99 Perspectives on cancer screening participation Background The Netherlands, as many other European countries, invests considerable time and effort in hosting three population-based cancer screening programmes (CSPs).1 These programmes focus on cervical, breast and colorectal cancer. CSPs aim to detect cancer in an early or precursor stage and thereby improving survival via early intervention. On average, this approach is assumed to lead to a better prognosis, as well as to fewer and less severe side effects of treatment.2-5 In the Netherlands, the screening tests of the CSPs are offered free of charge by the government to all citizens of a specific age and gender. The cervical CSP includes women aged between 30-60 and uses a Papanicolaou-smear test, a bilateral mammography is used to screen women between 50-75 years of age on breast cancer. The colorectal CSP is aimed at both women and men aged between 55-75 years, and screening is performed by a faecal immunochemical test. The National Institute for Public Health and the Environment (RIVM) and five regional screening organisations are charged with organizing and coordinating these programmes.6 Attendance is voluntary and monitored yearly by RIVM.7-9 Although the three CSPs show many similarities, each CSP has its unique procedures and organization, mainly due to the differences in screening methods.6 High participation rates are essential for screening programmes to be (cost-)effective.10, 11 According to the World Health Organization (WHO), at least 70% of the target population should be screened in order to be beneficial on population level.12-14 Throughout Europe participation in CSPs varies substantially, yet the Netherlands is/was always known for its high screening attendance and adherence.1 Latest published CSP attendance rates in the Netherlands, before the Covid-19 pandemic (concerning the year 2019), showed rates of 56.0%, 76.0% and 71.8% for the CSPs focused at cervical, breast and colorectal cancer, respectively.7-9 Although the attendance rates of two programmes are above the recommended rate from WHO, there is an alarming downward trend and wide regional variation in screening uptake. In 2010, the uptake rates of the CSPs for cervical and breast cancer were 65.5% and 80.7%.7,8 Since the colorectal CSP has only been fully operational since 2019, it is too early to draw any conclusions on trends regarding this screening programme. At the regional level, the four largest cities of the Netherlands are among the regions with the lowest attendance rates, below the minimal effective rate of 70% for all three screening programmes.15 In order to improve the attendance rates, it is essential to understand the motivations of citizens to participate in CSPs. A systematic review showed that earlier studies into cancer screening participation have not provided in-depth information on the underlying beliefs and motivations regarding willingness to participate in cancer screening.16 4
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