Frank A. Lederle, MD; Christine Pocha, MD, PhD
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-2678.
Lederle FA, Pocha C. Screening for Liver Cancer: The Rush to Judgment. Ann Intern Med. 2012;157:301-302. doi: 10.7326/0003-4819-157-4-201208210-00022
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Published: Ann Intern Med. 2012;157(4):301-302.
We agree with Drs. Sherman and Bruix on 3 important points. First, they do not dispute our main thesis that there is no level I evidence to support screening for liver cancer. Guideline recommendations should therefore be downgraded accordingly and, in our view, not used as performance measures. Second, we agree that an RCT of liver cancer screening would be difficult. Randomized, controlled trials usually are, especially when the emotional issues surrounding cancer screening are involved. Nevertheless, they are necessary, as shown by the considerable literature that identifies the bias in evaluating screening tests, and thus supports Malcolm Law's conclusion (1): “Before any screening for cancer is introduced, however, large randomised trials with mortality end points should be conducted to establish and quantify any benefit.” In de Koning's words (2), “Randomised screening trials are bothersome” but “ ... there is no second-best option.”
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