11 General introduction in 1968, Wilson and Jungner established specific criteria to help determine whether a certain disease is eligible for screening.14 These criteria include that the disease must be an important health problem, there must be an effective treatment available, the natural history of the disease must be well understood, the test must be suitable for mass application, and the outcome of the screening programme (SP) should be monitored and evaluated. The WHO added a couple of extra criteria in 2008, regarding: the availability of diagnostic and treatment services, a suitable infrastructure, acceptability to the population, and several ethical and social issues.15 One of these ethical criteria states that the benefits of screening should outweigh the potential disadvantages of the screening. As this appears to be rather complicated to determine, there is a strong and ongoing debate on the effectiveness of the CSPs.16-19 While proponents indicate that cancerspecific mortality is decreasing, critics indicate that it has changed little or nothing in absolute mortality within screened populations.20, 21 In general, most people do have a rather positive attitude towards the CSPs, and in the current literature there seems to be consensus that current (European) CSPs lead to a better prognosis, as well as to fewer and less severe side effects of the treatment(s).22-24 Consequently, most European countries have implemented population wide CSPs aiming at early diagnosis of cervical, breast, and colorectal cancer.25 In order for a screening programme (SP) to be successful the amount of attenders – i.e. the attendance rates – must be adequately high and should be evaluated.26-28 Modelling studies aimed to predict the effect on cancer mortality of CSPs were found to be highly dependent on the attendance rates.26, 29 According to the WHO at least 70% of a target population, without further pre-selection, should be screened in order for a CSP to be effective on population level.4, 30, 31 Cancer screening in the Netherlands The Netherlands currently hosts three centrally organized population-based cancer screening programmes (CSPs) aiming at cervical, breast, and colorectal cancer. These CSPs are offered free of charge by the Dutch government to all citizens of a specific age and gender. The National Institute for Public Health and the Environment (RIVM; Rijksinstituut voor Volksgezondheid en Milieu), and the national screening organisation (Bevolkingsonderzoek Nederland) are in charge of organizing and coordination these programmes.32, 33 The Netherlands has a strict law on population screening (Wbo; Wet op het Bevolkingsonderzoek), which has been in place since 1996.34 Attendance is voluntary and monitored yearly by RIVM.35-37 Although all three CSPs show many similarities, each CSP has its unique procedures and organization, mainly due to differences in screening methods and recruitment system (Table 1). 1
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