MyPeBS addresses the crucial and timely question of the future of breast cancer screening in Europe. Indeed current standard mammographic screening, with entry stratified by age alone, has recently been largely questioned. Despite a demonstrated mean 20% reduction in breast cancer-specific mortality, together with reduction of late-stage disease in women older than 50, it is associated with potential harms including false positive recalls and over-diagnosis. Individual breast cancer risk estimation, through models including clinical variables, mammographic breast density and more than 100 genetic polymorphisms, now has substantial clinical and scientific bases. Personalized screening strategies, based on individual risk levels, could potentially improve the individual benefit/harms ratio of screening (earlier cancer detection and less intensive treatments in high risk women, less false positives and over-diagnoses in low risk ones), and increase the cost-efficacy for health insurances. MyPEBS will conduct an international randomized phase III trial to validate this hypothesis. It will primarily assess the ability of an individual risk-based screening strategy to be non-inferior, and possibly superior, to the standard of care screening, in reducing the cumulative incidence of stage II+ breast cancers. The trial, conducted in 5 countries (France, Italy, UK, Belgium and Israel) will include 85000 European women aged 40-70, all followed for 4 years. MyPEBS will also evaluate if an individual risk-based screening strategy, compared with the standard, reduces screening-related harms (unnecessary biopsies, overdiagnoses) in low-risk women, is overall at least as cost-effective as well as more accepted by women resulting in a larger screening coverage. After analyses of all components, the final objective of MyPEBS is to deliver recommendations for the best future breast cancer screening strategy in Europe.

Colorectal, breast and cervical cancer cause 155,000 deaths each year in middle income countries (MIC) in Eastern Europe, while there is good evidence that a large proportion could be prevented by organized screening. Although many MIC in Eastern Europe have implemented some form of cancer screening, this screening is often non-organized, leading to lack of data and quality assurance systems. Also, coverage is commonly low and minority groups are not reached. In a previous HORIZON2020 project ‘EU-TOPIA’, we developed road maps to improve cancer screening programmes in Europe. In the current project, EU-TOPIA-EAST, these roadmaps will be refined and translated into action plans for three MICs: Georgia (breast), Romania (cervix) and Montenegro (colorectal). These action plans will take the local health and social system into account by performing detailed barrier and stakeholder analyses, leading to feasible changes to current screening programs. Next, we will implement these action plans: e.g. in Georgia, we will increase coverage of the programme by establishing a new screening unit; in Romania, we will develop new IT infrastructure to allow invitation-based cervical cancer screening; and finally in Montenegro we will establish a new colonoscopy center to increase programme capacity decrease travel time for participants. The implemented programs will be monitored and evaluated using key indicators and sophisticated decision models to predict the long-term and country-wide benefits, harms and cost-effectiveness. During workshops and roundtable discussions for policymakers and screening program coordinators from all countries in Eastern Europe and the Mediterranean to build capacity and upscale the implementation of these intervention(s) in Equitable, Accessible, and SusTainable (EU-TOPIA-EAST) ways. In this way, the project will improve the prevention and early diagnosis of cancer in real-life settings in Eastern European and Mediterranean countries.

Breast, colorectal and cervical cancer cause 250,000 deaths each year, representing 20% of EU-cancer mortality. Although important progress has been made in both detection and treatment, there is persisting inequity in progress to reduce its burden. Screening programmes vary substantially between countries and in most long-term effectiveness of screening has not yet been assessed. The objective of EU-TOPIA is to systematically evaluate and quantify the harms and benefits of the running programmes for breast, cervical, and colorectal cancer in all European countries, and identify ways to improve health outcomes and equity for citizens. We will first identify significant inequities in screening outcomes by assessing the key set of quality indicators for benefits and harms in each country. Using these indicators, outcomes and cost-effectiveness of existing cancer screening programmes in 2015 will be estimated. For this, state-of-the-art models of the natural history of the cancers will be constructed, using country-specific data with and from country-specific experts. Barriers hindering implementation of optimal screening programs will be assessed, leading to road maps for improved screening. These road maps contain feasible changes, e.g., to extend or reduce the program, to change the screen test used or change key quality indicators, to perform activities that reduce screen-related harm or incorporate new developments in screening, and provide policymakers with evidence for increased, decreased or optimized use of screening. Capacity for self-evaluation of screening will be built using three web-based tools (monitoring, model-quantification and barrier assessment) explained and trained in workshops with country representatives, also from the Associated Countries. The project will lead to reduced inequity, reduced number of cancer deaths and over-diagnosed cases, and increase in life years gained and better cost-effectiveness by 2025. That is why we call it EU-TOPIA.