LETTER
Cost-effectiveness of Prostate Cancer Screening and Treatment
David L. Hahn
15 November 1993 | Volume 119 Issue 10 | Pages 1054-1055
TO THE EDITOR:
My Swedish brother-in-law, who has lived and worked in the United States for more than two decades, observes that often Americans act first and analyze later. This tendency is manifest in aggressive recommendations for unproven yet demonstrably morbid screening programs such as those for asymptomatic prostate cancer.
Garnick [1] documents that screening for asymptomatic prostate cancer is unproven and that consensus groups in Sweden, France, Canada, and the United States, as well as the International Union Against Cancer, do not recommend it. Nevertheless, he devotes considerable space to a detailed description of unproven screening procedures recommended by the American Cancer Society and concludes that "a greater effort must be made to promote earlier diagnosis of prostate cancer".
It is time that American physicians recognize what physicians in the rest of the developed world already know: Advocates of screening procedures of unproven benefit but known harm would replace the traditional ethical precept of "primum non nocere" (first, do no harm) with its opposite, "primum facere" (first, do something).
1. Garnick MB. Prostate cancer: screening, diagnosis and management. Ann Intern Med. 1993; 118:804-18.
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