Robert A. Smith, PhD

Major studies looking at breast cancer screening with mammography may have more consistent findings than previously thought.

In this paper, the historic and recent evidence supporting the value of breast cancer screening will be described, along with the underpinnings of the current debate over the relative and absolute benefit of regular mammography screening.

At this time, two positions aboutlung cancer screening are defensiblebased on current evidence.First, it is quite reasonable todefend the position that there is insufficientevidence to recommend population-based screening for lung cancerwith spiral computed tomography(CT) for individuals at increased riskfor lung cancer.[1] Despite very favorableresults from observationalstudies,[2-4] broad consensus aboutpolicy depends, at a minimum, on resultsfrom a prospective randomizedtrial comparing lung cancer mortalityin an experimental group with a controlgroup. Ideally, this comparison isbetween a group invited to screeningand a group receiving usual care, andsuch trials have begun in France, theNetherlands, and Italy, but decisionsalso may be made for alternative comparisonsif circumstances warrant adifferent randomization scheme. TheNational Lung Screening Trial has justcompleted recruiting 50,000 individualsat elevated risk to a prospectiverandomized trial comparing chest radiographyto spiral CT.[5]