Screening Is a Process

While screening trials fund teams of specially trained individuals to ensure that recruitment, screening, and follow-up occur, these resources do not exist in daily clinical practice.12 In primary care practice, a number of organizations, institutions, and individuals must share responsibility for making sure that the entire screening process occurs. The number and complexity of steps in the screening process may lead to confusion or breakdowns in communication.12 These breakdowns may result in failure to follow up on a positive test or to treat diagnosed cancer.13,154,155 Factors outside the doctor-patient relationship, such as healthcare insurance and the clinical setting itself, influence individual propensity to seek screening and the likelihood that the screening process will be complete.12 This section summarizes some of what has been learned about the five major phases of the screening process: (1) identifying and understanding the population at risk; (2) identifying the method of recruitment; (3) clarifying the screening approach; (4) developing the follow-up approach; and (5) referring patients for treatment.

Identifying and Understanding the Population at Risk

The populations that should be screened for specific cancers are now easily identifiable from a strictly demographic

TABLE 24.8. Evidence for the efficacy of prostate cancer screening.
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