I was involved in two groups, the first one was related to monitoring of screening programmes and the second one was related to risk-based screening which is an emerging topic in the context of curation-based screening.
Why is monitoring and evaluation important as a tool for quality improvement in cancer screening?
It’s important because screening is, in fact, not just a test, it is a process of care. So along this process of care we need to transfer information about patients from the test results, screening test results, and the assessment and eventually treatment. So across all these types the information about the outcomes of the patient, about the situation of the patient, need to be transferred from one professional to another. If you don’t have this transfer of information, the quality of the process will be low. Monitoring in some way is a way to assess whether this information is flowing, whether you get the information about the different outcomes for the different steps of the process.
Lack of information is always related to a lack of organisation for taking care of the patient along this screening pathway. Therefore, implementing a robust, systematic monitoring system is important to ensure the quality of the process, that you can have an idea of what’s going on and you can take care of the patient and ensure that the expected impact of screening can be achieved.
What has been done so far to improve cancer screening in LMICs?
There are several collaborative programmes and interventions that are aiming to support the implementation of the infrastructures which are needed to implement high quality screening. Of course you need to assess the local needs and you need to see how you can adapt the guidelines, the international guidelines, to the local context to make the best use of the resources which are available. But, in fact, the problem of improving also the organisational infrastructure and character of organisation at the local level to involve NGO organisations, for example, or in the process of promoting screening to promote awareness of screening among people to overcome cultural barriers which are also present in highly developed countries, of course, because there are several underserved groups which are facing problems in access to screening. So there are common problems also which need to be addressed. But this is the background preparation activity for creating the conditions for implementing a programme.
What does the future look like?
Of course there is a problem of resources which needs to be addressed in all countries. These kinds of interventions need to be tailored in some way or to take into account, at least, the resources which are available. The first step is to assess what is the level of treatment services because we need to ensure that the people who are diagnosed within the screening programme could get high quality treatment and management of their condition. The other issue is that there are enough resources for implementing some screening technologies. Probably you should try to find approaches which require less resources or less engagement for the population, less intensive screening. But anyway also using effective tests might be an option.
So there is room for research based on the priorities of low- and middle-income countries. This is something that is starting to be implemented in these collaborative projects between also international institutions and low- and middle-income countries.
Anything to add?
We have already some indication that this kind of collaboration is improving also in terms of the field of monitoring screening activity. There are collaborative projects which are supporting and resulting in improvement of the activity also in low- and middle-income countries. But the improvement of monitoring activities is a common goal, not only in low- and middle-income countries but also, for example, in Europe or in the well developed countries. Because also in these countries sometimes it’s difficult to trace the progression of the patient along the screening process. So it’s something that effort should be devoted to also in well-developed countries to implement monitoring.