Cancer Screening

by

Juliet McMullin

• LAST REVIEWED: 24 August 2022
• LAST MODIFIED: 23 February 2011
• DOI: 10.1093/obo/9780199756797-0010

Introduction

According to the World Health Organization (WHO), cancer is among the leading causes of death worldwide, accounting for 7.4 million deaths in 2004. Early detection cancer screening is one of the more effective tools used to reduce cancer mortality, and it is estimated that a one-third cancer mortality reduction would occur with proper early detection. Cancer screening tests are designed to find cancers at an early stage, prior to the onset of symptoms, when the cancer is easier to treat. In some cases cancer screening for the cervix, colon, and rectum can identify precancerous cells, thus preventing the onset of cancer. This entry includes information for cancers where early detection tests currently exist: breast, colon, rectum, cervix, prostate, oral cavity, and skin cancers. While there is a large literature regarding medical technologies used in diagnostic testing, the primary purpose of this entry is to engage issues related to population-based cancer screening. Increased efforts to understand screening use have been addressed in behavioral research that focuses on the role of risk perception, informed decision making, and barriers that may hinder the uptake of cancer screening. These studies have also brought questions about the uneven distribution of cancer incidence and mortality to the fore. Discussions of cancer disparities are intertwined with social processes that reveal disparities in access, sociohistorical inequalities, and assumptions of medical practitioners and screening. Efforts at increasing the uptake of screening to address cancer mortality in populations as a whole and the associated disparities are evident in the cancer screening interventions literature. Despite the desire to make screening interventions available to all people, the cost-effectiveness literature examines the need to implement these technologies based on the distribution of specific cancers as well as considerations of how to implement costly programs in low-income countries. It is also important to note that these tests are not without risks, as the invasiveness of some of the screening tests can increase physical risks. Other diagnostic risks include overdiagnosis, being falsely diagnosed with cancer (false positives), and not being diagnosed when there is cancer (false negatives) Moreover, for some cancers early detection does not improve the chance of a cure or longer life. The potential benefits of cancer screening in the reduction of cancer mortalities produce an imperative to make the utmost of the available medical technology. And yet, the social, cultural, economic, and psychological complexities of cancer screening have given rise to an equally complex and prolific literature that show cancer and cancer screening to be more than the sole implementation of medical technologies.

Introductory Works

With well over 200 different types of cancer and a range of experiences across the cancer continuum (from biology, screening, and diagnosis to survivorship and bereavement) the body of literature on this topic is expansive. Many texts and articles tend to focus on one specific type of cancer or cancer in a specific population. A general perspective on cancer screening is often embedded in a conversation of the cancer continuum. The articles and texts in this section represent a sampling of key issues in cancer screening. These issues include screening guidelines, cost effectiveness, behavioral theory and inequality, and overdiagnosis. World Health Organization 2005 provides global cancer rates and lists screening efforts. Smith, et al. 2010 reviews current screening guidelines from the American Cancer Society (ACS). Contributors to Greenwald, et al. 1995 examine the broad issues in cancer prevention and control. Miller, et al. 2009 is a more recent publication that evaluates and examines basic constructs in behavioral theory across the cancer continuum. Coleman, et al. 2008 reports on cancer rates in Europe, focusing on efforts to reduce mortality from the disease and the risks associated with screening. Breen and Meissner 2005 provides a review with a focus on social and institutional systemic factors that influence screening. Barratt, et al. 2002 has a glossary of key terms in cancer screening. World Health Organization 2002 provides an international resource on policies for screening programs. Welch and Black 2010 examines issues associated with overdiagnosis and potential diagnostic risk and harms associated with cancer screening.

• Barratt, A., P. Mannes, L. Irwig, L. Trevena, J. Craig, and L. Rychetnik. 2002. Cancer screening. Journal of Epidemiology and Community Health 56:899–902.

  DOI: 10.1136/jech.56.12.899

  Provides a concise glossary of terms used in the cancer screening literature. Topics include false negative, false positive, sensitivity, relative risk reduction, and informed participation.

• Breen, Nancy, and Helen I. Meissner. 2005. Toward a system of cancer screening in the United States: Trends and opportunities. Annual Review of Public Health 26:561–582.

  DOI: 10.1146/annurev.publhealth.26.021304.144703

  Examines patient, physician, and systemic factors that influence the uptake of cancer screening services. In an effort to address the uneven access and efforts at increasing screening, the authors provide suggestions at the clinical and health-plan level that will work toward increasing screening and maintain their cost-effectiveness.

• Coleman, Michel P., Delia-Marina Alexe, Tit Albreht, and Martin McKee. 2008. Responding to the challenge of cancer in Europe. Ljubljana, Slovenia: Institute of Public Health of the Republic of Slovenia.

  This report covers the scope of cancer incidence, screening, diagnosis, and survivorship in Europe. The chapter on cancer screening is useful for examining the mechanisms of screening technologies, risks, and associated issues with overdiagnosis.

• Greenwald, Peter, Barnett S. Kramer, and Douglas L Weed, eds. 1995. Cancer prevention and control. New York: M. Dekker.

  This edited volume is among the earlier texts to examine the emergence of cancer prevention and control as a specific focus for research and knowledge production. Contributors examine issues ranging from methods, the uneven distribution of the cancer burden, basic biological issues in cancer, prevention and screening, and health communication.

• Miller, Suzanne M., Deborah J. Bowen, Robert T. Croyle, and Julia H. Rowland, eds. 2009. Handbook of cancer control and behavioral science: A resource for researchers, practitioners, and policy makers. Washington, DC: American Psychological Association.

  Contributors to this volume examine facets of cancer from primary prevention to early detection, treatment, survivorship, and grief. Sections on cancer screening examine the current state of knowledge in behavioral science and cultural contexts that influence the uptake of detection technologies.

• Smith, Robert A, Vilma Cokkinides, Durado Brooks, Debbie Saslow, and Otis W. Brawley. 2010. Cancer screening in the United States, 2010: A review of current American Cancer Society guidelines and issues in cancer screening. CA: A Cancer Journal for Clinicians 60.2: 99–119.

  DOI: 10.3322/caac.20063

  This journal provides a yearly update on cancer screening recommendations from the American Cancer Society. The 2010 update has a more detailed focus on breast cancer screening that reflects current debates on screening risks and recommended age to begin screening.

• Welch, H. Gilbert, and William C. Black. 2010. Overdiagnosis in cancer. Journal of the National Cancer Institute 102.9: 605–613.

  DOI: 10.1093/jnci/djq099

  Defines overdiagnosis in cancer screening. Reviews studies showing the occurrence of overdiagnosis, particularly in breast, prostate, and lung cancers. Provides suggestions for how to remedy the problem.

• World Health Organization. 2002. National cancer control programmes: Policies and managerial guidelines. 2d ed. Geneva, Switzerland: World Health Organization.

  Resource provides information on global cancer rates, prevention, screening, diagnosis, and care. Maps out issues to consider when implementing early detection programs.

• World Health Organization. 2005. Global action against cancer now! Geneva, Switzerland: World Health Organization.

  Short article that provides global cancer incidence and mortality rates. Outlines available screening mechanisms and some of the available programs across different countries.