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Editorials |

Deciding about Screening

Stephen G. Pauker, MD
[+] Article and Author Information

New England Medical Center, Tufts University School of Medicine, Boston, MA 02111. Requests for Reprints: Stephen G. Pauker, MD, Box 302, New England Medical Center, Boston, MA 02111. Grant Support: In part by grant LM 4493 from the National Library of Medicine and grant HS 06503 from the Agency for Health Care Policy Research.


Copyright 2004 by the American College of Physicians


Ann Intern Med. 1993;118(11):901-902. doi:10.7326/0003-4819-118-11-199306010-00013
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As shown in an accompanying article, the benefits of any broadly based screening program for ovarian cancer are limited more by the low prevalence of disease than by the potential benefits of treating early disease or the performance of currently available tests. Screening for such diseases is best restricted to special populations at markedly increased risk. In low-prevalence populations, false-positive results and the costs and risks of the workups they induce are magnified. In determining the marginal cost-effectiveness ratio of such programs, failure to consider even apparently minor factors can markedly affect the conclusions. In the case of screening for ovarian cancer, factoring in the discomfort and potential inconvenience of venipuncture and transvaginal sonography can eliminate the small benefit of the program. Taking the time and energy required to organize relevant data in constructing a decision analytic model can provide important insights into the usefulness of such screening programs.

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