SELF-PACED PROGRAMME: Improving the Monitoring of Cancer Screening

You have completed the final test and have retained some of the main messages of this course but have not yet reached the passing score (70%). Don’t hesitate to navigate back to any of the 3 modules to review some of the key concepts, before trying the final test again.

Regardless of your score, keep in mind that you should not feel ready to implement a cancer screening programme by yourself. Cancer screening is a team sport, and many stakeholders must be involved in the planning, implementation, monitoring, and evaluation for it to become a successful programme that achieves its goals and reaches its full potential.
Congratulations!

You have successfully completed the online learning programme on Improving the Quality of Cancer Screening. You may now download your certificate.

We hope you have enjoyed this course. We made it thinking of you. You should have expanded your understanding of cancer screening principles, planning, and implementation, and we expect you to use your new knowledge and skills to improve the quality of your cancer screening programme as an administrator, a provider, or a user; after all, everyone is a stakeholder when cancer screening is considered.

If you liked this course, please spread the word and share the link with your colleagues and friends.

If you have any queries or comments regarding the course, feel free to contact us at canscreen5@iarc.fr.

We wish you all the best and hope to cross your path in the future, as an active member of the global cancer screening community.

Finally, regardless of your scores for the various tests and quizzes, keep in mind that you should not feel ready to implement a cancer screening programme by yourself. Cancer screening is a team sport, and many stakeholders must be involved in the planning, implementation, monitoring, and evaluation for it to become a successful programme that achieves its goals and reaches its full potential.

Thank you,

The CanScreen5 Team

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Question 1 of 23

1. Question
Probably not, you would still need to assess the availability and readiness of the different components that are necessary for a proper cancer screening programme to work correctly.

After meeting with different stakeholders, you can confirm that:
- a target population has been defined;
- suitable screening tests are available;
- a protocol has been established, based on international guidelines;
- diagnosis and treatment services are available;
- human resources are properly trained;
- a budget is dedicated to the programme.
What components are missing?
- None, all key components are listed.
- Data protection principle, data quality dimension, qualitative and quantitative indicators.
- Laboratory accreditation and certification for the training programme.
- Quality assurance, governance, advocacy policy and plan.
Question 2 of 23

2. Question
Cancer screening programmes are complex and resource-intensive but can have huge benefits when implemented in the right manner with appropriate quality. Although some technologies and approaches have proven to be effective in high-resource settings, many of them may not be feasible and/or affordable in low- and middle-income countries (LMICs). However, alternative solutions can be implemented to tackle the cancer burden in such settings. It all starts by understanding your context, the cancer burden in your country, and how cancer screening programmes should operate.

In a fictitious country, cancer prevention and early detection activities have been introduced a few years ago. Despite a significant budget dedicated to these activities, annual reports from the national cancer registry show that the cancer burden is constantly growing.

The Ministry of Health decided to implement a cancer screening programme, and contacts you to help with the decision-making.

You decided to start by understanding the cancer burden in the country, so that proposing cancer screening would be more cost-benefit.

What are the two most important metrics you should use to measure the cancer burden?
- and
Question 3 of 23

3. Question
Great news! Based on your recommendation, the Ministry of Health validates the implementation an organized cancer screening programme and asks you to draft a plan.

After carefully getting a team together, you decide to use the 3 steps planning process from the WHO framework to write a National Cancer Control Plan that includes a cancer screening programme.

Select the right answer
- The first step consists in adopting a policy, including the defining the target population, setting goals and objectives, and deciding on priority interventions across the cancer continuum.
- The second step is to access the capacity to deliver through a landscape survey and an analysis of strengths, weaknesses, opportunities and threats.
- The third step is about identifying the steps and evidence-based strategies to implement the policy and achieve the goals.
Question 4 of 23

4. Question
Based on your analysis, what would you recommend policy-makers to prioritize when reviewing the cancer screening policy?
- To widen the target population eligible to cancer screening services.
- To prioritize interventions aiming at reducing physical, financial and social access barriers to the programme.
- To invest in cancer diagnosis equipment.
Question 5 of 23

5. Question
You present the new plan to all stakeholders and a kick-off meeting is organized, followed by a pilot implementation in one (or more) regions.

What are the important points the Ministry of Health should bear in mind for the implementation? (Select all right answers)
- Scaling-up of the cancer screening programme should be proposed quickly, to keep the momentum.
- The first step in the implementation process is to organize large awareness campaigns.
- Availability of service and a referral system should be ensured before invitations are sent to the target population.
- A health information system is necessary to track participants and to assess the quality of the programme.
- Quality assurance should focus on quantitative quality indicators.
- A budget should be dedicated to the implementation of the programme.
Question 6 of 23

6. Question
The table below summarize some of the quality performance data collected by your team.

As a cancer screening programme manager, what are those data telling you about the programme?

Select all right answers (negative points are subtracted if you select wrong answers).
- Increasing the invitation coverage would improve the other performance indicators.
- There may be a problem for the invited population to access the screening test.
- Awareness on the benefits of cancer screening might not reach the target population.
- Diagnosis tests should be changed to improve the detection rate.
- The referral system is effective.
Question 7 of 23

7. Question
Great news! Based on your recommendation, the Ministry of Health validates the implementation an organized cancer screening programme and asks you to draft a plan.

After carefully getting a team together, you decide to use the 3 steps planning process from the WHO framework to write a National Cancer Control Plan that includes a cancer screening programme.

Select the right answer
- The first step consists in adopting a policy, including the defining the target population, setting goals and objectives, and deciding on priority interventions across the cancer continuum.
- The second step is to access the capacity to deliver through a landscape survey and an analysis of strengths, weaknesses, opportunities and threats.
- The third step is about identifying the steps and evidence-based strategies to implement the policy and achieve the goals.
Question 8 of 23

8. Question
Based on your analysis, what would you recommend policy-makers to prioritize when reviewing the cancer screening policy?
- To widen the target population eligible to cancer screening services.
- To prioritize interventions aiming at reducing physical, financial and social access barriers to the programme.
- To invest in cancer diagnosis equipment.
Question 9 of 23

9. Question
You present the new plan to all stakeholders and a kick-off meeting is organized, followed by a pilot implementation in one (or more) regions.

What are the important points the Ministry of Health should bear in mind for the implementation?

Select all right answers (negative points are subtracted if you select wrong answers).
- Scaling-up of the cancer screening programme should be proposed quickly, to keep the momentum.
- The first step in the implementation process is to organize large awareness campaigns.
- Availability of service and a referral system should be ensured before invitations are sent to the target population.
- A health information system is necessary to track participants and to assess the quality of the programme.
- Quality assurance should focus on quantitative quality indicators.
- A budget should be dedicated to the implementation of the programme.
Question 10 of 23

10. Question
What can you find on the CanScreen5 platform to help you improve the programme? (Select all right answers)
- An online tool to compare, in a visual way, cancer incidence and mortality data from different countries in your region.
- Insights about how cancer screening programmes are implemented in other countries of the region.
- A list of internationally certified screening tests.
- Harmonized definitions and formulas to calculate performance indicators.
- An online interface to enter your programme performance data and analyse its evolution over the years.
- A quality check by the IARC CanScreen5 Secretariat, to ensure data consistency, completeness and validity.
Question 11 of 23

11. Question
Your quality indicators should address the structure, process and outcomes of the screening programme.

Select the right answer
- Cancer detection rate is a quantitative indicator informing about the programme’s outcomes.
- Participation rate is a quantitative indicator informing about the performance of the screening programme structure.
- The referral pathway is a qualitative indicator informing about the programme’s process.
Question 12 of 23

12. Question
You finally got your match of cancer(s) for which the scientific evidence and the national cancer burden justify cancer screening, and for which benefits of cancer screening would outweigh the harms.

Are you ready to go ahead and proposed the Ministry of Health to implement it?
- Yes
- No
- I'm not sure
Question 13 of 23

13. Question
The table below summarize some of the quality performance data collected by your team.

As a cancer screening programme manager, what are those data telling you about the programme? (Select all right answers)
- Increasing the invitation coverage would improve the other performance indicators.
- There may be a problem for the invited population to access the screening test.
- Awareness on the benefits of cancer screening might not reach the target population.
- Diagnosis tests should be changed to improve the detection rate.
- The screening protocol seems appropriate.
- The referral system is effective.
Question 14 of 23

14. Question
You finally got your match of cancer(s) for which the scientific evidence and the national cancer burden justify cancer screening, and for which benefits of cancer screening would outweigh the harms.

Are you ready to go ahead and proposed the Ministry of Health to implement it?
- Yes
- No
- I'm not sure
Question 15 of 23

15. Question
Your quality indicators should address the structure, process and outcomes of the screening programme.

Select the right answer
- Cancer detection rate is a quantitative indicator informing about the programme’s outcomes.
- Participation rate is a quantitative indicator informing about the performance of the screening programme structure.
- IT equipment is a qualitative indicator informing about the programme process
Question 16 of 23

16. Question
Cancer screening programmes are complex and resource-intensive but can have huge benefits when implemented in the right manner with appropriate quality. Although some technologies and approaches have proven to be effective in high-resource settings, many of them may not be feasible and/or affordable in low- and middle-income countries (LMICs). However, alternative solutions can be implemented to tackle the cancer burden in such settings. It all starts by understanding your context, the cancer burden in your country, and how cancer screening programmes should operate.

In a fictitious country, cancer prevention and early detection activities have been introduced a few years ago. Despite a significant budget dedicated to these activities, annual reports from the national cancer registry show that the cancer burden is constantly growing.

The Ministry of Health decided to implement a cancer screening programme, and contacts you to help with the decision-making.

You decided to start by understanding the cancer burden in the country, so that proposing cancer screening would be more cost-benefit.

What are the two most important metrics you should use to measure the cancer burden?
- and
Question 17 of 23

17. Question
Knowing that cancer screening programmes should balance benefits and harms, check below the cancer sites that are eligible for cancer screening based on scientific evidence, also proved to have the benefits outweighing the harms (select all right answers):
- Cervical
- Prostate
- Thyroid
- Oral cavity
- Liver
- Stomach
- Colorectal
- Breast
- Esophagus
- Skin
Question 18 of 23

18. Question
What are the potential harms of cancer screening? (Select all right answers)
- Low test positive predictive value
- False positive
- False negative
- Low test specificity
- Low test sensibility
- Over-diagnosis
- Burden on health services
Question 19 of 23

19. Question
Knowing that cancer screening programmes should balance benefits and harms, check below the cancer sites that are eligible for cancer screening based on scientific evidence, also proved to have the benefits outweighing the harms:

Select all right answers (negative points are subtracted if you select wrong answers).
- Cervical
- Prostate
- Thyroid
- Oral cavity
- Liver
- Stomach
- Colorectal
- Breast
- Esophagus
- Skin
Question 20 of 23

20. Question
What are the potential harms of cancer screening?

Select all right answers (negative points are subtracted if you select wrong answers).
- Low test positive predictive value
- False positive
- False negative
- Low test specificity
- Low test sensibility
- Over-diagnosis
- Burden on health services
Question 21 of 23

21. Question
For example, what could be the potential harms following a positive screening test? (Select all right answers)
- Individual being improperly re-assured.
- Increased cancer incidence.
- Unnecessary invasive diagnosis procedures and psychological impact.
- Cancer diagnosed at a late stage.
- Over-treatment of a very slow-growing cancer.
- Burden on health services, draining resources that can’t be used to address other public health issues.
Question 22 of 23

22. Question
Probably not, you would still need to assess the availability and readiness of the different components that are necessary for a proper cancer screening programme to work correctly.

After meeting with different stakeholders, you can confirm that:
- a target population has been defined;
- suitable screening tests are available;
- a protocol has been established, based on international guidelines;
- diagnosis and treatment services are available;
- human resources are properly trained;
- a budget is dedicated to the programme.
What components are missing?
- None, all key components are listed.
- Data protection principle, data quality dimension, qualitative and quantitative indicators.
- Laboratory accreditation and certification for the training programme.
- Quality assurance, governance, advocacy policy and plan.
Question 23 of 23

23. Question
For example, what could be the potential harms following a positive screening test?

Select all right answers (negative points are subtracted if you select wrong answers).
- Individual being improperly re-assured.
- Increased cancer incidence.
- Unnecessary invasive diagnosis procedures and psychological impact.
- Cancer diagnosed at a late stage.
- Over-treatment of a very slow-growing cancer.
- Burden on health services, draining resources that can’t be used to address other public health issues.