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Screening for a cancer: thinking before rethinking

A recent article (by Esserman et al.) called to serious question the diagnostic and prognostic premises of screening for breast and prostate cancers, and it proceeded to adduce, also, other radical rethinking of these screenings. That questioning was 'evidence-based' in the contemporary epidemiologi... Full description

Journal Title: European journal of epidemiology 2010-01-01, Vol.25 (6), p.365-374
Main Author: Miettinen, O. S
Format: Electronic Article Electronic Article
Language: English
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Publisher: Dordrecht: Springer
ID: ISSN: 0393-2990
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recordid: cdi_proquest_miscellaneous_733630577
title: Screening for a cancer: thinking before rethinking
format: Article
creator:
  • Miettinen, O. S
subjects:
  • Age Factors
  • Aged
  • Biological and medical sciences
  • Breast cancer
  • Breast Neoplasms - diagnosis
  • Breast Neoplasms - prevention & control
  • Cancer
  • Cancer screening
  • Cardiology
  • Data Interpretation, Statistical
  • Death
  • Early Detection of Cancer - methods
  • Early Detection of Cancer - standards
  • Epidemiology
  • Evidence-Based Medicine
  • Female
  • General aspects
  • Humans
  • Incidence
  • Infectious Diseases
  • Male
  • Medical practice
  • Medical sciences
  • Medical screening
  • Medicine
  • Medicine & Public Health
  • Middle Aged
  • Miscellaneous
  • Mortality
  • Oncology
  • Prevention and actions
  • Prostate cancer
  • Prostatic Neoplasms - diagnosis
  • Prostatic Neoplasms - prevention & control
  • Public Health
  • Public health. Hygiene
  • Public health. Hygiene-occupational medicine
  • Recommendations
  • SCREENING
  • Screening tests
  • Unnecessary Procedures
ispartof: European journal of epidemiology, 2010-01-01, Vol.25 (6), p.365-374
description: A recent article (by Esserman et al.) called to serious question the diagnostic and prognostic premises of screening for breast and prostate cancers, and it proceeded to adduce, also, other radical rethinking of these screenings. That questioning was 'evidence-based' in the contemporary epidemiological meaning of this—use was made of cancerregistry data as well as of evidence from such randomized trials as epidemiologists now take to be essential in actual research on screening for a cancer—and, evidence-based as it was, that questioning has been left unquestioned. But that questioning, as to the interpretation of the evidence, was not adequately thinking-based. It was, instead, rife with the misunderstandings that permeate contemporary epidemiological thinking about screening for a cancer and about research for the scientific knowledge-base of this. In the truly called-for rethinking, the point of departure would be the recognition that the premises of screening for a cancer are clinical in nature, as obviously also are both the entire process potentially leading to a cancer's early, preclinical diagnosis and the individual counselling about submitting oneself to this. Epidemiologists should focus on epidemiology—practice of and research for community medicine, community-level preventive medicine, that is—and to have no presumptions of understanding, better than clinicians, the (clinical) issues surrounding the pursuit of early diagnosis of a cancer, whether matters of practice, research, or public policy. Clinicians and clinical researchers, in turn, should disregard epidemiologists'—and other public-health professionals'—ideas about screening for a cancer, the practice of and research on this. The need for this aprioristic rethinking is manifest, very eminently, in the fresh recommendations about screening for breast cancer, issued by the US Preventive Services Task Force, and in the public uproar provoked by these.
language: eng
source:
identifier: ISSN: 0393-2990
fulltext: no_fulltext
issn:
  • 0393-2990
  • 1573-7284
url: Link


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descriptionA recent article (by Esserman et al.) called to serious question the diagnostic and prognostic premises of screening for breast and prostate cancers, and it proceeded to adduce, also, other radical rethinking of these screenings. That questioning was 'evidence-based' in the contemporary epidemiological meaning of this—use was made of cancerregistry data as well as of evidence from such randomized trials as epidemiologists now take to be essential in actual research on screening for a cancer—and, evidence-based as it was, that questioning has been left unquestioned. But that questioning, as to the interpretation of the evidence, was not adequately thinking-based. It was, instead, rife with the misunderstandings that permeate contemporary epidemiological thinking about screening for a cancer and about research for the scientific knowledge-base of this. In the truly called-for rethinking, the point of departure would be the recognition that the premises of screening for a cancer are clinical in nature, as obviously also are both the entire process potentially leading to a cancer's early, preclinical diagnosis and the individual counselling about submitting oneself to this. Epidemiologists should focus on epidemiology—practice of and research for community medicine, community-level preventive medicine, that is—and to have no presumptions of understanding, better than clinicians, the (clinical) issues surrounding the pursuit of early diagnosis of a cancer, whether matters of practice, research, or public policy. Clinicians and clinical researchers, in turn, should disregard epidemiologists'—and other public-health professionals'—ideas about screening for a cancer, the practice of and research on this. The need for this aprioristic rethinking is manifest, very eminently, in the fresh recommendations about screening for breast cancer, issued by the US Preventive Services Task Force, and in the public uproar provoked by these.
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subjectAge Factors ; Aged ; Biological and medical sciences ; Breast cancer ; Breast Neoplasms - diagnosis ; Breast Neoplasms - prevention & control ; Cancer ; Cancer screening ; Cardiology ; Data Interpretation, Statistical ; Death ; Early Detection of Cancer - methods ; Early Detection of Cancer - standards ; Epidemiology ; Evidence-Based Medicine ; Female ; General aspects ; Humans ; Incidence ; Infectious Diseases ; Male ; Medical practice ; Medical sciences ; Medical screening ; Medicine ; Medicine & Public Health ; Middle Aged ; Miscellaneous ; Mortality ; Oncology ; Prevention and actions ; Prostate cancer ; Prostatic Neoplasms - diagnosis ; Prostatic Neoplasms - prevention & control ; Public Health ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Recommendations ; SCREENING ; Screening tests ; Unnecessary Procedures
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descriptionA recent article (by Esserman et al.) called to serious question the diagnostic and prognostic premises of screening for breast and prostate cancers, and it proceeded to adduce, also, other radical rethinking of these screenings. That questioning was 'evidence-based' in the contemporary epidemiological meaning of this—use was made of cancerregistry data as well as of evidence from such randomized trials as epidemiologists now take to be essential in actual research on screening for a cancer—and, evidence-based as it was, that questioning has been left unquestioned. But that questioning, as to the interpretation of the evidence, was not adequately thinking-based. It was, instead, rife with the misunderstandings that permeate contemporary epidemiological thinking about screening for a cancer and about research for the scientific knowledge-base of this. In the truly called-for rethinking, the point of departure would be the recognition that the premises of screening for a cancer are clinical in nature, as obviously also are both the entire process potentially leading to a cancer's early, preclinical diagnosis and the individual counselling about submitting oneself to this. Epidemiologists should focus on epidemiology—practice of and research for community medicine, community-level preventive medicine, that is—and to have no presumptions of understanding, better than clinicians, the (clinical) issues surrounding the pursuit of early diagnosis of a cancer, whether matters of practice, research, or public policy. Clinicians and clinical researchers, in turn, should disregard epidemiologists'—and other public-health professionals'—ideas about screening for a cancer, the practice of and research on this. The need for this aprioristic rethinking is manifest, very eminently, in the fresh recommendations about screening for breast cancer, issued by the US Preventive Services Task Force, and in the public uproar provoked by these.
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abstractA recent article (by Esserman et al.) called to serious question the diagnostic and prognostic premises of screening for breast and prostate cancers, and it proceeded to adduce, also, other radical rethinking of these screenings. That questioning was 'evidence-based' in the contemporary epidemiological meaning of this—use was made of cancerregistry data as well as of evidence from such randomized trials as epidemiologists now take to be essential in actual research on screening for a cancer—and, evidence-based as it was, that questioning has been left unquestioned. But that questioning, as to the interpretation of the evidence, was not adequately thinking-based. It was, instead, rife with the misunderstandings that permeate contemporary epidemiological thinking about screening for a cancer and about research for the scientific knowledge-base of this. In the truly called-for rethinking, the point of departure would be the recognition that the premises of screening for a cancer are clinical in nature, as obviously also are both the entire process potentially leading to a cancer's early, preclinical diagnosis and the individual counselling about submitting oneself to this. Epidemiologists should focus on epidemiology—practice of and research for community medicine, community-level preventive medicine, that is—and to have no presumptions of understanding, better than clinicians, the (clinical) issues surrounding the pursuit of early diagnosis of a cancer, whether matters of practice, research, or public policy. Clinicians and clinical researchers, in turn, should disregard epidemiologists'—and other public-health professionals'—ideas about screening for a cancer, the practice of and research on this. The need for this aprioristic rethinking is manifest, very eminently, in the fresh recommendations about screening for breast cancer, issued by the US Preventive Services Task Force, and in the public uproar provoked by these.
copDordrecht
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pmid20458523
doi10.1007/s10654-010-9449-1