Screening for cancer: future potential

Cuzick, Jack

doi:10.1016/s0959-8049(99)00070-2

Cited by 37 publications

(7 citation statements)

References 50 publications

(38 reference statements)

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“…The lifetime risk of developing ovarian cancer for American women is 2% (Urban, 2003). The low incidence of ovarian cancer, the lack of specifi city of screening methods, and the invasive nature of follow-up required for defi nite diagnosis conspire to make routine screening for the general population inadvisable (Cuzick, 1999;Jacobs, 2003;Lee, 2000;Woodman, 1999). Consequently, the U.S. Preventive Services Task Force, American Cancer Society, American College of Obstetrics and Gynecology, and Canadian Task Force on Preventive Health Care agree that routine screening for ovarian cancer in the general population is not recommended (U.S. Preventive Services Task Force, 2004).…”

Section: Ovarian Cancer Screening and Riskmentioning

confidence: 99%

Ovarian Cancer Screening: A Look at the Evidence

Fields¹,

Chevlen²

2006

Clinical Journal of Oncology Nursing

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In 2005, more than 22,000 American women were diagnosed with ovarian cancer and 16,000 women died from the disease. The five-year relative survival rate for stage III and IV disease is 31%, and the five-year relative survival rate for stage I is 95%. Early diagnosis should lower the fatality rate. Unfortunately, early diagnosis is difficult because of the physically inaccessible location of the ovaries, the lack of specific symptoms in early disease, and the limited understanding of ovarian oncogenesis. Screening tests for ovarian cancer need high sensitivity and specificity to be useful because of the low prevalence of undiagnosed ovarian cancer. Because currently available screening tests do not achieve high levels of sensitivity and specificity, screening is not recommended for the general population. The theoretical advantage of screening is much higher for women at high risk (such as those with a strong family history of ovarian cancer and those with BRCA 1 or BRCA 2 mutations). However, even for women at high risk, no prospective studies have shown benefits of screening. The public health challenge is that 90% of ovarian cancer occurs in women who are not in an identifiable high-risk group, and most women are diagnosed with advanced-stage disease. Currently available tests (CA-125, transvaginal ultrasound, or a combination of both) lack the sensitivity and specificity to be useful in screening the general population. Ongoing clinical trials are assessing whether new tumor markers, including those generated by proteomic and genomic studies, will prove useful.

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Section: Ovarian Cancer Screening and Riskmentioning

confidence: 99%

Ovarian Cancer Screening: A Look at the Evidence

Fields¹,

Chevlen²

2006

Clinical Journal of Oncology Nursing

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“…Despite periodic modifications of specific recommendations, these screening tests continue to include the following: mammography for breast cancer; prostate-specific antigen for prostate cancer; the Papanicolaou test and testing for high-risk types of human papillomavirus for cervical cancer, and fecal occult blood test, flexible sigmoidoscopy and colonoscopy for colorectal cancer screening (1,2). In spite of their efficacy, uptake of these screening tests is not optimal, and further outreach and dissemination efforts are needed to inform the community about screening test availability and recommended intervals, to reduce health service access barriers to obtaining screening, and to encourage positive decisions to seek screening (2).…”

mentioning

confidence: 99%

Intraclass Correlation Estimates for Cancer Screening Outcomes: Estimates and Applications in the Design of Group-Randomized Cancer Screening Studies

et al. 2010

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Background Screening has become one of our best tools for early detection and prevention of cancer. The group-randomized trial is the most rigorous experimental design for evaluating multilevel interventions. However, identifying the proper sample size for a group-randomized trial requires reliable estimates of intraclass correlation (ICC) for screening outcomes, which are not available to researchers. We present crude and adjusted ICC estimates for cancer screening outcomes for various levels of aggregation (physician, clinic, and county) and provide an example of how these ICC estimates may be used in the design of a future trial. Methods Investigators working in the area of cancer screening were contacted and asked to provide crude and adjusted ICC estimates using the analysis of variance method estimator. Results Of the 29 investigators identified, estimates were obtained from 10 investigators who had relevant data. ICC estimates were calculated from 13 different studies, with more than half of the studies collecting information on colorectal screening. In the majority of cases, ICC estimates could be adjusted for age, education, and other demographic characteristics, leading to a reduction in the ICC. ICC estimates varied considerably by cancer site and level of aggregation of the groups. Conclusions Previously, only two articles had published ICCs for cancer screening outcomes. We have complied more than 130 crude and adjusted ICC estimates covering breast, cervical, colon, and prostate screening and have detailed them by level of aggregation, screening measure, and study characteristics. We have also demonstrated their use in planning a future trial and the need for the evaluation of the proposed interval estimator for binary outcomes under conditions typically seen in GRTs.

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“…Several large RCTs of FOB screening for colorectal cancer in the USA and Europe have been on-going for over 20 years [36]. Comprehensive national programs have yet to be implemented in Europe and even informal screening in the USA has only achieved modest rates of uptake in comparison with other forms of cancer screening [3].…”

Section: Looking Forwardmentioning

confidence: 99%

“…Second, the substantial investment in cervical screening made in many countries will not be abandoned, although it is probable that, from the pathology point of view, increasing use will be made of new interpretation methods (liquid-based cytology) and HPV testing [36]. An HPV vaccine is unlikely to be licensed within the next 5 years and many more years will have to pass before incidence falls to such a low level that regular Pap tests can no longer be justified.…”

Section: Key Issuesmentioning

confidence: 99%

Economics of cancer screening programs

Whynes

2004

Expert Review of Pharmacoeconomics & Outcomes Research

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Cancer is a common cause of mortality in the industrialized world. Several forms of the disease are preventable by screening and mass population screening programs have been implemented in many countries. Given the current concern over value for money in healthcare, cancer screening has increasingly attracted the attention of economists. In this review, it is argued that obtaining evidence to demonstrate cost-effectiveness with respect to a novel screening hypothesis is expensive, difficult and time-consuming, with the result that, in the past, screening programs have been implemented on the basis of inadequate evaluation evidence. Over-enthusiastic implementation has led to the institutionalization of inefficient programs, although the tendency to implement too rapidly can be explained by a simple economic model of incentives. Unfortunately, once programs have become established, the economic justification for screening becomes even more difficult to prove.

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Screening for cancer: future potential

Cited by 37 publications

References 50 publications

Ovarian Cancer Screening: A Look at the Evidence

Ovarian Cancer Screening: A Look at the Evidence

Intraclass Correlation Estimates for Cancer Screening Outcomes: Estimates and Applications in the Design of Group-Randomized Cancer Screening Studies

Economics of cancer screening programs

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