The amendment to the law enabling mandatory screening tests was criticized by both the profession and the general public. The Hungarian Medical Chamber has now spoken about the divisive measure.
In July, the Ministry of the Interior launched a social consultation on the concept called Prevention of diseases, principles of the new health screening system for early detection, which includes three organized (i.e. based on personal invitation) examinations:
• cervical cancer screening for women aged 25 to 65 every three years (cytology);
• biannual breast screening (mammography) of women between the ages of 40 and 70;
• colon screening of men and women aged 50-70 (proctology).
According to the legislators, the planned screening program would be justified, among other things, because Hungary is one of the OECD countries that are in the worst position in terms of regular screenings.
How does all this affect the care system?
Within the EU, Hungary is one of the leaders in preventable and avoidable deaths, ahead of only four countries. We live shorter and spend fewer years in health than the country's economic situation would justify.
In addition to education, health education, primary prevention, and the development of health care, screening tests carried out as widely as possible according to professional rules would be means of change, which is why the Hungarian Medical Chamber supports that screening tests have become the focus of the government and health care management.
However, for the time being, the law only creates the framework for the wider performance of adult screening tests, it does not contain a list or detailed rules. From the recent statement of the state health secretary Péter Takács on Tuesday, it seems that the emphasis has shifted from the "mandatory" nature to the creation of opportunities and the promotion of screening tests, as suggested by the chamber.
The opinion of the Medical Chamber was sought
There was no decision-making level consultation on the issue prior to the amendment of the law, but the opinion of the Hungarian Medical Chamber was also requested ex officio
Since only the framework regulations are known for now, the IOC does not yet see the government's intention in the form of an obligation.
In our opinion, it is important to keep the current organized screenings (breast, cervical, colon, oral cavity screenings) and possibly expand the range of examinations.
If screening tests become mandatory, consideration should be given to the creation of screening centers, the strengthening of occupational health services and primary care communities of practice, and the provision of adequate infrastructural background and funding for the treatment of screened lesions.
In their opinion, binding can be really effective not with sanctions, but primarily with positive incentives. Ensuring the necessary capacities for screening tests is a state task, but at the same time, the statement of the state secretary responsible for health revealed on Tuesday that
there are no plans for the time being to make screening tests that require some kind of instrumental intervention - such as mammography or colonoscopy - mandatory.
Health awareness instead of coercion
According to the IOC, promoting screenings instead of making them compulsory can be really effective.
By increasing health awareness, with poster and other campaigns, participation can be facilitated with days off given by the employer, some of the screening tests can be carried out/organized in the occupational health system by the occupational physician.
A late-diagnosed cancer that is difficult or impossible to cure also places a significant additional burden on society, the patient who is still able to work is out of work, the treatment costs many times the common and finite coffers - and we haven't even mentioned the burden on the patient's family.
For all these reasons – putting the individual and collective advantages side by side – the chamber is in favor of the widest possible implementation of justified screening tests and their promotion.
The government has not yet decided
"The government did not discuss the introduction of mandatory screenings, it did not make a decision on them," the Ministry of the Interior stated, so it is still questionable whether the previously announced screenings will really be mandatory from next year.
In June, the law amending the health insurance legislation was published in Magyar Közlöny No. 66, according to which the system of screening tests that can be used in the framework of health insurance may change. The amendment authorizes the Minister of the Interior Sándor Pintér, who is also responsible for health, to obligatorily require, from January 1, 2025, for a certain part of the age group over 18, public health screening tests for cancer, the performance of which was only strongly recommended until now.
Regarding the concept that caused a divisive and strong social reaction, feedback could be sent to the government until the first of August: from then on, they can decide on the creation of a decree and the regulation of the details of the issue.
According to the Ministry of the Interior, the government has not yet put the issue on the agenda, but it turned out that
"the complex development of the system of screening tests aimed at the prevention or early detection of chronic, non-communicable diseases (folk diseases) is underway."
Health Secretary Péter Takács said on Hír TV
"Colon screening is definitely out of the question, because it is an invasive procedure, and it can also be a colonoscopy in certain cases. Examinations that involve radiation exposure and affect only one gender, such as mammography, are also out of the question."
In connection with the new type of general health assessment and cardiovascular screening, the state secretary can imagine mandatory screening that they would like to introduce nationally from January 2025.
Cancer or heart disease are the two leading causes of death
In Hungary in 2020, most people died either from diseases of the circulatory system or some kind of cancer, which together account for nearly 70 percent of all deaths. In 2022, more than 136,400 people died, of which 30,400 were caused by some kind of malignant tumor disease, and 41,000 people died of some kind of cardiovascular or cerebrovascular disease.
All of this can be explained by the low willingness to participate in screening tests.
the report of the European Cancer Inequality Registry, in 2019 only in cervical cancer screening, 60 percent of Hungarian women between the ages of 50 and 69 reported that they had participated in breast cancer screening in the two years prior to the survey (compared to the EU average of 66 percent). Much more worrying, however, was the fact that among the 50-74-year-old population, a 15 percent participation rate in colon cancer screening was observed, which is significantly lower than the EU average (33 percent). The government wants to raise these numbers to 70 percent with the help of the measure.
Featured image: Photo by Michal Jarmoluk / Pixabay
