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. Screening programmes vary substantially between countries and in most long-term effectiveness of screening has not yet been assessed. The objective of EU-TOPIA is to systematically evaluate and quantify the harms and benefits of the running programmes for breast, cervical, and colorectal cancer in all European countries, and identify ways to improve health outcomes and equity for citizens. We will first identify significant inequities in screening outcomes by assessing the key set of quality indicators for benefits and harms in each country. Using these indicators, outcomes and cost-effectiveness of existing cancer screening programmes in 2015 will be estimated. For this, state-of-the-art models of the natural history of the cancers will be constructed, using country-specific data with and from country-specific experts. Barriers hindering implementation of optimal screening programs will be assessed, leading to road maps for improved screening. These road maps contain feasible changes, e.g., to extend or reduce the program, to change the screen test used or change key quality indicators, to perform activities that reduce screen-related harm or incorporate new developments in screening, and provide policymakers with evidence for increased, decreased or optimized use of screening. Capacity for self-evaluation of screening will be built using three web-based tools (monitoring, model-quantification and barrier assessment) explained and trained in workshops with country representatives, also from the Associated Countries. 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. That is why we call it EU-TOPIA.

Colorectal, breast and cervical cancer cause 155,000 deaths each year in middle income countries (MIC) in Eastern Europe, while there is good evidence that a large proportion could be prevented by organized screening. Although many MIC in Eastern Europe have implemented some form of cancer screening, this screening is often non-organized, leading to lack of data and quality assurance systems. Also, coverage is commonly low and minority groups are not reached. In a previous HORIZON2020 project ‘EU-TOPIA’, we developed road maps to improve cancer screening programmes in Europe. In the current project, EU-TOPIA-EAST, these roadmaps will be refined and translated into action plans for three MICs: Georgia (breast), Romania (cervix) and Montenegro (colorectal). These action plans will take the local health and social system into account by performing detailed barrier and stakeholder analyses, leading to feasible changes to current screening programs. Next, we will implement these action plans: e.g. in Georgia, we will increase coverage of the programme by establishing a new screening unit; in Romania, we will develop new IT infrastructure to allow invitation-based cervical cancer screening; and finally in Montenegro we will establish a new colonoscopy center to increase programme capacity decrease travel time for participants. The implemented programs will be monitored and evaluated using key indicators and sophisticated decision models to predict the long-term and country-wide benefits, harms and cost-effectiveness. During workshops and roundtable discussions for policymakers and screening program coordinators from all countries in Eastern Europe and the Mediterranean to build capacity and upscale the implementation of these intervention(s) in Equitable, Accessible, and SusTainable (EU-TOPIA-EAST) ways. In this way, the project will improve the prevention and early diagnosis of cancer in real-life settings in Eastern European and Mediterranean countries.

Screening for cervical cancer is a globally recommended public health policy. Many risk factors are known, but so far only “one-size-fits-all” screening programs have been implemented, providing suboptimal protection for women at high risk, suboptimal allocation of resources and substantial screening-related harms. Development of risk-stratified screening is a priority, because cervical cancer is on the rise in many countries, the uptake of screening remains moderate in subpopulations at high risk, and costs related to screening are high. RISCC will develop risk-based screening based on screening history, HPV vaccination status and other relevant risk factors. Risk profiles based on screening history will be developed using joint data from several large European randomized HPV screening trials with long-term follow-up, HPV self-sampling trials, and registries of both cytology- and HPV-based screening programs. Risk profiles based on vaccination status will be developed for cohorts with varying screening and vaccination coverage using data from a community randomized vaccination trial, linked vaccination/screening/cancer registries, and a cohort of women vaccinated at screening age. Risk-based screening algorithms will be evaluated with respect to effectiveness, harms and costs by predictive and health-economic modelling. Finally, open source e-health and m-health applications using the risk-based screening algorithms will be developed to support implementation into real-life programs. The use of risk-based screening and a digital platform for screening invitations will be evaluated in an implementation trial within the Swedish organized screening program. The RISCC risk-based approach to cervical screening is directly related to the work program as it is based on a wealth of data sources on different, important risk factors for cervical cancer, builds on open science enabling citizens, and could thus constitute a role model for personalized screening.