Screening and Cancer Control

This chapter focuses on the use of screening for cancer. Cancer is a leading cause of death worldwide, and in 2007 accounted for 7.9 million deaths (around 13% of all deaths), a figure that is predicted to rise to 12 million by 2030 (WHO, 2009). Screening represents a major part of the cancer control effort, particularly in developed countries. The Papanicolaou (Pap) test for the detection of pre-cancerous cervical lesions is the most widely used cancer screening test. It was developed in 1928 and is now available to women across the globe; albeit with different technologies and test frequencies. Some cervical cancer screening programs now also incorporate DNA testing for human papillomavirus (HPV), the viral precursor to cervical cancer. Mammography screening was developed in the 1950s for early diagnosis of breast cancer and involves taking a low-energy X-ray of the breast which is then examined for signs of calcification or soft tissue masses. More recently, colorectal cancer (CRC or bowel cancer) screening in the form of colonoscopy, sigmoidoscopy, or fecal occult blood (FOB) testing has been widely implemented. Screening for cervical, breast, and colorectal cancer is widely recommended for developed countries (e.g., by the US Preventive Services Task Force and the European Council). In addition, prostate-specific antigen (PSA) testing is used to detect prostate cancer in some

A. Steptoe (ed.), Handbook of Behavioral Medicine, DOI 10.1007/978-0-387-09488-5_26, © Springer Science+Business Media, LLC 2010

settings, although evidence for its efficacy is less clear. Throughout this chapter, examples from screening for these four common cancers will be used.

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