As early as 1948, the WHO proposed the three-dimensional concept of health: health is not just about the absence of diseases and physical weakness, but about the perfect state of physical, psychological and social adaptation.

Common types of depression (Chinese author). Image source: Verywell

The causes of depression are relatively complex, involving many factors such as genetics, environment, and individuals. In different patients with depression, the proportion of each factor is completely different. However, from the results, one theory with high acceptance is that one or several neurotransmitters in brain, such as 5-hydroxytryptamine, , norepinephrine, and dopamine, transmission disorder, leads to depression. Most of the classic antidepressants in clinical practice also act on the relevant pathways of these three neurotransmitters [4].

However, clinically speaking, depression is a disease that is diagnosed and evaluated entirely based on symptoms. There is currently no good physiological and biochemical test for auxiliary diagnosis. There are many self-measurement tables for depression on the Internet, which are highly subjective and have large deviations, but the results are actually not accurate. A more accurate way is to interview, evaluate, and score patients who come to the hospital through more than two psychiatric and psychological specialists, and then make a comprehensive judgment.

Although depression is a mental and psychological disorder, its manifestations are far more than mental and psychological aspects. The main complaints of patients may involve various organs, including dizziness, headache, insomnia and fatigue, vomiting and constipation, pain in any body part , etc. This situation is called "somaticization".

Mental Health in my country

Target and Current Situation

In 2015, 173 million people in my country were affected by various mental health problems, of which 95 million patients with depression reached 95 million, and the number of patients with cancer has exceeded that of cancer. Destiny has become the second largest disease after Cardiovascular and cerebrovascular disease [5][6]. This year, multiple departments in my country jointly issued the "National Mental Health Work Plan (2015-2020)", with its overall goal being to improve the mental health prevention, treatment and rehabilitation service system that is compatible with the level of economic and social development, and basically meet the people's mental health service needs. It specifically pointed out that the treatment rate of depression should be increased by 50% on the basis of the time [7].

In 2019, the Healthy China Action Promotion Committee issued the "Healthy China Action (2019-2030)", which also emphasized that mental health is an important part of health. Society and the government should take a number of measures to correctly understand, identify and deal with common mental disorders and psychological behavior problems [8].

situation seems to be deteriorating .

A cross-sectional study published in "The Lancet Psychology" in 2019 showed that in 1993, only 1.4% of people in my country had psychological problems, while this number was 16.6% in 2015 [6]. With the rapid development of the economy and society, people's pace of life has accelerated significantly, and the psychological stress factors encountered are increasing. There are 190 million children and teenagers in school and 28 million college students in my country. For them, academic requirements are increasing, competition among the same age is getting stronger, and the student base is so large that the scale of mental health problems for minors is unimaginable.

"China National Mental Health Development Report (2019-2020)" points out that the detection rate of depression among teenagers in in is 24.6%, and severe depression is 7.4%, which means that a 40-person high school class may suffer from depression, and 3 of them are severely depressed .

A statistical survey covering nearly 1,000 people in many rural areas in my country showed that more than 70% of preschool children (3-5 years old) have various psychological problems of different degrees, including attention disorders, communication disorders, etc. [6]. This figure is not only much higher than any previous statistics, but also higher than similar studies in other countries and regions. This number is so high that not only because the survey covers a wide range of psychological problems, but also because the gap in urban and rural living education levels has increased, the mental health of preschool children in rural areas really needs to be improved urgently.

Overall, on the one hand, common mental disorders and psychological behavior problems have increased year by year, but social prejudice and discrimination are widespread, resulting in low awareness of psychological problems and low medical treatment rate; on the other hand, my country's mental health service resources are very short of and unevenly distributed, and the community rehabilitation system for mental disorders has not yet been established, and my country's mental health work still faces severe challenges.

If you want to solve the public health hazards brought by a disease, the first step is to find all the patients in the population as much as possible, that is, screening for diseases .

Screen and treatment of depression:

Foreign experience

Although depression is an ancient concept, the treatment of depression has been lackluster before the 1990s. Since there are not enough good methods and drugs to treat depression, the population of people with depression has not received widespread attention. The research and development and promotion of selective serotonin Reuptake Inhibitor (SSRI) drugs can be regarded as a milestone in the history of the development of psychotropic drugs.Compared with all other antidepressants that were already available at the time, SSRI had fewer side effects and better results, which greatly promoted the treatment of depression. When a good drug starts to be widely used, the next step is naturally to identify as much as possible all patients who can benefit from new therapies.

However, the existing depression screening scales at that time were uneven, and the operation was complicated and there was a lack of easy methods. The combination of different methods could easily lead to results that confuses doctors. Until 1999, an article published in JAMA magazine reported the "PHQ-9" scale (Patient Health Questionnaire-9, PHQ-9), allowing patients to give a subjective and rough score for their symptoms. When the total score is greater than 10 points, further professional diagnosis and treatment interventions should be considered. This study greatly increased the accuracy of depression detection, making it possible for the first time to actually operate the screening of depression. To this day, the PHQ-9 scale is still an effective screening tool for (Table 1)[9].

Table 1: PHQ-9 scale. Image source: https://m.medsci.cn/scale/show.do?id=291e1050f3

After basically solving the problem of screening methods, how to deal with screening positive people has become the second problem to be solved. A series of subsequent studies have discovered four important factors to solve this problem [10]:

has sufficient clinical evidence to support the guideline of ,

provides full education of patient groups ,

has psychiatric practitioners participating in , and

implements individualized management of . In 2002, the U.S. Preventive Services Task Force (USPSTF) began to recommend extensive screening for depression, but the premise is that there is a mature system that can provide effective treatment and follow-up to support screening. They believed that the PHQ-9 scale at that time was not good enough, and that the patient management after screening was completely lacking in experience. Nevertheless, under their advocacy, grassroots spiritual practitioners began to pay attention to screening and post-screening work [10]. There are new problems with

. Although a group of psychologists have admitted that trying to screen and manage accordingly is indeed a great thing, commercial medical insurance does not include the cost of mental and psychological treatment in the scope of compensation , blocking most people who could have consciously participated in the screening. To promote the entry of mental and mental illness into insurance, a large number of studies have begun to focus on the value of the treatment of depression to public health. For example, depression can lead to some chronic complications, indirectly increasing medical investment, and making companies spend more money to pay employees' medical insurance, etc. These studies have directly contributed to the inclusion of depression treatment.

In 2016, the U.S. Preventive Services Task Force (USPSTF) issued an announcement, summarizing the progress made in screening and diagnosis and treatment of depression over the past decade, and concluded that screening and treatment work can reduce the prevalence of depression in adults and significantly alleviate the symptoms of the diseased population.

According to different age groups, they have made several recommendations.

1. Adult (age ≥18 years old):

There is sufficient clinical evidence to show that the benefits outweigh the harm in screening and subsequent treatment of this group. There are many screening tools, and the main tools are still the PHQ series scale mentioned earlier, but the appropriate frequency of screening has not been determined. Adults with abnormal screening results in

should be evaluated by professionals to determine whether the depression is present, severity, and other comorbidities (in addition to depression, there are other mental and psychological diseases).

Patients who are finally diagnosed with depression should receive mature and systematic drug treatment and psychotherapy .

2. Teenagers (ages between 12 and 18 years old):

recommendation level is similar to that of adults. The screening tool is mainly customized form PHQ-A for adolescents (Patient Health Questionnaire for Adolescents). Considering the safety of psychotropic drugs, in terms of treatment, only fluoxetine is approved for the treatment of patients over 8 years old, and estalopram is approved for the treatment of patients aged 12-17 years old.

For adolescents with high risk factors, repeated screening of in may have some benefits.

3. Children (age ≤11 years):

For children, all existing clinical evidence is insufficient to support any recommendation.

Treatment of depression:

Division of labor and cooperation

Currently, the most commonly used clinical treatment of depression is drug treatment and psychological treatment . For 60-70% of patients, the initial drug treatment for 1-2 months will significantly relieve the symptoms. After the symptoms have completely improved, stable treatment is still required for 1-2 years or more. Follow the doctor's advice and consider reducing the dosage according to the condition. If the symptoms are the most serious, electroconvulsation treatment can be selected. The specific drug and treatment for choosing will not be discussed in detail here. The opinions of psychiatrists in regular hospitals should be followed.

In addition to this, there are some potential therapies that are still in the research stage. For example, DBS pacemaker , which can implant pulse generator into the brain, release weak current pulses, stimulate relevant nuclei in the brain, and improve depression symptoms [11]. Although most of the symptoms of depression can be relieved by using traditional drugs, they all have the characteristics of taking the medicine continuously, taking the medicine for a long time, having a large adverse reaction, and a high risk of recurrence after stopping the medicine. In the past five years, some studies have focused on the possibility of using hallucinogens to treat depression, which has certain potential to solve the problems existing in traditional drugs [12], but it is still not ruled out that there will be other side effects such as addiction.

The treatment method of depression (Chinese version of the author). Image source: Verywell

In developed countries and regions such as Europe and the United States, the division of labor for research and treatment of depression is relatively complex. Not only are there big differences between countries and regions, but the regulations of different administrative regions within a country will also be different.

Generally speaking, psychiatrist needs to obtain a doctorate in medicine from the medical school and go through a long period of junior college clinical internship. is the main force in the treatment of mental illnesses . The professional background makes them more confident in drug treatment and psychological treatment of mental and psychological diseases. Among them, the marriage and family therapist also has long-term clinical experience, but the treatment of depression will take into account spouse, family relationships, etc., so that more people can participate in the treatment process.

Psychologists get the corresponding degree from psychology major . They can not only devote themselves to scientific research in different sub-specialties in psychology, but also serve as psychological counselors, becoming an important part of psychotherapy. However, they have less clinical experience in and usually do not have the right to prescribe and cannot prescribe medicine.

The occurrence of mental and psychological diseases is closely related to the living environment, working environment, and social relationships. Some people believe that individual-based treatment is difficult to solve practical problems in a considerable number of cases and do not see the full picture of the matter. In comparison, social workers do not have a related medical professional background, but they work at the grassroots level and have a better understanding of residents' community environment and living needs. Their career positioning is to help patients establish connections with the community and provide simple and timely psychological support [13]. Overall, patients can seek more help, and different choices for different needs .

Although there are also above occupations in our country, they are small in number and have low popularity. Most people may have only watched it on news or TV, or even heard of it. When they need psychological support, they will not think of seeking help from professionals at the first time. On the other hand, this type of occupation has low income and social recognition and poor professional happiness, making it difficult to become the first choice for career choice. There is still a long way to go to establish a treatment system with clear division of labor and easy access to patients.

Depression screening:

should know everything, is it certainly good?

: No matter how extensive screening for any disease is, we cannot only consider the "treatment" itself, but should comprehensively consider the investment and return ratio of screening, the social impact of screening, and disease management after screening, etc. This is because screening itself has its drawbacks. Labeling, stigma, interpretation of results and subsequent treatment are crucial and trade-offs [14].

The first challenge to screen for depression in adolescents is how to make the next diagnosis and treatment of if abnormalities are found during the screening of .

In today's era when depression has not been completely destigmatized, privacy protection is undoubtedly extremely important. In a highly competitive environment, accompanied by the risk of information transmission not being controlled by individuals, any negative label may cause people to lose and suffer discrimination in employment, schooling, and social interactions. This is undoubtedly a worse injury for adolescents who are already in a depressed state or suffer from depression. Therefore, only by providing informed consent, standardizing the screening process, and arranging the role allocation of parents, teachers, and professionals, can we hope to optimize the screening process to a level that can be promoted .

In addition, taking psychotropic drugs is often accompanied by serious adverse reactions, such as worsening symptoms, increased risk of suicide, etc. For adolescents and younger children, there are not many clinical studies focusing on early use of psychotropic drugs, and there is still a lack of solid evidence-based medical evidence for the benefits and risks of taking medication . Therefore, more stringent verification is needed before the use of medications for this type of population is written into the diagnosis and treatment guidelines.

At the same time, all those involved in the screening must realize that screening does not mean diagnosing .

"Diagnosis" means confirming the existence of a certain disease, and "screening" is just to select individuals in the population who are most likely to suffer from this disease and conduct more accurate further examinations and "diagnosis". The diagnosis of depression is not achieved by just one or two simple scales, but requires at least one professional to conduct an objective and subjective comprehensive assessment. my country has a large population. Even if screening is realized as the "front end" of the system, further diagnosis and treatment are the "back end" of the system, sufficient medical resource reserves are still required. As of the end of 2017, there were 33,400 psychiatric practitioners (assistant) physicians in my country, and the number of psychotherapists, medical social workers, and psychological counselors has also increased year by year, but compared with the huge population base, this number is not optimistic.

Finally, screening should not be just screening . The significance of a screening is limited. Even if no problems are found in the screening, the social and human factors that can cause depression may still exist. Therefore, depression screening should also be a kind of psychological health popular science education . While testing, the seeds of "mental health is no less than physical health" can be implanted in the hearts of students and parents, so that everyone can pay attention to and be alert to the signs of depression in their studies and life, prevent problems before they occur, and cure diseases before they are sick.

outlook

We have to realize that screening may not be the ultimate solution to the problem , but just a remedial measure that has to be taken at a certain stage.

From elementary school to university, our mental health education , such as frustration education, intimate relationship education, and career development education, is as unsatisfactory as the long-lost gender education. Even in the top universities in our country, there are no compulsory psychological education courses, and only elective courses are set. For personal development, this type of course is only of high importance compared to professional education. For example, how to properly handle the psychological gaps at different academic stages? What should I do when my own thoughts conflict with my parents’ thoughts? How can I quickly get out of my depression after the first intimate relationship ends in failure? How should students who are about to graduate choose the career development path that is most suitable for them? ...Among these numerous problems, any of them may be a roadblock to mental health and a high-risk factor in inducing depression. Most adolescents (including children) have difficulty in having enough ability to deal with the above situation for the first time, nor can they seek effective help at the right time. Therefore, what is more important than screening is to prevent .

Nevertheless, we have been screening for depression by nearly 20 years later than developed countries.

In November 2021, the Ministry of Education of my country responded to the "Proposal on Further Implementing Measures for Preventing Depression in Adolescents" by National Committee of the Chinese People's Political Consultative Conference, which clearly included depression screening in the content of students' health examinations, established students' mental health records, and evaluated students' mental health status, which for the first time raised the importance of adolescent mental health to an unprecedented level [15]. However, the importance of on screening for depression is only an attitude and a starting point. The ultimate goal is to establish a comprehensive mental health system starting with adolescents and covering prevention, screening, early diagnosis and treatment. This process is not accessible to individual efforts, but requires the common attention of the entire group. The road is long and long. Before that, each of us has the responsibility to understand, help and advise.

Compared with all other antidepressants that were already available at the time, SSRI had fewer side effects and better results, which greatly promoted the treatment of depression. When a good drug starts to be widely used, the next step is naturally to identify as much as possible all patients who can benefit from new therapies.

However, the existing depression screening scales at that time were uneven, and the operation was complicated and there was a lack of easy methods. The combination of different methods could easily lead to results that confuses doctors. Until 1999, an article published in JAMA magazine reported the "PHQ-9" scale (Patient Health Questionnaire-9, PHQ-9), allowing patients to give a subjective and rough score for their symptoms. When the total score is greater than 10 points, further professional diagnosis and treatment interventions should be considered. This study greatly increased the accuracy of depression detection, making it possible for the first time to actually operate the screening of depression. To this day, the PHQ-9 scale is still an effective screening tool for (Table 1)[9].

Table 1: PHQ-9 scale. Image source: https://m.medsci.cn/scale/show.do?id=291e1050f3

After basically solving the problem of screening methods, how to deal with screening positive people has become the second problem to be solved. A series of subsequent studies have discovered four important factors to solve this problem [10]:

has sufficient clinical evidence to support the guideline of ,

provides full education of patient groups ,

has psychiatric practitioners participating in , and

implements individualized management of . In 2002, the U.S. Preventive Services Task Force (USPSTF) began to recommend extensive screening for depression, but the premise is that there is a mature system that can provide effective treatment and follow-up to support screening. They believed that the PHQ-9 scale at that time was not good enough, and that the patient management after screening was completely lacking in experience. Nevertheless, under their advocacy, grassroots spiritual practitioners began to pay attention to screening and post-screening work [10]. There are new problems with

. Although a group of psychologists have admitted that trying to screen and manage accordingly is indeed a great thing, commercial medical insurance does not include the cost of mental and psychological treatment in the scope of compensation , blocking most people who could have consciously participated in the screening. To promote the entry of mental and mental illness into insurance, a large number of studies have begun to focus on the value of the treatment of depression to public health. For example, depression can lead to some chronic complications, indirectly increasing medical investment, and making companies spend more money to pay employees' medical insurance, etc. These studies have directly contributed to the inclusion of depression treatment.

In 2016, the U.S. Preventive Services Task Force (USPSTF) issued an announcement, summarizing the progress made in screening and diagnosis and treatment of depression over the past decade, and concluded that screening and treatment work can reduce the prevalence of depression in adults and significantly alleviate the symptoms of the diseased population.

According to different age groups, they have made several recommendations.

1. Adult (age ≥18 years old):

There is sufficient clinical evidence to show that the benefits outweigh the harm in screening and subsequent treatment of this group. There are many screening tools, and the main tools are still the PHQ series scale mentioned earlier, but the appropriate frequency of screening has not been determined. Adults with abnormal screening results in

should be evaluated by professionals to determine whether the depression is present, severity, and other comorbidities (in addition to depression, there are other mental and psychological diseases).

Patients who are finally diagnosed with depression should receive mature and systematic drug treatment and psychotherapy .

2. Teenagers (ages between 12 and 18 years old):

recommendation level is similar to that of adults. The screening tool is mainly customized form PHQ-A for adolescents (Patient Health Questionnaire for Adolescents). Considering the safety of psychotropic drugs, in terms of treatment, only fluoxetine is approved for the treatment of patients over 8 years old, and estalopram is approved for the treatment of patients aged 12-17 years old.

For adolescents with high risk factors, repeated screening of in may have some benefits.

3. Children (age ≤11 years):

For children, all existing clinical evidence is insufficient to support any recommendation.

Treatment of depression:

Division of labor and cooperation

Currently, the most commonly used clinical treatment of depression is drug treatment and psychological treatment . For 60-70% of patients, the initial drug treatment for 1-2 months will significantly relieve the symptoms. After the symptoms have completely improved, stable treatment is still required for 1-2 years or more. Follow the doctor's advice and consider reducing the dosage according to the condition. If the symptoms are the most serious, electroconvulsation treatment can be selected. The specific drug and treatment for choosing will not be discussed in detail here. The opinions of psychiatrists in regular hospitals should be followed.

In addition to this, there are some potential therapies that are still in the research stage. For example, DBS pacemaker , which can implant pulse generator into the brain, release weak current pulses, stimulate relevant nuclei in the brain, and improve depression symptoms [11]. Although most of the symptoms of depression can be relieved by using traditional drugs, they all have the characteristics of taking the medicine continuously, taking the medicine for a long time, having a large adverse reaction, and a high risk of recurrence after stopping the medicine. In the past five years, some studies have focused on the possibility of using hallucinogens to treat depression, which has certain potential to solve the problems existing in traditional drugs [12], but it is still not ruled out that there will be other side effects such as addiction.

The treatment method of depression (Chinese version of the author). Image source: Verywell

In developed countries and regions such as Europe and the United States, the division of labor for research and treatment of depression is relatively complex. Not only are there big differences between countries and regions, but the regulations of different administrative regions within a country will also be different.

Generally speaking, psychiatrist needs to obtain a doctorate in medicine from the medical school and go through a long period of junior college clinical internship. is the main force in the treatment of mental illnesses . The professional background makes them more confident in drug treatment and psychological treatment of mental and psychological diseases. Among them, the marriage and family therapist also has long-term clinical experience, but the treatment of depression will take into account spouse, family relationships, etc., so that more people can participate in the treatment process.

Psychologists get the corresponding degree from psychology major . They can not only devote themselves to scientific research in different sub-specialties in psychology, but also serve as psychological counselors, becoming an important part of psychotherapy. However, they have less clinical experience in and usually do not have the right to prescribe and cannot prescribe medicine.

The occurrence of mental and psychological diseases is closely related to the living environment, working environment, and social relationships. Some people believe that individual-based treatment is difficult to solve practical problems in a considerable number of cases and do not see the full picture of the matter. In comparison, social workers do not have a related medical professional background, but they work at the grassroots level and have a better understanding of residents' community environment and living needs. Their career positioning is to help patients establish connections with the community and provide simple and timely psychological support [13]. Overall, patients can seek more help, and different choices for different needs .

Although there are also above occupations in our country, they are small in number and have low popularity. Most people may have only watched it on news or TV, or even heard of it. When they need psychological support, they will not think of seeking help from professionals at the first time. On the other hand, this type of occupation has low income and social recognition and poor professional happiness, making it difficult to become the first choice for career choice. There is still a long way to go to establish a treatment system with clear division of labor and easy access to patients.

Depression screening:

should know everything, is it certainly good?

: No matter how extensive screening for any disease is, we cannot only consider the "treatment" itself, but should comprehensively consider the investment and return ratio of screening, the social impact of screening, and disease management after screening, etc. This is because screening itself has its drawbacks. Labeling, stigma, interpretation of results and subsequent treatment are crucial and trade-offs [14].

The first challenge to screen for depression in adolescents is how to make the next diagnosis and treatment of if abnormalities are found during the screening of .

In today's era when depression has not been completely destigmatized, privacy protection is undoubtedly extremely important. In a highly competitive environment, accompanied by the risk of information transmission not being controlled by individuals, any negative label may cause people to lose and suffer discrimination in employment, schooling, and social interactions. This is undoubtedly a worse injury for adolescents who are already in a depressed state or suffer from depression. Therefore, only by providing informed consent, standardizing the screening process, and arranging the role allocation of parents, teachers, and professionals, can we hope to optimize the screening process to a level that can be promoted .

In addition, taking psychotropic drugs is often accompanied by serious adverse reactions, such as worsening symptoms, increased risk of suicide, etc. For adolescents and younger children, there are not many clinical studies focusing on early use of psychotropic drugs, and there is still a lack of solid evidence-based medical evidence for the benefits and risks of taking medication . Therefore, more stringent verification is needed before the use of medications for this type of population is written into the diagnosis and treatment guidelines.

At the same time, all those involved in the screening must realize that screening does not mean diagnosing .

"Diagnosis" means confirming the existence of a certain disease, and "screening" is just to select individuals in the population who are most likely to suffer from this disease and conduct more accurate further examinations and "diagnosis". The diagnosis of depression is not achieved by just one or two simple scales, but requires at least one professional to conduct an objective and subjective comprehensive assessment. my country has a large population. Even if screening is realized as the "front end" of the system, further diagnosis and treatment are the "back end" of the system, sufficient medical resource reserves are still required. As of the end of 2017, there were 33,400 psychiatric practitioners (assistant) physicians in my country, and the number of psychotherapists, medical social workers, and psychological counselors has also increased year by year, but compared with the huge population base, this number is not optimistic.

Finally, screening should not be just screening . The significance of a screening is limited. Even if no problems are found in the screening, the social and human factors that can cause depression may still exist. Therefore, depression screening should also be a kind of psychological health popular science education . While testing, the seeds of "mental health is no less than physical health" can be implanted in the hearts of students and parents, so that everyone can pay attention to and be alert to the signs of depression in their studies and life, prevent problems before they occur, and cure diseases before they are sick.

outlook

We have to realize that screening may not be the ultimate solution to the problem , but just a remedial measure that has to be taken at a certain stage.

From elementary school to university, our mental health education , such as frustration education, intimate relationship education, and career development education, is as unsatisfactory as the long-lost gender education. Even in the top universities in our country, there are no compulsory psychological education courses, and only elective courses are set. For personal development, this type of course is only of high importance compared to professional education. For example, how to properly handle the psychological gaps at different academic stages? What should I do when my own thoughts conflict with my parents’ thoughts? How can I quickly get out of my depression after the first intimate relationship ends in failure? How should students who are about to graduate choose the career development path that is most suitable for them? ...Among these numerous problems, any of them may be a roadblock to mental health and a high-risk factor in inducing depression. Most adolescents (including children) have difficulty in having enough ability to deal with the above situation for the first time, nor can they seek effective help at the right time. Therefore, what is more important than screening is to prevent .

Nevertheless, we have been screening for depression by nearly 20 years later than developed countries.

In November 2021, the Ministry of Education of my country responded to the "Proposal on Further Implementing Measures for Preventing Depression in Adolescents" by National Committee of the Chinese People's Political Consultative Conference, which clearly included depression screening in the content of students' health examinations, established students' mental health records, and evaluated students' mental health status, which for the first time raised the importance of adolescent mental health to an unprecedented level [15]. However, the importance of on screening for depression is only an attitude and a starting point. The ultimate goal is to establish a comprehensive mental health system starting with adolescents and covering prevention, screening, early diagnosis and treatment. This process is not accessible to individual efforts, but requires the common attention of the entire group. The road is long and long. Before that, each of us has the responsibility to understand, help and advise.