Achieving national cancer governance reform: Lessons from a successful academic, clinical, and community advocacy approach in New Zealand.

e14131 Background: Cancer survival in New Zealand (NZ) is high in global terms but gains in outcome are less than in comparable countries over recent time cohorts. Outcomes of indigenous Māori New Zealanders are significantly worse for most major cancers. This is potentially due to decentralisation of cancer provision and lack of emphasis on national governance. Methods: In 2017, academics, clinicians and patient advocates embarked on a planned and sustained programme of advocacy with the goal of establishing a national cancer plan, centralised cancer governance, and publicly reportable cancer outcomes and quality indicators by region and ethnicity. Elements central to success were partnerships with politicians and opposition parties, building credible media voices, establishing international academic collaborations, clear problem identification, positive evidence-based policy solutions, sustained and consistent yet varied media messaging, and strong relatable patient stories with direct citizen engagement. Results: As a direct result, in 2019 the Government established a National Cancer Agency, updated the national cancer plan for the first time in 16 years, moved to dissolve regional cancer networks, and appointed a national director of cancer control. New funding specifically for cancer investment was also announced and commitments to additional funding have been made. We review the strategies that were most successful, challenges encountered, and outcomes achieved. Conclusions: Advocacy and collaboration between patients, academics and clinicians remains a powerful stimulus for meaningful policy change. Our approach can be instructive for other countries where national cancer control and governmental leadership are faltering.

Prevention of Cervical Cancer

Aims Annual opportunistic screening for cervical carcinoma has been carried out in Germany since 1971. The creation of this S3 guideline meets an important need, outlined in the National Cancer Plan, with regard to screening for cervical cancer, as the guideline aims to provide important information and support for planned organized screening for cervical cancer in Germany. Methods With the financial support of German Cancer Aid, 21 professional societies developed evidence-based statements and recommendations (classified using the GRADE system) for the screening, management and treatment of precancerous conditions of the cervix. Two independent scientific institutes compiled systematic reviews for this guideline. Recommendations The first part of this short summary presents the pathological basis and considers various questions related to screening for cervical cancer. As also reported in earlier reviews, the meta-analysis by Kleijnen Systematic Reviews showed that HPV-based screening offers better protection against invasive cervical cancer compared to cytology-based screening. The authors of this guideline therefore recommend – in accordance with the guideline of the Joint National Committee of Germany (Gemeinsamer Bundesauschuss, G-BA) – that women aged 35 and above should be examined at regular intervals (at least every 3 years) and undergo HPV-based screening. Co-testing can also be carried out. Women between the ages of 20 and 35 should have cytological screening every 2 years.