The EU-TOPIA evaluation tool: An online modelling-based tool for informing breast, cervical, and colorectal cancer screening decisions in Europe

Andrea Gini*, Nicolien T. van Ravesteyn, EU-TOPIA Consortium, Erik E.L. Jansen, Eveline A.M. Heijnsdijk, Carlo Senore, Ahti Anttila, Dominika Novak Mlakar, Piret Veerus, Marcell Csanádi, Nadine Zielonke, Sirpa Heinävaara, György Széles, Nereo Segnan, Harry J. de Koning, Iris Lansdorp-Vogelaar

*Corresponding author for this work

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Abstract

Background: Aiming to support European countries in improving their breast, cervical, and colorectal cancer (CRC) screening programmes, the EU-TOPIA consortium has developed an online user-friendly tool (the EU-TOPIA evaluation tool; https://miscan.eu-topia.org) based on the Microsimulation Screening Analysis (MISCAN) model. Methods: We designed an online platform that allows stakeholders to use their country-specific data (demographic, epidemiological, and cancer screening information) to quantify future harms and benefits of different cancer screening scenarios in their country. Current cancer screening programmes and impacts of potential changes in screening protocols (such as extending target ages or increasing screening attendance) can be simulated. Results are scaled to the country-specific population. To illustrate the tool, we used the tool to simulate two different CRC screening scenarios in the Netherlands: biennial fecal immunochemical testing (FIT) in ages 55–75 and colonoscopy every ten years in ages 55–75. Data from the Dutch screening programme was used to inform both scenarios. Results: A total of 482,700 CRC cases and 178,000 CRC deaths were estimated in the Netherlands with FIT screening (for individuals aged 40–100 years, 2018–2050), with 47.3 million FITs performed (1.92 million positives of which 1.64 million adhered to diagnostic colonoscopy). With colonoscopy screening, CRC incidence and mortality were, respectively, up to 17% and 14% lower than in the current FIT screening programme, requiring, however, a colonoscopy demand that was 7-fold higher. Conclusions: Our study presents an essential online tool for stakeholders and medical societies to quantify estimates of benefits and harms of early cancer detection in Europe.

Original languageEnglish
Article number101392
JournalPreventive Medicine Reports
Volume22
DOIs
Publication statusPublished - Jun 2021

Bibliographical note

Funding Information:
Despite its strengths, the tool has some noteworthy limitations. First, simulations provided by the CRC version of the EU-TOPIA evaluation tool are not stratified by gender. Second, stakeholders can modify several model parameters uploading country-specific data, but some of those, such as participation in surveillance, surveillance protocol, or relative survival, could not be dynamically changed inside the tool. These could, however, be adjusted as part of the uploaded data template. Third, if screening performance indicators in a country vary meaningfully from the data and indicators used to structure the tool, this may limit and affect the reliability of the model estimates. Real-life monitoring and evaluation of cancer screening programmes therefore remains essential, especially considering the impacts of the COVID-19 pandemic on discontinuity of the programmes. There is remarkable uncertainty in the estimates on incidence and mortality impacts between some screening strategies ( Buskermolen et al., 2019 ) and the modelled estimates depend respectively upon the natural history parameter values. Fourth, the EU-TOPIA evaluation tool is supported only up to the end of 2020 through funding (the EU-Framework Programme, Horizon 2020). It will remain available online, but future updates and support in interpreting the model results will be limited to European stakeholders involved in the field of cancer screening (their status will be assessed in the moment of the registration and access to the tool will be granted).

Funding Information:
Financial support for this study was provided entirely by the EU-Framework Programme (Horizon 2020, EU-TOPIA project, ref. number 634753, PI: HJ de Koning) of the European Commission. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report.

Publisher Copyright:
© 2021 The Author(s)

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