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- Page navigation anchor for RE: Response to Dr DermerRE: Response to Dr Dermer
Dr Dermer highlights a central issue in decision making on preventive cancer screening: how appropriate are overall mortality or disease-specific mortality as outcomes measures? This issue is important for family physicians because these measures provide the information needed for discussions with patients on the potential benefits associated with screening. The potential benefits need to be weighed with potential harms. Further, screening decisions occur in an environment where many patients and physicians overestimate the benefits of screening and there are strong messages from professional organizations and advocacy groups emphasizing the value of screening.
In his letter, Dr Dermer adds to previous debate on the advantages and disadvantages of overall mortality or disease specific mortality as outcome measures to inform decision making in preventive cancer screening (1-4). In contrast to Dr Dermer, who questions the use of disease-specific mortality, we believe that both disease-specific mortality and overall mortality can inform decision making in preventive cancer screening when the quality of evidence and the limitations of each of these outcomes measures is considered.
We agree that overall mortality is conceptually appealing as a benchmark outcome measure because it answers the crucial question of whether screening improves overall survival (1, 2, 4). However, there are several important limitations to this particular outcome measure (1, 2, 5). Firs...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: Using disease-specific mortality in discussions with patientsRE: Using disease-specific mortality in discussions with patients
I applaud the CFP on its planned series of articles on prevention in primary care, beginning with the "Better decision-making in preventive health screening" article in the July edition.
However, though I agree with most of the article I disagree with the authors’ claim that disease-specific mortality is an appropriate outcome measure to evaluate cancer screening.
I would suggest that the core of the issue is this: disease-specific mortality’s appropriateness is dependent on whether or not the reduction in disease-specific mortality is matched by the reduction in overall mortality. If overall and disease-specific mortalities are similarly reduced by the screening, then disease-specific mortality data is useful at the population level. However, if we are considering discussions with individual patients in daily practice, disease-specific mortality does not improve the data we bring to discussions with our patients about the likelihood of mortality.More important, when disease-specific mortality for a cancer is reduced by screening but overall mortality is not, it means that we have simply traded death from that specific cancer for death by another illness. Furthermore, it suggests that the screening/treatment process for the cancer with lower disease-specific mortality actually causes an increase in disease-specific mortality for other illnesses, something that we have suspected in prostate cancer.
Taking the logic to its conclusion, wh...
Show MoreCompeting Interests: None declared.