Screening for Prevention and Early Diagnosis of Cancer

The poor outcomes for cancers diagnosed at an advanced stage have been the driver behind research into techniques to detect disease before symptoms are manifest. For cer-vical and colorectal cancer, detection and treatment of “precancers ” can prevent the development of cancer, a form of primary prevention. For other cancers—breast, prostate, lung, and ovarian—screening is a form of sec-ondary prevention, aiming to improve outcomes through earlier diagnosis. International and national expert orga-nizations regularly assess the balance of benefits and harms of screening technologies, issuing clinical guide-lines for population-wide implementation. Psychological research has made important contributions to this process, assessing the psychological costs and benefits of possible screening outcomes (e.g., the impact of false positive re-sults) and public tolerance of overdiagnosis. Cervical, colorectal, and breast screening are currently recom-mended, and prostate, lung, and ovarian screening are under active review. Once technologies and guidelines are in place, delivery of screening is implemented according to the health care system of the country, with invitation sys-tems and provider recommendations playing a key role. Behavioral scientists can then investigate how individuals make screening decisions, assessing the impact of knowl-edge, perceived cancer risk, worry, and normative beliefs about screening, and this information can be used to de-velop strategies to promote screening uptake. This article describes current cancer screening options, discusses be-havioral research designed to reduce underscreening and minimize inequalities, and considers the issues that are being raised by informed decision making and the devel-opment of risk-stratified approaches to screening