When discussing screening programs one must keep in mind the distinction between the benefits and harms to the individual versus those to society. Some screening programs might be beneficial to a population of people but not to most of the individuals screened. In other cases the opposite may be true. Thus, when reading and discussing screening strategies one must be clear about the perspective being considered. The article we reviewed was looking at risks and benefits from a population perspective. Dr Steiner’s comments reflect more the perspective of the individual patient.
So where does that leave us now? Certainly there is much room for more studies looking at screening programs and their potential benefits, costs, and harms to both individuals and populations. Until such studies are completed we are left to try to sort out what is known (and not known) about each screening program. We then need to find a way to communicate this to our patients so they can make decisions about their health in accordance with their own values and desires. Unfortunately, many of the recommendations from professional organizations have not taken such a rigorous approach and therefore cannot be trusted as truly the best course of action for our patients and our society.
Michael Schooff, MD
Clarkson Family Medicine
Omaha, Nebraska
- Gotzsche P, Olsen O. Is screening for breast cancer with mammography justifiable? Lancet 2000; 355:129-34.
- Ewart R. Primum non nocere and the screening of evidence: rethinking the ethics of screening. J Am Board Fam Pract 2000; 13:188-96.