<b><i>Background:</i></b> Improving understanding of the genetic basis of disease susceptibility enables us to estimate individuals' risk of developing cancer and offer them disease prevention, including screening, stratified to reflect that risk. Little attention has so far been given to the implementation of stratified screening. This article reviews the issues that would arise in delivering such tailored approaches to prevention in practice. <b><i>Results:</i></b> Issues analysed include the organisational context within which implementation of stratified prevention would occur, how the offer of screening would be made, making sure consent is adequately informed, how individuals' risk would be assessed, the age at which risk estimation should occur, and the potential use of genetic data for other purposes. The review also considers how management might differ depending on individuals' risk, how their results would be communicated and their follow-up arranged, and the different issues raised by modification of an existing screening programme, such as that for breast cancer, and the establishment of a new one, for example for prostate cancer. <b><i>Conclusion:</i></b> Stratified screening based on genetic testing is a radically new approach to prevention. Various organisational issues would need to be considered before it could be introduced, and a number of questions require further research.
In order to update the previous version of the European Code against Cancer and formulate evidence-based recommendations, a systematic search of the literature was performed according to the methodology agreed by the Code Working Groups. Based on the review, the 4th edition of the European Code against Cancer recommends:. "Take part in organized cancer screening programmes for:. •Bowel cancer (men and women)•Breast cancer (women)•Cervical cancer (women)." Organized screening programs are preferable because they provide better conditions to ensure that the Guidelines for Quality Assurance in Screening are followed in order to achieve the greatest benefit with the least harm. Screening is recommended only for those cancers where a demonstrated life-saving effect substantially outweighs the potential harm of examining very large numbers of people who may otherwise never have, or suffer from, these cancers, and when an adequate quality of the screening is achieved. EU citizens are recommended to participate in cancer screening each time an invitation from the national or regional screening program is received and after having read the information materials provided and carefully considered the potential benefits and harms of screening. Screening programs in the European Union vary with respect to the age groups invited and to the interval between invitations, depending on each country's cancer burden, local resources, and the type of screening test used. For colorectal cancer, most programs in the EU invite men and women starting at the age of 50-60 years, and from then on every 2 years if the screening test is the guaiac-based fecal occult blood test or fecal immunochemical test, or every 10 years or more if the screening test is flexible sigmoidoscopy or total colonoscopy. Most programs continue sending invitations to screening up to the age of 70-75 years.For breast cancer, most programs in the EU invite women starting at the age of 50 years, and not before the age of 40 years, and from then on every 2 years until the age of 70-75 years.For cervical cancer, if cytology (Pap) testing is used for screening, most programs in the EU invite women starting at the age of 25-30 years and from then on every 3 or 5 years. If human papillomavirus testing is used for screening, most women are invited starting at the age of 35 years (usually not before age 30 years) and from then on every 5 years or more. Irrespective of the test used, women continue participating in screening until the age of 60 or 65 years, and continue beyond this age unless the most recent test results are normal.
Population-based screening for early detection and treatment of colorectal cancer (CRC) and precursor lesions, using evidence-based methods, can be effective in populations with a significant burden of the disease provided the services are of high quality. Multidisciplinary, evidence-based guidelines for quality assurance in CRC screening and diagnosis have been developed by experts in a project co-financed by the European Union. The 450-page guidelines were published in book format by the European Commission in 2010. They include 10 chapters and over 250 recommendations, individually graded according to the strength of the recommendation and the supporting evidence. Adoption of the recommendations can improve and maintain the quality and effectiveness of an entire screening process, including identification and invitation of the target population, diagnosis and management of the disease and appropriate surveillance in people with detected lesions. To make the principles, recommendations and standards in the guidelines known to a wider professional and scientific community and to facilitate their use in the scientific literature, the original content is presented in journal format in an open-access Supplement of Endoscopy. The editors have prepared the present overview to inform readers of the comprehensive scope and content of the guidelines. ; Fil: Arrossi, Silvina. Centro de Estudios de Estado y Sociedad; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina ; Fil: von Karsa, Lawrence. International Agency for Research on Cancer; Francia ; Fil: Patrick, J. NHS Cancer Screening Programmes Sheffield; Reino Unido. University of Oxford; Reino Unido ; Fil: Segnan, N. International Agency for Research on Cancer; Francia. AO Città della Salute e della Scienza di Torino; Italia ; Fil: Atkin, W. Imperial College London; Reino Unido ; Fil: Halloran, S. University of Surrey; Reino Unido ; Fil: Saito, H. National Cancer Centre; Japón ; Fil: Sauvaget, C. International Agency for Research on Cancer; Francia ; Fil: Scharpantgen, A. Ministry of Health; Luxemburgo ; Fil: Schmiegel, W. Ruhr-Universität Bochum; Alemania ; Fil: Senore, C. AO Città della Salute e della Scienza di Torino; Italia ; Fil: Siddiqi, M. Cancer Foundation of India; India ; Fil: Sighoko, D. University of Chicago; Estados Unidos. Formerly International Agency for Research on Cancer; Francia ; Fil: Smith, R. American Cancer Society; Estados Unidos ; Fil: Smith S. University Hospitals Coventry & Warwickshire NHS Trust; Reino Unido ; Fil: Suchanek, S. Charles University; República Checa ; Fil: Suonio, E. International Agency for Research on Cancer; Francia ; Fil: Tong, W. Chinese Academy of Sciences; República de China ; Fil: Törnberg, S. Stockholm Gotland Regional Cancer Centre. Department of Cancer Screening; Suecia ; Fil: Van Cutsem, E. Katholikie Universiteit Leuven; Bélgica ; Fil: Vignatelli, L. Agenzia Sanitaria e Sociale Regionale; Italia ; Fil: Villain, P. University of Oxford; Reino Unido ; Fil: Voti, L. Formerly International Agency for Research on Cancer; Francia. University of Miami; Estados Unidos ; Fil: Watanabe, H. Niigata University; Japón ; Fil: Watson, J. University of Oxford; Reino Unido ; Fil: Winawer, S. Memorial Sloan–Kettering Cancer Center; Estados Unidos ; Fil: Young, G. Flinders University. Gastrointestinal Services; Australia ; Fil: Zaksas, V. State Patient Fund; Lituania ; Fil: Zappa, M. Cancer Prevention and Research Institute; Italia ; Fil: Valori, R. NHS Endoscopy; Reino Unido
This overview describes the principles of the 4th edition of the European Code against Cancer and provides an introduction to the 12 recommendations to reduce cancer risk. Among the 504.6 million inhabitants of the member states of the European Union (EU28), there are annually 2.64 million new cancer cases and 1.28 million deaths from cancer. It is estimated that this cancer burden could be reduced by up to one half if scientific knowledge on causes of cancer could be translated into successful prevention. The Code is a preventive tool aimed to reduce the cancer burden by informing people how to avoid or reduce carcinogenic exposures, adopt behaviours to reduce the cancer risk, or to participate in organised intervention programmes. The Code should also form a base to guide national health policies in cancer prevention. The 12 recommendations are: not smoking or using other tobacco products; avoiding second-hand smoke; being a healthy body weight; encouraging physical activity; having a healthy diet; limiting alcohol consumption, with not drinking alcohol being better for cancer prevention; avoiding too much exposure to ultraviolet radiation; avoiding cancer-causing agents at the workplace; reducing exposure to high levels of radon; encouraging breastfeeding; limiting the use of hormone replacement therapy; participating in organised vaccination programmes against hepatitis B for newborns and human papillomavirus for girls; and participating in organised screening programmes for bowel cancer, breast cancer, and cervical cancer.
