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Dysutility of Screening Chest Roentgenograms for Lung Cancer: The Ulysses Syndrome

Jerome M. Reich, MD
Arch Intern Med. 1993;153(16):1933-1937. doi:10.1001/archinte.1993.00410160107012.
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In their article, entitled "P Screening for Cancers of the Lung and Colon,"1 Richter-Boe and Humphrey1 present an excellent summary convincingly reiterating the evidence that screening chest roentgenograms (SCXR) lack utility in improving mortality from lung cancer. What, perhaps, should have been added is an emphasis on their dysutility of SCXR.

The consequence of the low specificity of the screening examination is that a substantial number of individuals with nonmalignant shadows will undergo a series of adventures that, as Rang2 observed, had literary parallels and to which he gave the clever appellation, "the Ulysses syndrome":

The characteristic features are mental and physical disorders which follow the discovery of a false positive result. Ulysses, you may remember, fought in the Trojan War and then decided to come home. Twenty years passed before he returned to his point of departure. During this time he was involved in a series of


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