Advantages and disadvantages of population screening for cancer and surveillance of at-risk groups

Despite improvements in diagnostic and therapeutic modalities, the prognosi s of patients with gastrointestinal malignancies has remained poor. In esse nce, this poor outcome is related to the majority of patients presenting at an already advanced stage of disease at the time of diagnosis. Unfortunate ly, however, mass screening and surveillance programmes aimed at early dete ction and treatment in the population at large are in most countries consid ered to be cost-ineffective. Moreover, even with regard to established risk groups, there is considerable debate over whether current surveillance str ategies are beneficial to these patients in terms of a reduction in cancer- related mortality. This; chapter addresses various aspects of screening and surveillance. In the first part, general issues are discussed, whereas the second part focuses particularly on disease entities frequently encountere d in gastrointestinal practice.