Skip to main content
PMC home page
Bulletin of the World Health Organization logoLink to Bulletin of the World Health Organization
. 1986;64(3):421–429.

Secondary prevention of cancer: an overview

David M Eddy
PMCID: PMC2490882  PMID: 3533301

Abstract

Secondary prevention of cancer (screening) involves the use of tests to detect a cancer before the appearance of signs or symptoms. Before starting such a programme, the available evidence should be analysed to estimate the effectiveness of the proposed activities. Essential requirements are an understanding of the natural history of the particular cancer, availability of a test that can detect it, effective treatment for it, good evidence that early detection reduces the incidence and/or mortality, and that the expected benefits of screening outweigh the risks and costs. A screening programme should be limited to significant cancers and applied selectively, and should be integrated into the total health care programme. Programmes should take into account the risks, costs and expected benefits; provide quality assurance as well as facilities to follow, diagnose, and treat people with positive test results; maintain all records; and keep costs to a minimum. Ideally the effectiveness of screening should be demonstrated by randomized controlled trials showing a reduction in mortality, but this type of evidence exists for few cancers. Often an estimate of the effectiveness of screening must rest on other types of evidence, such as observations that the tests can detect the cancer before the appearance of signs or symptoms; that the tests can find a greater proportion of cancers in early stages; and that the patients with cancers detected through screening have higher survival rates after diagnosis and treatment although it must be recognized that these observations may be biased. This article discusses the available evidence on the effectiveness of screening for eight cancers, and gives estimates of the potential impact of secondary prevention for the year 2000.

Full text

PDF
421

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baker L. H. Breast Cancer Detection Demonstration Project: five-year summary report. CA Cancer J Clin. 1982 Jul-Aug;32(4):194–225. doi: 10.3322/canjclin.32.4.194. [DOI] [PubMed] [Google Scholar]
  2. Boddington M. M. Prevalence rates of cervical lesions in specifically defined areas. Tumori. 1976 May-Jun;62(3):319–325. doi: 10.1177/030089167606200310. [DOI] [PubMed] [Google Scholar]
  3. Boucot K. R., Weiss W. Is curable lung cancer detected by semiannual screening? JAMA. 1973 Jun 4;224(10):1361–1365. [PubMed] [Google Scholar]
  4. Brett G. Z. Earlier diagnosis and survival in lung cancer. Br Med J. 1969 Nov 1;4(5678):260–262. doi: 10.1136/bmj.4.5678.260. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Crespi M., Muñoz N., Grassi A., Aramesh B., Amiri G., Mojtabai A., Casale V. Oesophageal lesions in northern Iran: a premalignant condition? Lancet. 1979 Aug 4;2(8136):217–221. doi: 10.1016/s0140-6736(79)90236-8. [DOI] [PubMed] [Google Scholar]
  6. Dales L. G., Friedman G. D., Collen M. F. Evaluating periodic multiphasic health checkups: a controlled trial. J Chronic Dis. 1979;32(5):385–404. doi: 10.1016/0021-9681(79)90080-8. [DOI] [PubMed] [Google Scholar]
  7. Eckert D., Bloom H. J., Ross L. S. A review of oral cancer screening and detection in the metropolitan Detroit cancer control program. Prog Clin Biol Res. 1982;83:195–206. [PubMed] [Google Scholar]
  8. El-Bolkainy M. N., Chu E. W., Ghoneim M. A., Ibrahim A. S. Cytologic detection of bladder cancer in a rural Egyptian population infected with schistosomiasis. Acta Cytol. 1982 May-Jun;26(3):303–310. [PubMed] [Google Scholar]
  9. Gilbertsen V. A. Proctosigmoidoscopy and polypectomy in reducing the incidence of rectal cancer. Cancer. 1974 Sep;34(3):suppl–suppl:939. doi: 10.1002/1097-0142(197409)34:3+<936::aid-cncr2820340722>3.0.co;2-5. [DOI] [PubMed] [Google Scholar]
  10. Gilbertsen V. A. Status of screening for large bowel cancers. Prog Clin Biol Res. 1983;115:79–80. [PubMed] [Google Scholar]
  11. Guzick D. S. Efficacy of screening for cervical cancer: a review. Am J Public Health. 1978 Feb;68(2):125–134. doi: 10.2105/ajph.68.2.125. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. HERTZ R. E., DEDDISH M. R., DAY E. Value of periodic examinations in detecting cancer of the rectum and colon. Postgrad Med. 1960 Mar;27:290–294. doi: 10.1080/00325481.1960.11712835. [DOI] [PubMed] [Google Scholar]
  13. Johannesson G., Geirsson G., Day N. The effect of mass screening in Iceland, 1965-74, on the incidence and mortality of cervical carcinoma. Int J Cancer. 1978 Apr 15;21(4):418–425. doi: 10.1002/ijc.2910210404. [DOI] [PubMed] [Google Scholar]
  14. Levin M. L., Tockman M. S., Frost J. K., Ball W. C., Jr Lung cancer mortality in males screened by chest X-ray and cytologic sputum examination: a preliminary report. Recent Results Cancer Res. 1982;82:138–146. doi: 10.1007/978-3-642-81768-7_13. [DOI] [PubMed] [Google Scholar]
  15. Li F. P., Shiang E. L. Screening for oesophageal cancer in 62 000 Chinese. Lancet. 1979 Oct 13;2(8146):804–804. doi: 10.1016/s0140-6736(79)92166-4. [DOI] [PubMed] [Google Scholar]
  16. Macgregor J. E. Evaluation of mass screening programmes for cervical cancer in N.E. Scotland. Tumori. 1976 May-Jun;62(3):287–295. doi: 10.1177/030089167606200306. [DOI] [PubMed] [Google Scholar]
  17. Melamed M. R., Flehinger B. J., Zaman M. B., Heelan R. T., Perchick W. A., Martini N. Screening for early lung cancer. Results of the Memorial Sloan-Kettering study in New York. Chest. 1984 Jul;86(1):44–53. doi: 10.1378/chest.86.1.44. [DOI] [PubMed] [Google Scholar]
  18. Miki K., Hirayama Y., Ichinose M., Niwa H., Oka H., Oda T. Upper gastrointestinal mass survey with panendoscopy in a workplace. Gastrointest Endosc. 1982 May;28(2):70–72. doi: 10.1016/s0016-5107(82)73001-9. [DOI] [PubMed] [Google Scholar]
  19. Nash F. A., Morgan J. M., Tomkins J. G. South London Lung Cancer Study. Br Med J. 1968 Jun 22;2(5607):715–721. doi: 10.1136/bmj.2.5607.715. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Nemoto R., Kato T., Harada M., Shibata K., Kano M. Mass screening for urinary tract cancer with urine cytology. J Cancer Res Clin Oncol. 1982;104(1-2):155–159. doi: 10.1007/BF00402063. [DOI] [PubMed] [Google Scholar]
  21. Nishizawa M., Okada T., Hosoi T., Makino T. Detecting early esophageal cancers, with special reference to the intraepithelial stage. Endoscopy. 1984 May;16(3):92–94. doi: 10.1055/s-2007-1018543. [DOI] [PubMed] [Google Scholar]
  22. Okui K., Tejima H. Evaluation of gastric mass survey. Acta Chir Scand. 1980;146(3):185–187. [PubMed] [Google Scholar]
  23. Sakka M., Hisamichi S., Takano A., Hashizume T., Sasano N., Uzuka Y. Mass survey of gastric cancer and leukemia in Miyagi Prefecture, Japan. Tohoku J Exp Med. 1982 Nov;138(3):239–243. doi: 10.1620/tjem.138.239. [DOI] [PubMed] [Google Scholar]
  24. Shapiro S., Venet W., Strax P., Venet L., Roeser R. Ten- to fourteen-year effect of screening on breast cancer mortality. J Natl Cancer Inst. 1982 Aug;69(2):349–355. [PubMed] [Google Scholar]
  25. Tang Z. Y. Treatment of primary liver cancer -- with special reference to the east part of China. Ann Acad Med Singapore. 1980 Apr;9(2):251–255. [PubMed] [Google Scholar]
  26. Tang Z. Y., Yang B. H., Tang C. L., Yu Y. Q., Lin Z. Y., Weng H. Z. Evaluation of population screening for hepatocellular carcinoma. Chin Med J (Engl) 1980 Nov;93(11):795–799. [PubMed] [Google Scholar]
  27. Verbeek A. L., Hendriks J. H., Holland R., Mravunac M., Sturmans F., Day N. E. Reduction of breast cancer mortality through mass screening with modern mammography. First results of the Nijmegen project, 1975-1981. Lancet. 1984 Jun 2;1(8388):1222–1224. doi: 10.1016/s0140-6736(84)91703-3. [DOI] [PubMed] [Google Scholar]
  28. Weiss W., Boucot K. R., Seidman H. The Philadelphia Pulmonary Neoplasms Research Project. Clin Chest Med. 1982 May;3(2):243–256. [PubMed] [Google Scholar]
  29. Winawer S. J. Detection and diagnosis of colorectal cancer. Cancer. 1983 Jun 15;51(12 Suppl):2519–2524. doi: 10.1002/1097-0142(19830615)51:12+<2519::aid-cncr2820511323>3.0.co;2-b. [DOI] [PubMed] [Google Scholar]
  30. Woolner L. B., Fontana R. S., Sanderson D. R., Miller W. E., Muhm J. R., Taylor W. F., Uhlenhopp M. A. Mayo Lung Project: evaluation of lung cancer screening through December 1979. Mayo Clin Proc. 1981 Sep;56(9):544–555. [PubMed] [Google Scholar]
  31. Yanjin M., Guangyi L., Xianzhi G., Wenheng C. Detection and natural progression of early oesophageal carcinoma: preliminary communication. J R Soc Med. 1981 Dec;74(12):884–886. doi: 10.1177/014107688107401205. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. de Waard F., Collette H. J., Rombach J. J., Baanders-van Halewijn E. A., Honing C. The DOM project for the early detection of breast cancer, Utrecht, The Netherlands. J Chronic Dis. 1984;37(1):1–44. doi: 10.1016/0021-9681(84)90123-1. [DOI] [PubMed] [Google Scholar]

Articles from Bulletin of the World Health Organization are provided here courtesy of World Health Organization

RESOURCES