A workshop of the Project on Evaluation of Screening Programmes of the International Union against Cancer (UICC) was held in Lyon, France, on November 20-22, 1984. The focus of the workshop was on screening for gynaecological cancer, especially for cancer of the cervix uteri. This report summarizes the presentations, conclusions and recommendations from this workshop.

This is the 5th report of the UICC Project on the Evaluation of Screening for Cancer. Previous reports were based on our evaluation of screening for individual sites or groups of sites. The present report is based on a workshop at which most of the sites were re-evaluated in the light of new information that had become available since we previously considered the sites (4 years for breast cancer to 7 years for cancer of the cervix) together with an evaluation of 4 sites not previously considered (melanoma, neuroblastoma, nasopharyngeal carcinoma and prostate cancer). We elected not to re-evaluate screening for lung, bladder and oral cancer (considered in 1984) and endometrial cancer (considered in 1985) as we were not aware of any new data that would have led us to reconsider our previous conclusion, that screening should not be considered as public health policy for these sites.The present report comprises a summary of the communications presented at the workshop, together with our conclusions on the state of the art of screening for the cancers considered. At the end of the report we summarize some advances in the methodology of the evaluation of screening. A full report on the workshop will be published elsewhere. In drawing our conclusions, we have incorporated the evidence previously available Day et al., 1986;Hakama et al., 1985;Prorok et al., 1984) as well as that presented at the workshop.We emphasize that screening, as considered in our reports, is the detection of unrecognized disease by the application of tests in the general population, or an important subsegment of that population. We have not evaluated medical surveillance or public education campaigns, except to the extent that they have an impact on screening. Our recommendations are, in general, related to the application of screening as public health policy, and the research that we feel should be conducted before such policies on screening are implemented. Further, we are largely concerned with organized programmes of screening, as described in our report on cervical cancer screening (Hakama et al., 1985). Breast cancer screeningRecent results from breast screening trials in Sweden, the UK and Canada were considered. Updated mortality data to December 1989 in the Swedish 2-county (WE) trial show that the relative risk (RR) of dying from breast cancer in the study group allocated to screening has remained around 0.7 since the first publication in 1985. The effects in each 10-year age-group are relatively unchanged, with no reduction in mortality in those aged 4 W 9 on entry. For women aged 50-69 on entry, the reduction in breast cancer mortality is approximately 40%. Death rates due to other causes among women with breast cancer were close in h e 2 study arms.Updated mortality data in the Malmo study show an increasing reduction in breast cancer mortality in the study arm in women aged 55-64 on entry, now approximately 20%. No reduction in breast cancer mortality is seen for women aged 45-54. Poor survival of patients with interval cancers in th...

A prospective epidemiological study was carried out in the West Nile District of Uganda from 1972 to 1979 in order to investigate the aetiological role of the Epstein-Barr virus (EBV) in Burkitt's lymphoma (BL). By 1976, fourteen BL cases had been detected among the 42,000 children originally bled in the study area. Testing of sera from BL candidates and neighbourhood controls showed that children who develop BL later have EBV/VCA titres several dilutions higher than their age- and sex-matched neighbours. This appearance of a strong EBV activity long before BL development was taken as evidence of a causal role of EBV in BL. In order to add to the unique material of pre-bled BL cases, BL detection was continued up to March 1979 when field work became impossible in Uganda. Two additional pre-bled BL cases were found during this extension of the study. The serological and virological evaluation of these additional cases showed that the EBV/VCA titres, but not the EA and EBNA titres, were about two dilutions higher in the BL candidates than in the controls. Hybridization assays showed that both lymphomas contained EBV/DNA in the tumour cells. These additional results thus confirm the findings in the first 14 cases and strengthen the epidemiological evidence for a causal role of the EBV in endemic BL.

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Epidemiological data relating to all 202 patients diagnosed with Burkitt's Lymphoma (BL) in the West Nile District of Uganda in the period 1961 to 1975 have been reviewed and analysed. Statistically significant evidence of space-time clustering of cases, first reported for the period 1961-65, was also present during 1972-73, but not during other periods. The patients involved in such clusters were found to be older than other patients (P less than 0.001). The average annual incidence of BL in the District was 2.45 x 10(-5) and overall there was no change in the incidence during the study period. However, there were statistically significant changes in incidence in different counties, which could not be explained as case-ascertainment artifacts. One sib pair of patients with BL was found and the series also included 7 instances of BL in two cousins. It is suggested that study of variation in the intensity and type of malarial infestation in different areas at different times may help explain the epidemiological findings and suggest what, if any, aspects of this infection are critical for inducing BL.