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Editorial
December 28, 2018

Why Is Nonadherence to Cancer Screening Associated With Increased Mortality?

Author Affiliations
  • 1Department of Medicine, University of California, San Francisco
  • 2Medicine Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
  • 3Deputy Editor, JAMA Internal Medicine
  • 4Editorial Fellow, JAMA Internal Medicine
JAMA Intern Med. Published online December 28, 2018. doi:10.1001/jamainternmed.2018.6813

In this issue of JAMA Internal Medicine, Pierre-Victor and Pinsky1 use data from the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening trial2 to demonstrate an association between lack of adherence to cancer screening and increased mortality from causes not related to the screening. Participants in the PLCO Cancer Screening trial were 55 to 74 years of age and generally healthy. At trial entry, participants of both sexes in the screening arm were asked to undergo chest radiographs for lung cancer and flexible sigmoidoscopy for colon cancer, men were asked to undergo prostate-specific antigen tests and digital rectal examinations for prostate cancer, and women were asked to undergo cancer antigen 125 tests and transvaginal ultrasonography for ovarian cancer. Those randomized to the control group received usual care.

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    1 Comment for this article
    The best argument that this is correlation, not causation, is the choice of screens
    Al Lewis, JD | Author, the Outcomes, Economics and Ethics of the Workplace Wellness Industry (HealthMatrix: The Journal of Law-Medicine 27:1, 2017)
    Of the screens that are listed, only colonoscopies receive a "B" or higher from the US Preventive Services Task Force. Healthy people are simply not supposed to get these other screens -- absent a medical reason, in which case they wouldn't technically be screens.

    Therefore, it is extremely unlikely that submitting to those particular screens would have caused an increase in longevity. Must have been a correlation.
    CONFLICT OF INTEREST: I run the website www.theysaidwhat.net , which debunks the myths of workplace wellness. I run a company, Quizzify, that educates employees on not getting USPSTF C-rated and D-rated screens
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