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Should this patient be screened for cancer?
1Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. william.black@hitchcock.org
Context:
Advances in imaging technology have provided numerous opportunities for cancer screening but have also raised numerous questions.
General Question:
Who should be screened and how exactly should screening be performed?
Specific Research Challenge:
If spiral computed tomography (spiral CT) were being considered for lung cancer screening, for example, important questions would need to be answered: Should nonsmokers be screened? How often should screening take place? What should the diagnostic work-up be after abnormal findings were seen on spiral CT?
Standard Approach:
Randomized, controlled trials (RCTs) are the most valid method for determining which medical interventions are most effective. These trials are particularly useful in the evaluation of screening because they eliminate the early detection biases that may result in groosly misleading survival statistics.
Potential Difficulties:
Randomized, controlled trials of screening are subject to other biases, and their results may be difficult to generalize. In addition, because they require an enormous number of participants and many years of follow-up, RCTs can be applied only to a small proportion of the questions about cancer screening.
Alternate Approach:
Quantitative decision analysis can be applied to the remaining questions and help inform decision making about cancer screening.
