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JNCI Journal of the National Cancer Institute 2002 94(3):156-157; doi:10.1093/jnci/94.3.156
© 2002 by Oxford University Press
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Journal of the National Cancer Institute, Vol. 94, No. 3, 156-157, February 6, 2002
© 2002 Oxford University Press

EDITORIAL

Screening Trials Are Even More Difficult Than We Thought They Were

Helen G. Juffs, Ian F. Tannock

Affiliation of authors: Department of Medical Oncology and Hematology, Princess Margaret Hospital, Toronto, ON, Canada. Correspondence should be addressed to Dr Tannock at the above address.

Correspondence to: Ian F. Tannock, M.D., Ph.D., Department of Medical Oncology and Hematology, Princess Margaret Hospital, 610 University Ave., Toronto, ON, Canada M5G 2M9 (e-mail: ian.tannock@uhn.on.ca).

In this issue of the Journal, Black et al. (1) present an important analysis of methodologic pitfalls associated with randomized studies of screening interventions. The authors compare disease-specific and all-cause mortality from the 12 published randomized trials of cancer screening for which these end points were available. In seven of the 12 studies, major inconsistencies were detected in the direction or magnitude of these two outcomes. Black et al. propose that the use of disease-specific mortality as the primary end point renders screening trials subject to at least two forms of serious bias:

  1. Sticky-diagnosis bias—where deaths from other causes in the screened group are wrongly attributed to the target cancer or deaths in the control group are wrongly attributed to other causes. This bias favors the control group.
  2. . . . [Full Text of this Article]

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