13 General introduction General practitioner involvement in cancer screening As already briefly described, general practitioners (GPs) are involved in the current cancer screening programmes (CSPs) in the Netherlands and have certain ‘formal’ tasks. This involvement is however limited, varies between the programmes and has changed over time. GPs are relatively closely involved with the screening programme (SP) aiming at cervical cancer. Mostly they perform the Pap-smear, discuss the outcome, and refer the patient to the gynaecologist if necessary. Since 2017 procedures changed, and women have the option of using a self-sampling test. When women opt for this, the outcome of the self-sampling test is not automatically shared with the GP, due to privacy legislations. Outcomes will only be shared with the GP, if it is explicitly stated that the GP is allowed to receive this information. Regarding the CSP on breast cancer, the GP is involved in discussing the outcomes with participating women if abnormalities are detected (BIRADS 4-5), or if insufficient clarity could be obtained (BI-RADS 0), and also arranges the referrals to the hospital when indicated. As for the colorectal CSP, the GP is the least involved. The GP will only discuss the outcomes with the patient upon request, and subsequently provides an overview of the patient’s medical record for intake at the colonoscopy centre when indicated (Table 1). In addition to these ‘formal’ tasks, GPs also have certain other, less strict defined tasks, such as explaining the pros and cons of participating in the CSPs when patients ask for that, and/or following requests for the guidance of patients who received outcomes of the screening test(s).38-41 Regardless of the specific role GPs have regarding the CSPs, GPs will always have a vested interest in well-organized and effective operating CSPs, as they will be the first health professionals to notice the effects when they are not functioning properly. Challenges in current cancer screening Current Dutch cancer screening programmes (CSPs) face numerous challenges, of which several concern the uptake of screening participation. Both nationally and regionally, the average attendance rates of the CSP targeting cervical cancer have become insufficient already for a decade. In addition, at a national level, the attendance rates for all three CSPs have declined over the past years (Figure 1). Whereas the latest percentages for the three CSPs (2022) were 54.8%, 72.5%, and 70.6%, for the programmes aiming at cervical, breast and colorectal (CRC) respectively, the attendance rates in 2010, for the cervical and breast CSPs, were still 65.5% and 80.7% respectively.35-37 Since the CRC-SP has only been fully operational since 2019 (in all age groups), it is too early to 1
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