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January 25, 1995

Health System Reform: Will Controlling Cost Require Rationing Services?

JAMA. 1995;273(4):284-285. doi:10.1001/jama.1995.03520280028024

To the Editor.  —I write in response to the comments by Dr Eddy.1 Dr Eddy includes in his category of "uncertain waste" of medical resources "screening for prostate cancer with prostate specific-antigen [PSA] in men older than 50 years... and surgery for early-stage prostate cancer."In men with a life expectancy greater than 10. years, there are many reasons to believe that early detection with PSA and definitive treatment of early-stage cancers may provide remarkable benefit. The use of PSA for early detection of prostate cancer has been clearly demonstrated to cause a marked shift of the stage of the tumor at the time of diagnosis. In the era before PSA, 70% of cancers had spread beyond the prostate at the time of detection; in early detection programs using PSA along with digital rectal examination, 70% of the cancers are detected while still confined to the prostate. The results

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