Early detection of cancer. A new branch of oncology?

Cancer mortality has started to decrease in the Western World. The rôle played by early detection in this decrease is a matter for debate. To assess the impact on mortality it is important to distinguish between diagnosis of cancer in symptomatic patients, and early detection in asymptomatic individuals who may self-refer or who may be offered ad hoc or systematic screening. The policies for early detection and screening vary greatly between European countries, despite many similarities in their cancer burden, and this partly reflects the uncertainties surrounding asymptomatic testing for cancer. For some cancers such as those of the breast, mass screening programmes actively promoted by health authorities at a local or national level vary in their impact on cancer mortality reduction. The European School of Oncology has set up a special Task Force to address these issues, in particular the growing demand for early detection, and the first report is presented here. The task force brought together representatives from several European countries. The group recognised that combinations of early detection and screening will enforce the effectiveness of new treatments in curbing mortality curves, although policies will vary with different cancers. With the growing demand for early detection, there is a great need for cultural and scientific efforts towards structuring early detection as a specific competence (if not discipline) and linking it to preventive medicine. To cope with rising demand, one solution would be to promote early detection of cancer (EDC) preferably by specific outpatients clinics and not by hospitals, since the hospital is already related, in a psychological sense, to the concept of illness. Health professionals working in EDC should also receive specific training since the challenge facing them is not that of deciding whether a given lesion is, or is not, cancer, but rather whether or not an apparently healthy individual has cancer. The clinical approach to the healthy person who wishes to know their probability of already having cancer or the possibility of cancer developing in the future is very different from the traditional treatment-oriented attitude of oncologists. It is an approach which calls for different clinical and psychological skills.