Cancer screening guidelines and policy making: 15 years of experience in cancer screening guideline development in Japan.

Cancer deaths have remained a heavy burden in Japan, thus cancer screening has been anticipated to be a practical strategy for reducing mortality from cancers. The Basic Plan to Promote Cancer Control Program published in 2006 stated that evidence-based cancer screening is required. At the conception of national cancer screening programs, there were no cancer screening assessments. From 1998 to 2001, Hisamichi formed committees for the assessment of cancer screening and published three reports. These reports were the cornerstone in assessing primary studies of cancer screening in Japan which served as a stimulus for the development of cancer screening guidelines. Since 2003, research groups funded by the National Cancer Center have developed cancer screening guidelines based on established methods in reference to international standards. Screening guidelines for the following cancers have been published: gastric, colorectal, lung, prostate, cervical and breast cancers. Recommendations for screening are made following assessment of the balance of benefits and harms. The recommendation has been divided for population-based screening and opportunistic screening. New screening techniques with insufficient evidence have been suggested to further undergo research. The national committee has continued to appraise their evidence for cancer screening based on established guidelines and has discussed implementation problems. The screening methods for breast and gastric cancers have been revised based on cancer screening guidelines. Cancer screening guidelines have increasingly contributed to the promotion of evidence-based cancer screening for national programs. To provide appropriate cancer screening evidence, additional studies to further improve the methodology for guideline development are warranted.