Screening without evidence of efficacy

doi:10.1136/bmj.328.7435.301

BMJ 2004;328:301-302 (7 February), doi:10.1136/bmj.328.7435.301

Editorial

Screening without evidence of efficacy

Screening of unproved value should not be advocated

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

Screening has intuitive appeal. Cancer, for example, causesa quarter of all deaths, and a doctor does not diagnose manyincurable cancers without wanting some means of bringing forwardthe diagnosis. Before any screening for cancer is introduced,however, large randomised trials with mortality end points shouldbe conducted to establish and quantify any benefit. But thereis a view that there must be some gain from earlier diagnosis;awaiting trial results is a needless delay. The scientific rigourapplied to other areas of medicine may not always be appliedto screening.

Cancer of the prostate is an example. The serum concentrationof prostate specific antigen can predict mortality from prostatecancer.^1-4 There are no published randomised trials that theearlier detection improves prognosis, yet in the United Statesand Italy a third or more of healthy men aged over 50 have hadprostate specific antigen measured in the past . . . [Full text of this article]

Malcolm Law, professor of preventive medicine

Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine, London EC1M 6BQ

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Rapid Responses:

Read all Rapid Responses

Firstly, bed side assessing Oncological Terrain in all cancer screening.: Sergio Stagnaro
bmj.com, 6 Feb 2004 [Full text]
Useless or Fraud?: Ron Law
bmj.com, 6 Feb 2004 [Full text]
Thyroid ultrasound, for example: Yair Liel
bmj.com, 6 Feb 2004 [Full text]
The author omits systematic reviews: Joseph C Watine
bmj.com, 6 Feb 2004 [Full text]
It's time we stopped talking about breast self examination: Louisa Beejay
bmj.com, 6 Feb 2004 [Full text]
Screening uncertainties: of evidence, of efficacy, of decisions: Hazel Thornton
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evaluation of risk and benefit of a screening programme vs a new drug therapy: Arash Bakhtyari
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Talking testicles, but, for once, not b******ks: Keith A Hopcroft
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Prostate Cancer Hysteria: lorenzo q squarf
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PC survivor: charles brownhill
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A problem with knowledge translation: Giuseppe Giocoli
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Re: Useless or Fraud?: Ron Law
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Re: PC survivor: Tom P Marshall
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screening without evidence of efficacy: Stefano Ciatto
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The Balance Between Screening and Testing: Atef R Markos
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