Vinay Prasad , assistant professor 1 , Jeanne Lenzer , journalist 2 , David H Newman , professor 3 1Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, OR 97239, USA 2New York, USA 3Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA Correspondence to: V Prasad prasad{at}ohsu.edu Accepted 29 October 2015

The claim that cancer screening saves lives is based on fewer deaths due to the target cancer. Vinay Prasad and colleagues argue that reductions in overall mortality should be the benchmark and call for higher standards of evidence for cancer screening

Despite growing appreciation of the harms of cancer screening,1 2 3 advocates still claim that it “saves lives.”4 This assertion rests, however, on reductions in disease specific mortality rather than overall mortality.

Using disease specific mortality as a proxy for overall mortality deprives people of information about their chief concern: reducing their risk of dying.5 6 Although some people may have personal reasons for wanting to avoid a specific diagnosis, the burden falls on providers to provide clear information about both disease specific and overall mortality and to ensure that the overall goal of healthcare—to improve quantity and quality of life—is not undermined.7

In this article we argue that overall mortality should be the benchmark against which screening is judged and discuss how to improve the evidence upon which screening rests.