Organising cancer screening
Support for organising cancer screening
Under the national screening programme, municipalities are tasked with organising cancer screening. Under the current arrangement, municipalities can implement screening as a separate activity, in conjunction with other municipalities or as a purchase service. Cancer screenings are mainly implemented in Finland as a purchase service.
Tendering for cancer screening and drawing-up a purchase contract are demanding procedures that require detailed knowledge of the contents of the service, of screening and also of competition regulations. The procurement of screenings is not a matter of buying a single service; instead it is a screening chain that is a service process. The quality of each stage of the process must be high and special attention must be paid to the flow of information.
Quality Manuals for Screening Programs
The Cancer Screening Steering Group, appointed by the The Finnish Cancer Centre (FICAN), published national quality manuals for screening programs for cervical cancer, breast cancer, and colorectal cancer in April 2024. These quality manuals are intended to support decision-making and operations for those responsible for organizing and implementing screenings. The manuals provide recommendations based on research and practical experience for implementing effective and cost-efficient screening programs.
The preparation of the quality manuals for screening programs was done by experts appointed by the Cancer Screening Steering Group. The manuals provide detailed guidance on the various stages of the screening program, from sending invitations to follow-up examinations and reporting screening data to the Cancer Registry.
Quality manual for colorectal cancer screening
Quality manual for breast cancer screening
Quality manual for cervical cancer screening
SCREENING CHAIN
- Municipalities select a screening implementer, usually by a tendering process.
- The implementer invites the target population each year by personally addressed letter to take part in a screening test. The invitation service can also be ordered through the Mass Screening Registry, which is an easy and reliable solution. The number of participants will be increased when a reminder invitation is sent to those who have not participated. The invitation letter cannot be sent to persons with a non-disclosure for personal safety. They should be instructed to contact the screening implementer themselves.
- Those invited participate in the test. They receive the results of the test by letter. If the tests detect suspicious changes that require further investigation, the subjects will be invited for further tests. Further tests may detect indications of cancer or its precursor, and subjects and patients are either referred for procedures and treatments or notified that no additional action is indicated.
- The information generated during the different stages of the cancer screening chain is sent to the Mass Screening Registry.
- Using the registry data, the Mass Screening Registry monitors and evaluates the quality of cancer screenings and their impact on mortality, and publishes screening statistics.
Screening monitoring is the responsibility of the Regional State Administrative Agencies (RSAAs). The National Supervisory Authority for Welfare and Health (Valvira) directs the activities of the RSAAs. The National Institute for Health and Welfare monitors and evaluates on-going screening programmes and methods used in cooperation with other actors in the field. The Radiation and Nuclear Safety Authority monitors the safety of radiation use and provides guidelines for radiation protection.
The Screening Service Guide provides information on screening legislation, screening, tenders and procurement in Finnish Seulontapalveluopas (pdf)
SCREENING INVITATIONS
The municipality can organise and issue screening invitations itself or the invitations work can be outsourced. Women aged 50-68 are invited to breast cancer screening every two years. Similarly, women aged 30-65 are invited to cervical cancer screening every five years. In addition, municipalities may invite 25-year-old women. Hence, the screening organizer sends only a list of municipalities, which they are screening to the Mass Screening Registry. If the municipality also invites other age groups, such as 25 year-olds for cervical cancer screening, a list of these age groups is sent to the Mass Screening Registry.
A screening invitation must be directed and addressed to the recipient in person and must be in writing in a posted letter. The letter of invitation must be written in Finnish or Swedish or it can be bilingual. If there are significant linguistic minorities in the municipality, it is worth considering translating the invitation into other languages. It is essential to give the screening place and time in the letter of invitation, so that the recipients can easily change the appointment time by telephone or online. It is therefore advantageous to have a list of alternative available times that will include times in the evenings and weekends in addition to normal working hours. A repeat invitation must be sent to those who have not responded to the first screening invitation.
Both cervical cancer and breast cancer screening attendance rates have recently declined. Using flexible appointments and re-invitations, participation in screening can be improved by more than 10%.
Improving attendance to cervical cancer screening (pdf)
The brochure on cancer screening can also be attached to both the first invitation and the re-invitation. The brochure briefly and intelligibly describes the goals, benefits and disadvantages of screening.
The Mass Screening Registry has a screening invitation service from which information on women to be invited for screening and their contact details can be ordered, and subsequently extracted from the Population Information System (Digital and Population Data Services Agency). The use of the invitation service is easy and enables the municipality to ensure that all those invited for screening will receive the posted letter of invitation at the correct address.