Early detection of cancer depends on people knowing what to look for and seeking prompt advice from their doctor (Box 3.1). Education is essential for people to understand how the body works; knowing what is normal for our own bodies helps us detect when something changes. Fear can play a large part in delaying seeking help and is often driven by ‘I don’t want to know’ or ‘they won’t be able to do anything for me’. These feelings may be based on previous family experiences or out-of-date information. It is important to educate people that cancer can often be treated and have a good outcome if it is detected and treated early, emphasising that it is vitally important to note any changes in body function or appearance.

Activity

Identify simple ways you raise the awareness of the signs and symptoms of cancer in the individuals you meet.

NMC Domain 1: 1.3; 1.4

NMC Domain 2: 2.6

NMC Domain 3: 3.5; 3.7; 3.8

NMC Domain 4: 4.1

Screening

A possible way of detecting a cancer before symptoms develop is through screening. The primary aim of screening is to identify a cancer at an early stage, so that treatment can be prompt and the impact of treatment may be minimised and more successful, although this is not always the case. The general population are targeted for screening, although programmes select specific age groups or high-risk individuals.

Wilson and Junger (1968) developed 10 principles (for the World Health Organisation) that should govern a national screening programme:

Reflection point

Consider Wilson and Junger’s (1968) (see References) 10 principles of screening. Why do we have a breast screening programme and not a prostate screening programme?

NMC Domain 1: 1.4

NMC Domain 2: 2.6

NMC Domain 3: 3.5

Cervical screening

Cervical screening is fairly unique in the fact that it does not just detect cancer at an earlier stage but it can prevent cancer developing. This is because there is a recognised pre-cancerous stage called carcinoma in situ (CIN). If untreated, this condition will almost definitely develop into a cancer. However, if this is detected during screening then the affected tissues can be removed and the individual does not develop cancer. It is estimated that screening, the detection of CIN and prompt treatment can prevent 75% of cervical cancers.

The programme screens women between the ages of 25 to 49 every 3 years and 50 to 64 every 5 years. Women over 65 years who have not been screened since age 50 or have had an abnormal result can request screening. In 2005, the method of screening was changed to liquid-based cytology (involves brushing the cervix and suspending the brush in a medium before it is reviewed) to increase the reliability of the test.

The evidence in favour of screening for cancer of the cervix is convincing. Of the 4 million women in the UK invited for screening in 2007–2008, 3.3 million were tested and 93% were negative (NHS Cervical Screening Programme Statistical Bulletin (England 2009–10)).

Although commenced in the mid 1960s, the number of women attending cervical cancer screening has been sporadic and the number has declined slightly in the past 10 years. Of those women invited for screening, 78.9% attended. Women in the younger age groups have declined more rapidly.

Breast screening

The UK NHS Breast Screening Programme (1986) was the first of its kind in the world and national coverage was achieved by the mid 1990s. There have been numerous adjustments to the programme since this time. Currently all women aged 47 to 73 years are sent a letter inviting them to attend for a mammography every 3 years. Women over 73 can request screening.

In 2007–2008, of the 2.5 million women invited for screening, a total of 2 million were screened and 16 449 cancers were detected (Cancer Research UK 2010). Breast screening is well established and shown to be effective, lowering mortality rates (55–69 years) and saving approximately 1250 lives per year.