European Journal of Epidemiology

, Volume 28, Issue 4, pp 287–290 | Cite as

Screening, case finding or primary cancer prevention in the developing world?

  • Gustaf Edgren
  • Pagona Lagiou
  • Dimitrios Trichopoulos
  • Hans-Olov Adami


On account of increasingly successful control of infectious diseases and improvements in both maternal and perinatal mortality, the relative contribution of cancer to the global burden of disease is growing. The 2008 World Cancer Report predicts that the annual number of cancer deaths in the world will have increased by 70–124 % until the year 2030 [1]. Because relative changes in longevity, a key driver of the total cancer burden, will likely be largest in the developing world, this dramatic increase will disproportionately affect low income countries. Unavoidably, the result will be added stress on healthcare systems that are facing the heavy burden of communicable diseases.

With this gloomy picture in mind, it is perhaps understandable that implementation of cancer screening programs are sometimes proposed to stem this devastating tide [2, 3, 4]. However, aside from cervical cancer screening, the two arguably most widespread screening techniques, mammography and...


Cancer Screening Primary prevention Case finding Breast cancer Prostate cancer Cervical cancer Colorectal cancer 



We thank Dr Michelle Holmes at Harvard School of Public Health, Harvard University, and Dr Jacob Holmqvist, at Karlstad Central Hospital, Karlstad, Sweden for their comments on an earlier draft of this report. No specific funding was acquired, but Dr Gustaf Edgren is supported by a postdoctoral grant from Svenska Sällskapet för Medicinsk Forskning (SSMF).

Conflict of interest

We declare we have no relevant conflicts of interest.


  1. 1.
    Boyle P, Levin B, editors. World Cancer Report 2008. Lyon: International Agency for Research on Cancer (IARC); 2008.Google Scholar
  2. 2.
    Smith RA, Caleffi M, Albert US, et al. Breast cancer in limited-resource countries: early detection and access to care. Breast J. 2006;12(Suppl 1):S16–26. doi: 10.1111/j.1075-122X.2006.00200.x.PubMedCrossRefGoogle Scholar
  3. 3.
    Ifere GO, Abebe F, Ananaba GA. Emergent trends in the reported incidence of prostate cancer in Nigeria. Clin Epidemiol. 2012;4:19–32. doi: 10.2147/CLEP.S23536.PubMedGoogle Scholar
  4. 4.
    Farmer P, Frenk J, Knaul FM, et al. Expansion of cancer care and control in countries of low and middle income: a call to action. Lancet. 2010;376(9747):1186–93. doi: 10.1016/S0140-6736(10)61152-X.PubMedCrossRefGoogle Scholar
  5. 5.
    Kalager M, Zelen M, Langmark F, Adami HO. Effect of screening mammography on breast-cancer mortality in Norway. N Engl J Med. 2010;363(13):1203–10. doi: 10.1056/NEJMoa1000727.PubMedCrossRefGoogle Scholar
  6. 6.
    Jørgensen KJ, Zahl PH, Gøtzsche PC. Breast cancer mortality in organised mammography screening in Denmark: comparative study. BMJ. 2010;340:c1241.PubMedCrossRefGoogle Scholar
  7. 7.
    Gotzsche PC, Jorgensen KJ, Zahl PH, Maehlen J. Why mammography screening has not lived up to expectations from the randomised trials. Cancer Causes Control. 2012;23(1):15–21. doi: 10.1007/s10552-011-9867-8.PubMedCrossRefGoogle Scholar
  8. 8.
    Welch HG, Black WC. Overdiagnosis in cancer. J Natl Cancer Inst. 2010;102(9):605–13. doi: 10.1093/jnci/djq099.PubMedCrossRefGoogle Scholar
  9. 9.
    Adami HO. The prostate cancer pseudo-epidemic. Acta Oncol. 2010;49(3):298–304. doi: 10.3109/02841860903584945.PubMedCrossRefGoogle Scholar
  10. 10.
    Loeb S, Vonesh EF, Metter EJ, Carter HB, Gann PH, Catalona WJ. What is the true number needed to screen and treat to save a life with prostate-specific antigen testing? J Clin Oncol. 2011;29(4):464–7. doi: 10.1200/JCO.2010.30.6373.PubMedCrossRefGoogle Scholar
  11. 11.
    Chou R, Croswell JM, Dana T, Bougatsos C, Blazina I, Fu R, et al. Screening for prostate cancer: a review of the evidence for the U.S. Preventive Services Task Force. Ann intern med. 2011;155(11):762–71. doi: 10.1059/0003-4819-155-11-201112060-00375.
  12. 12.
    Prorok PC, Andriole GL, Bresalier RS, et al. Design of the prostate, lung, colorectal and ovarian (PLCO) cancer screening trial. Control Clin Trials. 2000;21(6 Suppl):273S–309S.PubMedCrossRefGoogle Scholar
  13. 13.
    Mandel JS, Bond JH, Church TR, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota colon cancer control study. N Engl J Med. 1993;328(19):1365–71. doi: 10.1056/NEJM199305133281901.PubMedCrossRefGoogle Scholar
  14. 14.
    Bretthauer M, Kalager M. Colonoscopy as a triage screening test. N Engl J Med. 2012;366(8):759–60. doi: 10.1056/NEJMe1114639.PubMedCrossRefGoogle Scholar
  15. 15.
    Clarke EA, Anderson TW. Does screening by “Pap” smears help prevent cervical cancer? A case-control study. Lancet. 1979;2(8132):1–4.PubMedCrossRefGoogle Scholar
  16. 16.
    Gustafsson L, Ponten J, Zack M, Adami HO. International incidence rates of invasive cervical cancer after introduction of cytological screening. Cancer Causes Control. 1997;8(5):755–63.PubMedCrossRefGoogle Scholar
  17. 17.
    Danaei G, Vander Hoorn S, Lopez AD, Murray CJ, Ezzati M. Causes of cancer in the world: comparative risk assessment of nine behavioural and environmental risk factors. Lancet. 2005;366(9499):1784–93.PubMedCrossRefGoogle Scholar
  18. 18.
    Beaglehole R, Bonita R, Horton R, et al. Priority actions for the non-communicable disease crisis. Lancet. 2011;377(9775):1438–47.PubMedCrossRefGoogle Scholar
  19. 19.
    Chokshi DA, Farley TA. The cost-effectiveness of environmental approaches to disease prevention. N Engl J Med. 2012;367(4):295–7. doi: 10.1056/NEJMp1206268.PubMedCrossRefGoogle Scholar
  20. 20.
    Whitby LG. Screening for disease: definitions and criteria. Lancet. 1974;2(7884):819–22.PubMedCrossRefGoogle Scholar
  21. 21.
    Ponten J, Adami HO, Bergstrom R, et al. Strategies for global control of cervical cancer. Int J Cancer. 1995;60(1):1–26.PubMedCrossRefGoogle Scholar
  22. 22.
    Jemal A, Bray F, Forman D, et al. Cancer burden in Africa and opportunities for prevention. Cancer. 2012;. doi: 10.1002/cncr.27410.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Gustaf Edgren
    • 1
    • 2
  • Pagona Lagiou
    • 1
    • 3
  • Dimitrios Trichopoulos
    • 1
  • Hans-Olov Adami
    • 1
    • 2
  1. 1.Department of Epidemiology, Harvard School of Public HealthHarvard UniversityBostonUSA
  2. 2.Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
  3. 3.Department of Hygiene, Epidemiology and Medical StatisticsUniversity of Athens Medical SchoolAthensGreece

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