Concepts and Controversies in Cancer Screening
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Screening for cancer is a common and expected part of primary care medicine. However, the known effects of lead time, length, and selection bias confound our ability to objectively evaluate screening tests, and often result in an overestimation of the benefits of screening. Because of these biases, the randomized controlled trial remains the only reliable way to measure the true effects of a screening program. Significant controversy remains for many screening tests, because most common screening procedures have come into widespread use without the benefit of definitive trials. These concepts are illustrated by exploring current controversies in screening for cancer of the lung, colon, breast and prostate, which together account for more than 50% of US cancer deaths. In the face of ongoing controversy and uncertainty about the value of screening tests, physicians are advised to engage patients in a process of shared decision making and informed consent.