Isabel Rubio, MD  |  President, European Cancer Organisation

October each year is Breast Cancer Awareness Month. Buildings turn pink, races are run, and for four weeks this disease holds the public attention it deserves.

This campaign has several objectives: ensuring that women know the symptoms, that they get screened and diagnosed sooner, and that they each receive the same quality of care, regardless of where they live in Europe.

Awareness matters. But awareness alone does not build a national screening programme. That takes systems that identify eligible women, invitations that reach them and are followed up, and services equipped to investigate and treat the cancers that are found.

Equal access is built through investment in budgets, facilities, specialist teams and policies that make timely care possible for every woman, wherever she lives.

As a breast cancer surgeon, I see the difference these systems make, one patient at a time. That is why October should be about more than raising awareness. It should be about turning awareness into action, and action into access, early diagnosis and better outcomes.

A woman diagnosed through an organised programme usually arrives with a small tumour, often one she cannot feel. Earlier diagnosis can mean less extensive surgery, a lower likelihood of chemotherapy, and a faster return to work.

A woman who finds the lump herself, because screening did not reach her, the invitation was missed, or follow-up was delayed, may arrive with a larger tumour. Her surgery is more extensive, treatments are longer, and the risk of lasting complications is greater. The difference between these two women is not their biology or their doctors. It is the effectiveness of the system where they live: whether screening is adequately resourced, reaches the eligible women, achieves high participation and connects to timely diagnosis and treatment.

Europe has spent more than twenty years building organised screening programmes, and many countries have already established funded systems. The policy challenge now is to close the gaps between countries, and within them, so that access, participation and quality do not depend on where a woman lives.

In 2003, the European Union agreed for the first time that member states should offer organised breast screening rather than leaving it to chance: an invitation sent to every woman aged 50 to 69, at fixed intervals, tracked and quality-controlled. That was a genuine advance. Before that, whether a woman was screened depended largely on whether she thought to ask.

In 2022, the Union widened the recommended age range to 45 to 74, bringing in younger women whose cancers tend to be more aggressive and older women who were being quietly written off. Alongside it, Europe's Beating Cancer Plan set a hard number: by 2025, 90% of eligible women should be offered screening.

And last year brought the most detailed step of all. In February 2025, the European Quality Assurance Scheme for Breast Cancer Services set out what good care looks like at every stage – how the invitation should be issued, how the mammogram should be read, how the diagnosis should be confirmed, who should sit on the team deciding treatment, and what follow-up a woman should receive afterwards. It is, in effect, a blueprint for an effective European breast cancer service. Any country could pick it up and build from it.

But not one line of it is binding.

The 2003 and 2022 agreements are recommendations, which member states are free to adopt, delay or ignore. The quality scheme is voluntary. The 90% target was the only commitment with a date attached, and that date has now passed without being met and without consequence.

Europe has spent two decades describing, with increasing precision, the care every woman on this continent should receive. It has never taken the final step of requiring it.

The gap is measurable. The European Cancer Organisation's own screening index scored Slovenia and Portugal above 90%, and Romania and Bulgaria below 35%. And where screening is unorganised, that same index finds that access divides sharply by income, by education, by whether a woman lives in a city or a two-hour drive from one. When policy does not deliver organised screening, early diagnosis becomes determined by circumstance rather than need. The result is predictable: the women with the fewest resources are more likely to be diagnosed later.

Certification remains voluntary. The European Society of Breast Cancer Specialists (EUSOMA) says a specialist breast unit should handle at least 150 new cases a year, alongside defined standards for multidisciplinary care, pathology and specialist expertise, but nothing requires it. A woman today may be operated on in a unit with limited annual case volume, by a team that does not meet regularly, without a certified pathology pathway, and no European rule is broken. We defined the standards, then made them optional.

So what could the European Union actually do?

Europe could use the tools it already has to turn voluntary standards into practical requirements. Rather than creating another layer of regulation, Europe could link European funding for breast cancer care to measurable quality standards.

Attach European funding to European standards. EU4Health, Horizon Europe, the Cohesion Fund, and the Recovery and Resilience Facility all put money into national cancer systems. Make it conditional on certification against the European quality scheme and on a published timetable for organised screening. This needs no new treaty, no new agency, no new guideline.

Publish results for each centre, so women and their doctors can see where the standard is met and where it is not. And fund the whole programme, not just the equipment. A mammography machine is the cheapest part of it. The biggest expense? The register of every eligible woman, invitations in a language she will read, an appointment she can reach without losing a day's wages, follow-up for those who do not respond, timely assessment of abnormal results and results she will actually receive.

Europe does not lack recommendations. It has a delivery problem. European funding is one of the strongest mechanisms available to close that gap.