Current and former workers who have been occupationally exposed to hazardous substances have unique medical and social needs. Few programs recognize and accommodate the needs of these workers. Consequently, screening and medical surveillance assume a pivotal role in a system that inadequately deals with the needs of workers identified and notified of occupational disease risks. In some cases, screening programs, ineffective in altering survival patterns, are established because they represent surrogates for other kinds of support programs that do not exist. Where screening techniques are effective and available, there still are problems in getting them funded and established in acceptable programs. This paper details these problems and argues for increased research to enhance the efficacy of screening, not only in preventing disease, but also in improving the quality of life for workers at risk.