The pretentions and achievements of cancer screening,in particular breast cancer screening

The 'Vereniging Nederlands Tijdschrift voor Geneeskunde' (Dutch Journal of Medicine Association) recently held a conference about the doubts expressed in recent publications concerning the value of cancer screening and breast-cancer screening in particular. In this the discussion mainly focused on whether disease-specific mortality or overall mortality should be taken as an endpoint in the evaluation of the screening procedure. In a recent advisory report, the Health Council of the Netherlands stated that the present form of breast cancer screening ought to be continued in the Netherlands for the time being. However, during the conference it was emphasized that cancer screening must be viewed as a highly complex system. Therefore, it is impossible to measure the effects of screening by considering just one end-point, such as cancer-specific mortality. The opinion was also expressed that with the introduction of new forms of cancer screening (e.g. colon or prostate-cancer screening), experience should first of all be gained with the small-scale screening of persons with an elevated risk. This is a task in which the government should lead the way. Furthermore, the government will also need to regulate the enthusiasm that can be expected for various types of secondary preventative diagnostics offered on the free market, including cancer screening. Another important aspect of cancer screening is ensuring that the general public are thoroughly and carefully informed about the pros and cons of cancer screening. The public must know that although cancer screening can save lives, it also causes harm. People scarcely realise that screening may more often involve a loss of carefree years of life than a small chance of living longer.