The decline in the incidence of distant stage disease holds the promise that testing for prostate-specific antigen may lead to a sustained decline in prostate cancer mortality. However, population data are complex, and it is difficult to confidently attribute relatively small changes in mortality to any one cause.

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...

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Background and study aim Inadequate colorectal cancer screening wastes limited endoscopic resources. We examined patients factors associated with inadequate flexible sigmoidoscopy (FSG) screening at baseline screening and repeat screening 3–5 years later in 10 geographically-dispersed screening centers participating in the ongoing Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial Methods A total of 64,554 participants (aged 55 – 74) completed baseline questionnaires and underwent FSG at baseline. Of these, 39,385 participants returned for repeat screening. We used logistic regression models to assess factors that are associated with inadequate FSG (defined as a study in which the depth of insertion of FSG was <50 cm or visual inspection was limited to <90% of the mucosal surface but without detection of a polyp or mass). Results Of 7,084 (11%) participants with inadequate FSG at baseline, 6,496 (91.7%) had <50 cm depth of insertion (75.3% due to patient discomfort) and 500 (7.1%) participants had adequate depth of insertion but suboptimal bowel preparation. Compared to 55–59 year age group, advancing age in 5-year increments (odds ratios (OR) from 1.08 to 1.51) and female sex (OR = 2.40; 95% confidence interval (CI): 2.27 – 2.54) were associated with inadequate FSG. Obesity (BMI >30 kg/m2) was associated with reduced odds (OR = 0.67; 95%CI: 0.62 – 0.72). Inadequate FSG screening at baseline was associated with inadequate FSG at repeat screening (OR = 6.24; 95%CI: 5.78 – 6.75). Conclusions Sedation should be considered for patients with inadequate FSG or an alternative colorectal cancer screening method should be recommended.