I’m going to talk about our new project that is called Cancer Screening in Five Continents, CanScreen5 in short. It is a global repository of information on cancer screening, especially focussing on the common cancers like cervical cancer, breast cancer, colorectal cancer screening. So this is an online repository where you get information on the cancer screening protocols, the policies, the organisation of cancer screening from the different countries across the globe. More importantly, which is very much needed, is that we also collect data from the countries to understand the performance of cancer screening. As you know, cancer screening programmes are quite a difficult public health exercise because it’s quite complex and until and unless it is appropriately evaluated with performance indicators, the quality can not be assured.
So the CanScreen5 project is not just a passive data collection. We actively engage with the Ministry of Health of the different countries, try to train the programme managers, programme coordinators, for them to understand the value of collecting performance data across the cancer screening continuum and use that data to monitor and to improve the quality of cancer screening. So that is essentially the goal and the major focus of CanScreen5.
It's a global project; recently we published, in the Nature journal we published data from 84 different countries, there was representation from all the different continents. As I mentioned before, we do not collect secondary data, we directly engage with the Ministry of Health and collect data and information directly from the Ministry of Health.
Have you found governments have been receptive to the project?
We have different ways to approach the Ministry of Health. As you know, it’s a big challenge to directly find out the appropriate person in the Ministry of Health. So we take help from the huge network of collaborators that IARC has across the globe. These collaborators are mostly researchers or clinicians in the National Cancer Institutes of the countries or other major academic institutions. They help us to get the contact within the ministry.
The response from the ministry, honestly it is mixed. Sometimes it is very, very prompt but sometimes it requires quite a lot of engagement. When they understand that we are not collecting data just for the sake of collecting data, there is a very strong component of building capacity, building capacity within the country for the programme managers to understand the value of quality in cancer screening, for the programme managers to understand how to monitor cancer screening using the performance indicators and also, we are providing them a ready database that they can use for improving the quality of the programme, they become more engaged with us.
What is the ideal outcome for countries involved in this project?
When we approach the countries, we first do the training of the programme managers. It’s a hybrid training – programme managers first do an online training followed by we do a very short on-site training programme. Then we give programme managers access to our online database. In the online database there is a ready form or ready data collection tool available. So the programme managers have to just fill in a survey and if they have data from the cancer screening programme they have to just fill in the database. As soon as the database is filled in, the key performance indicators are automatically generated and it is generated in a nice way as maps, as different kinds of graphics.
The biggest challenge is collecting data across the screening programme continuum. As you know, a screening programme is not just doing the test, we have to make sure that those who are positive on the screening test, they undergo further assessment. The pre-cancers or cancers that are diagnosed with screening, they need to be appropriately treated. The programme needs to have information on how many men or women have been screened, what happened to the screened population, how many pre-cancers and cancers have been treated. But then, this is unfortunate that most of the programmes, especially in the low and middle income countries, they are not collecting data which is across the screening continuum. They are only collecting data just to say how many numbers of people have been screened, which we call screening coverage. But then screening coverage alone does not tell you anything about the quality of the screening programmes. So this is what we are now focussing on.
We are trying to make the programme managers understand that health information systems are necessary to collect screening data across the screening continuum, not only collecting data but then also to analyse the data to understand the performance of the screening programme. So that is the main focus of CanScreen5.
We are making a gradual progress; we have now quantitative data even from quite a few low and middle income countries, especially on cervical cancer screening. Unfortunately, what we see is breast cancer screening data is very rarely available from the low and middle income countries. We have data from European countries, we have data from North American countries and also from Australia but then the rest of the globe where a huge amount of screening activity is ongoing we have very little performance data collected from these countries.
What can be done to improve breast cancer screening data collection from LMICs?
It’s a gradual process; I’m sure as the programmes understand the value of measuring performance and then monitoring the programmes, just like any other public health programme, they will start collecting data. COVID has created a great opportunity because COVID has shown that all low and middle income countries, they have the capabilities of having a health information system to collect programme data or monitor vaccination. So those databases that were used for COVID monitoring can be repurposed to collect data on cancer screening. So this will be a great opportunity for these programmes, especially in the low and middle income countries to see how they can repurpose these COVID databases to collect data for cancer screening and many of the countries are actually doing it.
Once they collect the data then, as I said, if the data is submitted to our platform automatically the performance indicators are calculated. This will be calculated in a harmonised manner. At the present moment the indicators are calculated in different ways in different programmes in different countries so it becomes very difficult to compare the performance of the screening programmes. So now, since in CanScreen5 all the indicators will be generated in the same way, it will be possible to compare the performance across the different countries. We already have, as I said, information from 84 countries. We have already data collected from at least 52% of them so we are making progress.
Can you give some examples of countries that are conducting screening programmes well?
We have Morocco, we have Rwanda that is doing cervical cancer. Morocco is focussing more on breast cancer screening because it does not have a huge load of cervical cancer whereas Rwanda has a big burden of cervical cancer. They are doing quite a reasonably good cervical screening programme and now they are moving towards a HPV detection screening programme, one of the first in the low and middle income category of countries.
Similarly, in this region of Asia we see Thailand is doing quite well in terms of rolling out a cervical cancer screening programme, a breast cancer screening programme and now they are also starting a colorectal cancer screening programme. So there are different examples. Bangladesh is doing quite well in terms of rolling out a VIA-based cervical cancer screening programme for a country with such a huge population. It’s remarkable that they have introduced a programme in a very systematic way, gradually it is being scaled up across the country. So in spite of all the challenges there are positive examples.
Is Vietnam involved in these programmes?
These training programmes are held in a group. So, for example, we have done training programmes for Latin American countries, the European countries, we have done training programmes for East African countries. We are trying to develop some kind of network in this region and we need help from organisations like the National Cancer Institute in Vietnam, the National Cancer Institute in South Korea or China. We are approaching them so that we can develop a network and have this training programme altogether.
So, if you look at the CanScreen5 data you will see more representation from Africa, Latin America, Europe, because we have done the training programme. Here we are still in a planning phase; hopefully in a few months we will be able to do that.
