CanScreen5, a global repository for breast, cervical and colorectal cancer screening programs

Abstract

The CanScreen5 project is a global cancer screening data repository that aims to report the status and performance of breast, cervical and colorectal cancer screening programs using a harmonized set of criteria and indicators. Data collected mainly from the Ministry of Health in each country underwent quality validation and ultimately became publicly available through a Web-based portal. Until September 2022, 84 participating countries reported data for breast (n = 57), cervical (n = 75) or colorectal (n = 51) cancer screening programs in the repository. Substantial heterogeneity was observed regarding program organization and performance. Reported screening coverage ranged from 1.7% (Bangladesh) to 85.5% (England, United Kingdom) for breast cancer, from 2.1% (Côte d'Ivoire) to 86.3% (Sweden) for cervical cancer, and from 0.6% (Hungary) to 64.5% (the Netherlands) for colorectal cancer screening programs. Large variability was observed regarding compliance to further assessment of screening programs and detection rates reported for precancers and cancers. A concern is lack of data to estimate performance indicators across the screening continuum. This underscores the need for programs to incorporate quality assurance protocols supported by robust information systems. Program organization requires improvement in resource-limited settings, where screening is likely to be resource-stratified and tailored to country-specific situations.

Fig. 1. The status of data collection for the CanScreen5 project from various countries for breast cancer, cervical cancer and CRC screening programs.

a–c, Status of data collection for breast cancer (a), cervical cancer (b) and CRC (c) screening. The dotted and dashed lines on the maps represent approximate borderlines for which there may not be full agreement as yet. The designations used and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the WHO/IARC concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Map disclaimer: all rights reserved.

Fig. 2. Comparative values of selected performance indicators for the breast cancer screening programs that provided data to the CanScreen5 project.

The reporting format is country or region, reporting year and screening protocol. Mx, mammography. ^aMexico: the target population is not the total of individuals eligible for screening (age-based). ^bJapan: women with a negative screening test receiving further assessment due to clinical recommendation were also included.

Fig. 3. Comparative values of selected performance indicators for cervical cancer screening programs that provided data to the CanScreen5 project.

The reporting format is country or region, reporting year and screening protocol. Cyto, cytology. ^aCuba: examination coverage might be slightly overestimated because some participants outside the screening program were screened. ^bRepublic of Korea: women with a previous diagnosis of cancer before the examination date were excluded from these screen-related data. ^cCôte d’Ivoire, Ethiopia, Morocco, Guyana, Mexico: the target population is not the total of individuals eleigible for screening (based on age); the project in Guyana is at the rolling out phase. ^dHungary: colposcopy was a substantial part of the screening primary visit. ^eNicaragua and Australia: the detection rate was only for CIN 3⁺. ^fBangladesh, Republic of Korea: the detection rate was only for cervical cancer.

Fig. 4. Comparative values of selected performance indicators for CRC screening programs that provided data to the CanScreen5 project.

The reporting format is country or region, reporting year and screening protocol. ^aCzech Republic: examination coverage is underestimated in program-specific age ranges because screened persons aged over 79 are not reported. ^bCuba: it was not possible to separate the number of individuals screened opportunistically outside the program, thus coverage may have been overestimated.