BMJ 2003;326:53 ( 4 January )

Letters

Screening populations at low risk carries high risks

The first 150 words of the full text of this article appear below.

EDITOR---In their key points Lu-Yao et al say that the lack of association between more intensive screening and treatment and lower mortality from prostate cancer means that trials should continue to settle this question.1 More research is the classic conclusion of all studies, but is it true?

Firstly, trials cannot be used to prove that something does not work. That is unethical; there has to be at least a sound presumption that screening will be effective.2 It is also futile, as newer screening tests will replace the older ones. The clamour for more testing will only increase.

Secondly, even if screening were effective, could it ever be efficient? The risk of any specific cancer is very low. The absolute risk of death from prostate cancer before the age of 75 was 1.33% in the Netherlands.3 If we assume a risk reduction of 25% (which would be high), the absolute . . . [Full text of this article]
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Relevant Article

Natural experiment examining impact of aggressive screening and treatment on prostate cancer mortality in two fixed cohorts from Seattle area and Connecticut
Grace Lu-Yao, Peter C Albertsen, Janet L Stanford, Therese A Stukel, Elizabeth S Walker-Corkery, and Michael J Barry
BMJ 2002 325: 740. [Abstract] [Full Text] [PDF]

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