Well, here we are again, it's November, or 'Movember' for those able to grow a moustache in support of prostate cancer awareness, and following hard on the heels of October's pink hue in aid of breast cancer awareness. Making the general public aware of the early signs of cancer can certainly save lives, and this is the premise behind research into the early detection of cancer. There are several high-profile early detection trials that are nearing an end, not least the prostate, colon, lung and ovarian (PCLO) early detection trials. But as the data from the PLCO prostate cancer screening trial show, routine screening and improved tumour detection rates do not necessarily equate to improved survival rates. Why might this be?

Perhaps we have been asking the wrong biological questions at the start of such trials because of the limit of our knowledge at that time. Indeed, on page 803, David Bowtell discusses the potential initial changes that underlie the development of high-grade serous ovarian cancer. Recent data indicate that these tumours might not arise from the ovary, but from the distal fallopian tube. Can the cell from which a tumour arises affect early detection? Yes, if the detection method focuses only on a particular cell type, and once a tumour is detected, we still need to have a clear idea of what to do next, and this will also be influenced by our knowledge of the biology of the mutated cell.

Perhaps we need to give more thought to how early we need to be able to detect a potential cancer lesion, keeping in mind that tumour cell dissemination might occur early on in cancer development. We need to be able to stratify patients with early lesions into appropriate treatments, and for this, there is no doubt, we need better biomarkers.