By Sana Al Sukhun, MD, MSc, President of Jordan Oncology Society. Early detection has become the motto of public health campaigns all over the world. Not only does it reduce the burden of disease by reducing morbidity (complications of both disease and treatment), but also by reducing associated mortality. This is true for all kinds of diseases, consider diabetes, hypertension, and even acute illnesses as in the case of pneumonia e.g., however, that impact is still questionable by many when it comes to malignancies. Therefore, delivering early detection requires proper delivery of both the concept and methodology as dictated by the unique characteristic of the targeted community.

Delivering the concept may sound simple, but can be challenged by cultural beliefs and practices, particularly in settings where misconceptions about diagnosis and treatment; stigma of cancer diagnosis; and social inequities can lead individuals to delay care or to avoid seeking help altogether. After all, you cannot change what you refuse to confront. Raising awareness among both the public and health care professionals about signs and symptoms of cancer is not enough. More important is the emphasis on the impact of early detection on making therapy simpler and more effective. Just as important is highlighting the positive impact of modern therapeutic approaches on treatment of more advanced stages, turning some cases into chronic illnesses, e.g. breast cancer or lymphoma. The latter is important when considering that signs and symptoms could help early detection in the case of some cancers, e.g. breast cancer, colorectal cancer, and cervical cancer, but not necessarily other common and fatal cancers, e.g. lung cancer often detected at advanced stage.

Delivering the methodology - screening- is another challenge. Screening requires expertise and equipment to test healthy populations to identify those who have the disease but no symptoms yet. Both components are limiting factors for the success of screening programs, representing economic challenges particularly when resources are limited. Many low-resource settings face a critical shortage of trained health professionals, a key barrier to the delivery of quality diagnosis and early detection. Investing in a skilled workforce to deliver early detection and screening is a priority, more so than having sophisticated equipment. Equipment is important (e.g. mammography) but not only is it costly, it is also dependent on the availability of expert personnel to interpret findings and follow up on those results. A clear example is illustrated by the Canadian trial demonstrating the equivalent survival for women screened by mammography regularly when compared to women screened whenever their expert nurse examination dictated a mammographic evaluation¹. In Jordan, a combination of all of the above- awareness campaigns, training general practitioners, and more, yet limited use of mammography- contributed to doubling in the proportion of women diagnosed with early stage breast cancer, 56% of newly diagnosed cases annually².

Successful delivery of early detection requires a multidisciplinary approach and cooperation between the public, health professionals and policy makers. No matter how limiting resources are in a setting, delivering the concept and training local personnel are achievable steps on the road to this mission success.

Sana Al Sukhun, MD, MSc, is President of the Jordan Oncology Society, a Consultant in Medical Oncology and Hematology in private practice, and Assistant Professor of Medicine at the Department of Hematology/ Oncology in the Faculty of Medicine at the University of Jordan.

References

1. Miller AB et al, Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomized screening trial. BMJ. 2014 Feb 11;348:g366.
2. http://www.moh.gov.jo/MOH/Files/Publication/Annual%20Incidence% 20of%20cancer%20in%20Jordan%202010_1.pdf.