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Part II

Part II

Part

EARLY DETECTION OF CANCER Early detection of cancer is based on the observation that treatment is more effective when the disease is detected earlier in its natural history, prior to the development of symptoms, than in an advanced stage. The aim is to detect the cancer when it is localized to the organ of origin without invasion of surrounding tissues or distant organs. A decision to implement early detection of cancer in health services should be evidence-based, with consideration for the public health importance of the disease, characteristics of early-detection tests, efficacy and cost-effectiveness of early detection, personnel requirements and the level of development of health services in a given setting. Even if the costs of the screening tests are relatively low, the whole process may involve substantial expenses and may divert resources from other health care activities. Early detection is only a part of a wider strategy that includes diagnosis, treatment of the condition detected, and follow-up. These activities need to be integrated at appropriate levels of health services, if early detection is to be sustained. Some specific additional investments in health services infrastructure may be required for the extra disease burden resulting from early detection. There are two principal components of early detection programmes for cancer: education to promote early diagnosis, and screening. Successful education leading to early diagnosis can result in substantial improvement in the health outcome of persons destined to develop cancer. Screening is unlikely to be successful unless based upon an effective education programme and effective treatment for the cancers detected. Both approaches involve costs to the individual (in terms of time spent, distance travelled, cash payments for detection/diagnosis) and the health services (staff, subsidies for detection/diagnosis, treatment, follow-up), and sometimes may be associated with undesired harm. It is important to establish that benefits of early detection outweigh complications and harmful effects before early detection is implemented as a public health policy. National health services often operate with limited resources against a wide variety of competing priorities. It is essential, therefore, to recommend for implementation only those interventions for which there is sufficient evidence on efficacy and cost-effectiveness. 5 55

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