General Principles Governing the Introduction of Early Detection Programs

The implementation of early detection programs requires considerable resources.
Education and screening programs generally involve costs to the individual (in terms of
time spent, distance traveled, cash payments for detection and diagnosis), as well as to the
health services providers (staff subsidies for detection and diagnosis, treatment, and
follow-up), and sometimes may be associated with undesired harm (WHO, 2002). For
these reasons, population-level screening programs should be undertaken as a componem
of early detection only where their effectiveness has been demonstrated, where resources
(e.g., personnel, equipment) are sufficient to cover at least 70%of the target group, where
facilities exist for confirming diagnoses and for treatment and follow-up of those with
abnormal results, and where prevalence of disease is high enough to justify the efforts and
cost of screening (WHO, 2003b). Because the implementation of screening programs is of
such importance to the control of cancer around the world, considerable attention has
been given to implementation of the process and related procedures. The International
Union Against Cancer (VICe) has established a general set of principles governing the
introduction of screening programs (Miller, Chamberlain, Day, Hakama, & Prorok, 1990;
Prorok, Chamberlain, Day, Hakarna, & Miller, 1984); These principles are the basis for
decisions regarding screening program implementation in both developed and developing
nations worldwide:


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