Policy evaluation population-based cancer screening

Cancer is still public disease number one. The number of Dutch people diagnosed with cancer is expected to continue to rise: from 130,000 new patients in 2022 to 156,000 in 2032. To detect cancer at an early stage, every year millions of Dutch people are invited by the government to take part in one or more population screenings.

Background

Three population cancer screenings are offered in the Netherlands, for cervical, breast and colon cancer. These examinations are free of charge and available to eligible people without obligation, aimed at detecting cancer at an early stage. These screening programmes are funded from the Public Health Subsidy Scheme of the Ministry of Health, Welfare and Sport (VWS). In 2024, a grant amount of over €158.3 million was available to carry out the screenings.

Ministries are required to periodically evaluate policies and expenditures and commission studies on their effectiveness and efficiency. As the last policy evaluation was conducted in 2015 and a merger of screening organisations took place in 2022, Ecorys recently conducted a new evaluation. The aim of our policy evaluation is to examine the effectiveness of population screening and explore improvements in the organisation and financing of screening.

Key findings

Our report was recently sent to the House of Representatives. In our report, we conclude that population screening programmes are generally effective and largely meet the central public values of quality, accessibility and affordability.

The screening programmes are effective in detecting cancer early, leading to better treatment options and health gains for participants. Despite the good results, we also see areas for improvement, especially around the uniformity of the programmes and the shortage of screening staff, especially for breast cancer screening. Accessibility also remains a concern; language barriers and mobility problems hinder certain target groups from participating. Innovations such as the self-taking kit for cervical cancer can help increase participation.

In financial terms, population screening is cost-effective. Although a slight increase in costs is expected due to the increasing number of examinations and rising rates, overall costs remain manageable. Moreover, cost increases are closely monitored and discussed to maintain funding levels. Finally, cooperation between stakeholders is going well. Despite the challenges of staff shortages and financial unpredictability, these issues are actively addressed and discussed.

Recommendations

Based on our review, we make the following recommendations:

• Continue efforts to attract and retain staff to conduct population screening.
• Continue to pay attention to increasing the accessibility of population screening, especially among hard-to-reach target groups.
• Reserve financial resources for the implementation of (large-scale) innovations and weigh up the costs and benefits of innovations.
• Ensure more efficient grant processing and timely advance payments by continuing to pay attention to capacity problems at DUS-I. In addition, guard against interim changes to the control protocol.
• Remain attentive to rising costs without losing sight of efficiency and respond proactively by including the necessary reserves in future budgets.
  

Want to know more? Then read our full report (in Dutch and/or the (Dutch) letter to House of Representatives.