Cancer screening is an effective strategy for reducing cancer mortality, but in resource-constrained settings the key challenge is not simply whether screening works but how its implementation should be prioritized. We propose a framework for prioritizing cancer screening under resource constraints, summarized in three ‘not all’ principles: not all cancers are suitable for screening; not all individuals need screening; and not all high-performance technologies are appropriate for population screening.
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References
Chen, R. et al. Effectiveness of one-time endoscopic screening programme in prevention of upper gastrointestinal cancer in China: a multicentre population-based cohort study. Gut. 70, 251–260 (2021).
Li, M. et al. Mapping overdiagnosis of thyroid cancer in China. Lancet Diabetes Endocrinol. 9, 330–332 (2021).
LoPiccolo, J., Gusev, A., Christiani, D. C. & Jänne, P. A. Lung cancer in patients who have never smoked — an emerging disease. Nat. Rev. Clin. Oncol. 21, 121–146 (2024).
Gao, W., Wen, C. P., Wu, A. & Welch, H. G. Association of computed tomographic screening promotion with lung cancer overdiagnosis among Asian women. JAMA Intern. Med. 182, 283–290 (2022).
Chen, Z. et al. Summary of the 2024 report on gastroenterology and digestive endoscopy in China. Chin. Med. J. 138, 2693–2701 (2025).
Zhu, X. et al. Development, validation, and evaluation of a risk assessment tool for personalized screening of gastric cancer in Chinese populations. BMC Med. 21, 159 (2023).
Dong, X. et al. Combining fecal immunochemical testing and questionnaire-based risk assessment in selecting participants for colonoscopy screening in the Chinese National Colorectal Cancer Screening Programs: a population-based cohort study. PLoS Med. 21, e1004340 (2024).
Castle, P. E. & Katki, H. A. Screening: a risk-based framework to decide who benefits from screening. Nat. Rev. Clin. Oncol. 13, 531–532 (2016).
Wang, S. et al. Cervical cancer screening via visual inspection with acetic acid and Lugol iodine for triage of HPV-positive women. JAMA Netw. Open 7, e244090 (2024).
Xie, J. et al. The impact of adherence on colorectal cancer screening cost-effectiveness: a modeling study. PLoS Med. 22, e1004807 (2025).
Acknowledgements
This work is supported by the Noncommunicable Chronic Diseases-National Science and Technology Major Project (2024ZD0520000, 2024ZD0520001) and the National Natural Science Foundation of China (grant number: 82404340).
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Dong, X., Wang, Y. & Li, N. A prioritization framework for large-scale cancer screening under resource constraints: three ‘not all’ principles. Nat Rev Clin Oncol (2026). https://doi.org/10.1038/s41571-026-01144-z
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DOI: https://doi.org/10.1038/s41571-026-01144-z
