Preparticipation cardiac evaluation of young competitive athletes is intended to identify and disqualify those with serious cardiac abnormalities. However, the effect of such screening on sudden cardiovascular death in young athletes has not been determined. Using population-based data from Italy, where preparticipation screening of athletes was introduced in 1982, Corrado and colleaguesArticle assessed 1979-2004 trends in sudden death among athletes and nonathletes. The authors found that the incidence of sudden cardiac death in young competitive athletes declined significantly after introduction of preparticipation athlete screening, whereas rates were steady among unscreened nonathletes. In an editorial, Thompson and LevineArticle discuss the contribution of these findings to the ongoing debate about the role and components of preparticipation screening programs.