In 2011, an estimated 1,596,670 people in the United States will be diagnosed with cancer, and 571,950 will die of cancer. Estimates of the premature deaths that could have been avoided through screening vary from 3% to 35%, depending on a variety of assumptions. Beyond the potential for avoiding death, screening may reduce cancer morbidity since treatment for earlier-stage cancers is often less aggressive than that for more advanced-stage cancers.
Simple vulvectomy gives a 5-year survival rate of essentially 100% but is seldom indicated. Other more limited surgical procedures produce equivalent results and are less deforming. The choice of treatment depends on the extent of the disease.
Vulvar intraepithelial neoplasia (VIN) occupying nonhairy areas can be considered an epithelial disease; however, VIN occupying hairy sites usually involves the pilosebaceous apparatus and requires a greater depth of destruction or excision. Whatever...
Several potential harms must be considered against any potential benefit of screening for cancer. Although most cancer screening tests are noninvasive or minimally invasive, some involve small risks of serious complications that may be immediate (e.g., perforation with colonoscopy) or delayed (e.g., potential carcinogenesis from radiation). Another harm is the false-positive test result, which may lead to anxiety and unnecessary invasive diagnostic procedures. These invasive diagnostic procedures carry higher risks of serious complications. A less familiar harm is overdiagnosis, i.e., the diagnosis of a condition that would not have become clinically significant had it not been detected by screening. This harm is becoming more common as screening tests become more sensitive at detecting tiny tumors. Finally, a false-negative screening test may falsely reassure an individual with subsequent clinical signs or symptoms of cancer and thereby actually delay diagnosis and effective treatment.
A 2009 publication of preliminary results of a cancer screening project in Japan using multiple whole-body screening technologies illustrates clearly the problems of false-positive screening results and potential overdiagnosis.
The project enrolled 1,217 healthy volunteers, aged 35 years and older between August 2003 and July 2004. The volunteers were employees of Hamamatsu Photonics K.K. and affiliated companies in Japan. Participants participated in a company-wide health insurance program and most received mandatory annual employee's health check-ups, including chest x-ray, fecal occult blood (FOB) testing, upper gastrointestinal series, and mammography screening for many years. Twenty applicants with a prior history of cancer were excluded, leaving 1,197 participants in the evaluation. All enrollees could be considered at low risk for screen-detected cancer.
Specific clinically relevant classifications were standardized for all test results and imaging tests received three independent readings with consensus resolution (for details refer to ). A screen was classified positive if any test was suggestive of malignancy, and in these cases the subject was referred to a local hospital for further testing or retesting at the screening center. Interval cancer events were ascertained at subsequent screenings or by interview.