followed by a modified Delphi consensus process with international screening RESEARCH Consolidated principles for screening based on a systematic review and consensus process Jungner published 10 principles of screening that often represent the de facto starting point for screening decisions today; 50 years on, are these principles still the right ones? Our objectives were to review published work that presents principles for population-based screening decisions since Wilson and Jungner's seminal publication, and to conduct a Delphi consensus process to assess the review results. METHODS:We conducted a systematic review and modified Delphi consensus process. We searched multiple databases for articles published in English in 1968 or later that were intended to guide population-based screening decisions, described development and modification of principles, and presented principles as a set or list. Identified sets were compared for basic characteristics (e.g., number, categorization), a citation analysis was conducted, and principles were iteratively synthesized and consolidated into categories to assess evolution. Participants in the consensus process assessed the level of agreement with the importance and interpretability of the consolidated screening principles. RESULTS:We identified 41 sets and 367 unique principles. Each unique principle was coded to 12 consolidated decision principles that were further categorized as disease/condition, test/intervention or program/system principles. Program or system issues were the focus of 3 of Wilson and Jungner's 10 principles, but comprised almost half of all unique principles identified in the review. The 12 consolidated principles were assessed through 2 rounds of the consensus process, leading to specific refinements to improve their relevance and interpretability. No gaps or missing principles were identified. INTERPRETATION:Wilson and Jungner's principles are remarkably enduring, but increasingly reflect a truncated version of contemporary thinking on screening that does not fully capture subsequent focus on program or system principles. Ultimately, this review and consensus process provides a comprehensive and iterative modernization of guidance to inform population-based screening decisions.HEALTH SERVICES

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Cancer screening and health system resilience: Keys to protecting and bolstering preventive services during a financial crisis

Cited by 37 publications

References 21 publications

Financing Public Health in Europe

Financing Public Health in Europe

European guidelines for quality assurance in colorectal cancer screening and diagnosis: Overview and introduction to the full Supplement publication

Consolidated principles for screening based on a systematic review and consensus process

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