202 Chapter 8 Currently, the Netherlands has three population-based cancer screening programmes (CSPs). These are the CSPs aiming at cervical, breast, and colorectal cancer. Potential participants are invited based on their age and gender to participate in these screening programmes. The primary screening methods – respectively the Pap smear/self-sampling test, bilateral mammography, and the faecal immunochemical test (i.e., stool test) – are offered free of charge to all residents registered and living in a Dutch municipality. It is known that the success of a screening programme is highly depends on the percentage of invitees who actually participate in the screening programme. According to the World Health Organization (WHO), at least 70% of invitees need to participate, without preselection, for a screening programme to be effective at the population level. Looking at the attendance rates in the Netherlands (the latest available data is from 2022), we can conclude that the national numbers are still reasonably high; with percentages of 54.8% for the cervical cancer screening programme (CC-SP), 72.5% for the breast cancer screening programme (BC-SP), and 70.6% for the colorectal cancer screening programme (CRC-SP). However, this does not mean that the attendance rates cannot be further enhanced or that there are no further challenges regarding the attendance rates of the current screening programmes. For years, the CC-SP has faced low attendance when we take the threshold of 70% participation into account. Additionally, there is a clear declining trend visible in the attendance rates of all three screening programmes over a period of several years. Hereby it should be noted that it might still be too early to draw this conclusion for the CRC-SP; the introduction of this screening programme dates back to 2014, and it has only been fully operational since 2019. Furthermore, significant regional differences exist in the attendance rates of the screening programmes, with particularly low rates in the major cities of the Netherlands – Amsterdam, Rotterdam, The Hague, and Utrecht. Finally, some general practitioners have informed us that they notice potential participants who might benefit the most from participating in the screening programmes are currently the least inclined to participate in the screening examinations. Although these challenges are not unique to the Netherlands, we have chosen to focus specifically on the Dutch context in this thesis. We have focused on a multicultural urban environment, as the accessibility and inclusivity of the screening programmes seem to be under pressure here. The overarching goal of this thesis is to contribute to the future optimalization of the current Dutch screening programmes, with particular emphasis on the role of primary care (including general practitioners).
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