14 Chapter 1 draw any conclusions on longer trends regarding this screening programme (SP). In this context, it should be noted that in literature, the CRC-SP is considered a success story; despite its recent introduction, it already achieved decent screening participation rates. Furthermore, at the regional level, there is a wide variation in screening participation rates, with lowest screening uptake among the four largest cities of the Netherlands, all way below the minimal intended effective rate of 70%, as stated by the WHO, for all three CSPs.32 Moreover, there is a growing belief among GPs working in the large cities – the highly urbanised areas – of the Netherlands, that the people who could potentially benefit most from participating in screening are the least likely to participate. These screening participation challenges are not unique to the Netherlands, as they also occur in other similar countries, such as the Scandinavian countries, the United Kingdom and Australia.42-45 Figure 1. Attendance rates between 2010 and 2021. Based on the yearly monitoring rapports of RIVM. The horizontal grey line at 70% indicates the minimal effective rate as stated by the WHO. CSP= Cancer Screening Programme Besides the challenges related to screening participation, there are other challenges related to both screening-eligible people and GPs. Issues which will be discussed in this thesis, are illustrated by the case of the Janssen family.
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