The work of the last five years has pointed up a number of areas of research needs and opportunities within a programme whose general aim is research on cancer screening and aetiology. First, it is clear that population service screening for breast cancer is dynamic, in terms of both the technical aspects of the screening process and the population served. For example there is a need to estimate the effect of the coming expansion of the age range for the UK mammography programme. There is also a need to provide rapid evaluation of innovative technologies for dealing with radiologically dense breast tissue, such as automated ultrasound and digital mammography.
Another observation in recent years is the large number of cancers diagnosed at an early stage, partly due to screening, partly to prompt referral and diagnosis, and partly due to improved public awareness. There is a need to develop therapeutic protocols which safely deliver a favourable clinical outcome, while avoiding (in so far as is possible) overtreatment of these tumours. For example, it has been observed that mammography screening may be increasing rates of radiotherapy as a result of more breast cancers treated with wide local excision.
A related subject is the less common phenomenon of screen-detection of tumours which are already advanced despite being asymptomatic. There is a need to derive clues from aetiological and natural history studies as to how to avoid this outcome in the future.
Other issues which need to be addressed include the highly topical and controversial question of the efficacy of spiral CT screening for lung cancer, and appropriate endoscopic regimes for those who have had adenomas removed from the large bowel. Finally, a number of aetiological and epidemiological issues urgently require investigation to assist in design and analysis of new primary and secondary prevention strategies. Of particular interest is breast density’s role in risk of, and prevention of, breast cancer, accurate delineation of lung cancer risk for selection of appropriate populations for screening and prevention interventions, and the epidemiology, biology and prognosis of breast cancer in certain ethnic groups.
Areas of research are:
- Continued evaluation of service screening for breast cancer, with particular focus on age subgroups, and evaluation of new technologies.
- Treatment and natural history of early stage and screen-detected cancers.
- Screening for lung cancer, surveillance for colorectal abnormalities, and prevention of colorectal cancer.
- Studies of aetiology, biology and natural history to inform primary or secondary prevention strategies.