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Thanks for the comments so far Armando said: <Here in Portugal we probably would do the Haemocult, the lung X-ray and a PSA for prostate Ca. All to reassure the patient, since neither have decent positive predictive values for asymptomatic patients, that is, for _screening_.> The reason for my question really does centre around the predictive nature of these tests and the evidence for using them in screening an asymtomatic patients. If we feel the test is unreliable for screening we should have the courage to put this view to the patient. I have my doubts about the usefulness of a battery of screening tests as a done by private clinics whihc seem to me to pander to the worried well - but them in the marketplace they clearly have a role if they are making money. However the downside is they give a perception that if you could afford it you could be screened for all manner of illnesses and avoid getting ill. I remember getting a mailing from the Eurpean Union of Cancer whihc seemed to put some of this in perspective - I'll have to dig around for it as it came in paper form - maybe it is on a web page somewhere I agree with an annual Faecal Occult blood test - there is no history of polyposis so colonoscopy does seem to invasive Re - Prostate Specific antigen - locally we have a lot of disagreement about its value and is currently only done in symptomatic patients Christopher Collins wrote: <I am concerned that the patient has had a dry intermittent cough for 4 years. Have they had any trials of treatment with inhaled steroids or oral steroids. > The patient is a non-smoker. There is no FH of asthma and he has not felt his symptoms warrant any therapy - he was in fact seen 2 years ago and has a normal CXR and offered inhaled steroids but declined. NO history asbestos exposure. He is an Antiques dealer in a rural area. No seasonal variation I left these details out initially to focus on the overall problem of requests for screening - thanks for your commentary Dr Amrit Takhar GP Cambs UK http://ourworld.compuserve.com/homepages/Amrit %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%