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UnPopular Truths Modern Health Care does not want you to know

  • Scott Popp D.C
  • 10 hours ago
  • 14 min read

Mammogram
Mammogram

Do screenings extend life expectancy? 

Everyone thinks they do, but in reality most of the common ones do not..



1: Mammograms


Routine mammogram screening is widely used for early detection of breast cancer, but its impact on overall life expectancy is limited or marginal for most women, especially when considering the general population.


Minimal or No Increase in Life Expectancy

  - Recent systematic analysis found that mammography screening did not significantly increase overall lifespan in the screened group compared to those who were not screened, with a mean gain of 0 days (95% CI, −190 to 237 days). This suggests no statistically significant longevity benefit for the general population from mammography screening[1][2].

  - Other studies showed that for women continuing screening after age 69, the added average life expectancy was extremely small—about 2.1 days to 7.2 hours, even when large cohorts were studied[3][4]. 


Cancer-Specific Mortality Reduction

 Mammograms do reduce the risk of dying from breast cancer, with estimates ranging from about a 15–25% decrease in breast cancer-specific deaths, particularly for women regularly screened between ages 40–74[5][6][7].

 However, since breast cancer represents a small proportion of overall deaths in most age groups, the effect on total life expectancy across populations is very slight.


Population-Level Impact

  The majority of women undergoing mammography screening will not have their lives extended by the intervention, due to the relatively low incidence of fatal breast cancer in the general population and the fact that most women will die from other causes[8][2].

   For certain sub-populations (such as those with strong risk factors or longer life expectancy), the gain may be slightly more, but on average, the impact remains marginal.


Considerations


Harms and Trade-offs

   Routine screening does carry risks—false positives, unnecessary biopsies, anxiety, and possible overtreatment—which must be balanced against the marginal gain in all-cause life expectancy[8].

  -Guidelines stress shared decision-making, especially for women over 75 or with limited life expectancy, as the benefits diminish further and harms may increase with age and comorbidities[9][10].


Summary Table


| Mammogram Screening Effect           | Population Outcome                                 |

|--------------------------------------|----------------------------------------------------|

| Overall life expectancy              | No statistically significant benefit[1][2]       |

| Breast cancer-specific mortality     | Decreased by 15–25% (age and adherence-dependent)[5][6][7] |

| Average gain in life expectancy      | 0–2.1 days[3][4]                                  |

| Potential harms                      | Overdiagnosis, false positives, overtreatment[8]  |


Conclusion:  

Routine mammogram screening may slightly reduce deaths from breast cancer but does not meaningfully alter total life expectancy for most women. The decision to screen should be individualized, weighing the small potential benefit in lifespan against possible harms and each woman's personal values and health situation.


Citations:

[1] Estimated Lifetime Gained With Cancer Screening Tests https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2808648

[2] Does cancer screening help us live longer? - Lown Institute https://lowninstitute.org/does-cancer-screening-help-us-live-longer/

[3] Continuing screening mammography in women aged 70 to 79 years https://pubmed.ncbi.nlm.nih.gov/10591338/

[4] Benefits and Risks of Screening Mammography for Women in Their ... https://academic.oup.com/jnci/article/90/19/1431/918742

[5] Study Finds Missing Regular Mammogram Increases Risk of Death ... https://pressroom.cancer.org/MissingMammogramStudy

[6] Benefits and Risks of Mammography Screening in Women Ages 40 ... https://pmc.ncbi.nlm.nih.gov/articles/PMC8796062/

[7] Breast Cancer: Screening - U.S. Preventive Services Task Force https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening

[8] Weighing the Benefits and Risks of Screening Mammography https://www.komen.org/breast-cancer/screening/mammography/benefits-risks/

[9] Screening for Breast Cancer in Women Age 75 Years and Older | AJR https://ajronline.org/doi/10.2214/AJR.17.18705

[10] Decision making around mammography screening for older women https://pmc.ncbi.nlm.nih.gov/articles/PMC5214520/

[12] Breast Cancer Screening in Older Women: the importance of shared ... https://pmc.ncbi.nlm.nih.gov/articles/PMC7822071/

[13] Health benefits and harms of mammography screening in older ... https://www.nature.com/articles/s41416-023-02504-7

[14] Effect of mammographic screening from age 40 years on breast ... https://www.thelancet.com/article/S1470-2045(20)30398-3/fulltext

[15] Weighing the Benefits and Burdens of Mammography Screening ... https://pmc.ncbi.nlm.nih.gov/articles/PMC2668704/












2: Prostate Screenings


Routine prostate cancer screening (primarily with the prostate-specific antigen or PSA test) has only a very small effect, if any, on overall life expectancy in the general population. Here are the key findings:


Effect on Life Expectancy

Large, long-term studies and meta-analyses show that routine PSA screening does not produce a statistically significant increase in overall lifespan for most men[1][2].

 A recent systematic review found that prostate cancer screening with PSA may extend life by about 37 days (around 5 weeks), with the true effect potentially ranging from no benefit to a bit more, but this increase was not statistically significant[1].

 Major randomized trials (like PLCO and ERSPC) have shown no reduction in all-cause mortality from PSA screening, even though some have found a small decrease in prostate cancer–specific deaths[2].


Cancer-Specific Outcomes**

PSA screening can reduce the risk of dying from prostate cancer itself by about 20% in some studies[3][2], but since deaths from prostate cancer are relatively uncommon in the general male population, this does not translate into a meaningful gain in total life expectancy.

To prevent a single death from prostate cancer, a large number of men must be screened—estimates suggest about 781 men screened to prevent one prostate cancer death over 13 years[2][4].


Potential Harms

Routine PSA screening leads to:

    - Many false positives and unnecessary prostate biopsies.

    - Overdiagnosis: detection of slow-growing cancers that would never have caused harm in a man's lifetime.

    - Overtreatment, which can result in urinary incontinence, erectile dysfunction, and bowel problems[5][6][4][7].

- Because so many men with detected prostate cancer would die of other causes or never experience symptoms, many are treated unnecessarily, experiencing side effects without longevity benefits[4].


Guideline Recommendations

- Most health guidelines recommend that men make individualized, informed decisions about PSA screening, especially considering age and personal risk.

- Screening is generally not recommended for men with a life expectancy of less than 10–15 years or for those over 70 in average health[8][9][10].


Summary Table


|             Screening Effect          | Population Outcome (General)                 |

|:-------------------------------------:|:--------------------------------------------:|

| Gain in life expectancy               | ~37 days (not statistically significant)[1]  |

| Prostate cancer death reduction       | ~20% relative reduction (select studies)[3][2]  |

| All-cause mortality                   | No reduction[1][2][11]                       |

| Major potential harms                 | Overtreatment, false positives, side effects[4][7] |


Conclusion:  

Routine PSA-based prostate cancer screening produces, at best, a very slight or no increase in total life expectancy for most men. The reduction in deaths from prostate cancer is outweighed by minimal impact on overall lifespan and significant risks of overdiagnosis and overtreatment. Decisions about screening should be based on individual preferences, risk factors, and in discussion with a healthcare provider.


Citations:

[1] Estimated Lifetime Gained With Cancer Screening Tests https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2808648

[2] Prostate Cancer: Screening - U.S. Preventive Services Task Force https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening

[3] Screening for Prostate Cancer: The Debate Continues - PMC https://pmc.ncbi.nlm.nih.gov/articles/PMC4093374/

[5] Prostate cancer screening: Should you get screened? - Mayo Clinic https://www.mayoclinic.org/tests-procedures/psa-test/in-depth/prostate-cancer/art-20048087

[6] Should I Get Screened for Prostate Cancer? - CDC https://www.cdc.gov/prostate-cancer/screening/get-screened.html

[8] Prostate Cancer Screening - StatPearls - NCBI Bookshelf https://www.ncbi.nlm.nih.gov/books/NBK556081/

[9] Remaining Life Expectancy Measurement and PSA Screening of ... https://pmc.ncbi.nlm.nih.gov/articles/PMC3388723/

[12] Prostate Screening Does Not Reduce Prostate Cancer or All-Cause ... https://www.hsrd.research.va.gov/research/citations/pubbriefs/articles.cfm?RecordID=279

[13] Early Detection Saves Lives: Screening and PSA Test https://zerocancer.org/about-prostate-cancer/early-detection

[14] The pros and cons of PSA tests for prostate cancer for midlife ... - NPR https://www.npr.org/sections/shots-health-news/2025/05/21/nx-s1-5405613/prostate-cancer-psa-test-age

[15] Finding the PSA-based screening stopping age using prostate ... https://www.sciencedirect.com/science/article/pii/S2468294224000030

[17] [PDF] Is Prostate Cancer Screening Right for You? https://www.uspreventiveservicestaskforce.org/Home/GetFileByID/3795

[19] Learn More – PSA tests for prostate cancer screening - NCBI https://www.ncbi.nlm.nih.gov/books/NBK284938/

[20] Variation in harms and benefits of prostate‐specific antigen ... https://bjui-journals.onlinelibrary.wiley.com/doi/10.1002/bco2.326






3: Colonoscopy


Routine colonoscopy and sigmoidoscopy are both used for colorectal cancer (CRC) screening, but they differ in their impact on overall life expectancy when used in population-widescreening. Evidence shows that routine colonoscopies add little to overall life expectancy, while routine sigmoidoscopies convey a modest but statistically significant benefit.


Routine Colonoscopy Screening


-Very Modest Impact on Life Expectancy**

  - Multiple analyses report that routine colonoscopy screening extends life by about 37–170 days (roughly 1–6 months), with some estimates closer to 37 days, and confidence intervals often spanning from potential harm to modest benefit. These changes are not always statistically significant[1][2][3].

  - For a typical adult population, this translates into an extremely small average gain: 104–123 days per person screened from ages 45 to 75, according to large modeling studies[2].

  - Studies emphasize that many people screened will not see any extension in their lifespan because colorectal cancer is only one of many possible causes of death.


- Benefits and Harms

  - Colonoscopies detect and remove pre-cancerous polyps, reducing CRC incidence and deaths. However, since overall mortality impact is so minimal, routine use in unselected populations, especially those with limited life expectancy or significant comorbidities, has limited net value[4][5].

  - Procedure risks (e.g., perforation, bleeding), discomfort, and preparation burden must also be considered.


## Routine Sigmoidoscopy Screening


- Demonstrated Life Expectancy Benefit

  - Long-term randomized trials and recent meta-analyses consistently show that sigmoidoscopy as a routine screening test can extend life expectancy by about 110 days (approximately 3–4 months)—a statistically significant and clinically meaningful gain compared to colonoscopy and other major cancer screening strategies[1][6][7][8][9].

  - The benefit appears after a lag of 5–10 years and is greatest in persons with a life expectancy >10 years[10].

  - Sigmoidoscopy reduces both the incidence of and deaths from colorectal cancer—particularly cancers located in the distal colon and rectum, which are accessible by the scope[11][12][13].


## Summary Table


| Screening Test    | Avg. Gain in Life Expectancy | Significance of Gain                | CRC-Specific Impact         | Population Recommendation           |

|-------------------|-----------------------------|-------------------------------------|-----------------------------|-------------------------------------|

| Colonoscopy       | 37–170 days (average: ~37)  | Not always statistically significant| Reduces CRC deaths/incidence| Moderate benefit; little effect on total lifespan for most[3][1][2] |

| Sigmoidoscopy     | ~110 days (about 3–4 months)| Statistically significant benefit    | Reduces CRC deaths/incidence| Routine use in people >10y LE* shows measurable longevity gain[1][6][7][10][8] |


*LE = Life Expectancy


## Conclusion


- Routine colonoscopy screening slightly reduces deaths from colorectal cancer but does not meaningfully increase overall life expectancy in most people.

- Routine sigmoidoscopy provides a significant, population-level longevity benefit of about three additional months of life on average, making it the only major cancer screening test with clear evidence of extending lifespan across randomized trial populations.

- The choice of screening method and timing should be individualized, especially for older adults or those with reduced life expectancy, to balance potential modest benefits against risks and burdens.


Citations:

[1] Estimated Lifetime Gained With Cancer Screening Tests https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2808648

[2] Colorectal Cancer: Screening - U.S. Preventive Services Task Force https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening

[3] The impact of colorectal cancer screening on life expectancy - PubMed https://pubmed.ncbi.nlm.nih.gov/10805834/

[6] Screenings don't extend lifespan - Cancer Rose https://cancer-rose.fr/en/2023/09/08/screenings-dont-extend-lifespan/

[7] Estimated Lifetime Gained With Cancer Screening Tests https://pmc.ncbi.nlm.nih.gov/articles/PMC10463170/

[8] Does cancer screening help us live longer? - Lown Institute https://lowninstitute.org/does-cancer-screening-help-us-live-longer/

[9] Do Cancer Screenings Save Lives? New Research Answers Question https://www.health.com/do-cancer-screening-tests-save-lives-7969527

[10] Time to benefit for colorectal cancer screening: survival meta ... https://pmc.ncbi.nlm.nih.gov/articles/PMC4399600/

[11] Long-term effects of once-only flexible sigmoidoscopy screening on ... https://www.thelancet.com/journals/langas/article/PIIS2468-1253(24)00190-0/fulltext

[12] Long term effects of once-only flexible sigmoidoscopy screening ... https://www.sciencedirect.com/science/article/pii/S0140673617303963

[13] Impact of Sigmoidoscopy and Colonoscopy on Colorectal Cancer ... https://www.irjournal.org/journal/view.php?doi=10.5217%2Fir.2014.12.4.268

[14] Life Expectancy and Surveillance Colonoscopy and Follow-up ... https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2802347

[15] Assessing the Impact of Screening Colonoscopy on Mortality in the ... https://pmc.ncbi.nlm.nih.gov/articles/PMC3235614/

[16] Effectiveness of Colonoscopy Screening vs Sigmoidoscopy ... https://pmc.ncbi.nlm.nih.gov/articles/PMC10905314/

[17] When to Discontinue Colorectal Cancer Screening in Older Adults https://gi.org/journals-publications/ebgi/okafor_mar2024/

[18] The impact of colorectal cancer screening on life expectancy https://www.sciencedirect.com/science/article/abs/pii/S0016510700702823













4: Regular doctor visits and physicals


The Impact of Routine Scheduled Doctor Visits (Physicals) on Life Expectancy


 Key Findings


- Routine scheduled physicals do not increase overall life expectancy.

    - Multiple high-quality randomized controlled trials and meta-analyses show that regularly scheduled, comprehensive health checks (general physicals for asymptomatic adults) do not reduce total mortality, cancer mortality, or cardiovascular mortality compared to the absence of such routine visits for the general population[1][2][3][4].

    - A Cochrane review of 17 trials (over 250,000 adults) found that invitations to general health checks had little or no effect on the risk of death from any cause (RR 1.00, 95% CI 0.97 to 1.03) and did not reduce deaths from cancer or cardiovascular causes[1][3]. These findings are robust, with a high degree of certainty from large datasets.

    - While these visits often detect more new diagnoses and can increase the use of preventive services (vaccinations, cancer screenings), this does not translate into longer life on average for healthy adults[2].


- Why don't routine physicals increase life expectancy?

    - Many serious illnesses develop between visits or can be detected and managed based on symptoms or risk factors during other medical consultations.

    - Primary care doctors are already likely to monitor relevant risks and intervene during visits for other concerns.

    - People at highest risk may avoid or not follow up on recommendations from routine visits.

    - Over-testing during physicals can lead to false positives, unnecessary further tests, anxiety, and potential overtreatment, while not significantly changing long-term outcomes[5][6][4][2].


- Potential Benefits of Routine Visits

    - Routine check-ups do improve vaccination rates, chronic illness management (e.g., hypertension, depression), and may increase patients' engagement in their own health[7][8]. These are valuable, but measurable gains in life expectancy are not observed.

    - They can also improve the doctor–patient relationship, provide reassurance, and create opportunities for early intervention on emerging health or lifestyle problems—yet these benefits do not equate to a significant reduction in deaths from major diseases[1][7][2][9].


- Harms, Costs, and Considerations

    - Unnecessary screening in healthy people creates the risk of overdiagnosis, excess healthcare spending, patient anxiety, and potential for harm from unnecessary procedures[5][2][6][4].

    - Frequent visits to healthcare facilities may even increase exposure to hospital-acquired illnesses, particularly in older adults[10].

    - For healthy adults, many expert groups now advise against routine annual physicals, recommending instead targeted, risk-based preventive care[5][2][1].


### Summary Table


| Outcome                  | Effect of Routine Physicals         |

|--------------------------|-------------------------------------|

| Life expectancy (total)  | No significant increase[1][2][3][4]  |

| Cancer/cardiovascular deaths | No reduction[1][2][3][4]           |

| New diagnoses made       | Increased[2]                        |

| Preventive care delivered| Increased (vaccinations, screenings)[8][7]|

| Patient reassurance / relationship   | Improved[7][9]            |

| Harms (false positives, overtesting) | Increased[5][2][6]            |


### Conclusion


Routine, scheduled doctor visits for physicals do not increase overall life expectancy for healthy, asymptomatic adults. While they can benefit preventive care delivery and the doctor–patient relationship, they do not reduce the risk of dying from cancer, heart disease, or other leading causes of death and may carry downsides from overtesting and overdiagnosis. Experts increasingly recommend a risk-based, individualized approach to check-ups, rather than routine annual physicals for all.


Citations:

[1] General health checks in adults for reducing morbidity and mortality ... https://pmc.ncbi.nlm.nih.gov/articles/PMC6353639/

[2] General Health Checks for Reducing Morbidity and Mortality - AAFP https://www.aafp.org/pubs/afp/issues/2013/1001/p432.html

[3] General health checks in adults for reducing morbidity and mortality ... https://pubmed.ncbi.nlm.nih.gov/30699470/

[8] Primary care visits increase utilization of evidence-based ... https://pmc.ncbi.nlm.nih.gov/articles/PMC7385977/

[9] Why Your Annual Physical Exam is Vital for Your Health - MyCHN https://mychn.org/why-your-annual-physical-exam-is-vital-for-your-health/

[12] 5 Reasons Why Annual Physical Exams are Important - Virtua https://www.virtua.org/articles/your-annual-physical-and-why-its-important

[13] Why You Need a Regular Physical at Every Age. - Medstar Health https://www.medstarhealth.org/blog/annual-physical-every-stage-of-life

[14] Are Annual Physical Exams Worth Your Time? Here's What Science ... https://globalrph.com/2025/07/are-annual-physical-exams-worth-your-time-heres-what-science-says/

[15] Patient and Visit Characteristics Associated With Use of Direct ... https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2769839

[17] Association of regular health check-ups with a reduction in mortality ... https://www.sciencedirect.com/science/article/abs/pii/S0033350624004359

[18] Evidence Brief: Role of the Annual Comprehensive Physical ... - NCBI https://www.ncbi.nlm.nih.gov/books/NBK82767/

[19] Advanced access scheduling outcomes: A systematic review - PMC https://pmc.ncbi.nlm.nih.gov/articles/PMC3154021/

[20] Continuity of care with doctors—a matter of life and death? A ... https://pmc.ncbi.nlm.nih.gov/articles/PMC6042583/








5: Dermatology Screenings


Routine dermatologist screenings have not been shown to increase overall life expectancy in the general population.**

 Large, well-controlled studies and systematic reviews confirm that, for most people, regularly scheduled full-body skin exams by a dermatologist do not measurably reduce all-cause mortality or extend lifespan when compared to people who do not attend such screenings[1][2][3][4][5].


Early Detection and Cancer-Specific Outcomes**

    - Skin checks by dermatologists can find skin cancers, including melanoma, at an earlier, thinner stage—which does improve cancer-specific outcomes such as survival from melanoma if detected early[3][6][7].

    - However, the absolute reduction in deaths from melanoma is very small at a population level, mainly because:

        - Melanoma is rare relative to other causes of death, and

        - Most suspicious skin lesions found during screening are not dangerous, leading to excessive biopsies and overdiagnosis without meaningful gains in total life expectancy[8][5].


- Evidence from Population Studies and Reviews

    - A large systematic review of cancer screening found no statistically significant increase in overall longevity—in days or years—due to skin cancer screening in the general population[2].

    - Cost-effectiveness models show only minimal quality-adjusted life-year (QALY) or survival gains for mass screening, even in higher-risk groups, and these gains are dwarfed by those of more effective screening programs (such as for colon cancer)[1].

    - A 2021 cohort study reported that routine skin checks were associated with lower all-cause mortality after adjusting for some (but not all) potential confounding factors, but no significant effect on melanoma-specific mortality remained after more rigorous adjustment for tumor characteristics and patient health—suggesting that healthier people, not the screening itself, may account for better survival rates observed in some studies[3][4].


- Risks and Harms of Routine Screenings

    - Routine full-body skin exams can result in:

        - Overdiagnosis and unnecessary removal of harmless lesions

        - Increased anxiety for patients (the "worried well" phenomenon)

        - Possible surgical complications from biopsies and excisions[8][9]

    - These downsides occur without a proven life expectancy benefit for most people.


- Current Guidelines and Recommendations

    - Major expert organizations such as the US Preventive Services Task Force have found insufficient evidence to recommend routine skin cancer screening for asymptomatic adults as a measure to improve overall survival or prolong life[5].


### Summary Table


| Outcome                          | Effect of Regular Dermatologist Screenings      |

|-----------------------------------|-----------------------------------------------|

| All-cause mortality/life expectancy | No statistically significant benefit for most people  |

| Melanoma-specific mortality       | Lower in screened groups, but not significant after adjusting for patient/tumor factors |

| Early cancer detection            | Increased                                      |

| Overdiagnosis/False positives     | Increased                                      |

| Best use                         | High-risk individuals, or evaluation of concerning lesions |


### Conclusion


Routine, scheduled skin checks by dermatologists do not increase overall life expectancy for the general adult population. While these exams may catch some cancers early—improving individual cancer survival odds—this does not translate into a meaningful increase in how long people live. For most adults, routine visits should be replaced with targeted exams for those at high risk or those with suspicious lesions. Overuse of routine skin screening may yield more harm than benefit in otherwise healthy individuals[8][1][2][3][4][5].


Citations:

[1] Visual Screening for Malignant Melanoma: A Cost-effectiveness ... https://jamanetwork.com/journals/jamadermatology/fullarticle/410727

[2] Estimated Lifetime Gained With Cancer Screening Tests https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2808648

[3] Melanoma Detection During Routine Skin Checks and Mortality https://jamanetwork.com/journals/jamadermatology/fullarticle/2785614

[4] Screening advice that's not just skin deep - Harvard Health https://www.health.harvard.edu/cancer/screening-advice-thats-not-just-skin-deep

[6] The Influence of Dermatologist and Primary Care Physician Visits on ... https://pmc.ncbi.nlm.nih.gov/articles/PMC4671079/

[7] Skin Cancer Screening: Updated Evidence Report and Systematic ... https://pubmed.ncbi.nlm.nih.gov/37071090/

[8] Skin cancer screening: recommendations for data-driven screening ... https://pmc.ncbi.nlm.nih.gov/articles/PMC5480135/

[9] Are We Screening Too Much for Skin Cancer? It's Complicated. https://undark.org/2021/01/25/debate-over-melanoma-diagnosis/

[10] Skin Cancer in US Elders: Does Life Expectancy Play a Role in ... https://pmc.ncbi.nlm.nih.gov/articles/mid/NIHMS770095/

[13] Should You See a Dermatologist Regularly? Here Are the Benefits https://www.skinmds.com/blog/3-benefits-of-having-a-dermatologist/

[14] Annual Skin Examination - U.S. Dermatology Partners https://www.usdermatologypartners.com/services/skin-cancer/annual-skin-examination/

[15] The Importance of Routine Skin Exams for Early Detection - Atlanta https://colecosmeticskincare.com/blog/the-importance-of-routine-skin-exams-for-early-detection/

[16] How do we avoid overtreating skin cancer in people with severe ... https://academic.oup.com/bjd/advance-article/doi/10.1093/bjd/ljaf174/8133179

[17] Survival is not the only valuable end point in melanoma screening https://pmc.ncbi.nlm.nih.gov/articles/PMC4575123/

[18] Association between dermatology follow-up and melanoma survival https://www.sciencedirect.com/science/article/pii/S0190962224003724

[19] Skin Cancer Screening: Updated Evidence Report and Systematic ... https://jamanetwork.com/journals/jama/fullarticle/2803798






 
 
 

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