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Reporting period: 2015-09-01 to 2017-02-28

Breast, colorectal and cervical cancer cause 250,000 deaths each year, representing 20% of EU-cancer mortality. Although important progress has been made in both detection and treatment, there is persisting inequity in progress to reduce its burden. Cancer screening programmes vary substantially between countries and in most countries long-term effectiveness of screening has not yet been assessed. In 2015 the EU-TOPIA project has started. The objective of EU-TOPIA is to systematically evaluate and quantify the harms and benefits of the screening programmes for breast, cervical, and colorectal cancer in all European countries, and identify ways to improve health outcomes and equity for citizens.

We will develop models for each region in Europe that can estimate the harms and benefits and cost-effectiveness of the existing screening programmes and the impact of changes to the programmes. In addition, we will develop a tool to monitor the screening programmes and a tool to identify barriers and explain inequities in cancer screening programmes between European countries and demographic groups. By organizing interactive workshops we will train people involved in cancer screening (for example researchers involved in the monitoring, programme coordinators or policymakers) from all countries in Europe to monitor their cancer screening programme, identify feasible ways to improve the programme and develop road maps to reach that goal.
We started by listing the harms and benefits of the three screening programmes. Important benefits are a reduction in mortality form the cancer and needing less aggressive treatment. Harms are, among others, overdiagnosis and overtreatment and false positive test results. We prioritized a set of short term key quality indicators harmonized across cancer sites, which can be measured to estimate the long-term effects of screening.

In addition, we systematically evaluated literature on the effects (in terms of mortality or incidence reduction) of cancer screening across the European countries. The literature search provided evidence that cancer screening reduces mortality from the three cancers in all European regions where screening was implemented and monitored. The mortality reduction in the regions will be used to validate decision models which will be used to find the optimal screening strategy.

We have started to develop a monitoring and a barrier analysis tool. In the monitoring tool, researchers and programme coordinators can enter annually the results of the screening programme (for example participation rates, number of screens, number of positive screens and cancers by age and stage). The monitoring tool will calculate the short term key indicators and the data can be used as input for the decision model to evaluate the long-term harms and benefits of the programme. In the barrier analysis tool, the user is systematically guided through each phase in the screening system (from invitation, participation and follow-up to treatment). In each phase, the user is requested to systematically think which parties are responsible and what information is missing to identify barriers in the existing programmes. Both the monitoring tool and the barrier assessment tool have been tested by all EU-TOPIA partners.

We will organize four workshops in a series of four workshops to build capacity to conduct cancer screening evaluation independently. The first workshop will focus on monitoring screening programmes and is planned for September 2017. Already 39 participants from 26 different countries in Europe have registered.
This project has the potential to impact the health and quality of life of millions of European women and men. Together, breast, cervical and colorectal cancer are responsible for approximately 250,000 deaths in the EU each year. However, the burden varies substantially across Europe. The ultimate aim of EU-TOPIA is to optimize screening for breast, cervical, and colorectal cancer throughout Europe. We are committed to ensure that our research has a substantial impact on policy level. EU-TOPIA will decrease the disparity of the burden of disease across Europe as described above by identifying existing barriers and comparing performance data that may indicate that some existing screening programmes are suboptimal. We will, therefore, provide evidence for the increased use, or discontinuation of, existing cancer screening programmes; improve health outcomes based on the road maps to be implemented, and build capacity in the assessment of these programmes. The project will lead to reduced inequity, reduced number of cancer deaths and over-diagnosed cases, and increase in life years gained and better cost-effectiveness by 2025.