Evaluation of screening programmes: Stud ies on breast cancer and prostate cancer

In the past century treatment and primary prevention of disease has focussed on decreasing mortality rates (Wolleswinkel-van den Bosch, 1998). The current challenge is directed towards secondary prevention. Screening for disease is becoming increasingly part of medical practice in the Western world. Screening for cervical cancer with PAP smears and for lung cancer with chest X-rays were the first examples of cancer screening that were expected to reduce mortality (Boucot, 1948; Papanicoulou and Traut, 1941; Victor, 1955). Although many in the medical profession had great expectations there were also opponents, at least for lung cancer screening (Boucot and Sokoloff, 1955). The natural course and the screening tools (chest X-rays) available for the detection of lung cancer seemed not to be able to detect the cancer in a phase where treatment resulted in substantially improved prognosis. The resuits of clinical trials, published approximately 30 years later, showed no overall decrease in lung cancer mortality and screening for lung cancer never became established as a public health service (Early Lung Cancer Cooperative Study, 1984). For cervical cancer however, the characteristics of screen test in combination with the natural history of the disease (I.e. the long duration of the screen detectable period), is estimated to reduce mortality by 75% (100% attendance of screening) (van Ballegooijen, 1998). Evidence about the effectiveness of cervical cancer screening is provided by historical studies, case-control studies, analysis of data from large screening programmes and analysis of the natural history of cervical cancer using mathematical models.

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