Early Disease, Early Detection, Early Treatment: Some Common Threads and Some Important Problems

  • John D. Potter


This chapter attempts to summarise and comment on the preceding chapters. It begins with some thoughts on differences between prevention and treatment. It notes that we have achieved a great deal in the accumulation of empirical data on cancer but still lack a coherent overall theory. The chapter then discusses, in the light of the rest of the book, the classification of cancers into five groups, based on the likely effectiveness of screening, early detection, and subsequent treatment and prevention strategies. It then notes, again referring to the earlier chapters, the next steps that might better inform our detection of early lesions. A section on the development, testing, and use of new screening markers follows, with an emphasis, as elsewhere in the chapter, on the problem of studies that are too small. The final section is concerned with the repeated failure of chemoprevention to deliver on its promise. It notes, in particular, the very primitive approach that we take in using single agents, a practice that we abandoned decades ago in chemotherapy, because clonal selection and progression are known to result. We do not yet seem to have noticed that the same is frequently true with chemoprevention.


Mammographic Density Stomach Cancer Early Lesion Somatic Evolution Adenomatous Colorectal Polyp 
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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleUSA

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