Screening for Cancer: Evaluating the Evidence - American Family Physician
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چکیده
Although screening is unquestionably important, other issues of equal importance include using scarce resources efficiently and rationally, refraining from unproven or ineffective interventions and doing no harm. In fact, sometimes there are good reasons not to screen. Basic to this is the understanding that the proposal to screen an asymptomatic patient involves a fundamental shift in the physician-patient relationship. In ordinary medical practice, the patient initiates an encounter because of a troubling symptom. The physician pledges to help but can make no guarantee and is not responsible if the symptom turns out to represent something beyond the ability of current medical practice to cure. By contrast, a screening test is usually initiated by the physician (or indirectly, by professional or advocacy groups) and, in this situation, there is an “implied promise” not just that the screening procedure might be beneficial, but that it is in fact beneficial, that it will do more good than harm. P atients frequently consult family physicians with the expectation of undergoing screening tests for cancer. However, controversy remains as to which screening procedures are justified and how proposed screening procedures should be evaluated. Failure to understand basic concepts can lead to unrealistic expectations for screening programs and sometimes to inefficient use of resources. This article reviews the kind of evidence required to justify screening tests for cancer, with the goal of guiding family physicians through current and future screening controversies.
منابع مشابه
Screening for cancer: concepts and controversies.
Early detection of cancer is a core task in family medicine, and patients have come to expect screening tests, sometimes out of proportion to what evidence can justify. To understand the controversies surrounding screening and to provide sound advice to patients, family physicians should be familiar with the fundamental concepts of screening. Failure to account for the effects of lead-time, len...
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تاریخ انتشار 2001