Screening: More cons than pros?

Issue: BCMJ, vol. 44, No. 9, November 2002, Page 462 Editorials

St. Paul’s Hospital’s Department of Radiology recently began offering screening CT scans of the chest or whole body to the public on a private paying basis, using the CT scanner in off hours. As a result of this private enterprise, enough funds have been raised to allow more rapid performance of MSP-funded (i.e., medically necessary) scans. Thus, the current wait for a CT scan of the chest has decreased from 6 to 8 weeks to less than 1 week. “A successful combination of private and public funding,” many might say, but I find myself a little worried about getting a segment of the public used to the concept of screening tests when those tests have not been shown to be medically valid.

The principles of screening include choosing a high-risk population, providing a survival advantage to those with the disease, and making sure that the risks of investigating false positives are acceptably low.

The most common fatal malignancy in both men and women is bronchogenic carcinoma. Fifty percent of lung cancers are inoperable and therefore incurable at the time of presentation. This has stimulated many attempts over the years to find an effective way to screen for lung cancer, with the idea that early detection will lead to lives saved. All of these attempts have been singularly unsuccessful. A glimmer of hope has emerged with a new CT scan technique called low-dose helical scanning; preliminary results suggest that small cancers that were not visible on routine chest X-rays can be detected by this method. However, follow-up has not yet been sufficient to demonstrate a survival advantage, and in one study there was a significant number of false positives. And this was in a selected population of middle-aged smokers! How tragic it would be for all concerned to proceed to a thoracotomy to prove that a lesion is benign rather than malignant, only to have the patient die of a postoperative complication.

It behooves us all, if we are asked by our patients regarding these screening tests, to explain to them not only what the tests may discover of importance, but also what they may turn up that is better left unknown!


Lindsay M. Lawson, MD. Screening: More cons than pros?. BCMJ, Vol. 44, No. 9, November, 2002, Page(s) 462 - Editorials.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.

For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit

BCMJ Guidelines for Authors

Leave a Reply