ECIS CS5 Programme – Pre-course test – Cancer Prevention and Early Detection

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We hope that it has helped you to identify the topics on which you would like to spend a bit more time in the learning sequences below.

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.

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Question 1 of 13

1. 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 2 of 13

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 13

3. 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 4 of 13

4. 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 5 of 13

5. 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.
Question 6 of 13

6. 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 7 of 13

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 13

8. 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 9 of 13

9. 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 10 of 13

10. Question
Thanks to your national cancer registry and to the IARC Global Cancer Observatory, you could find reliable cancer incidence and mortality data for several cancers in the country.

The figure below presents cancer incidence and mortality crude rates for men and women in the country.

Estimated crude incidence and mortality rates in 2018, both sexes, all ages

Crude rate

What cancers should be targeted in priority by a cancer screening programme?
- Cancers with the highest mortality-to-incidence ratios: oesophagus, liver and stomach.
- Cancers representing a significant cancer burden: cervix uteri and breast.
- Cancers for which effective vaccines are available: cervix uteri and colorectum.
Question 11 of 13

11. 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 12 of 13

12. 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 13 of 13

13. Question
What can you find on the CanScreen5 platform to help you improve the programme?

Select all right answers (negative points are subtracted if you select wrong 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.