[Cancer screening: for who? Why? How? What organizational evolution?]

Cancer screening: for who? Why? How? What organizational evolution? Screening aims to anticipate the occurrence of symptoms to get an early detection of cancerous or pre-cancerous lesions in order to favorably influence the prognosis. However, the deployment of a screening program is not always justified and it must be based on a rigorous evaluation of its benefits, risks and limitations, especially for people apparently "in good health". Exposure of healthy people to unjustified or unassessed risks could result in loss of opportunity and be considered as unethical. The evaluation is generally carried out on the basis of Wilson and Jungner's criteria (WHO, 1968) which relate in particular to the acceptability of screening and the documentation of its efficacy, safety and efficiency. Once these prerequisites are verified, the strategy must be refined (Who to invite? How ?, Etc.) and the underlying organization determined so as to allow the program to be rolled out and to ensure its continuous operation and monitoring (Which centers? What information? What data collection and which indicators, etc.). In particular, it must not generate inequalities in access to screening and loss of opportunity. In France, territorial coordination of programs is generally devolved to local non-profitorganizations relying on health professionals who perform screening; a major reorganization is currently being rolled out to achieve a regional network. This reform will be accompanied by a quality approach to ensure the harmonized implementation of the missions.