Do my eyes deceive me? A responsibly-written cancer screening article? From major media? Maybe there is hope after all. Needless to say, this is a must-read (emphasis mine):
. . . if you really want to find as much cancer as possible, we would suggest whole-body CT, MRI and PET scans every month. But that would be absurd. Why? Because the goal is not to find more cancer. The goal is to save lives. The two goals are not the same.The problem is that cancers detected early may not be the ones that kill. It turns out there is a spectrum of cancers. Some rapidly kill, some progress more slowly and some do not progress at all (and may even regress). That is why some doctors recommend watchful waiting for men with early prostate cancer — because most men diagnosed with the disease will not die from it.
Cancer epidemiologists have a name for the detection of cancer in people who would otherwise never develop symptoms (or die) from the cancer. They call it over-diagnosis. Over-diagnosis is the reason that the number of people with cancer diagnoses is increasing much more quickly than the numbers dying from those cancers. This phenomenon is now recognized as occurring not only in prostate cancer but also in breast cancer, thyroid cancer and melanoma . . .
. . . Doctors and the public need to understand that finding more cancer is not the answer. You want to know whether a test saves lives or reduces the number of people with metastatic cancer. And you want to know about the downsides: how many people suffer needlessly in the process.
Related posts:
- Is the test that finds the most cancers the best?
- Should I get a PSA test for prostate cancer? A new study shows that screening for prostate cancer doesn’t necessarily save lives
- Is prostate cancer being overdiagnosed?
- Ovarian cancer
- Are we finding too much breast cancer?
- What’s the latest on prostate cancer and the PSA screening test?
- Giuliani, prostate cancer, and David Gratzer
{ 6 comments }
Wow- what a great commentary. This is going to be copied and posted in all of my exam rooms.
Although this was published in the lay press, it is not written by laypersons. The tagline at the end says the authors are physician researchers with the VA Outcomes Group and on the medical faculty at Dartmouth.
It’s a really good commentary though.
We the public have had the mantra of screening and early detection remorselessly drummed into us.
The truth is that tumor biology is probably the biggest determining factor in cancer survival. And who ends up with the most favorable tumor biology is, as far as anyone can tell at this point, a complete crapshoot.
No one wants to hear that, though. People would rather feel they are in control, hence they will continue to conflate screening and prevention. They will continue to believe that more tests equals better early detection and lower mortality.
Sigh.
Anon at 12:40, I was about to post the same thing about the authors, but you beat me to it.
These are pretty well-known names. They are doctors and professors at Dartmouth Medical School. Dr H Gilbert Welch wrote a number of papers on the subject including the one mentioned in Orac’s posts recently. He also wrote book “Should I be tested for cancer” which talks about benefits and risks of screening in a manner that is easily understood by any reader. He also explains there why doctors are pushed to test including a story about his friend who was sued for not ordering a PSA test (not sure if it is the same as Merenstein becuase the book doesn’t mention names).
I wouldn’t blame people though for believing in earlier (and earlier) detection. As long as they hear “experts” in the media recommending more and more tests they are going to believe in it. The only way to change public perception is to have more articles like this one in the media.
brilliant. I too will post this in my office.
experts on tv need to be qualified by real experts before espousing the virtues of any test or procedure, as the lay public isn’t equipped to critically evaluate the information coming from an unknown with a white coat & stethoscope, and the term “doctor” is very loosely applied today.
Unfortunately the power of a priori logic will crumble under the effect of hindsight bias and regret. People, no matter how well informed beforehand, once diagnosed with cancer will regret that they did not get the more sensitive and more frequent testing. One manefestation of that regret is to seek counseling from the legal profession with the ultimate effect on the medical world. The ideal focus is on keeping individuals as healthy as possible, which requires not doing everything possible. The legal refocus medicine on doing the most possible, even if this has no marginal benefit, or even proves to be a detriment.
Great article. Thinking isn’t dead in medicine after all. Human beings consistently overestimate their ability to predict and control events–Americans most of all. Therefore, if someone gets a terminal disease, we blame them or look for someone else to blame, who we believe could have prevented it.
This puts us on a frantic escalation of health costs seeking to guarantee ourselves a long life–fruitlessly.
Comments on this entry are closed.