Screening for Cancer: Considerations for Low- and Middle-Income Countries
Authors: Terrence Sullivan, Richard Sullivan , Ophira Ginsburg
A cancer screening program should consider the burden of the cancer in the population at risk, cost-effectiveness, and the success in how well the test works. Key terms defined include opportunistic screening, organized screening, population-based screening, high-risk screening, and several types of bias (lead-time bias, length bias, and overdiagnosis). Ethical and cost-effectiveness considerations determine that benefits outweigh possible harms. Three cancers discussed more fully are (1) breast cancer for which several approaches to screening are analyzed; (2) cervical cancer which may have the greatest potential for screening-detected reductions in cancer mortality; and (3) colorectal cancer which becomes more common as less developed countries adopt Western lifestyles. A diagonal approach to screening involves an umbrella of maternal or reproductive health policy to encompass both cervical and breast cancer and creates a platform onto which other preventive and wellness care can be added. Developing a screening policy for cancer examines choice of diagnostic technologies and follow-up interventions, the age groups targeted, referral and enrollment strategies, and quality assurance processes.