Early detection and diagnosis of cancer is vital to reduce cancer mortality at the population level and increase survival rates in people with cancer. Systematic screening of the target population for breast, cervical and colorectal cancer is considered an impactful and cost-effective measure to tackle the burden of cancer. Most OECD countries have programmes for target populations, but the population concerned for each cancer type, screening frequency and methods vary.
WHO recommends organising population-based mammography screening programmes for breast cancer in women based on age (WHO, 2014[1]). OECD countries commonly organise screening every two years for women aged 50‑69, although some have expanded eligible age groups and are developing programmes to adapt screening to individual risk levels.
Figure 6.3 shows the proportion of women aged 50‑69 who had a mammography examination in the two years preceding 2013 and 2023. The screening rate varies widely across OECD countries; for the latest period, it reached a high of 83% of the target population in Denmark and Sweden, and a low in Greece, Mexico and Costa Rica, where fewer than 25% of women aged 50‑69 had a mammography examination during the previous two years. While the average breast cancer screening rate was similar in 2013 and 2023 across OECD countries, there were notable increases in Lithuania (by 21 p.p.) and Estonia (11 p.p.), following activities to increase access through investment in mammographs and geographical accessibility. Conversely, there have been notable decreases in the Netherlands and the United Kingdom (‑10 p.p.) and Costa Rica (‑9 p.p.). Data from the United Kingdom indicate increases in uptake in 2024, due to clearing of screening backlogs caused by the COVID‑19 pandemic.
For cervical cancer, WHO recommends human papillomavirus (HPV) DNA detection tests for women from age 30 every 5‑10 years. WHO’s global strategy for elimination of cervical cancer recommends a 90% HPV vaccination coverage rate among girls by age 15, 70% coverage of cervical cancer screening at ages 35 and 45, and improvements in early diagnosis and treatment coverage (treating 90% of women with pre‑cancer and managing 90% of women with invasive cancer) (WHO, 2021[2]). In OECD countries, cervical cancer screening is often provided every 3‑5 years to women within the target age group. The target population and screening recommendations have changed in a number of countries following integration of HPV DNA testing as the primary screening test – commonly undertaken at five‑year intervals – and HPV vaccination programmes (OECD, 2024[3]).
Figure 6.4 shows wide variation in the share of women screened for cervical cancer in line with national guidelines. In 2023, the highest rate was 78% in Sweden, followed by 75% in Switzerland and Czechia, while the lowest rates were in Poland (11%) and Costa Rica (4%), as well as OECD accession country Romania (6%). Costa Rica implemented opportunistic screening of eligible women and shifted to HPV DNA testing in 2024 in women aged 30‑64. Although excluding some private hospitals, national estimates indicate 34% women aged 35‑64 had a screening test in 2023.
Colorectal cancer is often highly treatable if detected early through routine screening, and many OECD countries have adopted nationwide screening programmes. Country guidelines typically recommend biennial faecal occult blood tests for people in their 50s and 60s, but some countries use other target age groups and methods, including colonoscopy examinations. Differences in recommended screening frequencies make comparisons of screening coverage across countries challenging.
Figure 6.5 shows coverage rates for colorectal cancer screening programmes based on national screening protocols. In 2023, proportions ranged from a high of 74% in Finland, followed by the United Kingdom (72%), the United States (68%) and the Netherlands (67%), to a low of 9% in Hungary. The Netherlands sends invitations, leaflets and test kits directly to eligible people, while Hungarians receive invitations only if their GP has joined the screening programme and recipients must order a test kit themselves (OECD, 2024[3]).
While cancer screening rates were generally increasing prior to the COVID‑19 pandemic, they dropped in 2020‑2021 due to pausing of programmes or delays in accessing health services. However, rates in most countries increased in 2023. Trends in screening uptake since the pandemic are the same for different types of cancer screening within the same country, suggesting a need for specific strategies to improve coverage – for example through greater awareness and accessibility of programmes (OECD, 2024[3]).
