We believe that current controversies surrounding screening might be better approached by shifting the question from 'does screening work?' to 'for whom does screening work?' We propose a 'rule-out/rule-in' principle as an intellectual basis and starting point for screening. Finally, we advocate the 'equal management of equal risks' principle as an unifying framework for developing simplified and consistent screening guidelines and practice.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Shieh, Y. et al. Population-based screening for cancer: hope and hype. Nat. Rev. Clin. Oncol. http://dx.doi.org/10.1038/nrclinonc.2016.50 (2016).
Saslow, D. et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J. Clin. 62, 147 (2012).
Ronco, G. et al. Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials. Lancet 383, 524–532 (2013).
Kovalchik, S. A. et al. Targeting of low-dose CT screening according to the risk of lung-cancer death. N. Engl. J. Med. 369, 245 (2013).
Katki, H. A. et al. Development and validation of risk models to select ever-smokers for CT lung cancer screening. JAMA http://dx.doi.org/10.1001/jama.2016.6255 (2016).
Wentzensen, N. & Wacholder, S. From differences in means between cases and controls to risk stratification: a business plan for biomarker development. Cancer Discov. 3, 148 (2013).
Katki, H. A. et al. Five-year risk of CIN 3+ to guide the management of women aged 21–24 years. J. Low. Genit. Tract. Dis. 17, S64–S68 (2013).
Kyrgiou, M. et al. Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis. Lancet 367, 489 (2006).
Schiffman, M. et al. Human papillomavirus testing in the prevention of cervical cancer. J. Natl Cancer Inst. 103, 368 (2011).
Castle, P. E. et al. Risk assessment to guide the prevention of cervical cancer. J. Low. Genit. Tract. Dis. 12, 1 (2008).
Roth, J. A. et al. Economic analysis of prostate-specific antigen screening and selective treatment strategies. JAMA Oncol. http://dx.doi.org/10.1001/jamaoncol.2015.6275 (2016).
Wilt, T. J. et al. Radical prostatectomy versus observation for localized prostate cancer. N. Engl. J. Med. 367, 203 (2012).
Acknowledgements
We acknowledge our late friend, mentor, and collaborator, Dr Sholom Wacholder, who made seminal contributions to this work.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing financial interests.
Rights and permissions
About this article
Cite this article
Castle, P., Katki, H. A risk-based framework to decide who benefits from screening. Nat Rev Clin Oncol 13, 531–532 (2016). https://doi.org/10.1038/nrclinonc.2016.101
Published:
Issue Date:
DOI: https://doi.org/10.1038/nrclinonc.2016.101
