Early detection of cancer. Psychologic and social dimensions.

Major strides in early detection research can be attributed to social and behavioral research. Social scientists have been involved in research determining the epidemiologic basis of and the cost-effectiveness of screening for asymptomatic disease. The availability of well accepted screening tests has been a barrier to early detection research, especially in the area of men's health. Early detection research has focused on the individual and system levels. Theoretical models are being adapted for early detection from smoking research and are a strength of current work. These models explain why people participate in early detection and how behavior change can occur. In studying system barriers to early detection, intervention efforts have been focused in the community and in the medical care delivery system. Methodologic issues are beginning to emerge, including measuring of program outcomes, and the appropriate research designs for community studies. Except for immigrant populations, initial screening rates are high, and the periodicity of screening becomes the outcome of choice. Some of these problems are the direct result of the success of research and public education efforts to increase cancer screening. The following are priorities for the next decade: theory driven research on behavior change and on interventions; the social determinants of physicians' participation in screening; process evaluation to relate community efforts to outcomes; and reductions in the stage at which cancer is diagnosed as an outcome measure.