Cancer screening is an important component of prevention and early detection in public
health and clinical medicine. The evidence for cancer screening, however, is often
contentious. A description and explanation of disagreements over the evidence for
cervical, breast, and prostate screening may assist physicians, policymakers, and
citizens faced with screening decisions and suggest directions for future screening
research. There are particular issues to be aware of in the evidence base for each
form of screening, which are summarized in this paper. Five tensions explain existing
conflicts over the evidence: (1) data from differing contexts may not be comparable;
(2) screening technologies affect evidence quality, and thus evidence must evolve
with changing technologies; (3) the quality of evidence of benefit varies, and the
implications are contested; (4) evidence about harm is relatively new, there are gaps
in that evidence, and there is disagreement over what it means; and (5) evidence about
outcomes is often poorly communicated. The following principles will assist people
to evaluate and use the evidence: (1) attend closely to transferability; (2) consider
the influence of technologies on the evidence base; (3) query the design of meta-analyses;
(4) ensure harms are defined and measured; and (5) improve risk communication practices.
More fundamentally, there is a need to question the purpose of cancer screening and
the values that inform that purpose, recognizing that different stakeholders may value
different things. If implemented, these strategies will improve the production and
interpretation of the methodologically challenging and always-growing evidence for
and against cancer screening.
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Published online: June 16, 2015
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© 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
