Screening is here to stay, so let’s get it right: Register now - #EAPM Presidency Conference 28 March

Screening for diseases - such as breast, prostate and lung cancers - has always been a topic beset with arguments, as well as debates about the pros and cons, writes European Alliance for Personalised Medicine (EAPM) Executive Director Denis Horgan.

The discussion has taken place for some time on both sides of the Atlantic and shows no sign of abating any time soon, with many arguing, for example, that over-testing can very easily lead to over-treatment, including unnecessary invasive surgery.

Some have even suggested that the intensive screening for cancer in women’s breasts is due to cosmetic reasons - relating to the perceived attractiveness of breasts and the way that society views a woman with missing breasts - to the detriment of screening for other parts of the body.

The latter is surely a patent nonsense, given the number of deaths that could occur with this type of cancer and the amount of fatalities that are actually avoided.

Screening should not be about cosmetic issues. Nor should be about cost or, indeed, politics (sexual or otherwise).

However, the over-treatment argument has also been used in respect of the aforementioned breast cancer screening, although the figures tend to show that it works very well in a preventative sense and even better in detecting early breast cancer in target age groups.

PSA testing for prostate cancer has also come in for similar criticism.

The counter-arguments - and they are very strong ones - is that our ‘social contract’ has obligations to ensure to the highest standards possible regarding the health of citizens and that, fiscally, forewarned is forearmed and can save a great deal of money down the line.

The majority of experts (and, importantly, patients) would argue that there is a clear added value in properly run screening programmes, although this may vary - as do resources - across the 28 EU member states.

These differences also affect data collection, storage and sharing, the general delivery of healthcare, and levels of reimbursement, to name but a few.

The US approach to screening is similar to that found in Europe, but clearly we should be relying on our own data, findings and - crucially - recommendations, without totally relying on theirs.

Without doubt, all screening programmes - wherever on the planet they take place - have to be based on gathered evidence of efficacy, cost effectiveness and risk. Any new screening initiative should also factor in education, testing and programme management, as well as other aspects such as quality-assurance measures.

Two vital bottom-lines are that access to such screening programmes should be equitable among the targeted population, and that benefit can be clearly shown to outweigh any harm.

Coming up very soon is the fifth annual presidency conference organized by the European Alliance for Personalised Medicine. The event will take place in Brussels on 27-28 March, 2017, under the auspices of the Maltese Presidency of the European Union.

While the conference will take a close look at lung-cancer screening, its general subject matter will be much broader than that.

Experts from all stakeholder groups in healthcare will be examining the need for more recommendations and guidelines on health and preventative measures across the current 28 member states, affecting some 500 million EU citizens, while taking into account the counter arguments with respect of population-based screening programmes.

In that respect, the conference will focus on a broad range of issues and diseases, albeit with lung cancer at the centre (as it is the biggest killer of all cancers).

Key to the conference will be the issues surrounding how healthcare is governed in the EU and what influence, in effect, Brussels can and does have, bearing in mind that much of the areas of health come under Member State competence (although Europe has stepped up of late in areas such as clinical trials and IVDs).

EU health-care governance can be divided in general into two paradigms - these are top-down regulatory frameworks and/or bottom-up frameworks.

Stakeholders will remember the admin and voting nightmare that was the general data protection regulation (which saw more than 4,000 amendments), as well as the clinical trials regulation, which took more than a decade to revise.

Arguably, today, guidelines (on screening and more) may well be the way forward, given that they potentially have less rigidity and therefore more flexibility (within strict standards of safety and ethics, of course).

We can clearly see that innovation has brought about a greater need for adaptation through appropriate frameworks that must be designed by experts, in consensus - albeit with plenty of necessary input from regulatory bodies.

It is vital to ensure that any and all agreed standards can be met down the line. These include the aforementioned ethical considerations, patient safety, certainty within timeframes and facilitation of advancements for the benefit of Europe’s patients and our society in general.

Screening needs to be continuously reassessed, with guidelines updated when applicable. Despite arguments of over-treatment and issues of cost, it is one of the most potent preventative tools available to us today.

To register for our upcoming Presidency Conference on 'Innovation and Screening: The Future', please click here.

To see the agenda 'Innovation and Screening: The Future', please click here.

Share this article: