The Czech Republic ranks among developed countries in cancer prevention
After many years of bad news, it seems that the Czech Republic is beginning to reap the benefits of the challenging fight against cancer. A programme of nationwide personalised invitations to cancer screening programmes has been launched, incidence trends of most cancer types – including the most common ones – have stabilised, and long-term survival rates of cancer patients have increased. Despite these encouraging facts, the Czech cancer care still faces challenges to be addressed, which might influence the lives of tens of thousands of current and future cancer patients.
The Czech cancer care was appreciated many times during the 4th year of the international conference European Colorectal Cancer Days. This event was held in Brno, Czech Republic, from 29th to 30th May 2015, and was organised jointly by Dr Pavel Poc (Member of the European Parliament), the Institute of Biostatistics and Analyses of the Masaryk University (IBA MU), the Institute of Health Information and Statistics of the Czech Republic (IHIS), the United European Gastroenterology (UEG), and the Association of European Cancer Leagues (ECL). Although colorectal cancer prevention and management were the main topics of the conference, many contributions and discussions went beyond this diagnosis. For example, one entire afternoon session was dedicated to the new European Code Against Cancer. Close attention was also paid to the presentation and evaluation of the Czech project of personalised invitations to nationwide screening programmes for breast cancer, colorectal cancer, and cervical cancer.
Low participation rate of the target population has been the main challenge of the Czech National Colorectal Cancer Screening Programme in the long term. The project of personalised invitations has ensured that each citizen aged above 50, who has not yet participated in this cancer prevention programme, obtained a letter containing an invitation to examination. After the first year of this project, which is the most massive preventive intervention in the history of Czech health care, as remarked Svatopluk Nemecek, MD, the Czech Minister of Health, the results have raised hopes that a more significant proportion of the Czech population might visit their GPs, and be examined by gastroenterologists if needed. More than 1.5 million people were invited in 2014 to participate in colorectal cancer (CRC) screening, and almost 15% of those invited actually attended the examination. Unlike most other European CRC screening programmes, the Czech programme is rather unique because the clients can choose between the faecal occult blood test (FOBT) and the primary screening colonoscopy. According to expert estimates, the coverage of the target population in 2014 was 32.5%. The project of personalised invitations carries on this year; hopefully, the participation rate of Czech citizens in CRC prevention programme might soon be high enough to affect both incidence and mortality of this disease on the national level.
The question how to effectively motivate the target population to participate in CRC screening is surely not a specific Czech issue, as it turned out during the ECCD conference and the pre-conference workshop held by the UEG. Almost all European countries are addressing this issue with more or less success, and each of them has to deal with different legal, cultural and socio-demographic factors. There are differences in screening methods and the way of invitations, and there are attempts to promote cancer prevention in hard-to-reach groups of population (economically disadvantaged people, immigrants, etc.). There are staggering differences in screening coverage of the target population even within individual countries, whether it be Czech or Italian regions. The target declared by the European Commission in 2010 (reducing health inequalities in the European Union) has therefore not been met yet, not least in the availability of CRC screening.
CRC screening might perhaps become more acceptable for the population it alternative methods of colon examination were used, i.e. those which are less invasive and do not require the client to manipulate with stool. Examples of such methods involve CT colonography or colon capsule endoscopy, which were presented at the conference by Czech and foreign experts. However, studies focusing on the cost-effectiveness and other aspects have shown that these methods cannot be used as primary screening examinations, but only as complementary examinations to commonly used FOBT and colonoscopy. Moreover, any “virtual” examination method lacks the main advantage of the classic colonoscopy, which is the possibility to remove adenomatous polyps and precancerous lesions.
But let us get back to the current issues of the Czech cancer care, which do not only involve the evaluation of good news, but also have to deal with challenges such as the above-mentioned large differences in screening coverage among regions, showing different attitudes of GPs to cancer prevention, among others. The issue of CRC management is also important: many patients with advanced tumours still do not have access to treatment in comprehensive cancer centres, undergoing instead treatment in local health care facilities, which do not have enough experience in this field. Cancer survivors must be followed up closely due to potential recurrences: almost 1 in 5 colorectal cancers are diagnosed as another primary cancers, and almost half of them are diagnosed at advanced stages. Planning more effective health care also involves an appropriate use of existing data sources and the ability to put together (de-identified) data contained e.g. in the Czech National Cancer Registry, hospital information systems, and registries of health care payers. This, however, goes beyond clinical research, and requires legislative support.
An ECL workshop followed immediately after the ECCD conference. The workshop was attended by 28 young people from various countries of the European Union, who jointly discussed possible options for an effective promotion of the new European Code Against Cancer. Dr Wendy Yared, Director of the Association of European Cancer Leagues, highlighted the importance of cancer prevention from a young age, and called on present “ambassadors” aged between 18 and 30 to come up with new and original ways of getting the principles of the new code into people’s minds, with a special emphasis on young people. All workshop participants agreed that the education on healthy lifestyle needs to be started already in preschool children, and that the current knowledge on cancer prevention should be a natural part of education in primary schools. It is however essential that such health education campaigns take into account the specific characteristics of different age groups of children and youth. Teenagers represent a very high-risk age group in terms of exposition to new risk factors, because lifelong habits often develop at this age in particular. In fact, teenagers might be effectively addressed by modern communication tools; it remains to come up with a campaign which would attract the teenagers’ attention to such level that young people would go along with the principles of the new code. We can only hope that the workshop has actually launched an effective platform for health education campaigns in the area of cancer prevention among the European youth.
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