When it comes to the raw data, the IARC report concludes that lung, colorectal, breast and stomach cancers are the top four killers. Lung cancer remains the biggest killer, with an estimated 334,800 deaths in 2006 (19.7% of the total number of deaths from cancer), followed by colorectal cancer (207,400 deaths), breast cancer (131,900 deaths) and stomach cancer (118,200 deaths). Since the previous estimates for 2004, breast cancer has overtaken lung cancer as the commonest cancer to be diagnosed overall, with 429,900 new cases in 2006 (13.5% of all cancer cases). It was followed by colorectal cancer (412,900 cases, 12.9%) and lung cancer (386,300 cases, 12.1%).

So much for the headline numbers confronting European governments and clinicians at the sharp end. Looking ahead, though, the IARC also highlights proactive measures designed to yield reductions in the incidence and mortality from various forms of cancer. Not surprisingly, tobacco control and dietary/lifestyle modification feature prominently. Another recurring theme is the case for more and better structured cancer-screening programmes. "Screening for colorectal cancer has been shown to be effective, and clearly there is a need for organized colorectal cancer screening programmes throughout Europe," notes IARC director Peter Boyle in a supporting press statement on the study. Furthermore, if efficient national cervical-cancer screening programmes were in place, says Boyle, "the number of years of life lost [to uterine cancer] could be reduced in women living in Central and Eastern European countries".

Politics and technology

Screening cannot prevent cancer, of course, only identify it early in asymptomatic people. Deconstruct it and the incentives are readily apparent: screening saves lives and also saves money at local and national level (it generally being cheaper to pick up and treat cancer early than to leave it and treat at a more advanced stage). Reality, however, is more complex than that. For starters, national screening programmes don't come cheap – both in terms of upfront capital investment and annual operational spend. Consequently, implementation is more often than not dependent on the alignment of political will versus fiscal prioritization versus the infrastructure (or absence of it) necessary to deliver such services.

At a more fundamental level, though, reliable cancer screening hinges on the development and introduction of compelling diagnostic technologies that lend themselves to volume roll-out. In terms of "must-haves", a good screening test should be both cost-effective and scalable. It must also minimize false-negative and false-positive results, be straightforward to perform, and not unpleasant or dangerous for the patient. On all of these counts, the biomedical research community of university scientists, industry engineers and their clinical counterparts have a pivotal role to play. What's encouraging is that even a cursory look through medicalphysicsweb's recent coverage indicates that the technology push on new and improved tools for cancer screening is proceeding apace. For example:

• Researchers at the Mayo Clinic (Rochester, MN) have teamed up with Gamma Medica-Ideas (Northridge, CA) and GE Healthcare of the UK to develop a gamma-camera technology for detecting breast tumours as small as 5 mm in diameter. The investigators claim their technology, called molecular breast imaging, should provide a "valuable complementary imaging technique" to mammography. See Molecular breast imaging sees tiny tumours.

• Belgian company AMD has developed a computer-aided diagnostic system called HistoScanning to analyse 3D ultrasound scans and distinguish between benign and malignant tumours quickly and non-invasively. According to results from a multicentre trial presented at the recent RSNA annual meeting in Chicago, IL, when used to examine ovarian cancers, it gets the diagnosis right more often than any other system. See Ovarian cancer: diagnosis by numbers.

• Given Imaging of Israel has initiated a collaborative project to enhance its PillCam video capsules with molecular diagnostics capabilities. The goal: to develop an integrated imaging-biosensing system that can screen for early cancer of the gastrointestinal tract. See Biosensors add impact to GI imaging.

• Medical technology company SpectRx (Norcross, GA) is developing a non-invasive optical test for detecting cervical cancers and precancers. The device, known as LightTouch, uses hyperspectral imaging spectroscopy to identify any early signs of cancer. Results of a recent study indicate that the technique could reduce unnecessary biopsies by 55% while accurately detecting disease. See Non-invasive test reduces need for biopsies.

What links these projects, and others like them, is the fact that they're seeking to benchmark potentially disruptive innovations via a process of rigorous clinical trial. Ultimately, if those evaluations shape up at the national/international level in studies involving thousands of patients, there's a pretty sound starting-point for evidence-based public-health measures such as cancer screening. If that turns into increased upward pressure on policy-makers to implement relevant and effective cancer-screening programmes, then that can only be for the better.