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The Medical Literature |

Users' Guides to the Medical Literature:  XVII. How to Use Guidelines and Recommendations About Screening

Alexandra Barratt, MBBS, MPH, PhD; Les Irwig, MBBCh, PhD; Paul Glasziou, MBBS, PhD; Robert G. Cumming, MBBS, MPH, PhD; Angela Raffle, BSc (Hons), MBChB; Nicholas Hicks, MA, BMBCh; J. A. Muir Gray, CBE, MD; Gordon H. Guyatt, MD, MSc; for the Evidence-Based Medicine Working Group
JAMA. 1999;281(21):2029-2034. doi:10.1001/jama.281.21.2029.
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Figures

Figure 1. Designs for Randomized Controlled Trials of Screening
Graphic Jump Location
Left, A randomized controlled trial can assess the entire screening process, in which case participants are randomized to be screened (and treated) or not screened. Right, Alternatively, everyone can participate in the screening, and those with positive results are randomized to be treated or not treated.
Figure 2. Flow Diagram of the Clinical Consequences for 1000 People Entering a Program of Annual Fecal Occult Blood Test (FOBT) Screening for Colorectal Cancer (CRC) at Age 50 Years and Remaining in the Program Until 85 Years of Age or Death
Graphic Jump Location
Usual survivors are those who would have survived with or without screening. Extra survivors are those in whom the earlier detection of cancer averts death. Adapted from Winawer et al.2
Figure 3. Mortality From Colorectal Cancer and Years of Life Lost Due to Colorectal Cancer With and Without Screening
Graphic Jump Location
Top, Mortality from colorectal cancer. Bottom, Life years lost due to colorectal cancer. Broken lines indicate with screening, and solid lines, without screening. Data from Towler et al.1

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