Personalizing follow-upsThis research group looks at whether there’s value to be gained in targeting the screening or follow-up policy to a person’s level of risk by collecting information on risk factors from screening participants and patients. It’s an intriguing puzzle, and a source of continuous debate.
Mireille Broeders explains
Headed by Mireille Broeders, the research group Cancer Screening & Follow-Up strives to gain cancer screening beneftis (primary screening) and follow-up benefits (secondary screening) that outweigh potential harms.
Q1 What is the aim of the unit Cancer Screening & Follow-up?
“Currently, cancer screening (primary population screening) and follow-up for people treated for cancer (secondary screening for recurrences) are arranged according to a one-size-fits-all approach. The benefits of cancer screening and follow-up have to outweigh any potential harms. This is where our research group comes in. We look at whether there’s value to be gained in targeting the screening or follow-up policy to a person’s level of risk by collecting information on risk factors from screening participants and patients. It’s an intriguing puzzle, and a source of continuous (international) debate.”
Q2 Can you explain why this personalization is an intriguing puzzle?
Targeting the screening or follow-up policy to a person’s level of risk is an intriguing puzzle.
“For example, people with a higher than average risk could potentially benefit from more intense primary screening. For this group, we could look at whether screening could be started earlier or stopped later. On the other hand, people with a lower than average risk might be better off with a less intense screening program, or even no screening at all. This principle of balancing benefits and harms is also applicable to treatment follow-up programs, where patients who have been treated with curative intent remain under surveillance for potential cancer recurrences or a second primary cancer. Thus, we have to consider a wide range of options when trying to find out what the optimal screening and follow-up program should entail. This is not only true for breast cancer, but can also be applied to other cancers, like cervical, colorectal, lung, melanoma and prostate cancer.”
Q3 Linking individual aspects to different policies is hard. Are there any other challenges?
“Personalization itself presents a new and major challenge: would people find it acceptable if we no longer offered one general, one-size-fits-all screening policy? For instance, how could we explain to those eligible for screening and are offered a less intense cancer screening regimen why this measure could still be beneficial for them. Providing clear messages is hard, but necessary, to enable people to make informed decisions. These same issues arise when discussing personalized follow-up schemes with patients who have been treated for cancer. Another challenge is that the information we need in order to create a personalized program, for instance specific characteristics of screening clients or patients, is not routinely collected.”
Q4 Can you tell us more about the data collection?
“In the case of screening, we still use the growing treasure trove of data that’s been collected as part of the Nijmegen breast screening program; it dates back to 1975. We use this to continually improve the monitoring of screened women and for evaluating the program. Follow-up schemes benefit from this, and we learn a great deal from these primary screening data. Surprisingly, the evidence base for follow-up schemes is not as strong as for primary screening. We therefore seek opportunities for developing and improving our methods and the follow-up schemes. We predominantly use observational studies to monitor and evaluate ongoing programs, and we work together with similar institutes all over the world."
Q5 What are goals for the nearby future?
“As long as we keep finding challenges, we will address these and make improvements to the current screening and follow-up programs. We’re already doing a lot of work, trying to figure out what the current values of these schemes are, how personalization of policies can prove valuable, and how to keep up with developments in technology and treatment. But that definitely doesn’t mean we can sit back and relax. If you offer screening and follow-up, you have to make sure that everyone gets the optimal scheme to ensure the best balance between benefits and harms.”
Mireille Broeders, PhD, is head of the Cancer Screening and Follow-up group. She believes that everything we do can be done better; always. The search for challenges and finding elements for improvement is continuous. This may require time and resources, but sometimes even a small step forward can prove meaningful.