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September 12, 2001

Discussing Cancer Screening With Elderly Patients—Reply

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

In Reply: We agree with Dr Cunningham that while survival benefit is an important outcome, other outcomes that affect quality of life need to be considered when making screening decisions. However, the impact of screening on important outcomes such as pain, suffering, or functional decline has not been studied. Therefore, while it is important to consider the harms of metastatic cancer, little data are available to estimate the likelihood that screening will prevent such harms, especially over time intervals of less than 5 years. Cunningham is technically correct in saying that if no screening had been done, published rates of cancer mortality might be slightly higher, causing our estimates of the risk of cancer death to be slightly lower. However, because rates of screening have historically been very low in elderly persons, this effect is probably minimal.1 On the other hand, among persons who have had regular screening, our estimates probably significantly overestimate the benefits of continued screening, as we discuss in our article.

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