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September 12, 2001

Discussing Cancer Screening With Elderly Patients

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

JAMA. 2001;286(10):1175-1176. doi:10.1001/jama.286.10.1173

To the Editor: Drs Walter and Covinsky1 provided an approach for counseling elderly patients about the risks and benefits of cancer screening tests. They claim that their approach is generalizable to other screening interventions beyond primary prevention of cancers.

Although it is generally thought that screening interventions should be judged by their effect on mortality, patients may have other reasons for seeking such tests. For example, imagine a patient who will die in 5 years, with or without screening for breast cancer. But, if in one scenario she will die in her sleep and if in the other die of painful metastatic breast cancer, she may well see an advantage to having the breast cancer diagnosed and treated, even if there is no survival benefit. Realistic estimates of the harms of the disease itself also need to be discussed with patients when providing information for the screening decision.

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