JMIR Publications

ABSTRACT

Background:

To make informed decisions about cancer screening, people need access to information that is understandable, unbiased, complete, and transparent about potential benefits and harms. Previous studies have identified important quality deficits in online cancer screening information. However, it remains unclear whether official online materials from organized cancer screening programs across Europe meet evidence-based quality standards.

Objective:

This study systematically evaluated the quality of official online information materials for organized breast, cervical, and colorectal cancer screening programs across Europe. Specifically, the study assessed the extent to which these materials support informed decision-making among people eligible for cancer screening. A secondary objective was to provide evidence-based recommendations for improving these materials. This study was conducted as part of the EuCanScreen project, co-funded by the European Union.

Methods:

Between October 2024 and April 2025, we collected 182 official online information materials, including websites and digital brochures, from 26 European countries. Materials covered breast (n=63), cervical (n=61) and colorectal (n=58) cancer screening. All materials were translated into English and independently assessed by paired raters using MAPPinfo, a validated 19-item checklist evaluating four evidence-based quality domains: definition, transparency, content, and presentation. Scores represent the percentage of quality criteria fulfilled (0-100%).

Results:

The mean MAPPinfo score across all materials was 25.65%, indicating low quality for most materials. Scores ranged from 6.82% to 78.26%; 16 materials fulfilled at least 50% of the quality criteria, and three exceeded 70%. No statistically significant differences were found between cancer types. Among the four domains, the definition domain achieved the highest mean score (60.30%), mainly because 96.7% of materials clearly identified the target group. The transparency domain showed the lowest performance (8.79%), with no materials reporting conflicts of interest or systematic search strategies. Most materials avoided persuasive language (78.2%) and narrative elements (87.4%). Mean scores for adequate presentation were 15.38% for benefits, 13.19% for harms, and 14.84% for test accuracy. Information on cancer prevalence or natural course was mentioned in 20.88% of materials.

Conclusions:

The analyzed cancer screening information materials showed substantial quality deficits, with an average fulfilment of one-quarter of evidence-based quality criteria. Major shortcomings exist in transparency and in the communication of benefits and harms. Many current materials showed limited adherence to criteria considered important for informed decision-making in cancer screening. As part of the EuCanScreen project, a toolkit is being developed to support the creation of higher-quality, evidence-based screening information materials.