PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

41 Acting early on NCDs The Partnership for Health System Sustainability and Resilience3 Secondary prevention: Screening and early detection Early detection of NCDs occurs through multiple pathways: organised population screening programmes, opportunistic case-finding during routine clinical encounters, and diagnostic testing when early symptoms emerge. Whilst systematic screening programmes represent the most visible and measurable approach, much early identification happens outside these formal structures: a primary care physician checking blood pressure during an unrelated visit, a pharmacist noting concerning symptoms whilst dispensing medication, or workplace health checks identifying previously unknown conditions. This window for early identification determines whether conditions remain manageable through lifestyle modification and simple treatments or progress to irreversible complications requiring complex interventions. This chapter examines the full spectrum of early detection, from population-level risk assessment through organised screening programmes to the critical role of opportunistic detection and initial diagnosis in primary care settings. Organised screening programmes Systematic population screening represents the most visible component of early detection strategies, with all eight countries maintaining at least some organised programmes. These initiatives aim to identify disease before symptoms emerge, when treatment is most effective and often less intensive. Yet implementation reveals dramatic variations in coverage, quality, and equity that determine whether screening fulfils its promise of reducing disease burden or merely identifies disease without improving outcomes. Cancer screening programmes Cancer screening represents the most developed area, with all eight countries maintaining programmes for at least some cancers, though performance diverges sharply, as Figure 14 illustrates. The WHO recommends organised, population-based screening programmes for cervical, colorectal, and breast cancers where resources and infrastructure allow. For cervical cancer, WHO recommends HPV DNA testing as the primary screening method for the general population of women starting at age 30, with regular testing every 5–10 years. For women living with HIV, screening should begin at age 25 with testing every 3–5 years (WHO, 2021). The WHO global strategy calls for 70% of women globally to be screened with a high-performance test by age 35 and again by age 45. While WHO provides frameworks for colorectal and lung cancer screening, specific global recommendations are less prescriptive, acknowledging varying resource availability and disease burden across countries. Cervical cancer screening is available across all eight countries, with each having adopted HPV testing alongside cervical cytology. Most programmes use age-stratified approaches, typically reserving HPV testing and cervical cytology for women aged 30–65, although some countries have expanded their cervical screening programmes to younger ages.