Periodic Reporting for period 3 - EU-TOPIA-EAST (TOwards imProved screening for breast, cervical and colorectal cancer in Eastern-Europe: Equitable, Actionable, Sustainable and Trustworthy)
Reporting period: 2024-05-01 to 2025-10-31
Colorectal, breast and cervical cancer cause 155,000 deaths per year in middle income countries (MIC) in Eastern Europe, while there is good evidence that a large proportion could be prevented by organised screening. Although many Eastern European MIC have implemented cancer screening, this is often non-organised, leading to lack of data and quality assurance. Also, coverage is commonly low and minority groups are not reached.
In a previous H2020 project ‘EU-TOPIA’, we developed road maps to improve cancer screening programmes in Europe. In the current project, EU-TOPIA-EAST, these roadmaps will be refined and translated into action plans for three MICs: Georgia (breast), Romania (cervix) and Montenegro (colorectal). These action plans will take local health and social system into account by performing detailed barrier and stakeholder analyses, leading to feasible changes to current screening programmes. Next, we will implement these action plans.
The implemented programmes will be monitored and evaluated using key indicators and decision models to predict long-term and country-wide benefits, harms and cost-effectiveness. During workshops and round-table discussions for policymakers and screening programme coordinators we build capacity and upscale the implementation of these intervention(s) in Equitable, Accessible, and SusTainable (EU-TOPIA-EAST) ways. In this way, the project will improve the prevention and early diagnosis of cancer in real-life settings.
The overall goal of EU-TOPIA-EAST is to implement effective screening programmes for breast, cervical and colorectal cancer in three exemplary MICs in Eastern Europe and to build capacity for screening implementation in other Eastern European and Mediterranean countries, in order to reduce the cancer burden in these countries and to achieve equity in cancer care.
Objectives:
1. Extend, update and refine innovative road maps, initiated in the EU-TOPIA project by Georgia, Montenegro and Romania, into concrete action plans with steps and timeliness to successfully implementing these
2. Follow the steps in the road maps and action plans and implement in some regions the identified feasible interventions in the existing screening programmes in Georgia, Romania and Montenegro
3. Monitor the impact of implemented interventions on important short-term screening performance indicators, such as participation and detection rates
4. Estimate required resources, health outcomes and cost-effectiveness of scaling up the interventions to a national level and to other MIC in Eastern-Europe/Mediterranean using innovative dedicated microsimulation models
5. Disseminate good practices from participating to other countries by organising workshops and round table discussions with national/regional/local policymakers and other stakeholders
In a previous H2020 project ‘EU-TOPIA’, we developed road maps to improve cancer screening programmes in Europe. In the current project, EU-TOPIA-EAST, these roadmaps will be refined and translated into action plans for three MICs: Georgia (breast), Romania (cervix) and Montenegro (colorectal). These action plans will take local health and social system into account by performing detailed barrier and stakeholder analyses, leading to feasible changes to current screening programmes. Next, we will implement these action plans.
The implemented programmes will be monitored and evaluated using key indicators and decision models to predict long-term and country-wide benefits, harms and cost-effectiveness. During workshops and round-table discussions for policymakers and screening programme coordinators we build capacity and upscale the implementation of these intervention(s) in Equitable, Accessible, and SusTainable (EU-TOPIA-EAST) ways. In this way, the project will improve the prevention and early diagnosis of cancer in real-life settings.
The overall goal of EU-TOPIA-EAST is to implement effective screening programmes for breast, cervical and colorectal cancer in three exemplary MICs in Eastern Europe and to build capacity for screening implementation in other Eastern European and Mediterranean countries, in order to reduce the cancer burden in these countries and to achieve equity in cancer care.
Objectives:
1. Extend, update and refine innovative road maps, initiated in the EU-TOPIA project by Georgia, Montenegro and Romania, into concrete action plans with steps and timeliness to successfully implementing these
2. Follow the steps in the road maps and action plans and implement in some regions the identified feasible interventions in the existing screening programmes in Georgia, Romania and Montenegro
3. Monitor the impact of implemented interventions on important short-term screening performance indicators, such as participation and detection rates
4. Estimate required resources, health outcomes and cost-effectiveness of scaling up the interventions to a national level and to other MIC in Eastern-Europe/Mediterranean using innovative dedicated microsimulation models
5. Disseminate good practices from participating to other countries by organising workshops and round table discussions with national/regional/local policymakers and other stakeholders
We started the project by collecting data from the exemplary countries. These data were needed by the workpackages on evaluation, road maps and monitoring. For all countries, simulation models were developed to evaluate the short and long term harms, benefits and cost-effectiveness of the current screening programme. Also, various strategies have been evaluated on costs, effects and capacity to determine the best protocol to implement in future.
The exemplary countries also performed a barrier analysis and a stakeholder analysis, to determine the stakeholders that can help in overcoming the barrier or that should be convinced to overcome the barrier. These analyses were used to outline appropriate and feasible actions in detailed action plans to improve the current screening programmes. A system to monitor the follow-up of the actions has been implemented.
In addition, we evaluated the monitoring systems of the exemplary countries. The current data flow was analysed and technical issues, related to data collection management and quality assurance of the necessary data, including IT and data base management competence, were identified. We checked whether the necessary information to calculate key quality indicators of cancer screening are available and whether the data collection is in compliance with the EU and national privacy legislation requirements and improved the systems where necessary.
The exemplary countries started with the implementing improved screening programmes. Besides the mentioned improvement of the IT systems, in Georgia the guidelines were revised, and a new screening center was opened and. In Romania and Montenegro efforts have been taken to get access to the population registry by intensive communication with stakeholders. In Montenegro a new colonoscopy center has been opened and the colorectal cancer screening program has been restarted since having stopped for 2 years. The programmes were continuously monitored and especially in Montenegro, there were improvements in invitation coverage, referral rate, compliance with colonoscopy and detection rate.
Currently, round tables are planned or have been performed in the three exemplary countries to further upscale the action to reach sustainable improvements.
In addition, two workshops for stakeholders were held, in Slovenia and in Hungary. These workshops aimed at key elements of screening (monitoring, evaluation and barrier assessment) and developments of road maps to improve programmes. Delegates (researchers, programme coordinators and policymakers) of all European and Mediterranean countries were invited to participate in the workshops. For two participants per Eastern European/ Mediterranean country participation in the workshops was free of charge and the travel and accommodation costs were funded. Participants from high-income countries in Eastern Europe joined the workshop for free and funded travel and accommodation at own expenses. In total, 95 people participated in the first workshop and 70 in the second workshop. Tools, to help with monitoring, evaluating, barriers analysis and development of road maps and action plans have been developed/updated and are available online for all workshop participants.
The exemplary countries also performed a barrier analysis and a stakeholder analysis, to determine the stakeholders that can help in overcoming the barrier or that should be convinced to overcome the barrier. These analyses were used to outline appropriate and feasible actions in detailed action plans to improve the current screening programmes. A system to monitor the follow-up of the actions has been implemented.
In addition, we evaluated the monitoring systems of the exemplary countries. The current data flow was analysed and technical issues, related to data collection management and quality assurance of the necessary data, including IT and data base management competence, were identified. We checked whether the necessary information to calculate key quality indicators of cancer screening are available and whether the data collection is in compliance with the EU and national privacy legislation requirements and improved the systems where necessary.
The exemplary countries started with the implementing improved screening programmes. Besides the mentioned improvement of the IT systems, in Georgia the guidelines were revised, and a new screening center was opened and. In Romania and Montenegro efforts have been taken to get access to the population registry by intensive communication with stakeholders. In Montenegro a new colonoscopy center has been opened and the colorectal cancer screening program has been restarted since having stopped for 2 years. The programmes were continuously monitored and especially in Montenegro, there were improvements in invitation coverage, referral rate, compliance with colonoscopy and detection rate.
Currently, round tables are planned or have been performed in the three exemplary countries to further upscale the action to reach sustainable improvements.
In addition, two workshops for stakeholders were held, in Slovenia and in Hungary. These workshops aimed at key elements of screening (monitoring, evaluation and barrier assessment) and developments of road maps to improve programmes. Delegates (researchers, programme coordinators and policymakers) of all European and Mediterranean countries were invited to participate in the workshops. For two participants per Eastern European/ Mediterranean country participation in the workshops was free of charge and the travel and accommodation costs were funded. Participants from high-income countries in Eastern Europe joined the workshop for free and funded travel and accommodation at own expenses. In total, 95 people participated in the first workshop and 70 in the second workshop. Tools, to help with monitoring, evaluating, barriers analysis and development of road maps and action plans have been developed/updated and are available online for all workshop participants.
This project has the potential to impact the health and quality of life of millions of women and men. Together, breast, cervical and colorectal cancer are responsible for approximately 200,000 deaths each year in the Eastern European and Mediterranean countries. In these countries cancer screening is mainly opportunistic, there is a lack of resources and in some instances suboptimal/inefficient target ages or screening intervals are used. The ultimate aim of EU-TOPIA-EAST is to optimize screening for breast, cervical, and colorectal cancer in these countries. EU-TOPIA-EAST will decrease the disparity of cancer burden across countries by using the knowledge gained in the implementation studies in the exemplary countries to build capacity among the other countries. By inviting policymakers, programme coordinators, and researchers from all Eastern Europe and Mediterranean countries, we will enable them to identify the barriers for implementing optimal screening programmes in their countries and use tools for developing a country-specific roadmap. Therefore, they will be able to improve their cancer screening programmes on a structural base. Improved screening programmes will contribute to the United Nations’ sustainable development goal 3.4: “by 2030, reduce by one-third mortality from non-communicable diseases by prevention and treatment.”