WP leader: Cancer Society of Finland (Satu Lipponen)

Outputs and deliverables

Insight and effectiveness of early diagnosis

Work Package 5 has four broad tasks: to identify how to advance early detection, to reinforce screening programmes and to plan sustainability and to strengthen cancer prevention and health promotion. Finally, the fourth task is to contribute to the Roadmap on Implementation and Sustainability of Cancer Control Actions, the main deliverable of the Joint Action.

The working mode of the Work package is co-creation which combines the strength of iPAAC consortium, its collaborative partners and multi-stakeholder voice. This is described in the task 5.1. report (Methodology of task 5.1.) Insight and effectiveness of early diagnosis. Conclusions in the report are drawing from three sources: a European-wide survey (n=153) of barriers to early detection (Milestone 5.1.), a background paper and co-creational conference of early diagnosis.

Early diagnosis of cancer as part of comprehensive cancer control means recognition of symptomatic cancer in patient with links to treatment without delays. Early diagnosis requires that there is good awareness of early signs of cancer. Another important factor is health system and especially easy access to primary health care without delays and affordable cost. Early diagnosis can increase inequalities if there are unnecessary tests leading to overuse of health care services. Currently, there is only limited amount of systematic data on early diagnosis in clinical settings. Cancer types differ greatly in their early stage and progression. Lack of evidence is one barrier identified in the survey and carefully planned pilots of early diagnosis could be welcome part of future research agenda. Most cancer types are not suitable for cancer screening programmes. There is room for developing programmatic services of early diagnosis. 

When addressing barriers to early diagnosis there should be a special focus of impact of these barriers to inequalities. There is much to gain if disadvantaged groups are specifically addressed, including tailored communications and messages. Both oral cancers and skin cancers have highest delays of early detection due to inequalities, according the survey done.

New openings of cancer screening in Europe

There have been considerable developments during the last 15 years in the implementation of population-based screening programmes for cancer within the European Union Member States. Yet many of the Member States lack systematic, comprehensive policy-making protocols and structures for well-functioning cancer screening programmes. Developed in previous Joint Actions, the iPAAC WP5 is looking for social innovations and tools for implementation in three EU council recommended screening programmes. One key area is reducing inequality through cancer screening programmes. The challenges with social inequalities in health are an important focus area also for the so-called risk-stratified screening concepts.

Quality assurance and good governance are important themes of effective programmes. WP5 will develop infographics available online.

Principles of risk-adjusted screening within the population-based screening programmes are addressed in the chapter Risk-stratified screening: criteria and innovations, which is based on the Milestone 5.2.

Other recommended reading of the report includes definitions, a comprehensive reference section and briefly updated suggestions on potential new programmes (lung, prostate).

Cancer prevention in the 2020s

European countries have a lot of potential to advance cancer prevention and health promotion. Prevention is the most cost-effective long-term strategy for cancer control. About 4 in 10 cancer cases can be preventable. Tobacco smoking is the most preventable cause of cancer. After tobacco, alcohol is one of the leading risk factors of premature mortality. In addition to alcohol, excessive body weight, lack of physical activity and unhealthy diet (low fibre, high processed meat) are important contributors to the cancer burden in Europe.

The European Union has emphasised cancer prevention in its launch and preparation for implementing Europe’s Beating Cancer Plan and Cancer Mission 2020–2021. Prevention and health promotion should span the whole cancer control continuum. For instance, quitting smoking and physical exercise can improve the survival of cancer patients.

Here, we mainly report on the results of collaborative meetings to find common ground for future actions. The focus is on primary prevention. The two cross-cutting goals were equity and innovation. The results are based on co-creational events held in 2020–2021 with hundreds participants online.

We arranged two online rounds. The first meeting, held in April 2020, concentrated on the European Code Against Cancer (ECAC). One of the tasks of WP5 was to prepare the 5th edition of the Code. The second round was held in February 2021. Its agenda was broadly focused cancer prevention and health promotion. The results of these events are summarised in this report.

Health services work predominantly with individuals with high risk. Major public health potential lies in reducing cancer risks through policies and broad health promotion. These risks are common to all non-communicable diseases. Reducing these diseases is also important for environmental sustainability.

The main conclusions include creating strong supporting structures and public health policies for cancer prevention; urgent action for evidence-based interventions; cross-sectional, collaborative efforts and capacity building for working across sectors. We emphasise cancer research that includes the whole cancer control continuum. Systematic reporting to reduce inequalities among populations, regions and countries is necessary.

The most important message of this report is clear: Decisive collaborative actions without delays are crucial for public health and for a healthy Europe.

Recommendations for the sustainability and monitoring of the European Code Against Cancer

The “Roadmap on Implementation and Sustainability of the Cancer Control Action in the field of cancer prevention” is the main deliverable of Work Package 5 (WP5) of the third European Commission Joint Action on Cancer, the Innovative Partnership for Action Against Cancer (iPAAC). This plan focuses specifically on the scope of a future 5th edition of the European Code Against Cancer (ECAC), including updating and maintaining the scientific evidence, and on the strategies to further expanding the scope, implementation, and dissemination of the ECAC across Europe. The International Agency for Research on Cancer (IARC/WHO), as the coordinator of the update for the 4th edition of the ECAC, has introduced recommendations for the monitoring and sustainable follow-up of the ECAC (WP5 Milestone 5.3.).

The methodology followed for developing this plan included a co-creational consultation process, and a virtual workshop in April 2021, coordinated by IARC, the Association of European Cancer Leagues (ECL), and the Cancer Society of Finland (CSF). Input on cancer prevention from more than 100 participants was collected and discussed, to assess the needs and pave the way for the future of the ECAC. Overwhelming support of the need for the ECAC and its continuous updating, optimization, and wider dissemination was expressed by all the stakeholders involved in the consultation process, including scientists and experts in cancer prevention and/or public health, advisors on dissemination and communication, and representatives of European authorities.

The third task of WP5, strengthening cancer prevention and health promotion is ongoing. The task 5.3. conference report will be published later in 2021. The report is based on an online meeting of well over 100 participants working in breakout sessions in February 2021 and outcomes of those discussions.

The cross-cutting theme on inequalities in the WP5 is based on the work of the Foundation for the Promotion of Health and Biomedical Research of Valencia Region, FISABIO.

Other deliverables

Activities

WP5 description and objectives

The aims of the work package is to

  • Update, build awareness and strengthen implementation of the European Code Against Cancer (ECAC) in Member States
  • Plan a sustainable monitoring system with a follow-up structure for ECAC
  • Target vulnerable populations to reduce inequalities and foster health promotion (building upon the CanCon policy papers and the Guide)
  • Reinforce cancer prevention via population-based screening programmes, further developing the principles of the 2003 EU recommendations on screening
  • Identify data collaboration partners and to describe the process leading to better implementation of screening.
  • Strengthen screening practices with quality criteria and to remove obstacles of early detection of cancer.

Specific objectives are the following:

  • Monitoring of ECAC recommendations in the long-term perspective
  • Providing a special focus on conflicting recommendations
  • Exploring early detection and management strategies
  • Organising European Week Against Cancer conferences and providing 3 reports for the article of the iPAAC chapter on prevention