The technology needed to implement mass screening by mammography existed well before the implementation of national screening programmes. This delay arose partly because of the complexities involved in conducting randomised controlled trials (RCTs) of screening programmes. These complexities not only extend the time needed to conduct trials of cancer screening, they reduce the external validity of the results. There is potential to improve the application of evidence-based medicine (EBM) to the evaluation of cancer screening programmes and other complex interventions through adding insights from Operational Research and Decision Theory. This would extend EBM to what might be called Decision-Analytic Medicine (DAM)
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