Cancer is one of the leading causes of death worldwide. While the etiology of many cancers remains unclear, existing evidence demonstrates that early diagnosis and treatment through appropriate screening can significantly reduce mortality risks and alleviate disease burden for certain cancers. Since the early 2000s, China has implemented population-based cancer screening and early diagnosis and treatment programs in several high-risk areas, achieving significant results. Nevertheless, from the perspective of evidence-based and value-based healthcare, the current evaluation framework for most cancer screening technologies is not yet fully established. There is a particular lack of sufficient and reliable localized research evidence supporting the safety, effectiveness, and health economic value of these technologies. In policy decision-making and programme implementation, adherence to the WHO-proposed ten principles of disease screening (the Wilson–Jungner criteria), which have been widely applied by most countries in the development of national cancer screening policies, remains insufficient. These gaps make it difficult for national authorities, when developing screening guidelines and implementing screening initiatives, to rely on high-level evidence to select target cancers, determine appropriate screening strategies, and optimize resource allocation. Over time, this insufficiency not only compromises the scientific credibility and authority of health policies, but also impedes the improvement of national cancer prevention and control. Therefore, there is an urgent need to establish a standardized routine evaluation framework for screening technologies, systematically conduct high-quality localized evaluation studies, and build an evidence base that reflects the characteristics of the Chinese population. Furthermore, it is crucial to facilitate the translation of findings into public health policy through multi-departmental collaboration. Ultimately, these measures will comprehensively enhance the scientific credibility and overall effectiveness of the country’s cancer prevention and control efforts.

Advances in medical technology and the roll out of the “early detection-early diagnosis-early treatment” strategy have improved cancer outcomes, yet the problem of overdiagnosis to over treatment has become increasingly salient, forming a risk chain from over diagnosis to over treatment. The typical mechanisms include the proliferation of screening and downward shifts in diagnostic thresholds, which promote more aggressive and redundant interventions. For several cancers in China, the rates and impacts of overdiagnosis are, overall, higher than international reports. Underlying causes include lagging updates to guideline thresholds and weak evidence bases, pronounced tumor heterogeneity, uneven technological development, entrenched traditional beliefs, misaligned provider-patient behaviors and incentives, and governance gaps coupled with mismatched insurance incentives. Internationally, measures such as redefining low-risk lesions, expanding active surveillance, implementing the Choosing Wisely initiative, and advancing payment reform provide useful lessons. China has launched relevant responses, but gaps remain in sustainability and conflict-of-interest management. Accordingly, we recommend building a multi-stakeholder governance ecosystem: advance dynamic guideline updates and screening optimization; leverage health big data for risk-stratified regulation; strengthen health promotion and social co-governance; deepen shared decision-making; and refine insurance and compensation reforms. Through coordinated, end-to-end and multi-dimensional action, resource allocation can be optimized while maximizing patients’ net health benefit.