Objectives

The overall aim of EU-TOPIA is to improve health outcomes and equity of breast, cervical and colorectal cancer screening programmes in ways that take full account of the different demographical, medical, political, economic and cultural contexts across Europe. We aim to do so by providing national, regional, and local policymakers with tools to evaluate and quantify their cancer screening programmes. More specifically, we aim:

1. to develop and validate innovative dedicated microsimulation models of the natural history of the three cancers for the evaluation of screening, tailored specifically to the different countries in Europe
2. to estimate the health outcomes (harms and benefits, quality of life) and cost-effectiveness for the year 2015 of the existing screening programmes for breast, cervical, and colorectal cancer in the respective European countries
3. to identify barriers and explain inequities in cancer screening programmes between European countries and demographic groups
4. to develop, in collaboration with the participating countries, innovative road maps that include feasible improvements to existing screening programmes (taking into account political and technical reality). These improvements will reduce inequity both between and within countries, increase the benefits of screening and decrease its harms by 2025
5. to build capacity for future self-evaluation of screening programmes in Europe by developing a web-based monitoring tool, a barrier assessment tool, and a model-evaluation tool for quantifying and predicting the long-term health outcomes (harms and benefits) of cancer screening; and by organising interactive workshops.

Over the past few decades, much attention has been given to implementing quality assurance systems, thereby producing and interpreting interim data and indicators for screening. But quantification of the actual effects of cancer screening in terms of benefits and harms for European citizens is still lacking for most countries, and it is unknown how screening outcomes can be optimised. It is therefore crucial to develop innovations that improve the impact of screening: by quantifying the lifetime benefits and harms of existing cancer screening programmes, and using this information to systematically assess whether continuation, discontinuation or improvements should be made for each country and cancer. In this EU-TOPIA project, we propose systematic and uniform evaluation and quantification of the impact of screening for breast, cervical, and colorectal cancer. The project includes an integrated capacity building process that enables interaction between programme owners and stakeholders. The goal is to improve existing cancer screening programmes and thus health outcomes of European citizens, as well as improve cost-effectiveness and equity across Europe. While utopia is a place of ideal perfection, but as such impossible to achieve, eutopia (εὖ means good or well) is a place of well-being, a practical aspiration of utopia towards cancer screening.