Ethical issues in cancer screening and prevention

November 2009 ’ s announcement of the USPSTF ’ s recommendations for screening for breast cancer raised a fi restorm of objections. Chief among them were that the panel had insuffi ciently valued patients ’ lives or allowed cost considerations to infl uence recommen-dations. The publicity about the recommendations, however, often either simplifi ed the actual content of the recommendations or bypassed signifi cant methodological issues, which a philosophical examination of both the science behind screening recommendations and their import reveals. In this article, I discuss two of the leading ethical considerations at issue in screening recommendations: respect for patient autonomy and benefi cence and then turn to the most signifi cant methodological issues raised by cancer screening: the potential biases that may infect a trial of screening effective-ness, the problem of base rates in communicating risk, and the trade-offs involved in a judgment of screening effectiveness. These issues reach more broadly, into the use of “ evidence-based ” medicine generally, and have important implications for informed consent