Stratified Cancer Screening: The Practicalities of ImplementationDent T. · Jbilou J. · Rafi I. · Segnan N. · Törnberg S. · Chowdhury S. · Hall A. · Lyratzopoulos G. · Eeles R. · Eccles D. · Hallowell N. · Pashayan N. · Pharoah P. · Burton H.
aPHG Foundation, and Departments of bPublic Health and Primary Care and cOncology, University of Cambridge, Cambridge, dDepartment of Community Healthcare Sciences, St George's, University of London, London, eUniversity of Southampton and Wessex Regional Genetics Service, Princess Anne Hospital, Southampton, fCentre of Applied Health Research, University College London, London, and gDivision of Cancer Genetics and Epidemiology, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, UK; hDepartment of Community Health, Université de Sherbrooke, Medical Training Centre of New Brunswick, Moncton, N.B., Canada; iDepartment of Cancer Screening and Unit of Cancer Epidemiology, CPO Piemonte and S. Giovanni University Hospital, Torino, Italy; jDepartment of Screening, Regional Cancer Centre, Karolinska University Hospital, Stockholm, Sweden
Background: Improving understanding of the genetic basis of disease susceptibility enables us to estimate individuals' risk of developing cancer and offer them disease prevention, including screening, stratified to reflect that risk. Little attention has so far been given to the implementation of stratified screening. This article reviews the issues that would arise in delivering such tailored approaches to prevention in practice. Results: Issues analysed include the organisational context within which implementation of stratified prevention would occur, how the offer of screening would be made, making sure consent is adequately informed, how individuals' risk would be assessed, the age at which risk estimation should occur, and the potential use of genetic data for other purposes. The review also considers how management might differ depending on individuals' risk, how their results would be communicated and their follow-up arranged, and the different issues raised by modification of an existing screening programme, such as that for breast cancer, and the establishment of a new one, for example for prostate cancer. Conclusion: Stratified screening based on genetic testing is a radically new approach to prevention. Various organisational issues would need to be considered before it could be introduced, and a number of questions require further research.