Cancer prevention and screening -
Bretthauer and Kalager 1 have coined the phrase cancer prevention screening to refer to cancer screening practices that aim to detect precancer, and the phrase early detection cancer screening to refer to cancer screening practices that aim to detect invasive cancer. Much of the theory and methodology regarding the assessment of cancer screening data arose during a time when the goal of cancer screening was to reduce cancer mortality by detection of invasive cancer at early stages.
The reason for that goal was that technology was not advanced enough to detect precancer. It is fair to ask whether that theory and methodology still apply in our current era, one in which both invasive cancer and precancer disease are detected through cancer screening. It does, with one exception: the interpretation of changes in cancer incidence.
The remainder of the principles laid out in the first seven chapters also are applicable to cancer prevention screening. This chapter presents material of relevance to cancer prevention screening for each of the first seven chapters of this primer.
Most researchers use those terms as well as the term pre-invasive interchangeably. I prefer precancer because I find it to be broader in meaning than pre-malignant or pre-invasive.
I use precancer to mean any change that is thought to be on the pathway to invasive cancer, be it DNA mutations in one cell or a tumor consisting of mutated cells that is on the verge of breaking through the basement membrane.
In general, the material presented in Chapters 1 through 7 are relevant to whatever abnormality cancer screening aims to find. Cancer prevention screening will be of value if some precancer detected through cancer screening would have become invasive and ultimately fatal cancer in the absence of cancer screening.
Detection of precancer that does not meet that designation represents overdiagnosis. The definition of overdiagnosis can be modified slightly to be inclusive: screen-detected precancer or invasive cancer that never would have been diagnosed, either as precancer or invasive cancer, in the absence of cancer screening.
The overarching goal of both early detection cancer screening and cancer prevention screening is to reduce cause-specific mortality. We should not, however, assume that cancer prevention screening is merely early detection cancer screening at a very early stage, and that the benefits would be more extensive and harms less extensive than detection at a later stage.
Precancer, at the time of detection, is not life-threatening as it cannot metastasize. Advances in technology have led to detection of more and more precancerous abnormalities with uncertain clinical relevance, creating quandaries for clinicians and patients.
It is almost certain that overdiagnosis is more prevalent in cancer prevention screening as compared with early detection cancer screening. Even so, treatment of precancer has the potential to be less onerous than treatment of invasive cancer.
Chapter 2 presented the four phase model Figure 1. The model did not incorporate invasiveness of disease as it is immaterial to its purpose: to classify the stages of the natural history of cancer at which an abnormality, invasive or not, could be detected at an asymptomatic stage through cancer screening.
While immaterial to the purpose of the model, the invasiveness of an abnormality is not immaterial to the assessment of cancer screening. The building blocks of performance measures were presented in Chapter 3 Table 3 ; a revised version that includes precancer is presented here as Table Note that Table 16 does not discriminate between positive test results that are suspicious for precancer and invasive cancer.
It is questionable whether they should, as cancer screening is not intended to provide that degree of information about the nature of suspicious abnormalities. The building blocks of performance measures for cancer screening tests that detect precancer and invasive cancer.
View in own window. Performance measures for cancer screening tests that detect both precancer and invasive cancer can be calculated by combining the two if measuring the complete impact and performance of the cancer screening test is desired.
Cells b and d do not change in this instance. The interpretations do not change, although to be as precise as possible it should be said, for example, that sensitivity is the percent of individuals with precancer or invasive cancer who received a positive test, and that specificity is the percent of individuals with neither precancer nor invasive cancer who received a negative test.
C p is somewhat of a theoretical quantity, as it is impossible to know whether a symptom-detected invasive cancer that is classified as a false negative was, at the time of the screen, a precancer or an invasive cancer. It is unlikely for a precancer to be detected due to symptoms, but should that occur, it seems fair to count that cancer towards c p.
For the other performance measures, the calculations will depend on how the outcome that is not of interest is classified and whether it is even included. If we wish, for example, to calculate performance measures for invasive disease, we have two options: precancer diagnoses could be excluded entirely from calculations, or screens that are associated with precancer diagnoses can be counted as false positives.
Cells b and d are affected, which means that any performance measure that utilizes them will be different for the two methods. Both options return results of similar magnitude if precancer and invasive cancer are rare. The manner in which intermediate and definitive outcomes are calculated does not change.
Incidence and case survival can be calculated for precancer and invasive cancer alone or combined. A category for precancer can be added to stage distributions. Mortality calculations will not change as they do not utilize diagnoses.
Recall from Chapter 5 that cancer screening that detects only invasive cancer will lead to an increase in invasive cancer incidence. Cancer screening that detects only precancer will lead to an increase in precancer. It also will lead to a decrease in invasive cancer incidence as long as not all precancer detected through cancer screening represents overdiagnosis.
Her cancer care team jumped into action to create a personalized plan to treat her leukemia. Clinical judgment is necessary to design treatment plans for individuals.
The online screening tools are for educational use only. Benchmarks provided by the National Committee for Quality Assurance NCQA Quality Compass® and represent all lines of business. Kaiser Permanente combined region scores were provided by the Kaiser Permanente Department of Care and Service Quality.
The source for data contained in this publication is Quality Compass and is used with the permission of NCQA. Quality Compass includes certain CAHPS data. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion.
Quality Compass® and HEDIS® are registered trademarks of NCQA. CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality.
Cancer care. Contents Cancer care. Overview Prevention Diagnosis Treatment Recovery Research. Cancer prevention and screening. At Kaiser Permanente, cancer screenings are part of your primary care. And preventing cancer is a critical part of your overall care. Our doctors aim to find cancer early — when many common cancers are more treatable.
When and how to screen for cancer. Here are cancer screening guidelines for the most common types of cancers. Learn more about breast cancer screening. Learn more about cervical cancer screening. Learn more about colon cancer screening. Learn more about lung cancer screening.
Learn more about prostate cancer screening. Learn more about skin cancer screening. Connecting to care. Ask your care team nonurgent questions about your health and prescriptions. Schedule a visit with your doctor to discuss the right preventive care for you. Browse by cancer type As a Kaiser Permanente member, you have access to a full spectrum of cancer screening services.
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Natural productivity enhancer information will help you and your prrevention care preventipn decide which xcreening screenings Cancer prevention and screening need, Anthocyanins and inflammation reduction to Flavonoids and joint health screening and anc often you should be Cancer prevention and screening. Unless otherwise noted, this preventioh follows screening guidelines csreening the American Cancer Society and are intended for those persons at average risk. Click on your age group and see what screenings you need. Download screenings overview chart [58 KB]. Talk with your health care provider about any personal or family history of cancer to determine if you should begin cancer screenings at an earlier age or be tested more frequently. Having one or more family members with a history of certain cancers, including breast, colorectal, and prostate, may place you at higher risk for the development of cancer. In this video, Dr. Cancet Richardson, Dr. Robert W. Carlson, and Dr. Laura Makaroff talk about the importance of routine cancer screenings.
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