Risk-stratified cancer screening: A consensus-based conceptual framework from EUCanScreen

BACKGROUND: Cancer screening is a cornerstone of effective cancer prevention. The 2022 European Council Recommendation on cancer screening encourages risk-based approaches, including risk stratification, when appropriate, to improve the balance of screening benefits, harms, and resource use. To address conceptual heterogeneity and fragmented guidance across cancer sites and countries, the EUCanScreen Joint Action convened a multidisciplinary working group from 22 European countries to develop a shared conceptual framework for risk-stratified cancer screening, as a specific operational approach. METHODS: We conducted a scoping review to identify definitions, key outcomes, benefits and harms, and ethical considerations relevant to risk-stratified screening. The findings informed a structured brainstorming session and a two-round Delphi survey among EUCanScreen participants. A consultation phase and plenary discussion were used to finalize the framework in May 2025. RESULTS: The core elements defining risk-stratified screening are (1) the availability of validated information to estimate individual risk (i.e., the different probability of disease or its natural history), (2) the definition of stratification criteria (i.e., risk thresholds defining groups with similar risk that can be managed similarly), and (3) the presence of evidence-based stratum-specific management protocols. The framework clarifies how risk stratification can be applied across the screening pathway, from eligibility and screening intensity to referral and follow-up. Crosscutting organizational and ethical, legal, and social considerations were identified, including data governance, privacy and data protection, management of genetic information, psychological impacts, equity and access, and training and communication needs. Conclusions This collaborative, consensus-based framework identifies essential elements and crosscutting issues for designing, implementing, monitoring, and evaluating risk-stratified cancer screening. The rationale of risk-stratified screening is to modulate screening intensity in both directions, intensifying it for those at higher risk and reducing it for those at lower risk.

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Journal
European Journal of Cancer
Published
2026-04-12
DOI
https://doi.org/10.1016/j.ejca.2026.116746
Primary Topic
Global Cancer Incidence and Screening
Type
article
Field-Weighted Citation Impact
0.00

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article

Risk-stratified cancer screening: A consensus-based conceptual framework from EUCanScreen

Yelena N. Tarasenko, Cristiano Piccinelli, Gianluigi Ferrante, Massimo Vicentini et al.
European Journal of Cancer
Global Cancer Incidence and Screening
article

Risk-stratified cancer screening: A consensus-based conceptual framework from EUCanScreen

Yelena N. Tarasenko, Cristiano Piccinelli, Gianluigi Ferrante, Massimo Vicentini, Lucie Véron, Anneza Yiallourou, Paola Mantellini, Francesca Leoni, Gaby Sroczynski, Cristina Barrufet, Paolo Giorgi Rossi, Andrea Burón, Nataša Antoljak, Itziar Gardeazábal, Paola Armaroli, Carlo Senore, Cinzia Campari, Francesco Venturelli, Beate Jahn, Béatrice Fervers, Suzette Delaloge, Laura Bonvicini, Trude Andreassen, Elisa Betti, Maria Isabel Portillo Villares, Marcello Di Pumpo, Tala Haddad, Carlos López López, Uwe Siebert, Erika Korobeinikova, Gabrielle Schittecatte, Silvia Deandrea, Livia Giordano
article en

Abstract

BACKGROUND: Cancer screening is a cornerstone of effective cancer prevention. The 2022 European Council Recommendation on cancer screening encourages risk-based approaches, including risk stratification, when appropriate, to improve the balance of screening benefits, harms, and resource use. To address conceptual heterogeneity and fragmented guidance across cancer sites and countries, the EUCanScreen Joint Action convened a multidisciplinary working group from 22 European countries to develop a shared conceptual framework for risk-stratified cancer screening, as a specific operational approach. METHODS: We conducted a scoping review to identify definitions, key outcomes, benefits and harms, and ethical considerations relevant to risk-stratified screening. The findings informed a structured brainstorming session and a two-round Delphi survey among EUCanScreen participants. A consultation phase and plenary discussion were used to finalize the framework in May 2025. RESULTS: The core elements defining risk-stratified screening are (1) the availability of validated information to estimate individual risk (i.e., the different probability of disease or its natural history), (2) the definition of stratification criteria (i.e., risk thresholds defining groups with similar risk that can be managed similarly), and (3) the presence of evidence-based stratum-specific management protocols. The framework clarifies how risk stratification can be applied across the screening pathway, from eligibility and screening intensity to referral and follow-up. Crosscutting organizational and ethical, legal, and social considerations were identified, including data governance, privacy and data protection, management of genetic information, psychological impacts, equity and access, and training and communication needs. Conclusions This collaborative, consensus-based framework identifies essential elements and crosscutting issues for designing, implementing, monitoring, and evaluating risk-stratified cancer screening. The rationale of risk-stratified screening is to modulate screening intensity in both directions, intensifying it for those at higher risk and reducing it for those at lower risk.

European Journal of CancerVol. 240
Université Claude Bernard Lyon 1 (FR), Università Cattolica del Sacro Cuore (IT), Lithuanian University of Health Sciences (LT), Norwegian Directorate of Health (NO), Mario Negri Institute for Pharmacological Research (IT), Institut Gustave Roussy (FR), University of Cyprus (CY), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), Istituto per lo Studio e la Prevenzione Oncologica (IT), Azienda Sanitaria Unità Locale di Reggio Emilia (IT), Marqués de Valdecilla University Hospital (ES), Austrian Institute for Health Technology Assessment GmbH (AT), Centre Léon Bérard (FR), Spanish Clinical Research Network (ES), Health Protection Agency (MV), Instituto de Investigación Marqués de Valdecilla (ES), UMIT - Private Universität für Gesundheitswissenschaften, Medizinische Informatik und Technik (AT), Osakidetza (ES), UniCancer Group (FR), Bioef - Fundación Vasca de Innovación e Investigación Sanitarias (ES), Sciensano (Belgium) (BE), Institute for Medical Research and Occupational Health (HR), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Department of Public Health (US), Azienda Usl Toscana Centro (IT), University of Turin (IT), University of Latvia (LV)
European Commission, European Health and Digital Executive Agency
Good health and well-being
Openalex Percentile: Top 25%
Global Cancer Incidence and Screening
DOIOpen Access PDFOpenAlex
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