The public health basis of cancer screening: principles and ethical aspects
Cancer is a dread disease. It ably fulfills, at least in the mind of the public and of many physicians, two of the requirements for screening, namely, that the disease should be an important public health problem and that the consequences of untreatable cancer are dire . However, we do not have a screening test for cancer; rather, we have a series of screening tests for different cancer sites. These tests use different approaches, possess varying sensitivity and specificity, and have produced varying evidence of efficacy and effectiveness. Thus screening for each cancer site has to be justified on its own merits and must therefore be evaluated using rigorous approaches, especially randomized controlled trials .
KeywordsCancer Screening Cervical Cancer Screening Cancer Site Breast Screening Breast Cancer Detection
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- 1.Miller AB. 1982. Fundamental issues in screening. In Schottenfeld D, Fraumeni JF Jr (eds.), Cancer Epidemiology and Prevention. Philadelphia: W.B. Saunders, pp. 1064–1074.Google Scholar
- 4.Miller AB. 1994. Screening for cancer: Is it time for a paradigm shift? Ann R Coll Physicians Surgeons Canada 27: 353–355.Google Scholar
- 5.Miller AB. 1985. Principles of screening and of the evaluation of screening programs. In Miller AB (ed.), Screening for cancer. Orlando, FL: Academic Press, pp. 3–24.Google Scholar
- 7.Miller AB, Baines CJ, To T, Wall C, et al. 1992. Canadian national breast screening study: 1. Breast cancer detection and death rates among women age 40–49 years. Can Med Assoc J 147: 1459–1476.Google Scholar
- 8.Miller AB, Baines CJ, To T, Wall C, et al. 1992. Canadian national breast screening study: 2. Breast cancer detection and death rates among women age 50–59 years. Can Med Assoc J 147: 1477–1488.Google Scholar
- 11.Auvinen A, Rietbergen JBW, Denis LJ, Prorok PC, Schröder FH, for the International Prostate Cancer Screening Trial Evaluation Group. In preparation. Prospective evaluation plan for randomized trials of prosate cancer screening.Google Scholar
- 12.Beahrs OH, Shapiro S, Smart S. 1979. Report of the working group to review the National Cancer Institute-American Cancer Society Breast Cancer Detection Demonstration Projects. J Natl Cancer Inst 62: 641–709.Google Scholar
- 13.Mandel JS, Bond J, Snover D, Williams S, Bradley M, Walker C, Schuman LM, Gilbertsen V. 1988. The University of Minnesota’s Colon Cancer Control Study. In Chamberlain J, Miller AB (eds.), Screening for Gastrointestinal Cancer. Toronto: Hans Huber, pp. 17–24.Google Scholar
- 14.Chamberlain J. 1986. Reasons that some screening programmes fail to control cervical cancer. In Hakama M, Miller AB, Day NE (eds.), Screening for Cancer of the Cervix Uteri. IARC Scientific Publications No. 76. Lyon: International Agency for Research on Cancer, pp. 161–168.Google Scholar
- 19.Greenwald P, Sondik EJ (eds.). 1986. Cancer control objectives for the nation: 1985–2000. NCI Monographs, No. 2.Google Scholar