A Piece of My Mind |

Making the Call

H. Gilbert Welch, MD, MPH
JAMA. 2011;306(24):2649-2650. doi:10.1001/jama.2011.1898.
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A recommendation against PSA screening?1 I’ve been raising questions about the value of cancer screening for more than a decade,2 yet I’ve never recommended against it. But then again, I’ve never recommended for screening either. I guess that's why I’m not a member of the US Preventive Services Task Force.

As you can probably tell, I am a fence-sitter (and, by the end of this essay, maybe even a flip-flopper). While I believe that media campaigns, advocacy groups, and physicians have systematically exaggerated the benefits of cancer screening and have downplayed—or, worse, ignored—its harms, I also believe that both benefits and harms exist. And no matter how well researchers can quantify this trade-off (and there is much room for improvement here), the metrics are different: small changes in cancer-specific mortality vs a boatload of hassle factors and fear, some unnecessary treatment, some resulting complications, and even a very few deaths (that can be missed in the measurement of cancer-specific mortality3).


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