According to the International Agency for Research on Cancer (IARC), in 2030 cancer will be the leading cause of death worldwide and the number of cases will increase to 21.6 million. Thus, it is estimated that, in Spain, one in two men, and one in three women, will be diagnosed with cancer throughout their lives.
However, preventing new cases of cancer and, therefore, increasing life expectancy, is also possible thanks to health promotion strategies (primary prevention) and early detection (secondary prevention).
In fact, it is estimated that between 30 and 50% of cancer cases can be avoided by following these prevention methods . This includes both the acquisition of healthier lifestyle habits and the correct implementation and participation in screening programs for the population at risk.
On the other hand, according to the study ‘The economic and social impact of cancer in Spain’ , prepared by Oliver Wyman for the Spanish Association Against Cancer, early detection and prevention of healthy lifestyle habits could reduce the total costs of cancer in around 9,000 million euros.
As we said, early detection, through screening programs, is one of the fundamental pillars for cancer control. Cancer screening programs consist of carrying out diagnostic tests on people, who are initially healthy, but who are in a risk group, to detect precancerous lesions, and thus try to improve their prognosis.
They have shown benefits, both in the decrease in the number of cases and in mortality, mainly in breast, colon and cervical cancer, for which there are population-based screenings. That is to say, organized by the health system – unlike opportunistic screening, at the request of the interested party. In the case of lung cancer, evidence is starting to be obtained along the same lines.
The breast cancer is the most common tumor in women worldwide and is particularly prevalent in women aged between 45 and 65 years.
In Spain, there has been early detection of breast carcinoma since 1990, but it was in 2005 when it was implemented throughout the country, following European guidelines.
The recommendation for the breast program is to have a mammogram every two years for women aged between 50 and 69 years . However, in some regions screening begins at age 45. Currently, the coverage of the screening program for breast cancer in our country is 89.13%, according to the study ‘The economic and social impact of cancer in Spain’.
It has been shown that, thanks to breast cancer screening , mortality from this disease has decreased significantly , at least when performed at the age of greatest incidence (above 50 years).
On average, metastatic breast cancer is estimated to cost almost 4 times more than locally detected cancer . The costs of metastatic breast cancer can exceed 200,000 euros per patient.
The colorectal cancer is the second leading cause of cancer death, and is the highest number of recorded cases if we consider both sexes. But it is also one of the easiest to deal with early diagnosis. Currently, there are two early detection tests: the fecal occult blood test (TSOH) and colonoscopy .
The recommendation for the colon screening program is to carry out a biennial fecal occult blood test in men and women aged 50 to 69.
It is a very simple test carried out by the person at home. The goal is to detect whether or not there is blood in the stool. If the test result is positive , the study is completed with a colonoscopy to visualize the origin of the bleeding and to prevent the development of malignant tumors and / or the detection of the tumor in early stages.
In recent years, important advances have been made for the implementation of this screening test in Spain. Currently, the coverage of the colon cancer screening program is 66%, according to the study ‘The economic and social impact of cancer in Spain’.
Colon cancer is estimated to be overcome in 90% of cases when detected early . Thus, a study carried out in the Basque Country – one of the first communities to implement the program in 2009 – has shown an increase in 5-year survival of 23.4% in people who participated versus those who did not done. As key data to achieve this percentage, this study points out, is to achieve a high participation of the population at risk.
Colon cancer population screening programs, in addition to saving suffering and saving lives, are capable of saving costs to the public health system. Thus, according to the study carried out by Oliver Wyman for the Spanish Association Against Cancer, a metastatic colon cancer costs 3 times more than a cancer detected in the local stage. The costs of metastatic colon cancer exceed 150,000 euros per patient.
Cervical cancer (CCU) is the third most frequent neoplasm in the world in women.
Until now, cervical cancer screening in our country has been opportunistic, however, as of July 1, 2019, the autonomous regions have the obligation to implement population-based screening for cervical cancer within a maximum period of five years.
The new recommendation is to expressly invite by letter all women between the ages of 25 and 65 to undergo the appropriate tests. Specifically, in the population aged 25 to 34 years, cytologies will be performed every three years, and those between the ages of 35 and 65 will undergo a test to detect the high-risk human papilloma virus . In this case, if the result is negative, it will be repeated after 5 years, and if it is positive, a cytology will be done.
The screening of healthy women by cervical cytology has clearly demonstrated its effectiveness, since its application in an appropriate and systematic way in certain countries has managed to reduce by 70-80% the incidence and mortality from cervical cancer. This benefit is due to the detection of asymptomatic premalignant lesions, the diagnosis and treatment of which prevents their progression to invasive carcinoma.
For some time, early detection of lung cancer with low-dose tomography has been proving effective in reducing mortality in specific high-risk groups.
While mortality is declining in most cancers, lung cancer continues to increase worldwide, especially among women. Also, most lung cancers are diagnosed at an advanced stage ; making it difficult to diagnose and treat the disease.
Therefore, as more results are obtained, it could become a key national screening program in cancer prevention , along with effective strategies for the prevention of smoking (main risk factor).
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