Time to abandon early detection cancer screening

Ever since 1971, when the US President signed the “War on Cancer” National Cancer Act, screening has been a hallmark in cancer control. The fundamental idea was that more cancers would be cured if they were detected and treated before symptoms arise. During the following decades, astronomic amounts of money and great hopes were invested to implement population‐based screening programs. Over time, prioritization of cancer screening has hardly declined. The expectation of success has rather increased and, for example, the attendance to mammography screening for early detection of breast cancer has indeed been used as a quality indicator of the health care system. Aggressive efforts to diagnose pre‐symptomatic cancer becomes an attractive resort to accelerate the reduction in cancer mortality. Until relatively recently, this remained an elusive goal. Currently, declines in cancer mortality have been documented for several cancers. However, the lion's share for this improvement seems to have been due to therapeutic advances rather than screening. Nevertheless, several investigators continue to argue that screening has made a substantial contribution to this improvement for breast cancer and others claim that reducing screening intensity for prostate cancer can be detrimental. Clearly, such screening efforts continue to have strong supporters. Moreover, the advent of new biomarkers, for example genetic or epigenetic test panels rekindle wider interest in screening for cancer control. Many biotech companies and start‐ups are fiercely building a case for the adoption of new methods of massive testing for screening purposes. Screening has remained enthusiastically recommended by health care providers as an indicator of commitment, progress and success. The value of early detection of cancer by screening has an intuitive appeal both to medical practitioners and the general population. Promotion of population‐based cancer screening remains a key activity for many cancer societies and charities. Many patient organizations—dominated by cancer survivors many of whom are convinced that screening saved their lives— have become powerful advocates. A cadre of scholars have based their scientific careers on theoretical and empirical studies of cancer screening. And an even larger community of health care providers make their living on screening, diagnostic workup, treatment and surveillance of cancer patients. Screening is big business: more screening means more patients, more clinical revenue to diagnostic and clinical departments, and more survivors in need of care and follow‐up. Critics are met with fierce opposition and not much changes. We believe, however, that a major, radical change is urgently needed after more than four decades of enormous investments and failing expectations.