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Dear Dr. Barbani,

What you've heard is at least true for cancer screening, which  I've worked on and where there are a number of biases. One of the most important ones that an RCT takes care of is lead-time bias. Here's an important paper by colleagues of mine demonstrating overdiagnosis of lung cancer through screening:

Pamela M. Marcus , Erik J. Bergstralh, Mark H. Zweig, Ann Harris, Kenneth P. Offord, Robert S. Fontana. Extended lung cancer incidence follow-up in the Mayo Lung Project and overdiagnosis. J Natl Cancer Inst 2006; 98(11):748-756

and an editorial on the paper in the same issue:

Patz, E.
J. Natl. Cancer Inst. 2006 98: 724-725

I haven't read the following review but it's also by colleagues whose work I know and can recommend, and I expect it will be a useful overview:

Kramer BS, Croswell JM. Cancer screening: the clash of science and intuition. Annu Rev Med. 2009;60:125-37. Review.

Regards,

Emily DeVoto
London, UK



On Thu, Dec 17, 2009 at 8:02 AM, Barbani Federico <[log in to unmask]> wrote:
Dear members,
Merry Christmas to all from snowy Italy.
Is it true for you (as I heard) that efficacy of screening programmes has to
be evaluated by RCTs because of too serious risk of bias of any other
design?
Could you cite articles about it?
Thank you!


dr. Federico Barbani
Health Service Purchasing Unit
Health Authority Modena
via San Giovanni del Cantone 23
41100 MODENA, Italy
tel 059/435813 - 435731



--
Emily DeVoto
http://health-counterspin.blogspot.com
mobile 07514 822 416
landline 020 8933 1119
(from US, dial 011-44- and leave off the zeros)