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Cancer screening | Ch 3 | |
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The goal of cancer screening is to detect asymptomatic cancers by using diagnostic tests or methods which can be proposed to a great number of healthy persons. The result of these tests enable the separation of healthy subjects with no cancer from persons who may be affected by cancer and for whom further thorough examinations are needed.
The validity of a screening policy can be demonstrated by the reduction of mortality (and reduced treatment morbidity) in patients who have been screened compared to patients for whom cancer has been diagnosed after the apparition of classical symptoms.
Ideal cancers for screening should :
- · be frequent with heavy mortality,
- · remain over a long period at a pre-clinical stage (without symptoms),
- · be detected at a stage when therapy is efficient,
- · be detected using a high sensitivity and high specificity test, of a moderate cost and limiting inconvenience to the healthy person in order to be accepted and regularly repeated.
In reality, up to now, the only cancers which can be practically screened are : breast, cervix uteri, skin, colon and rectum, prostate, although controversy remains regarding certain techniques.
Every screening technique should be evaluated for its postive and negative effects.
The benefits include :
- · improved prognosis for patients for whom cancer has been detected through screening,
- ·reduction in aggressive treatment necessary to treat this screened cancer,
- · peace of mind for subjects with a negative test,
- · reduction of the general cost of cancer treatment,
- · and, of course, a reduction in mortality via the screening policy.
Negative aspects
The negative aspects should not be neglected: in fact, we are dealing with a healthy population presenting no symptoms and with no particular demand. They include:
- · discomfort brought by screening tests,
- · psychological and economical consequences of false positive results (more complex examinations which take place to finally reveal absence of pathology): precise description of morbidity (and sometimes mortality) induced for no reason,
- · the more tragic consequences of false negative.
In summary, potential drawbacks should be minimal in relation to genuinely observed advantages.
Other chapters of this website
- Natural history of cancer
- Cancer prevention
- Cancer screening
- Cancer diagnosis
- Tumour markers
- Principles of Cancer Classification
- Cancer surgery
- Cancer radiotherapy
- Cancer chemotherapy
- Cancer hormonotherapy
- Other cancer therapies
- Multidisciplinary approach of cancer patients
- Psychological aspects
- Post-therapeutic follow-up
- Palliative care in cancer
- Cancer emergencies
References |
Index |
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