EMUC16: National cancer prevention plans need a boost

National cancer plans, which are vital for an effective pan-European cancer care programme, should look closer at prevention, rehabilitation and survivorship issues, according to a public healthcare expert who spoke at the 8th European Multidisciplinary Meeting on Urological Cancers (EMUC16) held over the weekend in Milan, Italy.

“National cancer plans and strategies are also one of the important instruments in trying to organize and structure cancer care,” said Dr. Tit Albreht, Associate Professor of Public Health at the Department of Public Health of the Medical Faculty in Ljubljana (SL) and coordinator of the Joint Action Cancer Control (CanCon). CanCon provides health policy support and advice to cancer control strategies to the European Union (EU) and its member states.

Albreht said such a structure can provide the framework which will enable the proper planning of the necessary human, financial and infrastructure resources.

He, however, noted there are two key blocks or obstacles in European healthcare which are health promotion and prevention. In particular, more attention should be given to cancer care, rehabilitation, survivorship and palliative care issues.

According to Albreht, Cancon together with other European policy-makers have agreed on key deliverables and outcomes one of which concerns cancer screening. “These include governance of cancer screening…and an in-depth assessment of the existing and potential new screening programmes in cervix, breast, colon/rectum, lung, stomach and prostate,” he said.

With regards prostate cancer, Albreht mentioned salient issues in prostate cancer screening such as cost-effectiveness and the ongoing debate on harms and benefits of biopsy-based screening programmes.

Taking note of the European Randomised Study of Screening for Prostate Cancer (ERSPC), Albreht noted one of the issues raised in the debate was that the trial efficacy point estimates varied between participating countries due to differences in length of follow-up and PSA testing contamination in the control arm.

Regarding PCA screening, he said cost effectiveness with a single screen at age 55 years was estimated at US$31,500, and added that these cost-effectiveness ratios apply to healthcare costs in the US and may be lower in European settings. On the positive side, Albreht said further improvements are expected due to the wider use of active surveillance and better identification of indolent and significant disease using biomarkers and new imaging.

In CanCon, Albreht said it has been recommended that “quantitative estimates of the benefits, harms and cost-effectiveness of possible new cancer screening programmes are needed to decide on implementation.”

“At present, these estimates are becoming available for prostate cancer screening, indicating that a cost-effective programme could be designed although some questions remain regarding the harm-benefit ratio,” he said.

CanCon is due to present its policy paper during its final conference in Malta on February 14 to 15 next year. He disclosed that draft policy papers are currently being finalized and evaluated in time for the Malta meeting.