10 Chapter 1 Cancer is a heterogenic group of diseases characterized by uncontrolled growth of abnormal cells with the potential to invade surrounding tissue or spread throughout the body.1 Each type has its own causes, symptoms, and specific treatment.2 Worldwide, cancer is a major and growing health problem, and one of the leading causes of death.3 The increase of cancer cases can be largely attributed to the aging and growing population, as well as to current and persisting lifestyle habits.4 Recent numbers show that worldwide one in five men (20%), and one in six women (17%) will get cancer at some point in their lives. Approximately one in eight men (13%), and one in 11 women (9%) who develop cancer, will also die as a result of the disease.5 Many people around the world will thus encounter cancer (directly or indirectly). According to the World Health Organization (WHO) between 30% and 50% of the cancer cases can be avoided through the effective implementation of prevention strategies.6 Currently in the Netherlands, more than 120,000 people are diagnosed with cancer each year (incidence) and about 600,000 people live with a cancer diagnosis (prevalence).7, 8 Since both the incidence and prevalence are expected to further increase in the upcoming years, it is not surprising that cancer also plays an important role in primary care, and in general practice (GP)- practices.9, 10 Not only are GPs involved in recognising early symptoms and diagnosing the disease, they are also involved in the guidance of cancer patients during and after treatment. The Dutch College of General Practitioners (NHG; Nederlands Huisartsen Genootschap) stated that GPs have an increasingly important role to ensure continuous and person-centred care with respect to the care for cancer patients.11 Per standard practice (around 2500 patients) a GP is encountered by an average of 25 new adult patients with (different types of) cancer per year, which equals one new patient per two weeks.12 During the course of their disease, these patients require substantial high levels of care and support. The future increase of patients will therefore also lead to a further increase of the cancer related activities for GPs and GPpractices. Cancer screening Since cancer requires time to develop, cancer screening can be used as an important tool for reducing the cancer related burden and mortality worldwide. Cancer screening aims to detect a specific cancer in an early or precursor stage, when symptoms are minimal, chances of recovery are highest, and less intense treatment options with fewer side effects are often available. Therefore, most developed countries have established some form of cancer screening. In Europe and other Western-countries, screening is most often offered in the context of a population-based cancer screening programme (CSP).13 As cancer is a heterogenic disease, not all types of cancer are suitable for screening. Already
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