High risk groups and screening for cancer

Selective screening for cancer in high risk groups is attractive. For cancer of the breast and cervix uteri, evidence is accumulating regarding the beneficial effects of lowering morbidity and mortality from these diseases. Although a number of risk factors are known for both breast and cervical cancer, the use of such knowledge in selecting high risk groups for screening has been disappointing. Experience from existing mass screening programs shows that a large proportion of cases arise in the low risk individuals. Age represents, so far, the only characteristic of use for the selection of screenees. It is proposed that risk factors be identified as part of an initial unselective screening program to individualize further screenings, for example, by shorter intervals between screenings for high risk than for low risk groups.