1. Definition of Cancer Screening
The presumptive identification of unrecognized cancer by the application of tests, examinations, or other procedures which can be applied rapidly to an asymptomatic population to sort out those who probably have cancer from those who probably do not.

2. Analytic Framework for Screening
(Adapted from USPSTF, Am J Prev Med 20(3S):25, 2001) 1 5
Screening
Test
Treatment
Association
Early Detection
of Targeted
Condition
Reduced Morbidity
and/or
Mortality
Persons
At Risk
Intermediate
Outcome 3 4 6 2 7 8
Adverse Effects
of Screening
Adverse Effects
of Treatment

3. Zapka, J. et al. J Natl Cancer Inst Monogr 2010 2010:58-71.

4. Screening Tests for Asymptomatic Patients
Breast Cancer
Screening Tests for Asymptomatic Patients
(Females)
Test or Procedure ACS++ USPSTF+
Mammography preceded by CBE q yr q 2 yr
with or without CBE**
MRI NR IE***
Clinical breast exam (CBE) q3 yr* IE*** q yr*
Breast self exam Optional Against
+ USPSTF at
++ Smith RA et al. CA Cancer J Clin 60:99-119, 2010
NR = not recommended
* As part of a health examination
** Before age 50, make an informed decision with your doctor
*** Insufficient evidence

5. Average Annual In Situ Female Breast Cancer Rates, Iowa, (rates expressed per 100,000 persons using 2000 U.S. population as standard)
6-fold increase

6. Female Breast Cancer Mortality Rates, Iowa, (Rates are per 100,000 women and age-adjusted to the U.S population.)
Study (NEJM Oct 27, 2005)
reported 46% of breast
cancer mortality reduction
attributed to screening;
remainder due primarily to
Improved treatment.
32% decline between 1992
and 2006

7. Asymptomatic Patients
Prostate Cancer (Smith RA et al. CA Cancer J Clin 60:99-119; 2010 &
Screening Tests for
Asymptomatic Patients
(Males)
Test or Procedure ACS USPSTF
Prostate specific antigen (PSA) test Age 50+ q yr Insufficient
and digital rectal exam (DRE) thereafter* evidence for men
< 75; against for
men 75+ years
* Require informed decision with health care provider for men who have a life expectancy of at least 10 years.

8. PSA Acceptance: Controversy:
Widely used as cancer marker for initial diagnosis and monitoring response to therapy
Aids in prediction of prostate cancer risk and of treatment outcome
Controversy:
Leads to diagnosis and treatment of prostate cancers that pose no real threat
Disagreement over the threshold level of PSA that should indicate biopsy
Levels differ by racial, ethnic, age groups
Clinical trials not showing benefit

9. Malignant Prostate Cancer Rates, Iowa, (Rates are per 100,000 men and age-adjusted to the U.S population.)
15% decrease in incidence between 1994 and 2006
37% decrease in mortality between 1994 and 2006

10. Avenues for Cancer Prevention and Control
Primary
Secondary
Tertiary
Prevention
Screening
Early
Detection
Treatment
Rehabilitation
Palliative
Care
Quality of Life/Care
Genes
Environment
Quantity of Life
Birth
Cancer Diagnosis
Death
Incidence Rates
Stage Distribution
Survival Rates
Mortality Rates