Background
The “Improving Cancer Screening in Slovenia (ICSIS) project” (2024–2026) supports Slovenia in advancing organised, population-based cancer screening by: (A) planning a national lung screening pathway; (B) transitioning from opportunistic to organised risk-adapted prostate screening; and (C) transitioning the long-standing cytology-based organised, population-based cervical screening programme ZORA to HPV-detection based screening with reflex triage. The project responds to updated EU Council screening recommendations and the need to sustain ZORA’s population impact while improving the benefit–harm balance and cost-effectiveness.
Methods
ICSIS applies a governance-embedded approach through the National Screening Committee and associated steering and operational structures to ensure evidence-informed protocols, feasibility, and policy readiness. The technical work integrates: (1) health-system capacity and readiness assessment (including capacity mapping along the clinical pathway) and protocol development with stakeholder engagement; (2) evaluation of cost-effectiveness and budget impact through modelling using the MISCAN framework to guide resource requirements and strengthen national modelling capacity; and (3) research examining barriers and facilitators among health professionals and screening programme target populations to inform implementation planning and the development of targeted, evidence-based communication strategies.
Results
ICSIS supports Slovenia across three pillars. A capacity-informed implementation research is underway (ProScreen-Slovenia project 2025–2026) to generate evidence to inform national scale-up and optimisation of the clinical pathway for prostate cancer (PETER). For lung cancer (LUKA), the screening protocol for implementation trial is in final phase; capacity mapping along the clinical pathway is informing subsequent mathematical modelling to identify feasible and optimal strategies under Slovenian context (capacity, costs, benefits, and harms). For cervical cancer (ZORA), national stakeholders endorsed the transition to primary HPV testing with reflex triage, a modified starting age (20 to 25 years), and an extended screening interval (3 to 5 years). A technical dialogue was conducted as part of the public procurement process; outputs were used to support a preliminary budget impact analysis and reimbursement negotiations with the national decision makers, with the aim of enabling an open national procurement procedure and inclusion in health insurance funding in 2026. Across all three pillars, focus groups with key stakeholders (including NGOs), and the target population have been conducted and will be followed by surveys to support implementation planning and communication strategies. A national workshop titled “Fundamentals of HTA and Decision Modelling” was delivered in synergy with the SG REFORM TSI project ENACT HTAR, led by the iMTA, Netherlands. MISCAN capacity-building workshops are ongoing to strengthen national modelling capability.
Conclusions
ICSIS illustrates how a governance-embedded approach, integrating health-system capacity mapping, decision modelling (cost-effectiveness and budget impact), evidence-based strategies, and stakeholder-informed implementation research, can accelerate translation of European recommendations into feasible, nationally endorsed screening protocols and reimbursement planning. By aligning technical protocol development with National Screening Committee processes and strengthening national modelling and communication capacity, ICSIS supports implementation readiness across emerging (lung, prostate) and renewed (cervical) screening pathways in Slovenia.
Acknowledgements
The ICSIS project is funded by EU SG REFORM Technical Support Instrument. Pro-Screen-Slovenia project is funded by the UICC. Both projects are coordinated by IARC, with collaboration of ERASMUS MC.