To the Editor.
—Gerber et al1 found that patients who participate in a digital rectal examination screening program at regular intervals have a higher disease-specific mortality than those whose prostate cancer is identified on an initial examination. The observation appears to contradict the conventional wisdom that early detection and treatment of cancer result in a higher survival rate. They conclude, "Annual digital rectal examination alone may be insufficiently frequent and/or sensitive to prevent significant mortality from this disease." In their perspicacious discussion they offer alternative explanations, including speculation on the role of tumor growth rate.Analogous findings in screening for breast cancer suggest the apparent benefit of screening in many cancer studies is due to bias introduced in the study by the unrecognized effect of tumor growth rate in the study cohorts. Two decades ago a study of visits to a breast screening clinic indicated that the 5-year survival
Maloney JV. Digital Rectal Examination Screening for Prostate Cancer. JAMA. 1993;270(11):1315. doi:10.1001/jama.1993.03510110051016
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