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April 9, 1997

Is Prostate Cancer Screening Analogous to Lung Cancer Screening?-Reply

Author Affiliations

Massachusetts General Hospital Boston

JAMA. 1997;277(14):1121-1122. doi:10.1001/jama.1997.03540380035018

In Reply.  —We disagree with Dr Farkas and colleagues when they assert that the efficacy of screening and treatment for prostate cancer are separable. Screening may find cancers early, but unless those cancers are effectively treated, no mortality reduction can be realized. Similarly, once one treats cancers detected by screening, one engenders the risks of therapy. We feel that all downstream consequences of screening need to be considered when estimating the outcomes of an early detection program for any cancer. However, we do agree that costs as well as risks must be weighed against the potential benefits of cancer screening.As Dr Petty illustrates in his letter, the lung cancer screening saga is not over. In fact, the effectiveness of lung cancer screening is currently being readdressed in the National Cancer Institute's Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, which is also examining prostate, colorectal, and ovarian cancer screening.1 Nevertheless,