Table Of ContentAdvances in Cancer Screening
Cancer Treatment and Research
Steven T. Rosen, M.D., Series Editor
Nathanson, L (ed): Malignant Melanoma: Biology, Diagnosis, and Therapy. 1988. ISBN 0-89838-384-6
Pinedo HM, Verweij J (eds): Treatment of Soft Tissue Sarcomas. 1989. ISBN 0-89838-391-9
Hansen HH (ed): Basic and Clinical Concepts of Lung Cancer. 1989. ISBN 0-7923-0153-6
Lepor H, Ratliff, TL (eds): Urologic Oncology. 1989. ISBN 0-7923-0161-7
Benz C, Liu, E (eds): Oncogenes. 1989. ISBN-7923-0237-0
Ozols RF (ed): Drug Resistance in Cancer Therapy. 1989. ISBN 0-7923-0244-3
Surwit EA, Alberts DS (eds): Endometrial Cancer. 1989. ISBN 0-7923-0286-9
Champlin R (ed): Bone Marrow Transplantation. 1990. ISBN 0-7923-0612-0
Goldenberg D (ed): Cancer Imaging with Radiolabeled Antibodies. 1990. ISBN 0-7923-0631-7
Jacobs C (ed): Carcinomas of the Head and Neck. 1990. ISBN 0-7923-0668-6
Lippman ME, Dickson R (eds): Regulatory Mechanisms in Breast Cancer: Advances in Cellular and
Molecular Biology of Breast Cancer, 1990. ISBN 0-7923-0868-9
Nathanson L (ed): Malignant Melanoma: Genetics, Growth Factors. Metastases, and Antigens. 1991.
ISBN 0-7923-0895-6
Sugarbaker PH (ed): Management of Gastric Cancer. 1991. ISBN 0-7923-1102-7
Pinedo HM, Verweij J, Suit HD, (eds): Soft Tissue Sarcomas: New Developments in the Multidisciplinary
Approach to Treatment. 1991. ISBN 0-7923-1139-6
Ozols RF (ed): Molecular and Clinical Advances in Anticancer Drug Resistance. 1991. ISBN 0-7923-1212-0
Muggia FM (ed): New Drugs, Concepts and Results in Cancer Chemotherapy. 1991. ISBN 0-7923-1253-8
Dickson RB, Lippman, M.E. (eds): Genes, Oncogenes and Hormones: Advances in Cellular and Molecular
Biology of Breast Cancer. 1992. ISBN 0-7923-1748-3
Humphrey G Bennett, Schraffordt Koops H, Molenaar WM, Postma, A. (eds): Osteosarcoma in Adolescents
and Young Adults: New Developments and Controversies. 1993. ISBN 0-7923-1905-2
Benz CC, Liu ET (eds): Oncogenes and Tumor Suppressor Genes in Human Malignancies. 1993.
ISBN 0-7923-1960-5
Freireich EJ, Kantarjian H (eds): Leukemia: Advances in Research and Treatment. 1993.
ISBN 0-7923-1967-2
Dana BW (ed): Malignant Lymphomas, Including Hodgkin's Disease: Diagnosis, Management, and Special
Problems. 1993. ISBN 0-7923-2171-5
Nathanson L (ed): Current Research and Clinical Management of Melanoma. 1993.
ISBN 0-7923-2152-9
Verweij J, Pinedo HM, Suit HD (eds): Multidisciplinary Treatment of Soft Tissue Sarcomas. 1993.
ISBN 0-7923-2183-9
Rosen ST, Kuzel TM (edl;) Immunoconjugate Therapy of Hematologic Malignancies. 1993.
ISBN 0-7923-2270-3
i
Sugarbaker PH ed): Hepatobiliary Cancer. 1994. ISBN 0-7923-2501-X
Rothenberg ML (ed): Gynecologic Oncology: Controversies and New Developments. 1994.
ISBN 0-7923-2634-2
Dickson RB, Lippman ME (eds.): Mammary Tumorigenesis and Malignant Progression. 1994.
ISBN 0-7923-2647-4
Hansen HH (ed): Lung Cancer. Advances in Basic and Clinical Research. 1994. ISBN 0-7923-2835-3
Goldstein LJ, Ozols RF (eds.): Anticancer Drug Resistance. Advances in Molecular and Clinical Research.
1994. ISBN 0-7923-2836-1
Hong WK, Weber RS (eds.): Head and Neck Cancer. Basic and Clinical Aspects. 1994. ISBN 0-7923-3015-3
Thall PF (ed): Recent Advances in Clinical Trial Design and Analysis. 1995. ISBN 0-7923-3235-0
Buckner CD (ed): Technical and Biological Components of Marrow Transplantation. 1995.
ISBN 0-7923-3394-2
Muggia FM (ed): Concepts, Mechanisms, and New Targets for Chemotherapy. 1995. ISBN 0-7923-3525-2
Klastersky J (ed): Infectious Complications of Cancer. 1995. ISBN 0-7923-3598-8
Kurzrock R, Talpaz M (eds): Cytokines: Interleukins and Their Receptors. 1995. ISBN 0-7923-3636-4
Sugarbaker P (ed): Peritoneal Carcinomatosis: Drugs and Diseases. 1995. ISBN 0-7923-3726-3
Sugarbaker P (ed): Peritoneal Carcinomatosis: Principles of Management. 1995. ISBN 0-7923-3727-1
Dickson RB, Lippman ME (eds.): Mammary Tumor Cell Cycle. Differentiation and Metastasis. 1995.
ISBN 0-7923-3905-3
Freireich EJ, Kantarjian H (eds.): Molecular Genetics and Therapy of Leukemia. 1995. ISBN 0-7923-3912-6
Caban ill as F, Rodriguez MA (eds.): Advances in Lymphoma Research. 1996. ISBN 0-7923-3929-0
Advances in
Cancer Screening
edited by
ANTHONY B. MILLER
University of Toronto. Canada
.
.,
~
1996 KLUWER ACADEMIC PUBLISHERS
BOSTON I DORDRECHTI LONDON
Distributors for North America:
Kluwer Academic Publishers
101 Philip Drive
Assinippi Park
Norwell, Massachusetts 02061 USA
Distributors for all other countries:
Kluwer Academic Publishers Group
Distribution Centre
Post Office Box 322
3300 AH Dordrecht, THE NETHERLANDS
Library of Congress Cataloging-in-Publication Data
Advances in cancer screening / edited by Anthony B. Miller.
p. cm. - (Cancer treatment and research; 86)
Includes bibliographical references and index.
ISBN-13: 978-1-4612-8539-7 e-ISBN-13: 978-1-4613-1265-9
DOl: 10.1007/978-1-4613-1265-9
1. Cancer - Diagnosis. 2. Cancer - Prevention. 3. Medical
screening. I. Miller, A. B. (Anthony B.) II. Series: Cancer treatment
and research; v. 86.
[DNLM: 1. Neoplasms - prevention & control. 2. Mass Screening
- methods. W1 CA693 v. 86 1996/ QZ 200 A2442 1996]
RA645.C3A34 1996
362.1'96994 - dc20
DNLMIDLC
for Library of Congress 96-7537
CIP
Copyright © 1996 by Kluwer Academic Publishers
Softcover reprint of the hardcover 1s t edition 1996
All rights reserved. No part of this publication may be reproduced, stored in a
retrieval system or transmitted in any form or by any means, mec~anical,
photo-copying, recording, or otherwise, without the prior written permission
of the publisher, Kluwer Academic Publishers, 101 Philip Drive, Assinippi
Park, Norwell, Massachusetts 02061
Printed on acid-free paper.
Contents
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Vll
Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IX
1. The public health basis of cancer screening: principles and ethical
aspects ................................................... 1
ANTHONY B. MILLER
2. The theoretical basis for cancer screening . . . . . . . . . . . . . . . . . . . . . 9
NICOLAS E. DAY
3. Principles of economic evaluation in cancer screening. . . . . . . . . . . 25
MURRAY KRAHN and GARY NAGLIE
4. Screening for cervical cancer 41
MATTI HAKAMA
5. Advaces is screening for color ectal cancer. . . . . . . . . . . . . . . . . . . . . 51
JACK S. MANDEL
6. Advances in screening for breast cancer 77
SUE M. MOSS
7. Prostate cancer screening: current issues ...................... 93
PHILIP C. PROROK, ARNOLD L. POTOSKY,
JOHN K. GOHAGAN, and BARNETT S. KRAMER
8. Screening for gastric cancer ................................. 113
PAOLA PISANI and D. MAXWELL PARKIN
9. Screening for lung cancer ............................ . . . . . .. 121
D. MAXWELL PARKIN and PAOLA PISANI
v
10. Screening for melanoma ....... . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 129
J. MARK ELWOOD
11. Screening for neuroblastoma ................................ 149
MARK L. BERNSTEIN and WILLIAM G. WOODS
12. Screening for cancer in high-risk families. . . . . . . . . . . . . . . . . . . . .. 165
WILLIAM D. FOULKES and STEVEN A. NAROD
13. Screening in developing countries: problems and opportunities. .. 183
ANTHONY B. MILLER
Index. . .. . . .. . . . .. . . . . . .. . . . . .. . . .. . . .. . . . .. . . ... . .. . . .. . .. . .. 191
vi
Contributors
MARK L., Bernstein, M.D., Montreal Children's Hospital, 2300 Tupper
Street, Montreal, Quebec, H3H 1P3, Canada
NICHOLAS E., Day, Ph.D., MRC Biostatistics Unit, The Institute of Public
Health, University of Cambridge, University Forvie Site, Robinson Way,
Cambridge CB2 2SR, United Kingdom
MARK J., Elwood, M.D., FRCP(C), Director, Hugh Adam Cancer Epidemi
ology Unit, Faculty of Preventive and Social Medicine, University of
Dunedin, PO Box 913, Dunedin, New Zealand
WILLIAM D., Foulkes, Ph.D., MRCP(UK), Division of Medical Genetics,
Department of Medicine, McGill University, 1650 Cedar Avenue,
Montreal, Quebec, H3G 1A4, Canada
JOHN K., Gohagen, Ph.D., Biometry Branch DCPC, National Cancer
Institute, Executive Plaza North, Suite 344, 6130 Executive Blvd. MSC
7354, Bethesda, MD 20892-7392, USA
MATTI Hakama, Sc.D., University of Tampere, Department of Public
Health, Box 607 SF-33101 Tampere, Finland
MURRAY Krahn, M.D., FRCP(C), Division of General Internal Medicine
and Clinical Epidemiology, The Toronto Hospital, Eaton Wing N, 200
Elizabeth Street, Ground Floor, Rm 248, Toronto, Ontario, M5G 2C4,
Canada
BARNETT S., Kramer, M.D., Biometry Branch DCPC, National Cancer
Institute, Executive Plaza North, Suite 344, 6130 Executive Blvd. MSC
7354, Bethesda, MD 20892-7394, USA
JACK S., Mandel, Ph.D., MPH, School of Public Health-Environmental &
Occupational Health, University of Minnesota, Box 807 UMHC, 420
Delaware SE, Minneapolis, MN 55455. USA
ANTHONY B., Miller, M.B., FRCP, Department of Preventive Medicine and
Biostatistics, University of Toronto, 12 Queens Park Crescent West,
Toronto, Ontario, M5S 1A8, Canada
SUE M., Moss, Ph.D., Cancer Screening Evaluation Unit, The Institute of
Cancer Research, Royal Cancer Hospital, Block D, Cots wold Road,
Sutton, Surry, SM2 5NG United Kingdom
vii
GARY Naglie, M.D., FRCP(C), The Toronto Hospital, 238-200 Elizabeth
Street, Toronto, Ontario, M5G 2C4, Canada
STEVEN A., Narod, M.D., FRCP(C), University of Toronto/Women's Col
lege Hospital, Department of Breast Cancer Research, Women's College
Hospital, 76 Grenville Street, Toronto, Ontario, M5S IB2, Canada
MAXWELL D., Parkin, Ph.D., Unit of Descriptive Epidemiology, Interna
tional Agency for Research on Cancer, 150, Cours Albert Thomas, 69372
Lyon, Cedex 08 France
PAOLA Pisani, Ph.D., Unit of Descriptive Epidemiology, International
Agency for Research on Cancer, 150, Cours Albert Thomas, 69372 Lyon,
Cedex 08 France
ARNOLD L., Potosky, Ph.D., Biometry Branch DCPC, National Cancer
Institute, Executive Plaza North, Suite 344, 6130 Executive Blvd. MSC
7354, Bethesda, MD 20892-7394, USA
PHILIP c., Prorok, Ph.D., Biometry Branch DCPC, National Cancer Insti
tute, Executive Plaza North, Suite 344, 6130 Executive Blvd. MSC 7354,
Bethesda, MD 2892-7394, USA
WILLIAM G., Woods, M.D., Department of Pediatrics, Box 454, University
of Minnesota, 420 Delaware Street, Minneapolis, MN 55455, USA
viii
Preface
Screening for cancer is an important focus of cancer control. Yet screening,
since it involves administering a test to large segments of the population
deemed at risk for the disease of interest, is potentially a major consumer of
scarce health care resources. Further, the benefits sought from cancer screen
ing, particularly reduction in mortality from the disease, are not always real
ized, sometimes for biological reasons and sometimes for organizational ones.
Thus the paradigm that "early detection must always be beneficial," taught to
health care professionals and publicized widely through the media to the
public, has been challenged in the last two decades for a number of cancer
sites. It is the purpose of this volume to determine the extent to which the
requirements for the introduction of population-based screening programs
have been met, as a result of extensive research on screening during the last
two decades, with the major concentration on findings from the recent decade.
The volume addresses important issues for the majority of the sites for
which data on the effectiveness of screening are currently available. It also
addresses some general principles that apply to screening and pays attention to
the advances in understanding of the genetic basis of some cancers, which are
beginning to raise important ethical as well as practical issues. The viewpoint
is largely that of epidemiology, and many of the authors are former contribu
tors to the series of publications on evaluation of screening for cancer that
arose from the program of the International Union Against Cancer Project on
Screening for Cancer, which I had the honor to chair for many years [1-5].
Thus the authors of the various chapters have carefully evaluated the available
evidence on the effectiveness of screening and have usually been able to reach
a conclusion as to whether screening for the relevant cancer site should be part
of a cancer-control, public health policy approach. However, clinical aspects
have not been neglected, especially when they form a major part of the
approach to screening for a particular site (as for colorectal cancer and mela
noma screening, for example), or where part of the concern has to be whether
adequate treatment is available for the abnormalities identified by screening
(as for screening for cancer in high-risk families). Indeed, we must constantly
be aware of the requirement for effective screening that there should be
effective treatment - a potential difficulty of management for many of the
IX
lesions found after screening for cervical cancer, and also for breast cancer,
perhaps particularly in women under the age of 50.
This volume has been planned as a valuable resource document for all
interested in cancer screening, including government and nongovernment or
ganizations concerned with cancer control; cancer researchers; and members
of national cancer societies and of international organizations concerned with
cancer.
I should like to pay tribute to the many authors who have contributed to
this volume, and who, with considerable patience, acceded to my urgings over
various matters of detail. This has truly been a multi-authored production,
though with a great deal of mutual understanding of objective and purpose.
A.B. Miller
Toronto, Canada
References
1. Prorok PC, Miller AB. 1984. Screening for Cancer. I - General Principles on Evaluation of
Screening for Cancer and Screening for Lung, Bladder and Oral, Cancer (UICC technical
report series, vol. 78). Geneva: International Union Against Cancer.
2. Hakama M, Miller AB, Day NE. 1986. Screening for Cancer of the Uterine Cervix (IARC
scientific publications no. 76). Lyon: International Agency for Research on Cancer.
3. Chamberlain J, Miller AB (eds.). 1988. Screening for Gastrointestinal Cancer Toronto: Hans
Huber.
4. Day NE, Miller AB (eds.). 1988. Screening for Breast Cancer. Toronto: Hans Huber.
5. Miller AB, Chamberlain J, Day NE, Hakama M, Prorok PC (eds.). 1991. Cancer Screening.
Cambridge: Cambridge University Press.
x
