The power of gut feeling in cancer screening

The power of gut feeling in cancer screeningCancer screening has always been an emotional topic.

In recent years, both prostate and breast cancer screening have come under increasing scrutiny. Studies are beginning to question the benefits of early detection, and, in the case of prostate cancer screening, whether more harm is done than good.

In fact, the USPSTF recently downgraded their prostate cancer screening recommendation.

In a recent study from the Archives of Internal Medicine, researchers conclude that the benefits of breast cancer screening are overstated:

Among the 60 percent of women with breast cancer who detected the disease by screening, only about 3 percent to 13 percent of them were actually helped by the test, the analysis concluded.

Translated into real numbers, that means screening mammography helps 4,000 to 18,000 women each year. Although those numbers are not inconsequential, they represent just a small portion of the 230,000 women given a breast cancer diagnosis each year, and a fraction of the 39 million women who undergo mammograms each year in the United States.

The increasingly nuanced view of cancer screening is going to take a significant communications commitment to convince patients, who tend to prefer black and white options.

How can statistics compete with the patient anecdote? Saying that a “screening mammogram helps [only] 4,000 to 18,000 women each year” will not persuade someone who knows a friend whose life was saved by a mammogram.

Consider this typical patient response, courtesy of the New York Times’ Well blog:

I have heard this before and wish I could understand it. I just can’t square the math with my gut feeling and I wonder if other women feel the same. I know 3 people who have had breast cancer, one detected by screening, two by palpitation. The one who found hers by screening is alive the other two are not. One found hers before it moved through her body, the other two did not.

I certainly don’t want to have unnecessary tests, but it seems clear (at least to my gut) that earlier detection might have reached my two friends before their cancers became unmanageable.

I applaud Dr. Gilbert Welch and the Dartmouth researchers for their continuing effort to cast evidence-based doubt on cancer screening and publicize the real threats of overtesting.

But their job is only half-done. To convince patients they need to better utilize the power of story to overcome conventional gut feeling.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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  • http://www.facebook.com/profile.php?id=553105686 Leslie Edwards

    I believe the key is to publicize the stories of patients who are harmed by a false positive, overtreatment, etc.

    Harm can come in many ways. It’s mostly known as psychological and physical, but if it continued long enough, you’re also looking at the wasted time, medical bills, insurance hassles, effects on relationships, any impacts on work/career, and one that is significant but overlooked: the reluctance to continue future screening that may be beneficial in the future.

    The effects of harm can also be multiplied. Close family and friends who see their loved one suffer needlessly may become reluctant to have the same tests. 

    It’s easy to dismiss the harm that comes from an error until you see it up close.

    My 2-cents.

  • Anonymous

    You’re oh-so-right. Anecdotal story-telling can be more powerful than facts.  While I was in my late 30s, a mammogram (which had been ordered because one day in the shower, I found a breast lump that we were pretty sure was an egg-shaped benign cyst) showed something else that looked alarmingly like an irregular, rod-shaped calcified mass located deep on the chest wall. Very frightening scenario, requiring a subsequent mammogram, this time to insert a long thin wire touching the mass, then an immediate trip upstairs to the O.R. to take out the mass along with a substantial chunk of my left breast (a ‘quadrant resection’ in which both the tumor and surrounding tissue are removed).  The good news: the mass was not malignant, but the emotional trauma and resulting disfigurement remained.

    Just my own little story….