Indicators, Sources & Calculation Methods

Indicators: Breast, cervical and colorectal cancer screening

 

Breast cancer screening

Cervical cancer screening

Colorectal cancer screening

Cancer screening implementation (policy levers)

Source: ‘Beating Cancer Inequalities in the EU’ OECD 2024 report as a baseline for policy status in 2024, complemented with policy updates drawn from other sources such as the OECD 2025 Cancer Country Profiles, the OBS-PACE database and desk research for national sources of information

Specific source for self-sampling availability in cervical cancer screening: self-sampling for cervical cancer screening, 2025 HPV Prevention Atlas of the European Parliamentary Forum for Sexual and Reproductive Rights (EPF)

Cancer screening coverage rate (performance indicators)

Cancer screening examination coverage rate among the target population

Source: Data Explorer of the Organisation for Economic Co-operation and Development (OECD) as a primary source, complemented with Eurostat indicators on programme- and self-reported cancer screening coverage data as a complement in case of missing data

(most recent programme data available; most recent survey data available used where no programme data available and/or no organised programme in place)

Equity gaps in cancer screening (performance indicators)

Self-reported examination coverage rate among the target population by:

  • educational attainment level
  • income quintile
  • degree of urbanisation

Source: Eurostat

 

Indicators: Lung, prostate and gastric cancer screening

 

Lung cancer screening

Prostate cancer screening

Gastric cancer screening

Cancer screening implementation (policy levers)

Implementation (Organised programme/Pilot or implementation study/None)

Coverage (National/Some regions only/None)

Roll-out (Complete/Ongoing/Started/Planned/None)

Cancer screening coverage rate (performance indicators)

Source: Desk research using publicly available materials from PRAISE-U, SOLACE and TOGAS projects, together with other relevant databases (e.g. Lung Cancer Policy Network, OBS-PACE), complemented with outreach to identified contact points in relevant national authorities and stakeholder groups

 

In respect to the implementation status, definitions from the ECO ‘Next Level for Cancer Screening’ report were used, i.e.:

  • Organised population-based programmes are defined as a resource-intensive public health activity:
    • including such elements as a documented policy on access to, and management of, screening, as well as systems for invitations and quality assurance
    • designed and managed at the central level (nationwide or regionally) to reach most of the population at risk according to the national screening policy
  • Pilots or implementation studies are defined as small-scale implementation of a screening programme to assess feasibility, acceptability, impact on health services, barriers and facilitators of participation

Calculation methods

In brief, the following steps are applied for the calculation of country ranking scores per category and overall:

  • Application of a dedicated scoring scale for each qualitative indicator of cancer screening implementation, assessing alignment of country practices with EU-level recommendations for the specific aspect of cancer screening organisation considered
  • Differential weighing of scores corresponding to screening programmes’ organisational features to reflect their respective importance (and strength of corresponding recommendations), for the calculation of overall cancer screening programme implementation scores (policy scores)
  • Adjustment for the lower comparability of coverage rates drawn from survey data as compared to those drawn from programme data, through a corrective factor of x0,7 for the former
  • Calculation of Concentration Index (CI) values for each social determinant and each organised cancer screening programme (using the Fuller and Lury formula), from which ‘Equity Gap’ values are drawn (absolute values of Concentration Index)
  • Calculation of a ‘Concentration Index Factor’ (CIF) as the product of (1-|CI|) for each of the three socio-economic dimensions, followed by a normalisation of the CIF distribution
  • Product of cancer screening programme implementation scores (policy scores), adjusted coverage rates and normalised CIF (following the ‘health achievement’ approach in health economics for the combination of average performance and equity measurements), followed by z-score normalisation to set the distribution of category country ranking scores with an average of 50% and a standard deviation of 20%, considered best for cross-country benchmarking
  • Weighted average of category country ranking scores into the overall country ranking scores using age-standardised cancer incidence rates in the respective country, thereby accounting for differential public health prioritisation depending on each country’s epidemiological situation

While the above steps could be applied to organised breast, cervical and colorectal cancer screening programmes, the relatively lower level of detail in the information available for organised lung, prostate and gastric cancer, due to the recent nature of EU recommendations in the field, did not make it possible to incorporate information for the latter cancer types into the calculation of overall country ranking scores. They are therefore included in the Index indicators as context information.