Screening and diagnosis of cancer in office practice

Nearly all cancers, with the exception of lung cancer, are amenable to screening in the primary care office. For many of these tumors, appropriate screening holds greater promise than improved cures for decreasing mortality rates. Screening of asymptomatic patients can be associated with significant costs, both financial and emotional. Excessively rigorous screening efforts can alienate patients from the concept of early diagnosis and may even cause them to avoid seeking other needed medical care. Failure to screen adequately may result in unnecessary loss of life from potentially curable tumors. Because of the complexities involved in carrying out adequate randomized controlled trials of various cancer-screening methods, recommendations must necessarily be based on incomplete information. Although there is room for disagreement among authors and organizations formulating screening plans, the recommendations of the ACS were selected and reproduced in this article. A review of other recommendations is available.