Cost-effectiveness of cancer screening
Quinn, et al's assessment of the effectiveness of cervical cancer
screening(1) is an indictment of the cost effectiveness of this screening
Cervical cancer is a rare disease that was declining before the
introduction of the screening programme. Quinn, et al say that the £132
million spent each year "might have prevented 800 deaths from cervical
cancer in 1997". That is £165 000 for each death that "might have been
prevented". That money could be better spent.
In 1911 an embryologist, Dr John Beard, published his trophoblastic
theory of cancer's origins(2). This taught that cancers were similar to
pregnancy trophoblast and, in a similar way, caused the production of
human chorionic gonadotrophin (hCG), well known now as the basis of the
urinary diagnostic test for pregnancy. In the middle of the century, H H
Beard (no relation) and colleagues used this principle to detect cancers
at a very early stage with great accuracy(3).
Although these pioneers received little attention, new research by
Acevedo and co-workers at the University of Health Sciences, Pittsburg,
Pennsylvania on cancer cell lines in vitro and in vivo has confirmed their
The hCG urine test for pregnancy has a retail cost of less than £6.
It is quick and easy to use and accurate for a wide range of cancers. Its
use as a screening tool would not only save a great deal of scarce NHS
resources it would also help patients: detection of malignancies at a much
earlier stage; less anxiety due to long waiting times; a lower incidence
of false negatives and false positives; and no risk of mix-ups in tissue
samples at pathology laboratories.
I have no competeing interests
Barry A Groves
1. Quinn M, Babb P, Jones J, Allen E. Effect of screening on
incidence of and mortality from cancer of cervix in England: evaluation
based on routinely collected statistics. BMJ 1999;318:904
2. Beard J. The Enzyme Treatment of Cancer and its Scientific Basis.
Chatto & Windus, London, 1911.
3. Terrell TC, Beard HH. A biochemical test for chorionic
gonadotrophin in the urine and its value as an aid in the diagnosis of
pregnancy and malignancy. Southern Med J 1955; 49: 1352.
4. Acevedo HF, Kritchevsky A, Campbell-Acevedo EA, Galyon JC, Buffo
MJ, Hartsock RJ. Flow cytometry method for the analysis of membrane
associated chorionic gonadotrophin, its subunits, and fragments on human
cancer cells. Cancer 1992; 69: 1818-28.
5. Acevedo HF, Kritchevsky A, Campbell-Acevedo EA, Galyon JC, Buffo
MJ, Hartsock RJ. Expression of membrane-associated human chorionic
gonadotrophin, its subunits, and fragments by human cancer cells. Cancer
1992; 69: 1829-42.
6. Acevedo HF, Tong JY, Hartsock RJ. Human chorionic gonadotrophin-
beta subunit gene expression in cultured human fetal and cancer cells of
different types and origins. Cancer 1995; 76: 1467-75.
7. Acevedo HF, Hartsock RJ. Metastatic phenotype correlates with high
expression of membrane-associated complete beta-human chorionic
gonadotrophin in vivo. Cancer 1996; 78: 2388-99.
Competing interests: No competing interests