Re: Margaret McCartney: Early cancer diagnosis: how low should we go?
Margaret’s concern about how low in the criteria of screening one should go for early diagnosis is important. Not sure how CEO of CRUK takes a cut off 75% take up for cancer screening? There was reason for Margaret’s rise in blood pressure level! If Harpal Kumar had included cancer with all non-communicable diseases it would be more convincing! As per WHO recommendation of likely successful cancer control, it is synchronized with advocacy for non-communicable diseases and other cancer-related problems. In India, the National cancer control programme (NCCP) is now merged with NCDS -- National Programme for prevention and control of cancer, diabetes, cardiovascular diseases & stroke (NPCDCS).
Such recommendations of 75% take up of GP patients of cancer screening would be region dependent. If high income countries can take up higher screen positives – they have other problems of harms related to over-investigating those results into over-diagnosis. Of course some health education of current evidence is needed for GPs especially in the Indian context and maybe other regions too. In such a case, for a high income country, a small or low incidence disease is also concerning and actions for control are needed. The scenarios for low and middle income countries if there are more screen positives with a low strategy, there are no resources and facilities for diagnosis and treatment. The strategies should be evidence based and the level should depend on facilities and resources. Questions have recently arisen such as Is doing research as important as treating your patients (BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h6329 (Published 27 November 2015) Cite this as: BMJ 2015;351:h6329). In order to understand the current evidence in clinical research, GPs if they do not undertake research should at least understand research and update themselves for evidence on cancer screening strategies. Leaving the percent of referrals out of the total GP load, there is definite need for knowledge at the GP level to inform patients about the harms and benefits on low and high strategies of screening adoptable for early cancer diagnosis.
Satyanarayana Labani, Scientist G
Smita Asthana Scientist D
Divisiion of Epidemiology & Biostatistics
Institute of Cytology & Preventive Oncology (ICMR)
Dept of Health Research (MOHFW)
Noida, India
Competing interests:
No competing interests
04 December 2015
Satyanarayana Labani
Scientist
Smita Asthana
institute of cytology and preventive oncology (icmr) noida (uttar pradesh), india
Rapid Response:
Re: Margaret McCartney: Early cancer diagnosis: how low should we go?
Margaret’s concern about how low in the criteria of screening one should go for early diagnosis is important. Not sure how CEO of CRUK takes a cut off 75% take up for cancer screening? There was reason for Margaret’s rise in blood pressure level! If Harpal Kumar had included cancer with all non-communicable diseases it would be more convincing! As per WHO recommendation of likely successful cancer control, it is synchronized with advocacy for non-communicable diseases and other cancer-related problems. In India, the National cancer control programme (NCCP) is now merged with NCDS -- National Programme for prevention and control of cancer, diabetes, cardiovascular diseases & stroke (NPCDCS).
Such recommendations of 75% take up of GP patients of cancer screening would be region dependent. If high income countries can take up higher screen positives – they have other problems of harms related to over-investigating those results into over-diagnosis. Of course some health education of current evidence is needed for GPs especially in the Indian context and maybe other regions too. In such a case, for a high income country, a small or low incidence disease is also concerning and actions for control are needed. The scenarios for low and middle income countries if there are more screen positives with a low strategy, there are no resources and facilities for diagnosis and treatment. The strategies should be evidence based and the level should depend on facilities and resources. Questions have recently arisen such as Is doing research as important as treating your patients (BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h6329 (Published 27 November 2015) Cite this as: BMJ 2015;351:h6329). In order to understand the current evidence in clinical research, GPs if they do not undertake research should at least understand research and update themselves for evidence on cancer screening strategies. Leaving the percent of referrals out of the total GP load, there is definite need for knowledge at the GP level to inform patients about the harms and benefits on low and high strategies of screening adoptable for early cancer diagnosis.
Satyanarayana Labani, Scientist G
Smita Asthana Scientist D
Divisiion of Epidemiology & Biostatistics
Institute of Cytology & Preventive Oncology (ICMR)
Dept of Health Research (MOHFW)
Noida, India
Competing interests: No competing interests