1. To understand how screening is currently implemented in Europe.
2. To understand the challenges familiar to all screening programmes when aiming to continually enhance quality and minimise harms.
3. To understand the emerging technologies in screening of lung, breast and colorectal cancer.
This session will review common aspects of screening for lung cancer, colorectal cancer and breast cancer: namely the evidence for the particular screening programme, the additional challenges of implementing screening in the real world compared to a research setting, and future developments in each area. Common areas of debate such as overdiagnosis will also be addressed.
1. To understand the current situation with lung cancer screening in Europe.
2. To understand the challenges of implementing a new screening programme for lung cancer.
3. To discuss areas for quality assurance and standardisation in lung cancer screening.
1. To understand the rationale for a colorectal cancer screening programme.
2. To be updated about current experiences on screening CT colonography.
3. To learn about advantages and limitations of CT colonography in comparison with other colorectal cancer screening tests.
Colo-rectal cancer (CRC) is currently the second leading cause of cancer-related deaths in males and females. However, it could be easily prevented because of the favourable natural history. Radiologists can now fully support CRC screening, thanks to the availability of Computed Tomography Colonography (CTC). Three randomised clinical trials, investigating the performances of CTC in asymptomatic average-risk individuals, demonstrated good CTC patient acceptance, lower than FOBT, but higher than FS and CC, and good CTC adenoma detection rate, slightly lower than CC, but much higher than FS and FOBT.CTC in the setting of CRC screening has different roles, depending if an organised CRC screening program is available or not. If it is not available, CTC might be used as an opportunistic screening test together with FOBT/ FIT, FS and CC. In this case, individuals should be informed about the benefits and possible drawbacks of CTC in comparison with other tests. In many European countries, where established screening programs based on FOBT/FIT are available, CTC can be used as a back-up for an incomplete CC, performed after a positive FOBT/FIT. Alternatively, CTC might be offered as an alternative test in those patients (they are not few) tested positive at FOBT/FIT, but who refuse CC. The next goal would be to introduce CTC as a population screening test, replacing FOBT/FIT. However, the demonstration of higher cost-effectiveness compared with the available screening test is still missing and the major barrier preventing the endorsement by policymakers.
1. To list the cancer detection rates of radiographic, ultrasound and MR imaging for screening of breast cancer.
2. To describe the respective diagnostic accuracies published for breast MRI with abbreviated vs full diagnostic protocols.
3. To list rates and causes of over- and underdiagnosis of breast cancer in current breast cancer screening programmes.
Early diagnosis improves the survival of women with breast cancer. Mammographic screening improves early diagnosis of breast cancer. And yet, there appears to be room for improvement. Major shortcomings of mammographic screening are overdiagnosis of prognostically unimportant cancer, as well as underdiagnosis of cancers that are indeed relevant. Failure to detect biologically relevant breast cancer with mammographic screening is driven by host-related factors, i.e. breast tissue density, but also tumour-related factors: Biologically relevant cancers may exhibit imaging features that renders them indistinguishable from normal or benign breast tissue on mammography. These cancers will then progress to become the advanced-stage interval cancers observed in women undergoing mammographic screening. Since breast cancer continues to represent a major cause of cancer death in women, the search for improved breast cancer screening method continues. Abbreviated breast MRI has been proposed for this purpose because it will greatly reduce the cost associated with this method, due to a greatly reduced magnet time (down to 3 minutes), but especially also due to a greatly abridged image interpretation time, i.e. radiologist reading time. This lecture will review the current evidence and presents the EA1141 trial designed to investigate the utility of abbreviated breast MRI for screening average-risk women with dense breast tissue.