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Cancer screening with germline genetic sequencing and liquid biopsy could facilitate early cancer detection. But testing if these technologies reduce the burden of cancer mortality will require rethinking how clinical trials are run.

Breast cancer is the primary cause of cancer mortality, worldwide, and in Indonesian women. Late stage cancer is an important predictor of cancer mortality. Breast self-examination (BSE) is recommended as a way to potentially allow for early detection of any breast anomalies. A previous study found that only 39.5% of nurses reported practicing BSE on a regular monthly basis. Cancer-related stigma among non-cancer patients is an important predictor of cancer screening. This study aimed to identify the relationship between cancer stigma and BSE among nurses. The study applied a cross-sectional analytic design. A total of 88 nurses were selected via random sampling. The Chi-square test was used to analyze the data. The results showed that there is a significant association between cancer stigma and BSE among nurses (p

Background Cardiovascular disease (CVD) followed by cancer are the two leading causes of death worldwide. SCORE charts have been recommended in Europe to identify individuals at increased CVD risk. However, the SCORE ability to identify individuals at increased risk of cancer has not yet been evaluated. The aim of this study was to determine the SCORE chart calibration in a country with changing CVD epidemiology, and its discrimination ability to identify individuals at increased risk of cancer over 20-years. Methods The present analysis includes data from two cross-sectional independent surveys within the Czech post-MONICA study (randomly selected representative population samples of the Czech Republic, aged 25–64 years); 3209 individuals in 1997/98 and 3612 in 2006–2009. Results The SCORE had reasonable discrimination to predict 10-year CVD mortality, but significantly overestimated the risk across all risk categories. During the 20-year follow up, high and very high-risk categories were associated with an increased risk of cancer morbidity (in particular colorectal, other gastrointestinal, lung and malignant skin) and cancer mortality, as compared to low risk category. Conclusions The present study shows that periodical calibration testing of SCORE charts is needed in countries with changing CVD epidemiology. Furthermore, we show that in middle-aged individuals, identified by SCORE charts as being at high or very high risk for CVD, cancer morbidity and cancer mortality is increased. Rigorous cancer screening may be appropriate in this group, especially in countries with falling CVD mortality, where relative proportion of cancer mortality is increasing.

OBJECTIVE: Cancer mortality inequity among persons of African Ancestry is remarkable. Yet, Black inclusion in cancer biology research is sorely lacking and warrants urgent attention. Epidemiologic research linking African Ancestry and the African Diaspora to disease susceptibility and outcomes is critical for understanding the significant and troubling health disparities among Blacks. Therefore, in a cohort of diverse Blacks, this study examined differences in genetic ancestry informative markers (AIMs) in the DNA repair pathway and the cancer related biomarker 4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL). METHODS: Participants completed a questionnaire and provided bio-specimens. AIMs in or around DNA repair pathway genes were analyzed to assess differences in minor allele frequency (MAF) across the 3 ethnic subgroups. NNAL concentration in urine was measured among current smokers. RESULTS: To date the cohort includes 852 participants, 88.3% being Black. Of the 752 Blacks, 51.3% were US-born, 27.8% were Caribbean-born, and 19.6% were Africa-born. Current and former smokers represented 14.9% and 10.0%, respectively. US-born Blacks were more likely to be smokers and poor metabolizers of NNAL. Two-way hierarchical clustering revealed MAF of AIMs differed across the 3 ethnic subgroups. CONCLUSION: Our findings are consistent with the emerging literature demonstrating Black heterogeneity underscoring African Ancestry genetic subgroup differences— specifically relevant to cancer. Further investigations, with data harmonization and sharing, are urgently needed to begin to map African Ancestry cancer biomarkers as well as race, and race by place\region comparative biomarkers to inform cancer prevention and treatment in the era of precision medicine.

Early detection is essential to reduce cancer mortality. Oral cancer could be subject to screening programs (similar as for cervical cancer) by collecting Pap smear samples at any dentist visit. However, manual analysis of the resulting massive amount of data is prohibitively costly. Convolutional neural networks (CNNs) have shown promising results in discriminating between cancerous and non-cancerous cells, which enables efficient automated processing of cancer screening data. We investigate different CNN architectures which explicitly aim to utilize texture information, for cytological cancer classification, motivated by studies showing that chromatin texture is among the most important discriminative features for that purpose. Results show that CNN classifiers inspired by Local Binary Patterns (LBPs) achieve better performance than general purpose CNNs. This holds also when different levels of general data augmentation, as well as pretraining, are considered.

Background The aim was to evaluate whether this gastric cancer-screening programme was effective in reducing oesophageal cancer mortality. Methods A population-based retrospective cohort study was conducted using the Korean National Cancer Screening Programme (NCSP) database. The study cohort comprised 16,969 oesophageal cancer patients who had been diagnosed in 2007–2014. We analysed the association between the history of NSCP for gastric cancer and oesophageal cancer mortality. Results Compared with never-screened subjects, ever-screened subjects had an overall HR for oesophageal cancer mortality of 0.647 (95% CI, 0.617–0.679). According to the time interval since screening, the HRs of death were 0.731 (95% CI, 0.667–0.801) for 6–11 months, 0.635 (95% CI, 0.594–0.679) for 12–23 months, 0.564 (95% CI, 0.522–0.610) for 24–35 months and 0.742 (95% CI, 0.679–0.810) for ≥36 months. According to the last screening modality, the HRs of death were 0.497 (95% CI, 0.464–0.531) for upper endoscopy, and 0.792 (95% CI, 0.749–0.838) for UGIS. Upper endoscopy reduced the mortality consistently in all age groups over 50 years, whereas UGIS could not. Conclusion The NCSP for gastric cancer was effective in reducing the mortality of oesophageal cancer, and upper endoscopy was superior to UGIS.

Among Peruvian women, cervical cancer is the leading cause of death from cancer in women of reproductive age and has the second highest incidence of all cancers (behind breast cancer). The coastal capital, Lima, is home to the country's National Institute of Cancer (INEN) and has substantially lower rates of cervical cancer than elsewhere in the country, partially due to higher socioeconomic status and better access to screening and specialised care, such as chemotherapy and radiotherapy. This disparity has important implications in Peru, where uptake of early screening via the Papanicolaou (Pap) test is low, particularly for women who live in rural areas, have a low socioeconomic status, and speak indigenous languages...

45 Background: Despite the increase of our knowledge about carcinogenesis and recent successful development of innovative cancer drugs, cancer mortality has only slightly decreased in the past decades. Cancer early detection is probably the most cost-effective means to reduce cancer mortality as prognosis is much better when cancer is detected and treated at the early stage. Recently studies have demonstrated that blood-based mutation detection approaches may be effective to identify asymptomatic cancer patients from general population. Methods: Here we reported a novel multivariate cancer risk score (MCRS) model that interrogates shallow whole genome sequencing (WGS) data from cell-free DNA (cfDNA) and protein markers results in a single blood draw. Results: In a prospective clinical study consisting of 76 stage I-IV cancer patients and 152 normal individuals, the MCRS model demonstrated 60% sensitivity at 98.5% specificity. In order to validate clinical utility of the MCRS model in detection of cancer patients, we collated the data from a previous study of occult maternal malignancies from 1.93 million pregnant women undergoing NIPT test between 2016 and 2017. 466 out of the 639 pregnant women who tested positive for multiple chromosomal aneuploidies (MCAs) in the initial NIPTs (i.e. 0.06 - 0.1x WGS), have also underwent the protein markers test. Out of the 466 subjects, 39 maternal malignant cancer cases were diagnosed with a median follow-up of 399 days (IR, 303 - 487 days) by imaging and histology. The cancer patients presented a wide spectrum of cancer types, the most frequent being breast cancer (10 cases), liver cancer (8) and lymphoma (8), at stage II to IV. This subgroup of 466 subjects was selected as an independent validation cohort for our study. Through our new method, we analyzed shallow WGS and proteins data. The MCRS model allowed 28 of the 39 (71.8%) cancer cases to be identified with a positive predictive value of 73.7% and specificity of 97.7%. Conclusions: Taken together, these data demonstrate the MCRS model holds promise for detecting cancer in asymptomatic individuals, particularly in the populations at high risk of cancer.

Millions of homeless Americans have lower cancer screening and higher cancer mortality rates. We explored perspectives and perceptions regarding cancer and cancer screening among homeless.Using random and criteria sampling, we conducted in-depth semi-structured interviews with 50 homeless adults from New York City's (NYC) shelters and shelter-based clinics.Mean age was 51.66 years with average 2.03 years of homelessness; 33/50 were older than 50. Only a small number of participants had their recommended cancer screening. Contrary to general assumptions and despite significant barriers, the homeless were concerned about cancer, believed their risk of cancer is higher compared to the general population, and generally considered screening a high priority during homelessness. While they acknowledged several individual- and systems-level barriers, they welcomed targeted measures to address their multi-level barriers. Suggested strategies included active counseling by providers, health education or reminders via mHealth strategies or face-to-face in shelters, addressing potential providers' prejudice and biases regarding their priorities, incentives, and patient navigators or coach to help navigating the complex cancer screening process.There are gaps in effective cancer screening despite adequate attitude and perceptions among homeless. The health system needs to shift from addressing only basic care to a more equitable approach with accessible and acceptable opportunities for preventive cancer care for the homeless.

Contains fulltext : 177890.pdf (Publisher’s version ) (Open Access) EUSOBI and 30 national breast radiology bodies support mammography for population-based screening, demonstrated to reduce breast cancer (BC) mortality and treatment impact. According to the International Agency for Research on Cancer, the reduction in mortality is 40 % for women aged 50-69 years taking up the invitation while the probability of false-positive needle biopsy is

Each year, about 7-8 million deaths occur due to cancer around the world. More than half of the cancer-related deaths occur in the less-developed parts of the world. Cancer mortality rate can be reduced with early detection and subsequent treatment of the disease. In this paper, we introduce a microfluidic microscopy-based cost-effective and label-free approach for identification of cancerous cells. We outline a diagnostic framework for the same and detail an instrumentation layout. We have employed classical computer vision techniques such as 2D principal component analysis-based cell type representation followed by support vector machine-based classification. Analogous to criminal face recognition systems implemented with help of surveillance cameras, a signature-based approach for cancerous cell identification using microfluidic microscopy surveillance is demonstrated. Such a platform would facilitate affordable mass screening camps in the developing countries and therefore help decrease cancer mortality rate.

Federally qualified health centers (FQHCs) offer primary and preventive healthcare, including cancer screening, for the nation’s most vulnerable population. The purpose of this study was to explore the relationship between access to FQHCs and cancer mortality-to-incidence ratios (MIRs). One-way analysis of variance was conducted to compare the mean MIRs for breast, cervical, prostate, and colorectal cancers for each U.S. county for 2006–2010 by access to FQHCs (direct access, in-county FQHC; indirect access, adjacent-county FQHC; no access, no FQHC either in the county or in adjacent counties). ArcMap 10.1 software was used to map cancer MIRs and FQHC access levels. The mean MIRs for breast, cervical, and prostate cancer differed significantly across FQHC access levels (p < 0.05). In urban and healthcare professional shortage areas, mean MIRs decreased as FQHC access increased. A trend of lower breast and prostate cancer MIRs in direct access to FQHCs was found for all racial groups, but this trend was significant for whites only. States with a large proportion of rural and medically underserved areas had high mean MIRs, with correspondingly more direct FQHC access. Expanding FQHCs to more underserved areas and concentrations of disparity populations may have an important role in reducing cancer morbidity and mortality, as well as racial-ethnic disparities, in the United States.

Progress toward early diagnosis of cancer would have important clinical benefits in reducing cancer mortality; thus, there is an urgent need to improve cancer screening by providing in vivo real-time high-resolution diagnosis through optical imaging modalities. Microelectromechanical systems (MEMS) based optical endoscopes have been playing a key role in miniaturization of fiber-optical endoscopy for cancer diagnosis for over 30 years. In this paper, both review and technology outlook of MEMS based fiber-optical microendoscopy for real-time in vivo disease diagnosis will be provided.

In their systematic review, Islami et al [1] performed an extensive search of the literature on the association between smoking and prostate cancer incidence and death [1]. We compliment the authors on their thorough work. Without doubt, smoking is associated with moderately increased mortality. The authors have analysed and discussed this in detail. Less detailed attention was given to the finding that the incidence of prostate cancer in smokers was higher in the era before prostate-specific antigen (PSA), and lower in the post-PSA era. The only explanation suggested by the authors is that smoking may reduce the risk of indolent nonaggressive cancers that have predominated in more recent years, while promoting more aggressive cancers. We believe that another, more important, factor may account for these differences. It could well be that this contrast between the preand post-PSA eras illustrates an important difference associated with lifestyle and the availability of health care services. In the pre-PSA era, themajority of prostate cancers found were clinically relevant, and the majority of prostate cancer patients would have had a disease burden. Smoking may have altered the clinical progression of prostate cancer, resulting in a higher number of clinical diagnoses. By contrast, in the post-PSA era, the vast majority of prostate cancers are diagnosed in men who have been screened. Health literacy and the availability of screening options may be worse for those living an unhealthier lifestyle, such as smokingmen. Rolison et al [2] showed that smoking men were indeed less likely to undergo prostate cancer screening compared to former smokers and nonsmokers [2]. All the current guidelines on prostate cancer diagnosis advocate shared decision-making before a PSA test is performed.We agreewith this need, but we also realise that such shared decision-making may be easier with wellinformed men who generally having a healthier lifestyle. We should be aware that smoking men—who apparently have a worse outcome after initial diagnosis—may have poorer access to health services. Thus, those who might benefit the most are less likely to ask for physician opinions, for example in early diagnosis of prostate cancer.We believe that this deserves our attention, as we are physicians for all of our patients, not just wellinformed healthy patients, in our practices.

Randomized controlled trials that seek to measure the ability of a screening test to lower cancer mortality generally do not provide data that bear on the relative efficacy of different screening intervals. Guidance regarding the choice of a screening interval that achieves a high level of case-finding, without being excessively costly, can be obtained from one or more of several study designs that examine the subsequent occurrence of cancer in persons who have had a negative screening test. However, each of these can potentially provide a misleading result, and so their limitations must be considered before using the data they generate to develop a rational rescreening policy.

Globally, gastric cancer is the third-leading cause of cancer-related death in men and the fifth-leading in women (1), and is especially prevalent in Eastern Asia, including Korea (2). To lower gastric cancer mortality, a national gastric cancer screening program including esophagogastroduodenoscopy (EGD) has been introduced in Korea since 1999 (3). Korean people aged 40 years or older are invited to participate in the National Gastric Cancer Screening Program biennially. The Korean National Cancer Screening Program has been expanding steadily. The participation rate of gastric cancer screening has increased from 7.4% in 2002 to 45.4% in 2011 (4).

The Australian mammography screening program was introduced as a joint Commonwealth and state/territory initiative in 1991. Australian evaluation studies suggest a breast cancer mortality reduction from mammography screening in Australia that is generally higher than estimated from the original field trials (reported by an International Association of Research on Cancer expert group to be about 35% for screening participants aged 50-69 years, and following a meta-analysis of data for all ages, to be about 25%). More research is needed to broaden the evidence on over-detection. Intervention research is also needed to determine the comparative effectiveness and cost-effectiveness of digital breast tomosynthesis in the Australian screening environment.

Resumen Introduccion y objetivos Universalmente se evidencia un aumento en la incidencia de cancer prostatico, consecuencia de una mayor expectativa de vida y del uso del tamizaje con el antigeno prostatico especifico. La mortalidad secundaria es variable y constituye un problema de salud publica. El presente estudio busca describir la evolucion de la mortalidad por cancer de prostata en Colombia en el ambito nacional y regional. Materiales y metodos Se desarrollo un estudio ecologico mixto, teniendo como grupos de estudio: el pais, sus regiones y departamentos, con una serie temporal de 1997 a 2012 para el pais, y de 2008 a 2012 para las regiones y departamentos; se incluyeron todas las defunciones relacionadas con el codigo CIE-10 C61 de la base de estadisticas del Departamento Administrativo Nacional de Estadisticas. Resultados Se encontro una tasa de mortalidad nacional entre el 8,9 y el 10,9 por cada 100.000 habitantes hombres en la serie temporal. En las regiones pacifica y andina, se encuentran las mayores tasas de mortalidad. Los departamentos del Cesar y Valle concentran las mayores tasas de mortalidad. La tasa estandarizada de mortalidad nacional es similar a otros paises de caracteristicas socioeconomicas semejantes. Conclusiones La tasa de mortalidad por cancer de prostata en Colombia ha disminuido en los ultimos 4 anos. Se deben optimizar las estrategias de atencion medica en regiones con predominio de raza negra y poblacion rural, donde las tasas son superiores al promedio. © 2013 Sociedad Colombiana de Urologia. Publicado por Elsevier Espana, S.L. Todos los derechos reservados.

Recent studies show that patients with myotonic dystrophy (DM) have an increased risk of specific malignancies, but estimates of absolute cancer risk accounting for competing events are lacking. Using the Swedish Patient Registry, we identified 1,081 patients with an inpatient and/or outpatient diagnosis of DM between 1987 and 2007. Date and cause of death and date of cancer diagnosis were extracted from the Swedish Cause of Death and Cancer Registries. We calculated non-parametric estimates of absolute cancer risk and cancer mortality accounting for the high non-cancer competing mortality associated with DM. Absolute cancer risk after DM diagnosis was 1.6% (95% CI=0.4-4%), 5% (95% CI=3-9%) and 9% (95% CI=6-13%) at ages 40, 50 and 60 years, respectively. Females had a higher absolute risk of all cancers combined than males: 9% (95% CI=4-14), and 13% (95% CI=9-20) vs. 2% (95%CI= 0.7-6) and 4% (95%CI=2-8) by ages 50 and 60 years, respectively) and developed cancer at younger ages (median age =51 years, range=22-74 vs. 57, range=43-84, respectively, p=0.02). Cancer deaths accounted for 10% of all deaths, with an absolute cancer mortality risk of 2% (95%CI=1-4.5%), 4% (95%CI=2-6%), and 6% (95%CI=4-9%) by ages 50, 60, and 70 years, respectively. No gender difference in cancer-specific mortality was observed (p=0.6). In conclusion, cancer significantly contributes to morbidity and mortality in DM patients, even after accounting for high competing DM mortality from non-neoplastic causes. It is important to apply population-appropriate, validated cancer screening strategies in DM patients.

Objective: To elicit women's responses to information about the nature and extent of overdiagnosis in mammography screening (detecting disease that would not present clinically during the woman's lifetime) and explore how awareness of overdiagnosis might influence attitudes and intentions about screening. Design: Qualitative study using focus groups that included a presentation explaining overdiagnosis, incorporating different published estimates of its rate (1-10%, 30%, 50%) and information on the mortality benefit of screening, with guided group discussions Setting: Sydney, Australia Participants: Fifty women aged 40-79 years with no personal history of breast cancer and with varying levels of education and participation in screening. Results: Prior awareness of breast cancer overdiagnosis was minimal. Women generally reacted with surprise, but most came to understand the issue. Responses to overdiagnosis and the different estimates of its magnitude were diverse. The highest estimate (50%) made some women perceive a need for more careful personal decision making about screening. In contrast, the lower and intermediate estimates (1-10% and 30%) had limited impact on attitudes and intentions, with many women remaining committed to screening. For some women, the information raised concerns, not about whether to screen but whether to treat a screen detected cancer or consider alternative approaches (such as watchful waiting). Information preferences varied: many women considered it important to take overdiagnosis into account and make informed choices about whether to have screening, but many wanted to be encouraged to be screened. Conclusions: Women from a range of socioeconomic backgrounds could comprehend the issue of overdiagnosis in mammography screening, and they generally valued information about it. Effects on screening intentions may depend heavily on the rate of overdiagnosis. Overdiagnosis will be new and counterintuitive for many people and may influence screening and treatment decisions in unintended ways, underscoring the need for careful communication. Refereed/Peer-reviewed

Yes. Public health adviser David Roder and Cancer Council Australia CEO Ian Olver believe the reduction in breast cancer mortality in Australia reflects both treatment and screening effects.

BACKGROUND: The success of the "war on cancer" initiated in 1971 continues to be debated, with trends in cancer mortality variably presented as evidence of progress or failure. We examined temporal trends in death rates from all-cancer and the 19 most common cancers in the United States from 1970-2006. METHODOLOGY/PRINCIPAL FINDINGS: We analyzed trends in age-standardized death rates (per 100,000) for all cancers combined, the four most common cancers, and 15 other sites from 1970-2006 in the United States using joinpoint regression model. The age-standardized death rate for all-cancers combined in men increased from 249.3 in 1970 to 279.8 in 1990, and then decreased to 221.1 in 2006, yielding a net decline of 21% and 11% from the 1990 and 1970 rates, respectively. Similarly, the all-cancer death rate in women increased from 163.0 in 1970 to 175.3 in 1991 and then decreased to 153.7 in 2006, a net decline of 12% and 6% from the 1991 and 1970 rates, respectively. These decreases since 1990/91 translate to preventing of 561,400 cancer deaths in men and 205,700 deaths in women. The decrease in death rates from all-cancers involved all ages and racial/ethnic groups. Death rates decreased for 15 of the 19 cancer sites, including the four major cancers, with lung, colorectum and prostate cancers in men and breast and colorectum cancers in women. CONCLUSIONS/SIGNIFICANCE: Progress in reducing cancer death rates is evident whether measured against baseline rates in 1970 or in 1990. The downturn in cancer death rates since 1990 result mostly from reductions in tobacco use, increased screening allowing early detection of several cancers, and modest to large improvements in treatment for specific cancers. Continued and increased investment in cancer prevention and control, access to high quality health care, and research could accelerate this progress.

Large-scale randomised controlled trials in Europe and the United States are informing evidence-based clinical advice.

The incidence of cervical cancer in Latin America and the Caribbean (LAC) is among the highest in the world. Because there are major demographic shifts happening in LAC countries (population growth, urbanization and ageing) cervical cancer incidence and mortality will likely continue to be a significant public health problem. Overall human papillomavirus (HPV) prevalence in the LAC general population has been found to be 2-fold higher than the average worldwide prevalence. The large HPV and cancer burden may be explained by the highly prevalent HPV variants of HPV types -16 and 18, which have an increased oncogenic potential. Given the major mode of transmission of genital HPV is sexual, certain, patterns of sexual behaviour (early age at first sexual intercourse, number of sexual partners and sexual behaviour of the partner) are associated with an increased risk of HPV genital acquisition. Although HPV infection is necessary for carcinogenesis, certain co-factors (high parity, long term use of oral contraceptives, smoking and co-infection with the human immunodeficiency virus (HIV)) help in the progression from infection to cancer. Many studies that have contributed to this evidence have been carried out in LAC and are reviewed and summarised in this article. Since HPV vaccines will likely take years to implement, and many more years to show impact on disease, cervical cancer screening programmes remain as the key intervention to control disease in LAC in the years to come. © 2008 Elsevier Ltd. All rights reserved.

Background Because randomized cancer screening trials are very expensive, observational cancer screening studies can play an important role in the early phases of screening evaluation. Periodic screening evaluation (PSE) is a methodology for estimating the reduction in population cancer mortality from data on subjects who receive regularly scheduled screens. Although PSE does not require assumptions about natural history of cancer it requires other assumptions, particularly progressive detection – the assumption that once a cancer is detected by a screening test, it will always be detected by the screening test. Methods We formulate a simple version of PSE and show that it leads to an upper bound on screening efficacy if the progressive detection assumption does not hold (and any effect of birth cohort is minimal) To determine if the upper bound is reasonable, for three randomized screening trials, we compared PSE estimates based only on screened subjects with PSE estimates based on all subjects. Results In the three randomized screening trials, PSE estimates based on screened subjects gave fairly close results to PSE estimates based on all subjects. Conclusion PSE has promise for obtaining an upper bound on the reduction in population cancer mortality rates based on observational screening data. If the upper bound estimate is found to be small and any birth cohort effects are likely minimal, then a definitive randomized trial would not be warranted.

1558 Background: Regular screening for early detection can decrease cancer mortality. Our aim was to identify factors associated with recurrent screening among all people eligible to be screened fo...

6514 Background: To address disparities in cancer mortality, the factors affecting participation in screening need to be identified. For African American cancer survivors in particular, little is k...

Significant progress has been made in the treatment of cancer in the past 25 years, so that in the USA 49% of patients with disease diagnosed in 1976–1981 survived for at least five years, compared with an estimated 38% in 1960–1963 [5]. However, the number of patients that have state-of-the-art therapy available to them is still relatively small because of the great variability in the expertise and resources within our health care system. The National Cancer Institute (NCI) has set a goal of 50% reduction in cancer mortality by the year 2000, which depends on three factors; success in cancer prevention (i.e. reducing tobacco use and changing dietary habits), achieving recommended cancer screening measures, and wider application of the gains that have been made from new cancer treatment methods [6,7].

It is widely claimed and believed that cancer screening saves lives. The main sources of doubt about this belief are (1) the lack of evidence that screening changes the natural history of cancer; (2) the lack of correlation between screening activity and cancer mortality; (3) the lack of evidence from randomised controlled trials that screening ‘saves lives’. Other objections include doubts about the wisdom of population screening for cancer on the grounds of medicalisation of health, psychological harm, and the adverse harm-benefit balance.