Cancer screening statistics

Data extracted in July 2023.

Planned article update: August 2024.

Highlights

In 2021, at least 80 % of women aged 50 to 69 years in Denmark, Finland and Sweden had been screened for breast cancer (using a mammography) within the previous two years.

In 2021, around three quarters of women aged 20 to 69 years in Sweden and Czechia had been screened for cervical cancer within the previous three years.

In 2021, close to four fifths of people aged 50 to 74 years in Finland had been screened for colorectal cancer within the previous two years.

Breast cancer screening, women aged 50 to 69 years, 2011 and 2021
(%)
Source: Eurostat (hlth_ps_prev)

This article presents an overview of European Union (EU) statistics related to cancer screening.

This article is one of a set of statistical articles concerning healthcare activities in the EU which forms part of an online publication on health statistics.

While most data in this article relate to 2019, the data from screening programmes are generally for 2021. As such, this article includes data that may have been impacted by the COVID-19 pandemic and its related restrictions. For this reason, particular attention should be paid when comparing the 2021 data with data from earlier years.

In some EU Member States, healthcare resources were placed under intense pressure (particularly at the start of the pandemic) from an influx of patients with COVID-19. The pandemic also resulted in a range of knock-on effects including, among others, some services being curtailed/postponed due to the number of COVID-19 patients, staff shortages within hospitals and day care centres due to infection/quarantine procedures, and patients being hindered accessing medical services due to their own infection/quarantine as well as lockdown or travel restrictions.

Full article

Breast cancer screening

The indicator covering breast cancer screening as presented in Figure 1 is defined in line with the 2003 Council Recommendation on cancer screening (2003/878/EC).

The information presented for breast cancer screening is administrative data from screening programmes. The standard analysis is the proportion of women aged 50–69 years who had received a mammography within the previous two years; in practice, some countries use different age ranges. Overall, the rates for breast cancer screening across EU Member States are somewhat higher than those reported for cervical cancer screening (see Figure 5) and much greater than those for colorectal cancer screening (see Figure 8).

Data on breast cancer screening rates are available for 2021 for 23 of the EU Member States (2020 data for Belgium and 2017 data for Bulgaria); see Figure 1 for footnotes, in particular concerning the age coverage. Among these, screening rates were below 40.0 % in six Member States, with a low of 20.6 % in Bulgaria (2017 data). Denmark, Finland and Sweden reported screening rates that were four fifths or higher, while Malta and Slovenia also had rates that were above three quarters.

A comparison of data for the two years shown in Figure 1 indicates that breast cancer screening rates increased in 6 of the 19 EU Member States for which data are available. The largest increases (in percentage point terms) were observed in Malta (up 26.9 points; note that the age range changed over time) and Lithuania (up 12.9 points). In the 13 Member States where screening rates fell between the two years shown, the decreases were generally less than 10.0 percentage points. Larger decreases were observed in Luxembourg, Ireland (note that the age range changed over time) and Hungary.

Figure 1: Breast cancer screening, women aged 50 to 69 years, 2011 and 2021
(%)
Source: Eurostat (hlth_ps_prev)

Figures 2–4 present self-reported data for the EU Member States, Iceland, Norway, Serbia and Türkiye from the European health interview survey (EHIS); the third wave of this survey was conducted for the 2019 reference year. Figure 2 shows an analysis of the female population aged 50–69 years in terms of the period when they had had their most recent X-ray breast examination.

In Finland, Sweden, Portugal, Luxembourg, Czechia and Austria, the share of women that had never had an X-ray breast examination was below 5.0 % and in nine other Member States it was at least 5.0 % but less than 10.0 %. At the other end of the scale, around one quarter (24.1 %) of women in Bulgaria, and 71.6 % of women in Romania in this age group had never had such an examination.

Figure 2: Self-reported screening – proportion of women aged 50 to 69 years having had an X-ray breast examination within the specified time periods, 2019
(%)
Source: Eurostat (hlth_ehis_pa7e)

Women having completed a level of tertiary education were most likely to have had an X-ray breast examination recently

Figure 3 focuses on the share of women aged 50–69 years who had had an X-ray breast examination in the two years prior to the survey: it presents an analysis based on their highest level of educational attainment. While 63.9 % of women in the EU having completed at most a lower secondary education reported in 2019 that they had had an X-ray breast examination within the two years prior to the survey, the corresponding share among women with a tertiary level of educational attainment was 71.5 %.

In 22 of the EU Member States, the proportion of women reporting in 2019 that they had had an X-ray breast examination within the two years prior to the survey was lowest among those having completed at most a lower secondary education. The exceptions were in two groups: in Luxembourg, Portugal and Belgium, the lowest proportions were recorded among women with an upper secondary or post-secondary non-tertiary education; in Denmark and the Netherlands, the lowest proportions were recorded among women with a tertiary education. For most of these five exceptions, the difference in proportions for the two education levels with the lowest proportions were small. Luxembourg stood out, as women having completed at most a lower secondary education had in fact the highest proportion. Generally, the share of women having had an X-ray breast examination tended to be highest among those with a tertiary level of educational attainment, although there were several exceptions where the highest share was recorded for those with an upper secondary or post-secondary non-tertiary education.

When analysed by education level, particularly large ranges in the proportion of women aged 50–69 years reporting in 2019 that they had had an X-ray breast examination were observed in Bulgaria, Poland and Greece. The narrowest ranges were observed in France, Denmark, Portugal, Sweden and the Netherlands.

Figure 3: Self-reported screening – proportion of women aged 50 to 69 years having had an X-ray breast examination within the two years prior to the survey, by educational attainment level, 2019
(%)
Source: Eurostat (hlth_ehis_pa7e)

Women with lower incomes are more likely to have never had an X-ray breast examination

An analysis by income quintile for 2019 shows that 15.2 % of women across the EU in the first income quintile (the 20 % of the population with the lowest income) reported having never had an X-ray breast examination (see Figure 4). This share was lower for each higher/successive income quintile, with 7.3 % of women in the fifth income quintile (the 20 % of the population with the highest income) reporting never having had such an examination.

Among the EU Member States, there was no common pattern relating income quintiles to the likelihood of women never having had an X-ray breast examination. Looking at all five income quintiles (not just the three shown in Figure 4), Belgium, Bulgaria, Greece, France, Italy and Romania had a similar pattern to the EU average, with their shares systematically decreasing as the income quintile increased; a similar situation was observed in Malta, but with no difference between the shares for the third and fourth quintiles. Several other EU Member States – Denmark, Germany, Estonia, Spain, Lithuania, Hungary, the Netherlands and Sweden – displayed a similar trend of the share decreasing for higher income quintiles, but not in a consistent manner: in each case, one quintile had a higher share than at least one of the lower quintiles, disrupting the general pattern. The remaining 12 Member States had no clear pattern between the proportion of women never having had an X-ray breast examination and income quintiles.

In most EU Member States, large differences were observed across income quintiles concerning the proportion of women who had never had an X-ray breast examination. The largest gaps were recorded in Romania and Bulgaria, where the difference between the quintiles with the highest and lowest shares was around 30 percentage points: in both cases, the shares of women never having had an X-ray breast examination were highest for women with the lowest incomes, and lowest for women with the highest incomes. By contrast, Portugal, Finland, Denmark, Austria and Croatia reported relatively narrow ranges across income quintiles.

Figure 4: Self-reported screening – proportion of women aged 50 to 69 years never having had an X-ray breast examination, by income quintile, 2019
(%)
Source: Eurostat (hlth_ehis_pa7i)

Cervical cancer screening

The indicator covering cervical cancer screening as presented in Figure 5 is defined in line with the 2003 Council Recommendation on cancer screening. It concerns the population of women aged 20–69 years having been screened for cervical cancer within the previous three years (or according to the specific screening frequency recommended in each country). The data presented are administrative data from cervical cancer screening programmes.

Data are available for 19 of the EU Member States, although the latest year, age coverage and screening frequency vary for several Member States – see Figure 5 for more details. Among these, cervical cancer screening rates peaked at close to four fifths (78.5 %) in Sweden and nearly reached three quarters (74.5 %) in Czechia. At the other end of the range, the proportion of women who had been screened for cervical cancer was 12.1 % in Poland and 3.9 % in Romania.

Figure 5: Cervical cancer screening rate, women aged 20 to 69 years, 2021
(%)
Source: Eurostat (hlth_ps_prev)

Figures 6 and 7 present data from the EHIS. The first of these shows an analysis of the timing of the most recent cervical smear test for the female population aged 20–69 years. In 2019, some 13.7 % of this subpopulation in the EU reported that they had never had a smear test. There were 12 EU Member States where the proportion of women that had never had such an examination was below 10.0 %, while more than one fifth of the female population in Portugal, the Netherlands and Bulgaria had never had a smear test (20.2 %, 21.4 % and 23.5 %, respectively), as was the case for nearly a half (47.4 %) of women in Romania.

Figure 6: Self-reported screening – proportion of women aged 20 to 69 years having had a cervical smear test within the specified time periods, 2019
(%)
Source: Eurostat (hlth_ehis_pa8e)

Women having completed, at most, lower secondary education were least likely to have had a recent cervical smear test

Across the EU in 2019, the proportion of women aged 20–69 years having had a cervical smear test in the three years prior to the survey was lowest (61.0 %) among women having completed, at most, a lower secondary level of education. The proportion was highest, close to four fifths (79.1 %), among the female population with a tertiary level of educational attainment. This pattern was repeated in all of the EU Member States: the lowest screening rates were consistently recorded for those with no more than a lower secondary education while the highest were recorded for those with a tertiary level of education.

When analysed by education level, particularly large ranges in the proportion of women aged 20–69 years reporting in 2019 that they had had a cervical smear test in the three years prior to the survey were observed in Bulgaria, Poland, Romania and Slovakia. The narrowest ranges were observed in the Netherlands, Portugal and Lithuania.

Figure 7: Self-reported screening – proportion of women aged 20 to 69 years having had a cervical smear test within the three years prior to the survey, by educational attainment level, 2019
(%)
Source: Eurostat (hlth_ehis_pa8e)

Colorectal cancer screening

Administrative data on colorectal screening are also from screening programmes and are presented in Figure 8. The indicators covering colorectal screening are also defined in line with the 2003 Council Recommendation on cancer screening. Data on colorectal cancer screening rates are available for 2021 for 16 of the EU Member States (2019 data for Germany). Among these, screening rates were above 50.0 % in five Member States, reaching 70.6 % in the Netherlands and 79.4 % in Finland. Rates below 20.0 % were observed in Latvia (18.8 %), Germany (15.0 %; 2019 data) and Hungary (2.8 %).

Figure 8: Colorectal cancer screening rate, people aged 50 to 74 years, 2021
(%)
Source: Eurostat (hlth_ps_prev)

In just over half of the EU Member States, the majority of the population aged 50–74 years had never been screened for colorectal cancer

The data presented in Figures 9 and 10 come from the third wave of the EHIS, which asked respondents when they had most recently been screened for colorectal cancer. Overall, the rates for colorectal screening were much lower than those reported for breast or cervical cancer screening. This is partly due to the fact that national colorectal screening plans were established only at the beginning of the 2000s whereas breast cancer screening plans started in the 1960s and cervical cancer screening plans in the 1980s.

Across the EU, some 48.7 % of the population aged 50–74 years had never been screened for colorectal cancer (at the time of the survey for 2019). Denmark, Austria, Germany and Slovenia had the highest proportions of this age group having been screened (at some time) for colorectal cancer, with less than a third having never been screened. In 14 EU Member States, a majority of respondents reported that they had never been screened, with this share peaking at over 90.0 % in Romania, Cyprus and Bulgaria.

In a large majority of the EU Member States, more than half of the people who had actually been screened for colorectal cancer reported that this screening had taken place within the two years prior to the survey. In the Netherlands, Denmark and Belgium, more than four fifths of people who had been screened reported that this had been within the two years prior to the survey; by contrast, this share was less than half in Latvia, Cyprus, Greece, Hungary, Poland and Finland.

Figure 9: Self-reported screening – proportion of people aged 50 to 74 years having had a colorectal cancer screening test within the specified time periods, 2019
(%)
Source: Eurostat (hlth_ehis_pa5e)

Figure 10 provides a further analysis of these data, focusing on the population that had never been screened for colorectal cancer. An analysis according to respondents’ highest completed level of education shows a similar pattern to that observed for breast and cervical cancer screening: the proportion of the population never having been screened was generally higher for people having completed, at most, lower secondary education, while it was lowest for people with a tertiary level of educational attainment. Across the whole of the EU, some 51.4 % of people with no more than a lower secondary education in 2019 had never had a screening test for colorectal cancer, a share that was 44.2 % among people with a tertiary level of education. When analysed by level of educational attainment, there was a relatively high degree of variation in the proportion of the population never having been screened in Lithuania, Hungary and Latvia; there were relatively narrow differences observed in Cyprus and Greece.

Figure 10: Self-reported screening – proportion of people aged 50 to 74 years never having had a colorectal cancer screening test, by educational attainment level, 2019
(%)
Source: Eurostat (hlth_ehis_pa5e)

Source data for tables and graphs

Cancer screening statistics: tables and figures

Data sources

This article presents data on preventive services from two main sources of data: the first relies on screening programme data whereas the other is based on self-reported information from population surveys.

Healthcare resources and activities

Statistics on healthcare resources and healthcare activities (such as cancer screening) are documented in the background article Healthcare non-expenditure statistics – methodology which provides information on the scope of the data, its legal basis, the methodology employed, as well as related concepts and definitions.

Programme data

Breast cancer screening rates show the proportion of women (eligible for screening) that have been screened. This is based on the number of women aged 50–69 years who had received a bilateral mammography within the two years prior to the reference date (or according to the specific screening frequency recommended in each country) as a share of women eligible for an organised screening programme.

Cervical cancer screening rates show the proportion of women (eligible for screening) that have been screened. This is based on the number of women aged 20–69 years who have been screened for cervical cancer within the three years prior to the reference date (or according to the specific screening frequency recommended in each country) as a share of women eligible for an organised screening programme.

Colorectal cancer screening rates show the proportion of people (eligible for screening) that have been screened. This is based on the number of people women aged 50–74 years who have been screened for cervical cancer within the two years prior to the reference date (or according to the specific screening frequency recommended in each country) as a share of people eligible for an organised screening programme.

For country specific notes on these data collections, please refer to the annexes at the end of the national metadata reports accessible from links at the beginning of the European metadata report.

The Healthcare non-expenditure statistics manual provides an overview of the classifications, both for mandatory variables and variables provided on voluntary basis.

Health status

Self-reported statistics covering the health status of the population – including X-ray breast examinations, cervical smear tests and screening for colorectal cancer – are provided by the European health interview survey (EHIS). This source is documented in more detail in the background article European health interview survey – methodology which provides information on the scope of the data, its legal basis, the methodology employed, as well as related concepts and definitions.

Context

Primary prevention offers the most cost-effective, long-term strategy for reducing the burden of diseases across the EU. It involves tackling major health determinants (see Chapter 3), such as smoking, unhealthy diets and physical inactivity. The European Commission has supported many projects related to health determinants and health promotion in general.

Secondary prevention aims to reduce mortality by early detection, for example, the detection of cancer through screening.

In December 2003, a Council Recommendation on cancer screening (2003/878/EC) was adopted, setting out principles of best practice. This invited EU Member States to take common action to implement national population-based screening programmes for breast, cervical and colorectal cancer, with appropriate quality assurance at all levels.
In 2014, the European Commission released a report on the implementation of the 2009 Communication on action against cancer: European partnership and the second implementation report on the 2003 Council Recommendation.
A proposal to update the 2003 Recommendation to reflect the latest available scientific advice was adopted by the European Commission in September 2022 and in December 2022, the Council of the European Union adopted a new approach on cancer screening. This aims to improve early detection throughout the EU.
This new approach is a key element of the EU supported cancer screening scheme. The scheme is one of the flagship initiatives of the Europe’s Beating Cancer Plan, a key pillar of a stronger European Health Union.

Indicators on breast, cervical and colorectal cancer screenings are included in the health services chapter of the European core health indicators (ECHI).