Population Screening for Cancer

Question 1

What is the definition of screening?

Answer 1

The examination of a group of usually asymptomatic individuals to detect those with a high probability of having or developing a given disease, typically by means of an inexpensive diagnostic test.

Question 2

What are the Wilson and Jungner criteria for an effective screening programme?

Answer 2

• Disease
  
  • ​Should be an important public health problem.
  • The natural history of the disease should be understood.
  • There should be a latent or early symptomatic stage.
• Test
  
  • ​There should be a suitable test for the population.
  • The test should be acceptable to the population.
• Treatment
  
  • ​There should be an accepted treatment for patients with recognised disease.
  • Facilities for diagnosis and treatment should be available.
• Process
  
  • ​The cost of case finding should be economically balanced in relation to the cost of medical care as a whole.
  • Case-finding should be a continuous process and not a once for all’.

Question 3

What is the role of population screening?

Answer 3

Prevention of premature morbidity and mortality.

Question 4

What are the 3 UK cancer screening programmes?

Answer 4

• Cervical cancer
• Breast cancer
• Colorectal cancer

Question 5

What are some of the problems with population screening for cancer?

Answer 5

• Screening is an ecological fallacy - by definition, personalised medicine is designed for the individual. Screening is designed for the population.
• Screening does not suit everyone. And, usually the people who it does not suit are those who are less likely to be able to come forward and access care.
• It can be harmful because:
  
  • It is a system without negative feedback.
  • It can cause anxiety.
  • Ethics?
  • Informed consent?
  • Error in measurement
• Inequelities (picture attached)