A perspective from countries using organized screening programs

Abstract

Cancer screening may be offered to a population opportunistically, as part of an organized program, or as some combination of the preceding two options. Organized screening is distinguished from opportunistic screening primarily on the basis of how invitations to screening are extended. In organized screening, invitations are issued from centralized population registers. In opportunistic screening, however, due to the lack of central registers, invitations to screening depend on the individual's decision or on encounters with health care providers. The current article outlines key differences between organized and opportunistic screening. In the current study, literature searches were performed using PubMed and MEDLINE. Additional data were assembled from interviews with health officials in the five countries investigated and from the authors' personal files. Opportunistic screening was found to be distinguishable from organized screening on the basis of whether screening invitations were issued from centralized population registers. Organized screening programs also assumed centralized responsibility for other key elements of screening, such as eligibility requirements, quality assurance, follow-up, and evaluation. Organized programs focused on reducing mortality and morbidity at the level of the population rather than at the level of the individual. Thus, programs did not necessarily offer the most sensitive screening test for a particular cancer, and tests sometimes were offered at suboptimal intervals with respect to individual-level protection. Nonetheless, organized systems paid greater attention to the quality of screening, as measured by factors such as cancer detection rates, tumor characteristics, and false-positive biopsy rates. As a result, participants in organized screening programs received greater protection from the harmful effects associated with screening. In addition, organized programs worked more systematically toward providing value for money in an inevitably resource-limited environment. Although organized and opportunistic models of screening can yield similar uptake rates, organized programs exhibited greater potential ability to reduce cancer incidence and mortality, because of the higher levels of population coverage and centralized commitment to quality and monitoring; were more likely to be cost-effective; and offered greater protection against the harmful effects associated with poor quality or overly frequent screening.

Opportunistic Screening for Cervical Cancer in a Tertiary Hospital in Bihar

“…[15] The mean age in the present study was 37.5 years which was comparable to the study of Chang et al [16] in which the mean age was 37 years. The mean age was slightly higher in other studies.…”

Explaining variations in breast cancer screening across European countries

“…Compared to the alternative of opportunistic screening, 9 organized screening puts a much greater emphasis on the quality of the screening process as measured by factors such as, tumour characteristics, cancer detection rates and false-positive biopsy rates (Miles et al, 2004). Thus, it provides better protection against the harms of screening-including overscreening, poor quality, and complications of screening-and poor follow-up of those who test positively (Levin et al, 2012, Miles et al, 2004.)…”

“…Thus, it provides better protection against the harms of screening-including overscreening, poor quality, and complications of screening-and poor follow-up of those who test positively (Levin et al, 2012, Miles et al, 2004.) Accordingly, Strumpf, Chai and Kadiyala (2010) found that the implementation of an organized mammography screening program in Quebec strongly increased adherence to cancer screening guidelines and screening uptake.…”

Rastreamento mamográfico do câncer de mama no Sul do Brasil e fatores associados: estudo de base populacional

“…Este recomenda que rastreamento do câncer de mama por mamografia seja realizado em mulheres entre 50 e 69 anos, com no máxi-mo dois anos de intervalo 9,10 . Entretanto, o rastreamento é de forma oportunística 11 , no qual a solicitação do exame dependerá do interesse da mulher em procurar o serviço de saúde 12,13 . Além disto, não há evidência de que o programa de controle do câncer de mama seja efetivo 11 , pois não ocorre acompanhamento dos casos suspeitos, premissas nos rastreamentos organizados 12,13 .…”