Current status of research in detection and diagnosis

Following the passage of the National Cancer Act of 1972, the National Cancer Institute created a Division of Cancer Biology and Diagnosis. This marked the renewal of a commitment of the National Cancer Institute to diagnostic research. Within the scope of diagnostic research there are three separate subheadings: screening or detection, diagnosis itself, and prognosis. Asymptomatic individuals are studied by screening procedures to determine if they might have a cancer. Those that are selected by the screen are then subject to definitive diagnostic procedures to determine whether they have a cancer. Prognosis attempts to predict the outcome from knowledge gained in the past. At the present time the only screening method that has been proven in a rigorous manner to be effective in reducing mortality is a combination of a physical examination and mammography for carcinoma of the breast. The Pap test is accepted but precisely how much it has reduced the mortality from cervical carcinoma remains to be determined. The National Cancer Institute is now engaged in research designed to test various aspects of screening to develop new screening techniques and to evaluate them. In the diagnostic field it is particularly concerned with imaging by radiologic means and ultrasound. Visualization by endoscopy is becoming important. These aspects of screening, diagnosis and prognosis will be reviewed.