title: Public health implications of diagnostic and therapeutic strategies.
abstract: More often than not, Public Health offers the prospect of administrative, economic and political constraints, and more rarely that of progress such as fairness in health care, a better distribution of health resources, and an improvement in the quality of life. As a backcloth to this symposium on cancerology, one finds the desire for a greater concentration between the clinical medical decision, and the other decision, that taken by those responsible for the organisation of social life, and more especially of health care institutions. The clinical medical decision does indeed include the epidemiological data of the cancer, the validity of a screening examination, and the state of the therapeutic science. But does it also match the intake capacity of the health-care institutions, the qualification level of the personnel involved, the material and financial possibilities of a screening and early treatment programme? The variable nature of date from one community to another, from one population group to another, calls for a rigorous analysis of the various strategies as far as prevention is concerned. Should it be selective or systematic? The choice of a group of high-risk individuals, of a type of cancer; is or is not the result of a determination of priorities: there is no such thing as a purely technical decision. Decisions are often pluralist, sometimes contradictory. Moreover, the upheaval caused in protocols by a new diagnosis or therapy implies a flexible planning and sound appraisal models. In the event of effective screening, the prescription of a costly treatment to an increasing number of positive patients may encumber the initial estimates.
mesh_terms: D003933:Diagnosis; D011634:Public Health / Q000191:economics*; D013812:Therapeutics / Q000592:standards*