Cancer screening is the subject of much debate; while screening has the potential to save lives by identifying and treating cancers in early stages, it is also the case that not all cancers cause symptoms, and the diagnosis of these cancers can lead to unnecessary treatments and subsequent side-effects and complications. This paper explores the relationships between epistemic risks in cancer diagnosis and screening, the social organization of medical research and practice, and policy making; it does this by examining 2018 recommendations by the United States Preventative Services Task Force that patients make individualized, autonomy-based decisions about cancer screening on the basis of discussions with their physicians. While the paper focuses on prostate cancer screening, the issues that it raises are relevant to other cancer screening programs, especially breast cancer. The paper argues that prostate cancer screening-and, more generally, the process of risk assessment for prostate cancer-is pervaded by epistemic risks that reflect value judgments and that the pervasiveness of these epistemic risks creates significant and under-explored difficulties for physician-patient communication and the achievement of autonomous patient decision making.

中文翻译：

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癌症筛查中的流行病风险：对道德和政策的影响。

癌症筛查是许多争论的主题。尽管筛查有可能通过早期识别和治疗癌症挽救生命，但并非所有癌症都能引起症状，而且这些癌症的诊断可能导致不必要的治疗以及随后的副作用和并发症。本文探讨了癌症诊断和筛查中的流行病风险，医学研究和实践的社会组织以及政策制定之间的关系；它通过检查美国预防服务工作队2018年的建议来做到这一点，即患者在与医生讨论的基础上就癌症筛查做出个性化，基于自主的决定。虽然本文着重介绍前列腺癌筛查，但它提出的问题与其他癌症筛查计划有关，特别是乳腺癌。该论文认为，前列腺癌的筛查（更广泛地说是前列腺癌的风险评估过程）被反映了价值判断的认知风险所渗透，这些认知风险的普遍性给医患带来了巨大的，探索不足的困难。交流和实现患者自主决策。