Early Detection of Cancer in Primary Care in Less-developed Countries

arly detection is an important approach for controlling cancers for which an effective treatment is available. For cancers such as breast, uterine cervix, ovary, head and neck and colorectum, early detection and appropriate treatment contribute to significant improvement in survival and good quality of life. There is wide variation in the proportion of cancer patients presenting in early clinical stages that permit successful treatment and avoid death from cancer. Unfortunately, a significant proportion of patients with these cancers present in advanced stages in lessdeveloped countries and thus have poor prospects of longterm survival as compared to the scenario in developed countries (Table 1). Cancer early detection approaches include screening programs, early clinical diagnosis and a high level of awareness among the general public and health professionals in addition to well-developed and accessible health services supported with adequate infrastructure and trained human resources. Developing and implementing national cancer control programmes as advocated by the World Health Organization provides an effective and pragmatic framework to develop early detection, treatment and follow-up care services as a continuum in less developed countries. Organized screening programmes aim to detect predominantly preclinical invasive cancers (e.g. breast cancer screening) or precancerous lesions (e.g. cervix cancer screening) in systematically invited asymptomatic subjects in the general population. Given the level of resources required, cancer screening programmes are not feasible in the vast majority of less-developed countries. A more widely applicable early detection approach relies on early clinical diagnosis among people with symptoms and signs. This requires improved awareness among the public of the disease, its symptoms and signs and on the health services available to support diagnosis and treatment in the region; it requires welltrained and empowered health care personnel in primary care who can promptly recognize and refer people with suspected signs and symptoms for early diagnosis or to rule out disease in higher levels of health services. We briefly discuss what is pragmatically feasible and what skills are required at the primary health care level to enhance early detection, referral and prevention of cervix and breast cancer in this publication EARLY DETECTION OF CANCER IN PRIMARY CARE IN LESS-DEVELOPED COUNTRIES