On 2014 Feb 17, David Keller commented:

In their discussion of the harms of screening for lung cancer, Harris and colleagues discuss harms associated with earlier initiation of treatments which would have been started later or not at all without screening.

The authors state that screening and earlier treatment delays death for only 20% of patients destined to die from lung cancer. This raises the question of why the other 80% of patients are being exposed to ineffective treatments and the associated harms. Is the problem that we are not able to identify which patients will be among the fortunate 20% to postpone death by being treated? If so, then studies should be done to learn which characteristics differentiate patients who benefit from these treatments (e.g. tumor stage, grade, patient functional status, genetic profile or other factors). Perhaps these treatments are given to the unfortunate 80% for the purpose of palliation of symptoms, with the knowledge that there will be no mortality benefit. If so, then the treatments are beneficial to the patient despite failing to prolong life.

The authors state that the 80% of patients who are identified as having fatal cancers which cannot be treated to prolong life suffer harms from screening by virtue of their early diagnosis, in that they will have longer to live with the knowledge of their fate, causing anxiety and other psychological harms. However, other patients might strongly prefer to be informed as early as possible of their fatal diagnosis, in order to make better use of their remaining time alive and pain-free; for them, the earlier diagnosis afforded by screening is not a harm, but a benefit.

To facilitate discussion, I respectfully request the person who found this comment "not helpful" to state their reason

On 2014 Feb 17, David Keller commented:

In their discussion of the harms of screening for lung cancer, Harris and colleagues discuss harms associated with earlier initiation of treatments which would have been started later or not at all without screening.

The authors state that screening and earlier treatment delays death for only 20% of patients destined to die from lung cancer. This raises the question of why the other 80% of patients are being exposed to ineffective treatments and the associated harms. Is the problem that we are not able to identify which patients will be among the fortunate 20% to postpone death by being treated? If so, then studies should be done to learn which characteristics differentiate patients who benefit from these treatments (e.g. tumor stage, grade, patient functional status, genetic profile or other factors). Perhaps these treatments are given to the unfortunate 80% for the purpose of palliation of symptoms, with the knowledge that there will be no mortality benefit. If so, then the treatments are beneficial to the patient despite failing to prolong life.

The authors state that the 80% of patients who are identified as having fatal cancers which cannot be treated to prolong life suffer harms from screening by virtue of their early diagnosis, in that they will have longer to live with the knowledge of their fate, causing anxiety and other psychological harms. However, other patients might strongly prefer to be informed as early as possible of their fatal diagnosis, in order to make better use of their remaining time alive and pain-free; for them, the earlier diagnosis afforded by screening is not a harm, but a benefit.

To facilitate discussion, I respectfully request the person who found this comment "not helpful" to state their reason