Report on a workshop of the UICC project on evaluation of screening for cancer

Abstract

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...

Risk variables affecting high-grade pap smears at second visit: Effects of screening interval, year, age and low-grade smears

“…13,19 Findings in Finland have been interpreted to the effect that a 5-year screening interval gives comparable protection to a 3-year interval, 14,20 and the Committee on Screening of the International Union Against Cancer (UICC) recommended a screening interval of 3 to 5 years. 21 In the present study, the calculated risk of high-grade smears was 60% higher when the screening interval was 5 rather than 2 years. This together with increasing incidence of both invasive and preinvasive disease in Finland during the last decade could indicate that the UICC recommendations are in need of re-evaluation.…”

Repeated Screening for Carcinoma of the Prostate by Digital Rectal Examination in a Randomly Selected Population

“…Only 7% of the men invited to partake in the second round did not attend due to scepticism of the programme or health care in general. The 'willingness-to-pay' approach is based on the assumption that the aim of cost-benefit analysis is to maximize the individuals preference rather than the decisions-maker's which usual cost-effectiveness analyses tend to d o (15)(16)(17). The result of our 'willingness-to-pay' study indicates that most men perceived the examination as worthwhile.…”

Screening for gastric cancer in Japan

“…Therefore, the photofluorographic screening of an asymptomatic population would not be likely to be adopted widely in other parts of the world. The International Union Against Cancer (UICC) currently takes the position that, although the screening should continue in those regions with high gastric cancer incidence where they are already underway (i.e., Japan and a few countries in Latin America), it cannot be recommended in other countries as a public health policy [55].…”