Key learnings from breast cancer initiatives:
However, regional disparities and technical and resource-related issues hinder large-scale consistent implementation. |
In the European Union, breast cancer remains the most commonly diagnosed cancer among women, with an estimated 374,800 new cases in 2022. It also remains the leading cause of cancer-related mortality among women, with approximately 95,800 deaths, representing 16.7% of all cancer deaths in women (European Commission, 2023). As a result, across Europe, governments are advancing breast cancer initiatives, aligning with Europe’s Beating Cancer Plan (2021) in ensuring that 90% of the EU population who qualify for breast cancer screenings are offered screening by 2025. Aimed at improving early detection, reducing inequalities, and strengthening data-driven health planning, Slovenia, Greece and Flanders (Belgium) offer three distinct examples of this trend (see Box 1). While each operates in a different health system and governance structure, their approaches to breast cancer screening and care share notable similarities and are rooted from challenges such as:
- Strict rules around data privacy, which make it hard and slow for doctors and health services to access cancer screening data, and in turn make it more difficult to send timely invitations and follow up with patients
- Disparities in quality and outcomes caused by differences in cancer care across hospitals in Slovenia
- Restricted access to screening programs, especially in rural areas in Greece
Box 1. Summary of breast cancer initiatives in Belgium, Greece, Slovenia Belgium: In the Flanders region, the Centre for Cancer Detection (CvKO) leads a data-driven screening program in partnership with the Belgian Cancer Registry. It integrates registry data, patients’ screening histories and general practitioner (GP) information to tailor screening invitations and ensure timely follow-up. Greece’s national breast cancer screening program, “Fofi Genimmata”, offers free digital mammograms and ultrasounds (when needed) to all women aged 45–74 with a social security number, regardless of insurance status. The program uses the national e-prescription system to issue referrals and sends automated SMS reminders, which has significantly increased participation among women who activated the application (26.5% vs 5%). Unlike Belgium’s tailored invitations via GP records, Greece does not yet match invitations to patient history, but collects real-time data on participation rates, follow-up diagnostics and outcomes through electronic health records. These data support policy planning by identifying gaps in screening coverage and enabling the design of targeted health interventions, especially for underserved populations. Although integration with GPs is more limited than in Flanders, plans to expand access via Mobile Medical Units are underway to reach remote regions with lower participation rates. Slovenia: To address disparities in cancer care outcomes and building on the success of its breast cancer screening program, Slovenia’s National Cancer Control Program (NCCP) is currently establishing a clinical breast cancer registry as part of a wider national effort to monitor cancer care. This registry is being developed by a multidisciplinary expert group and aims to monitor care quality and outcomes. Inspired by the success of the breast cancer screening program in Slovenia, which was developed through years of collaboration between policymakers and experts, the NCCP is establishing the National Committee for Cancer Screening. The committee plays a central role in ensuring new screening programs are guided by expert input and built on proven methods, offering structured processes for proposal development and pilot planning (currently lung and prostate cancer screening were initiated). |
A shared focus on data to improve outcomes
All three countries have recognized the critical role of high-quality data in shaping effective breast cancer strategies. In each case, data serves a practical purpose: from optimizing care outcomes and designing evidence-based screening programs in Slovenia to delivering personalized invitations in Flanders and identifying gaps in participation in Greece; all with the goal of improving access, quality and equity in cancer care.
Digital tools for participation and access
Digital integration has played a central role in improving participation and reducing barriers, as seen in Belgium, which relies on integrated digital records to optimize targeted screening invitations. Similarly, Greece’s program enables the development of targeted health policies by leveraging electronic health records. While Slovenia’s registries are not currently linked to an invitation platform, the IT systems underpinning data collection are being developed with long-term integration in mind.
Primary care engagement important for outreach and patient compliance
Both Flanders and Greece demonstrate the value of engaging primary care providers in breast cancer screening. Flanders sends results and screening data directly to GPs, helping ensure follow-up, patient compliance and support. Additionally, its targeted approach helps avoid unnecessary screening invitations. Greece’s screening process is integrated into the broader health system, with physicians playing a key role in referral and continuity. Due to demand and the need for broader coverage, the program is currently being expanded. In Slovenia, clinical registry data has the potential to inform GP practice, though direct engagement mechanisms are still evolving.
Strong governance, sustainable financing and strategic use of digital infrastructure supported effective implementation
All initiatives benefited from strong political support from the Ministry of Health, patient organizations and relevant stakeholders, such as the NCCP (Slovenia) (Governance). This ensured high-quality monitoring and gave room for adjustments.
Additionally, Greece emphasized the importance of funding, through the Recovery and Resilience Fund, ensuring continuous financial support until its completion (Financing), as well as the establishment of a network with Regional Health Authorities to support effective communication and coordinated service delivery (Service delivery).
Furthermore, digital infrastructure played a key role (Resources), with tools like Greece’s e-prescription system and SMS reminders boosting participation and referral rates. In Belgium, access to detailed cancer screening data enabled more targeted invitations, improved patient compliance, streamlined follow-ups, and supported informed decision-making across the health system, with potential for future research through anonymized data.
Equity challenges require tailored solutions
Though these countries’ initiatives generate successes, geographic disparities in screening access still remain (Service delivery). This primarily concerns rural and island populations in Greece, where participations rates remain low due to limited availability of diagnostic centres. Additionally, long waiting times contribute to the suboptimal use of breast ultrasound services, limiting the overall effectiveness and success of the initiative. As a result, plans for mobile medical units are under way.
To address variation in participation, Flanders has leveraged local stakeholder engagement. In Slovenia, rather than focusing directly on expanding access to screening, its registry initiative aims to generate detailed data on care quality and outcomes. This includes identifying differences in how patients are diagnosed and treated across regions and population groups, which may be linked to factors like geography, health literacy or socio-economic status.
Implementation barriers and systemic challenges
Implementing these initiatives has presented notable challenges. In Slovenia, developing national consensus demanded considerable time, effort and negotiation (Resources), while limited interoperability between hospital data systems and the national registry, along with workforce shortages, have slowed data collection and analysis. Belgium, on the other hand, has encountered obstacles related to data protection regulations, which involve complex and time-intensive access procedures. Additional challenges include the need for IT system adjustments and ensuring effective communication with all stakeholders, including the general public, to support program transparency and engagement (Governance).
Across all three, the need to tailor services to ensure broader equity is clear.
Moving toward sustainability and scalability
All three initiatives face the ongoing challenge of sustaining and expanding their efforts. Greece has secured EU funding to continue its program, with mobile expansion planned. Flanders’ integration of screening and registry data into a broader population health management system provides a strong model for scalability. Slovenia is gradually expanding its registry network, with breast cancer already in early data collection stages. Continuous monitoring, institutional support and political alignment are helping these programs evolve into lasting reforms.
Conclusion
Though launched in different contexts, the breast cancer initiatives in Slovenia, Greece and Flanders demonstrate common priorities: data-driven planning, digital engagement and commitment to equity. Together, they highlight the value of using information not only to detect cancer early, but to reshape health systems for better outcomes.
For more information
CvKO https://www.cvko.vlaanderen
Belgian Cancer Registry https://kankerregister.org/en, https://health.gov.mt/public-bodies/cancer-care-pathways
References
European Commission (2023). Breast Cancer in the EU. [Internet] (https://ecis.jrc.ec.europa.eu/sites/default/files/2024-01/jrc_Breast_cancer_2022_Oct_2023.pdf, accessed 25 June 2025)
European Commission (2021). Europe’s Beating Cancer Plan: Communication to the European Parliament and the Council [Internet] (https://health.ec.europa.eu/system/files/2022-02/eu_cancer-plan_en_0.pdf, accessed 10 March 2025).
National Cancer Control Programme (NCCP) in Slovenia: https://www.dpor.si/za-strokovno-javnost/drzavna-komisija-za-presejalne-programe, accessed 10 March 2025.
Onko-i.si, n.d. Cancer registry of Slovenia. Available at: https://www.onko-i.si/en/crs (accessed 10 March 2025).
Piñeros, M. et al. (2019) “Essential TNM: a registry tool to reduce gaps in cancer staging information”, The Lancet Oncology, 20(2), pp. e103–e111. Available at: https://doi.org/10.1016/S1470-2045(18)30897-0.
