Early Detection & Screening

The Early Detection and Screening department operates at the forefront of evaluating screening and early detection strategies, addressing one of the most critical challenges in modern healthcare: how to maximize population health benefits while minimizing harm, inefficiency and inequity.

Rapid technological developments create new opportunities for earlier detection, but also increase the risk of unproven, harmful or unsustainable screening practices if introduced without robust evidence. Our programme plays a central role in generating this evidence. Our approach combines three complementary pillars: large-scale randomized controlled trials (RCT), monitoring and evaluation of ongoing programmes, and advanced microsimulation modelling. This framework allows us to evaluate screening strategies comprehensively, from effectiveness to cost and system-level implications.
Recent trials in which we play an initiating and leading role include the NELSON trial, demonstrating reduced lung cancer mortality through low-dose CT screening), and the ROBINSCA trial, showing that CT-based calcium scoring can reduce cardiovascular overtreatment. We are currently leading in the European 4-IN-THE-LUNG-RUN implementation trial, evaluating extended screening intervals after a baseline negative CT lung scan), and we initiated and lead the PERFECT-FIT study which evaluates the impact of varying colorectal screening intervals based on prior test result.
Beyond randomized trials, our programme has for many years served as the national monitoring and evaluation body for the three population-based cancer screening programmes in the Netherlands. Our microsimulation models have directly informed the design, optimization and revision of these programmes, as well as multiple international cancer-screening guidelines, including those in the United States. Together, these pillars enable continuous, evidence-based improvement of screening strategies, supporting more effective, equitable and sustainable healthcare systems.
A central strength of the programme lies in its close collaboration with key stakeholders within and beyond Erasmus MC. We work in strong partnership with clinical departments across the medical centre, integrating cutting-edge test developments, clinical expertise and patient perspectives into the design and evaluation of screening and early detection strategies. In addition, the programme maintains extensive collaborations with national and international partners, including public health institutes, policy-making bodies, screening organisations, academic groups and professional societies within and outside the Netherlands.

Aims

The primary aim of this research line is to improve health outcomes by systematically evaluating and optimizing screening programmes, with explicit attention to effectiveness, safety, and the balance between benefits and harms. A key focus is the development and application of innovative methods, models and technologies, such as risk adapted screening strategies, microsimulation modelling, and data-driven evaluations, to support evidence-based clinical and policy decision making. The programme also seeks to contribute to more sustainable and future-proof healthcare by reducing overdiagnosis and overtreatment, optimizing screening intervals, and promoting efficient use of resources. Throughout all activities, strong emphasis is placed on an ethical, equitable, and inclusive approach to screening, ensuring informed choice, addressing health inequalities, and maximizing societal value.

Research priorities

Large-Scale Randomized Controlled Screening Trials
Design and conduct large, pragmatic RCTs to evaluate the effectiveness of existing and emerging screening programmes in reducing morbidity and mortality.
Microsimulation computer modelling MISCAN
Use MISCAN microsimulation models to extrapolate evidence from RCTs and population and clinical studies, quantifying benefits, harms, costs and resource use to determine optimal screening strategies in local contexts.
Health technology assessment for screening
Perform model-based HTAs to inform national and international clinical guidelines and policy decisions, including the introduction or modification of screening programmes.
Evaluation of emerging screening technologies
Critically assess new tests and technologies before large-scale implementation to prevent ineffective or harmful screening.
Balancing benefits and harms of screening
Quantify overdiagnosis, overtreatment, false positives, radiation exposure, psychological impact and downstream consequences across screening strategies.
Optimizing screening intervals
Assess the safety, effectiveness and cost-effectiveness of extended or personalized screening intervals following negative baseline or follow-up tests.
Risk-adapted screening strategies
Develop and evaluate risk-based and stratified screening approaches (e.g., by age, sex, breast density, baseline test result, or biomarker profile) in lung, breast, colorectal and other screening programmes.
Equity, access and inclusivity in screening
Evaluate how screening strategies affect health equity, participation and outcomes across subgroups, and design approaches that reduce disparities and improve fairness.
Screening capacity and health system constraints
Assess the impact of real-world constraints (e.g., workforce shortages, diagnostic capacity, COVID-related disruptions) on screening outcomes and programme performance.
Advancing screening beyond cancer
Develop and apply screening and early-detection models for non-cancer conditions, including cardiovascular disease, liver disease, dementia, mental health disorders, child abuse, and combined risk screening.

Staff

Eveline Heijnsdijk

Assistent professor

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