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Definitions

"Programme" vs. "non-programme" screening:

In many health care systems, prophylactic examination of apparently healthy individuals for the purpose of early detection and treatment of cancer may take place both in the framework of publicly mandated screening programmes as well as outside of any such programme. To qualify as a programme there should be a public screening policy documented in a law, or an official regulation, decision, directive or recommendation. The policy should define, as a minimum, the screening test, the examination intervals and the group of persons eligible to be screened; and the screening examinations should be financed by public sources (apart from a possible co-payment). In numerous countries, an appreciable amount of non-programme examinations for early detection of cancer may also be performed in a diagnostic or clinical context (commonly referred to as "grey", “wild,” or “opportunistic” screening). Such examinations may or may not be performed according to the public screening policy, if one exists. For example, some apparently healthy women receiving non-programme mammography in a clinical setting may be older or younger than the recommended age for mammography screening. Also, their mammographic examinations may or may not be publically financed, depending on the rules for reimbursement and/or payment of diagnostic mammography in the respective Member State. It is generally not possible to distinguish "grey" screening examinations from solely diagnostic examinations in official statistics. For the purposes of the present report, "grey" screening examinations are not considered to entail screening performed in the context of a programme.

Organised screening:

"Organised" programmes for delivery of screening services generally require a higher degree of programme management than the minimum expected to distinguish between "programme screening" as opposed to "non-programme screening". In an "organised" programme, in addition to the targeted population group(s), the screening test and the screening interval(s), the programme policy generally also specifies other procedures and provides for a team at the national or regional level which is responsible for implementing the policy, i.e., for coordinating the delivery of the screening services, maintaining requisite quality, and reporting on performance and results. Such elements generally provide for supervision and monitoring of most steps in the screening process, as well as comprehensive guidelines and rules defining standard operating procedures. In addition, a quality assurance structure is required and a means of ascertaining the population burden of the disease should be available [ref. 1] , [ref. 2] , [ref. 3] , [ref. 4] .

Population-based screening:

Population-based screening means that in each round of screening the persons in the eligible target population in the area served by a programme are individually identified and personally invited to attend screening. Population-based screening programmes generally require a high degree of organisation in order to assure that the invitational activities are performed reliably and effectively and are adequately coordinated with the subsequent steps in the screening process [1] .

Note

[1] Particularly in cervical cancer screening programmes with intervals of three or more years, some population-based programmes only individually invite non-attenders.

References

[ref. 1] European Commission. European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis. Fourth edition Perry N, Broeders M, de Wolf C, Törnberg S, Holland R, von Karsa L, Puthaar E (eds). Office for Official publications of the European Communities, Luxembourg, 2006
[ref. 2] European Commission. European Guidelines for Quality Assurance in Cervical Cancer Screening. Second edition. Arbyn M, Anttila A, Jordan J, Schenck U, Ronco G, Segnan N, Wiener H, Herbert A, Daniel J, von Karsa L (eds) Office for Official Publications of the European Communities, Luxembourg, 2008
[ref. 3] International Agency for Research on Cancer. Breast Cancer Screening (2002) IARC Handbooks of Cancer Prevention (vol. 7). IARC Press, Lyon
[ref. 4] International Agency for Research on Cancer (2005) Cervical Cancer Screening. IARC Handbooks of Cancer Prevention (vol. 10). IARC Press, Lyon